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Papers by Alexander Karatzanis

Einleitung: Die Applikation der transoralen CO2-Laser-Mikrochirurgie (TLM) in der Behandlung der ... more Einleitung: Die Applikation der transoralen CO2-Laser-Mikrochirurgie (TLM) in der Behandlung der Hypopharynxkarzinome ermöglicht einen direkten und einfachen Zugang zum Tumor und erspart größere Eingriffe von außen, die eine Rekonstruktion erforderlich machen würden. Ziele dieser[for full text, please go to the a.m. URL]

Journal of Clinical Medicine, 2021

Rhinitis describes a pattern of symptoms as a result of nasal inflammation and/or dysfunction of ... more Rhinitis describes a pattern of symptoms as a result of nasal inflammation and/or dysfunction of the nasal mucosa. It is an umbrella entity that includes many different subtypes, several of which escape of complete characterization. Rhinitis is considered as a pathologic condition with considerable morbidity and financial burden on health care systems worldwide. Its economic impact is further emphasized by the fact that it represents a risk factor for other conditions such as sinusitis, asthma, learning disabilities, behavioral changes, and psychological impairment. Rhinitis may be associated with many etiologic triggers such as infections, immediate-type allergic responses, inhaled irritants, medications, hormonal disturbances, and neural system dysfunction. It is basically classified into three major clinical phenotypes: allergic rhinitis (AR), infectious rhinitis, and non-allergic, non-infectious rhinitis (NAR). However, this subdivision may be considered as an oversimplification...

Case Reports in Otolaryngology, 2020

Background. Buccal space tumors constitute rare pathologies with significant histological diversi... more Background. Buccal space tumors constitute rare pathologies with significant histological diversity. They may pose serious diagnostic and therapeutic challenges for the head and neck surgeon. Methods. A case of buccal space tumor diagnosed and treated in a tertiary center is presented. Clinical presentation, imaging, and surgical approach are discussed, followed by review of the literature. Results. A 79-year-old male patient with a slowly growing painless mass on the right cheek presented to a head and neck reference center. Imaging revealed a tumor of the right buccal space with nonspecific characteristics. Imaging studies revealed extended infiltration of the masseter muscle as well as the anterior border of the parotid gland. FNA biopsy was performed but was nondiagnostic. The decision of surgical excision with a modified parotidectomy incision was taken. The lesion was completely excised with preservation of neighboring facial nerve branches and ipsilateral Stensen’s duct. The ...

Case Reports in Otolaryngology, 2019

Introduction. Cases of extensive nasal polyps rarely occur and may mimic more aggressive lesions ... more Introduction. Cases of extensive nasal polyps rarely occur and may mimic more aggressive lesions of the nose and paranasal sinuses. A case of extensive nasal polyposis with unusually aggressive behavior and its management is presented. Presentation of Case. A 27-year-old male patient visited the emergency department of a tertiary center, complaining of recurrent episodes of epistaxis. The patient presented with a large polypoid lesion protruding from the right nostril and producing asymmetry of the face. Diagnostic imaging illustrated a lesion of the right maxillary sinus producing excessive bone remodeling and extension into neighboring structures in every direction. Fine limits were noted, however, with no invasive characteristics. Biopsy under local anesthesia was performed, showing findings consistent with nonspecific inflammation. Open surgery through a lateral rhinotomy under general anesthesia was performed, and the mass was readily mobilized and removed. No macroscopic invas...

Turkish Archives of Otorhinolaryngology, 2019

Tissue engineering implies a number of established techniques in several fields in medicine. A th... more Tissue engineering implies a number of established techniques in several fields in medicine. A thorough review of current clinical applications for tissue engineering in rhinology is addressed. Current status, as well as, published in vivo studies is presented. Moreover, relevant clinical applications and future perspectives of tissue engineering are demonstrated. There is a lack of high quality clinical studies in the literature regarding the role of tissue engineering in the rhinology field. Further research is needed to translate this concept from bench to bedside.

Journal of Otolaryngology - Head & Neck Surgery, 2014

Background Management of advanced laryngeal cancer is complex and ideal strategy is yet to be def... more Background Management of advanced laryngeal cancer is complex and ideal strategy is yet to be defined. This study evaluates the experience of a single head and neck oncologic centre in the management of T4 laryngeal cancer. Methods Retrospective assessment of cases primarily treated for T4a squamous cell carcinoma of the larynx, between 1980 and 2007, at a tertiary referral center. Results A total of 384 cases were studied. Five-year disease specific survival was 56.2% and local control 87.4%. Regional and distal control estimates were 90.3% and 88.3% respectively. Prognosis was significantly superior for cases treated with primary surgery compared to cases solely managed with non-surgical modalities. Positive surgical margins and regional disease worsened prognosis. Conclusion This study suggests that primary surgery remains a key element in the treatment of advanced laryngeal cancer. The need for well-designed, prospective, randomised studies in order to further evaluate the remai...

