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From diagnosis to treatment of hepatocellular carcinoma: An epidemic problem for both developed and developing world 被引量:52
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作者 dimitrios dimitroulis Christos Damaskos +12 位作者 Serena Valsami Spyridon Davakis Nikolaos Garmpis Eleftherios Spartalis Antonios Athanasiou Demetrios Moris Stratigoula Sakellariou Stylianos Kykalos Gerasimos Tsourouflis Anna Garmpi Ioanna Delladetsima Konstantinos Kontzoglou Gregory Kouraklis 《World Journal of Gastroenterology》 SCIE CAS 2017年第29期5282-5294,共13页
Hepatocellular carcinoma(HCC) is the most frequent primary liver malignancy and the third cause of cancer-related death in the Western Countries. The well-established causes of HCC are chronic liver infections such as... Hepatocellular carcinoma(HCC) is the most frequent primary liver malignancy and the third cause of cancer-related death in the Western Countries. The well-established causes of HCC are chronic liver infections such as hepatitis B virus or chronic hepatitis C virus, nonalcoholic fatty liver disease, consumption of aflatoxins and tobacco smocking. Clinical presentation varies widely; patients can be asymptomatic while symptomatology extends from right upper abdominal quadrant paint and weight loss to obstructive jaundice and lethargy. Imaging is the first key and one of the most important aspects at all stages of diagnosis, therapy and follow-up of patients with HCC. The Barcelona Clinic Liver Cancer Staging System remains the most widely classification system used for HCC management guidelines. Up until now, HCC remains a challenge to early diagnose, and treat effectively; treating management is focused on hepatic resection, orthotopic liver transplantation, ablative therapies, chemoembolization and systemic therapies with cytotocix drugs, and targeted agents. This review article describes the current evidence on epidemiology, symptomatology, diagnosis and treatment of hepatocellular carcinoma. 展开更多
关键词 HEPATOCELLULAR Cancer EPIDEMIOLOGY TREATMENT DIAGNOSIS STAGING Transplantation
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Role of surgery in colorectal liver metastases:Too early or too late? 被引量:5
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作者 dimitrios dimitroulis Nikolaos Nikiteas +3 位作者 Theodore Troupis dimitrios Patsouras Panayiotis Skandalakis Gregory Kouraklis 《World Journal of Gastroenterology》 SCIE CAS CSCD 2010年第28期3484-3490,共7页
As colorectal cancer and colorectal liver metastases become a serious public health problem,new treatment modalities are needed in order to achieve better results. In the last decade there has been very important prog... As colorectal cancer and colorectal liver metastases become a serious public health problem,new treatment modalities are needed in order to achieve better results. In the last decade there has been very important progress in oncology,with new and more effective chemotherapeutic agents administered alone or in combination improving the resectability rate in up to 40%of patients with colorectal liver metastases.Advances in interventional radiology,in particular,with the use of portal vein embolization and radiofrequency thermal ablation are new strategies allowing major liver resections and treatment of small liver metastases or early recurrences.Surgery,however,remains the gold standard strategy with intention to treat.In this review article we will describe the advanced role of surgery in the multidisciplinary approach to colorectal liver metastases,and the clinical problems the liver surgeon has to deal with,such as theresectability of the metastases,the presence of bilobar liver lesions and extrahepatic disease,the impact of chemotherapy in already resectable liver metastases,the problem of vanishing metastases after chemotherapy and the dilemma of staged or combined liver and colon operations and which organ first in the clinical scenario of synchronous colorectal liver metastases. 展开更多
关键词 METASTASES Liver metastases Colorectal cancer SURGERY
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Hepatocellular carcinoma in patients co-infected with hepatitis C virus and human immunodeficiency virus 被引量:4
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作者 dimitrios dimitroulis Serena Valsami +2 位作者 Eleftherios Spartalis Emmanuel Pikoulis Gregory Kouraklis 《World Journal of Hepatology》 CAS 2013年第6期323-327,共5页
Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) share a common route of transmission so that about one third of HIV infected individuals show HCV coinfection. Highly active antiretroviral therapy has of... Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) share a common route of transmission so that about one third of HIV infected individuals show HCV coinfection. Highly active antiretroviral therapy has offered a longer and better life to infected patients. While has removed AIDS-related diseases from the list of most common causes of death their place has been taken by complications of HCV infection, such as cirrhosis, end stage liver disease and hepatocellular carcinoma (HCC). HIV/HCV co-infection requires complex management, especially when HCC is present. Co-infected patients with HCC undergo the same therapeutic protocol as their mono-infected counterparts, but special issues such as interaction between regimens, withdrawal of therapy and choice of immunosuppressive agents, demand a careful approach by specialists. All these issues are analyzed in this minireview. 展开更多
关键词 HEPATOCELLULAR carcinoma Hepatitis C virus Human IMMUNODEFICIENCY VIRUS CO-INFECTION
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Indications,limitations and maneuvers to enable extended hepatectomy:Current trends 被引量:5
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作者 dimitrios dimitroulis Petros Tsaparas +4 位作者 Serena Valsami dimitrios Mantas Eleftherios Spartalis Charalampos Markakis Gregory Kouraklis 《World Journal of Gastroenterology》 SCIE CAS 2014年第24期7887-7893,共7页
The liver is a solid organ with a wide variety of primary benign or malignant tumors as well as metastatic lesions.Surgical resection of these tumors remains the only curative modality.Several limitations,however,do n... The liver is a solid organ with a wide variety of primary benign or malignant tumors as well as metastatic lesions.Surgical resection of these tumors remains the only curative modality.Several limitations,however,do not allow the performance of these operations.This review evaluates the indications and limitations regarding these extended hepatic resections,as well as describing all the manipulations that increase the candidates for such operations.A thorough review of the literature was performed in order to define indications for extended hepatectomy,as well as to present all methods that contribute to increasing the volume of the future remnant liver.The role of portal vein ligation,portal vein embolization,two-stage hepatectomy,and in situ liver transection are evaluated in the setting of indications and results.Extended hepatectomies are a necessity due to oncological reasons.All methods developed in order to increase the volume of the remnant liver are safe and efficient.in situ liver transection is a novel and revolutionary two-step procedure for extended hepatic resections.Further clinical studies are required to estimate long-term results and the oncological basis of this technique. 展开更多
关键词 Extended hepatectomy Portal vein ligation Remnant liver volume
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Mechanistic insights of rapid liver regeneration after associating liver partition and portal vein ligation for stage hepatectomy 被引量:2
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作者 Demetrios Moris Spyridon Vernadakis +4 位作者 Alexandros Papalampros Michail Vailas Nikolaos Dimitrokallis Athanasios Petrou dimitrios dimitroulis 《World Journal of Gastroenterology》 SCIE CAS 2016年第33期7613-7624,共12页
AIM To highlight the potential mechanisms of regeneration in the Associating Liver Partition and Portal vein ligation for Stage hepatectomy models(clinical and experimental) that could unlock the myth behind the extra... AIM To highlight the potential mechanisms of regeneration in the Associating Liver Partition and Portal vein ligation for Stage hepatectomy models(clinical and experimental) that could unlock the myth behind the extraordinary capability of the liver for regeneration,which would help in designing new therapeutic options for the regenerative drive in difficult setup,such as chronic liver diseases. Associating Liver Partition and Portal vein ligation for Stage hepatectomy has been recently advocated to induce rapid future liver remnant hypertrophy that significantly shortens the time for the second stage hepatectomy. The introduction of Associating Liver Partition and Portal vein ligation for Stage hepatectomy in the surgical armamentarium of therapeutic tools for liver surgeons represented a real breakthrough in the history of liver surgery. METHODS A comprehensive literature review of Associating Liver Partition and Portal vein ligation for Stage hepatectomy and its utility in liver regeneration is performed. RESULTS Liver regeneration after Associating Liver Partition and Portal vein