stelios apostolidis | Aristotle University of Thessaloniki (original) (raw)

Papers by stelios apostolidis

Surgical and Radiologic Anatomy, 2015

The goal of the study is to analyze the morphometric diversity of the pyramidalis muscle (PM) and... more The goal of the study is to analyze the morphometric diversity of the pyramidalis muscle (PM) and to evaluate how it is affected by gender and side of occurrence. Ninety-six (50 male and 46 female) formalin-embalmed Greek cadavers were dissected. The PM was present in 93.8 %, usually bilaterally (79.2 %) than unilaterally (14.6 %) (p = 0.003) and more frequently in females (91.3 %) than in males (68 %) (p = 0.0001). Side symmetry was detected. The mean length of PM in males and females was 8.37 ± 2.80 and 6.18 ± 1.64 cm on the right and 7.50 ± 2.66 and 6.56 ± 1.68 cm on the left side. Male predominance existed on the right and left-sided PM lengths (p = 0.0001 and p = 0.054). The mean width of the right-sided PMs in males and females was 1.61 ± 0.55 and 1.50 ± 0.44 cm and the left-sided 1.56 ± 0.53 and 1.55 ± 0.38 cm without gender dimorphism. The positive correlation between the PM length and width indicates a symmetrical muscle augmentation on the two dimensions. The study demonstrates that the PM is almost constant in Greeks. Among populations the muscle morphometric variability, its clinical significance and its variable uses will help surgeons when intervening in the lower abdominal wall.

The European Journal of Surgery

Surgical and Radiologic Anatomy, 2015

The European Journal of Surgery, 1999

Objective: To design a device for myoelectric assessment of intestinal ischaemia and compare it w... more Objective: To design a device for myoelectric assessment of intestinal ischaemia and compare it with every day surgical experience and Doppler signals recorded on the bowel wall. Design: Experimental study. Setting: Thessaloniki university hospital, Greece. Material: 12 adult mongrel dogs. Interventions: On the first day the large intestine was devascularised for a length of 20 cm, 5 cm away from the ileocaecal valve, and the threshold of the electric stimulus (mA) required to produce a contraction of the normal large bowel was recorded. On the second day, measurements were made on the ischaemic segment of the large bowel at 0.5 cm intervals. Bowel resection and anastomoses were done at the stimulus level of 40 mA. Results: The mean (SD) stimulus threshold of the normal large intestine was 12.2 mA. The necrotic intestine demanded current stimulus of 100 mA or failed to contract. On the eighth postoperative day the animals were killed to assess anastomotic healing. Of the 12 anastomoses made at the 40mA stimulus point, only one ruptured. The 40mA limit of the stimulus level seems to be of value in assessments of bowel viability in vivo. Conclusion: The use of a personal computer as a read out device makes myoelectric analysis easier and more reliable in the assessment of intestinal viability. This method may have a clinical application.

Techniques in Coloproctology, 2004

Introduction: Cow's milk allergy is the most frequent food allergy in Europe and western countrie... more Introduction: Cow's milk allergy is the most frequent food allergy in Europe and western countries and shows a wide spectrum of clinical features, including atopic dermatitis and gastrointestinal disease. To the best of our knowledge, this report is the first to describe Kawasaki disease-like clinical features and echocardiographic alterations which resolved after a cow's milk-free diet. Case presentation: We report a case of a 9-month-old Caucasian girl with atopic dermatitis who developed clinical features commonly present in Kawasaki disease (erythematous skin rash, non-exudative conjunctivitis, fissured lips and neck lymph nodes), together with mild echocardiographic alterations (perivascular brightness, pericardial effusion) in the absence of fever. These features resolved within 2 weeks after the beginning of a cow's milk-free diet. Conclusion: Kawasaki disease has recently been considered a possible risk factor for subsequent allergic disease secondary to immune dysfunction. This case report suggests that the immune-related alterations which are commonly present in allergic patients could be similar to the antigen-related immune response in Kawasaki disease and thus could lead to similar clinical features.

