Gregory Skalkeas

Surgical Treatment for Lung Hydatid Disease

Abstract. Lung is the second most common site for hydatid disease after the liver. The aim of this study is to present the clinical symptomatology, diagnostic evaluation, and surgical techniques for the treatment of lung hydatid disease. During the last 25 years, 42 patients with lung hydatid cysts were treated surgically in our department. In four patients there were cysts in the liver and in one case in the spleen. The cysts were located in the right lung in 16 patients (38%), in the left lung in 23 patients (54.8%), and in both lungs in 3 patients (7.14%). Eighteen patients (42.9%) presented with complications: suppuration in one patient (2.4%), rupture to the bronchial tree in 16 patients (38%), and pneumothorax in one patient (2.4%). Diagnosis was established preoperatively in all cases; chest radiography and computed tomography were most helpful for diagnosis. Forty-six operations were performed in 42 patients; three patients with bilateral cysts underwent staged thoracotomies, and one patient was reoperated for recurrent disease. All cases were managed surgically, with several types of radical (34 cases) or conservative (12 cases) procedures. Radical procedures were lobectomy and rarely pneumonectomy, which were used more often during the first half of the study period. Cystectomy with capitonnage, the most commonly performed conservative procedure, was mainly used during the second half of the study period. Postoperative morbidity was 15.2% and the 30-day mortality rate was 0%. In one case there was postoperative hemorrhage that required reexploration. The median hospital stay for uncomplicated cases was 12 days and for complicated cases 21 days. In conclusion, pulmonary hydatidosis often presents with complications requiring emergency surgery. A lung-conserving operation is the treatment of choice for lung hydatid disease and offers a good surgical outcome with a minimal recurrence rate.

Serum zinc levels and urinary zinc excretion in patients with bronchogenic carcinoma: Effects of tumor resection

Low serum zinc levels and high urinary zinc excretion were found in 25 patients with bronchogenic carcinoma. Twenty of them underwent successful removal of the tumor by lobectomy or pneumonectomy; in the other 5 patients surgical exploration revealed unresectable pulmonary lesions. The latter had significantly lower serum zinc and higher urinary zinc levels than the patients in whom surgical removal of the tumor could be performed. Tumor resection was followed by restoration of serum and urinary zinc to normal. In contrast, in the inoperable patients a further decrease in serum zinc and no significant change in urinary zinc excretion were noted 15 days after thoracic exploration. In both patient groups a significant negative correlation existed between preoperatively obtained values of serum and urinary zinc. Hypozincemia in patients with bronchogenic carcinoma may result from an increase in urinary zinc losses, probably related to a decrease in zinc binding to plasma proteins. Determination of serum and urinary zinc may be useful in evaluating the prognosis of primary lung cancer.

Traumatic Hemopericardium and Chronic Constrictive Pericarditis

Chronic constrictive pericarditis following traumatic hemopericardium has been reported in recent years, but it has not been reproduced experimentally in dogs. The present study attempted to produce posttraumatic constrictive pericarditis in 34 experimental animals. Hemopericardium by means of trauma to the epicardium or pericardium was produced by a sharp instrument or by the injection of autologous blood inside the pericardial sac. All animals were killed at intervals between 3 and 31 months. The animals in which hemopericardium was induced by injecting blood into the pericardial cavity showed no changes. The hemopericardium was completely resolved without noticeable residual trace. Animals having hemopericardium as a result of trauma evidenced a well-developed constrictive pericarditis that was documented clinically, hemodynamically, and histologically. These experimental findings indicate that chronic constrictive pericarditis may well be due to traumatic hemopericardium rather than to specific infection.

The 10 years single center experience of using elderly donors for living related kidney transplantation

The use of elderly donors has been advocated to expand the organ donor pool because of increased needs and organ shortage. The aim of the study was to analyse whether old age of donors affects the outcome of renal transplantation and the long term safety of retrieval for the donors. We present data of 335 consecutive living related kidney transplants, performed in our centre the last 10 years, where in 174 patients the donor was less than 60 years of age, while in the rest 161 patients the donor was more than 60 years of age. No statistical difference was noted in either group at the incidence of irreversible acute rejections, early acute tubular necrosis, vascular complications and patient deaths. The graft survival was 86.7%, 80.4% and 78.1% for the 3rd, the 5th and the 8th year for the younger group of donors, while it was 83.6%, 78.2% and 67.8% for the older group (p = 0.13). Patient survival of the younger group was 95.9%, 94.7% and 94.7%, while for the older was 94.4%, 92.0% and 89.2% for the 3rd, the 5th, and the 8th year post transplantation (p = 0.24). Functional rehabilitation and quality of life were good in donors and recipients of both groups. These results suggest that renal transplantation from elderly donors offers comparable results from those obtained from younger donors.

Cell senescence and a mechanism of clonal evolution leading to continuous cell proliferation, loss of heterozygosity, and tumor heterogeneity: studies on two immortal colon cancer cell lines.

