Tzaneion General Hospital

Intracorporeal anastomosis (IA) has gained increasing acceptance in minimally invasive colorectal surgery, primarily owing to its demonstrated association with improved perioperative outcomes compared with extracorporeal techniques. Nevertheless, the specific role of intracorporeal handsewn anastomosis remains insufficiently explored within the context of laparoscopic colorectal procedures. The present study describes a standardized technique for performing a side-to-side isoperistaltic handsewn intracorporeal ileocolic anastomosis following laparoscopic right colectomy and evaluates its safety and feasibility through a review of the relevant literature and institutional experience. The procedure is executed employing a medial-to-lateral dissection approach, and a single-layer isoperistaltic handsewn anastomosis is constructed entirely intracorporeally. Over a three-year period, 68 laparoscopic right colectomies were completed using this technique, predominantly for malignant disease, all performed by a single surgeon. Notably, no anastomotic leaks or anastomosis-related complications, including bleeding, stenosis, or hematoma formation, were observed. Available evidence supports the advantages of intracorporeal anastomosis, including reduced surgical trauma, lower incidence of wound-related complications, faster recovery of bowel function, and comparable oncological outcomes. Furthermore, emerging data from robotic-assisted colorectal surgery suggest potential benefits of handsewn techniques with respect to hemostasis and anastomotic quality. In conclusion, intracorporeal handsewn ileocolic anastomosis following laparoscopic right colectomy appears to represent a safe and reproducible technique when performed by experienced surgeons, thereby warranting further prospective, comparative and multicenter studies to delineate its broader applicability and long-term outcomes.

Postoperative endophthalmitis is a rare but vision-threatening complication of cataract surgery. Multidrug-resistant organisms present additional therapeutic challenges. We report a 52-year-old man who underwent uncomplicated phacoemulsification for posterior subcapsular cataract. On the first postoperative day, visual acuity was 8/10, but inflammation gradually appeared without the classic signs of endophthalmitis. On the fifth postoperative day, the patient's vision deteriorated significantly, reaching 1/10, accompanied by a strong inflammatory reaction in the anterior chamber. A pars plana vitrectomy was performed and vancomycin and ceftazidime were administered intravitreally. Staphylococcus hominis, resistant to most common antibiotics but sensitive to gentamicin, was isolated from the vitreous culture. The medication was modified accordingly, with topical gentamicin and oral doxycycline, under daily close monitoring. One month later, cystoid macular edema appeared, which was successfully treated with acetazolamide, topical corticosteroids, and bromfenac. Three months after surgery, the patient's vision had returned to 9/10 without any permanent damage. Early surgical intervention, culture-guided therapy, and intensive follow-up can preserve vision even in postoperative endophthalmitis due to multidrug-resistant organisms.

Sepsis is heterogeneous, and the optimal strategy for tailoring immunotherapy is uncertain. To investigate whether precision immunotherapy guided by the presence of macrophage activation-like syndrome or sepsis-induced immunoparalysis improves organ dysfunction by day 9. A randomized, double-blind, double-dummy, placebo-controlled clinical trial conducted in 6 countries. Patients with sepsis, defined by Sepsis-3, were included if they had community-acquired or hospital-acquired pneumonia or ventilator-associated pneumonia or bacteremia and sepsis and had displayed either macrophage activation-like syndrome (blood ferritin >4420 ng/mL) or sepsis-induced immunoparalysis (blood ferritin ≤4420 ng/mL and <5000 human leukocyte antigen DR receptors on CD45/CD14 monocytes). The first patient was enrolled August 5, 2021, and the last follow-up, April 29, 2024. Eligible patients were randomized to receive standard care and precision immunotherapy or standard care and placebo. Those in the precision immunotherapy group with macrophage activation-like syndrome received anakinra intravenously (IV) and placebo subcutaneously, and those with sepsis-induced immunoparalysis received subcutaneous recombinant human interferon gamma and IV placebo. Those in the placebo group received both IV and subcutaneous placebo. Treatment was administered for up to 15 days. The primary end point was a decrease of at least 1.4 points in the mean Sequential Organ Failure Assessment (SOFA) score from baseline by day 9. The SOFA score evaluates 6 organ systems, ranging from 0, no dysfunction, to 4, failure, and the total score ranges from 0, normal, to 24, most severe form of multiorgan failure. Key secondary outcomes included 28-day mortality. Of 672 patients assessed for eligibility, 281 were randomized and 276 were included in the primary analysis population (mean [SD] age, 70 [13] years; 93 females [33.7%]; median baseline SOFA score, 9 [IQR, 7-11]). The SOFA decrease end point was attained by 46 of 131 patients (35.1%) in the precision immunotherapy group and by 26 of 145 patients (17.9%) in the placebo group (difference, 17.2% [95% CI, 6.8% to 27.2%]; P = .002). Mortality at 28 days was not statistically significantly different between groups. A total of 1069 serious treatment-emergent adverse events (88.8%) were reported; increased incidence of anemia was noted in the anakinra group; and hemorrhage in the recombinant human interferon gamma group. Among patients with sepsis, precision immunotherapy targeting macrophage activation-like syndrome and sepsis-induced immunoparalysis improved organ dysfunction by day 9 compared with placebo. ClinicalTrials.gov Identifier: NCT04990232.

