Development of a Prognostic Model That Predicts Survival After Pancreaticoduodenectomy for Ampullary Cancer.

Objectives: The aims of this study were to i) identify independent predictors of survival following pancreaticoduodenectomy for ampullary cancer and ii) develop a prognostic model of survival. Methods: Data were analysed retrospectively on 110 consecutive patients who underwent pancreaticoduodenectomy between 2002-2013. Subjects were categorised into 3 nodal sub-groups as per the recently proposed nodal sub-classification: N0 (node negative), N1 (1-2 metastatic nodes) or N2 (≥3 metastatic nodes). Clinicopathological features and overall survival were compared by Kaplan Meier and Cox regression analyses. Results: The overall 1-, 3- and 5-year survival rates were 79.8%, 42.2% and 34.9% respectively. The overall 1-, 3- and 5-year survival rates for the N0 group were 85.2%, 71.9% and 67.4% respectively. The 1-,3-,5-year survival rates for the N1 and N2 subgroups were 84.6%, 58.4%, 56.4% and 80.2%, 38.8% and 8.0% respectively (log rank, p<0.0001). After performing a multivariate Cox regression analysis vascular invasion and lymph node ratio were the only independent predictors of survival. Hence a prediction model of survival was constructed based on those 2 variables. Conclusion: Using data from a carefully selected cohort of patients we created a pilot prognostic model of post-resectional survival. The proposed model may help clinicians to guide treatments in the adjuvant setting.Mr Siong S. Liau is funded by the Medical Research Council (MRC) and Academy of Medical Sciences Clinician Scientist Fellowship

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Health effects on human eye resulting from the increased ambient solar ultraviolet radiation

This review deals with total ozone depletion, increase in surface solar ultraviolet radiation and the impact of biologically active ultraviolet (UV-B) radiation on human health, with emphasis on eyes. Emphasis is on up to date results from experiments and observations

The role of the cloud optical thickness in the attenuation of the solar ultraviolet radiation reaching the ground: Implications to the human health impacts

Cloud optical depth, as it is derived from the King&apos;s method, is compared with that deduced from the simple two stream approximation for the greater Athens, Greece area. The results show that King&apos;s method overestimates the cloud optical thickness, in comparison to the two stream approximation. These estimations were also compared with satellite observations provided by the International Satellite Cloud Climatology Project. This comparison showed that there are large deviations between ground-based and satellite observations. These deviations are probably due to the uncertainty introduced by the integration procedure of the satellite spatial analyzing resolution (distinctness). Furthermore, values of the simple scattering albedo were calculated by employing a recently proposed theoretical method and using the solar ultraviolet irradiance measurements performed at the Athens University on a routine basis. These results are of great importance for the densely populated areas like Athens, in a sense of health impacts, from enhanced incident solar ultraviolet radiation. © 1999 OPA (Overseas Publishers Association) N.V. Published by license under the Gordon and Breach Science Publishers imprint

Glaucoma associated with the management of rhegmatogenous retinal detachment

George Mangouritsas, Spyridon Mourtzoukos, Dimitra M Portaliou, Vassilios I Georgopoulos, Anastasia Dimopoulou, Elias Feretis Eye Clinic, General Hospital "Hellenic Red Cross", Athens, Greece Abstract: Transient or permanent elevation of intraocular pressure (IOP) is a common complication following vitreoretinal surgery. Usually secondary glaucoma, which develops after scleral buckling procedures, or pars plana vitrectomy for repair of rhegmatogenous retinal detachment, is of multifactorial origin. It is essential, for appropriate management, to detect the cause of outflow obstruction. An exacerbation of preexisting open-angle glaucoma or a steroid-induced elevation of IOP should also be considered. Scleral buckling may be complicated by congestion and anterior rotation of the ciliary body resulting in secondary angle closure, which can usually resolve with medical therapy. The use of intravitreal gases may also induce secondary angle-closure with or without pupillary block. Aspiration of a quantity of the intraocular gas may be indicated. Secondary glaucoma can also develop after intravitreal injection of silicone oil due to pupillary block, inflammation, synechial angle closure, or migration of emulsified silicone oil in the anterior chamber and obstruction of the aqueous outflow pathway. In most eyes medical therapy is successful in controlling IOP; however, silicone oil removal with or without concurrent glaucoma surgery may also be required. Diode laser transscleral cyclophotocoagulation and glaucoma drainage devices constitute useful treatment modalities for long-term IOP control. Cooperation between vitreoretinal and glaucoma specialists is necessary to achieve successful management. Keywords: retinal detachment, intraocular pressure elevation, glaucoma, vitrectomy, intravitreal gas, silicone oi