Methods and Findings in Experimental and Clinical Pharmacology, 2006

Blood transfusions have been shown in the past to compromise wound healing in experimental models... more Blood transfusions have been shown in the past to compromise wound healing in experimental models of colonic anastomosis. Transforming growth factor beta (TGFbeta) has been proposed to play a major role in the process of colonic wound healing, and its expression is believed to be modulated by interleukin-2 (IL2). According to an earlier report, the postoperative administration of the histamine receptor-2 antagonist ranitidine increases the blood levels of soluble IL2 receptor in humans undergoing abdominal surgery and could thus affect molecular determinants of colonic anastomosis. In this study we examined the effect of blood transfusions, with and without ranitidine administration, on the gene expression of TGFbeta(1) and the specificity-conveying alpha subunit of the receptor for IL2, in rat perianastomotic tissue. Analysis of gene expression by semiquantitative RT-PCR revealed a tendency for downregulation of both genes, albeit in a statistically nonsignificant manner. This effect was not prevented by the postoperative administration of ranitidine. On the other hand, there appears to be a significant correlation between expression of TGFbeta(1) and that of IL2 receptor alpha subunit, irrespective of treatment.

British Journal of Surgery, 2008

Background The aim was to assess the feasibility of performing stapled haemorrhoidopexy under loc... more Background The aim was to assess the feasibility of performing stapled haemorrhoidopexy under local anaesthesia. Methods Fifty-eight patients with haemorrhoid prolapse were randomized to receive local or general anaesthesia. The perianal block was applied immediately peripheral to the external sphincter. Submucosal block was added after applying the purse-string suture. Patients reported average and peak pain daily for 14 days using a visual analogue scale (VAS). They also completed anal symptom questionnaires before the operation and at follow-up. The surgeon assessed the restoration of the anal anatomy 3–6 months after surgery. Results The anal block was sufficient in all patients. The mean accumulated VAS score for average pain was 23·1 in the general anaesthesia group and 29·4 in the local anaesthesia group (P = 0·376); mean peak pain scores were 42·1 and 47·9 respectively (P = 0·537). Mean change in symptom load was also similar between the groups, with score differences of 7·0...

Acta Chirurgica Belgica, 2008

This case report concerns a previously healthy thirty-five-year-old female with complaints of ing... more This case report concerns a previously healthy thirty-five-year-old female with complaints of inguinal hernia that ultimately proved to be a retroperitoneal haematoma. The patient suffered from a car accident 5 months before admission and was hospitalized. During her prior hospitalization, explorative laparotomy revealed a haematoma of the mesentery. The haematoma was treated conservatively, with fluid resuscitation and rest. During her second admission, MRI of the inguinal region revealed localized haematoma. During inguinal exploration, a fluid-filled bluish indirect hernia sac was identified and found to be contoured by free-flowing, non-clotting blood. The postoperative course was uneventful, and the patient was discharged six days following surgery.

Hippokratia

Anastomotic failure is one of the most frequent complications in rectal surgery. The present stud... more Anastomotic failure is one of the most frequent complications in rectal surgery. The present study aims to elucidate the effect of intraoperative lavage with short chain fatty acids (SCFAs) on rectal anastomosis of rats receiving corticosteroids. Fifty male Wistar rats were divided into five groups. Group A (control group, without lavage and medication), group B (lavage with saline solution and no medication), group C (lavage with SCFAs and no medication), group D (lavage with saline solution and injection of 30mg/kg methylprednisolone 7 days pre-operatively and 4 days post-operatively), group E (lavage with a SCFAs and methylprednisolone). On the 4(th) postoperative day the animals were sacrificed and bursting pressure of the anastomosis, CRP, IL-6 and TNF-a were measured. Kruskal-Wallis variance analysis showed statistically significant differences between the groups (p<0.001). The bursting pressure of the anastomosis was lower in groups B and D, while it was higher in group C....

SpringerPlus, 2014

Introduction: The axillary artery presents abnormalities in its origin and course and a variable ... more Introduction: The axillary artery presents abnormalities in its origin and course and a variable branching. Case description: A rare case of axillary artery bifurcation and branching was observed in a 60-years-old European male cadaver of Greek origin. The right axillary artery at the second part was bifurcated into a superficial and a deep brachial artery. The superficial brachial artery anteromedial to the median nerve and lateral to the ulnar nerve gave off the acromio-thoracic artery and two lateral thoracic arteries. The deep brachial artery behind the median nerve, after giving rise to the anterior circumflex humeral artery trifurcated into a branch that coursed distally, the posterior circumflex humeral artery and the subscapular artery. The latter subdivided into the circumflex scapular artery, a muscular branch for the subscapularis and the thoracodorsal artery. The continuation of the deep brachial artery divided laterally into a humeral nutrient artery and medially into a trunk which trifurcated into the profunda brachii artery, a deep muscular branch and a branch to the posterior compartment of the arm. The profunda brachii artery ended as radial and middle collateral arteries. Discussion and evaluation: Deviations from the normal arterial pattern are of immense significance for anatomists, plastic, cardiovascular and orthopedic surgeons, vascular radiologists and interventional cardiologists.

