Linos D.,Athens Medical School |
Linos D.,Hygeia Hospital |
Linos D.,Harvard University |
Economopoulos K.P.,Harvard University |
And 3 more authors.
Surgery (United States) | Year: 2013
Background: An incision less than 3 cm in length in the neck is the main feature that discriminates the minimally invasive thyroidectomy and parathyroidectomy from traditional procedures. Smaller neck scars are assumed to yield better patient satisfaction, although no established data support this. In this analysis, we evaluated the satisfaction of patients who had undergone both procedures, while examining the effects of sociodemographic and surgical characteristics. Methods: We analyzed data from 691 patients who underwent a thyroidectomy or parathyroidectomy between January 2000 and March 2010. We assessed the satisfaction of patients who underwent conventional compared to minimally invasive procedures, using the validated Patient Scar Assessment Questionnaire (PSAQ). We included both the appearance and the consciousness subscales. Results: Overall, patients were satisfied with their neck scars, as indicated by the low scores in appearance (13.3; range, 9 to 31) and consciousness (8.5; range, 6 to 24) subscales. The degree of satisfaction improved with increased time since surgery (P < .001). Patient satisfaction was similar regardless of the procedure used, implying that smaller scars do not provide better patient satisfaction. Most patients (81.2%) reported that they would not have preferred a transaxillary procedure over the procedure they received. Conclusion: A smaller incision in the neck was not associated with better patient satisfaction. New surgical approaches aimed at maximizing cosmesis while minimizing scar size should be evaluated for cost-effectiveness and clinical outcomes, as well as patient satisfaction, before becoming the standard of care. © 2013 Mosby, Inc. All rights reserved.
Toutouzas K.,Hippokration Hospital |
Grassos C.,Hippokration Hospital |
Drakopoulou M.,Hippokration Hospital |
Synetos A.,Hippokration Hospital |
And 12 more authors.
Journal of the American College of Cardiology | Year: 2012
Objectives: This study investigated whether temperature differences: 1) can be measured in vivo noninvasively by microwave radiometry (MR); and 2) are associated with ultrasound and histological findings. Background: Studies of human carotid artery samples showed increased heat production. MR allows in vivo noninvasive measurement of internal temperature of tissues. Methods: Thirty-four patients undergoing carotid endarterectomy underwent screening of carotid atherosclerosis by ultrasound and MR. Healthy volunteers were enrolled as a control group. During ultrasound study, plaque texture, plaque surface, and plaque echogenicity were analyzed. Temperature difference (ΔT) was assigned as maximal minus minimum temperature. Association of thermographic with ultrasound and histological findings was performed. Results: ΔT was higher in atherosclerotic carotid arteries compared with the carotid arteries of controls (p < 0.01). Fatty plaques had higher ΔT compared with mixed and calcified (p < 0.01) plaques. Plaques with ulcerated surface had higher ΔT compared with plaques with irregular and regular surface (p < 0.01). Heterogeneous plaques had higher ΔT compared with homogenous (p < 0.01). Specimens with thin fibrous cap and intense expression of CD3, CD68, and vascular endothelial growth factor (VEGF) had higher ΔT compared with specimens with thick cap and low expression of CD3, CD68, and VEGF (p < 0.01). Conclusions: MR provides in vivo noninvasive temperature measurements of carotid plaques, reflecting plaque inflammatory activation. © 2012 American College of Cardiology Foundation.
Apostolou E.,Academy of Athens |
Stavropoulos A.,Academy of Athens |
Sountoulidis A.,Academy of Athens |
Xirakia C.,Academy of Athens |
And 10 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2012
Rationale: Activin-A is up-regulated in various respiratory disorders. However, its precise role in pulmonary pathophysiology has not been adequately substantiated in vivo. Objectives: To investigate in vivo the consequences of dysregulated Activin-A expression in the lung and identify key Activin-A-induced processes that contribute to respiratory pathology. Methods: Activin-A was ectopically expressed in murine lung, and functional, structural, and molecular alterations were extensively analyzed. The validity of Activin-A as a therapeutic target was demonstrated in animals overexpressing Activin-A or treated with intratracheal instillation of LPS. Relevancy to human pathology was substantiated by demonstrating high Activin-A levels in bronchoalveolar lavage (BAL) samples from patients with acute respiratory distress syndrome (ARDS). Measurements and Main Results: Overexpression of Activin-A inmouse airways caused pulmonary pathology reminiscent of acute lung injury (ALI)/ARDS. Activin-A triggered a lasting inflammatory response characterized by acute alveolar cell death and hyaline membrane formation, sustained up-regulation of high-mobility group box 1, development of systemic hypercoagulant state, reduction of surfactant proteins SpC, SpB, and SpA, decline of lung compliance, transient fibrosis, and eventually emphysema. Therapeutic neutralization of Activin-A attenuated the ALI/ARDS-like pathology induced either by ectopic expression of Activin-A or by intratracheal instillation of LPS. In line with the similarity of the Activin-A-induced phenotype to human ARDS, selective up-regulation of Activin-A was found in BAL of patients with ARDS. Conclusions: Our studies demonstrate for the first time in vivo the pathogenic consequences of deregulated Activin-A expression in the lung, document novel aspects of Activin-A biology that provide mechanistic explanation for the observed phenotype, link Activin-A to ALI/ARDS pathophysiology, and provide the rationale for therapeutic targeting of Activin-A in these disorders. Copyright © 2012 by the American Thoracic Society.
