Petros Vlastarakos - Academia.edu (original) (raw)

Papers by Petros Vlastarakos

PubMed, 2013

Introduction: The authors present a potential complication associated with the surgical managemen... more Introduction: The authors present a potential complication associated with the surgical management of post-tonsillectomy haemorrhage using absorbable cellulose haemostatic dressings. The article discusses the deficiencies of our current understanding of how best to manage this common and potentially life-threatening ENT emergency. Case report: A 40-year-old man presented to Accident-and-Emergency with a post-tonsillectomy haemorrhage on the 7th postoperative day. The bleeding was managed surgically, with suturing of the faucial pillars incorporating a piece of Surgicel into the closure. Two days later the patient experienced an episode of partial airway obstruction, due to a piece of dislodged haemostatic material, owing to failure of the closure. The techniques used in the operative management of post-tonsillectomy bleeding are not formally evaluated or discussed in the current literature, and in some cases are unreliable or even potentially hazardous. Further discussion, research, and formulation of a more stepwise approach would be of considerable benefit.

PubMed, 2020

Elective tonsillectomy remains one of the most commonly performed operations in otolaryngology, w... more Elective tonsillectomy remains one of the most commonly performed operations in otolaryngology, with postoperative hemorrhage (PTH) being the most significant potential complication. Anecdotal evidence among ENT Surgeons suggested that bodybuilding athletes may be at increased risk of suffering from PTH, a notion corroborated by a recent case report, regarding primary PTH. The problem has been attributed to muscle-enhancing dietary supplements, or androgenic anabolic steroid abuse, albeit without satisfactory explanation regarding the mechanism of potential action. That is because, blood coagulation tests performed preoperatively are typically normal, and extensive blood coagulation workup postoperatively is not suggestive of any bleeding tendency. We recently came across two cases of PTH in male patients practicing body building. Both were in their mid-twenties, had regularly been using muscle enhancing dietary supplements, and occasionally androgenic anabolic steroids; the first up to four months preoperatively, whereas the second was still an active user at the time of the tonsillectomy. The first patient experienced five episodes of PTH, from the fourth until the 23 rd postoperative day, and required bipolar cautery in theatre on the first two occasions, with the latter three episodes being managed with oxygen peroxide-soaked tamponade in an outpatient setting. The second patient experienced persistent intraoperative bleeding and two postoperative PTHs on the first and 11 th day, requiring bipolar cautery in theatre. Pre-and postoperative blood coagulation workup were normal in both patients, and abdominal U/S did not suggest a fatty liver. Hence, the condition of the tonsillar vasculature remained as the last potentially implicated part of the patients' bleeding tendency. Indeed, vascular fragility resulting from pressure and minor traumas is known to be a potential complication of hypercorticism (i.e. anabolic steroid abuse), and incipient vasculitis may be associated with high protein and amino-acid intake for muscle enhancement, due to the occurring oxidative stress and the ensuing free radical cascade. PTH is a common emergency encountered in ENT surgical practice, affecting 2.5-4.1% of patients with normal coagulation studies. However, bodybuilding enthusiasts may represent a subgroup of an otherwise healthy population with higher potential risk of PTH, not only requiring appropriate preoperative informed consent, with frank account of the substances used for performance enhancement, but also increased perioperative vigilance, and prolonged period of postoperative observation. ENT Surgeons should be aware of the increased possibility of PTH even in apparently healthy and fit bodybuilding enthusiasts, and the necessity of repeated surgical management in most of these cases.

Indian Journal of Plastic Surgery, May 1, 2018

Shaping the nasal tip is one of most challenging parts of rhinoplasty. Evolving experience has sh... more Shaping the nasal tip is one of most challenging parts of rhinoplasty. Evolving experience has shifted nasal tip surgery from alar cartilage-cutting techniques to alar cartilage-sparing surgery. [1] Hence, intervening in the nasal tip increasingly relies on cartilage relocation and reorientation , rather than reduction and cutting.

