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Anastasios Papanastasiou,1 Konstantinos Sapalidis,1 Stylianos Mantalobas,1 Stefanos Atmatzidis,1 Nikolaos Michalopoulos,1 Valeriu Surlin,1 Athanasios Katsaounis,1 Aikaterini Amaniti,1 Paul Zarogoulidis,1 Ioannis Passos,1 Charilaos Koulouris,1 Efstathios Pavlidis,1 Dimitrios Giannakidis,1 Stelian Mogoanta,2 Christoforos Kosmidis,1 Isaak Kesisoglou113rd Department of Surgery, “AHEPA” University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece; 2Department of Surgery, Faculty of Dentistry, University of Medicine and Pharmacy of Craiova, Craiova, RomaniaBackground: Temporary hypocalcemia is the most common complication in patients after total thyroidectomy. To date, according to the literature, various predictors of the above complication have been proposed, but none of them seems to be effective enough.Objectives: The aim of this study was to develop a reliable predictive tool for biochemical hypocalcemia in the first 48 hrs after total thyroidectomy without central dissection by analyzing several parameters relevant to this operation and to suggest a new score.Methods: A retrospective study was performed on patients who had undergone total thyroidectomy without central neck dissection from October 2017 until January 2018. Data were collected from 36 patients and studied if there was a statistically significant relationship between the risk of hypocalcemia and 10 preselected prognostic factors.Results: The prognostic score was formed, which included the 6 factors that showed a statistically significant relationship. Moreover, an extensive check of the predictive value of the above score was performed. It was found, therefore, that at a value of 3 and above the sensitivity was 100%, the specificity 79.16%, the positive prognostic value (PPV) 70.58% and the negative predictive value (NPV) 100%.Conclusions: High sensitivity of CaReBe’S TiP score makes it feasible to predict patients with postoperative hypocalcemia. High NPV would allow surgeons to exclude patients with a score less than 3 from supplementary calcium medication and achieve a shorter hospitalization for them.Keywords: design, thyroidectomy, hypocalcemia, prognostic factors

Christopher Kosmidis,1,2 Konstantinos Sapalidis,1 Alexandros Tsakalidis,1 Stefanos Atmatzidis,1 Nikolaos Michalopoulos,1 Georgios Koimtzis,1 Georgia Karayannopoulou,3 Sofia Lypiridou,3 Nikolaos Varsamis,2 Georgios Kouklakis,2 Sofia Baka,2 Paul Zarogoulidis,1 Isaac Kesisoglou1 1Third Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 2Department of Oncology, Interbalkan Medical Center, Thessaloniki, Greece; 3Department of Pathology, Aristotle University of Thessaloniki, Thessaloniki, Greece Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. However, rectal GISTs represent only 5% of this category. We report a case of a rectal GIST treated with local excision after neoadjuvant therapy. Case presentation: A 41-year-old male patient presented with anal bleeding. Colonoscopy revealed a mass located 5 cm from the anal verge. Histological examination showed a GIST with immunohistochemical positivity for CD117 and CD34. Transanal local excision was performed after neoadjuvant therapy. Conclusion: Neoadjuvant immunotherapy for GISTs with unfavorable localization may facilitate local excision and avoid complications of more demanding operations. Keywords: gastrointestinal stromal tumor, rectal, neoadjuvant therapy, transanal excision

Christoforos Kosmidis,1 Georgios Koimtzis,1 Dimitrios Giannakidis,1 Nikos Tteralli,1 Stylianos Mantalovas,1 Alexandros Tsakalidis,1 Konstantina Tsopouridou,1 Stefanos Atmatzidis,1 Lazaros Liavas,1 Paul Zarogoulidis2 13rd Department of Surgery, “AHEPA” University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece; 2Department of Pharmacology and Clinical Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece Abstract: Lung cancer is still diagnosed at a late stage although novel diagnostic techniques are in use. However, as pharmacogenomics have evolved novel targeted therapies either with tyrosine kinase inhibitors or immunotherapy can be currently used as daily treatment. We present the case of a woman with anaplastic lymphoma-positive expression and programmed death-ligand 1 (PD-L1) 0% score upon diagnosis who underwent therapeutic surgery and represented PD-L1 90% expression, however, without anaplastic lymphoma kinase expression. Transformation of the tumor or new tumor is a question to be answered for this patient and possibly we should try and direct rebiopsies for this group of targeted therapy patients. Keywords: lung cancer, adenocarcinoma, EBUS, PD-L1, ALK

One of the complications of laparoscopic cholecystectomy for gallstone disease that seems to exceed that of the traditional open method is the gallbladder perforation and gallstone spillage. Its incidence can occur in up to 40% of patients, and in most cases its course is uneventful. However in few cases an abdominal abscess can develop, which may lead to significant morbidity. Rarely an abscess formation due to spilled and lost gallstones may occur in the retroperitoneal space. We herein report the case of a female patient who presented with clinical symptoms of sepsis six months following laparoscopic cholecystectomy. Imaging investigations revealed the presence of a retroperitoneal abscess due to retained gallstones. Due to patient’s decision to refuse abscess’s surgical drainage, she underwent CT-guided drainage. The 24-month followup of the patient has been uneventful, and the patient remains in good general condition.

