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Marinopoulos S, Safioleas P, Skorda L, Vassilopoulou E, Zagouri F, Sotiropoulou M, Drakakis P, Dimitrakakis C. Breast lymphoma in a patient with B-cell Non Hodgkin Lymphoma: A case report study. Int J Surg Case Rep 2017; 40:1-5. [PMID: 28915427 PMCID: PMC5602741 DOI: 10.1016/j.ijscr.2017.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/03/2017] [Accepted: 09/03/2017] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Breast involvement in Non Hodgkin Lymphoma is a rare entity as it accounts for 2.2% of all extranodal lymphomas. PRESENTATION OF CASE A 59-year-old woman was referred to our Breast Unit because of two nodules of the right breast newly discovered during her annual mammography. Moreover, during the physical examination, a red-brown itchy lump of the scalp was discovered. The punch biopsies of the scalp lesion and ultrasound-guided core biopsies of both nodules of the right breast, revealed the presence of diffuse large B-cell Non Hodgkin Lymphoma in all tissue specimen sites. DISCUSSION Breast lymphomas represent an uncommon form of localized extranodal lymphomas that can be classified as Primary (PBL) or Secondary (SBL) breast lymphomas. CONCLUSION The value of preoperative diagnosis should be underlined as the patient avoids unnecessary surgical intervention and has earlier initiation of chemotherapy.
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Affiliation(s)
- Spyridon Marinopoulos
- Breast Unit, 1st Ob/Gyn Department, Athens University Medical School, "Alexandra" Hospital, Greece.
| | - Panagiotis Safioleas
- Breast Unit, 1st Ob/Gyn Department, Athens University Medical School, "Alexandra" Hospital, Greece
| | - Lamprini Skorda
- 1st Internal Medicine Clinic, Red Cross Hospital, Athens, Greece
| | - Eleni Vassilopoulou
- Breast Unit, 1st Ob/Gyn Department, Athens University Medical School, "Alexandra" Hospital, Greece
| | - Flora Zagouri
- Therapeutic Clinic, Athens University Medical School, "Alexandra" Hospital, Greece
| | | | - Peter Drakakis
- Breast Unit, 1st Ob/Gyn Department, Athens University Medical School, "Alexandra" Hospital, Greece
| | - Constantine Dimitrakakis
- Breast Unit, 1st Ob/Gyn Department, Athens University Medical School, "Alexandra" Hospital, Greece
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Papakonstantinou E, Yfantis E, Theofani A, Skourbouti A, Georgutsu P, Safioleas P, Sereti C, Manti C. C0259 Thrombin generation and conventional coagulation markers in patients with hypercoagulable state due to low PT and/or APTT. Thromb Res 2012. [DOI: 10.1016/j.thromres.2012.08.111] [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]
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Mastoraki S, Mastoraki A, Lefantzis N, Safioleas P, Sakorafas G, Safioleas M. Controversies and challenging therapeutic modalities in gastric cancer. Indian J Surg 2012; 73:251-5. [PMID: 22851836 DOI: 10.1007/s12262-011-0285-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 01/15/2011] [Indexed: 11/29/2022] Open
Abstract
Gastric cancer is still the fourth common neoplasm worldwide. Gastric ulcers, adenomatous polyps, and intestinal metaplasia have been associated with an increased relative risk. Tissue diagnosis and anatomic localization of the primary tumor are best obtained by upper gastrointestinal endoscopy. Despite new screening techniques peritoneal tumor spread and occult liver and lymph node metastases are only detected intra-operatively. Therapy is becoming more and more complex comprising surgical resection, investigational neoadjuvant, adjuvant or palliative chemotherapy, or supportive care. Complete surgical eradication of a tumor with resection of adjacent lymph nodes represents the best chance for long-term survival. The choice of operation depends upon the location of the tumor, the clinical stage, and the histologic type. Chemotherapy can provide symptom palliation, improve quality of life, and prolong survival in patients with advanced gastric cancer. Preoperative radiation therapy may allow for tumor downstaging and reduced probability of residual microscopic disease at surgery.
