Factors Associated With Retinal Vessel Diameters in an Elderly Population: the Thessaloniki Eye Study

Purpose: To identify the factors associated with retinal vessel diameters in the population of the Thessaloniki Eye Study. Methods: Cross-sectional population-based study (age ≥ 60 years). Subjects with glaucoma, late age-related macular degeneration, and diabetic retinopathy were excluded from the analyses. Retinal vessel diameters were measured using the IVAN software, and measurements were summarized to central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and arteriole to venule ratio (AVR). Results: The analysis included 1614 subjects. The hypertensive group showed lower values of CRAE (P = 0.033) and AVR (P = 0.0351) compared to the normal blood pressure (BP) group. On the contrary, the group having normal BP under antihypertensive treatment did not have different values compared to the normal BP group. Diastolic BP (per mm Hg) was negatively associated with CRAE (P < 0.0001) and AVR (P < 0.0001), while systolic BP (per mm Hg) was positively associated with CRAE (P = 0.001) and AVR (P = 0.0096). Other factors significantly associated included age, sex, alcohol, smoking, cardiovascular disease history, ophthalmic medication, weight, and IOP; differences were observed in a stratified analysis based on BP medication use. Conclusions: Our study confirms previous reports about the association of age and BP with vessel diameters. The negative correlation between BP and CRAE seems to be guided by the effect of diastolic BP as higher systolic BP is independently associated with higher values of CRAE. The association of BP status with retinal vessel diameters is determined by diastolic BP status in our population. Multiple other factors are also independently associated with retinal vessel diameters

Assessments of Severity and Management of Acute Pancreatitis Based on the Santorini Consensus Conference Report

No abstract available.Image: View of Santorini, Greece

Definition and classification of chyle leak after pancreatic operation: A consensus statement by the International Study Group on Pancreatic Surgery

Recent literature suggests that chyle leak may complicate up to 10% of pancreatic resections. Treatment depends on its severity, which may include chylous ascites. No international consensus definition or grading system of chyle leak currently is available. The International Study Group on Pancreatic Surgery, an international panel of pancreatic surgeons working in well-known, high-volume centers, reviewed the literature and worked together to establish a consensus on the definition and classification of chyle leak after pancreatic operation. Chyle leak was defined as output of milky-colored fluid from a drain, drain site, or wound on or after postoperative day 3, with a triglyceride content ≥110 mg/dL (≥1.2 mmol/L). Three different grades of severity were defined according to the management needed: grade A, no specific intervention other than oral dietary restrictions; grade B, prolongation of hospital stay, nasoenteral nutrition with dietary restriction, total parenteral nutrition, octreotide, maintenance of surgical drains, or placement of new percutaneous drains; and grade C, need for other more invasive in-hospital treatment, intensive care unit admission, or mortality. This classification and grading system for chyle leak after pancreatic resection allows for comparison of outcomes between series. As with the other the International Study Group on Pancreatic Surgery consensus statements, this classification should facilitate communication and evaluation of different approaches to the prevention and treatment of this complicatio

Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines

Diagnostic and therapeutic strategies for acute biliary inflammation/ infection (acute cholangitis and acute cholecystitis), according to severity grade, have not yet been established in the world. Therefore we formulated flowcharts for the management of acute biliary inflammation/ infection in accordance with severity grade. For mild (grade I) acute cholangitis, medical treatment may be sufficient/appropriate. For moderate (grade II) acute cholangitis, early biliary drainage should be performed. For severe (grade III) acute cholangitis, appropriate organ support such as ventilatory/circulatory management is required. After hemodynamic stabilization is achieved, urgent endoscopic or percutaneous transhepatic biliary drainage should be performed. For patients with acute cholangitis of any grade of severity, treatment for the underlying etiology, including endoscopic, percutaneous, or surgical treatment should be performed after the patient's general condition has improved. For patients with mild (grade I) cholecystitis, early laparoscopic cholecystectomy is the preferred treatment. For patients with moderate (grade II) acute cholecystitis, early laparoscopic or open cholecystectomy is preferred. In patients with extensive local inflammation, elective cholecystectomy is recommended after initial management with percutaneous gallbladder drainage and/or cholecystostomy. For the patient with severe (grade III) acute cholecystitis, multiorgan support is a critical part of management. Biliary peritonitis due to perforation of the gallbladder is an indication for urgent cholecystectomy and/or drainage. Delayed elective cholecystectomy may be performed after initial treatment with gallbladder drainage and improvement of the patient's general medical condition. © Springer-Verlag Tokyo 2007.published_or_final_versio

Combined Epiretinal Proliferation and Internal Limiting Membrane Inverted Flap for the Treatment of Large Macular Holes.