Journal of Otolaryngology-ENT Research, Jun 22, 2016

Intensive and Critical Care Nursing, Feb 1, 2016

The objective of this study was to investigate the effect of relaxation techniques on the stress/... more The objective of this study was to investigate the effect of relaxation techniques on the stress/anxiety of parents with hospitalised premature infants, three months following discharge from the neonatal intensive care unit. A randomised controlled trial was conducted in the neonatal intensive care unit of a tertiary maternity hospital including 59 parents, who were randomised into two groups: 31 in the intervention group and 28 in the control group. Parents in the intervention group practiced three different relaxation techniques, in addition to undergoing the same information-based training courses as did the parents of the control group. Data were collected 10-15 days post delivery and three months post discharge. The assessment measures included the Perceived Stress Scale, the State and Trait Anxiety Inventory 1 and 2 and salivary cortisol levels. The psychometric assessment at baseline was comparable between the two groups. The intervention group showed a significant reduction in trait anxiety (p=0.02) compared with the control group three months post discharge. The perceived stress decreased in both groups (p=0.699). No difference in salivary cortisol levels was detected. The multivariate analysis revealed that higher initial stress levels (p&amp;amp;amp;amp;amp;lt;0.001) and university/college education (p=0.003) were associated with higher parental stress, whereas moderate-to-high income satisfaction was associated with lower parental stress (p=0.003). Further long-term follow-up of families with a neonatal intensive care unit experience could assess more delayed effects of stress management by relaxation techniques.

Archives of academic emergency medicine, Jan 5, 2021

Central European Journal of Public Health, Mar 1, 2015

Ear, nose, & throat journal, Apr 24, 2019

The present study aimed to identify the association between sociodemographic and lifestyle-relate... more The present study aimed to identify the association between sociodemographic and lifestyle-related factors with the response time from the appearance of symptoms potentially related to head and neck cancer (HNC) and gain an insight regarding the main source of health information about this specific area. Specific perceptions about human papillomavirus (HPV) infection in the head and neck area were also explored. An Internet-based survey was conducted between June 30, 2016, and July 31, 2016, using a structured questionnaire. The study sample comprised 1058 adults. A direct association was found between the response time period from the potential appearance of a mouth ulcer/soreness (P < .001), earache (P ¼ .014), hoarseness (P < .001), or painless lump in the neck (P ¼ .003) and alcohol consumption, as well as between smoking (P ¼ .012) and soft-drink consumption (P < .001) and the appearance of hoarseness. Inverse association was found between age and the appearance of a mouth ulcer/soreness (P ¼ .017) and between a person's educational level (P < .001) and yearly income (P ¼ .006) and the appearance of an earache. A total of 79.1% of study participants seemed aware that oral sex represents the main mode of HPV transmission; this understanding was directly associated with a person's educational level (P < .001) and yearly income (P ¼ .001) and inversely associated with alcohol consumption (P ¼ .037). Health policy makers and health professionals need to devise strategies to increase the awareness of HNC risk associated with sexual behavior especially in young adults. The repressing effect of alcohol on timely patient response should be demonstrated in targeted campaigns, and the understanding of the ''iceberg phenomenon,'' frequently associating even common head and neck symptoms with HNC, acknowledged in undergraduate and postgraduate physician training.

Advances in Anatomic Pathology, 2000

Balkan medical journal/Balkan Medical Journal, Jan 26, 2024

Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is the causative factor of coronavir... more Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is the causative factor of coronavirus disease 2019 (COVID-19) infection, and since 2020, it has developed into a public health emergency of international concern, displaying the characteristics of a pandemic. The mutagenic evolution of the virus has led the World Health Organization (WHO) to identify several variants of interest and a smaller, albeit significant, number of variants of concern (VOC). The Omicron variant is the fifth VOC announced by the WHO. It forms the genetic basis for the emergence of new SARS-CoV-2 variants because of its dominant presence since February 2022, coupled with its high antigenic and functional plasticity. 1

Journal of Plastic Reconstructive and Aesthetic Surgery, May 1, 2010

Pinna deformities, combined with congenital aural atresia, have been a matter of serious debate i... more Pinna deformities, combined with congenital aural atresia, have been a matter of serious debate in the literature as they are associated with major aesthetic and functional problems that are difficult to manage. These problems have been described as early as 2000 BC. The aim of the present article is to approach the whole problem as one (pinna malformation and aural atresia) and present the history as well as the current approaches in reconstruction. Extensive literature search and medical history books were used as scientific sources. For many centuries, the prevalent view was that any surgical attempts to reconstruct the pinna and the ear canal were of little value. In addition, the aesthetic result of these early surgical procedures was mostly unacceptable. Over time, new surgical techniques and synthetic materials were used, leading to satisfactory and lasting aesthetic and functional results in selected patients, improving their quality of life, while reducing the complication rate. However, many cases are still challenging for plastic surgeons and ENT surgeons alike. Despite significant progress in the field, surgery for pinna deformities combined with congenital aural atresia still remains one of the most challenging and risky procedures. Accurate audiological evaluation of newborns as well as assessment of their craniofacial development is necessary and can help the plastic surgeons and otologists choose proper candidates for surgical repair and a suitable and age-appropriate therapeutic plan. History and repeated failures have taught us that close multidisciplinary approach is of paramount importance.