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Zagouri F, Gounaris A, Liakou P, Chrysikos D, Flessas I, Bletsa G, Giannakopoulou G, Michalopoulos NV, Safioleas P, Zografos GC, Sergentanis TN. Vacuum-assisted breast biopsy: more cores, more hematomas? In Vivo 2011; 25:703-705. [PMID: 21709018] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Vacuum-assisted breast biopsy (VABB) is used for the diagnosis of non-palpable breast lesions. Hematoma has been recognized as the main complication of the procedure. Its main disadvantage is the underestimation rate. Generally speaking, approximately up to 24 cores are excised in most published series. It has been suggested that excision of more cores per lesion can reduce the underestimation rate. The present study aims to evaluate hematoma formation with regard to the number of cores excised. PATIENTS AND METHODS A total of 660 women underwent VABB; 232 women were allocated to the standard protocol (24-36 cores excised, 2-3 offsets) and 428 women were allocated to the extended protocol (96 cores excised, 8 offsets). Cases were derived from a double blind study, as well as from the periods before (standard protocol) and after (mainly extended protocol) the study. In all cases, the occurrence of organized hematomas within the subsequent 20 days was followed up by ultrasound. RESULTS In the standard protocol, the frequency of clinically significant and subsequently organized hematomas was 3.5%. However, in the extended protocol the respective hematoma percentage was 7.5%. Clinically significant and subsequently organized hematomas were significantly more frequent in the extended protocol (Pearson's chi-squared=4.29, p=0.038). CONCLUSION Despite the superiority of the extended protocol in terms of underestimation, the approximately two-fold increase in hematoma occurrence prompts the need for careful patient selection prior to its performance.
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Affiliation(s)
- Flora Zagouri
- Breast Unit, First Department of Propaedeutic Surgery, Hippokratio Hospital, University of Athens, Greece
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Zagouri F, Sergentanis T, Nonni A, Papadimitriou C, Pazaiti A, Michalopoulos NV, Safioleas P, Lazaris A, Theodoropoulos G, Patsouris E, Zografos G. Decreased Hsp90 expression in infiltrative lobular carcinoma: an immunohistochemical study. BMC Cancer 2010; 10:409. [PMID: 20691061 PMCID: PMC2925828 DOI: 10.1186/1471-2407-10-409] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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] [Received: 11/13/2009] [Accepted: 08/06/2010] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Elevated Hsp90 expression has been documented in breast ductal carcinomas, whereas decreased Hsp90 expression has been reported in precursor lobular lesions. This study aims to assess Hsp90 expression in infiltrative lobular carcinomas of the breast. METHODS Tissue specimens were taken from 32 patients with infiltrative lobular carcinoma. Immunohistochemical assessment of Hsp90 was performed both in the lesion and the adjacent normal breast ducts and lobules; the latter serving as control. Concerning Hsp90 assessment: i) the percentage of positive cells and ii) the intensity were separately analyzed. Subsequently, the Allred score was adopted and calculated. The intensity was treated as an ordinal variable-score (0: negative, low: 1, moderate: 2, high: 3). Statistical analysis followed. RESULTS All infiltrative lobular carcinoma foci mainly presented with a positive cytoplasmic immunoreaction for Hsp90. Compared to the adjacent normal ducts and lobules, infiltrative lobular carcinoma exhibited a statistically significant decrease in Hsp90 expression, both in terms of Hsp90 positive cells (%) and Allred score (74.2 +/- 11.2 vs. 59.1 +/- 14.2 p = 0.0001; 7.00 +/- 0.95 vs. 6.22 +/- 1.01, p = 0.007, Wilcoxon matched-pairs signed-ranks test). Concerning the intensity of Hsp90 immunostaining only a marginal decrease was noted (2.16 +/- 0.68 vs. 1.84 +/- 0.63, p = 0.087, Wilcoxon matched-pairs signed-ranks test). CONCLUSION ILC lesions seem to exhibit decreased Hsp90 expression, a finding contrary to what might have been expected, given that high Hsp90 expression is a trait of invasive ductal carcinomas.
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Affiliation(s)
- Flora Zagouri
- Breast Unit, 1stDepartment of Propaedeutic Surgery, Hippokratio Hospital, School of Medicine, University of Athens, Athens, Greece
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Stamatakos M, Douzinas E, Stefanaki C, Safioleas P, Polyzou E, Levidou G, Safioleas M. Gastrointestinal stromal tumor. World J Surg Oncol 2009. [DOI: https:/doi.org/10.1186/1477-7819-7-61] [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: 03/05/2023] Open
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Stamatakos M, Safioleas C, Tsaknaki S, Safioleas P, Iannescu R, Safioleas M. Insulinoma: a rare neuroendocrine pancreatic tumor. Chirurgia (Bucur) 2009; 104:669-673. [PMID: 20187464] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Insulinomas are functional endocrine tumors originating from the pancreatic b-cells. In 1902 Nicholls described the first adenoma of pancreatic islets, while the first insulinoma was described in 1927 in Mayo Clinic, which was dissected two years later in 1929 in Toronto. The first enucleation of insulinoma took place in a St. Jouis hospital in 1931, and after four years, in 1935, Whipple described the classic diagnostic triad: symptoms of fasting hypoglycemia or fatigue, blood glucose levels under 50 mg/dl and disappearance of symptoms after glucose administration.