Extensive karyotypic analysis was performed on early and late passages of two continuous human cell lines, SW480 and SW620, that were derived from the same colon cancer patient. We cultivated these two cell lines in vitro for a period of 24 months and periodically examined their chromosome constitution. SW480 cells, from passage 138, were injected subcutaneously into 20 nude mice. The tumors that grew in nude mice were then cultivated in vitro for several passages to compare histopathologic findings and tumor growth patterns with clonal chromosomal profiles. Despite some karyotypic diversity, the two cell lines exhibited common marker chromosomes and followed similar patterns of evolution. During subsequent passages, acquisition of new chromosomal abnormalities gave rise to sidelines with a near-diploid genome that frequently underwent endoreduplication. Genomic instability seemed to play an important role in the emergence, growth, and subsequent elimination of the heterogenous sidelines by selection, clonal expansion, and cell death by senescence. Despite continuous growth, both the cell lines occasionally showed telomeric associations and random dicentric and multicentric formations. These lesions were considered evidence of cell senescence and were related to the disappearance of particular sidelines through evolution. Successful evolutionary steps were characterized by elimination of pre-existing marker chromosomes that were subsequently replaced in the karyotype by their cytologically intact homologous chromosomes possibly after selective endoreduplication. Frequent loss of heterozygosity for the chromosomes taking part in this process is postulated. We suggest that one of the mechanisms by which cancer cells bypass senescence may be related to their potential for continuous clonal diversification.

Atrial natriuretic peptide levels during and after acute cardiac tamponade in dogs

The ability of the atrial wall to secrete atrial natriuretic peptide was studied in eight dogs during 2 h of cardiac tamponade and for 2 h after decompression of the pericardium. Cardiac tamponade was induced by instillation of 5% dextrose in water into the pericardial cavity until aortic systolic pressure was reduced by 30% to 35%. Heart rate, cardiac output and atrial, pericardial and aortic pressures were measured at 60 and 120 min of tamponade and at 5, 30, 60, 90 and 120 min after decompression. Blood samples were withdrawn at the same time for the determination of atrial natriuretic peptide and aldosterone levels. Aortic pressure decreased significantly during tamponade and increased after decompression to near control levels. Right and left atrial pressures as well as intrapericardial pressure increased significantly during tamponade and returned to control levels after decompression. The effective transmural pressure, which was reduced during tamponade, was increased significantly at 5 min after decompression. Cardiac output was significantly reduced during tamponade and returned to pretamponade levels after decompression. Over the total experimental period, no significant changes in the levels of atrial natriuretic peptide were observed, whereas aldosterone increased significantly. It is concluded that the increased atrial pressure observed during cardiac tamponade did not stimulate the secretion of atrial natriuretic peptide. Furthermore, atrial distension observed immediately after decompression was not sufficient or of long enough duration to induce measurable increases in atrial natriuretic peptide levels. Finally, the secondary hyperaldosteronism did not activate atrial natriuretic peptide secretion either during cardiac tamponade or after decompression.

Evaporative water loss of adult surgical patients in Greece

Abstract Daily evaporative water loss was studied in seventy-two adult surgical patients in Greece. It was found to average 1,480 ml in preoperative patients and 1,751 ml in postoperative ones. It is concluded that the daily amount of water given to surgical patients for replacement of evaporative water loss in temperate climates should be 1,500 to 2,000 ml.

Tubular musculopleural pedicle grafting of esophageal long gaps in dogs

Direct anastomosis of the esophagus is the treatment of choice in patients with esophageal atresia. If, however, a long esophageal gap exists, the anastomosis is performed under tension or a staged procedure is anticipated. The aim of this study was to prove that a pedicle musculopleural graft can be used to bridge the two esophageal ends. In 14 dogs through a right thoracotomy, the periosteum of the fifth rib was mobilized and the rib was excised. An intercostal musculopleural flap was created leaving the muscle attached to its vascular pedicle posteriorly with the intercostal vessels and nerve carefully preserved. A tube-like portion including pleural and intercostal muscles was formed from the free part of the graft. A 5 cm segment of the esophagus was excised and the tubular graft was interimposed. Animals were studied 1 month postoperatively with a barium meal that showed free passage through the esophageal neolumen. Peristaltic activity was studied with strain gauges above, below, and at the grafted area. Histologic examination revealed good healing at both anastomotic sites, while esophageal squamous epithelium covered the lumen all over the graft. Survival of the musculopleural pedicle graft seems to be feasible providing that its vascular supply is preserved. It is, thus, suggested that this technique might offer an alternative method in bridging long gaps in esophageal surgery.

Cushing's syndrome: Analysis of 18 cases

Eighteen patients with Cushings syndrome were analyzed retrospectively. Eleven patients had diffuse or adenomatous hyperplasia, 5 an adenoma and 3 a carcinoma. Iodocholesterol scanning provides considerable help in localization of the disease. Surgical treatment, while curative for benign cases, affects only slightly the course of malignant disease.

Effect of aprotinin on fibrinopurulent peritonitis in rats

The effect of aprotinin on the clinical and pathologic course of experimentally induced peritonitis in the rat was studied. Peritonitis was induced in 40 rats by creating a closed ileal loop 4 cm long 5 cm from the ileocecal valve. The rats were divided into two groups of 20 rats each. Group 1 served as a control group, whereas each animal in Group 2 received a bolus dose of aprotinin (10 ml) intraperitoneally immediately after closing the laparotomy. In the aprotinin-treated group, survival was drastically increased (p less than 0.01) and formation of adhesions and abscesses was considerably reduced. The results of peritoneal cultures showed a decreased incidence of Escherichia coli and Clostridia in the aprotinin-treated group. We conclude that the administration of aprotinin significantly prolongs the survival time of animals with peritonitis and reduces the development of adhesions and abscesses in the peritoneal cavity. This beneficial effect can be attributed to decreased fibrinogen deposits within the peritoneal cavity and the stabilization of the organism after bacterial shock. Thus, bacteria were more susceptible to cellular and noncellular clearing mechanisms.