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Ymittos Athens, Greece

Chaudhary V.,McMaster University | Barbosa J.,McMaster University | Lam W.-C.,University of Toronto | Mak M.,University of Toronto | And 2 more authors.
Canadian Journal of Ophthalmology | Year: 2016

Objective: To evaluate the utility of dexamethasone intravitreal implant (DXI; Ozurdex; Allergan, Irvine, Calif.) in combination with ranibizumab (Lucentis; Novartis Pharma AG, Basel, Switzerland) versus ranibizumab monotherapy on visual acuity (VA) and anatomical outcomes in a neovascular age-related macular degeneration (nAMD) cohort. Design: Multicentred, single-blinded, pilot randomized control trial. Participants: Ten patients 50 years or older with subfoveal choroidal neovascularization secondary to AMD were randomized to receive DXI in combination with ranibizumab (group 1) or ranibizumab alone (group 2) after a 3-month ranibizumab loading period. Methods: Group 1 patients received 1 DXI after the loading phase with the option of retreatment at months 4 to 6. Ranibizumab was administered pro re nata for 6 months in both study arms. Mean VA and central macular thickness (CMT) reductions from baseline to study endpoint (9 months) were reported in addition to adverse event frequency across study cohorts. Results: From baseline to the study endpoint, VA improved by 10.8 ± 13.2 Early Treatment of Diabetic Retinopathy Study letters in the control arm and 3.0 ± 10.5 letters in the intervention arm (p = 0.331). CMT decreased by 31.7% ± 17.5% and 13.3% ± 27.0% (p = 0.236) for the control and intervention cohorts, respectively. One patient developed intraocular pressure in excess of 30 mm Hg 3 months after DXI administration. Conclusions: For this nAMD population, no visual or anatomical benefits were observed when treating with DXI in adjunct to ranibizumab relative to ranibizumab monotherapy. DXI-related adverse events were consistent with those previously documented for dexamethasone. Objet: Évaluer l'utilité de combiner un implant intravitréen de dexaméthasone (Ozurdex;Allergan, Irvine, Californie) à un traitement au ranibizumab (Lucentis; Novartis Pharma AG, Bâle, Suisse) plutôt que d'opter pour le ranibizumab en monothérapie, des points de vue de l'acuité visuelle (AV) et des résultats anatomiques, chez des patients atteints de la forme néovasculaire de la dégénérescence maculaire liée à l'âge (DMLAn). Nature: Essai contrôlé randomisé pilote à simple insu, multicentrique. Participants: Dix patients de 50 ans ou plus avec une néovascularisation choroïdienne rétrofovéolaire secondaire à la DMLA ont été choisis au hasard pour recevoir soit un implant intravitréen de dexaméthasone jumelé à un traitement au ranibizumab (groupe 1), soit du ranibizumab seulement (groupe 2) après une phase d'induction de ranibizumab d'une durée de trois mois. Méthodes: Les patients du groupe 1 ont reçu un implant intravitréen de dexaméthasone après la phase d'induction, avec la possibilité de retraitement au quatrième, cinquième et sixième mois.Le ranibizumab a été administré au besoin pendant 6 mois dans les deux groupes. On a fait état de l'AV moyenne et de la réduction de l'épaisseur maculaire centrale (EMC) moyenne entre le début et la fin de l'étude (9 mois), en plus d'événements indésirables dans les deux groupes. Résultats: Du début à la fin de l'étude, l'AV s'est améliorée de 10,8 ± 13,2 lettres ETDRS dans le groupe témoin et de 3,0 ± 10,5 lettres ETDRS dans le groupe d'intervention (p = 0,331).L'EMC a diminué de 31,7 ± 17,5 % dans le groupe témoin et de 13,3 ± 27,0 % dans le groupe d'intervention (p = 0,236).Un patient avait développé une pression intraoculaire de plus de 30 mmHg trois mois après avoir reçu l'implant. Conclusions: Pour la cohorte DMLAn étudiée, la combinaison d'un implant intravitréen de dexaméthasone à un traitement au ranibizumab n'a eu aucun avantage visuel ni anatomique par rapport au ranibizumab en monothérapie.Les événements indésirables liés à l'implant correspondaient à ceux déjà documentés pour la dexaméthasone. © 2016 Canadian Ophthalmological Society. Source

Spragg R.G.,University of California at San Diego | Spragg R.G.,Veterans Affairs Medical Center 151C | Taut F.J.H.,Nycomed GmbH | Lewis J.F.,University of Western Ontario | And 6 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2011

