Pantelis Vassiliu - Academia.edu (original) (raw)

Papers by Pantelis Vassiliu

British Journal of Surgery, Nov 28, 2023

American Surgeon, Mar 1, 2001

Cervical aerodigestive trauma is rare and most centers have a limited experience with its managem... more Cervical aerodigestive trauma is rare and most centers have a limited experience with its management. The purpose of this review was to study the epidemiology, diagnosis, and problems related to the early evaluation and management of these injuries. This was a retrospective study based on trauma registry and on chart, operative, radiological, and endoscopic reports. There were 1560 admissions with blunt or penetrating trauma to the neck. The overall incidence of aerodigestive trauma was 4.9 per cent (10.2% for gunshot wounds, 4.6% for stab wounds, and 1.2% for blunt trauma). All patients with aerodigestive trauma had suspicious signs or symptoms on admission. The most common life-threatening problem in the emergency room and directly related to the aerodigestive trauma was airway compromise. Twenty-nine per cent of patients with laryngotracheal trauma required an emergency room airway establishment because of threatened airway loss. Although rapid sequence induction was successful in the majority of cases, in 11.9 per cent there was loss of airway and a cricothyroidotomy was necessary. Overall, 9 per cent of cases with aerodigestive injuries were successfully treated nonoperatively. Thirty-six per cent of patients with laryngotracheal trauma and surgical repair were successfully treated without a protective tracheostomy. There was no mortality due to the aerodigestive injuries. Cervical aerodigestive trauma is rare. In conclusion, all patients with significant aerodigestive injuries requiring treatment had suspicious signs and symptoms. Airway compromise was a common problem in the emergency room. Loss of airway after rapid sequence induction is a potentially lethal complication and the trauma team should be ready for a surgical airway. Repair of laryngotracheal injuries without a protective tracheostomy is safe in selected cases.

Hellenic Journal of Surgery, May 1, 2018

The paper of Tsiftsis and colleagues [1], published in this issue is both novel and substantial. ... more The paper of Tsiftsis and colleagues [1], published in this issue is both novel and substantial. In the "dry" Hellenic environment the interest in scientific publishing diminished during the financial crisis, which relegated novel academic activities to a lower priority. The paper answers a focused and clinically applicable dilemma, with valid scientific methodology. The effort of the authors is most welcome under these circumstances, as the study was conducted by clinicians who deal with emergency cases, and who, over and above their clinician responsibilities, found the time to cooperate on the design and execution of an academic product. Focusing on the field of trauma, they have elected to evaluate the efficacy of a diagnostic tool, ultrasonography (U/S), that needs no consumables, is noninvasive, does not convey radiation, can be used in situ by the clinician and can give substantial information (if not always a diagnosis) that allows the emergency physician to make rapid and objectively justified clinical decisions. In the Hellenic environment, all these features constitute a major medicoeconomic advantage. We are all aware that all tertiary hospitals on emergency duty accept patients from the National Ambulance Services, as well as direct from the community, with no limitations. The volume and diversity of these cases is enormous, and not all comprise emergencies. Triage is conducted by capable doctors who identify the emergency, urgent, chronic and simple cases [2]. The system does not allow for the less urgent cases to be to deferred until the next day, as such a hospital, in the mind of the health consumers is "the end of the road". An answer and a definitive one, must be given to their problem, "here and now". On top of that, every case

Journal of Investigative Surgery, Dec 21, 2020

Primary Gastrointestinal Angiosarcoma (PGAS) constitutes a rare malignant tumor arising from vasc... more Primary Gastrointestinal Angiosarcoma (PGAS) constitutes a rare malignant tumor arising from vascular or lymphatic endothelial cells. The aim of this study was to review the available literature on PGAS and to elucidate its biological behavior and optimal therapeutic approach. PubMed and Embase bibliographical databases were systematically searched (last search April 8 th , 2020) for studies concerning PGAS. Ninety-eight studies met our inclusion criteria, involving 110 patients (male/female ¼ 1.5) with an age of 62.40 ± 17.84 (mean, SD) years. They were most frequently located at small (44.5%) and large intestine (35.5%), while 12.7% were multifocal. Surgical resection of the tumor was conducted at 84.0% of the cases combined with adjuvant therapy at 12.3%. One-year cumulative survival was 55.18% (95% CI: 34.33%-71.84%) for large intestine, 30.2% (95% CI: 17.1%-44.5%) for small intestine, whereas multifocal PGAS had a 6-months cumulative survival of 23.08% (95% CI: 5.58%-47.46%). Therefore, PGAS is an extremely rare entity with atypical clinical presentation, challenging diagnosis and aggressive behavior. High clinical suspicion is crucial for its prompt management. Further studies and the development of novel therapeutic agents are required in order to improve survival.

