Our local experience with the surgical treatment of ampullary cancer

BACKGROUND: The aim of this study is to report the outcome after surgical treatment of 32 patients with ampullary cancers from 1990 to 1999. METHODS: Twenty-one of them underwent pancreaticoduodenectomy and 9 local excision of the ampullary lesion. The remaining 2 patients underwent palliative surgery. RESULTS: When the final histological diagnosis was compared with the preoperative histological finding on biopsy, accurate diagnosis was preoperatively established in 24 patients. The hospital morbidity was 18.8% as 9 complications occurred in 6 patients. Following local excision of the ampullary cancer, the survival rate at 3 and 5 years was 77.7% and 33.3% respectively. Among the patients that underwent Whipple's procedure, the 3-year survival rate was 76.2% and the 5-year survival rate 62%. CONCLUSION: In this series, local resection was a safe option in patients with significant co-morbidity or small ampullary tumors less than 2 cm in size, and was associated with satisfactory long-term survival rates

Cement production with the use of greek fly and bottom ashes, and study of its properties

77 σ.Αντικείμενο της παρούσας διπλωματικής εργασίας είναι η παρασκευή τσιμέντου Portland με αντικατάσταση μέρους των πρώτων υλών που χρησιμοποιούνται παραδοσιακά με ποσοστό ελληνικών τεφρών (ιπτάμενων και υγρών) και η μελέτη των μηχανικών ;ιδιοτήτων του. Η μελέτη αξιοποίησης του συγκεκριμένου παραπροϊόντος θεωρήθηκε απαραίτητη καθώς στην Ελλάδα υπάρχουν τεράστιες ποσότητες που παραμένουν ανεκμετάλλευτες και επιβαρύνουν το περιβάλλον. Για την πραγματοποίηση των πειραματικών διαδικασιών χρησιμοποιήθηκαν ΙΤ (ιπτάμενες τέφρες) από δύο ενεργειακούς σταθμούς, Καρδιάς και Μεγαλόπολης καθώς και ΥΤ (υγρή τέφρα) Μεγαλόπολης. Τα τσιμέντα που παράχθηκαν είχαν το μέγιστο δυνατό ποσοστό υποκατάστασης από αυτές τις τέφρες και μελετήθηκαν οι αντοχές τους στις 2,7 και 28 μέρες καθώς και η πορεία ενυδάτωσης τους σε 2,7,28 και 90 μέρες. Στο θεωρητικό μέρος αντιμετωπίζονται: i) η πορεία παραγωγής του τσιμέντου με ιδιαίτερη έμφαση στην έψηση, ii) τα είδη τσιμέντου που υπάρχουν, iii) οι πρώτες ύλες στην βιομηχανία του τσιμέντου (παραδοσιακές και εναλλακτικές) και iv) οι χρήσεις και οι υπάρχουσες έρευνες για την αξιοποίηση των ιπτάμενων και υγρών τεφρών τόσο σε παγκόσμιο όσο και σε εθνικό επίπεδο. Στο πλαίσιο του πειραματικού μέρους σταδιακά αντιμετωπίζονται: i) ο χαρακτηρισμός των πρώτων υλών και των τεφρών με διάφορες μεθόδους (XRF, XRD, TG), ii) η σύνθεση των φαρινών, iii) η επιλογή της θερμοκρασίας έψησης iv) οι αντοχές των παραγόμενων τσιμέντων και v) η μελέτη ενυδάτωσης τους με XRD και TG-DTG . Συμπερασματικά οι ελληνικές τέφρες μπορούν να υποκαταστήσουν παραδοσιακές πρώτες ύλες για την παρασκευή τσιμέντου με ενεργειακά οφέλη και βελτίωση των ιδιοτήτων των παραγόμενων προϊόντων.The purpose of this thesis is to manufacture cement using Greek fly and bottom ashes as raw materials and study its properties. The study was necessary as in Greece there is a large quantity of fly and bottom ashes that remain indisposed. To carry out the experimental procedures two kinds of fly ash was used from two power stations (Kardia, Megalopoli) and one kind of bottom ash (Megalopoli). The cement that was produced had the maximum possible rate of substitution of each ash. The compressive strength was studied at 2,7 and 28 days as well as the progress of hydration at 2,7,28 and 90 days after the cement production with XRD and TG-DTG.Δημήτριος Β. Μπότσιο

