KAT General Hospital

Athens, Greece

KAT General Hospital

Athens, Greece
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Makris K.,KAT General Hospital | Rizos D.,National and Kapodistrian University of Athens | Kafkas N.,KAT General Hospital | Haliassos A.,Toyota Central R&D Labs.
Clinical Chemistry and Laboratory Medicine | Year: 2012

Neutrophil gelatinase-associated lipocalin (NGAL) is a 25 kDa protein of the lipocalin superfamily. This protein is expressed and secreted by immune cells, hepatocytes, and renal tubular cells in various pathologic states. NGAL has recently generated great interest as an early biomarker of renal injury. However, like many other endogenous biomarkers it is not produced by just one cell type and it exists in more than one molecular form. As recent research has shown different pathological conditions may involved in the production of this molecule. This review summarizes the current knowledge about the biology of NGAL and examines the role of this molecule of acute renal injury as well as in other pathologic conditions like neoplasia, anemia, pregnancy, cardiovascular disease chronic kidney disease and in cardiorenal syndrome. Commercial and research immunoassays are used to measure NGAL in both plasma and urine but these assays are not standardized. The existence of different molecular forms of NGAL and their expression at various disease states further complicates the interpretation of the results. Pre analytical issues and biological variation are also not fully elucidated. © 2012 by Walter de Gruyter. Berlin. Boston.

Aktselis I.,KAT General Hospital | Kokoroghiannis C.,KAT General Hospital | Fragkomichalos E.,KAT General Hospital | Koundis G.,KAT General Hospital | And 4 more authors.
International Orthopaedics | Year: 2014

Purpose: The purpose of this prospective randomised trial was to assess whether an intramedullary nail is superior to a sliding hip screw in the treatment of multifragmentary intertrochanteric fractures Methods: Eighty patients with a 31-A2.2 or A2.3 Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) intertrochanteric fracture were randomly allocated to fixation with either the Gamma nail or the AMBI sliding hip screw device. Results: All patients were followed up at one, three, six and 12 months postoperatively, except for nine who died. There was no statistical difference in Parker mobility score between groups. The Gamma nail group had significantly higher Barthel Index and EuroQol-5D (EQ-5D) scores than the AMBI group at 12 months. At the same time, the EQ-5D score had returned to its pre-operative values in the Gamma nail group but not in the AMBI group. There were no differences in mortality, radiation time and hospital stay. Duration of the operation, incision length and hip pain occurrence were significantly less in the Gamma nail group. Conclusions: Few failures occur when unstable 31-A2.2 and A2.3 AO/OTA fractures are fixed with a sliding hip screw. Nevertheless, an intramedullary nail seems superior in reconstituting patients to their pre-operative state. © 2013 Springer-Verlag Berlin Heidelberg.

Makris K.,KAT General Hospital | Kafkas N.,KAT General Hospital
Advances in Clinical Chemistry | Year: 2012

Acute kidney injury (AKI) is recognized as an independent risk factor for morbidity and mortality. Unfortunately, this syndrome was historically underdiagnosed due to inconsistent definition of AKI as well as insensitive and nonspecific diagnostic tools. Recent advances in defining AKI, understanding its pathophysiology, and improving its diagnostic accuracy have an impact in disease management and clinical outcome. Prompt recognition and treatment of AKI still remains the cornerstone of clinical management of this syndrome. This chapter focuses on the recent advances in diagnosis of AKI using novel serum and urine biomarkers. The role of neutrophil gelatinaseassociated lipocalin (NGAL) in pathophysiology and diagnosis of AKI is presented. A detailed analysis of the biology of NGAL and presentation of laboratory methods of measurement is also provided. The role of NGAL as biomarker beyond the boundaries of nephrology is also presented.