HPB Surgery, 1998

We report 210 cases of external biliary fistula treated in our clinics between 1970–1992. In 7 ca... more We report 210 cases of external biliary fistula treated in our clinics between 1970–1992. In 7 cases, fistulas were formed after iatrogenic bile duct injury, in 4 cases after exploration of common bile duct, in 4 cases due to disruption of biliary-intestinal anastomosis, and in 2 cases due to liver trauma. In 85 cases bile leak was observed after cholecystomy, in 103 cases after hydatid disease surgery, and in 4 cases after the passage of P.T.C. catheter. In one patient the appearance of the fistula was due to spontaneous discharge of a gallbladder empyema. 173 cases were managed conservatively, and 37 cases surgically.

Techniques in Coloproctology

Hernia, 2006

Femoral hernia, which is a less common occurrence than inguinal hernia, is not congenital in most... more Femoral hernia, which is a less common occurrence than inguinal hernia, is not congenital in most cases and is uncommon in young males. It is considered to be more common in females than in males due to an enlarged femoral ring in the former. A case of bilateral femoral hernia in a 64-year-old male cadaver is described within the framework of an anatomical approach. On the right side, the protrusion of the viscus appeared as a small intestine coil, whereas on the left side the protruded viscus appeared as a pelvic colon's appendix appiplocae. On both sides, the protruded viscus was located in front of an aberrant obturator artery, which oriented from the external iliac artery and not from the internal iliac artery as should be the case. The puberal branch of the inferior epigastric artery was absent. The cadaver's medical history and his skin examination excluded an abdominal surgery. In the literature, case reports of bilateral femoral hernia appear only seldom, especially those of male patients who had not undergone inguinal hernia repair surgery. In femoral hernias more often than in other types of hernia, the protruded viscus is strangulated and undergoes a tissue necrosis. Morbidity and mortality for complicated femoral hernia is high. Knowledge of vascular variation such as presented by the cadaver under study is extremely useful to the surgeon because any iatrogenic injury of the aberrant obturator artery during a laparoscopic repair may result in dangerous hemorrhage.

Hernia, 2007

The shape and the position of the stomach and its anatomic relations to the round viscera vary fr... more The shape and the position of the stomach and its anatomic relations to the round viscera vary from individual to individual, but they also vary in the same subject depending on many factors. The downward displacement of the stomach is called gastroptosis. In the literature, there are only Wve case reports where the stomach constituted the content of a femoral hernia. The current study presents a case of a gastric femoral hernia in a cadaver along with a review of the relevant literature. During routine dissection of a 67-year-old male cadaver with a very large stomach and gastroptosis, a femoral hernia containing a part of the great curvature of the stomach was found. The length of the hernia sac was 5 cm, and its width was 3.5 cm. There was a disposition of the intestinal coils to the posterior wall and the lesser pelvis. The cadaver's former medical history and skin observation before dissection excluded any previous abdominal surgery. This is the second case of stomach herniation through the femoral ring in a male subject ever reported. The symptoms in this pathology vary from complete absence to symptoms due to high stenosis of the digestive tract, stomach strangulation and stomach wall necrosis.

Anatomical Science International, 2014

The study determines the variability of the length of the styloid process in a Greek population a... more The study determines the variability of the length of the styloid process in a Greek population and investigates how it is affected by gender and age; it also evaluates the side asymmetry, highlighting clinical implications. One hundred and forty-nine dry adult modern skulls (94 male and 55 female) were divided into subgroups according to their age: 20-39, 40-59 and older than 60 years. The lengths of 262 styloid processes (127 right and 135 left-sided) were measured. The lengths of rightsided styloid processes ranged from 6.4 to 70.2 mm and left-sided styloid processes from 5.2 to 69.0 mm. The processes were classified according to their lengths as short \18 mm, normal 18-33 mm and elongated [33 mm. The majority of the processes were normal (45.8 %), 27.5 % were short and 26.7 % elongated. No statistical significant correlation was established among the lengths of the styloid processes, gender and age. Side asymmetry was found only in the group with elongated styloid processes (right processes were longer, 28.3 %, than the left ones 25.2 %; p = 0.016). Our study contributes to the literature, adding important information about the length of the styloid process and its diversity in the Greek population. It also confirms the existence of an osseous landmark as a starting point for the measurement of the length of the styloid process and proposes a method of measurement for the evaluation of the actual length of the styloid process.

