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Magouliotis DE, Tatsios E, Giamouzis G, Samara AA, Xanthopoulos A, Briasoulis A, Skoularigis J, Athanasiou T, Bareka M, Kourek C, Zacharoulis D. Validation of Perioperative Troponin Levels for Predicting Postoperative Mortality and Long-Term Survival in Patients Undergoing Surgery for Hepatobiliary and Pancreatic Cancer. J Cardiovasc Dev Dis 2024; 11:130. [PMID: 38667748 PMCID: PMC11050037 DOI: 10.3390/jcdd11040130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/06/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Hepatopancreato and biliary (HPB) tumors represent some of the leading cancer-related causes of death worldwide, with the majority of patients undergoing surgery in the context of a multimodal treatment strategy. Consequently, the implementation of an accurate risk stratification tool is crucial to facilitate informed consent, along with clinical decision making, and to compare surgical outcomes among different healthcare providers for either service evaluation or clinical audit. Perioperative troponin levels have been proposed as a feasible and easy-to-use tool in order to evaluate the risk of postoperative myocardial injury and 30-day mortality. The purpose of the present study is to validate the perioperative troponin levels as a prognostic factor regarding postoperative myocardial injury and 30-day mortality in Greek adult patients undergoing HPB surgery. Method: In total, 195 patients undergoing surgery performed by a single surgical team in a single tertiary hospital (2020-2022) were included. Perioperative levels of troponin before surgery and at 24 and 48 h postoperatively were assessed. Model accuracy was assessed by observed-to-expected (O:E) ratios, and area under the receiver operating characteristic curve (AUC). Survival at one year postoperatively was compared between patients with high and normal TnT levels at 24 h postoperatively. Results: Thirteen patients (6.6%) died within 30 days of surgery. TnT levels at 24 h postoperatively were associated with excellent discrimination and provided the best-performing calibration. Patients with normal TnT levels at 24 h postoperatively were associated with higher long-term survival compared to those with high TnT levels. Conclusions: TnT at 24 h postoperatively is an efficient risk assessment tool that should be implemented in the perioperative pathway of patients undergoing surgery for HPB cancer.
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Affiliation(s)
- Dimitrios E. Magouliotis
- Unit of Quality Improvement, Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Evangelos Tatsios
- Department of Surgery, University of Thessaly, Biopolis, 41110 Larissa, Greece; (E.T.); (A.A.S.); (D.Z.)
| | - Grigorios Giamouzis
- Department of Cardiology, University of Thessaly, Biopolis, 41110 Larissa, Greece; (G.G.); (A.X.); (J.S.)
| | - Athina A. Samara
- Department of Surgery, University of Thessaly, Biopolis, 41110 Larissa, Greece; (E.T.); (A.A.S.); (D.Z.)
| | - Andrew Xanthopoulos
- Department of Cardiology, University of Thessaly, Biopolis, 41110 Larissa, Greece; (G.G.); (A.X.); (J.S.)
| | - Alexandros Briasoulis
- Department of Therapeutics, Faculty of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - John Skoularigis
- Department of Cardiology, University of Thessaly, Biopolis, 41110 Larissa, Greece; (G.G.); (A.X.); (J.S.)
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London W2 1NY, UK;
| | - Metaxia Bareka
- Department of Anesthesiology, University of Thessaly, Biopolis, 41110 Larissa, Greece;
| | - Christos Kourek
- Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), 11521 Athens, Greece;
| | - Dimitris Zacharoulis
- Department of Surgery, University of Thessaly, Biopolis, 41110 Larissa, Greece; (E.T.); (A.A.S.); (D.Z.)
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Christodoulidis G, Koumarelas KE, Kouliou MN, Samara M, Thodou E, Zacharoulis D. The Genomic Signatures of Linitis Plastica Signal the Entrance into a New Era: Novel Approaches for Diagnosis and Treatment. Int J Mol Sci 2023; 24:14680. [PMID: 37834127 PMCID: PMC10572839 DOI: 10.3390/ijms241914680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/20/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
Linitis Plastica (LP) is a rare and aggressive tumor with a distinctive development pattern, leading to the infiltration of the gastric wall, the thickening of the gastric folds and a "leather bottle appearance". LP is an extremely heterogeneous tumor caused by mutations in oncogenic and tumor suppressive genes, as well as molecular pathways, along with mutations in stromal cells and proteins related to tight junctions. Elucidating the molecular background of tumorigenesis and clarifying the correlation between cancerous cells and stromal cells are crucial steps toward discovering novel diagnostic methods, biomarkers and therapeutic targets/agents. Surgery plays a pivotal role in LP management, serving both as a palliative and curative procedure. In this comprehensive review, we aim to present all recent data on the molecular background of LP and the novel approaches to its management.
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Affiliation(s)
- Grigorios Christodoulidis
- Department of General Surgery, University Hospital of Larissa, University of Thessaly, Biopolis Campus, 41110 Larissa, Greece; (K.E.K.); (M.N.K.); (D.Z.)
| | - Konstantinos Eleftherios Koumarelas
- Department of General Surgery, University Hospital of Larissa, University of Thessaly, Biopolis Campus, 41110 Larissa, Greece; (K.E.K.); (M.N.K.); (D.Z.)
| | - Marina Nektaria Kouliou
- Department of General Surgery, University Hospital of Larissa, University of Thessaly, Biopolis Campus, 41110 Larissa, Greece; (K.E.K.); (M.N.K.); (D.Z.)
| | - Maria Samara
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis Campus, 41110 Larissa, Greece; (M.S.); (E.T.)
| | - Eleni Thodou
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis Campus, 41110 Larissa, Greece; (M.S.); (E.T.)
| | - Dimitris Zacharoulis
- Department of General Surgery, University Hospital of Larissa, University of Thessaly, Biopolis Campus, 41110 Larissa, Greece; (K.E.K.); (M.N.K.); (D.Z.)
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Vangelakou K, M. Pitsilka M, Magouliotis D, Zacharoulis D. New Energy Devices in the Treatment of Cystic Echinococcosis. Infect Dis (Lond) 2023. [DOI: 10.5772/intechopen.109372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Treatment of cystic echinococcosis of the liver still remains a debatable subject. The method of choice should aim for the total elimination of the parasite with minimum morbidity and mortality. Different approaches have been proposed. Medical treatment as a monotherapy has been abandoned due to the high chances of recurrence and is mostly used as an adjuvant to surgery or minimally invasive methods. Surgical methods are divided into conservative ones, which include cystectomy and partial pericystectomy, and radical ones, total pericystectomy and hepatectomy. Radical procedures are correlated with lower complication and recurrence rates and, therefore, should be attempted when indications are present. On the other hand, conservative surgery can be the first option in endemic areas, performed by non-specialized general surgeons. The development of laparoscopic techniques made their use a possible alternative approach in selected cases. The use of percutaneous treatments is also quite widespread due to their minimally invasive nature. New energy devices seem to play a significant role in the treatment of cystic echinococcosis, although more studies are needed to establish their efficacy. Observation without intervention is an option for inactive uncomplicated cysts.
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Liotiri D, Diamantis A, Papapetrou E, Grapsidi V, Sioka E, Stamatiou G, Zacharoulis D. External oblique intercostal (EOI) block for enhanced recovery after liver surgery: a case series. Anaesth Rep 2023; 11:e12225. [PMID: 37124666 PMCID: PMC10139870 DOI: 10.1002/anr3.12225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 05/02/2023] Open
Abstract
We report our clinical experience with the external oblique intercostal block in three consecutive adult patients who underwent liver surgery for resection of metastases. Enhanced recovery guidelines for liver surgery recommend intrathecal opioids and peripheral regional anaesthetic techniques in the context of multimodal analgesia to achieve adequate postoperative analgesia and early functional recovery. However, both laparoscopic and open approaches to liver surgery involve incisions in the upper abdomen, an anatomical area not well covered by previously described peripheral regional anaesthetic techniques. The external oblique intercostal block is a novel motor- and opioid-sparing technique which blocks both the anterior and lateral cutaneous branches of the thoracoabdominal nerves which innervate the upper abdominal quadrant. In all cases in this series, we performed the blocks in a short period of time and without complications. All patients remained pain- and opioid-free in the postoperative period and achieved enhanced recovery outcomes early. We found the external oblique intercostal block to be a simple, convenient, effective and opioid-sparing regional anaesthetic technique for postoperative analgesia after liver surgery. By minimising opioid use and by obviating the need for central neuraxial anaesthesia techniques in the postoperative period, this block could be incorporated into enhanced recovery protocols for hepatobiliary surgery.
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Affiliation(s)
- D. Liotiri
- Anaesthetic DepartmentIASO Thessalias General HospitalLarissaGreece
| | - A. Diamantis
- Department of SurgeryIASO Thessalias General HospitalLarissaGreece
| | - E. Papapetrou
- Accident & Emergency DepartmentLewisham and Greenwich NHS TrustLondonUK
| | - V. Grapsidi
- Department of SurgeryGeneral Hospital of TrikalaTrikalaGreece
| | - E. Sioka
- Department of SurgeryIASO Thessalias General HospitalLarissaGreece
| | - G. Stamatiou
- Anaesthetic DepartmentIASO Thessalias General HospitalLarissaGreece
| | - D. Zacharoulis
- Department of SurgeryUniversity of ThessalyLarissaGreece
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Magouliotis DE, Karamolegkou AP, Zotos PA, Tatsios E, Samara AA, Alexopoulou D, Koutsougianni F, Sakellaridis N, Zacharoulis D, Dimas K. Bioinformatic Analysis of the BCL-xL/BCL2L1 Interactome in Patients with Pancreatic Cancer. Medicina (Kaunas) 2022; 58:medicina58111663. [PMID: 36422202 PMCID: PMC9698957 DOI: 10.3390/medicina58111663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/07/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
Objectives: The aim of the present study was to analyze the differential gene expression of BCL-xL/BCL2L and the associated genetic, molecular, and biologic functions in pancreatic ductal adenocarcinoma (PDAC) by employing advanced bioinformatics to investigate potential candidate genes implicated in the pathogenesis of PDAC. Materials and Methods: Bioinformatic techniques were employed to build the gene network of BCL-xL, to assess the translational profile of BCL-xL in PDAC, assess its role in predicting PDAC, and investigate the associated biologic functions and the regulating miRNA families. Results: Microarray data extracted from one dataset was incorporated, including 130 samples (PDAC: 69; Control: 61). In addition, the expression level of BCL-xL was higher in PDAC compared to control samples (p < 0.001). Furthermore, BCL-xL demonstrated excellent discrimination (AUC: 0.83 [95% Confidence Intervals: 0.76, 0.90]; p < 0.001) and calibration (R squared: 0.31) traits for PDAC. A gene set enrichment analysis (GSEA) demonstrated the molecular functions and miRNA families (hsa-miR-4804-5p, hsa-miR-4776-5p, hsa-miR-6770-3p, hsa-miR-3619-3p, and hsa-miR-7152-3p) related to BCL-xL. Conclusions: The current findings unveil the biological implications of BCL-xL in PDAC and the related molecular functions and miRNA families.
