Emmanouil Giorgakis

Abstract:

Abstract:

Abstract:

Abstract: Scope: Aim of this presentation is to investigate whether there has been any change in the frequency of acute appendicitis and appendectomy. Material-method: Retrospective study of the cases of acute appendicitis treated surgically in the last seven years (1999-2005) in the A� Surgery Department of Rhodes General Hospital. The study has been conducted in relation to specific epidemiological data (age, gender and ethnicity) and based on the fact that diagnosis and operation during all this period of time has been performed by the same surgical team and that indications for surgery have remained the same. A gradual reduction of the acute appendicitis cases has been noted. The factors of age and gender do not seem to affect this decrement and this reduction is more evident in Greek patients as compared to that of the financial immigrants. Discussion: As seen in the international literature and specifically in countries with high standards of living, there has been a reduction in the frequency of acute appendicitis. Probably, broader epidemiological series will prove the true decline of the incidence of this clinical entity.

Abstract: RHODES GENERAL HOSPITAL, GREECE A' Surgery Department Scope of the study is to show whether the survival of the patients operated for advanced gastric cancer is affected when classified with two different systems (UICC �87, UICC �97). Material-Method: During �99-30/06/06, 37 patients with gastric cancer had been operated. 22 patients underwent subtotal gastrectomy, while 15 total. 8 patients received D1 lymphadenectomy, while 29 had D2. The 8 patients, who had D1 lymphadenectomy, are not included in the study. Histological classification was according to Lauren, while disease staging was according to TNM, UICC �97. 21 patients underwent chemotherapy. Postoperative follow-up is performed every 6 months. Statistic analysis has been performed mono-factorily according to Kaplan-Mayer analysis and multifactorily on a cox model. Results: Ro was achieved in 27, while R2 in 10/37 patients. Postoperative morbidity had been 8.1, whereas morbidity 2.7. In average, 19 lymph nodes were being removed, 9.5 of which had been positive. According to UICC �87, one patient was stage II, 12 patients were IIIa, 12 patients were IIIb and 4 at stage IV, while with classification UICC �97, the staging was: stage II one, stage IIIa 9, stage IIIb 15 and four at stage IV. Due to the different distribution of the lymph nodes in the two classifications, there seems to be a reduction of stage IIIa and a rising of stage IIIb with UICC �97 classification. On Kaplan-Mayer analysis, a changing of the 5 year survival is being noted, which is not statistically important (p<0.1), yet apparent, especially if we consider that a 6 month increase of survival in advanced gastric cancer patients after chemotherapy is considered a significant success. Conclusion: Despite the fact that the patient sample has been narrow, the patients� survival appears to be affected by the selected classification system. Thus, it is essential that a single classification-staging system should be employed in order to secure validity in the comparison of the results.

Abstract: Scope: On the present retrospective study it is investigated whether the presence of nasogastric tube during gastrectomies for gastric cancer of advanced stage, contribute to the development of intraluminal recurrence. Material-Method: During 1996-2006, 37 patients had been operated for advanced gastric cancer. A nasogastric tube was placed in all patients. On the 6th month follow-up, 5 recurrences had been detected. 3 recurrences were extraluminal and 2 intraluminal. In one patient with intraluminal recurrence, the tumor developed on the anastomosis, in 5 cm distance on the small intestine loop. In the second patient, the tumor developed 10 cm from the anastomosis on the small intestinal loop. Since on both patients, the factors usually related to local recurrence were not clear and there had not been any extraluminal recurrence, a cause of tumor development could had been the insemination of cancerous cells in the mucosa of the small intestine after micro-trauma of the mucosa by the nasogastric tube during its repositioning. For that reason, on the last 3 patients operated for gastric cancer, after the dissection of the stomach and prior to its removal, the nasogastric tube was removed and its content was examined for cancerous cells. On 2 patients the cytology came negative, while on the third patient it had been positive for cancerous cells. On the patient with positive cytology, follow-up gastroscopy after 6 months showed a healthy esophageal and small intestinal mucosa with normal anastomosis. The next gastroscopy, being performed after 6 months, showed vegetations at the area of the anastomosis and beyond, the pathology of which proved gastric adenocarcinoma. CT was negative for local recurrence. Conclusion: Retrospectively, it is worth discussing about the possible role of the nasogastric tube in the intraluminal development of recurrence post gastrectomy for gastric cancer, especially away from the anastomosis. It would be wise to avoid placing the NG tube during the operation; it should be placed after the completion of the anastomosis.

