Μελέτη της χειρουργικής ανατομίας του κοιλιακού τοιχώματος σε σχέση με αποκατάσταση πολύπλοκων κηλών

Οι κήλες αποτελούν ένα ολοένα και συχνότερο πρόβλημα στη χειρουργική επιστήμη. Η νεώτερη ταξινόμηση των κηλών του πρόσθιου κοιλιακού τοιχώματος δίνει έμφαση στο μέγεθος του ελλείμματος του χάσματος καθώς και στο εάν πρόκειται για μετεγχειρητική κοιλιοκήλη. Στην δεύτερη κατηγορία κατατάσσονται οι πολύπλοκες κήλες, οι κήλες δηλαδή που δεν μπορούν να αντιμετωπισθούν με απλές χειρουργικές τεχνικές. Η λεπτομερέστερη γνώση της ανατομίας και της λειτουργικής ανατομίας του κοιλιακού τοιχώματος ανέδειξε ως έναν κύριο παθοφυσιολογικό μηχανισμό την έλξη των πλάγιων κοιλιακών μυών προς τα εκτός που τείνουν να μεγαλώσουν συνεχώς το χάσμα, και ευθύνονται πολλές φορές για αποτυχημένη επιδιόρθωση μιας κήλης. Η επίτευξη πρωτογενούς σύγκλεισης της περιτονίας για την επαναδημιουργία μιας μέσης γραμμής αναδεικνύεται ως προτεραιότητα. Αυτό μπορεί να επιτευχθεί με ανατομικές παρασκευές όπισθεν της θήξης του ορθού κοιλιακού μυός ή με τις πιο σύνθετες τεχνικές του πρόσθιου και του οπίσθιου διαχωρισμού των στοιχείων. Μια ανατομική επιδιόρθωση ενισχύεται συνήθως με την τοποθέτηση πλέγματος. Νέωτερες τεχνικές, όπως η χρήση της τοξίνης της αλλαντίασης για την προσωρινή παράλυση των πλάγιων μυών του κοιλιακού τοιχώματος , που αποκαλείται χημικός διαχωρισμός των στοιχείων, αναδεικνύονται ως νέα εργαλεία στις απακαταστάσεις με έμφαση στην αποκατάσταση της ανατομικής τάξης. Συμπερασματικά, η λεπτομερής γνώση της ανατομίας συνδέεται με τα καλύτερα αποτελέσματα και ως προς την υποτροπή της κήλης και ως προς τις μετεγχειρητικές επιπλοκές, επιτρέποντας την επιτυχή αντιμετώπιση ολοένα και πιο μεγάλων ελλειμμάτων.Hernias comprise a growing problem in surgical science. The most recent classification scheme for hernias emphasises on the size of defect as well as on whether it is an incisional hernia. The latter group includes complex hernias, namely hernias that can not be managed with simple surgical techniques. This can be accomplished with retromuscular repairs or the more complex anterior and posterior component separation techniques. An anatomic repair is usually reinforced with interposition of mesh. Newest techniques, such as the use of botulinum toxin to induce temporary paralysis of the lateral abdominal wall musculature, referred to as chemical component separation, now present new tools in the restoration of anatomy- based repairs. To conclude with, detailed knowledge of anatomy is associated with better outcomes regarding hernia recurrence as well as postoperative complications, allowing for a successful management of defects that evermore increase in size

Calcium Channel Blockers and Esophageal Sclerosis: Should We Expect Exacerbation of Interstitial Lung Disease?

Esophageal sclerosis is the most common visceral manifestation of systemic sclerosis, resulting in impaired esophageal clearance and retention of ingested food; in addition, co-existence of lung fibrosis with esophageal scleroderma is not uncommon. Both the progression of generalized connective tissue disorders and the damaging effect of chronic aspiration due to esophageal dysmotility appear to be involved in this procedure of interstitial fibrosis. Nifedipine is a widely prescribed calcium antagonist in a significant percentage of rheumatologic patients suffering from Raynaud syndrome, in order to inhibit peripheral vasospasm. Nevertheless, blocking calcium channels has proven to contribute to exacerbation of gastroesophageal reflux, which consequently can lead to chronic aspiration. We describe the case of severe exacerbation of interstitial lung disease in a 76-year-old female with esophageal sclerosis who was treated with oral nifedipine for Raynaud syndrome

Anatomical and Surgical Principles of Ventral Hernia Repairs

Hernias comprise a growing problem in surgical science. The most recent classification scheme for hernias emphasizes on the size of defect as well as on whether it is an incisional hernia. The latter group includes complex hernias, namely hernias that can not be managed with simple surgical techniques. This can be accomplished with retromuscular repairs or the more complex anterior and posterior component separation techniques. An anatomic repair is usually reinforced with interposition of mesh. Newest techniques, such as the use of botulinum toxin to induce temporary paralysis of the lateral abdominal wall musculature, referred to as chemical component separation, now present new tools in the restoration of anatomy-based repairs. The chapter entitled “Anatomical and surgical principles of ventral hernia repairs” aims to describe the anatomical and surgical principles of current practice regarding the repair of ventral -primary and incisional-hernias

Appendicectomy and clostridium difficile infection: is there a link?

