Gastrointestinal stromal tumors (GISTs) are relatively common mesenchymal tumors of the digestive... more Gastrointestinal stromal tumors (GISTs) are relatively common mesenchymal tumors of the digestive tract characterized by c-KIT mutations. This is a comprehensive review of the current data of the literature on the various aspects of the diagnosis and treatment of these tumors. The stomach is the most commonly involved site for these tumors in the digestive tract. Computed tomography and endoscopy can usually establish the diagnosis. The study of certain specific immunohistochemical markers may contribute to better characterization of these tumors. Surgical resection of GISTs has been the most effective therapy. In addition, targeted therapy with tyrosine kinase inhibitors may reduce the development of recurrence or decrease the disease progression in patients with metastatic disease. The introduction of tyrosine kinase inhibitors has resulted in significant improvement in the overall prognosis of these patients. Furthermore, preoperative imatinib can decrease tumor volume and is associated with complete surgical resection in locally advanced primary GISTs.
International angiology: a journal of the International Union of Angiology
During the past 23 years, 12 patients with aneurysm of the carotid bifurcation were treated in ou... more During the past 23 years, 12 patients with aneurysm of the carotid bifurcation were treated in our department. There were 11 men and one woman between 20 and 68 years (mean age 54.2 years). In as much as 217 patients were operated on for extracranial occlusive carotid disease during the same period, the incidence of these aneurysms in our series has been estimated to be 5%. Eleven patients presented with TIAs ipsilateral to the aneurysm. One patient presented with a painful pulsatile enlarging mass in the neck (ruptured aneurysm) without any neurological complications. Eleven patients underwent surgical repair. Ligation of the common carotid artery was done in one patient, resection of the aneurysm with end-to-end anastomosis was performed in 2 patients, aneurysmorraphy in 4, excision and reconstruction with reversed saphenous vein in one, excision and reconstruction with PTFE graft in one and 2 patients underwent endarterectomy and angioplasty of the carotid bifurcation. One patient with a high internal carotid artery aneurysm (base of the skull) was classified as nonoperable. There were no deaths or strokes postoperatively. Persistent cranial nerve injury was noted in 1 case (8%). Follow-up at 6 months - 10 years (mean 5.5 years) yielded and incidence of post-op TIAs of 8% attributed to intracranial occlusive disease. Surgical correction is the treatment of choice for extracranial carotid aneurysm and can be performed with a very low morbidity and mortality and carries excellent long-term results.
Intra-abdominal fibromatosis (IAF), usually located at the mesenteric level, is a locally invasiv... more Intra-abdominal fibromatosis (IAF), usually located at the mesenteric level, is a locally invasive tumor of fibrous origin. Although lacking the ability to metastasize, it has the tendency to recur. The case described here is a case of mesenteric fibromatosis with involvement of the bowel wall, which had the appearance of a gastrointestinal stromal tumor (GIST), a tumor with malignant behavior. This report outlines the fact that certain non-typical cases of IAF with involvement of the bowel wall can be misdiagnosed as GIST. It is of outmost importance to make an early and correct diagnosis in such equivocal cases, so that the appropriate treatment can be closed.
The decreased synthesis of nitric oxide (NO) during ischaemia/reperfusion (I/R) has been implicat... more The decreased synthesis of nitric oxide (NO) during ischaemia/reperfusion (I/R) has been implicated as the major underlying mechanism for the pathogenesis of acute ischaemic colitis (A.I.C.). The aim of this study was to investigate the prophylactic effect of L-arginine, a NO donor, on tissue injury during intestinal I/R, and compare its efficacy with that of exogenous vasodilators (molsidomine) and inert nitrogen-containing molecules (casein). One hundred forty four Wistar rats underwent occlusion of the superior mesentery artery for 30, 60 and 90 min for induction of intestinal ischaemia, followed by 90 min of reperfusion. The rats were randomly assigned to receive L-arginine, molsidomine, or casein hydrolysate. In all groups, apart of the histological study, we determined the levels of serum malondialdehyde (MDA), a reliable marker indicating the degree of the tissue damage after intestinal I/R. Serum MDA levels were significantly lower in the L-arginine group compared to the unt...