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Affiliation(s)
- M Stamatakos
- 4h Department of Surgery, University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece.
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Stamatakos M, Kontzoglou K, Safioleas P, Safioleas C, Manti C, Safioleas M. Breast cancer incidence in Greek women in relation to ABO blood groups and Rh factor. Int Semin Surg Oncol 2009; 6:14. [PMID: 19689811 PMCID: PMC2741482 DOI: 10.1186/1477-7800-6-14] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Accepted: 08/18/2009] [Indexed: 11/10/2022]
Abstract
Aim To investigate the correlation between breast cancer in Greek women and ABO blood groups. Material-methods In 166 female patients with breast cancer factors such as blood group, histological type, family history, presence or absence of nodal and/or distant metastases were examined. These patients had similar demographic, clinical, surgical, immunohistochemical, laboratory, and follow-up data and this group is representative of general population of women in Greece. Results The ductal type of breast cancer was differentially distributed in blood groups Rh (+) (P ≤ 0.001). In patients with A (+) blood group the ductal type of breast cancer was present in 49.6% of cases, in relation to the other blood groups and in AB blood group the same type occurred rarely (3.6%). Rh (+) women with positive family history were more often found in A blood group. The relative risk of metastasis in Rh (-) patients was 4.2 times higher than that in Rh (+) patients. Among Rh (+) patients, the relative risk of metastasis was 1.29 times higher in A blood group than in other blood groups. Conclusion Blood group A is often associated with ductal breast cancer (49.6%), in contrast to the other blood groups and particularly to blood group AB (3.6%). Blood group A and, particularly, A (-) has the worst prognosis of all.
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Affiliation(s)
- Michael Stamatakos
- 2nd Department of Propaedeutic Surgery, University of Athens, School of Medicine, LAIKO General Hospital, Athens, Greece.
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Stamatakos M, Kontzoglou K, Safioleas P, Safioleas C, Manti C, Safioleas M. Breast cancer incidence in Greek women in relation to ABO blood groups and Rh factor. Int Semin Surg Oncol 2009. [PMID: 19689811 DOI: 10.1186/1447-7800-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM To investigate the correlation between breast cancer in Greek women and ABO blood groups. MATERIAL-METHODS In 166 female patients with breast cancer factors such as blood group, histological type, family history, presence or absence of nodal and/or distant metastases were examined. These patients had similar demographic, clinical, surgical, immunohistochemical, laboratory, and follow-up data and this group is representative of general population of women in Greece. RESULTS The ductal type of breast cancer was differentially distributed in blood groups Rh (+) (P </= 0.001). In patients with A (+) blood group the ductal type of breast cancer was present in 49.6% of cases, in relation to the other blood groups and in AB blood group the same type occurred rarely (3.6%). Rh (+) women with positive family history were more often found in A blood group. The relative risk of metastasis in Rh (-) patients was 4.2 times higher than that in Rh (+) patients. Among Rh (+) patients, the relative risk of metastasis was 1.29 times higher in A blood group than in other blood groups. CONCLUSION Blood group A is often associated with ductal breast cancer (49.6%), in contrast to the other blood groups and particularly to blood group AB (3.6%). Blood group A and, particularly, A (-) has the worst prognosis of all.
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Affiliation(s)
- Michael Stamatakos
- 2nd Department of Propaedeutic Surgery, University of Athens, School of Medicine, LAIKO General Hospital, Athens, Greece.
