University Hospital of Larisa

Lárisa, Greece

University Hospital of Larisa

Lárisa, Greece

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Siasios I.,University Hospital of Larisa | Siasios I.,University of Thessaly | Kapsalaki E.Z.,University Hospital of Larisa | Kapsalaki E.Z.,University of Thessaly | And 3 more authors.
Neuroradiology | Year: 2012

Introduction: Aneurysmal subarachnoid hemorrhage constitutes a clinical entity associated with high mortality and morbidity. It is widely accepted that improper clip placement may have as a result of incomplete aneurysm occlusion and/or partial or complete obstruction of an adjacent vessel. Various modalities, including intraoperative or postoperative digital subtracting angiography, near-infrared indocyanine green angiography, micro-Doppler ultrasonography (MDU), and neurophysiological studies, have been utilized for verifying proper clip placement. The aim of our study was to review the role of MDU during aneurysmal surgery. Methods: A literature search was performed using any possible combination of the following terms: aneurysm, brain, cerebral, clip, clipping, clip malpositioning, clip repositioning, clip suboptimal positioning, Doppler, intracranial, microsurgery, micro-Doppler, residual neck, ultrasonography, ultrasound, and vessel occlusion. Additionally, reference lists from the retrieved articles were reviewed for identifying any additional articles. Case reports and miniseries were excluded. Results: A total of 19 series employing intraoperative MDU during aneurysmal microsurgery were retrieved. All studies demonstrated that MDU accuracy is extremely high. The highest reported false-positive rate of MDU was 2 %, while the false-negative rate was reported as high as 1.6 %. It has been demonstrated that the presence of subarachnoid hemorrhage, specific anatomic locations, and large size may predispose to improper clip placement. Intraoperative MDU's technical limitations and weaknesses are adequately identified, in order to minimize the possibility of any misinterpretations. Conclusion: Intraoperative MDU constitutes a safe, accurate, and low cost imaging modality for evaluating blood flow and for verifying proper clip placement during microsurgical clipping. © 2012 Springer-Verlag.


Tzovaras N.,University Hospital of Larisa | Karvouniaris M.,University Hospital of Larisa | Makris D.,University Hospital of Larisa | Zakynthinos E.,University Hospital of Larisa
Infectious Disorders - Drug Targets | Year: 2011

Aim: To review available evidence for the role of adjunctive therapies in severe pneumonia. Methods: We fo-cused on therapies that have attracted recently interest such as glucocorticosteroids (GCs), statins and recombinant acti-vated protein-C. Results: Experimental animal and human studies showed that GCs are able to modulate the inflammatory response and may offer a benefit in patients with severe sepsis. Randomized trials in pneumonia are few, mostly limited in septic shock and ARDS patients. Recombinant activated protein C is a potent anticoagulant and profibrinolytic enzyme which can inhibit the systemic inflammatory response. Available data, although limited, showed that activated protein C can reduce mortality in severe sepsis, especially in severe pneumonia due to S. Pneumoniae. Statins have pleiotropic properties which can affect the inflammatory cascade. The use of statins has been found to be associated with decreased mortality in some studies with pneumina whereas the use of statins was associated with increased risk of death in others. However, data come from observational or retrospective studies. Conclusion: Treatment with GCs may modulate the inflammatory response in critically ill patients with pneumonia but a clear effect of steroids on survival is debatable. The administration of GCs should be considered in patients with severe pneumonia when vasopressor dependent septic shock. Activated protein-C may be considered in patients with severe CAP or HAP and sepsis or organ failure. The role of statins in the management of severe pneumonia remains controversial until data from clinical trails will be available. © 2011 Bentham Science Publishers.


Karvouniaris M.,University Hospital of Larisa | Papanikolaou J.,University Hospital of Larisa | Makris D.,University Hospital of Larisa | Zakynthinos E.,University Hospital of Larisa
American Journal of Emergency Medicine | Year: 2012

Sepsis is a stressful physical condition, and at the acute phase, overstimulation of the sympathetic nervous system may occur; these events have the potential to induce cardiomyopathy. Takotsubo cardiomyopathy (TTC) is a form of catecholamine-induced cardiomyopathy, which occurs very rarely in sepsis. However, TTC management in critically ill patients with sepsis may be challenging because the use of exogenous catecholamines for circulatory support might augment further TTC. Herein, we report a rare case of TTC after urosepsis; and we point out that cardiac function may improve after catecholamine withdrawal and the application of calcium channel sensitizer levosimendan. © 2012 Elsevier Inc. All rights reserved.