Εισαγωγή: Ο μετεγχειρητικός ίκτερος παρατηρείται στο 15% των καρδιοχειρουργικών και περίπου στο 1... more Εισαγωγή: Ο μετεγχειρητικός ίκτερος παρατηρείται στο 15% των καρδιοχειρουργικών και περίπου στο 1% των προγραμματισμένων ενδοκοιλιακών επεμβάσεων. Συνοδεύεται από άμεση υπερχολερυθριναιμία, αύξηση της αλκαλικής φωσφατάσης και ήπια τρανσαμινασαιμία. Συχνά οφείλεται σε χοληδοχολιθίαση μετά από διενεργηθείσα χολοκυστεκτομή και σπανιότερα σε ηπατοκυτταρικές παθήσεις. Σκοπός: Παρουσιάζουμε σπάνια περίπτωση εμφάνισης ικτέρου μετά από λαπαροσκοπική χολοκυστεκτομή, οφειλόμενου σε αμυλοείδωση καρδιάς-ήπατος. Υλικό-Μέθοδος: Γυναίκα 71 ετών, με ιστορικό χολολιθίασης, υποθυρεοειδισμού και περιφερικής νευροπάθειας υπεβλήθη σε τυπική λαπαροσκοπική χολοκυστεκτομή με ομαλή μετεγχειρητική πορεία. Τρεις μήνες μετά επανήλθε για διερεύνηση εμμένοντος ικτέρου (ολική χολερυθρίνη ~ 6mg/dl). Αποτελέσματα: Εμφάνιζε όψη πάσχουσας, ικτερική χροιά δέρματος, μειωμένη αισθητικότητα, μακρογλωσσία, μείωση αναπνευστικού ψιθυρίσματος άμφω, μετεωρισμό κοιλίας με εντερικούς ήχους παρόντες και ηπατοσπληνομεγαλία. Η ERC...
Despite recent improvements in diagnosis, surgical treatmentand neo-adjuvant therapy, patients wi... more Despite recent improvements in diagnosis, surgical treatmentand neo-adjuvant therapy, patients with esophageal cancerhave poor prognosis with overall 5-year survival rates of 5-15%.Esophagectomy is the standard treatment for resectableesophageal cancer, but only one third of patients are consideredcandidates for cure. Minimally invasive techniques have beenattempted to improve the postoperative outcomes in such asurgical procedure with high postoperative morbidity andmortality. The purpose of this review is to analyze theminimally invasive esophagectomy (MIE) techniques in theearly-stage esophageal carcinoma. MIE is still crowed withheterogeneous studies with several different techniques. MIEcomparing to open esophagectomy procedures have lessmorbidity with less overall in-hospital incidence of pulmonaryinfections and shorter duration of ICU admission. In addition,MIE techniques preserve the quality of life better than the openprocedures, with faster postoperative recovery. Celsius.
Journal of B.U.ON. : official journal of the Balkan Union of Oncology
Incidentally discovered pancreatic lesions that are asymptomatic have become much more common in ... more Incidentally discovered pancreatic lesions that are asymptomatic have become much more common in recent years. It is important to characterize these lesions and to determine which patients can be safely observed and which should undergo an operation, as a substantial proportion of them might be malignant or premalignant. This review focus on the diagnostic approach and management of the different types of cystic and solid incidental pancreatic lesions based on appropriate clinical input, imaging screening and histological criteria. The task of developing guidelines to deal with an incidentally found pancreatic lesion, however, is much more complex and controversial than with other organs incidentalomas. In most series, pancreatic incidentalomas (PIs) <2 cm and of cystic appearance are likely to be benign, whereas those >2 cm are usually premalignant or malignant. Serous cystadenomas can reach very large size and are usually benign lesions. The presence of a solid mass or a mur...
HPB surgery : a world journal of hepatic, pancreatic and biliary surgery, 2011
Peutz-Jeghers syndrome is a rare autosomal dominant inherited disease characterized by a special ... more Peutz-Jeghers syndrome is a rare autosomal dominant inherited disease characterized by a special type of hamartomatous gastrointestinal polyps combined with mucocutaneous melanin pigmentations. Patients with the syndrome have a high risk of developing neoplasia, with colon, small bowel, and stomach being the most common gastrointestinal sites. Herein, we present the occurrence of a rare tumor in patients with Peutz-Jeghers syndrome; a cholangiocarcinoma of the endopancreatic bile duct. A minireview is also presented. It can be concluded that cholangiocarcinoma remains a possible diagnosis in PJS patients, as in others that present with biliary obstruction. PJS patients may be at higher risk than others in view of their propensity for malignancy.