Techniques in Coloproctology, 2004

Techniques in Coloproctology, 2000

The surgical treatment of haemorrhoids with the use of a circular stapler is a novel method. A co... more The surgical treatment of haemorrhoids with the use of a circular stapler is a novel method. A comparative retrospective study of two groups of patients treated surgically for third- and fourth-degree haemorrhoids was conducted. Fifty patients (group A) underwent a surgical intervention with the circular stapler in the rectal mucosa 4 cm above the dentate line. In another group of

Journal of Cranio-Maxillofacial Surgery, 2014

Mandibular nerve entrapment has great significance, as it may be responsible for the appearance o... more Mandibular nerve entrapment has great significance, as it may be responsible for the appearance of several neurological pathologies, such as chewing disorders, taste loss, facial or tongue paraesthesia and neuralgia. The ossified pterygoalar (Pta) bar is the result of calcification and/or ossification of the ligament extending from the pterygospinous process of the lateral pterygoid lamina to the infratemporal surface of the sphenoid bone. The ossified bar may act as the cause for this entrapment. One hundred and forty-five Greek adult dry skulls were examined for the existence of a complete or incomplete Pta bar and a relative foramen. The Pta bar appeared in 31.7% of the skulls, in total, in 4.1% completely and in 27.6% incompletely ossified. The mean sagittal and transverse diameters of Pta foramen were 3.21 ± 1.70 and 4.79 ± 1.39 mm, respectively. There was no statistical significant difference between the presence of Pta bar and the side or gender. Apart from the neurological interest, this study highlights the importance of the existence of Pta bar in neurosurgery, anaesthesiology, oral and maxillofacial surgery. The passage of the needle through the foramen ovale for the injection of anaesthetics, as a treatment for trigeminal neuralgia may not be achieved due to this anatomical obstacle. In this case, intra- or postoperative radiologic investigation may be helpful.

Surgical and Radiologic Anatomy, 2015

The goal of the study is to analyze the morphometric diversity of the pyramidalis muscle (PM) and... more The goal of the study is to analyze the morphometric diversity of the pyramidalis muscle (PM) and to evaluate how it is affected by gender and side of occurrence. Ninety-six (50 male and 46 female) formalin-embalmed Greek cadavers were dissected. The PM was present in 93.8 %, usually bilaterally (79.2 %) than unilaterally (14.6 %) (p = 0.003) and more frequently in females (91.3 %) than in males (68 %) (p = 0.0001). Side symmetry was detected. The mean length of PM in males and females was 8.37 ± 2.80 and 6.18 ± 1.64 cm on the right and 7.50 ± 2.66 and 6.56 ± 1.68 cm on the left side. Male predominance existed on the right and left-sided PM lengths (p = 0.0001 and p = 0.054). The mean width of the right-sided PMs in males and females was 1.61 ± 0.55 and 1.50 ± 0.44 cm and the left-sided 1.56 ± 0.53 and 1.55 ± 0.38 cm without gender dimorphism. The positive correlation between the PM length and width indicates a symmetrical muscle augmentation on the two dimensions. The study demonstrates that the PM is almost constant in Greeks. Among populations the muscle morphometric variability, its clinical significance and its variable uses will help surgeons when intervening in the lower abdominal wall.

The European Journal of Surgery

Surgical and Radiologic Anatomy, 2015

The European Journal of Surgery, 1999

Objective: To design a device for myoelectric assessment of intestinal ischaemia and compare it w... more Objective: To design a device for myoelectric assessment of intestinal ischaemia and compare it with every day surgical experience and Doppler signals recorded on the bowel wall. Design: Experimental study. Setting: Thessaloniki university hospital, Greece. Material: 12 adult mongrel dogs. Interventions: On the first day the large intestine was devascularised for a length of 20 cm, 5 cm away from the ileocaecal valve, and the threshold of the electric stimulus (mA) required to produce a contraction of the normal large bowel was recorded. On the second day, measurements were made on the ischaemic segment of the large bowel at 0.5 cm intervals. Bowel resection and anastomoses were done at the stimulus level of 40 mA. Results: The mean (SD) stimulus threshold of the normal large intestine was 12.2 mA. The necrotic intestine demanded current stimulus of 100 mA or failed to contract. On the eighth postoperative day the animals were killed to assess anastomotic healing. Of the 12 anastomoses made at the 40mA stimulus point, only one ruptured. The 40mA limit of the stimulus level seems to be of value in assessments of bowel viability in vivo. Conclusion: The use of a personal computer as a read out device makes myoelectric analysis easier and more reliable in the assessment of intestinal viability. This method may have a clinical application.

