Papers by Stavros Gourgiotis
Trauma remains the leading cause of mortality among persons 1 to 44 years old inthe United States... more Trauma remains the leading cause of mortality among persons 1 to 44 years old inthe United States1 and accounts for almost 9 % of total mortality worldwide.2 In2008 a total of 663000 injury-related deaths occurred in Europe (6.9 % of total deaths).2Uncontrolled bleeding and exsanguination are the leading cause of preventable deathafter trauma3 and require early detection of potential bleeding sources and prompt
Diagnosis and surgical approach of popliteal artery entrapment syndrome: a retrospective study
Hot Topics in Acute Care Surgery and Trauma, Dec 31, 2022
Mini-invasive Approach in Acute Care Surgery
Hot Topics in Acute Care Surgery and Trauma, 2020
British Journal of Surgery, Dec 1, 2021
18 of the 21 responses were male Time diagnosed with cancer: 57% were between 12 to 18 months pos... more 18 of the 21 responses were male Time diagnosed with cancer: 57% were between 12 to 18 months post diagnosis and 43% between 6 to 11 months. Source of Information received: 43% reported verbal information provided and 38% reported written information was provided Current engagement with Mental Health Services: National, Community, and Exercise programmes were used by a very small number of patients-6 in total out of 21 respondents Reasons for not engaging with Mental Health Services responses included 'Not being interested or required' to 'fearful' 'No knowledge of service' to 'Cant remember ' or 'Plans to engage' 93% of respondents would recommend use of wellbeing or mental health services to someone with a diagnosis of an Upper GI Cancer Suggestions for improvements varied from use of information packs, information on life post op and more guidance needed surrounding availability of current mental health supports Conclusions: Psychosocial issues need to be addressed and there is a huge deficit in current service provision. Current service is not meeting service user needs and not empowering patients how best to manage mental burden and thus contribute to maximising treatment outcomes. National Cancer Strategy acknowledges lack of access for cancer patients to pyschoncology services. The Cancer Centre is awaiting appointment of a Pyschoncology Consultant and Team in the coming months. The Upper GI MDT will seek access to this service once available for their patient cohort. In interim use limited national and community resources available. Provide education to wider team members to standardise approach providing both written and verbal information on available mental health and well being services, embed mental health awareness into daily practice with encouragement for early patient intervention if cancer related distress evident. Re Audit after introduction of these measures.
Case Reports in Surgery, 2014
Malignant fibrous histiocytoma (MFH) is a common soft tissue sarcoma usually involving limbs and ... more Malignant fibrous histiocytoma (MFH) is a common soft tissue sarcoma usually involving limbs and retroperitoneum. MFH of the rectus abdominis muscle is extremely rare. Surgery in similar cases leads to large abdominal wall defects needing reconstruction. Biological and synthetic laminar absorbable prostheses are available for the repair of hernia defects in the abdominal wall. They share the important feature of being gradually degraded in the host, resulting the formation of a neotissue. We herein report the case of an 84-year-old man with MFH of the rectus abdominis muscle which was resected and the large abdominal wall defect was successfully repaired with a biological mesh.
Turkish journal of trauma & emergency surgery, 2011
Askeri cerrah, standart bir klinik alanda çalışan ancak aynı zamanda becerilerini olağan dışı dur... more Askeri cerrah, standart bir klinik alanda çalışan ancak aynı zamanda becerilerini olağan dışı durumlara adapte etmeyi öğrenmek zorunda olan ve askeri tıbbi strateji planlamasını etkileyen başlıca faktörlere ve kriz bölgelerinde mevzisine bağlı güçlüklerle baş etmek zorunda bulunan bir doktordur. Tek kesin olan şey, bu özel koşulların temelde anavatanın askeri hastanelerindeki rutin koşullardan farklılık göstermesidir. Personel, ekipman ve teknik kaynaklardaki kısıtlılıklar, mevzi bölgesindeki yalıtım, yerel bir sağlık sisteminin olmaması, hastaların özel durumları ile yaralanma ve hastalıkların doğası, başlıca benzersiz zorluklardır.
Saudi Journal of Anaesthesia, 2012
![Research paper thumbnail of [Retroperitoneal Castleman's disease. A report of two cases and analysis of the literature]](https://a.academia-assets.com/images/blank-paper.jpg)
PubMed, Mar 17, 2007
Castleman's disease is a rare disorder of the lymphoid tissue with three possible histological va... more Castleman's disease is a rare disorder of the lymphoid tissue with three possible histological variants--the hyalin-vascular type, with a good prognosis, the plasma-cellular type and the mixed type; the latter two are both more aggressive than the hyalin-vascular type. Two clinical types of this disease have already been described: the localized or unifocal type and the multicentric or multifocal type. The aetiology of Castleman's disease remains unclear due to polymorphic clinical features that give rise to many diagnostic and treatment problems. Its diagnosis, therefore, can only be confirmed by histological examination. Surgical treatment is the treatment of choice in patients with Castleman's disease, but radical removal of the tumour mass, especially in the multicentric type, is not always possible. We are still in no position to draw definitive conclusions as to treatment, because there are only a few reports with different regimens regarding patients with multicentric Castleman's disease. A better understanding of the pathogenesis of this rare disorder may help in deciding the best treatment approach. In this study, we report two cases of Castleman's disease, one hyalin-vascular and the other plasma-cellular, both of which were unifocal and located in a retroperitoneal-pararenal site. We also analyse the main clinical, diagnostic and treatment problems associated with this rare condition, with an overview of the literature.
