T. Dosios - Academia.edu (original) (raw)

Papers by T. Dosios

European Journal of Cancer Supplements, 2009

The Thoracic and Cardiovascular Surgeon, 2005

The Thoracic and Cardiovascular Surgeon, 2007

Respiration, 2001

Although mixed venous O2 saturation (SvO2) accurately indicates the balance of O2 supply/demand a... more Although mixed venous O2 saturation (SvO2) accurately indicates the balance of O2 supply/demand and provides an index of tissue oxygenation, the use of a pulmonary artery (PA) catheter is associated with significant costs, risks and complications. Central venous O2 saturation (ScvO2), obtained in a less risky and costly manner, can be an attractive alternative to SvO2. To investigate whether the values of ScvO2 and SvO2 are well correlated and interchangeable in the evaluation of critically ill ICU patients and to create an equation that could estimate SvO2 from ScvO2. Sixty-one mechanically ventilated patients were catheterized upon admission and ScvO2 and SvO2 values were simultaneously measured in the lower part of the superior vena cava and PA respectively. SvO2 was 68.6 +/- 1.2% (mean +/- SEM) and ScvO2 was 69.4 +/- 1.1%. The difference is statistically significant (p < 0.03). The correlation coefficient r is 0.945 for the total population, 0.937 and 0.950 in surgical and medical patients, respectively. In 90.2% of patients the difference was <5%. When regression analysis was performed, among 11 models tested, power model [SvO2 = b0(ScvO2)b1] best described the relationship between the two parameters (R2 = 0.917). ScvO2 and SvO2 are closely related and are interchangeable for the initial evaluation of critically ill patients even if cardiac indices are different. SvO2 can be estimated with great accuracy by ScvO2 in 92% of the patients using a power model.

European Journal of Cardio-Thoracic Surgery, 1996

To investigate how the members of the European Association for Cardio-Thoracic Surgery (EACTS) fo... more To investigate how the members of the European Association for Cardio-Thoracic Surgery (EACTS) follow up their patients after pulmonary resection for bronchogenic carcinoma. A questionnaire was sent to 317 EACTS members (thoracic and cardiothoracic surgeons as well as surgeons of unknown field of clinical practice). We eventually received completed questionnaires from 101 (31.9%) surgeons, who were classified into "thoracic" and "others". Their answers were analysed by the chi-square test. One out of four EACTS members does not follow up his/her patients, while the remainder follow them up with or without the collaboration of a clinical oncologist, a pneumonologist or a family physician. Among the surgeons who follow up their patients, only one out of two does so throughout the patient's remaining life. The frequency of the routine follow-up visits as well as the type and frequency of the examinations used vary significantly among the members of the Association, but generally the frequency of visits tends to decrease with time. Although 89.8% of surgeons believe that a well scheduled follow-up is beneficial to the patient, only 67% think that such a follow-up is cost-effective. A great diversity was observed in the way patients operated on for lung cancer are followed up by the EACTS members. The differences were more evident between "thoracic" and "other" surgeons. However, hard data showing the effect of these differences on patients' long-term survival are not available and prospective cooperative studies on this subject are required. Taking into account that these patients are, for the rest of their lives, at high risk of development of a metachronous primary bronchogenic carcinoma or other potentially curable malignancies, we believe that a life-long follow-up is mandatory.

European Journal of Cardio-Thoracic Surgery, 1993

A patient suffering from blunt traumatic rupture of the right hemidiaphragm is presented. Chest r... more A patient suffering from blunt traumatic rupture of the right hemidiaphragm is presented. Chest radiography and computed tomography (CT) suggested the type of injury, but magnetic resonance imaging (MRI) established unequivocally the correct preoperative diagnosis.

European Journal of Cardio-Thoracic Surgery, 2000

Objective: To investigate the alterations of structure and mechanical properties of the aortic wa... more Objective: To investigate the alterations of structure and mechanical properties of the aortic wall, resulting from impairment of vasa vasorum¯ow. Methods: Eight healthy Landrace pigs were subjected to interruption of vasa vasorum¯ow to the upper segment of their descending thoracic aorta. Under sterile conditions, the periaortic tissue was excised and the contiguous intercostal arteries were ligated. Ten sham-operated pigs were used as controls. Fifteen days postoperatively, the animals were sacri®ced and their upper descending thoracic aortas were removed. Histology, and collagen and elastin content determination by image analysis technique were performed. Mechanical analysis of aortic strips was carried out with a uniaxial tension device and stress±strain curves were obtained. Results: In contrast to normal aortic walls of the control group, histology of the avascular aortas revealed severe ischemic necrosis of the outer media along with abnormal straightening of the elastin and collagen ®bers, without signi®cant collagen and elastin content changes. The borderline between the outer ischemic and inner non-ischemic media was sharp, and an outset of dissection was observed at this point. Mechanical analysis showed that at the same level of strain, the ischemic aorta was signi®cantly stiffer at both low (P 0:03) and high strains (P 0:003). Conclusions: Impairment of blood supply to the thoracic aorta leads to abnormal morphology of elastin and collagen ®bers of the outer media, resulting in increased aortic stiffness under a wide range of stresses. In the clinical setting, decreased vasa vasorum¯ow, reportedly occurring in arterial hypertension, may increase the stiffness of the outer media of the thoracic aorta and produce interlaminar shear stresses, contributing to the development of aortic dissection. q