We are presenting a new method for the treatment of large macular holes (MHs) with the use of an inverted flap consisting of both internal limiting membrane (ILM) and epiretinal proliferation (EP). A prospective interventional case series was conducted from September 2021 to January 2023. MH patients with coexistent EP visualized preoperatively in macula optical coherence tomography and with a MHs minimum linear diameter larger than 400 microns underwent standard pars plana vitrectomy with the creation of an inverted petaloid flap (consisting of both ILM and EP) and gas tamponade. Sixteen eyes were included in our case series. MHs closure was successful in all the eyes with a single procedure. The preoperative minimum linear diameter was 707.63 (±164.02 μm), and the preoperative best corrected visual acuity was 1.11 ± 0.52. The postoperative BCVA was 0.51 ± 0.20 (p = 0.01) at 6 weeks postoperatively, and the final BCVA was 0.45 ± 0.20 (p = 0.008). EP can be safely combined with ILM for the creation of an inverted, petaloid flap to cover and facilitate the closure of large MHs

Pleurobiliary fistula, a rare complication of hepatocellular carcinoma after locoregional chemotherapy: a case report

A rare complication of the compilation of high intrahepatic biliary pressure and the formation of a subdiaphragmatic abscess is that of pleurobiliary fistula. We present a case of 67-year-old male who presented with pleurobiliary fistula following transarterial chemoembolization in a patient with a large hepatocellular carcinoma, as well as the course of the diagnostic procedures and the therapeutics interventions which took place

Primary hepatic carcinoid; a diagnostic dilemma: a case report

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Solid Pseudopapillary Tumor of the Pancreas: An Enigmatic Tumor

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

Risk factors analysis concerning infections in general surgery

Σκοπός:Oι λοιμώξεις που ακολουθούν τις χειρουργικές επεμβάσεις αποτελούν σημαντική πηγή νοσηρότητας και θνητότητας στους ασθενείς. Με σειρά συχνότητας καταγράφονται η λοίμωξη του χειρουργικού πεδίου, η πνευμονία, η βακτηριαιμία που σχετίζεται με τον φλεβικό καθετήρα και οι ουρολοιμώξεις. Σε δύο τμήματα γενικής χειρουργικής τριτοβάθμιου νοσοκομείου διεξήχθη μελέτη ασθενών-μαρτύρων προκειμένου να εκτμηθούν οι παράγοντες κινδύνου για τις μετεγχειρητικές λοιμώξεις.Υλικά-Μέθοδοι: Ως παράγοντες κινδύνου καθορίσθηκαν: το γένος, η ηλικία, η συννοσηρότητα (σακχαρώδης διαβήτης, ηπατική ανεπάρκεια, καρδιακή ανεπάρκεια, αναπνευστική ανεπάρκεια, νόσος κολλαγόνου, νεοπλασία), η χρήση κορτικοστεροειδών, η χρήση αντινεοπλασματικών, η παχυσαρκία (>30 kg/m2), η υποθρεψία, ο χρόνος της επέμβασης (επείγουσα ή προγραμματισμένη), η ταξινόμηση της επέμβασης (καθαρή, καθαρή-μολυσμένη, μολυσμένη, ρυπαρή), η διάρκεια της επέμβασης, η φυσική κατάσταση του ασθενούς όπως καθορίζεται από το ASA score, το είδος της αναισθησίας (γενική, ραχιαία, επισκληρίδιος), η χρήση καπνού ή/και αλκοόλ.Αποτελέσματα:Η λοίμωξη του χειρουργικού πεδίου ήταν η συχνότερη μετεγχειρητική λοίμωξη στη μελέτη. Χρησιμοποιώντας μοντέλο μονοπαραγοντικής λογιστικής παλινδρόμησης οι ακόλουθοι παράγοντες βρέθηκαν στατιστικά σημαντικοί για την πρόκληση λοίμωξης (p3, και το άρρεν φύλο.Συμπεράσματα: Η λοίμωξη του χειρουργικού πεδίου είναι η συχνότερη μετεγχειρητική λοίμωξη. Παράγοντες κινδύνου στατιστικά σημαντικοί για λοίμωξη είναι ο σακχαρώδης διαβήτης, ο χρόνος της επέμβασης, ASA score >3, και το άρρεν φύλο.Background: Postoperative infectious complications are important source of morbidity and mortality in surgical patients. Surgical Site Infection (SSI), is the most common followed by pneumonia, Central Venous Catheter (CVC) bloodstream infection and Urinary Tract Infection (UTI).Methods: A case-control study was conducted in two general surgery departments trying to assess the risk factors for postsurgical infections. Gender, age, co-morbidities (diabetes mellitus, liver failure, heart failure, respiratory failure, connective tissue disease, neoplasia), use of corticosteroids, use of chemotherapeutic agents, obesity (>30 kg/m2), malnutrition, time of operation (elective or scheduled), wound classification (clean, clean-contaminated, contaminated, dirty), duration of surgical procedure, ASA score, type of anesthesia (general, epidural, spinal), smoke abuse and alcohol abuse were defined as risk factors.Results: SSI was the most common postsurgical infection in our study. The univariable logistic regression model revealed the following significant predictors (p3 and male sex, retained statistical significance (p3 and emergency procedure, are considered statistically significant