Annals of The Royal College of Surgeons of England, Sep 1, 2019
IntroductionWe aimed to enhance the emergency general surgical service in our high-volume centre ... more IntroductionWe aimed to enhance the emergency general surgical service in our high-volume centre in order to reduce four-hour target breaches, to expedite senior decision making and to avoid unnecessary admissions.Materials and methodsThe aggregation of marginal gains theory was applied. A dual consultant on-call system was established by the incremental employment of five emergency general surgeons with a specialist interest in colorectal or oesophagogastric surgery. A surgical ambulatory care unit, which combines consultant-led clinical review with dedicated next-day radiology slots, and a dedicated working week half-day gastrointestinal urgent theatre session were instituted to facilitate ambulatory care pathways.ResultsThe presence of two consultant surgeons being on call during weekday working hours decreased the four-hour target breaches and allowed consultant presence in the surgical ambulatory care clinic and the gastrointestinal urgent theatre list. Of 1371 surgical ambulatory care clinic appointments within 30 months, 1135 (82.7%) avoided a hospital admission, corresponding to savings of £309,752 . The coordinated functioning of the surgical ambulatory care clinic and the gastrointestinal urgent theatre list resulted in statistically significantly reduced hospital stays for patients operated for abscess drainage (gastrointestinal urgent theatre median 11 hours (interquartile range 3, 38) compared with emergency median 31 hours (interquartile range 24, 53), P < 0.001) or diagnostic laparoscopy/appendicectomy (gastrointestinal urgent theatre median 52 hours (interquartile range 41, 71) compared with emergency median 61 hours (interquartile range 43, 99), P = 0.005). Overnight surgery was reduced with only surgery that was absolutely necessary occurring out of hours.ConclusionThe expansion of the ‘traditional’ on-call surgical team, the establishment of the surgical ambulatory care clinic and the gastrointestinal urgent theatre list led to marginal gains with a reduction in unnecessary inpatient stays, expedited decision making and improved financial efficiency.
The Annals of Thoracic Surgery, Feb 1, 2010
PubMed, 2008
Introduction: We aimed to retrospectively assess the prevalence of microcarcinoma in thyroidectom... more Introduction: We aimed to retrospectively assess the prevalence of microcarcinoma in thyroidectomy specimens from a Greek population and the role of histopathology in determining management of these patients. Methods: We used histopathological reports of thyroidectomies performed in a Greek general district hospital. The samples consisted of 191 thyroidectomies performed between January 1997 and July 2001. The female:male ratio was approximately 2:1 and the follow-up period was 327 weeks. Results: There were 29 microcarcinomas (15.2 percent) with a female:male ratio of 6:1. The prevalence rate in cases with Hashimoto's thyroiditis was significantly higher compared to cases with other benign thyroid pathology (26.8 percent versus 11.9 percent, p-value equals 0.02). Eight microcarcinomas (27.6 percent) were multifocal. The histological type was that of papillary tumour in ten cases (34.5 percent) and follicular in 18 cases (62.1 percent). There were no deaths, recurrences or metastases during the follow-up period. Conclusion: Our results suggest that incidental microcarcinomas are low-risk tumours that do not require routine further intervention. The latter may be necessary for tumours with poor differentiation or for non-incidental microcarcinomas.
