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Aravantinos E.,Thriassio General Hospital | Anagnostou T.,Thriassio General Hospital | Samarinas M.,University Hospital of Larisa | Ioannides K.,Thriassio General Hospital | And 3 more authors.
Urology | Year: 2013

Objective: To suggest minipercutaneous ureterolithotripsy using the mininephroscope as an alternative process for impacted stones of the upper ureter because these stones can be challenging to treat and can produce severe symptoms. Materials and Methods: We report our results of cases in which the percutaneous approach using 2-step minipercutaneous ureteroscopy with the mininephroscope was used to achieve relief from the stone, with minimal anesthesia risks. A total of 54 patients (33 men and 21 women) presented with impacted stones in the proximal ureter. The mean stone size was 16.2 mm (range 10-21). All patients were treated with 2-step minipercutaneous antegrade ureterolithotripsy under multimodal analgesia. Results: The mean operative time was 49 minutes (range 40-110). Placement of the percutaneous drainage tube was quick and was performed with the patient under local anesthesia. The minipercutaneous session followed several days later, with the patient under multimodal anesthesia. The initial stone-free rate was 94%. The stone-free rate 2 months after the procedure was 100%. All procedures were well tolerated by the patients (group mean visual analog scale score 3.1 ± 0.7 standard deviation). No severe adverse events were noted. The mean hospital stay was 5.3 days (range 3-12). Conclusion: In selected emergency cases of impacted proximal ureteral stones, the approach of the initial insertion of a nephrostomy tube followed by a second session of antegrade ureterolithotripsy using the mininephroscope is a safe and effective alternative treatment, especially, because it can be accomplished with minimal anesthesia requirements. © 2013 Elsevier Inc. All Rights Reserved.

Makris D.,University Hospital of Lille | Makris D.,University Hospital of Larisa | Lubret R.,University Hospital of Lille | Nseir S.,University Hospital of Lille
Current Respiratory Medicine Reviews | Year: 2010

Opioids are routinely used to provide analgesia in mechanically ventilated patients. Opioid use is associated with increased risk of ICU-acquired infection, particularly VAP. Prolongation of exposure to mechanical ventilation, microaspiration, gastrointestinal motility disturbances, and immunomodulatory effects are the potential mechanisms by which opioids may favour VAP in these patients. Activation of sympathic nervous system, and hypothalamic-pituitary- adrenal axis was identified after morphine withdrawal. In addition, suppression of mitogen-stimulated proliferation of T and B-lymphocytes, natural killer activity, antibody production, IL2, IL12, INFγ, and NO production are the main immune effects observed during acute and chronic morphine exposure. The use of short acting opioids is associated with shorter duration of mechanical ventilation and ICU stay, and might be helpful in preventing VAP. Future studies should compare the effect of different opioid agents, and the impact of progressive opioid discontinuation compared with abrupt discontinuation on VAP incidence. © 2010 Bentham Science Publishers Ltd.

Skoufi G.I.,University of Thessaly | Nena E.,Democritus University of Thrace | Kostikas K.,University of Thessaly | Lialios G.A.,University Hospital of Larisa | And 3 more authors.
International Journal of Occupational and Environmental Medicine | Year: 2013

Background: Hairdressers are occupationally exposed to a number of agents in their workplace that result in respiratory symptoms and changes in pulmonary function. Objective: To evaluate associations between occupational exposure and respiratory function and reported symptoms in a group of hairdressers compared to a control group. Methods: A questionnaire on respiratory symptoms and workplace characteristics was completed by 94 hairdressers and 39 age- and sex-matched controls. Spirometry and exhaled nitric oxide (FeNO) measurements were also performed. Results: Hairdressers reported more severe dyspnea (p=0.03) and eye (p=0.001) and throat (p=0.007) irritation, compared to the control group, at the workplace; no differences were noted at home. Lower FEV1 /FVC (p<0.001) and higher FeNO values (p=0.012) were observed in hairdressers. A larger working area and presence of window ventilation were associated with better pulmonary function. Conclusion: Worsening of symptoms and pulmonary function at workplace, and alleviating the symptoms at home, indicate that they may be related to occupational exposure.

Mauri D.,General Hospital of Lamia | Mauri D.,Panhellenic Association for Continual Medical Research PACMeR | Kamposioras K.,Panhellenic Association for Continual Medical Research PACMeR | Tsali L.,General Hospital of Lamia | And 9 more authors.
Cancer Treatment Reviews | Year: 2010

Background: Taxanes have been extensively tested in patients with advanced breast cancer, but it is unclear whether their weekly use might offer any benefits against standard every three weeks administration. We therefore performed a meta-analysis of randomized controlled trials that compared weekly and every three weeks taxanes regimens in advanced breast cancer. Methods: The endpoints that we assessed were objective response rate, progression free survival (PFS) and overall survival. Efficacy data for paclitaxel and docetaxel were separately analyzed. Trials were located through PubMed and Cochrane Library searches and abstracts of major international conferences. Results: Οbjective response rate was notably better when paclitaxel was used as every three weeks regimen (7 studies, 1772 patients, fixed effect model pooled RR 1.20 95%CI 1.08-1.32 p < 0.001). No difference were found for PFS (6 studies, 1610 patients, random effect model HR 1.02, 95%CI 0.81-1.30 p = 0.860); while OS was statistically higher among patients receiving weekly paclitaxel (5 studies, 1471 patients, fixed effect model pooled HR 0.78, 95%CI 0.67-0.89 p = 0.001). No differences were observed for the weekly compared to the every three weeks use of docetaxel either for objective response, PFS and OS. Overall, the incidence of serious adverse events, neutropenia, neutropenic fever, and peripheral neuropathy were significantly lower in weekly taxanes schedules. The incidence of nail changes and epiphora were significantly lower in the every three weeks docetaxel regimens. Conclusions: Use of paclitaxel in weekly regimen give overall survival advantages compared with the standard every three weeks regimen. The observed survival benefit does not seem to stem from an increased potency of the drug with weekly regimens. The use of weekly paclitaxel regimens is therefore recommended for the treatment of locally advanced/metastatic breast cancer. © 2009 Elsevier Ltd. All rights reserved.

Fragioudaki M.,University Hospital of Heraklion | Tsirakis G.,University Hospital of Heraklion | Pappa C.A.,Venizelion Hospital of Heraklion | Aristeidou I.,University Hospital of Heraklion | And 5 more authors.
Leukemia Research | Year: 2012

B-cell activating factor (BAFF) is a B-cell growth factor. We measured its serum levels and correlated them with parameters of disease activity, as serum levels of tumor necrosis factor-α and lactate dehydrogenase, bone marrow microvascular density and proliferating cell nuclear antigen expression, in 50 myeloma patients, in 22 of them in plateau phase and in 20 controls. All of them were higher in patients and in advanced disease while reduced in plateau phase. BAFF correlated with all the above markers. Higher BAFF levels predicted a shorter survival, suggesting an important prognostic marker and a possible therapeutic target in myeloma. © 2012 Elsevier Ltd.

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