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Stamatakos M, Douzinas E, Stefanaki C, Safioleas P, Polyzou E, Levidou G, Safioleas M. Gastrointestinal stromal tumor. World J Surg Oncol 2009; 7:61. [PMID: 19646278 PMCID: PMC2749031 DOI: 10.1186/1477-7819-7-61] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 08/01/2009] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND GISTs are a subset of mesenchymal tumors and represent the most common mesenchymal neoplasms of GI tract. However, GIST is a recently recognized tumor entity and the literature on these stromal tumors has rapidly expanded. METHODS An extensive review of the literature was carried out in both online medical journals and through Athens University Medical library. An extensive literature search for papers published up to 2009 was performed, using as key words, GIST, Cajal's cells, treatment, Imatinib, KIT, review of each study were conducted, and data were abstracted. RESULTS GIST has recently been suggested that is originated from the multipotential mesenchymal stem cells. It is estimated that the incidence of GIST is approximately 10-20 per million people, per year. CONCLUSION The clinical presentation of GIST is variable but the most usual symptoms include the presence of a mass or bleeding. Surgical resection of the local disease is the mainstay therapy. However, therapeutic agents, such as Imatinib have now been approved for the treatment of advanced GISTs and others, such as everolimus, rapamycin, heat shock protein 90 and IGF are in trial stage demonstrate promising results for the management of GISTs.
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Affiliation(s)
- Michael Stamatakos
- 4th Department of Surgery, University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece
| | - Emmanouel Douzinas
- 3rd Department of Critical Care, Athens University, Eugenidion Hospital, Athens, Greece
| | - Charikleia Stefanaki
- 4th Department of Surgery, University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece
| | - Panagiotis Safioleas
- 4th Department of Surgery, University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece
| | - Electra Polyzou
- 4th Department of Surgery, University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece
| | - Georgia Levidou
- Department of Pathology, School of Medicine, University of Athens, Greece
| | - Michael Safioleas
- 4th Department of Surgery, University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece
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Stamatakos M, Stefanaki C, Tsaknaki S, Safioleas P, Iannescu R, Safioleas M. Primary adenocarcinoma of the appendix: an update. Chirurgia (Bucur) 2009; 104:389-392. [PMID: 19886044] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Adenocarcinoid arising in the vermiform appendix is a rarity. The diagnosis of appendiceal adenocarcinoma has never been made preoperatively and is frequently an incidental finding at the time of operation for unrelated conditions. Because of the rarity of the disease, its natural history is poorly understood. Benefits from adjuvant radiation, chemotherapy, or a combination have not been reported. Most studies emphasize survival outcome based on surgical technique. There are few data and, consequently, much debate on the appropriate management of these lesions. The aim of this article is to review this entity and to assess and report new data, through a study of the literature.
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Affiliation(s)
- M Stamatakos
- 4th Surgical Department of Surgery, University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece.
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Stamatakos M, Sargedi C, Angelousi A, Kontzoglou K, Safioleas P, Petropoulou C, Safioleas M. Management of the rare entity of primary pancreatic cystic neoplasms. J Gastroenterol Hepatol 2009; 24:1203-10. [PMID: 19467142 DOI: 10.1111/j.1440-1746.2009.05855.x] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Primary cystic neoplasms of the pancreas constitute a rare entity and are composed of a variety of neoplasms with a wide range of malignant potential. Approximately 90% of these lesions are serous cystic neoplasms or mucin-producing neoplasms. In contrast to serous cystadenomas which are nearly always benign, the mucinous cystic neoplasms represent a more diverse, heterogeneous spectrum of related neoplasms. Intraductal papillary mucinous neoplasms manifest a much greater latent or overt malignant potential than other cystic neoplasms of the pancreas. The various subgroups of cystic neoplasms of the pancreas are evaluated and compared through a review of current literature. No symptoms or signs are pathognomonic for the cystic pancreatic neoplasms. While identification of a cystic tumor is relatively easy, the identification of the specific tumor type may be difficult. Most investigators agree that accurate differentiation of benign from malignant neoplasms can be made only at histopathologic examination of the entire resected segment of the pancreas. Because of the low mortality and low postoperative morbidity, surgical resection is indicated in all patients with cystic tumors.
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Affiliation(s)
- Michael Stamatakos
- 4th Department of Surgery, Medical School, University of Athens, Attikon Hospital, Athens, Greece.
