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Kapriniotis K, Tzelves L, Lazarou L, Mitsogianni M, Mitsogiannis I. Circulating Tumour DNA and Its Prognostic Role in Management of Muscle Invasive Bladder Cancer: A Narrative Review of the Literature. Biomedicines 2024; 12:921. [PMID: 38672275 PMCID: PMC11048625 DOI: 10.3390/biomedicines12040921] [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: 03/27/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Current management of non-metastatic muscle invasive bladder cancer (MIBC) includes radical cystectomy and cisplatin-based neoadjuvant chemotherapy (NAC), offers a 5-year survival rate of approximately 50% and is associated with significant toxicities. A growing body of evidence supports the role of liquid biopsies including circulating tumour DNA (ctDNA) as a prognostic and predictive marker that could stratify patients according to individualised risk of progression/recurrence. Detectable ctDNA levels prior to radical cystectomy have been shown to be correlated with higher risk of recurrence and worse overall prognosis after cystectomy. In addition, ctDNA status after NAC/neoadjuvant immunotherapy is predictive of the pathological response to these treatments, with persistently detectable ctDNA being associated with residual bladder tumour at cystectomy. Finally, detectable ctDNA levels post-cystectomy have been associated with disease relapse and worse disease-free (DFS) and overall survival (OS) and might identify a population with survival benefit from adjuvant immunotherapy.
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Affiliation(s)
| | - Lazaros Tzelves
- 2nd Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens (NKUA), 115 27 Athens, Greece; (L.L.); (I.M.)
| | - Lazaros Lazarou
- 2nd Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens (NKUA), 115 27 Athens, Greece; (L.L.); (I.M.)
| | - Maria Mitsogianni
- 4th Department of Medical Oncology, “Hygeia” Hospital, 151 23 Athens, Greece;
| | - Iraklis Mitsogiannis
- 2nd Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens (NKUA), 115 27 Athens, Greece; (L.L.); (I.M.)
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Katsimperis S, Kapriniotis K, Manolitsis I, Bellos T, Angelopoulos P, Juliebø-Jones P, Somani B, Skolarikos A, Tzelves L. Early investigational agents for the treatment of benign prostatic hyperplasia'. Expert Opin Investig Drugs 2024; 33:359-370. [PMID: 38421373 DOI: 10.1080/13543784.2024.2326023] [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: 10/25/2023] [Accepted: 02/28/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Benign prostatic hyperplasia (BPH), as a clinical entity that affects many people, has always been in the forefront of interest among researchers, pharmaceutical companies, and physicians. Patients with BPH exhibit a diverse range of symptoms, while current treatment options can occasionally cause adverse events. All the aforementioned have led to an increased demand for more effective treatment options. AREAS COVERED This review summarizes the outcomes of new medications used in a pre-clinical and clinical setting for the management of male lower urinary tract symptoms (LUTS)/BPH and provides information about ongoing trials and future directions in the management of this condition. More specifically, sheds light upon drug categories, such as reductase‑adrenoceptor antagonists, drugs interfering with the nitric oxide (NO)/cyclic guanosine monophosphate (GMP) signaling pathway, onabotulinumtoxinA, vitamin D3 (calcitriol) analogues, selective cannabinoid (CB) receptor agonists, talaporfin sodium, inhibitor of transforming growth factor beta 1 (TGF-β1), drugs targeting the hormonal control of the prostate, phytotherapy, and many more. EXPERT OPINION Clinical trials are being conducted on a number of new medications that may emerge as effective therapeutic alternatives in the coming years.
