C Dervenis

Publications (11)20.37 Total impact

• Article: Nutrition in severe acute pancreatitis: Does the route of administration or the content of feeding matter?

  K. Paraskeva, C. Avgerinos, C. Manes, C. Dervenis
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  ABSTRACT: Severe acute pancreatitis (AP) is a hypercatabolic disease characterized by increased energy expenditure and protein breakdown. Traditionally, nutritional support has been provided parenterally due to fears concerning stimulation of the exocrine pancreas and exacerbation of disease. Recently, studies mainly in trauma and burn patients suggested that the gut plays a key role in the development of infection and multiple organ failure and created a trend away from the parenteral route in favor of the enteral route of delivering nutrients. In severe AP, early enteral nutrition (EN) has proven to be safe and in most cases efficacious in terms of providing adequate nutrition. Even more importantly, it seems that EN helps to maintain gut integrity and reduces infectious and inflammatory morbidity. Additionally, in comparison with total parenteral nutrition (TPN), EN is significantly less expensive and eliminates potential septic complications associated with TPN. Therefore, in patients with severe AP, the enteral route is considered the preferred means of nutritional support. The optimal feeding formula has yet to be determined, but at present a semi-elemental or immune-enhancing diet perfused to the jejunum is suggested.
  07/2009; 2(3):166-170.
• Article: Groove pancreatitis: a diagnostic challenge.

  C Triantopoulou, C Dervenis, N Giannakou, J Papailiou, P Prassopoulos
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  ABSTRACT: Groove pancreatitis is a distinct form of chronic pancreatitis characterized by inflammation and fibrous tissue formation, affecting the groove area between the head of the pancreas, the duodenum and the common bile duct. It is manifested on imaging by a sheet-like mass in the groove area near the minor papilla. Thickening of the duodenal wall and cystic transformation in the duodenal wall also represent common imaging features. Pathogenesis is still unclear, and clinical presentation is not specific. Endoscopic ultrasonography (EUS), computed tomography (CT) and magnetic resonance imaging (MRI) demonstrate imaging findings consistent with the disease in typical cases, but specific diagnosis is challenging in a number of patients where biopsy is required. The disease may mimic pancreatic, common bile duct or duodenal wall cancer that requires prompt and excessive surgical intervention, as opposed to groove pancreatitis where initial conservative treatment is suggested. The clinical, histopathological and radiological features on cross-sectional imaging of this entity are discussed in this review, and differential diagnostic clues are given.
  European Radiology 03/2009; 19(7):1736-43. · 3.22 Impact Factor
• Article: One thousand laparoscopic cholecystectomies in a single surgical unit using the "critical view of safety" technique.

  C Avgerinos, D Kelgiorgi, Z Touloumis, L Baltatzi, C Dervenis
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  ABSTRACT: Bile duct injuries have been substantially increased after the introduction of laparoscopic cholecystectomy (LC). They are accompanied by major morbidity, occasional mortality, lengthening of hospital stay, additional health costs, and deterioration of patients' quality of life and life expectancy. The aim of this study was to present the method of "critical view of safety" (CVS) as safe and feasible for the prevention of bile duct injuries during laparoscopic cholecystectomy. During a 6-year period from January 2002 till December 2007, 1,046 LCs (369 men and 677 women) were performed mainly for symptomatic gallstone disease. The CVS technique recommends clearing the triangle of Calot of fat and fibrous tissue and taking the gallbladder off the lowest part of its attachment to the gallbladder bed. The "infundibular" technique (identification of cystic duct and gallbladder junction) was used whenever CVS was not possible to perform. The CVS was performed in 998 patients (95.4%). Overall, 27 patients needed conversion to the open approach (2.6%). This rate was higher in patients with acute inflammation undergoing early operation (nine of 128, 7%) compared with patients operated later or electively (18 of 914, 1.9%). There was no bile duct injury in the 1,046 cholecystectomies. Postoperatively, five patients had bile leaks which were transient and stopped spontaneously after 2-14 days. Two reoperations were performed because of severe bleeding. CVS clarifies the relations of the anatomic structures that should be divided, and therefore, it should be ideally and routinely applied in all LCs because of its highly protective role against bile duct injuries.
  Journal of Gastrointestinal Surgery 12/2008; 13(3):498-503. · 2.83 Impact Factor
• Source

  Available from: Charikleia Triantopoulou

  Article: Solid pseudopapillary tumor of the pancreas: an enigmatic tumor.