Cureus, Jul 24, 2023

Background: Renal cell carcinoma (RCC) is the most common primary kidney cancer. In up to 4-10% o... more Background: Renal cell carcinoma (RCC) is the most common primary kidney cancer. In up to 4-10% of patients, the tumor is complicated with a malignant thrombus extending to the inferior vena cava (IVC). Complete surgical excision of the RCC and the neoplastic thrombus can be curative. We aim to present a safe and feasible alternative transabdominal operative technique with the omission of thoracotomy, as applied in six patients diagnosed with RCC and IVC thrombus extending over the diaphragm. Methods: This case series study was conducted in a tertiary university hospital in Athens, Greece. All six patients, who were operated on for RCC and a malignant thrombus exceeding in the intrapericardial IVC in our department from January 2009 until March 2020, were screened. Intraoperatively, the infrarenal and intrapericardial IVC were clamped simultaneously with the renal and liver blood inflow. Access to the intrapericardial IVC was obtained via the central tendon of the diaphragm. Intrathoracic extension of the tumor was confirmed by transesophageal or intraoperative ultrasonography. The intrathoracic IVC was exposed to direct vision and two finger palpation was applied to secure the clamping of the IVC above the tip of the thrombus. The tumor was resected through a longitudinal venotomy and the operation was completed on a standard radical nephrectomy. Results: During the study period six patients presented with RCC and intrapericardial IVC thrombus. All patients, five female and one male, underwent radical nephrectomy combined with IVC thrombectomy, without the need for a thoracotomy. The mean age was 66 years old and the mean operative time was 122.5 minutes. Mean blood loss was 338 ml and only four of the patients were transfused with two units of RBC. Operative and hospital mortality was 0%. The hospital stay was seven (six to nine) days. Only one patient required readmission and reoperation 30 days later, due to intrapericardial herniation. Conclusions: The proposed surgical technique may be curative in patients with advanced intracaval thrombus and helps reduce the associated morbidity, mortality, and the overall cost of more extended operations.

Annals of Vascular Surgery, Nov 1, 2021

Trauma and abdominal surgery that involves the diaphragm and pericardium rarely ends up in post-o... more Trauma and abdominal surgery that involves the diaphragm and pericardium rarely ends up in post-operative visceral herniation into the pericardial cavity. Urgent intervention is crucial to restore the cardiac output and prevent bowel strangulation. A case of a patient with intrapericardial hernia following nephrectomy for renal cell carcinoma and en block resection of an IVC neoplasmatic thrombus via transdiaphragmatic approach is presented.

Journal of B.U.ON. : official journal of the Balkan Union of Oncology, Mar 1, 2021

COVID-19 pandemic has obviously affected patients' behavior towards seeking medical help as well ... more COVID-19 pandemic has obviously affected patients' behavior towards seeking medical help as well as physicians' decision in the management of emergencies. Our recent experience as surgeons at a COVID-19 referral hospital revealed cases which share an alerting characteristic: the delay in appropriate management. Unfortunately for COVID-19 negative patients a "coronacentric" health system has been adopted. In view of measures applied to avoid spread of the disease, a significant delay in patients' presentation as well as in their in-hospital management is observed. We present cases where delay in appropriate management affected the patients' outcome and underline the fact that balancing between COVID-19 safety measures and a patient who needs urgent treatment can be very challenging and stressful.

