Ekaterini Christina Tampaki

Cabozantinib and Vandetanib in medullary thyroid carcinoma: mitochondrial function and its potential as a therapeutic target towards novel strategies to design anti-CSCs drugs

Ekaterini Christina Tampaki, Athanasios Tampakis, Raoul Droeser, Efstratios Patsouris, and Gregory Kouraklis B Department of Propaedeutic Surgery, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; National Organization for the Provision of Healthcare Services, Department of Planning and Monitoring of Medicines Dispensing, Medicines Division, Greece; Department of General and Visceral Surgery, University Hospital of Basel, Switzerland; Institute for Surgical Research and Hospital Management ICFS, Basel, Switzerland; A Department of Pathology, Laiko General Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece

Letter by Tampaki et al Regarding Article, “Empagliflozin and Cerebrovascular Events in Patients With Type 2 Diabetes Mellitus at High Cardiovascular Risk”

The unfavorable stroke-related results in the EMPA-REG OUTCOME trial (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients) could be pure chance or a warning requiring further elucidation. Confirmed by the authors,1 the population from Europe accounting >40% of the study population experienced strokes driving the event rate. The Endocrine and Metabolic Drug Advisory of the Food and Drug Administration correlated increased stroke risk with patient subgroups coming from Europe, of age 8.5% and on insulin treatment.2 Possible aggravating factors included lack of detailed medication changes recording, vital signs and laboratory tests performed not timely close to stroke events, and intermittent interruptions in empagliflozin therapy because of hypoglycemia episodes, leading to different drug exposures, whereas patients lacked a baseline …

Current clostridium difficile treatments: Lessons that need to be learned from the clinical trials

ABSTRACT Clostridium difficile infection (CDI) is the most common infectious disease cause of nosocomial diarrhea in adults in developed countries. Judging from the clinical trials on drugs used in CDIs, no approved treatment for recurrences exists, possibly indicating that a combination of treatment approaches are mandatory especially in severe infections, with current studies not being fully representative. Among the new strategies researched intensively fidaxomicin is presented, which demonstrates reduced CDI recurrences. Moreover, biotherapeutic strategies, mainly fecal microbiota transplantation but also competitive inhibition with non-toxigenic strains of C. difficile, and finally monoclonal antibodies against C. difficile toxins which offer protection against recurrences. Careful interpretation of the results based on lessons learned from previous trials conducted seems crucial. Questions are raised regarding how the results of future studies regarding new strategies researched will be managed and interpreted especially with regard to recurrence management as relevant data must be monitored for at least 30 days after end of treatment.

Orchitis reveals an extragonadal primary mediastinal thymic seminoma: a coincidence or not?

BackgroundMediastinal thymic seminomas are rare male germ cell tumors with extragonadal origin that appear predominately with a cystic appearance.Case presentationA 22-year-old male was referred to our department for further investigation of a mediastinal mass discovered incidentally during routine chest X-ray. The patient has denied any symptoms including dyspnea, chest pain, cough, fever, dysphagia, hemoptysis, weight loss, and weakness. His past medical history was remarkable for orchitis, for which he had undergone a bilateral testicular biopsy, without the latter however, indicating the presence of a germ cell tumor or a premalignant lesion. Contrast-enhanced chest computed tomography revealed a lobulated and well-marginated cystic lesion in the anterior mediastinum. Differential diagnosis included mostly a multilocular thymic cyst, a lymphoma, a seminoma, or a soft tissue tumor. Resection of the mass revealed a primary thymic seminoma.ConclusionsA surgical approach for the management of these tumors might be reasonable considering that an extensive sampling is mandatory to gain an appropriate biopsy preoperatively in order to securely confirm or refute the presence of a mediastinal extragonadal tumor. Orchitis might be a sign of a general disorder of the germ cells which might transform in time.

