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Ku C.S.,Karolinska Institutet | Cooper D.N.,University of Cardiff | Zioga D.E.,University of Ioannina | Halkia E.,METAXA Cancer Memorial Hospital | And 2 more authors.
Current Opinion in Obstetrics and Gynecology | Year: 2013

Purpose of Review: To highlight the recent advances in cancer genome research and its clinical applications made possible by next-generation sequencing (NGS), with particular emphasis on gynecological and breast cancers is the purpose of the review. Recent Findings: Through advances in NGS technologies, whole-exome sequencing and whole-genome sequencing (WGS) have been performed on various cancers, identifying in the process numerous recurrent mutations and highly mutated genes. These cancers include uterine serous carcinomas, high-grade serous ovarian adenocarcinomas and breast cancer. In contrast to identifying somatic mutations in sporadic cancers, a far smaller number of studies using NGS have been conducted to identify new causal mutations or genes for hereditary cancer syndromes. In addition to research discovery, diagnostic applications of NGS have also become increasingly evident. Thus, WGS has been applied in a diagnostic context to identify a complex chromosomal rearrangement in a patient with acute myeloid leukemia of unclear subtype. Similarly, the targeted sequencing of panels of known cancer genes using NGS has demonstrated its robustness in the context of identifying known pathological mutations. Summary: The research and clinical applications of cancer genome sequencing have progressed at an unprecedented pace over the last few years, and this promises to be accelerated with new developments of high-throughput NGS technologies and robust analytical tools. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source


Spiliotis J.,METAXA Cancer Memorial Hospital
Gastric and Breast Cancer | Year: 2012

Over the past two decades no systemic therapy has been established as standard in the treatment of patients with neuroendocrine tumors in the pancreas. Targeted therapy alone or in combination with chemotherapy has revolutionized systemic treatment of cancer over the last 13 years after a first approval of a monoclonal antibody. Since then, the field of small molecules receptors tyrosine kinase (RTKs) inhibitors has rapidly being expanded included many such signal transduction drugs for various cancer types. Two of these drugs, everolimus and sunitinib have demonstrated substantial antitumor activity in experimental and clinical studies. In this review, the advances in diagnostics, tumor staging, and treatment of patients with pancreatic neuroendocrine tumors with particular emphasis on targeted drugs and their efficacy and safety are discussed considering the results of recent phase 3, randomized trials. Source


Msaouel P.,Greek Junior Doctors and Health Scientists Society | Kappos T.,METAXA Cancer Memorial Hospital | Tasoulis A.,Alexandra Hospital | Apostolopoulos A.P.,Asklipiio Hospital | And 3 more authors.
Medical Education Online | Year: 2014

Purpose: The aim of this study is to determine the perceived familiarity of medical residents with statistical concepts, assess their ability to integrate these concepts in clinical scenarios, and investigate their susceptibility to the gambler's fallacy and the conjunction fallacy. Methods: A multi-institutional, cross-sectional survey of Greek medical residents was performed. Participants were asked to indicate their familiarity with basic statistical concepts and answer clinically oriented questions designed to assess their biostatistics knowledge and cognitive biases. Univariate, bivariate, and multivariate statistical models were used for the evaluation of data. Results: Out of 153 respondents (76.5% response rate), only two participants (1.3%) were able to answer all seven biostatistics knowledge questions correctly while 29 residents (19%) gave incorrect answers to all questions. The proportion of correct answers to each biostatistics knowledge question ranged from 15 to 51.6%. Residents with greater self-reported familiarity were more likely to perform better on the respective knowledge question (all pB0.01). Multivariate analysis of the effect of individual resident characteristics on questionnaire performance showed that previous education outside Greece, primarily during medical school, was associated with lower biostatistics knowledge scores (pB0.001). A little more than half of the respondents (54.2%) answered the gambler's fallacy quiz correctly. Residents with higher performance on the biostatistics knowledge questions were less prone to the gambler's fallacy (odds ratio 1.38, 95% confidence intervals 1.12-1.70, p=0.003). Only 48 residents (31.4%) did not violate the conjunction rule. Conclusions: A large number of medical residents are unable to correctly interpret crucial statistical concepts that are commonly found in the medical literature. They are also especially prone to the gambler's fallacy bias, which may undermine clinical judgment and medical decision making. Formalized systematic teaching of biostatistics during residency will be required to de-bias residents and ensure that they are proficient in understanding and communicating statistical information. © 2014 Pavlos Msaouel et al. Source


Polydorou A.,National and Kapodistrian University of Athens | Karapanos K.,METAXA Cancer Memorial Hospital | Vezakis A.,National and Kapodistrian University of Athens | Melemeni A.,National and Kapodistrian University of Athens | And 3 more authors.
Surgical Laparoscopy, Endoscopy and Percutaneous Techniques | Year: 2012

The treatment of acute biliary pancreatitis during pregnancy remains controversial. We present our experience of treating 7 pregnant women with acute biliary pancreatitis and verified or suspected choledocholithiasis, by using magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and sphincterotomy followed by laparoscopic cholecystectomy. MRCP was performed in all patients to confirm the presence of common bile duct stones, their size and number. ERCP and sphincterotomy were performed without the use of radiation. The procedure was terminated only when all stones (the number clarified at MRCP), were retrieved into the duodenum. All patients underwent laparoscopic cholecystectomy the following day. Neither post-ERCP nor postoperative major complications were noted. All but one patient reached a healthy natural-term labor. One patient had a planned cesarean section on 35th week. The combination of MRCP, nonradiation ERCP, and immediate laparoscopic cholecystectomy provides definite treatment and seems to put both mother and fetus at lower risk than presumed. Copyright © 2012 by Lippincott Williams & Wilkins. Source


Spiliotis J.,METAXA Cancer Memorial Hospital
Gastric and Breast Cancer | Year: 2011

Many surgeons have standardized the surgery for colon and rectal cancer including "high tie" of the inferior mesenteric artery. This strategy allows additional dissection of lymph nodes around the root of the inferior mesenteric artery leading to a true complete tumor (R0) resection. Depending on T-stage, the rate of these lymph nodes containing metastases may be substantial and thus a less radical lymphadenectomy increases the risk of nodal recurrence at the root of the inferior mesenteric artery. The reduced blood supply and increased risk of anastomosis can be overcome with standardized mobilization of splenic flexure in open or laparoscopic surgery. Another method is to dissect lymph nodes while preserving the inferior mesenteric artery and left colic artery. Source

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