N Gombakis

Publications (15)25.89 Total impact

• Source

  Available from: hippokratia.gr

  Article: Use of propranolol in infantile haemangiomas: report of five cases and review of the literature.

  D Gidaris, M Economou, V Hatzidemetriou, N Gombakis, M Athanassiou-Metaxa
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  ABSTRACT: Infantile haemangiomas are common benign tumours that do not require treatment unless they cause significant functional impairment or disfigurement. We report our experience with the off-label use of propranolol in 5 children with haemangiomas and review the relevant literature.
  Hippokratia 01/2011; 15(1):81-3. · 0.52 Impact Factor
• Article: Successful treatment of a spontaneous haemothorax with recombinant factor VIIa in a haemophilic child with inhibitors.

  D Gidaris, M Economou, R Valeri, N Gombakis, M Athanasiou-Metaxa
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  ABSTRACT: Haemophilia A is an X-linked disorder caused by a deficiency of factor VIII. Haemorrhage in various sites may occur spontaneously or secondary to trauma depending on the severity of the deficiency. Common manifestations include haemarthrosis, epistaxis, gastrointestinal haemorrhage and haematuria. Spontaneous haemothorax has rarely been reported both in children and adults1,2. We report the case of a haemophiliac child presenting with spontaneous haemothorax due to the rarity of this clinical presentation in order to raise the awareness among clinicians.
  Hippokratia 10/2010; 14(4):289-90. · 0.52 Impact Factor
• Article: A patient with Lemierre syndrome.

  Efthimia G Vargiami, E Farmaki, D Tasiopoulou, D I Zafeiriou, M Badouraki, A Anastasiou, C Karkos, N Gombakis, M Athanasiou-Metaxa
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  ABSTRACT: Lemierre syndrome, also known as postanginal sepsis, is a severe complication of an acute oropharyngeal infection that results in septic thrombophlebitis of the ipsilateral internal jugular vein with subsequent septicemia, often complicated by metastatic infections (Syed et al., Laryngoscope 117:1605-1610, 2007). We present the case of a previously healthy 12-year-old boy with Lemierre syndrome, caused by streptococci (Abiotrophia defectiva), complicating a subcutaneous neck abscess. The patient had metastatic sequelae, was treated with antibiotics (clindamycin and vancomycin) and low molecular weight heparin, and had an uneventful outcome.
  European Journal of Pediatrics 04/2010; 169(4):491-3. · 1.88 Impact Factor
• Article: Scarlet Fever and hepatitis: a case report.

  D Gidaris, D Zafeiriou, P Mavridis, N Gombakis
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  ABSTRACT: Scarlet fever is a streptococcal infection with a good prognosis. Complications are well described. Hepatitis is a rare complication. We describe a 6-year old boy with scarlet fever, jaundice and elevated liver transaminases.
  Hippokratia 08/2008; 12(3):186-7. · 0.52 Impact Factor
• Article: Expression of multidrug resistance 1 (MDR1), multidrug resistance-related protein 1 (MRP1), lung resistance protein (LRP), and breast cancer resistance protein (BCRP) genes and clinical outcome in childhood acute lymphoblastic leukemia.