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Stamatakos M, Stefanaki C, Mastrokalos D, Arampatzi H, Safioleas P, Chatziconstantinou C, Xiromeritis C, Safioleas M. Mesenteric ischemia: still a deadly puzzle for the medical community. TOHOKU J EXP MED 2009; 216:197-204. [PMID: 18987453 DOI: 10.1620/tjem.216.197] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The main goal of this article is to update etiology, epidemiology, diagnosis, treatment and outcome of the various causes of mesenteric ischemia in order to elucidate its labyrinthine clinical riddle, by reviewing the current English medical literature. Mesenteric ischemia is a quite uncommon disorder, observed in the emergency department. It is a life-threatening vascular emergency that requires early diagnosis and intervention to restore mesenteric blood flow and to prevent bowel necrosis and patient death. Consequently, it is a vital diagnosis to make because of its high mortality rate and its thorny complications. The underlying causes vary, and the prognosis depends on the specific findings during clinical examination. Vague and nonspecific clinical findings and limitations of diagnostic studies make the diagnosis a significant challenge. The prognosis of acute mesenteric ischemia of any type is grave. The complications following this medical jigsaw puzzle are also severe. Patients in whom the diagnosis is missed until infarction occurs have a mortality rate of 90%. Even with good treatment, up to 50-80% of patients die. Survivors of extensive bowel resection face lifelong disability. Despite the progress in understanding the pathogenesis of mesenteric ischemia and the development of treatment modalities, the entity remains a diagnostic challenge for clinicians. Delay in diagnosis contributes to a high mortality rate. Early diagnosis and adequate treatment can improve the clinical outcome. Even if diagnostic modalities have improved since the first successful attempts to confront effectively this clinical entity, mesenteric ischemia still remains a lethal diagnostic enigma for the medical community.
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Affiliation(s)
- Michael Stamatakos
- Second Department of Propaedeutic Surgery, Medical School, University of Athens, Laiko General Hospital, Athens, Greece.
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Stamatakos M, Zervas A, Sargeti C, Tsaknaki S, Iannescu R, Safioleas P, Safioleas M. Hydatid disease of the urinary tract: an update. Chirurgia (Bucur) 2008; 103:621-627. [PMID: 19274905] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Hydatid disease constitutes an endemic zoonosis caused by different species of the cestode Echinococcus. The main organs affected are the liver and the lungs. Echinococcosis of the urinary tract is an extremely rare medical condition, met in 2-4% of cases. This pathologic entity has to be included in the differential diagnosis of occupying lesions of the urinary tract at any age, especially among patients in endemic areas. Meticulous laboratory and imaging control when taking into consideration the suspicion for the disease, can guarantee an accurate diagnosis and successful outcome.
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Affiliation(s)
- M Stamatakos
- 2nd Department of Propaedeutic Surgery, University of Athens, School of Medicine, Laiko General Hospital, Athens, Greece.
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Safioleas M, Stamatakos M, Safioleas P, Diab A, Iannescu R, Safioleas C. Superficial parotidectomy under local anaesthesia. Chirurgia (Bucur) 2008; 103:453-454. [PMID: 18780619] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The modern tendency of surgery is to perform a constantly rising number of operations under local anaesthesia. Superficial parotidectomy under local anaesthesia has not been widely attempted. However only few reports show that this kind of procedure could be feasible. If this is the case, standard assessment of benign parotid tumors will change radically.
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Affiliation(s)
- M Safioleas
- 2nd Department of Propaedeutic Surgery, University of Athens, School of Medicine, Laiko General Hospital, Athens, Greece.
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Safioleas M, Stamatakos M, Safioleas P, Smyrnis A, Revenas C, Safioleas C. Mirizzi Syndrome: an unexpected problem of cholelithiasis. Our experience with 27 cases. Int Semin Surg Oncol 2008; 5:12. [PMID: 18495037 PMCID: PMC2413250 DOI: 10.1186/1477-7800-5-12] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Accepted: 05/21/2008] [Indexed: 12/16/2022]
Abstract
PURPOSE Mirizzi syndrome is a rare complication of long standing cholelithiasis. The purpose of this study is to retrospectively estimate the diagnostic and treatment methods applied in patients with Mirizzi syndrome. MATERIALS AND METHODS Our experience with 27 cases with Mirizzi syndrome is presented. They were diagnosed either by imaging techniques, or during surgical operation. All of the patients were managed surgically. RESULTS 8 patients were diagnosed preoperatively and the rest intraoperatively. Morbidity rate after surgery was 18,5%, and mortality rate was zero. The patients presented free of symptoms three months after surgery during the follow-up. CONCLUSION Mirizzi syndrome is rarely diagnosed preoperatively and US proved inadequate for this purpose. Surgery is the only therapy and usually provides additionally definitive diagnosis.
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Affiliation(s)
- Michael Safioleas
- 2nd Department of Propaedeutic Surgery, Medical School, University of Athens, Laiko General Hospital, Athens, Greece.
