E Paraskevas

Saint Savvas Hospital, Athínai, Attica, Greece

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Publications (33)89.93 Total impact


  • No preview · Article · Oct 2011 · European Journal of Internal Medicine
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    ABSTRACT: Postoperative anastomotic strictures frequently complicate colorectal resection. Currently, various endoscopic techniques are being employed in their management, but the establishment of an optimal therapeutic strategy is still pending. The purpose of our study is to compare through-the-scope (TTS) balloon dilators versus Eder-Puestow metal olive dilators in the treatment of postoperative benign rectal strictures, considering the clinical outcome and cost-effectiveness of each method. A total of 39 patients with benign anastomotic rectal stenosis were retrospectively studied. In group A, 15 patients underwent dilation with Eder-Puestow metal olives, while in group B 19 patients were treated by means of TTS balloon dilators. The technical and clinical success of dilation, complications, number of repeated sessions required, disease-free time intervals, and the overall cost of each procedure were evaluated. Dilations were technically successful in all patients. No major complications occurred in either group. The number of dilations needed, rate of stricture recurrence, and duration of stenosis-free time intervals were not statistically significantly different between the two groups. Both methods proved more effective in older patients, given the greater number of dilations required in younger patients of both groups and higher frequency of stricture relapse in younger balloon-dilated patients (median 64.00 years) compared with older ones (median 75.00 years) (p = 0.001). An indisputable advantage of the Eder-Puestow technique, compared with TTS balloon dilators, is the low cost of equipment (median 22.30 compared with 680 , respectively; p < 0.001). Endoscopic dilation of postoperative benign rectal strictures is equally effective and safe, especially in older patients, when performed by Eder-Puestow bougies or TTS balloon dilators. However, metal olivary tips seem to surpass balloon dilators when considering the obvious economical benefits of the first method.
    Full-text · Article · Oct 2010 · Surgical Endoscopy
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    ABSTRACT: Chronic hepatitis C virus infection (HCV) is the most common infectious disease among intravenous drug users. To determine and compare compliance rates between two groups of chronic HCV patients from the methadone substitution program of the National Greek Organization Against Drugs treated with either pegylated interferon alpha-2b/ribavirin or with interferon alpha-2b/ribavirin during 48 weeks of therapy and 24 weeks of follow-up. Furthermore, to evaluate the efficacy of each treatment modality. Forty-five consecutive methadone maintenance (MM) patients (group A, 36 males, nine females) were treated with pegylated interferon alpha-2b (weight-based dosing 1.5 microg/kg/week) and ribavirin 1000-1200 mg/day orally. Sixty-five consecutive MM patients (group B, 52 males, 13 females) were treated with interferon alpha-2b (6 MIU, three times/week) and ribavirin with the doses reported above. During the study, all patients were followed up periodically by hepatologists, internists, and psychiatrists. Baseline characteristics were similar between the two groups. Thirty-four out of 45 patients (75.6%) from group A and 31 of 65 patients (47.7%) from group B completed therapy (P =0.006). Thirty-two (71.1%) patients from group A and 27 patients (41.5%) from group B were followed-up until the end of week 72 (P = 0.004). At the end of the follow-up, sustained virologic response was achieved in 23 of 45 (51.1%) patients from group A and 21 of 65 patients (32.3%) from group B (P =0.075). Pegylated interferon alpha-2b/ribavirin treatment achieved a significantly higher compliance rate than interferon alpha-2b/ribavirin in MM patients with chronic HCV infection. After 24 weeks of follow-up, response rates were similar for patients who were compliant to treatment for both groups.
    No preview · Article · Dec 2009 · European journal of gastroenterology & hepatology
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    ABSTRACT: Background/Aim: To evaluate the efficacy of gemcitabine as palliation in patients with advanced pancreatic cancer (PC) previously treated with the placement of a covered metal biliary stent, taking into account survival and quality of life (QoL). Methods: Forty-nine patients with unresectable PC, and obstructive jaundice previously treated with the placement of a covered metal endoprosthesis, were randomized to receive gemcitabine (Group A: 9M,7F) or to followed without any anticancer intervention (Group B: 18M,15F). Gemcitabine was administered weekly as an intravenous 30 min infusion of 1000 mg/m2 for 3 consecutive weeks followed by a 1-week rest in each cycle (28 days). QoL was evaluated with the QLQ-C30 questionnaire. Results: 229 gemcitabine doses were administered [median 14.3 doses per patient (range 7-22)]. No statistically significant differences were observed regarding the survival (Group A: median 21 weeks, range 13-33, Group B: median 22 weeks, range 13-29, p=0.809). According to the average QLQ-C30 score for each patient, Group B presented statistically significant higher values (p=0.0001). Leucocytopenia, neutropenia, thrombocytopenia and anemia were the most common side effects in group A (81.25%, 68.75%, 56.25%, 31.25% respectively). Conclusion: Gemcitabine didn't show to improve survival and QoL in patients with advanced PC previously treated with a covered metallic endoprosthesis due to obstructive jaundice.
