Publications by authors named "Gregory Christodoulidis"

14 Publications

  • Page 1 of 1

The Contribution of a Collagen Patch Coated With Fibrin Glue in Sealing Upper Gastrointestinal Defects: An Experimental Study.

In Vivo 2021 Sep-Oct;35(5):2697-2702

Laboratory of Experimental Surgery, University of Thessaly, Larissa, Greece.

Background/aim: We aimed to evaluate the safety and efficacy of sealing primary upper gastrointestinal (GI) perforations with a collagen patch coated with fibrin glue (Tachosil).

Materials And Methods: Thirty New Zealand rabbits were used in this study. An iatrogenic gastric perforation was created, and primary repair was performed on the control group. Tachosil, without suturing the deficit, was used in the intervention group.

Results: Leakage was observed in 3 (20%) and 2 rabbits (13.3%) in the control and intervention group, respectively; however, the difference was not statistically significant (p=0.62). Moreover, adhesions formed in 10/15 and all rabbits in the intervention and control group, respectively (p=0.014); however, based on the Zuhlke adhesion's classification, there was no statistically significant difference between the two groups.

Conclusion: A collagen patch coated with fibrin glue is not a replacement but can be considered a safe option for the reinforcement of suturing, preventing leakages in the upper GI tract.
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http://dx.doi.org/10.21873/invivo.12553DOI Listing
August 2021

In-depth bioinformatic study of the cadherin 5 interactome in patients with thoracic aortic aneurysm unveils 8 novel biomarkers.

Eur J Cardiothorac Surg 2021 Jul 19. Epub 2021 Jul 19.

Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK.

Objectives: Thoracic aortic aneurysm (TAA) is characterized by the dilation of the aorta and is associated with poor prognosis if not diagnosed and treated early. In this context, the identification of biomarkers regarding the TAA diagnosis, monitoring and prognosis is crucial. The purpose of the current study was to investigate the differential gene expression profile of the cadherin 5 (CDH5 or VE-Cadherin) gene network in patients with TAA, to propose novel biomarkers.

Methods: In silico techniques were used to construct the interactome of the CDH5 network, identify the differentially expressed genes (DEGs) in TAA as compared to healthy controls, and uncover the related molecular functions and the regulating miRNAs.

Results: Transcriptomic data of one microarray dataset were included, incorporating 43 TAA and 43 control samples. Eight DEGs were identified; 7 were up-regulated and 1 was down-regulated. A molecular signature of 8 genes (CDH5; Calcitonin Receptor-Like Receptor-CALCRL; Activin A Receptor-Like Type 1-ACVRL1, Tryptophanyl-TRNA Synthetase 1-WARS; Junction Plakoglobin-JUP, Protein Tyrosine Phosphatase Receptor Type J-PTPRJ, Purinergic Receptor P2X 4-P2RX4, Kinase Insert Domain Receptor-KDR) were identified as biomarkers associated with TAA. PTPRJ was associated with excellent discrimination and calibration in predicting TAA presentation. Positive correlations were reported regarding the expression of CDH5-CALCRL, CDH5-ACVRL1, CDH5-WARS and CDH5-PTPRJ. Finally, gene set enrichment analysis indicated the molecular functions and miRNA families (hsa-miR-296-5p, hsa-miR-6836-5p, hsa-miR-6132, hsa-miR-27a-5p and hsa-miR-6773-5p) relevant to the 8 biomarkers.

Conclusions: These outcomes propose an 8-gene molecular panel associated with TAA.
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http://dx.doi.org/10.1093/ejcts/ezab338DOI Listing
July 2021

Metastatic rectal cancer in the ampulla of Vater: A unique case.

Cancer Rep (Hoboken) 2021 Jul 17:e1510. Epub 2021 Jul 17.

Department of Surgery, University Hospital of Larissa, Larissa, Greece.

Background: A metastatic lesion located in the ampulla of Vater is considered extremely rare, with only 32 cases reported globally.

Case: A 65-year-old patient was primarily diagnosed with a rectal adenocarcinoma. Twenty-four months later as part of the oncological follow-up, the patient was diagnosed with a single secondary tumor in the ampulla of Vater. After undergoing a pancreaticoduodenectomy (Whipple procedure), the patient experienced an uneventful recovery and received adjuvant chemotherapy. Sixteen months later the patient remained disease-free.