Papadopoulos G.,Asklipieion General Hospital |
Delakas D.,Asklipieion General Hospital |
Nakopoulou L.,Athens Medical School |
Kassimatis T.,Asklipieion General Hospital
European Journal of Cancer | Year: 2011
The field of the potential applications of 3-hydroxy-3-methylglutaryl- coenzyme A (HMG-CoA) reductase inhibitors (statins) beyond their unambiguous cardiovascular beneficial effects is steadily increasing. In this regard, statins have also been shown to possess anti-inflammatory, immunomodulatory, antioxidant and growth inhibitory properties. Regarding their role in carcinogenesis, both preclinical and clinical studies report conflicting results. Intriguingly, accumulating evidence suggests that statins may relate to decreased prostate cancer incidence and recurrence risk. However, data from clinical studies seem to be still weak and are confounded by several factors. Nonetheless, preclinical data suggest that statins might exert a chemopreventive role against prostate cancer by inhibiting the proliferation and inducing apoptosis of prostate cancer cells and also inhibiting angiogenesis, inflammation and metastasis. Cholesterol lowering as well as statin pleiotropy through inhibition of the synthesis of isoprenoids have both been implicated in their anticancer properties. In this review, we discuss the preclinical and clinical evidence supporting the preventive or potentially harmful effects of statins on prostate tumourigenesis and conclude that statins should not be recommended for the prevention of prostate cancer development or progression based on the current data. © 2010 Elsevier Ltd. All rights reserved.
Skolarikos A.,Athens Medical School |
Laguna M.P.,University of Amsterdam |
Alivizatos G.,Athens Medical School |
Kural A.R.,Istanbul Science University |
De La Rosette J.J.M.C.H.,University of Amsterdam
Journal of Endourology | Year: 2010
Background and Purpose: All urinary stones may not need prompt active treatment. The aim of our study was to identify urinary stones that can be actively monitored safely. Materials and Methods: We performed a systematic review of the natural history and the role of active monitoring for urinary stones. Results: Thirty-seven studies have selected. Of symptomatic ureteral calculi <4mm, 38% to 71% will pass spontaneously while only 4.8% of stones <2mm will need intervention during surveillance. Follow-up with history, physical examination, urinalysis, and plain radiography every 2 weeks for 1 month is necessary. If spontaneous passage does not occur within this period, intervention is recommended. When shockwave lithotripsy for caliceal stones is prospectively compared with observation, there is no difference in stone-free rates (28% vs 17%), need for additional treatment (15% vs 21%), or visits to a general practitioner (18.5% vs 20.8%). Patients under observation may need more invasive procedures and may be more commonly left with residual stone fragments >5mm (58% vs 30%). Isolated, nonuric acid calculi <4mm may be most amenable to active monitoring. Physical examination, urinalysis, and CT scan performed on an annual basis up to year 2 or 3, followed by intervention, are recommended. Lower pole stones <10mm could be actively monitored on an annual basis by alternating ultrasonoraphy with CT scan, provided the patients are adequately informed. Up to 58.6% and 43% of patients with residual fragments after shockwave and percutaneous lithotripsy, respectively, may become symptomatic or require intervention during follow-up. Noninfected, asymptomatic fragments, <4mm postextracorporeal lithotripsy, and <2mm postpercutaneous surgery could be followed expectantly on an annual basis, in combination with medical therapy. Conclusion: Active stone monitoring has a certain role in the treatment of patients with urinary stones. The success is largely dependent on the stone size, location, and composition, as well as the time after the diagnosis. Medical therapy is a useful adjunct to observation. © Mary Ann Liebert, Inc. 2010.