ligation for Stage hepatectomy is a combination of portal flow changes and parenchymal transection that generate a systematic response inducing hepatocyte proliferation and remodeling. CONCLUSION Associating Liver Partition and Portal vein ligation for Stage hepatectomy represents a real breakthrough in the history of liver surgery because it offers rapid liver regeneration potential that facilitate resection of liver tumors that were previously though unresectable. The jury is still out though in terms of safety,efficacy and oncological outcomes. As far as Associating Liver Partition and Portal vein ligation for Stage hepatectomy-induced liver regeneration is concerned,further research on the field should focus on the role of nonparenchymal cells in liver regeneration as well as on the effect of Associating Liver Partition and Portal vein ligation for Stage hepatectomy in liver regeneration in the setup of parenchymal liver disease. 展开更多
关键词 LIVER regeneration Associating LIVER PARTITION with PORTAL VEIN LIGATION for staged HEPATECTOMY PORTAL VEIN embolization PORTAL VEIN LIGATION LIVER transection
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Barrett's esophagus with high-grade dysplasia:Focus on current treatment options 被引量:2
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作者 Leonidas Lekakos Nikolaos P Karidis +3 位作者 dimitrios dimitroulis Christos Tsigris Gregory Kouraklis Nikolaos Nikiteas 《World Journal of Gastroenterology》 SCIE CAS CSCD 2011年第37期4174-4183,共10页
High-grade dysplasia(HGD) in Barrett's esophagus(BE) is the critical step before invasive esophageal adenocarcinoma.Although its natural history remains unclear,an aggressive therapeutic approach is usually indica... High-grade dysplasia(HGD) in Barrett's esophagus(BE) is the critical step before invasive esophageal adenocarcinoma.Although its natural history remains unclear,an aggressive therapeutic approach is usually indicated.Esophagectomy represents the only treatment able to reliably eradicate the neoplastic epithelium.In healthy patients with reasonable life expectancy,vagal-sparing esophagectomy,with associated low mortality and low early and late postoperative morbidity,is considered the treatment of choice for BE with HGD.Patients unfit for surgery should be managed in a less aggressive manner,using endoscopic ablation or endoscopic mucosal resection of the entire BE segment,followed by lifelong surveillance.Patients eligible for surgery who present with a long BE segment,multifocal dysplastic lesions,severe reflux symptoms,a large fixed hiatal hernia or dysphagia comprise a challenging group with regard to the appropriate treatment,either surgical or endoscopic. 展开更多
关键词 Barrett's esophagus High-grade dysplasia Endoscopic ablation Endoscopic excision Surgical treatment
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Surgical dilemmas in the management of colorectal liver metastases: the role of timing 被引量:1
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作者 dimitrios dimitroulis Gregory Kouraklis 《World Journal of Gastroenterology》 SCIE CAS 2016年第21期4963-4965,共3页
Colorectal cancer(CRC) is an emerging health problem in the Western World both for its raising tendency as well as for its metastatic potential. Almost half of the patients with CRC will develop liver metastases durin... Colorectal cancer(CRC) is an emerging health problem in the Western World both for its raising tendency as well as for its metastatic potential. Almost half of the patients with CRC will develop liver metastases during the course of their disease. The liver surgeon dealing with colorectal liver metastases faces several surgical dilemmas especially in the setting of the timing of operation. Synchronous resectable metastases should be treated prior or after induction chemotherapy? Furthermore in the case of synchronous colorectal liver metastases which organ should we first deal with, the liver or the colon? All these questions are set in the editorial and impulse for further investigation is put focusing on multidisciplinary approach and individualization of treatment modalities. 展开更多
关键词 Colorectal cancer CHEMOTHERAPY Timing of surgery Colorectal liver metastases Liver first procedure Multidisciplinary approach Individualized treatment strategies
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Role of platelet-rich plasma in ischemic heart disease: An update on the latest evidence 被引量:1
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作者 Eleftherios Spartalis Periklis Tomos +6 位作者 Demetrios Moris Antonios Athanasiou Charalampos Markakis Michael D Spartalis Theodore Troupis dimitrios dimitroulis Despina Perrea 《World Journal of Cardiology》 CAS 2015年第10期665-670,共6页
