Irákleion, Greece
Irákleion, Greece

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Gecse K.B.,Semmelweis University | Sebastian S.,Inflammatory Bowel Disease Unit | de Hertogh G.,Catholic University of Leuven | Yassin N.A.,St Marks Hospital and Academic Institute | And 8 more authors.
Journal of Crohn's and Colitis | Year: 2016

Background and Aims: Perianal fistulas affect up to one-third of Crohn's patients during the course of their disease. Despite the considerable disease burden, current treatment options remain unsatisfactory. The Fifth Scientific Workshop [SWS5] of the European Crohn's and Colitis Organisation [ECCO] focused on the pathophysiology and clinical impact of fistulas in the disease course of patients with Crohn's disease [CD]. Methods: The ECCO SWS5 Working Group on clinical aspects of perianal fistulising Crohn's disease [pCD] consisted of 13 participants, gastroenterologists, colorectal surgeons, and a histopathologist, with expertise in the field of inflammatory bowel diseases. A systematic review of literature was performed. Results: Four main areas of interest were identified: Natural history of pCD, morphological description of fistula tracts, outcome measures [including clinical and patient-reported outcome measures, as well as magnetic resonance imaging] and randomised controlled trials on pCD. Conclusions: The treatment of perianal fistulising Crohn's disease remains a multidisciplinary challenge. To optimise management, a reliable classification and proper trial endpoints are needed. This could lead to standardised diagnosis, treatment, and follow-up of Crohn's perianal fistulas and the execution of well-designed trials that provide clear answers. The prevalence and the natural history of pCD need further evaluation. © 2016 European Crohn's and Colitis Organisation (ECCO).


Laliotis A.,University Hospital Heraklion | De Bree E.,University Hospital Heraklion | Papadakis M.,University Hospital Heraklion | Melissas J.,University Hospital Heraklion
Polish Journal of Pathology | Year: 2013

Spindle cell lipoma is a relatively rare adipocytic neoplasm, which usually occurs in the posterior neck, shoulder or upper back of male patients aged 45-65 years. We report here an unusual coexistence of ordinary and spindle cell lipoma. The patient presented with a painless mass in the area of the right scapula. Imaging was sug-gestive of a lipomatous mass, possibly liposarcoma. Histological examination revealed the concurrent existence of an intramuscular spindle cell lipoma and an ordinary lipoma. In the literature there are only fourteen cases of intramuscular spindle cell lipoma and only in four cases there was a coexisting mature lipoma. As exclusion of malignancy remains clinicians main concern,diagnosis and treatment of deep seated lipomatous tumors remains challenging.


PubMed | University of Amsterdam, University Hospital Heraklion, University of Zürich, Semmelweis University and 7 more.
Type: Journal Article | Journal: Journal of Crohn's & colitis | Year: 2016

Perianal fistulas affect up to one-third of Crohns patients during the course of their disease. Despite the considerable disease burden, current treatment options remain unsatisfactory. The Fifth Scientific Workshop [SWS5] of the European Crohns and Colitis Organisation [ECCO] focused on the pathophysiology and clinical impact of fistulas in the disease course of patients with Crohns disease [CD].The ECCO SWS5 Working Group on clinical aspects of perianal fistulising Crohns disease [pCD] consisted of 13 participants, gastroenterologists, colorectal surgeons, and a histopathologist, with expertise in the field of inflammatory bowel diseases. A systematic review of literature was performed.Four main areas of interest were identified: natural history of pCD, morphological description of fistula tracts, outcome measures [including clinical and patient-reported outcome measures, as well as magnetic resonance imaging] and randomised controlled trials on pCD.The treatment of perianal fistulising Crohns disease remains a multidisciplinary challenge. To optimise management, a reliable classification and proper trial endpoints are needed. This could lead to standardised diagnosis, treatment, and follow-up of Crohns perianal fistulas and the execution of well-designed trials that provide clear answers. The prevalence and the natural history of pCD need further evaluation.


Mantzaris G.J.,Evangelismos Hospital | Viazis N.,Evangelismos Hospital | Polymeros D.,National and Kapodistrian University of Athens | Papamichael K.,Evangelismos Hospital | And 2 more authors.
Annals of Gastroenterology | Year: 2015

Crohn’s disease (CD) is a chronic idiopathic inflammatory bowel disease (IBD) which affects any site of the gastrointestinal tract and occasionally extraintestinal organs. The natural history of CD varies remarkably but a considerable proportion of patients develop complications leading to hospitalizations and surgeries, impaired quality of life, and disability. In these patients, effective medical therapy should aim beyond control of clinical symptoms to include induction and maintenance of steroid-free clinical and serological remission and mucosal healing, as this has shown to reduce complications, hospitalizations and surgeries, and to decrease the risk of colorectal cancer, at least in the short term. This therapeutic goal can be achieved in a considerable proportion of patients with anti-tumor necrosis factor (TNF)-α agents if applied early in the disease course. Clinical recommendations from a panel of Greek IBD experts are herein provided, regarding the clinical profiles and the use of anti-TNF-α therapy in patients with moderate and severe CD, based on literature review and personal experience. The objectives of this advisory workshop were to define the profiles of patients with moderate and severe CD using routine clinical and laboratory parameters, as well as the clinical profiles of patients with moderate CD, severe CD, perianal CD, and/or extraintestinal manifestations, who are candidates for biologic therapies. Emphasis was given on patients with newly diagnosed CD. The proposed recommendations may provide a useful and practical approach for improving therapeutic strategies with anti-TNF-α in patients with active moderate and severe CD. © 2015 Hellenic Society of Gastroenterology.