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Affiliation(s)
| | | | - Prokopis-Andreas Zotos
- Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41500 Larissa, Greece
| | - Evangelos Tatsios
- Department of Surgery, University of Thessaly, Biopolis, 41500 Larissa, Greece
| | - Athina A. Samara
- Department of Surgery, University of Thessaly, Biopolis, 41500 Larissa, Greece
| | - Dimitra Alexopoulou
- Department of Pharmacology, University of Thessaly, Biopolis, 41500 Larissa, Greece
| | - Fani Koutsougianni
- Department of Pharmacology, University of Thessaly, Biopolis, 41500 Larissa, Greece
| | - Nikos Sakellaridis
- Department of Pharmacology, University of Thessaly, Biopolis, 41500 Larissa, Greece
| | | | - Konstantinos Dimas
- Department of Pharmacology, University of Thessaly, Biopolis, 41500 Larissa, Greece
- Correspondence: ; Tel.: +30-2413502803
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Balakrishnan A, Jah A, Lesurtel M, Andersson B, Gibbs P, Harper SJF, Huguet EL, Kosmoliaptsis V, Liau SS, Praseedom RK, Ramia JM, Branes A, Lendoire J, Maithel S, Serrablo A, Achalandabaso M, Adham M, Ahmet A, Al-Sarireh B, Albiol Quer M, Alconchel F, Alejandro R, Alsammani M, Alseidi A, Anand A, Anselmo A, Antonakis P, Arabadzhieva E, de Aretxabala X, Aroori S, Ashley S, Ausania F, Banerjee A, Barabino M, Bartlett A, Bartsch F, Belli A, Beristain-Hernandez J, Berrevoet F, Bhatti A, Bhojwani R, Bjornsson B, Blaz T, Byrne M, Calvo M, Castellanos J, Castro M, Cavallucci D, Chang D, Christodoulis G, Ciacio O, Clavien P, Coker A, Conde-Rodriguez M, D'Amico F, D'Hondt M, Daams F, Dasari B, De Beillis M, de Meijer V, Dede K, Deiro G, Delgado F, Desai G, Di Gioia A, Di Martino M, Dixon M, Dorovinis P, Dumitrascu T, Ebata T, Eilard M, Erdmann J, Erkan M, Famularo S, Felli E, Fergadi M, Fernandez G, Fox A, Galodha S, Galun D, Ganandha S, Garcia R, Gemenetzis G, Giannone F, Gil L, Giorgakis E, Giovinazzo F, Giuffrida M, Giuliani T, Giuliante F, Gkekas I, Goel M, Goh B, Gomes A, Gruenberger T, Guevara O, Gulla A, Gupta A, Gupta R, Hakeem A, Hamid H, Heinrich S, Helton S, Heumann A, Higuchi R, Hughes D, Inarejos B, Ivanecz A, Iwao Y, Iype S, Jaen I, Jie M, Jones R, Kacirek K, Kalayarasan R, Kaldarov A, Kaman L, Kanhere H, Kapoor V, Karanicolas P, Karayiannakis A, Kausar A, Khan Z, Kim DS, Klose J, Knowles B, Koh P, Kolodziejczyk P, Komorowski A, Koong J, Kozyrin I, Krishna A, Kron P, Kumar N, van Laarhoven S, Lakhey P, Lanari J, Laurenzi A, Leow V, Limbu Y, Liu YB, Lob S, Lolis E, Lopez-Lopez V, Lozano R, Lundgren L, Machairas M, Magouliotis D, Mahamid A, Malde D, Malek A, Malik H, Malleo G, Marino M, Mayo S, Mazzola M, Memeo R, Menon K, Menzulin R, Mohan R, Morgul H, Moris D, Mulita F, Muttillo E, Nahm C, Nandasena M, Nashidengo P, Nickkholgh A, Nikov A, Noel C, O'Reilly D, O'Rourke T, Ohtsuka M, Omoshoro-Jones J, Pandanaboyana S, Pararas N, Patel R, Patkar S, Peng J, Perfecto A, Perinel J, Perivoliotis K, Perra T, Phan M, Piccolo G, Porcu A, Primavesi F, Primrose J, Pueyo-Periz E, Radenkovic D, Rammohan A, Rowcroft A, Sakata J, Saladino E, Schena C, Scholer A, Schwarz C, Serrano P, Silva M, Soreide K, Sparrelid E, Stattner S, Sturesson C, Sugiura T, Sumo M, Sutcliffe R, Teh C, Teo J, Tepetes K, Thapa P, Thepbunchonchai A, Torres J, Torres O, Torzili G, Tovikkai C, Troncoso A, Tsoulfas G, Tuzuher A, Tzimas G, Umar G, Urbani L, Vanagas T, Varga, Velayutham V, Vigano L, Wakai T, Yang Z, Yip V, Zacharoulis D, Zakharov E, Zimmitti G. Heterogeneity of management practices surrounding operable gallbladder cancer - results of the OMEGA-S international HPB surgical survey. HPB (Oxford) 2022; 24:2006-2012. [PMID: 35922277 DOI: 10.1016/j.hpb.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gallbladder cancer (GBC) is an aggressive, uncommon malignancy, with variation in operative approaches adopted across centres and few large-scale studies to guide practice. We aimed to identify the extent of heterogeneity in GBC internationally to better inform the need for future multicentre studies. METHODS A 34-question online survey was disseminated to members of the European-African Hepatopancreatobiliary Association (EAHPBA), American Hepatopancreatobiliary Association (AHPBA) and Asia-Pacific Hepatopancreatobiliary Association (A-PHPBA) regarding practices around diagnostic workup, operative approach, utilization of neoadjuvant and adjuvant therapies and surveillance strategies. RESULTS Two hundred and three surgeons responded from 51 countries. High liver resection volume units (>50 resections/year) organised HPB multidisciplinary team discussion of GBCs more commonly than those with low volumes (p < 0.0001). Management practices exhibited areas of heterogeneity, particularly around operative extent. Contrary to consensus guidelines, anatomical liver resections were favoured over non-anatomical resections for T3 tumours and above, lymphadenectomy extent was lower than recommended, and a minority of respondents still routinely excised the common bile duct or port sites. CONCLUSION Our findings suggest some similarities in the management of GBC internationally, but also specific areas of practice which differed from published guidelines. Transcontinental collaborative studies on GBC are necessary to establish evidence-based practice to minimise variation and optimise outcomes.
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Affiliation(s)
- Anita Balakrishnan
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
| | - Asif Jah
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Mickael Lesurtel
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University of Paris Cité, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Bodil Andersson
- Department of Surgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Paul Gibbs
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Simon J F Harper
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Emmanuel L Huguet
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Vasilis Kosmoliaptsis
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Siong S Liau
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Raaj K Praseedom
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Jose M Ramia
- Department of Surgery, Hospital General Universitario de Alicante, Avenida Pintor Baeza, 12 03010 Alicante, Spain
| | - Alejandro Branes
- Department of HPB Surgery, Hospital Sotero del Rio, Av. Concha y Toro 3459, Puente Alto, Región Metropolitana, Chile
| | - Javier Lendoire
- Department of Surgery, University of Buenos Aires, Hospital Dr Cosme Argerich, Buenos Aires, Argentina
| | - Shishir Maithel
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, 30322 USA
| | - Alejandro Serrablo
- Department of HPB Surgery, Miguel Servet University Hospital, Zaragoza, Spain
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Manuel-Vázquez A, Balakrishnan A, Agami P, Andersson B, Berrevoet F, Besselink MG, Boggi U, Caputo D, Carabias A, Carrion-Alvarez L, Franco CC, Coppola A, Dasari BVM, Diaz-Mercedes S, Feretis M, Fondevila C, Fusai GK, Garcea G, Gonzabay V, Bravo MÁG, Gorris M, Hendrikx B, Hidalgo-Salinas C, Kadam P, Karavias D, Kauffmann E, Kourdouli A, La Vaccara V, van Laarhoven S, Leighton J, Liem MSL, Machairas N, Magouliotis D, Mahmoud A, Marino MV, Massani M, Requena PM, Mentor K, Napoli N, Nijhuis JHT, Nikov A, Nistri C, Nunes V, Ruiz EO, Pandanaboyana S, Saborido BP, Pohnán R, Popa M, Pérez BS, Bueno FS, Serrablo A, Serradilla-Martín M, Skipworth JRA, Soreide K, Symeonidis D, Zacharoulis D, Zelga P, Aliseda D, Santiago MJC, Mancilla CF, Fragua RL, Hughes DL, Llorente CP, Lesurtel M, Gallagher T, Ramia JM. A scoring system for predicting malignancy in intraductal papillary mucinous neoplasms of the pancreas: a multicenter EUROPEAN validation. Langenbecks Arch Surg 2022; 407:3447-3455. [PMID: 36198881 DOI: 10.1007/s00423-022-02687-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 09/14/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE A preoperative estimate of the risk of malignancy for intraductal papillary mucinous neoplasms (IPMN) is important. The present study carries out an external validation of the Shin score in a European multicenter cohort. METHODS An observational multicenter European study from 2010 to 2015. All consecutive patients undergoing surgery for IPMN at 35 hospitals with histological-confirmed IPMN were included. RESULTS A total of 567 patients were included. The score was significantly associated with the presence of malignancy (p < 0.001). In all, 64% of the patients with benign IPMN had a Shin score < 3 and 57% of those with a diagnosis of malignancy had a score ≥ 3. The relative risk (RR) with a Shin score of 3 was 1.37 (95% CI: 1.07-1.77), with a sensitivity of 57.1% and specificity of 64.4%. CONCLUSION Patients with a Shin score ≤ 1 should undergo surveillance, while patients with a score ≥ 4 should undergo surgery. Treatment of patients with Shin scores of 2 or 3 should be individualized because these scores cannot accurately predict malignancy of IPMNs. This score should not be the only criterion and should be applied in accordance with agreed clinical guidelines.
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Affiliation(s)
- Alba Manuel-Vázquez
- Department of General and Digestive Surgery, Hospital Universitario de Getafe, Carretera de Toledo, Km 12, 500, 28905, Madrid, Spain.
| | - Anita Balakrishnan
- Department of Hepatopancreatobiliary Surgery, Addenbrooke's Hospital, and Department of Surgery, University of Cambridge, Cambridge, UK
| | - Paul Agami
- Moscow Clinical Scientific Center, Moscow, Russia
| | - Bodil Andersson
- Department of Clinical Sciences Lund, Surgery, Lund University and Skåne University Hospital, Lund, Sweden
| | - Frederik Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium
| | | | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Damiano Caputo
- General Surgery Department, Medico University of Rome, Campus Bio, Rome, Italy
| | - Alberto Carabias
- Department of General and Digestive Surgery, Hospital Universitario de Getafe, Carretera de Toledo, Km 12, 500, 28905, Madrid, Spain
| | | | - Carmen Cepeda Franco
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Team, Virgen del Rocio University Hospital, Seville, Spain
| | - Alessandro Coppola
- General Surgery Department, Medico University of Rome, Campus Bio, Rome, Italy
| | | | - Sherley Diaz-Mercedes
- Department of Pathology, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Michail Feretis
- Department of Hepatopancreatobiliary Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - Constantino Fondevila
- Department of General and Digestive Surgery, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, CIBERehd, Spain
| | - Giuseppe Kito Fusai
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Giuseppe Garcea
- Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
| | - Victor Gonzabay
- Department of General and Digestive Surgery, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, CIBERehd, Spain
| | - Miguel Ángel Gómez Bravo
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Team, Virgen del Rocio University Hospital, Seville, Spain
| | - Myrte Gorris
- Academic Medical Center, Amsterdam, The Netherlands
| | - Bart Hendrikx
- Department of General and HPB Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium
| | - Camila Hidalgo-Salinas
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK
| | | | - Dimitrios Karavias
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Emanuele Kauffmann
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Amar Kourdouli
- Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
| | - Vincenzo La Vaccara
- General Surgery Department, Medico University of Rome, Campus Bio, Rome, Italy
| | - Stijn van Laarhoven
- Department of HPB Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Mike S L Liem
- Division of HPB Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Nikolaos Machairas
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK
| | | | - Adel Mahmoud
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Marco V Marino
- Azienda Ospedaliera, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Marco Massani
- Department of Surgery, Regional Hospital "Ca Foncello"Azienda ULSS2 Marca Trevigiana, Treviso, Italy
| | | | | | - Niccolò Napoli
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Jorieke H T Nijhuis
- Division of HPB Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Andrej Nikov
- Department of Surgery, Military University Hospital Prague, Prague, Czech Republic
| | - Cristina Nistri
- Department of Surgery, Regional Hospital "Ca Foncello"Azienda ULSS2 Marca Trevigiana, Treviso, Italy
| | - Victor Nunes
- HPB Surgery, Hospital Prof Dr Fernando Fonseca, Amadora, Portugal
| | - Eduardo Ortiz Ruiz
- Department of Pathology, Hospital Clínico Universitario Virgen de La Arrixaca, Murcia, Spain
| | | | - Baltasar Pérez Saborido
- Department of General and Digestive Surgery, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Radek Pohnán
- Department of Surgery, Military University Hospital Prague, Prague, Czech Republic
| | - Mariuca Popa
- Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
| | | | | | - Alejandro Serrablo
- Department of Surgery, Miguel Servet University Hospital, Saragossa, Spain
| | | | - James R A Skipworth
- Department of HPB Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | | | | | - Piotr Zelga
- Department of Hepatopancreatobiliary Surgery, Addenbrooke's Hospital, Cambridge, UK
| | | | | | | | | | - Daniel Llwyd Hughes
- Department of HPB Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | | | - Mickaël Lesurtel
- Department of Digestive Surgery and Liver Transplantation, Croix Rousse University Hospital, University of Lyon I, Hospices Civils de Lyon, Lyon, France
| | - Tom Gallagher
- Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland
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Magouliotis DE, Zacharoulis D. Radiomics Represent a New Opportunity for Bariatric Surgery When Implemented in a Quality Improvement Context. Obes Surg 2022; 32:3179-3180. [PMID: 35717491 DOI: 10.1007/s11695-022-06160-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 11/26/2022]
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Magouliotis DE, Zotos PA, Zacharoulis D. Implementation of Routine Computed Tomography (CT) Following Laparoscopic Sleeve Gastrectomy: New Evidence Brings New Challenges. Obes Surg 2022; 32:2477-2478. [DOI: 10.1007/s11695-022-06098-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 12/30/2022]
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Magouliotis DE, Lafazanis K, Koutsougianni F, Sakellaridis N, Ioannou M, Zacharoulis D, Dimas K. Establishment of Patient-derived Orthotopic Xenografts (PDX) as Models for Pancreatic Ductal Adenocarcinoma. In Vivo 2022; 36:1114-1119. [PMID: 35478141 PMCID: PMC9087066 DOI: 10.21873/invivo.12809] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Pancreatic cancer (PC) is one of the leading causes of cancer-related death. The purpose of the present study was to establish a patient-derived orthotopic xenograft model (PDOX) for pancreatic ductal adenocarcinoma (PDAC), thus providing a tumor microenvironment resembling that of the human pancreas to identify novel potential biomarkers and treatment regimens. MATERIALS AND METHODS PDAC tissue samples were received from 35 patients, following informed consent, and three mouse strains were implemented. RESULTS Successful PDOX engraftment was performed in nonobese diabetic/severe combined immunodeficient (NOD/SCID) and NOD/SCID gamma (NSG) mice. Nonetheless, we found a higher rate of successful engraftment and tumor growth in NSG compared to NOD/SCID mice, possibly owning to the different level of immunosuppression and more specifically of the natural killer cells presence. CONCLUSION Our suggested PDOX model represents a preclinical cancer research model with a high affinity for the patient's tumor microenvironment, thus enabling the acceleration of PDAC research.
