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Piraeus, Greece

Stamatiou K.,Tzaneion General Hospital | Moschouris H.,Tzaneion General Hospital | Papadaki M.,General Hospital of Thebes | Perlepes G.,General Hospital of Thebes | Skolarikos A.,National and Kapodistrian University of Athens
Medical Ultrasonography

Purpose: The present study was carried out to establish the accuracy of modern ultrasonographic techniques in the follow up of patients with superficial bladder carcinoma and to evaluate the patients tolerability of cystoscopy. Methods: Thirty three patients with a history of superficial bladder carcinoma under active surveillance were initially examined using transabdominal ultrasound followed in the same day by cystoscopy. Results: Fourteen out of the 33 subjects were found to have bladder carcinoma recurrence on cystoscopy. In 11 cases (78.57%) US accurately diagnosed the bladder carcinoma. Two out of the 3 patients in which, the US examination failed to clearly diagnose bladder carcinoma, were found with a tumor smaller than 3 mm while, in the remaining patient the tumor was located in the inner part of a diverticula. The sensitivity of modern ultrasonographic techniques in the diagnosis of bladder cancer recurrence was 78.5%, the specificity 100%, the positive predictive value 100% and the negative predictive value 86.3%. Regarding the patient tolerability for cystoscopy, 17 patients (51.5%) reported excessive discomfort-low tolerability, 9 (27.2%) moderate discomfort-intermediate tolerability and 7 (21.2%) reported no discomfort-high tolerability. Conclusion: The technological evolution has rendered ultrasonography more accurate in the diagnosis of bladder carcinoma and thus it can be incorporated in the follow up schedule of patients with superficial bladder carcinoma. Source

Tsakris A.,National and Kapodistrian University of Athens | Poulou A.,National and Kapodistrian University of Athens | Pournaras S.,University of Thessaly | Voulgari E.,National and Kapodistrian University of Athens | And 4 more authors.
Journal of Antimicrobial Chemotherapy

Background: The increasing frequency of class A KPC enzymes and class B metallo-β-lactamases (MBLs) among Enterobacteriaceae as well as their possible co-production makes their early differentiation urgent. Methods: A simple phenotypic algorithm employing three combined-disc tests consisting of meropenem alone and with phenylboronic acid (PBA), EDTA, or both PBA and EDTA was designed for the differentiation of KPC and MBL enzymes. Augmentation of the zone of inhibition by ≥5 mm was considered a positive combined-disc test result. A total of 141 genotypically confirmed carbapenemase-positive Enterobacteriaceae clinical isolates (63 KPC producers, 47 MBL producers, and 31 KPC and MBL producers) with various carbapenem MICs were examined. For comparison, 84 genotypically confirmed carbapenemase-negative Enterobacteriaceae clinical isolates [39 extended-spectrum β-lactamase (ESBL) producers, 22 AmpC producers, and 23 ESBL and AmpC producers] were also tested. Results: The phenotypic algorithm was able to differentiate MBL from KPC producers as well as to detect the possible co-production of both carbapenemases (positive result only with the combined-disc test using meropenem alone and with both PBA and EDTA). The method detected all KPC or MBL producers (sensitivity 100%) as well as 30 of the KPC and MBL producers (sensitivity 96.8%). All three combined-disc tests were negative for non-carbapenemase-producing isolates, except two ESBL and AmpC producers that gave positive combineddisc tests using meropenem alone and with PBA and both PBA and EDTA (specificity for KPC detection 98.8%). Conclusions: This phenotypic method is very helpful to detect carbapenemase production and provides a simple algorithm for the differentiation of KPC and MBL enzymes, especially in regions where KPC- and MBL-possessing Enterobacteriaceae are highly prevalent. © The Author 2010. Source

Tsakris A.,National and Kapodistrian University of Athens | Themeli-Digalaki K.,Tzaneion General Hospital | Poulou A.,National and Kapodistrian University of Athens | Vrioni G.,National and Kapodistrian University of Athens | And 5 more authors.
Journal of Clinical Microbiology