Grouzi E.,KAT General Hospital | Kyriakou E.,KAT General Hospital | Panagou I.,KAT General Hospital | Spiliotopoulou I.,KAT General Hospital
Clinical and Applied Thrombosis/Hemostasis | Year: 2010

Heparin-induced thrombocytopenia (HIT) is a life-threatening immune response to heparin that is associated with a high risk of thromboembolic complications. The syndrome is caused by antibodies that are reactive against complexes of platelet factor 4/heparin (PF4/H). For patients with HIT, the discontinuation of heparin alone is not sufficient and the diagnosis necessitates the administration of an alternative anticoagulant. Fondaparinux is a synthetic pentasaccharide that binds to antithrombin and potentiates inhibition of factor Xa. Data have shown that fondaparinux is structurally too short to induce an antibody response and could be a useful agent to treat HIT. In our hospital, we retrospectively analyzed the use of fondaparinux in the treatment of 24 patients with acute HIT during unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) administration and compared the results to a similar population of 20 patients who were treated with lepirudin. The treated patients had a complete platelet count recovery, and none experienced a new thromboembolic complication or major bleeding. The development of limb gangrene (2 patients who received lepirudin and 1 who received fondaparinux) likely resulted from a delay in diagnosis and treatment initiation. Our data suggest that fondaparinux may be considered a safe and an effective alternative treatment in HIT complicated with or without thrombosis. © The Author(s) 2010.

Macheras G.A.,KAT General Hospital | Kateros K.,KAT General Hospital | Kateros K.,Gennimatas General Hospital | Galanakos S.P.,KAT General Hospital | And 3 more authors.
Journal of Bone and Joint Surgery - Series B | Year: 2011

We report the long-term results of the management of neglected chronically infected total knee replacements with a two-stage re-implantation protocol. In 18 of 34 patients (53%) a resistant organism was isolated. All cases were treated by the same surgical team in a specialist centre and had a mean follow-up of 12.1 years (10 to 14). They were evaluated clinically and radiologically using the Knee Society Score (KSS) and the American Knee Society Roentgenographic scoring system, respectively. One patient died after eight years from an unrelated cause and two were lost to follow-up. Three patients (8.8%) developed a recurrent infection for which further surgery was required. The infection was eradicated successfully in 31 patients (91.1%). There was one case of aseptic loosening after 13 years. We found a significant improvement in the KSS at final follow-up (p < 0.001). © 2011 British Editorial Society of Bone and Joint Surgery.

Iavazzo C.,IASO Maternity Hospital | Gkegkes I.D.,KAT General Hospital
International Journal of Medical Robotics and Computer Assisted Surgery | Year: 2013

Background: Robotic surgery is a new technique and the aim of this study was to review the available literature on robotic port-site metastasis in oncological patients. Methods: The results of this study were retrieved after performing a systematic electronic search in PubMed, Scopus and Cochrane databases. Results: In total 204 patients were included in the study, of which five had robotic port-site metastasis. Their age ranged from 35-77 years. The types of cancers causing port-site metastasis were one squamous cell cervical carcinoma, two cervical adenocarcinomas, one gallbladder carcinoma and one transitional cell bladder carcinoma. The port-site metastasis occurred from 3 weeks up to 18 months postoperatively with the tumor measuring from 1.1 to 10.5 cm. Conclusions: Port-site metastasis is an extremely rare complication of robotic surgery. No safe conclusion can be drawn, but the aim of this study was to raise doctors' suspicion levels to such a rare new entity. © 2013 John Wiley & Sons, Ltd.

Makris K.,KAT General Hospital | Spanou L.,KAT General Hospital
Journal of Diabetes Science and Technology | Year: 2011

Measurement of hemoglobin A1c (HbA1c) is considered the gold standard for monitoring chronic glycemia of diabetes patients. Hemoglobin A1c indicates an average of blood glucose levels over the past 3 months. Its close association with the risk for the development of long-term complications is well established. However, HbA1c does not inform patients about blood glucose values on a daily basis; therefore, frequent measurements of blood glucose levels are necessary for the day-to-day management of diabetes. Clinicians understand what HbA1c means and how it relates to glucose, but this is not the case with patients. Therefore, the translation of the HbA1c results into something more familiar to patients seemed a necessity. The scope of this article is to review the literature to search for enough scientific evidence to support the idea of a close relationship between HbA1c and mean blood glucose (MBG), and to justify the translation of HbA1c into something that reflects the MBG. Most studies confirm a close relationship between HbA1c and MBG, although different studies result in different linear equations. Factors affecting this relationship may limit the usefulness and applicability of a unique mathematical equation to all diabetes populations. © Diabetes Technology Society.

