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1.
LICHTENSTEIN INGUINAL HERNIA REPAIR – OUR EXPERIENCE IN THE LAST
5 YEARS
Sdregas M., Andreadis S., Kalogiannidis I., Tagia A., Nikoloudis N., Saliangas K,
Ghrisidis T.
HERNIA - The Journal of Hernias and Abdominal wall Surgery (Abstract Book) 1999;
3(2): Tit.89
(Ανακοινώθηκε στο: ΧΧΙ INTERNATIONAL CONGRESS OF THE EUROPE HERNIA SOCIETY
Madrid, 4-6 November 1999)
The purpose of this retrospective study is to analyze our 5 years experience using the
Lichtenstein hernia repair technique. During the study period 327 patients underwent
hernioplasty using the Lichtenstein technique. We used polypropylene mesh in 285 and
polytetrafluroethelene mesh in 42 patients. According our results mean operative time
was 61 min, recurrent hernia from previous operation 21 patients, direct complications in
3 patients with scrotum haematoma, mean hospitalization 3.5 days. As a conclusion
Lichtenstein is a safe technique with low cost and low rate of recurrences.
2.
LICHTENSTEIN LAPAROSCOPIC TENSION FREE INGUINAL HERNIA REPAIR
COMPARED WITH CONVENTIONAL HERNIOPLASTY
Sdregas M., Andreadis S., Kalogiannidis I., Tagia A., Goussopoulos N., Saliangas K.,
Ghrisidis T.
HERNIA - The Journal of Hernias and Abdominal wall Surgery (Abstract Book) 1999;
3(2): Tit.94
(Ανακοινώθηκε στο: ΧΧΙ INTERNATIONAL CONGRESS OF THE EUROPEAN HERNIA
SOCIETY Madrid, 4-6 November 1999)
Tension free and conventional hernia repair technique was compared using 3 groups of
male subjects during the period 1994 to 1995. In the first group comprised of 58 patients,
(36 to 67 years old) a trasperitoneal laparoscopic repair technique (LTPH) of inguinal
hernia was used. The second group of 65 patients (41 to 73 years old) the Lichtenstein
repair techinique with Goretex or Prolene mesh was used. Conventional hernioplasty was
used for the third group. We compared the three techniques using the following criteria:
anesthesia used, operative time, postoperative analgesia, hospitalization time, return to
normal activity, complications and recurrence rate. With LTPH we observed less
hospitalization, cost and postoperative analgesia. With conventional hernioplasty we
needed more hospitalization time, longer period to return to full activity and higher rate
of complications.
3.
EMERGENCY COLON RESECTIONS
K Saliangas, Th Ghrisidis, A Ikonomou, A Eleftheriadou, S Siminou,I Kalogiannidis, A
Provadidis, G Fantakis.
HEPATO-GASTROENTEROLOGY 2000; 47(2): Tit 184
(Ανακοινώθηκε στο: 10th WORLD CONGRESS-INTERNATIONAL GASTRO- SURGICAL CLUB
Roma, 17-20 October 2000)
From January 1986 to April 2000, 282 patients were operated for colon diseases. In 66
(23%) an emergency coon resection was performed because of actual clinical
presentation. The most common causes of urgent colon recession were acute large bowel
obstruction because of Sigmoid volvulus (6 cases), Caecum volvulus (2 cases),
inflammatory tumors of the Caecum (10 cases), Hepatic flexure (5 cases), carcinoma of
Sigmoid-rectum (14 cases). One stage colectomy was performed in the majority of the
cases of right sided bowel obstruction or perforation, while the Hartman procedure was
the methods of choice in perforation and diverticulitis and left side obstructions. Despite
the postoperative complications and the 5 deaths we believe that in urgent colon related
situations an emergency colectomy may resolve the problem with safety.
4.
TREATMENT OUTCOME AND RECURRENCES IN VULVAL CANCER
Papanikolaou A., Kalogiannidis Ι., Goutzioulis M., Stergioudas I., Drizis
E., Makedos G.
INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER 2005; 15 (2): No
371
(Ανακοινώθηκε στο: 14th INTERNATIONAL MEETING OF THE EUROPEAN SOCIETY OF
GYNAECOLOGICAL ONCOLOGY-ESGO Istanbul, Turkey, September 25-29, 2005)
The aim of this study is to present treatment outcome in vulval cancer in a University
Hospital. Endpoints of the study were the overall survival (OS) and the disease free
survival (DFS) rates as well as treatment related morbidity. We studied retrospectively
31 patients that presented with vulval cancer in 10 years (1993-2003). Nine (29%)
patients were excluded from the analysis because of incomplete data. The median  SD
age of the women was 70  9.1yrs (range 45-83), and the median  SD follow up was 39
27months (range 8-110). Patients were treated wit radical wide excision or radical
vulvectomy and groin dissection  adjuvant radiotherapy . Squamous cell carcinoma was
the most common histopathology type (86%). Two groups of patients were compared a)
early stage (I-II) 73% and advanced stage(III-IV) 27%. The OS in-group A compared
with group B was 0.95 vs. 0.29 (95%CI) (p=0.07) and DFS rate 0.74 vs. 0.22, which was
statistical significant (p=0.04). The recurrence rate was 45% (40% local, 60%
locoregional). All the patients with local recurrence were treated by local excision and
are alive without disease [median time 12months (range 10-40)],. Only one patient
(14%) is alive more than 5yrs without disease after locoregional recurrence. Treatment
related morbidity was 36%, only after radical approach. Wound breakdown was the most
common complication. It is concluded that early stage vulva cancer has good survival.
Locoregional relapse has a bad prognosis. Treatment related morbidity is high after
radical treatment.
5.
TREATMENT OUTCOME IN HIGH RISK PATIENTS WITH ENDOMETRIAL
CANCER
Kalogiannidis I., Papanikolaou A., Goutzioulis M., Karamitzas D.,Makedos G.
INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER
2005; 15 (2): No 43
(Ανακοινώθηκε στο: 14th INTERNATIONAL MEETING OF THE EUROPEAN SOCIETY OF
GYNAECOLOGICAL ONCOLOGY-ESGO Istanbul, Turkey, September 25-29, 2005)
The aim of this study is to present the outcome of high-risk patients with endometrial
cancer treated in a University Hospital from 1996-2003. Out of 131 patients studied
retrospectively, 104 had complete follow up. In this study 39 (37.5%) low-risk women
were eliminated, 65 patients remained in the final analysis. The staging distribution was:
stage I (66%), II (17%), III (14%), IV (3%). Endometrioid was the most common type of
carcinoma (89%). The standard treatment was total hysterectomy (TAH), bilateral
salpingo-oophorectomy (BSO) followed either by
formal staging with pelvic
lymphadenectomy and omentectomy or by adjuvant radiotherapy based on pathologic
examination of the uterus. Surgical node positive staging was followed by
irradiation.The overall survival (OS) and disease-free survival (DFS) rates when disease
was confined in uterine corpus were 0.88 and 0.84 (95%CI) respectively which were
statistical significant compared with extrauterine spread (0.57 and 0.52, 95%CI)
(p=0.003 and p=0.002 respectively). The same results were obtained between node
negative and positive status (p=0.001 and p=0.001 respectively). No significant
differences were noted in OS and DFS between surgically staged node negative patients
with no adjuvant treatment and unstaged patients that received adjuvant radiotherapy in
uterine corpus restricted tumor (p=0.7and p=0.9 respectively). Treatment related
morbidity was almost double after postoperative irradiation compared to surgical staging
(11% vs. 5.4%). It is concluded that the endometrial cancer has good survival when
tumor is limited in uterine corpus even in high-risk patients. Surgical staging aims to
spare patients from further postoperative treatment and its related morbidity.
6. HER-2 METASTATIC BREAST CANCER: TIME FROM
PRIMARY
DIAGNOSIS TO METASTASES BY ER-STATUS
Marquette S, Kalogiannidis I, Neven P, Leunen K, Amant F, Berteloot P,
Drijkoningen M, Van den Bempt I. Wildiers H, Paridaens R, Christiaens MR, Vergote I.
INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER 2006; 16 (2): p593
(Ανακοινώθηκε στο: 5th BIENNIAL INTERNATIONAL MEETING OF THE FLEMISH
GYNAECOLOGICAL ONCOLOGY GROUP-FGOC Brussels-BELGIUM, January 26-28, 2006)
Background: HER-2 overexpressing breast cancers have a shorter time to progression
than tumours not overexpressing HER-2. It is unclear whether this early relapse in HER2 positive breast cancers is affected by the ER-status. In studies of early relapse from
breast cancer, median time to metastases is shorter in women with an ER-negative than
in women with an ER-positive tumour (Breast Cancer Res Treat 1998;52:227-37). We
studied HER-2 positive metastatic breast cancers (MBC) for time from primary diagnosis
to metastases by ER-status. Patients and methods: We identified all patients treated in
our centre with trastuzumab for a HER-2 MBC between April 2002 and August 2005.
Women with a primary metastatic breast cancer were excluded. We calculated the
median
time
from
primary
diagnosis
to
metastases
by
ER-status.
ER
immunohistochemical stains were performed according to the Envision method and
semi-quantitatively scored using monoclonal antibody NCL-ER-6F11/2. ER was defined
negative when a score of 50/300 or 2/8 or less was given using the H- or Allred-score
respectively. HER-2 was defined positive by FISH. Results: 51 women with a metastatic
HER-2 positive breast cancer receiving trastuzumab were identified. 28 were ERnegative and 23 were ER-positive. 52.9% of women with a HER-2 MBC were treated for
their primary tumour within 24 months; this was 64.3% of those being ER-negative and
39.1% of those being ER-positive.
Patient & Tumour
ER-negative
ER-positive
Characteristics
(n=28)
(n=23)
Age, years [median, range]
49.5 [34-60]
51 [30-80]
Proportion grade 3 (%)
92.8
86.9
Proportion T ≥ 2cm (%)
71.4
69.5
Proportion Node positive (%)
67.9
73.9
Proportion adjuvant chemotherapy (%)
92.9% (26/28)
43.5% (10/23)
Median time to metastases, months [median, range]
21 [7-216]
35 [8-72]
Discussion and conclusion: Median time to relapse from the primary diagnosis of breast
cancer differs by ER-status in women with a HER-2 MBC. Although our data are from a
population of women with a MBC who need trastuzumab, our data may have
implications for trastuzumab in the adjuvant setting of HER-2 positive breast cancers
that are also ER-positive. It may take longer to obtain a clear benefit and treatment may
have to be given for a longer time.
7. P53 OVEREXPRESSION AND PROGNOSTIC IMPACT IN ENDOMETRIAL
CARCINOMA OF ENDOMETRIOID SUBTYPE Kalogiannidis I., Papanikolaou A.,
Bobos M., Nenopoulou E., Aplianitis I., Makedos G.
VIRCHOWS ARCHIV 2006; 448: 665-737, P174
(Ανακοινώθηκε στο: 2nd INTER-CONGRESS OF THE EUROPEAN SOCIETY OF PATHOLOGY
Ioannina, Greece, May 25-26, 2007)
Objective: p53 overexpression is the most common alteration of human malignancies.
Overexpression of p53 in endometrial carcinoma has been reported to correlate with the
unfavorable clinicopathologic features and poor prognosis. The objective of the study
was to estimate the relationship between the different clinicopathologic factors with the
p53 overexpression and its prognostic significance in patients with endometrial cancer of
endometrioid subtype. Methods: Immunohistochemistry for p53 expression was
performed on paraffin embedded material of 71 surgically treated patients with
endometrial carcinoma of endometrioide histologic subtype. The evaluation of staining
was performed using a relative rank scale from 0 to 2 (0: negative or <10% of cells
positive, 1+:>10 to ≤50% of cells showing weak or focal staining, 2+: diffuse and strong
staining in >50% of cells). The latter (2+) was considered as overexpression. The median
follow-up time was 43 months. Statistical analyses were analyzed with SPSS 11.5 for
Windows. Results: The median age of the women was 65 years (range 35-80). Thirty
seven of the 71 patients (52%) stained positive for p53, while overexpression of p53 was
detected in 20 of 71 patients (28%). p53 overexpression was significant correlated with
unfavorable tumor differentiation (P=0.028) and positive nodal status (P=0.032). The
cancer related survival and disease free survival (DFS) were significant correlated with
the tumor differentiation (grade 3), deep myometrial infiltration, advanced FIGO stage,
positive nodal status and gross tumor diameter (P<0.05), while the p53 overexpression
related with the overall survival and DFS was insignificant (P=NS). Conclusion:
According to our data p53 overexpression is more commonly found in low differentiated
tumors and retroperitoneal disease, while prognosis was not significant correlated with
p53 overexpression.
