Publications by authors named "Jim Iliopoulos"

11 Publications

  • Page 1 of 1

Direct transarterial embolization via the deep circumflex iliac artery for a type II endoleak using a novel Onyx™ mixture.

J Surg Case Rep 2020 Dec 24;2020(12):rjaa526. Epub 2020 Dec 24.

Vascular Surgery Department, Liverpool Hospital, SWSLHD, NSW 2173, Australia.

Internal iliac artery aneurysms (IIAA) can be associated with abdominal aortic aneurysms. We describe a technique of successful transarterial embolization using a mixture of Onyx™ formulations in a 72-year-old with previous open and endovascular aneurysm repairs of his abdominal aorta and a residual large left IIAA causing a Type II endoleak. We demonstrate that utilization of the deep circumflex iliac artery is a safe and viable alternate route to treating IIAA when direct access is not achievable.
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http://dx.doi.org/10.1093/jscr/rjaa526DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758993PMC
December 2020

Accuracy of hiatal hernia diagnosis in bariatric patients: Preoperative endoscopy intraoperative reference.

JGH Open 2020 Dec 30;4(6):1074-1078. Epub 2020 Jul 30.

Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine The Chinese University of Hong Kong Hong Kong SAR China.

Background And Aim: Obesity is becoming increasingly prevalent in Asia. Bariatric surgery in the region is growing in popularity to reflect increasing demand. Hiatal hernia (HH) is common among the obese population. There is a lack of evidence comparing preoperative endoscopy against intraoperative findings as a standard of reference for HH diagnosis.

Methods: This was a retrospective analysis of a bariatric procedure database from a single tertiary teaching hospital and high-volume endoscopy center. Electronic medical records were reviewed. Endoscopy results were compared to intraoperative findings, and subgroup analysis of >2 cm hernias was performed. Sensitivity, specificity, predictive values, likelihood ratios, and global diagnostic test accuracy were calculated.

Results: A total of 434 patients were eligible for this study, of which HH was detected in 37 patients (prevalence rate 8.55%). Mean age was 41.51 ± 11.07 years, and body mass index was 39.37 ± 5.67 kg/m. Endoscopy sensitivity was 75.68% (95% confidence interval, 58.80-88.23%) and specificity 91.44% (88.24-94.00%). Positive likelihood ratio was 8.53 (6.11-12.79) and negative likelihood ratio 0.27 (0.15-0.47). Positive predictive value was 45.16% (36.27-54.38%) and negative predictive value 97.58% (95.80-98.62%). Accuracy of endoscopy for preoperative HH diagnosis was 90.09% (86.89-92.74%).

Conclusion: Endoscopy can have a high diagnostic accuracy of preoperative HH diagnosis in obese Asian patients using intraoperative diagnosis as the reference standard.
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http://dx.doi.org/10.1002/jgh3.12388DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731797PMC
December 2020

Management of an inflammatory abdominal aortic aneurysm causing ureteric obstruction: a case report.

J Surg Case Rep 2020 Nov 30;2020(11):rjaa457. Epub 2020 Nov 30.

Department of Vascular Surgery, Liverpool Hospital, SWSLHD, Liverpool, NSW, Australia.

Inflammatory abdominal aortic aneurysms (IAAAs) are rare large-vessel pathology, with potentially life-threatening complications including obstructive uropathy secondary to retroperitoneal fibrosis. Comprising a small proportion of all AAA, their pathogenesis remains unknown, with the hypothesis of infective and immunological aetiologies circulating in current literature. Management principles of IAAAs aim at prevention of aortic rupture and include open-surgical or endovascular therapies. Due to their involvement of other structures, additional considerations are needed when approaching their management for optimal patient outcomes. We present the case of a 53-year-old otherwise healthy male with a large IAAA complicated by adjacent ureteric obstruction, successfully treated with ureteric stenting and delayed endovascular aortic aneurysm repair.
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http://dx.doi.org/10.1093/jscr/rjaa457DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7700772PMC
November 2020

Acute bilateral renal vein thrombosis diagnosis and management: a case report.

J Surg Case Rep 2020 Aug 14;2020(8):rjaa238. Epub 2020 Aug 14.

Liverpool Hospital, SWSLHD, Liverpool, NSW 2170, Australia.

Undifferentiated abdominal pain accounts for a significant proportion of emergency presentations and often presents as a diagnostic dilemma. Renal vein thrombosis (RVT) has many aetiologies including nephrotic syndrome, malignancy, trauma, infection and hypercoagulable states. RVT should be considered in cases of persistent abdominal pain where other, more common, pathologies have been excluded. We present the case of a 42-year-old male with a delayed diagnosis of bilateral RVT after presenting with multiple episodes of intractable abdominal pain and adverse sequelae of this condition. This case report aims to emphasize the importance of prompt RVT recognition and the utility of bedside emergency department (ED) investigations, which can guide initial differential diagnoses of abdominal pain, reduce the delay in diagnosis as well as limit unnecessary investigations.
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http://dx.doi.org/10.1093/jscr/rjaa238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7427035PMC
August 2020

The management of malignant lower limb ulcers: clinical considerations.

