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Pavlidou E.,Aristotle University of Thessaloniki | Zafrakas M.,Hippokrateion Hospital | Agorastos T.,Aristotle University of Thessaloniki
International Journal of Gynecological Cancer | Year: 2010

Introduction: The aim of the present study was to analyze cervical, uterine corpus, and ovarian cancer mortality, between 1980 and 2005, in Greece. Methods: Mortality data and population age distribution were provided by the National Statistical Service of Greece. Time trends of mortality were calculated for each tumor type per 100,000 women in the whole female population of Greece, and 2 different age groups, that is, women aged 49 years and younger and those 50 years and older. Joinpoint regression was used for further analysis of mortality trends. Results: Overall, cervical and uterine corpus cancer mortality in the whole female population of Greece had a slightly decreasing trend between 1980 and 2005, whereas ovarian cancer mortality rates increased steadily throughout the period studied. Subgroup analyses according to age showed that cervical cancer mortality decreased very slightly only in women older than 50 years, whereas it remained steady in younger women. Uterine corpus cancer mortality decreased slightly in both age groups, but increased during the last years of the study period in the older age group. Ovarian cancer mortality increased in women older than 50 years, whereas it remained steady in the younger age group. Joinpoint regression analysis showed that only the increase after 1997 in the mortality trend for uterine corpus cancer in women 50 years and older was statistically significant (P = 0.0044). Conclusions: Although our findings regarding cervical cancer mortality in Greece are encouraging, still more efforts are needed, particularly in preventing cervical cancer in younger women. The increasing trend of uterine corpus and ovarian cancer mortality in older women suggests that development of well-organized tertiary centers for the implementation of modern therapeutic modalities is urgently needed. Copyright © 2010 by IGCS and ESGO ISSN: 1048-891X.


Chrysovergis A.,Hippokrateion Hospital | Gorgoulis V.G.,National and Kapodistrian University of Athens | Giotakis I.,Hippokrateion Hospital | Tsiambas E.,417 NIMTS Hospital | And 3 more authors.
Medical Oncology | Year: 2011

Overexpression of Epidermal Growth Factor Receptor (EGFR) and also of cell cycle control proteins, such as cyclin D1 is a frequent event in squamous cell carcinoma of the larynx (LSSC). Our aim was to correlate their protein levels with telomerase catalytic subunit (h-TERT) expression. Using tissue microarray technology, fifty-five paraffin embedded histologically confirmed primary LSSCs and also ten dysplastic lesions were cored at a diameter of 1.5 mm. Immunohistochemistry (IHC) was performed by the use of anti-EGFR, anti-cyclin D1, and anti-h TERT monoclonal antibodies. Chromogenic in situ hybridization (CISH) analysis was also applied using EGFR gene and chromosome 7 probes, respectively. EGFR, cyclin D1 and h-TERT protein overexpression was observed in 48/55 (87.2%), 19/55 (34.5%) and 21/55 (38.1%) carcinoma cases, respectively. EGFR protein expression was statistically associated with grade (P = 0.01), and also with stage (P = 0.001) of the examined tumors. Borderline statistical significance was assessed correlating overall cyclin D1 expression to h TERT expression (P = 0.06). Simultaneous up regulation of the three proteins was established in 7/55 (12.7%) cases, correlated to the stage of the tumors (P = 0.05). EGFR gene amplification was observed in 7/65 (10.7%) carcinomas and dysplasias, whereas chromosome 7 aneuploidy was detected in 4/65 (6.1%) of those cases.Simultaneous up regulation of EGFR, cyclin D1 and h TERT proteins correlates with advanced stage in LSCC. EGFR gene amplification and not only protein over expression maybe is the eligible criterion for targeted therapeutic strategies in those patients. © 2010 Springer Science+Business Media, LLC.


