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G H Sakorafas

Publications and source records attributed to G H Sakorafas.

At least 19 recordsLinked to original sources
PubMed2005

Squamous cell carcinoma of the rectum: a case report and review of the literature.

Squamous cell carcinoma of the colon and rectum are extremely rare neoplasms. Many questions regarding their histogenesis and biological behaviour remain unanswered. Surgery is the most effective therapy, and adjuvant chemotherapy and radiotherapy should be considered, especially for node-positive patients. We present a patient with squamous cell carcinoma of the middle rectum who underwent abdominoperineal resection and postoperative adjuvant chemotherapy. The pertinent literature is reviewed.

Aged↗
PubMed2004

The clinical significance of axillary lymph node micrometastases in breast cancer.

OBJECTIVE: To evaluate the clinical significancer of axillary lymph-node micrometastases, in the era of sentinel lymph node (SLN) biopsy. DATA SOURCES: Searches of MEDLINE (1966-2003) and an extensive manual review of journals were performed using the key search terms breast cancer, axillary lymph-node micrometastases, micrometastatic disease, and SLN biopsy. STUDY SELECTION: All articles identified from the data sources were evaluated and all information deemed relevant was included for this review. CONCLUSIONS: Axillary lymph-node micrometastases can be detected by serial sectioning, immunohistochemistry, or reverse transcriptase-polymerase chain reaction (RT-PCR). The presence of axillary SLN micrometastases is generally associated with a worse prognosis and is an indication for axillary lymph node dissection (ALND) and adjuvant therapy. The clinical significance of micrometastases identified by RT-PCR remains unknown and further research with longer follow-up is needed to ascertain the clinical implications of a positive result.

Axilla↗
PubMed2004

Management of septic shock: current concepts, with a particular emphasis on the role of source control, and future perspectives.

Sepsis is an infection-induced syndrome characterized by a generalized inflammatory state. The normal reaction to infection involves a series of complex immunological processes. A potent, complex immunological cascade ensures a prompt protective response to microbial invasion in human beings. Although activation of the immune system during microbial invasion is generally protective, septic shock develops in a number of patients as a consequence of excessive or poorly regulated immune response to the offending organism. This unbalanced reaction may harm the host through a maladaptive release of endogenously generated inflammatory compounds. Early recognition of the syndrome is of key importance to promptly start appropriate management. Timely, aggressive resuscitation to preserve organ function remains a fundamental principle in the care of septic patients. The specific treatment is directed at identifying and treating the underlying disorder. The physician should investigate diligently for the presence of active infection using modern imaging methods and other diagnostic studies to localize the site of infection and to obtain adequate culture specimens from potential infective sources. Early administration of appropriate, effective antibiotic therapy is important in the management of septic patients. Infected fluid collections and/or infected necrotic tissues should be drained or debrided without delay. Adequate nutritional support is indicated in the management of the septic patient. A number of adjuvant therapies, aimed at blunting/downregulating the host immune response to bacterial infection are currently under intensive investigation; however, the complexity of immunological defences and the potential for complementary interaction of the different components of the inflammatory cascade make the development of these pharmacological interventions difficult.

Anti-Bacterial Agents↗
PubMed2003

Pancreatic cancer after surgery for chronic pancreatitis.

BACKGROUND: Chronic pancreatitis is known to be a risk factor for pancreatic cancer. AIMS: To identify patients who were diagnosed with pancreatic cancer after undergoing surgery for histologically documented chronic pancreatitis. PATIENTS/METHODS: Records of 484 consecutive patients who underwent surgery for chronic pancreatitis from 1976 to 1997 were reviewed. RESULTS: Pancreatic cancer was diagnosed after a mean of 3.4 years (range: 2 months-1 years) in 14 patients (2.9%). In four patients, pancreatic cancer became evident within 12 months of surgery for chronic pancreatitis, suggesting cancer was present at the original surgery. Cancer presented with recurrent or persistent pain, jaundice, and/or weight loss. Pancreatic resection was possible in eight patients, but in the others, the cancer was inoperable. There was one long-term survivor (alive 14 years postoperatively), but for theothers mean survival was 10 months (16 months after resection vs. 4 months for inoperable cancer). CONCLUSION: Pancreatic malignancy should be suspected in patients who have had surgery for chronic pancreatitis when symptoms (such as recurrent pain, jaundice, weight loss, or anorexia) recur. Attempts at curative pancreatic resection are indicated and can offer palliation and the potential for a cure.