Abstract: Scope: Colorectal cancer is a disease with significant prevalence in the West World. It is the 3rd cause of death due to cancer in the USA and accounts for about 15 % of all cancers. The present study analyses the results over a seven year period in our Department, during which 144 patients had been treated for colorectal adenocarcinoma. Material-Method: During the seven year period 1999-2006, 144 patients underwent surgical treatment of colorectal cancer at the A� Surgical Department. 119 patients had elective surgery, while 25 had been operated urgently due to acute obstruction, hemorrhage or perforation. The factors being analyzed were gender, age, elective or urgent surgery, R, the number of removed lymph nodes, the stage of the disease according to TNM-UICC 1987, chemotherapy, local recurrence and survival. Statistic analysis was performed via x2 test, while multi-factorial analysis has been performed on a Cox model. Results: Postoperative complications� percentage has been 12 %. Postoperative mortality was totally 4.17 % and regarded about 20 % of urgently operated patients, in contrast to the patients operated electively, were postoperative mortality was 0 %. The average number of removed lymph nodes in elective operations was 16.0 (6-57), while in emergency was 8.1 (2-20). Therapeutic en block tumor resection with negative resection edges, with no obvious residual disease (Ro) had been achieved in 105 patients (72.9 %). Local recurrence of the disease occurred in 12 patients (8.3%). Survival has been better in patients with therapeutic en block resection with negative edges (Ro), in elective patients, in patients staging I-II, according to TNM-UICC 1987 classification and in patients who underwent postoperative chemotherapy. Conclusion: Survival has been better in patients who had Ro tumor resection, scheduled operations, in those staging I-II according to TNM-UICC 1987 and, finally in patients who had adjuvant chemotherapy.

Abstract: Scope: Analysis of the results of our seven year experience in the treatment of patients operated for advanced gastric cancer. Material and method: During the period 1/1/99 to 30/06/06, 37 patients have been operated for advanced gastric cancer. Pre-operatively, they had staging of the disease and the necessary laboratory tests. 22 patients had subtotal gastrectomy, while 15 had total gastrectomy. R0 tumor removal had been achieved in 27 patients, while 10 patients had R2 resection. 8 patients had D1 lymphadenectomy, while 29 had D2. Histological classification has been performed according to Lauren, while staging according to TNM, UICC 1997 classification. 21 patients received postoperative chemotherapy. Postoperative follow-up is every 6 months. The factors being analyzed are survival in relation to residual tumor, type of lymphadenectomy (D1 or D2), stage according to TNM classification UICC �97, postoperative chemotherapy and, finally, recurrence. Results: Postoperative morbidity has been 8.1 % (3 patients), while mortality 2.7 % regarding one patient. Recurrence presented in 4 out of 5 the patients with diffuse type according to Lauren. 12month survival in patients with R0 resection and D2 lymphadenectomy who had post-op chemotherapy has been higher than the one of patients who had R2 tumor removal, D1 lymphadenectomy and no post-op chemotherapy. Finally, three year survival has been low in the Ro group and nil in the group who had R2 resection. Conclusion: Despite the small case volume, the factors which seem to affect survival of patients operated for advanced gastric cancer is advanced disease stage, R, lymphadenectomy level, postoperative chemotherapy and histological type.

Abstract: Rhodes General Hospital, Greece A' Surgery Department Scope of the study is the presentation of a case of a giant retroperitoneal tumor and review of the relative literature. Material-Method: On a patient, aged 72, due to an increase of the abdominal girth, a retroperitoneal lipomatous tumor had been diagnosed two years before. There had not been any other symptomatology. A CT guided biopsy was performed. Pathology exam showed lipoma; no evidence of malignancy was present on the material sent to the lab. 12 months later, the patient was complaining for increasing tension of the abdominal walls and disturbances of the bowel movements. Clinically, there had been an increase in the palpated mass. Due to the increasing size of the tumor mass, its resection was decided. After the necessary pre-op preparation, a retroperitoneal mass was removed, 51x52x23 cm, 11.2 kg. Pathology showed a sarcomatous tumor with good differentiation. Discussion: Despite the progression of the diagnostic means, the diagnosis of retroperitoneal tumors is made in advanced stage: 50 % of tumors have a diameter of > 20 cm during diagnosis. This delay is attributed to the lack of symptomatology. CT is the method of choice. MRI facilitates the differentiation between malignant and benign tumors. The validity of preoperative biopsy is equivocal. The latter is valuable in the presence of metastases, in order to put the diagnosis of a primary tumor. The diagnostic value of the biopsy is depended upon the experience of the examiner. False negative results are present in 10 % of the biopsies, while, in a small percentage, there is also a spreading of the disease, for which reason, surgical removal of these tumors offers the final diagnosis plus better outcomes. Conclusion: In retroperitoneal tumors, due to the significant possibility for false negative results of the transdermal biopsies and the increased risk of tumor spreading, it would be wiser to avoid biopsies and to perform directly surgical tumor removal.