The accurate phenotypic detection of Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae is an increasing necessity worldwide. We evaluated the performance of boronic acid combined-disk tests using as substrate imipenem or meropenem and as inhibitor of KPC production 300 μg aminophenylboronic acid (APBA), 600 μg APBA, or 400 μg phenylboronic acid (PBA). Tests were considered positive when an increase in the growth-inhibitory zone around a carbapenem disk with KPC inhibitor was 5 mm or greater of the growth-inhibitory zone diameter around the disk containing carbapenem alone. The comparison of the combined-disk tests was performed with 112 genotypically confirmed KPC-possessing Enterobacteriaceae isolates. To measure the specificity of the tests, 127 genotypically confirmed KPC-negative Enterobacteriaceae isolates that were nonsusceptible to at least one carbapenem were chosen for testing. Using disks containing imipenem without and with 300 μg APBA, 600 μg APBA, or 400 μg PBA, 72, 92, and 112 of the KPC producers, respectively, gave positive results (sensitivities, 64.3%, 82.1%, and 100%, respectively). Using disks containing meropenem without and with 300 μg APBA, 600 μg APBA, or 400 μg PBA, 87, 108, and 112 of the KPC producers, respectively, gave positive results (sensitivities, 77.7%, 96.4%, and 100%, respectively). Among KPC producers, the disk potentiation tests using meropenem and PBA demonstrated the largest differences in inhibition zones (P < 0.001). All combined-disk tests correctly identified 124 of the 127 non-KPC producers (specificity, 97.6%). This comparative study showed that PBA is the most effective inhibitor of KPC enzymes, and its use in combined-disk tests with meropenem may give the most easily interpreted results. Copyright © 2011, American Society for Microbiology. All Rights Reserved. Source

Marinis A.,Tzaneion General Hospital | Gkiokas G.,National and Kapodistrian University of Athens | Argyra E.,National and Kapodistrian University of Athens | Fragulidis G.,National and Kapodistrian University of Athens | And 2 more authors.
Scandinavian Journal of Surgery

The occurrence of an enteric fistula in the middle of an open abdomen is called an enteroatmospheric fistula, which is the most challenging and feared complication for a surgeon to deal with. It is in fact not a true fistula because it neither has a fistula tract nor is covered by a well-vascularized tissue. The mortality of enteroatmospheric fistulae was as high as 70% in past decades but is currently approximately 40% due to advanced modern intensive care and improved surgical techniques. Management of patients with an open abdomen and an enteroatmospheric fistula is very challenging. Intensive care support of organs and systems is vital in order to manage the severely septic patient and the associated multiple organ failure syndrome. Many of the principles applied to classic enterocutaneous fistulae are used as well. Control of enteric spillage, attempts to seal the fistula, and techniques of peritoneal access for excision of the involved loop are reviewed in this report. Additionally, we describe our recent proposal of a lateral surgical approach via the circumference of the open abdomen in order to avoid the hostile and granulated surface of the abdominal trauma, which is adhered to the intraperitoneal organs. Source

Staikou C.,National and Kapodistrian University of Athens | Avramidou A.,Tzaneion General Hospital | Ayiomamitis G.D.,Tzaneion General Hospital | Vrakas S.,Tzaneion General Hospital | Argyra E.,National and Kapodistrian University of Athens
Journal of Gastrointestinal Surgery

Methods: Between December 2011 and February 2013, 60 patients were randomly allocated to IVL, LEA, or control group. The IVL group received intraoperatively lidocaine 2 % intravenously (1.5 mg/kg bolus, 2 mg/kg/h infusion) and normal saline (NS) epidurally. The LEA group received lidocaine epidurally (1.5 mg/kg bolus, 2 mg/kg/h infusion) and NS intravenously. The control group received NS both intravenously and epidurally, as bolus and infusion. All NS volumes were calculated as if containing lidocaine 2 % at the aforementioned doses. We assessed pain intensity at rest/cough at 1, 2, 4, 12, 24, and 48 h postoperatively (numerical rating scale 0–10), 48-h analgesic consumption, and time to first flatus passage.Results: Data from 60 patients (20 per group) were analyzed. The IVL group had significantly lower pain scores at rest and cough compared to LEA or control group only at 1, 2, and 4 h postoperatively (P < 0.005 for all comparisons). The 48-h analgesic requirements and time to first flatus passage did not differ significantly between IVL group and LEA or control group (P > 0.05).Conclusions: Compared with LEA-lidocaine or placebo, intravenous lidocaine offered no clinically significant benefit in terms of analgesia and bowel function.Background: We compared the effects of intravenous lidocaine (IVL) with lumbar epidural lidocaine analgesia (LEA) on pain and ileus after open colonic surgery. © 2014, The Society for Surgery of the Alimentary Tract. Source

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