A Manouras

Publications (42)65.12 Total impact

• Article: Jejunojejunal lipoma causing intussusception.

  G Charalambous, V Katergiannakis, A Manouras
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  ABSTRACT: Jejunojejunal intussusception and jejunojejunal lipomas are both very rare clinical entities. The present case report describes this event in an adult patient with severe episodes of hematochezia and colicky upper abdominal pain. The diagnosis was not made preoperatively, as none of the endoscopic findings were pathognomonic and, furthermore, CT scans could not rule out malignancy. Exploratory laparotomy was mandatory and at surgery a jejunojejunal intussusception secondary to a lipoma was found. Segmental resection and primary reanastomosis were performed in the presence of evidence of bowel ischemia.
  Case Reports in Gastroenterology 09/2012; 6(3):684-8.
• Article: High small bowel obstruction from a gallstone

  K. Toutouzas, D. Tsamis, Th. Delistathi, M. Tsiriva, A. Manouras, G. Zografos
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  ABSTRACT: Gallstones are a very uncommon cause of obstruction at any site of the gastrointestinal tract and commonly affect the elderly. The mechanism by which the stones pass into the intestine is a biliary-enteric fistula, more often after an episode of acute cholecystitis. Radiologic studies may prove very helpful in diagnosis, but a high index of suspicion and accurate medical history are also warranted. We present the case of a 77-year-old patient who was admitted with signs of acute cholecystitis. During his hospitalization, he developed symptoms of small bowel obstruction. Imaging studies revealed an obstacle in the proximal intestine and the patient underwent exploratory laparotomy which identified a 5 cm gallstone lodged in the proximal jejunum; an enterolithotomy was performed. Surgical options in such cases are affected by the general condition of the patient and the extent of the inflammatory and ischemic process at the affected organs. Despite developments, this clinical entity still carrries high mortality rates. This could be attributed to the comorbidities of the elderly and the fact that it remains a rare and difficult diagnostic entity. KeywordsGallstone ileus-Small bowel obstruction-Cholelithiasis complication-Biliary enteric fistula
  Hellēnikē cheirourgikē. Acta chirurgica Hellenica 04/2012; 82(4):257-260.
• Article: The value of TOP2A, EZH2 and paxillin expression as markers of aggressive breast cancer: relationship with other prognostic factors.

  D Panousis, E Patsouris, E Lagoudianakis, A Pappas, V Kyriakidou, Z Voulgaris, G Xepapadakis, A Manouras, A M Athanassiadou, P Athanassiadou
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  ABSTRACT: The immunocytochemical expression of topoisomerase II alpha (TOP2A), enhancer of zeste homologue 2 (EZH2) and paxillin has recently gained increasing attention. Although previous studies have commented on the clinical usefulness of these markers, their role remains controversial. The purpose of the study was to investigate the expression of TOP2A, EZH2 and paxillin in relation to classic prognostic parameters and their significance as prognostic markers in imprints of resected breast carcinomas. Imprint smears from 55 patients who underwent surgical treatment for primary carcinoma in our department between 2005 and 2006 were studied immunocytochemically with the use of TOP2A, EZH2 and paxillin antibodies. The expression of TOP2A correlated with higher histologic grade, tumor size and negative PR expression. High intensity staining for EZH2 expression was associated with higher histologic grade, negative ER and PR expression and positive Ki-67 expression. The expression of paxillin showed no correlation with estrogen/progesterone and HER2 expression nor with tumor grade and stage. Our data indicate that TOP2A and EZH2 expression are related to a more aggressive tumor phenotype. The expression of paxillin failed to correlate with any of the studied clinicopathologic factors. Further studies are needed to verify these results.
  European journal of gynaecological oncology 01/2011; 32(2):156-9. · 0.47 Impact Factor
• Article: The value of proliferation indexes in breast cancer.