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Affiliation(s)
- Stamatios Katsimperis
- 2nd University Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Ioannis Manolitsis
- 2nd University Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Themistoklis Bellos
- 2nd University Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Angelopoulos
- 2nd University Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Andreas Skolarikos
- 2nd University Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Lazaros Tzelves
- 2nd University Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Department of Urology, University College of London Hospitals (UCLH), London, UK
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Loufopoulos I, Kapriniotis K, Pakzad M, Noah A, Gresty H, Greenwell T, Ockrim J. Bulkamid® injection as a salvage treatment option in patients with recurrent stress urinary incontinence: Medium term outcomes from a tertiary unit. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00926-0] [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: 02/12/2023]
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Geropoulos G, Psarras K, Papaioannou M, Giannis D, Meitanidou M, Kapriniotis K, Symeonidis N, Pavlidis ET, Pavlidis TE, Sapalidis K, Ahmed NM, Abdel-Aziz TE, Eddama MMR. Circulating microRNAs and Clinicopathological Findings of Papillary Thyroid Cancer: A Systematic Review. In Vivo 2022; 36:1551-1569. [PMID: 35738604 PMCID: PMC9301440 DOI: 10.21873/invivo.12866] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 03/20/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND/AIM Papillary thyroid cancer (PTC) is the most common endocrine malignancy with a rising incidence. There is a need for a non-invasive preoperative test to enable better patient counselling. The aim of this systematic review was to investigate the potential role of circulating microRNAs (miRNAs) in the diagnosis and prognosis of PTC. MATERIALS AND METHODS A systematic literature search was performed using MEDLINE, Cochrane, and Scopus databases (last search date was December 1, 2021). Studies investigating the expression of miRNAs in the serum or plasma of patients with PTC were deemed eligible for inclusion. RESULTS Among the 1,533 screened studies, 39 studies met the inclusion criteria. In total, 108 miRNAs candidates were identified in the serum, plasma, or exosomes of patients suffering from PTC. Furthermore, association of circulating miRNAs with thyroid cancer-specific clinicopathological features, such as tumor size (13 miRNAs), location (3 miRNAs), extrathyroidal extension (9 miRNAs), pre- vs. postoperative period (31 miRNAs), lymph node metastasis (17 miRNAs), TNM stage (9 miRNAs), BRAF V600E mutation (6 miRNAs), serum thyroglobulin levels (2 miRNAs), 131I avid metastases (13 miRNAs), and tumor recurrence (2 miRNAs) was also depicted in this study. CONCLUSION MiRNAs provide a potentially promising role in the diagnosis and prognosis of PTC. There is a correlation between miRNA expression profiles and specific clinicopathological features of PTC. However, to enable their use in clinical practice, further clinical studies are required to validate the predictive value and utility of miRNAs as biomarkers.
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Affiliation(s)
- Georgios Geropoulos
- Department of General and Endocrine Surgery, University College London Hospitals, London, U.K.;
- 2 Propedeutical Department of Surgery, Hippokration Hospital, School of Medicine,Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kyriakos Psarras
- 2 Propedeutical Department of Surgery, Hippokration Hospital, School of Medicine,Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Papaioannou
- Laboratory of Biological Chemistry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki, Greece
| | - Dimitrios Giannis
- Department of Surgery, North Shore University Hospital, Manhasset, NY, U.S.A
| | - Maria Meitanidou
- 2 Propedeutical Department of Surgery, Hippokration Hospital, School of Medicine,Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Nikolaos Symeonidis
- 2 Propedeutical Department of Surgery, Hippokration Hospital, School of Medicine,Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efstathios T Pavlidis
- 2 Propedeutical Department of Surgery, Hippokration Hospital, School of Medicine,Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros E Pavlidis
- 2 Propedeutical Department of Surgery, Hippokration Hospital, School of Medicine,Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Sapalidis
- 3 General Surgery Department, "AHEPA" University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nada Mabrouk Ahmed
- Department of General and Endocrine Surgery, University College London Hospitals, London, U.K
- Department of Pathology, University of Alexandria, Alexandria, Egypt
| | - Tarek Ezzat Abdel-Aziz
- Department of General and Endocrine Surgery, University College London Hospitals, London, U.K
| | - Mohammad M R Eddama
- Department of General and Endocrine Surgery, University College London Hospitals, London, U.K
- Research Department of Surgical Biotechnology, University College London, London, U.K
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Kapriniotis K, Jenks J, Toia B, Pakzad M, Gresty H, Stephens R, Malde S, Sahai A, Greenwell T, Ockrim J. Does response to percutaneous tibial nerve stimulation predict similar outcome to sacral nerve stimulation? Neurourol Urodyn 2022; 41:1172-1176. [PMID: 35481714 DOI: 10.1002/nau.24944] [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: 11/13/2021] [Revised: 01/31/2022] [Accepted: 03/15/2022] [Indexed: 11/07/2022]
Abstract
AIMS Percutaneous tibial nerve stimulation (PTNS) is a simple neuromodulation technique to treat an overactive bladder. It is unclear whether the response to PTNS would suggest a similar response to sacral nerve stimulation (SNS), and whether PTNS could be utilized as an alternative test phase for an SNS implant. This study assessed whether PTNS response was a reliable indicator for subsequent SNS trials. METHODS We performed a retrospective review of the hospital databases to collect all patients who had PTNS and who subsequently had an SNS trial in two tertiary hospitals from 2014 to 2020. Response to both interventions was assessed. A 50% reduction in overactive symptoms (frequency-volume charts) was considered a positive response. McNemar's tests using exact binomial probability calculations were used. The statistical significance level was set to 0.05. RESULTS Twenty-three patients who had PTNS subsequently went on to a trial of SNS. All patients except one had previously poor response to PTNS treatment. Eight of them also failed the SNS trial. However, 15 patients (including the PTNS responder) had a successful SNS trial and proceeded with the second-stage battery implantation. The difference in response rates between the PTNS and SNS trial was statistically significant (p < 0.001). CONCLUSIONS Poor response to PTNS does not seem to predict the likelihood of patients responding to SNS. A negative PTNS trial should not preclude a trial of a sacral nerve implant. The predictive factors for good and poor responses will be the subject of a larger study.
