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Increased Chromosome Fragility in Gastric Cancer Patients
Petros Kouridakis,Evangelos Digkas,Georgios Kouklakis,Georgios Minopoulos
Cancer and Clinical Oncology , 2012, DOI: 10.5539/cco.v1n1p148
Abstract: Gastric cancer is one of the most common lethal malignancy in global and survival mainly depends on prognosis. Sister Chromatid Exchanges (SCEs) assay is a very sensitive method of detecting chromosome fragility. The aim of our study was to determine the chromosomal fragility of gastric cancer patients in vitro. Samples from 32 gastric cancer patients and 12 healthy donors were controlled. Cancer patients lymphocytes’ genome is highly fragile as treatment of the cell cultures with MMC caused a statistically significant increase of the mean SCEs frequency (p<0.01). Also, so simultaneous as MMC-induced SCEs frequency of gastric cancer patients was statistically significant (p<0.01) higher compared to the healthy donors. PRI and MI of treated with MMC and untreated lymphocytes of gastric cancer patients were significantly (p<0.01) lower than that of healthy donors. These results suggest that peripheral lymphocyte chromosomes of cancer patients are highly fragile and alkyliotic agents increase their fragility.
Esophageal Crohn's Disease Treated “Topically” with Swallowed Aerosolized Budesonide
Petros Zezos,Georgios Kouklakis,Anastasia Oikonomou,Michail Pitiakoudis,Constantinos Simopoulos
Case Reports in Medicine , 2010, DOI: 10.1155/2010/418769
Abstract: Proximal Crohn's disease, involving the esophagus, the stomach, the duodenum, and the proximal jejunum, is uncommon. Treatment for proximal Crohn's disease is based on data derived from case series than from controlled trials. We present a case of Crohn's colitis with concomitant proximal esophagogastroduodenal involvement treated with conventional treatment plus swallowed aerosolized budesonide as a novel adjuvant topical treatment for the esophageal disease, and we review the treatment options for proximal Crohn's disease.
Total Splenectomy due to an Unexpected “Complication” after Successful Extended Laparoscopic Partial Decapsulation of a Giant Epidermoid Splenic Cyst: A Case Report
Michail Pitiakoudis,Petros Zezos,Anastasia Oikonomou,Prodromos Laftsidis,Georgios Kouklakis,Constantinos Simopoulos
Case Reports in Medicine , 2011, DOI: 10.1155/2011/318208
Abstract: Splenic cysts are rare entities and are classified as true cysts or pseudocysts based on the presence of an epithelial lining. Congenital nonparasitic true cysts can be epidermoid, dermoid, or endodermoid, present at a young age, and are commonly located in the upper pole of the spleen. Surgical treatment is recommended for symptomatic, large (more than 5 cm), or complicated cysts. Depending on cyst number, location, relation to hilus, and the major splenic vessels, the surgical options include aspiration, marsupialization, cystectomy, partial cystectomy (decapsulation), and partial or complete splenectomy. Laparoscopic techniques have now become the standard approach for many conditions, including the splenic cysts, with emphasis on the spleen-preserving minimally invasive operations. We present the successful extended partial laparoscopic decapsulation of a giant epidermoid splenic cyst in a young female patient that, although asymptomatic, was unfortunately followed by complete splenectomy five days later due to a misinterpreted abdominal CT suggesting splenic postoperative ischemia.