Techniques in Coloproctology, 2004

Introduction: Cow's milk allergy is the most frequent food allergy in Europe and western countrie... more Introduction: Cow's milk allergy is the most frequent food allergy in Europe and western countries and shows a wide spectrum of clinical features, including atopic dermatitis and gastrointestinal disease. To the best of our knowledge, this report is the first to describe Kawasaki disease-like clinical features and echocardiographic alterations which resolved after a cow's milk-free diet. Case presentation: We report a case of a 9-month-old Caucasian girl with atopic dermatitis who developed clinical features commonly present in Kawasaki disease (erythematous skin rash, non-exudative conjunctivitis, fissured lips and neck lymph nodes), together with mild echocardiographic alterations (perivascular brightness, pericardial effusion) in the absence of fever. These features resolved within 2 weeks after the beginning of a cow's milk-free diet. Conclusion: Kawasaki disease has recently been considered a possible risk factor for subsequent allergic disease secondary to immune dysfunction. This case report suggests that the immune-related alterations which are commonly present in allergic patients could be similar to the antigen-related immune response in Kawasaki disease and thus could lead to similar clinical features.

Methods and Findings in Experimental and Clinical Pharmacology, 2006

Blood transfusions have been shown in the past to compromise wound healing in experimental models... more Blood transfusions have been shown in the past to compromise wound healing in experimental models of colonic anastomosis. Transforming growth factor beta (TGFbeta) has been proposed to play a major role in the process of colonic wound healing, and its expression is believed to be modulated by interleukin-2 (IL2). According to an earlier report, the postoperative administration of the histamine receptor-2 antagonist ranitidine increases the blood levels of soluble IL2 receptor in humans undergoing abdominal surgery and could thus affect molecular determinants of colonic anastomosis. In this study we examined the effect of blood transfusions, with and without ranitidine administration, on the gene expression of TGFbeta(1) and the specificity-conveying alpha subunit of the receptor for IL2, in rat perianastomotic tissue. Analysis of gene expression by semiquantitative RT-PCR revealed a tendency for downregulation of both genes, albeit in a statistically nonsignificant manner. This effect was not prevented by the postoperative administration of ranitidine. On the other hand, there appears to be a significant correlation between expression of TGFbeta(1) and that of IL2 receptor alpha subunit, irrespective of treatment.

British Journal of Surgery, 2008

Background The aim was to assess the feasibility of performing stapled haemorrhoidopexy under loc... more Background The aim was to assess the feasibility of performing stapled haemorrhoidopexy under local anaesthesia. Methods Fifty-eight patients with haemorrhoid prolapse were randomized to receive local or general anaesthesia. The perianal block was applied immediately peripheral to the external sphincter. Submucosal block was added after applying the purse-string suture. Patients reported average and peak pain daily for 14 days using a visual analogue scale (VAS). They also completed anal symptom questionnaires before the operation and at follow-up. The surgeon assessed the restoration of the anal anatomy 3–6 months after surgery. Results The anal block was sufficient in all patients. The mean accumulated VAS score for average pain was 23·1 in the general anaesthesia group and 29·4 in the local anaesthesia group (P = 0·376); mean peak pain scores were 42·1 and 47·9 respectively (P = 0·537). Mean change in symptom load was also similar between the groups, with score differences of 7·0...

Acta Chirurgica Belgica, 2008

This case report concerns a previously healthy thirty-five-year-old female with complaints of ing... more This case report concerns a previously healthy thirty-five-year-old female with complaints of inguinal hernia that ultimately proved to be a retroperitoneal haematoma. The patient suffered from a car accident 5 months before admission and was hospitalized. During her prior hospitalization, explorative laparotomy revealed a haematoma of the mesentery. The haematoma was treated conservatively, with fluid resuscitation and rest. During her second admission, MRI of the inguinal region revealed localized haematoma. During inguinal exploration, a fluid-filled bluish indirect hernia sac was identified and found to be contoured by free-flowing, non-clotting blood. The postoperative course was uneventful, and the patient was discharged six days following surgery.