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Safioleas M, Stamatakos M, Spyrakos C, Safioleas P, Chatzikonstantinou C, Iannescu R, Safioleas C. Evaluation and surgical management of the gallstone ileus. A single center experience. Chirurgia (Bucur) 2008; 103:297-300. [PMID: 18717278] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Gallstone ileus representing 1-4% of all bowel obstructions cholelithiasis. Impaction of a gallstone in the human of the bowel is a surgical emergency. Relief of the obstruction is the treatment of choice, but controversy exists regarding the repair of the fistula and cholecystectomy. Our experience in the management of gallstone ileus is presented in the following article.
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Affiliation(s)
- M Safioleas
- 2nd Department of Propedeutic Surgery, University of Athens, School of Medicine, Laiko General Hospital, Athens, Greece
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Safioleas M, Stamatakos M, Safioleas P, Diab A, Karanikola E, Safioleas C. Short bowel syndrome: amelioration of diarrhea after vagotomy and pyloroplasty for peptic hemorrhage. TOHOKU J EXP MED 2008; 214:7-10. [PMID: 18212482 DOI: 10.1620/tjem.214.7] [Citation(s) in RCA: 5] [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: 02/03/2023]
Abstract
Acute mesenteric ischemia is a rare symptomatic manifestation of arteriosclerosis. Prognosis crucially depends on rapid diagnosis and surgical management to prevent or at least minimize the bowel infarction. The length of the small bowel is considered to be between 3 and 8 m, and a normal bowel function can be maintained even after resection of its one third. But loss of a major part (> 60%) can lead to malnutrition and death. However, patients, who survived an extended intestinal resection due to improved postoperative care (intensive care unit and parenteral nutrition), develop short bowel syndrome. This phenomenon is a medical problem, and several surgical techniques have been used to slow down intestinal transit time or to increase the area of absorption. All these procedures have controversial outcomes and are still on different experimental levels; namely, they cannot be recommended for routine use. In our report of a patient suffering from short bowel syndrome, vagotomy and pyloroplasty were performed to repair a sudden peptic hemorrhage. This operation cured bleeding peptic ulcer and also palliated the diarrhea, a main clinical manifestation of short bowel syndrome. In this study, our aim is to emphasize the favorable clinical outcome of vagotomy concerning a principal manifestation of short bowel syndrome, such as diarrhea. To the best of our knowledge, the present study is the first report showing the vagotomy as a possible procedure for the treatment of diarrhea, although this occurrence has no clear explanation. We also discuss the management of short bowel syndrome.
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Affiliation(s)
- Michael Safioleas
- Second Department of Propaedeutic Surgery, Medical School, University of Athens, Laiko General Hospital, Athens, Greece
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Safioleas M, Safioleas P, Stamatakos M, Safioleas C. Retroperitoneal fibrosis obstructing the ureter: a new technique to prevent stenosis recurrence. Surgery 2008; 143:299-300. [PMID: 18242349 DOI: 10.1016/j.surg.2007.09.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2007] [Accepted: 09/18/2007] [Indexed: 10/22/2022]
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20
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Safioleas M, Stamatakos M, Safioleas C, Iannescu R, Safioleas P, Mantas D. Adrenal rupture after blunt abdominal trauma. Chirurgia (Bucur) 2008; 103:107-109. [PMID: 18459507] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The case of a patient, victim of a car accident, with rupture of the left adrenal gland associated with splenic rupture and liver laceration is reported. Injury of the adrenal glands is most frequently caused by blunt abdominal trauma and is usually associated with injuries of other abdominal organs. Careful exploration of the upper retroperitoneal space where adrenals are located is considered necessary during laparotomy for severe blunt abdominal trauma. If adrenal lesion has been overlooked continuous hemorrhage may occur, which could be lethal if not promptly treated.
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Affiliation(s)
- M Safioleas
- 2nd Department of Propedeutic Surgery, University of Athens, School of Medicine, Laiko General Hospital, Athens, Greece
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21
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Safioleas M, Nikiteas N, Stamatakos M, Safioleas C, Manti CH, Revenas C, Safioleas P. Echinococcal cyst of the subcutaneous tissue: a rare case report. Parasitol Int 2007; 57:236-8. [PMID: 18203655 DOI: 10.1016/j.parint.2007.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Revised: 11/05/2007] [Accepted: 11/09/2007] [Indexed: 10/22/2022]
Abstract
Hydatid disease is an endemic zoonosis caused by the cestode Echinococcus granulosus. The most common affected organs are the liver and the lungs. Echinococcal cyst located in the subcutaneous tissue constitutes an extremely rare manifestation of the hydatid disease. Here we present a case report with a cystic mass in the subcutaneous tissue of the left gluteal area, diagnosed as being a hydatid cyst.