Endoscopic Treatment of a Gastrocutaneous Fistula Using the Over-The-Scope-Clip System: A Case Report
Georgios Kouklakis,Petros Zezos,Nikolaos Liratzopoulos,Anthia Gatopoulou,Anastasia Oikonomou,Michail Pitiakoudis,Eleni Efremidou,Constantinos Simopoulos
Diagnostic and Therapeutic Endoscopy , 2011, DOI: 10.1155/2011/384143
Abstract: The over-the-scope-clip (OTSC; Ovesco Endoscopy GmbH, Tuebingen, Germany) system is a newly designed method for the mechanical compression of large areas in the gastrointestinal tract. So far, indications for OTSC application are hemostasis of primary or postinterventional bleeding, closure of iatrogenic full-thickness or covered perforations. Recently closure of gastrointestinal tract fistulas using this device has been described. A 44-year-old man developed a gastrocutaneous fistula after surgical treatment for a perforated gastric ulcer. We describe the successful endoscopic closure of the fistula using the OTSC system. The patient's clinical followup was uneventful. Fistula closure was successfully implemented as it was documented by imaging and endoscopic examinations performed on the 2nd day and 6th week after the application of the clip. Endoscopic application of the OTSC device was safe and effective for the treatment of a gastrocutaneous fistula. 1. Introduction The over-the-scope-clip (OTSC) system (Ovesco Endoscopy GmbH, Tuebingen, Germany) is a newly designed method for the mechanical compression of large areas in the gastrointestinal tract. So far, indications for OTSC application are hemostasis primary or postinterventional bleeding and closure of iatrogenic full-thickness or covered perforations during endoscopic mucosal resection or after natural orifice transluminal endoscopic surgery procedures (NOTES) [1]. We report the successful treatment of a gastrocutaneous fistula with closure of the gastric orifice using the OTSC system without postprocedure complications. 2. Case Presentation A 44-year-old man, who had been having a history of recurrent abdominal pain, attended the emergency services with peritonitis. Upright chest X-ray demonstrated free subdiaphragmatic air bilaterally (Figure 1). An emergent laparotomy was performed and a perforated pyloric ulcer was found which was treated with simple surgical sutures and omental patches. Figure 1: Upright posteroanterior chest radiograph: there is free subdiaphragmatic air bilaterally that is more clearly noted on the left side (white arrows). A few days later the patient displayed a septic course with persistent fever and leukocytosis. An abdominal CT scanning revealed an abscess in the left subphrenic space and in the space of Douglas. A new surgical intervention was undertaken and peritoneal drainage was reestablished in the areas with the abscesses. The immediate postoperative period was uneventful with the exception of a persistent draining of gastric contents by the abdominal drains
Spontaneous idiopathic pneumoperitoneum presenting as an acute abdomen: a case report
Michail Pitiakoudis, Petros Zezos, Anastasia Oikonomou, Michail Kirmanidis, Georgios Kouklakis, Constantinos Simopoulos
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-86
Abstract: We present the case of an idiopathic spontaneous pneumoperitoneum. A 69-year-old Greek woman presented with acute abdominal pain, fever and vomiting. Diffuse abdominal tenderness on deep palpation without any other signs of peritonitis was found during physical examination, and laboratory investigations revealed leukocytosis and intraperitoneal air below the diaphragm bilaterally. Her medical history was unremarkable except for previous cholecystectomy and appendectomy. The patient did not take any medication, and she was not a smoker or an alcohol consumer. Emergency laparotomy was performed, but no identifiable cause was found. A remarkable improvement was noticed, and the patient was discharged on the seventh postoperative day, although the cause of pneumoperitoneum remained obscure.A thorough history and physical examination combined with the appropriate laboratory tests and radiologic techniques are useful tools in identifying patients with non-surgical pneumoperitoneum and avoiding unnecessary operations.Pneumoperitoneum is the result of a gastrointestinal (GI) tract perforation in more than 90% of cases [1]. Perforation of the stomach or duodenum