John Melissas | University of Crete (original) (raw)
Papers by John Melissas
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 1987
Pancreatic trauma is uncommon and severe, combined pancreaticoduodenal injuries are rare. Differe... more Pancreatic trauma is uncommon and severe, combined pancreaticoduodenal injuries are rare. Different surgical techniques for the management of these injuries have been used. In this article a case of severe pancreaticoduodenal injury which required pancreaticoduodenectomy is reported. This case is unusual because there was no history of trauma, the serum amylase level and abdominal radiograph were normal and the abdominal findings on admission to hospital were minimal. A system of grading pancreatic trauma in terms of severity is advocated and the management of pancreaticoduodenal injuries is discussed.
![Research paper thumbnail of [PP.05.01] the Effect of a Side-To-Side Jejunoileal Anastomosis on Glycemic Control. Experimental Study in a Non-Obese Diabetic Rat Model](https://attachments.academia-assets.com/109691458/thumbnails/1.jpg)
](Journal of Hypertension, 2016
Obesity Surgery, 2016
Background The feasibility of a simple side-to-side jejunoileal anastomosis (SJA) in non-morbidly... more Background The feasibility of a simple side-to-side jejunoileal anastomosis (SJA) in non-morbidly obese individuals to control type 2 diabetes mellitus (T2DM) was studied in six diabetic patients with BMI 28-32. This novel procedure was performed in two Academic Centers and preliminary data is presented. Methods SJA bypassing a significant part of the small bowel and diverting food and biliopancretic secretions to the distal ileum was performed laparoscopically in six diabetic patients with BMI 28-32 kg/m 2. SJA was performed at a distance of 100 cm from the Treitz ligament and 150 cm from the ileocecal valve, thus a total bowel alimentary and biliopancreatic loop length of 2.5 m was created. Results Three of the patients (two female, one male) experienced complete remission of diabetes from the immediate postoperative period and up to 3 years after the procedure. Two other patients remained medication-free after the operation experiencing partial diabetes remission, and the third patient significantly reduced his daily insulin requirements immediately after surgery. There were no early or late postoperative complications. Conclusions A simple SJA, diverting the food and biliopancreatic secretion to the distal small bowel, was able to control T2DM in all patients offering total or partial remission of the disease soon after the procedure. Those preliminary data and the simplicity of the operation are encouraging and promising. However, further studies are in progress in both Institutions to reveal the possible mechanism of diabetes control and investigate the effect of this operation on larger number of patients, with longer follow-up period.
Obesity, Bariatric and Metabolic Surgery, 2016
The rapid increase in bariatric surgery has stimulated much effort to improve the quality of the ... more The rapid increase in bariatric surgery has stimulated much effort to improve the quality of the service provided, by setting standards of care for these patients.
Obesity, Bariatric and Metabolic Surgery, 2016
Purpose of review Enhanced recovery after surgery (ERAS) methodology has demonstrated consistent ... more Purpose of review Enhanced recovery after surgery (ERAS) methodology has demonstrated consistent benefits in patients undergoing colorectal, urological and thoracic surgeries. Principles of these protocols and their advantages are expected to extend into other surgical specialties such as bariatric surgery. In this review, we summarize the components of ERAS protocols for bariatric surgery and present the evidence on the emerging role of ERAS principles in obese patients. Recent findings Many recent trials have evaluated ERAS protocols for bariatric surgery. Most of these protocols originate from modifications within the individual hospital-based conventional perioperative care strategies. Studies demonstrate that 'ERAS based' care requires evidence-based modifications in all preoperative, intraoperative and postoperative phase. Despite a lack of standardization in protocols at present, benefits such as decreased length of hospital stay, rapid patient turnover, shorter operating room times and lower healthcare costs have been well demonstrated repeatedly. Summary ERAS for bariatric surgery is in its early phase. Nevertheless, literature supports its role in improving perioperative outcomes compared with conventional care in this scenario. Evidence-based protocols, multidisciplinary teamwork and meticulous audit seem to be the key factors for success in ERAS methodology.