Rhinology, 2009

To assess the effect of allergic rhinitis (AR) on septoplasty outcome in terms of subjective and ... more To assess the effect of allergic rhinitis (AR) on septoplasty outcome in terms of subjective and objective measurements and clarify whether patients with nasal septum deviation (NSD) and allergic rhinitis (AR) benefit from septoplasty to the same extent as patients who do not have allergic rhinitis. A prospective study, with consecutive sampling of all patients undergoing septoplasty from June 2005 to February 2007, conducted in a tertiary care otorhinolaryngologic clinic. One hundred and seventy-six patients underwent septoplasty over the study period. Follow-up data were obtained from one hundred and forty-nine subjects. All participants underwent active anterior rhinomanometry (AAR) and assessed the severity of their symptoms based on a Nasal Obstruction Symptom Evaluation (NOSE) Scale prior to and following septo- plasty. Patients were divided into two groups according to AR status. Comparisons were made between symptoms and rhinomanometry data. Following septoplasty, subjective...

Head & face medicine, 2006

Traumatic auricular amputation due to human bite is not a common event. Nonetheless, it constitut... more Traumatic auricular amputation due to human bite is not a common event. Nonetheless, it constitutes a difficult challenge for the reconstructive surgeon. Microsurgery can be performed in some cases, but most microsurgical techniques are complex and their use can only be advocated in specialized centers. Replantation of a severed ear without microsurgery can be a safe alternative as long as a proper technique is selected. We present two cases, one of a partial and one of a total traumatic auricular amputation, both caused by human bites, that were successfully managed in our Department. The technique of ear reattachment as a composite graft, with partial burial of the amputated part in the retroauricular region, as first described by Baudet, was followed in both cases. The prementioned technique is described in detail, along with the postoperative management and outcome of the patients. In addition, a brief review of the international literature regarding ear replantation is performe...

Otolaryngology - Head and Neck Surgery, 2010

The Laryngoscope, 2009

This study aims to assess the oncologic results of open and transoral surgical techniques in T1a ... more This study aims to assess the oncologic results of open and transoral surgical techniques in T1a and T1b category glottic carcinomas. Retrospective clinical study. The files of 438 T1a and T1b glottic cancer cases managed with primary surgery were reviewed. Transoral laser surgery and open surgical procedures used to treat these cases, including cordectomy, vertical partial laryngectomy, and frontolateral partial laryngectomy, were compared for disease specific survival and local control rates. In addition, all techniques were compared for incidence of major complications and related tracheotomies. No statistically significant differences were noted between laser surgery and open procedures with regard to disease specific survival and local control for both T1a and T1b cases. Laser surgery showed a significantly lower incidence of complications and tracheotomies. Laser surgery appears to be a very effective management modality for T1 glottic cancer with comparable results to open procedures and a lower incidence of complications. A transcervical approach should be reserved only for selected cases where individual anatomic factors do not permit complete tumor exposure during diagnostic microlaryngoscopy.

The Laryngoscope, 2009

Genetic alterations, such as microsatellite instability (MSI) and loss of heterozygosity (LOH), h... more Genetic alterations, such as microsatellite instability (MSI) and loss of heterozygosity (LOH), have been detected in various inflammatory diseases, providing evidence that acquired somatic mutations might play a role in the aetiopathogenesis of chronic inflammatory conditions. The aim of this study is to assess the presence of MSI and/or LOH in nasal cytology of patients with nasal polyps. Prospective case-controlled basic science experiment utilizing human blood and human nasal brush samples. Nasal brush samples and peripheral blood from 12 patients with nasal polyps were analyzed. DNA was extracted and analyzed for MSI and LOH using the following microsatellite markers: D2S2113, D6S344, D6S1002, D11S1253, D11S480, USAT24G1, and D13S273, harboring potential susceptibility genes for nasal polyposis. Microsatellite DNA analysis was also performed in 7 control subjects. MSI or LOH were revealed in 3 specimens of the nasal polyps group. Among these there were 2 cases of LOH, one for marker D11S1273 and one for D13S273, and one case of MSI in marker USAT24G1. Each one of these alterations was detected in a different patient. None of the control subjects exhibited any genetic alterations in the 7 markers tested. This is the first time that microsatellite genetic alterations are reported in nasal disease. The presence of such alterations suggests that acquired genomic somatic mutations might play a role in the pathogenesis of nasal polyps.