Fragoulakis V.,National School of Management |
Kourlaba G.,National School of Management |
Goumenos D.,University of Patras |
Konstantoulakis M.,Athens Medical School |
Maniadakis N.,National School of Management
ClinicoEconomics and Outcomes Research | Year: 2012
Purpose: To conduct an economic evaluation comparing Ferinject® (ferric carboxymaltose [FCM]) with Venofer® (iron sucrose [IS]) and CosmoFer® (low-molecular-weight iron dextran [LMWID]) in the management of iron deficiency anemia in Greece. Patients and methods: A cost-minimization analysis was conducted since there are no clear data indicating that one of these regimens is superior to the others in terms of efficacy. Main data inputs were based on bibliography and validated by clinicians. The economic evaluation was conducted for inpatients (ie, surgical patients or patients hospitalized due to a disease related to chronic or acute blood loss) and outpatients (eg, nondialysis chronic kidney disease patients), separately. Analysis was carried out from a National Health Service (NHS) perspective and also from a patient perspective. Total cost treatment reflects the cost of drugs, the cost of all resources expended in patient management such as the cost of disposables for each infusion, the monitoring costs during infusion (salaries of personnel), other hospital expenses, the cost for management of adverse events, the productivity loss, and the traveling cost for patients. Results: In the case of outpatients, the mean total cost per patient in the FCM arm was €198.6, in the IS arm €627.7, and in the LMWID arm, €510.5. For inpatients the mean total cost was estimated at €189.2 for FCM while it was €419.9 and €228.8 for IS and LMWID, respectively. Budget impact analysis for a typical Greek hospital with 100 patients revealed that the total cost of FCM (inpatients analysis) was 113% and 15.4% lower against their comparators. In an outpatient situation, the total cost of FCM was 201.1% and 151.8% lower compared with IS and LMWID, respectively. Conclusion: Ferric carboxymaltose may represent a cost-saving option compared with the most likely alternative existing therapies used for the management of anemia in the National Health Service of Greece. © 2012 Fragoulakis et al, publisher and licensee Dove Medical Press Ltd.
Gandaglia G.,Vita-Salute San Raffaele University |
Briganti A.,Vita-Salute San Raffaele University |
Jackson G.,Guys And St Thomas Hospitals London |
Kloner R.A.,University of Southern California |
And 3 more authors.
European Urology | Year: 2014
Context Erectile dysfunction (ED) is considered a vascular impairment that shares many risk factors with cardiovascular disease (CVD). A correlation between ED and CVD has been hypothesized, and ED has been proposed as an early marker of symptomatic CVD. Objective To analyze the relationship between ED and CVD, evaluating the pathophysiologic links between these conditions, and to identify which patients would benefit from cardiologic assessment when presenting with ED. Evidence acquisition A systematic literature review searching Medline, Embase, and Web of Science databases was performed. The search strategy included the terms erectile dysfunction, cardiovascular disease, coronary artery disease, risk factors, pathophysiology, atherosclerosis, low androgen levels, inflammation, screening, and phosphodiesterase type 5 inhibitors alone or in combination. We limited our search to studies published between January 2005 and May 2013. Evidence synthesis Several studies reported an association between ED and CVD. The link between these conditions might reside in the interaction between androgens, chronic inflammation, and cardiovascular risk factors that determines endothelial dysfunction and atherosclerosis, resulting in disorders of penile and coronary circulation. Because penile artery size is smaller compared with coronary arteries, the same level of endothelial dysfunction causes a more significant reduction of blood flow in erectile tissues compared with that in coronary circulation. Thus ED could be an indicator of systemic endothelial dysfunction. From a clinical standpoint, because ED may precede CVD, it can be used as an early marker to identify men at higher risk of CVD events. ED patients at high risk of CVD should undergo detailed cardiologic assessment and receive intensive treatment of risk factors. Conclusions ED and CVD should be regarded as two different manifestations of the same systemic disorder. ED usually precedes CVD onset, and it might be considered an early marker of symptomatic CVD. © 2013 European Association of Urology.
Karaolides T.,Anticancer Hospital Agios Sabas |
Skolarikos A.,Athens Medical School |
Bourdoumis A.,Athens Medical School |
Konandreas A.,Anticancer Hospital Agios Sabas |
And 3 more authors.
