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Biomedical subjects

E Pikoulis

Publications and source records attributed to E Pikoulis.

51 records · Page 3Linked to original sources
PubMed1997

Cellular responses to surgical trauma, hemorrhage, and resuscitation with diaspirin cross-linked hemoglobin in rats.

BACKGROUND: Resuscitation with acellular oxygen carrier solutions offers the potential advantage of improved oxygen delivery compared with crystalloid solutions, but the detailed consequences of improved resuscitation have not been fully evaluated. This study evaluated local and systemic cellular effects of trauma, hemorrhage, and resuscitation in a model of hemorrhage and surgical trauma. METHODS: Rats with a 10 cm full-thickness incisional wound and a 15 mL/kg hemorrhage were either not resuscitated or resuscitated with blood or diaspirin cross-linked hemoglobin (DCLHb). Cellular proliferative responses were evaluated at 1.5, 6, 24, and 48 hours after wounding by labeling in vivo with 5-bromo-2'-deoxyuridine. Plasma levels of interleukin-6, tumor necrosis factor-alpha, and interferon-gamma were measured by bioassay or enzyme-linked immunosorbent assay (ELISA). Bacterial translocation was measured by culturing liver homogenates. RESULTS: Trauma inhibited keratinocyte and hepatocyte proliferation at 1.5 and 6 hours, and stimulated subsequent proliferation of keratinocytes and liver nonparenchymal cells. DCLHb stimulated wound keratinocyte proliferation, attenuated the inhibition of hepatocyte proliferation, eliminated bacterial translocation to the liver, protected the intestine from ischemic damage, and induced a rapid increase of interleukin-6 during the early phase of injury. CONCLUSIONS: Surgical trauma alone, or in combination with hemorrhage, modulated cell proliferation both in the wound and in the remote organs of intestine and liver. DCLHb enhanced wound healing and cell proliferation as well as, or better than, freshly drawn blood, which may be beneficial for trauma care.

Animals↗
PubMed1997

Benign retroperitoneal neural sheath tumors in patients without von Recklinghausen's disease.

Benign retroperitoneal neural sheath tumors in patients without von Recklinghausen's disease are quite rare and usually presented as isolated case reports. There are two types of benign neural sheath neoplasms: schwannoma and neurofibroma. Confusion exists in the nomenclature of these tumors due to the disagreement upon their cell of origin. In a collective report from two institutions, three cases with benign retroperitoneal neural sheath tumors are presented, and the histological features, diagnostic and therapeutic options are discussed.

Aged↗
PubMed1997

The role of profunda femoris revascularization in aortofemoral surgery. An analysis of factors affecting graft patency.

BACKGROUND: To determine the long-term results of aortofemoral grafts using the profunda femoris artery as an outflow vessel and to determine the factors affecting the outcome of these procedures. DESIGN: Prospective study. METHODS: From 1980 to 1993, 224 profundoplasties were performed as an adjunctive outflow procedure of aortofemoral grafts in 180 patients. There were 167 men and 13 women with a mean age of 63.7 years. Severe claudication was the indication for operation in 147 limbs (65.6%), and critical ischemia in 77 (34.4%). Good runoff was present in 159 limbs (71%), while poor run-off in 65 (29%). Profundoplasty was extended distally in 67 cases (29.9%), while in the remaining 157 (70.1%) it was limited to the proximal portion of the artery. Arterial and venous patches were used alternatively for the profundoplasty. RESULTS: The 30-day mortality was 1.6% and the 5-year and 9-year survival rate was 69.7% and 49.1% respectively. Primary graft patency was 87.2% in 5 years and 78.5% in 9 years, while secondary graft patency was 90.1% in 5 years and 81.4% in 9 years. Limb salvage rate was 92.7% in 5 years and 87.6% in 9 years. There were four factors which were predictive of inferior longterm results namely; critical ischemia, poor run-off, extended profundoplasty and vein patch used for the profundoplasty. CONCLUSIONS: Angioplasty of the profunda femoris artery is a durable outflow procedure for aortofemoral graft surgery, when the above mentioned risk factors are absent; however when they do exist, the use of arterial patch for profundoplasty may improve the prognosis.