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Affiliation(s)
- M Safioleas
- 2nd Department of Propaedeutic Surgery, School of Medicine, Athens University, Laiko General Hospital, 7 Kyprou Ave, 15237, Filothei, Athens, Greece
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22
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Stamatakos M, Tsaknaki S, Iannescu R, Stathellis A, Safioleas P, Rompoti N, Safioleas M. Abdominal compartment syndrome: effects on organ function. Chirurgia (Bucur) 2007; 102:633-640. [PMID: 18323225] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Abdominal compartment syndrome (ACS) constitutes a critical clinical situation presenting a remarkable incidence being the causal factor of variable abdominal and extra-abdominal pathology, thus a rising issue of interest in intensive medical care over the past decade. Moreover, ACS as a condition potentially leading to Multiple Organ Failure (MOF), its better understanding could provide more effective management resulting to limitation of MOF incidence and mortality.
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Affiliation(s)
- M Stamatakos
- 2nd Department of Propaedeutic Surgery, University of Athens, School of Medicine, Laiko General Hospital, Athens, Greece.
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23
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Safioleas M, Stamatakos M, Giaslakiotis K, Smirnis A, Safioleas P. Acute abdomen due to primary omentitis: a case report. Int Semin Surg Oncol 2007; 4:19. [PMID: 17655767 PMCID: PMC1948008 DOI: 10.1186/1477-7800-4-19] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Accepted: 07/26/2007] [Indexed: 11/10/2022]
Abstract
Background Idiopathic segmental infarction of the greater omentum (ISIGO) is an uncommon cause of acute abdomen in children and adults and its etiology is rather vague and speculative. The clinical presentation is usually with atypical acute or subacute abdominal pain. In a number of cases radiologic imaging allows proper preoperative diagnosis and treatment. Case presentation We report a case of ISIGO in a 31 year old patient, who presented with acute abdominal pain, nausea, vomiting and leukocytosis. Radiologic investigation was non-specific. The patient underwent surgical resection of the infracted omentum with compete recovery. Conclusion ISIGO should be considered in the differential of acute abdomen especially when presentation is atypical and all other causes have been excluded. In cases with non-specific radiologic findings, laparotomy is necessary for proper diagnosis and treatment. Surgical resection of the infracted omentum results in uneventful recovery in the majority of cases.
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Affiliation(s)
- Michael Safioleas
- 2nd Department of Propedeutic Surgery, School of Medicine, Athens University, Laiko General Hospital, Greece
| | - Michael Stamatakos
- 2nd Department of Propedeutic Surgery, School of Medicine, Athens University, Laiko General Hospital, Greece
| | | | - Anastasios Smirnis
- 2nd Department of Propedeutic Surgery, School of Medicine, Athens University, Laiko General Hospital, Greece
| | - Panagiotis Safioleas
- 2nd Department of Propedeutic Surgery, School of Medicine, Athens University, Laiko General Hospital, Greece
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Safioleas M, Stamatakos M, Moulakakis K, Safioleas P, Skandalakis P. Spigelian hernia. A rare case of bilateral hernia and presentation of our experience. Chirurgia (Bucur) 2007; 102:429-432. [PMID: 17966940] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Spigelian hernia is a relatively rare defect of the abdominal wall. Due to its unspecific and variable clinical presentation, presents a difficult diagnostic challenge. We present a rare case of bilateral Spigelian hernia that was diagnosed and successfully treated with open surgery and hernioplasty. Also we present our experience in management of the disease. In our department the last fifteen years, 12 cases of Spigelian hernia have been treated surgically, using direct reconstruction with excellent results.
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Affiliation(s)
- M Safioleas
- 2nd Propaedeutic Surgical Department of University of Athens, Laiko Hospital, Greece
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25
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Giannopoulou P, Kyratsa A, Graphakos I, Kontekaki E, Chondrothanassi A, Safioleas P, Zambou K, Trikka-Graphakos E. R2211 Gram-positive anaerobic bacteria: frequency of isolation and antimicrobial resistance pattern. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)72050-2] [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: 10/23/2022]
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Safioleas M, Chatziconstantinou C, Felekouras E, Stamatakos M, Papaconstantinou I, Smirnis A, Safioleas P, Kostakis A. Clinical considerations and therapeutic strategy for sigmoid volvulus in the elderly: A study of 33 cases. World J Gastroenterol 2007; 13:921-4. [PMID: 17352024 PMCID: PMC4065930 DOI: 10.3748/wjg.v13.i6.921] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate different types of treatment for sigmoid volvulus and clarify the role of endoscopic intervention versus surgery.