    Preview · Article · Nov 2009
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    ABSTRACT: The synchronous occurrence of GIST and other primary gastrointestinal malignancies has been rarely reported. We report the case of an 84 year-old female who presented with a rectal blood loss. Total coloscopy revealed a stenotic lesion at sigmoid colon covered by endoscopically healthy mucosa and also a massive polypoid cecal mass. The patient underwent left subtotal colectomy and ileorectal J-pouch anastomoses without diverting stoma. Histologically the sigmoid tumor met the GIST criteria and the cecal mass was a well differentiated adenocarcinoma. To our knowledge this synchronous occurrence is reported for first time in the literature.
    Preview · Article · Oct 2009

  • No preview · Article · Apr 2009 · Journal of Hepatology
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    ABSTRACT: Data concerning the efficacy of PEG-IFN alpha 2a plus ribavirin treatment in treatment-naive, genotype 4-infected chronic hepatitis C (CHC) patients from Europe are limited. Hence the aim of this study was to investigate the viral kinetics as well as the sustained virological response (SVR) rates and their predictors, in these patients. One hundred and twenty-three patients were retrospectively analysed. Early (EVR) and late virological response (LVR) was confirmed by undetectable (<50 IU/mL) serum HCV-RNA at week 12 and week 24 of treatment, respectively. SVR was confirmed by undetectable serum HCV-RNA at the end of treatment as well as 6 months later. Overall, 43.5% of patients exhibited SVR, 42.6% were nonresponders and 13.9% were relapsers. EVR was observed in 40.74% and LVR in 59.25% of them. The positive predictive values of EVR and LVR were 72.97% and 86.27% whereas their negative predictive values were 64.29% and 92.85%, respectively. EVR independently predicted SVR in Caucasian patients (P < 0.001) but not in Egyptian patients (P = 0.613), in whom the only independent predictor of SVR was the absence of cirrhosis (P = 0.004). LVR seems to be a better predictor of SVR than EVR in the vast majority of genotype 4-infected CHC patients, irrespective of ethnicity and all the other baseline parameters.
    No preview · Article · Apr 2009 · Journal of Viral Hepatitis
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    ABSTRACT: Dysphagia and respiratory complications are the major problems in patients suffering from malignant strictures of the cervical esophagus. In inoperable cases, interventional palliation is the cornerstone of treatment. The aim of this study was to evaluate the use of self-expanding plastic stents (SEPS) in this group of patients. In a retrospective study, 23 patients suffering from various malignant obstructive diseases of the cervical esophagus, including squamous cell carcinoma (n = 10), laryngeal cancer (n = 7), lung cancer with esophageal invasion (n = 5), and metastatic breast cancer (n = 1), underwent SEPS placement, under endoscopic and fluoroscopic guidance. Tracheoesophageal fistula was documented in five patients. Technical success rate, improvement of dysphagia grade, and stent-related complications were evaluated after stent placement. Stent insertion was successfully achieved in all cases, namely in 20 patients at the first stent placement attempt and in three patients after a second attempt. Dysphagia grade was notably improved after 24 h. In two cases, major complications occurred. These were successfully treated without the need of stent extraction. Barium swallowing studies demonstrated complete sealing of all fistulas. Foreign-body sensation that gradually disappeared within the first week after stent placement was observed in eight patients. Recurrence of dysphagia occurred in three patients, due to hyperplastic tissue proliferation (n = 2) and tumor overgrowth (n = 1). Late migration of the stent was detected in one case after 67 days. SEPS placement is an effective and safe palliative treatment for malignant strictures of the cervical esophagus. Main advantages include easy retrievability and reduced rates of reinterventions.