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Affiliation(s)
| | - Kostas Lafazanis
- Department of Pharmacology, University of Thessaly, Biopolis, Larissa, Greece
| | - Fani Koutsougianni
- Department of Pharmacology, University of Thessaly, Biopolis, Larissa, Greece
| | - Nikos Sakellaridis
- Department of Pharmacology, University of Thessaly, Biopolis, Larissa, Greece
| | - Maria Ioannou
- Department of Pathology, University of Thessaly, Biopolis, Larissa, Greece
| | | | - Konstantinos Dimas
- Department of Pharmacology, University of Thessaly, Biopolis, Larissa, Greece;
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11
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Drabble E, Spanopoulou S, Sioka E, Politaki E, Paraskeva I, Palla E, Stockley L, Zacharoulis D. How to tie dangerous surgical knots: easily. Can we avoid this? BMJ Surg Interv Health Technol 2022; 3:e000091. [PMID: 35047808 PMCID: PMC8749257 DOI: 10.1136/bmjsit-2021-000091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/23/2021] [Indexed: 11/04/2022] Open
Abstract
Objective Secure knots are essential in all areas of surgical, medical and veterinary practice. Our hypothesis was that technique of formation of each layer of a surgical knot was important to its security. Design Equal numbers of knots were tied, by each of three groups, using three techniques, for each of four suture materials; a standard flat reef knot (FRK), knots tied under tension (TK) and knots laid without appropriate hand crossing (NHCK). Each knot technique was performed reproducibly, and tested by distraction with increasing force, till each material broke or the knot separated completely. Setting Temporary knot tying laboratory. Materials The suture materials were, 2/0 polyglactin 910 (Vicryl), 3/0 polydioxanone, 4/0 poliglecaprone 25 (Monocryl) and 1 nylon (Ethilon). Participants Three groups comprised, a senior surgeon, a resident surgeon and three medical students. Outcome measures Proportion of each knot type that slipped, degree of slippage and length of suture held in loop secured by each knot type. Results 20% of FRK tied with all suture materials slipped; all knots tied with the other two techniques, with all materials, slipped, TK (100%) and NHCK (100%). The quantitative degree of slip was significantly less for FRK (mean 6.3%–, 95% CI 2.2% to 10.4%) than for TK (mean 312%, 95% CI 280.0% to 344.0%) and NHCK (mean 113.0%, –95% CI 94.3% to 131.0%). The mean length of suture in loops held within (FRK mean 25.1 mm 95% CI 24.2 to 26.0 mm) was significantly greater than mean lengths held by the other techniques (TK mean 17.0 mm, 95% CI 16.3 to 17.7 mm), (NHCK mean 16.3 mm, 95% CI 15.9 to 16.7 mm). The latter two types of knot may have tightened more than anticipated, in comparison to FRK, with potential undue tissue tension. Conclusion Meticulous technique of knot tying is essential for secure knots, appropriate tissue tension and the security of anastomoses and haemostasis effected.
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Affiliation(s)
- Eric Drabble
- Clinical lead BSS course RCS England, Consultant Surgeon (retired), University ofPlymouth Hospitals NHS Trust, Plymouth, UK.,Royal College of Surgeons of England, London, London, UK.,Surgical Directorate, University of Plymouth Hospitals NHS Trust, Derriford Hospital, PlymouthPL6, Greece
| | - Sofia Spanopoulou
- Department of Plastic Surgery, Hopital Universitaire Henri Mondor, Paris, France
| | - Eleni Sioka
- Department of Surgery, IASO Hospital Thessalias, Larissa, Greece
| | - Ellie Politaki
- Surgical clinic B, General Hospital Georgios Gennimatas, Athens, Greece
| | - Ismini Paraskeva
- Department of General Surgery, University Hospital of Larissa, Mezourlo, Greece
| | - Effrosyni Palla
- Department of Otorhinolaryngology, University Hospital of Larissa, Mezourlo, Greece
| | - Lauren Stockley
- Department of Statistical Analysis, University of Plymouth, Plymouth, Devon, UK
| | - Dimitris Zacharoulis
- Department of Surgery, IASO Hospital Thessalias, Larissa, Greece.,Department of General Surgery, University Hospital of Larissa, Mezourlo, Greece
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12
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Fergadi MP, Magouliotis DE, Rountas C, Vlychou M, Athanasiou T, Symeonidis D, Pappa PA, Zacharoulis D. A meta-analysis evaluating the role of high-intensity focused ultrasound (HIFU) as a fourth treatment modality for patients with locally advanced pancreatic cancer. Abdom Radiol (NY) 2022; 47:254-264. [PMID: 34718835 DOI: 10.1007/s00261-021-03334-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study aimed to evaluate the outcomes of high-intensity focused ultrasound (HIFU) on patients with advanced pancreatic cancer. METHODS A literature search was performed in PubMed, Scopus and Cochrane databases, in accordance with the PRISMA guidelines. The Odds Ratio, Weighted Mean Difference, and 95% Confidence Interval were evaluated by means of the Random-Effects model. RESULTS Nineteen articles met the inclusion criteria, incorporating 939 patients. This study reveals that patients in the HIFU group presented increased median overall survival (OS), along with higher OS at 6 and 12 months after treatment compared with the control group (p < 0.05). Furthermore, patients treated with HIFU in conjunction with chemotherapy presented reduced levels of pain (p < 0.05) compared to the traditional treatment group. In addition, HIFU contributed to significant tumor responsiveness, in terms of CA19-9 reduction (p < 0.05). Finally, HIFU was a considerably safe treatment modality with a low incidence of complications. CONCLUSION These outcomes suggest that HIFU is a feasible and safe treatment modality for patients with advanced pancreatic cancer and provides enhanced outcomes regarding survival and quality of life. Given the lack of a significant number of randomized clinical trials, this meta-analysis represents the best currently available evidence. New randomized trials assessing HIFU are necessary to further evaluate their outcomes.
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Affiliation(s)
- Maria P Fergadi
- Department of Radiology, University of Thessaly, 41110, Biopolis, Larissa, Greece
| | - Dimitrios E Magouliotis
- Department of Radiology, University of Thessaly, 41110, Biopolis, Larissa, Greece
- Division of Surgery and Interventional Sciences, UCL, London, UK
| | - Christos Rountas
- Department of Radiology, University of Thessaly, 41110, Biopolis, Larissa, Greece
| | - Marianna Vlychou
- Department of Radiology, University of Thessaly, 41110, Biopolis, Larissa, Greece
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, W2 1NY, UK
| | - Dimitris Symeonidis
- Department of Surgery, University of Thessaly, 41110, Biopolis, Larissa, Greece
| | - Polyxeni A Pappa
- Department of Radiology, University of Thessaly, 41110, Biopolis, Larissa, Greece
| | - Dimitris Zacharoulis
- Department of Surgery, University of Thessaly, 41110, Biopolis, Larissa, Greece.
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13
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Christodoulidis G, Magouliotis D, Samara A, Floros T, Zotos PA, Tolia M, Zacharoulis D. The surgical challenge of oligometastatic pancreatic cancer: A systemic review of the literature. J BUON 2021; 26:1742-1746. [PMID: 34761577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE We aim to review the available literature on surgical management of oligometastatic pancreatic ductal adenocarcinoma (PDAC), in order to assess the clinical outcomes and intraoperative parameters of the different strategies. METHODS A systematic literature search was performed in PubMed database, in accordance with the PRISMA guidelines. Nine studies met the inclusion criteria incorporating 401 patients. RESULTS Perioperative mortality was as low as 0%, regarding resection of pancreatic cancer combined with synchronous metastasectomy. CONCLUSIONS Currently, postoperative overall survival and progression-free survival have increased compared to previous trials. Nevertheless, the lack of precise operative indications delays the enhancement of survival rates. Well-designed, randomized controlled studies, assessing pancreatic surgery combined with metastasectomy, are necessary to further assess their clinical outcomes.
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14
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Samara AA, Sgantzou IK, Diamantis A, Kokkalis A, Tsapakidis K, Tolia M, Christodoulidis G, Rountas C, Zacharoulis D. Metastatic rectal cancer in the ampulla of Vater: A unique case. Cancer Rep (Hoboken) 2021; 5:e1510. [PMID: 34272839 PMCID: PMC9124495 DOI: 10.1002/cnr2.1510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/18/2021] [Accepted: 06/14/2021] [Indexed: 12/13/2022] Open
Abstract
Background A metastatic lesion located in the ampulla of Vater is considered extremely rare, with only 32 cases reported globally. Case A 65‐year‐old patient was primarily diagnosed with a rectal adenocarcinoma. Twenty‐four months later as part of the oncological follow‐up, the patient was diagnosed with a single secondary tumor in the ampulla of Vater. After undergoing a pancreaticoduodenectomy (Whipple procedure), the patient experienced an uneventful recovery and received adjuvant chemotherapy. Sixteen months later the patient remained disease‐free. Conclusion To the best of our knowledge, the present case represents the first reported metastatic tumor in the ampulla of Vater, originating from a rectal adenocarcinoma. This case underlines the critical role of immunohistochemistry in arriving at a correct diagnosis in order to guide clinical decision‐making.
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Affiliation(s)
- Athina A Samara
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | | | | | | | | | - Maria Tolia
- Department of Radiotherapy, University of Crete, Heraklion, Greece
| | | | - Christos Rountas
- Department of Radiology, University Hospital of Larissa, Larissa, Greece
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15
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Magouliotis D, Fergadi M, Koukousaki D, Symeonidis D, Diamantis A, Tatsios E, Christodoulidis G, Zacharoulis D. Differences in surgical oncology practice in Greece and Cyprus between the first and second COVID-19 pandemic waves: Lessons from a paradigm shift. J BUON 2021; 26:1679-1682. [PMID: 34565036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The SARS-CoV-2 (COVID-19) pandemic has led to the implementation of certain restrictions and rearrangements regarding the surgical oncology operations, thus affecting the surgical lists, the availability of surgical time, along with the consultations of oncologic patients. The purpose of the present study was to identify the differences in surgical oncology practices in Greece and Cyprus between the first and second pandemic waves. We designed a questionnaire for surgeons treating surgical oncology patients. A total of 104 surgeons participated in the present study by answering our questionnaire. According to our outcomes, there was a significant shift between the two waves in patients' willingness to undergo surgery and to present to consultations. Nonetheless, the availability of surgical services remained limited. The consequent mismatch in patients' needs and the availability of healthcare services, we demonstrate herein, is alarming and should be taken into consideration by the policymakers.