Mediastinal cysts compromise almost 20% of all mediastinal masses with bronchogenic subtype accou... more Mediastinal cysts compromise almost 20% of all mediastinal masses with bronchogenic subtype accounting for 60% of all cystic lesions. Although compression of adjoining soft tissues is usual, spinal complications and neurological symptoms are outmost rare and tend to characterize almost exclusively the neuroenteric cysts. A young patient with intermittent, dull pain in his back and free medical history presented in the orthopaedic department of our hospital. There, the initial clinical and radiologic evaluation revealed a mediastinal mass and the patient was referred to the thoracic surgery department for further exploration. The following computed tomography (CT) and magnetic resonance imaging (MRI) shown a huge mediastinal cyst compressing the T4-T6 vertebral bodies. The neurological symptoms of the patient were attributed to this specific pathology due to the complete agreement between the location of the cyst and the nervous rule area of the compressed thoracic vertebrae. Despite...
World journal of gastroenterology : WJG, Jan 28, 2005
Gastrointestinal duplication is an uncommon congenital abnormality in two-thirds of cases manifes... more Gastrointestinal duplication is an uncommon congenital abnormality in two-thirds of cases manifesting before the age of 2 years. Ileal duplication is common while colonic duplication, either cystic or tubular, is a rather unusual clinical entity that remains asymptomatic and undiagnosed in most cases. Mostly occurring in pediatric patients, colonic duplication is encountered in adults only in a few cases. This study reports two cases of colonic duplication in adults. Both cases presented with rectal bleeding on admission. The study was focused on clinical, imaging, histological, and therapeutical aspects of the presenting cases. Gastrografin enema established the diagnosis in both cases. The cystic structure and the adjacent part of the colon were excised en-block. The study implies that colonic duplication, though uncommon, should be included in the differential diagnosis of rectal bleeding.
Gastrointestinal stromal tumors (GISTs) are relatively common mesenchymal tumors of the digestive... more Gastrointestinal stromal tumors (GISTs) are relatively common mesenchymal tumors of the digestive tract characterized by c-KIT mutations. This is a comprehensive review of the current data of the literature on the various aspects of the diagnosis and treatment of these tumors. The stomach is the most commonly involved site for these tumors in the digestive tract. Computed tomography and endoscopy can usually establish the diagnosis. The study of certain specific immunohistochemical markers may contribute to better characterization of these tumors. Surgical resection of GISTs has been the most effective therapy. In addition, targeted therapy with tyrosine kinase inhibitors may reduce the development of recurrence or decrease the disease progression in patients with metastatic disease. The introduction of tyrosine kinase inhibitors has resulted in significant improvement in the overall prognosis of these patients. Furthermore, preoperative imatinib can decrease tumor volume and is associated with complete surgical resection in locally advanced primary GISTs.
International angiology: a journal of the International Union of Angiology
During the past 23 years, 12 patients with aneurysm of the carotid bifurcation were treated in ou... more During the past 23 years, 12 patients with aneurysm of the carotid bifurcation were treated in our department. There were 11 men and one woman between 20 and 68 years (mean age 54.2 years). In as much as 217 patients were operated on for extracranial occlusive carotid disease during the same period, the incidence of these aneurysms in our series has been estimated to be 5%. Eleven patients presented with TIAs ipsilateral to the aneurysm. One patient presented with a painful pulsatile enlarging mass in the neck (ruptured aneurysm) without any neurological complications. Eleven patients underwent surgical repair. Ligation of the common carotid artery was done in one patient, resection of the aneurysm with end-to-end anastomosis was performed in 2 patients, aneurysmorraphy in 4, excision and reconstruction with reversed saphenous vein in one, excision and reconstruction with PTFE graft in one and 2 patients underwent endarterectomy and angioplasty of the carotid bifurcation. One patient with a high internal carotid artery aneurysm (base of the skull) was classified as nonoperable. There were no deaths or strokes postoperatively. Persistent cranial nerve injury was noted in 1 case (8%). Follow-up at 6 months - 10 years (mean 5.5 years) yielded and incidence of post-op TIAs of 8% attributed to intracranial occlusive disease. Surgical correction is the treatment of choice for extracranial carotid aneurysm and can be performed with a very low morbidity and mortality and carries excellent long-term results.