Aravantinos E.,Thriassio General Hospital | Anagnostou T.,Thriassio General Hospital | Samarinas M.,University Hospital of Larisa | Samarinas M.,Thriassio General Hospital | And 4 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.


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.


Rouka E.,University Hospital of Larisa | Kyriakou D.,University Hospital of Larisa
Transfusion Medicine | Year: 2015

Background: Human Herpesviruses (HHVs) maintain life-long latent persistence in the majority of the adult population including blood donors. The necessity for their study resides in the potential risk of transfusion-associated infection and the subsequent complications in the immunocompromised host. We aimed to assess the prevalence of HHVs types 1-6 and 8 among healthy blood donors of Thessaly prefecture in order to evaluate the frequency distribution of HHVs in Greek population and to ascertain possible correlations with demographic factors. Materials and Methods: Polymerase chain reaction (PCR) detection of HHVs DNA was determined in 401 randomly selected consecutive blood donors of Central Greece. Epidemiological data were recorded through a well structured questionnaire. Results: The overall PCR positivity for HHVs was 25·4%. HHVs types 1-3 were not detected in any donor sample. A specimen with high level of HHV-6 DNA (1580400 copies per mL) was recorded. HHV-4 DNA positivity was significantly associated with rural residency. Conclusion: HHV-4 DNA is commonly detected in whole blood specimens of healthy individuals. HHVs types 5, 6 and 8 are rarely detected. However, the existence of a donor sample with high HHV-6 viral load raises questions regarding the potential risk of HHV-6 blood-borne infection and the safety of blood products. © 2015 British Blood Transfusion Society.


Rouka E.,University Hospital of Larisa | Kyriakou D.,University Hospital of Larisa
Journal of Biological Research (Greece) | Year: 2015

Epigenetic deregulation is a common feature in the pathogenesis of Epstein-Barr Virus (EBV)-related lymphomas and carcinomas. Previous studies have demonstrated a strong association between EBV latency in B-cells and epigenetic silencing of the tumor suppressor gene BIM. This study aimed to the construction and functional analysis of the BIM interactome in order to identify novel host genes that may be targeted by EBV. Fifty-nine unique interactors were found to compose the BIM gene network. Ontological analysis at the pathway level highlighted infectious diseases along with neuropathologies. These results underline the possible interplay between the BIM interactome and EBV-associated disorders. © 2015 Rouka and Kyriakou.


PubMed | University Hospital of Larisa
Type: | Journal: Journal of biological research (Thessalonike, Greece) | Year: 2015

Epigenetic deregulation is a common feature in the pathogenesis of Epstein-Barr Virus (EBV)-related lymphomas and carcinomas. Previous studies have demonstrated a strong association between EBV latency in B-cells and epigenetic silencing of the tumor suppressor gene BIM. This study aimed to the construction and functional analysis of the BIM interactome in order to identify novel host genes that may be targeted by EBV. Fifty-nine unique interactors were found to compose the BIM gene network. Ontological analysis at the pathway level highlighted infectious diseases along with neuropathologies. These results underline the possible interplay between the BIM interactome and EBV-associated disorders.


PubMed | Boston University, General Hospital of Larisa and University Hospital of Larisa
Type: | Journal: Neurologia i neurochirurgia polska | Year: 2016

Cerebral microdialysis enables assessment of regional metabolic physiology and provides biomarkers for clinical correlation in critical conditions, such as subarachnoid hemorrhage (SAH). The aim of our current study was to investigate the correlation between regional cerebral blood flow and microdialysis parameters (glucose, lactate, glycerol, pyruvate concentrations, and lactate/pyruvate metabolic ratio) in patients with SAH.Twenty-one patients with SAH were enrolled in our retrospective study. Cerebral blood flow (CBF) based on thermal diffusion methodology, the thermal coefficient K, and microdialysis biochemical markers were recorded. The duration of the brain monitoring was 10 days.Microdialysis glucose concentration was inversely related to the cerebral temperature and to the L/P ratio. Furthermore, it was positively correlated to all other microdialysis parameters but glycerol. The K coefficient was strongly and positively correlated with the temperature and marginally with the CBF. The L/P ratio was positively correlated with glycerol, while it was inversely correlated with the CBF. Patients who died had elevated L/P ratio and K coefficient compared to the survivors in our series.Thermal conductivity coefficient may change over time as cerebral injury progresses and tissue properties alter. These alterations were found to be associated with the microdialysis metabolite concentrations and the CBF itself. The microdialysis biochemical indices of cell stress and death (glycerol, L/P ratio) were positively related to each other, while the measured L/P metabolic ratio was higher among patients who died.

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