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Affiliation(s)
- Dimitrios Magouliotis
- Division of Surgery and Interventional Sciences, UCL, London; Department of Surgery, University of Thessaly, Biopolis, 41110, Larissa, Greece
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16
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Magouliotis DE, Tzovaras G, Tasiopoulou VS, Christodoulidis G, Zacharoulis D. Closure of Mesenteric Defects in Laparoscopic Gastric Bypass: a Meta-Analysis. Obes Surg 2021; 30:1935-1943. [PMID: 31955371 DOI: 10.1007/s11695-020-04418-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The purpose of the current study was to review the available literature on morbidly obese patients treated with laparoscopic Roux-en-Y gastric bypass (LRYGB) in order to assess the clinical outcomes of the routine closure of the mesenteric defects. METHODS A literature search was performed in PubMed, Cochrane library, and Scopus, in accordance with the PRISMA guidelines. RESULTS Nine studies met the inclusion criteria. A total of 16,520 patients were incorporated with a mean follow-up ranging from 34 to 120 months. The closure of the mesenteric defects was associated with a lower incidence of internal hernias (odds ratio, 0.25 [95% confidence interval 0.20, 0.31]; p < 0.01), small bowel obstruction (SBO) (0.30 [0.17, 0.52]; p < 0.0001) and reoperations (0.28 [0.15, 0.52]; p < 0.001). Both approaches presented similar complication rates and % excess weight loss (%EWL). CONCLUSION The present meta-analysis is the best currently available evidence on the topic and supports the routine closure of the mesenteric defects.
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Affiliation(s)
- Dimitrios E Magouliotis
- Department of Surgery and Interventional Sciences, UCL, London, UK.,Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - George Tzovaras
- Department of Surgery, University of Thessaly, Biopolis, 41110, Larissa, Greece
| | | | | | - Dimitris Zacharoulis
- Department of Surgery, University of Thessaly, Biopolis, 41110, Larissa, Greece.
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17
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Magouliotis DE, Fergadi MP, Zacharoulis D. Comment on: Randomized clinical trial on closure versus non-closure of mesenteric defects during laparoscopic gastric bypass surgery. Br J Surg 2021; 108:e254. [PMID: 33729444 DOI: 10.1093/bjs/znab100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/23/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Dimitrios E Magouliotis
- Division of Surgery and Interventional Sciences, UCL, London.,Department of Surgery, University of Thessaly, Biopolis, Larissa, Greece
| | - Maria P Fergadi
- Department of Radiology, University of Thessaly, Biopolis, Larissa, Greece
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18
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Magouliotis DE, Fergadi MP, Zacharoulis D. The Significant Hormonal Traits of Laparoscopic Sleeve Gastrectomy Are Further Supported Using Three-Dimensional MDCT Gastrography. Obes Surg 2021; 31:2291-2292. [PMID: 33393000 DOI: 10.1007/s11695-020-05140-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/08/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Dimitrios E Magouliotis
- Division of Surgery and Interventional Sciences, UCL, London, UK.,Department of Surgery, University of Thessaly, Biopolis, 41110, Larissa, Greece
| | - Maria P Fergadi
- Department of Radiology, University of Thessaly, Biopolis, 41110, Larissa, Greece
| | - Dimitris Zacharoulis
- Department of Surgery, University of Thessaly, Biopolis, 41110, Larissa, Greece.
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19
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Samara AA, Diamantis A, Perivoliotis K, Mavrovounis G, Symeonidis D, Baloyiannis I, Zacharoulis D. Surgical versus non-operative initial management of post-endoscopic retrograde cholangiopancreatography perforation: a systematic review and meta-analysis. Ann Gastroenterol 2021; 35:95-101. [PMID: 34987295 PMCID: PMC8713336 DOI: 10.20524/aog.2021.0671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/20/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Athina A. Samara
- Department of Surgery, University Hospital of Larissa, Greece
- Correspondence to: Athina A. Samara, Department of Surgery, University Hospital of Larissa, Greece, 41110, Mezourlo Hill, Greece, e-mail:
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20
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Magouliotis DE, Sakellaridis N, Dimas K, Tasiopoulou VS, Svokos KA, Svokos AA, Zacharoulis D. In Silico Transcriptomic Analysis of the Chloride Intracellular Channels (CLIC) Interactome Identifies a Molecular Panel of Seven Prognostic Markers in Patients with Pancreatic Ductal Adenocarcinoma. Curr Genomics 2020; 21:119-127. [PMID: 32655306 PMCID: PMC7324877 DOI: 10.2174/1389202921666200316115631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/12/2020] [Accepted: 02/29/2020] [Indexed: 11/27/2022] Open
Abstract
Background Pancreatic ductal adenocarcinoma (PDAC) is associated with poor prognosis. In this context, the identification of biomarkers regarding the PDAC diagnosis, monitoring, and prognosis is crucial. Objectives The purpose of the current study was to investigate the differential gene expression profile of the chloride intracellular channel (CLIC) gene family network in patients with PDAC, in order to suggest novel biomarkers. Methods In silico techniques were used to construct the interactome of the CLIC gene family, identify the differentially expressed genes (DEGs) in PDAC as compared to healthy controls, and evaluate their potential prognostic role. Results Transcriptomic data of three microarray datasets were included, incorporating 114 tumor and 59 normal pancreatic samples. Twenty DEGs were identified; eight were up-regulated and twelve were downregulated. A molecular signature of seven genes (Chloride Intracellular Channel 1 – CLIC1; Chloride Intracellular Channel 3 – CLIC3; Chloride Intracellular Channel 4 – CLIC4; Ganglioside Induced Differentiation Associated Protein 1 – GDAP1; Ganglioside Induced Differentiation Associated Protein 1 Like 1 – GDAP1L1; Glutathione S-Transferase Pi 1 - GSTP1; Prostaglandin E Synthase 2 – PTGES2) were identified as prognostic markers associated with overall survival. Positive correlations were reported regarding the expression of CLIC1-CLIC3, CLIC4-CLIC5, and CLIC5-CLIC6. Finally, gene set enrichment analysis demonstrated the molecular functions and miRNA families (hsa‐miR‐122, hsa‐miR‐618, hsa‐miR‐425, and hsa‐miR‐518) relevant to the seven prognostic markers. Conclusion These outcomes demonstrate a seven-gene molecular panel that predicts the patients’ prospective survival following pancreatic resection for PDAC.
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Affiliation(s)
- Dimitrios E Magouliotis
- 1Division of Surgery and Interventional Science, Faculty of Medical Sciences, UCL, London, UK and Department of Surgery, University of Thessaly, Biopolis, Larissa, Greece; 2Department of Pharmacology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; 3Department of Pharmacology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; 4Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; 5The Warren Alpert Medical School of Brown University, Providence, RI, USA; 6Geisinger Medical Center, Danville, PA, USA; 7Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - Nikos Sakellaridis
- 1Division of Surgery and Interventional Science, Faculty of Medical Sciences, UCL, London, UK and Department of Surgery, University of Thessaly, Biopolis, Larissa, Greece; 2Department of Pharmacology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; 3Department of Pharmacology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; 4Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; 5The Warren Alpert Medical School of Brown University, Providence, RI, USA; 6Geisinger Medical Center, Danville, PA, USA; 7Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - Konstantinos Dimas
- 1Division of Surgery and Interventional Science, Faculty of Medical Sciences, UCL, London, UK and Department of Surgery, University of Thessaly, Biopolis, Larissa, Greece; 2Department of Pharmacology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; 3Department of Pharmacology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; 4Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; 5The Warren Alpert Medical School of Brown University, Providence, RI, USA; 6Geisinger Medical Center, Danville, PA, USA; 7Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - Vasiliki S Tasiopoulou
- 1Division of Surgery and Interventional Science, Faculty of Medical Sciences, UCL, London, UK and Department of Surgery, University of Thessaly, Biopolis, Larissa, Greece; 2Department of Pharmacology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; 3Department of Pharmacology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; 4Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; 5The Warren Alpert Medical School of Brown University, Providence, RI, USA; 6Geisinger Medical Center, Danville, PA, USA; 7Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - Konstantina A Svokos
- 1Division of Surgery and Interventional Science, Faculty of Medical Sciences, UCL, London, UK and Department of Surgery, University of Thessaly, Biopolis, Larissa, Greece; 2Department of Pharmacology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; 3Department of Pharmacology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; 4Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; 5The Warren Alpert Medical School of Brown University, Providence, RI, USA; 6Geisinger Medical Center, Danville, PA, USA; 7Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - Alexis A Svokos
- 1Division of Surgery and Interventional Science, Faculty of Medical Sciences, UCL, London, UK and Department of Surgery, University of Thessaly, Biopolis, Larissa, Greece; 2Department of Pharmacology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; 3Department of Pharmacology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; 4Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; 5The Warren Alpert Medical School of Brown University, Providence, RI, USA; 6Geisinger Medical Center, Danville, PA, USA; 7Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - Dimitris Zacharoulis
- 1Division of Surgery and Interventional Science, Faculty of Medical Sciences, UCL, London, UK and Department of Surgery, University of Thessaly, Biopolis, Larissa, Greece; 2Department of Pharmacology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; 3Department of Pharmacology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; 4Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; 5The Warren Alpert Medical School of Brown University, Providence, RI, USA; 6Geisinger Medical Center, Danville, PA, USA; 7Department of Surgery, University Hospital of Larissa, Larissa, Greece
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Magouliotis DE, Christodoulidis G, Zacharoulis D. Letter to the Editor Concerning: Clinical Outcomes of Sleeve Gastrectomy Versus Roux-En-Y Gastric Bypass After Failed Adjustable Gastric Banding. Obes Surg 2019; 29:3710-3711. [PMID: 31493138 DOI: 10.1007/s11695-019-04171-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Dimitrios E Magouliotis
- Division of Surgery and Interventional Sciences, UCL, London, UK.,Department of Surgery, University of Thessaly, Biopolis, 41110, Larissa, Greece
| | | | - Dimitris Zacharoulis
- Department of Surgery, University of Thessaly, Biopolis, 41110, Larissa, Greece.
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Sodergren MH, Huang KW, Reebye V, Chee CE, Zacharoulis D, Habib R, Blakey D, Rossi J, Habib N. Abstract 3211: MTL-CEBPA combined with radiofrequency ablation and immunotherapy enhances immunological anti-tumour response in an HCC mouse model. Immunology 2019. [DOI: 10.1158/1538-7445.am2019-3211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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23
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Magouliotis DE, Tasiopoulou VS, Dimas K, Sakellaridis N, Svokos KA, Svokos AA, Zacharoulis D. Transcriptomic analysis of the Aquaporin (AQP) gene family interactome identifies a molecular panel of four prognostic markers in patients with pancreatic ductal adenocarcinoma. Pancreatology 2019; 19:436-442. [PMID: 30826259 DOI: 10.1016/j.pan.2019.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/29/2019] [Accepted: 02/09/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND This study aimed to assess the differential gene expression of aquaporin (AQP) gene family interactome in pancreatic ductal adenocarcinoma (PDAC) using data mining techniques to identify novel candidate genes intervening in the pathogenicity of PDAC. METHOD Transcriptome data mining techniques were used in order to construct the interactome of the AQP gene family and to determine which genes members are differentially expressed in PDAC as compared to controls. The same techniques were used in order to evaluate the potential prognostic role of the differentially expressed genes. RESULTS Transcriptome microarray data of four GEO datasets were incorporated, including 142 primary tumor samples and 104 normal pancreatic tissue samples. Twenty differentially expressed genes were identified, of which nineteen were downregulated and one up-regulated. A molecular panel of four genes (Aquaporin 7 - AQP7; Archain 1 - ARCN1; Exocyst Complex Component 3 - EXOC3; Coatomer Protein Complex Subunit Epsilon - COPE) were identified as potential prognostic markers associated with overall survival. CONCLUSION These outcomes should be further assessed in vitro in order to fully understand the role of these genes in the pathophysiological mechanism of PDAC.