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Affiliation(s)
| | - Julie Jenks
- Department of Urology, University College London Hospital, London, UK
| | - Bogdan Toia
- Department of Urology, University College London Hospital, London, UK
| | - Mahreen Pakzad
- Department of Urology, University College London Hospital, London, UK
| | - Helena Gresty
- Department of Urology, University College London Hospital, London, UK
| | - Ross Stephens
- Department of Urology, Guy's and St Thomas' Hospital, London, UK
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' Hospital, London, UK
| | - Arun Sahai
- Department of Urology, Guy's and St Thomas' Hospital, London, UK
| | - Tamsin Greenwell
- Department of Urology, University College London Hospital, London, UK
| | - Jeremy Ockrim
- Department of Urology, University College London Hospital, London, UK
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Loufopoulos I, Geropoulos G, Kapriniotis K, Kakos C, Bhakhri K, Panagiotopoulos N. 284 Pneumomediastinum in the COVID-19 Era: To Drain or Not to Drain. Br J Surg 2022. [PMCID: PMC9383482 DOI: 10.1093/bjs/znac039.186] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Introduction Although quite uncommon in the pre-COVID-19 era, pneumomediastinum has been increasingly reported in COVID-19 cases complicating the management and prognosis of these patients. The aim of this study is to present the current experience on COVID-19 associated pneumomediastinum and to propose a management algorithm based on the existing literature. Method A search strategy focused on electronic databases (Medline, Embase, Google Scholar) was performed. Main search keywords were pneumomediastinum and COVID-19-related keywords. Eligible studies were included without strict limitations on type of study, type of publication, language, or date. Results Several reports of pneumomediastinum management in the context of COVID-19 infection have been reported. An initial diagnostic approach with computed tomography scan is recommended for all patients with increased oxygen requirements and suspicious chest X ray. In stable, non-intubated patients, pneumomediastinum can be initially monitored, whereas in the event of progressing air accumulation and cardiorespiratory compromise, a subxiphoid drain alone may preserve the cardiopulmonary reserve. In cases with coexisting pneumothorax and pneumomediastinum, a pleural drain should be prioritised and a subxiphoid drain should be reserved for cases not responding to initial treatment. In surgical emphysema cases, conservative management, especially in non-intubated patients, is suggested, while coexisting pneumothorax as described above. For refractory surgical emphysema cases, subcutaneous drain or subxiphoid drain- in presence of pneumomediastinum- might be required. Conclusions In air space complications such as pneumomediastinum, surgical emphysema and pneumothorax, a proposed treatment algorithm can be applied aiming to improve the outcomes of these complicated COVID-19 patients.
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Affiliation(s)
- I. Loufopoulos
- University College London Hospitals, London, United Kingdom
| | - G. Geropoulos
- University College London Hospitals, London, United Kingdom
| | - K. Kapriniotis
- University College London Hospitals, London, United Kingdom
| | - C. Kakos
- University College London Hospitals, London, United Kingdom
| | - K. Bhakhri
- University College London Hospitals, London, United Kingdom
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Kapriniotis K, Loufopoulos I, Kennedy Hutchinson C, Geropoulos G, Gresty H, Pakzad M, Greenwell T, Ockrim J. 285 ‘Smart Phrase’ Ward Rounds: Do They Improve Documentation and Efficiency? Br J Surg 2022. [DOI: 10.1093/bjs/znac039.187] [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: 11/12/2022]
Abstract
Abstract
Aim
Accurate ward round documentation plays a crucial role in patient management. In the last two years, UCLH has introduced EPIC software. This gives opportunity to create templates for repetitive processes (‘smart phrases’). The aim of this project was to assess if the introduction of ‘smart phrase’ templates can improve the quality of ward round documentation.
