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S Raptis

Publications and source records attributed to S Raptis.

At least 55 records · Page 3Linked to original sources
PubMed1997

Endoscopic sclerotherapy versus variceal ligation in the long-term management of patients with cirrhosis after variceal bleeding. A prospective randomized study.

BACKGROUND/AIMS: Long-term endoscopic injection sclerotherapy of oesophageal varices prevents rebleeding in patients with cirrhosis surviving an acute variceal bleeding episode. However, this treatment is associated with a substantial complication rate. Endoscopic band ligation is a newly developed technique in an attempt to provide a safer alternative. The aim of this study was to compare the efficacy and safety of injection sclerotherapy versus variceal ligation in the management of patients with cirrhosis after variceal haemorrhage. METHODS: Seventy-seven patients with cirrhosis who proved to have oesophageal variceal bleeding were studied. After initial control of haemorrhage by sclerotherapy, 40 of the patients were randomly assigned to sclerotherapy and 37 to ligation. Both procedures were performed under midazolam sedation at intervals of 7-14 days until all varices in the distal oesophagus were eradicated or were too small to receive further treatment. RESULTS: The eradication of varices required a lower mean number of sessions with ligation (3.7 +/- 1.9) than with sclerotherapy (5.8 +/- 2.7, p = 0.002). The mean duration of follow-up was similar in both groups (15.6 months +/- 7.3 and 15 +/- 7.4, respectively). The proportion of patients remaining free from recurrent bleeding against time was significantly higher in the ligation group as compared to the sclerotherapy group (chi 2 = 3.86, p = 0.05). Only 13 patients (35%) developed complications in the ligation group as compared to 24 (60%, p = 0.05) in the sclerotherapy group. The mortality rate was similar in both groups (20% and 21%, respectively). CONCLUSIONS: Variceal ligation is better than sclerotherapy in the long-term management of patients with cirrhosis after variceal haemorrhage which was initially controlled with sclerotherapy.

Aged↗
PubMed1997

Arterial injury in the lower limb from blunt trauma.

BACKGROUND: The present study was performed to identify the factors associated with amputation in patients with blunt injuries to the lower limb associated with arterial injury. The ability of a scoring system to predict the outcome was tested. METHODS: There were 122 lower limb arterial injuries in 119 patients treated at the Royal Adelaide Hospital in the years 1962-1994. Prognostic factors considered were the site of the injury, the severity of the soft-tissue injury and shock, the presence of associated injuries and a description of the bone or joint injury. The mangled extremity severity score (MESS) was calculated retrospectively for each patient. RESULTS: The outcome was primary amputation in 27 patients, delayed amputation in 36 patients and limb salvage in 59 patients. The seven deaths were all due to associated injuries. Factors associated with amputation were the severity of shock and soft-tissue injury (P < 0.01), and tibial artery injury compared with more proximal injury (P < 0.001). Factors that did not affect outcome included delay before repair, method of fracture fixation, or performance of fasciotomy. Amputation was performed in 48/71 (68%) patients with Gustilo type-IIIC fractures of the tibia. Applying the MESS to our patients resulted in a positive predictive value (PPV) of 71%, a negative predictive value (NPV) of 84% and an overall accuracy of prediction of 75%. CONCLUSIONS: The major factor determining outcome was the severity of the soft-tissue injury. Progressive necrosis and infection was a major cause of late amputation. The MESS is not sufficiently precise to allow the decision regarding amputation to be made at the initial operation.

Accidents, Occupational↗
PubMed1997

'Trash foot' following operations involving the abdominal aorta.

BACKGROUND: Acute lower limb ischaemia following aortic surgery is commonly termed 'trash foot'. The exact cause of the ischaemia is unknown, but it has been attributed to athero-emboli from native arteries, thrombo-emboli from any prosthetic graft or thrombosis of small vessels in the distal arterial tree. METHODS: Review of 1601 aortic reconstructions performed between 1976 and 1995. RESULTS: 'Trash foot' occurred in 32 patients (44 limbs): 23 cases followed aortic aneurysm repair and nine cases followed an aorto-femoral bypass for occlusive disease. Six cases of 'trash foot' (13.6%) underwent an early amputation (one above-knee, two below-knee and three cases of amputation of one or more toes) while a further nine cases (20.5%) underwent a delayed amputation (four above the knee, two below the knee and three cases of toe amputation). Eight patients (25%) with 'trash foot' died within 30 days of surgery. CONCLUSION: 'Trash foot' following aortic surgery is an unwelcome complication that is associated with a high morbidity and mortality. Attempts to reduce the incidence involve early mobilization and clamping of the iliac arteries, and irrigation of the aortic anastomosis and graft with heparin saline solution.