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Affiliation(s)
- Dimitrios E Magouliotis
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, UCL, London, UK; Department of Surgery, University of Thessaly, Biopolis, Larissa, Greece.
| | - Vasiliki S Tasiopoulou
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece.
| | - Konstantinos Dimas
- Department of Pharmacology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece.
| | - Nikos Sakellaridis
- Department of Pharmacology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece.
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Magouliotis D, Christodoulidis G, Tasiopoulou V, Sakellaridis N, Dimas K, Zacharoulis D. Expression profile of the Cadherins (CDHs) gene family in patients with pancreatic cancer. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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25
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Magouliotis DE, Tasiopoulou VS, Svokos KA, Svokos AA, Sioka E, Tzovaras G, Zacharoulis D. Banded vs. non-banded Roux-en-Y gastric bypass for morbid obesity: a systematic review and meta-analysis. Clin Obes 2018; 8:424-433. [PMID: 30144284 DOI: 10.1111/cob.12274] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 06/11/2018] [Accepted: 06/21/2018] [Indexed: 01/05/2023]
Abstract
We aim to review the available literature on patients with morbid obesity treated with banded (BRYGB) or non-banded Roux-en-Y gastric bypass (NBRYGB), in order to compare the clinical outcomes and intraoperative parameters of the two methods. A systematic literature search was performed in PubMed, Cochrane library and Scopus databases, in accordance with the PRISMA guidelines. Eight studies met the inclusion criteria incorporating 3899 patients. This study reveals similar rates of complications, mortality, remission of type 2 diabetes, hypertension, dyslipidaemia, gastroesophageal reflux and obstructive sleep apnoea, along with similar % excess weight loss (%EWL) at 1 and 2 years postoperatively. In contrast, according to an analysis of two eligible studies the BRYGB procedure was associated with increased %EWL at 5 years postoperatively. These results should be interpreted with caution due to the small number of statistical arms and randomized controlled studies. However, the present article represents the best available evidence in the field. Well-designed, randomized controlled studies, comparing BRYGB to NBRYGB, are necessary to further assess their clinical outcomes.
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Affiliation(s)
- D E Magouliotis
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - V S Tasiopoulou
- School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - K A Svokos
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - A A Svokos
- Department of Obstetrics and Gynecology, Riverside Regional Medical Center, Newport News, VA, USA
| | - E Sioka
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - G Tzovaras
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - D Zacharoulis
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
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Magouliotis DE, Tasiopoulou VS, Zacharoulis D. Comment on: Single-stage conversions from failed gastric band to sleeve gastrectomy versus Roux-en-Y gastric bypass: a closer look. Surg Obes Relat Dis 2018; 14:1788. [PMID: 30205940 DOI: 10.1016/j.soard.2018.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 08/17/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Dimitrios E Magouliotis
- Department of Surgery, University Hospital of Larissa, Biopolis, Larissa, Greece; Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece
| | - Vasiliki S Tasiopoulou
- Department of Surgery, University Hospital of Larissa, Biopolis, Larissa, Greece; Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece
| | - Dimitris Zacharoulis
- Department of Surgery, University Hospital of Larissa, Biopolis, Larissa, Greece; Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece
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Zacharoulis D, Bakalis V, Zachari E, Sioka E, Tsimpida D, Magouliotis D, Tasiopoulou V, Chatedaki C, Tzovaras G. Current knowledge and perception of bariatric surgery among Greek doctors living in Thessaly. Asian J Endosc Surg 2018; 11:138-145. [PMID: 29105338 DOI: 10.1111/ases.12436] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 08/29/2017] [Accepted: 09/03/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The purpose of this study was to assess doctors' knowledge, current conceptions, and clinical practice regarding obesity and bariatric surgery. METHODS A self-administered survey was administered to 500 doctors with varying medical specialties in public and private practice. RESULTS The response rate was 60%. Most participants (77.3%) were in private practice. Although almost half of the participants could define morbid obesity and obesity-related comorbidities, only 8.7% felt educated about bariatric surgery. Participants had little knowledge of various types of bariatric procedures. A minority of doctors (24.7%) knew of the existence of a bariatric center in their area. Only 21.3% of doctors had referred a patient to a bariatric center. Reasons for non-referral included lack of interest in bariatric surgery (37.3%), patient refusal (35.3%), increased operative fees (17.3%), lack of confidence in bariatric surgery (6.3%), and lack of access to a nearby bariatric center (3.7%). The majority of doctors were interested in learning more about bariatric surgery and related guidelines, but they remained reluctant to conduct patients' postoperative follow-ups. CONCLUSION The penetration of bariatric surgery in the medical community remains limited, despite its proven effectiveness in facilitating sustained weight loss and resolving several obesity-related comorbidities. A great effort should be made to inform health-care providers about the evolution of bariatric procedures, the potential benefits they offer, and the existence of certified bariatric centers. This will allow doctors to provide optimum health care to patients who could benefit from bariatric surgery.
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Affiliation(s)
- Dimitris Zacharoulis
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Vissarion Bakalis
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Eleni Zachari
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Eleni Sioka
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Dialecthi Tsimpida
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Dimitrios Magouliotis
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Vasiliki Tasiopoulou
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Christina Chatedaki
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - George Tzovaras
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
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Kumar J, Reccia I, Sodergren MH, Kusano T, Zanellato A, Pai M, Spalding D, Zacharoulis D, Habib N. Radiofrequency assisted pancreaticoduodenectomy for palliative surgical resection of locally advanced pancreatic adenocarcinoma. Oncotarget 2018; 9:15732-15739. [PMID: 29644005 PMCID: PMC5884660 DOI: 10.18632/oncotarget.24596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 02/21/2018] [Indexed: 02/07/2023] Open
Abstract
Background Despite careful patient selection and preoperative investigations curative resection rate (R0) in pancreaticoduodenectomy ranges from 15% to 87%. Here we describe a new palliative approach for pancreaticoduodenectomy using a radiofrequency energy device to ablate tumor in situ in patients undergoing R1/R2 resections for locally advanced pancreatic ductal adenocarcinoma where vascular reconstruction was not feasible. Results There was neither postoperative mortality nor significant morbidity. Each time the ablation lasted less than 15 minutes. Following radiofrequency ablation it was observed that the tumor remnant attached to the vessel had shrunk significantly. In four patients this allowed easier separation and dissection of the ablated tumor from the adherent vessel leading to R1 resection. In the other two patients, the ablated tumor did not separate from vessel due to true tumor invasion and patients had an R2 resection. The ablated remnant part of the tumor was left in situ. Conclusion Whenever pancreaticoduodenectomy with R0 resection cannot be achieved, this new palliative procedure could be considered in order to facilitate resection and enable maximum destruction in remnant tumors. Method Six patients with suspected tumor infiltration and where vascular reconstruction was not warranted underwent radiofrequency-assisted pancreaticoduodenectomy for locally advanced pancreatic ductal adenocarcinoma. Radiofrequency was applied across the tumor vertically 5–10 mm from the edge of the mesenteric and portal veins. Following ablation, the duodenum and the head of pancreas were removed after knife excision along the ablated line. The remaining ablated tissue was left in situ attached to the vessel.
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Affiliation(s)
- Jayant Kumar
- Department of Surgery and Cancer, Hammersmith Campus, Imperial College London, London, UK
| | - Isabella Reccia
- Department of Surgery and Cancer, Hammersmith Campus, Imperial College London, London, UK
| | - Mikael H Sodergren
- Department of Surgery and Cancer, Hammersmith Campus, Imperial College London, London, UK
| | - Tomokazu Kusano
- Department of Surgery and Cancer, Hammersmith Campus, Imperial College London, London, UK
| | - Artur Zanellato
- Department of Surgery and Cancer, Hammersmith Campus, Imperial College London, London, UK
| | - Madhava Pai
- Department of Surgery and Cancer, Hammersmith Campus, Imperial College London, London, UK
| | - Duncan Spalding
- Department of Surgery and Cancer, Hammersmith Campus, Imperial College London, London, UK
| | | | - Nagy Habib
- Department of Surgery and Cancer, Hammersmith Campus, Imperial College London, London, UK
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Magouliotis DE, Tasiopoulou VS, Svokos AA, Svokos KA, Zacharoulis D. Extracorporeal membrane oxygenation versus cardiopulmonary bypass during lung transplantation: a meta-analysis. Gen Thorac Cardiovasc Surg 2017; 66:38-47. [PMID: 28918471 DOI: 10.1007/s11748-017-0836-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 09/11/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND We reviewed the available literature on patients undergoing lung transplantation supported by cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO). METHODS A systematic literature search was performed in three databases, in accordance with the PRISMA guidelines. Meta-analyses were used to compare the outcomes of ECMO and CPB procedures. RESULTS Seven observational studies met the inclusion criteria incorporating 785 patients. ECMO support showed lower rate of primary graft dysfunction, bleeding, renal failure requiring dialysis, tracheostomy, intraoperative transfusions, intubation time, and hospital stay. Total support time was greater for the ECMO-supported group. No difference was reported between operative and ischemic time. CONCLUSIONS The present study indicates that the intraoperative use of ECMO is associated with increased efficacy and safety, regarding short-term outcomes, compared to CPB. Well-designed, randomized studies, comparing ECMO to CPB, are necessary to assess their clinical outcomes further.
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Affiliation(s)
| | - Vasiliki S Tasiopoulou
- Department of Surgery, Faculty of Medicine, University of Thessaly, Viopolis, Larissa, Greece
| | - Alexis A Svokos
- Department of Obstetrics and Gynecology, Riverside Regional Medical Center, Newport News, VA, USA
| | - Konstantina A Svokos
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Magouliotis D, Svokos A, Svokos K, Olland A, Massard G, Tasiopoulou V, Zacharoulis D. Intraoperative extracorporeal membrane oxygenation versus cardiopulmonary bypass for lung transplantation: A meta-analysis. Transplantation 2017. [DOI: 10.1183/1393003.congress-2017.pa1550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sioka E, Tzovaras G, Tsiopoulos F, Papamargaritis D, Potamianos S, Chatzitheofilou C, Zacharoulis D. Esophageal motility after laparoscopic sleeve gastrectomy. Clin Exp Gastroenterol 2017; 10:187-194. [PMID: 28769580 PMCID: PMC5529110 DOI: 10.2147/ceg.s128631] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Laparoscopic sleeve gastrectomy (LSG) modifies the upper gastrointestinal tract motility. Controversial data currently exist. The aim of the study was to evaluate esophageal motility before and after LSG. Patients and methods Morbid obese patients scheduled for LSG underwent reflux symptoms evaluation and manometry preoperatively and postoperatively. The preoperative and postoperative results were compared and analyzed. Results Eighteen patients were enrolled. Heartburn and regurgitation improved in 38.9% and 11.1% of the patients, but deteriorated in 11.1% and 27.8% of the patients, respectively. Lower esophageal sphincter (LES) total length decreased postoperatively (p=0.002). Resting and residual pressures tended to decrease postoperatively (mean difference [95% confidence interval]: −4 [−8.3/0.2] mmHg, p=0.060; −1.4 [−3/0.1] mmHg, p=0.071, respectively). Amplitude pressure decreased from 95.7±37.3 to 69.8±26.3 mmHg at the upper border of LES (p=0.014), and tended to decrease at the distal esophagus from 128.5±30.1 to 112.1±35.4 mmHg (p=0.06) and mid-esophagus from 72.7±34.5 to 49.4±16.7 mmHg (p=0.006). Peristaltic normal swallow percentage increased from 47.2±36.8 to 82.8±28% (p=0.003). Postoperative regurgitation was strongly negatively correlated with LES total length (Spearman’s r=−0.670). When groups were compared according to heartburn status, statistical significance was observed between the groups of improvement and deterioration regarding postoperative residual pressure and postoperative relaxation (p<0.002, p<0.002, respectively). With regard to regurgitation status, there was statistically significant difference between groups regarding preoperative amplitude pressure at the upper border of LES (p<0.056). Conclusion Patients developed decreased LES length and weakened LES pressure after LSG. Esophageal body peristalsis was also affected in terms of decreased amplitude pressure, especially at the upper border of LES. Nevertheless, body peristalsis was normalized postoperatively. LSG might not deteriorate heartburn. Regurgitation might increase following LSG due to shortening of LES length, particularly in patients with range of preoperative amplitude pressure at the upper border of LES of 38.9–92.6 mmHg.
