85 results on '"Apostolou, D."'
Search Results
52. Innovative designs with social, mobile and wearable technologies for creative teaching and learning
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Buchem, I., Isa Jahnke, Mor, Y., and Apostolou, D.
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Human-Computer Interaction ,Architecture ,Media Technology ,Social Sciences (miscellaneous) ,Computer Science Applications ,Education
53. Managing kowledge at multiple organizational levels using faceted ontologies
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Apostolou, D., Mentzas, G., and Andreas Abecker
54. Information markets for social participation in public policy design and implementation
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Grigorios Mentzas, Apostolou, D., Bothos, E., and Magoutas, B.
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In this paper we propose a research agenda on the use of information markets as tools to collect, aggregate and analyze citizens’ opinions, expectations and preferences from social media in order to support public policy design and implementation. We argue that markets are institutional settings able to efficiently allocate scarce resources, aggregate and disseminate information into prices and accommodate hedging against various types of risks. We discuss various types of information markets, as well as address the participation of both human and computational agents in such markets.
55. Word Embeddings for Unsupervised Named Entity Linking
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Enza Messina, Debora Nozza, Cezar Sas, Elisabetta Fersini, Douligeris, C, Kanagiannis, D, Apostolou, D, Nozza, D, Sas, C, Fersini, E, and Messina, E
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Information retrieval ,Microblogging ,Computer science ,010102 general mathematics ,Word Embeddings ,02 engineering and technology ,Space (commercial competition) ,Named Entity Linking ,NATURAL LANGUAGE PROCESSING978-3-030-29562-2 ,01 natural sciences ,Task (project management) ,NAMED ENTITY LINKING, SOCIAL MEDIA, WORD EMBEDDINGS, NATURAL LANGUAGE PROCESSING978-3-030-29562-2 ,Social media ,020204 information systems ,Word Embedding ,Similarity (psychology) ,0202 electrical engineering, electronic engineering, information engineering ,Benchmark (computing) ,Profitability index ,0101 mathematics ,Representation (mathematics) ,Word (computer architecture) - Abstract
The huge amount of textual user-generated content on the Web has incredibly grown in the last decade, creating new relevant opportunities for different real-world applications and domains. In particular, microblogging platforms enables the collection of continuously and instantly updated information. The organization and extraction of valuable knowledge from these contents are fundamental for ensuring profitability and efficiency to companies and institutions. This paper presents an unsupervised model for the task of Named Entity Linking in microblogging environments. The aim is to link the named entity mentions in a text with their corresponding knowledge-base entries exploiting a novel heterogeneous representation space characterized by more meaningful similarity measures between words and named entities, obtained by Word Embeddings. The proposed model has been evaluated on different benchmark datasets proposed for Named Entity Linking challenges for English and Italian language. It obtains very promising performance given the highly challenging environment of user-generated content over microblogging platforms.
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- 2019
56. Comparative study between half body irradiation (HBI) and Sr 89 in multiple bone metastasis from cancer of the prostate
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Antonadou, D., Sarris, G., Apostolou, D., Koutsiouba, P., and Throuvalas, N.
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- 1993
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57. 216Comparative study between exclusive irradiation or combined with surgery in stage I b, II a and “proximal” II b carcinoma of the cervix with tumor diameter ⩾ 5CM
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Throuvalas, N., Antonadou, D., Apostolou, D., Pulizzi, M., and Synodinou, M.
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- 1996
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58. Permissioned blockchain network for proactive access control to electronic health records.
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Psarra E, Apostolou D, Verginadis Y, Patiniotakis I, and Mentzas G
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- Humans, Neural Networks, Computer, Confidentiality standards, Fuzzy Logic, Electronic Health Records, Blockchain, Computer Security standards
- Abstract
Background: As digital healthcare services handle increasingly more sensitive health data, robust access control methods are required. Especially in emergency conditions, where the patient's health situation is in peril, different healthcare providers associated with critical cases may need to be granted permission to acquire access to Electronic Health Records (EHRs) of patients. The research objective of this work is to develop a proactive access control method that can grant emergency clinicians access to sensitive health data, guaranteeing the integrity and security of the data, and generating trust without the need for a trusted third party., Methods: A contextual and blockchain-based mechanism is proposed that allows access to sensitive EHRs by applying prognostic procedures where information based on context, is utilized to identify critical situations and grant access to medical data. Specifically, to enable proactivity, Long Short Term Memory (LSTM) Neural Networks (NNs) are applied that utilize patient's recent health history to prognose the next two-hour health metrics values. Fuzzy logic is used to evaluate the severity of the patient's health state. These techniques are incorporated in a private and permissioned Hyperledger-Fabric blockchain network, capable of securing patient's sensitive information in the blockchain network., Results: The developed access control method provides secure access for emergency clinicians to sensitive information and simultaneously safeguards the patient's well-being. Integrating this predictive mechanism within the blockchain network proved to be a robust tool to enhance the performance of the access control mechanism. Furthermore, the blockchain network of this work can record the history of who and when had access to a specific patient's sensitive EHRs, guaranteeing the integrity and security of the data, as well as recording the latency of this mechanism, where three different access control cases are evaluated. This access control mechanism is to be enforced in a real-life scenario in hospitals., Conclusions: The proposed mechanism informs proactively the emergency team of professional clinicians about patients' critical situations by combining fuzzy and predictive machine learning techniques incorporated in the private and permissioned blockchain network, and it exploits the distributed data of the blockchain architecture, guaranteeing the integrity and security of the data, and thus, enhancing the users' trust to the access control mechanism., (© 2024. The Author(s).)
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- 2024
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59. Post-dissection abdominal aorto-iliac aneurysm open repair: a surgical technique description and systematic review of the literature.
