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Search Results: 1 - 10 of 10589 matches for " Andreas Gkiokas "
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Painful rib hump: a new clinical sign for detecting intraspinal rib displacement in scoliosis due to neurofibromatosis
Andreas Gkiokas, Socratis Hadzimichalis, Elias Vasiliadis, Marina Katsalouli, Georgios Kannas
Scoliosis , 2006, DOI: 10.1186/1748-7161-1-10
Abstract: A 13-year-old girl was evaluated for progressive left thoracic kyphoscoliotic curve due to a type I neurofibromatosis. Clinical examination revealed multiple large thoracic and abdominal "cafe-au-lait" spots, neurological impairment of the lower limbs and the presence of a thoracic gibbous that was painful to pressure at the level of the left eighth rib (Painful Rib Hump). CT-scan showed detachment and translocation of the cephalic end of the left eighth rib into the adjacent enlarged neural foramen. The M.R.I. examination of the spine showed neither cord abnormality nor neurogenic tumor.The patient underwent resection of the intraspinal mobile eighth rib head and posterior spinal instrumentation and was neurologically fully recovered six months postoperatively.Spine surgeons should be aware of intraspinal rib displacement in scoliotic curves in neurofibromatosis. Painful rib hump is a valuable diagnostic tool for this rare clinical entity.Neurofibromatosis (NF) is an autosomal dominant hereditary disorder that was first described by Frederick Daniel von Recklinghausen and is associated with skeletal, skin and soft tissue abnormalities. The most common skeletal manifestations in NF are scoliosis and kyphoscoliosis due to dystrophic osseous changes [1].The typical spinal deformity in NF has been described as a progressive short, sharp, angular kyphoscoliotic curve [2]. Right thoracic curves predominate in scoliosis in NF but there is an increasing incidence of left thoracic curves compared to idiopathic scoliosis [3].Rib dislocation into the spinal canal that causes spinal cord compression in patients with NF and scoliosis has previously been described [4-10]. The present report introduces a new clinical sign for detection of this rare clinical entity.A 13-year-old girl was referred for evaluation of a progressive left thoracic kyphoscoliotic curve (Figure 1) due to a type I NF. Clinical examination revealed multiple large thoracic and abdominal "cafe-au-lait" spots
Esophagopericardial fistula as a rare complication after total gastrectomy for cancer
Nikolaos Dafnios, Georgios Anastasopoulos, Athanasios Marinis, Andreas Polydorou, Georgios Gkiokas, Georgios Fragulidis, Panayiotis Athanasopoulos, Theodosios Theodosopoulos
World Journal of Surgical Oncology , 2009, DOI: 10.1186/1477-7819-7-58
Abstract: We present a case of an esophagopericardial fistula as a rare complication in a 53-year-old male patient, 7 months after total gastrectomy for an adenocarcinoma of the esophagogastric junction.The prognosis of esophagopericardial fistula is poor, especially when it is associated with malignancy.Esophagopericardial fistula (EPF) is a rare clinical entity which carries a dismal prognosis and is associated with benign, malignant or traumatic disease of the esophagus. Esophageal ulcers, chronic esophagitis, foreign body impaction, post-bouginage perforation and breakdown of anastomotic sites are the most common benign causes. Clinical symptoms include retrosternal pain, dyspnea and fever. Pneumopericardium is the most common radiographic finding, while upper GI series may demonstrate the fistulous tract or the accumulation of the contrast material inside the pericardial sac. Endoscopy may reveal the orifice of the fistulous tract or evidence of the underlying pathology. In this report we present a case of an EPF as a rare complication after total gastrectomy for gastric cancer. The prognosis of EPF is poor, especially when it is associated with malignancy.A 53-year-old male patient underwent a total gastrectomy for an adenocarcinoma of the esophagogastric junction with an esophagojejunal reconstruction in Roux-en-Y configuration. Histology of the surgical specimen showed a moderately differentiated adenocarcinoma of the esophagogastric junction, with a maximal diameter 5 cm, microscopically positive proximal margins and 21 negative lymph nodes (T3, N0, M0). The patient developed postoperatively a leakage from the esophagojejunal anastomosis, which was treated endoscopically with placement of a covered stent. Post-discharge, the patient received adjuvant radio- and chemo-therapy.Several months after surgery the patient was re-admitted due to progressive dyspnea, retrosternal pain and hypotension. Physical examination revealed a dyspneic patient with dilated jugular veins
Bioabsorbable Pins for Treatment of Osteochondral Fractures of the Knee after Acute Patella Dislocation in Children and Young Adolescents
A. Gkiokas,L. G. Morassi,S. Kohl,C. Zampakides,P. Megremis,D. S. Evangelopoulos
Advances in Orthopedics , 2012, DOI: 10.1155/2012/249687
Abstract: A retrospective study was performed on the use of bioabsorbable pins in the fixation of osteochondral fractures (OCFs) after traumatic patellar dislocation in children. Eighteen children (13 females, 5 males) aged 11 to 15 years (mean age 13.1 years) with osteochondral fracture (OCF) of the knee joint were treated at the authors’ institution. Followup ranged from 22 months to 5 years. Diagnosis was verified by X-ray and magnetic resonance imaging (MRI) of the knee and patella. In seven patients the osteochondral fragment was detached from the patella and in 11 it was detached from the lateral femoral condyle. All patients were subjected to open reduction and fixation of the lesion with bioabsorbable pins. Postoperatively, the knee was immobilized in a cast and all patients were mobilized applying a standardized protocol. Bone consolidation was successful in 17 of the 18 patients. Bioabsorbable pins reliably fix OCF in children and adolescents, demonstrating a high incidence of consolidation of the detached osteochondral fragment in short- and middle-term followup without requiring further operative procedures.