Pulmonary Pharmacology & Therapeutics, 2010

The author(s) declare that they have no competing interests. Authors' contributions: KS recruited... more The author(s) declare that they have no competing interests. Authors' contributions: KS recruited the study subjects, carried out sputum induction and processing, performed the immuno-magnetic separation studies, and drafted the manuscript. ET conceived of the study, participated in its design and coordination and drafted the manuscript. EN carried out the molecular genetic studies. AK participated in the recruitment of the subjects. IL carried out bronchoscopy and BALF. NT carried out bronchoscopy and BALF and performed the statistical analysis. NS conceived of the study, and participated in its design and helped to draft the manuscript. All authors read and approved the final manuscript.

Oncology Reports, 2007

Genetic alterations in the microsatellite DNA level have been successfully detected in sputum sam... more Genetic alterations in the microsatellite DNA level have been successfully detected in sputum samples of patients with COPD and have been shown to be disease specific. Furthermore, previous studies have shown that inflammation coexists in the nasal mucosa of patients with COPD. The aim of this study was to assess the presence of MSI in nasal cytological samples of patients with COPD comparing the results with sputum samples of the same individuals. Nasal brush samples, sputum samples obtained by induction, and peripheral blood from 20 patients with COPD were analyzed. DNA was extracted and analyzed for MSI using the following microsatellite markers: RH70958, D5S207, D6S344, D6S263, G29802, D13S71, D14S588, D14S292 and D17S250. Microsatellite analysis was also performed in 8 healthy nonsmokers. MSI was detected in the sputum samples of 7 patients with COPD (35%). In contrast, no microsatellite DNA instability was noted in the nasal cytological samples of the same COPD patients. In addition, no genetic alteration was detected in the control group. These results suggest that MSI is a specific finding for the target organ of COPD, i.e. the lungs, despite the fact that inflammation coexists in the nasal mucosa of COPD patients. Our study supports the hypothesis that MSI could be an index of the somaticacquired genetic alterations in the lungs of COPD patients.

Medical Mycology, 2008

Descending mediastinitis occurs as a complication of oropharyngeal or cervical infections and its... more Descending mediastinitis occurs as a complication of oropharyngeal or cervical infections and its delayed diagnosis and treatment are associated with high mortality. A rare case of an odontogenic infection in a diabetic patient, complicated by Candida parapsilosis and Candida krusei parapharyngeal space infection, descending mediastinitis and aspiration pneumonia is described. Isolate identification was based on colonial and microscopic morphological characteristics and carbohydrate assimilation test results. The patient was successfully treated with surgical drainage and debridement, broad spectrum antibacterials and liposomal amphotericin B followed by prolonged oral voriconazole therapy.

Journal of Travel Medicine, 2009

A naphylaxis is an acute, severe reaction that results from the release of preformed and newly sy... more A naphylaxis is an acute, severe reaction that results from the release of preformed and newly synthesized bioactive mediators from mast cells and basophils. 1 More than 500 fatal cases of anaphylaxis per year are estimated to occur in the United States, while more than 12 deaths are reported in Greece. 1-4 Foods, venoms, and drugs are the most common exogenous antigens, which can provoke an immunoglobulin (Ig) E-mediated reaction, whereas exercise, radiocontrast media, as well as nonsteroidal anti-infl ammatory drugs may induce clinical symptoms with a not yet completely understood mechanism. When no etiologic agent is found despite repeated evaluations, the term idiopathic anaphylaxis is used. 2 Food allergy, in particular, is often implicated in multiple allergies as well as in several reactions such as anaphylactic shock, laryngeal angioedema, and severe acute asthma. 5,6 Crete is a 1,000 km coastline island in the south of Greece. Every year almost 3 million tourists visit this island and enjoy its beaches. Some of the commonest causes of anaphylaxis, including hymenoptera bites, high-risk food, exercise, and jellyfi sh bites, are often encountered on the beach. Even though the risk of anaphylaxis in schools and other public places has been emphasized by various authors, no studies regarding the risk of anaphylactic shock on the beach have been reported so far. 3-8 We evaluate the training level of lifeguards working on the beaches of the island of Crete regarding the management of anaphylaxis. In addition, we assess the sufficiency of medical equipment that lifeguards possess to treat an anaphylactic reaction. Method of Study A prospective, randomized study was conducted in an academic tertiary referral medical center (

