General Hospital of Chania

Crete, Greece

General Hospital of Chania

Crete, Greece
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Carrero J.J.,Karolinska University Hospital | Carrero J.J.,Karolinska Institutet | Kyriazis J.,General Hospital of Chios | Qureshi A.R.,Karolinska University Hospital | And 6 more authors.
Clinical Journal of the American Society of Nephrology | Year: 2012

Background and objectives Both prolactin clearance and production are altered in CKD. In nonrenal populations, emerging evidence suggests that prolactin participates in the atherosclerotic process. Given the elevated cardiovascular risk of CKD, this study examined links between prolactinemia, vascular derangements, and outcomes. Design, setting, participants, & measurements This observational study was conducted in two cohorts: one with 457 nondialyzed CKD patients (mean age 52 ± 12 years; 229 men) with measurements of flow-mediated dilation (FMD) and carotid intima-media thickness and one with 173 hemodialysis patients (65±12 years; 111 men) with measurements of pulse wave velocity (PWV). Patients were followed for cardiovascular events (n=146, nondialyzed cohort) or death (n=79, hemodialysis cohort). Results Prolactin levels increased along with reduced kidney function. Prolactin significantly and independently contributed to explain the variance of both FMD (in nondialyzed patients) and PWV (in hemodialysis patients), but not intima-media thickness. In Cox analyses, the risk of cardiovascular events in nondialyzed patients increased by 27% (hazard ratio [HR], 1.27; 95% confidence interval [95% CI], 1.17-1.38) for each 10 ng/ml increment of prolactin. Similarly, the risk for all-cause and cardiovascular mortality in hemodialysis patients increased by 12% (HR, 1.12; 95% CI, 1.06-1.17) and 15% (HR, 1.15; 95% CI, 1.08-1.21), respectively. This was true after multivariate adjustment for confounders and after adjustment within the purported causal pathway (FMD or PWV). Conclusions Prolactin levels directly associated with endothelial dysfunction/stiffness and with increased risk of cardiovascular events and mortality in two independent cohorts of CKD patients. © 2012 by the American Society of Nephrology.

Chaidas K.S.,General Hospital of Volos | Kaditis A.G.,National and Kapodistrian University of Athens | Papadakis C.E.,General Hospital of Chania | Papandreou N.,General Hospital of Volos | And 2 more authors.
Laryngoscope | Year: 2013

Objectives/Hypothesis Adenoidectomy and tonsillectomy (TE) is the standard treatment for obstructive sleep-disordered breathing (SDB) in children with adenotonsillar hypertrophy. Tonsilloplasty (TP) is a new surgical technique that includes partial TE. The purpose of this study was to assess the short- and long-term outcomes of TP compared to TE. Study Design A comparison study. Methods Children with SDB and tonsillar hypertrophy underwent TP or TE. The two groups were compared regarding immediate postoperative course and long-term effects. Results Fifty-one children (age, 6.3 ± 2.5 years) underwent TE, and 50 children (age, 5.9 ± 2.1 years) had TP. The TP group had significantly less intraoperative bleeding compared to the TE group (25.6 ± 8.2 vs. 38.3 ± 12.3 mL, P <.001). Subjects with TP were pain free earlier than children with TE (4.5 ± 0.4 vs. 7.7 ± 0.4 days, P <.001) and returned to a normal diet sooner (3.8 ± 0.2 vs. 7.1 ± 0.3 days, P <.001). By the 3rd to 4th postoperative night, upper airway obstruction was relieved in all participants. Six years postoperatively, 48 of 51 children in the TE group and 43 of 50 children in the TP group participated in a telephone survey. No significant differences were found between the two groups regarding the frequency of recurrent snoring (30.2% in TP vs. 25% in TE), apneas (4.7% vs. 0%), and upper airway infections per year (P >.05). Conclusions TP is an alternative surgical method for treatment of SDB related to tonsillar hypertrophy with favorable postoperative course and comparable long-term results. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

Pappa C.,Venizelion Hospital of Heraklion | Alexandrakis M.,University Hospital of Heraklion | Boula A.,Venizelion Hospital of Heraklion | Psarakis F.,University Hospital of Heraklion | And 4 more authors.
Hematological Oncology | Year: 2013