Endurance exercise is widely recognized for its cardiovascular benefits, including improved longevity and metabolic health. However, excessive endurance training may lead to adverse cardiac adaptations, such as myocardial fibrosis, detected via late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR). This review examines the dual role of myocardial fibrosis in athletes—as a potential risk marker for life-threatening arrhythmias or a benign byproduct of physiological remodeling. While moderate exercise promotes beneficial cardiac hypertrophy, ultra-endurance athletes exhibit a 10–20% increase in ventricular size and mass, alongside elevated cardiac biomarkers post-exercise. Myocardial fibrosis, particularly in the left ventricle (LV), is associated with arrhythmias and sudden cardiac death, especially when presenting as a subepicardial/midmyocardial patchy pattern. Studies report that 22% of athletes with this pattern experienced malignant arrhythmias, underscoring its clinical significance. Conversely, fibrosis may also reflect adaptive remodeling in some cases, complicating its interpretation. The mechanisms underlying fibrosis in athletes remain unclear but may involve repeated cardiac stress, inflammation, or distinct atherosclerotic plaque dynamics. CMR is critical for detecting fibrosis, though differentiating pathological from physiological patterns requires careful clinical correlation. Risk stratification must consider LGE patterns, arrhythmia history, and symptoms. Despite concerns, elite athletes generally exhibit increased longevity, highlighting the complex interplay between exercise benefits and risks. Further research is needed to clarify fibrosis mechanisms, refine diagnostic criteria, and guide management strategies to ensure athlete safety while preserving the advantages of endurance training.

Abstract Introduction Heart failure (HF) is a one of the main complications among patients with congenital heart disease (CHD), leading to significant morbidity and mortality. While the efficacy and safety of angiotensin receptor-neprilysin inhibitors (ARNi) in the general HF population is well-documented, data specific to the CHD cohort remain limited. Purpose To comprehensively assess the efficacy of ARNi in this unique patient population, we conducted a meta-analysis synthesizing available evidence on ARNi use in patients with CHD. Methods Following PRISMA guidelines, we systematically explored PubMed, SCOPUS, and Cochrane databases up to November 30, 2024. We gathered data on N-terminal pro b-type natriuretic peptide (NT-proBNP) pre and post the administration of sacubitril/ valsartan, New York Heart Association (NYHA) class improvement and death/ transplantation during follow up in the total cohort. Regarding systemic RV, fractional area change (FAC), global longitutinal strain (GLS) of the systematic RV and subpulmonic left ventricle (LV), 6-minute walking distance (6MWD) and maximal oxygen consumption (VO2) pre and post the administration of sacubitril/ valsartan were collected. Results This meta-analysis comprised 10 studies including 444 patients with CHD (mean age was 25.7 ± 18.3 years, 32.6% males) and 158 with systematic RV, who were administered sacubitril/ valsartan. During a mean follow up period of 11.9 ± 8 months, at least one grade of NYHA improvement was reported in 30% (95% CI: 0.14-0.49, I2=84.2%) of the patients with a parallel significant decrease in NT-proBNP levels with a Standardized Mean Difference (SMD) of -0.67 (95% CI -1.00, -0.33, I²=55.2%) (Figure 1). Mortality or need for transplantation was observed in 6% of the patients. In patients with systematic RV, sacubitril/ valsartan administration led to a significant NT-proBNP reduction (SMD -0.64, 95% CI: -1.04, -0.24, I2=52.9%) (Figure 2). Functional capacity of these patients was also improved, with at least one grade of NYHA improvement being reported in 27% (95% CI: 0.11-0.47, I2=78.4%) of the patients and a significantly increase in 6MWD (SMD 1.02, 95% CI: 0.20, 1.83, I2=85.4%) No significant difference was demonstrated in VO2 measurements (SMD -0.21, 95% CI: -0.54, 0.12, I2=0.0%). Echocardiographic parameters were also significantly improved, FAC (SMD 0.52, 95% CI: 0.09, 0.96, I2=65.1%), GLS of systematic RV (SMD 1.22, 95% CI: 0.30, 2.15, I2=89.1%) and GLS of subpulmonary LV (SMD 0.47, 95% CI: 0.01, 0.93, I2=63.8%). Conclusion ARNIs seem to have a beneficial impact in patients with CHD and HF, particularly those with a systemic RV. ARNIs in intention to treat cohorts improved functional capacity, NT-proBNP levels and echocardiographic parameters. Further controlled studies of ARNIs on CHD patients are clearly warranted.