Journal of Surgical Oncology, 2012

Background and Objective: Base-of-tongue carcinoma is a relatively rare disease with aggressive b... more Background and Objective: Base-of-tongue carcinoma is a relatively rare disease with aggressive behavior and poor prognosis. Up to date no consensus exists regarding the ideal management strategy for each stage of the disease. This study aims to evaluate the experience of a single head and neck oncology center in the management of advanced stage base-of-tongue cancer. Methods: A retrospective evaluation of cases primarily treated for stage III/IV A-B base-of-tongue carcinoma, between 1980 and 2007, at a tertiary referral center. Results: A total of 366 cases were studied. Five-year disease specific survival (DSS) was 42% and local control (LC) 80%. Regional and distal control estimates were 91.3 and 84%, respectively. Prognosis was significantly superior for cases receiving surgery plus adjuvant treatment compared to cases solely managed with non-surgical modalities. Positive surgical margins and regional disease significantly worsened prognosis. Satisfactory retention of pharyngeal function and no fatal complications were noted in surgical cases. Conclusion: Although no consensus exists regarding ideal therapy for advanced base-of-tongue carcinoma, combined strategies with the use of surgery and adjuvant chemoradiotherapy (CRT) seem to offer the best possibility for a positive outcome.

Journal of Surgical Oncology, 2009

This study aims to assess the prognostic significance of free histopathologic margins in the surg... more This study aims to assess the prognostic significance of free histopathologic margins in the surgical treatment of glottic cancer. Furthermore, it evaluates other prognostic factors regarding cases that receive surgical management for glottic lesions. A retrospective case-series study was conducted at an academic tertiary referral center. The files of 1,314 cases that underwent primary surgical treatment for glottic cancer were studied. Various prognostic factors, including age, surgical procedure, T classification, N classification, histological grade, and status of margins were assessed in univariate and multivariate analyses. All variables were investigated for their association with local and regional disease control as well as disease specific and overall survival. Status of margins significantly affected disease specific survival and local control regardless of tumor stage in this series. All other variables assessed in the univariate analysis for their association with survival were also found to be significant. However, status of surgical margins and N classification were the only significant variables in multivariate analysis. The prognostic value of negative surgical margins for the treatment of glottic cancer cannot be overestimated. Responsibility of the surgeon during primary surgical treatment of glottic carcinomas is emphasized.

International Journal of Surgery Case Reports, 2014

INTRODUCTION: A few cases of concomitant medullary and papillary carcinoma in the same thyroid no... more INTRODUCTION: A few cases of concomitant medullary and papillary carcinoma in the same thyroid nodule have been described in the literature. However, the presence of multiple foci of both types of malignancy in the same gland is very rare. PRESENTATION OF CASE: A 39 year-old female with multiple thyroid nodules, elevated serum calcitonin levels and elastographic findings suggestive of thyroid malignancy, underwent total thyroidectomy and central neck dissection. Histology revealed the presence of one focus of medullary and one focus of papillary carcinoma on each thyroid lobe. Subsequently, the patient underwent treatment with radioactive iodine. DISCUSSION: This is the third case of synchronous multifocal medullary and papillary thyroid carcinoma reported in the literature. Several theories for the simultaneous development of these malignant entities have been proposed. CONCLUSION: Ultrasound elastography can be a useful, noninvasive tool in the assessment of thyroid nodules.

International Journal of Medical Sciences, 2012

Head & Neck, 2009

Background. This study was undertaken to evaluate the oncologic results of endoscopic and open su... more Background. This study was undertaken to evaluate the oncologic results of endoscopic and open surgical techniques in early supraglottic cancer. Methods. We performed a retrospective evaluation of 101 patients surgically treated for stage I or II supraglottic carcinomas. Laser surgery, horizontal laryngectomy, and total laryngectomy were compared for disease-specific survival and local control rates. Surgical techniques were additionally compared for incidence of major complications, related tracheotomies, and swallowing function retention. Results. No statistically significant differences were noted among the different types of procedures regarding diseasespecific survival and local control. A lower incidence of major complications, permanent gastrostomies, and significantly lower incidence of tracheotomies were noted for laser surgery compared with open techniques. Conclusion. Larynx-preserving surgical modalities offer comparable oncologic results with total laryngectomy in early supraglottic cancer. In addition, laser surgery has a lower incidence of complications and better functional results compared with open partial or total laryngectomy. V