Weil's disease and abdominal compartment syndrome

Purpose: To report a rare complication of Weil’s disease.Report of case: A 47-years-old man was referred to ICU of our hospital in shock. The clinical findings and the serological tests established the diagnosis of Weil’s disease. After the patient became haemodynamic stable, underwent a cholecystectomy for acute acalculous cholecystitis, while ten days later he developed abdominal compartment syndrome (ACS). The later, was successfully managed surgically, with decompression laparotomy, placement of a 3 lit TPN (Total Parenteral Nutrition) bag to cover the viscera and gradual closure of the abdomen by tying the tension sutures each time more tight. The patient returned home after two months of hospitalization, in a good general condition.Conclusion: Patients with Weil’s disease seem to be susceptible to the development of ACS. The clinicians must be always suspicious for the possibility of its occurrence, in order to have an early diagnosis and a therapeutic surgical intervention

The effect of glutamine and synbiotics on the healing of colonic anastomosis

Introduction: Intestinal wound healing is an essential process for surgical reconstruction of the digestive tract. The purpose of this study is to evaluate the effect of perioperative administration of glutamine and synbiotics on the biological behavior of intestinal mucosal barrier and the healing of colonic anastomosis in rats. Material and methods: 80 Wistar rats were divided in five groups. A: Control. B: Mechanical bowel preparation and antibiotics. C: Glutamine. D: Synbiotics. E: Glutamine and synbiotics. The animals were sacrificed on 3rd and 7th postoperative day. Results: Zero mortality and no septic complications were noted. On 3rd postoperative days, a significant weight loss was observed in all groups in comparison with the preoperative weights, but on the 7th day in groups C and E, in contrast with the other groups, weight loss was not significant. On the 3rd postoperative day, neoangiogenesis, inflammatory infiltration and fibroblast activity were significantly enhanced in group E compared to control. On the 7th postoperative day in group E fibroblast activity was significantly enhanced and inflammatory infiltration was significantly limited compared to control. The bursting pressures as well as the hydroxyproline tissue content were significantly higher in the group E on 3rd and 7th postoperative days. The percentage of positive mesenteric lymph node cultures were significantly limited in group E compared to control. Conclusions: The administration of synbiotics in conjunction with glutamine resulted in increasing the mechanical strength of the anastomosis, thus increasing the bursting pressure and decreasing or effacing of anastomotic dehiscence and limiting bacterial translocation

Generalized gas gangrene after elective cholecystectomy - Fatal outcome from a rare infection nowdays - Report of a case and literature review

The development of generalized gas gangrene after elective open cholecystectomy of a 73-year-old male patient is described. After such a common, elective surgical procedure, the patient developed excessive tissue necrosis and massive rabdomyolysis with a fatal outcome. This disastrous complication was completely unexpected and unpredictable after immaculate performance in theatres and antibiotic coverage. Patient risk factors and postoperative warning signs were not properly evaluated. In case where subcutaneous emphysema is observed or excessive hemolysis and high serum CK levels are recorded, urgent operation and radical debridement should be undertaken without any delay

Omega 3 fatty acids supplementation has an ameliorative effect in experimental ulcerative colitis despite increased colonic neutrophil infiltration Los suplementos de ácidos grasos omega 3 tienen efectos beneficiosos en colitis ulcerosa a pesar del aumento de la infiltracción por neutrófilos del colon

Purpose: omega 3 polyunsaturated fatty acids have anti-inflammatory properties and can be beneficial in the treatment of inflammatory diseases, such as ulcerative colitis. Dextran sodium sulphate (DSS) colitis in rats appears to mimic nearly all of the morphological characteristics and lesion distributions of ulcerative colitis. The purpose of the current study was to investigate the efficacy of omega 3 fatty acids in the treatment of experimental ulcerative colitis. Methods: thirty-six Wistar rats were randomly assigned to group A or group B receiving 5% dextran sulfate sodium (DSS) in their drinking water for eight days. For the next eight days post-DSS, group A animals received tap-water, and group B animals were fed a nutritional solution containing high levels of omega 3 polyunsaturated fatty acids (ProSure®, Abbott Laboratories, Zwolle, Netherlands) once per day, administrated with a orogastric feeding tube. Results: animals fed an omega 3 rich diet exhibited a statistically significant increase in hematocrit and hemoglobin levels, compared to animals drinking tap water, and a trend towards histopathological and clinical improvement, with the administration of omega 3 fatty acids ameliorating epithelial erosion by day 8 post-DSS, but no statistically significant difference was observed between group A and group B animals at 4 or 8 days post-DSS. Also, a statistically significant increase in neutrophil infiltration was observed, as depicted by myelohyperoxidase activity. Conclusion: our findings support a positive role of omega 3 polyunsaturated fatty acids supplementation in an experimental model of ulcerative colitis despite the increased colonic neutrophil infiltration. Further studies are needed in order to investigate the role of increased neutrophils in colonic mucosa