Andreas Manios

A simple digital image processing system to aid in melanoma diagnosis in an everyday melanocytic skin lesion unit: a preliminary report.

Background  For early melanoma diagnosis, experienced dermatologists have an accuracy of 64–80% using clinical diagnostic criteria, usually the ABCD rule, while automated melanoma diagnosis systems are still considered to be experimental and serve as adjuncts to the naked‐eye expert prediction. In an attempt to aid in early melanoma diagnosis, we developed an image processing program with the aim to discriminate melanoma from melanocytic nevi, establishing a mathematical model to come up with a melanoma probability.

Super giant basal cell carcinoma of the abdominal wall: still possible in the 21st century

Basal cell carcinoma (BCC) is very common and usually encountered when it is small in size. Giant BCC (i.e. greater than 5 cm in diameter) is quite rare and comprises 0.5 percent of all BCC. Extremely rarely, tumors larger than 20 cm have been reported. Herein, a case with an enormous, vegetating BCC of the abdominal wall, 30 x 20 cm in size, is described. This report demonstrates that such a case can still be observed in the civilized world of the 21st century, which remains profoundly astonishing. A literature survey was performed and revealed only 7 cases with such super giant BCC (i.e. larger than 20 cm in diameter). Generally, this tumor attains these enormous proportions due to neglect on the patient’s part, and is usually located at sites covered by clothes. Treatment is mainly surgical and generally curative, resulting also in an improved quality of life. Tumor size of more than 10 cm in diameter is associated with increased risk for metastatic disease, severe morbidity and consequently impaired prognosis.

Tonsilloplasty in children with obstructive symptoms.

OBJECTIVE Obstructive symptoms, caused by tonsillar hypertrophy, have been attracting increasing interest, and tonsillectomy is often performed as a result of this indication. This study was undertaken to investigate the effect of the different surgical techniques, tonsilloplasty and tonsillectomy, on clinical symptoms in children with obstructive symptoms owing to tonsillar hypertrophy. METHODS Thirty children, 3 to 12 years old, were included; 15 of them underwent tonsilloplasty and 15 tonsillectomy. Tonsilloplasty was performed with a knife or scissors, and the trauma was closed with two or three sutures. The tonsillar capsule and about 15 to 20% of tonsillar tissue remain as a barrier to prevent exposure of the pharyngeal muscles. All children were operated on under the same anesthesia and followed the same postoperative scheme for analgesia. RESULTS All of the children were cured of their breathing obstruction. In the tonsilloplasty group, the tonsillar remnants healed completely within 1 week. The postoperative pain recorded was significantly less than in the tonsillectomy group. No major side effects occurred. The mean time used for the surgery was the same, and no postoperative bleeding was seen in both groups. The intraoperative bleeding observed was small in both groups, although significantly smaller for the tonsilloplasty group. CONCLUSIONS Tonsilloplasty is a less traumatic and much less painful surgical method, and children recover more quickly. The results with respect to breathing obstruction are almost the same for both methods at the 1-year follow-up. It seems to be the most suitable method for children with tonsillar hypertrophy and obstructive symptoms.

Treatment of nasal fractures by Paul of Aegina

OBJECTIVE: The most exact description of the management of nasal fractures given by any physician of ancient times belongs to Paul of Aegina (AD 625–690). The goal of this article is to describe the therapeutic methods and surgical techniques used by Paul of Aegina in the treatment of nasal injuries. STUDY DESIGN: We studied the original Greek texts and the translation published in Venice, titled “The seven books of excellent doctor Paul of Aegina.” The sixth book of his medical compendium is devoted to surgery. We identified the treatments and techniques applied to the restoration of injured noses. CONCLUSION: In this historical article we present the management of nasal fractures by Paul of Aegina. Paul of Aeginas conservative and surgical management for each form of injury was adopted by later physicians and influenced European medicine, a management surprisingly identical with the way nasal fractures are managed nowadays.

Computer assisted evaluation of wound healing in chronic ulcers.

The aim of this work was to present an efficient and objective method of wound healing assessment based on serial measurements of ulcer dimensions and calculation of wound margin advancement towards the center of the lesion. The method is implemented via computer software, which permits clinicians to perform necessary computations. The proposed method of wound assessment integrates pieces of work that have been published in the past into a user-friendly environment. The high accuracy of computations may help clinicians to make objective decisions in the management of difficult to heal ulcers.

Anthropometric Analysis of the Face.

Background:Facial anthropometric analysis is essential for planning cosmetic and reconstructive facial surgery, but has not been available in detail for modern Greeks. In this study, multiple measurements of the face were performed on young Greek males and females to provide a complete facial anthropometric profile of this population and to compare its facial morphology with that of North American Caucasians. Materials and Methods:Thirty-one direct facial anthropometric measurements were obtained from 152 Greek students. Moreover, the prevalence of the various face types was determined. The resulting data were compared with those published regarding North American Caucasians. Results:A complete set of average anthropometric data was obtained for each sex. Greek males, when compared to Greek females, were found to have statistically significantly longer foreheads as well as greater values in morphologic face height, mandible width, maxillary surface arc distance, and mandibular surface arc distance. In both sexes, the most common face types were mesoprosop, leptoprosop, and hyperleptoprosop. Greek males had significantly wider faces and mandibles than the North American Caucasian males, whereas Greek females had only significantly wider mandibles than their North American counterparts. Conclusions:Differences of statistical significance were noted in the head and face regions among sexes as well as among Greek and North American Caucasians. With the establishment of facial norms for Greek adults, this study contributes to the preoperative planning as well as postoperative evaluation of Greek patients that are, respectively, scheduled for or are to be subjected to facial reconstructive and aesthetic surgery.