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Mortola L, Apostolou D, Mariani E, Scovazzi P, Peluttiero I, Maione M, and Frola E
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Background: Post-dissection abdominal aortic aneurysms (pDAAA) may develop in up to 7% of patients affected by aortic dissection. However, there is no consensus on the optimal management. Different endovascular and open surgical techniques have been reported. This case-series describes the open surgical technique employed at a tertiary vascular surgery center to manage this complex pathology to allow future treatment of the visceral aorta if needed. A systematic review of the relevant literature on surgical and endovascular management of pDAAA was conducted., Method: Consecutive patients surgically treated at a single center for pDAAA metachronous to a Stanford type A or type B aortic dissection from January 2018 to March 2023 were retrospectively retrieved. The surgical technique we employed entails the use of large-diameter bifurcated grafts (≥ 9 mm branches) with longer main body, fenestration of the septum at renal arteries ostia and landing on a common femoral artery in case of small caliber iliac arteries (< 8 mm) to provide a suitable landing zone and access route for future endovascular thoracoabdominal repair in case of subsequent aneurysmal degeneration. The primary outcome was 30-day mortality. Secondary outcomes were major complications, late mortality, aortic-related mortality, and aortic-related reinterventions. Then, a systematic review of the literature until March 2023 was conducted., Results: Five patients were included, all males with a mean age of 61 years. 30-day mortality was 0. One patient suffered from post-operative acute kidney injury and acute distress respiratory syndrome, and another one underwent repeat laparotomy for abdominal seroma. The mean follow-up was 44 months with no aortic-related reinterventions to date. One patient died from non-aortic-related causes 9 months after surgery., Conclusions: Open repair of pDAAA appears to be an effective treatment in selected patients, with low mortality rates, and technical choices should consider future endovascular treatment of the thoracoabdominal aorta., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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60. External validation of Traditional and Modified Harborview Risk Scores for ruptured abdominal aortic aneurysm 30-day mortality prediction.
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Frola E, Mortola L, Barili F, Mariani E, Scovazzi P, Peluttiero I, Carignano G, Apostolou D, and Maione M
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Objective: To validate traditional and modified Harborview Risk Score (tHRS and mHRS) for patients with ruptured abdominal aortic aneurysm (rAAA) in an external population., Methods: Consecutive patients undergoing rAAA repair from January 2012 to January 2024 at a tertiary Vascular Surgery Center were retrospectively reviewed. The scores were calculated for each patient; receiver operating characteristic curves (ROC), area under the curve (AUC) with 95% confidence intervals (CIs) and calibration plots were built to evaluate discrimination and calibration. Furthermore, the relationship of mortality with score variables was updated running a multivariate logistic model, then applied to one thousand bootstrap samples., Results: One hundred and five patients treated for rAAA (97 males, 92.4%) were included in the study (77±8.5 years). An endovascular repair (rEVAR) was performed in 35 patients (3 women, 80±9.0 years) while an open repair (rOAR) in 70 patients (5 women, 75±8.0 years). The 30-day mortality rate was 31.4%. (33/105), 25.7% (9/35) and 34.3% (24/70) for rEVAR and rOAR respectively (p 0.5). Eight patients (7.6%) were on therapy with warfarin at the time of admission. AUC for tHRS was 0.56 while AUC for mHRS was 0.68 (DeLong test = 0.29). The tHRS' calibration showed underestimation for patients with predicted mortality < 25% and overestimation for the remaining; for mHRS, the predictions were well calibrated for patients with estimated mortality < 40% with overprediction afterward. The model update demonstrated that the wider effects are due to the interaction between the HRS factors., Conclusions: THRS and mHRS showed limited prediction capability with 30-day mortality overestimation in an external validation, raising many concerns about their extended and systematic application. Interaction between factors should be taken into account to enhance the score's performance, especially in high risk patients., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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61. Combined brain-heart MRI identifies cardiac and white matter lesions in patients with systemic lupus erythematosus and/or antiphospholipid syndrome: A pilot study.
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Markousis-Mavrogenis G, Pepe A, Lupi A, Apostolou D, Argyriou P, Velitsista S, Vartela V, Quaia E, and Mavrogeni SI
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- Humans, Female, Pilot Projects, Male, Middle Aged, Adult, Prospective Studies, White Matter diagnostic imaging, White Matter pathology, Brain diagnostic imaging, Brain pathology, Multimodal Imaging, Antiphospholipid Syndrome diagnostic imaging, Antiphospholipid Syndrome complications, Lupus Erythematosus, Systemic diagnostic imaging, Lupus Erythematosus, Systemic complications, Magnetic Resonance Imaging methods
- Abstract
Background: Antiphospholipid syndrome (APS) can occur primarily (PAPS) or secondary to another autoimmune disease (SAPS), most commonly systemic lupus erythematosus (SLE). Recently, we reported that subclinical brain involvement was highly prevalent in patients with autoimmune diseases, including SLE. We aimed to investigate whether patients with SLE, PAPS or SAPS and cardiac symptoms showed differences in cardiac/brain involvement based on combined brain-heart magnetic resonance imaging (MRI)., Methods: We prospectively recruited 15 patients with SAPS (86 % with SLE) and 3 patients with PAPS and compared their MRI findings to those of 13 patients with SLE from our previous publication. All patients underwent routine cardiovascular/neurological examination and standard echocardiography., Results: No patients had abnormalities in routine clinical workup/echocardiography. The vast majority had white matter hyperintensities (WMHs) and all had evidence of myocardial fibrosis and/or inflammation. Patients with SAPS had a lower median WMH number [1.00 (1.00, 2.00)] than those with PAPS [3.00 (2.50, 3.00)] or SLE [2.00 (2.00, 3.00)] (p = 0.010). Subcortical and deep WM were highly prevalent. Periventricular WMHs were more frequent in patients with SLE [6 (46.2 %)] or PAPS [2 (66.7 %)] (p = 0.023). Higher lesion burdens (1 WMH vs. 2 WMHs vs. ≥ WMHs) were associated with the presence of cardiac fibrosis [3 (33.3 %) vs. 10 (83.3) vs. 7 (77.8), p = 0.039] and affected the deep and periventricular WM (p < 0.001 for both)., Conclusion: In patients with PAPS, SAPS or SLE, cardiac symptoms and normal routine workup, combined brain-heart MRI identified abnormalities in both organs in the majority of patients. Combined brain-heart MRI offers excellent diagnostic value, but its incorporation into routine clinical practice should be further investigated. Clinical relevance statement Combined brain-heart magnetic resonance imaging in antiphospholipid syndrome may help to assess the presence of abnormalities in both organs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)
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- 2024
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62. Multicenter Comparison of Aortic Arch Aneurysms and Dissections Zone 0 Hybrid and Total Endovascular Repair.