Angiogenesis is an essential process for the expansion of multiple myeloma (MM), in which many angiogenic factors participate. Endoglin (CD105) is a transforming growth factor-β co-receptor, being mainly expressed in angiogenic endothelial cells and has been used as a marker of tumor angiogenesis, having prognostic potential. The aim of the study was to evaluate serum levels of soluble CD105 (sCD105) in MM patients, both during diagnosis and after effective conventional chemotherapy, in the plateau phase, and to correlate them with the clinical stage of the disease, as well as with the known angiogenic factors vascular endothelial growth factor, angiogenin and interleukin-18 (IL-18). Serum levels of the aforementioned factors were measured, by enzyme-linked immunosorbent assay, in 56 newly diagnosed MM patients, in 35 of them who entered plateau phase and in 24 healthy controls. Bone marrow aspirations were also performed in all patients to determine plasma cell infiltration. All measured cytokines were higher in MM patients compared with controls and with advancing disease stage (p<0.001 for all cases). Furthermore, the values of all factors decreased significantly in the plateau phase (p<0.001 for all cases). Serum levels of sCD105 correlated with the other angiogenic cytokines, whereas only serum levels of angiogenin had prognostic value for the survival. In conclusion, CD105 and the angiogenic cytokines vascular endothelial growth factor, angiogenin and IL-18, seem to have emerging roles both in angiogenesis and tumor growth in MM. © 2013 John Wiley & Sons, Ltd.

Tsirakis G.,University Hospital of Heraklion | Pappa C.A.,Venizelion General Hospital of Heraklion | Kolovou A.,General Hospital of Chania | Kokonozaki M.,University Hospital of Heraklion | And 2 more authors.
Hematology | Year: 2015

Objective: Interleukin-22 (IL-22) is a cytokine participating in many aspects of inflammation. Multiple myeloma (MM) is a malignant disease of plasma cells with characteristic immune deregulation. We estimated serum levels of IL-22 in MM patients, both in activity and remission, in order to apprehend its possible participation in MM biology. Methods: We measured serum levels of IL-22 along with beta-2 microglobulin (B2M), paraprotein, and interleukin-1beta (IL-1beta), as well as degree of bone marrow infiltration, in 51 patients with active MM and in 22 of them in remission. Results: We found that IL-22 was higher in active MM patients, compared to both controls and patients in remission, and also in patients in remission compared to controls. Moreover, IL-22 was increasing in parallel with the disease stage and also correlated with B2M, IL1-beta, and degree of infiltration. Discussion:We suggest that the elevated levels of IL-22 in active MMpatients, in parallel with disease activity, and in positive correlation with IL-1beta, may represent the inflammatory element of the disease. This increased occurrence of IL-22 may enhance myeloma proliferation and growth, and moreover, may participate in the mechanisms of immune deregulation. © W. S. Maney & Son Ltd 2015.

Kounelakis M.G.,Technical University of Crete | Zervakis M.E.,Technical University of Crete | Giakos G.C.,University of Akron | Postma G.J.,Radboud University Nijmegen | And 2 more authors.
IEEE Journal of Biomedical and Health Informatics | Year: 2013

The proposed analysis considers aspects of both statistical and biological validation of the glycolysis effect on brain gliomas, at both genomic and metabolic levels. In particular, two independent datasets are analyzed in parallel: one engaging genomic (microarray expression) data and the other metabolomic (magnetic resonance spectroscopy imaging) data. The aim of this study is twofold. First to show that, apart from the already studied genes (markers), other genes such as those involved in the human cell glycolysis significantly contribute in gliomas' discrimination. Second, to demonstrate how the glycolysis process can open new ways toward the design of patient-specific therapeutic protocols. The results of our analysis demonstrate that the combination of genes participating in the glycolytic process (ALDOA, ALDOC, ENO2, GAPDH, HK2, LDHA, LDHB, MDH1, PDHB, PFKM, PGI, PGK1, PGM1, and PKLR) with the already known tumor suppressors (PTEN, Rb, and TP53), oncogenes (CDK4, EGFR, and PDGF), and HIF-1 enhance the discrimination of low- versus high-grade gliomas, providing high prediction ability in a cross-validated framework. Following these results and supported by the biological effect of glycolytic genes on cancer cells, we address the study of glycolysis for the development of new treatment protocols. © 2011 IEEE.

Philippakis G.E.,Jilin Heart Hospital | Moustardas M.,General Hospital of Chania
International Journal of Surgery Case Reports | Year: 2013

INTRODUCTION: Primary aortoenteric fistula is a rare clinical situation with a high mortality rate. One should suspect that condition when an abdominal aortic aneurysm is known to be present. We describe the case of a 60 year old man who presented with upper gastrointestinal bleeding as the first and sole manifestation of an abdominal aortic aneurysm, due to the rupture of the aneurysm in the jejunum. PRESENTATION OF CASE: The patient was admitted with hematemesis and melena. He reported no abdominal pain. Upper gastrointestinal endoscopy disclosed no bleeding or lesions of the stomach and duodenum. Bleeding stopped the following day, only to recur 4 days later. The patient was then subjected to abdominal CT scan, which revealed the presence of a subrenal aortic aneurysm, with fistulization to the small intestine. At laparotomy the aortic aneurysm was adherent to the first centimeters of jejunum. The diseased aorta was excised and replaced with a Dacron Y graft in situ. DISCUSSION: Primary aortojejunal fistulas are only rarely encountered. They usually are the result of a nonspecific aneurysm of the abdominal aorta. They usually manifest with premonitory bleeding, followed by catastrophic hemorrhage few days later. Even with surgery the mortality rate is high. CONCLUSION: Diagnosis of primary aortoenteric fistula requires a high index of suspicion in cases of upper gastrointestinal bleeding, especially when endoscopy is negative and there is no knowledge of the existence of an abdominal aortic aneurysm. CT scan and prompt surgery are crucial to the survival of these patients. © 2013 Surgical Associates Ltd.