Abstract: Scope: In this retrospective study, we attempt to investigate the frequency of thyroid cancer detection in patients admitted in a surgical department for treatment of benign thyroid disease. Material and method: In the period 1999-30/06/2006, 172 patients had been surgically treated for benign thyroid disease. None of these patients had pre-operative diagnosis of thyroid cancer. In the first three years, the treatment strategy included thyroid lobectomy, subtotal thyroidectomy or total thyroidectomy, depending on the endocrine profile, the ultrasonographic and scintigraphic findings. In the second three-year period, surgical strategy had been solely total thyroidectomy. Postoperative complications are being analyzed in this presentation along with the pathology reports of the specimens. Results: In the first three-year period we had 10 transient hypocalcaemias, a transient hypoparathyroidism, no inferior laryngeal nerve palsy, while, at the same time, 7 thyroid cancers had been depicted. During the second three-year period, there had been 42 hypocalcaemias, 3 tetanies, 2 patients developed persistent hypoparathyroidism and one patient had a transient inferior laryngeal nerve palsy, while 27 thyroid cancers had been diagnosed, 11 of which were bilobal carcinomas and 7 multifocal. Conclusion: The increment of thyroid cancer frequency as well of the post-operative complications could be explained with the shift of the surgical tactic. Total thyroidectomy has become the surgical technique of choice in our department, since: a) It raises the chance of finding non-detected thyroid carcinomas, especially bilobal carcinomas and multifocal. b) Upon incidentally diagnosing a carcinoma, the patient does not need to be re-operated, given that the risk of postoperative complications remains low (<1%). The problematic emerging is that the surgeon performing total thyroidectomy for treating benign thyroid disease is not legally protected for that case when the thyroid tissue removed is normal and the patient develops serious complications, such as bilateral laryngeal nerve palsy or tetany.

Abstract: Scope: This study attempts to review the strategy followed in patients with suspected hemorrhage of unknown etiology in the gastrointestinal tract, as well as their prognosis. Material and method: During the 5year period 1999-2003, 301 patients had been hospitalized in A� Surgery Department due to gastrointestinal hemorrhage. Diagnostic workup included gastroscopy, colonoscopy, abdominal ultrasound, abdominal CT and small intestinal imaging after gastrografin swallow. Results: In 223 patients (74%), gastroscopy and in 66 patients (22.4%), colonoscopy put the diagnosis. In 12 patients (3.6 %), no bleeding cause had been found. 9 of them (75 %) were readmitted for re-bleeding. The other three remaining had been free of recurrence. From these nine patients who had been re-admitted for bleeding recurrence, three underwent exploratory laparotomy, where it was found that one patient had a bleeding Meckel�s diverticulum, the second had a hemorrhagic jejunal diverticulum and the third had a small intestinal stromal tumor. Three patients refused exploratory laparotomy end died of hemorrhagic shock. In the last three patients (of the group of 9 patients with no apparent bleeding cause at the workup during their initial presentation who had to be re-admitted for re-bleeding), no cause of hemorrhage was found. Conclusion: Endoscopy leads in a very high percentage (96.4 % in our study) to the source of a gastrointestinal hemorrhage. A small percentage (3.6% in our study) remains undiagnosed. These patients are usually of high risk due to co-morbid conditions, with high morbidity (66.6%) and mortality (25%). In this latter patient group, upon re-bleeding with negative findings in repetitive diagnostic workup, it is prudent to perform exploratory laparotomy, ideally in conjunction with intra-operative enteroscopy for further exploration, especially when selective angiography or scintigraphy are not readily available.