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Frola E, Mortola L, Ferrero E, Ferri M, Apostolou D, Quaglino S, Maione M, and Gaggiano A
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- Humans, Blood Vessel Prosthesis, Endoleak surgery, Treatment Outcome, Retrospective Studies, Risk Factors, Aortic Aneurysm, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic surgery, Aortic Aneurysm, Thoracic etiology, Blood Vessel Prosthesis Implantation adverse effects, Aneurysm, Aortic Arch, Endovascular Procedures adverse effects, Aneurysm surgery, Stroke surgery
- Abstract
Purpose: Comparison of hybrid and total endovascular aortic arch repair at two tertiary vascular surgery centers., Materials and Methods: Consecutive patients undergoing hybrid (HG) or total endovascular (TEG) total aortic arch repair for aneurysms or dissections were included (2008-2022). Primary outcome measure was 30-day mortality. Secondary outcomes were major complications, technical success (defined as absence of surgical conversion/mortality, high-flow endoleaks or branch/limb occlusion), clinical success (defined as absence of disabling clinical sequelae), late and aortic-related mortality/reinterventions, freedom from endoleaks, aortic diameter growth > 5 mm, graft migration and supra-aortic trunks (SAT) patency., Results: In total, 30 patients were included, 17 in HG and 13 in TEG. TEG presented shorter intervention time (240.5 vs 341 min, p = 0.01), median ICU stay (1 vs 4.5 days, p < 0.01) and median length of stay (8 vs 17.5 days, p < 0.01). No intraoperative deaths occurred. Technical success was 100%; clinical success was 70.6% in HG and 100% in TEG (p = 0.05). Thirty-day mortality was 13.3%, exclusively in HG (p = 0.11). Nine major complications occurred in 8 patients, 5 in HG and 3 in TEG (p = 0.99), among which five strokes, two in HG and three in TEG (p = 0.62). Late mortality was 38.5%, six patients in HG and four in TEG, p = 0.6. Two late aortic-related deaths occurred in HG (p = 0.9). Two aortic-related reinterventions, no graft migration or SAT occlusion was observed., Conclusions: Total endovascular repair seems to shorten operative times and provide higher clinical success compared with hybrid solutions, without significant 30-day mortality differences. The most common major complication is stroke., (© 2023. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).)
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- 2023
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63. SARS-CoV-2-specific T cell therapy for severe COVID-19: a randomized phase 1/2 trial.
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Papadopoulou A, Karavalakis G, Papadopoulou E, Xochelli A, Bousiou Z, Vogiatzoglou A, Papayanni PG, Georgakopoulou A, Giannaki M, Stavridou F, Vallianou I, Kammenou M, Varsamoudi E, Papadimitriou V, Giannaki C, Sileli M, Stergiouda Z, Stefanou G, Kourlaba G, Gounelas G, Triantafyllidou M, Siotou E, Karaglani A, Zotou E, Chatzika G, Boukla A, Papalexandri A, Koutra MG, Apostolou D, Pitsiou G, Morfesis P, Doumas M, Karampatakis T, Kapravelos N, Bitzani M, Theodorakopoulou M, Serasli E, Georgolopoulos G, Sakellari I, Fylaktou A, Tryfon S, Anagnostopoulos A, and Yannaki E
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- Humans, SARS-CoV-2, Immunotherapy, Adoptive adverse effects, Cell- and Tissue-Based Therapy, Treatment Outcome, COVID-19 therapy
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Despite advances, few therapeutics have shown efficacy in severe coronavirus disease 2019 (COVID-19). In a different context, virus-specific T cells have proven safe and effective. We conducted a randomized (2:1), open-label, phase 1/2 trial to evaluate the safety and efficacy of off-the-shelf, partially human leukocyte antigen (HLA)-matched, convalescent donor-derived severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific T cells (CoV-2-STs) in combination with standard of care (SoC) in patients with severe COVID-19 compared to SoC during Delta variant predominance. After a dose-escalated phase 1 safety study, 90 participants were randomized to receive CoV-2-ST+SoC (n = 60) or SoC only (n = 30). The co-primary objectives of the study were the composite of time to recovery and 30-d recovery rate and the in vivo expansion of CoV-2-STs in patients receiving CoV-2-ST+SoC over SoC. The key secondary objective was survival on day 60. CoV-2-ST+SoC treatment was safe and well tolerated. The study met the primary composite endpoint (CoV-2-ST+SoC versus SoC: recovery rate 65% versus 38%, P = 0.017; median recovery time 11 d versus not reached, P = 0.052, respectively; rate ratio for recovery 1.71 (95% confidence interval 1.03-2.83, P = 0.036)) and the co-primary objective of significant CoV-2-ST expansion compared to SοC (CoV-2-ST+SoC versus SoC, P = 0.047). Overall, in hospitalized patients with severe COVID-19, adoptive immunotherapy with CoV-2-STs was feasible and safe. Larger trials are needed to strengthen the preliminary evidence of clinical benefit in severe COVID-19. EudraCT identifier: 2021-001022-22 ., (© 2023. The Author(s), under exclusive licence to Springer Nature America, Inc.)
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- 2023
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64. Guidelines on the management of abdominal aortic aneurysms: updates from the Italian Society of Vascular and Endovascular Surgery (SICVE).
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Pratesi C, Esposito D, Apostolou D, Attisani L, Bellosta R, Benedetto F, Blangetti I, Bonardelli S, Casini A, Fargion AT, Favaretto E, Freyrie A, Frola E, Miele V, Niola R, Novali C, Panzera C, Pegorer M, Perini P, Piffaretti G, Pini R, Robaldo A, Sartori M, Stigliano A, Taurino M, Veroux P, Verzini F, Zaninelli E, and Orso M
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- Humans, Italy epidemiology, Treatment Outcome, Aortic Aneurysm, Abdominal diagnostic imaging, Aortic Aneurysm, Abdominal surgery, Aortic Rupture, Endovascular Procedures methods
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The objective of these Guidelines was to revise and update the previous 2016 Italian Guidelines on Abdominal Aortic Aneurysm Disease, in accordance with the National Guidelines System (SNLG), to guide every practitioner toward the most correct management pathway for this pathology. The methodology applied in this update was the GRADE-SIGN version methodology, following the instructions of the AGREE quality of reporting checklist as well. The first methodological step was the formulation of clinical questions structured according to the PICO (Population, Intervention, Comparison, Outcome) model according to which the Recommendations were issued. Then, systematic reviews of the Literature were carried out for each PICO question or for homogeneous groups of questions, followed by the selection of the articles and the assessment of the methodological quality for each of them using qualitative checklists. Finally, a Considered Judgment form was filled in for each clinical question, in which the features of the evidence as a whole are assessed to establish the transition from the level of evidence to the direction and strength of the recommendations. These guidelines outline the correct management of patients with abdominal aortic aneurysm in terms of screening and surveillance. Medical management and indication for surgery are discussed, as well as preoperative assessment regarding patients' background and surgical risk evaluation. Once the indication for surgery has been established, the options for traditional open and endovascular surgery are described and compared, focusing specifically on patients with ruptured abdominal aortic aneurysms as well. Finally, indications for early and late postoperative follow-up are explained. The most recent evidence in the Literature has been able to confirm and possibly modify the previous recommendations updating them, likewise to propose new recommendations on prospectively relevant topics.
