General Hospital of Rethymnon

Crete, Greece

General Hospital of Rethymnon

Crete, Greece
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Chara L.,General Hospital of Rethymnon | Eleftherios V.,George Papanikolaou General Hospital | Maria M.,University General Hospital | Anastasia T.,George Papanikolaou General Hospital | Chryssoula S.,Aretaieion Hospital
Indian Journal of Anaesthesia | Year: 2014

Background and Aims: Difficult airway assessment is based on various anatomic parameters of upper airway, much of it being concentrated on oral cavity and the pharyngeal structures. The diagnostic value of tests based on neck anatomy in predicting difficult laryngoscopy was assessed in this prospective, open cohort study. Methods: We studied 341 adult patients scheduled to receive general anaesthesia. Thyromental distance (TMD), sternomental distance (STMD), ratio of height to thyromental distance (RHTMD) and neck circumference (NC) were measured pre-operatively. The laryngoscopic view was classified according to the Cormack-Lehane Grade (1-4). Difficult laryngoscopy was defined as Cormack-Lehane Grade 3 or 4. The optimal cut-off points for each variable were identified by using receiver operating characteristic analysis. Sensitivity, specificity and positive predictive value and negative predictive value (NPV) were calculated for each test. Multivariate analysis with logistic regression, including all variables, was used to create a predictive model. Comparisons between genders were also performed. Results: Laryngoscopy was difficult in 12.6% of the patients. The cut-off values were: TMD ≤7 cm, STMD ≤15 cm, RHTMD >18.4 and NC >37.5 cm. The RHTMD had the highest sensitivity (88.4%) and NPV (95.2%), while TMD had the highest specificity (83.9%). The area under curve (AUC) for the TMD, STMD, RHTMD and NC was 0.63, 0.64, 0.62 and 0.54, respectively. The predictive model exhibited a higher and statistically significant diagnostic accuracy (AUC: 0.68, P < 0.001). Gender-specific cut-off points improved the predictive accuracy of NC in women (AUC: 0.65). Conclusions: The TMD, STMD, RHTMD and NC were found to be poor single predictors of difficult laryngoscopy, while a model including all four variables had a significant predictive accuracy. Among the studied tests, gender-specific cut-off points should be used for NC.

Anastassakis K.K.,G Gennimatas General Hospital | Chatzimichail A.,Democritus University of Thrace | Androulakis I.,National and Kapodistrian University of Athens | Riga M.,Democritus University of Thrace | And 2 more authors.
European Archives of Oto-Rhino-Laryngology | Year: 2010

Allergic rhinitis (AR) is prevalent in Mediterranean countries, but there are no epidemiological studies in the Hellenic milieu in accordance with the recent ARIA guidelines. We investigated aetiological aeroallergens in AR patients of Central Greece using the ARIA classification. Between 2002 and 2006, 911 patients with rhinitis symptomatology were interviewed and underwent Skin prick testing and 623 completed the study. Seasonal rhinitis (SAR) represented 37.6%, Perennial rhinitis (PAR) 46.4% and SAR + PAR 16%. Intermittent mild and moderate/severe AR was evident in 9.3 and 24.5%, persistent mild and moderate/severe in 23.2 and 43.0%. Persistent AR appeared in overall 66.2% of patients and was prevalent in PAR and SAR + PAR (p < 0.0001). Severity of AR symptoms did not correlate more with ARIA than with the traditional subgroups. Marked statistical (p < 0.05) differences were evident for seven aeroallergens between the four geographic areas of the study. Pollen allergy was found in 77.8% but all pollens were significantly lower in coastal areas (p < 0.001), besides Parietaria (p < 0.003). Mite sensitivity manifested in 43.2%. Alternaria affected mostly the paediatric population (p < 0.0001). 12.4% (N = 77) was monosensitive, 58.7% (N = 366) oligosensitive, and 28.9% (N = 180) polysensitive. Rhinitis and asthma comorbidity was high (45.3%) and occurrence of asthma was related with PAR (p < 0.007) and SAR + PAR (p < 0.023) but not with the ARIA classification subgroups. This study provides compelling evidence of a typical Mediterranean allergic profile of patients of Central Greece with significant regional variability. Both classifications had approximately equal diagnostic value in our study besides the fact that ARIA subdivision is considered superior in determining treatment. © 2009 Springer-Verlag.