  M Kourti, N Vavatsi, N Gombakis, V Sidi, G Tzimagiorgis, T Papageorgiou, D Koliouskas, F Athanassiadou
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  ABSTRACT: The aim of this prospective study was to analyze the expression of messenger RNA of genes, such as MDR1, MRP1, BCRP, and LRP, implicated in the mechanism of multidrug resistance (MDR) in relation to the response to induction chemotherapy and relapse and these genes' correlation with each other and with pretreatment laboratory and clinical characteristics. We prospectively studied 49 children (26 boys and 23 girls) with acute lymphoblastic leukemia (ALL) (median age, 5.5 years; range, 15 months to 12.5 years) who were treated with the BFM95 chemotherapy protocol. We used bone marrow mononuclear cells from 7 healthy children as controls. The expression of MDR genes and the beta-actin housekeeping gene was detected by the reverse transcription-polymerase chain reaction with the appropriate primers. The mean expression of each MDR gene was significantly higher in the patients than in the control group (P < .01). We found statistically significant correlations between MRP1 and LRP expression and between MRP1 or LRP expression and MDR1 expression (P < .05). High expression for the MDR1 gene was found in 18 patients (36.7%), and their prognoses were significantly worse than those with low expression (event-free survival, 55.56% versus 86.67%; P = .03, log-rank test). Expression of each of the MDR genes was independent of the initial white blood cell count, immunophenotype, National Cancer Institute risk classification, and prednisone response. Interestingly, MDR1 expression was significantly higher at relapse than at diagnosis for 4 sample pairs. Evaluation of MDR1 expression at diagnosis of childhood ALL may contribute to the early identification of patients at risk of treatment failure.
  International Journal of Hematology 08/2007; 86(2):166-73. · 1.27 Impact Factor
• Article: Ethylmalonic encephalopathy: clinical and biochemical observations.

  D I Zafeiriou, P Augoustides-Savvopoulou, D Haas, J Smet, P Triantafyllou, E Vargiami, M Tamiolaki, N Gombakis, R van Coster, A C Sewell, C Vianey-Saban, N Gregersen
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  ABSTRACT: Ethylmalonic encephalopathy (EE) is a rare, recently defined inborn error of metabolism which affects the brain, gastrointestinal system and peripheral blood vessels and is characterized by a unique constellation of clinical and biochemical features. A 7-month-old male, who presented with psychomotor retardation, chronic diarrhea and relapsing petechiae is described with the objective of highlighting the biochemical and neuroradiological features of this disorder as well as the effect of high-dose riboflavin therapy. Urinary organic acid analysis revealed markedly increased excretion of ethylmalonic acid, isobutyrylglycine, 2-methylbutyrylglycine and isovalerylglycine. Acylcarnitine analysis in dried blood spots showed increased butyrylcarnitine. Short-chain acyl-CoA dehydrogenase (SCAD) activity in muscle was normal as were mitochondrial OXPHOS enzyme activities in cultured skin fibroblasts. In skeletal muscle the catalytic activity of complex II was decreased. Brain MRI revealed bilateral and symmetrical atrophy in the fronto-temporal areas, massive enlargement of the subarachnoid spaces and hyperdensities on T (2) sequences of the basal ganglia. Mutation analysis of the ETHE1 gene demonstrated homozygosity for the Arg163Gly mutation, confirming the diagnosis of EE at a molecular level. On repeat MRI, a significant deterioration was seen, correlating well with the clinical deterioration of the patient.
  Neuropediatrics 05/2007; 38(2):78-82. · 0.94 Impact Factor
• Article: Use of amifostine in the treatment of recurrent solid tumours in children.

  V Sidi, G Arsos, E Papakonstantinou, E Hatzipantelis, I Fragandrea, N Gombakis, E Koliouskas
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  ABSTRACT: Preclinical and clinical evaluation of amifostine (AMI) administration in conjunction with systemic chemotherapy supports its role as a cytoprotective agent of normal tissues without loss of impairing the antitumour effectiveness of chemotherapeutic agents. Since only a limited number of clinical studies has been performed using AMI in paediatric pts with malignancies we investigated the protective effect of AMI against carboplatin-induced myelotoxicity and nephrotoxicity in a paediatric group of patients. AMI was administered in 18/28 paediatric patients with reccurent solid tumours along with ICE (ifosfamide, carboplatin, etoposide) chemotherapy. A significant (p<0.05) decrease in GFR was observed in the control group whereas it was maintained at pre-treatment levels in the AMI-treated group. Leukopenia and neutropenia were significantly (p<0.05) less in AMI-group. No protective effect of AMI was shown concerning thrombocytopenia. AMI was generally well tolerated at the dose of 740 mg/m2. Side effects including nausea, vomiting, hypotension, flushing and rigors were moderate and reversible and the interruption of infusion was never required.
  Hippokratia 02/2007; 11(1):25-9. · 0.52 Impact Factor
• Article: Transfusion related acute lung injury syndrome (TRALI) in a patient with thalassaemia.