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- 2022
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65. An International, Multicenter Retrospective Observational Study to Assess Technical Success and Clinical Outcomes of Patients Treated with an Endovascular Aneurysm Sealing Device for Type III Endoleak.
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Zoethout AC, Ketting S, Zeebregts CJ, Apostolou D, Mees BME, Berg P, Beyrouti HE, De Vries JPM, Torella F, Migliari M, Silingardi R, and Reijnen MMPJ
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- Blood Vessel Prosthesis, Endoleak diagnostic imaging, Endoleak etiology, Endoleak surgery, Humans, Prosthesis Design, Retrospective Studies, Risk Factors, Stents, Treatment Outcome, Aortic Aneurysm, Abdominal diagnostic imaging, Aortic Aneurysm, Abdominal surgery, Blood Vessel Prosthesis Implantation adverse effects, Endovascular Procedures adverse effects
- Abstract
Introduction: Type III endoleaks post-endovascular aortic aneurysm repair (EVAR) warrant treatment because they increase pressure within the aneurysm sac leading to increased rupture risk. The treatment may be difficult with regular endovascular devices. Endovascular aneurysm sealing (EVAS) might provide a treatment option for type III endoleaks, especially if located near the flow divider. This study aims to analyze clinical outcomes of EVAS for type III endoleaks after EVAR., Methods: This is an international, retrospective, observational cohort study including data from 8 European institutions., Results: A total of 20 patients were identified of which 80% had a type IIIb endoleak and the remainder (20%) a type IIIa endoleak. The median time between EVAR and EVAS was 49.5 months (28.5-89). Mean AAA diameter prior to EVAS revision was 76.6±19.9 mm. Technical success was achieved in 95%, 1 patient had technical failure due to a postoperative myocardial infarction resulting in death. Mean follow-up was 22.8±15.2 months. During follow-up 1 patient had a type Ia endoleak, and 1 patient had a new type IIIa endoleak at an untreated location. There were 5 patients with aneurysm growth. Five patients underwent AAA-related reinterventions indications being: growth with type II endoleak (n=3), type Ia endoleak (n=1), and iliac aneurysm (n=1). At 1-year follow-up, the freedom from clinical failure was 77.5%, freedom from all-cause mortality 94.7%, freedom from aneurysm-related mortality 95%, and freedom from aneurysm-related reinterventions 93.8%., Conclusion: The EVAS relining can be safely performed to treat type III endoleaks with an acceptable technical success rate, a low 30-day mortality rate and no secondary ruptures at short-term follow-up. The relatively low clinical success rates, related to reinterventions and AAA enlargement, highlight the need for prolonged follow-up.
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- 2022
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66. EVAR Solution For Acutely Thrombosed Abdominal Aortic Aneurysm in a Patient with COVID-19.
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Robaldo A, Apostolou D, Persi F, Peano E, and Maione M
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Introduction: Acute thrombosis of an infrarenal abdominal aortic aneurysm (ATAAA) represents an uncommon but catastrophic pathology, which can lead to life threatening complications. This is a report of the infrequent use of an endovascular solution to successfully treat ATAAA in a patient with COVID-19 viral pneumonia and ischaemia induced lower extremity neurological deficits., Report: An 89 year old white male, with a history of cardiovascular comorbidities was admitted to the emergency room with dyspnoea associated with the sudden onset of abdominal and back pain followed by partial motor and sensory deficits in both legs. The CT scan showed both an 8 cm infrarenal AAA with middle (inferior mesenteric artery patent) and distal thrombotic occlusion of the sac and non-aneurysmal but thrombosed common iliac arteries. An additional finding was imaging features typical of interstitial pneumonia. After the molecular test detected active COVID-19 infection, the patient was treated as an emergency with an aorto-uni-iliac stent graft and femorofemoral crossover graft. The post-operative course was uneventful with AAA exclusion and disappearance of ischaemic symptoms. There were no vascular complications. At three month follow up the patient remained asymptomatic and was looking after himself., Discussion: This case supports the feasibility and safety of a minimally invasive endovascular procedure to treat ATAAA in selected patients with favourable anatomy and high risk of respiratory complications in the context of the COVID-19 pandemic., Competing Interests: None., (© 2022 The Author(s).)
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- 2022
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67. A center experience with lung transplantation for COVID-19 ARDS.
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Franco-Palacios DJ, Allenspach L, Stagner L, Pinto J, Olexsey K, Sherbin E, Dillon W, Sternberg D, Bryce K, Simanovski J, Apostolou D, Tanaka D, Nemeh H, Wang Z, and Alangaden G
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COVID-19 can cause irreversible lung damage from acute respiratory distress syndrome (ARDS), chronic respiratory failure associated with post COVID-19 de novo fibrosis or worsening of an underlying fibrotic lung disease. Pregnant women are at increased risk for invasive mechanical ventilation, extracorporeal membrane oxygenation, and death. The Centers for Disease Control and Prevention reported more than 22,000 hospitalizations and 161 deaths for COVID-19 in pregnant women. Between August 2020 and September 2021, five patients underwent bilateral lung transplant (LT) for COVID-19 ARDS at the Henry Ford Hospital in Detroit, Michigan. De-identified demographics data, clinical characteristics, perioperative challenges, explanted lung pathology, and post-transplant outcomes are described. In post-hospitalization follow-up (median survival 273 days), we see improving endurance and excellent lung function. One patient did not survive to hospital discharge and succumbed to complications 5 months after LT. We report the first cases of bilateral LT in two postpartum women., Competing Interests: The author(s) declare that there is no conflict of interest., (© 2022 The Authors.)
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- 2022
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68. Alternative Access for Transcatheter Aortic Valve Replacement: A Comprehensive Review.
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Eng MH, Qintar M, Apostolou D, and O'Neill WW
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- Aortic Valve surgery, Humans, Risk Factors, Treatment Outcome, Aortic Valve Stenosis surgery, Transcatheter Aortic Valve Replacement
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Transfemoral is the most widely used access to perform transcatheter aortic valve replacement (TAVR). However, alternative access is needed in up to 21% of patients with TAVR because of a myriad of factors. The authors provide a comprehensive review on alternative access for TAVR, discussing the relevant data and providing the pros and cons of each access route., (Copyright © 2021 Elsevier Inc. All rights reserved.)
