Dionysios E Kyrmizakis - Academia.edu (original) (raw)

Papers by Dionysios E Kyrmizakis

Archives of Otolaryngology-head & Neck Surgery, Dec 1, 2004

ABSTRACT The use of angiotensin-converting enzyme inhibitors (ACEIs) has been implicated in many ... more ABSTRACT The use of angiotensin-converting enzyme inhibitors (ACEIs) has been implicated in many cases of angioedema, but, given the potential mechanism of this complication, it was not expected to be caused by angiotensin II receptor blockers (ARBs). However, in the past few years, scattered reports of angioedema associated with ARBs have appeared in the medical literature. We performed a retrospective chart review from January 1, 1998, through June 30, 2003, and a review of the literature. During this time, we managed head and neck angioedema induced by ACEIs (n = 27) and ARBs (n = 4) in 31 patients. All of them had significant mucosal swelling, and in some of them dyspnea and dysphagia coexisted. The most frequently involved areas were the oral tongue (13 cases), uvula and soft palate (5 cases), and larynx, mouth floor, and lips (3 cases each). Angioedema may be a more common complication of ACEI and/or ARB use than originally thought. This complication may occur after long-term use of these drugs. We advise that ARBs not be prescribed to patients with a history of angioedema, particularly that due to the use of ACEIs.

Clinical Otolaryngology, Feb 9, 2016

Sir, I am writing to you in reference to a very interesting article published in your esteemed jo... more Sir, I am writing to you in reference to a very interesting article published in your esteemed journal titled ‘The effect of ofloxacin otic drops on the regeneration of human traumatic tympanicmembrane perforations’ by LouZ et al. The study is indeed very interesting and revolutionary in terms of its conclusion, and I would like to compliment the authors for the same. However, I beg to differ from the author’s conclusion and would like to express the same through your esteemed journal. It has been consistently proved inmultitude of studies that most traumatic perforations heal spontaneously and no intervention is required in most of the cases. Even though there have been previous studies in which different materials like fibroblast growth factor and hyaluronic acid have proved to hasten the healing of traumatic tympanic perforations, the logic of using them is derived from the fact that these materials have already been proven to help in early wound healing. The concept of moist environment in the middle ear for the healing of traumatic perforation does seem to be tempting, but in this regard I would like to quote an interesting study by Buyten J et al. in which the authors have proved the healing rates of traumatic perforations are same in ofloxacin versus isotonic saline solution. In such a situation, the use of ofloxacin ear drops for traumatic tympanic perforations, albeit large ones, do not seem to be justified. With the widespread development of drug resistance, our options for treating infections are becoming limited in such a situation the rational use of antibiotics is the need of the hour. A larger prospective randomised study comparing ofloxacin, no intervention and isotonic saline solution should be planned for conclusive evidence in determining the best modality for the management of traumatic ear perforations.

Archives of Otolaryngology-head & Neck Surgery, 2001

Acta otorhinolaryngologica Italica : organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale, 2007

Fibrous histiocytoma is a benign tumour composed of a mixture of fibroblastic and histiocytic cel... more Fibrous histiocytoma is a benign tumour composed of a mixture of fibroblastic and histiocytic cells. Based on the location of this tumour, fibrous histiocytoma are usually divided into cutaneous types and those involving deep tissues. These lesions most often arise on the skin, but may rarely occur in soft deep tissues. The diagnosis of fibrous histiocytoma may be clinically difficult when the lesion is located in the deep tissues, and is frequently confirmed after local excision. The most important diagnostic distinction is the separation of this tumour from aggressive forms of fibrohistiocytic neoplasms, including dermatofibrosarcoma protuberans and malignant fibrous histiocytoma. A 19-year-old male presented with a painless swelling on the right cheek. Detailed clinical and laboratory examinations were performed. The lesion had been totally excised under local anaesthesia, and histopathology revealed a benign fibrous histiocytoma. The diagnosis, location, treatment and prognosis ...