Giotakis E.,National and Kapodistrian University of Athens | Eleftheriadou A.,General Hospital of Rethymnon | Ferekidou E.,National and Kapodistrian University of Athens | Kandiloros D.,National and Kapodistrian University of Athens | And 2 more authors.
B-ENT | Year: 2010

Background: Endoscopic sinus surgery has become popular for the management of sinonasal inverted papillomas (IP). Objective: The purpose of this report is to review our 13 years of experience in managing IPs. Methods: Retrospective chart study. Sixty-seven patients with sinonasal IPs were treated in our department from 1991 to 2004. Seventeen were managed using an endonasal non-endoscopic approach, 39 endoscopically, 8 through external techniques, and the remaining 3 using a combined approach. Results: After 1994, as we gained experience using endoscopic sinus surgery, most cases were treated endoscopically. In only 3 cases, where the tumour attachment site was in the lateral / anterior wall of the maxillary sinus and in the lateral wall of the frontal sinus, could the lesions not be accessed by extended endoscopic techniques, and an appropriate combination with external methods was required. The mean follow up period was 91 (range, 36-146) months. The recurrence rate was 59% using an endonasal non-endoscopic approach, 12.5% using an external incision, and 12.8% using endoscopic techniques. Average time to recurrence was 15 months. Conclusion: Our findings suggest that endoscopic sinus surgery for sinonasal IP is a viable approach, with a low rate of recurrence and minor morbidity. Complete tumour resection at the site of attachment, including a surrounding rim of normal mucosa and drilling the underlying bone, is the key to successful treatment when it is combined with the preservation of healthy tissue. Non-endoscopic endonasal surgery is no longer a treatment option because the recurrence rate is too high.

Felekis D.,National and Kapodistrian University of Athens | Eleftheriadou A.,General Hospital of Rethymnon | Papadakos G.,National Technical University of Athens | Bosinakou I.,National and Kapodistrian University of Athens | And 5 more authors.
Nutrition and Cancer | Year: 2010

Administration of imunno-enhanced nutritional support may decrease postoperative morbidity, mortality, and infectious complications in cancer patients. The aim of this study was to verify that perioperative enteral diet, enriched with the nutrients arginine, ribonucleic acid (RNA), and ω-3 fatty acids improves outcomes of head and neck cancer patients undergoing major surgery. Forty patients with squamous cell carcinoma of the head and neck were studied. Group 1 received no preoperative nutritional support, whereas Group 2 received an oral formula with nutrients arginine, RNA, and ω-3 fatty acids. After surgery, Group 1 received a standard enteral formula, whereas Group 2 received an enriched enteral formula. Albumin (g/dl), prealbumin, fibrinogen, CRP, Il-6, and TNFa were measured 5 days before and 8 days after surgery. No statistically significant difference was observed for all the evaluated markers between postoperative and preoperative levels for both groups. The rate of complications was significantly reduced in the total number of patients receiving immunonutrition and in the particular subgroup of well-nourished patients receiving an immuno-enhanced diet. Perioperative enteral immuno-enhanced feeding in head and neck cancer patients undergoing major surgery may influence the postoperative outcomes by reducing the frequency rate of infections and wound complications. Copyright © 2010, Taylor & Francis Group, LLC.

Iacovou E.,National and Kapodistrian University of Athens | Chrysovergis A.,National and Kapodistrian University of Athens | Eleftheriadou A.,General Hospital of Rethymnon | Yiotakis I.,National and Kapodistrian University of Athens | Kandiloros D.,National and Kapodistrian University of Athens
Acta Otorhinolaryngologica Italica | Year: 2011

The case is presented of a 73-year-old male with a history of right-sided nasal obstruction, hyponasal speech and three episodes of recurrent epistaxis. On examination, there was a tumour in the right nasal cavity. Computed tomography showed a mass in the right nasal cavity extending to the right maxillary sinus, ethmoidal cells and right sphenoid sinus. The patient underwent a functional endoscopic removal of the tumour. Biopsy revealed a small cell neuroendocrine carcinoma. This is an extremely rare tumour of the nasal cavity and sinuses. Because of the aggressive behaviour of this tumour, he was also treated with combined chemotherapy and radiation. Ten months later, he remains free of disease.