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- 2021
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69. Atherosclerotic saccular aneurysm of the extracranial internal carotid artery: Surgical repair.
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Robaldo A, Persi F, Trucco A, and Apostolou D
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Introduction and Importance: Extracranial carotid aneurysms (ECCAs) are relatively uncommon. Most of these lesions are due to atherosclerosis, trauma, infection, radiotherapy, previous surgery or iatrogenic event. Severe complications include rupture, dysphagia, respiratory symptoms and brain embolization., Case Presentation: We report a case of a large saccular aneurysm of the extracranial internal carotid artery (EICA) in a 83-year old asymptomatic woman without any apparent causative history. The patient underwent a successful repair of the aneurysm by aneurysmectomy and primary end-to-end anastomosis between the proximal and distal portion of the remaining vessel with continuity restored without tension., Clinical Discussion: ECCAs are rare with few cases reported in the most recent literature. There is little knowledge of their natural history and management. Both surgical and endovascular as well as medical treatments have been recommended depending on disease-location and comorbidities., Conclusion: Although treatment should be individualized time by time by evaluating patient's characteristics, the surgical repair could be a safe and effective solution to treat distal EICAs, especially for symptomatic and true growing lesions. The presentation, the diagnostic evaluation, and the successful surgical treatment are discussed., Competing Interests: -All Authors agree to publication if paper is accepted.-The authors have no conflicts of interest to declare., (© 2021 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)
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- 2021
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70. Right Ventricular Device HeartWare Implant to the Right Atrium with Fixation to the Chest Wall in Patient with Biventricular Support.
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Chamogeorgakis T, Cowger J, Apostolou D, Tanaka D, and Nemeh H
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- 2020
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71. HeartMate 3 left ventricular assist device implant after excision of a large apical aneurysm.
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Chamogeorgakis T, Kostopanagiotou K, Behler A, and Apostolou D
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The presence of a left ventricular apical aneurysm may pose a technical challenge during implantation of a left ventricular assist device (LVAD). We describe implantation of a HeartMate III LVAD under cardioplegic arrest. A ventricular aneurysmectomy was performed and the LVAD was implanted at the left ventricular apex at the level of the transition zone between the scar tissue and the viable myocardium. Two pursestring 2-0 Prolene Fontan sutures were placed circumferentially at the transition zone to make up for the size discrepancy between the left ventricular opening and the HeartMate 3 pump. The echocardiographic analysis demonstrated optimal inflow cannula orientation, and the patient had an uneventful recovery., (Copyright © 2020 Baylor University Medical Center.)
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- 2020
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72. Combined Brain-Heart Magnetic Resonance Imaging in Autoimmune Rheumatic Disease Patients with Cardiac Symptoms: Hypothesis Generating Insights from a Cross-sectional Study.
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Markousis-Mavrogenis G, Mitsikostas DD, Koutsogeorgopoulou L, Dimitroulas T, Katsifis G, Argyriou P, Apostolou D, Velitsista S, Vartela V, Manolopoulou D, Tektonidou MG, Kolovou G, Kitas GD, Sfikakis PP, and Mavrogeni SI
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Background: Autoimmune rheumatic diseases (ARDs) may affect both the heart and the brain. However, little is known about the interaction between these organs in ARD patients. We asked whether brain lesions are more frequent in ARD patients with cardiac symptoms compared with non-ARD patients with cardiovascular disease (CVD)., Methods: 57 ARD patients with mean age of 48 ± 13 years presenting with shortness of breath, chest pain, and/or palpitations, and 30 age-matched disease-controls with non-autoimmune CVD, were evaluated using combined brain-heart magnetic resonance imaging (MRI) in a 1.5T system., Results: 52 (91%) ARD patients and 16 (53%) controls had white matter hyperintensities ( p < 0.001) in at least one brain area (subcortical/deep/periventricular white matter, basal ganglia, pons, brainstem, or mesial temporal lobe). Only the frequency and number of subcortical and deep white matter lesions were significantly greater in ARD patients ( p < 0.001 and 0.014, respectively). ARD vs. control status was the only independent predictor of having any brain lesion. Specifically for deep white matter lesions, each increase in ECV independently predicted a higher number of lesions [odds ratio (95% confidence interval): 1.16 (1.01-1.33), p = 0.031] in ordered logistic regression. Penalized logistic regression selected only ARD vs. control status as the most important feature for predicting whether brain lesions were present on brain MRI (odds ratio: 5.46, marginal false discovery rate = 0.011)., Conclusions: Subclinical brain involvement was highly prevalent in this cohort of ARD patients and was mostly independent of the severity of cardiac involvement. However, further research is required to determine the clinical relevance of these findings., Competing Interests: The authors declare no conflict of interest.
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- 2020
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- View/download PDF
73. Giant saccular aneurysm of the innominate artery.
- Author
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Robaldo A, Apostolou D, Peano E, and Novali C
- Subjects
- Aged, Female, Humans, Stents, Treatment Outcome, Aneurysm diagnosis, Aneurysm surgery, Brachiocephalic Trunk
- Abstract
We report a rare case of a saccular aneurysm of innominate artery without any apparent causative history. Although the treatment choice remains debatable, due to the poor condition of the patient, the lesion was excluded by using a balloon-expandable covered stent with a satisfactory early-term outcome., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
74. Cardiovascular Magnetic Resonance Identifies High-Risk Systemic Sclerosis Patients with Normal Echocardiograms and Provides Incremental Prognostic Value.