Intra-abdominal fibromatosis (IAF), usually located at the mesenteric level, is a locally invasiv... more Intra-abdominal fibromatosis (IAF), usually located at the mesenteric level, is a locally invasive tumor of fibrous origin. Although lacking the ability to metastasize, it has the tendency to recur. The case described here is a case of mesenteric fibromatosis with involvement of the bowel wall, which had the appearance of a gastrointestinal stromal tumor (GIST), a tumor with malignant behavior. This report outlines the fact that certain non-typical cases of IAF with involvement of the bowel wall can be misdiagnosed as GIST. It is of outmost importance to make an early and correct diagnosis in such equivocal cases, so that the appropriate treatment can be closed.
The decreased synthesis of nitric oxide (NO) during ischaemia/reperfusion (I/R) has been implicat... more The decreased synthesis of nitric oxide (NO) during ischaemia/reperfusion (I/R) has been implicated as the major underlying mechanism for the pathogenesis of acute ischaemic colitis (A.I.C.). The aim of this study was to investigate the prophylactic effect of L-arginine, a NO donor, on tissue injury during intestinal I/R, and compare its efficacy with that of exogenous vasodilators (molsidomine) and inert nitrogen-containing molecules (casein). One hundred forty four Wistar rats underwent occlusion of the superior mesentery artery for 30, 60 and 90 min for induction of intestinal ischaemia, followed by 90 min of reperfusion. The rats were randomly assigned to receive L-arginine, molsidomine, or casein hydrolysate. In all groups, apart of the histological study, we determined the levels of serum malondialdehyde (MDA), a reliable marker indicating the degree of the tissue damage after intestinal I/R. Serum MDA levels were significantly lower in the L-arginine group compared to the unt...
Εισαγωγή: Ο μετεγχειρητικός ίκτερος παρατηρείται στο 15% των καρδιοχειρουργικών και περίπου στο 1... more Εισαγωγή: Ο μετεγχειρητικός ίκτερος παρατηρείται στο 15% των καρδιοχειρουργικών και περίπου στο 1% των προγραμματισμένων ενδοκοιλιακών επεμβάσεων. Συνοδεύεται από άμεση υπερχολερυθριναιμία, αύξηση της αλκαλικής φωσφατάσης και ήπια τρανσαμινασαιμία. Συχνά οφείλεται σε χοληδοχολιθίαση μετά από διενεργηθείσα χολοκυστεκτομή και σπανιότερα σε ηπατοκυτταρικές παθήσεις. Σκοπός: Παρουσιάζουμε σπάνια περίπτωση εμφάνισης ικτέρου μετά από λαπαροσκοπική χολοκυστεκτομή, οφειλόμενου σε αμυλοείδωση καρδιάς-ήπατος. Υλικό-Μέθοδος: Γυναίκα 71 ετών, με ιστορικό χολολιθίασης, υποθυρεοειδισμού και περιφερικής νευροπάθειας υπεβλήθη σε τυπική λαπαροσκοπική χολοκυστεκτομή με ομαλή μετεγχειρητική πορεία. Τρεις μήνες μετά επανήλθε για διερεύνηση εμμένοντος ικτέρου (ολική χολερυθρίνη ~ 6mg/dl). Αποτελέσματα: Εμφάνιζε όψη πάσχουσας, ικτερική χροιά δέρματος, μειωμένη αισθητικότητα, μακρογλωσσία, μείωση αναπνευστικού ψιθυρίσματος άμφω, μετεωρισμό κοιλίας με εντερικούς ήχους παρόντες και ηπατοσπληνομεγαλία. Η ERC...
