Georgiadou D.,George Gennimatas General Hospital |
Sergentanis T.N.,National and Kapodistrian University of Athens |
Sakellariou S.,National and Kapodistrian University of Athens |
Filippakis G.M.,Hippokratio Hospital |
And 6 more authors.
European Journal of Surgical Oncology | Year: 2014
Abstract Objectives The significance of vascular endothelial growth factor (VEGF) and inhibitor of differentiation/DNA synthesis (Id-1) in tumor neoangiogenesis and tumor progression in pancreatic ductal adenocarcinoma (PDAC) is still unclear. Given the central role of VEGF in cancer angiogenesis and the inconclusive results on Id-1 expression in PDAC, it is of great interest to investigate whether Id-1 and VEGF expression are associated with angiogenesis and prognosis in PDAC. Methods Paraffin-embedded specimens from 60 consecutive patients with PDAC were immunostained for VEGF, Id-1 and CD34 and staining quantification was assessed by Image analysis system. The correlations among the expression of individual angiogenic factors and microvessel density (MVD), clinicopathologic features and clinical prognosis were analyzed. Results Id-1 and VEGF Positive Activity Indices (PAIs) closely correlated with each other. MVD positively correlated with both Id-1 and VEGF expression. More advanced T and N status correlated with more intense expression of Id-1, VEGF and higher MVD. With regard to prognostic significance higher Id-1 PAI (adjusted HR = 1.69, 95%CI: 1.10-2.59, p = 0.017), higher VEGF PAI (adjusted HR = 2.66, 95%CI: 1.09-6.50, p = 0.032), and MVD (adjusted HR = 1.55, 95%CI: 1.27-1.88, p < 0.001) were associated with poorer survival. Conclusions VEGF and Id-1 overexpression were found to be associated with high MVD and emerged as adverse prognostic factors in terms of patient survival in PDAC. The potential of selective anti-angiogenic targeting therapy for pancreatic malignancies should prompt further validation of the present findings in studies encompassing larger samples and more elaborate techniques. © 2014 Elsevier Ltd. All rights reserved.
PubMed | Euroclinic Hospital, St Paul Hospital, University of Thessaly, Roche Holding AG and 12 more.
Type: Journal Article | Journal: Clinical and experimental rheumatology | Year: 2016
To evaluate the long-term safety of rituximab (RTX) in rheumatoid arthritis (RA) patients in daily clinical practice.This was a multicentre (17 Greek Rheumatology sites), prospective, long-term, pharmacovigilance study of patients with moderate to severe RA and an inadequate response or intolerance to 1 anti-tumour necrosis factor (TNF) agents. Adverse events (AEs) were recorded and collected prospectively every 2-6 months.234 patients (mean age: 5912.5, 79.5% women, mean DAS28: 5.351.32) were included and followed for 27.7 months (median). The overall AEs, serious AE (SAEs) and serious infection (SIEs) rate were 48.36, 6.68 and 2.53/100 patient-years, respectively. Three cases of hepatitis B virus (HBV) reactivation were recorded (two in chronic and one in past HBV infection). Withdrawals due to AEs (5.6%) occurred more frequently during the first cycles of RTX therapy while repeated RTX cycles were not associated with an increased risk of AEs. There were 3 deaths with an incidence rate of 0.69/100 patient-years. Age 65 years was associated with a higher incidence rate ratio of AEs and SAEs as compared to <65 years (1.53, p=0.002 and 2.88, p=0.005, respectively). Drug retention rate during 434.28 patient-years of follow-up was 57.3%. Factors associated with drug discontinuation by multivariate analysis included age, baseline swollen joint count and no use of concomitant methotrexate therapy.Long-term RTX therapy in a real-life RA cohort, did not reveal any new safety issues. Advanced age was associated with increased risk of AEs and premature drug discontinuation.
PubMed | Hippokratio Hospital, Hellenic Anticancer Institute, 3rd Surgical Clinic of George Gennimatas General Hospital and National and Kapodistrian University of Athens
Type: Journal Article | Journal: Anticancer research | Year: 2015
The objectives of our explorative study were to (i) evaluate the immunohistochemical expression of sex steroid hormone receptors (estrogen receptor a [ER], estrogen receptor [ER], progesterone receptor [PR] and androgen receptor [AR]), angiogenesis factors (vascular endothelial growth factor [VEGF] and inhibitor of differentiation/DNA synthesis 1 [Id-1]) and cell-cycle regulators (cyclin D1, p16 and p27) in intraductal papillary mucinous neoplasms (IPMNs) in comparison to normal adjacent pancreatic tissues and (ii) assess their correlation with the grade and histological sub-type of those lesions.Paraffin-embedded specimens from 12 consecutive patients with IPMNs were immunostained for the studied markers and staining quantification was assessed by an image analysis system.AR H-score and cyclin D1 H-score were significantly higher in the IPMN lesions (0.860.33 vs. 0.570.12 in the normal tissue, p=0.010 and 0.470.23 vs. 0.210.20 in the normal tissue, p=0.019, respectively). No significant differences were noted regarding the expression of ER, ER, PR, p16, p27, VEGF, Id-1 or MVD. Moreover, no significant associations were found between the expression of studied markers and grade or histological subtype.Our study showed higher expression of AR and cyclin D1 in IPMNs compared to normal pancreatic ducts without any association between AR and cyclin D1 expression and IPMNs grade or subtype.