- Author
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Markousis-Mavrogenis G, Bournia VK, Panopoulos S, Koutsogeorgopoulou L, Kanoupakis G, Apostolou D, Katsifis G, Polychroniadis M, Dimitroulas T, Kolovou G, Kitas GD, Mavrogeni SI, and Sfikakis PP
- Abstract
Background: Acute cardiac events are a significant contributor to mortality in systemic sclerosis (SSc). However, echocardiographic evaluation may be deceptively normal during an acute presentation. We hypothesized that in diffuse SSc patients presenting with acute cardiac events and a normal echocardiogram, cardiovascular magnetic resonance (CMR) would have incremental diagnostic/prognostic value., Methods: 50 consecutive diffuse SSc patients with normal echocardiograms were evaluated using a 1.5T system. A total of 27 (63%) had experienced an acute cardiac event three to tendays before CMR evaluation (rhythm disturbances, angina pectoris, shortness of breath). Left/right ventricular (LV/RV) volumes and ejection fractions (EF), as well as LV mass, the T2-signal ratio, early/late gadolinium enhancement (EGE/LGE), native/post-contrast T1-mapping, T2-mapping and extracellular volume fraction (ECV) were compared between the event and no-event groups., Results: No differences were identified in LV/RV volumes/EF/mass. In logistic regression analyses, independent predictors of belonging to the event group were EGE (odds ratio (95% CI): 1.55 (1.06-2.26), p = 0.024), LGE (1.81 (1.23-2.67), p = 0.003), T2 mapping (1.20 (1.06-1.36), p = 0.004) and native/post-contrast T1 mapping (1.17 (1.04-1.32), p = 0.007 and 0.86 (0.75-0.98), p = 0.025). At a median follow-up of ~1.2 years, 42% vs. 11% of the event/no-event group respectively reached a combined endpoint of event occurrence/recurrence or cardiovascular mortality. Of the independent predictors resulting from logistic regression analyses, only LGE (hazard ratio (95% CI): 1.20 (1.11-1.30), p < 0.001), T2-mapping (1.07 (1.01-1.14), p = 0.025) and native T1-mapping (1.08 (1.01-1.15), p = 0.017) independently predicted the combined endpoint., Conclusions: A normal echocardiogram does not preclude myocardial lesions in diffuse SSc patients, which can be detected by CMR especially in symptomatic patients.
- Published
- 2019
- Full Text
- View/download PDF
75. Silent Myocardial Perfusion Abnormalities Detected by Stress Cardiovascular Magnetic Resonance in Antiphospholipid Syndrome: A Case-Control Study.
- Author
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Mavrogeni SI, Markousis-Mavrogenis G, Karapanagiotou O, Toutouzas K, Argyriou P, Velitsista S, Kanoupakis G, Apostolou D, Hautemann D, Sfikakis PP, and Tektonidou MG
- Abstract
Objective: To examine the prevalence of silent myocardial ischemia and fibrosis in antiphospholipid syndrome (APS), using stress cardiovascular magnetic resonance (CMR). Methods: Forty-four consecutive APS patients without prior cardiac disease (22 primary APS, 22 systemic lupus erythematosus (SLE)/APS, mean age 44 (12.9) years, 64% women) and 44 age/gender-matched controls were evaluated using CMR at 1.5 T. Steady-state free precession imaging for function assessment and adenosine stress-CMR for perfusion-fibrosis evaluation were employed. The myocardial perfusion reserve index (MPRI), and myocardial fibrosis expressed as late gadolinium enhancement (LGE), were evaluated. Coronary angiography was indicated in patients with LGE. Associations with APS characteristics, classic cardiovascular disease (CVD) risk factors, high-sensitivity CRP (hs-CRP) and high-sensitivity Troponin (hs-TnT) levels were tested. All patients were followed up for 12 months. Results: Median MPRI was significantly lower in APS patients versus controls [1.5 (0.9-1.9) vs. 2.7 (2.2-3.2), p < 0.001], independently of any LGE presence. LGE was detected in 16 (36.3%) patients versus none of controls ( p < 0.001); 12/16 were subsequently examined with coronary angiography and only two of them had coronary artery lesions. In multivariable analysis, none of the APS-related and classic CVD risk factors, or hs-CRP and hs-TnT covariates, were significant predictors of abnormal MPRI or LGE. At the twelve month follow-up, three (6.8%) patients experienced coronary artery disease, notably those with the lowest MPRI values. Conclusions: Abnormal MPRI and LGE are common in asymptomatic APS patients, independently so of any APS-related and classic CVD risk factors, or coronary angiography findings in cases with LGE. Stress-CMR is a valuable tool to detect silent myocardial ischemia and fibrosis in APS.
- Published
- 2019
- Full Text
- View/download PDF
76. Aortic Valve Rupture: An Important Cause of Ventilator-Dependent Respiratory Failure after Blunt Chest Trauma.
- Author
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Philip S and Apostolou D
- Subjects
- Aortic Rupture diagnosis, Humans, Male, Middle Aged, Respiration, Artificial, Respiratory Insufficiency therapy, Aortic Rupture etiology, Aortic Rupture surgery, Aortic Valve injuries, Respiratory Insufficiency etiology, Thoracic Injuries complications, Wounds, Nonpenetrating complications
- Published
- 2018
77. Multiple Injuries in Blunt Abdominal Trauma.
- Author
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Philip S, Mostafa G, and Apostolou D
- Subjects
- Abdominal Injuries diagnosis, Angiography, Aortic Rupture diagnosis, Diaphragm diagnostic imaging, Humans, Male, Radiography, Thoracic, Rupture, Tomography, X-Ray Computed, Vascular System Injuries diagnosis, Wounds, Nonpenetrating diagnosis, Young Adult, Abdominal Injuries complications, Aorta, Thoracic injuries, Aortic Rupture etiology, Diaphragm injuries, Multiple Trauma, Vascular System Injuries etiology, Wounds, Nonpenetrating complications
- Published
- 2017
- Full Text
- View/download PDF
78. T1 and T2 Mapping in Cardiology: "Mapping the Obscure Object of Desire".
- Author
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Mavrogeni S, Apostolou D, Argyriou P, Velitsista S, Papa L, Efentakis S, Vernardos E, Kanoupaki M, Kanoupakis G, and Manginas A
- Subjects
- Fibrosis, Heart diagnostic imaging, Humans, Heart physiopathology, Heart Diseases diagnostic imaging, Image Processing, Computer-Assisted, Magnetic Resonance Imaging, Myocardium pathology
- Abstract
The increasing use of cardiovascular magnetic resonance (CMR) is based on its capability to perform biventricular function assessment and tissue characterization without radiation and with high reproducibility. The use of late gadolinium enhancement (LGE) gave the potential of non-invasive biopsy for fibrosis quantification. However, LGE is unable to detect diffuse myocardial disease. Native T1 mapping and extracellular volume fraction (ECV) provide knowledge about pathologies affecting both the myocardium and interstitium that is otherwise difficult to identify. Changes of myocardial native T1 reflect cardiac diseases (acute coronary syndromes, infarction, myocarditis, and diffuse fibrosis, all with high T1) and systemic diseases such as cardiac amyloid (high T1), Anderson-Fabry disease (low T1), and siderosis (low T1). The ECV, an index generated by native and post-contrast T1 mapping, measures the cellular and extracellular interstitial matrix (ECM) compartments. This myocyte-ECM dichotomy has important implications for identifying specific therapeutic targets of great value for heart failure treatment. On the other hand, T2 mapping is superior compared with myocardial T1 and ECM for assessing the activity of myocarditis in recent-onset heart failure. Although these indices can significantly affect the clinical decision making, multicentre studies and a community-wide approach (including MRI vendors, funding, software, contrast agent manufacturers, and clinicians) are still missing., (© 2017 S. Karger AG, Basel.)
