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  • 1
    Language: English
    In: Gastroenterology, 2010, Vol.139(4), pp.e5-e7
    Keywords: Medicine
    ISSN: 0016-5085
    E-ISSN: 1528-0012
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  • 2
    In: The Journal of Trauma: Injury, Infection, and Critical Care, 2011, Vol.71(6), pp.E123-E127
    Description: BACKGROUND:: The purpose of this study was to identify which age-related groups of hemodynamically stable blunt trauma patients will present a positive cost-to-benefit ratio, in regard to the screening of incidental findings on Focused Assessment with Sonography for Trauma (FAST). METHODS:: We conducted a prospective study using retrospective data taken from the trauma registry of 6,041 consecutive hemodynamically stable blunt trauma patients who underwent FAST at our Level I urban trauma hospital during the year 2009. A receiver operating characteristic curve was used to determine whether age level is useful in detecting organ-/system-specific incidental findings in trauma patients undergoing FAST and to establish the required diagnostic cutoff value of this selected test. A cost-benefit analysis was then performed for the age-specific cutoff values of each organ/system evaluated by FAST. RESULTS:: We found 522 incidental findings in 468 patients (7.8%). Further diagnostic workup was instructed in 35% (168 of 468) of patients with incidental findings. The cost-benefit analysis for the age-specific cutoff values found in the receiver operating characteristic curve analysis showed that the project of screening for incidental findings on FAST was viable only when the ultrasound operator additionally searches the liver/biliary tree (≥43 years) and the kidneys (≥56 years). CONCLUSIONS:: A systematic examination of the liver and biliary tree and both kidneys of specific age groups during FAST screening of hemodynamically stable blunt trauma patients may disclose a potentially unknown pathology with a positive cost-to-benefit ratio.
    Keywords: Health Care Costs ; Incidental Findings ; Ultrasonography, Doppler -- Economics ; Wounds, Nonpenetrating -- Diagnostic Imaging;
    ISSN: 0022-5282
    E-ISSN: 15298809
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  • 3
    Language: English
    In: Tumor Biology, 2014, Vol.35(6), pp.5993-6002
    Description: This pilot study aimed to determine the feasibility of serum neurotensin/IL-8 values being used as a screening tool for colorectal cancer. Fifty-six patients and 15 healthy controls were assigned to seven groups according to their disease entity based on theater records and histology report. Blood samples for neurotensin and IL-8 were measured using an enzyme-linked immunosorbent assay. There were no differences in the clinical and biochemical parameters of patients and controls. Group ( p  = 0.003) and age ( p  = 0.059, marginally significant) were independent predictors of neurotensin plasma values. Neurotensin ( p  = 0.004) and IL-8 ( p  = 0.029) differed between healthy and colorectal cancer patients. Neurotensin values differentiate the control group from all remaining groups. The value of plasma neurotensin ≤54.47 pg/ml at enrollment selected by receiver operating characteristic (ROC) curves demonstrated a sensitivity of 77 %, specificity of 90 %, and an estimate of area under ROC curve (accuracy) of 85 % in predicting colorectal cancer. At enrollment, the value of plasma IL-8 ≥8.83 pg/ml had a sensitivity of 85 %, specificity 80 %, and an estimate of area under ROC curve (accuracy) of 81 % in predicting colorectal cancer. IL-8 should be used complementary to neurotensin due to its lower specificity. None of the colorectal cancer patients displayed a combination of high neurotensin and low IL-8 values (beyond cutoffs). It seems that a blood neurotensin/IL-8 system may be used as a screening tool for colorectal cancer, but much has to be done before it is validated in larger-scale prospective studies.
    Keywords: IL-8 ; Neurotensin ; Colon cancer ; Rectal cancer ; Colorectal cancer screening ; Sensitivity and specificity
    ISSN: 1010-4283
    E-ISSN: 1423-0380
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  • 4
    In: Transplantation Journal, 2012, Vol.94(11), pp.1138-1144
    Description: BACKGROUND: Preoperative imaging and donor selection are cardinal components of adult-to-adult live donor liver transplantation (ALDLT). The purpose of this study was to evaluate our three-dimensional (3D) computed tomography image-derived computer-assisted surgical planning (3D CASP) in ALDLT. METHODS: Eighty-three consecutive ALDLTs (71 right and 12 left) were planned with 3D CASP. Graft, remnant, and total liver volume compliance were calculated and compared with actual intraoperative values. Computed risk analysis encompassing territorial liver mapping, functional (safely drained) volumes, and outflow congestion volumes in grafts and remnants allowed for the individualized management of the middle hepatic vein (MHV). RESULTS: Graft volume compliance was 13.5%±4.4%. Three small-for-size (SFS) grafts with lethal SFS syndrome (SFSS) had nonsignificant volume compliance with maximal graft volume-body weight ratios of less than 0.83. Seven SFS grafts with reversible or absent SFSS showed maximal graft volume-body weight ratios of 0.9 to 1.16. Significant differences were identified for (a) virtual graft and remnant congestion volumes of risky versus nonrisky MHV types (49%±6% and 34%±7% vs. 29%±8% and 33%±12%, P〈0.001 and P〈0.02, respectively) and (b) virtual mean functional versus surgical volumes of grafts (527±119 vs. 963±176 mL, P〈0.0001) and remnants (419±182 vs. 640±213 mL, P〈0.001). CONCLUSIONS: CASP allowed for (a) prevention of SFSS in extremely small grafts by predicting donor liver plasticity and (b) individualized MHV management for both donors and recipients based on functional graft/remnant volume analysis.
