Nikolaos Syrmos

Dealing with the Surgical and Medical Challenges of Penetrating Brain Injuries

Peacetime has reduced the overall incidence of penetrating brain injuries (PBI), and those related to missile penetration are not common anymore at least in western countries. Nevertheless, PBI still occur, and car crashes or work accidents are their main causes. The management of such cases is characterized by many challenges, not only from a surgical and medical point of view, but also for the different and sometimes bizarre dynamics by which they present. Herein we report an unusual deep penetrating brain injury, due to a high-energy crash against a metallic rod in a construction site, with a good surgical outcome despite dramatic clinical conditions on admission. A discussion of the surgical results and functional outcome related to PBI, as found in the English medical literature, is provided. Moreover the most common postoperative complications along with the diagnostic flow charts and therapeutic options useful to prevent inappropriate treatment are highlighted.

Microcephaly in ancient Greece—The Minoan Microcephalus of Zakros

Microcephaly is a neurodevelopmental disorder in which the circumference of the head is more than two standard deviations smaller than average for the persons age and sex. Microcephaly may be congenital or it may develop in the first few years of life. The disorder may stem from a wide variety of conditions that cause abnormal growth of the brain or from syndromes associated with chromosomal abnormalities. The eterogenity of the condition poses

Historical back training in most important points of neurosurgery

Background The History of Neurosurgery begins with the presence of human in the earth. Begins from the depths of History (reports in Bible, Greek Mythology), as a part with Surgery until the last half of the 20th Century. Archaeological discoveries of human skull’s proved the affair that the first neurosurgical action is the trepanation of skull or trephination (Burr hole in the cranial capsule with hand working drill), from material proportional the epoch (stone copper, iron, brass etc). Chronological probably before the presence of written proofs and the use of metals, perhaps and from this 10.000 b.C. This action perhaps presented as a cerebration (in dead), but also as therapeutic in alive. This is the first surgical technique that prepared the trepanation of skull or trephination and later the craniectomy.

Craniotomy infections: the Venizeleio hospital experience

Background Surgical site infections (SSIs) are defined as infections occurring up to 30 days after surgery and affecting either the incision or deep tissue at the operation site. Despite improvements in prevention, SSIs remain a significant clinical problem as they are associated with substantial mortality and morbidity and impose severe demands on healthcare resources. The incidence of SSIs may be as high as 20%, depending on the surgical procedure, the surveillance criteria used, and the quality of data collection. In many SSIs, the responsible pathogens originate from the patient’s endogenous flora. The causative pathogens depend on the type of surgery; the most commonly isolated organisms are Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus spp. and Escherichia coli.

Exploring attitudes towards endocrine diseases in Greece

Although patients with different types of endocrine diseases exist worldwide, and relevant knowledge is rapidly progressing through clinical and experimental medical research [1], still little is known about the knowledge and attitudes that the Greek public has on health problems related to the endocrine system. Thoughts and feelings have been extensively examined mainly for psychiatric diseases [2], but attitudes and possible misconceptions for other types of physical diseases are still not thoroughly examined. The level and extent of the general public’s understanding of endocrine diseases and their prevention is related to the public health as their prevalence increases worldwide [3]. A wider or narrower knowledge among the general population means less or more emphasis on early diagnosis and management programs, while schemes for the improvement of health from the healthcare system and relative allocation of resources is influenced. More specifically, knowledge of the public’s attitudes may have direct implications for clinical practice, as the ability to treat adults may depend, in part, on understanding attitudes toward endocrine diseases. Therefore, the main objective of this cross-sectional descriptive survey is to identify the public’s attitudes towards endocrine diseases. This can be achieved by assessing the knowledge and attitudes towards endocrine diseases in Greece both in healthy adults and a subgroup of patients already suffering from an endocrine disease. A total of 894 proficient speakers of Greek, including both native Greek participants and non-native permanent Greek residents (514 men and 380 women, with ages ranging from 18–75 years) from different geographical areas of Greece (Thessaloniki, Drama, Larissa, Xanthi, Serres, Kavala, Athens, Ioannina), replied voluntarily to a questionnaire related to their attitudes towards endocrine diseases during 2012–2016. The sample consisted of 792 healthy participants and 130 endocrine patients (68 with a diagnosed thyroid disorder and 62 with diabetes with an official diagnosis no more than one year). The educational level of the participants varied from 2 to 21 years (M= 11.40, SD = 3.30). Volunteers were recruited from a variety of sources (older healthy participants at senior centers and retirement homes, younger healthy participants mainly after university classes and youth centers, and patients from various hospitals). We applied exclusion criteria for the healthy participants concerning a history of psychiatric disorder, substance abuse and/or dependence or any other medical condition relevant to endocrine diseases. The exclusion criteria were chosen based on the fact that if the above conditions were present, then the participants could not be characterized as healthy, while in particular, severe psychopathology would skew the correctness of the answers. Additionally, all participants with a medical education and/or working as healthcare professionals were also excluded, because they represent individuals with extensive medical knowledge that is not typical of the general population. The same exclusion criteria with the exception of the medical condition related to endocrine diseases, were also applied to the endocrine patient participants. The * Vaitsa Giannouli giannouliv@hotmail.com

