Breast reconstruction with autologous tissue following mastectomy

Hippokratia 2006; 10 (4): 153-162

HR Teymouri, S Stergioula, M Eder, L Kovacs, E Biemer, NA Papadopulos
Dpt Plastic & Reconstructive Surgery, Technical University, Munich, Germany

Abstract

Breast cancer remains to be one of the most malignant diseases in the female population. It affects an essential part of female self-consciousness, and therefore causes a wide range of psychological traumas. The incidence in Europe and North America varies between 70 up to 100 new cases in 100.000 inhabitants per year. According to contemporary literature, mastectomy remains one of the most effective methods in the laborious effort to treat and overcome cancer. In this report the history of breast reconstruction is presented. The established methods which are taken into consideration after mastectomy and their clinical outcome are portrayed. The authors propose the free TRAM and DIEP flap as the methods of first choice after mastectomy, which offer most reliable transfer and low morbidity. In the recent past, increasing interest is observed for the SIEA flap. The free S-GAP flap is proposed for patients who are not candidates for a TRAM, DIEP or SIEA flap. Moreover, the pedicled Latissimus Dorsi flap remains still as a reliable, versatile alternative, particularly in case of contra-indications for the above mentioned free flaps or when complications occurred.

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Hypomagnesemia and cardiovascular system

Hippokratia 2006; 10 (4): 147-152

G Efstratiadis, M Sarigianni, I Gougourelas
Reanl Dpt, Hippokratio Hospital, Thessaloniki, Greece
2nd Internal Medicine Dpt, Hippokratio Hospital, Thessaloniki, Greece

Abstract

Magnesium depletion in clinical practice is mainly related to loop diuretics and thiazides. Among patients treated with diuretics more than 1/3 exhibit hypomagnesemia. Arrhythmias and sudden death attributed to magnesium depletion could be prevented by Mg administration. Magnesium deficiency in experimental animals promotes atherosclerotic lesions whereas this ion is involved in various stages of myocardial damage after experimental coronary artery occlusion. In humans magnesium administration in the first 24 hours of myocardial infarction was related to beneficial effects in first year mortality rate. Nevertheless more evidence from clinical investigation is needed for permanent conclusions.

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Experience from the use of absorbable type I collagen as haemostatic agent in obstetric and gynecological operations

Hippokratia 2006; 10 (4): 182-184

V Karagiannis, A Daniilidis, D Rousso, V Palapelas, T Karagiannis, D Kiskinis
3rd Dpt Obstetrics and Gynaecology, Hippokratio Hospital, Thessaloniki, Greece
1st Cardiology Clinic, Papageorgiou Hospital, Thessaloniki, Greece

Abstract

During the third stage of labour there are a lot of causes of significant hemorrhage. The commonest causes of acute hemorrhage are the uterine atony, the retained placenta, the lower tract lacerations, uterine rupture, placenta accreta, hereditary coagulopathy. Also, there could be significant bleeding, during caesarian section, usually at the time of removal of the placenta in cases of low lying placenta or placenta previa. A lot of times we have to confront serious hemorrhages in gynecological procedures like hysterectomies in cases of cervical, uterine or ovarian cancers. In order to deal with these problems successfully, general and specific measures are being taken. In cases of atonic uterus when all the other methods are unsuccessful we have to proceed to ligation of the internal iliac artery or even hysterectomy.
Material-Methods: We have tried to use the hemostatic type I collagen in obstetrical and gynecological cases in order to control the bleeding. We have used the collagen type I totally in 8 cases. Five of them were cases of atonic uterus after normal delivery or caesarian section and three of them were gynecological cases of uterine fibroids and ovarian cancer.
Results and conclusions: By placing the collagen type I over the bleeding surfaces we have realized that in a very short period of time, there has been satisfactory control of the bleeding and immediate clinical improvement of the patient. In four out of five obstetrical cases that we have used the type I collagen, we have managed to avoid the hysterectomy.