Aged↗
PubMed1996

Fine-needle aspiration cytology of metastatic ovarian carcinoma to the breast.

Metastatic ovarian carcinoma to the breast is rare. It represents a diagnostic challenge to the cytologist. It usually signifies a progressive widespread metastatic ovarian tumor with a poor prognosis. This report evaluates the breast fine-needle aspiration (FNA) cytomorphologic features of six cases of metastatic ovarian carcinoma and compares them to those reported in the literature. The cytologic features included hypercellularity, abundant papillary fragments, and necrotic background. The tumor cells showed high nuclear/cytoplasmic ratio, anisonucleosis, prominent nucleoli, and psammoma bodies in cases of serous papillary carcinoma. In addition, the clear-cell carcinoma had prominent finely vacuolated and clear cytoplasm, multinucleated giant cells, and papillary fragments with hobnail nuclei. Recognition of these unusual patterns in a breast FNA cytology should raise the suspicion of a metastatic ovarian tumor. Direct comparison between the breast FNA cytology and the original primary ovarian tumor should confirm the diagnosis. The proper diagnosis of metastatic ovarian cancer to the breast will prevent unnecessary surgical treatment and ensure the appropriate therapy.

Adenocarcinoma, Clear Cell↗
PubMed1996

Treatment of high risk myelodysplastic syndromes with idarubicin and cytosine arabinoside supported by granulocyte-macrophage colony-stimulating factor. (GM-CSF).

In this prospective study, patients with "high risk' primary MDS, namely RAEB or RAEBt, were treated with combination chemotherapy (CT) supported by GM-CSF. The induction CT consisted of idarubicin 6 mg/m2 days 1-3 and cytosine-arabinoside 200 mg/m2 in 12 h infusion, days 1-5. The GM-CSF 3 micrograms/kg s.c. was given on day 6 until the neutrophil count was 1 x 10(9)/l. Postremission CT consisted of two similar courses. Patients not in remission after two courses of CT were considered as treatment failures. Twenty-two patients with a median age of 64 years, range 50-79 years (11 RAEB and 11 RAEBt) were evaluable. Twelve out of 22 patients (54.5%) achieved complete remission (CR) and four, partial remission. Six patients were resistant to treatment; there were two toxic deaths; seven patients achieved CR after the first course and five after two courses. The median time of neutrophil recovery to 1 x 10(9)/l was day 15 (range 3-22) after the first course of treatment and day 14 (range 4-21) after the second. Thirteen out of 22 patients developed febrile episodes after the first course of treatment and nine after the second. The median duration of CR was 12 months. The median survival for CR patients was 24 months, for non-CR patients, 12 months; while survival for the whole population was 18 months. In conclusion, the results of this study indicate that the administration of moderately intensive CT supported by GM-CSF in "poor risk' MDS gives promising results; the response rate is high for this disease, while the incidence of toxic death is low. GM-CSF appears to accelerate neutrophil recovery and probably reduces the incidence of infection.

Aged↗
PubMed1996

Efficacy of balloon angioplasty of the superficial femoral artery and popliteal artery in the relief of leg ischemia.

PURPOSE: To assess the efficacy of balloon angioplasty in the superficial femoral artery (SFA) and popliteal artery for relief of lower-limb claudication and critical ischemia. METHODS: All patients who underwent SFA or popliteal balloon angioplasty at the Royal Adelaide Hospital between January 1989 and September 1994 were reviewed. Risk factors, indications, angiographic variables, and complications were assessed. Outcome was expressed in life-table form as patency, limb survival, and patient survival rates. RESULTS: One hundred seventy-six patients (96 men, 80 women) who underwent 200 balloon angioplasty procedures were monitored for a mean of 25 months. Seventy-four percent of procedures were for claudication relief and 26% for critical ischemia. The cumulative patency rate at 24 months for all cases was 46%. The limb salvage rate was 95%, and the patient survival rate was 91% at 24 months. CONCLUSION: Percutaneous transluminal angioplasty of the SFA and popliteal arteries is commonly used to treat claudication and critical ischemia but is associated with a high initial failure rate and poor patency at 24 months. Balloon angioplasty is not recommended to treat claudication.

Adult↗
PubMed1996

Infected false aneurysms of the carotid arteries after carotid endarterectomy.