  G Karanikas, N Koronakis, E E Lagoudianakis, D Grosomanidis, G Karavitis, I Koukoutsis, A Pappas, K Kotzadimitriou, A Papadima, J Chrysikos, G Zografos, G Xepapadakis, A Manouras
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  ABSTRACT: During the past several years, the Ki-67 antigen has gathered great interest in its role as a prognostic marker. Nevertheless, despite the large number of published papers, the role of Ki-67 in clinical practice remains controversial. To evaluate the association between Ki-67 immunoreactivity and other clinicohistopathological parameters. We retrospectively analyzed the archival pathology tissues of 356 patients, diagnosed and treated in our department, from 2002 to 2006. Statistical analysis was used to examine the association between Ki-67 expression and other clinicopathological factors. The expression of Ki-67 was correlated with the mitotic count, tumor grade and size and p53, HER2 and EGFR expression. Furthermore Ki-67 expression was significantly related with nodal status and inversely associated with hormonal expression. Moreover, invasive carcinomas appeared to have greater proliferation values than in situ carcinomas, while invasive ductal carcinomas were correlated with higher Ki-67 expression compared to lobular cancers. The expression of Ki-67 appears to be a valuable method of proliferation measurement that could prove helpful in clinical practice. Further research is warranted in order to standardize the methodology and to reach uniformity in regard with the optimal cut-off value.
  European journal of gynaecological oncology 01/2010; 31(2):181-4. · 0.47 Impact Factor
• Article: Analysis of clinical and molecular associations of triple negative breast cancers in node-negative patients.

  N Koronakis, G Karanikas, E E Lagoudianakis, D Grosomanidis, A Pappas, J Chrysikos, G Xepapadakis, A Manouras
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  ABSTRACT: Therapeutic modalities in node-negative breast cancer patients remain a matter of controversy. Various prognostic factors have been proposed to help select those patients that would most likely benefit from adjuvant therapy. In view of this notion the triple negative phenotype (hormone receptors and HER2 negative tumors) has gained increasing attention. To evaluate the clinicopathologic characteristics of triple negative (TN) tumors in node-negative invasive breast carcinomas. We retrospectively analyzed the archival pathology tissues of 160 patients with node-negative invasive carcinomas, diagnosed and treated in two surgical departments in Greece from 1999 to 2006. Statistical analysis was used to examine the association between TN tumors and other clinicopathological factors. Triple negative breast cancers correlated with higher histologic grade, mitotic activation index and Ki-67 expression (p < 0.05). Moreover TN tumors were correlated with negative staining for bcl-2 (p < 0.05). In node-negative breast cancer patients, triple negativity is associated with aggressive biologic behavior. Further studies are required to better understand the clinical implications of these findings.
  European journal of gynaecological oncology 01/2010; 31(3):304-7. · 0.47 Impact Factor
• Article: The role of sonography in the diagnosis of cystic lesions of the breast.

  M Bilali, E E Lagoudianakis, P Peitsidis, D Grosomanidis, A Papadima, N Koronakis, J Chrysikos, D Tsekouras, S Nakos, V Katergiannakis, A Manouras
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  ABSTRACT: Breast sonography is appropriate in the initial assessment of a women younger than 30 years with a palpable lump and in the adjunctive evaluation of mammographic masses, and palpable abnormalities not seen mammographically. A total of 269 patients underwent breast examination with ultrasound due to the presence of bilateral or unilateral palpable lesions. Women under 40 years old were submitted to US examination only while patients older than 40 years underwent US breast assessment and conventional mammography. Mammography had an accurancy of 57.3% and confirmed diagnosis in 113 out of 197 patients; in 57 patients (28.4%) it identified the lesion but could not determine the diagnosis. False-positive results for malignancy were detected in 23 patients (11.7%) and there were no false-negative results. Ultrasound assessment had an accuracy in diagnosis reaching 87.3%, 172 cases out of 196. (87.3% vs 57.3% p < 0.05); false-positive results were identified in 17 cases (8.6%). Sonography demonstrates a better diagnostic significance than mammography in the early detection of cystic breast carcinoma.
  European journal of gynaecological oncology 01/2009; 30(5):506-8. · 0.47 Impact Factor
• Article: Laparoscopic fenestration of multiple giant biliary mucinous cystadenomas of the liver.

