Fotios Chatzinikolaou

Burnout syndrome and job satisfaction in Greek residents: exploring differences between trainees inside and outside the country

BACKGROUNDnThe purpose of this study is to investigate the levels of burnout among Greek residents, highlighting potential differences between those practicing at home and abroad, as well as to investigate correlations with demographic, individual and labor factors.nnnMETHODSnThe research was conducted on a sample of 131 residents, using an anonymous questionnaire which included demographic, individual and labor characteristics, Maslachs Burnout Inventory, questions regarding job and life satisfaction levels, working conditions and the impacts of the economic recession.nnnRESULTSnFifty two point seven percent of the sample were training in the Greek National Health Service (N.H.S.), 27.5% in Germany and 19.8% in the United Kingdom. One out of three residents in the Greek system showed high levels of burnout in all three dimensions of the syndrome, while 51.1%, 72.2% and 30.8% of the Greek, British and German team, respectively, appeared burnt out simultaneously in two dimensions. Levels of job and life satisfactions ranged on average, while workload appeared heavy.nnnCONCLUSIONSnThe occurrence of burnout was associated with gender, specialty, employment characteristics (working hours, autonomy, support etc.), proneness to accidents, country, job satisfaction and quality of life, but was not associated with age or marital status. No correlation was found with susceptibility to medical errors.

Surgical anatomy of the internal thoracic arteries and their branching pattern: a cadaveric study

BACKGROUNDnThe purpose of this study is to review the anatomic characteristics of internal thoracic artery (ITA) and its branches, in order to pursue the extension of its utilization and avoid intraoperative and postoperative complications.nnnMETHODSnThe study was carried out on anterior chest walls obtained during routine autopsies of 50 specimens (30 male, 20 female). Macroscopic and microscopic dissection was performed and the following were studied: origin, length and termination of ITA, size and distance from the sternum, and types of branches.nnnRESULTSnFrom the origin to the termination point, the length of the left internal thoracic artery (LITA) varied from 159 to 220 mm; with a mean of 182.60 mm. The length of the right internal thoracic artery (RITA) varied from 150 to 231 mm; with a mean of 185 mm. Four types of branches were distinguished. The RITA mean diameter was 2.31 mm, measured at the 2(nd) intercostal space, while the distance from the sternum was 12.77 mm, measured at the 3(rd) intercostal space. The LITA mean diameter was 1.98 mm with the distance from the sternum measured at 12.01 mm.nnnCONCLUSIONSnITA has become the primary conduit for cardiac bypass surgery; many studies have generated fundamental anatomical knowledge for its clinical utilization, which is always useful in order to avoid intraoperative and postoperative complications.

Percutaneous tracheostomy—beware of the thyroidea-ima artery

Percutaneous tracheostomy is a minimally invasive operation performed in patients, in order to provide an air passage through the windpipe. A rare cause of severe bleeding during such operation is the injury of the thyroidea-ima artery. This case report presents a patient with hemorrhage after thyroidea-ima injury during percutaneous dilatational tracheostomy. Surgeons should always be aware of such anatomic variation, in order to prevent urgent sternotomy.

Coexistence of squamous cell tracheal papilloma and carcinoma treated with chemotherapy and radiotherapy: a case report

Background Papillomatosis presents, most frequently, as multiple lesions of the respiratory tract, which are usually considered benign. Malignant degeneration into squamous cell carcinoma is quite common, although curative approaches vary a lot in modern literature. Case report We report a case of a 66-year-old male patient with the coexistence of multiple squamous cell papilloma and carcinoma in the upper trachea with severe airway obstruction that was diagnosed through bronchoscopy and treated by performing an urgent tracheostomy, followed by concurrent chemotherapy and radiotherapy. There was no evidence of recurrence after a 12-month follow-up period. Conclusion This study underlines the diagnostic and therapeutic value of bronchoscopy as well as multimodality palliative treatment in such cases. To the best of our knowledge, this is the first study to describe an immediate treatment protocol with tracheostomy and concurrent chemotherapy/radiotherapy in a patient with squamous cell tracheal papilloma and carcinoma.