Solitary Adrenal Metastasis from Esophageal Adenocarcinoma: A Case Report and Review of the Literature
D. Dellaportas,P. Lykoudis,G. Gkiokas,G. Polymeneas,A. Kondi-Pafiti,D. Voros
Case Reports in Medicine , 2011, DOI: 10.1155/2011/487875
Abstract: Introduction. In patients with extra-adrenal malignancy, an adrenal mass necessitates investigating the possibility of metastatic tumor. Curable adrenal metastasis are considered as a rare event. Case report. A 52-year-old male suffering from lower esophageal adenocarcinoma with a solitary left adrenal metastasis is presented herein, who underwent concomitant transhiatal esophagectomy and left adrenalectomy. The patient remains disease-free 18 months later. Discussion. Adrenal metastases mostly occur in patients with lung, kidney, breast, and gastrointestinal carcinomas. Primary esophageal adenocarcinoma gives adrenal metastatic deposits according to autopsy series with an incidence of about 3%–12%. When no other evidence of metastatic disease in cancer patients exists, several authors advocate adrenalectomy with curative intent. Isolated cases of long-term survival after resection of solitary adrenal metastasis from esophageal adenocarcinoma, like in our case, have been reported only as case reports. Conclusion. This study concludes that surgical resection may result in survival benefit in selected patients with solitary adrenal metastasis from esophageal adenocarcinoma.
Bioabsorbable Pins for Treatment of Osteochondral Fractures of the Knee after Acute Patella Dislocation in Children and Young Adolescents
A. Gkiokas,L. G. Morassi,S. Kohl,C. Zampakides,P. Megremis,D. S. Evangelopoulos
Advances in Orthopedics , 2012, DOI: 10.1155/2012/249687
Abstract: A retrospective study was performed on the use of bioabsorbable pins in the fixation of osteochondral fractures (OCFs) after traumatic patellar dislocation in children. Eighteen children (13 females, 5 males) aged 11 to 15 years (mean age 13.1 years) with osteochondral fracture (OCF) of the knee joint were treated at the authors’ institution. Followup ranged from 22 months to 5 years. Diagnosis was verified by X-ray and magnetic resonance imaging (MRI) of the knee and patella. In seven patients the osteochondral fragment was detached from the patella and in 11 it was detached from the lateral femoral condyle. All patients were subjected to open reduction and fixation of the lesion with bioabsorbable pins. Postoperatively, the knee was immobilized in a cast and all patients were mobilized applying a standardized protocol. Bone consolidation was successful in 17 of the 18 patients. Bioabsorbable pins reliably fix OCF in children and adolescents, demonstrating a high incidence of consolidation of the detached osteochondral fragment in short- and middle-term followup without requiring further operative procedures. 1. Introduction Acute patellar dislocation is a common injury in early adolescence, with an incidence ranging from 29 to 42 per 100,000 children under 16 years of age [1, 2]. The etiology is mainly traumatic, involving either direct trauma to the knee or a twisting action. Adolescents, particularly those with preexisting ligamentous laxity of the knee, are prone to patellar dislocation. Osteochondral fractures (OCFs) of the patella or femur represent a major complication following patella dislocation, its incidence varying from 5% to 39% after dislocation [1]. The fractured fragments consist of both cartilaginous and bony parts. Certain anatomic variables may predispose to patellar lateral instability in adolescents, including patella alta, genu valgum, internal torsion of the femur, trochlear dysplasia, laxity of the medial patellofemoral ligament (MPFL), or increased Q angle [3]. The majority of lateral patellar dislocations occur at the initial stages of flexion of the knee joint, when the patella is not fully engaged in the femoral sulcus. In this phase, the MPFL acts as the primary restraint to the patella’s lateral translation [2, 4]. Multiple surgical procedures have been described for the treatment of OCF. In the past, such lesions were regarded as loose bodies and were simply excised, leaving an area of bone devoid of cartilage. The absence of cartilage, especially on weight-bearing surfaces of the lateral condyle and the medial articular
Multifocal Retroperitoneal Sarcoma
Theodosios Theodosopoulos,Dionysios Dellaportas,Vasiliki Psychogiou,Anneza Yiallourou,George Polymeneas,Georgios Gkiokas,Dionysios Voros
Case Reports in Surgery , 2013, DOI: 10.1155/2013/763702