Aorta, Abdominal↗
PubMed1997

Anomalous inferior vena cava complicating abdominal aortic aneurysmectomy.

Variations in the site and course of the inferior vena cava (IVC), although relatively infrequent, can have important surgical implications, especially during surgery for abdominal aortic aneurysm. We report two cases of left-sided IVC encountered during aneurysmectomy. In both cases, the anomaly was not detected during preoperative ultrasound examination, but was identified by CT scan in one case. Careful mobilization of the IVC and left iliac vein allow retraction of the IVC to the right, after which the aneurysm can be approached in the usual manner.

Aged↗
PubMed1997

Benefits of early thymectomy in patients with myasthenia gravis.

OBJECTIVE: To report our experience of early thymectomy in patients with myasthenia gravis. DESIGN: Retrospective study. SETTING: University department of surgery, Greece. SUBJECTS: 76 Patients with myasthenia gravis. INTERVENTIONS: Transcervical thymectomy in all cases, additional left thoracotomy in four cases. MAIN OUTCOME MEASURES: Mortality, morbidity, and early (6 months) and late (mean follow-up 4.8 years) response to thymectomy. RESULTS: 20 Patients had thymomas (26%). There was no postoperative mortality; morbidity was 11% (n = 8). There was complete remission in 19 (25%), improvement in 49 (65%) no change in 7 (9%), and impairment in 1 (1%) of the patients at 6 months. Patients who had had symptoms for less than 5 years (p < 0.001), were in an earlier stage of disease (p = 0.006), and who did not have thymomas (p = 0.006) responded better. 3 Patients died of invasive thymoma at 2 1/2, 3, and 5 1/2 years postoperatively and 25/76 (33%) were lost to follow-up. Of the 51 patients available for late follow-up, 19 (37%) were in remission, in 26 (51%) the symptoms had improved, 3 (6%) were unchanged, and 3 (6%) had died of the disease. CONCLUSIONS: Transcervical thymectomy should be considered in patients with early myasthenia gravis.

Adult↗
PubMed1996

Fluid resuscitation in a model of uncontrolled hemorrhage: too much too early, or too little too late?

UNLABELLED: Early fluid resuscitation in hypotensive trauma patients is controversial due to the risk of increasing blood loss and mortality. We determined the effects of infusion rate and time of resuscitation on blood loss and mortality and compared the outcome to nonresuscitated animals in severe, uncontrolled hemorrhagic shock in a rat model. In anesthetized rats, piercing of the infrarenal aorta with a 25-G needle caused a fall of mean arterial pressure to <20 mm Hg and blood loss of about 20 ml/kg in 90% of the animals. Animals were assigned to the following treatment groups (n = 6): 60 ml/kg of lactated Ringer's solution (LR) infused at a rate of 1.5 ml/min and given at 2.5 min (Group I), 5 min (Group II), or 10 min (Group III) postinjury, or LR infused at a rate of 3.0 ml/min and given at 5 min (Group IV) or 10 min (Group V) postinjury. Another group (n = 9) was not resuscitated. The animals were followed for 3 hr. Total blood loss in Group I (30.5 +/- 2.6 ml/kg) was significantly (P < 0.05) higher when compared to nonresuscitated animals (22.1 +/- 0.8 ml/ kg) or Group III (22.7 +/- 1.0 ml/kg), and also significantly higher in Group IV (35.8 +/- 4.1 ml/kg) when compared to nonresuscitated animals or Group V (23.0 +/- 1.2 ml/kg). The mortality rate was 7/9 in nonresuscitated animals and 5/6 in Group IV, both were significantly higher than in Groups II, III, and V (0 or 1/6) and markedly higher than in Group I (2/6). CONCLUSIONS: In this model of uncontrolled hemorrhage, initially uncorrected severe shock resulted in a high mortality rate. The risk of increased blood loss and mortality associated with early fluid resuscitation could be diminished by avoiding too fast of infusion rates early after the injury.