Hippokratia

Anastomotic failure is one of the most frequent complications in rectal surgery. The present stud... more Anastomotic failure is one of the most frequent complications in rectal surgery. The present study aims to elucidate the effect of intraoperative lavage with short chain fatty acids (SCFAs) on rectal anastomosis of rats receiving corticosteroids. Fifty male Wistar rats were divided into five groups. Group A (control group, without lavage and medication), group B (lavage with saline solution and no medication), group C (lavage with SCFAs and no medication), group D (lavage with saline solution and injection of 30mg/kg methylprednisolone 7 days pre-operatively and 4 days post-operatively), group E (lavage with a SCFAs and methylprednisolone). On the 4(th) postoperative day the animals were sacrificed and bursting pressure of the anastomosis, CRP, IL-6 and TNF-a were measured. Kruskal-Wallis variance analysis showed statistically significant differences between the groups (p<0.001). The bursting pressure of the anastomosis was lower in groups B and D, while it was higher in group C....

SpringerPlus, 2014

Introduction: The axillary artery presents abnormalities in its origin and course and a variable ... more Introduction: The axillary artery presents abnormalities in its origin and course and a variable branching. Case description: A rare case of axillary artery bifurcation and branching was observed in a 60-years-old European male cadaver of Greek origin. The right axillary artery at the second part was bifurcated into a superficial and a deep brachial artery. The superficial brachial artery anteromedial to the median nerve and lateral to the ulnar nerve gave off the acromio-thoracic artery and two lateral thoracic arteries. The deep brachial artery behind the median nerve, after giving rise to the anterior circumflex humeral artery trifurcated into a branch that coursed distally, the posterior circumflex humeral artery and the subscapular artery. The latter subdivided into the circumflex scapular artery, a muscular branch for the subscapularis and the thoracodorsal artery. The continuation of the deep brachial artery divided laterally into a humeral nutrient artery and medially into a trunk which trifurcated into the profunda brachii artery, a deep muscular branch and a branch to the posterior compartment of the arm. The profunda brachii artery ended as radial and middle collateral arteries. Discussion and evaluation: Deviations from the normal arterial pattern are of immense significance for anatomists, plastic, cardiovascular and orthopedic surgeons, vascular radiologists and interventional cardiologists.

HPB Surgery, 1998

We report 210 cases of external biliary fistula treated in our clinics between 1970–1992. In 7 ca... more We report 210 cases of external biliary fistula treated in our clinics between 1970–1992. In 7 cases, fistulas were formed after iatrogenic bile duct injury, in 4 cases after exploration of common bile duct, in 4 cases due to disruption of biliary-intestinal anastomosis, and in 2 cases due to liver trauma. In 85 cases bile leak was observed after cholecystomy, in 103 cases after hydatid disease surgery, and in 4 cases after the passage of P.T.C. catheter. In one patient the appearance of the fistula was due to spontaneous discharge of a gallbladder empyema. 173 cases were managed conservatively, and 37 cases surgically.

Techniques in Coloproctology

Hernia, 2006

Femoral hernia, which is a less common occurrence than inguinal hernia, is not congenital in most... more Femoral hernia, which is a less common occurrence than inguinal hernia, is not congenital in most cases and is uncommon in young males. It is considered to be more common in females than in males due to an enlarged femoral ring in the former. A case of bilateral femoral hernia in a 64-year-old male cadaver is described within the framework of an anatomical approach. On the right side, the protrusion of the viscus appeared as a small intestine coil, whereas on the left side the protruded viscus appeared as a pelvic colon's appendix appiplocae. On both sides, the protruded viscus was located in front of an aberrant obturator artery, which oriented from the external iliac artery and not from the internal iliac artery as should be the case. The puberal branch of the inferior epigastric artery was absent. The cadaver's medical history and his skin examination excluded an abdominal surgery. In the literature, case reports of bilateral femoral hernia appear only seldom, especially those of male patients who had not undergone inguinal hernia repair surgery. In femoral hernias more often than in other types of hernia, the protruded viscus is strangulated and undergoes a tissue necrosis. Morbidity and mortality for complicated femoral hernia is high. Knowledge of vascular variation such as presented by the cadaver under study is extremely useful to the surgeon because any iatrogenic injury of the aberrant obturator artery during a laparoscopic repair may result in dangerous hemorrhage.