Abstract: Introduction. Retroperitoneal sarcomas comprise a small proportion of all soft tissue sarcomas, and multiple factors influence their clinical behavior. Histopathological type and grade as well as complete surgical resection especially on the first operative attempt are well recognized as the main prognostic factors. Multifocality is another prognostic factor, which compromises therapy and finally makes prognosis worse due to multiple adverse implications. Case Presentation. A rare case of a 65-year-old male patient suffering from a multifocal retroperitoneal liposarcoma successfully treated in our hospital is presented herein. Discussion. Also, general considerations for these tumors are discussed, and especially multifocality is underlined as an ominous sign of retroperitoneal sarcomas behavior. Despite multifocality, once again complete surgical excision remains the mainstay of treatment of these patients, as long as further systemic and local therapies do not provide durable results. 1. Introduction Sarcomas are uncommon neoplasms of mesenchymal origin accounting for 1% of all solid tumors, while retroperitoneal sarcomas (RPS) are even less often found accounting for 10% of all soft tissue sarcomas [1]. They comprise a heterogeneous group of various histopathologic subtypes, and liposarcomas, leiomyosarcomas, and malignant fibrous histiocytomas are the commonest found in the retroperitoneal space [2]. Multiple factors such as complete surgical resection and histopathologic type and grade influence prognosis of these challenging in the management of tumors. Another ominous sign often not highlighted enough is multifocality [3, 4]. The latter is defined as having more than one tumor and has been associated with poor prognosis and higher recurrence rates. This feature obviously complicates management options of these patients. We report a rare case of a 65-year-old male patient with four different foci of retroperitoneal liposarcoma at the time of diagnosis and its management. 2. Case Presentation A 65-year-old white male complaining of mild abdominal discomfort and nonspecific abdominal pain, as well as a swelling in his left inguinal area, underwent an abdominal computed tomography (CT) scan (Figure 1). A large mass in his left iliac fossa measuring 11 × 10.5 × 9?cm and another one in his right iliac fossa measuring 4.3?cm were revealed, as well as another solid and individual mass measuring 6 × 5.5 × 2.2?cm in his left inguinal area (Figure 2). Afterwards and because of the possible sarcomatous lesion being the most probable scenario, he underwent a
Pancreatic Remnant Occlusion after Whipple's Procedure: An Alternative Oncologically Safe Method
Theodosios Theodosopoulos,Dionysios Dellaportas,Anneza I. Yiallourou,George Gkiokas,George Polymeneas,Alexios Fotopoulos
ISRN Surgery , 2013, DOI: 10.1155/2013/960424
Abstract: Introduction. To present our experience regarding the use of pancreatic stump occlusion technique as an alternative management of the pancreatic remnant after pancreatoduodenectomy (PD). Methods. Between 2002 and 2009, hospital records of 93 patients who had undergone a Whipple's procedure for either pancreatic-periampullary cancer or chronic pancreatitis were retrospectively studied. In 37 patients the pancreatic duct was occluded by stapling and running suture without anastomosis of the pancreatic remnant, whereas in 56 patients a pancreaticojejunostomy was performed. Operative data, postoperative complications, oncological parameters, and survival rates were recorded. Results. 2/37 patients of the occlusion group and 9/56 patients of the anastomosis group were treated for chronic pancreatitis, whereas 35/37 and 47/56 patients for periampullary malignancies. The duration of surgery for the anastomosis group was significantly longer (mean time 220 versus 180 minutes). Mean hospitalization time was 6 days for both groups. The occlusion group had a lower morbidity rate (24% versus 32%). With regard to postoperative complications, a slightly higher incidence of pancreatic fistulas was observed in the anastomosis group. Conclusions. Pancreatic remnant occlusion is a safe, technically feasible, and reducing postoperative complications alternative approach of the pancreatic stump during Whipple's procedure. 1. Introduction Progress in surgical technique and perioperative management has significantly reduced the morbidity and mortality rate of pancreatic resection procedures [1, 2]. The majority of postoperative complications after pancreatoduodenectomy (PD) arise from pancreatic leakage by the pancreatic stump. The pancreatic anastomosis is called by some authors the “Achilles heel” of pancreatic surgery due to its high rate of complications among all abdominal anastomoses [3, 4]. The optimal management of the pancreatic remnant after PD remains a challenge. More than 80 different methods of pancreaticoenteric reconstruction have been described, indicating the absence of a gold standard technique [5]. An interesting alternative option is the pancreatic stump occlusion technique with various methods. Our institution’s eight-year experience using this approach in a nonselected group of patients is presented herein. The objective of our trial was to compare the two operative approaches for the management of the pancreatic remnant with regard to mean operative time, postoperative complications, oncological parameters, and one-year survival rates. 2. Materials