Einleitung: Die Applikation der transoralen CO2-Laser-Mikrochirurgie (TLM) in der Behandlung der ... more Einleitung: Die Applikation der transoralen CO2-Laser-Mikrochirurgie (TLM) in der Behandlung der Hypopharynxkarzinome ermöglicht einen direkten und einfachen Zugang zum Tumor und erspart größere Eingriffe von außen, die eine Rekonstruktion erforderlich machen würden. Ziele dieser[for full text, please go to the a.m. URL]

Journal of Clinical Medicine, 2021

Rhinitis describes a pattern of symptoms as a result of nasal inflammation and/or dysfunction of ... more Rhinitis describes a pattern of symptoms as a result of nasal inflammation and/or dysfunction of the nasal mucosa. It is an umbrella entity that includes many different subtypes, several of which escape of complete characterization. Rhinitis is considered as a pathologic condition with considerable morbidity and financial burden on health care systems worldwide. Its economic impact is further emphasized by the fact that it represents a risk factor for other conditions such as sinusitis, asthma, learning disabilities, behavioral changes, and psychological impairment. Rhinitis may be associated with many etiologic triggers such as infections, immediate-type allergic responses, inhaled irritants, medications, hormonal disturbances, and neural system dysfunction. It is basically classified into three major clinical phenotypes: allergic rhinitis (AR), infectious rhinitis, and non-allergic, non-infectious rhinitis (NAR). However, this subdivision may be considered as an oversimplification...

Case Reports in Otolaryngology, 2020

Background. Buccal space tumors constitute rare pathologies with significant histological diversi... more Background. Buccal space tumors constitute rare pathologies with significant histological diversity. They may pose serious diagnostic and therapeutic challenges for the head and neck surgeon. Methods. A case of buccal space tumor diagnosed and treated in a tertiary center is presented. Clinical presentation, imaging, and surgical approach are discussed, followed by review of the literature. Results. A 79-year-old male patient with a slowly growing painless mass on the right cheek presented to a head and neck reference center. Imaging revealed a tumor of the right buccal space with nonspecific characteristics. Imaging studies revealed extended infiltration of the masseter muscle as well as the anterior border of the parotid gland. FNA biopsy was performed but was nondiagnostic. The decision of surgical excision with a modified parotidectomy incision was taken. The lesion was completely excised with preservation of neighboring facial nerve branches and ipsilateral Stensen’s duct. The ...

Case Reports in Otolaryngology, 2019

Introduction. Cases of extensive nasal polyps rarely occur and may mimic more aggressive lesions ... more Introduction. Cases of extensive nasal polyps rarely occur and may mimic more aggressive lesions of the nose and paranasal sinuses. A case of extensive nasal polyposis with unusually aggressive behavior and its management is presented. Presentation of Case. A 27-year-old male patient visited the emergency department of a tertiary center, complaining of recurrent episodes of epistaxis. The patient presented with a large polypoid lesion protruding from the right nostril and producing asymmetry of the face. Diagnostic imaging illustrated a lesion of the right maxillary sinus producing excessive bone remodeling and extension into neighboring structures in every direction. Fine limits were noted, however, with no invasive characteristics. Biopsy under local anesthesia was performed, showing findings consistent with nonspecific inflammation. Open surgery through a lateral rhinotomy under general anesthesia was performed, and the mass was readily mobilized and removed. No macroscopic invas...

Turkish Archives of Otorhinolaryngology, 2019

Tissue engineering implies a number of established techniques in several fields in medicine. A th... more Tissue engineering implies a number of established techniques in several fields in medicine. A thorough review of current clinical applications for tissue engineering in rhinology is addressed. Current status, as well as, published in vivo studies is presented. Moreover, relevant clinical applications and future perspectives of tissue engineering are demonstrated. There is a lack of high quality clinical studies in the literature regarding the role of tissue engineering in the rhinology field. Further research is needed to translate this concept from bench to bedside.

Journal of Otolaryngology - Head & Neck Surgery, 2014

Background Management of advanced laryngeal cancer is complex and ideal strategy is yet to be def... more Background Management of advanced laryngeal cancer is complex and ideal strategy is yet to be defined. This study evaluates the experience of a single head and neck oncologic centre in the management of T4 laryngeal cancer. Methods Retrospective assessment of cases primarily treated for T4a squamous cell carcinoma of the larynx, between 1980 and 2007, at a tertiary referral center. Results A total of 384 cases were studied. Five-year disease specific survival was 56.2% and local control 87.4%. Regional and distal control estimates were 90.3% and 88.3% respectively. Prognosis was significantly superior for cases treated with primary surgery compared to cases solely managed with non-surgical modalities. Positive surgical margins and regional disease worsened prognosis. Conclusion This study suggests that primary surgery remains a key element in the treatment of advanced laryngeal cancer. The need for well-designed, prospective, randomised studies in order to further evaluate the remai...