Hernia, 2007

The shape and the position of the stomach and its anatomic relations to the round viscera vary fr... more The shape and the position of the stomach and its anatomic relations to the round viscera vary from individual to individual, but they also vary in the same subject depending on many factors. The downward displacement of the stomach is called gastroptosis. In the literature, there are only Wve case reports where the stomach constituted the content of a femoral hernia. The current study presents a case of a gastric femoral hernia in a cadaver along with a review of the relevant literature. During routine dissection of a 67-year-old male cadaver with a very large stomach and gastroptosis, a femoral hernia containing a part of the great curvature of the stomach was found. The length of the hernia sac was 5 cm, and its width was 3.5 cm. There was a disposition of the intestinal coils to the posterior wall and the lesser pelvis. The cadaver's former medical history and skin observation before dissection excluded any previous abdominal surgery. This is the second case of stomach herniation through the femoral ring in a male subject ever reported. The symptoms in this pathology vary from complete absence to symptoms due to high stenosis of the digestive tract, stomach strangulation and stomach wall necrosis.

Anatomical Science International, 2014

The study determines the variability of the length of the styloid process in a Greek population a... more The study determines the variability of the length of the styloid process in a Greek population and investigates how it is affected by gender and age; it also evaluates the side asymmetry, highlighting clinical implications. One hundred and forty-nine dry adult modern skulls (94 male and 55 female) were divided into subgroups according to their age: 20-39, 40-59 and older than 60 years. The lengths of 262 styloid processes (127 right and 135 left-sided) were measured. The lengths of rightsided styloid processes ranged from 6.4 to 70.2 mm and left-sided styloid processes from 5.2 to 69.0 mm. The processes were classified according to their lengths as short \18 mm, normal 18-33 mm and elongated [33 mm. The majority of the processes were normal (45.8 %), 27.5 % were short and 26.7 % elongated. No statistical significant correlation was established among the lengths of the styloid processes, gender and age. Side asymmetry was found only in the group with elongated styloid processes (right processes were longer, 28.3 %, than the left ones 25.2 %; p = 0.016). Our study contributes to the literature, adding important information about the length of the styloid process and its diversity in the Greek population. It also confirms the existence of an osseous landmark as a starting point for the measurement of the length of the styloid process and proposes a method of measurement for the evaluation of the actual length of the styloid process.

Techniques in Coloproctology, 2004

Techniques in Coloproctology, 2000

The surgical treatment of haemorrhoids with the use of a circular stapler is a novel method. A co... more The surgical treatment of haemorrhoids with the use of a circular stapler is a novel method. A comparative retrospective study of two groups of patients treated surgically for third- and fourth-degree haemorrhoids was conducted. Fifty patients (group A) underwent a surgical intervention with the circular stapler in the rectal mucosa 4 cm above the dentate line. In another group of

Journal of Cranio-Maxillofacial Surgery, 2014

Mandibular nerve entrapment has great significance, as it may be responsible for the appearance o... more Mandibular nerve entrapment has great significance, as it may be responsible for the appearance of several neurological pathologies, such as chewing disorders, taste loss, facial or tongue paraesthesia and neuralgia. The ossified pterygoalar (Pta) bar is the result of calcification and/or ossification of the ligament extending from the pterygospinous process of the lateral pterygoid lamina to the infratemporal surface of the sphenoid bone. The ossified bar may act as the cause for this entrapment. One hundred and forty-five Greek adult dry skulls were examined for the existence of a complete or incomplete Pta bar and a relative foramen. The Pta bar appeared in 31.7% of the skulls, in total, in 4.1% completely and in 27.6% incompletely ossified. The mean sagittal and transverse diameters of Pta foramen were 3.21 ± 1.70 and 4.79 ± 1.39 mm, respectively. There was no statistical significant difference between the presence of Pta bar and the side or gender. Apart from the neurological interest, this study highlights the importance of the existence of Pta bar in neurosurgery, anaesthesiology, oral and maxillofacial surgery. The passage of the needle through the foramen ovale for the injection of anaesthetics, as a treatment for trigeminal neuralgia may not be achieved due to this anatomical obstacle. In this case, intra- or postoperative radiologic investigation may be helpful.