Minerva chirurgica, 2009
The prevalence of obesity has increased three-fold in the past two decades. In Europe, 150.000.00... more The prevalence of obesity has increased three-fold in the past two decades. In Europe, 150.000.000 adults and 15.000.000 children are currently affected and obesity epidemic is responsible for approximately 1,000,000 deaths annually. Bariatric surgery for the severely obese has resulted in an overall of 61% weight reduction, across all procedures and has been shown to ameliorate or significantly improve many of the obesity-related comorbidities. Surgery is a serious intervention with procedural risks. Safety, quality and efficacy of the service offered to the morbidly obese patients, from both surgeons and hospitals are therefore, of outmost importance, to ensure optimal outcome of the surgical intervention, with the lowest possible risk for complications and mortality. An institution that can be certified by an independent organization, as capable to undertake the management of morbidly obese patients with outstanding results, is a Centre of Excellence (COE) in Bariatric and Metabo...
Klinichna khirurhiia / Ministerstvo okhorony zdorov'ia Ukraïny, Naukove tovarystvo khirurhiv Ukraïny, 2012
Experience of laparoscopic sleeve gastric resection performance for morbid obesity was summarized... more Experience of laparoscopic sleeve gastric resection performance for morbid obesity was summarized. Indications for the method application, the operation procedure details, its mechanism of action, securing the body mass reduction, are adduced. The efficacy and security of the intervention were estimated.
Acta orthopaedica Belgica, 2007
The applications of bioabsorbable implants in orthopaedic surgery have mainly been mandated from ... more The applications of bioabsorbable implants in orthopaedic surgery have mainly been mandated from the need to eliminate implant removal operations. Although they have not gained widespread popularity among orthopaedic surgeons, they still represent an area of evolution. Considerable effort has been put into developing new bioabsorbable materials with fewer adverse effects. In this article an extensive review of the literature is presented emphasising on basic science and clinical applications of these materials. A review of the types of implants, the materials used, their biochemical properties, their adverse effects and some of the potential future applications is presented.
Acta gastro-enterologica Belgica
Endometriosis is a relatively frequent disease in fertile women. The intestine is involved in 12-... more Endometriosis is a relatively frequent disease in fertile women. The intestine is involved in 12-37% of cases. Intestinal endometriosis is usually asymptomatic and complete obstruction of the bowel lumen occurs in less than 1% of cases. We report a case of endometriosis of the sigmoid, which caused complete intestinal obstruction and mimicked carcinoma of the sigmoid colon. This case demonstrates the difficulty of establishing an accurate pre- and peroperative diagnosis and the propensity of intestinal endometriosis to mimic colon cancer.
The American surgeon, 1998
A prospective randomized study questioning the benefit of neck drainage in thyroid surgery is pre... more A prospective randomized study questioning the benefit of neck drainage in thyroid surgery is presented. Two hundred consecutive patients, candidates for elective thyroid surgery, were randomized into Group A (no drain) and Group B (drain). Reoperation for bleeding was necessary for two patients of Group A and for one patient in Group B. Minor hematomas occurred in seven patients from Group A and five patients from Group B; wound infection occurred in two and four patients in Groups A and B, respectively; and lymphatic discharge occurred in two patients from Group B. These differences were not statistically different. The present study failed to demonstrate any protective value from the use of drains. However, the hospital stay was shorter and pain scores were smaller in the non-drain Group A.