Voudoukis E.,Venizelion General Hospital | Karmiris K.,Venizelion General Hospital | Koutroubakis I.E.,University Hospital Heraklion
World Journal of Gastroenterology | Year: 2014

There is evidence that inflammatory bowel diseases (IBD) combine both inflammation and coagulation in their pathogenesis and clinical manifestations. Although platelets (PLT) are well known for their role in hemo-stasis, there are a rising number of studies supporting their considerable role as inflammatory amplifiers in chronic inflammatory conditions. IBD are associated with several alterations of PLT, including number, shape, and function, and these abnormalities are mainly attributed to the highly activated state of circulating PLT in IBD patients. When PLT activate, they increase in size, release a great variety of bio-active inflammatory and procoagulant molecules/particles, and express a variety of inflammatory receptors. These inflammatory products may represent a part of the missing link between coagulation and inflammation, and can be considered as possible IBD pathogenesis instigators. In clinical practice, thrombocytosis is associated both with disease activity and iron deficiency anemia. Controlling inflammation and iron replacement in anemic patients usually leads to a normalization of PLT count. The aim of this review is to update the role of PLT in IBD and present recent data revealing the possible therapeutic implications of anti-PLT agents in future IBD remedies. © 2014 Baishideng Publishing Group Co., Limited. All rights reserved.


Germanakis I.,University Hospital Heraklion | Germanakis I.,University of Crete | Pepes S.,University Hospital Heraklion | Sifakis S.,University Hospital Heraklion | And 2 more authors.
Fetal Diagnosis and Therapy | Year: 2012

Aim: To evaluate the feasibility of offline anatomic M-mode (AMM) to study fetal atrioventricular annulus long-axis displacement (LAD) and compare its performance against real-time conventional M-mode (MM). Material and Methods: Paired AMM and MM LAD studies were recorded prospectively in 54 fetuses, and performance was compared. Insonation angles were less than 30° in all but 4 cases. The overall feasibility of AMM was tested in a composite total sample of 91 normal singleton pregnancies (median gestational age 23+6 weeks, range 12-36). AMM LAD was measured by placement of a virtual M-mode line on digitally stored raw data of fetal 4-chamber video loops. We studied annulus LAD at the lateral mitral (left ventricle; LV), proximal mitral (intraventricular septum; IVS), and lateral tricuspid (right ventricle; RV) myocardial segments. We compared LAD and its regression with gestational age measured using both methods in paired studies and AMM in the whole cohort. Results: Annulus LAD was measured using AMM, in all cases and segments, irrespective of cardiac axis alignment to the ultrasound beam. Good correlation existed between AMM and MM (RV r = 0.901, LV r = 0.899, IVS r = 0.815, p < 0.001). AMM recorded higher LAD values than MM in RV [mean 6.17 (SD 1.46) vs. 5.82 (SD 1.74) mm, p = 0.002] and LV [mean 4.18 (SD 1.11) vs. 3.98 (SD 1.12), p = 0.007]. Both methods showed LAD in RV > LV > IVS and a significant gestational increase in LAD values in all segments (p < 0.001) Conclusions: AMM permits offline evaluation of fetal longitudinal myocardial function in routinely obtained 2D fetal heart images with similar values to conventional MM in paired studies recorded <30°. Copyright © 2012 S. Karger AG, Basel.


PubMed | University Hospital Heraklion
Type: Comparative Study | Journal: Fetal diagnosis and therapy | Year: 2012

To evaluate the feasibility of offline anatomic M-mode (AMM) to study fetal atrioventricular annulus long-axis displacement (LAD) and compare its performance against real-time conventional M-mode (MM).Paired AMM and MM LAD studies were recorded prospectively in 54 fetuses, and performance was compared. Insonation angles were less than 30 in all but 4 cases. The overall feasibility of AMM was tested in a composite total sample of 91 normal singleton pregnancies (median gestational age 23 weeks, range 12-36). AMM LAD was measured by placement of a virtual M-mode line on digitally stored raw data of fetal 4-chamber video loops. We studied annulus LAD at the lateral mitral (left ventricle; LV), proximal mitral (intraventricular septum; IVS), and lateral tricuspid (right ventricle; RV) myocardial segments. We compared LAD and its regression with gestational age measured using both methods in paired studies and AMM in the whole cohort.Annulus LAD was measured using AMM, in all cases and segments, irrespective of cardiac axis alignment to the ultrasound beam. Good correlation existed between AMM and MM (RV r = 0.901, LV r = 0.899, IVS r = 0.815, p < 0.001). AMM recorded higher LAD values than MM in RV [mean 6.17 (SD 1.46) vs. 5.82 (SD 1.74) mm, p = 0.002] and LV [mean 4.18 (SD 1.11) vs. 3.98 (SD 1.12), p = 0.007]. Both methods showed LAD in RV > LV > IVS and a significant gestational increase in LAD values in all segments (p < 0.001)AMM permits offline evaluation of fetal longitudinal myocardial function in routinely obtained 2D fetal heart images with similar values to conventional MM in paired studies recorded <30.

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