Iavazzo C.,IASO Maternity Hospital | Darlas F.M.,IASO Maternity Hospital | Gkegkes I.D.,KAT General Hospital
Acta Informatica Medica | Year: 2013

The preservation of ovarian function in young patients after radical hysterectomy has an important role at the post-oncologic management and preserves life quality. Ovarian transposition is a technique in order to avoid irreversible damage to the ovaries caused by irradiation. The principal surgical ways in the transposition of the ovaries is both through laparotomy and laparoscopy. Recently, the application of the robotic technology on this method seems to be promising. We performed a literature search with terms related to robotic surgery and ovarian transposition in Pubmed and Scopus. Two articles were identified dealing with this technique. Robotic assisted ovarian transposition is presented and the possible advantages and disadvantages of such a technique are discussed. © AVICENA 2013.

Macheras G.A.,KAT General Hospital | Kateros K.,KAT General Hospital | Kateros K.,Gennimatas General Hospital | Koutsostathis S.D.,KAT General Hospital | And 3 more authors.
Journal of Bone and Joint Surgery - Series B | Year: 2010

Between November 1997 and December 2000 we performed 27 total hip replacements in 22 patients with high congenital dislocation of the hip using porous tantalum monoblock acetabular components implanted in the true acetabular bed. Clinical and radiological evaluation was performed at regular intervals for a mean of 10.2 years (8.5 to 12). The mean Harris Hip Score improved from 48.3 (15 to 65) pre-operatively to 89.5 (56 to 100) at the final follow-up. The mean Oxford Hip Score was 49.5 (35 to 59) pre-operatively and decreased to 21.2 (12 to 48) at one year and 15.2 (10 to 28) at final follow-up. Migration of the acetabular component was assessed with the EBRA software system. There was a mean migration of 0.68 mm (0.49 to 0.8) in the first year and a mean 0.89 mm (0.6 to 0.98) in the second year, after excluding one initial excessive migration. No revision was necessary for any reason, no acetabular component became loose, and no radiolucent lines were observed at the final follow-up. The porous tantalum monoblock acetabular component is an implant offering adequate initial stability in conjunction with a modulus of elasticity and porosity close to that of cancellous bone. It favours bone ingrowth, leading to good mid-term results. ©2010 British Editorial Society of Bone and Joint Surgery.

Kafkas N.,KAT General Hospital | Demponeras C.,KAT General Hospital | Zoubouloglou F.,KAT General Hospital | Spanou L.,KAT General Hospital | And 2 more authors.
International Journal of Inflammation | Year: 2012

Background. Atherosclerosis is a chronic inflammatory disease and the acute clinical manifestations represent acute on chronic inflammation. Neutrophil gelatinase-associated lipocalin (NGAL) is found in the granules of human neutrophils, with many diverse functions. The aim of this study was to evaluate the hypothesis that levels NGAL in blood may reflect the inflammatory process in various stages of coronary artery disease. Methods. We studied 140 patients, with SA 40, UA 35, NSTEMI 40, and STEMI 25, and 20 healthy controls. Serum NGAL was measured upon admission and before coronary angiography. Results. Significant differences were observed in median serum-NGAL(ng/mL) between patients with SA (79.23 (IQR, 37.50100.32)), when compared with UA (108.00 (68.34177.59)), NSTEMI (166.49 (109.24247.20)), and STEMI (178.63 (111.18305.92)) patients and controls (50.31 (44.3069.78)) with significant incremental value from SA to STEMI. We observed a positive and significant correlation between serum-NGAL and hs-CRP (spearman coefficient rho = 0.685, P 0.0001) as well as with neutrophil counts (r = 0.511, P 0.0001). Conclusions. In patients with coronary artery disease serum levels of NGAL increase and reflect the degree of inflammatory process. In patients with acute coronary syndromes, serum levels of NGAL have high negative predictive value and reflecting the inflammatory status could show the severity of coronary clinical syndrome. © 2012 Nikolaos Kafkas et al.

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