Myocardial infarction is the most common cause of congestive heart failure. Novel strategies such as directly reprogramming cardiac fibroblasts into cardiomyocytes are an exciting area of investigation for repair of i... Myocardial infarction is the most common cause of congestive heart failure. Novel strategies such as directly reprogramming cardiac fibroblasts into cardiomyocytes are an exciting area of investigation for repair of injured myocardial tissue. The ultimate goal is to rebuild functional myocardium by transplanting exogenous stem cells or by activating native stem cells to induce endogenous repair. Cell-based myocardial restoration, however, has not penetrated broad clinical practice yet. Plateletrich plasma, an autologous fractionation of whole blood containing high concentrations of growth factors, has been shown to safely and effectively enhance healing and angiogenesis primarily by reparative cell signaling. In this review, we collected all recent advances in novel therapies as well as experimental evidence demonstrating the role of platelet-rich plasma in ischemic heart disease, focusing on aspects that might be important for future successful clinical application. 展开更多
关键词 Platelet-rich plasma ISCHEMIC HEART disease Myocar
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Co-existence of hepatocellular adenoma and focal nodular hyperplasia in a young female
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作者 dimitrios dimitroulis Panagiotis Lainas +7 位作者 Petros Chara-lampoudis Theodore Karatzas Nikolaos Karidis Gregory Kouraklis Ioanna Delladetsima Nikolaos Karidis Gregory Kouraklis Stratigoula Sakellariou 《World Journal of Hepatology》 CAS 2012年第11期314-318,共5页
Focal nodular hyperplasia (FNH) and hepatocellular adenoma (HA) are both benign hepatocellular lesions, presenting mainly in women of childbearing age in non-cirrhotic, non-fibrotic livers. Simultaneous occurrence of ... Focal nodular hyperplasia (FNH) and hepatocellular adenoma (HA) are both benign hepatocellular lesions, presenting mainly in women of childbearing age in non-cirrhotic, non-fibrotic livers. Simultaneous occurrence of these two lesions is extremely rare. We herein report a case of a young female without any predisposing risk factors who presented to our emergency department complaining of acute abdominal pain. Imaging studies revealed a 6 cm lesion in the right hepatic lobe and a 2.5 cm lesion in the left hepatic lobe, respectively. In view of the patient’s symptoms and lack of a confirmed diagnosis based on imaging, we performed a bisegmentectomy V-VI and a wedge resection of the lesion in segment III by laparotomy. Postoperative course was uneventful and the patient was discharged on the fourth postoperative day. The pathology report demonstrated an HA in segments V-VI and FNH in segment III, respectively. Six months later, the patient remains asymptomatic with normal liver function tests, ultrasound and magnetic resonance imaging follow-up. To our best knowledge, this is the first case to describe simultaneous occurrence of HA and FNH without the presence of any known risk factors for these entities. The uncertainty in diagnosis and acuteness of presenting symptoms were established criteria for prompt surgical intervention. 展开更多
关键词 Liver surgery Liver disease Hepatocellular adenoma Focal nodular hyperplasia Benign hepatic tumor
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Amyand's hernia: A case report
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作者 Sofia Anagnostopoulou dimitrios dimitroulis +5 位作者 Theodore G Troupis Maria Allamani Alexandras Paraschos Antonios Mazarakis Nikolaos I Nikiteas Alkiviadis Kostakis 《World Journal of Gastroenterology》 SCIE CAS CSCD 2006年第29期4761-4763,共3页
The presence of vermiform appendix in inguinal hernia is rare and is known as Amyand's hernia. We report an Amyand's hernia, where the appendix was found in a right inguinal hernia in one male cadaver aged ninety tw... The presence of vermiform appendix in inguinal hernia is rare and is known as Amyand's hernia. We report an Amyand's hernia, where the appendix was found in a right inguinal hernia in one male cadaver aged ninety two years. 展开更多
关键词 Amyand's hernia APPENDIX Inguinal hernia
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Robotic-assisted microsurgery in andrology: a systematic review
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作者 Konstantinos Douroumis Eleftherios Spartalis +4 位作者 Konstantinos Stravodimos Panagiotis K Levis Gerasimos Tsourouflis dimitrios dimitroulis Nikolaos I Nikiteas 《Asian Journal of Andrology》 SCIE CAS CSCD 2023年第4期454-461,共8页