Colonic lipomas are uncommon nonepithelial neoplasms that are typically sessile, asymptomatic and incidentally found during endoscopy, surgery, or autopsy. We present a very rare case of a 34-year-old female patient with symptomatic pedunculated cecal lipoma causing intermittent colo-colonic intussusception. Despite adequate imaging studies, definite preoperative diagnosis was not established and the patient underwent exploratory laparotomy. Intraoperatively, intussusception of the cecum into the ascending colon was found and right hemicolectomy was performed. Macroscopic assessment of the resected specimen showed the presence of a giant cecal pedunculated polypoid tumor with features of lipoma, causing intussusception. Histopathological examination confirmed the diagnosis of pedunculated cecal lipoma.

Femoral hernias are more common in women and lead to a substantial higher rate for an emergency operation, due to strangulation. Incarcerated femoral hernia with fallopian tube as a content is an extremely rare condition. A 20-year-old woman presented to the emergency department complaining of a 6-day right groin swelling, which became painful and tender to palpation during the last 48 hours. Preoperative ultrasonography detected an oedematous hernia sac, above the femoral vessels, suggesting the presence of an incarcerated femoral hernia. The patient eventually underwent emergency surgery and the diagnosis of a strangulated femoral hernia sac, containing fallopian tube, was established. No resection of the uterine tube was performed and the hernia was repaired with polypropylene plug. The postoperative period was uneventful and the woman was discharged on the second postoperative day.

Ghrelin ist ein, vom Magen gebildetes, orexigenes Peptidhormon. Basale Ghrelinplasmaspiegel sind bei Adipositas erniedrigt. Eine Ursache dafür, könnte ein hemmender Einfluss von Sekretionsprodukten der Fettzelle wie das Hormon Leptin sein. In der vorliegenden Arbeit wurde ein direkter, hemmender Effekt auf die Ghrelinfreisetzung des Rattenmagens in vitro demonstriert. Orexine sind orexigene Neuropeptide, die hauptsächlich im Hypothalamus, aber auch im Magen synthetisiert werden. Die Applikation von Orexinen oder von einem Orexin-Antagonisten in verschiedenen Konzentrationen zeigte keinerlei signifikante Effekte auf die Ghrelinfreisetzung des Rattenmagens. Ghrelin is an orexigenic peptide hormone of gastric origin. Ghrelin plasma levels are decreased in obese subjects. This could be explained due to a negative feedback of fat cell secretory products, such as the hormone leptin. In the present study has been demonstrated a direct, in vitro, inhibitory effect of leptin on gastric ghrelin secretion in rats. Orexins are orexigenic neuropeptides mainly produced in hypothalamus, but also in the stomach of rats. The application of orexins in several concentrations had no significant effect on gastric ghrelin secretion in rats.

Ghrelin ist ein, vom Magen gebildetes, orexigenes Peptidhormon. Basale Ghrelinplasmaspiegel sind bei Adipositas erniedrigt. Eine Ursache dafür, könnte ein hemmender Einfluss von Sekretionsprodukten der Fettzelle wie das Hormon Leptin sein. In der vorliegenden Arbeit wurde ein direkter, hemmender Effekt auf die Ghrelinfreisetzung des Rattenmagens in vitro demonstriert. Orexine sind orexigene Neuropeptide, die hauptsächlich im Hypothalamus, aber auch im Magen synthetisiert werden. Die Applikation von Orexinen oder von einem Orexin-Antagonisten in verschiedenen Konzentrationen zeigte keinerlei signifikante Effekte auf die Ghrelinfreisetzung des Rattenmagens., Ghrelin is an orexigenic peptide hormone of gastric origin. Ghrelin plasma levels are decreased in obese subjects. This could be explained due to a negative feedback of fat cell secretory products, such as the hormone leptin. In the present study has been demonstrated a direct, in vitro, inhibitory effect of leptin on gastric ghrelin secretion in rats. Orexins are orexigenic neuropeptides mainly produced in hypothalamus, but also in the stomach of rats. The application of orexins in several concentrations had no significant effect on gastric ghrelin secretion in rats.