  C Triantopoulou, Z Touloumis, D Apessou, I Scotiniotis, D Rodogianni, J Papailiou, C Dervenis
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  ABSTRACT: Solid pseudopapillary tumor of the pancreas is a rare pancreatic tumor that predominantly occurs in young non-Caucasian women. Although most tumors show benign behavior, malignant degeneration may occur. A case of solid pseudopapillary pancreatic tumor in a Caucasian woman is presented that was investigated by endoscopic ultrasonography (EUS), computed tomography, magnetic resonance imaging and EUS-guided fine needle aspiration. The patient underwent surgery and radiological findings are correlated with histopathology. The preoperative diagnosis of solid pseudopapillary tumor of the pancreas is challenging, frequently leading to imaging by multiple different modalities.
  Case Reports in Gastroenterology 09/2008; 2(3):486-93.
• Article: Sclerosing cholangitis in the era of target chemotherapy: a possible anti-VEGF effect.

  S Delis, C Triantopoulou, A Bakoyiannis, N Tassopoulos, K Athanasiou, C Dervenis
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  ABSTRACT: Preoperative systemic chemotherapy is generally applied in patients who undergo hepatic resection for colorectal metastases. Although the tumour response rate has been improved recently with the development of new molecular targeted therapies the related hepatic injury is ill defined. Bevacizumab is a monoclonal antibody to vascular endothelial growth factor. It can achieve high response rates and is accepted as a first line treatment in the metastatic colorectal disease. However, the data about its hepatotoxicity profile is still limited. We describe a case of secondary sclerosing cholangitis in a patient with liver metastases treated by Bevacizumab in the neoadjuvant setting and liver resection. It is possible that Bevacizumab may have induced a hypercoagulative condition that was further precipitated by surgery.
  Digestive and Liver Disease 03/2008; 41(1):72-7. · 3.05 Impact Factor
• Article: Can exchange transfusions treat postoperative intrahepatic colestasis in patients with sickle cell anemia?

  S G Delis, Z Touloumis, A Bourli, J Madariaga, C Dervenis
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  ABSTRACT: Although the most common cause of liver failure (LF) in hematologic patients is viral hepatitis, several episodes of sickle cell intrahepatic cholestasis (IHC) have been reported as rare but potentially causative of fulminant LF. Reviewing the literature, we have presented a single case of intrahepatic cholestasis after major liver resection, which was effectively treated by exchange transfusion. Serial hemoglobin S, D levels and liver enzymes were monitored postoperatively. Although the patient's intra- and postoperative courses were uneventful, an increased serum bilirubin was identified to be due to intrahepatic sinusoid congestion and subsequent cholestasis. Exchange transfusion was required to maintain HbS below 20% and reverse bilirubin levels to normal values. Sickle cell anemia is a rare cause of cholestasis after major hepatic surgery. To our knowledge, this case is the only documented incidence of IHC following major hepatectomy that was effectively treated with exchange transfusion.
  Transplantation Proceedings 07/2006; 38(5):1385-6. · 1.00 Impact Factor
• Article: Alterations of platelet function, number and indexes during acute pancreatitis.

  K Mimidis, V Papadopoulos, J Kotsianidis, D Filippou, E Spanoudakis, G Bourikas, C Dervenis, G Kartalis
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  ABSTRACT: Acute pancreatitis constitutes a systemic inflammatory process which is often accompanied by thrombosis and bleeding disorders. The role of platelets in the pathophysiology of the disease has not been elucidated yet. The present study focuses on two successive end-points: (1) the activation of platelets during acute pancreatitis and (2) the alterations of platelet number and indexes between onset and remission of the disease, which reflect the bone marrow response. A cohort of 54 patients with acute pancreatitis was enrolled. Cause and severity of the disease (APACHE II score) were estimated. Activated platelet ratio (APR) was estimated using flow cytometry at onset and remission. Platelet number (PLT), mean platelet volume (MPV), platelet large cell ratio (P-LCR) and platelet distribution width (PDW) were collected at onset and remission. The first end-point was reached in patient 14 as APR was found elevated at onset of acute pancreatitis (p = 0.01). The second end-point was fulfilled in patient 12 for MPV, P-LCR and PDW, which were found elevated at remission of the disease (p < 0.01) but not for PLT until the last patient (p = 0.34). Platelets are directly involved in the systemic inflammatory process of acute pancreatitis, which leads to consumption, compensated by an immediate bone marrow response.
  Pancreatology 01/2004; 4(1):22-7. · 1.99 Impact Factor
• Article: Localized unilateral perirenal fibrosis: CT and MRI appearances.