Abstract: Rhodes General Hospital, Greece A' Surgery Department Scope: Peritoneal mesothelioma as a rare cause of non-hemorrhagic ascites. Case Presentation: 55 y/o patient was admitted to the Medical Department of the Hospital for investigation of abdominal pain, loss of weight and increase of the abdominal girth. Physical examination and para-clinical exams (gastroscopy, colonoscopy, and enteroscopy with capsule, CT of the abdomen and chest, lab control, Mantoux test) had been unremarkable. Aspiration of the ascitic fluid was performed, removing 5 liters of non-hemorrhagic ascitic fluid. Biochemical control exhibited characteristics of exudate. Cytology showed multi-nuclear mesothelial cells. No evidence of malignancy on the examined specimen was noted. The patient was discharged in good general condition. In a period of 2 months, 2 more admissions to the medical department with ascitic fluid aspiration took place, the cytology of which had been negative for malignancy. The CT performed during the last admission of the patient exhibited a large collection in the abdomen with peritoneal changes, compatible with insemination. The patient was admitted to the surgical department for exploratory laparotomy. Discussion: Laparotomy proved to be very difficult. Omentum was adhered to the anterior abdominal wall and exhibited micronodular changes. These same changes were evident on the peritoneum. 8 L of ascitic fluid were drained. Between the loops of the small intestine and sub-diaphragmatically there were fibrous elements characteristic of past peritonitis. Investigation of the small intestine through its all length proved to be impossible. Biopsies were taken from the peritoneum and omentum and ascitic fluid was sent to the microbiology for common microbes and Koch. Peritoneal and omental biopsies proved the presence of malignant mesothelioma. On ascitic fluid culture multi-resistant MRSA staphylococcus developed, probably secondary to the previous multiple paracenteses. The postoperative progress had been uneventful. Conclusion: In prolonged presence of non-hemorrhagic ascites of unknown origin, peritoneal tumors should be included in the differential diagnosis. Upon negative ascitic fluid cytology, there is an indication for laparoscopy or laparotomy for biopsies taking and confirmation of the diagnosis.

Abstract: The co-existence of acute inflammation of the appendix and loci of endometriosis is extremely interesting, yet rare. Case summary: The presentation describes a case of a female, aged 35, of Finlandian origin, gravida X 27 weeks, being operated for acute appendicitis. During the operation, there was acute gangrenous appendicitis with perforation at the base of the appendix and commencing plastron development. The operation performed had been appendectomy and pathology report of the specimen returned gangrenous inflammation of the appendicular process upon which existed loci of endometrial tissue. Results: Due to the rarity of similar cases in the current literature, it is impossible to extract conclusions for the etiologic or symptomatic relation between endometriosis and appendicular inflammation.

Abstract: Scope: Extrahepatic biliary obstruction is usually due to calculi, inflammation or malignant diffusion of the biliary tree from the duct itself or from the head of the pancreas. A rare cause of obstruction is parasites. While obstruction due to rupture of echinococcal cyst happens in 3-17 % of patients with liver echinococcus, the percentage of obstruction due to Fasciola Hepatica is unknown. Scope of this project is the presentation of a �Fasciola Hepatica� case treated in our Department along with a short review of the literature regarding the clinical presentation, diagnostic procedures and treatment. Material and method: A 27 y/o patient had been admitted to the hospital due to right subcostal pain, fever with chills, jaundice and vomiting. Laboratory investigation exhibited leukocytosis with neutrophil domination and a rise of γGT, ALT, AST, ALP and bilirubin levels. Emergency U/S showed cholecystitis with extrahepatic biliary dilatation, confirmed with CT of the abdomen. Intravenous cholangiography showed extrahepatic biliary dilatation. ERCP was not possible. Results: After completion of the investigations the patient was led to the theatre. During the operation, cholecystitis was apparent and cholecystectomy was performed. Choledochal duct investigation showed three Fasciola Hepatica parasites. The parasites were removed and a Kehr tube was placed. Fecal parasitology showed eggs of Fasciola. Pharmaceutical treatment for Fasciola followed. Postoperative progress was uneventful. Conclusion: Recurrent cholangitides are typical of Fasciola Hepatica, which should be included in the differential diagnosis of obstructive jaundice, especially in endemic areas. Treatment of choice is ERCP with synchronous administration of antibiotics.

Abstract: Scope: Analysis of the results of our six year experience in the treatment of patients operated for advanced gastric cancer. Material and method: From 1/1/99 to 30/06/05, 37 patients had been operated for advanced gastric cancer. Pre-operatively, they had staging of the disease and the necessary laboratory tests. 22 patients had subtotal gastrectomy, while 15 had total gastrectomy. R0 tumor removal was achieved in 27 patients, while R2 in 10 patients. 8 patients had D1 lymphadenectomy, wile 29 had D2. Histological classification was performed according to Lauren, while staging was performed according to TNM, UICC 1997. 21 patients received postoperative chemotherapy. Postoperative follow-up is every 6 months. Results: Postoperative morbidity was 8.1 % (3 patients), while mortality was 2.7 % and included one patient. Local recurrence of the disease was noticed on 5 patients. 12month survival in patients with R0 was higher than the one of patients with R2, while three year survival was generally low. Conclusion: Despite the small number of cases, factors that affect survival of patients operated for advanced gastric cancer is advanced stage, R and histological type.