Erratum to “eComment. Management of deep sternal wound infections after cardiac surgery: Towards development of new substrates for sustained multiagent delivery release profiles” [Interact CardioVasc Thorac Surg 2017;25(1):11; doi: 10.1093/icvts/ivx176]

a Department of Propaedeutic Surgery, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece b National Organization for the Provision of Healthcare Services, Department of Planning and Monitoring of Medicines Dispensing, Medicines Division, Greece c Department of Thoracic Surgery, University Hospital of Basel, Basel, Switzerland d Department of General and Visceral Surgery, University Hospital of Basel, Basel, Switzerland

Commentary: Conservative Management of a Scar Abscess Formed in a Cesarean-Induced Isthmocele

We read with great interest the article by Boukrid et al. on the very interesting case of a primiparous woman presenting a symptomatic abscess in the isthmocele 10 years after a cesarean section (CS) (1). Any post-caesarian wound infection such as a scar abscess is caused usually due to a bacterial infection in the surgical incision site, commonly developing with signs of lower abdominal pain, fever, and wound sensitivity. In fact, many CS wound infections usually appear within the first couple of weeks after delivery and are diagnosed at follow-up visits. What makes, however, this case so interesting is the development of the surgical site infection (SSI) 10 years after the CS took place. First, we certainly agree that the presentation of this so rare case brings up excellent discussion topics on the subject. Therefore, interesting to know regarding this patient would be if there were specific risk factors for any post-SC wound infection occurrence, including obesity, immunosuppression, or existence of diabetes in the patient’s history. Moreover, presence of chorioamnionitis during labor, poor prenatal care (not so significant in this case because of the 10-year occurrence of the ISS), previous C-sections that were indeed denied by the patient, not administering prophylactic antibiotics or pre-incision antibacterial care, a prolonged lasting labor or switch to surgery, and extreme blood loss during the procedure seem also crucial. Interestingly, many SSIs have been described in patients who smoke as well as after use of long-term systemic corticosteroids. According to Chunder et al. in a randomized controlled prospective study in Africa, they positively correlated the nylon or staple sutures use after a CS with higher infection risk. However, polyglycolide sutures are favored because of their absorbability and biodegradability (2), whereas skin closure with subcutaneous contrarily to staple sutures minimizes the superficial infections rates (3). Apart from that, of high significance appears the categorization of the types and the appearance of the related infections after a CS, being usually classified as wound-related cellulitis or abdominal abscess, contributing to the most common post-SC infections including endometriitis and pelvic cellulitis (4). As CS wound infections may also spread and even cause serious complications such as necrotizing fasciitis, fascia rupture, or even wound dehiscence and in worst cases evisceration with septicemia or even progression to septic shock, the correct antibiotic treatment is highly important to clear up the infection, with common choices including β-lactam antibiotica administration as they

Commentary: Evidence for Replacement of an Infected Synthetic by a Biological Mesh in Abdominal Wall Hernia Repair

It was a pleasure to go through the manuscript by Montgomery et al. because it provides stimulating arguments in favor of using biologic meshes and replacing infected synthetic ones in difficult abdominal wall reconstruction (AWR), whereas it brings up excellent discussion topics on the subject (1). First, we certainly agree that biologic meshes are being used with increased frequency in many fields and, indeed, the outcomes are perceived to be better than those for traditional polymerbased prosthetic mesh replacement materials. However, we believe that the use of biological grafts increased rapidly without clear clinical evidence of efficacy and, therefore, we would like to highlight that selection of the proper implant is always crucial along with careful consideration of patient characteristics related to prosthetic will as this could effectively lead us to decreased complication rates, readmissions, and number of postoperative visits. Interestingly, the same side of the coin as suggested above is being presented in recent clinical reports focusing on the successful use of light weighted, macroporous synthetic meshes in contaminated ventral hernia reconstructions, showing that in contaminations with Staphylococcus aureus and Escherichia coli, the biologic meshes proved to be less resistant compared to reduced-weight synthetics and, therefore, raising the question whether biologics should be questioned in contaminated ventral hernia reconstruction (2). Furthermore, a highly anticipated multicenter prospective double-blinded randomized controlled trial by Rosen et al. examining material safety, efficacy, and cost effectiveness wants to demonstrate that the use of a macroporous light-weight polypropylene mesh is much more cost effective in comparison to the use of a biologic mesh (3). As suggested above, with currently >200 meshes being commercially available in the United States, it is significant to highlight strength and weaknesses of materials used and always explore possibilities of combining them so as to take advantage of their benefits. As far as synthetic meshes are concerned, tensile strength, porosity, elasticity, and fabrication method are significant. Excessive tensile strength leads often to inflammation, material contraction, and further postoperative pain, whereas the various pore sizes influence the meshes