Adult↗
PubMed2001

Paget's disease of the breast: a clinical perspective.

Paget's disease of the breast is a rare disorder of the nipple-areola complex often associated with an underlying in situ or invasive carcinoma. Eczematoid changes of the nipple-areola complex and persistent soreness or itching should raise suspicion of this disease. The histogenesis of Paget's disease of the breast continues to be debated and is important when considering treatment options. The epidermotropic theory suggests that Paget's cells are ductal carcinoma cells that have migrated from an underlying carcinoma of the breast parenchyma to the epidermis of the nipple. The in situ transformation theory has been proposed to explain the development of this disorder in patients in whom an underlying mammary carcinoma is not found or when there is an underlying carcinoma anatomically remote from the nipple-areola complex. Paget's cells are believed to arise as malignant cells in the epidermis of the nipple independent from any other pathologic process within the breast parenchyma. The current standard treatment of biopsy-proven Paget's disease involves mastectomy, although some studies have proposed the use of breast conservation therapy for patients in whom an underlying breast cancer cannot be located. We propose a treatment algorithm for patients presenting with Paget's disease of the breast.

Algorithms↗
PubMed2001

Open tension free repair of inguinal hernias; the Lichtenstein technique.

BACKGROUND: Recurrences have been a significant problem following hernia repair. Prosthetic materials have been increasingly used in hernia repair to prevent recurrences. Their use has been associated with several advantages, such as less postoperative pain, rapid recovery, low recurrence rates. METHODS: In this retrospective study, 540 tension-free inguinal hernia repairs were performed between August 1994 and December 1999 in 510 patients, using a polypropylene mesh (Lichtenstein technique). The main outcome measure was early and late morbidity and especially recurrence. RESULTS: Inguinal hernia was indirect in 55 % of cases (297 patients), direct in 30 % (162 patients) and of the pantaloon (mixed) type in 15 % (81 patients). Mean patient age was 53.7 years (range, 18 - 85). Follow-up was completed in 407 patients (80 %) by clinical examination or phone call. The median follow-up period was 3.8 years (range, 1 - 6 years). Seroma and hematoma formation requiring drainage was observed in 6 and 2 patients, respectively, while transient testicular swelling occurred in 5 patients. We have not observed acute infection or abscess formation related to the presence of the foreign body (mesh). In two patients, however, a delayed rejection of the mesh occurred 10 months and 4 years following surgery. There was one recurrence of the hernia (in one of these patients with late mesh rejection) (recurrence rate = 0.2 %). Postoperative neuralgia was observed in 5 patients (1 %). CONCLUSION: Lichtenstein tension-free mesh inguinal hernia repair is a simple, safe, comfortable, effective method, with extremely low early and late morbidity and remarkably low recurrence rate and therefore it is our preferred method for hernia repair since 1994.

Adult↗
PubMed2001

Postobstructive chronic pancreatitis: results with distal resection.