Dimitriadou M.,Aristotle University of Thessaloniki |
Christoforidis A.,Aristotle University of Thessaloniki |
Economou M.,Aristotle University of Thessaloniki |
Tsatra I.,Hippokratio Hospital |
And 4 more authors.
European Journal of Haematology | Year: 2010
Objectives: Despite advances in conventional treatment, iron-induced cardiomyopathy is still the most frequent cause of death among patients with β-thalassaemia major. Recent studies have correlated increased myocardial iron content to decreased levels of vitamin D in thalassaemic patients. The aim of this study was to measure parathormone (PTH) and metabolites of vitamin D and consequently to investigate whether these parameters predispose to myocardial iron overload in patients with β-thalassaemia major. Methods: In 62 patients (29 M and 33 F, mean age: 22.79 ± 6.18 yr) with β-thalassaemia major levels of intact parathormone (iPTH) and vitamin D metabolites [25(OH)D 3 and 1,25(OH) 2D 3] were measured in serum. Additionally, estimation of myocardial iron content was performed by magnetic resonance imaging, whereas mean serum ferritin concentrations were calculated for 1 yr prior to the study. Results: Results showed markedly decreased levels of serum 25(OH)D 3 in 37 patients (60%), whereas 7 patients (11%) had borderline 25(OH)D 3 levels (between 50 and 75 nmol/L). Serum iPTH levels were significantly higher in patients having increased myocardial iron compared to those having normal myocardial iron (44.04 ± 22.09 pg/mL vs. 31.39 ± 14.30 pg/mL, P = 0.017). Multivariant regression analysis identified PTH levels as the major predictor of increased myocardial iron. © 2009 John Wiley & Sons A/S.
Zegkos T.,University Hospital |
Kitas G.,University of Manchester |
Dimitroulas T.,Hippokratio Hospital
Therapeutic Advances in Musculoskeletal Disease | Year: 2016
Rheumatoid arthritis (RA) is associated with increased cardiovascular (CV) morbidity and mortality which cannot be fully explained by traditional CV risk factors; cumulative inflammatory burden and antirheumatic medication-related cardiotoxicity seem to be important contributors. Despite the acknowledgment and appreciation of CV disease burden in RA, optimal management of individuals with RA represents a challenging task which remains suboptimal. To address this need, the European League Against Rheumatism (EULAR) published recommendations suggesting the adaptation of traditional risk scores by using a multiplication factor of 1.5 if two of three specific criteria are fulfilled. Such guidance requires proper coordination of several medical specialties, including general practitioners, rheumatologists, cardiologists, exercise physiologists and psychologists to achieve a desirable result. Tight control of disease activity, management of traditional risk factors and lifestyle modification represent, amongst others, the most important steps in improving CV disease outcomes in RA patients. Rather than enumerating studies and guidelines, this review attempts to critically appraise current literature, highlighting future perspectives of CV risk management in RA. © 2016, © The Author(s), 2016.
PubMed | University Hospital, Hippokratio Hospital and University of Manchester
Type: Journal Article | Journal: Therapeutic advances in musculoskeletal disease | Year: 2016
Rheumatoid arthritis (RA) is associated with increased cardiovascular (CV) morbidity and mortality which cannot be fully explained by traditional CV risk factors; cumulative inflammatory burden and antirheumatic medication-related cardiotoxicity seem to be important contributors. Despite the acknowledgment and appreciation of CV disease burden in RA, optimal management of individuals with RA represents a challenging task which remains suboptimal. To address this need, the European League Against Rheumatism (EULAR) published recommendations suggesting the adaptation of traditional risk scores by using a multiplication factor of 1.5 if two of three specific criteria are fulfilled. Such guidance requires proper coordination of several medical specialties, including general practitioners, rheumatologists, cardiologists, exercise physiologists and psychologists to achieve a desirable result. Tight control of disease activity, management of traditional risk factors and lifestyle modification represent, amongst others, the most important steps in improving CV disease outcomes in RA patients. Rather than enumerating studies and guidelines, this review attempts to critically appraise current literature, highlighting future perspectives of CV risk management in RA.