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Cardiac rehabilitation effects on quality of life in patients after acute myocardial infarction

Hippokratia 2006; 10 (4): 176-181

H Antonakoudis, K Kifnidis, A Andreadis, E Fluda, Z Konti, N Papagianis, H Stamou, E Anastasopoulou, G Antonakoudis, L Poulimenos
Cardiology Dpt, Asclepeion Hospital, Athens, Greece

Abstract

Aim of this study was to investigate the significance of cardiac rehabilitation (CR) on Health Related Quality of Life ( HRQoL) in post acute myocardial infarction (AMI) patients.
Methods. A total number of 110 individuals divided in 3 groups was included in the study. Group A consisted of 60 post-AMI patients participating in a CR program. It was a multidisciplinary rehabilitative approach including supervised bike exercise, with parallel education, counselling, psychological and social support, performed 3 times per week for 2 months after AMI. Group B consisted of 40 post-AMI patients not participating in any CR program while the control group C consisted of 10 apparently healthy people. HRQoL was evaluated by the Velasco-Del Barrio questionnaire. Questions on this questionnaire are refered to 9 categories (health, sleep and rest, emotional behavior, concerns for the future, mobility, social interaction, alertness behavior, communication, work and leisure time). A 5-point scale (1=all of the time, 5=none of the time) and a special (1 to 8 coefficient for each parameter were used for the evaluation of each parameter. The highest score of 220 indicates the poorest QL.Results. Group A patients had better score of HRQoL as compared to Group B (94??3 vs 114??3, p < 0.001) and slightly worse than Group C patients (94??4 vs 69??3, p < 0.01). Significant difference was found among Group A and B patients regarding the most important evaluated parameters such as symptoms (17 ??6.8 vs 22??6.5, p < 0.001) and social behavior (21??4.2 vs 23??5.5, p < 0.0001). Conclusion. It is concluded that participation in a multidisciplinary CR program significantly improves HRQoL in post AMI patients. All these patients must urged to take part in such programs.

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Anterior cervical discectomy and interbody fusion with a dentate titanium cage: An experimental radiological and histopathological study in pigs

Hippokratia 2006; 10 (4): 171-175

PD Tsitsopoulos, Cha Tsonidis, PPh Tsitsopoulos, AI Mintelis, DA Psalla, AK Desiris
2nd Neurosurgery Dpt, Hippokratio Hospital, Thessoloniki, Greece
Pathology Dpt, Veterinary School of Medicine, Aristotle University, Thessaloniki, Greece
Dpt Surgery, Aristotle Univesrity, Thessaloniki, Greece

Abstract

Background - Aim: The distraction and stabilization provided by anterior cervical discectomy and fusion contribute to neural decompression and optimize osteogenesis. A new titanium cervical implant with specific properties was applied through an anterior approach in ten pigs. Implant behavior regarding in situ position and related osteogenesis were evaluated. Methods: In this controlled animal study, the progress of fusion and osteogenesis was evaluated after one level cervical interbody fusion with a new titanium cage. Ten pigs underwent anterior cervical discectomy and fusion. No substitutes stimulating osteoblastic activity were used. Plain radiographs were carried out. The animals were euthanised 12 and 14 weeks after the operation respectively. Tissue samples were processed routinely and studied histologically. Results: All pigs survived the surgery. Plain radiographs confirmed implant position. Histological analysis demonstrated fibrous connective tissue formation inside and around the implant which was largely transformed into cartilaginous and osseous tissue. Conclusions: Intervertebral space stabilization remains a parameter of crucial importance for early bone healing after anterior cervical discectomy and fusion. The new titanium alloy cage tested in this experimental study can offer the necessary stabilization for osteogenesis and adequate cervical interbody fusion without the need of growth factors.