HYPOTHESIS: For most patients with chronic obstructive pancreatitis, distal pancreatectomy confers pain relief. DESIGN: Retrospective case series. Follow-up was complete in 80% of study subjects (mean follow-up, 6.7 years). SETTING: Tertiary care center. PATIENTS: Among 484 patients with chronic pancreatitis undergoing operation from 1976 to 1997, 40 with postobstructive chronic pancreatitis were identified. Criteria for selection included an isolated, dominant major pancreatic duct stricture or cutoff, changes of chronic pancreatitis in the distal pancreas, and ostensibly normal parenchyma without calcification in the proximal gland. The patients were reviewed with regard to operative procedure, postoperative course, and outcome. MAIN OUTCOME MEASURES: Outcome measures included degree of pain relief, morbidity and mortality of operation, survival, rates of endocrine and exocrine insufficiency, and ability to return to work and/or normal activities. RESULTS: All but 1 of the 40 patients had abdominal pain, and 20 (50%) had recurrent episodes of acute pancreatitis. Suspicion of malignancy was a concern in 16 patients (40%). Thirty-eight patients underwent distal pancreatectomy; 1 had a central resection and another a Roux-en-Y cystojejunostomy. There was no operative mortality, but significant morbidity occurred in 15%. Among 31 patients with preoperative pain in whom long-term follow-up was available, complete or significant pain relief was achieved in 25 (81%); 74% returned to normal social function, but about half had some element of pancreatic insufficiency. CONCLUSIONS: Distal pancreatectomy is a safe procedure and achieves pain relief and good quality of life in a large percentage of patients (80%) with presumed postobstructive chronic pancreatitis. However, some of these patients with chronic pancreatitis involving the entire gland have disease masquerading as postobstructive chronic pancreatitis secondary to an ostensibly isolated dominant pancreatic ductal stricture.

Abdominal Pain↗
PubMed2001

Surgical management of chronic pancreatitis at the Mayo Clinic.

The authors' approach to the overall surgical management of chronic pancreatitis is to treat complications, that is, pain and, less commonly, obstruction and bleeding. The authors' practice is to exhaust nearly all forms of nonsurgical intervention before suggesting a surgical approach. Nonresponders are then evaluated for severity of pain, interference of quality of life, and presence of chemical dependency. Appropriate candidates undergo imaging examinations to determine the primary site of disease, presence of pancreatic ductal dilatation, and associated peripancreatic complications. The surgical treatment approach involves classic lines of proximal resection (pylorus-preserving pancreaticoduodenectomy) for small duct disease and lateral pancreaticojejunal drainage for a dilated pancreatic duct. The authors have not yet routinely adopted the duodenum-preserving head resections of Beger and Frey, or thoracoscopic transthoracic splanchnicectomy, but they remain open-minded and avidly await good confirmatory, independent trials of these promising surgical interventions.

Chronic Disease↗
PubMed2001

Lateral pancreatojejunostomy in the surgical management of chronic pancreatitis. Current concepts and future perspectives.

Chronic pancreatitis is a medical disease, but surgery will be required for a selected subgroup of patients. Main indications for surgery in chronic pancreatitis are severe truly incapacitating pain refractory to medical therapy, local complications of pancreatitis or suspicion of malignancy. Surgical options include resective and drainage procedures. The choice of operation depends on the structural anatomy of the gland and the adjacent organs. Lateral pancreatojejunostomy is the preferred drainage procedure, because it is safe and effective in relieving the pain, while it preserves whatever pre-surgical pancreatic endocrine/exocrine function exists. It is indicated in large duct chronic pancreatitis (diameter of the main pancreatic duct >7 mm]; however, recently there is an increased interest in defining its role in small duct disease. The main advantage of the lateral pancreatojejunostomy over the resectional procedures is the preservation of the pancreatic parenchyma and endocrine and exocrine pancreatic function and the significantly lower early and late morbidity and mortality

Animals↗
PubMed2001

Paget's disease of the breast.