- Published
- 2017
- Full Text
- View/download PDF
79. Major Lung Resections Using Manual Suturing Versus Staplers During Fiscal Crisis.
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Potaris K, Kapetanakis E, Papamichail K, Midvighi E, Verveniotis A, Parissis F, Apostolou D, Tziortziotis V, Maimani S, Pouliara E, Vogiatzis G, Kakaris S, and Konstantinou M
- Abstract
AbstractObjective: During fiscal crisis there was a period of shortage of staplers in our hospital, which drove us to manual suturing of bronchi and pulmonary vessels during major lung resections. We present our experience during that period in comparison to a subsequent period when staplers became available again., Methods: A total of 256 lobectomies and 78 pneumonectomies were performed using manual suturing (group A), between September 2009 and September 2010, and compared regarding surgical outcome to 248 lobectomies and 60 pneumonectomies using staplers (group B), between September 2011 and September 2012., Results: Although we did not observe statistically significant differences but only a trend towards less operative time, for both lobectomies (p=0.21) and pneumonectomies (p=0.31), we actually noted a 41 and 47 minutes saving of operative time using staplers (group B), in comparison to manual suturing (group A). We also observed a trend towards less morbidity rates in patients of group B, who underwent lobectomy (10.48%), and pneumonectomy (20%), versus patients of group A, who underwent lobectomy (15.62%), and pneumonectomy (30.76%); we did not observe any substantial differences in the other surgical outcome variables, and in patients' demographics comorbidities, and anatomic allocation of surgical procedures performed., Conclusions: The use of staplers offers safety with secure bronchial or vascular sealing, and saving of operative time. Their unavailability at an interval during fiscal crisis although it did not affect surgical outcome, revealed their usefulness and value.
- Published
- 2015
- Full Text
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80. Ultrasonography of the healing process during a 3-month follow-up after a splenic injury.
- Author
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Rafailidis V, Apostolou D, Kaitartzis C, and Rafailidis D
- Abstract
We present a 14-year-old boy with a grade III splenic injury due to a bicycle accident, who was treated conservatively. The boy's medical history included splenomegaly due to thalassemia. The splenic lesion was initially investigated with computed tomography (CT) and then, was followed by ultrasonography for 3 months. CT revealed a large intraparenchymal hematoma which appeared hyperechoic on ultrasonography. During follow-up, the hematoma developed a more complex echogenicity and became gradually hypoechoic. The hematoma increased in size during the first week but then, started decreasing until it eventually resolved completely. The patient had an uneventful full recovery. In this report, we discuss the ultrasonographic changes of the hematoma throughout the healing process.
- Published
- 2015
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81. Sonography of the scrotum: from appendages to scrotolithiasis.
- Author
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Rafailidis V, Apostolou D, Charsoula A, and Rafailidis D
- Subjects
- Diagnosis, Differential, Humans, Infant, Newborn, Infant, Newborn, Diseases diagnostic imaging, Male, Patient Positioning methods, Lithiasis diagnostic imaging, Scrotum abnormalities, Scrotum diagnostic imaging, Spermatic Cord Torsion diagnostic imaging, Testicular Hydrocele diagnostic imaging, Ultrasonography methods
- Abstract
In this pictorial essay, we review and discuss the varying morphologic characteristics of scrotal appendages and calculi. Characteristic sonograms obtained from patients with coexisting hydrocele are presented, and recent literature is included. Hydrocele greatly facilitates the imaging of these intrascrotal structures, as it acts as a "water path". On the one hand, torsion of a scrotal appendage should always be included in the differential diagnosis of acute scrotum, especially in children. On the other hand, scrotolithiasis may occasionally cause mild discomfort. As a consequence, and given the widespread use of sonography for the evaluation of both acute and chronic conditions of the scrotum, radiologists should be familiar with these entities., (© 2015 by the American Institute of Ultrasound in Medicine.)
- Published
- 2015
- Full Text
- View/download PDF
82. Dual oxidase-2 has an intrinsic Ca2+-dependent H2O2-generating activity.
- Author
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Ameziane-El-Hassani R, Morand S, Boucher JL, Frapart YM, Apostolou D, Agnandji D, Gnidehou S, Ohayon R, Noël-Hudson MS, Francon J, Lalaoui K, Virion A, and Dupuy C
- Subjects
- Animals, Blotting, Western, CHO Cells, Catalysis, Cell Line, Cell Membrane metabolism, Cells, Cultured, Cricetinae, DNA, Complementary metabolism, Dual Oxidases, Electron Spin Resonance Spectroscopy, Endoplasmic Reticulum metabolism, Flavoproteins metabolism, Glycosylation, Green Fluorescent Proteins metabolism, Humans, Hydrogen Peroxide pharmacology, Leukocytes enzymology, Magnetics, Models, Biological, Mutation, NADPH Oxidases metabolism, Protein Processing, Post-Translational, Protein Structure, Tertiary, Spin Trapping, Superoxides metabolism, Swine, Thyroid Gland metabolism, Thyroid Hormones metabolism, Transfection, Calcium metabolism, Flavoproteins physiology, Hydrogen Peroxide metabolism
- Abstract
Duox2 (and probably Duox1) is a glycoflavoprotein involved in thyroid hormone biosynthesis, as the thyroid H2O2 generator functionally associated with Tpo (thyroperoxidase). So far, because of the impairment of maturation and of the targeting process, transfecting DUOX into nonthyroid cell lines has not led to the expression of a functional H2O2-generating system at the plasma membrane. For the first time, we investigated the H2O2-generating activity in the particulate fractions from DUOX2- and DUOX1-transfected HEK293 and Chinese hamster ovary cells. The particulate fractions of these cells stably or transiently transfected with human or porcine DUOX cDNA demonstrate a functional NADPH/Ca2+-dependent H2O2-generating activity. The immature Duox proteins had less activity than pig thyrocyte particulate fractions, and their activity depended on their primary structures. Human Duox2 seemed to be more active than human Duox1 but only half as active as its porcine counterpart. TPO co-transfection produced a slight increase in the enzymatic activity, whereas p22(phox), the 22-kDa subunit of the leukocyte NADPH oxidase, had no effect. In previous studies on the mechanism of H2O2 formation, it was shown that mature thyroid NADPH oxidase does not release O2*- but H2O2. Using a spin-trapping technique combined with electron paramagnetic resonance spectroscopy, we confirmed this result but also demonstrated that the partially glycosylated form of Duox2, located in the endoplasmic reticulum, generates superoxide in a calcium-dependent manner. These results suggest that post-translational modifications during the maturation process of Duox2 could be implicated in the mechanism of H2O2 formation by favoring intramolecular superoxide dismutation.