Conclusion: To the best of our knowledge, the present case represents the first reported metastatic tumor in the ampulla of Vater, originating from a rectal adenocarcinoma. This case underlines the critical role of immunohistochemistry in arriving at a correct diagnosis in order to guide clinical decision-making.
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http://dx.doi.org/10.1002/cnr2.1510DOI Listing
July 2021

Low-Grade Appendiceal Mucinous Neoplasm (LAMN) Primarily Diagnosed as an Ovarian Mucinous Tumor.

Case Rep Surg 2021 22;2021:5523736. Epub 2021 Apr 22.

Department of Surgery, University Hospital of Larissa, Greece.

Background: Low-grade appendiceal mucinous neoplasms (LAMN) are detected in 0.7 to 1.7% of all appendicectomies. The diagnosis can be challenging, particularly in female patients where the differential diagnosis of primary appendiceal and ovarian mucinous neoplasms is unclear. . A 71-year-old female was referred to our tertiary hospital with the working diagnosis of a right ovarian cystic tumor. The lesion was identified through a transvaginal ultrasound performed for vague lower abdominal pain symptoms. CT scan confirmed these findings. Intraoperatively, an appendiceal mucocele was identified and a right hemicolectomy was performed. The histopathology examination revealed a LAMN. Six months later, the patient remains disease-free. A close biannual oncological follow-up has been suggested.

Conclusion: This case underlines the difficulty in determining the origin of mucinous neoplasms of the right pelvic area. Mucocele of the appendix should be considered in the differential diagnosis of a mass in the right iliac fossa.
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http://dx.doi.org/10.1155/2021/5523736DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8084675PMC
April 2021

Leiomyosarcoma of the spermatic cord presenting as an incarcerated inguinal hernia: a rare presentation of a rare condition.

J Surg Case Rep 2021 Feb 10;2021(2):rjaa589. Epub 2021 Feb 10.

Surgery Department, University Hospital of Larissa, Larissa, Greece.

Leiomyosarcomas of the spermatic cord are rare malignancies with only sporadic cases (less than 150) reported in the literature. Preoperative diagnosis of a paratestical leiomyosarcoma is challenging. Clinicians do not typically consider inguinoscrotal lumps as underlying sarcomas due to their relatively low prevalence compared with hernias. As a result the diagnosis of a sarcoma of the paratesticular area is often hard to reach. Herein, we report a rare case of a leiomyosarcoma originating from the spermatic cord, masquerading as a strangulated inguinal hernia. Intraoperatively, a mass arising from the spermatic cord was found and excised. A supplementary orchiectomy with high ligation of the spermatic cord was also performed.
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http://dx.doi.org/10.1093/jscr/rjaa589DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872508PMC
February 2021

A meta-analysis of laparoscopic versus open left lateral hepatic sectionectomy.

HPB (Oxford) 2018 12 23;20(12):1130-1136. Epub 2018 Jul 23.

Department of Surgery, University Hospital of Larissa, Larissa, Greece. Electronic address:

Background: This study aimed to assess the perioperative outcomes of laparoscopic left lateral sectionectomy (LLLS) compared with an open (OLLS) approach.

Method: A systematic literature search was performed in PubMed, Scopus and Cochrane library, in accordance with the PRISMA guidelines. The Odds Ratio (ORs), the weighted mean difference (WMD) and 95% confidence interval (95% CI) were evaluated, by means of Random-Effects model.

Results: Ten articles met the inclusion criteria and incorporated 2640 patients. This study reveals comparable mean operative time, mean operative margin size and rate of R1 resection between LLLS and OLLS. The intraoperative mean blood loss, mean length of ICU stay, mean hospital stay were significantly increased in the OLLS group (p < 0.05). Complications were assessed according to the Clavien-Dindo classification. The incidence of grade I-II complications was similar between the two groups. The incidence of grade III-V complications was increased in the OLLS group (p = 0.008). The mean perioperative cost was similar between the two techniques.

Conclusion: These outcomes for left lateral sectionectomy suggest that both approaches are feasible and safe. However, the results should be treated with caution given the small number of the included randomized controlled studies and potential for selection bias between the two techniques.
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http://dx.doi.org/10.1016/j.hpb.2018.06.1812DOI Listing
December 2018

α2-Heremans-schmid glycoprotein (fetuin A) downregulation and its utility in inflammatory bowel disease.