European Journal of Cardio-Thoracic Surgery, 2000

A 15-year old boy presented with subcutaneous emphysema after an asthmatic attack. Chest X-ray sh... more A 15-year old boy presented with subcutaneous emphysema after an asthmatic attack. Chest X-ray showed no evidence of pneumothorax. Computed tomography (CT) scan revealed the presence of air into the spinal canal associated with pneumomediastinum (Fig. 1) . The ...

Chest, 2003

Surgical subxiphoid drainage of the pericardial cavity has been established as a safe and effecti... more Surgical subxiphoid drainage of the pericardial cavity has been established as a safe and effective method of treatment of pericardial effusion; however, the risk factors affecting survival of these patients have not been clarified. The aim of this study was to investigate the risk factors affecting the short-term and long-term survival of patients with pericardial effusion submitted to subxiphoid pericardiostomy. Retrospective study. The records of all patients who underwent subxiphoid pericardiostomy for treatment of pericardial effusion from January 1991 to December 2001 were reviewed. According to underlying pathology the patients were classified into four groups: (1) hematologic malignancies (n = 17); (2) other malignant diseases (n = 29); (3) AIDS (n = 5); and (4) other benign diseases (n = 53). Multivariate Cox regression analysis was used to test the relationship of short-term and long-term survival to age, sex, cardiac tamponade, pericardial malignant invasion, postoperative low cardiac output syndrome (PLCOS), and underlying pathology. There were 104 patients (59 men) with a mean age of 53.6 years (range, 13 to 85 years). Follow-up was complete in 99 patients (95.2%) for a mean of 23.9 months (range, 0 to 92 months). Overall 30-day mortality was 16.3%, while operation-related mortality was 4.8%. The underlying disease was the main risk factor for short-term and long-term survival (p < 0.00001), while PLCOS was a major predictor of early mortality (p = 0.029). Patients with AIDS showed the worst prognosis. On the contrary, patients with hematologic malignancies presented significantly longer survival compared to all other patients with malignant diseases (p < 0.05). The underlying disease was the main risk factor for short-term and long-term survival, while PLCOS was a major predictor of early mortality. The prognosis of AIDS patients with pericardial effusion was grave; therefore, surgical intervention in such patients should be reevaluated. Patients with hematologic malignancies had significantly longer survival compared to all other patients with malignant diseases.

The Annals of Thoracic Surgery, 2010

benefits, questions surrounding the cost-effectiveness of this model need to be addressed. This i... more benefits, questions surrounding the cost-effectiveness of this model need to be addressed. This involved task is currently underway.

The Thoracic and Cardiovascular Surgeon, 2008

Introduction ! Lung cancer is the leading cause of cancer-related death in the U. S. male and fem... more Introduction ! Lung cancer is the leading cause of cancer-related death in the U. S. male and female population . Unfortunately, the majority of patients are diagnosed with advanced stage cancer, which means that curative surgery is excluded as a therapeutic option. One third of patients with non small cell lung cancer (NSCLC) have early stage disease (stage I and II). Although the majority of these patients are offered curative surgery, a five-year survival of 50 -85% and 30 -50 % for stage I and II, respectively, has been estimated [2, 3]. The identification of specific patient subgroups with early stage aggressive tumors which are at high risk for future relapse is important for prognostic and treatment purposes. There are a number of reports on prognostic factors affecting survival in patients with resected early stage NSCLC, including age, stage, preoperative hemoglobin level, histology and gender [4 -7]. The majority of these studies included pa-tients treated with multimodal therapy and sublobar pulmonary resection. These treatment variations can make it difficult to identify more aggressive tumor subgroups in early stage NSCLC. The purpose of this study was to identify prognostic factors and, more specifically, to investigate the impact of preoperative anemia and the type of resection on midterm survival in patients with early stage NSCLC who underwent only lobectomy or pneumonectomy without preoperative neo-adjuvant treatment.