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Affiliation(s)
| | | | - Fotios Tsiopoulos
- Department of Gastroenterology, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | | | - Spyros Potamianos
- Department of Gastroenterology, University Hospital of Larissa, University of Thessaly, Larissa, Greece
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32
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Sarakatsianou C, Georgopoulou S, Baloyiannis I, Chatzimichail M, Vretzakis G, Zacharoulis D, Tzovaras G. Spinal versus general anesthesia for transabdominal preperitoneal (TAPP) repair of inguinal hernia: Interim analysis of a controlled randomized trial. Am J Surg 2017; 214:239-245. [PMID: 28173938 DOI: 10.1016/j.amjsurg.2017.01.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 01/15/2017] [Accepted: 01/29/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND General anesthesia has been used as standard for laparoscopic hernia repair by the transabdominal preperitoneal (TAPP) approach. Regional anesthesia has been occasionally applied in high risk patients where general anesthesia is contraindicated. This randomized clinical trial compares spinal anesthesia with general anesthesia for TAPP inguinal hernia repair in non-high risk patients. METHODS Seventy adult American Society of Anesthesiologists I, II and III patients undergoing elective TAPP inguinal hernia repair were randomized to either general or spinal anesthesia. RESULTS Postoperative morphine consumption was significantly less immediately postoperatively (p < 0.001) in the spinal anesthesia group. Postoperative pain was also significantly decreased within the first 8 h postoperatively (p < 0.05) in the spinal anesthesia group. CONCLUSIONS Spinal anesthesia offers some advantages in patient analgesia during the early postoperative period after TAPP inguinal hernia repair and can be proposed as an effective alternative method of anesthesia for TAPP repair.
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Affiliation(s)
| | | | | | - Maria Chatzimichail
- Department of Anesthesiology, University Hospital of Larissa, Larissa, Greece
| | - George Vretzakis
- Department of Anesthesiology, University Hospital of Larissa, Larissa, Greece
| | | | - George Tzovaras
- Department of Surgery, University Hospital of Larissa, Larissa, Greece.
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33
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Yoon S, Huang KW, Reebye V, Spalding D, Przytycka TM, Wang Y, Swiderski P, Li L, Armstrong B, Reccia I, Zacharoulis D, Dimas K, Kusano T, Shively J, Habib N, Rossi JJ. Aptamer-Drug Conjugates of Active Metabolites of Nucleoside Analogs and Cytotoxic Agents Inhibit Pancreatic Tumor Cell Growth. Mol Ther Nucleic Acids 2016; 6:80-88. [PMID: 28325302 PMCID: PMC5363417 DOI: 10.1016/j.omtn.2016.11.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 10/21/2016] [Accepted: 11/02/2016] [Indexed: 01/05/2023]
Abstract
Aptamer-drug conjugates (ApDCs) have the potential to improve the therapeutic index of traditional chemotherapeutic agents due to their ability to deliver cytotoxic drugs specifically to cancer cells while sparing normal cells. This study reports on the conjugation of cytotoxic drugs to an aptamer previously described by our group, the pancreatic cancer RNA aptamer P19. To this end, P19 was incorporated with gemcitabine and 5-fluorouracil (5-FU), or conjugated to monomethyl auristatin E (MMAE) and derivative of maytansine 1 (DM1). The ApDCs P19-dFdCMP and P19-5FdUMP were shown to induce the phosphorylation of histone H2AX on Ser139 (γ-H2AX) and significantly inhibited cell proliferation by 51%–53% in PANC-1 and by 54%–34% in the gemcitabine-resistant pancreatic cancer cell line AsPC-1 (p ≤ 0.0001). P19-MMAE and P19-DM1 caused mitotic G2/M phase arrest and inhibited cell proliferation by up to 56% in a dose-dependent manner when compared to the control group (p ≤ 0.001). In addition, the cytotoxicity of P19-MMAE and P19-DM1 in normal cells and the control human breast cancer cell line MCF7 was minimal. These results suggest that this approach may be useful in decreasing cytotoxic side effects in non-tumoral tissue.
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Affiliation(s)
- Sorah Yoon
- Department of Molecular and Cellular Biology, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Kai-Wen Huang
- Department of Surgery and Hepatitis Research Center, National Taiwan University Hospital, College of Medicine, Taipei 10051, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 10051, Taiwan
| | - Vikash Reebye
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
| | - Duncan Spalding
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
| | - Teresa M Przytycka
- National Center of Biotechnology Information, National Library of Medicine, NIH, Bethesda, MD 20894, USA
| | - Yijie Wang
- National Center of Biotechnology Information, National Library of Medicine, NIH, Bethesda, MD 20894, USA
| | - Piotr Swiderski
- Drug Discovery and Structural Biology Core-DNA/RNA Synthesis Laboratory, Department of Molecular Medicine, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Lin Li
- Department of Molecular Immunology, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Brian Armstrong
- Light Microscopy Digital Imaging Core, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Isabella Reccia
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
| | - Dimitris Zacharoulis
- Department of Surgery and Pharmacology, University Hospital of Larissa, Larissa 41110, Greece
| | - Konstantinos Dimas
- Department of Surgery and Pharmacology, University Hospital of Larissa, Larissa 41110, Greece
| | - Tomokazu Kusano
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
| | - John Shively
- Department of Molecular Immunology, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Nagy Habib
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
| | - John J Rossi
- Department of Molecular and Cellular Biology, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA; Irell and Manella Graduate School of Biological Sciences, Beckman Research Institute of City of Hope, City of Hope, 1500 East Duarte Rd., Duarte, CA 91010, USA.
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Papamargaritis D, Tzovaras G, Sioka E, Zachari E, Koukoulis G, Zacharoulis D. Comparison of glucose homeostasis parameters between patients with high and low risk of diabetes at 6 weeks and 6 months after sleeve gastrectomy. Surg Obes Relat Dis 2016; 13:1016-1024. [PMID: 28254260 DOI: 10.1016/j.soard.2016.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 11/23/2016] [Accepted: 12/03/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND The changes in glucose homeostasis after sleeve gastrectomy (SG) for patients with high (HRD) and low risk (LRD) of developing diabetes have not been investigated. OBJECTIVE To compare the glucose homeostasis parameters between patients with HRD and LRD after SG. SETTING University hospital in Greece. METHODS Thirteen patients were categorized as HRD (9 females, mean body mass index 46.3±1.6 kg/m2) and 10 as LRD (8 females, mean body mass index 45.4±1.7 kg/m2) based on a preoperative 2-hour oral glucose tolerance test (OGTT). OGTT was repeated 6 weeks and 6 months postoperatively. OGTT-derived indices of insulin secretion, insulin sensitivity, and β-cell function (oral disposition index [ODI]) were calculated. RESULTS Preoperatively, in the HRD group, fasting and postload glucose levels were higher and the ODIs were lower compared with those in the LRD group. Six weeks postoperatively, glucose levels and ODIs were not different between the 2 groups. However, 6 months postoperatively, the HRD group had demonstrated higher postload glucose levels and lower ODI (0-30) and ODI (0-120) compared with the LRD group. Six weeks postoperatively, insulin levels, early insulin secretion, and insulin resistance indices were decreased compared with preoperative levels only in the HRD group. Six months postoperatively, ODIs and insulin sensitivity indices improved in both groups compared with baseline. CONCLUSION Six months after SG, glucose levels and ODIs improved for both HRD and LRD patients; however, postprandial glucose levels and ODI (0-30) and ODI (0-120) in HRD patients did not return to LRD levels. Moreover, during the first 6 postoperative weeks, the changes in glucose homeostasis parameters compared with preoperative levels were different for HRD and LRD patients.
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Affiliation(s)
- Dimitris Papamargaritis
- Leicester Diabetes Centre, University of Leicester, Leicester, United Kingdom; Department of Endocrinology, University Hospital of Larissa, Larissa, Greece
| | - George Tzovaras
- Department of Surgery, University Hospital of Larissa, Larissa, Greece.
| | - Eleni Sioka
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - Eleni Zachari
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - George Koukoulis
- Department of Endocrinology, University Hospital of Larissa, Larissa, Greece
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Mamaloudis I, Zacharoulis D, Samara M, Papadopoulos G, Samara S, Koukoulis G, Chatzitheofilou C, Kollia P. Expression profile of the GA733 gene family in colorectal cancer: correlation with clinicopathological parameters. Genet Mol Res 2015; 14:14772-81. [PMID: 26600538 DOI: 10.4238/2015.november.18.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
GA733-1/-2/-3 genes have been detected in various types of cancer, although their role has not been fully clarified. GA733-2 and GA733-1 have been correlated with lymph node metastases in laryngeal cancer and liver metastases, respectively. Only a few studies have elucidated the mechanisms regulating GA733-1/-2 expression and their effect on colorectal cancer. Therefore, the expression pattern and the role of the aforementioned molecules in colorectal carcinogenesis were evaluated in this study. Tissue samples were obtained from 40 patients with colorectal cancer with no liver metastases. GA733-1/-2 mRNA levels were evaluated by quantitative real-time polymerase chain reaction. GA733-1/-2 gene expression in noncancerous/cancerous tissues was also correlated with clinicopathological parameters. The GA733-1 mRNA levels were very low; however, the GA733-1 mRNA transcripts were higher in cancerous tissues than in normal tissues (median ratio, 0.004391/0.00093; range, 0.000001- 0.025139/0.000001-0.007761), respectively (P = 0.012). GA733-2 gene expression was higher in noncancerous tissues than in cancerous tissues (median ratio 273.31/115.64; range, 65.24-1,486.41/11.58-1,189.14; P = 0.0000195). Lower GA733-2 expression in cancer tissues appeared to correlate with lymph node metastases (P < 0.05). GA733-1 gene expression was significantly higher in cancerous samples; conversely, the GA733-2 mRNA levels were higher in noncancerous tissues, and were significantly correlated with lymph node perforation in colorectal cancer (P < 0.05). Therefore, GA733-1/-2 mRNA expression levels appear to be a potential predictive marker of tumorigenesis.
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Affiliation(s)
- I Mamaloudis
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - D Zacharoulis
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - M Samara
- Department of Pathology, School of Medicine, University of Thessaly, Larissa, Greece
| | - G Papadopoulos
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - S Samara
- Department of Genetics and Biotechnology, Faculty of Biology, School of Physical Sciences, University of Athens, Athens, Greece
| | - G Koukoulis
- Department of Pathology, School of Medicine, University of Thessaly, Larissa, Greece
| | - C Chatzitheofilou
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - P Kollia
- Department of Genetics and Biotechnology, Faculty of Biology, School of Physical Sciences, University of Athens, Athens, Greece
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Tepetes K, Christodoulidis G, Spyridakis M, Zacharoulis D, Margonis E, Papadamou G, Zachou K, Dalekos G. 357. Liver resection for hepatocellular carcinoma diagnosed patients who were under surveillance for liver diseases: A survival analysis. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.08.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
Hepatocellular carcinoma is a leading cause of cancer death worldwide in both adult and pediatric patients. Despite many options, no ideal treatment exists for this highly malignant tumor, and management strategies have varied accordingly. Angiogenesis, the formation of new blood vessels, is an essential component of hepatocellular carcinoma biology. Innovative approaches such as targeting the nontransformed, less resistant, tumor-supporting endothelial cells are currently under investigation in hepatocellular carcinoma. This review will focus on the current knowledge of the pathophysiology of hepatocellular carcinoma angiogenesis, as well as the reported data with angiogenesis inhibitors against hepatocellular carcinoma.