Hiridis S.,Athens Medical Center | Konstantinidis K.,Athens Medical Center | Menenakos E.,Hippokrateion Hospital | Diamantis T.,Laiko Hospital | Zografos G.,Hippokrateion Hospital
Obesity Surgery | Year: 2016

Background: Type 2 diabetic obese patients present with a normalization of plasma glucose levels shortly after most bariatric procedures, before any significant weight loss takes place. There is only scarce literature in the new field of metabolic surgery, with most experiments being performed on small animal models. Aim: Our aim is to develop a reliable large animal model for assessment of surgical correction of diabetes. Method: Titrated doses of streptozotocin (STZ) were used for induction of diabetes mellitus. After standardization of the surgical technique to avoid any restrictive component, three groups were created, a duodenojejunal bypass (DJB; n = 4), a gastroileal conduit (GIC; n = 3) near the ileocecal valve, and a sham (control; n = 5) group. Preoperative and postoperative glycemic curves were recorded by means of intravenous glucose tolerance tests. Body weight fluctuations were recorded as well. Results: Diabetes was successfully induced with the use of STZ in all cases. Animals in the sham group remained diabetic for 3 weeks after operation. There was normalization of blood glucose levels in the operative groups during the 3-week postoperative follow-up, without significant body weight changes. The duodenojejunal group resulted in stronger positive response of glycemia. Conclusion: STZ-induced diabetes in swine leads to a reliable large animal model for assessment of metabolic surgical procedures. STZ is an effective but highly toxic means for inducing stable diabetes in the sensitive porcine model. Duodenojejunal bypass, although less invasive, seems to exert better antidiabetic effects than gastroileal conduit. © 2016, Springer Science+Business Media New York.


Markogiannakis H.,Hippokrateion Hospital | Memos N.,Hippokrateion Hospital | Messaris E.,Hippokrateion Hospital | Dardamanis D.,Hippokrateion Hospital | And 4 more authors.
Surgery | Year: 2011

Background: To our knowledge, the predictive value of procalcitonin for bowel strangulation has been evaluated in only 2 experimental studies that had conflicting results. The objective of this study was to evaluate the value of procalcitonin for early diagnosis of intestinal ischemia and necrosis in acute bowel obstruction. Methods: We performed a prospective study of 242 patients with small- or large-bowel obstructions in 2005. A total of 100 patients who underwent operation were divided into groups according to the presence of ischemia (reversible and irreversible) and necrosis, respectively, as follows: ischemia (n = 35) and nonischemia groups (n = 65) and necrosis (n = 22) and nonnecrosis groups (n = 78). Data analyzed included age, sex, vital signs, symptoms, clinical findings, white blood cell count, base deficit, metabolic acidosis, procalcitonin levels on presentation, the time between symptom onset and arrival at the emergency department and the time between arrival and operation, and the cause of the obstruction. Results: Procalcitonin levels were greater in the ischemia than the nonischemia group (9.62 vs 0.30 ng/mL; P = .0001) and in the necrosis than the non-necrosis group (14.53 vs 0.32 ng/mL; P = .0001). Multivariate analysis identified procalcitonin as an independent predictor of ischemia (P = .009; odds ratio, 2.252; 95% confidence interval, 1.225-4.140) and necrosis (P = .005; odds ratio, 2.762; 95% confidence interval, 1.356-5.627). Using receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) of procalcitonin for ischemia and necrosis was 0.77 and 0.87, respectively. A high negative predictive value for ischemia and necrosis of procalcitonin levels <0.25 ng/mL (83% and 95%, respectively) and a positive predictive value of procalcitonin >1 ng/mL were identified (95% and 90%, respectively). Conclusion: Procalcitonin on presentation is very useful for the diagnosis or exclusion of intestinal ischemia and necrosis in acute bowel obstruction and could serve as an additional diagnostic tool to improve clinical decision-making. © 2011 Mosby, Inc. All rights reserved.