Abstract Background There is a significant trend in the use of drug coated balloons (DCBs) for the treatment of in-stent restenosis (ISR). However, there is a lack of robust comparative data between –limus drug coated balloons (DCBs) vs paclitaxel coated balloons (PCBs) on the efficacy and safety in treating ISR. Aims The objective of this systematic review and meta-analysis was to compare the efficacy and safety of -limus DCBs vs PCBs in terms of clinical and angiographic outcomes during a 12-month follow-up. Methods Following PRISMA guidelines, we systematically explored PubMed, SCOPUS, and Cochrane databases up to August 9, 2024, for studies comparing –limus DCBs vs PCBs in terms of safety, efficacy and angiographic outcomes in treating ISR. The primary outcomes were the incidence of clinically driven target lesion revascularization (TLR) and failure (TLF). Secondary endpoints were major adverse cardiovascular events (MACE) and angiographic findings during follow up. Results Data from six RCTs, including a total of 639 patients treated with limus DCBs and 569 with PCBs for ISR, were analyzed with a mean follow-up of 12 months. In this analysis, all six RCTs reported on TLR incidence, showing no significant difference between the limus DCB and PCB groups (14% vs. 11.4%, RR: 1.16, 95% CI: 0.82-1.64, I2=14%). Similarly, TLF rates were comparable between the two groups (15% vs. 14%, RR: 1.14, 95% CI: 0.86-1.53, I2=0%). Procedural success rates were high and similar (limus DCB: 100% vs. PCB: 99.5%). No significant differences were observed in MACEs (16.4% vs. 13.5%, RR: 1.11, 95% CI: 0.84-1.46, I2=0%), all-cause mortality (1.8% vs. 1.4%, RR: 1.25, 95% CI: 0.50-3.08, I2=0%), cardiac death (1.4% vs. 1%, RR: 1.19, 95% CI: 0.42-3.41, I2=0%), or target vessel myocardial infarction (TVMI) (0.9% vs 1%; RR: 0.58; 95% CI: 0.20-1.67, I2=0%). Angiographic outcomes showed no significant difference in post-intervention minimum luminal diameter (MLD) (SMD: +0.06, 95% CI: -0.07 to 0.18, I2=0%) and binary restenosis (19.5% vs 12.9%; RR: 1.45; 95% CI: 0.77-2.71, I2=63%) at follow-up between the groups. The risk of late lumen loss (LLL) was also comparable between limus DCB and PCB for in-segment analysis (SMD: 0.02, 95% CI: -0.18 to 0.23; I2=32%) and for in-lesion (SMD:-0.03, 95% CI: -0.31 to 0.24; I2=27%). Low heterogeneity was observed across the studies. Conclusion Our findings suggest that limus-DCBs are equally effective and safe as PCBs for treating ISR, demonstrating non-inferiority in both clinical and angiographic outcomes at 12 months post-intervention.

Mechanical complications following acute myocardial infarction (MI) represent some of the most challenging conditions in contemporary cardiology, often leading to rapid clinical deterioration and high mortality despite advances in reperfusion therapy. These complications span a spectrum of presentations, from early-phase structural disruptions such as ventricular septal rupture, papillary muscle rupture with acute mitral regurgitation (MR), and left ventricular free wall rupture (LVFWR), to later-stage manifestations, including true ventricular aneurysms and pseudoaneurysms. While surgical intervention has traditionally been considered the standard of care, surgical intervention is often associated with prohibitive risk in hemodynamically unstable or frail patients. In this context, transcatheter approaches have gained traction as viable, less invasive alternatives, offering the potential for hemodynamic stabilization, symptom relief, and improved short-term outcomes in selected patients. Nonetheless, data from observational studies and registry-based analyses remain limited, underscoring the need for further research. This review synthesizes the current evidence base and clinical experience related to transcatheter management of mechanical complications after MI, emphasizing patient selection, procedural strategies, device selection, and reported outcomes.