    Keywords: Donors ; Computed Tomography ; Hepatic Vein ; Mapping ; Imaging ; Plasticity (Functional) ; Computed Tomography ; Donors ; Mapping ; Plasticity (Functional) ; Hepatic Vein ; Imaging ; Transplantation;
    ISSN: 0041-1337
    E-ISSN: 15346080
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  • 5
    Language: English
    In: The American Journal of Surgery, 2010, Vol.199(6), pp.776-781
    Description: The aim of this study was to compare the immediately postoperative and follow-up results of open and laparoscopic surgery of hepatic cysts in a tertiary hepatobiliary referral center. From March 1999 to February 2007, 59 patients underwent surgical treatment for nonparasitic liver cysts. Patients were assigned to the laparoscopic (n = 42) or open group (n = 17) for analysis. Three conversions to open procedures had to be performed in the laparoscopic group. One patient had to be reoperated because of a bile leakage in the laparoscopic group. Follow-up examination showed 2 recurrences in the laparoscopic and 3 in the open group. Three out of 17 patients in the open group had to be operated for incisional hernias. Time to previous activities was significantly shorter after laparoscopy. Laparoscopic treatment of symptomatic nonparasitic liver cysts is superior concerning short- and long-term results in a vast majority of cases.
    Keywords: Liver Cysts ; Laparoscopy ; Open Treatment ; Follow-Up ; Recurrence
    ISSN: 0002-9610
    E-ISSN: 1879-1883
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  • 6
    In: Transplantation, 2010, Vol.89(12), pp.1518-1525
    Description: BACKGROUND.: The knowledge of “venous dominance” is essential to prevent serious venous congestion in live donor liver transplantation and extended liver resections. AIMS.: The purpose of our study was to delineate our proposed anatomic-functional classification of hepatic venous drainage. METHODS.: One hundred forty consecutive live liver donor candidates underwent three-dimensional computed tomography reconstructions and three-dimensional virtual hepatectomies. Five different venous dominance types were defined on drainage volumes or territories. “Risky” configurations were identified and classified. RESULTS.: The right hepatic vein (RHV) was dominant for the entire liver and right hemiliver (RHH) in most (83.5%) cases irrespective of the presence of inferior (accessory) hepatic veins (IHVs). The middle hepatic vein (MHV) was dominant for the total liver (TL) in 15.5% of cases and for the RHH in 27% of cases. The left hepatic vein was almost always (92%) dominant for the left hemiliver. When associated with a large IHV drainage volume, a RHV/IHV complex dominant for the TL led to a RHH dominant MHV (mean 59.5%RHH) if the IHV was not reconstructed. CONCLUSIONS.: Our proposed anatomic-functional classification provides a valuable insight into hepatic vein dominance patterns. RHH venous drainage patterns at “high risk” for venous congestion include (1) a dominant MHV for the TL and (2) a dominant RHV/IHV complex with a large IHV drainage volume.
    Keywords: Hepatic Veins -- Pathology ; Image Processing, Computer-Assisted -- Methods ; Liver -- Blood Supply ; Liver Transplantation -- Methods ; Tomography, X-Ray Computed -- Methods;
    ISSN: 0041-1337
    E-ISSN: 15346080
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  • 7
    Language: English
    In: International Journal of Surgery, August 2015, Vol.20, pp.35-40
    Description: Intraoperative wound infiltration with local anaesthetic is commonly used. Apart from the obvious immediate action it has been supported that a possible down regulation of pain receptors may lead to longer effects. Our aim was to compare the use of local anaesthetic versus placebo in order to assess if indeed there is a late beneficial effect. We conducted an RCT involving 400 consecutive general surgery patients randomized in 2 groups: Group A = placebo, Group B = wound infiltration with 15 ml of ropivacaine 10%. We recorded the preoperative and postoperative pain for the 1st week as well as the type and quantity of the analgesia used during the study period. No significant difference was found between the groups in all known confounding factors recorded. No significant difference was found in the intensity of postoperative pain. More people of group A required NSAIDs during the first 3 PO days while more people of Group B required stronger painkillers. For those patients who underwent a non urgent operation and especially laparoscopic surgery higher pain score was recorded in the group B from the 3 PO day onwards. Intraoperative local infiltration of the wound with local anaesthetic offers no further benefit for the general surgery apart from that of the immediate PO period. There is no late effect for pain control. Considering that during the immediate postoperative period stronger systematic painkillers are given the intraoperative, infiltration of the wound with the local anaesthetic under study offers no obvious benefit.