Paget's disease of the breast is a rare disorder of the nipple-areola complex that is often associated with an underlying in situ or invasive carcinoma. A change in sensation of the nipple-areola, such as itching and burning, is a common presenting symptom. Objectively, eczematoid changes of the nipple-areola complex are common. The later stages of Paget's disease of the breast are characterized by ulceration and destruction of the nipple-areola complex. Eczematoid changes of the nipple-areola complex and persisting soreness or itching, without obvious reason, is a suspicious symptom for Paget's disease of the breast and calls for thorough evaluation, including mammography. Exfoliative cytology with demonstration of Paget's cells may be useful, but a negative finding does not exclude Paget's disease of the breast. Surgical biopsy is the diagnostic standard and therefore the diagnosis should always be confirmed by open (surgical) biopsy. The histogenesis of Paget's disease of the breast continues to be debated. The epidermotropic theory holds that Paget's cells are ductal carcinoma cells that have migrated from the underlying breast parenchyma to the nipple epidermis. According to the in situ transformation theory, the Paget's cells arise as malignant cells in the nipple epidermis independent from any other pathologic process within the breast parenchyma. This theory has been proposed to explain those cases in which there is no underlying mammary carcinoma or when there is a carcinoma remote from the nipple-areola complex. Each of these theories is plausible; however, treatment approaches differ markedly depending on the theory of histogenesis. Mastectomy has been considered the standard of care in the management of patients with Paget's disease of the breast. Nowadays, however, some patients with Paget's disease of the breast are candidates for breast-conserving therapy. Patients must be selected carefully on an individual basis. Until there is a better understanding of the relationship of Paget's disease of the breast to the underlying cancer the surgeon should understand the natural history and behaviour of this lesion and be aware of both the risks of under- and over-treating patients with Paget's disease of the breast.

Breast Neoplasms↗
PubMed2001

Nipple discharge: current diagnostic and therapeutic approaches.

Nipple discharge is a complex diagnostic challenge for the clinician. A variety of diseases (such as intraductal papillomas, mammary duct ectasia, breast cancer, pituitary adenomas, breast abscesses/infections, etc.) can manifest as nipple discharge. The importance of nipple discharge for both the patient and the physician is the possible association of this condition with an underlying carcinoma. With heightened public awareness of breast cancer, an increasing number of women are asking their health care providers about nipple discharge. A detailed clinical evaluation is invaluable to determine the pathophysiology, assess the risk of malignancy, and plan treatment of the patient with nipple discharge. A combination of diagnostic tests, including mammography, breast ultrasonography, and possibly galactography can help the clinician to establish the diagnosis and plan proper management. Depending on the underlying breast pathology, a central or single lactiferous duct excision is the procedure of choice. Breast carcinoma associated with nipple discharge should be treated by either a modified radical mastectomy of breast-conservation therapy (i.e. duct-lobular segmentectomy with adequate, free margins [ideally>1cm], levels I and II axillary lymph node dissection, followed by breast irradiation).

Breast Diseases↗
PubMed2001

Breast cancer surgery--historical evolution, current status and future perspectives.

The diagnosis and management of breast cancer have changed dramatically over the past two decades in response not only to new technologies but also to cultural and social aspects of the discase. Mastectomy (either radical or modified radical) was the historical mainstay of the treatment of breast cancer for decades. Although mastectomy continues to be appropriate for some patients, breast conservation has become the preferred method of treatment for many patients. Meeting the dual goal of optimum cosmesis and minimal rates of in-breast recurrences after breast-conservation therapy requires the selection and integration of appropriate diagnostic methods (including breast imaging techniques and breast biopsy techniques) its well as therapeutic methods (breast irradiation techniques, and systemic cytotoxic and hormonal therapy). To achieve optimal breast-conservation treatment, a multidisciplinary approach is neccessary. Mastectomy followed by breast reconstruction is a valuable alternative for patients who require or choose mastectomy. After tumor downstaging with induction chemotherapy, a large percentage of patients with large or locally advanced tumors will be able to undergo breast-conservation therapy Partial (levels I and II) axillary lymph node dissection remains the standard of care in the surgical management of patients with invasive breast cancer. Recently there has been intense interest in selective axillary lymph node dissection, focused mainly on the identification of patients who are likely to benefit from axillary lymph node dissection, using sentinel lymph node biopsy.

Biopsy, Needle↗
PubMed2001

Problems of reconstruction during pancreatoduodenectomy.

Pancreatoduodenectomy may be a difficult operation, not only during the resectional part of the procedure, but also during reconstruction. Usually, these problems are due to local conditions of the organs/tissues, such as small diameter of the common bile duct or pancreatic duct, friable soft pancreas, vascular anomalies, etc. Reconstruction may also be problematic because of the hemodynamic instability of the patient during surgery (subsequent to massive hemorrhage), and in those unusual cases, delayed reconstruction may be a life-saving, wise choice.

Anastomosis, Surgical↗