Papers by Stylianos Germanos
Journal of gastrointestinal and liver diseases : JGLD, 2015
Annals of the Royal College of Surgeons of England, 2008
Journal of the American College of Surgeons, 2009
A 49-year-old man with alcoholic chronic pancreatitis had a pseudocyst 5 cm in diameter in the he... more A 49-year-old man with alcoholic chronic pancreatitis had a pseudocyst 5 cm in diameter in the head of pancreas (A, arrow) with dilated pancreatic duct and calcifications of the gland. A followup CT scan showed marked enhancement within the lesion similar to that of the blood vessels, strongly suggesting a large pseudoaneurysm (B, arrow). Angiography confirmed the pseudoaneurysm arising from the gastroduodenal artery corresponding to the enhanced lesion that appeared on CT (C, arrow). After localizing the exact origin of the pseudoaneurysm, embolization was performed with coils through the gastroduodenal and inferior pancreaticoduodenal arteries. Postembolization gastroduodenal and superior mesenteric angiography confirmed obliteration of the pseudoaneurysm (D). Contrast-enhanced CT scan repeated the next day showed shrinkage of the lesion (E). The patient was discharged home one day after embolization, and did not require further treatment. He remains well over one year after the procedure.
Journal of Clinical Gastroenterology, 2007
Pancreatic cystic neoplasms are less frequent than other pancreatic tumors, but because of the wi... more Pancreatic cystic neoplasms are less frequent than other pancreatic tumors, but because of the wide availability and improvement of modern imaging methods, these neoplasms are being recognized with increasing frequency and it is often possible to be differentiated preoperatively not only from other cystic pancreatic disorders but also from one another. Most patients have no symptoms while clinical signs are not really useful in the clinical work up, and when they are present, they never help us to identify the type of pathology. Treatment differs with the diagnosis. Serous cystic neoplasms are uniformly benign and usually do not mandate resection unless this lesion is symptomatic. In contrast, mucinous cystic neoplasms and intraductal papillary mucinous neoplasms have a premalignant or malignant tendency, and therefore should be managed aggressively by pancreatic resection; in the absence of invasive disease, prognosis is excellent after appropriate surgery, but the presence of invasive malignancy signifies a poor prognosis. Solid pseudopapillary neoplasms have nonaggressive behavior and their management is related to the extension of the disease. The purpose of this article is to review the types of pancreatic cystic neoplasms, their diagnosis, indications for surgical treatment, and outcome.
Archives of Surgery, 2012
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2008
Diaphragmatic and urinary bladder ruptures are rare entities after blunt abdominal trauma and the... more Diaphragmatic and urinary bladder ruptures are rare entities after blunt abdominal trauma and they are usually the results of high energy injuries. They seldom occur in isolation. For the diaphragmatic rupture, the accurate diagnosis depends on high index of suspicion and careful scrutiny of the chest X-ray, while gross hematuria is the hallmark finding in patients with bladder rupture. Suprapubic pain, tenderness, and inability to void are the main symptoms and signs of bladder rupture. In this report, we describe our successful experience with a case of combined diaphragmatic and urinary bladder rupture occurred in isolation as a result of low energy trauma, with special emphasis on diagnosis and surgical treatment.
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
Laparoscopic cholecystectomy (LC) is increasingly being used as an appropriate early treatment in... more Laparoscopic cholecystectomy (LC) is increasingly being used as an appropriate early treatment in patients with cholecystitis. This study evaluated the safety, effectiveness, and complications of LC in all cases of acute cholecystitis. A retrospective study involved the patients who underwent LC for acute cholecystitis within 72 hours of admission. The preoperative diagnosis was based on clinical, laboratory, and echographic examinations, while the final diagnosis was confirmed by histopathological examination of the excised gallbladder. We identified 184 patients with acute cholecystitis. Intraoperative cholangiography (IOC) was not performed. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) was performed in 62 patients (33.7%), and postoperative ERCP in 13 patients (7.1%). Conversion to open cholecystectomy was necessary in 19 patients (10.3%); 16 patients for severe inflammation and adhesions and 3 patients because of uncontrolled bleeding. The mean operative ti...
International Journal of Emergency Medicine, 2010
Journal of Gastrointestinal Cancer, 2011
The American Journal of Surgery, 2010
Presacral venous hemorrhage is an uncommon but potentially life-threatening complication of recta... more Presacral venous hemorrhage is an uncommon but potentially life-threatening complication of rectal surgery. It is difficult to control presacral venous hemorrhage with conventional hemostatic measures and several alternative methods for hemostasis have been proposed. We described our experience of using the combination of a hemostatic matrix and an absorbable hemostat as an alternative method of hemostasis. From September 2007 to March 2009, 83 patients underwent rectal surgery for cancer, ulcerative colitis, or familial adenomatous polyposis. Three patients (3.6%) had severe presacral hemorrhage, which was controlled by the combined use of a hemostatic matrix (FloSeal; Baxter, USA) and an absorbable hemostat (Surgicel Fibrillar; Ethicon, USA). Intraoperative blood transfusion was required in 1 patient. Postoperative blood loss was minimal and drain was removed on day 4 in all 3 patients. The use of synthetic hemostatic agents is an effective and simple way to arrest presacral bleeding where conventional methods fail.