Clostridium difficile infection (CDI) is a gradually emerging healthcare problem in the western world, occurring predominantly from the de-arrangement of the gut microbiota and the widespread use of antibiotics. Recently, it has been proposed that the presence or absence of the appendix could be a factor influencing the occurrence and/or the severity of CDI. We performed a review of the literature, aiming to identify and interpret in an accumulative way the results of the published clinical studies which addressed the issue of a possible association between prior appendicectomy and the features of CDI. A total of five suitable studies were retrieved, which were all conducted retrospectively. Although the results were conflicting regarding the impact of prior appendicectomy in the occurrence and relapse of CDI, it appears that the presence or absence of the appendix is not associated with the clinical severity of CDI. Based on the current evidence and considering the effects of the widespread use of antibiotics in the clinical practice, it appears that an in situ appendix does not have a definitive impact on the development and severity of CDI. Further observational studies are warranted to clarify any potential association

Multidisciplinary approach to synchronous prostate and rectal cancer: current experience and future challenges.

The management of synchronous prostate and rectal cancer is a challeging task for the general surgeons and urologists, due to the complex anatomy of the pelvis and the sequential significant effects on the patient's functional independency and quality of life. As both rectal and prostate cancers still remain leading causes of death in the male population, along with the increase of the average life expectancy, it is certain that synchronous prostate and rectal cancer will be a clinical scenario that the clinicians of the future will encounter more frequently. Our aim is to perform a comprehensive review on the management of this oncological entity, focusing on the significance of multidisciplinary approach which will enable the formation of an accurate strategy plan, having at all times the patient in the center of desicion-making

«Η διερεύνηση των αντιλήψεων και στάσεων των εκπαιδευτικών πρωτοβάθμιας εκπαίδευσης για τη Διαταραχή Ελλειμματικής Προσοχής-Υπερκινητικότητα στα σχολεία του Δήμου Ιλίου»

Η παρούσα διατριβή εκπονήθηκε στα πλαίσια του διακρατικού προγράμματος σπουδών «Σχολική Συμβουλευτική και Καθοδήγηση» του Εθνικού και Καποδιστριακού Πανεπιστημίου Αθηνών και του Πανεπιστημίου Κύπρου, για την απόκτηση μεταπτυχιακού διπλώματος από τον Σερέτη Φώτιο. Σκοπός της έρευνας ήταν η διερεύνηση των γνώσεων, των αντιλήψεων και στάσεων των εκπαιδευτικών γύρω από θέματα που σχετίζονται με τη Διαταραχή Ελλειμματικής Προσοχής-Υπερκινητικότητα. Πιο συγκεκριμένα στην έρευνα συμμετείχαν 110 εκπαιδευτικοί πρωτοβάθμιας εκπαίδευσης του δήμου Ιλίου,των οποίων μελετήθηκε ο βαθμός ενημέρωσης σχετικά με τη ΔΕΠ-Υ. Το ποσοστό σωστών απαντήσεων ήταν 59,1% (έναντι 18,7% λάθος απαντήσεων). Τα αποτελέσματα έδειξαν πως οι συμμετέχοντες στην παρούσα έρευνα δάσκαλοι φαίνεται να είναι περισσότερο ενήμεροι σχετικά με τη Συμπτωματολογία και τον Ορισμό της ΔΕΠ- Υ και λιγότερο ενημερωμένοι για τα Αίτια και την Αντιμετώπισή της. Οι γνώσεις των δασκάλων βρέθηκαν να επηρεάζονται από την ηλικία, τα χρόνια υπηρεσίας και την προηγούμενη διδακτική τους εμπειρία με μαθητές με ΔΕΠ-Υ, ενώ δεν βρέθηκαν να επηρεάζονται από την εκπαίδευση του δασκάλου, το φύλο ή την παρακολούθηση κάποιου σεμιναρίου σχετικού με ΔΕΠ-Υ. Τα ευρήματα της έρευνας υποδεικνύουν την ανάγκη επιμόρφωσης των δασκάλων σε γενικά και ειδικά θέματα που αφορούν στη συγκεκριμένη διαταραχή καθώς και τη σπουδαιότητα του ρόλου τους στην υποστήριξη των μαθητών με ΔΕΠ-Υ στη σχολική τάξη.This dissertation was developed within the framework of the transnational curriculum "School Counseling and Guidance" of the National and Kapodistrian University of Athens and the University of Cyprus, for the acquisition of a postgraduate diploma by Seretis Fotios. The purpose of the research was to investigate the knowledge, perceptions and attitudes of teachers on issues related to Attention Deficit Hyperactivity Disorder. In particular, 110 primary school teachers from the municipality of Ilion participated in the survey and studied the degree of information on ADHD. The correct answer rate was 59.1% (vs. 18.7% error). The results showed that the participants in the present study appear to be more aware of ADHD's Symptomatology and Definitions and less aware of its Causes and Treatment. Teacher's knowledge was found to be influenced by age, years of service, and previous teaching experience with students with ADHD, but they were not found to be affected by teacher training, gender, or attending an ADHD seminar . Research findings suggest the need to educate teachers on general and specific issues per-taining to the particular disorder as well as the importance of their role in supporting students with ADHD in the classroom