British Journal of Surgery, Dec 1, 2021
Background Perforation of the cervical oesophagus is an extremely rare but recognised complicatio... more Background Perforation of the cervical oesophagus is an extremely rare but recognised complication of thyroidectomy. As with all oesophageal perforations management depends on timing of diagnosis in relation to the timing of injury, the size of the oesophageal wall defect, extent of extraluminal contamination, and how unwell the patient is with respect to sepsis. We report a case of complete transection of the cervical oesophagus during total thyroidectomy and its subsequent management. Methods A previously well 32-year-old female had a complete cervical oesophageal transection during total thyroidectomy and neck dissection for papillary carcinoma of thyroid. This was recognised by her ENT surgeon who repaired the oesophagus primarily. Subsequently, she developed sepsis with cellulitis of her anterior chest wall. Cross-sectional imaging demonstrated a leak at the site of the cervical oesophageal repair. Gastroscopy confirmed a 50% dehiscence of the oesophageal anastomosis. Control and management of her oesophageal leak was achieved with EVT delivered using an ad-hoc endoluminal vacuum device (EVD) constructed from open cell foam sutured around the distal end of a nasogastric tube. Results The patient was managed in the intensive care unit (ICU) with appropriate organ support and antimicrobial cover. A surgical jejunostomy was placed to facilitate enteral feeding. EVT was delivered using the ad-hoc EVD which was placed endoscopically and situated intraluminally across the anastomotic leak site. Continuous negative pressure (125 mmHg) was applied. Six EVD changes were required to heal the leak. Her total length of stay was 41 days, of which 38 days were in ICU. There were no periprocedural complications related to using the EVD or EVT, although the patient subsequently developed an oesophageal stricture which required endoscopic dilatation. Conclusions Accidental complete transection of the cervical oesophagus is extremely rare. This case highlights the importance of a multidisciplinary team approach for managing such cases. EVT is an emerging treatment option for upper gastrointestinal (UGI) leaks and is reported to be safe and effective for leaks from a wide range of causes throughout the UGI tract. Successful resolution of the oesophageal leak in this unusual case demonstrates the utility of EVT in difficult clinical situations which may otherwise pose a formidable management challenge using traditional treatment strategies.
Hellenic Journal of Surgery, 2016
Demand for critical care services is increasing. The role of surgeons in intensive care units (IC... more Demand for critical care services is increasing. The role of surgeons in intensive care units (ICUs) provides specific insights and perspectives concerning the care of surgical patients, sometimes not fully appreciated by the non-surgical practitioners caring for these patients. The training and education of surgeons is becoming more complex, fragmented, and lengthy. The knowledge-based skills required to manage critically ill patients are also becoming more extensive. However, surgeons need to spend focused attention on how best to train and educate upcoming surgical trainees in regard to the principles of critical care medicine; educational programmes could be developed for better surgical education within the basic residency and surgical critical care programmes. The critically ill patient needs this focused attention as does the specialty of surgical critical care medicine.
Annals of The Royal College of Surgeons of England, Mar 1, 2022
Peutz–Jeghers syndrome (PJS) is a rare hereditary disease characterised by hyperpigmentation of t... more Peutz–Jeghers syndrome (PJS) is a rare hereditary disease characterised by hyperpigmentation of the oral mucosa and gastrointestinal hamartomatous polyps. We report a case of a 27-year-old man who presented with a 5-day history of epigastric pain and rectal bleeding. Computed tomography suggested small bowel obstruction secondary to ileocolic intussusception and an incidental polyp in the mid jejunum. The patient underwent exploratory laparotomy during which right hemicolectomy and small bowel resection were performed. Histology from surgical specimens revealed Peutz–Jeghers polyps, one of which had low-grade dysplasia. This case emphasises that although rare, adults with PJS can present with intussusception. Also illustrated is the extremely rare possibility of concurrent polyps occurring in different parts of the bowel with neoplastic transformation. Intussusception is a challenge to diagnose because the presentation is often non-specific. Clinical history-taking and physical examination along with prompt axial imaging is important for the diagnosis. Careful examination of the bowel and polypectomy during laparotomy may prevent neoplastic transformation and short bowel syndrome.
Il Giornale di chirurgia, 2019
Hemoperitoneum due to ruptured retroperitoneal varices is an extremely rare condition and a poor ... more Hemoperitoneum due to ruptured retroperitoneal varices is an extremely rare condition and a poor prognostic sign with a catastrophic and life-threatening situation. Early recognition affords appropriate management and urgent surgical intervention in order to favor the survival rate. In this case report we accurately describe the complex clinical course of a 56-year old woman with retroperitoneal varices, who few months earlier had a chest trauma with multiple left lower rib fractures and 10 years earlier she underwent to ovarian hyperstimulation for an ovulation induction. She was taken to the emergency room for a fainting episode with signs of a clear hemodinamic shock without a present history of trauma. The intricacy of this case was mostly due to the choice of the correct management, where the damage control resuscitation turned out to have an important role.
Journal of Digestive Diseases, May 1, 2008
The synchronous occurrence of gastrointestinal stromal tumour (GIST) in the stomach and early gas... more The synchronous occurrence of gastrointestinal stromal tumour (GIST) in the stomach and early gastric cancer is uncommon, with only a few previous reports. In particular, the collision of GIST and early gastric cancer in a patient with idiopathic thrombocytopenic purpura (ITP) has never been reported. We present the case of a 78-year-old male patient with ITP who was diagnosed with a synchronous development of GIST and early gastric cancer of the stomach. He underwent an elective subtotal gastrectomy with splenectomy. We discuss whether the development of GIST in the stomach in concert with early gastric cancer is an incidental coexistence or involve the same carcinogenic agents. Furthermore, it is not known whether or not such a situation is connected with ITP. To our knowledge this is the second report of a small GIST concomitant with an early gastric cancer and the first one in a patient with ITP.
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Papers by Stavros Gourgiotis