8.
CLINOCOPATHOLOGICAL STUDY OF BCL-2 IMMUNOHISTOCHEMICAL
EXPRESSION IN ENDOMETRIOID ADENOCARCINOMA
Bobos M., Kalogiannidis I., Papanikolaou A., Makedos A., Makedos G.,
Nenopoulou E.
VIRCHOWS ARCHIV 2006; 448: 665-737, P173
(Ανακοινώθηκε στο: 2nd INTER-CONGRESS OF THE EUROPEAN SOCIETY
OF PATHOLOGY Ioannina, Greece, May 25-26, 2007)
Objective: The bcl-2 is an anti-apoptotic protein that resides on the cytoplasmic face of
the mitochondrial outer membrane, endoplasmic reticulum and nuclear envelope and
plays a central role in apoptosis, acting as an inhibitor of the apoptotic process. The aim
of our study was to evaluate the expression of Bcl-2 in endometrioid adenocarcinoma
and its clinocopathological significance. Methods: 78 surgically treated patients with
endometrial carcinoma of endometrioid subtype were included in the study. Clinical data
were available for all the patients and the median follow-up time was 43 months.
Immunohistochemical analysis for Bcl-2 antigen was performed on formalin-fixed,
paraffin embedded sections of 74 patients. The expression of the staining was divided in
two categories: 0, negative or <25% of cells positive; 1+, >25 of cells expressing weak
or focal staining, or diffuse and strong staining. Statistical analyses were performed
using the statistical software SPSS 11.5 for Windows. Results: The median age of the
women was 65 years (range 35-80). The cancer related survival was significant
correlated with advanced FIGO stage (P=0.0025) and metastatic disease (P=0.0005).
Disease free survival was closely associated with tumor diameter (P=0.04), risk factor
(P=0.035) and tumor depth (P=0.013), while the most important correlations were
associated with metastatic status (P=0.007), FIGO stage (P<0.0001) and tumor
differentiation (P<0.0001). Bcl-2 immunoreactivity was detected in 24/74 (32%) of
patients, only in patients with low histologic grade (grade 1, 2) and in none with grade 3
(0/7), P=0.028. Lack of Bcl-2 expression was directly correlated with high risk patients
(9/38), P=0.001. There was no association between Bcl-2 expression and FIGO stage,
age of the patients, tumor diameter and positive nodal status. Conclusions: Bcl-2 is an
early event in endometrioid adenocarcinoma. The anti-apoptotic effect of the Bcl-2 is
limited in advance stage carcinomas as well in high risk patients.
