Stamatios Petousis - Academia.edu (original) (raw)

Papers by Stamatios Petousis

Journal of personalized medicine, Mar 21, 2024

Medicine international, Feb 9, 2024

Italian Journal of Gynaecology and Obstetrics

Background: Uterine myoma is considered the most common gynecological benign neoplasm occurring i... more Background: Uterine myoma is considered the most common gynecological benign neoplasm occurring in 50-60% of women. Generally, the patients are asymptomatic, but almost a third of women with leiomyomas will require treatment due to symptoms such as heavy uterine bleeding, severe pelvic pain, bulk symptoms, dyspareunia or infertility. Cervical myomas are uncommon, with a prevalence of only 0.6%. Vaginal approach is the classical option for their removal, but when it is impossible, in some cases laparoscopy may be an alternative. Objective: this article aims to describe a safe laparoscopic technique for a complete removal of a large cervico-vaginal myoma, the removal of which was impossible with a classical vaginal approach due to its size. Description of the technique: In consideration of the myoma's size, location, characteristics and the impossible vaginal approach, the patient was considered eligible for a laparoscopic myomectomy. Followings are the main surgical steps: Set up of surgical view of the intervention field; Vertical posterior colpotomy; Myoma's peduncle identification and incision; Reduction of myoma's size with power morcellation within the vagina; Extraction of the fibroid from the vagina to the peritoneal cavity through the colpotomy; Completion of the power morcellator and extraction of the whole specimen; Colporraphy; Peritoneal washing. Conclusion: When the vaginal approach is not practicable, laparoscopic management of large myomas in difficult locations such as the cervico-vaginal region seems to be a feasible and a safe surgical option.

Journal of Personalized Medicine, 2024

Surgical site infections (SSIs) refer to infections in the incision, organ, or postoperative spac... more Surgical site infections (SSIs) refer to infections in the incision, organ, or postoperative space. As common healthcare-associated infections, SSIs correlate with prolonged hospital stay, additional procedures, ICU stay, and higher mortality rates. Around 8-10% of gynecologic surgery patients may experience infectious complications, influenced by microbial contamination, surgical nature, and patient factors. The goal of this narrative review is to compare and merge recommendations from globally published guidelines concerning the utilization of antibiotics in the perioperative phase. A comparative descriptive/narrative review of the guidelines issued by the American College of Obstetrics and Gynecology (ACOG), Society of Obstetricians and Gynecologists of Canada (SOGC), Royal College of Obstetricians and Gynecologists (RCOG), National Institute for Health and Care Excellence (NICE), Royal Australian and New Zealand College of Obstetricians and Gynecologists (RANZCOG), European Society of Gynecologic Oncology (ESGO), Société Française d' Anésthesie et de Réanimation (SFAR), Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), and Hellenic Society of Obstetrics and Gynecology (HSOG) was conducted. For hysterectomy, first/second-generation cephalosporins are suggested, with metronidazole as an option. Laparoscopy without entering the bowel or vagina typically does not require prophylaxis. Uterine evacuation and hysteroscopy may involve doxycycline or azithromycin based on risk factors, whereas, for vulvectomy, cefazolin is recommended. Urogynecology procedures may include cefazolin with metronidazole. In cases of penicillin allergy, cephalosporins are suggested, and, for obese patients, adjusted doses are advised. Additional doses may be needed for prolonged procedures or excessive blood loss. Timing recommendations are 15-60 min before incision, adjusting for specific antibiotics. Clear indications exist for certain surgeries like hysterectomy, termination of pregnancy, and urogynecologic procedures. Conversely, procedures such as intrauterine device insertion, hysteroscopy, and laparoscopy typically do not necessitate antibiotic prophylaxis. For several other procedures, the evidence is inconclusive, while considering dose, timing, and indications can mitigate infectious complications and provide benefits for the healthcare system.

Authorea (Authorea), Nov 22, 2022

Even in cases of large myomatous uterus where laparoscopical resection is not feasible, it is sti... more Even in cases of large myomatous uterus where laparoscopical resection is not feasible, it is still possible to perform the method of sentinel node with open surgical technique. We present the clinical image of a large myomatous uterus with endometrial cancer where sentinel node was performed succesffuly by laparotomy.