South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie, 1987
South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie, 1987
World journal of surgery, 2015
The aim of this study was to evaluate the effects of surgically induced weight loss on the abdomi... more The aim of this study was to evaluate the effects of surgically induced weight loss on the abdominal adipose tissue depots and the metabolic profile in morbidly obese (MO) patients. The study was performed with a semi-automated quantification of adipose tissue compartments on single-slice abdominal CT series before surgery, 6 and 12 months after bariatric surgery. Thirty-eight MO patients with mean age of 35.7 ± 10.1 years and mean body mass index (BMI) of 43.6 ± 6.5 kg/m(2) were studied (20 patients underwent gastric banding and 18 patients underwent sleeve gastrectomy). Anthropometric measurements, metabolic and inflammatory parameters were analyzed in each patient. Markedly decreased levels of total abdominal adipose tissue, abdominal subcutaneous adipose tissue (AbSAT) and visceral adipose tissue (VAT) at 6 and 12 months were noted in comparison to the preoperative values. The total % reduction of VAT was significant higher in comparison to the total % reduction of AbSAT at 12 m...
World Journal of Surgery, 2011
Background The aim of the present study was to evaluate the effects of surgically induced weight ... more Background The aim of the present study was to evaluate the effects of surgically induced weight loss on the metabolic profile and adipocytokine levels in premenopausal morbidly obese females. Methods Twenty premenopausal morbidly obese (MO) women with a median age of 34 years (range: 24-48 years) and a median body mass index (BMI) of 41.47 kg/m 2 (range: 38.0-56.73 kg/m 2) were studied (13 women underwent gastric banding and 7 women underwent sleeve gastrectomy). In addition, 20 lean premenopausal women with a median age of 32 years (range: 22-44 years) and a median BMI of 20.0 kg/m 2 (range: 18.5-24.7 kg/m 2) were also studied. Anthropometric measurements and metabolic parameters were analyzed in each patient, along with changes in leptin, adiponectin, resistin, and interleukin-6 (IL-6) before surgery, 6 months after surgery, and 12 months after surgery. Comparisons with the reference normal-weight subjects were also performed. Results Both weight and BMI were found to be significantly decreased postoperatively. A 54.5% loss of excess BMI was observed 12 months after surgery, and was associated with significant improvement in all anthropometric and metabolic parameters. Twelve months after surgery we also observed decreased levels of serum leptin, resistin, and IL-6; increased levels of serum adiponectin; and a remarkable improvement in metabolic syndrome markers. Furthermore, postoperative serum resistin and IL-6 levels were found to reach those of normal-weight volunteers. Conclusions The results of this study suggest that weight loss through restrictive bariatric surgery results in a significant reduction in leptin, resistin, and IL-6 levels, and an increase in adiponectin levels, in addition to improving insulin sensitivity and glucose and lipid homeostasis in young morbidly obese female patients. These changes were significantly correlated with the magnitude of weight loss.
The Breast, 2013
Recently an increased interest on Elk1 protein and its role in breast cancer evolution has been n... more Recently an increased interest on Elk1 protein and its role in breast cancer evolution has been noted. This protein is an element of the Ets family of transcription factors and it has been involved in a number of important cell processes through the activation of different genes, in a number of normal tissues as well as in many malignancies. One hundred and seventy (n = 170) cases of operable breast cancer (invasive ductal, lobular and mixed type breast carcinomas) were randomly selected and investigated for the expression of pElk-1, Ki-67 and Cyclin D1 using immunohistochemistry. Our findings were correlated with tumors' clinicopathologic data and biologic profile. Activated Elk1 is positively associated with ER (p-value: 0.018) and also shows a positive association of with Cyclin D1 (p-value: <0.001). No relationship was noted between pElk1 and Ki67 (p-value: 0.213). Luminal A and B Her-2 negative breast cancer subtypes were showing greater pElk-1 immunoreactivity compared to Her-2 and Basal breast cancer subtypes, and also a higher staining intensity. No association of the molecule with other clinicopathologic characteristics (tumor size, stage, histological type or lymph node metastases) or disease adverse events (local recurrence, metastasis or death) was evidenced. Our findings offer a new perspective for the role of pElk-1 in breast neoplasia suggesting a direct relation of this molecule to tumor biology and a putative target of personalized breast cancer therapies, although its prognostic/discriminant role is not supported.