European Journal of Cancer Supplements, 2009

The Thoracic and Cardiovascular Surgeon, 2005

The Thoracic and Cardiovascular Surgeon, 2007

Respiration, 2001

Although mixed venous O2 saturation (SvO2) accurately indicates the balance of O2 supply/demand a... more Although mixed venous O2 saturation (SvO2) accurately indicates the balance of O2 supply/demand and provides an index of tissue oxygenation, the use of a pulmonary artery (PA) catheter is associated with significant costs, risks and complications. Central venous O2 saturation (ScvO2), obtained in a less risky and costly manner, can be an attractive alternative to SvO2. To investigate whether the values of ScvO2 and SvO2 are well correlated and interchangeable in the evaluation of critically ill ICU patients and to create an equation that could estimate SvO2 from ScvO2. Sixty-one mechanically ventilated patients were catheterized upon admission and ScvO2 and SvO2 values were simultaneously measured in the lower part of the superior vena cava and PA respectively. SvO2 was 68.6 +/- 1.2% (mean +/- SEM) and ScvO2 was 69.4 +/- 1.1%. The difference is statistically significant (p < 0.03). The correlation coefficient r is 0.945 for the total population, 0.937 and 0.950 in surgical and medical patients, respectively. In 90.2% of patients the difference was <5%. When regression analysis was performed, among 11 models tested, power model [SvO2 = b0(ScvO2)b1] best described the relationship between the two parameters (R2 = 0.917). ScvO2 and SvO2 are closely related and are interchangeable for the initial evaluation of critically ill patients even if cardiac indices are different. SvO2 can be estimated with great accuracy by ScvO2 in 92% of the patients using a power model.

European Journal of Cardio-Thoracic Surgery, 1996

To investigate how the members of the European Association for Cardio-Thoracic Surgery (EACTS) fo... more To investigate how the members of the European Association for Cardio-Thoracic Surgery (EACTS) follow up their patients after pulmonary resection for bronchogenic carcinoma. A questionnaire was sent to 317 EACTS members (thoracic and cardiothoracic surgeons as well as surgeons of unknown field of clinical practice). We eventually received completed questionnaires from 101 (31.9%) surgeons, who were classified into "thoracic" and "others". Their answers were analysed by the chi-square test. One out of four EACTS members does not follow up his/her patients, while the remainder follow them up with or without the collaboration of a clinical oncologist, a pneumonologist or a family physician. Among the surgeons who follow up their patients, only one out of two does so throughout the patient's remaining life. The frequency of the routine follow-up visits as well as the type and frequency of the examinations used vary significantly among the members of the Association, but generally the frequency of visits tends to decrease with time. Although 89.8% of surgeons believe that a well scheduled follow-up is beneficial to the patient, only 67% think that such a follow-up is cost-effective. A great diversity was observed in the way patients operated on for lung cancer are followed up by the EACTS members. The differences were more evident between "thoracic" and "other" surgeons. However, hard data showing the effect of these differences on patients' long-term survival are not available and prospective cooperative studies on this subject are required. Taking into account that these patients are, for the rest of their lives, at high risk of development of a metachronous primary bronchogenic carcinoma or other potentially curable malignancies, we believe that a life-long follow-up is mandatory.

European Journal of Cardio-Thoracic Surgery, 1993

A patient suffering from blunt traumatic rupture of the right hemidiaphragm is presented. Chest r... more A patient suffering from blunt traumatic rupture of the right hemidiaphragm is presented. Chest radiography and computed tomography (CT) suggested the type of injury, but magnetic resonance imaging (MRI) established unequivocally the correct preoperative diagnosis.

European Journal of Cardio-Thoracic Surgery, 2000

Objective: To investigate the alterations of structure and mechanical properties of the aortic wa... more Objective: To investigate the alterations of structure and mechanical properties of the aortic wall, resulting from impairment of vasa vasorum¯ow. Methods: Eight healthy Landrace pigs were subjected to interruption of vasa vasorum¯ow to the upper segment of their descending thoracic aorta. Under sterile conditions, the periaortic tissue was excised and the contiguous intercostal arteries were ligated. Ten sham-operated pigs were used as controls. Fifteen days postoperatively, the animals were sacri®ced and their upper descending thoracic aortas were removed. Histology, and collagen and elastin content determination by image analysis technique were performed. Mechanical analysis of aortic strips was carried out with a uniaxial tension device and stress±strain curves were obtained. Results: In contrast to normal aortic walls of the control group, histology of the avascular aortas revealed severe ischemic necrosis of the outer media along with abnormal straightening of the elastin and collagen ®bers, without signi®cant collagen and elastin content changes. The borderline between the outer ischemic and inner non-ischemic media was sharp, and an outset of dissection was observed at this point. Mechanical analysis showed that at the same level of strain, the ischemic aorta was signi®cantly stiffer at both low (P 0:03) and high strains (P 0:003). Conclusions: Impairment of blood supply to the thoracic aorta leads to abnormal morphology of elastin and collagen ®bers of the outer media, resulting in increased aortic stiffness under a wide range of stresses. In the clinical setting, decreased vasa vasorum¯ow, reportedly occurring in arterial hypertension, may increase the stiffness of the outer media of the thoracic aorta and produce interlaminar shear stresses, contributing to the development of aortic dissection. q