caused by peptic ulcer is considered the most common cause of pneumoperitoneum. Pneumoperitoneum can also be the result of a diverticular rupture or of an abdominal trauma [1]. It commonly presents with signs and symptoms of peritonitis, and subphrenic free gas in an upright chest radiograph is the most common radiologic finding. In most cases, pneumoperitoneum requires urgent surgical exploration and intervention [1].However, sometimes pneumoperitoneum not associated with a perforated viscus can occur; this is called spontaneous pneumoperitoneum (SP) or "non-surgical" pneumoperitoneum. SP is associated with intrathoracic, intraabdominal, gynecologic, iatrogenic or other miscellaneous causes [1]. Although it is not usually complicated with peritonitis, SP is characterized by a benign course and can be managed conserv
Spontaneous Colo-Umbilical Fistula Complicating Diverticulitis of the Sigmoid Colon
Helen Bolanaki,Georgios Kouklakis,Nikos Courcoutsakis,Panagoula Oikonomou,Anastasios J. Karayiannakis
Case Reports in Surgery , 2013, DOI: 10.1155/2013/925041
Abstract: Colocutaneous fistula caused by diverticulitis is relatively uncommon with colo-umbilical fistulas being even rarer. We herein report a rare case of a spontaneous colo-umbilical fistula due to diverticulitis of the sigmoid colon. The fistula developed from a diverticulum of the sigmoid colon that discharged through the umbilicus after two episodes of acute diverticulitis. The condition was successfully treated by resectional surgery. 1. Introduction Diverticular disease is an increasingly common condition in Western countries especially among elderly people. The disease affects mostly the left colon. It is usually asymptomatic and becomes manifest only when complicated with bleeding or inflammation. Acute diverticulitis may complicate with free perforation resulting in fecal or purulent peritonitis or with pericolic abscess formation, involvement of adjacent organs, and fistulation. Fistulas occur in approximately 5% of cases either spontaneously or after surgical or drainage procedures [1, 2]. The most common diverticulitis-associated fistulas are colovesical, colovaginal, and enterocolic, whereas colocutaneous fistulation has been only occasionally described [3–8]. We herein report a rare case of a spontaneous colo-umbilical fistula due to diverticulitis of the sigmoid colon. 2. Case Presentation A 54-year-old man presented with a 15-day history of low-grade fever and continuous mild pain around the umbilicus. Three days before admission he noticed foul smelling discharge emanating from the umbilical pit. His medical history included irritable bowel syndrome, diverticulosis of the sigmoid colon, and two episodes of acute diverticulitis over the last two years that were treated conservatively. On physical examination the abdomen was slightly distended with mild tenderness in the left lower quadrant without palpable masses or any evidence of acute abdomen. Guarding, rigidity, and rebound tenderness were absent and bowel peristalsis was normal. The umbilicus and the periumbilical skin were inflamed and macerated, with spontaneous fecal discharge from the umbilical pit (Figure 1). The laboratory results showed slightly elevated white blood cell counts (11,670/mm3) and C-reactive protein (2.8?mg/dL). A plain abdominal radiography was unremarkable. Figure 1: The inflamed and macerated umbilicus and periumbilical skin with fecal material into the umbilical pit. Abdominal computed tomography (CT) revealed diffuse diverticulosis in the sigmoid colon with inflammatory changes and mesenteric stranding and a cavity beneath the abdominal wall at the level of the
The Histological and Immunohistochemical Aspects of Bile Reflux in Patients with Gastroesophageal Reflux Disease
Andreas Nakos,Georgios Kouklakis,Michail Pitiakoudis,Petros Zezos,Eleni Efraimidou,Alexandra Giatromanolaki,Alexandros Polychronidis,Nikolaos Liratzopoulos,Efthimios Sivridis,Konstantinos Simopoulos
Gastroenterology Research and Practice , 2011, DOI: 10.1155/2011/905872