This report provides a concise selective representative overview of the predictor factors for progression in Idiopathic Scoliosis (IS). The Cobb angle method, rib hump deformity, imaging and advanced techniques for assessing skeletal maturity serve as key elements in evaluating prognostic factors for IS progression based on the patient's age at diagnosis-particularly in Infantile Idiopathic Scoliosis (IIS), Juvenile Idiopathic Scoliosis (JIS), and Adolescent Idiopathic Scoliosis (AIS). The commonly used approaches for determining skeletal maturity include the assessment of the iliac apophysis and scoliosis curve deterioration, the Sanders skeletal maturity staging system, the distal radius and ulna (DRU) classification for predicting growth spurts and curve progression in IS, as well as the ossification of vertebral epiphyseal rings, the humeral head, and the calcaneal apophysis. Prognostic factors influencing IS progression are further discussed in relation to the patient's age at onset-whether in infancy, childhood, or adolescence-as well as in both untreated and braced AIS patients. Additionally, the apical convex rib-vertebra angle in AIS is explored as an indicator of progression. Predictors for curve progression at skeletal maturity are outlined, along with various models for forecasting IS deterioration. Lastly, the Rib and Segmental Rib Index, a rib cage deformity parameter, is introduced as a predictor of scoliosis progression. In conclusion, this concise and selective overview of predictor factors for progression in IS highlights the current understanding of IS progression factors. It also introduces the Rib and Segmental Rib Index-a rib cage deformity parameter-as a predictor of IS progression.

Heart failure (HF) burden and care varies significantly across different countries. We aimed to illustrate the clinical characteristics and HF-related care among cardiology inpatients in Greece. We collected information about all cardiology inpatients on the 3rd of March 2022. The current analysis focuses on acute or chronic HF. Among a total of 923 participants, 280 (30%) concerned cases of acute HF whereas 351 patients (38%), (median age 79 ± 12years, male gender 63.8%) had a history of chronic HF, with their majority presenting with multiple comorbidities and previous HF hospitalizations. 173 (49%) of chronic HF participants had reduced LVEF. Ischemic heart disease was the predominant HF etiology (182, 51.9%). Prior to the index admission, chronic HF cases were receiving diuretics, beta blockers, ACEi/ARBs, ARNI, MRAs, and SGLT2i at 79.8%, 74.4%, 43.3%, 10.8%, 40.7%, and 14%, respectively. Independent predictors of lower prescription rates of Guideline Directed Medical Therapy (GDMT) included advanced age (p < 0.001), chronic kidney disease (RASi OR 0.392, p = 0.008, MRA OR 0.523 p = 0.097), and lack of follow-up in dedicated HF clinics (p = 0.006). No regional differences with regards to GDMT were identified. In this nation-wide real-world snapshot study, patients with chronic and acute HF accounted for a significant proportion of cardiology inpatients, while ischemic heart disease was the leading HF cause. GDMT and device therapy can be improved. Follow-up in dedicated HF units was related with increased prescription rates of GDMT, whereas this was not affected by geographical region.

Background: Capillary tortuosity is a morphological variant of microcirculation. However, the mechanisms by which tortuous vessels meet metabolic requirements in health and disease remain unknown. We recently reported that capillary tortuosity score (CTS) is significantly higher in patients with septic shock than in steady-state individuals, and that CTS is significantly associated with alveolar-to-arterial oxygen (A-a O2) gradient and oxygen debt in septic shock patients. Objective: We aimed to investigate the characteristics of the magnetic fields in the sublingual microcirculation of individuals with normal physiology and patients with septic shock. Methods: Systemic hemodynamics were recorded, and sublingual microcirculation was monitored using sidestream dark field (SDF+) imaging. The number of capillary red blood cells (NRBC), the intensity of the magnetic field of a red blood cell (HRBC), the intensity of the magnetic field of each capillary (HCAP), and the intensity with which the magnetic field of a capillary acts on an RBC (FCAP) were calculated. Results: Significant differences in macro- and microhemodynamic variables were observed between the two groups. Although NRBC was significantly higher in individuals with steady-state physiology [87.4 (87.12) vs. 12.23 (6.9)], HRBC was significantly stronger in patients with septic shock [5.9 × 10-16 (6.9 × 10-16) A m-1 vs. 1.6 × 10-15 (1.4 × 10-15) A m-1]. No significant difference was observed in HCAP [2.16 × 10-14 (2.17 × 10-14) A m-1 vs. 1.34 × 10-14 (1.23 × 10-14) A m-1] and FCAP [1.66 × 10-24 (3.36 × 10-24) A m-1 vs. 6.44 × 10-25 (1.1 × 10-24) A m-1] between the two groups. In patients with septic shock, HRBC was associated with De Backer score (rho = -0.608) and venous-arterial carbon dioxide difference (rho = 0.569). In the same group, HCAP was associated with convective oxygen flow (rho = 0.790) and oxygen extraction ratio (rho = -0.596). Also, FCAP was significantly associated with base deficit (rho = 0.701), A-a O2 gradient (rho = 0.658), and oxygen debt (rho = -0.769). Conclusions: Despite the microcirculatory impairment in patients with septic shock, HRBC was significantly stronger in that group than in steady-state individuals. Also, HCAP and FCAP were comparable between the two groups. Tortuous vessels may function as biomagnetic coils that amplify RBC-induced magnetic fields, enhancing perfusion and oxygenation of adjacent tissues.