Economic Growth and a Low Carbon Economy―Does the Earth Suffer from an “Easter Island Syndrome”?  [PDF]
Andreas Oberheitmann
Low Carbon Economy (LCE) , 2011, DOI: 10.4236/lce.2011.24024
Abstract: The history of the Eastern Islands in the Pacific with an increasing over-utilization of natural resources reminds us of the mistakes modern societies are making and the question is obvious whether the Earth is suffering from an Eastern Islands Syndrome, in other words whether the egoism inherent in humans long-term might have fatal consequences for our species homo sapiens. Climate research identified two important phenomena, which should remind us of the Easter Islands: feedbacks and tipping points, i.e. self-accelerating phenomena of global warming and reaching irreversible points of climate change. Only a quick worldwide return to a low carbon economy is able to stabilize global warming on a bearable level. Both, Annex-I countries and Non-Annex-I countries have to contribute to reaching this goal taking their historical, current and future responsibilities into account. A post Kyoto regime based on cumulative per-capita CO2-emission rights and a international emission trading could provide for incentives to achieve a low carbon economy, especially for newly industrialized countries.
Development of a Low Carbon Economy in Wuxi City  [PDF]
Andreas Oberheitmann
American Journal of Climate Change (AJCC) , 2012, DOI: 10.4236/ajcc.2012.12007
Abstract: The development of a Low Carbon Economy is a vital instrument to encounter climate change and take into account the growing challenges of an increasing urbanization in China. Wuxi City in East China’s Jiangsu Province is starting to implement a Low Carbon City Plan for safeguarding a sustainable development of the city until 2020 and beyond. This paper aims at estimating the impact of the Low Carbon City plan for Wuxi’s energy demand and CO2-emissions until 2050. Using an econometric energy supply and demand model to estimate and forecast the Wuxi energy and CO2-balance aggregates until 2050, it compares a scenario without specific Low Carbon City measures to reduce sectoral CO2-intensities to a Low Carbon scenario implementing these measures according to the Low Carbon City Plan until 2020 and beyond. The decomposition of the Kaya-identity reveals that the increase of per capita income has the largest impact on the growth of CO2-emissions and the decrease of energy intensity of Gross Value Added the largest impact on the reduction of CO2-emissions in Wuxi. A decrease of population and CO2-intensity of Primary energy supply only have average contributions. The decrease of energy intensity of Gross Value Added is due to energy efficiency gains in the single economic sectors, but to a large extent due to structural changes of the economy away from energy intensive sectors such as iron and steel, chemical industry or cement industry towards the energy extensive service sectors. A growing residential sector also reduces the industrial share of energy demand. Only following the assumed national trend with a shift from CO2-intensive industries to a CO2-extensive service economy, the Low Carbon goal of a 50% reduction of CO2-intensity of Gross Value Added compared to 2005 cannot be reached in Wuxi. Specific sectoral CO2 -intensity goals have to be successfully observed by the economic sectors in Wuxi, especially by the industry. The promotion of combined heat and power generation also has to contribute to the specific activities in Wuxi.
A Global Solution of the Einstein-Maxwell Field Equations for Rotating Charged Matter  [PDF]
Andreas Georgiou
Journal of Modern Physics (JMP) , 2012, DOI: 10.4236/jmp.2012.329168
Abstract: A stationary axially symmetric exterior electrovacuum solution of the Einstein-Maxwell field equations was obtained. An interior solution for rotating charged dust with vanishing Lorentz force was also obtained. The two spacetimes are separated by a boundary which is a surface layer with surface stress-energy tensor and surface electric 4-current. The layer is the spherical surface bounding the charged matter. It was further shown, that all the exterior physical quantities vanished at the asymptotic spatial infinity where spacetime was shown to be flat. There are two different sets of junction conditions: the electromagnetic junction conditions, which were expressed in the traditional 3-dimensional form of classical electromagnetic theory; and the considerably more complicated gravitational junction conditions. It was shown that both—the electromagnetic and gravitational junction conditions—were satisfied. The mass, charge and angular momentum were determined from the metric. Exact analytical formulae for the dipole moment and gyromagnetic ratio were also derived. The conditions, under which the latter formulae gave Blackett’s empirical result for rotating stars, were investigated.
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