Robot-assisted surgery is the gold standard of treatment in many fields of urology. In this systematic review, we aim to reportits usage in andrology and to evaluate any advantages. A systematic search of the PubMed a... Robot-assisted surgery is the gold standard of treatment in many fields of urology. In this systematic review, we aim to reportits usage in andrology and to evaluate any advantages. A systematic search of the PubMed and Cochrane Library databases wasconducted to identify articles referring to robotic-assisted microsurgery in andrology. The search strategy was in line with thePreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Handbook. Thearticles were then reviewed by two authors. A qualitative analysis of the articles that met the inclusion criteria was performed.Thirty-one articles that met the inclusion criteria were reviewed. The first results for robot-assisted vasovasostomy (RAVV) areencouraging as excellent patency rates, short operative times, and learning curves were achieved. Interestingly, patency rates weregreater in some case series for RAVV than for microsurgical vasovasostomy, with a statistically significant difference. In addition,robot has been shown to be of great use in bypassing fibrotic changes in cases of iatrogenic vasal injuries, difficulties encounteredwith traditional microsurgery. In addition, the feasibility of robot-assisted microsurgery has been proven for varicocelectomy andmicrosurgical denervation of the spermatic cord, with acceptable improvement in sperm parameters and pain, respectively. Thecurrent evidence suggests that there are potential advantages of the use of robots in andrology. However, for robotic surgery tobecome incorporated into the daily use of the andrologists, large, multicenter randomized trials are needed. As robotics systemsare becoming standard in urology practice, it is reasonable for one to believe that they will also find their place in andrology. 展开更多
关键词 ANDROLOGY male infertility robotic surgical procedures VARICOCELE VASOVASOSTOMY
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Comparison of cosmetic outcomes between remote-access and conventional thyroidectomy:A review of the current literature
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作者 Anna Kasouli Eleftherios Spartalis +3 位作者 Alexios Giannakodimos Gerasimos Tsourouflis dimitrios dimitroulis Nikolaos I.Nikiteas 《World Journal of Otorhinolaryngology-Head and Neck Surgery》 CSCD 2023年第1期1-8,共8页
Objective:The pursuit of an esthetically pleasing scar following open thyroid surgery has led to the development of endoscopic thyroidectomy through remote incisions placed in several locations outside the neck.The ob... Objective:The pursuit of an esthetically pleasing scar following open thyroid surgery has led to the development of endoscopic thyroidectomy through remote incisions placed in several locations outside the neck.The objective of this study is to review the recent literature and compare the incision site appearance and patient satisfaction with the cosmetic outcome after extracervical and conventional thyroidectomy.Methods:The English literature published since 2010 was searched through the PubMed/Medline database for studies comparing the cosmetic outcomes between remote-access endoscopic and conventional thyroidectomy using a form of scar assessment scale.Results:A total of 9 relevant papers fulfilled the eligibility criteria including 1486 patients.Among them,595 patients underwent endoscopic thyroidectomy through several remote-access approaches and 891 patients were assigned to the conventional group.Only one randomized-controlled trial was identified,whereas among the rest,four were prospective and four were retrospective nonrandomized cohorts.Regarding the extracervical modifications performed in the endoscopic groups,the axillary approach was performed in three studies and the breast approach in four studies,while the retroauricular facelift technique and the transoral vestibular method were applied in one study,respectively.Conclusions:Evaluation of the wound appearance and patient satisfaction with the cosmetic outcome at various time points during the follow-up highlighted the superiority of the extracervical approaches over the conventional cervicotomy.Considering these findings,remote-access techniques could possibly be the ideal surgical method for patients with high esthetic requirements,providing an excellent appearance of the thoroughly exposed neck. 展开更多
关键词 ESTHETIC COSMESIS COSMETIC cosmetic results INCISION SCAR THYROIDECTOMY
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