The American Journal of Surgery, 2010
BACKGROUND: Rectal cancer treatment has become multimodal as a result of significant advances in ... more BACKGROUND: Rectal cancer treatment has become multimodal as a result of significant advances in imaging, staging, surgery, radiotherapy, and chemotherapy. Multidisciplinary teams can incorporate these developments into tailor-made treatment plans and offer state-of-the-art services for rectal cancer patients. METHODS: We searched the MEDLINE and PubMed databases using the following keywords: "rectal cancer," "total mesorectal excision," "multidisciplinary treatment/team," "radiotherapy," "chemotherapy," and their combinations. There were no language or publication year restrictions. References in published articles also were reviewed. RESULTS: Total mesorectal excision surgery, high-resolution pelvic magnetic resonance imaging, preoperative chemoradiotherapy, and pathologic reports according to Quirke protocol are preconditions for the initiation of an effective multidisciplinary team. Common topics for discussion are the status of the circumferential margin, the type of radiotherapy and surgery required, and the chemotherapeutic agent to be used. CONCLUSIONS: This review focuses on this issue based on two main principles. First, the status of the circumferential margin dictates the use of preoperative chemoradiotherapy. Second, preoperative chemoradiotherapy is superior in terms of free circumferential resection margin rate, local recurrence rate, and toxicity.
Respiration, 2005
Backround: Angiogenesis is an adaptation mechanism of skeletal muscles to increased load. Animal ... more Backround: Angiogenesis is an adaptation mechanism of skeletal muscles to increased load. Animal data have shown increased vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and transforming growth factor-β1 (TGF-β1) mRNA levels in the diaphragm as a result of increased minute ventilation, but there are no data concerning the human diaphragm. Objectives: The purpose of this study was to investigate the VEGF, bFGF, TGF-β1 mRNA levels in the human diaphragm of normal subjects and patients with altered respiratory mechanics. Methods: We studied 9 patients with chronic obstructive pulmonary disease (COPD), 4 obese patients and 12 controls. We performed multiplex semiquantitative reverse transcription polymerase chain reaction to determine the VEGF, bFGF and TGF-β1 mRNA levels in specimens taken from their diaphragm. Results: VEGF mRNA levels were 18% higher in COPD patients compared with controls (p = 0.04), while for the obese patients, these levels were n...
Obesity Surgery, 2003
Background: Obesity causes structural changes to the heart that may influence its function. Furth... more Background: Obesity causes structural changes to the heart that may influence its function. Furthermore, morbid obesity is associated with an acquired prolongation of the QTc interval that may lead to potentially hazardous arrhythmias. The present study investigated the effect of body weight loss following vertical banded gastroplasty (VBG) on the QTc interval. Methods: 17 morbidly obese patients, scheduled for elective VBG, were studied before the operation and 8-10 months postoperatively, when each patient had achieved a weight loss of 25% of the preoperative body weight. Results: 15 patients achieved significant body weight loss of 25% within the first 8-10 postoperative months (P<0.001). This weight loss, corresponding to an excess weight loss of 48.7% and a mean body mass index (BMI) reduction from 49.7 kg/m 2 to 36.6 kg/m 2 , was followed by significant shortening of the QTc interval from 428 msec to 393 msec (P<0.001). Conclusions: The significant postoperative weight loss following VBG was accompanied by shortening of the QTc interval. This effect is expected to reduce the incidence of fatal conditions associated with the long QT syndrome, such as malignant ventricular arrhythmias and sudden death, and therefore improve morbidity and mortality.