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Reebye V, Sætrom P, Mintz P, Huang K, Swiderski P, Peng L, Liu C, Liu X, Jensen S, Zacharoulis D, Kostomitsopoulos N, Kasahara N, Nicholls J, Jiao L, Pai M, Mizandari M, Chikovani T, Emara M, Haoudi A, Tomalia D, Rossi J, Habib N, Spalding D. Novel RNA oligonucleotide improves liver function and inhibits liver carcinogenesis in vivo. Hepatology 2014; 59:216-27. [PMID: 23929703 PMCID: PMC4655108 DOI: 10.1002/hep.26669] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 07/31/2013] [Indexed: 12/11/2022]
Abstract
UNLABELLED Hepatocellular carcinoma (HCC) occurs predominantly in patients with liver cirrhosis. Here we show an innovative RNA-based targeted approach to enhance endogenous albumin production while reducing liver tumor burden. We designed short-activating RNAs (saRNA) to enhance expression of C/EBPα (CCAAT/enhancer-binding protein-α), a transcriptional regulator and activator of albumin gene expression. Increased levels of both C/EBPα and albumin mRNA in addition to a 3-fold increase in albumin secretion and 50% decrease in cell proliferation was observed in C/EBPα-saRNA transfected HepG2 cells. Intravenous injection of C/EBPα-saRNA in a cirrhotic rat model with multifocal liver tumors increased circulating serum albumin by over 30%, showing evidence of improved liver function. Tumor burden decreased by 80% (P = 0.003) with a 40% reduction in a marker of preneoplastic transformation. Since C/EBPα has known antiproliferative activities by way of retinoblastoma, p21, and cyclins, we used messenger RNA (mRNA) expression liver cancer-specific microarray in C/EBPα-saRNA-transfected HepG2 cells to confirm down-regulation of genes strongly enriched for negative regulation of apoptosis, angiogenesis, and metastasis. Up-regulated genes were enriched for tumor suppressors and positive regulators of cell differentiation. A quantitative polymerase chain reaction (PCR) and western blot analysis of C/EBPα-saRNA-transfected cells suggested that in addition to the known antiproliferative targets of C/EBPα, we also observed suppression of interleukin (IL)6R, c-Myc, and reduced STAT3 phosphorylation. CONCLUSION A novel injectable saRNA-oligonucleotide that enhances C/EBPα expression successfully reduces tumor burden and simultaneously improves liver function in a clinically relevant liver cirrhosis/HCC model.
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MESH Headings
- Albumins/metabolism
- Animals
- CCAAT-Enhancer-Binding Protein-alpha/metabolism
- Carcinoma, Hepatocellular/complications
- Carcinoma, Hepatocellular/drug therapy
- Carcinoma, Hepatocellular/pathology
- Drug Evaluation, Preclinical
- Gene Expression Regulation
- Genetic Therapy
- Hep G2 Cells
- Humans
- Injections, Intravenous
- Liver/pathology
- Liver Cirrhosis/complications
- Liver Function Tests
- Liver Neoplasms, Experimental/complications
- Liver Neoplasms, Experimental/drug therapy
- Liver Neoplasms, Experimental/pathology
- Male
- Oligonucleotide Array Sequence Analysis
- Proto-Oncogene Proteins c-myc/metabolism
- RNA/therapeutic use
- Rats
- Rats, Wistar
- Receptors, Interleukin-6/metabolism
- STAT3 Transcription Factor/metabolism
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Affiliation(s)
- V. Reebye
- Department of Surgery and Cancer; Faculty of Medicine, Imperial College London, London, W12 0NN, UK
| | - P. Sætrom
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, NO-7489 Trondheim, Norway
- Department of Computer and Information Science, Norwegian University of Science and Technology, NO-7489 Trondheim, Norway
| | - P.J. Mintz
- Department of Surgery and Cancer; Faculty of Medicine, Imperial College London, London, W12 0NN, UK
| | - K.W. Huang
- Department of Surgery & Hepatitis Research Center. National Taiwan University Hospital, Taipei City, 10002, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University. Taipei City, 10002, Taiwan
| | - P. Swiderski
- Department of Molecular Medicine, Beckman Research Institute of the City of Hope, CA 91010. USA
| | - L. Peng
- Centre Interdisciplinaire de Nanoscience de Marseille, 13288 Marseille, France
| | - C. Liu
- Centre Interdisciplinaire de Nanoscience de Marseille, 13288 Marseille, France
| | - X.X. Liu
- Centre Interdisciplinaire de Nanoscience de Marseille, 13288 Marseille, France
| | - S. Jensen
- Department of Surgery and Cancer; Faculty of Medicine, Imperial College London, London, W12 0NN, UK
| | - D. Zacharoulis
- Department of Surgery, University Hospital of Larissa Mezourlo, Larisa, Greece
| | - N. Kostomitsopoulos
- Centre for Experimental Surgery, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece
| | - N. Kasahara
- Department of Medicine, UCLA School of Medicine, Los Angeles, CA 90095-7019, USA
| | - J.P. Nicholls
- Department of Surgery and Cancer; Faculty of Medicine, Imperial College London, London, W12 0NN, UK
| | - L.R. Jiao
- Department of Surgery and Cancer; Faculty of Medicine, Imperial College London, London, W12 0NN, UK
| | - M. Pai
- Department of Surgery and Cancer; Faculty of Medicine, Imperial College London, London, W12 0NN, UK
| | - M. Mizandari
- Department of Radiology. Tbilisi 1 Hospital University Clinic. High Technology Medical Center. Tbilisi, Georgia
| | - T. Chikovani
- Department of Microbiology and Immunology. Faculty of Medicine. Tbilisi State Medical University. Tbilisi, Georgia
| | - M.M. Emara
- Qatar Biomedical Research Institute, Education City, P.O BOX 5825, Doha, Qatar
| | - A. Haoudi
- Qatar Biomedical Research Institute, Education City, P.O BOX 5825, Doha, Qatar
| | - D.A. Tomalia
- Department of Chemistry, University of Pennsylvania, Philadelphia, PA, USA
| | - J.J. Rossi
- Division of Molecular Biology, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - N.A. Habib
- Department of Surgery and Cancer; Faculty of Medicine, Imperial College London, London, W12 0NN, UK
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Sioka E, Zacharoulis D, Zachari E, Papamargaritis D, Pinaka O, Katsogridaki G, Tzovaras G. Complicated gallstones after laparoscopic sleeve gastrectomy. J Obes 2014; 2014:468203. [PMID: 25105023 PMCID: PMC4106056 DOI: 10.1155/2014/468203] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 06/12/2014] [Accepted: 06/16/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The natural history of gallstone formation after laparoscopic sleeve gastrectomy (LSG), the incidence of symptomatic gallstones, and timing of cholecystectomy are not well established. METHODS A retrospective review of prospectively collected database of 150 patients that underwent LSG was reviewed. RESULTS Preoperatively, gallbladder disease was identified in 32 of the patients (23.2%). Postoperatively, eight of 138 patients (5.8%) became symptomatic. Namely, three of 23 patients (13%) who had evident cholelithiasis preoperatively developed complicated cholelithiasis. From the cohort of patients without preoperative cholelithiasis, five of 106 patients (4.7%) experienced complicated gallstones after LSG. Total cumulative incidence of complicated gallstones was 4.7% (95% CI: 1.3-8.1%). The gallbladder disease-free survival rate was 92.2% at 2 years. No patient underwent cholecystectomy earlier than 9 months or later than 23 months indicating the post-LSG effect. CONCLUSION A significant proportion of bariatric patients compared to the general population became symptomatic and soon developed complications after LSG, thus early cholecystectomy is warranted. Routine concomitant cholecystectomy could be considered because the proportion of patients who developed complications especially those with potentially significant morbidities is high and the time to develop complications is short and because of the real technical difficulties during subsequent cholecystectomy.
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Affiliation(s)
- Eleni Sioka
- Department of Surgery, University Hospital of Larissa, Viopolis, 41110 Larissa, Greece
| | - Dimitris Zacharoulis
- Department of Surgery, University Hospital of Larissa, Viopolis, 41110 Larissa, Greece
- *Dimitris Zacharoulis:
| | - Eleni Zachari
- Department of Surgery, University Hospital of Larissa, Viopolis, 41110 Larissa, Greece
| | | | - Ourania Pinaka
- Department of Surgery, University Hospital of Larissa, Viopolis, 41110 Larissa, Greece
| | - Georgia Katsogridaki
- Department of Surgery, University Hospital of Larissa, Viopolis, 41110 Larissa, Greece
| | - George Tzovaras
- Department of Surgery, University Hospital of Larissa, Viopolis, 41110 Larissa, Greece
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Huang KW, Reebye V, Mintz PJ, Saetrom P, Swiderski P, Peng L, Liu C, Liu XX, Jensen SL, Zacharoulis D, Kostomitsopoulos N, Kasahara N, Nicholls J, Jiao LR, Pai M, Spalding D, Farzaneh F, Mizandari M, Chikovani T, Emara M, Haoudi A, Tomalia D, Rossi JJ, Habib NA. Abstract B225: Short activating RNA (saRNA) targeting C/EBPA significantly inhibits cell proliferation of undifferentiated cancer cells. Mol Cancer Ther 2013. [DOI: 10.1158/1535-7163.targ-13-b225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
In general, ‘poorly’ differentiated tumours have a worse prognosis when compared to more ‘well’ differentiated ones. Therefore, the use of a biological agent that could promote differentiation might have a therapeutic advantage. CCAAT enhancer binding protein alpha (C/EBPα) is a transcription factor known to be involved in the regulation of cell differentiation in a number of tissue types. Loss of C/EBPα expression, for example, causes abnormal levels of biliary transcription factors, impaired hepatocyte maturation and liver fibrosis. In contrast C/EBPα overexpression inhibits the development of hepatocellular carcinoma, restores myeloid differentiation and prevents hyperproliferation of hematopoietic cells in acute myeloid leukemia. In this study, we tested the effect of stimulation of C/EBPα expression by a specific small activating RNA (saRNA) on a panel of cell lines representing both well-differentiated and poorly-differentiated cancer cell types. The C/EBPα-saRNA inhibited proliferation of poorly differentiated small cell lung cancer and pancreatic cancer cell lines compared to treatment with scrambled double-stranded RNA controls. However C/EBPα-saRNA was not as effective in suppressing proliferation in well-differentiated insulinoma and breast cancer (MCF7) cell lines. Comparison of endogenous levels of C/EBPα, using qPCR and Western blots, showed that undifferentiated tumour cell lines expressed lower levels of C/EBPα when compared to the well-differentiated tumor types. Gene expression analysis in tumours from xenografts and cirrhotic DEN treated HCC rats, demonstrated that saRNA mediated stimulation of C/EBPα expression, could suppress the steady-state transcript levels for KLF4, OCT3, SOX2, C-Myc and C-Kit. The inhibited expression of these transcription factors correlated with greater expression of differentiation markers and reduced epithelial mesenchymal transition by the C/EBPα saRNA treated cells. Our results suggest that saRNA mediated stimulation of C/EBPα, could be of potential therapeutic value, especially in poorly differentiated cancers. Furthermore, intracellular expression levels of C/EBPα could be an important prognostic factor for predicting the therapeutic response in poor or un-differentiated tumors.
Citation Information: Mol Cancer Ther 2013;12(11 Suppl):B225.
Citation Format: K W. Huang, Vikash Reebye, Paul J. Mintz, Pal Saetrom, Piotr Swiderski, L Peng, C Liu, X X. Liu, Steen Lindkaer Jensen, Dimitris Zacharoulis, Nikos Kostomitsopoulos, Noriyaki Kasahara, Joanna Nicholls, Long R. Jiao, Madhava Pai, Duncan Spalding, Farzin Farzaneh, Malkhaz Mizandari, Tina Chikovani, Mohammed Emara, Abdelali Haoudi, Don Tomalia, John J. Rossi, Nagy A. Habib. Short activating RNA (saRNA) targeting C/EBPA significantly inhibits cell proliferation of undifferentiated cancer cells. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2013 Oct 19-23; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2013;12(11 Suppl):Abstract nr B225.