Rhinology, 2000

Topical nasal steroids have become increasingly popular for the treatment of allergic and other t... more Topical nasal steroids have become increasingly popular for the treatment of allergic and other types of rhinitis. However, undesirable local effects of intranasal steroids, such as nasal irritation and burning, crusting and epistaxis are quite common. Candidiasis of the pharyngeal mucosa is a complication, which has not been described so far after treatment of rhinitis with intranasal topical corticosteroids. Between March 1997 and September 1998, we managed to treat successfully three patients with acute erythematous candidiasis of the pharynx, which was the result of the use of intranasal topical steroids. Mechanism, clinical features of acute pharyngeal candidiasis, differential diagnosis and treatment are discussed.

American Journal of Otolaryngology, Jul 1, 1997

The Internet Journal of Otorhinolaryngology, 2007

Objective: To evaluate the treatment of hypertrophy of inferior turbinates' with the combined use... more Objective: To evaluate the treatment of hypertrophy of inferior turbinates' with the combined use of endoscopic bipolar radiofrequencies with lateralization. Design-Setting: Preliminary non randomized prospective uncontrolled clinical trial conducted in a secondary ENT clinic. Participants-Methods: We present the management of 35 patients with hypertrophy of the inferior turbinates using bipolar radiofrequencies submucosally under endoscopic control, in combination with lateralization of the inferior turbinates bilaterally. All the procedures were performed under local anesthesia. Main outcome-Measures: The complications were pain during the procedure in two patients (5.7%) and synechiae in three patients (9.6%). Thirty patients (93.75%) reported a significant improvement of their nasal patency at the end of the fourth month of the follow up based on five point scale. The 12-month follow-up revealed also good results in 26 patients (81.3%). Results-Conclusion: Preliminary results indicate that endoscopic bipolar radiofrequencies and lateralization of inferior turbinates present an efficient outpatient option for the treatment of inferior turbinates hypertrophy. A randomized controlled study has been designed to compare this technique for the treatment of inferior turbinates hypertrophy with radiofrequencies application alone.

Acta oto-rhino-laryngologica Belgica, 2002

Malignant tumors of the temporal bone are rare neoplasms. Adenoid cystic carcinoma (ACC) is the m... more Malignant tumors of the temporal bone are rare neoplasms. Adenoid cystic carcinoma (ACC) is the most common malignant tumor of minor salivary glands, while a quite rare tumor of the major. It is considered a slow-growing tumor with a course that is characterized by local recurrences and late distant metastases to lungs (80-90%), bone and liver. When metastases occur in bone especially the spine, the course of disease is usually fulminant. Intracranial involvement can occur by direct extension, hematogenous or perineural spread and represents an advanced stage of the disease. In this paper, we present a rare case of temporal bone ACC reporting for the first time simultaneous bony and pulmonary distant metastases. The origin, the pathology, the imaging techniques, the differential diagnosis, the treatment options and the prognosis of these tumors are discussed.

Otolaryngology - Head and Neck Surgery, 2001

A 62-year-old man with a history of moderate smoking and drinking presents with a slightly red, e... more A 62-year-old man with a history of moderate smoking and drinking presents with a slightly red, elevated, firm, asymptomatic lesion 1.5 cm in diameter, on the dorsal surface of his tongue (Fig 1). He had no history of illness or hospitalization. Results of the remaining examination of the oral cavity, pharynx, and larynx were normal. He had no cervical adenopathy. An incisional biopsy was performed. Histologic findings showed the lesion to be a granular cell tumor with pseudoepitheliomatous hyperplasia of the overlying squamous epithelium. A few days later, the tumor was excised with a CO2 laser with the patient under local anesthesia. The histopathology report of the surgical specimen confirmed the diagnosis as well as the need for complete excision of the lesion.