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Endonasal bilateral simultaneous orbital decompression

Hippokratia 2006; 10 (4): 167-170

A Tsikoudas, G Thiel, E Blenke, G McDougall
Western General Hospital, Dpt Otorhinolaryngology, Head & Neck Surgery, Edinburg, UK

Abstract

Objective: To study the morbidity of the operation, to investigate it's safety and effectiveness in order to establish if it is reasonable to offer it as treatment to patients in one sitting instead of a staged procedure. Finally, to identify the patient's long term satisfaction and to establish best practice.
Design: Retrospective case series study and prospective telephone interview.
Setting: Teaching General Hospital, Scotland, UK.
Subjects: 14 patients with dysthyroid orbitopathy who underwent the operation over a 4 year period.
Results: Proptosis improved in all but one of the cases. There was a relatively small morbidity and short inpatient stay. A significant amount of patients reported satisfaction with the results. All patients expressed strong preference for the simultaneous procedure instead of a staged one.
Conclusions: The study shows that for the management of orbitopathy bilateral simultaneous orbital decompression with endoscopic approach is a safe and effective operation, with small morbidity and significant patient satisfaction. Therefore, it is reasonable to offer it to patients instead of a staged procedure.

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Quality of life survey and palliative care in lung cancer patients

Hippokratia 2006; 10(4): 163-166

L Zoganas, G Bablekos, M Maiwand, A Charalabopoulos, V Andronadi, A Batistatou, G Vergoulas, K Charalabopoulos
Thoracic Surgery Dpt, Red Cross Hospital, Athens, Greece
Thoracic Surgery Dpt, Harefield Hospital, Harefield, UK
Surgery Dpt, Peterborough and Stamford Hospitals, Cambridgeshire, UK
Dpt Physiology, Clinical Unit, University of Ioannina, Ioannina, Greece
Pathology Dpt, University of Ioannina, Ioannina, Greece
Organ Transplant Unit, Hippokratio Hospital, Thessaloniki, Greece

Abstract

Aim. In patients with advanced and/or inoperable bronchial tumors, methods of palliative care such as radiotherapy, chemotherapy, brachytherapy and cryotherapy, singly and/or in combination, aiming at extending the survival time and improving the quality of life, were examined.
Methods. One hundred and sixty three (163) patients, with mean age 67.9 yrs (range 22-25) and a male / female ratio at 1.34 / 1, treated between 2000-2004 were studied. Eighty one (81) patients receiving only cryotherapy presented a two -year survival rate at 19.3%, whilst eighty three (83) patients treated with radiotherapy or brachytherapy and/or chemotherapy showed a two-year survival rate at 25%. Sixty - five percent (65%) of patients only cryotreated had improvement in at least one or more Karnofsky and WHO indices.
Results. Eighty percent (80%) of patients who received cryotherapy accompanied with supplementary palliative treatment showed amelioration of their clinical status.
Conclusion. It seems that for patients with advanced or inoperable lung tumors, cryotherapy associated with additional palliative care may influence the survival time and improve their quality of life.

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Pulmonary renal syndrome in an adult patient with Henoch-Shönlein purpura

Hippokratia 2006; 10(4):185-187

Th Eleftheriadis, V Liakopoulos, M Boulbou, F Karasavvidou, F Atmatzidis, S Dovas, G Antoniadi, I Stefanidis
Dpt Nephrology and Pathology, Medical School, University of Thessali, Larissa, Greece

Abstract

Henoch-Schönlein purpura (HSP) is a small vessel vasculitis characterized by purpuric skin rash, haematuria, abdominal pain, gastrointestinal bleeding and arthritis. Nephritis is more frequent and severe in adults than in children, with relatively more adults developing renal insufficiency. Another, fortunately rare, manifestation of HSP that increases mortality significantly, is diffuse alveolar haemorrhage. We report a rare case of an adult male patient with full-blown HSP that followed a respiratory tract infection. He successively, but not concurrently, developed all the clinical manifestations of HSP, i.e. arthritis, abdominal pain and bloody stools, a nonthrombocytopenic purpuric rash, and renal involvement; nephrotic range proteinuria first and haemodialysis-requiring nephritic syndrome later. Most interesting he developed life-threatening pulmonary haemorrhage fulfilling the criteria of the pulmonary-renal syndrome. An immunosuppressive regimen consisting of intravenous cyclophosphamide and corticosteroids was administered with success. In conclusion, HSP should be considered in the diagnosis of pulmonary-renal syndrome. In our opinion, the severity of the condition justifies the use of aggressive immunosuppressive treatment, like the one applied successfully to our patient.

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