European journal of public health, May 9, 2007

Background: To assess health practitioners' views on the issue of hospital administration and exp... more Background: To assess health practitioners' views on the issue of hospital administration and explore possible conflicts. Methods: Questionnaire-based, multi-stage cluster sampling technique was used as the design,in which 124 doctors, 154 certified nurses and 15 hospital managers participated. Results: Only 39% of doctors and 51% of nurses were aware of the manager's basic degree and 70% of them considered it inadequate. Health sciences were chosen as the best basic degree for effective management by 65% of health practitioners. Moreover, 74% of doctors and 96% of nurses believed that an interdisciplinary board of directors, with the manager acting as a chairman could be the ideal administrative model. Even though this model was the current system in the interviewed hospitals, most health practitioners (87%) considered it ineffective. With regard to the acceptance of the manager as authority in the hospital, 76% of the doctors believed that there were related problems (47% considered the manager as an outsider to the health sector), whereas only 45% of the managers admitted such problems. Trainees showed a less tolerant attitude towards managerial administration in comparison to specialists. Conclusion: Most health professionals believe that hospital administration is ineffective. The interdisciplinary model, with a manager having both health sciences and economics degrees and exercising his/her role with flexibility and taking the widest consent of health professionals may improve the very low rates of acceptance and perceived efficacy. Trainees and nurses seem to often have different views, suggesting the importance of their participation in the administrative model.

Metastatic tumors of the tongue are rare, most commonly arising from carcinomas of the lung, kidn... more Metastatic tumors of the tongue are rare, most commonly arising from carcinomas of the lung, kidney, breast, and melanomas. They usually appear in end-stage disease, especially in the tongue base, probably because of the rich blood supply. Metastatic sarcomas of the tongue are even rarer. We report the seventh case of metastatic tongue sarcoma and the first one in the literature, arising from a pleomorphic malignant fibrous histiocytoma (MFH) of the lower extremity. ENT surgeons, Maxillofacial surgeons, and Oncologists should be aware of the possibility of metastatic sarcomas of the tongue, even though these lesions are extremely rare. Furthermore, metastatic sarcomas of the tongue represent a late manifestation of a previously identified primary tumor, although if the primary site has not been identified, a thorough investigation to locate an occult tumor should be conducted.

PubMed, Aug 1, 2016

Our aim was to critically assess the influence of preoperative computed tomography (CT) scans on ... more Our aim was to critically assess the influence of preoperative computed tomography (CT) scans on implantation decisions for adult cochlear implant candidates. The working hypothesis was that these routine scans might not provide critical additional information in most adult cochlear implant candidates. The charts of 175 adults with unilateral cochlear implantation were reviewed. Preoperative CT scan reports were audited, and scans with reported pathology were examined by an Otologist/ENT Surgeon. Clinic notes and multidisciplinary team meeting summaries were also analyzed to assess whether the results of the radiology report had influenced the decision to implant or the laterality of implantation. Twenty-five of the 175 scans (14.3%) showed an abnormality. Five of those 25 scans showed evidence of previous surgeries already known to the clinicians. Of the remaining 20 scans, 17 showed abnormalities, including wide vestibular aqueducts, Mondini deformities, and varying degrees of otospongiosis, the identification of which can be considered preoperatively helpful. Of the 175 scans, 3 (1.7%) demonstrated abnormalities that influenced the side of implantation or the decision to implant and, therefore, had an impact on treatment. We conclude that a preoperative CT scan seems to have an impact on treatment in only a small percentage of adult cochlear implantees. Hence, it may only need to be performed in patients with a history or clinical suspicion of meningitis or otosclerosis, if the individual was born deaf or became deaf before the age of 16, or if there are other clinical reasons to scan (e.g., otoscopic appearance). The related resources can be allocated to other facets of cochlear implant programs.

Clinical Pediatrics, Mar 28, 2013

To provide an easy-to-follow evidence-based diagnostic and therapeutic algorithm for the manageme... more To provide an easy-to-follow evidence-based diagnostic and therapeutic algorithm for the management of chronic otitis media (COM) in children. Materials/Methods: Literature review and critical analysis of the available evidence in Medline and other scientific database sources. Data synthesis: Otorrhea and hearing loss are the cardinal symptoms of COM, while oto-microscopy and imaging techniques can confirm the diagnosis. Conservative treatment is acceptable to some extent (i.e. mild cases of COM without cholesteatoma). It involves topical drops (quinolones as first choice drugs-strength of recommendation B), as well as performing aural toilet (strength of recommendation B), and avoiding water ingress. Tympanoplasty without mastoidectomy is expected to improve hearing in cases of non-cholesteatomatous COM (strength of recommendation C), and positively affect the children's quality of life (strength of recommendation B). Less experienced surgeons and inflamed, wet middle ear mucosa represent the two most important factors, which could lead to reperforations (strength of recommendation C). The surgical management of COM with cholesteatoma tends to employ the least invasive surgical technique, in order to obtain a small self-cleaning mastoid cavity, as well as good hearing results (strength of recommendation C). Conclusion: The treatment of choice in most cases of pediatric COM is surgery. Figure 1 proposes a detailed and easy-to-follow evidence-based algorithm with regard to the diagnosis and management of COM in children.