http://isrctn.com/, Mar 17, 2018

European review for medical and pharmacological sciences, 2017

Broadening clinical evidence has markedly designated inositol(s) as a common and effective therap... more Broadening clinical evidence has markedly designated inositol(s) as a common and effective therapeutic approach for PCOS and infertility. Although considerable research has been focused on the use in clinical practice of myo-inositol (myo-ins) and D-chiro-inositol (D-chiro-ins), the two major inositol stereoisomers, less attention has been paid to their bioavailability. Therefore, the aim of this paper is to gather and analyze information on inositol(s) bioavailability, to better delineate its optimal concentration for scientific and clinical purposes. Throughout the search in PubMed, Google Scholar, and ResearchGate we identified only two studies that investigated the pharmacokinetic (PK) profile of different myo-ins administrations. This analysis found no advantage in terms of PK for single 4 g dosing of myo-ins compared to 2 g twice a day, which allowed to get a 24-hour coverage, contrary to the singular dose. Indeed, the differences regarding the area under the curve (AUC) betwe...

Global Journal of Reproductive Medicine, 2018

BMC Public Health, 2019

Background: Mongolia was one of the four countries that received a measles-elimination certificat... more Background: Mongolia was one of the four countries that received a measles-elimination certificate from the World Health Organization Regional Office for the Western Pacific in 2014. Following the outbreaks in many countries including China, a large measles outbreak occurred in Mongolia in 2015. This study reports 2015-2016 measles outbreak incidence, mortality, and complications, according to time, geographical distribution, and host characteristics. Methods: The epidemiological characteristics and trends of measles outbreak were analyzed using the Mongolian national surveillance data reported to the Center for Health Development, Ministry of Health, from January 2015 to December 2016. Results: In total, 23,464 cases of measles including eight deaths were reported in 2015, and 30,273 cases of measles including 132 deaths were reported in 2016, which peaked in June 2015 and March 2016, respectively. Majority of the cases were reported from Ulaanbaatar (35,397, 65.9%). The highest attack rates were 241 per 10,000 population in Darkhan-Uul aimag, and 263 per 10,000 population in Ulaanbaatar. Measles-related death, nosocomial infection, and complications were most frequent among children aged < 1 year. Conclusions: Following no reports of measles since 2011, a large nationwide outbreak occurred in Mongolia, despite the high vaccination coverage in the past. The highest incidence rate was reported in Ulaanbaatar city, and Umnugovi aimag in 2015 and Darkhan-Uul aimag in 2016. The most affected age group were aged < 1 year and those aged 15-24 years. Mortality cases were prominent among children aged < 1 year who were not eligible for vaccination. A systematic vaccination strategy is required to prevent another measles outbreak.

The International Journal of Medical Robotics and Computer Assisted Surgery, 2017

Objective Finding of a significant replaced left hepatic artery (RLHA) during esophagectomy is re... more Objective Finding of a significant replaced left hepatic artery (RLHA) during esophagectomy is relatively rare, with an incidence of approximately 5%. Sparing of the artery may be required to avoid complications of liver ischemia. Robotic assistance during esophagectomy may provide a technically superior method of artery preservation with minimally invasive approaches. Methods This is a retrospective case series of patients undergoing robotic-assisted minimally invasive esophagectomy (RAMIE) identified to have a significant RLHA at time of surgery. Results Five patients with a significant RLHA were identified from a series of over 100 RAMIE operations. Preservation of RLHA was accomplished in all cases without need for conversion, no intra-operative complications, and no post-operative liver dysfunction. The stomach was suitable and used for conduit reconstruction in all patients. Conclusions Sparing of the RLHA during RAMIE is feasible and effective. The robotic assisted approach may obviate the need for open conversion during these complex minimally invasive operations.

Gastroenterology, 2015

Esophageal adenocarcinoma (EAC) is rapidly increasing in incidence in Western cultures. Barrett's... more Esophageal adenocarcinoma (EAC) is rapidly increasing in incidence in Western cultures. Barrett's esophagus is the presumed precursor lesion for this cancer. Several other risk factors for this cancer have been described, including chronic heartburn, tobacco use, white race, and obesity. Despite these known associations, most patients with EAC present with symptoms of dysphagia from late-stage tumors; only a small number of patients are identified by screening and surveillance programs. Diagnostic analysis of EAC usually commences with upper endoscopy followed by cross-sectional imaging. Endoscopic ultrasonography is useful to assess the local extent of disease as well as the involvement of regional lymph nodes. T1a EAC may be treated endoscopically, and some patients with T1b disease may also benefit from endoscopic therapy. Locally advanced disease is generally managed with esophagectomy, often accompanied by neoadjuvant chemoradiotherapy or chemotherapy. The prognosis is based on tumor stage; patients with T1a tumors have an excellent prognosis, whereas few patients with advanced disease have long-term survival.