Abstract: Introduction. The pathogenesis of GERD is strongly related with mixed acid and bile reflux. Benign and malignant esophageal and gastric lesions have been associated with synergetic activity between those parameters. Bile reflux causes reactive gastropathy evaluated with Bile Reflux Index (BRI). The aim was to investigate if the sequence: bile reflux-intestinal metaplasia-GERD-esophagitis, is associated with apoptotic/oncogenetic disturbances. Materials/Methods. Fifteen asymptomatic subjects and 53?GERD patients underwent gastroscopy with biopsies. The specimens examined histologically and immunohistochemically for p53, Ki-67, Bax, and Bcl-2. Results. Elevated BRI score detected in 47% (25/53) of patients with GERD and in 13% (2/15) of controls ( ). Severe esophageal lesions were significantly more common in BRI (+) patients (14/25) compared to BRI (?) ones ( ). Immunohistochemical analysis did not show associations between BRI score and biomarker expression. Conclusions. Bile reflux gastropathy is associated with GERD severity, but not with oncogene expression or apoptotic discrepancies of the upper GI mucosa. 1. Introduction The gastroesophageal reflux disease (GERD) represents one of the most common gastrointestinal disorders, especially in the western countries [1, 2]. It is the result of the exposure of the esophageal mucosa to acidic gastric juice and/or bile-containing duodenal refluxates via an incompetent lower esophageal sphincter. The acid and bile exposure times, as demonstrated by 24?h monitoring methodologies, greatly overlap among the cases of GERD with diverse endoscopic findings ranging from normal mucosa (nonerosive reflux disease (NERD)) to severe reflux oesophagitis, Barrett’s esophagus, and complications such as strictures or ulcers [3–6]. Although in the past the pathogenesis of GERD was strongly associated with the gastric acid, during the last two decades the role of mixed reflux has been increasingly investigated. The synergetic activity between acid and bile has largely been implicated in the clinical spectrum of GERD and methods such as Bilitec 2000 and the multichannel intraluminal impedance are nowadays widely used towards the thorough evaluation of the disorder [7]. The highest esophageal exposure to bile has been observed in patients with Barrett’s dysplasia and esophageal adenocarcinoma. However, it has also been associated with erosive oesophagitis, Barrett’s esophagus without dysplasia, and intestinal metaplasia of the gastric antrum [8–15]. The passage of duodenal contents through the stomach produces consistent
What must we do in a patient with multiple polyps through the large bowel?
G.S. Kouklakis
Annals of Gastroenterology , 2007,
ErbB Receptors and ErbB Targeted Therapies in Endometrial Cancer  [PDF]
Georgios Androutsopoulos, Georgios Michail, Georgios Adonakis, Georgios Decavalas
Journal of Cancer Therapy (JCT) , 2014, DOI: 10.4236/jct.2014.56055

The Epidermal Growth Factor system is present in human organs and plays an important role in cell proliferation, differentiation and apoptosis during embryogenesis and postnatal development. It has four receptors (EGFR, ErbB-2, ErbB-3 and ErbB-4) and numerous ligands. Dysregulation of the Epidermal Growth Factor signaling network is implicated in the pathogenesis of various disorders. Especially in cancer, the Epidermal Growth Factor system becomes hyperactivated with various mechanisms (ligand overproduction, receptor overproduction, constitutive receptor activation). EGFR overexpression may have a dual role in endometrial cancer. It seems that in type I endometrial cancer, EGFR overexpression did not affect disease progression. However in type II endometrial cancer, EGFR overexpression associated with high grade disease and adverse clinical outcome. Moreover ΕrbB-2 overexpression especially in type II endometrial cancer, is an indicator of a highly aggressive disease with poor overall survival. The potential role of ErbB receptors (especially EGFR and ErbB-2) as targets for cancer therapy has been investigated for over 20 years. There are 2 major classes of ErbB targeted therapies: anti-ErbB monoclonal antibodies (MoAbs) and ErbB-specific tyrosine kinase inhibitors (TKIs). ErbB targeted therapies have still shown modest effect in unselected endometrial cancer patients. However, they may be clinically active as adjuvant therapy in well-defined subgroups of type II endometrial cancer patients with EGFR and ErbB-2 overexpression.

Correlation between Epstein Barr Virus and early gastric cancer
. Kouklakis G.,Stefanidis S.,Minopoulos G.
Annals of Gastroenterology , 2007,
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