Method
Following consultation, 5 fundamental domains were agreed to be included in the template, namely: Procedure and postoperative day, current clinical issues, physical examination, objective assessment (including vital signs, fluid balance/drains, blood tests, DVT prophylaxis, antibiotic status), and 24h treatment plan. A baseline audit was performed, then the new template was introduced. Two PDSA cycles were performed, for 3 weeks after introduction, and repeated two months later. Chi-square tests was used to assess statistical significance of change (p<0.05).
Results
A statistically significant improvement in documentation for all domains - apart from ‘current clinical issues’ and ‘24h planning', which were well documented to start - was observed after the introduction of smart phrases; with an average improvement of 34.8% (range 0–65.6%). The improvement was maintained at 2 months (improvement from baseline 35.1%, range 0–59%). A small decrement in documentation occurred between introduction and the 2-month PDSA assessments in some domains (mean change 0.7%, range -12.3 to 23%), although this was not statistically significant.
Conclusions
The introduction of smart phrases significantly improved ward round documentation of important parameters. Evolution of additional smart phrase is expected to further improve the accuracy leading to more efficient decisions and safer clinical practice.
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Affiliation(s)
- K. Kapriniotis
- Department of Urology, University College London Hospital, London, United Kingdom
| | - I. Loufopoulos
- Department of Urology, University College London Hospital, London, United Kingdom
| | | | - G. Geropoulos
- Department of General Surgery, University College London Hospital, London, United Kingdom
| | - H. Gresty
- Department of Urology, University College London Hospital, London, United Kingdom
| | - M. Pakzad
- Department of Urology, University College London Hospital, London, United Kingdom
| | - T. Greenwell
- Department of Urology, University College London Hospital, London, United Kingdom
| | - J. Ockrim
- Department of Urology, University College London Hospital, London, United Kingdom
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Loufopoulos I, Kapriniotis K, Kennedy C, Huq S, Reid T, Sridhar A. 248 Urethral Self-Insertion of a USB Cable as Sexual Experimentation: A Case Report. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.162] [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
Abstract
Introduction
The insertion of a foreign body in the urethra is an uncommon urological emergency. A wide variety of inserted objects have been described, presenting either asymptomatically or with lower abdominal discomfort and lower urinary tract symptoms. Sexual experimentation and gratification as well as mental disorders are considered the main underlying causes. The aim of this report is to present the case of a USB wire self-insertion and its challenging urological management.
Case Presentation
A 15-year-old male patient presented to his local Accident and Emergency department with gross haematuria following self-insertion of the knotted cable of a USB wire into his urethra in the context of sexual experimentation. Endoscopic approach via rigid cystoscopy and optical urethrotomy was not effective. A suprapubic catheter was inserted, and the patient was urgently transferred to our hospital for tertiary management.
Following radiological assessment to confirm the position of the wire, a longitudinal peno-scrotal incision over the palpable foreign body was made. Urethrotomy revealed the knotted cable in the proximal aspect of the penile urethra, which was cut and removed. Urethra was subsequently closed over a urethral catheter. Postoperative recovery was uneventful, and patient was discharged home with oral antibiotics. Urethral catheter was removed following normal fluoroscopic assessment of the urethra two weeks later.
Conclusions
The management of a foreign urethral body can be challenging and usually requires tertiary expertise to achieve optimal outcomes. Poor initial management could potentially lead to devastating long-term complications such as urethral strictures and fistulas.