Gkaliagkousi E.,Hippokrateion Hospital | Doumas M.,Hippokrateion Hospital | Gavriilaki E.,Hippokrateion Hospital | Triantafyllou A.,Hippokrateion Hospital | And 4 more authors.
Clinical and Experimental Hypertension | Year: 2012

Increased expression and activity of metalloproteinases have been implicated in the pathophysiology of vascular remodeling and in the growth of atherosclerotic lesions. We aimed at determining the levels of MMP-2, MMP-9, their specific inhibitors TIMP-2 and TIMP-1, and the inflammatory cytokines IL-6 and TNF-α, which are related to the stimulation of MMPs, in patients with untreated mild essential hypertension (UH) and normotensive (NT) volunteers. Serum MMP-9 and TIMP-1 levels were significantly different in UH volunteers when compared to NT volunteers. Thus, MMP-9 is elevated in the early stages of essential hypertension and may be used as a marker of cardiovascular risk and vascular dysfunction. © 2012 Informa Healthcare USA, Inc.


PubMed | Hippokrateion Hospital
Type: Journal Article | Journal: Clinical and experimental hypertension (New York, N.Y. : 1993) | Year: 2012

Increased expression and activity of metalloproteinases have been implicated in the pathophysiology of vascular remodeling and in the growth of atherosclerotic lesions. We aimed at determining the levels of MMP-2, MMP-9, their specific inhibitors TIMP-2 and TIMP-1, and the inflammatory cytokines IL-6 and TNF-, which are related to the stimulation of MMPs, in patients with untreated mild essential hypertension (UH) and normotensive (NT) volunteers. Serum MMP-9 and TIMP-1 levels were significantly different in UH volunteers when compared to NT volunteers. Thus, MMP-9 is elevated in the early stages of essential hypertension and may be used as a marker of cardiovascular risk and vascular dysfunction.


PubMed | Evangelismos Hospital, Metaxa Hospital, Hippokrateion Hospital and National and Kapodistrian University of Athens
Type: Journal Article | Journal: International journal of antimicrobial agents | Year: 2016

Carbapenemase-producing Klebsiella pneumoniae (CP-Kp) are currently among the most important nosocomial pathogens in many geographic regions. A retrospective study was conducted between 2010 and 2014 in four hospitals located in a high-prevalence area (Athens, Greece) to describe the clinical features, treatment and outcomes of neutropenic patients with haematological diseases complicated with CP-Kp bloodstream infections. A total of 50 patients were identified, including 48 with haematological malignancies and 2 with aplastic anaemia. All patients had neutropenia (<500 cells/mm(3)), of whom 40 had <100 neutrophils/mm(3). The probable source of bacteraemia was identified in 9 patients; in the remaining 41 patients the bacteraemia was considered primary. For definitive treatment, 30 patients received combination therapy (two or more active drugs), 10 received monotherapy (one active drug) and 4 received therapy with no active drug; the remaining 6 patients died within 48 h after the onset of bacteraemia. The 14-day all-cause mortality rate was 50%, 38% and 33% for those who received one, two or three active drugs respectively. In the Cox proportional hazards model, unresolved neutropenia [hazard ratio (HR)=19.28, 95% confidence interval (CI) 2.31-160.69; P=0.006], septic shock (HR=3.04, 95% CI 1.06-8.78; P=0.04) and treatment with one active drug (HR for monotherapy versus combination therapy=3.95, 95% CI 1.23-12.65; P=0.02) were independent predictors of death, whilst combination therapy was associated with lower mortality. These findings may assist physicians in making treatment decisions for neutropenic patients with CP-Kp infections.


PubMed | Laiko Hospital, Hippokrateion Hospital and Athens Medical Center
Type: Journal Article | Journal: Obesity surgery | Year: 2016