  Afroditi Koussi, Maria Trachana, Paraskevi Pliaki, N Gombakis, M Athanassiou-Metaxa
  Pediatric Blood & Cancer 07/2006; 46(7):829-30; author reply 831. · 1.89 Impact Factor
• Article: Russell's diencephalic syndrome.

  D I Zafeiriou, D Koliouskas, E Vargiami, N Gombakis
  Neurology 10/2001; 57(5):932. · 8.31 Impact Factor
• Article: L-2-Hydroxyglutaric aciduria presenting as status epilepticus.

  D I Zafeiriou, A Sewell, P Savvopoulou-Augoustidou, N Gombakis, G Katzos
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  ABSTRACT: L-2-Hydroxyglutaric aciduria (L-2-HGA) is a rare organic aciduria with a slowly progressive course regarding CNS involvement. We present a 13.5-year-old female patient who presented at the Emergency Department with a generalized status epilepticus, which promptly responded to intravenous phenytoin. CT and MRI demonstrated subcortical white matter alterations. The neurological examination revealed mild mental retardation, macrocephaly and ataxic gait with cerebellar signs. Repeated urinary organic acid analysis demonstrated increased excretion of 2-hydroxyglutaric acid which was of the L-configuration. The constellation of macrocephaly in a patient with mental retardation, cerebellar tract involvement and subcortical white matter signal alterations on MRI should alert the physician to the possibility of L-2-HGA. Although rare, epileptic seizures or even status epilepticus can be among the presenting symptoms in organic acidurias with a slow course, such as L-2-HGA.
  Brain and Development 08/2001; 23(4):255-7. · 2.12 Impact Factor
• Article: Xeroderma pigmentosum group G with severe neurological involvement and features of Cockayne syndrome in infancy.

  D I Zafeiriou, F Thorel, A Andreou, W J Kleijer, A Raams, V H Garritsen, N Gombakis, N G Jaspers, S G Clarkson
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  ABSTRACT: We describe a premature, small for gestational age infant girl with micropthalmia, bilateral congenital cataracts, hearing impairment, progressive somatic and neurodevelopmental arrest, and infantile spasms. She presented a massive photosensitive reaction with erythema and blistering after minimal sun exposure, which slowly gave place to small skin cancers. Her skin fibroblasts were 10-fold more sensitive than normal to UV exposure due to a severe deficiency in nucleotide excision repair. By complementation analysis, the patient XPCS4RO was assigned to the very rare xeroderma pigmentosum (XP) group G (XP-G). One allele of her XPG gene contained a 526C-->T transition that changed Gln-176 to a premature UAG stop codon. Only a minor fraction of XPG mRNA was encoded by this allele. The second, more significantly expressed XPG allele contained a 215C-->A transversion. This changed the highly conserved Pro-72 to a histidine, a substitution that would be expected to seriously impair the 3' endonuclease function of XPG in nucleotide excision repair. In cases suspected of having XP and/or early-onset Cockayne syndrome, extensive DNA repair studies should be performed to reach a correct diagnosis, thereby allowing reliable genetic counseling and prenatal diagnosis.
  Pediatric Research 04/2001; 49(3):407-12. · 2.70 Impact Factor
• Article: Clinical features, laboratory findings and differential diagnosis of benign acute childhood myositis.

  D I Zafeiriou, G Katzos, N Gombakis, E E Kontopoulos, C Tsantali
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  ABSTRACT: We report clinical and laboratory data from 32 children with benign acute childhood myositis (BACM), children who presented with calf tenderness and gait abnormality. Laboratory evidence of a viral infection was evident in 23 patients, while serum creatine phosphokinase was uniformly increased (558 to 6800 U/L). Twenty-five patients (78.1%) were given a diagnosis other than BACM by their general practitioner or paediatrician. All patients made a rapid recovery within one week. We conclude that BACM should be encountered among the main causes of sudden-onset gait abnormality in young children.
  Acta Paediatrica 01/2001; 89(12):1493-4. · 2.07 Impact Factor
• Article: Outbreak of varicella in a pediatric oncology unit.