World J Gastroenterol 2017 Jan;23(3):437-446

Anastassios C Manolakis, Andreas N Kapsoritakis, Elisavet K Tiaka, Kostas Oikonomou, Spyros P Potamianos, Department of Gastroenterology, University of Thessaly, School of Medicine, 41110 Larissa, Greece.

Aim: To investigate the impact of inflammatory bowel disease (IBD) on α2-Heremans-Schmid Glycoprotein (AHSG/fetuin A) and potential associations with disease and patient characteristics.

Methods: AHSG serum levels were determined in treatment-naïve newly-diagnosed patients, 96 with ulcerative colitis (UC), 84 with Crohn's disease (CD), 62 with diarrhea-predominant or mixed irritable bowel syndrome (IBS, D- and M- types) and 180 healthy controls (HC), by an enzyme linked immunosorbent assay (ELISA). All patients were followed for a minimum period of 3 years at the Gastroenterology Department of the University Hospital of Larissa, Greece. C-reactive protein (CRP), anti-glycan antibodies, anti- mannan antibodies IgG, anti-mannobioside carbohydrate antibodies IgG, anti-laminariobioside carbohydrate antibodies IgG and anti-chitobioside carbohydrate antibodies IgA were also determined immunonephelometry and ELISA, respectively.

Results: The mean ± SE of serum AHSG, following adjustment for confounders, was 0.32 ± 0.02 g/L in IBD, 0.32 ± 0.03 g/L in CD and 0.34 ± 0.03 g/L in UC patients, significantly lower than in IBS patients (0.7 ± 0.018 g/L) and HC (0.71 ± 0.02 g/L) ( < 0.0001, in all cases). AHSG levels were comparable between the CD and UC groups. Based on AHSG levels IBD patients could be distinguished from HC with about 90% sensitivity and specificity. Further adjusted analysis verified the inverse association between AHSG and penetrating, as well as stricturing CD (partial correlation coefficient: -0.45 and -0.33, respectively) ( < 0.05). After adjusting for confounding factors, inverse correlations between AHSG and CRP and the need for anti-TNFα therapy or surgery, were found (partial correlation coefficients: -0.31, -0.33, -0.41, respectively, < 0.05, in all cases). Finally, IBD individuals who were seropositive, for at least one marker, had AHSG levels falling within the two lower quartiles (OR = 2.86, 95%CI: 1.5-5.44, < 0.001) while those with at least two serological markers positive exhibited AHSG concentrations within the lowest quartile (OR = 5.03, 95%CI: 2.07-12.21, < 0.001), after adjusting for age, sex and smoking.

Conclusion: AHSG can be used to distinguish between IBD and IBS patients or HC while at the same time "predicting" complicated disease behavior, need for therapy escalation and surgery. Moreover, AHSG may offer new insights into the pathogenesis of IBD, since it is involved in key processes.
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http://dx.doi.org/10.3748/wjg.v23.i3.437DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5291848PMC
January 2017

Matrix metaloproteinase-2 and -9 serum levels as potential markers of intraperitoneal adhesions.

J Invest Surg 2013 Jun 20;26(3):134-40. Epub 2013 Mar 20.

General Surgery Department, University Hospital of Larissa, Larissa, Greece.

Objective: To assess the value of matrix metalloproteinases-2 (MMP-2) and -9 (MMP-9) as prognostic serum markers for intraperitoneal adhesions.

Background: Postoperative adhesions are associated with serious complications responsible for increased patient's morbidity.

Methods: Forty-eight rabbits were used and randomized into groups A, B, C, and D. Abdominal laparotomy and experimental adhesion formation model was carried out. In group A, 60 mL of N/S 0.9% were instilled intraperitoneally, in group B 60 mL of icodextrin 4% were instilled intraperitoneally, in group C 0.1 mL/kg of dimetindene maleate were administered intravenously, and in group D both agents were administered. Prior to euthanasia 0.5 mL of blood was obtained. The type, the surface area of adhesions, and serum concentration of MMPs were assessed.