Double primary non-small cell lung cancer with synchronous small cell lung cancer N2 nodes: a case report

Synchronous multiple primary lung cancer (SMPLC) is rare and very hard to distinguish from metastatic disease. Recent studies indicate the presence of this entity in the lung, with no mention to the involvement of the mediastinum. An extremely rare case of a 68-year-old male with double primary non-small cell lung cancer (NSCLC) in the left upper lobe and N2 positive nodes for small cell lung cancer (SCLC) is presented. Modern diagnostic criteria as well as aggressive curative strategies are encouraged, in order to achieve better survival rates for such patients.

Smoking habit of children and adolescents: an overview

Smoking represents one of the largest public health problems due to its detrimental effects on multiple organs of the human body and its association with a variety of chronic and/or lethal diseases. Most smokers start smoking in their youth when growth has not been yet completed and they are more susceptible to the harmful components of tobacco. Purpose of this review was to present current data about the extent of tobacco use in childhood and adolescence, the situations facilitating smoking initiation at an early age and the available policies aiming to prevent early age smoking and to promote smoking cessation in non-adult individuals. Data were collected from the international PubMed database and through research in Google Scholar. Smoking rates among children and adolescents are alarming. Health care specialists should be aware of the real reasons leading to early age smoking, which are mainly the influence of family and its economic status, social life and internet. However, psychological reasons contribute also to early smoking initiation. Interventions in these fields should be achieved in order to prevent children and adolescents from smoking. For those who unfortunately smoke many smoking cessation programs exist worldwide and can help young people to quit smoking. However their results are often controversial. The significant increase of smoking among children and adolescents should be dealt with well-designed national smoking prevention and cessation programs after analyzing thoroughly the causes of young people smoking initiation. Both of these programs, but mainly the one aiming to the prevention part, should be practiced with the cooperation of all social parts, while school should have a central role.

Single sternal metastasis due to malignant melanoma with unexpected long-term survival: a case report.

Metastases from melanoma have a very poor prognosis for the patient. Single metastatic lesions in the sternum due to melanoma are extremely rare. A rare case of a presternal mass in a 56-year-old patient who had undergone excision for malignant melanoma is presented. Review of the patient’s history and surgical resection of a single metastatic soft tissue lesion offer the best chance of long-term survival.

Successful surgical treatment of a complicated esophageal perforation, by use of primary closure and lung parenchyma reinforcement

Esophageal perforation (EP) is a medical condition which demands urgent confrontation with significant complications. The cause of the perforation may be common, spontaneous or iatrogenic, with conservative or surgical therapeutic strategy, which is needed in the majority of incidents, depending on the characteristics of the lesion. We report a case of a 68-year-old man, with the existence of an ulcerative lesion 31 cm approximately from the dental barrier, and a coexistent stenosis, diagnosed through esophagogastroduodenoscopy, which evolved to an extensive purulent necrotic mediastinitis, diagnosed through a thorax CT scan after the patient began to complain of asphyxiation during eating. A right posterolateral thoracotomy was performed along with intensive wide spectrum antibiotic therapy. Primary closure of the perforation as well as pulmonary tenting was used with satisfactory results. There was no evidence of leakage after a 12-month follow-up period. The early diagnosis of an EP combined with immediate surgical procedure and frequent follow-up of the patient, eliminate the risks for the patients life and ensure a satisfactory outcome.

eComment. Cryoanalgesia in post-thoracotomy pain: Efficiency and pain measurement methods

We have read with great interest the article by Khanbhai et et al., concerning the effectiveness of cryoanalgesia in post-thoracotomy pain management compared to other analgesic methods used over the years [1]. n nCryoanalgesia is a method that ensures prolonged intercostal blockage, and was first introduced in 1975 [2]. The results of cryoanalgesia alone or in combination with other analgesic methods (i.e. epidural analgesia) in post-thoracotomy pain management vary, as seen in the article by Khanbhai et al. n nThe aim of this brief comment is to highlight the role of intercostal catheter analgesia with bupivacaine or similar drug, placed during surgery, and its effectiveness in post-thoracotomy pain. The key is that it is also a less invasive method, compared to epidural analgesia, and there is evidence of satisfactory results in the literature [3]. n nIt would also be useful to evaluate and treat post-thoracotomy pain using more complete pain scales, such as the Pain Quality Assessment Scale (PQAS), and the Numeric Rating Scale (NRS-11), in order to have a more precise comparison between different types of analgesia [4,5].