Comparison between minimally invasive and open pancreaticoduodenectomy: A systematic review

Introduction: Minimally invasive approaches (laparoscopic or robotic) are used in various operations. Our aim was to compare them with the open approach in pancreaticoduodenectomy. Methods: We conducted a search for articles published in MEDLINE database comparing minimally invasive (laparoscopic or robotic) with open pancreaticoduodenectomy on June 15, 2014. Results: Our search yielded 136 articles. We excluded 122 articles and we took into consideration 14 (10 for laparoscopic and 4 for robotic pancreaticoduodenectomies). Most cases were related to malignant diseases and tumors treated with minimally invasive operations tended to be smaller. There were relatively high conversion rates in both laparoscopic (0% to 15%) and robotic procedures (4.5% to 10%). There were no significant differences regarding resection margins, rates of pancreatic fistula formation, bile leak, and delayed gastric emptying, reoperation rates, and intraoperative and postoperative mortality. On the contrary, blood loss was less in minimally invasive than open operations, although this difference was not always significant. Moreover, totally laparoscopic and robotic procedures lasted longer than the open ones, whereas hand-assisted laparoscopic procedures did not. However, the findings regarding the number of the retrieved lymph nodes, the length of hospital stay, and costs were inconclusive and controversial. Conclusions: Laparoscopic and robotic pancreaticoduodenectomy are feasible, safe, and oncologically equivalent alternatives to open pancreaticoduodenectomy. Minimally invasive operations have the advantage of the less blood loss, but totally laparoscopic and robotic procedures last longer than open procedures. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved

Macular hole surgery with short-acting gas and short-duration face-down positioning

Tina Xirou,1 Panagiotis G Theodossiadis,2 Michael Apostolopoulos,3 A Stamatina Kabanarou,1 Elias Feretis,1 Ioannis D Ladas,3 Chrysanthi Koutsandrea31Vitreoretinal Unit, Red Cross Hospital, 2B Department of Ophthalmology, University of Athens, Greece; 3A Department of Ophthalmology, University of Athens, GreecePurpose: To report on the outcomes of vitrectomy and sulfur hexafluoride (SF6) gas tamponade for idiopathic macular holes with 2 days of face-down positioning.Patients and methods: This was a prospective, nonrandomized, observational sequential case-series study on 23 consecutive patients receiving macular hole surgery using 20% SF6 and advised to stay in a face-down position for 2 days postoperatively (SF6 group). These patients were compared to 23 consecutive patients who had previously undergone macular hole surgery, had received 14% C3F8, and were advised to maintain a face-down position for 2 days (C3F8 group). Patients in both groups underwent vitrectomy, internal limiting membrane peeling, and fluid gas exchange using either SF6 or C3F8. Preoperative and postoperative data included best corrected visual acuity recorded in LogMAR units, slit-lamp biomicroscopy, and optical coherence tomography.Results: At a 6-month follow-up, macular hole closure was noted in 23/23 eyes (100%) and in 22/23 eyes (96%) in the SF6 and C3F8 groups, respectively. The improvement in visual acuity (measured through Snellen acuity lines both preoperatively until 6 months postoperatively) was 4.08 &amp;plusmn; 2.31 (95% confidence interval [CI]: 3.08&amp;ndash;5.08) for the SF6 group and 2.87 &amp;plusmn; 2.30&amp;nbsp;(95% CI: 1.87&amp;ndash;3.86) for the C3F8 group; this difference was not statistically significant (P = 0.06).Conclusion: Vitrectomy with internal limiting membrane peeling and a short-acting gas tamponade using SF6 with posture limitation for 2 days may give a high success rate in macular hole surgery.Keywords: idiopathic macular holes, SF6 gas tamponade, C3F8 gas tamponad

On the plausible association between environmental conditions and human eye damage

The increase in solar ultraviolet radiation can have various direct and indirect effects on human health, like the incidence of ocular damage. Data of eye damage in residents of three suburban regions in Greece and in two groups of monks/nuns and fishermen are examined here. The statistics performed on these data provides new information about the plausible association between increased levels of solar ultraviolet radiation, air-pollution at ground level, and the development of ocular defects