Lagopoulos V.,Hippokratio Hospital |
Gigi E.,Aristotelion University
Hippokratia | Year: 2011
Anaphylactic reactions in the peri-operative period are often serious and potentially life-threatening conditions, involving multiple organ systems in which the clinical manifestations are the consequence of the release of preformed mediators from mast cells and basophils. Anaphylaxis is an immune mediated type I allergic reaction following the massive release of mediators from mast cells and basophils as a response to an allergen. Anaphylactoid reactions are defined as those reactions that produce the same clinical picture with anaphylaxis but are not IgE mediated, occur through a direct nonimmune-mediated release of mediators from mast cells and/or basophils or result from direct complement activation. The occurrence of these reactions during anesthesia, although quite rare, remains a major concern for the anesthesiologists. Thus, the need for systematic screening before surgery and the awareness and expert advice to anaesthesiologists seems to be very critical.
Papazoglou K.,Hippokratio Hospital |
Mallios A.,Institute Mutualiste Montsouris |
Rafati F.,Staffordshire University |
Zambas N.,Hippokratio Hospital |
Karkos C.,Hippokratio Hospital
Annals of Vascular Surgery | Year: 2013
Background: Endovascular treatment of ruptured aortic aneurysms is performed in many centers around the world. New endovascular stent-grafts may prove to improve results. We report our experience with the Endurant device. Methods: From June 2010 to November 2010, we treated five male patients (mean age: 75.8 years) suffering from ruptured abdominal aortic aneurysm with the Endurant device. The mean aneurysm diameter was 90.2 mm; the mean neck length was 13 mm; the mean proximal neck diameter was 27 mm; and the mean proximal angulation was 64°. Results: Technical success rate was 100%. In one patient, a proximal leak was diagnosed intraoperatively, and a proximal extension was successfully deployed. No secondary procedures were necessary and no open conversions required during the first admission. One patient required a proximal extension at 3 months for a type I endoleak. The 30-day mortality was 20%, and no further deaths occurred during the follow-up (mean duration: 15 months). Conclusion: New stent-grafts may ameliorate the prognosis of ruptured abdominal aortic aneurysms. Our experience with the Endurant device has shown promising results. To our knowledge, this is the first report of endovascular treatment of ruptured aortic aneurysms with this stent-graft. © 2013 Elsevier Inc. All rights reserved.
Brili S.,Hippokratio Hospital |
Stamatopoulos I.,Hippokratio Hospital |
Misailidou M.,Hippokratio Hospital |
Chrysohoou C.,Hippokratio Hospital |
And 3 more authors.
International Journal of Cardiology | Year: 2013
Background: Previous studies using speckle tracking-derived strain for quantification of right ventricular (RV) function in pulmonary hypertension (PHT) have focused on the magnitude of global and regional peak longitudinal systolic strains (PLSS) and systolic strain-related indices of dyssynchrony. The aim of our study was to investigate the pattern of RV contraction and relaxation with the use of the contour and timing of strain and velocity curves in PHT. Methods: The study population consisted of thirty-seven patients with PHT (45 ± 18 years, 16 women) and thirty-seven controls. A complete two-dimensional echo with speckle-tracking-derived longitudinal strain of the basal RV free wall and interventricular septum (IVS) was performed and the cycle length-corrected time to PLSS (SST) and time from PLSS to 50% of PLSS (systolic strain half time - SSHT) in both regions were calculated. Results: Patients with PHT had significantly reduced PLSS (- 24.9 ± 2.0% vs - 43.2 ± 3.0%, p < 0.001) and increased SST (0.47 ± 0.02 vs 0.39 ± 0.02, p = 0.043) and SSHT (0.22 ± 0.02 vs 0.16 ± 0.02, p = 0.047) in the basal RV free wall compared to controls. Furthermore, peak systolic velocities were observed earlier in the cardiac cycle in both regions in patients with PHT compared to controls. Conclusions: Longitudinal strain curves in the RV free wall reach peak values later in the cardiac cycle and return slower towards the baseline in PHT. Furthermore, peak systolic velocities are observed earlier in the cardiac cycle in both the basal RV free wall and the basal IVS. The above observations effectively illustrate changes in patterns of RV contraction and relaxation caused by PHT. © 2012 Elsevier Ireland Ltd.
PubMed | Theageneio Cancer Hospital and Hippokratio Hospital
Type: Journal Article | Journal: Hippokratia | Year: 2015
Struma ovarii is the presence of thyroid tissue as a major cellular component in an ovarian teratoma.A 46-year-old old woman, with a palpable mass at the anatomical position of the right adnexa known for the preceding 3 years underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histology reported struma ovarii.Struma ovarii is a rare tumor of the ovaries and its clinical appearance may vary: it may be asymptomatic, mimic malignant ovarian tumor, or present with symptoms of hyperthyroidism and, in rare cases, it can even be a malignant tumor.