Obesity Surgery, 2005
Our field is "bariatric" surgery. Bari means weight or pressure in ancient and modern Greek. Howe... more Our field is "bariatric" surgery. Bari means weight or pressure in ancient and modern Greek. However, bari denotes obese in biblical Hebrew and healthy in modern Hebrew. The Greek language and the Hebrew language (spoken by many ancient Northwest Semitic peoples) come from different language roots. We surveyed interactions between the two languages, to determine historically how bari could have become a "loanword". Ample mingling of the peoples was found.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 1987
Pancreatic trauma is uncommon and severe, combined pancreaticoduodenal injuries are rare. Differe... more Pancreatic trauma is uncommon and severe, combined pancreaticoduodenal injuries are rare. Different surgical techniques for the management of these injuries have been used. In this article a case of severe pancreaticoduodenal injury which required pancreaticoduodenectomy is reported. This case is unusual because there was no history of trauma, the serum amylase level and abdominal radiograph were normal and the abdominal findings on admission to hospital were minimal. A system of grading pancreatic trauma in terms of severity is advocated and the management of pancreaticoduodenal injuries is discussed.
Journal of Hypertension, 2016
Obesity Surgery, 2016
Background The feasibility of a simple side-to-side jejunoileal anastomosis (SJA) in non-morbidly... more Background The feasibility of a simple side-to-side jejunoileal anastomosis (SJA) in non-morbidly obese individuals to control type 2 diabetes mellitus (T2DM) was studied in six diabetic patients with BMI 28-32. This novel procedure was performed in two Academic Centers and preliminary data is presented. Methods SJA bypassing a significant part of the small bowel and diverting food and biliopancretic secretions to the distal ileum was performed laparoscopically in six diabetic patients with BMI 28-32 kg/m 2. SJA was performed at a distance of 100 cm from the Treitz ligament and 150 cm from the ileocecal valve, thus a total bowel alimentary and biliopancreatic loop length of 2.5 m was created. Results Three of the patients (two female, one male) experienced complete remission of diabetes from the immediate postoperative period and up to 3 years after the procedure. Two other patients remained medication-free after the operation experiencing partial diabetes remission, and the third patient significantly reduced his daily insulin requirements immediately after surgery. There were no early or late postoperative complications. Conclusions A simple SJA, diverting the food and biliopancreatic secretion to the distal small bowel, was able to control T2DM in all patients offering total or partial remission of the disease soon after the procedure. Those preliminary data and the simplicity of the operation are encouraging and promising. However, further studies are in progress in both Institutions to reveal the possible mechanism of diabetes control and investigate the effect of this operation on larger number of patients, with longer follow-up period.
Obesity, Bariatric and Metabolic Surgery, 2016
The rapid increase in bariatric surgery has stimulated much effort to improve the quality of the ... more The rapid increase in bariatric surgery has stimulated much effort to improve the quality of the service provided, by setting standards of care for these patients.
Obesity, Bariatric and Metabolic Surgery, 2016
Purpose of review Enhanced recovery after surgery (ERAS) methodology has demonstrated consistent ... more Purpose of review Enhanced recovery after surgery (ERAS) methodology has demonstrated consistent benefits in patients undergoing colorectal, urological and thoracic surgeries. Principles of these protocols and their advantages are expected to extend into other surgical specialties such as bariatric surgery. In this review, we summarize the components of ERAS protocols for bariatric surgery and present the evidence on the emerging role of ERAS principles in obese patients. Recent findings Many recent trials have evaluated ERAS protocols for bariatric surgery. Most of these protocols originate from modifications within the individual hospital-based conventional perioperative care strategies. Studies demonstrate that 'ERAS based' care requires evidence-based modifications in all preoperative, intraoperative and postoperative phase. Despite a lack of standardization in protocols at present, benefits such as decreased length of hospital stay, rapid patient turnover, shorter operating room times and lower healthcare costs have been well demonstrated repeatedly. Summary ERAS for bariatric surgery is in its early phase. Nevertheless, literature supports its role in improving perioperative outcomes compared with conventional care in this scenario. Evidence-based protocols, multidisciplinary teamwork and meticulous audit seem to be the key factors for success in ERAS methodology.