  A Manouras, E Lagoudianakis, L Alevizos, H Markogiannakis, G Kafiri, C Bramis, K Filis, K Toutouzas
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  ABSTRACT: Biliary cystadenomas of the liver are rare, cystic neoplasms of the biliary ductal system usually occur in middle aged women. We report a case of synchronous multiple huge biliary mucinous cystadenomas with unique features. This is, according to our knowledge, the first report in the literature about three synchronously occurring hepatobiliary cystadenomas. Cystadenomas have a strong tendency to recur, particularly following incomplete excision, and a potential of malignant transformation. A therapeutic re-evaluation may be necessary when the diagnosis of hepatobiliary cystadenoma is made after the operation and an open liver resection should be considered.
  World Journal of Gastroenterology 07/2008; 14(26):4257-9. · 2.47 Impact Factor
• Article: Predictive factors of operative or nonoperative management of blunt hepatic trauma.

  H Markogiannakis, E Sanidas, I Michalakis, A Manouras, J Melissas, D Tsiftsis
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  ABSTRACT: Nonoperative management (NOM) has revolutionized the care of blunt hepatic trauma patients. The aim of the present study was to identify and evaluate the predictors of NOM of these patients. The Trauma Registry data of 55 consecutive adult patients admitted with blunt hepatic trauma over a 4-year period was reviewed. Patients were divided into immediately operated (OP-group) and selected for NOM (NOM-group). Factors analyzed were: demographics, injury mechanism, initial vital signs, liver injury grade, concomitant injuries, and total injury severity scoring systems. Concomitant abdominal trauma, high Injury Severity Score (ISS), low International Classification of Diseases 9(th) revision Injury Severity Score (ICISS), and low probability of survival (Ps) were predictors for operative management. Compared to NOM-patients (66%, N=36), OP-patients (34%, N=19) suffered more frequently concomitant abdominal injuries (84.2% vs 47.2%, P=0.004) and were more severely totally injured as expressed by higher ISS (25 vs 20, P=0.01), lower ICISS (0.51 vs 0.74, P=0.003), and lower Ps (0.81 vs 0.98, P=0.005). NOM resulted in lower intensive care unit admission and mortality rates (47.2% vs 78.9%, P=0.002 and 2.7% vs 15.8%, P=0.03, respectively). NOM-success rate was 92%. NOM of blunt hepatic trauma is safe and efficient. Concomitant abdominal trauma, ISS, ICISS, and Ps are predictors for operative or nonoperative management.
  Minerva chirurgica 07/2008; 63(3):223-8. · 0.77 Impact Factor
• Article: Anaesthetic considerations in parathyrotoxic crisis.

  A Papadima, E E Lagoudianakis, H Markogiannakis, A Pappas, L Georgiou, A Manouras
  European Journal of Anaesthesiology 06/2008; 25(9):772-4. · 2.23 Impact Factor
• Article: Primary hydatidosis of the gluteus muscles: report of three cases.

  A Manouras, E E Lagoudianakis, H Markogiannakis, A Larentzakis, P Kekis, K Filis, C Bramis, V Katergiannakis
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  ABSTRACT: Hydatid disease caused by the tapeworm Echinococcus granulosus is a worldwide problem especially in sheep and cattle raising countries. Muscle involvement is most commonly encountered as recurrence of previously treated disease or concurrently with primary lesions of the liver or lung. Furthermore, the rarity of muscle hydatidosis has unique implications in diagnosis and management. We report on three cases of primary echinococcus of the gluteus muscles presented in our clinic during a 10-year period. We have administered albendazole for one cycle of 28 days in two of our patients based on the size and appearance of the cyst. All patients underwent total pericystectomy without cyst rupture. We have not found any recurrences after minimum follow up of 12 months. Muscle echinococciasis respond well to surgical intervention. Complete and intact removal of the cyst in primary muscular hydatidosis should be considered curative.
  Irish Journal of Medical Science 05/2008; 178(3):359-62. · 0.58 Impact Factor
• Article: Postchemotherapy resection of a metastatic retroperitoneal nonseminomatous germ cell tumor of the testes.