European Journal of Cardio-Thoracic Surgery, 2000

A 15-year old boy presented with subcutaneous emphysema after an asthmatic attack. Chest X-ray sh... more A 15-year old boy presented with subcutaneous emphysema after an asthmatic attack. Chest X-ray showed no evidence of pneumothorax. Computed tomography (CT) scan revealed the presence of air into the spinal canal associated with pneumomediastinum (Fig. 1) . The ...

Chest, 2003

Surgical subxiphoid drainage of the pericardial cavity has been established as a safe and effecti... more Surgical subxiphoid drainage of the pericardial cavity has been established as a safe and effective method of treatment of pericardial effusion; however, the risk factors affecting survival of these patients have not been clarified. The aim of this study was to investigate the risk factors affecting the short-term and long-term survival of patients with pericardial effusion submitted to subxiphoid pericardiostomy. Retrospective study. The records of all patients who underwent subxiphoid pericardiostomy for treatment of pericardial effusion from January 1991 to December 2001 were reviewed. According to underlying pathology the patients were classified into four groups: (1) hematologic malignancies (n = 17); (2) other malignant diseases (n = 29); (3) AIDS (n = 5); and (4) other benign diseases (n = 53). Multivariate Cox regression analysis was used to test the relationship of short-term and long-term survival to age, sex, cardiac tamponade, pericardial malignant invasion, postoperative low cardiac output syndrome (PLCOS), and underlying pathology. There were 104 patients (59 men) with a mean age of 53.6 years (range, 13 to 85 years). Follow-up was complete in 99 patients (95.2%) for a mean of 23.9 months (range, 0 to 92 months). Overall 30-day mortality was 16.3%, while operation-related mortality was 4.8%. The underlying disease was the main risk factor for short-term and long-term survival (p < 0.00001), while PLCOS was a major predictor of early mortality (p = 0.029). Patients with AIDS showed the worst prognosis. On the contrary, patients with hematologic malignancies presented significantly longer survival compared to all other patients with malignant diseases (p < 0.05). The underlying disease was the main risk factor for short-term and long-term survival, while PLCOS was a major predictor of early mortality. The prognosis of AIDS patients with pericardial effusion was grave; therefore, surgical intervention in such patients should be reevaluated. Patients with hematologic malignancies had significantly longer survival compared to all other patients with malignant diseases.

The Annals of Thoracic Surgery, 2010

benefits, questions surrounding the cost-effectiveness of this model need to be addressed. This i... more benefits, questions surrounding the cost-effectiveness of this model need to be addressed. This involved task is currently underway.

The Thoracic and Cardiovascular Surgeon, 2008

Introduction ! Lung cancer is the leading cause of cancer-related death in the U. S. male and fem... more Introduction ! Lung cancer is the leading cause of cancer-related death in the U. S. male and female population . Unfortunately, the majority of patients are diagnosed with advanced stage cancer, which means that curative surgery is excluded as a therapeutic option. One third of patients with non small cell lung cancer (NSCLC) have early stage disease (stage I and II). Although the majority of these patients are offered curative surgery, a five-year survival of 50 -85% and 30 -50 % for stage I and II, respectively, has been estimated [2, 3]. The identification of specific patient subgroups with early stage aggressive tumors which are at high risk for future relapse is important for prognostic and treatment purposes. There are a number of reports on prognostic factors affecting survival in patients with resected early stage NSCLC, including age, stage, preoperative hemoglobin level, histology and gender [4 -7]. The majority of these studies included pa-tients treated with multimodal therapy and sublobar pulmonary resection. These treatment variations can make it difficult to identify more aggressive tumor subgroups in early stage NSCLC. The purpose of this study was to identify prognostic factors and, more specifically, to investigate the impact of preoperative anemia and the type of resection on midterm survival in patients with early stage NSCLC who underwent only lobectomy or pneumonectomy without preoperative neo-adjuvant treatment.