OBJECTIVE: To determine the incidence and management of infected false aneurysms following carotid endarterectomy. DESIGN: Case notes of patients undergoing carotid endarterectomy (CEA) between the years of 1980 and 1993 at two major teaching hospitals, or those patients who represented with complications were reviewed. RESULTS: Eight patients were identified with infected false aneurysms, an incidence of 0.625%, in five CEA had been performed at one of the teaching hospitals, whilst in three other cases the primary operation had been done elsewhere. Presentation was a median 19 days following CEA. In five cases the original arteriotomy was closed by direct suture whilst in three a saphenous vein patch was used. Staphylococcal organisms were cultured in all cases. Antibiotics had not been administered at the original operation. Repair with saphenous vein graft from the common to the internal carotid artery had the least complications. CONCLUSION: Infected false aneurysms are a rare complication following CEA, resection of the false aneurysm and reconstruction with autologous saphenous vein is recommended. Ligation alone is associated with a high incidence of stroke.

Aged↗
PubMed1996

Relationship of p53 Genotype to Second-look Recurrence and Survival in Ovarian Epithelial Malignancy.

Background: Clinical stage at presentation and tumor status at second-look laparotomy are currently the best predictors of patient survival in epithelial ovarian carcinoma (EOC). Methods and Results: To evaluate the predictive value of genetic analysis, the presence and type of p53 mutation (p53 genotype) was determined in 76 patients treated for EOC between 1987 and 1992 and subjected to second-look laparotomy following initial treatment. Mutational analysis of p53 was performed retrospectively by means of topographic genotyping (TG), using formalin-fixed, paraffin-embedded tissue of the primary and recurrent tumor. In TG, minute tissue samples were dissected from unstained histologic sections, amplified for p53 exons 5-8 with the polymerase chain reaction (PCR), and then direct sequenced. The p53 genotype was correlated with tumor stage, histologic grade and type, tumor status at second look, and survival at 3 and 5 years. Mutational change involving p53 exons 5-8 was found in 41 of 76 tumors (54%), consisting of 29 cases manifesting missense alterations and 12 cases having truncations (deletions, insertions, or stop codons). Tumor mutational change for each patient was strictly limited to a single type, being identical in all recurrences of an individual primary cancer. Mutations of p53 were distributed over exons 5-8, with certain "hot spots" being evident (codons 220, 245, and 273). Mutational change was present in all stages of primary EOC, but was relatively more frequent in tumors of advanced stage (III and IV). Epithelial ovarian carcinoma manifesting p53 mutational damage was significantly more likely to show recurrence at second-look laparotomy (P <.001) and to have shorter survival at the 3- and 5-year follow-up (P <.001) evaluation. The predictive value of p53 genotype was independent of stage at presentation, histologic grade, or histopathologic type. Conclusions: Genotyping of p53 provides useful information on tumor aggressiveness and is an informative predictive marker of biologic tumor behavior, treatment response, and survival in EOC.

Journal Article↗
PubMed1996

Primary extranodal non-Hodgkin's lymphoma in adults: clinicopathological and survival characteristics.

Among 318 cases of non-Hodgkin's lymphoma (NHL) treated in our unit, 145 (45.6%) had primary extranodal NHL (PE-NHL). The stomach was the most common site (42.1%), followed by the PE-NHL of the head and neck region. Histologically aggressive histologies (65.5% intermediate and 20.7% high grade) predominated. 89.6% of the cases were localized (stage IE, 51% and stage II, 38.6%) but 28% had B symptoms. CR was achieved in 82.1% of the cases. 5-years disease free survival and overall survival were both 65%. Factors that influence prognosis were stage and high grade histology. Among various primary sites the Waldeyer's ring, small intestine and testes had the worse prognosis. Compared to nodal NHL, the PE-NHL were more frequently localized, belonged more often to aggressive histologies and had more often distal extranodal relapses. CR rates and disease free and overall survival were significantly better for PE-NHL. The survival rates, however, listed according to stage and histology for nodal and PE-NHL were not different. We conclude that although PE-NHL differed from nodal NHL in several respects, prognosis is mainly a factor of stage and histology rather than of the primary localization per se.

Adolescent↗
PubMed1995

Influence of a vein cuff on polytetrafluoroethylene grafts for primary femoropopliteal bypass.