  F Archontovasilis, S Katsaragakis, E E Lagoudiannakis, D Tsekouras, M Genetzakis, H Markogiannakis, K Albanopoulos, A Manouras
  Minerva urologica e nefrologica = The Italian journal of urology and nephrology 04/2008; 60(1):69-70.
• Article: Metastatic breast carcinoma initially presenting as acute cholecystitis: a case report and review of the literature.

  A Manouras, E E Lagoudianakis, M Genetzakis, N Pararas, A Papadima, P B Kekis
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  ABSTRACT: The gallbladder is an infrequent site of metastatic malignant disease. Although malignant melanoma, renal cell and cervical carcinoma have been documented, breast carcinoma has rarely been reported to metastasize in the gallbladder. We describe such a case that manifested as acute cholecystitis and was incidentally recognized after cholecystectomy, in an otherwise disease-free 46-year-old female who had undergone mastectomy for breast cancer two years before. The patient was subjected to adjuvant chemotherapy, but unfortunately died just a year after diagnosis because of generalized peritoneal seeding of the tumor. Metastatic gallbladder involvement is rare, especially in cases of primary breast carcinoma, usually leading to symptoms of abdominal pain, mimicking acute or chronic cholecystitis. Thus, abdominal pain in a patient with a previous history of breast carcinoma should raise suspicion of gallbladder metastasis.
  European journal of gynaecological oncology 02/2008; 29(2):179-81. · 0.47 Impact Factor
• Article: Primary insular carcinoid of the ovary.

  E E Lagoudianakis, H Markogiannakis, G Karantzikos, A Papadima, L Alevizos, A Manouras
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  ABSTRACT: Primary ovarian carcinoids are very rare tumors that account for less than 5% of all carcinoids and 0.1% of all ovarian malignancies. We present a rare case of a primary, non-functioning, insular carcinoid of the left ovary in a 44-year-old woman originating from the outer surface of a mature cystic teratoma. After an uneventful unilateral salpingo-oophorectomy, the patient had no sign of recurrence with computed tomography and 5-HIAA evaluation at 3-year follow-up. Although rare, primary ovarian insular carcinoid tumors that are confined to the ovary and treated with surgery are expected to have an excellent overall outcome.
  European journal of gynaecological oncology 02/2008; 29(5):554-5. · 0.47 Impact Factor
• Article: Extensive nodular lymphoid hyperplasia of the small intestine in common variable immunodeficiency.

  D Kalliabakos, A Manouras, E Lagoudianakis, I Gartzonis, A Papathanassiou, M Genetzakis, P V Kekis, E Kalafatis
  Minerva gastroenterologica e dietologica 10/2007; 53(3):302-3.
• Source

  Available from: Konstantinos A Filis

  Article: Malignant gastrointestinal melanomas of unknown origin: should it be considered primary?

  A Manouras, M Genetzakis, E Lagoudianakis, H Markogiannakis, A Papadima, G Kafiri, K Filis, P-B Kekis, V Katergiannakis
  World Journal of Gastroenterology 09/2007; 13(29):4027-9. · 2.47 Impact Factor
• Article: True radial artery aneurysm in a mild haemophilia A patient.

  K Filis, F Arhontovassilis, D Theodorou, G Theodossiades, A Manouras
  Haemophilia 08/2007; 13(4):440-2. · 2.60 Impact Factor
• Source

  Available from: Konstantinos A Filis

  Article: Intact germinal layer of liver hydatid cysts removed after administration of albendazole.