    No preview · Article · Feb 2009 · Diseases of the Esophagus
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    ABSTRACT: To evaluate the efficacy of gemcitabine as palliative treatment in patients with advanced pancreatic cancer (PC) previously treated with placement of a covered metal biliary stent, taking into account survival and quality of life (QoL). Forty-nine patients with unresectable PC and obstructive jaundice, previously treated with the placement of a covered metal biliary endoprosthesis, were randomized to receive gemcitabine (group A: 9 males, 7 females) or to be followed without any anticancer intervention (group B: 18 males, 15 females). Gemcitabine was administered weekly as intravenous (i.v.) 30 min infusion of 1000 mg/m2 for 3 consecutive weeks followed by 1-week rest (28-day cycle). QoL was evaluated with the QLQ-C30 questionnaire. 229 gemcitabine doses were administered (median doses per patient 14.3, range 7-22). No statistically significant differences were observed regarding survival (group A: median 21 weeks, range 13-33; group B: median 22 weeks, range 13-29; p=0.809). According to the average QLQ-C30 score, group B patients showed statistically significant higher values (p=0.0001). Leukopenia, neutropenia, thrombocytopenia and anemia were the most common side effects in group A (81.25, 68.75, 62.50 and 31.25%, respectively). Gemcitabine didn't show to improve survival and QoL in patients with advanced PC previously treated with a covered metallic biliary endoprosthesis due to obstructive jaundice.
    No preview · Article · Jul 2008 · Journal of B.U.ON.: official journal of the Balkan Union of Oncology
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    ABSTRACT: The carcinoid tumor, argentaffinoma, is a member of a very exclusive neoplastic family, known also in the past as neuroendocrine or amine precursor uptake and decarboxylation tumors. Carcinoids have been found to arise from almost every organ and system derived from the primitive endoderm, but most frequently originated from the gastrointestinal tract, accounting for approximately half of all gastrointestinal endocrine tumors. Between 75,5 and 90% of all gastrointestinal carcinoids are located in only three sites: the appendix, rectum and small intestine. Irrespectively to their location, carcinoids are capable of producing various peptides. These tumors may present at different disease stages with either hormonal or hormonal-related symptoms/syndromes, or without hormonal symptoms and may occur either sporadically or as a part of hereditary syndromes. Their clinical course is often indolent but can also be aggressive and resistant to treatment. This review provides a broad outline of progress that has been made in the elucidation of their clinical and laboratory diagnosis including recent advances in genetics, molecular biology, histopathology, biochemical markers, radiologic and scintigraphic imaging and endoscopy of gastrointestinal carcinoid tumors.
    No preview · Article · Jan 2008 · Annals of Gastroenterology
  • D. Dimitroulopoulos · E. Paraskevas
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    ABSTRACT: Hepatocellular carcinoma (HCC) is the one of the leading causes of worldwide cancer mortality and is linked aetiologically to hepatitis B and C viruses, chemical carcinogens (aflatoxin) and other environmental and host factors causing chronic liver injury. The diagnosis of hepatocellular carcinoma can be difficult and often requires the use of serum markers, one or more imaging techniques and histological confirmation. Liver transplantation is considered to be the optimal treatment for HCC because it ensures removal of all tumor(s) sited in the organ and corrects the underlying liver disease which precipitates the formation of this tumour. Hepatic resection and percutaneous tumour ablation methods are considered also as curative or palliative therapeutic options.
    No preview · Article · Jan 2008 · CME Journal Gastroenterology, Hepatology and Nutrition
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    ABSTRACT: To evaluate the effect of shortened duration of pegylated interferon (PEG-IFN) and ribavirin (RIB) treatment on sustained virological response (SVR) rates in treatment-naomicronve patients with chronic hepatitis due to genotype 2 or 3 hepatitis C virus (HCV) infection and high pre-treatment viral load (>800,000 IU/mL). Records of 142 patients with chronic hepatitis C (22 with cirrhosis) who had been treated with PEG-IFN and RIB for 24 weeks (Group A, n=88), both drugs for 12-16 weeks (Group B, n=39), or with PEG-IFN for 12-16 weeks and RIB for 24 weeks (Group C, n=15), were analyzed retrospectively. Overall, 81.7% of patients had SVR (Group A: 88.6%, Group B: 69.2% and Group C: 73.3%, p=0.02). Failure to achieve SVR was significantly related to treatment group (p=0.026 for Group B and p=0.002 for Group C, versus Group A), older age (p=0.023), higher liver biopsy stage (p=0.001) and presence of cirrhosis (p< 0.0001). In patients without cirrhosis, only the treatment group (p=0.018 for Group B and p=0.002 for Group C, compared to Group A) independently predicted failure to achieve SVR. Shorter duration of PEG-IFN treatment (12-16 weeks) adversely affected the SVR rate in patients with genotype 2 or 3 HCV infection. However, increasing the duration of RIB administration (12-16 weeks versus 24 weeks) in such patients did not have any beneficial effect on SVR in patients receiving short-duration PEG-IFN.