Br J Nurs 2020 Aug;29(15):S34-S40

Clinical Superintendent, Department of Vascular Surgery, Liverpool Hospital, Sydney, Australia.

Lower limb malignant ulcers are an uncommon finding, making diagnosis complex and their management costly. Yet, despite this, the increase in skin cancers over the past 30 years means that clinicians require an awareness and understanding of their existence, particularly in the primary care setting. Familiarity with common aetiologies and presentations is vital for prompt recognition, diagnosis and referral of wounds suspicious for malignancy. Lower limb malignant wounds often develop insidiously, with a wide variation in clinical presentation that overlaps between entities. Therefore, a fundamental algorithm for approaching lower limb ulcers that raise suspicion of malignancy should be possessed by all clinicians. This article reviews the clinical features of malignant wounds that should alert clinicians to the need for further evaluation, such as atypical location and appearance. The authors also highlight the various diagnostic and therapeutic modalities available and review current clinical guidelines for the referral and follow-up of suspicious lesions.
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http://dx.doi.org/10.12968/bjon.2020.29.15.S34DOI Listing
August 2020

RNAi modulation of placental sFLT1 for the treatment of preeclampsia.

Nat Biotechnol 2018 Nov 19. Epub 2018 Nov 19.

RNA Therapeutics Institute, University of Massachusetts Medical School, Worcester, Massachusetts, USA.

Preeclampsia is a placentally induced hypertensive disorder of pregnancy that is associated with substantial morbidity and mortality to mothers and fetuses. Clinical manifestations of preterm preeclampsia result from excess circulating soluble vascular endothelial growth factor receptor FLT1 (sFLT1 or sVEGFR1) of placental origin. Here we identify short interfering RNAs (siRNAs) that selectively silence the three sFLT1 mRNA isoforms primarily responsible for placental overexpression of sFLT1 without reducing levels of full-length FLT1 mRNA. Full chemical stabilization in the context of hydrophobic modifications enabled productive siRNA accumulation in the placenta (up to 7% of injected dose) and reduced circulating sFLT1 in pregnant mice (up to 50%). In a baboon preeclampsia model, a single dose of siRNAs suppressed sFLT1 overexpression and clinical signs of preeclampsia. Our results demonstrate RNAi-based extrahepatic modulation of gene expression with nonformulated siRNAs in nonhuman primates and establish a path toward a new treatment paradigm for patients with preterm preeclampsia.
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http://dx.doi.org/10.1038/nbt.4297DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6526074PMC
November 2018

Placental Growth Factor Reduces Blood Pressure in a Uteroplacental Ischemia Model of Preeclampsia in Nonhuman Primates.

Hypertension 2016 06 18;67(6):1263-72. Epub 2016 Apr 18.

From the Medicine Faculty, Western Sydney University and Ingham Institute, Sydney, NSW, Australia (A.M., K.R.Y., S.M.L., J.I., M.C.K., B.X., A.H.); Medicine Faculty, University of New South Wales, Sydney, NSW, Australia (A.M., M.C.K., J.Y.); Nephrology Department, Liverpool Hospital, Liverpool, NSW, Australia (A.M., J.I.); Vascular Immunology Group, Heart Research Institute, Sydney, NSW, Australia (A.M., K.R.Y., S.M.L., B.X., A.H.); Nephrology Department (N.S., S.H.), Melanoma Unit (J.F.T.), and Obstetrics Department (R.F.O.), Royal Prince Alfred Hospital, Sydney, NSW, Australia; Department of Surgery, University of Sydney, Sydney, NSW, Australia (J.F.T.); Anatomical Pathology Department (M.C.K., J.Y.) and Vascular Surgery Department (J.I.), Liverpool Hospital, Liverpool, NSW, Australia; Division of Nephrology, Massachusetts General Hospital, Boston (R.T.); and Centre for Vascular Biology, Beth Israel Deaconess Medical Centre, Boston, MA (S.A.K.).

An imbalance in the angiogenesis axis during pregnancy manifests as clinical preeclampsia because of endothelial dysfunction. Circulating soluble fms-like tyrosine kinase 1 (sFLT-1) increases and placental growth factor (PlGF) reduces before and during disease. We investigated the clinical and biochemical effects of replenishing the reduced circulating PlGF with recombinant human PlGF (rhPlGF) and thus restoring the angiogenic balance. Hypertensive proteinuria was induced in a nonhuman primate (Papio hamadryas) by uterine artery ligation at 136 days gestation (of a 182-day pregnancy). Two weeks after uteroplacental ischemia, rhPlGF (rhPlGF, n=3) or normal saline (control, n=4) was administered by subcutaneous injection (100 μg/kg per day) for 5 days. Blood pressure was monitored by intra-arterial radiotelemetry and sFLT-1 and PlGF by ELISA. Uteroplacental ischemia resulted in experimental preeclampsia evidenced by increased blood pressure, proteinuria, and endotheliosis on renal biopsy and elevated sFLT-1. PlGF significantly reduced after uteroplacental ischemia. rhPlGF reduced systolic blood pressure in the treated group (-5.2±0.8 mm Hg; from 132.6±6.6 mm Hg to 124.1±7.6 mm Hg) compared with an increase in systolic blood pressure in controls (6.5±3 mm Hg; from 131.3±1.5 mm Hg to 138.6±1.5 mm Hg). Proteinuria reduced in the treated group (-72.7±55.7 mg/mmol) but increased in the control group. Circulating levels of total sFLT-1 were not affected by the administration of PlGF; however, a reduction in placental sFLT-1 mRNA expression was demonstrated. There was no significant difference between the weights or lengths of the neonates in the rhPlGF or control group; however, this study was not designed to assess fetal safety or outcomes. Increasing circulating PlGF by the administration of rhPlGF improves clinical parameters in a primate animal model of experimental preeclampsia.
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.116.07286DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4867111PMC
June 2016