Despite recent improvements in diagnosis, surgical treatmentand neo-adjuvant therapy, patients wi... more Despite recent improvements in diagnosis, surgical treatmentand neo-adjuvant therapy, patients with esophageal cancerhave poor prognosis with overall 5-year survival rates of 5-15%.Esophagectomy is the standard treatment for resectableesophageal cancer, but only one third of patients are consideredcandidates for cure. Minimally invasive techniques have beenattempted to improve the postoperative outcomes in such asurgical procedure with high postoperative morbidity andmortality. The purpose of this review is to analyze theminimally invasive esophagectomy (MIE) techniques in theearly-stage esophageal carcinoma. MIE is still crowed withheterogeneous studies with several different techniques. MIEcomparing to open esophagectomy procedures have lessmorbidity with less overall in-hospital incidence of pulmonaryinfections and shorter duration of ICU admission. In addition,MIE techniques preserve the quality of life better than the openprocedures, with faster postoperative recovery. Celsius.
Journal of B.U.ON. : official journal of the Balkan Union of Oncology
Incidentally discovered pancreatic lesions that are asymptomatic have become much more common in ... more Incidentally discovered pancreatic lesions that are asymptomatic have become much more common in recent years. It is important to characterize these lesions and to determine which patients can be safely observed and which should undergo an operation, as a substantial proportion of them might be malignant or premalignant. This review focus on the diagnostic approach and management of the different types of cystic and solid incidental pancreatic lesions based on appropriate clinical input, imaging screening and histological criteria. The task of developing guidelines to deal with an incidentally found pancreatic lesion, however, is much more complex and controversial than with other organs incidentalomas. In most series, pancreatic incidentalomas (PIs) <2 cm and of cystic appearance are likely to be benign, whereas those >2 cm are usually premalignant or malignant. Serous cystadenomas can reach very large size and are usually benign lesions. The presence of a solid mass or a mur...
HPB surgery : a world journal of hepatic, pancreatic and biliary surgery, 2011
Peutz-Jeghers syndrome is a rare autosomal dominant inherited disease characterized by a special ... more Peutz-Jeghers syndrome is a rare autosomal dominant inherited disease characterized by a special type of hamartomatous gastrointestinal polyps combined with mucocutaneous melanin pigmentations. Patients with the syndrome have a high risk of developing neoplasia, with colon, small bowel, and stomach being the most common gastrointestinal sites. Herein, we present the occurrence of a rare tumor in patients with Peutz-Jeghers syndrome; a cholangiocarcinoma of the endopancreatic bile duct. A minireview is also presented. It can be concluded that cholangiocarcinoma remains a possible diagnosis in PJS patients, as in others that present with biliary obstruction. PJS patients may be at higher risk than others in view of their propensity for malignancy.
Mediastinal cysts compromise almost 20% of all mediastinal masses with bronchogenic subtype accou... more Mediastinal cysts compromise almost 20% of all mediastinal masses with bronchogenic subtype accounting for 60% of all cystic lesions. Although compression of adjoining soft tissues is usual, spinal complications and neurological symptoms are outmost rare and tend to characterize almost exclusively the neuroenteric cysts. A young patient with intermittent, dull pain in his back and free medical history presented in the orthopaedic department of our hospital. There, the initial clinical and radiologic evaluation revealed a mediastinal mass and the patient was referred to the thoracic surgery department for further exploration. The following computed tomography (CT) and magnetic resonance imaging (MRI) shown a huge mediastinal cyst compressing the T4-T6 vertebral bodies. The neurological symptoms of the patient were attributed to this specific pathology due to the complete agreement between the location of the cyst and the nervous rule area of the compressed thoracic vertebrae. Despite...
World journal of gastroenterology : WJG, Jan 28, 2005
Gastrointestinal duplication is an uncommon congenital abnormality in two-thirds of cases manifes... more Gastrointestinal duplication is an uncommon congenital abnormality in two-thirds of cases manifesting before the age of 2 years. Ileal duplication is common while colonic duplication, either cystic or tubular, is a rather unusual clinical entity that remains asymptomatic and undiagnosed in most cases. Mostly occurring in pediatric patients, colonic duplication is encountered in adults only in a few cases. This study reports two cases of colonic duplication in adults. Both cases presented with rectal bleeding on admission. The study was focused on clinical, imaging, histological, and therapeutical aspects of the presenting cases. Gastrografin enema established the diagnosis in both cases. The cystic structure and the adjacent part of the colon were excised en-block. The study implies that colonic duplication, though uncommon, should be included in the differential diagnosis of rectal bleeding.
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