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Affiliation(s)
- I. Loufopoulos
- University College London Hospitals, London, United Kingdom
| | - K. Kapriniotis
- University College London Hospitals, London, United Kingdom
| | - C. Kennedy
- University College London Hospitals, London, United Kingdom
| | - S. Huq
- University College London Hospitals, London, United Kingdom
| | - T. Reid
- University College London Hospitals, London, United Kingdom
| | - A. Sridhar
- University College London Hospitals, London, United Kingdom
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Kapriniotis K, Toia B, Noah A, Pakzad M, Hamid R, Greenwell T, Ockrim J, Gresty H. Do patients prefer telecommunication to traditional face-to face clinic review: A benefit of covid-19? Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00184-1] [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: 11/15/2022]
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Loufopoulos I, Kapriniotis K, Kennedy C, Huq S, Reid T, Sridhar A. Urethral self-insertion of a USB cable as sexual experimentation: A case report. Urol Case Rep 2021; 39:101850. [PMID: 34557384 PMCID: PMC8445838 DOI: 10.1016/j.eucr.2021.101850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/24/2021] [Accepted: 09/10/2021] [Indexed: 12/02/2022] Open
Abstract
The insertion of a foreign body into the urethra is a delicate matter that may prevent patients from presenting promptly. It can have serious long-term implications. Sexual experimentation and gratification, as well as underlying mental disorders, are considered the main causes of retained foreign bodies in the urethra and bladder. Management varies depending on the shape and size of the object, and the mechanism of insertion. Here we describe the case of a 15-year-old boy who self-inserted a USB wire into his proximal urethra. Manual and endoscopic attempts at removal were unsuccessful. A peno-scrotal urethrostomy was performed.
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Affiliation(s)
| | | | - Clio Kennedy
- University College Hospital at Westmoreland Street, London, United Kingdom
| | - Sabareen Huq
- University College Hospital at Westmoreland Street, London, United Kingdom
| | - Thomas Reid
- University College Hospital at Westmoreland Street, London, United Kingdom
| | - Ashwin Sridhar
- University College Hospital at Westmoreland Street, London, United Kingdom
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Kapriniotis K, Bania A, Lampridis S, Geropoulos G, Mitsos S, Monk F, Moore DA, Panagiotopoulos N. Metastatic mandibular ameloblastoma of the lung ten years after primary resection: A rare case report. Monaldi Arch Chest Dis 2021; 91. [PMID: 33849261 DOI: 10.4081/monaldi.2021.1643] [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] [Received: 10/17/2020] [Accepted: 01/31/2021] [Indexed: 11/23/2022] Open
Abstract
Ameloblastoma is a rare odontogenic neoplasm of the jaw. It usually behaves as a benign, slow growing tumour of the oral cavity with a high recurrence rate, especially when it is inadequately resected. A small proportion of ameloblastomas metastasize to distant organs, with lungs representing the most common site of metastatic spread. In this report, we present the case of a middle-aged man with two pulmonary nodules and a history of mandibular ameloblastoma excised 10 years prior to this radiological finding. Following resection and histopathological analysis of the lung lesion, a diagnosis of metastatic ameloblastoma was confirmed. No local recurrence of the primary tumour was identified. At 1-year follow-up, the patient had no evidence of local or metastatic disease.
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Affiliation(s)
- Konstantinos Kapriniotis
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, London.
| | - Angelina Bania
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, London.
| | - Savvas Lampridis
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, London.
| | - Georgios Geropoulos
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, London.
| | - Sofoklis Mitsos
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, London.
| | - Fleur Monk
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London.
| | - David A Moore
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London.
| | - Nikolaos Panagiotopoulos
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, London.
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Kapriniotis K, Giannis D, Geropoulos G, Evangeliou AP, Ziogas IA, Panagiotopoulos N. Heart and Lung Transplantation in the Era of COVID-19: Early Recommendations and Outcomes. EXP CLIN TRANSPLANT 2021; 19:1117-1123. [PMID: 33535932 DOI: 10.6002/ect.2020.0289] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The severe acute respiratory syndrome coronavirus 2 pandemic has dramatically changed medical practices worldwide. These changes have been aimed both to reallocate resources toward fighting the novel coronavirus and to prevent its transmission during nonurgent medical and surgical interventions. Heart and lung transplantation could not be an exception, as most transplant centers have either restricted their activity to only urgent, lifesaving procedures or stopped these surgical procedures for various periods of time depending on the local virus epidemiology. The effect of this infection on the immunosuppressed heart and lung transplant recipient is still questionable; however, there are limited reports suggesting that there is no increased risk of transmission or more severe disease course compared with that shown in the general population. Transplant organizations have disseminated early recommendations as a guidance in a yet evolving situation. Finally, data suggest that lung transplant could potentially serve as an ultimate, lifesaving procedure for COVID-19-related end-stage respiratory failure in carefully selected patients.