Rhinology, 2009

To assess the effect of allergic rhinitis (AR) on septoplasty outcome in terms of subjective and ... more To assess the effect of allergic rhinitis (AR) on septoplasty outcome in terms of subjective and objective measurements and clarify whether patients with nasal septum deviation (NSD) and allergic rhinitis (AR) benefit from septoplasty to the same extent as patients who do not have allergic rhinitis. A prospective study, with consecutive sampling of all patients undergoing septoplasty from June 2005 to February 2007, conducted in a tertiary care otorhinolaryngologic clinic. One hundred and seventy-six patients underwent septoplasty over the study period. Follow-up data were obtained from one hundred and forty-nine subjects. All participants underwent active anterior rhinomanometry (AAR) and assessed the severity of their symptoms based on a Nasal Obstruction Symptom Evaluation (NOSE) Scale prior to and following septo- plasty. Patients were divided into two groups according to AR status. Comparisons were made between symptoms and rhinomanometry data. Following septoplasty, subjective...

Head & face medicine, 2006

Traumatic auricular amputation due to human bite is not a common event. Nonetheless, it constitut... more Traumatic auricular amputation due to human bite is not a common event. Nonetheless, it constitutes a difficult challenge for the reconstructive surgeon. Microsurgery can be performed in some cases, but most microsurgical techniques are complex and their use can only be advocated in specialized centers. Replantation of a severed ear without microsurgery can be a safe alternative as long as a proper technique is selected. We present two cases, one of a partial and one of a total traumatic auricular amputation, both caused by human bites, that were successfully managed in our Department. The technique of ear reattachment as a composite graft, with partial burial of the amputated part in the retroauricular region, as first described by Baudet, was followed in both cases. The prementioned technique is described in detail, along with the postoperative management and outcome of the patients. In addition, a brief review of the international literature regarding ear replantation is performe...

Otolaryngology - Head and Neck Surgery, 2010

The Laryngoscope, 2009

This study aims to assess the oncologic results of open and transoral surgical techniques in T1a ... more This study aims to assess the oncologic results of open and transoral surgical techniques in T1a and T1b category glottic carcinomas. Retrospective clinical study. The files of 438 T1a and T1b glottic cancer cases managed with primary surgery were reviewed. Transoral laser surgery and open surgical procedures used to treat these cases, including cordectomy, vertical partial laryngectomy, and frontolateral partial laryngectomy, were compared for disease specific survival and local control rates. In addition, all techniques were compared for incidence of major complications and related tracheotomies. No statistically significant differences were noted between laser surgery and open procedures with regard to disease specific survival and local control for both T1a and T1b cases. Laser surgery showed a significantly lower incidence of complications and tracheotomies. Laser surgery appears to be a very effective management modality for T1 glottic cancer with comparable results to open procedures and a lower incidence of complications. A transcervical approach should be reserved only for selected cases where individual anatomic factors do not permit complete tumor exposure during diagnostic microlaryngoscopy.

The Laryngoscope, 2009

Genetic alterations, such as microsatellite instability (MSI) and loss of heterozygosity (LOH), h... more Genetic alterations, such as microsatellite instability (MSI) and loss of heterozygosity (LOH), have been detected in various inflammatory diseases, providing evidence that acquired somatic mutations might play a role in the aetiopathogenesis of chronic inflammatory conditions. The aim of this study is to assess the presence of MSI and/or LOH in nasal cytology of patients with nasal polyps. Prospective case-controlled basic science experiment utilizing human blood and human nasal brush samples. Nasal brush samples and peripheral blood from 12 patients with nasal polyps were analyzed. DNA was extracted and analyzed for MSI and LOH using the following microsatellite markers: D2S2113, D6S344, D6S1002, D11S1253, D11S480, USAT24G1, and D13S273, harboring potential susceptibility genes for nasal polyposis. Microsatellite DNA analysis was also performed in 7 control subjects. MSI or LOH were revealed in 3 specimens of the nasal polyps group. Among these there were 2 cases of LOH, one for marker D11S1273 and one for D13S273, and one case of MSI in marker USAT24G1. Each one of these alterations was detected in a different patient. None of the control subjects exhibited any genetic alterations in the 7 markers tested. This is the first time that microsatellite genetic alterations are reported in nasal disease. The presence of such alterations suggests that acquired genomic somatic mutations might play a role in the pathogenesis of nasal polyps.

