Browsing by Author "Giannopoulos, Spyridon"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    Prevention and management of internal hernias after bariatric surgery: an expert review
    (OAE Publishing, 2022-04-21) Pokala , Bhavani; Giannopoulos, Spyridon; Stefanidis, Dimitrios; Surgery, School of Medicine
    Internal hernia formation is a feared complication following bariatric surgery. Protrusion of the small bowel through mesenteric defects can result in volvulus presenting with symptoms of bowel obstruction. If left untreated, patients may go on to develop bowel ischemia with possible perforation or necrosis necessitating emergent surgical exploration with resection. In severe cases, extensive bowel resection is required, leading to short-gut syndrome, which can have devastating consequences for the already nutritionally vulnerable bariatric patient. This review presents a comprehensive summary of various surgical techniques and technical factors implicated in the formation of internal hernias. The clinical presentation of patients with internal hernias, appropriate diagnostic work-up, and effective management and treatment strategies are discussed based on the established literature.
  • Thumbnail Image
    Item
    Targeting Both Autophagy and Immunotherapy in Breast Cancer Treatment
    (MDPI, 2022-10-12) Giannopoulos, Spyridon; Bozkus, Cansu Cimen; Zografos, Eleni; Athanasiou, Aikaterini; Bongiovanni, Ann Marie; Doulaveris, Georgios; Bakoyiannis, Chris N.; Theodoropoulos, Georgios E.; Zografos, Georgios C.; Witkin, Steven S.; Orfanelli, Theofano; Surgery, School of Medicine
    As clinical efforts towards breast-conserving therapy and prolonging survival of those with metastatic breast cancer increase, innovative approaches with the use of biologics are on the rise. Two areas of current focus are cancer immunotherapy and autophagy, both of which have been well-studied independently but have recently been shown to have intertwining roles in cancer. An increased understanding of their interactions could provide new insights that result in novel diagnostic, prognostic, and therapeutic strategies. In this breast cancer-focused review, we explore the interactions between autophagy and two clinically relevant immune checkpoint pathways; the programmed cell death-1 receptor with its ligand (PD-L1)/PD-1 and the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4)/CD80 and CD86 (B7-1 and B7-2). Furthermore, we discuss emerging preclinical and clinical data supporting targeting both immunotherapy and autophagy pathway manipulation as a promising approach in the treatment of breast cancer.
  • Thumbnail Image
    Item
    Venous thromboembolism (VTE) prophylaxis after bariatric surgery: a national survey of MBSAQIP director practices
    (Elsevier, 2023) Giannopoulos, Spyridon; Kalantar Motamedi, Seyed Mohammad; Athanasiadis, Dimitrios I.; Clapp, Benjamin; Lyo, Victoria; Ghanem, Omar; Edwards, Michael; Puzziferri, Nancy; Stefanidis, Dimitrios; ASMBS Research Committee; Surgery, School of Medicine
    Background: Venous thromboembolism (VTE) is the most common cause of death following metabolic/bariatric surgery (MBS), with most events occurring after discharge. The available evidence on ideal prophylaxis type, dosage, and duration after discharge is limited. Objectives: Assess metabolic/bariatric surgeon VTE prophylaxis practices and define existing variability. Setting: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)-accredited centers. Methods: The members of the ASMBS Research Committee developed and administered a web-based survey to MBSAQIP medical directors and ASMBS members to examine the differences in clinical practice regarding the administration of VTE prophylaxis after MBS. Results: Overall, 264 metabolic/bariatric surgeons (136 medical directors and 128 ASMBS members) participated in the survey. Both mechanical and chemical VTE prophylaxis was used by 97.1% of the participants, knee-high compression devices by 84.7%, enoxaparin (32.4% 40 mg every 24 hours, 22.7% 40 mg every 12 hours, 24.4% adjusted the dose based on body mass index) by 56.5%, and heparin (46.1% 5000 units every 8 hours, 22.6% 5000 units every 12 hours, 20.9% 5000 units once preoperatively) by 38.1%. Most surgeons (81.6%) administered the first dose preoperatively, while the first postoperative dose was given on the evening of surgery by 44% or the next morning by 42.2%. Extended VTE prophylaxis was prescribed for 2 weeks by 38.7% and 4 weeks by 28.9%. Conclusions: VTE prophylaxis practices vary widely among metabolic/bariatric surgeons. Variability may be related to limited available comparative evidence. Large prospective clinical trials are needed to define optimal practices for VTE risk stratification and prophylaxis in bariatric surgery patients.