Type 2 diabetic obese patients present with a normalization of plasma glucose levels shortly after most bariatric procedures, before any significant weight loss takes place. There is only scarce literature in the new field of metabolic surgery, with most experiments being performed on small animal models.Our aim is to develop a reliable large animal model for assessment of surgical correction of diabetes.Titrated doses of streptozotocin (STZ) were used for induction of diabetes mellitus. After standardization of the surgical technique to avoid any restrictive component, three groups were created, a duodenojejunal bypass (DJB; n=4), a gastroileal conduit (GIC; n=3) near the ileocecal valve, and a sham (control; n=5) group. Preoperative and postoperative glycemic curves were recorded by means of intravenous glucose tolerance tests. Body weight fluctuations were recorded as well.Diabetes was successfully induced with the use of STZ in all cases. Animals in the sham group remained diabetic for 3weeks after operation. There was normalization of blood glucose levels in the operative groups during the 3-week postoperative follow-up, without significant body weight changes. The duodenojejunal group resulted in stronger positive response of glycemia.STZ-induced diabetes in swine leads to a reliable large animal model for assessment of metabolic surgical procedures. STZ is an effective but highly toxic means for inducing stable diabetes in the sensitive porcine model. Duodenojejunal bypass, although less invasive, seems to exert better antidiabetic effects than gastroileal conduit.


PubMed | Aghia Sofia Childrens Hospital, University of Crete, Hippokrateion Hospital, P & A Kuriakou Childrens Hospital and National and Kapodistrian University of Athens
Type: | Journal: Journal of paediatrics and child health | Year: 2017

To describe children with pertussis who required intensive care.This is a retrospective analysis of pertussis admissions to all (six) national intensive care units in Greece from 2003 to 2013.A total of 31 children were included, 28 of whom were younger than 12months old. Cough was the most prominent symptom, being present in 27 of 31 (87%) patients, and on admission, only 7 (22.6%) satisfied the case definition. Mechanical ventilation was initiated in 13 (42%) patients. Six patients died because of respiratory failure (two) or multi-organ system failure (four). The patients who died had significantly higher white blood cell counts (WBC) (77800-31600, P=0.031) and neutrophils (29016-12795, P=0021) than those who survived and lower minimum values of serum sodium (125-133, P=0002). They also had a longer duration of hospitalisation prior to their paediatric intensive care unit admission (6-1days, P=0022). Three patients were diagnosed with pulmonary hypertension, and only one of them survived. Age, gender and immunisation status did not differ between survivors and non-survivors. Two patients received exchange blood transfusion, and survival benefit was not apparent.Young infants are at risk of severe pertussis, resulting in serious complications or death. Elevated WBC and low serum sodium are associated with higher mortality. Despite advances in life support and treatment of organ failure in childhood critical illness, pertussis still has substantial mortality.


PubMed | S Hospital, Hippokrateion Hospital, Evangelismos Hospital, National and Kapodistrian University of Athens and 4 more.
Type: | Journal: BMC endocrine disorders | Year: 2016

The rare incidence of neuroendocrine neoplasms (NENs) has contributed to a paucity of large epidemiologic studies of patients with this condition. We investigated the occurrence and clinicopathologic features of NENs in Greece.Between October 2010 and November 2012 we collected data on 246 newly diagnosed patients from a broad-based multi-institutional registry that comprises eight academic and hospital sites in Greece. The WHO 2010 pathologic classification and the 7th AJCC Staging system was applied in all cases.Of all patients 94 % had a sporadic and 6 % a multiple endocrine neoplasia tumor; 63.4 % were gastroenteropancreatic-(GEP)-NENs, 17.9 % Head & Neck NENs, 9.8 % NENs of Unknown Primary, 6.5 % Lung NENs and 2.4 % Pheochromocytomas. Gastric and pancreatic NENs were the most common primary sites. Poorly differentiated neuroendocrine carcinomas (NEC) were 9.3 %, all sporadic. Fifteen percent of patients were asymptomatic at presentation, 24 % had a first symptom of the disease related to endocrine syndrome and 61 % had symptoms related to locally advanced or metastatic disease. Metastatic disease was established in 25 % of tumors most frequently in the GEP NEN group. Findings are presented according to Ki-67 distribution. MRI had a higher diagnostic positive yield than Octreoscan. Somatostatin analogs, lanreotide and octreotide acetate, were prescribed at 38.5 & 61.5 % of NEN patients respectively and were found to be equally effective at providing symptomatic relief.This is to our knowledge the first study of a Greek tumor registry and one of the few European Registries providing information regarding clinicopathologic characteristics and therapies in patients with neuroendocrine tumors of various origin sites, beyond GEP NENs.

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