Animals↗
PubMed1996

A quick and simple method to close vascular, biliary, and urinary tract incisions using the new Vascular Closure Staples: a preliminary report.

Traditional suture reconstruction of tubular organs creates a perforating needle injury, leaves suture material on the endothelial or mucosal surfaces, and is cumbersome when done endoscopically. One alternative method of reconstruction of tubular organs could use the new nonpenetrating clip to create an everted closure. In five pigs, a longitudinal incision of the infrarenal aorta, inferior vena cava, left ureter, gallbladder, and the common bile duct (in two) was closed with Vascular Closure Staples (VCS-clips). Four weeks after surgery, all ten blood vessels remained patent with no thrombosis. There was a well-healed wound with continuous intimal layer. The ureteral, gallbladder, and common bile duct wounds healed without leakage or obstruction in all animals. There was complete mucosal bridging of the wound, although in some specimens one or two clips were exposed to the lumen. The VCS-clips are easily and quickly applied and are safe insofar as can be determined by short-term follow-up.

Animals↗
PubMed1996

Early resuscitation with low-volume PolyDCLHb is effective in the treatment of shock induced by penetrating vascular injury.

OBJECTIVE: To study the efficacy of an oxygen-carrying solution in early resuscitation of hemorrhagic shock induced by penetrating vascular injury. DESIGN: Experimental study with anesthetized rats. MATERIALS AND METHODS: Severe hemorrhagic shock was induced by a 25-gauge needle puncture to the infrarenal aorta. Forty animals were resuscitated 10 minutes after injury with either lactated Ringer's solution (LR; 60 mL/kg), 7.5% hypertonic saline (HTS; 5 mL/kg), or modified diaspirin cross-linked hemoglobin (PolyDCLHb; 5 or 20 mL/kg) or were not resuscitated (NR) and followed for 6 hours. RESULTS: Total blood loss was similar in all treatment groups. Mean arterial pressure was restored to baseline values, base deficit was corrected to base excess, and venous oxygen saturation improved with PolyDCLHb and more slowly with LR but persisted below baseline values with HTS and NR. The 6-hour mortality rates were zero of eight (low-dose PolyDCLHb), three of eight (high-dose PolyDCLHb), two of eight (LR), six of eight (HTS), and six of eight (NR). CONCLUSION: Early resuscitation with low-volume hemoglobin is effective in restoring tissue perfusion and improving survival in uncontrolled hemorrhagic shock.

Animals↗
PubMed1996

Hydatid disease: a rare cause of adrenal cyst.

A case of hydatid cyst in the adrenal gland is presented. Eight cases have been previously reported. The diagnosis of an adrenal cyst is usually incidental, and the diagnosis of hydatid cyst is seldom made preoperatively. Surgical excision of the gland including the cyst is the treatment of choice.

Adrenal Gland Diseases↗
PubMedDate not supplied

Spiral computerized tomography : a diagnostic aid in patients with atypical acute appendicitis.

This retrospective study aimed to estimate the value of spiral Computerized Tomography (sCT) in patients with suspected appendicitis who remained undiagnosed after 48 hours of expectant management. We assessed a cohort of 150 patients by focused unenhanced sCT. According to the clinical scenario we occasionally employed contrast media and extended the scanned area. The major radiological signs were appendiceal enlargement and inflammatory changes of periappendiceal tissue and mesenteric fat. Regarding acute appendicitis the examination was 95.8% sensitive, 97.4% specific, had a positive predictive value of 97.18%, a negative predictive value of 96.2% and an accuracy of 96.7%. It also provided alternative diagnoses in 55 patients leading correctly 31 of them to the theatre for a variety of abdominal surgical diseases. For abdominal surgical pathology in general, sCT was 97.1% sensitive, 95.7% specific, had a positive predictive value of 98% and a negative predictive value of 93.8%. The importance of good communication between the clinicians and radiologists was pointed out by the correct alternative diagnoses set by imaging in the 55 patients after modifying the sCT protocol and was highlighted by the unnecessary appendectomy of three patients with negative imaging. Our results verify the accuracy and value of unenhanced sCT in patients with a clinical picture which remains inconclusive after an initial period of expectant management.

