65 research outputs found
Achaiki Iatriki : official publication of the medical society of western Greece and Peloponnesus
In the current issue, the editorial by Cauchi et al.
argues for eco-friendly measures in endoscopy and
emphasies the role of healthcare providers in reducing waste. The editorial adeptly employs the three Rs
(Reduce, Reuse, Recycle) framework to tackle waste
management, offering practical solutions. The editorial by Milionis et al. focuses on the reverse cascade
screening for paediatric familial hypercholesterolaemia
(FH), which is an upcoming tool for public health. Advantages, practices, and challenges regarding FH are
thoroughly discussed. Lastly, the editorial by Fousekis
et al. presents the main aspects of a chronic immune-mediated cutaneous disease, dermatitis herpetiformis
(DH), which constitutes an extraintestinal manifestation
of celiac disease, including its diagnosis, pathogenesis,
and management.
Moreover, this issue includes three review articles.
The review article by Krontira et al. discusses the evolving data on the epidemiology, diagnostic approach and
appropriate management of foreign body and caustic
substance ingestion, based on updated guidelines
published by gastroenterological and endoscopic societies. The review by Halliasos et al. provides data on the
clinical presentation, diagnosis, and management of
metastatic acute spinal cord compression, focusing on
the importance of a multidisciplinary team approach,
including spine surgeons, radiation oncologists, medical
oncologists, palliative care clinicians, physiotherapists,
and psychologists. Lastly, the review by Schinas et al.
outlines the potential of immune modulation in the
treatment of infections and the need for individualised approaches in the modern world of personalised
medicine by examining some of the key strategies and
immune-based therapies being developed to combat
infectious diseases.peer-reviewe
The Hypothesis Regarding the Benefit of Carotid Endarterectomy Under Locoregional Anesthesia in Prevention of Stroke May be Unanswered
A recent trial attempted to investigate the role of locoregional
anesthesia (LA) in carotid endarterectomy (CEA) compared with general
anesthesia. The hypothesis regarding the advantage of LA is based on the
intraprocedural neurologic evaluation and the early identification of
neurologic deficit. The trial has not demonstrated the superiority of
the rocoregional anesthesia versus general anesthesia and revealed equal
results concerning the prevention of stroke. We analyze the reasons
which explain why the hypothesis regarding the advantage of LA in CEA,
in comparison to general anesthesia cannot be answered
An Unusual Case of Acute Thrombosis of Abdominal Aortic Aneurysm without Acute Limb Ischemia.
Acute thrombosis of an abdominal aortic aneurysm (AAA) is a rare and often devastating complication with high morbidity and mortality. In some cases, however, it may be associated with a silent course without signs of acute limb ischemia. The aim of this report is to describe an unusual case of acute thrombosis of AAA without signs of acute limb ischemia. Preoperative anxiety, stress, and phobia for surgery may be factors predisposing to acute thrombosis of an AAA
Stapled cholecystojejunostomy for palliative treatment of the malignant jaundice; an effective and feasible alternative to hand-sewn method
Unresectable periampullary cancer is commonly characterized by painless
jaundice and has a rapid evolution with dismal prognosis. Biliary
drainage can be achieved by various techniques and approaches, with the
endoscopic drainage being the preferred method. However, when open
surgery is performed with the intent to resect a tumor which is finally
found to be unresectable, open drainage of the biliary tree is
indicated. We present a new technique of cholecystojejunostomy using a
circular mechanical stapler, which could be used in patients with intact
gallbladder and widely patent the cystic duct. The described
cholecystoenterostomy with the use of a circular mechanical stapler is
the first reported in the literature. The procedure has been
successfully used in 6 patients with excellent results. No early
recurrence of biliary obstruction, cholangitis or post-operative
anastomotic complications were observed. The relative simplicity of the
procedure, the shorter operative time and the effective relief of
jaundice, are the main advantages of the proposed technique. We believe
that this method needs further investigation and can be proved effective
in reducing hospitalization and anastomotic complications, compared to
hand-sewn techniques. (C) 2010 Surgical Associates Ltd. Published by
Elsevier Ltd. All rights reserved
Abdominal aortic endograft proximal collapse resulting in aortic aneurysm rupture
An 82-year-old man was transferred to our emergency department due to
acute abdominal pain. He had undergone an endovascular abdominal aortic
aneurysm repair (EVAR) six years ago. An intravenous contrast-enhanced
abdominal computed tomography revealed the rupture of the abdominal
aortic aneurysm (AAA) with a large retroperitoneal hematoma. A Talent
(Medtronic, Santa Rosa, CA, USA) modular bifurcated endoprosthesis had
vertically collapsed approximately 7 cm after losing its infrarenal
fixation. As a result, it led to the repressurization of the aneurysm
sac and rupture. The patient was successfully treated by placing three
Talent (Medtronic) aortic cuffs. To our knowledge, this is the first
reported case of endograft collapse that has manifested with aortic
aneurysm rupture. Although they are gradually declining, considerable
rates of complications create the ‘Achilles’ heel of endovascular repair
of AAAs. A lifelong follow-up strategy for patients treated for AAA with
EVAR is essential for the early detection and treatment of complications
of the procedure
Arterial Stiffness Assessed by Cardio-Ankle Vascular Index in Patients With Abdominal Aortic Aneurysm and Its Alterations After Treatment
Purpose: The aim of the present study was to investigate a potential difference on the arterial stiffness among aneurysm patients and non-aneurysm controls, as well as to explore potential changes between patients treated either with endovascular or open repair. Materials and Methods: A 110 patients with an infrarenal AAA were prospectively enrolled in this study. Fifty-six patients received an EVAR, whereas 54 patients received an open surgical repair. Moreover, 103 gender and age-matched subjects without AAA served as controls. The cardio-ankle vascular index (CAVI) was applied for measurement of the arterial stiffness. Results: CAVI values were statistically higher in the AAA patients when compared with control subjects. Although at 48 hours postoperatively the CAVI values were increased in both groups when compared to baseline values, the difference in CAVI had a tendency to be higher in the open group compared to the endovascular group. At 6 months of follow up the CAVI values returned to the baseline for the patients of the open repair group. However, in the endovascular group CAVI values remained higher when compared with the baseline values. Conclusion: Patients with AAAs demonstrated a higher value of CAVI compared to healthy controls. A significant increase of arterial stiffness in both groups during the immediate postoperative period was documented. The increase in arterial stiffness remained significant at 6 months in EVAR patients. Further studies are needed to elucidate the impact of a decreased aortic compliance after stentgraft implantation on the cardiac function of patients with AAA
- …