  J Kavaliotis, I Loukou, M Trachana, N Gombakis, H Tsagaropoulou-Stigga, D Koliouskas
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  ABSTRACT: Varicella-zoster virus (VZV) infection is usually benign but immunocompromised patients are at great risk for visceral dissemination and fatal outcome. During a nationwide varicella outbreak, several of our patients contracted the disease. We undertook studies of the epidemiology and the efficacy of antiviral treatment and immunoprophylaxis. During a 9-month period, 52 patients were exposed to cases of active varicella. Twenty-seven of these children were reexposed to active varicella > 1 month after their initial exposure. The exposure concerned 7 VZV waves of varying intimacy. In all cases, prophylaxis with intravenous immunoglobulin (IVIG), varicella zoster globulin (VZIG), or both was given. The spread of the disease was limited and only 6 patients (all immunosuppressed) developed varicella (7.6%). Three of 6 had been given IVIG and 3 VZIG + IVIG. All patients with varicella received acyclovir 30 mg/kg/day for 14 days. The disease was mild and all patients were ultimately cured. Our results show that prophylaxis was not 100% effective, but appearance to reduce the rate of spread. The differences in incidence among the regimens used were not significant. For the moment, immunoprophylaxis and acyclovir administration appear to be quite satisfactory in managing immunocompromised children exposed to VZV. This may change with the wider use of the varicella vaccine.
  Medical and Pediatric Oncology 10/1998; 31(3):166-9.
• Article: Hereditary giant platelet disorder presented as pseudothrombocytopenia.

  E S Hatzipantelis, H Tsantali, M Athanassiou-Metaxa, K Avramidou, D Zambul, N Gombakis
  European Journal Of Haematology 67(5-6):330-1. · 2.61 Impact Factor
• Article: Central nervous system abnormalities in asymptomatic young patients with Sβ-thalassemia

  D I Zafeiriou, M Prengler, N Gombakis, K. Kouskouras, M Economou, A. Kardoulas, C Tsantali, A Dimitriadis, M Athanasiou, F J Kirkham
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  ABSTRACT: Twenty-one children and young adults with sickle/-thalassemia without overt stroke were examined with magnetic resonance imaging and angiography (MRA), transcranial Doppler (TCD), visual (VEP) and median nerve somatosensory (SEP)-evoked potential recordings, and neuropsychological testing (Wechsler Intelligence Scale [WISC-III]). Eight (38%) had silent infarction in the parietooccipital cortex, deep white matter, or basal ganglia, including two of three with previous seizures. Of 17 undergoing TCD, none had maximum middle cerebral artery (MCA) velocities greater than 126cm/sec, but 9 were abnormal, with low velocities and difficulty in tracking the MCA and/or asymmetry. Three patients had abnormal MRA, one of whom also had silent infarction. One patient had pathological VEP recordings, whereas all SEP recordings were normal. WISC-III was performed in all 11 children, 4 with silent infarction: all but 1 had IQ scores greater than 85 (mean, 97.7; standard deviation, 14.2). We conclude that Greek children and young adults with S-thalassemia and no history of clinical stroke have TCD abnormalities and silent infarction similar to those reported in children and adolescents with sickle cell anemia, but cognitive function is not necessarily compromised. International collaboration is needed to establish the risk factors for central nervous system sequelae in patients with sickle cell disease, including S-thalassemia, leading to evidence-based prevention.
  Zafeiriou, D.I. and Prengler, M. and Gombakis, N. and Kouskouras, K. and Economou, M. and Kardoulas, A. and Tsantali, C. and Dimitriadis, A. and Athanasiou, M. and Kirkham, F.J. (2004) Central nervous system abnormalities in asymptomatic young patients with Sβ-thalassemia. Annals of Neurology, 55 (6). pp. 835-839. ISSN 03645134.