Pulmonary Pharmacology & Therapeutics, 2010

The author(s) declare that they have no competing interests. Authors' contributions: KS recruited... more The author(s) declare that they have no competing interests. Authors' contributions: KS recruited the study subjects, carried out sputum induction and processing, performed the immuno-magnetic separation studies, and drafted the manuscript. ET conceived of the study, participated in its design and coordination and drafted the manuscript. EN carried out the molecular genetic studies. AK participated in the recruitment of the subjects. IL carried out bronchoscopy and BALF. NT carried out bronchoscopy and BALF and performed the statistical analysis. NS conceived of the study, and participated in its design and helped to draft the manuscript. All authors read and approved the final manuscript.

Oncology Reports, 2007

Genetic alterations in the microsatellite DNA level have been successfully detected in sputum sam... more Genetic alterations in the microsatellite DNA level have been successfully detected in sputum samples of patients with COPD and have been shown to be disease specific. Furthermore, previous studies have shown that inflammation coexists in the nasal mucosa of patients with COPD. The aim of this study was to assess the presence of MSI in nasal cytological samples of patients with COPD comparing the results with sputum samples of the same individuals. Nasal brush samples, sputum samples obtained by induction, and peripheral blood from 20 patients with COPD were analyzed. DNA was extracted and analyzed for MSI using the following microsatellite markers: RH70958, D5S207, D6S344, D6S263, G29802, D13S71, D14S588, D14S292 and D17S250. Microsatellite analysis was also performed in 8 healthy nonsmokers. MSI was detected in the sputum samples of 7 patients with COPD (35%). In contrast, no microsatellite DNA instability was noted in the nasal cytological samples of the same COPD patients. In addition, no genetic alteration was detected in the control group. These results suggest that MSI is a specific finding for the target organ of COPD, i.e. the lungs, despite the fact that inflammation coexists in the nasal mucosa of COPD patients. Our study supports the hypothesis that MSI could be an index of the somaticacquired genetic alterations in the lungs of COPD patients.

Medical Mycology, 2008

Descending mediastinitis occurs as a complication of oropharyngeal or cervical infections and its... more Descending mediastinitis occurs as a complication of oropharyngeal or cervical infections and its delayed diagnosis and treatment are associated with high mortality. A rare case of an odontogenic infection in a diabetic patient, complicated by Candida parapsilosis and Candida krusei parapharyngeal space infection, descending mediastinitis and aspiration pneumonia is described. Isolate identification was based on colonial and microscopic morphological characteristics and carbohydrate assimilation test results. The patient was successfully treated with surgical drainage and debridement, broad spectrum antibacterials and liposomal amphotericin B followed by prolonged oral voriconazole therapy.

Journal of Travel Medicine, 2009

A naphylaxis is an acute, severe reaction that results from the release of preformed and newly sy... more A naphylaxis is an acute, severe reaction that results from the release of preformed and newly synthesized bioactive mediators from mast cells and basophils. 1 More than 500 fatal cases of anaphylaxis per year are estimated to occur in the United States, while more than 12 deaths are reported in Greece. 1-4 Foods, venoms, and drugs are the most common exogenous antigens, which can provoke an immunoglobulin (Ig) E-mediated reaction, whereas exercise, radiocontrast media, as well as nonsteroidal anti-infl ammatory drugs may induce clinical symptoms with a not yet completely understood mechanism. When no etiologic agent is found despite repeated evaluations, the term idiopathic anaphylaxis is used. 2 Food allergy, in particular, is often implicated in multiple allergies as well as in several reactions such as anaphylactic shock, laryngeal angioedema, and severe acute asthma. 5,6 Crete is a 1,000 km coastline island in the south of Greece. Every year almost 3 million tourists visit this island and enjoy its beaches. Some of the commonest causes of anaphylaxis, including hymenoptera bites, high-risk food, exercise, and jellyfi sh bites, are often encountered on the beach. Even though the risk of anaphylaxis in schools and other public places has been emphasized by various authors, no studies regarding the risk of anaphylactic shock on the beach have been reported so far. 3-8 We evaluate the training level of lifeguards working on the beaches of the island of Crete regarding the management of anaphylaxis. In addition, we assess the sufficiency of medical equipment that lifeguards possess to treat an anaphylactic reaction. Method of Study A prospective, randomized study was conducted in an academic tertiary referral medical center (