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Affiliation(s)
- Konstantinos Kapriniotis
- From the Thoracic Surgery Department, University College London Hospitals, NHS Foundation Trust, London, United Kingdom
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13
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Kasivisvanathan V, Lindsay J, Rakshani-Moghadam S, Elhamshary A, Kapriniotis K, Kazantzis G, Syed B, Hines J, Bex A, Ho DH, Hayward M, Bhan C, MacDonald N, Clarke S, Walker D, Bellingan G, Moore J, Rohn J, Muneer A, Roberts L, Haddad F, Kelly JD. A cohort study of 30 day mortality after NON-EMERGENCY surgery in a COVID-19 cold site. Int J Surg 2020; 84:57-65. [PMID: 33122153 PMCID: PMC7584883 DOI: 10.1016/j.ijsu.2020.10.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 08/24/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 12/23/2022]
Abstract
Background Two million non-emergency surgeries are being cancelled globally every week due to the COVID-19 pandemic, which will have a major impact on patients and healthcare systems. Methods During the peak of the pandemic in the United Kingdom, we set up a multicentre cancer network amongst 14 National Health Service institutions, performing urological, thoracic, gynaecological and general surgical urgent and cancer operations at a central COVID-19 cold site. This is a cohort study of 500 consecutive patients undergoing surgery in this network. The primary outcome was 30-day mortality from COVID-19. Secondary outcomes included all-cause mortality and post-operative complications at 30-days. Results 500 patients underwent surgery with median age 62.5 (IQR 51–71). 65% were male, 60% had a known diagnosis of cancer and 61% of surgeries were considered complex or major. No patient died from COVID-19 at 30-days. 30-day all-cause mortality was 3/500 (1%). 10 (2%) patients were diagnosed with COVID-19, 4 (1%) with confirmed laboratory diagnosis and 6 (1%) with probable COVID-19. 33/500 (7%) of patients developed Clavien-Dindo grade 3 or higher complications, with 1/33 (3%) occurring in a patient with COVID-19. Conclusion It is safe to continue cancer and urgent surgery during the COVID-19 pandemic with appropriate service reconfiguration. Priority surgeries are being cancelled every week due to the COVID-19 pandemic. A multicentre surgical referral network was set up as part of an NHS England approach to continuing safe surgery The referral network consisted of 14 NHS trusts and surgery was performed at a single COVID-19 ‘cold site’. After 500 surgeries performed, there was a 0% 30-day mortality from COVID-19. It is safe to continue cancer and priority surgery during the COVID-19 pandemic with appropriate service reconfiguration.
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Affiliation(s)
- Veeru Kasivisvanathan
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK.
| | - Jamie Lindsay
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Sara Rakshani-Moghadam
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Ahmed Elhamshary
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | | | - Georgios Kazantzis
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Bilal Syed
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - John Hines
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Axel Bex
- Department of Urology, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Daniel Heffernan Ho
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Martin Hayward
- Department of Thoracic Surgery, University College London Hospital NHS Foundation Trust, London, UK
| | - Chetan Bhan
- Department of General Surgery, Whittington Health NHS Trust, London, UK
| | - Nicola MacDonald
- Department of Gynaecology, University College London Hospital NHS Foundation Trust, London, UK
| | - Simon Clarke
- Department of Anaesthetics, University College London Hospital NHS Foundation Trust, London, UK
| | - David Walker
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Intensive Care, University College London Hospital NHS Foundation Trust, London, UK
| | - Geoff Bellingan
- Department of Intensive Care, University College London Hospital NHS Foundation Trust, London, UK
| | - James Moore
- NHS England and NHS Improvement, England, UK
| | - Jennifer Rohn
- Centre for Urological Biology, Department of Renal Medicine, Division of Medicine, University College London, London, UK
| | - Asif Muneer
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK; National Institute for Health and Research Biomedical Research Centre, University College London Hospital, London, UK
| | - Lois Roberts
- Division of Surgery, University College London Hospital NHS Foundation Trust, London, UK
| | - Fares Haddad
- Division of Surgery and Interventional Science, University College London, London, UK
| | - John D Kelly
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
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14
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Kapriniotis K, Geropoulos G, Vianna T, Mitsos S, Panagiotopoulos N. Facilitating robotic thymectomy in patients with pectus excavatum deformity. Gen Thorac Cardiovasc Surg 2020; 69:618-620. [PMID: 33090363 DOI: 10.1007/s11748-020-01515-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/05/2020] [Indexed: 11/29/2022]
Abstract
Robotic procedures in the anterior mediastinum can be challenging in the existence of pectus excavatum deformity due to the limited intrathoracic working space caused by sternal depression. We propose that the temporary application of a vacuum bell device during the procedure can correct the deformity and thus, facilitate robotic approach similarly to the standard procedure.