Rationale: Patients with acute lung injury have impaired function of the lung surfactant system. Prior clinical trials have shown that treatment with exogenous recombinant surfactant protein C (rSP-C)-based surfactant results in improvement in blood oxygenation and have suggested that treatment of patients with severe direct lung injury may decrease mortality. Objectives: Determine the clinical benefit of administering an rSP-C-based synthetic surfactant to patients with severe direct lung injury due to pneumonia or aspiration. Methods:Aprospective randomized blinded study was performed at 161 centers in 22 countries. Patients were randomly allocated to receive usual care plus up to eight doses of rSP-C surfactant administered over 96 hours (n 5 419) or only usual care (n 5 424). Measurements and Main Results: Mortality to28 days after treatment, the requirement for mechanical ventilation, and the number of nonpulmonary organ failure-free days were not different between studygroups.Incontrasttoprior studies,there wasnoimprovement in oxygenation in patients receiving surfactant compared with the usual care group. Investigation of the possible reasons underlying the lack of efficacy suggested a partial inactivation of rSP-C surfactant caused by a step of the resuspension process that was introduced with this study. Conclusions: In this study, rSP-C-based surfactant was of no clinical benefit to patients with severe direct lung injury. The unexpected lack of improvement in oxygenation, coupled with the results of in vitrotests, suggest that the administered suspension may have had insufficient surface activity to achieve clinical benefit. Clinical trial registered with www.clinicaltrials.gov (NCT00074906). Source

Papagrigorakis M.J.,National and Kapodistrian University of Athens | Toulas P.,Euromedica ENCEFALOS | Tsilivakos M.G.,National and Kapodistrian University of Athens | Kousoulis A.A.,National and Kapodistrian University of Athens | And 3 more authors.
World Neurosurgery | Year: 2014

Objective: Paleoneurosurgery represents a comparatively new developing direction of neurosurgery dealing with archaeological skull and spine finds and studying their neurosurgical aspects. Trepanation of the cranial vault was a widespread surgical procedure in antiquity and the most convincing evidence of the ancient origin of neurosurgery. The present study considers a case of trepanation from the Middle Bronze Age Greece (1900-1600 B.C.). Methods: The skull under study belongs to skeletal material unearthed from Kirra, Delphi (Central Greece). Macroscopic examination and palpation, as well as three-dimensional computed tomography, were used in this study. Results: There is osteological evidence that the skull belongs to a man who died at 30-35 years of age. The procedure of trepanation was performed on the right parietal bone. Both macroscopic and computed tomography evaluation demonstrate an intravital bone reaction at the edges of the aperture. Projected on the right surface of the brain, the trepanation is located on the level of the central groove. The small dimensions and the symmetrical shape of this hole give us an indication that it was made by a metal tool. Conclusion: We conclude that this paleopathological case provides valuable information about the condition of life and the pre-Hippocratic neurosurgical practice in Bronze Age Greece. Source

Bazoukis G.,General Hospital of Athens | Tsimos K.,University of Ioannina | Korantzopoulos P.,University of Ioannina
Annals of Noninvasive Electrocardiology | Year: 2016

Episodic (transient/ intermittent) left bundle branch block (LBBB) has been associated with different conditions such as bradycardia, tachycardia, anesthesia, acute pulmonary embolism, changes in intrathoracic pressure, chest trauma, cardiac interventional procedures, mad honey poisoning, and in other clinical settings. Of note, exclusion of an acute coronary syndrome in the setting of episodic LBBB is of great importance. Moreover, episodic LBBB is sometimes symptomatic and may be associated with left ventricular systolic and/or diastolic dysfunction or conduction disturbances leading to syncope. This review article provides a comprehensive overview of the conditions associated with episodic LBBB and discusses the clinical impact of this phenomenon. © 2016 Wiley Periodicals, Inc. Source

Kanakis M.A.,General Hospital of Athens | Thomas T.,Hannover Medical School | Martinakis V.G.,General Hospital of Athens | Brountzos E.,National and Kapodistrian University of Athens | Varsamidakis N.,General Hospital of Athens
Updates in Surgery | Year: 2012

We present the case of an 18-year-old female with severe liver trauma after a motorcycle accident. Due to initial hemodynamic instability, fluid resuscitation and transfusion of two units of red packed cells was required. After stabilization, a CT scan was performed, showing grade V liver injuries according to the American Association for the Surgery of Trauma grading system. Angiography revealed multiple extravasations during the early arterial phase, as well as active extravasation from the proximal left hepatic artery in the late arterial phase. The patient was successfully treated by arterial embolization using metal microcoils, after which no further need for blood transfusion ensued. This report highlights that, in carefully selected cases, arterial embolization can improve the clinical condition of patients, reduce the need for blood transfusion and lessen the possibility of an operation, even if severe liver trauma has ensued. © Springer-Verlag 2012. Source

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