  C Triantopoulou, S Rizos, A Bourli, E Koulentianos, C Dervenis
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  ABSTRACT: We report a rare case of localized perirenal retroperitoneal fibrosis (RPF) in a woman presenting with anemia. The increased diagnostic capabilities and imaging characteristics of CT and MRI are emphasized. Extensive search through the literature revealed that perirenal distribution of RPF has been reported in eight cases, being unilateral in only three.
  European Radiology 12/2002; 12(11):2743-6. · 3.22 Impact Factor
• Article: Mixed (composite) glandular-endocrine cell carcinoma of the gallbladder.

  N Yannakou, S Rizos, P Parissi-Mathiou, D Smailis, S Charanioti, C Dervenis
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  ABSTRACT: A mixed pattern of glandular and neuroendocrine elements is rare in tumours at any site within the gastrointestinal tract but particularly so in the gallbladder. A 72-year-old woman presented with abdominal pain and jaundice and was found to have a large mass in the fundus of the gallbladder.The mass was radically excised to include a wedge of liver and the hepatoduodenal lymph nodes. Histopathological examination of the resected gallbladder showed an invasive tumour composed of both adenocarcinoma and endocrine cell carcinoma, with apparent transitions between them. The patient received no further treatment and died two months later. There are 14 previous case reports of mixed adeno/endocrine carcinoma of the gallbladder. Histochemical similarities between the two neoplastic components of the present tumour would support their origin from a common precursor cell, but the alternative hypothesis of coincidental neoplastic change in two different cell types cannot be excluded.
  HPB 02/2001; 3(1):7-9. · 1.60 Impact Factor
• Article: Adult ileocolic intussusception secondary to a submucosal cecal lipoma.

  C Triantopoulou, A Vassilaki, D Filippou, S Velonakis, C Dervenis, E Koulentianos
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  ABSTRACT: Intussusception is a relatively common cause of intestinal obstruction in children but a rare clinical entity in adults, representing fewer than 1% of intestinal obstructions in this patient population. We present a rare case of a 44-year-old female patient with intestinal obstruction due to ileocolic and colocolonic intussusception secondary to an intramural cecal lipoma. Diagnosis was made by barium enema and abdominal computed tomography and was confirmed by colonoscopy. After failure of conservative treatment, the patient underwent surgery.
  Abdominal Imaging 29(4):426-8. · 1.73 Impact Factor
• Article: Virtual CT cholangiography in patients with choledocholithiasis.

  P Maniatis, C Triantopoulou, E Sofianou, I Siafas, E Psatha, C Dervenis, E Koulentianos
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  ABSTRACT: We evaluated the feasibility and accuracy of virtual computed tomographic cholangiography (VCTC) in detecting choledocholithiasis and imaging anatomic variations of the biliary tree. Thirty-three consecutive patients with clinical and biological signs of choledocholithiasis underwent spiral CT after intravenous infusion of iotroxindimeglumine. Patients with total serum bilirubin levels above 3 mg/dL were not included in this study. Spiral data sets were used to construct intralumenal images of the biliary tree. The images were reviewed by two abdominal radiologists. The biliary ducts were divided into three segments, so the analysis was based on 99 segments. The diagnosis obtained by VCTC was compared with the final diagnosis established by endoscopic retrograde cholangiography or intraoperative cholangiography. VCTC correctly depicted biliary stones in nine of 10 patients and anatomic variations in all five patients, and no false-positive cases were observed. VCTC showed excellent endolumenal visualization of 87 of 99 segments of the biliary tree. The processing time (9.3 +/- 2.1 min) was particularly short. VCTC with intravenous infusion of iotroxindimeglumine may be a feasible clinical tool, with acceptable accuracy in selected cases.
  Abdominal Imaging 28(4):536-44. · 1.73 Impact Factor