    Keywords: Local Anaesthetic ; Wound Infiltration ; Pain ; Determinants of Pain ; Surgery
    ISSN: 1743-9191
    E-ISSN: 1743-9159
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  • 8
    Language: English
    In: The Thoracic and cardiovascular surgeon, September 2013, Vol.61(6), pp.470-8
    Description: The aim of our study was to develop a prognostic index score for patients undergoing surgical resection for esophageal cancer that accurately determines survival with specific clinicopathological characteristics. Clinical, histological, and demographical variables of 475 patients were entered in an univariate and multivariate regression model, followed by individual calculation of the Prognostic Indicator Score and model validation via simulation. Significant variables included in the scoring system were number of positive lymph nodes, pT, pL, R, obesity, and American Society of Anesthesiologist classification. Survival probability and its associated hazard function was significantly different between the scores, with an increase of hazard ratio ranging from 2.56 (score 2) to 20 (score 6 or higher). Comparing histological cancer entities revealed statistical significance only between stage IIA versus IIB in squamous cell and stage IIIA versus IIIB in adenocarcinoma. According to our methodology, an individualized follow-up by each possible score might allow interdisciplinary selection of patients for treatments based on expected survival. This may represent a breakthrough in patient selection for currently available treatments and clinical studies.
    Keywords: Decision Support Techniques ; Esophagectomy ; Adenocarcinoma -- Surgery ; Carcinoma, Squamous Cell -- Surgery ; Esophageal Neoplasms -- Surgery
    ISSN: 01716425
    E-ISSN: 1439-1902
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  • 9
    Language: English
    In: The American surgeon, March 2012, Vol.78(3), pp.366-72
    Description: During the initial assessment of trauma patients they usually undergo a Focused Assessment with Sonography for Trauma (FAST) in which there are occasionally incidental findings of other surgical conditions. In this audit we discuss the incidence, demographics, and implications of these findings and we propose a management algorithm. Within 2 years we managed 6041 trauma patients in the emergency department based on the Advanced Trauma Life Support protocols, 95 per cent of which underwent a FAST ultrasound. Incidental findings were reported in 468 patients (7.8%), whereas in a further 11.2 per cent of these patients there was a second finding. The mean age of these patients was 57.55 years (15-105), and most of them were men (51.1%). The vast majority of the findings were related to the liver and biliary tree (52.1%) followed by the urinary track (27.1% + 8%). In multivariate analysis only the age was a significant factor associated with incidental findings (P 〈 0.001) whereas in univariate analysis both the gender [men (54.1%) vs women (45.9), P = 0.013] and the mechanism of trauma (P 〈 0.001) were as important as the age (P 〈 0.001). The patients who had incidental findings were 15 years older than the rest. The detection of unknown surgical conditions in FAST may lead to managerial and possible medico-legal issues rendering the development of a proper algorithm mandatory.
    Keywords: Incidental Findings ; Wounds and Injuries -- Diagnostic Imaging
    ISSN: 00031348
    E-ISSN: 1555-9823
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  • 10
    In: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2012, Vol.22(5), pp.471-476
    Description: Laparoscopic appendicectomy (LA) may be the treatment of choice for acute appendicitis. Our aim was to assess LA in Greek reality. Within a year, 135 patients with a mean age of 29.25 years (14 to 67) underwent an operation for “acute appendicitis.” We analyzed the hospital stay, the morbidity, the cost, and the severity of the inflammation and compared the open appendicectomy [OA (78)] with the LA (57) approach. There were no differences in the appendicitis severity (P=0.667), and similar complication rate (P=0.414) and mean hospital stay were observed between the groups (LA=3.18 vs. OA=2.97, P=0.664). In the way, medical procedures are priced in Greece; the mean net cost of LA was 1320.60 euros (1748.05 USD), whereas for OA, it was 237.8 euros (314.77 USD). The severity of appendicitis is not a limitation for LA. Because of an insufficient costing system in Greece, the best cost effectiveness is for young women and obese men.
    Keywords: Appendectomy -- Methods ; Appendicitis -- Surgery ; Laparoscopy -- Methods;
    ISSN: 1530-4515
    E-ISSN: 15344908
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