9. CHANGES OF SERUM C-REACTIVE PROTEIN (CRP) AND HOMOCYSTEINE
LEVELS IN WOMEN WITH POLYCYSTIC OVARY SYNDROME (PCOS) DURING
HORMONAL THERAPY
A. Makedos, D. Panidis, A. Papanikolaou, A. Hitoglou, I. Kalogiannidis, C. Asteriadis,
G. Makedos
HUMAN REPRODUCTION Abstract book 2007; 22: i183
(Ανακοινώθηκε στο: 23rd ANNUAL MEETING OF ESHRE Lion, France, 1-4 July 2007)
Introduction: This study was conducted in order to evaluate the effect of five different
hormone therapy schemes on serum levels of C-reactive protein (CRP) and
Homocysteine (Hcy), two established risk factor for cardiovascular disease (CVD), in
women with Polycystic Ovary Syndrome (PCOS). Material and Methods: Eighty-three
(83) with PCOS diagnosed according the new criteria of Rotterdam ESHRE/ASRMSponsored PCOSC Consensus Workshop Group (2003), received in a randomized way
five different hormonal therapy scheme. 22 women (age 22 ± 3.9, BMI 21.8 ± 5.6)
(Group A) received combined medication of 1.25mg/day of conjugated estrogens from
5th-24th day of the menstrual cycle and 50 mg/day Cyproterone Acetate from 5th-14th day
of the menstrual cycle. 17 women (age 22 ± 5.3, BMI 24 ± 3.3) (Group B) received
combined medication of 2 mg/day17b estradiol from 5th-24th day of the menstrual cycle
and 50 mg/day Cyproterone Accetate from 5th-14th day of the menstrual cycle. 20 women
(age 20 ± 3.3, BMI 26 ± 4.9) (Group C) received combined medication of 2 mg/day
ethynylestradiol from 5th-25th day of the menstrual cycle and 50 mg/day Cyproterone
Accetate from 5th-14th day of the menstrual cycle. 12 women (age 21 ± 4.6, BMI 22 ±
3.8) (Group D) received combined medication of 0.035 mg/day ethynylestradiol from the
first day of the menstrual cycle and for three consecutive cycles with interruption of the
medication. Moreover 12 women (age 20.5 ± 2.3, BMI 23 ± 3.9) (Group E) received
combined hormonal pill with 0.15mg Desogestrel and 0.02 mg ethynylestradiol per day
from 5th-25th day of the menstrual cycle. Blood sampling for the evaluation of serum
CRP and Hcy, and the ultrasonographic control of the internal genital organs of the
women with PCOS took lpace between 5th-7th day of spontaneous menstrual cycle,
before the onset of the medication. Further blood sampling for the evaluation of serum
CRP and Hcy were repeated at the 4th, 7th and 12th months between the 8th and 10th day
from the onset of the medication. Results: Only in the group of women who received 17b
estradiol and Cyproterone Acetate, there was a significant drop (p<0.001) of the serum
CRP levels, during the first four months, from the beginning of the medication to the 7th
month (p=0.019) and to the end of the therapy (p=0.028). All the hormonal therapy
schemes resulted in the drop of the Hcy levels from the beginning until the therapy.
Conclusions: All the hormonal therapies that were used in this study resulted in the
suppression of the Hcy serum levels during the yearly therapy and so all can act against
hypehormocysteinemia in women with PCOS. The most effective hormone therapy used,
regarding the possible protective role against CVD, is proven to be the combination of
17b estradiol and Cyproterone Acetate, which results in the suppression of both CRP and
Hcy serum levels in women with PSOS.
10. FASCIN EXPRESSION I PATIENTS WITH
ENDOMETRIAL
CANCER AND SURVIVAL DATA
I. Kalogiannidis, M. Bobos, A. Papanikolaou, E. Nenenopoulou, G. Makedos
VIRCHOWS ARCHIV 2007; 451: 301-308, PP3-37
(Ανακοινώθηκε στο: 21st EUROPEAN CONGRESS OF PATHOLOGY Istanbul, Turkey, September
8-13, 2007)
Objective: The aim of this study is to correlate clinico-pathologic factors and survival
data with FASCIN expression in patients with endometrial cancer. Methods: Specimens
from 58 patients with endometrial adenocarcinoma were used to stain the tissue
microarray. Clinical, pathologic and survival data were collected and correlated with the
immunhistochemical FASCIN expression. Results: The mean age of patients was 63
years (range 35-80). Ninety-six % of patients were of endometrioid histology subtype,
while 79% of stage I. FASCIN expression was seen in 76% (44 of 58) of cases. FASCIN
immunostaining was more common in favorable tumor grade (grade 1), in tumor
diameter of <2cm and superficial myometrial infiltration but did not reach statistically
significant (P = 0.2, P = 0.1 and P = 0.1, respectively). The estimate overall survival
(OS), cancer related survival (CRS) and disease free survival (DFS) of patients with
FASCIN expression (85%, 92,5% and 90% respectively) were not significantly higher
from the unstaining tumors. DFS was not significantly improved when FASCIN
expression was correlated by the different clinico-pathologic parameters (age, FIGO
staging, grade, myometrial infiltration, tumor diameter, extrauterine disease).
Conclusion:
According our data, it seems that PTEN expression in patients with
endometrial cancer is related with favorable grade, myometrial invasion and tumor
diameter but there is no impact in patients’ survival.