Contribution of 99mTc-anti-carcinoembryonic antigen antibody and 99mTc-sestamibi scintimammography in the evaluation of high risk palpable breast lesions.

Mammography is the screening test of choice for breast cancer. Its low specificity leads to a large number of unnecessary biopsies. Scintimammography, with either 99mTc-sestamibi (MIBI) or 99mTc-anti-carcinoembryonic antigen (CEA) Fab′, has been proposed as a non-invasive test to lower the high false positive rate of mammography in certain patients. The two agents have not been compared, nor has their combined application been evaluated. We performed a prospective, non-randomized, open-label, single-centre study of 32 women with clinically and mammographically suspected breast cancer [Breast Imaging Reporting and Data System (BI-RADS™, American College of Radiology) 4 or 5]. All patients underwent 99mTc-MIBI and 99mTc-anti-CEA Fab′ scintimammography, and the results were correlated with histopathology. Overall, the accuracies for MIBI and CEA scans were 90.3% (28/31) and 77.4% (24/31), respectively. The probability of disease after mammography was 0.939±0.081 (95% confidence interval, CI). The post-mammography probabilities after positive MIBI or CEA scan were 0.965 and 0.960, respectively, and after negative MIBI or CEA scan 0.750 and 0.875, respectively. None of the above differences is significant. The post-test probability when both scans were positive (irrespective of which was performed first) was 0.977. It can be concluded that there are indications that scintimammography with 99mTc-MIBI is superior to that with 99mTc-anti-CEA Fab′ when these tests are used as screening tests for breast cancer. However, mammography remains the screening test of choice for highly suspicious clinically palpable breast lesions. In this group of patients, the application of scintimammography with either 99mTc-MIBI or 99mTc-anti-CEA Fab′ (alone or in combination) offers no additional advantage.

Paul of Aegina's surgical instruments: a complete surgical instrumentarium in the seventh century AD.

Although current progress in surgical instruments is oriented towards stapler devices, minimally invasive instrumentation and advanced cautery tools, it definitely seems intriguing to determine what instruments were used in antiquity and to appraise their use. Most adequate information can be retrieved from manuscripts of early medical authors, of whom Paul of Aegina (AD 625–690), also being a most important surgeon, is the most recent. The aim of this study is to present surgical instruments used in his practice.

Pilomatrix carcinoma: More malignant biological behavior than was considered in the past

Pilomatrix carcinoma is a very rare malignancy, with ~130 cases reported in the literature. In the past, pilomatrix carcinoma was considered to be a low-grade malignant tumor. Currently, however, its significant recurrence and metastatic potential has been well documented. Lymph node and systemic metastases are frequently observed. Wide surgical excision of the primary lesion is the principal modality of treatment, whereas adjuvant radiotherapy may be beneficial in local tumor control. Lymph node metastases may be treated surgically or with radiotherapy. Systemic disease is not responsive to chemotherapy, and is hence associated with a poor prognosis. Since the majority of nodal and systemic metastases present after the initial diagnosis and treatment, follow-up examinations of these patients may be warranted, despite the currently inadequate treatment options. In the present study, a case of pilomatrix carcinoma of the parotid region with early local recurrence only 2 months after complete excision with negative surgical margins is reported. The local recurrence was treated by excision and radiotherapy. The associated literature is also discussed.

Significant Differences in Skin Irritation by Common Suture Materials Assessed by a Comparative Computerized Objective Method

Background: Erythema can be described only through subjective evaluation, except when it is quantified by digital image analysis software. Using such software, the authors performed comparisons of the erythema produced after skin closure of clean surgical wounds. Five suture materials were compared with respect to the local skin irritation that was caused. Different quantities of erythema are produced by suture material after the skin closure of clean surgical wounds. The authors present an objective method of measuring how unreactive a suture material is in comparison with another when applied to the skin. Methods: The suture materials polydioxanone, polypropylene blue, polyamide 6, metallic clips, and polyglactin were compared in the present study. Digital photographs of 100 patients were compared by means of software, evaluating red color superiority (mean value of red color) in the region surrounding the wound. Results: The least to most irritation caused to the skin by different suture materials was established for paired data. The Kolmogorov-Smirnov criterion and the Wilcoxon signed rank test were used. Polydioxanone was found to have the best performance, followed in order by polyglactin, polyamide, polypropylene, and metallic clips. Immediately after suture removal, differences between the effects of suture materials were statistically significant on postoperative day 10. Conclusions: Absorbable sutures can be used in skin closure of clean surgical wounds and can produce less erythematous reaction than nonabsorbable ones. Digital image analysis is a reliable method of quantitative evaluation of skin erythema resulting after skin closure of surgical wounds.