Otolaryngology–Head and Neck Surgery

performed via an endonasal microscopic-endoscopic approach. Results: A significant improvement of... more performed via an endonasal microscopic-endoscopic approach. Results: A significant improvement of vision after surgical decompression was obtained in 4 patients: The visual acuity of 2 patients increased from recognition of hand motion to 20/400 and to recognition of count fingers, respectively. Another patient experienced an increase of visual acuity from preoperative light perception to postoperative 20/25. The fourth patient improved from 20/500 to 20/200. After surgery, the fifth patient had no change of his preoperative state of complete amaurosis. No specific surgical complications were seen in any of these 5 cases. Conclusion: The surgical decompression of the optic nerve after a time interval of 1 to 5 days has shown a reasonably improved prognosis for reconstitution of vision. Also the surgical intervention is necessary to be performed as early as possible. According to our results, a late decompression is still beneficial.

Introduction: there is no consensus over the best approach to selection of patients for septoplas... more Introduction: there is no consensus over the best approach to selection of patients for septoplasty. Clinical examination is often inadequate and objective testing has not gained wide popularity due to technical, cost and training issues. The aim of this study was to evaluate bilateral nasal spirometry (BNS) as a quick and easily interpretable method of selecting appropriate candidates for septoplasty. BNS measures airflow asymmetry caused by a nasal septal deviation (NSD) and it is expressed as the nasal partitioning ratio (NPR). The NPR after decongestion can be used as an objective measure of the degree of NSD. NPR ranges from –1 (complete left nasal obstruction) to +1 (complete right nasal obstruction). Patients/methods: Thirty patients (25 males/5 females, mean age 33 years) with nasal obstruction and a NSD were assessed by subjective measures (NOSE score, 10 cm visual analogue scale, 10-point double vertical scale) and the BNS before and after septoplasty. Thirty healthy contr...

Nonmicrosurgical reconstruction of the auricle after traumatic amputation due to human bite

Lymphoepithelial carcinoma is a rare type of undifferentiated carcinoma, characterized by atypica... more Lymphoepithelial carcinoma is a rare type of undifferentiated carcinoma, characterized by atypical epithelial cells surrounded by a reactive lymphoplasmacytic infiltrate. We report a case of sinonasal lymphoepithelial carcinoma arising in the left maxillary sinus in an 80-year-old Caucasian male patient. The lesion had invaded the adjacent lateral wall of the nasal cavity appearing on the palate as a painful swelling. There was no evidence of tumor involvement from the nasopharynx and larynx assessment and no swollen cervical lymph nodes were noticed on the head and neck imaging examination. An incisional biopsy from the oral cavity, as well as an endoscopic biopsy of the neighboring nasal mass were performed. The histopathological and immunohistochemical analysis of both specimens showed identical features and a common diagnosis of sinonasal lymphoepithelial carcinoma was rendered. In conclusion, oral swellings located on the palate may be associated with maxillary sinus malignancies. Thus, the clinician should include in the differential diagnosis not only primary oral carcinomas, but also malignant neoplasms arising from neighboring anatomic sites.

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 ...

British Journal of Medicine and Medical Research, 2016

$Research paper thumbnail of Combined irinotecan, docetaxel and conventionally fractionated radiotherapy in locally advanced head and neck cancer. A phase I dose escalation study$

Anticancer research

Both docetaxel and irinotecan have shown strong radiosensitizing properties in vitro. Encouraging... more Both docetaxel and irinotecan have shown strong radiosensitizing properties in vitro. Encouraging results have been reported by phase I/II studies on combined docetaxel or irinotecan with radiotherapy. In the present study we investigated the feasibility of double radiosensitization with weekly docetaxel and irinotecan in head and neck cancer. Twelve patients with locally advanced squamous cell head and neck cancer were recruited in a phase I/II dose escalation protocol. Radiotherapy was given as a standard fractionation regimen (2 Gy/day, 5 fractions/week) to a total dose of 66-70 Gy. Three Docetaxel/Irinotecan dose levels were examined thus, 20/25 mg/m2 (level 1), 20/40 mg/m2 (level 2) and, 25/55 mg/m2 (level 3). Severe asthenia was observed in 1/4 patients treated in the 2nd dose level and in all 4 patients treated in the 3rd. The onset of severe asthenia was associated with the onset of severe grade 3/4 mucositis during the 4th week of treatment. Radiation induced mucositis was ...