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Affiliation(s)
- K W. Huang
- 1National Taiwan University Hospital, Taipei City, Taiwan
| | | | | | - Pal Saetrom
- 3Norwegian University of Science & Technology, Trondheim, Norway
| | | | - L Peng
- 5Centre Interdiscipinaire de Nanoscience de Marseille, Marseille, France
| | - C Liu
- 5Centre Interdiscipinaire de Nanoscience de Marseille, Marseille, France
| | - X X. Liu
- 5Centre Interdiscipinaire de Nanoscience de Marseille, Marseille, France
| | | | | | | | | | | | - Long R. Jiao
- 2Imperial College London, London, United Kingdom
| | - Madhava Pai
- 2Imperial College London, London, United Kingdom
| | | | | | | | | | | | | | - Don Tomalia
- 12University of Pennsylvania, Philadelphia, PA
| | - John J. Rossi
- 4Beckman Research Institute of the City of Hope, Duarte, CA
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Zacharoulis D, Rountas C, Katsimpoulas M, Morianos J, Chatziandreou I, Vassilopoulos G. Efficient liver gene transfer with foamy virus vectors. Med Sci Monit Basic Res 2013; 19:214-20. [PMID: 23941977 PMCID: PMC3747017 DOI: 10.12659/msmbr.883996] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Liver gene transfer offers hope for the correction of genetic and acquired disorders. Efficient gene transfer in large animals can be obtained with hydrodynamic gene transfer (HGT), a method that can achieve sufficient levels of gene delivery. Material/Methods To test the relative efficiency between plasmid versus foamy virus (FV) vector-based liver gene transfer efficiency, we applied HGT in 4 juvenile pigs, using the same plasmid backbone, either naked or coated as a FV vector particle. Gene transfer efficiency and persistence of expression was assayed by PCR and real-time PCR, respectively, at 1 week and at 1 month after the infusions. Results HGT was tolerated well and no adverse reactions were observed. Plasmid injections resulted in no detectable DNA sequences at 1 week. At the 1 month time point, 2/15 liver sections analyzed were positive for the presence of plasmid DNA. When FV vectors were infused under identical conditions, 18/28 (64.3%) of the liver samples were positive for the presence of vector sequences, and the expression levels reached 29.7 and 15.6% of the endogenous GAPDH levels in the injected and the adjacent liver lobes. Conclusions Our results indicate that medium-term therapeutic levels of gene expression can be obtained with FV vectors, an effect that can be attributed to the potential of the HGT procedure and to the natural affinity of FV vectors for hepatocytes.
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Zacharoulis D, Sioka E, Tzovaras G, Jiao LR, Habib N. Laparoscopic left lateral sectionectomy with the use of Habib 4X: technical aspects. J Laparoendosc Adv Surg Tech A 2013; 23:549-52. [PMID: 23621832 DOI: 10.1089/lap.2012.0464] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Various techniques and energy-based devices have been used to minimize the blood loss during transection of the liver parenchyma laparoscopically. The laparoscopic Habib™ 4X sealer (Rita Medical Systems, Inc., Fremont, CA) is a promising device using bipolar radiofrequency energy. The purpose of the study was to test the safety and the efficiency of the device in laparoscopic left lateral sectionectomy. PATIENTS AND METHODS Five patients underwent laparoscopic left lateral sectionectomy using the laparoscopic Habib 4X in a period of 12 months. Indications for liver resection were hepatocellular carcinoma in 2 cirrhotic patients and colorectal cancer liver metastasis in 3 patients. Technical aspects were analyzed. RESULTS All the patients underwent formal laparoscopic left lateral sectionectomy. The Pringle maneuver was not applied in any of the patients. Mean operative time was 75 minutes (range, 60-90 minutes). Bleeding control along the transection line was satisfactory. No conversion to laparotomy was required. Operative blood loss was minimal. No blood transfusion was recorded. The postoperative period was uneventful. Median hospital stay was 3 days (range, 2-5 days). Histopathology revealed that the margins were disease free. CONCLUSIONS Laparoscopic left lateral segmentectomy with the use of Habib 4X proved safe and efficient. This technique may be an initial step for surgeons shifting to laparoscopic liver surgery provided they have previous experience in laparoscopic and liver surgery. Well-designed controlled randomized studies are needed in order to evaluate further the role of the device used in the present study in minimally invasive liver surgery.
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Papamargaritis D, le Roux CW, Sioka E, Koukoulis G, Tzovaras G, Zacharoulis D. Changes in gut hormone profile and glucose homeostasis after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2013. [DOI: 10.1016/j.soard.2012.08.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Zacharoulis D, Lazoura O, Sioka E, Potamianos S, Tzovaras G, Nicholls J, Koukoulis G, Habib N. Habib EndoHPB: a novel endobiliary radiofrequency ablation device. An experimental study. J INVEST SURG 2012; 26:6-10. [PMID: 23273142 DOI: 10.3109/08941939.2012.681832] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Habib EndoHPB is a bipolar radiofrequency (RF) catheter developed to be introduced across malignant strictures of the bile ducts, so that RF energy can locally ablate the tumor prior to stent placement. This experiment aims to assess the ability of the catheter to coagulate the wall of the common bile duct (CBD) in a porcine model, to establish power requirement and time parameters and correlate them to the depth of thermal injury, and to assess the ease of operation of the device. METHODS The CBD was catheterized using the device in 20 pigs. RF energy was applied to the CBD wall with various generator settings. The pigs were sacrificed 24 hr after the application and the CBD was excised for histological analysis. RESULTS The device was easy to handle. Statistically significant correlations between the power, the time of RF application, and the thermal injury depth were found. CONCLUSION The Habib EndoHPB catheter can effectively deliver RF energy intraluminally in the porcine CBD. Clinical studies are warranted in order to define proper settings for safe and efficient use in malignant biliary obstruction.
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Zacharoulis D, Sioka E, Oikonomou K, Papamargaritis D, Zachari E, Rountas C, Tzovaras G. The Role of Drain in Laparoscopic Sleeve Gastrectomy. Am Surg 2012. [DOI: 10.1177/000313481207801110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Eleni Sioka
- Department of Surgery University Hospital of Larissa Larissa, Greece
| | - Kostas Oikonomou
- Department of Surgery University Hospital of Larissa Larissa, Greece
| | | | - Eleni Zachari
- Department of Surgery University Hospital of Larissa Larissa, Greece
| | - Christos Rountas
- Department of Surgery University Hospital of Larissa Larissa, Greece
| | - George Tzovaras
- Department of Surgery University Hospital of Larissa Larissa, Greece
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Zacharoulis D, Sioka E, Oikonomou K, Papamargaritis D, Zachari E, Rountas C, Tzovaras G. The role of drain in laparoscopic sleeve gastrectomy. Am Surg 2012; 78:E465-E466. [PMID: 23089420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Sioka E, Rountas C, Zacharoulis D. Hydatid disease mimicking urinary tract infection. J Postgrad Med 2012; 58:215-6. [PMID: 23023359 DOI: 10.4103/0022-3859.101409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- E Sioka
- Department of Surgery, University Hospital of Larissa, Viopolis, Larissa, Greece
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Zacharoulis D, Lazoura O, Rountas C, Katsimboulas M, Zachari E, Angelini GD, Habib NA. A new endovascular radiofrequency device for dilatation of vascular stenosis in a rabbit model. J INVEST SURG 2012; 25:253-61. [PMID: 22571174 DOI: 10.3109/08941939.2011.630124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the use of a new endovascular radiofrequency (RF) device, the Habib™ VesCoag™ Catheter, to induce vascular remodeling and dilatation of arterial stenosis in a rabbit model. MATERIALS AND METHODS RF was used to induce arterial stenosis in 10 rabbits and this was confirmed by angiography and color Doppler ultrasound. Two groups of five animals were then subjected to (1) balloon dilatation of the stenosis (intervention group), (2) no intervention (control group). Two rabbits from each group were sacrificed following the procedures to investigate vessel histopathology. At six weeks, the remaining six rabbits underwent follow-up angiogram and color Doppler ultrasound to assess vessel patency. They were then sacrificed and the vessels prepared for histopathological analysis. Three-dimensional images with confocal microscopy of the arterial lumen were also acquired. RESULTS In the intervention group, stenosis was reversed and patency confirmed by angiography and color Doppler ultrasound six weeks later in all surviving rabbits. Histopathology revealed degenerative changes of elastic fibers, focal losses of elastica lamella, disorganization of myocytes and extensive hyalinization of the tunica adventitia. Focal elastin changes of the arterial elastic lamella were also shown by three-dimensional confocal microscopy images. CONCLUSION We have developed a novel endovascular RF catheter that can be safely and effectively used to induce vascular remodeling and dilatation of arterial stenosis in an experimental rabbit model.
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Zacharoulis D, Sioka E, Papamargaritis D, Lazoura O, Rountas C, Zachari E, Tzovaras G. Influence of the learning curve on safety and efficiency of laparoscopic sleeve gastrectomy. Obes Surg 2012; 22:411-5. [PMID: 21562796 DOI: 10.1007/s11695-011-0436-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a relatively new bariatric procedure, and data regarding the learning curve are scarce. The aim of this study is to assess how the procedure can be safely implanted in a newly established bariatric unit and to define the learning curve. METHODS Proctorship and mentorship in bariatric surgery were attended by two surgeons who were previously experienced in advanced laparoscopic surgery. The first consecutive 102 patients who underwent LSG in our newly established bariatric center were included. Patients were divided into three groups of 34 (groups 1, 2, and 3) according to case sequence. Data on demographics, operative time, conversion rate, hospital stay, morbidity, mortality, and excess weight loss (EWL) over time were compared between the groups. RESULTS The operative time was significantly lower in groups 2 (p = 0.016) and 3 (p = 0.003) compared to group 1. The learning curve was flat up to the 68th case. A significant decrease in hospital stay was noted for group 3 compared to groups 1 (p < 0.001) and 2 (p = 0.002). The conversion rate, mortality and morbidity rates, and EWL did not differ significantly between the groups. Mortality was 0.98% and procedure-related morbidity was 7.8%. CONCLUSIONS LSG can be safely and efficiently performed in a newly established bariatric center following a mentorship procedure. Proficiency seems to require 68 cases. The operative time and hospital stay may significantly decrease with experience early in the learning curve, as opposed to mortality and morbidity rates, conversion rate, and EWL.
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Affiliation(s)
- Dimitris Zacharoulis
- Department of Surgery, University Hospital of Larissa, Larissa, 41110, Viopolis, Greece.
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Tzovaras G, Baloyiannis I, Zachari E, Symeonidis D, Zacharoulis D, Kapsoritakis A, Paroutoglou G, Potamianos S. Laparoendoscopic rendezvous versus preoperative ERCP and laparoscopic cholecystectomy for the management of cholecysto-choledocholithiasis: interim analysis of a controlled randomized trial. Ann Surg 2012; 255:435-9. [PMID: 22261836 DOI: 10.1097/sla.0b013e3182456ec0] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although the ideal management of cholecysto-choledocholi-thiasis is controversial, the 2-stage approach [endoscopic retrograde cholangiopancreatography (ERCP), sphincterotomy, and common bile duct (CBD) clearance followed by laparoscopic cholecystectomy] remains the standard way of management worldwide. One-stage approach using the so-called laparoendoscopic rendezvous (LERV) technique offers some advantages, mainly by reducing the hospital stay and the risk of post-ERCP pancreatitis. OBJECTIVE To compare the LERV 1-stage approach with the standard 2-stage approach consisting of preoperative ERCP followed by laparoscopic cholecystectomy for the treatment of cholecysto-choledocholithiasis. SETTING Controlled randomized trial, University/Teaching Hospital. METHODS : Patients with cholecysto-choledocholithiasis were randomized either to LERV or to the 2-stage approach. Both elective and emergency cases were included in the study. Primary endpoint was to detect difference in overall hospital stay, whereas secondary endpoints were (i) to detect differences in morbidity (especially post-ERCP pancreatitis) and (ii) success of CBD clearance. This is an interim analysis of the first 100 randomized patients. RESULTS Hospital stay was significantly shorter in the LERV group; median 4 (2-19) days versus 5.5 (3-22) days, P = 0.0004. There was no difference in morbidity and success of CBD clearance between the 2 groups. Post-ERCP amylase value was found significantly lower in the LERV group: median 65 (16-1159) versus 91 (30-1846), P = 0.02. CONCLUSIONS Interim analysis of the results suggests the superiority of the LERV technique in terms of hospital stay and post-ERCP hyperamylasemia.
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Affiliation(s)
- George Tzovaras
- Department of Surgery, University of Thessaly Medical School, University Hospital of Larissa, Larissa, Greece.
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