Cognitive function in Hashimoto's thyroiditis under levothyroxine treatment.

OBJECTIVE: Although overt hypothyroidism has been documented as exerting detrimental effects on cognition and behavior, it remains controversial whether subclinical hypothyroidism or euthyroid patients with Hashimoto’s thyroiditis (HT) under levothyroxine (LT4) treatment may experience any noticeable decline in cognitive function. PATIENTS: Two otherwise healthy, highly-functioning, first-degree relatives with a diagnosis of HT, under LT4 treatment for two years, were prospectively recruited into a clinical research study setting and followed for a year. MEASUREMENTS: Thyroid functions tests and a detailed battery of tests assessing global cognitive status, attention, verbal and working memory, visuoperceptual skills, executive functions and mood were performed at baseline and at one year after recruitment. RESULTS: Overall, patients’ performance on the neuropsychological battery was good and, in the majority of cognitive functions, their performance could be characterized as exceptional. No noticeable changes in any of the studied parameters were detected. CONCLUSIONS: The present case study failed to detect any noticeable changes in the cognitive and emotional function of two women with HT under LT4 treatment. The course of cognitive function of the two HT patients, evaluated by a detailed battery of tests, tends to confirm the benign nature of HT.

Remembering a good friend

Evangelos Markakis (Figs. 1 and 2), a well-known Cretan neurosurgeon, pediatric neurosurgeon, and professor emeritus of Neurosurgery of the Medical School of Heraklion, Crete passed away on 03 February 2018. He was born in Neapoli, Lasithi, Crete in 1936. He studied Medicine in Freiburg and Kiel, in Germany. He completed his doctoral thesis in Hannover and afterwards, he did a 3-year stage in Saudi Arabia, at Riyadh Central Hospital (1983–1986). On his way back to Germany, he served as a professor of Neurosurgery in Göettingen. In 1999, he was elected first full professor of Neurosurgery in the University of Heraklion, Crete. He served in this position until his retirement in 2003. A pioneer neurosurgeon of his era, he was one of the first who attempted to operate on the brain stem. An innovator, he designed more than 100 neurosurgical instruments. His research interests and his publications were about neuro-oncology, epilepsy, and functional and pediatric neurosurgery. He was a very active member of the European Society of Pediatric Neurosurgery and also served as the treasurer of the society and member of the scientific committee. He actively participated as a faculty member in the post-graduate courses and in congresses, all around Europe. He was also an active member of the International Society of Pediatric Neurosurgery. Evangelos was a very good friend of my father Christos N. Syrmos (1943–2015) (Fig. 3), professor of Neurosurgery of the Medical School of Thessaloniki, Macedonia, Greece and he helped me a lot since my years of neurosurgery residence.

Preoperative anxiety in children undergoing neurosurgical operations and proposed effective interventions