Surgery, 2008
A 20-year-old man with no previous significant medical abnormalities presented with a 1-month his... more A 20-year-old man with no previous significant medical abnormalities presented with a 1-month history of abdominal pain, weight loss, anorexia, and vomiting. On physical examination, his abdomen was slightly swollen and tender, and a large liver was palpable. Routine hematologic and blood biochemistry results were normal. Carcinoembryonic antigen, ␣-fetoprotein, and cancer antigen 19-9 levels were in the reference range. Computed tomography (CT) showed hepatomegaly and a large, hypodense lesion of the liver with multicystic appearance with septations and solid portions including the left and part of the right lobe of the liver
Journal of Surgical Education, 2007
International Journal of Surgery, 2008
Damage control is well established as a potentially life-saving procedure in a few selected criti... more Damage control is well established as a potentially life-saving procedure in a few selected critically injured patients. In these patients the 'lethal triad' of hypothermia, acidosis, and coagulopathy is presented as a vicious cycle that often can not be interrupted and which marks the limit of the patient's ability to cope with the physiological consequences of injury. The principles of damage control have led to improved survival and to stopped bleeding until the physiologic derangement has been restored and the patient could undergo a prolong operation for definitive repair. Although morbidity is remaining high, it is acceptable if it comes in exchange for improved survival. There are five critical decision-making stages of damage control: I, patient selection and decision to perform damage control; II, operation and intraoperative reassessment of laparotomy; III, resuscitation in the intensive care unit; IV, definitive procedures after returning to the operating room; and V, abdominal wall reconstruction. The purpose of this article is to review the physiology of the components of the 'lethal triad', the indication and principles of abdominal damage control of trauma patients, the reoperation time, and the pathophysiology of abdominal compartment syndrome.
Digestive Diseases and Sciences, 2009
Pancreatic adenocarcinoma is the sixth leading cause of cancer-related death in Europe with survi... more Pancreatic adenocarcinoma is the sixth leading cause of cancer-related death in Europe with survival rates remaining unchanged over the last three decades. Early diagnosis and accurate staging are essential due to the difficulty of curing this tumor in its advanced form. Endoscopic or laparoscopic ultrasonography and computed tomography are the preferred imaging and staging modalities for many patients with pancreatic adenocarcinoma. Morbidity and mortality are similar for pylorus-preserving and classic pancreaticoduodenectomy. Extended retroperitoneal lymphadenectomy does not improve survival and increases morbidity compared with standard pancreaticoduodenectomy, while adjuvant chemoradiotherapy prolongs survival in selected groups of patients. This article reviews the causes, risk factors, and clinical features of pancreatic adeno-carcinoma and discusses the methods of optimal diagnosis, staging and treatment.
Journal of Hepato-Biliary-Pancreatic Surgery, 2007
Background/Purpose. Liver trauma, especially that as result of road traffi c accidents, still rem... more Background/Purpose. Liver trauma, especially that as result of road traffi c accidents, still remains a complicated problem in severely injured patients. The aim of this study was to extract useful conclusions from the management in order to improve the fi nal outcome of such patients. Methods. Details for 86 patients with blunt hepatic trauma who were examined and treated in our department during a 6-year period were analyzed. We retrospectively reviewed the severity of liver injury, associated injuries, treatment, and outcome. Results. Forty-nine liver injuries (57%) were of low severity (grades I and II), while 37 (43%) were of high severity (grades III, IV, and V). Liver trauma with associated injury of other organs was noted in 62 (72.1%) patients. Forty-three (50%) patients underwent an exploratory laparotomy within the fi rst 24 h of admission. Thirty-fi ve (71.4%) of the 49 patients with low-grade hepatic injuries were managed conservatively; no mortality occurred. Six (14%) of forty-three patients with liver trauma initially considered for conservative management required surgery due to hemodynamic instability. Five (13.5%) of 37 patients who were fi nally managed nonoperatively required adjunctive treatment for biloma, hematoma, or biliary leakage; no mortality occurred. The overall mortality rate was 9.3%; mortality rates of 5.8% and 3.5% were due to liver injuries and concomitant injuries, respectively. Conclusions. Severe hepatic injuries require surgical intervention due to hemodynamic instability. Low-grade injuries can be managed nonoperatively with excellent results, while patients with hepatic trauma with associated organ injuries require surgery, because they continue to have signifi cantly higher mortality.
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Papers by Stylianos Germanos