Minerva chirurgica, 2009
The prevalence of obesity has increased three-fold in the past two decades. In Europe, 150.000.00... more The prevalence of obesity has increased three-fold in the past two decades. In Europe, 150.000.000 adults and 15.000.000 children are currently affected and obesity epidemic is responsible for approximately 1,000,000 deaths annually. Bariatric surgery for the severely obese has resulted in an overall of 61% weight reduction, across all procedures and has been shown to ameliorate or significantly improve many of the obesity-related comorbidities. Surgery is a serious intervention with procedural risks. Safety, quality and efficacy of the service offered to the morbidly obese patients, from both surgeons and hospitals are therefore, of outmost importance, to ensure optimal outcome of the surgical intervention, with the lowest possible risk for complications and mortality. An institution that can be certified by an independent organization, as capable to undertake the management of morbidly obese patients with outstanding results, is a Centre of Excellence (COE) in Bariatric and Metabo...
Klinichna khirurhiia / Ministerstvo okhorony zdorov'ia Ukraïny, Naukove tovarystvo khirurhiv Ukraïny, 2012
Experience of laparoscopic sleeve gastric resection performance for morbid obesity was summarized... more Experience of laparoscopic sleeve gastric resection performance for morbid obesity was summarized. Indications for the method application, the operation procedure details, its mechanism of action, securing the body mass reduction, are adduced. The efficacy and security of the intervention were estimated.
Acta orthopaedica Belgica, 2007
The applications of bioabsorbable implants in orthopaedic surgery have mainly been mandated from ... more The applications of bioabsorbable implants in orthopaedic surgery have mainly been mandated from the need to eliminate implant removal operations. Although they have not gained widespread popularity among orthopaedic surgeons, they still represent an area of evolution. Considerable effort has been put into developing new bioabsorbable materials with fewer adverse effects. In this article an extensive review of the literature is presented emphasising on basic science and clinical applications of these materials. A review of the types of implants, the materials used, their biochemical properties, their adverse effects and some of the potential future applications is presented.
Acta gastro-enterologica Belgica
Endometriosis is a relatively frequent disease in fertile women. The intestine is involved in 12-... more Endometriosis is a relatively frequent disease in fertile women. The intestine is involved in 12-37% of cases. Intestinal endometriosis is usually asymptomatic and complete obstruction of the bowel lumen occurs in less than 1% of cases. We report a case of endometriosis of the sigmoid, which caused complete intestinal obstruction and mimicked carcinoma of the sigmoid colon. This case demonstrates the difficulty of establishing an accurate pre- and peroperative diagnosis and the propensity of intestinal endometriosis to mimic colon cancer.
The American surgeon, 1998
A prospective randomized study questioning the benefit of neck drainage in thyroid surgery is pre... more A prospective randomized study questioning the benefit of neck drainage in thyroid surgery is presented. Two hundred consecutive patients, candidates for elective thyroid surgery, were randomized into Group A (no drain) and Group B (drain). Reoperation for bleeding was necessary for two patients of Group A and for one patient in Group B. Minor hematomas occurred in seven patients from Group A and five patients from Group B; wound infection occurred in two and four patients in Groups A and B, respectively; and lymphatic discharge occurred in two patients from Group B. These differences were not statistically different. The present study failed to demonstrate any protective value from the use of drains. However, the hospital stay was shorter and pain scores were smaller in the non-drain Group A.
South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie, 1987
South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie, 1987
World journal of surgery, 2015
The aim of this study was to evaluate the effects of surgically induced weight loss on the abdomi... more The aim of this study was to evaluate the effects of surgically induced weight loss on the abdominal adipose tissue depots and the metabolic profile in morbidly obese (MO) patients. The study was performed with a semi-automated quantification of adipose tissue compartments on single-slice abdominal CT series before surgery, 6 and 12 months after bariatric surgery. Thirty-eight MO patients with mean age of 35.7 ± 10.1 years and mean body mass index (BMI) of 43.6 ± 6.5 kg/m(2) were studied (20 patients underwent gastric banding and 18 patients underwent sleeve gastrectomy). Anthropometric measurements, metabolic and inflammatory parameters were analyzed in each patient. Markedly decreased levels of total abdominal adipose tissue, abdominal subcutaneous adipose tissue (AbSAT) and visceral adipose tissue (VAT) at 6 and 12 months were noted in comparison to the preoperative values. The total % reduction of VAT was significant higher in comparison to the total % reduction of AbSAT at 12 m...