Commentary: Hernia, Mesh, and Topical Antibiotics, Especially Gentamycin: Seeking the Evidence for the Perfect Outcome…

It was a pleasure to go through the manuscript by Hacan Kulacoglou (1) published in Frontiers in Surgery, which focuses on topical antibiotic prophylaxis use especially gentamycin in clean surgeries such as in inguinal hernia mesh reconstructions, as he brings up excellent discussion topics. Indisputably there are benefits in using antibiotics topically rather than orally or intravenously, reducing the chances of bacterial resistance and presumably the risk of having a surgical site infection (SSI), however leading to unwanted effects development, with the most common being contact dermatitis (2). It has been suggested that gentamycin, topically or parenterally administered (1), is effective especially against Gram-negative bacteria; however, its use as empirical monotherapy or in combination with other antibiotics in clean surgeries has not been officially comparatively evaluated. Antibiotic choice, duration, dose, dosing interval, and first dose timing in contaminated but also in clean fields appear significant and would rather depend on the antibiotic’s adverse effect profile, drug interactions, and the probability of bacterial resistance, especially given the emergence of bacterial resistance to third-generation cephalosporins, causing great concerns. Although antibiotic prophylaxis is not mandatory in clean, elective operations, regular use of implants, accounting a 90% of inguinal hernia repairs, creates controversies (2). The European Hernia Society (3) does not suggest routine antibiotic prophylaxis. However, it is recommended where patient-related or procedure-related risks exist, as also Mazaki et al. indicated in a randomized controlled trial, showing that prophylaxis use proves to have effect on SSI prevention (4). Interestingly, mesh use in inguinal hernia reconstructive surgeries does not necessarily lead to greater wound infection risk (5). Latest data concerning wound infections regarding open mesh contrarily to non-mesh techniques used in inguinal hernia reconstructive surgeries suggest that deep infections surface rare and do not necessarily lead to mesh removal when monoor multifilament mesh fabrics are applied along with drainage. Furthermore, the majority of RCTs are against using prophylaxis

Commentary: Somatic Stem Cells and Their Dysfunction in Endometriosis

It was a pleasure to go through the manuscript by Dusan Djokovic and Carlos Calhaz-Jorge on somatic stem cells (SSCs) and their dysfunction in the pathogenesis of endometriosis (1). As EnSCs are adult stem cells comprising of an epithelial stem cells population, mesenchymal stem cells, and side population stem cells, they are of particular interest being implicated in angiogenesis and vascularization processes during tissue regeneration, being a steady supply of autologous stem cells for women and currently being tested in several clinical trials regarding their regenerative and therapeutic potential (2). However, although we agree concerning the clarity of the data presented by the authors, we believe that there is always an association worth mentioning between the role of SSCs regarding the pathophysiology of endometriosis and the epithelial to mesenchymal transition (EMT) and mesenchymal to epithelial transition (MET) mechanisms when accumulating data are reviewed and presented regarding neoplastic and chronic inflammatory conditions such as endometriosis. A possible crucial connection between EMT and the stem cell niche, in other words the microenvironment favoring the disease, possibly all being involved in the pathogenesis of endometriosis is also a matter of great future investigation worth mentioning. Indeed, a possible role of EnSCs related to the development of ovarian endometriosis and ovarian endometrioid carcinoma has been supported by a variety of studies as also suggested by Mirantes et al. (3). As already known, the endometrium normally deriving from the intermediate mesoderm, via MET taking place during the development of the urogenital system, could be prone to return to its original state via EMT, meaning endometrial epithelial cells returning to their mesenchymal origin and consequently being involved in the pathogenesis of pelvic endometriosis (4). Epithelial to mesenchymal transition and MET-like processes are involved in the pathogenesis of endometriosis, as shed menstrual effluent can induce the EMT in mesothelial cells leading to phosphorylation cascades activation regarding proteins involved in cytoskeletal restructuring including a filament system transit from cytokeratin to vimentin, intermediate filaments, and