Philippakis G.,General Hospital of Chania | Marinakis A.,General Hospital of Chania | Manoloudakis N.,General Hospital of Chania
International Journal of Surgery Case Reports | Year: 2013

Introduction: Pericardial window procedures are generally designed to relieve pericardial fluid pressure on the heart, in cases of cardiac tamponade, and to restore the hemodynamic stability of the patient. Rarely, however, may acute left ventricular failure develop after creation of a pericardial window. Presentation of Case: We describe a patient in whom that complication developed. We are trying to give an insight to the pathophysiology, existence of potential predisposing factors, as well as to propose therapeutic measures. Discussion: Acute heart failure, developing after pericardiocentesis or surgical creation of a pericardial window is an unusual complication, with several theories developed to explain that paradox. Conclusion: Treatment is supportive, but that complication of pericardial window procedures may carry a high mortality rate. © 2013 Surgical Associates Ltd.

Mamoulakis C.,University of Crete | Mamoulakis C.,University of Amsterdam | Efthimiou I.,General Hospital of Chania | Kazoulis S.,General Hospital of Chania | And 2 more authors.
World Journal of Urology | Year: 2011

Purpose: The aim of the study was to evaluate the applicability of the modified Clavien classification system (CCS) in grading perioperative complications of transurethral resection of the prostate (TURP). Methods: All patients with benign prostatic hyperplasia submitted to monopolar TURP from January 2006 to February 2008 at a non-academic center were evaluated for complications occurring up to the end of the first postoperative month. All complications were classified according to the modified CCS independently by two urologists, and the final decision was based on consensus. If multiple complications per patient occurred, categorization was done in more than one grade. Results were presented as complication rates per grade. Results: Forty-four complications were recorded in 31 out of 198 patients (overall perioperative morbidity rate: 15.7%), and their grading was generally easy, non-time-consuming and straightforward. Most of them were classified as grade I (59.1%) and II (29.5%). Higher grade complications were scarce (grade III: 2.3% and grade IV: 6.8%, respectively) There was one death (grade V: 2.3%) due to acute myocardial infarction (overall mortality rate: 0.5%). Negative outcomes such as mild dysuria during this early postoperative period or retrograde ejaculation were considered sequelae and were not recorded. Nobody was complicated with severe dysuria. There was one re-operation due to residual adenoma (0.5%). Conclusions: The modified CCS represents a straightforward and easily applicable tool that may help urologists to classify the complications of TURP in a more objective and detailed way. It may serve as a standardized platform of communication among clinicians allowing for sound comparisons. © 2010 The Author(s).

Philippakis G.E.,General Hospital of Chania | Manoloudakis N.,General Hospital of Chania | Marinakis A.,General Hospital of Chania
International Journal of Surgery Case Reports | Year: 2013

INTRODUCTION: Lymphangiomas are benign lesions that are most commonly encountered in the neck of small infants, but are quite uncommon in the adult population. Their removal can be quite difficult, when they reach enormous dimensions or they develop in critical locations. Complete resection is curative, but incomplete resections entail the risk of relapse. Lymphangiomas of the chest wall are quite rare. PRESENTATION OF CASE: We report a case of a 35-year old man with a giant cavernous lymphangioma of the right lateral chest wall extending into the axilla, which was removed en bloc. DISCUSSION: These tumors of lymphatic origin tend to grow, as is the case in our patient, but they also tend to recur if not resected completely. Clinical examination and chest CT scan may provide a clue to the diagnosis. CONCLUSION: Lymphangiomas of the thoracic wall are extremely rare lesions and wide resection is recommended due to the high recurrence rate of these benign lesions. © 2012 Surgical Associates Ltd.

Philippakis G.E.,General Hospital of Chania | Moustardas M.P.,General Hospital of Chania
International Journal of Surgery Case Reports | Year: 2012

INTRODUCTION: Chylothorax is a very rare complication of chronic lymphocytic leukemia. PRESENTATION OF CASE: We describe the case of an 83-year old woman with chronic lymphocytic leukemia, complicated by recurrent chylothorax and ultimately treated by pleurodesis with bleomycin. DISCUSSION: There are several options for management of patients presenting with chylothorax due to chronic lymphocytic leukemia. CONCLUSION: Pleurodesis is a reasonable and effective treatment modality for patients with refractory chylothorax. © 2012 Surgical Associates Ltd. Published by Elsevier Ltd.

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