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Affiliation(s)
- Konstantinos Kapriniotis
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland Street, London, W1G8PH, UK.
| | - Georgios Geropoulos
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland Street, London, W1G8PH, UK
| | - Thabbta Vianna
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland Street, London, W1G8PH, UK
| | - Sofoklis Mitsos
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland Street, London, W1G8PH, UK
| | - Nikolaos Panagiotopoulos
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland Street, London, W1G8PH, UK
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15
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Abstract
Total hip arthroplasty (THA) in sickle cell disease (SCD) patients can be a challenging procedure. This systematic review evaluated the revision rate, functional outcomes and complications of THA in sicklers. A systematic search was conducted according to the PRISMA guidelines, using four search engines from inception to May 2019. Fifteen studies with 971 THAs were included. There were 437 cemented and 520 uncemented THAs. There were 164 revision THAs (16.8%); 52 uncemented and 105 cemented THAs. Forty-two infections were recorded; 16 infections for cemented and 23 for uncemented THAs. Fifty-seven cups, 26 stems, eight cup/stem with aseptic loosening that were more frequently cemented were reported. The 28 unspecified aseptic loosening cases were more frequently uncemented THAs. All studies demonstrated the functional improvement of patients. There were 109 medical complications (14.3%). Sickle cell crises (SCC) and transfusion reactions were most usually recorded. Forty-six intraoperative complications (4.7%) were reported; 18 femoral fractures, four acetabular and 18 femoral perforations. Seventeen femoral fractures occurred during uncemented THA. THA in SCD is still related to a high risk of complications. The outcomes in properly selected sicklers have been improved. Perioperative adequate hydration, warming, oxygen supply and transfusion protocols are mandated to prevent SCC and transfusion reactions. The surgeon must be prepared to deal with a high rate of intraoperative fractures and have different implant options readily available. No definite conclusion can be made regarding the best fixation mode. Cemented implants demonstrated a higher revision rate and uncemented implants a higher risk for intraoperative complications.
Cite this article: EFORT Open Rev 2020;5:180-188. DOI: 10.1302/2058-5241.5.190038
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Affiliation(s)
- Eustathios Kenanidis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Hellas, Greece.,Center of Orthopaedics and Regenerative Medicine (C.O.RE.) - Center of Interdisciplinary Research and Innovation (C.I.R.I.) - Aristotle University Thessaloniki, Balkan Center, Hellas, Greece.,Hôpital de la Tour, Geneva, Switzerland
| | - Konstantinos Kapriniotis
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.) - Center of Interdisciplinary Research and Innovation (C.I.R.I.) - Aristotle University Thessaloniki, Balkan Center, Hellas, Greece
| | - Panagiotis Anagnostis
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.) - Center of Interdisciplinary Research and Innovation (C.I.R.I.) - Aristotle University Thessaloniki, Balkan Center, Hellas, Greece
| | - Michael Potoupnis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Hellas, Greece.,Center of Orthopaedics and Regenerative Medicine (C.O.RE.) - Center of Interdisciplinary Research and Innovation (C.I.R.I.) - Aristotle University Thessaloniki, Balkan Center, Hellas, Greece
| | | | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Hellas, Greece.,Center of Orthopaedics and Regenerative Medicine (C.O.RE.) - Center of Interdisciplinary Research and Innovation (C.I.R.I.) - Aristotle University Thessaloniki, Balkan Center, Hellas, Greece
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16
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Kapriniotis K, Lampridis S, Mitsos S, Patrini D, Lawrence DR, Panagiotopoulos N. Biologic Agents in the Treatment of Multicentric Castleman Disease. Turk Thorac J 2018; 19:220-225. [PMID: 30455994 DOI: 10.5152/turkthoracj.2018.18066] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 08/07/2018] [Indexed: 01/09/2023]
Abstract
Multicentric Castleman disease (MCD) causes an extensive range of systematic symptoms and can be life-threatening if not treated promptly and appropriately. The pathophysiology of the disease remains unclear; however, interleukin 6 (IL-6) pathway and human herpesvirus 8 infection appear to play an important role. As a result, the treatment of MCD remains complex and often insufficient, although a plethora of therapeutic approaches have been used. Between these, biological agents in the form of monoclonal antibodies against specific pathogenic processes of the disease have improved survival rates significantly. In the present study, we review the clinical results of rituximab, which targets B lymphocytes, siltuximab and tocilizumab, which target the IL-6 pathway, bortezomib, which is a selective proteasome inhibitor, and anakinra, which is an interleukin 1 receptor antagonist. The introduction of these biological agents in the treatment of MCD appears to be promising in the first studies performed. However, more clinical trials are required to assess the efficacy and safety of each agent and to form therapeutic strategies that will be widely accepted.