The Journal of Laryngology & Otology, 2010

Aim:To present the current treatment approach for oroantral fistula causing maxillary sinusitis.D... more Aim:To present the current treatment approach for oroantral fistula causing maxillary sinusitis.Design:Case series. Four cases of oroantral fistula (diameters: 6, 9, 11 and 13 mm) due to chronic maxillary sinusitis were treated by excision of all diseased oroantral fistula tissue, followed by endoscopic creation of a large middle antrostomy and closure of the fistula using buccal flaps. A synthetic surgical glue and local alveolar bone were used.Results:Patients were followed up for six months to three years; all were considered cured.Conclusion:Most surgeons use buccal or palatal flaps, combined with the Caldwell–Luc procedure, to treat chronic odontogenic sinusitis and to repair fistulae more than 5 mm in diameter. This study supports the hypothesis that an endoscopic technique could be successfully used in patients with oroantral fistula causing chronic maxillary sinusitis of dental origin, instead of the Caldwell–Luc procedure, at least in patients with a small to medium-sized o...

Auris Nasus Larynx, 2001

Objecti6e: To show the superiority of 'two-man' FNAB technique comparing to the standard FNAB tec... more Objecti6e: To show the superiority of 'two-man' FNAB technique comparing to the standard FNAB technique, in order to identify the cause of non-thyroid neck masses. Methods: Over an 18 months period, a consecutive paired study was conducted in the tertiary referral Venizelion General Hospital. Forty-four cytologic examinations were performed in patients with non-thyroid head and neck masses. The samples were taken from the same side using both techniques the standard FNAB technique and the 'two-man' FNAB technique (for which two persons carried out the procedure). The slides were seen by the pathologist and were defined as diagnostic, suggestive or inconclusive. The diagnosis was confirmed in any case by definite histology after surgical treatment or open biopsy. Results: From 44 samples taken with the 'two-man' technique, 34 were diagnostic (all true) verified by histopathology, seven suggestive (five true and two false) and three inconclusive (6.82%). The correct diagnosis was confirmed in 39 cases (88.64%). From 44 samples of standard technique, 22 were diagnostic (all true), 12 suggestive (five true and seven false) and 10 inconclusive (22.72%). The correct diagnosis was confirmed in 27 cases (61.36%). The accuracy of diagnosis with the standard FNAB technique was 0.79 (SE =0.07), while with the 'two-man' FNAB technique was 0.95 (SE = 0.03), a significant statistical difference (Fischer exact test, P=0.041). Conclusions: 'Two-man' FNAB technique proved to be as safe and patient friendly as the standard FNAB, but more accurate and may be easier to perform than this. The 'two-man' FNAB technique could become the preferred method for fine-needle cytology, particularly for difficult to reach areas of the head and neck.

American Journal of Otolaryngology, 1998

European Journal of General Practice, 2007

Several reports on angioedema (AE) related to the use of angiotensin-converting enzyme inhibitors... more Several reports on angioedema (AE) related to the use of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) have been published recently. This study reports on the experience gained at the Ear, Nose, and Throat (ENT) Clinic of the University Hospital of Heraklion, Crete. A retrospective chart review of the patients admitted to this clinic, in a 42-month period (1999-2003), and discharged with a diagnosis ENT code for AE was performed (14 eligible patients). A complementary telephone survey was conducted during January 2005. Ten patients responded to our invitation. Of those patients, five were under ACE-I and one was under ARB treatment during the AE episode. The mean length of time between the onset of symptoms and presentation to the hospital was 4.5 hours (range 0.5-12 hours). The mean duration between the initiation of antihypertensive treatment and AE episode was 26.2 months (range 1-60 months). Patients reported that no information was provided about the possible adverse effects of these drugs. Although AE introduced by ACE-I and ARBs is an uncommon side effect, this case series conveys a key message to primary care physicians.