A retrospective investigation was performed to study the benefit obtained from a vein cuff inserted at the distal anastomosis of a primary femoropopliteal bypass graft with polytetrafluoroethylene (PTFE). When PTFE was preferred to vein an attempt was made to assess whether there was subsequent use for the spared vein. A series of 559 primary PTFE bypasses was studied and found to have a cumulative patency rate of 62 per cent at 36 months. Subgroups were also studied for a similar period. In the above-knee position there was no difference in the primary patency rate of PTFE with or without a cuff at 36 months (69 versus 68 per cent, P = 0.89). Below the knee, grafts with a cuff had a better 36-month patency rate than those without (57 versus 29 per cent, P = 0.01). Cuffed PTFE for claudication had a better patency rate than that for threatened limbs at 36 months (68 versus 60 per cent, P = 0.03). Thrombectomy of occluded cuffed PTFE grafts improved the 36-month patency rate from 64 to 74 per cent. The limb salvage rate at 36 months was 97 per cent for claudication and 89 per cent for threatened limbs with cuffed PTFE. Occlusion of cuffed PTFE was associated with preservation of outflow in 91 (51 per cent) of 179 cases, permitting subsequent graft thrombectomy or insertion of a new bypass. Spared vein was rarely used to salvage an occluded PTFE graft, and was associated with poor patency and a high amputation rate. Although this study does not support the use of PTFE for the primary graft, PTFE with a vein cuff interposed at the distal anastomosis is a reasonable substitute when vein is not available.

Adult↗
PubMed1995

Insulin sensitivity and antiandrogenic therapy in women with polycystic ovary syndrome.

Polycystic ovary (PCO) syndrome is strongly associated with insulin resistance and the accompanying adverse metabolic profile. To distinguish the mechanisms of this association, we determined the interactions of PCO with obesity and the influence of ameliorating direct androgenic actions via short-term treatment with the antiandrogen flutamide. Insulin sensitivity was determined by the hyperinsulinemic euglycemic clamp in groups of lean and obese PCO women and weight-matched controls. Compared with control values, insulin-mediated glucose utilization in PCO women was significantly lower in lean (1.96 +/- 0.17 v 1.24 +/- 0.10, P < .01) and obese (1.23 +/- 0.18 v 1.03 +/- 0.09 mmol/m2/min, P < .01) subjects. ANOVA indicated that the effects of obesity and androgenicity are independent and additive. In both lean and obese PCO women, treatment with flutamide for 1 or 3 months markedly improved the clinical and biochemical androgenic features, but did not significantly influence the overall insulin sensitivity. A large disparity between individuals in the response to treatment correlated significantly with a simultaneous reduction in plasma levels of dehydroepiandrosterone sulfate (DHEA-S). Thus in women, PCO and obesity exert synergistic effects on insulin resistance. The decreased insulin sensitivity is mediated via indirect androgenic actions or nonandrogenic mechanisms. In some individuals, a direct effect of androgens might have been masked by a decrease in DHEA-S levels.

Adolescent↗
PubMed1995

Cytogenetic study of 11 gastric adenocarcinomas.

We describe the cytogenetic findings in 11 gastric cancer cases. Nine cases showed a variable number of numerical and structural aberrations, while two cases had a normal karyotype. The chromosomes most frequently involved are chromosome 3 in six cases, 6 in four cases, and 13 in three cases. They mainly exhibited structural aberrations. An additional segment on chromosome 3p was observed in three cases, while two cases had a del(3q). A der(5) chromosome resulting from a translocation between chromosomes 3 and 5 was observed in two cases. Both cases had also a del(6q), a der(12), and an add(17p) chromosome as common abnormalities. Deletion of 6q chromosome distal to band 6q21 was observed in three cases. Trisomy 8 as a sole anomaly was found in one case. Our cytogenetic findings are discussed in relation to the reported in the literature data.

Adenocarcinoma↗
PubMed1995

The fate of the aortofemoral graft.

OBJECTIVE: To determine the incidence and cause for reoperation following aortofemoral bypass surgery. DESIGN: This paper describes the results of all aortofemoral grafts performed in the years 1978-1991, 251 of these patients underwent an aortobifemoral graft (ABF) whilst the remaining 50 had an aortounifemoral graft (AUF). RESULTS: The aortofemoral bypass was the only operation performed in fewer than half of the patients. Sixteen per cent of ABF and 50% of the AUF patients had surgery before the index operation. Subsequently 33% of the ABF patients and 60% of the AUF group had one or more additional vascular procedures. Graft infections and false aneurysms continued to present in about 1% patients per year at least up to 10 years following surgery. The 5 year actuarial survival was 73% in the ABF group and 38% in the AUF patients. The primary patency at 5 years was 85% in the ABF patients and 81% in the AUF group. Amputation was performed in 6% of the ABF patients and in 20% of the AUF patients. CONCLUSIONS: The frequent need for later surgery (1:3 for the ABF patients) should be considered in the decision to undertake the initial aortofemoral operation when the patient presents with intermittent claudication.

Aneurysm, False↗