World Journal of Surgery, 2011
Background The aim of the present study was to evaluate the effects of surgically induced weight ... more Background The aim of the present study was to evaluate the effects of surgically induced weight loss on the metabolic profile and adipocytokine levels in premenopausal morbidly obese females. Methods Twenty premenopausal morbidly obese (MO) women with a median age of 34 years (range: 24-48 years) and a median body mass index (BMI) of 41.47 kg/m 2 (range: 38.0-56.73 kg/m 2) were studied (13 women underwent gastric banding and 7 women underwent sleeve gastrectomy). In addition, 20 lean premenopausal women with a median age of 32 years (range: 22-44 years) and a median BMI of 20.0 kg/m 2 (range: 18.5-24.7 kg/m 2) were also studied. Anthropometric measurements and metabolic parameters were analyzed in each patient, along with changes in leptin, adiponectin, resistin, and interleukin-6 (IL-6) before surgery, 6 months after surgery, and 12 months after surgery. Comparisons with the reference normal-weight subjects were also performed. Results Both weight and BMI were found to be significantly decreased postoperatively. A 54.5% loss of excess BMI was observed 12 months after surgery, and was associated with significant improvement in all anthropometric and metabolic parameters. Twelve months after surgery we also observed decreased levels of serum leptin, resistin, and IL-6; increased levels of serum adiponectin; and a remarkable improvement in metabolic syndrome markers. Furthermore, postoperative serum resistin and IL-6 levels were found to reach those of normal-weight volunteers. Conclusions The results of this study suggest that weight loss through restrictive bariatric surgery results in a significant reduction in leptin, resistin, and IL-6 levels, and an increase in adiponectin levels, in addition to improving insulin sensitivity and glucose and lipid homeostasis in young morbidly obese female patients. These changes were significantly correlated with the magnitude of weight loss.
The Breast, 2013
Recently an increased interest on Elk1 protein and its role in breast cancer evolution has been n... more Recently an increased interest on Elk1 protein and its role in breast cancer evolution has been noted. This protein is an element of the Ets family of transcription factors and it has been involved in a number of important cell processes through the activation of different genes, in a number of normal tissues as well as in many malignancies. One hundred and seventy (n = 170) cases of operable breast cancer (invasive ductal, lobular and mixed type breast carcinomas) were randomly selected and investigated for the expression of pElk-1, Ki-67 and Cyclin D1 using immunohistochemistry. Our findings were correlated with tumors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; clinicopathologic data and biologic profile. Activated Elk1 is positively associated with ER (p-value: 0.018) and also shows a positive association of with Cyclin D1 (p-value: &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). No relationship was noted between pElk1 and Ki67 (p-value: 0.213). Luminal A and B Her-2 negative breast cancer subtypes were showing greater pElk-1 immunoreactivity compared to Her-2 and Basal breast cancer subtypes, and also a higher staining intensity. No association of the molecule with other clinicopathologic characteristics (tumor size, stage, histological type or lymph node metastases) or disease adverse events (local recurrence, metastasis or death) was evidenced. Our findings offer a new perspective for the role of pElk-1 in breast neoplasia suggesting a direct relation of this molecule to tumor biology and a putative target of personalized breast cancer therapies, although its prognostic/discriminant role is not supported.
