Local excision as a treatment for tumors of ampulla of Vater

BACKGROUND: Although local excision (ampullectomy) was first described by Halsted in 1899, its adequacy as an alternative surgical treatment for the ampullary tumors is still a matter of debate. The aim of this study was to evaluate the results of ampullectomy as a curative treatment for benign and malignant tumors arising from the ampulla, in a 14-year single-institution experience. METHODS: From 1990 to 2004, a total of 20 patients of adenocarcinoma (12) or adenoma (8) of the ampulla of Vater underwent local excision. Clinical data were collected and morbidity, mortality, as well as long-term survival were evaluated. The usefulness of several pre or intraoperative diagnostic methods was also recorded. Median follow-up was 85 (range 6–180) months. RESULTS: The combination of endoscopic preoperative biopsies and intraoperative frozen section examination adequately diagnosed ampullary tumors in all cases. The postoperative morbidity and mortality were 0%, whereas the 3 and 5-year survival rates for the patients with adenocarcinoma was 75 % and 33.3 % respectively. All the patients with adenoma are still alive without any sign of recurrence. CONCLUSION: In our series, local excision was a safe option, associated with satisfactory long-term survival rates in patients with benign lesions and in those with small(<2 cm), pT1, well differentiated ampullary tumours without nodal involvement

A Customized Light Sheet Microscope to Measure Spatio-Temporal Protein Dynamics in Small Model Organisms

We describe a customizable and cost-effective light sheet microscopy (LSM) platform for rapid three-dimensional imaging of protein dynamics in small model organisms. The system is designed for high acquisition speeds and enables extended time-lapse in vivo experiments when using fluorescently labeled specimens. We demonstrate the capability of the setup to monitor gene expression and protein localization during ageing and upon starvation stress in longitudinal studies in individual or small groups of adult Caenorhabditis elegans nematodes. The system is equipped to readily perform fluorescence recovery after photobleaching (FRAP), which allows monitoring protein recovery and distribution under low photobleaching conditions. Our imaging platform is designed to easily switch between light sheet microscopy and optical projection tomography (OPT) modalities. The setup permits monitoring of spatio-temporal expression and localization of ageing biomarkers of subcellular size and can be conveniently adapted to image a wide range of small model organisms and tissue samples.MR, GZ and AZ acknowledge funding from the Projects “Skin-DOCTor” Grant No. 1778 and “Neureka!” Grant No. LSF7-341 implemented under the "ARISTEIA" and "Supporting Postdoctoral Researchers" Actions respectively, of the "OPERATIONAL PROGRAMME EDUCATION AND LIFELONG LEARNING", (http://www.espa.gr/en/pages/staticOPEducationandLifelongLearning.aspx), which is co-funded by the European Social Fund and National Resources and from the EU Marie Curie Initial Training Network “OILTEBIA”, Grant No. PITNGA-2012-317526 (http://ec.europa.eu/research/mariecurieactions/, http://gdo.uc3m.es/oiltebia/index. php?option = com_content&view = frontpage). JR acknowledges support from EC FP7 CIG grant HIGHTHROUGHPUT TOMO PICIG12-GA-2012-333632, (http://cordis.europa.eu/projects/333632), and Spanish MINECO grant MESO-IMAGING FIS2013-41802-R, (https://sede.micinn.gob.es/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

One-year infliximab administration for the treatment of chronic refractory pouchitis

Abstract Aim To determine the efficacy of infliximab in the treatment of chronic refractory pouchitis, following ileo-pouch anal anastomosis (IPAA) for ulcerative colitis (UC). Methods Seven patients (4 females, 3 males) with chronic refractory pouchitis were included in an open study. Pouchitis was diagnosed by clinical plus endoscopic and histological criteria. Three patients also had fistulae (pouch-bladder in 1 and perianal in 2). Extraintestinal manifestations were also present in 4 patients (erythema nodosum in 2, arthralgiae in 2). All patients were refractory to standard therapy. Crohn&apos;s disease was carefully excluded in all patients after re-evaluation of the history and examination of the small bowel with enteroclysis or small bowel capsule endoscopy. Patients received Infliximab 5 mg/kg at 0, 2 and 6 weeks and thereafter every 2 months for 1 year. Clinical response was classified as complete, partial, and no response. Fistulae closure was classified as complete, partial, and no closure. The pouchitis disease activity index (PDAI) was also used as an outcome measure. Results Clinically, all patients improved. After 1 year of follow-up, 5 of the 7 patients had a complete clinical response, and 2 of the 3 patients with a fistula had complete fistulae closure. At the end of the follow-up period the median PDAI dropped from 11 (baseline) (range, 10-14) to 5 (range, 3-8). Extraintestinal manifestations were in complete remission at the end of the followup period as well. Conclusions Our results indicate that infliximab may be recommended for the treatment of chronic refractory pouchitis complicated or not by fistulae following IPAA for UC