Evaluation of arterial grafts prior to coronary bypass in pseudoxanthoma elasticum.

Heart Lung Circ 2011 Nov 8;20(11):726-7. Epub 2011 Sep 8.

Department of Vascular Surgery, Liverpool Hospital, Liverpool, NSW 2170, Australia.

Pseudoxanthoma elasticum is a rare, inherited connective tissue disorder associated with coronary and peripheral arterial disease and accelerated atherosclerosis in medium sized arteries. We describe 110-month symptom-free survival in a patient with pseudoxanthoma elasticum who underwent coronary bypass using the left internal mammary artery at 56 years of age. The vessel was evaluated pre-operatively with angiography to determine suitability, and he has not required further investigation or intervention due to lack of symptoms.
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http://dx.doi.org/10.1016/j.hlc.2011.08.007DOI Listing
November 2011

Evaluation of a bioresorbable polylactide sheet for the reduction of pelvic soft tissue attachments in a porcine animal model.

J Biomed Mater Res B Appl Biomater 2006 Oct;79(1):166-75

Orthopaedic Research Laboratories, Division of Surgery, University of New South Wales, Prince of Wales Hospital, Sydney, 2031 Australia.

In an adult porcine model, the effectiveness of a bioresorbable film to minimize soft tissue attachment to the pelvic viscera was evaluated at 4-week and 12-week endpoints. Following a transperitoneal laparotomy through a midline incision, the bladder and uterus were abraded in all animals to promote soft tissue attachment to the viscera. Control animals received no further treatment. The experimental group animals were treated with bioresorbable polylactide (PLa) sheets, 0.02 mm thick, one between the bladder and the abdominal wall, and a second sheet between the bladder and the uterus. Quantitative assessment of the severity and location of soft tissue attachments, and qualitative histologic assessment were performed at 4 and 12 weeks post-operatively. Statistically significant differences in the quantitative soft tissue attachment scores were observed in comparing the PLa film treated animals versus the control animals, at both the 4-week and 12-week time points. In the control animals, the formation of numerous thick fibrous bands was observed at both time points. Histology revealed no adverse reaction to the bioresorbable PLa barrier film. The bioresorbable PLa sheet provided an effective barrier between adjacent anatomical structures and minimized soft tissue attachments to the device when in contact with the viscera as compared to the control groups. Surgical dissection planes between the abdominal wall and adjacent soft tissues were maintained with the use of the PLa sheet at both time points.
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http://dx.doi.org/10.1002/jbm.b.30527DOI Listing
October 2006

Traumatic pulmonary arteriovenous malformation presenting with massive hemoptysis 30 years after penetrating chest injury.

Ann Thorac Surg 2003 Sep;76(3):942-4

Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia.

A 39-year-old man presented with massive hemoptysis requiring emergency double lumen endobronchial intubation, bronchial arteriography and embolization, and subsequent right lower lobectomy. He had suffered a shrapnel blast injury to the right chest as a 9-year-old boy. Pathology of the resected specimen revealed lodged metallic foreign body with traumatic arteriovenous malformation. We present this case to alert thoracic surgeons to this extremely rare clinical entity that can present itself many years after the penetrating trauma, which requires urgent surgery.
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http://dx.doi.org/10.1016/s0003-4975(03)00527-7DOI Listing
September 2003

Pseudoxanthoma elasticum: is the left internal mammary artery a suitable conduit for coronary artery bypass grafting?

Ann Thorac Surg 2002 Feb;73(2):652-3

Department of Cardiothoracic Surgery, The Prince of Wales Hospital, The University of New South Wales, Sydney, Australia.

Coronary artery revascularization remains a feasible and beneficial treatment for coronary artery disease in patients with pseudoxanthoma elasticum. Careful angiographic evaluation of the left internal mammary artery and coronary arteries is required in patients with pseudoxanthoma elasticum with suspected coronary artery disease. A nonstenosed left internal mammary artery at angiography may be used as a conduit for coronary artery revascularization; however, both the effect of harvest and anastomosis on the disease process in the left internal mammary artery and the long-term patency of left internal mammary artery grafts remain unknown.
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http://dx.doi.org/10.1016/s0003-4975(01)03011-9DOI Listing
February 2002