Archives of Surgery, May 1, 2001

Hypothesis: Spiral computed tomographic pulmonary angiography (CTPA) is sensitive and specific in... more Hypothesis: Spiral computed tomographic pulmonary angiography (CTPA) is sensitive and specific in diagnosing pulmonary embolism (PE) in critically ill surgical patients. Design: Prospective study comparing CTPA with the criterion standard, pulmonary angiography (PA). Setting: Surgical intensive care unit of an academic hospital. Patients: Twenty-two critically ill surgical patients with clinical suspicion of PE. The CTPAs and PAs were independently read by 4 radiologists (2 for each test) blinded to each other's interpretation. Clinical suspicion was classified as high, intermediate, or low according to predetermined criteria. All but 2 patients had marked pulmonary parenchymal disease at the time of the event that triggered evaluation for PE. Interventions: Computed tomographic pulmonary angiography and PA in 22 patients, venous duplex scan in 19. Results: Eleven patients (50%) had evidence of PE on PA, 5 in central and 6 in peripheral pulmonary arteries. The sensitivity and specificity of CTPA was, respectively, 45% and 82% for all PEs, 60% and 100% for central PEs, and 33% and 82% for peripheral PEs. Duplex scanning was 40% sensitive and 100% specific in diagnosing PE. The independent reviewers disagreed only in 14% of CTPA and 14% of PA interpretations. There were no differences in risk factors or clinical characteristics between patients with and without PE. The level of clinical suspicion was identical in the 2 groups. Conclusions: Pulmonary angiography remains the gold standard for the diagnosis of PE in critically ill surgical patients. Computed tomographic pulmonary angiography needs further evaluation in this population.

International Journal of Colorectal Disease, Jan 7, 2021

Diverticular disease (DD) refers to the presence of diverticula throughout the gastrointestinal (... more Diverticular disease (DD) refers to the presence of diverticula throughout the gastrointestinal (GI) tract, mainly along colon. DD might evolve into diverticulitis that is accompanied by severe clinical presentation, which includes abscess formation, perforation, stricture, obstruction and/or fistula. The aim of the present review is to summarize the role of molecular and genetic factors in DD development, as well as their possible contribution towards new prognostic indicators, diagnostic algorithms and new therapeutic approaches. Except from common predisposing parameters, several genetic mutations, immune factors, neurotransmitters, hormones and protein dysfunctions have been associated to the early onset of DD symptoms, pathogenesis and prognosis of the disease. Specific structural changes in the colonic wall, altered matrix composition and compromised motility have been verified as possible pathogenic factors for the development of DD. Dysregulation in peristaltic activity and reduced ability of the longitudinal muscle to relax following contraction has been also associated with DD evolution. In addition, it has been suspected that genetic defects combined with alterations in intestinal microbiota might play an important role in diverticulitis presentation.

International Surgery, Dec 13, 2017

Journal of The American College of Surgeons, Feb 1, 2002

BACKGROUND: Angiographic embolization (AE) is increasingly used to control bleeding after severe ... more BACKGROUND: Angiographic embolization (AE) is increasingly used to control bleeding after severe trauma. Serious concerns have been raised about the safety of high-volume IV contrast in hypotensive, hypovolemic patients. STUDY DESIGN: In a prospective cohort study, 100 consecutive trauma patients underwent AE for bleeding in the abdomen and pelvis. Serum creatinine (Cr) levels were measured before the procedure and up to 5 days after the procedure. Contrast nephropathy was defined as an increase in Cr levels after AE of more than 25% over the baseline measurement. An average of 248Ϯ59mL of nonionic, low-osmolality contrast was used in all cases. RESULTS: Compared with the baseline, no increase in Cr levels after AE was observed among all patients (1.02Ϯ0.24 versus 0.94Ϯ0.26mg/dL; pϭ0.01) or among subgroups of patients who had any of the following risk factors for renal failure: older than 60 years, Injury Severity ScoreՆ15, shock on arrival, renal injury, elevated Cr levels (Ն1.5mg/dL) before AE, or administration of a high volume of contrast (Ͼ250mL). Contrast nephropathy developed in five patients by means of mild Cr elevations. In all of these patients, Cr returned to baseline within 5 days of AE. Renal failure requiring hemodialysis developed at 41 and 55 days after AE in two patients with multiple organ failure who eventually died. CONCLUSIONS: Administration of nonionic contrast during AE causes mild and transient contrast nephropathy in 5% of severely injured patients. Our study adds additional support for the safety of AE for trauma. (