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Affiliation(s)
- Konstantinos Kapriniotis
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Savvas Lampridis
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sofoklis Mitsos
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Davide Patrini
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - David R Lawrence
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Nikolaos Panagiotopoulos
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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17
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Gamie Z, Kapriniotis K, Papanikolaou D, Haagensen E, Da Conceicao Ribeiro R, Dalgarno K, Krippner-Heidenreich A, Gerrand C, Tsiridis E, Rankin KS. TNF-related apoptosis-inducing ligand (TRAIL) for bone sarcoma treatment: Pre-clinical and clinical data. Cancer Lett 2017; 409:66-80. [PMID: 28888998 DOI: 10.1016/j.canlet.2017.08.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 06/30/2017] [Revised: 08/24/2017] [Accepted: 08/28/2017] [Indexed: 01/25/2023]
Abstract
Bone sarcomas are rare, highly malignant mesenchymal tumours that affect teenagers and young adults, as well as older patients. Despite intensive, multimodal therapy, patients with bone sarcomas have poor 5-year survival, close to 50%, with lack of improvement over recent decades. TNF-related apoptosis-inducing ligand (TRAIL), a member of the tumour necrosis factor (TNF) ligand superfamily (TNFLSF), has been found to induce apoptosis in cancer cells while sparing nontransformed cells, and may therefore offer a promising new approach to treatment. We cover the existing preclinical and clinical evidence about the use of TRAIL and other death receptor agonists in bone sarcoma treatment. In vitro studies indicate that TRAIL and other death receptor agonists are generally potent against bone sarcoma cell lines. Ewing's sarcoma cell lines present the highest sensitivity, whereas osteosarcoma and chondrosarcoma cell lines are considered less sensitive. In vivo studies also demonstrate satisfactory results, especially in Ewing's sarcoma xenograft models. However, the few clinical trials in the literature show only low or moderate efficacy of TRAIL in treating bone sarcoma. Potential strategies to overcome the in vivo resistance reported include co-administration with other drugs and the potential to deliver TRAIL on the surface of primed mesenchymal or immune cells and the use of targeted single chain antibodies such as scFv-scTRAIL.
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Affiliation(s)
- Zakareya Gamie
- Northern Institute for Cancer Research, Paul O'Gorman Building, Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK.
| | - Konstantinos Kapriniotis
- Academic Orthopedic Department, "PapaGeorgiou" General Hospital, Thessaloniki, Greece; CORE-Center for Orthopedic Research at CIRI-AUTh, Aristotle University Medical School, Thessaloniki, Hellas, Greece.
| | - Dimitra Papanikolaou
- Academic Orthopedic Department, "PapaGeorgiou" General Hospital, Thessaloniki, Greece; CORE-Center for Orthopedic Research at CIRI-AUTh, Aristotle University Medical School, Thessaloniki, Hellas, Greece.
| | - Emma Haagensen
- Northern Institute for Cancer Research, Paul O'Gorman Building, Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK.
| | - Ricardo Da Conceicao Ribeiro
- School of Mechanical and Systems Engineering, Stephenson Building, Claremont Road, Newcastle Upon Tyne, NE1 7RU, UK.
| | - Kenneth Dalgarno
- School of Mechanical and Systems Engineering, Stephenson Building, Claremont Road, Newcastle Upon Tyne, NE1 7RU, UK.
| | - Anja Krippner-Heidenreich
- Northern Institute for Cancer Research, Paul O'Gorman Building, Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK.
| | - Craig Gerrand
- North of England Bone and Soft Tissue Tumour Service, Freeman Hospital, Freeman Road, Newcastle Upon Tyne, NE7 7DN, UK.
| | - Eleftherios Tsiridis
- Academic Orthopedic Department, "PapaGeorgiou" General Hospital, Thessaloniki, Greece; CORE-Center for Orthopedic Research at CIRI-AUTh, Aristotle University Medical School, Thessaloniki, Hellas, Greece; Secretary General European Hip Society, Austria.
| | - Kenneth Samora Rankin
- Northern Institute for Cancer Research, Paul O'Gorman Building, Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK.
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