Results: The mean surface area and Zuhlke classification of adhesions of groups B, C, and D has been proved to be significantly lower compared to group A. Serum MMP-2 levels were significantly higher in groups B and D than in group A, while group D was higher when compared to group C. Serum MMP-9 levels were significantly higher in group D compared to groups A, B, and C. Serum MMP-9 was the most accurate test to differentiate between animals with and without adhesions with a sensitivity of 81.8% and a specificity of 100% at a cut-off point of 21.5 (AUC = 0.934).

Conclusions: The administration of icodextrin 4% and dimetindene maleate seems to prevent postoperative adhesion formation. Serum levels of MMP-2 and MMP-9 may serve as prognostic markers to identify postoperative adhesions.
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http://dx.doi.org/10.3109/08941939.2012.730599DOI Listing
June 2013

A giant inguinoscrotal bladder hernia as a cause of chronic renal failure: A rare case.

Int J Surg Case Rep 2013 26;4(3):345-7. Epub 2013 Jan 26.

Department of Urology, University of Thessaly School of Medicine, Larissa, Greece. Electronic address:

Introduction: Giant inguinoscrotal bladder hernias are very rare and require surgical intervention. They usually do not cause any specific symptoms and thus, they are often misdiagnosed. If left untreated though, they might lead to severe medical conditions, such as renal failure.

Presentation Of Case: We present the case of a 71-year-old male patient suffering from a giant inguinoscrotal mass, accompanied by symptoms of the lower urinary track (LUTS) and chronic renal failure.

Discussion: In our case, the patient presented with bladder hernia causing non specific symptoms of renal failure. In contrast to acute renal failure, a chronic renal impairment most often comes with no specific symptoms and thus, it can be present for many years before the diagnosis is made. It is evident that such serious conditions should be suspected and treated.

Conclusion: Inguinoscrotal bladder hernias may be associated with severe medical conditions, such as renal deterioration, and should be considered in the differential diagnosis of renal failure, when accompanied by any inguinal, scrotal, or low abdominal wall hernia.
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http://dx.doi.org/10.1016/j.ijscr.2012.12.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3604660PMC
July 2013

Inverted Meckel's diverticulum manifested as adult intussusception: Age does not matter.

World J Gastrointest Surg 2011 Aug;3(8):123-7

Eleni Sioka, Gregory Christodoulidis, Grigorios Garoufalis, Dimitris Zacharoulis, Department of General Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece.

Adult intussusception due to Meckel's diverticulum (MD) is an uncommon cause of intestinal obstruction. However, the surgeon should still be suspicious of this condition since the non specific symptoms and the rarity of it make a preoperative diagnosis uncertain. Considering the secondary nature of adult intussusception and the necessity of early surgical intervention to avoid morbidity and mortality, we report two cases of intussusception due to MD in adults. A diverticulectomy using a TA stapler was performed in the first patient. In the second patient extensive fibrosis of the adjacent mesentery and thickening of jejunal mucosa were observed, so a segmental resection of the small bowel or affected ileal part and a hand-sewn anastomosis was performed. The postoperative period along with the long term follow-up was uneventful for both patients. The decision between diverticulectomy vs bowel resection can be based on the intussuscepted bowel condition. Early surgical intervention may ensure a favorable outcome.
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http://dx.doi.org/10.4240/wjgs.v3.i8.123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3192218PMC
August 2011

The role of the platelet-rich plasma in accelerating the wound-healing process and recovery in patients being operated for pilonidal sinus disease: preliminary results.

World J Surg 2009 Aug;33(8):1764-9

General Surgery Department, University Hospital of Larissa, Larissa, 41110, Greece.

Background: Because of the poor quality of life that results from the open technique (open excision and packing) for surgically treating pilonidal cyst disease, several alternatives that accelerate the wound-healing process have been proposed. This study aimed to evaluate the effect of platelet-derived growth factors on the healing process.

Methods: Fifty-two patients with pilonidal sinus disease who underwent open excision and secondary closure of the surgical wound (n = 22) or additional local postoperative infusion of platelet-derived growth factors (n = 30) were evaluated. Duration of total wound healing and time to return to normal activities were evaluated. Quality of life of patients in each group was assessed via a stabilized questionnaire.