Hajiioannou J.,General Hospital of Pireus | Koudounarakis E.,General Hospital of Rethymnon | Alexopoulos K.,General Hospital of Veroia | Kotsani A.,General Hospital of Veroia | Kyrmizakis D.E.,General Hospital of Veroia
Journal of Laryngology and Otology | Year: 2010

Aim: To present the current treatment approach for oroantral fistula causing maxillary sinusitis.Design: Case series. Four cases of oroantral fistula (diameters: 6, 9, 11 and 13mm) due to chronic maxillary sinusitis were treated by excision of all diseased oroantral fistula tissue, followed by endoscopic creation of a large middle antrostomy and closure of the fistula using buccal flaps. A synthetic surgical glue and local alveolar bone were used.Results: Patients were followed up for six months to three years; all were considered cured.Conclusion: Most surgeons use buccal or palatal flaps, combined with the Caldwell-Luc procedure, to treat chronic odontogenic sinusitis and to repair fistulae more than 5mm in diameter. This study supports the hypothesis that an endoscopic technique could be successfully used in patients with oroantral fistula causing chronic maxillary sinusitis of dental origin, instead of the Caldwell-Luc procedure, at least in patients with a small to medium-sized oroantral fistula. Copyright © JLO (1984) Limited 2010.

Georgolios A.,Virginia Commonwealth University | Eleftheriadou A.,General Hospital of Rethymnon | Batistatou A.,University of Ioannina | Charalabopoulos K.,Democritus University of Thrace
Medical Oncology | Year: 2012

Dysadherin is a cancer-related cell membrane glycoprotein, recently identified, playing an important role in tumor progression and metastasis. In the present minireview article, we are focusing on the role of dysadherin in E-cadherin downregulation, the various expression patterns of the molecule in head and neck cancer as well as its potential role as a molecular target for future applications in diagnosis, clinical routine and prognosis of the disease. © Springer Science+Business Media, LLC 2011.

Alshaikh N.A.,Dammam Medical Complex | Eleftheriadou A.,General Hospital of Rethymnon
Ear, Nose and Throat Journal | Year: 2015

Staging of tumors is very important in treatment and surgical decision making, as well as in predicting disease recurrence and prognosis. This review focuses on the different available classifications of juvenile nasopharyngeal angiofibroma (JNA) and their impact on the evaluation, management, and prognosis of JNA. The literature was reviewed, and publications on JNA staging were examined. Our MEDLINE search of the entire English-language literature found no review article on the current available staging systems for JNA. In this article, we review the common JNA classification systems that have been published, and we discuss some of their advantages and disadvantages. The most commonly used staging systems for JNA are the Radkowski and the Andrews-Fisch staging systems. However, some newer staging systems that are based on advances in technology and surgical approaches-the Onerci, INCan, and UPMC systems-have shown promising utility, and they will probably gain popularity in the future. © 2015 Vendome Group, LLC All rights reserved.

Eleftheriadou A.,General Hospital of Rethymnon | Skalidi N.,General Hospital of Rethymnon | Velegrakis G.A.,University of Crete
European Archives of Oto-Rhino-Laryngology | Year: 2012

Ever since the introduction of Cawthorne- Cooksey exercises, vestibular rehabilitation (VR) has been gaining popularity in the treatment of the dizzy patient. Numerous studies support the effectiveness of VR in improving balance/walking skills, eye-head coordination and the quality of life of the patient. Different rehabilitation protocols have been used to treat patients with peripheral and central vestibular disorders. Assessment of the patients' progress is based on the patients' selfperception of dizziness and their functional skills. Factors such as age, medication, time of onset of vertigo and home based VR have been evaluated on their effect on the rehabilitation's outcome. The aim of this review is to evaluate rehabilitation strategies and discuss the factors that affect the outcome. © Springer-Verlag 2012.

Eleftheriadou A.,General Hospital of Rethymnon | Koudounarakis E.,General Hospital of Rethymnon
European Archives of Oto-Rhino-Laryngology | Year: 2011

Recently, the favoured approach for unilateral testing of saccular function is the recently developed method of vestibular-evoked myogenic potentials (VEMPs). VEMP testing is a reliable technique, since it selectively stimulates and investigates each lateral canal in isolation from the other, providing information for the assessment of otolith function and inferior vestibular nerve integrity. The aim of this study was to provide a current review of the different methods used to record VEMPs. We noticed discrepancies in relation to the ways used to record the VEMPs in relation to the following factors: types of stimuli used (clicks or tone bursts) and body muscles tested, patient position at the time of recording, response, type of phone used and way of stimulus presentation (mono or binaural, ipsi or contralateral) and others. As a conclusion, despite the numerous studies in the field, there is no consensus in the literature as to the best recording method for VEMPs. However, the new ocular VEMPs in response to bone conducted vibration seem to be of clinical importance for the evaluation of utricular function. Further research is needed to support its clinical usefulness. © 2010 Springer-Verlag.

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