Enhancing the Accuracy of Platelet to Lymphocyte Ratio after Adjustment for Large Platelet Count: A Pilot Study in Breast Cancer Patients

Background. The objective of our study is to investigate the potential effect of adjusting preoperative platelet to lymphocyte ratio, an emerging biomarker of survival in cancer patients, for the fraction of large platelets. Methods. A total of 79 patients with breast neoplasias, 44 with fibroadenomas, and 35 with invasive ductal carcinoma were included in the study. Both conventional platelet to lymphocyte ratio (PLR) and the adjusted marker, large platelet to lymphocyte ratio (LPLR), were correlated with laboratory and histopathological parameters of the study sample. Results. LPLR elevation was significantly correlated with the presence of malignancy, advanced tumor stage, metastatic spread in the axillary nodes and HER2/neu overexpression, while PLR was only correlated with the number of infiltrated lymph nodes. Conclusions. This is the first study evaluating the effect of adjustment for large platelet count on improving PLR accuracy, when correlated with the basic independent markers of survival in a sample of breast cancer patients. Further studies are needed in order to assess the possibility of applying our adjustment as standard in terms of predicting survival rates in cancer

Adhesive Ileus Complicating Recurrent Intestinal Pseudo-Obstruction in a Patient with Myasthenia Gravis

Intestinal pseudo-obstruction is considered to be one of the most frequent gastrointestinal manifestations of myasthenia gravis, accompanied by the presence of neoplasia of the thymus gland in the vast majority of the cases presented in the international literature. Despite the fact that myasthenia gravis has been implicated to be the cause of recurrent episodes of intestinal pseudo-obstruction, adhesive ileus has never been reported to complicate this – in any sense rare – condition. We present a unique case of a patient with myasthenia gravis, free of thymus neoplasia, who was submitted to emergency surgery due to the presence of extended adhesive ileus as a complication of chronic intestinal functional obstruction

Management of acute mesenteric ischaemia: Results of a worldwide survey

© 2023 The AuthorsBackground: Acute mesenteric ischaemia (AMI) is a condition with high mortality. This survey assesses current attitudes and practices to manage AMI worldwide. Methods: A questionnaire survey about the practices of diagnosing and managing AMI, endorsed by several specialist societies, was sent to different medical specialists and hospitals worldwide. Data from individual health care professionals and from medical teams were collected. Results: We collected 493 individual forms from 71 countries and 94 team forms from 34 countries. Almost half of respondents were surgeons, and most of the responding teams (70%) were led by surgeons. Most of the respondents indicated that diagnosis of AMI is often delayed but rarely missed. Emergency revascularisation is often considered for patients with AMI but rarely in cases of transmural ischaemia (intestinal infarction). Responses from team hospitals with a dedicated special unit (14 team forms) indicated more aggressive revascularisation. Abdominopelvic CT-scan with intravenous contrast was suggested as the most useful diagnostic test, indicated by approximately 90% of respondents. Medical history and risk factors were thought to be more important in diagnosis of AMI without transmural ischaemia, whereas for intestinal infarction, plasma lactate concentrations and surgical exploration were considered more useful. In elderly patients, a palliative approach is often chosen over extensive bowel resection. There was a large variability in anticoagulant treatment, as well as in timing of surgery to restore bowel continuity. Conclusions: Delayed diagnosis of AMI is common despite wide availability of an adequate imaging modality, i.e. CT-scan. Large variability in treatment approaches exists, indicating the need for updated guidelines. Increased awareness and knowledge of AMI may improve current practice until more robust evidence becomes available. Adherence to the existing guidelines may help in improving differences in treatment and outcomes