Urology | Year: 2012
Objective: To evaluate the effect of hexaminolevulinate (HAL)-induced fluorescence during resection of noninvasive bladder cancer on tumor recurrence compared with resection under white light. Methods: Between 2008 and 2010, 102 consecutive patients with suspected bladder cancer were randomized to undergo transurethral resection with either conventional white light or combination of white light and HAL-induced fluorescence. Difference in tumor recurrence rate and recurrence-free survival between the 2 groups was evaluated. Subgroup analysis on recurrence-free survival was performed for different tumor parameters. Results: Cystoscopy at 3 months revealed tumor recurrence in 6 of 45 (13.3%) patients of the white light group compared with only 1 of 41 patients of the HAL group (2.4%) (P <.001). The recurrence-free rates in white light patients at 12 and 18 months were 56.3% and 50.6%, respectively, compared with 91% and 82.5% in HAL patients (P =.0006). In subgroup analyses, recurrence-free survival was similar between the 2 groups when solitary tumors were treated (P =.3525). However, the HAL group had a favorable recurrence-free survival compared with the white light group when multifocal tumors (P <.001), primary tumors (P =.0237), recurrent tumors (P =.0189), nonaggressive (papillary urothelial neoplasm of low malignant potential and low grade) tumors (P =.0204), or aggressive (high grade and carcinoma in situ) tumors (P =.0134) were treated. Conclusion: HAL significantly aids resection of non-muscle-invasive bladder cancer with the result of reduction in tumor recurrence rates. © 2012 Elsevier Inc.
News Article | September 5, 2016
Smoking reduces calorie intake by affecting levels of hunger hormone ghrelin in the body, says a small study presented at the European Respiratory Society International Congress. Smoking and weight loss have been associated before but it wasn't exactly clear how smoking cigarettes causes a drop in a smoker's weight. According to earlier research, it may be related to hormonal activity. Now, a study carried out by Dr. Konstantina Zachari and colleagues at the Harokopio University Athens, with Athens Medical School Greece as a collaborator, is saying that it's because smoking causes a drop in ghrelin. With the hunger hormone low, hunger levels are also down, leading to a reduction in food (and thus, calories) consumed. For the study, the researchers worked with 14 healthy males who underwent two trials after abstaining from smoking and food. In the first trial, the subjects smoked two cigarettes from their brand of choice, while they simply held a cigarette as if smoking it for the second trial, the control trial. Each trial was set for 15 minutes. Forty-five minutes after each one, the subjects were given the liberty to eat whatever snacks they wanted. Dietary intake, appetite feelings (desire to eat, hunger, satiety), and craving for smoking were then recorded at standard time points and samples of blood were collected to test for the hormones ghrelin, obestatin, insulin, CCK and GLP-1. Overall, the researchers saw a drop in dietary intake, resulting in a reduction of 152 calories. Additionally, plasma ghrelin concentrations were lower after the control trial. The trials, however, had no effect on macronutrient intake or taste preference. Appetite feelings and levels of obestatin, insulin, CCK and GLP-1 were also unaffected. The belief that smoking helps in regulating body weight starts with adolescent smokers and sticks well into their adulthood. As such, many who may be looking to control their weight may be demotivated to quit smoking, even with the realization of its harmful effects to health. Their worries may also be supported by their own experience or that of others where weight is gained after smoking cessation. The researchers acknowledge this, pointing out the need to further investigate other possible biological mediators to help come up with ways to address post-cessation weight gain while still promoting smoking cessation and lowering relapse rates. To help smokers quit, Britain's Royal College of Physicians has thrown its weight behind e-cigarettes. They may still have their dangers but e-cigarettes are healthier alternatives to smoking, at least in that they have fewer cancer-causing chemicals than standard cigarettes. © 2017 Tech Times, All rights reserved. Do not reproduce without permission.
Theodorakopoulou M.,Athens Medical School |
Perros E.,General District Hospital of Piraeus |
Giamarellos-Bourboulis E.J.,Athens Medical School |
Dimopoulos G.,Athens Medical School
International Journal of Antimicrobial Agents | Year: 2013
Probiotics are commercially available, viable, non-pathogenic micro-organisms that, when ingested in sufficient quantities, exert a health benefit to the host derived through modification of the gut flora, local release of antimicrobial factors, maintenance of integrity of the gut barrier, competition for epithelial adherence, prevention of bacterial translocation, and modulation of the local immune response. In critically ill patients, probiotics appear to lead to decreased susceptibility to antibiotic-associated diarrhoea, Clostridium difficile infections, ventilator-associated pneumonia, necrotising enterocolitis, acute severe pancreatitis, sepsis and multiple organ dysfunction syndrome as well as a shortened duration of infections. Current scientific evidence supporting the use of probiotics is not conclusive and is mainly derived from single-centre, not very well designed trials that are limited by many factors including small sample sizes, heterogeneity in the probiotic strains used, effectiveness of the combined strains, optimum dose regimens, frequency and duration of administration, and certainly incomplete knowledge of the mechanism of action of each strain. Probiotics appear to be well tolerated, whilst adverse events are very rare. The most commonly reported adverse events include bacteraemia, fungaemia and sepsis. At present, based on the available evidence and although helpful and relatively safe for certain disease conditions, routine use of probiotics in the critically ill is not recommended. © 2013 Elsevier B.V. and the International Society of Chemotherapy.