Pharmacies in Greece

PHARMACIES IN GREECE Author: Georgios Zacharakis Tutor: RNDr. Jana Kotlářová, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, Czech Republic Aim of diploma thesis: The aim is to get current facts and knowledge about the situation of pharmacies in Greece, including their basic problems, and to compare it with the Czech Republic. Methods: Data collection through appreciation of information and studying of literature, esp. Greek legislation. Results: It was given necessary information on the National Health System in Greece and about place and role of pharmacies in this. The main part of thesis deals wits pharmacies in Greece (legislation, statistics, pharmacists, activities in pharmacy). There are many private community pharmacies and low amount of hospital pharmacies which are only for inpatients. Both Greece and Czech Republic made considerable efforts in latest years to harmonize their legislation to the European standards. However, a significant difference between Greece and Czech Republic is profit margins of wholesalers, which are higher in the Czech Republic in comparison to Greece, while the production of drugs in Greece is significant higher than Czech Republic, which based more in its neighboring countries for the supply..

Crisis management and management skills in public authorities: the case o the social insurance institute

The purpose of this PhD dissertation is to investigate the issue of the skills of directors of Public Organizations and Enterprises in crisis management issues as well as on issues of preventing and dealing with corruption in the working environment. The methodology of the dissertation was based on the collection of primary and secondary data. The secondary data was collected through books, articles in magazines, and through official web sites. The primary data was collected through the primary quantitative research. The research sample consisted of 60 directors working in the social services of IKA at the beginning of this research. The sample collected was an non propability sample. The research revealed that 60% of the directors had identified the symptoms of the crisis. Of course, we observe that a significant part of the directors are not trained or qualified to deal with crises, and deem it necessary to implement a crisis management plan. As for the barriers that exist in the operation of the agency, these mainly referred to the conflicts between citizens and employees, followed by conflicts between colleagues. The incidents that have occurred in the workplace of the agency reveal the need for security personnel to guard the premises. Sometimes the integrity and the life of the employees appear to be at risk. It has also been found that the most important cause of conflict in the operation of the agency are the different interests of the parties involved, the inadequate communication followed by rivalry between employees. The directors mentioned ways of reducing corruption by the creation and strengthening of the legislative framework, by abolishing the multiplicity of laws, through the computerization and the development of the portal of DIAVGEIA, through meritocracy, staff evaluation and continuous updating, and through the lifting of the permanence and the changing of attitudes.Σκοπός της παρούσης διδακτορικής διατριβής είναι να διερευνήσει το θέμα των δεξιοτήτων των διευθυντικών στελεχών των Δημοσίων Οργανισμών και Επιχειρήσεων σε θέματα διαχείρισης κρίσεων καθώς και σε θέματα πρόληψης και αντιμετώπισης κρουσμάτων διαφθοράς στο εργασιακό περιβάλλον. Η μεθοδολογία της εργασίας στηρίχθηκε στη συλλογή πρωτογενών και δευτερογενών δεδομένων. Τα δευτερογενή δεδομένα συλλέχθηκαν μέσα από βιβλία, άρθρα σε περιοδικά αλλά και μέσα από επίσημους διαδικτυακούς τόπους. Τα πρωτογενή δεδομένα συλλέχθηκαν μέσα από τη διεξαγωγή πρωτογενούς ποσοτικής έρευνας. Το δείγμα της έρευνας αποτέλεσαν τα 60 διευθυντικά στελέχη που εργάζονταν στις κοινωνικές υπηρεσίες του ΙΚΑ κατά την έναρξη της παρούσας έρευνας. Το δείγμα που συλλέχθηκε ήταν δείγμα μη πιθανότητας. Από την έρευνα προέκυψε ότι το 60% των διευθυντών είχε εντοπίσει τα συμπτώματα της κρίσης. Βέβαια παρατηρούμε ότι ένα σημαντικό ποσοστό από διευθυντές, δεν είναι εκπαιδευμένοι ή κατάλληλοι για την αντιμετώπιση κρίσεων και θεωρούν απαραίτητο την εφαρμογή ενός σχεδίου αντιμετώπισης των κρίσεων. Ως προς τα εμπόδια που υπάρχουν στην λειτουργία της υπηρεσίας αναφέρθηκαν κυρίως οι συγκρούσεις μεταξύ πολιτών και συναδέλφων και ακολουθούσαν οι συγκρούσεις μεταξύ συναδέλφων. Από τα περιστατικά τα οποία έχουν συμβεί στους χώρους εργασίας της υπηρεσίας προκύπτει η ανάγκη φύλαξης των χώρων με προσωπικό ασφαλείας. Κάποιες φορές φαίνεται να κινδυνεύει η ακεραιότητα και η ζωή των εργαζομένων. Βρέθηκε ακόμα ότι το σημαντικότερο αίτιο σύγκρουσης στην λειτουργία του οργανισμού ήταν τα διαφορετικά συμφέροντα των εμπλεκόμενων μερών, ακολουθεί η ανεπαρκής επικοινωνία και έπεται ο ανταγωνισμός μεταξύ των υπαλλήλων. Οι διευθυντές ανέφεραν ως τρόπους μείωσης των φαινομένων διαφθοράς την δημιουργία και αυστηροποίηση νομοθετικού πλαισίου, την κατάργηση της πολυνομίας, τη μηχανογράφηση, την ανάπτυξη της ΔΙΑΥΓΕΙΑΣ, την αξιοκρατία, την αξιολόγηση του προσωπικού και τη συνεχή ενημέρωσή του, την άρση της μονιμότητας και την αλλαγή νοοτροπίας