Journal of Surgical Oncology, 2012

Background and Objective: Base-of-tongue carcinoma is a relatively rare disease with aggressive b... more Background and Objective: Base-of-tongue carcinoma is a relatively rare disease with aggressive behavior and poor prognosis. Up to date no consensus exists regarding the ideal management strategy for each stage of the disease. This study aims to evaluate the experience of a single head and neck oncology center in the management of advanced stage base-of-tongue cancer. Methods: A retrospective evaluation of cases primarily treated for stage III/IV A-B base-of-tongue carcinoma, between 1980 and 2007, at a tertiary referral center. Results: A total of 366 cases were studied. Five-year disease specific survival (DSS) was 42% and local control (LC) 80%. Regional and distal control estimates were 91.3 and 84%, respectively. Prognosis was significantly superior for cases receiving surgery plus adjuvant treatment compared to cases solely managed with non-surgical modalities. Positive surgical margins and regional disease significantly worsened prognosis. Satisfactory retention of pharyngeal function and no fatal complications were noted in surgical cases. Conclusion: Although no consensus exists regarding ideal therapy for advanced base-of-tongue carcinoma, combined strategies with the use of surgery and adjuvant chemoradiotherapy (CRT) seem to offer the best possibility for a positive outcome.

Journal of Surgical Oncology, 2009

This study aims to assess the prognostic significance of free histopathologic margins in the surg... more This study aims to assess the prognostic significance of free histopathologic margins in the surgical treatment of glottic cancer. Furthermore, it evaluates other prognostic factors regarding cases that receive surgical management for glottic lesions. A retrospective case-series study was conducted at an academic tertiary referral center. The files of 1,314 cases that underwent primary surgical treatment for glottic cancer were studied. Various prognostic factors, including age, surgical procedure, T classification, N classification, histological grade, and status of margins were assessed in univariate and multivariate analyses. All variables were investigated for their association with local and regional disease control as well as disease specific and overall survival. Status of margins significantly affected disease specific survival and local control regardless of tumor stage in this series. All other variables assessed in the univariate analysis for their association with survival were also found to be significant. However, status of surgical margins and N classification were the only significant variables in multivariate analysis. The prognostic value of negative surgical margins for the treatment of glottic cancer cannot be overestimated. Responsibility of the surgeon during primary surgical treatment of glottic carcinomas is emphasized.

International Journal of Surgery Case Reports, 2014

INTRODUCTION: A few cases of concomitant medullary and papillary carcinoma in the same thyroid no... more INTRODUCTION: A few cases of concomitant medullary and papillary carcinoma in the same thyroid nodule have been described in the literature. However, the presence of multiple foci of both types of malignancy in the same gland is very rare. PRESENTATION OF CASE: A 39 year-old female with multiple thyroid nodules, elevated serum calcitonin levels and elastographic findings suggestive of thyroid malignancy, underwent total thyroidectomy and central neck dissection. Histology revealed the presence of one focus of medullary and one focus of papillary carcinoma on each thyroid lobe. Subsequently, the patient underwent treatment with radioactive iodine. DISCUSSION: This is the third case of synchronous multifocal medullary and papillary thyroid carcinoma reported in the literature. Several theories for the simultaneous development of these malignant entities have been proposed. CONCLUSION: Ultrasound elastography can be a useful, noninvasive tool in the assessment of thyroid nodules.

International Journal of Medical Sciences, 2012

Head & Neck, 2009

Background. This study was undertaken to evaluate the oncologic results of endoscopic and open su... more Background. This study was undertaken to evaluate the oncologic results of endoscopic and open surgical techniques in early supraglottic cancer. Methods. We performed a retrospective evaluation of 101 patients surgically treated for stage I or II supraglottic carcinomas. Laser surgery, horizontal laryngectomy, and total laryngectomy were compared for disease-specific survival and local control rates. Surgical techniques were additionally compared for incidence of major complications, related tracheotomies, and swallowing function retention. Results. No statistically significant differences were noted among the different types of procedures regarding diseasespecific survival and local control. A lower incidence of major complications, permanent gastrostomies, and significantly lower incidence of tracheotomies were noted for laser surgery compared with open techniques. Conclusion. Larynx-preserving surgical modalities offer comparable oncologic results with total laryngectomy in early supraglottic cancer. In addition, laser surgery has a lower incidence of complications and better functional results compared with open partial or total laryngectomy. V