    No preview · Article · Sep 2007 · Indian Journal of Gastroenterology
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    ABSTRACT: To estimate if and to what extent long acting octreotide (LAR) improves survival and quality of life in patients with advanced hepatocellular carcinoma (HCC). A total of 127 cirrhotics, stages A-B, due to chronic viral infections and with advanced HCC, were enrolled in the study. Scintigraphy with 111Indium labeled octreotide was performed in all cases. The patients with increased accumulation of radionuclear compound were randomized to receive either oral placebo only or octreotide/octreotide LAR only as follows: octreotide 0.5 mg s.c. every 8 h for 6 wk, at the end of wk 4-8 octreotide LAR 20 mg i.m. and at the end of wk 12 and every 4 wk octreotide LAR 30 mg i.m.. Follow-up was worked out monthly as well as the estimation of quality of life (QLQ-C30 questionnaire). Patients with negative somatostatin receptors (SSTR) detection were followed up in the same manner. Scintigraphy demonstrated SSTR in 61 patients. Thirty were randomized to receive only placebo and 31 only octreotide. A significantly higher survival time was observed for the octreotide group (49+/-6 wk) as compared to the control group (28+/-1 wk) and to the SSTR negative group (28+/-2 wk), LR=20.39, df=2, P<0.01. The octreotide group presented 68.5% lower hazard ratio [95% CI (47.4%-81.2%)]. During the first year, a 22%, 39% and 43% decrease in the QLQ-C30 score was observed in each group, respectively. The proposed therapeutic approach has shown to improve the survival and quality of life in SSTR positive patients with advanced HCC.
    Preview · Article · Jun 2007 · World Journal of Gastroenterology
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    ABSTRACT: The aim of this retrospective study was to evaluate the efficacy and safety of endoscopic therapy with self-expanding metallic endoprostheses in the management of inoperable primary malignant esophageal obstruction or stenosis and the cost-effectiveness of the method. Between 5/1997-12/2002, obstruction of the esophagus was diagnosed in 78 patients (52 males, 26 females, age range 53-102, mean 72.3 years). The etiology was squamous cell carcinoma (n=42) and adenocarcinoma of the oesophagus (n=36). In total, 89 ultraflex metal stents were introduced endoscopically. In 46 patients dilation with Savary dilators prior to stent placement was required. A cost-effective analysis was performed, comparing oesophageal stenting with laser therapy. Stents were placed successfully in all patients. After 48 h, all patients were able to tolerate solid or semi-solid food. During the follow-up period 8 patients developed dysphagia due to food impaction (treated successfully endoscopically). Eleven patients developed recurrent dysphagia 4-16 weeks after stenting due to tumor overgrowth and were treated with placement of a second stent. The median survival time was 18 weeks. There was no survival difference between squamous cell and adenocarcinoma of the esophagus. A similar cost was calculated for both procedures. A significant improvement in quality of life was noted in patients undergoing stenting (96% and 75% vs. 71% and 57% for the first two months). Placement of self-expanding metal stents is a safe and cost-effective treatment modality that improves the quality of life, compared with laser therapy, for patients with inoperable malignant esophageal obstruction.
    No preview · Article · Oct 2005 · Journal of B.U.ON.: official journal of the Balkan Union of Oncology
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    ABSTRACT: The aim was to demonstrate adherence to treatment has been suggested to enhance rates of sustained response in patients with hepatitis C. In this study, we evaluated the effect of drug dosage reduction or the duration of the expected therapy in patients treated with interferon (IFN)-alpha2b plus ribavirin. Virologic response rates were re-analysed according to compliance to therapy in (i) 301 naive and (ii) 142 nonresponders to previous IFN therapy treated with either IFN 5 MU TIW for 8 weeks followed by IFN 3 MU TIW for 40 weeks plus ribavirin or IFN 3 MU QD for 16 weeks followed by IFN 3 MU TIW for 24 weeks plus ribavirin. Patients were separated into those who adhered to > or =80% of their intended treatment schedule (dose of both drugs and duration) and those who did not. Compliance to treatment resulted in significantly higher response rates in both groups of patients: 43.93% compared with 6.90% of noncompliant naive patients and 30.77% compared with 10.53% of nonresponder patients. Compliance to treatment was found to have a similar effect when the results were analysed according to HCV genotype. Our findings suggest that compliance to treatment for > or =80% of the intended treatment schedule results in significantly higher sustained response rates in both naive and nonresponder patients. Consequently, every effort should be made to improve patient adherence to therapy.