New and old biomarkers of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a significant cause of mortality in patients with chronic liver disease around the world. Development of biomarkers for early HCC detection is a primary public health goal to decrease mortality. The ideal biomarkers should be highly sensitive and specific for surveillance of high-risk populations and early detection of HCC and also be able to predict therapeutic outcome and provide a prognosis on survival. Currently, the new biomarkers do not perform better than the conventional ones such as alpha-fetoprotein in such a way that they could be widely adopted in clinical practice. Another problem is the low sensitivity of these biomarkers in the detection of HCC. Further work on the development of novel biomarkers and on a combination of them is necessary. Advances in identifying unique molecular signatures including genomic, proteomic, metabolomic, and glycomic profiles have improved our understanding of many biological processes involved in HCC. This review focuses on the role of old and new biomarkers in surveillance, diagnosis, prognosis, and prediction of response to therapeutic targets for HCC and provides up-to-date data to health-care providers which would be applied in clinical practice

Contemporary best practice in the evaluation and management of stuttering priapism

Stuttering priapism is rare and under-investigated clinical entity. Although it shares similarities with ischaemic priapism, by definition, stuttering priapism has distinct characteristics that advocate for a different management in the clinical setting. Therefore, the management of stuttering priapism aims primarily to prevent recurrence rather than the resolution of spontaneous attacks. A multimodal approach and the individualization of each case are essential because of the diversity of the condition and the plethora of proposed therapeutic strategies. Understanding the underlying pathophysiology and familiarity with contemporary, past and emerging future agents and therapeutic options are required in order to provide an optimal solution for each patient. In addition, patient counselling and the option to combine therapeutic strategies and challenge second-line therapies are essential weapons in the armament of the urologist. Although further clinical trials and studies are mandatory in order to obtain solid data and provide recommendations, all therapeutic options are analysed, with specific interest in the potential advantages and disadvantages. A structured evaluation procedure is also described