Introduction: The genesis of pilonidal sinus disease is still disputed, but there is mounting evi... more Introduction: The genesis of pilonidal sinus disease is still disputed, but there is mounting evidence that occipital cut hair may play a major role, with the folliculitis theory losing ground. Translocation of cut hair from the head to the lower back has not been proven so far. Methods: Eight men were asked to undress their upper body immediately following a dry haircut. A large layer of sticky transparent plastic sheeting was applied to their chest and back, then removed and placed on millimeter scale paper, fixing all hairs in position. Cut hairs were counted and the totals were transferred to Excel matrix datasheets. Results: Despite protective measures taken during haircuts, all customers had cut hair on their upper body (chest and back) (38-630 hair fragments; median 325), with the majority of hairs (62%) located on the back. Cut fragments were mostly found close to or within the sweat crest, and were also present in the lower back. Conclusion: Any haircut results in large numbers of sharp hair fragments on the upper body despite the use of a protective gown and an elastic paper collar. This sharp hair slides down the posterior sweat crest towards the nates and into the intergluteal fold, where it can inject itself into the healthy skin. Young patients should shower or take a bath following a haircut to reduce their intergluteal hair load. It is highly likely, but not yet proven, that the frequent exposure to a large number of cut hair fragments at a certain age leads to pilonidal sinus disease. If we solve this question, then prevention of pilonidal sinus would be possible.

Surgical Oncology-oxford, May 1, 2022

Desmoid-type fibromatosis (DF) is a distinctly rare condition, mostly of younger adults, characte... more Desmoid-type fibromatosis (DF) is a distinctly rare condition, mostly of younger adults, characterized by the development of locally aggressive tumors of mesenchymal origin. Desmoid tumors (DT) arise either sporadically or in association with FAP (familial adenomatous polyposis), although certain risk factors have also been identified, including pregnancy and antecedent surgical trauma. They can emerge from any connective tissue including muscle, fascia and aponeurosis and are therefore classified, according to location, as intra-abdominal, of the abdominal wall and extra-abdominal. Despite the lack of metastasizing potential, the course can be unpredictable. Various mutations of APC and β-catenin genes, among others, play a catalytic role in the pathogenesis of this neoplastic entity. Surgery has lost its traditional role as first line treatment of the disease and several other treatment methods are being considered. Cytotoxic chemotherapy, non-cytotoxic systemic therapy and targeted therapy have been revealed as part of different treatment regimens. Recent progress regarding DT biology and molecular pathways has led to the development of promising novel biological agents. In any case, a multidisciplinary approach is required and is gradually employed, espe-cially in intra-abdominal DTs. In this review, we aim to present current knowledge on DF and summarize current treatment regimens as well as their effectiveness, with emphasis on the intraperitoneal type of DT.

The American Surgeon

Örebro University Hospital, 2017

Journal of the Pancreas, 2017

Context/Objective The aim of this study was to evaluate the effect of extended lymphadenectomy in... more Context/Objective The aim of this study was to evaluate the effect of extended lymphadenectomy in a subgroup of patients with early stage periampullary cancer. Methods From January 2005 until December 2010, 152 consecutive patients underwent pancreaticoduodenectomy in a single institution for periampullary adenocarcinoma. Half of these patients were subjected to standard pancreaticoduodenectomy, and comprised the control group of this study while the other half underwent an extended lymph node dissection approach. The subjects of each group were divided in two subgroups according to the size of the primary tumor, with a cutoff of 2 cm. Results There were no significant differences in age (median age 61 and 62 in two groups respectively) and gender distribution (65.8% versus 60.6% male) among study groups, nor in the primary tumor size (median size 3.15 and 3.11 in two groups respectively). All patients underwent a pylorus preserving standard or extended lymph node dissection pancrea...

Indian Journal of Surgery, 2019

Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in publishe... more Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.