The American Journal of Surgery, 2010
BACKGROUND: Rectal cancer treatment has become multimodal as a result of significant advances in ... more BACKGROUND: Rectal cancer treatment has become multimodal as a result of significant advances in imaging, staging, surgery, radiotherapy, and chemotherapy. Multidisciplinary teams can incorporate these developments into tailor-made treatment plans and offer state-of-the-art services for rectal cancer patients. METHODS: We searched the MEDLINE and PubMed databases using the following keywords: "rectal cancer," "total mesorectal excision," "multidisciplinary treatment/team," "radiotherapy," "chemotherapy," and their combinations. There were no language or publication year restrictions. References in published articles also were reviewed. RESULTS: Total mesorectal excision surgery, high-resolution pelvic magnetic resonance imaging, preoperative chemoradiotherapy, and pathologic reports according to Quirke protocol are preconditions for the initiation of an effective multidisciplinary team. Common topics for discussion are the status of the circumferential margin, the type of radiotherapy and surgery required, and the chemotherapeutic agent to be used. CONCLUSIONS: This review focuses on this issue based on two main principles. First, the status of the circumferential margin dictates the use of preoperative chemoradiotherapy. Second, preoperative chemoradiotherapy is superior in terms of free circumferential resection margin rate, local recurrence rate, and toxicity.
Respiration, 2005
Backround: Angiogenesis is an adaptation mechanism of skeletal muscles to increased load. Animal ... more Backround: Angiogenesis is an adaptation mechanism of skeletal muscles to increased load. Animal data have shown increased vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and transforming growth factor-β1 (TGF-β1) mRNA levels in the diaphragm as a result of increased minute ventilation, but there are no data concerning the human diaphragm. Objectives: The purpose of this study was to investigate the VEGF, bFGF, TGF-β1 mRNA levels in the human diaphragm of normal subjects and patients with altered respiratory mechanics. Methods: We studied 9 patients with chronic obstructive pulmonary disease (COPD), 4 obese patients and 12 controls. We performed multiplex semiquantitative reverse transcription polymerase chain reaction to determine the VEGF, bFGF and TGF-β1 mRNA levels in specimens taken from their diaphragm. Results: VEGF mRNA levels were 18% higher in COPD patients compared with controls (p = 0.04), while for the obese patients, these levels were n...
Obesity Surgery, 2003
Background: Obesity causes structural changes to the heart that may influence its function. Furth... more Background: Obesity causes structural changes to the heart that may influence its function. Furthermore, morbid obesity is associated with an acquired prolongation of the QTc interval that may lead to potentially hazardous arrhythmias. The present study investigated the effect of body weight loss following vertical banded gastroplasty (VBG) on the QTc interval. Methods: 17 morbidly obese patients, scheduled for elective VBG, were studied before the operation and 8-10 months postoperatively, when each patient had achieved a weight loss of 25% of the preoperative body weight. Results: 15 patients achieved significant body weight loss of 25% within the first 8-10 postoperative months (P<0.001). This weight loss, corresponding to an excess weight loss of 48.7% and a mean body mass index (BMI) reduction from 49.7 kg/m 2 to 36.6 kg/m 2 , was followed by significant shortening of the QTc interval from 428 msec to 393 msec (P<0.001). Conclusions: The significant postoperative weight loss following VBG was accompanied by shortening of the QTc interval. This effect is expected to reduce the incidence of fatal conditions associated with the long QT syndrome, such as malignant ventricular arrhythmias and sudden death, and therefore improve morbidity and mortality.
Obesity Surgery, 2005
Our field is "bariatric" surgery. Bari means weight or pressure in ancient and modern Greek. Howe... more Our field is "bariatric" surgery. Bari means weight or pressure in ancient and modern Greek. However, bari denotes obese in biblical Hebrew and healthy in modern Hebrew. The Greek language and the Hebrew language (spoken by many ancient Northwest Semitic peoples) come from different language roots. We surveyed interactions between the two languages, to determine historically how bari could have become a "loanword". Ample mingling of the peoples was found.