Adult↗
PubMedDate not supplied

Expanding ulnar artery aneurysm presenting with signs of threatened rupture.

The case of a 25-year-old man admitted with an ulnar artery aneurysm of the wrist is presented. The size of the aneurysm (1.5 x 2.7 cm) and progressive pain gave the impression of a threatened rupture. Radiologic examinations confirmed the existence of a non-thrombosed ulnar artery aneurysm with occlusion of the 4th and 5th digital arteries. During an urgent surgical exploration a pseudo-aneurysm was found and resected and the artery was repaired. Thrombolysis of the digital arteries was performed with a good result. The combination of a large-sized pseudo-aneurysm, lack of a history of penetrating trauma and presentation of threatened rupture are unique and not reported previously in the literature.

Adult↗
PubMedDate not supplied

Carcinoid of the ampulla of Vater: presentation of a new case.

The appendix is the most common location for carcinoid tumors within the gastrointestinal tract. Carcinoid tumors of the ampulla of Vater is an extremely rare entity; only 71 cases of carcinoid of the ampulla of Vater have been reported in the literature to date. The clinical picture is non-specific, and endoscopy is the main diagnostic procedure; but large and deep biopsies are often needed to verify the histological nature of the tumor. Surgery is the treatment of choice. We report a new case of this rare tumor, and a review of the literature concerning the clinical findings, diagnosis, therapeutic challenge and results.

Ampulla of Vater↗
PubMedDate not supplied

Contrast-enhanced spiral CT evaluation of blunt abdominal trauma.

The purpose of this study was to examine the usefulness and validity of contrast enhanced-spiral computerized tomography in assessing blunt abdominal trauma. 257 patients were admitted in a general hospital over a period of five years and were examined with computed tomography. Two-dimension reconstruction and delayed imaging were used when appropriate. 169 patients underwent a laparotomy, while 88 were treated conservatively. Scans were true positive for intraabdominal damage in 212 patients depicting chiefly splenic, liver, renal, urinary bladder, and mesenteric/intestinal injuries (41%, 18%, 6.6%, 6.6%, and 13.7% respectively). True negative examinations amounted up to 35. 10 non-specific examinations displayed the existence of hemoperitoneum but not the actual damage itself, therefore they were considered false negative. No false positive examination existed. Overall sensitivity was 95%, specificity 100%, positive predictive value 100% and negative predictive value 78%. In conclusion spiral computed tomography is a valuable examination in blunt abdominal trauma as it facilitates diagnosis of intraabdominal damage, assists in defining treatment and occasionally allows foretelling the outcome.

Abdominal Injuries↗
PubMedDate not supplied

Acute segmental intestinal ischemia: diagnosis with spiral computed tomography.

The purpose of this study was to examine the usefulness and the validity of spiral computerized tomography (CT) in assessing acute segmental intestinal ischemia. We present the spiral CT imaging findings in surgically proven cases of intestinal ischemia. 46 patients were admitted to our facility over a five-year period with suspicion of acute enteric ischemia. 34 were first examined with spiral CT and underwent surgery. In 24 of the 34 patients (sensitivity 70.6%), at least one imaging finding specific for segmental intestinal ischemia was recognised (true positive examinations). Spiral-CT examination demonstrated non-specific or normal findings in 7 out of 34 patients with proven intestinal ischemia (20.6% false negative studies). In conclusion, spiral CT can be used in the investigation of patients with suspected acute intestinal ischemia to confirm or suggest the diagnosis or exclude other potential diagnoses.

Acute Disease↗