  A Manouras, M Genetzakis, E E Lagoudianakis, A Papadima, C Triantafillou, P V Kekis, K Filis, V Katergiannakis
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  ABSTRACT: Hydatid disease is a common health problem especially in Mediterranean and sheep-farming countries, caused by infection with the metacestode stage of the tapeworm Echinococcus. The liver is the most frequent primary site of Echinococcus granulosus infection in humans. Surgery remains the main treatment modality for cystic hepatic hydatid disease, with complete resection of the germinal layer being of major importance for recurrence. Perioperative administration of albendazole has been reported to improve surgical outcome but the results are controversial. We report here our observations on the usefulness of preoperative chemotherapy in surgical outcome in terms of morbidity and recurrence. Five patients with complex liver hydatid cysts received 28 days of albendazole prior to partial cystectomy. Radiological examinations with computed tomography and ultrasound and surgical outcome were used to assess the efficacy of the regimen. Three patients underwent a complete removal of the germinal layer of the cyst and there were no cases of biliary fistula in these patients. There were no relapses in any of the patients at 12 months' follow-up. Preoperative use of medical therapy consisting of albendazole facilitates complete resection of the germinal layer by detaching it from the laminar layer, thus reducing not only the recurrence rates but also the postoperative complications, especially bilious fistulas.
  The Netherlands Journal of Medicine 04/2007; 65(3):112-6. · 2.07 Impact Factor
• Article: Parecoxib vs. lornoxicam in the treatment of postoperative pain after laparoscopic cholecystectomy: a prospective randomized placebo-controlled trial.

  A Papadima, E E Lagoudianakis, P T Antonakis, M Pattas, F Kremastinou, V Katergiannakis, A Manouras, L Georgiou
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  ABSTRACT: Non-steroidal anti-inflammatory drugs are considered as an effective treatment of postoperative pain after laparoscopic cholecystectomy. COX-2 inhibitors are newer drugs having less adverse effects. Data supporting their efficacy postoperatively in comparison to older non-steroidal anti-inflammatory drugs are scarce. Our study is a prospective, randomized, double-blinded, placebo-controlled trial comparing the efficacy of lornoxicam vs. parecoxib for the management of pain after laparoscopic cholecystectomy. We enrolled 76 patients, ASA I and II, scheduled for elective laparoscopic cholecystectomy. The patients were randomized to receive before induction parecoxib 40 mg i.v., lornoxicam 8 mg i.v. or placebo. Pain at rest and on movement was assessed using a visual analogue scale at 0, 6, 12 h postoperatively. Total meperidine consumption and adverse effects were also recorded. At 12 h, visual analogue scale scores at rest and on movement were significantly lower with parecoxib and lornoxicam compared with control ( P = 0.047). The percentage of patients needing meperidine and the average dose of meperidine administered was significantly lower with parecoxib and lornoxicam compared with control (P < 0.001 and P = 0.018). There was no difference between parecoxib and lornoxicam. One patient receiving lornoxicam vomited. Parecoxib 40 mg i.v. and lornoxicam 8 mg i.v. were equianalgesic and both were more efficacious than placebo for the management of pain after laparoscopic cholecystectomy.
  European Journal of Anaesthesiology 03/2007; 24(2):154-8. · 2.23 Impact Factor
• Article: Endovascular obliteration of a ruptured right gastric artery aneurysm.

  E E Lagoudianakis, K A Filis, D K Tsekouras, M Genetzakis, F Archontovassilis, M Pattas, A Papadima, A Manouras
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  ABSTRACT: Aneurysms of the right gastric artery are extremely rare lesions. They constitute less than 0.001% of reported visceral artery aneurysms. A unique case of a ruptured right gastric artery aneurysm is presented. Angiographic diagnosis and endovascular treatment by right gastric artery embolization proved safe and efficacious, resulting in complete obliteration of the aneurysm with no adverse sequelae.
  Minerva gastroenterologica e dietologica 10/2006; 52(3):333-7.
• Article: Abdominal compartment syndrome after self-expandable stent placement. A potentially detrimental consequence of bile duct perforation during ERCP.

  E E Lagoudianakis, K G Toutouzas, A Papadima, A Romanos, A Manouras
  Digestive and Liver Disease 08/2006; 38(7):530-1. · 3.05 Impact Factor