    Full-text · Article · Feb 2005 · Journal of Viral Hepatitis
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    ABSTRACT: To evaluate the diagnostic sensitivity and accuracy and the cost-effectiveness of this technique in the detection of gastroenteropancreatic carcinoid tumors and their metastases in comparison with conventional imaging methods. Somatostatin receptor scintigraphy (SRS) was performed in 24 patients with confirmed carcinoids and 7 under investigation. The results were compared with those of conventional imaging methods (chest X-ray, upper abdominal ultrasound, chest CT, upper and lower abdominal CT). Also a cost-effectiveness analysis was performed comparing the cost in Euro of several combinations of SRS with conventional imaging modalities. SRS visualized primary or metastatic sites in 71.0% of cases and 61.3% of conventional imagings. The diagnostic sensitivity of the method was higher in patients with suspected lesions (85.7% vs 57.1%). SRS was less sensitive in the detection of metastatic sites (78.9% vs 84.2%). The undetectable lesions by SRS metastatic sites were all in the liver. Between several imaging combinations, the combinations of chest X-ray/upper abdominal CT/SRS and chest CT/upper abdominal CT/SRS showed the highest sensitivity (88.75%) in terms of the number of detected lesions. The combinations of chest X-ray/upper abdominal US/SRS and chest CT/upper abdominal ultrasound /SRS yielded also a quite similar sensitivity (82%). Compared to the cost of the four sensitive combinations the combination of chest X-ray/upper abdominal ultrasound/SRS presented the lower cost, 1183.99 Euro vs 1251.75 Euro for chest CT/upper abdominal ultrasound/SRS, 1294.93 Euro for chest X/ray/upper abdominal CT/SRS and 1362.75 Euro for chest CT/upper abdominal CT/SRS. SRS imaging is a very sensitive method for the detection of gastroenteropancreatic carcinoids but is less sensitive than ultrasound and CT in the detection of liver metastases. Between several imaging combinations, the combination of chest X-ray/upper abdominal CT/SRS shows the highest sensitivity with a cost of 1294.93 Euro.
    Preview · Article · Jan 2005 · World Journal of Gastroenterology
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    E Paraskevas · D Dimitroulopoulos
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    ABSTRACT: Epstein-Barr is a member of the herpesvirus family that infects more than 90% of the world‘s population. Although primary infection typically occurs within the first few years of life or in adolescence and is generally asymptomatic or results in infectious mononucleosis respectively, in some cases the virus is implicated with the development of a large spectrum of gastrointestinal malignant and benign diseases. Thus, Epstein-Barr virus is strongly involved in the patho-genesis of non-Hodgkin’s lymphomas and is associated also with some cases of Hodgkin’s disease, Burkitt’s lympho-ma, gastric and esophageal cancer and rarely with some benign gastrointestinal diseases.
    Preview · Article · Jan 2005 · Annals of Gastroenterology
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    ABSTRACT: Immune thrombocytopenic purpura is an acquired disorder characterized by severe thrombocytopenia and caused by one or more antiplatelet autoantibodies. We present a case of a 20-year-old woman referred to our Unit for chronic hepatitis C virus (HCV) infection. At week 28 of treatment with interferon (alfacon-1), undetectable HCV RNA and transaminase levels within normal limits, the patient presented with immune thrombocytopenic purpura, which was successfully treated with immunoglobulin and methylprednisolone. Despite the high doses and long life of corticosteroid treatment HCV RNA remained undetectable.
    No preview · Article · Oct 2004 · Journal of Viral Hepatitis

  • No preview · Article · Apr 2004 · Journal of Hepatology
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    ABSTRACT: The aim of the present study was to compare the efficacy, safety, and cost of endoscopic palliative treatment with selfexpanding metallic stents with that of stoma creation in the management of inoperable malignant colonic obstructions. A total of 30 patients with inoperable malignant partial obstruction (due to metastases, hemodynamic instability, or pulmonary instability) in the left colon arising from colorectal or ovarian cancer were included in the study. Fifteen were randomized to undergo palliative metallic colonic stent placement and 15 to undergo stoma creation. The efficacy and safety of the two methods was compared. A cost-effectiveness analysis was also performed, including the cost of postinterventional care. Stents were placed successfully in 14 of 15 patients. In one patient with obstruction of a tortuous rectosigmoid flexure colon, stenting was not possible; this patient was excluded from the study. During the follow-up period, a moderate, nonocclusive ingrowth of tumor into the stent lumen was observed in six patients; they were all treated with internal laser ablation. The cost-effectiveness analysis showed that although the stoma creation procedure was less expensive, the total difference in average costs for the two methods was 6.9% (132 Euros). Self-expanding metallic stent placement is a palliative alternative to colostomy for patients with inoperable malignant colonic strictures. This treatment option provides a better quality of life for the patient, without the psychological repercussions of a colostomy, and it appears to be cost-effective.
    No preview · Article · Apr 2004 · Surgical Endoscopy