METHODS: A retrospective review of the clinical presentation and imaging characteristics of 33 sigmoid volvulus patients was presented, as well as their diagnosis and treatment, in combination with a literature review.
RESULTS: In 26 patients endoscopic detorsion was achieved after the first attempt and one patient died because of uncontrollable sepsis despite prompt operative treatment. Seven patients had unsuccessful endoscopic derotation and were operated on. On two patients with gangrenous sigmoid, Hartmann’s procedure was performed. In five patients with viable colon, a sigmoid resection and primary anastomosis was carried out. Three patients had a lavage “on table” prior to anastomosis, while in the remaining 2 patients a diverting stoma was performed according to the procedure of the first author. Ten patients were operated on during their first hospital stay (3 to 8 d after the deflation). All patients had viable colon; 7 patients had a sigmoid resection and primary anastomosis, 2 patients had sigmoidopexy and one patient underwent a near-total colectomy. Two patients (sigmoidectomy-sigmoidopexy) had recurrences of volvulus 43 and 28 mo after the initial surgery. Among 15 patients who were discharged from the hospital after non-operative deflation, 3 patients were lost to follow-up. Of the remaining 12 patients, 5 had a recurrence of volvulus at a time in between 23 d and 14 mo. All the five patients had been operated on and in four a gangrenous sigmoid was found. Three patients died during the 30 d postoperative course. The remaining seven patients were admitted to our department for elective surgery. In these patients, 2 subtotal colectomies, 3 sigmoid resections and 2 sigmoidopexies were carried out. One patient with subtotal colectomy died. Taken together of the results, it is evident that after 17 elective operations we had only one death (5.9%), whereas after 15 emergency operations 6 patients died, which means a mortality rate of 40%.
CONCLUSION: Although sigmoid volvulus causing intestinal obstruction is frequently successfully encountered by endoscopic decompression, however, the principal therapy of this condition is surgery. Only occasionally in patients with advanced age, lack of bowel symptoms and multiple co-morbidities might surgical repair not be considered.
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Affiliation(s)
- Michael Safioleas
- 2nd Department of Propedeutic Surgery, School of Medicine, Athens University, Laiko Hospital, 7 Kyprou Ave, Filothei, Athens 15237, Greece.
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Safioleas M, Stamatakos M, Safioleas C, Safioleas P. Choledochoduodenal anastomosis: a technical tip to ensure the impermeability of the anastomosis. Chirurgia (Bucur) 2007; 102:107-8. [PMID: 17410741] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
In 1891 O. Sprengel described a successful side-to-side choledochoduodenostomy and since then this has been a method frequently used in dealing with the problem of constriction of the lower third-portion of the bile duct, due to malignant or benign causes. Taking in consideration that the first choledochoduodenostomy was performed by H. Riedel in 1888 and the patient died 9 hours after surgery due to leakage of the anastomosis (disclosed in autopsy), it is evident to conclude that hermetic anastomosis is the main factor for fast and uncomplicated recovery of the patient. In order to ensure intraoperatively a hermetic "bile-proof" anastomosis, we have applied a technical tip, which has been proved to be efficient.
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Affiliation(s)
- M Safioleas
- 2nd Department of Propedeutic Surgery, University of Athens, School of Medicine, Laiko General Hospital, Athens, Greece.
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Safioleas M, Agapitos E, Kontzoglou K, Stamatakos M, Safioleas P, Mouzopoulos G, Kostakis A. Primary melanoma of the gallbladder: Does it exist? Report of a case and review of the literature. World J Gastroenterol 2006; 12:4259-61. [PMID: 16830389 PMCID: PMC4087388 DOI: 10.3748/wjg.v12.i26.4259] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
With the occasion of a case of malignant melanoma of the gallbladder, which appeared to be primary, we have reviewed the literature and the result of this research was that primary melanoma of the gallbladder remains a questionable medical entity. Only few cases of both primary and metastatic gallbladder melanoma have been reported so far, and the only agreement is that surgery is the mainstay treatment. The role of adjuvant chemotherapy, hormonotherapy or immunotherapy for both primary and metastatic disease remains undefined.
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Affiliation(s)
- Michail Safioleas
- Department of Propedeutic Surgery, School of Medicine, Athens University, Laiko Hospital, Greece.
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