Dear Editor, Preoperative anxiety is characterized by the patient’s experience of Bbeing stressed and anxious^ while awaiting surgery. As Perks, Chakravarti and Manninen indicated in their original study [1], the incidence of preoperative anxiety in neurosurgery patients was 89%, while the 55% diagnosed with a high level of anxiety. Patients’ anxiety mainly related to concerns about surgical factors, such as results of the operation and the possible physical injuries or mental suffering, while a small proportion of the patients reported anxiety due to the anesthesia procedure. It was pointed out that patients who experienced a high level of anxiety, presented more worries about the operation and needed more information about the surgical procedure. Although neurosurgical interventions and their outcome are great sources of anxiety for patients, little attention has been given on this field. Relative to this notion, we state that the research is even more scarce in pediatric patients [1]. Young patients come up with many emotional and physical challenges when preparing for surgery. It has been argued that preoperative procedures such as venipuncture, anesthesia induction, pre-surgical injection, and parting from the parents, may provoke fear, anxiety, distress, and physical pain to the pediatric patients [2]. Similar to these findings, Wennstrom, Hallberg, and Bergh carried out interviews in children undergoing day surgery and supported that prior to the surgery, children’s anxiety was related to fears about the Bunknown^ and feelings of insecurity and uncertainty about surgical procedure and potential postoperative discomfort [3]. Furthermore, preoperative anxiety may lead to adverse postoperative outcomes. Kain et al. found in their study [4] that children rated high in preoperative anxiety measures experienced more postoperative pain, consumed more analgesics, and had a higher incidence of postoperative anxiety and sleep disturbances, than children who were not anxious. Interestingly enough, little attention has been given in regard to preoperative anxiety in pediatric neurosurgery patients. A noteworthy study conducted by Chieng et al. [5], clarified that in children undergoing many types of surgery, including neurosurgery, preoperative anxiety may be related to negative emotional behaviors. Additionally, children who experienced anxiety prior to the surgery, had more postoperative pain [5]. A more recent paper of Riquin et al. [6], examined the psychological impact of surgery while awake in children for resection of brain tumors. Patients experienced little anticipatory anxiety. No child presented symptoms of posttraumatic stress disorder or acute stress. As authors quoted Bthe results are encouraging, allowing us to contemplate using brain surgery while awake for children without particular worries about the psychologic aspect^ [6]. Moreover, it has been found that parental anxiety may increase the preoperative anxiety in children [7]. Under those circumstances, there is an imperative need for the implementation of effective preparation programs in the medical environment. Looking beyond the Btraditional^ anesthetic care and pharmacological interventions, children facing preoperative anxiety need psychological support as well as extensive information about the surgery, possible pain effects, anesthesia, and thorough informing about the pre-surgical procedures, the perioperative medical environment, and potential detrimental outcomes [8]. As Chow et al. suggested in their recent review [9], preoperative anxiety symptoms in children may be effectively alleviated by audiovisual interventions such as providing comprehensive procedural information through interactive videos and games and multi-faceted programs. The effectiveness of such interventions can be amply demonstrated by a randomized clinical trial where the use of * Nikolaos Ch. Syrmos milanako76@yahoo.gr

Effect of Infliximab and Adalimumab on Experimental Colitis Following Orally Supplemented Iron

ABSTRACT Background: Orally administered iron can induce colonic inflammation in healthy animals and aggravate experimental colitis. Aim: To investigate the influence of the biologic agents infliximab and adalimumab on the severity of TNBS colitis following orally supplemented iron. Materials-Methods: 204 Wistar rats were allocated into 14 groups. Colitis was induced by TNBS. Iron was administered via a mouth catheter at a dose of 0.027, 0.3, and 3%/kg diet per day, respectively. Infliximab was subcutaneously administered on the 2nd and 6th day in a dose of 5 mg/kgBW, while adalimumab was administered on the 2nd day in a dose of 2 mg/kgBW. On the 8th day, all animals were euthanatized. Activity of colitis and extent of tissue damage were assessed histologically. Tissue Tumor Necrosis Factor-α (t-TNF-α) and malondialdehyde (t-MDA) were estimated. Results: In normal rats both agents significantly worsen the degree of inflammation induced by moderate or high iron supplementation despite the disappearance of t-TNF-α, and reduction of t-MDA. In the groups of TNBS colitis and moderate or high iron administration, both agents again significantly worsen the degree of inflammation despite the significant reduction in the t-TNF-α and t-MDA. Conclusion: Adalimumab and infliximab do not ameliorate the inflammation in TNBS-induced colitis aggravated by orally administered iron. These findings might be clinically relevant in patients with active IBD under concurrent treatment with biologic agents and per oral iron.

Are Greeks afraid of nuclear medicine

Attitude may be defined as the tendency of a person to evaluate objects, people, or issues favorably or unfavorably. This favorable or unfavorable evaluative reaction toward something/someone is usually exhibited in one’s beliefs, feelings, or intended behavior and is still one of the most interesting topics in social psychology [1–6]. Every day numerous people worldwide receive healthcare through nuclear medicine applications that help to maintain or restore their health and ability to work and function properly. Although social psychology has focused on diverse attitudes toward different subjects, little research has been conducted until now on attitudes toward medical specialties and more specifically in the field of nuclear medicine and its applications. Although everyday experiences reveal the ignorance of the public about nuclear medicine, with examples of patients in various countries triggering radiation alarms at security checks [7,8], even physicians need to have a better understanding and be given a record of the radioactive tests and doses that the patient had received before [9].