- Published
- 2005
- Full Text
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83. Cystic adventitial disease of the popliteal artery. Report of 1 case and review of the literature.
- Author
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Rispoli P, Moniaci D, Zan S, Cassatella R, Varetto G, Maselli M, Apostolou D, Raso AM, and Conforti M
- Subjects
- Humans, Intermittent Claudication etiology, Magnetic Resonance Angiography, Male, Middle Aged, Peripheral Vascular Diseases complications, Peripheral Vascular Diseases diagnosis, Radiography, Intermittent Claudication surgery, Peripheral Vascular Diseases surgery, Popliteal Artery diagnostic imaging
- Abstract
Cystic adventitial disease (CAD) of the popliteal artery is a rare but well-known cause of intermittent claudication, especially in young patients. The etiology of the disease is still controversial and the literature reports various hypotheses for its origin. Diagnosis starts with thorough history taking and physical examination; non invasive diagnostic studies comprise color duplex scanner (ECD), computed tomography (CT), better if elicoidal (3D CT) and magnetic resonance imaging (MRI), which can aid in establishing correct recognition of the disease in most cases. A 48-year-old man presented with intermittent right calf claudication that had begun 4 months earlier; the symptom-free interval was about 100 m. MRI and MR angiography of right popliteal fossa revealed the presence of an oval cystic (maximum diameter 45 mm). The caudal aspect of the cyst showed pedicles protruding between the popliteal vein and the popliteal artery that compressed the artery, causing complete occlusion of its lumen. Surgery was performed through the posterior approach using an S-shaped incision; the affected segment of the popliteal artery was successfully excised and replaced with an autogenous external saphenous vein graft. A follow-up is underway, both clinical and with; no cyst recurrence has so far been detected either clinically or by duplex scanner during the 15-month postoperative follow-up period; the graft is patent and the patient is completely symptom free. Severe claudication in young patients, possibly without significant vascular risk factors, should prompt the clinical suspicion of adventitial cystic disease of the popliteal artery. Medical history, clinical examination and non invasive instrumental investigations, such as duplex scanner, elicoidal CT and/or MRI, may aid in establishing the correct diagnosis.
- Published
- 2003
84. Compliance of geriatric patients subjected to antiplatelet agents with Triflusal in peripheral arteriopathy. Preliminary data.
- Author
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Zan S, Maselli M, Moniaci D, Varetto G, Ortensio M, Apostolou D, Comelli S, and Scovazzi P
- Subjects
- Age Factors, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Male, Patient Compliance, Platelet Aggregation Inhibitors administration & dosage, Platelet Aggregation Inhibitors adverse effects, Risk Factors, Salicylates administration & dosage, Salicylates adverse effects, Time Factors, Arterial Occlusive Diseases drug therapy, Platelet Aggregation Inhibitors therapeutic use, Salicylates therapeutic use
- Abstract
Background: Triflusal is an irreversible inhibitor of platelet cyclooxygenase. Triflusal significantly reduced the incidence of nonfatal myocardial infarction in patients with unstable angina. Antithrombotic properties have also been demonstrated in patients with aortocoronary vein grafting, coronary angioplasty, peripheral arteriopathy and cerebrovascular disease. Moreover, in diabetic patients it has a protective effect against retinal microangiopathy, improves renal flow and reduces proteinuria. The drug has a high tolerability and has low incidence of side effects, with prevalence of gastrointestinal and skin disorders. Because of its demonstrated effectiveness and its good handling, we decided to use Triflusal in treatment of geriatric patients with peripheral arteriopathy. Often these patients have a diffused arteriopathic disease which can be associated with chronic diseases. For this reason there are severe problems of compliance due to contemporary administration of several drugs; so the utilization of effective drugs, without side effects, promotes a safer clinical management of patients., Methods: Between April 2000 and March 2001, we treated with Triflusal 70 patients, over 65 years old, with peripheral arteriopathy. The group comprises patients who had undergone traditional vascular surgery, or endovascular surgery and patients treated exclusively with drug therapy. During the follow-up we obser-ved the possible clinical development of side effects of the drug reported in the literature (nausea, vomiting, etc.)., Results: One patient, already affected by gastroduodenal disease, suspended the therapy because of severe epigastric burning., Conclusions: The follow-up of the patients goes on in order to evaluate the tolerability and handling of Triflusal, observing a larger number of patients.
- Published
- 2002
85. Surgical and endovascular treatment of stenosis of the innominate artery.
- Author
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Merlo M, Conforti M, Apostolou D, and Carignano G
- Subjects
- Angioplasty, Balloon, Brachiocephalic Trunk physiopathology, Humans, Vascular Surgical Procedures methods, Arteriosclerosis surgery, Brachiocephalic Trunk surgery
- Abstract
Background: Atherosclerotic lesions of the brachiocepfialic trunk are relatively rare compared with other types of vascular diseases. Median sternotomy with direct endothoracic repair is recommended because of good early and long-term results. Nevertheless, this procedure is not without risks such as hemorrhaging, embolism, aortic dissection, infection or death., Methods: This report therefore, describes our experience in intraoperative balloon angioplasty and additional stent placement of isolated stenosis of the brachiocephalic trunk with cerebral protection ensured by common carotid artery clamping. Through an anterolateral cervical approach the right common carotid artery was surgically exposed. After dilating the brachiocephalic trunk and positioning the stent, the vessel was repaired with a continuous suture., Results: In all patients the dilation of the stenosis of the brachiocephalic trunk and the stent placement were successful without any side-effects. No distal embolism with neurologic events, innominate artery dissection, rupture, occlusion or neck hematoma occurred. All patients were discharged three days after the intervention., Conclusions: This technique offers a safe, effective approach to stenoses of innominate arteries because it is less invasive than conventional transthoracic or extrathoracic surgery and offers excellent early and mid-term results. We believe that this technique is a safe and effective alternative to conventional surgery.
- Published
- 1999
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