Indian Journal of Otolaryngology and Head & Neck Surgery, Feb 17, 2012

Connective tissue disorders (CTDs) involve multiple organ systems and may have a significant impa... more Connective tissue disorders (CTDs) involve multiple organ systems and may have a significant impact on the overall health and quality of life of the affected individuals. The present paper aims to review the current knowledge on the laryngeal manifestations of CDTs, and describe the available diagnostic and treatment options. Systematic literature review in Medline and other database sources. Information from related books was also included. Prospective controlled, double-blind prospective, prospective, and transversal cohort studies, case series, case reports, systematic reviews, and consensus papers. Laryngeal involvement mostly occurs in rheumatoid arthritis (13-75% of patients). It is not uncommon in active and progressive clinical course, though can also occur in silent or inactive CDTs. The crico-arytenoid joint is the most commonly affected site. Common symptoms include throat pain, dyphonia and hoarseness. Careful clinical assessment of the larynx by flexible naso-endoscopy, video-stroboscopy, or direct laryngoscopy, and appropriate imaging are required for pertinent patient management. Stridor is a sign of a life-threatening condition, and may require prompt surgical intervention. However, mild symptomatology may mislead clinicians, and the related diagnosis may be significantly delayed. The current evidence as identified in the present study suggest that laryngeal manifestations of CDTs are often underdiagnosed, due to a range of nonspecific symptoms. A multidisciplinary team approach with ENT input is necessary to improve the overall patient management.

Case Reports in Medicine, 2011

Although unilateral peritonsillar abscess is a common complication of acute bacterial tonsillitis... more Although unilateral peritonsillar abscess is a common complication of acute bacterial tonsillitis, bilateral peritonsillar abscesses are quite rare. The incidence of unsuspected contralateral peritonsillar abscess identified at tonsillectomy has been reported to be between 1.9% and 24%, while the overall incidence of bilateral peritonsillar abscess is reported to reach 4.9%. Diagnosis can be based on clinical criteria or imaging techniques. As far as the treatment is concerned, it is generally accepted that the basic strategy consists of systemic antibiotics and drainage of the pus. We report the case of a 19-year-old girl, treated in the emergency room with a bilateral diagnostic needle aspiration followed by bilateral incision and drainage along with intravenous clindamycin plus anti-inflammatory agents and hydration. Following treatment, the patient progressively experienced a marked alleviation of her odynophagia. She was discharged 48 hours later on a 10-day course of clindamycin.

Otology & Neurotology, Sep 1, 2008

Genetic manipulation of the cell-cycle exit, induction of new hair cells (HCs) through gene modif... more Genetic manipulation of the cell-cycle exit, induction of new hair cells (HCs) through gene modification therapy, and introduction of stem cells (SCs) into damaged cochleas potentially offer exciting new strategies in treating sensorineural hearing loss. Literature review from Medline and database sources. Ex vivo models, animal studies, in vitro studies, and review articles. Embryonic SCs, neural SCs, or bone marrow SCs survive in the mammalian inner ear after transplantation. The scala media and the modiolus seem more functionally appropriate injection sites. The clear evidence that transplanted neural SCs can adopt the morphologic phenotypes of HCs was the most significant milestone achieved in the related research. The normal cytoarchitecture in the organ of Corti may also be restored through mouse atonal homologue 1 transgene expression and transduction of the nonsensory cells, producing clinically measured improvement in hearing thresholds. Embryonic SC-derived neurons have the potential for synapse formation with auditory HCs and reinnervation of the auditory epithelia. However, fluctuations in survival rates, functional recovery of the spiral-ganglion neurons, integration to the host tissue, and potential immune barriers are also areas of utmost importance. There is an already exciting progress in the fields of sensory cell regeneration and SC research in an attempt to restore hearing or prevent deafness. However, further understanding of the underlying mechanisms of auditory genetics, continuing investigation of the human genome, refinement of the delivering techniques, and specification of the therapeutic strategies have to be developed before functional regeneration of the cochlea can be achieved in clinical practice.