Results: Wound-healing rates were much greater for the platelet group (p < 0.01). Complete healing of the surgical wound required 24 days for the platelet group while the respective time for the control group was more than 30 days (p < 0.01). Patients in the platelet group returned to their normal activities around the postoperative day 17 when mean wound volume was about 10 cc, while control group patients managed to do so around the postoperative day 25.

Conclusions: These data provide evidence that the use of platelet-derived growth factors directly to the surgical wound enhances the healing process resulting in faster recovery of patients surgically treated for pilonidal sinus disease.
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http://dx.doi.org/10.1007/s00268-009-0046-yDOI Listing
August 2009

Large solitary retroperitoneal echinococcal cyst: a rare case report.

World J Gastroenterol 2007 Dec;13(45):6101-3

General Surgery Department, University Hospital of Larissa, Mezourlo, Larissa, Athinas 2 Str. Larissa, Greece.

Echinococcal disease remains a problem within some endemic areas. Echinococcal cysts usually involve the liver and lungs, but any other organ can potentially be involved. Extrahepatic localization is reported in 14%-19% of all cases of abdominal hydatid disease. We report the case of a large echinococcal cyst localized in the lower pelvis. A 28-year-old woman was admitted to a surgical ward with lower abdominal pain and discomfort lasting for a month. Ultrasonography and computed tomography scanning revealed a large retroperitoneal cystic mass (9 cm multiply 4 cm) in contact with the left ovary and left ureter. There were no cysts in any other location. Serological tests were positive for Echinococcus. The patient was operated on and the entire cyst was excised intact. Histopathological results confirmed the diagnosis of echinococcosis. Antihelminthics were administered postoperatively and the patient was discharged after 6 d, and is now being closely followed up. Total cystectomy when possible represents the treatment of choice for large extrahepatic echinococcal cysts.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4250900PMC
http://dx.doi.org/10.3748/wjg.v13.45.6101DOI Listing
December 2007

Tissue preserving hepatectomy by a vessel sealing device.

J Surg Oncol 2008 Feb;97(2):165-8

General Surgery Department, University Hospital of Larissa, Larissa, Greece.

Background: The intraoperative blood loss and the biliary leak constitute the major causes of postoperative morbidity following liver resection. We describe a new technique for liver parenchyma transection using the Atlas modification of the ligasure vessel sealing system. The gradual closure of the instrument may cause crushing of the hepatic tissue and heat sealing of the vessels and bile ducts at the same time.

Materials And Methods: Ten cirrhotic patients (group A) underwent minor liver resections due to hepatocellular carcinoma (HCC). In four of these patients a bisegmentectomy was carried out, whereas in the remaining six the resection involved one segment. In addition, twelve patients with localized metastatic liver disease (group B) underwent tissue preserving hepatectomy also. Six of these patients underwent a bisegmentectomy and six had a local resection involving one segment.

Results: The blood loss in the first group varied from 120 to 350 ml, whereas in the second group varied from 80 to 280 ml. No postoperative biliary leakage was mentioned.

Conclusion: This alternative technique of dividing the hepatic parenchyma seems to be simple and efficacious in preventing significant blood loss and bile leak in minor liver resections.
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http://dx.doi.org/10.1002/jso.20889DOI Listing
February 2008

Liposarcoma of the stomach: a rare case report.

World J Gastroenterol 2007 Aug;13(30):4154-5

General Surgery Department, University Hospital of Larissa, Athinas street, 241220 Larissa, Greece.

Liposarcoma is the most common soft tissue sarcoma and accounts for 15%-20% of all mesenchymal malignancies. The tumor occurs most frequently in the limbs, retroperitoneum and rarely has a visceral location. We report a case of a gastric liposarcoma in a male patient. A 68 years old male patient was admitted to hospital for abdominal discomfort and fullness lasting for a month. He reported rare episodes of vomiting. The CT examination revealed a large epigastric mass (8 cm x 4 cm) involving the lesser curvature of the stomach, in contact with the pancreas and gallbladder. Fatty areas within the mass were evident. A total gastrectomy together with cholecystectomy was performed. The histopathological diagnosis was a well differentiated liposarcoma. The patient did not undergo any adjuvant treatment, he is under close follow up and two years later he is disease free. We report this case due to the rarity of this tumor in the stomach (nine cases reported in the literature).
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4205325PMC
http://dx.doi.org/10.3748/wjg.v13.i30.4154DOI Listing
August 2007
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