Abstract: Scope: Analysis of the factors contributing to the development of local recurrence in patients operated for advanced gastric cancer. Material and method: During 1996-2006, 37 patients had been operated for advanced gastric cancer. A nasogastric tube was placed in all patients, while staging was performed with all the necessary paraclinical investigations (gastroscopy with biopsies, CT abdomen, tumor markers). 22 patients had subtotal gastrectomy, while 15 had total gastrectomy. Ro tumor removal was achieved in 27 patients, while R1 in 10 patients. 8 patients had D1 lymphadenectomy, while 29 patients had D2. Histological classification was according to Lauren, while staging was based on TNM, UICC 1997. A cytology specimen from the contents of the nasogastric tube of the last three patients was collected and sent for analysis. 20 patients received postoperative chemotherapy. Postoperative follow-up is every six months. Results: Local recurrence was noted on 4 patients with D1 lymphadenectomy and to a patient with D2. 4 patients had diffuse type according to Lauren. Patients with recurrence had greater number of diffused lymph nodes as compared to the non-recurrence group. In 2 patients recurrence was on the anastomosis, in one patient recurrence was on the anastomosis and the helix (10 cm from the anastomosis), one had extraluminal diffusion 10 cm from the anastomosis and diffusion of the helix 10 cm from the anastomosis and in one case recurrence was in the helix 15 cm from the anastomosis. Cytology of the content of nasogastric tube was positive for cancerous cells in one case. 12 month survival in patients with Ro was 86.4%, while in patients with R1 was 33.3%. Conclusion: Factors contributing to local recurrence in patients operated for advanced gastric cancer are advanced stage of the disease, R and histology. Worth of notice and scepticism might be the role of the nasogastric tube in the development of local recurrence.

Abstract: Scope: Presentation of the factors contributing to the selection of treatment in splenic trauma. Material and method: From 1/1/99 to 31/12/06, 48 patients had been hospitalized at the A� Surgery Department with splenic injury. All patients had ultrasound and CT investigation of the abdomen. Treatment had been based on a) the haemodynamic status, b) the degree of the splenic injury according to AAST after CT control and c) the presence of other intra or extra-abdominal injuries. Statistic analysis was performed via x2 test and Cox model. Results: 93% of patients with stage I & II splenic trauma were treated conservatively, while the rest had been operated due to the haemodynamic instability due to other intra abdominal injuries. At these patients, splenic injury was treated with splenic suturing. All patients with splenic trauma of stage III and IV had been treated surgically. Splenectomy was necessary to 90% of patients, while 10% were treated with suturing. Interestingly, 40% of stage III patients had been treated surgically and the rest 60% conservatively. At this stage, patients with other abdominal traumas and patients above 70 years old with haemodynamic instability and other extra abdominal injuries received surgical treatment. Between the patients groups treated conservatively or surgically there was not any statistically significant difference regarding gender, injury mechanics and type of accident. Statistically significant difference between the two groups was reported with regard the haemodynamic status, the presence of other injuries and age. Conclusion: Despite the fact that the number of patients is small, conservative treatment could be followed in hemodynamic stable patients, in patients with splenic injury AAST stage I and II and to a part of patients stage III with extra abdominal trauma which does not affect the haemodynamic condition of the patient. Surgical treatment should be followed in hemodynamically unstable patients with free peritoneal fluid and other abdominal trauma in patients with AAST stage III & IV and to a part of stage III with other extra abdominal injuries and persons over 70 years of age.

Abstract: Scope: The present study analyzes the results over a seven year period in our A' Surgery Department at Rhodes General Hospital, during which 133 patients had been treated for colorectal adenocarcinoma. Material-Method: During the seven year period 1999-2006, 133 patients underwent surgical treatment of colorectal cancer at the A� Surgical Department. 108 patients had elective surgery, while 25 had been operated urgently due to acute obstruction, hemorrhage or perforation. The factors being analyzed were gender, age, elective or urgent surgery, R, the number of removed lymph nodes, the stage of the disease according to TNM-UICC 1987, chemotherapy, local recurrence and survival. Statistic analysis was performed via x2 test, while multi-factorial analysis has been performed on a Cox model. Results: Postoperative complications� percentage has been 12 %. Postoperative mortality was totally 4.5 % and regarded 6 patients who had emergency surgery, in contrast to the patients operated electively, were postoperative mortality was 0 %. The average number of removed lymph nodes in elective operations was 16.9 (6-57), while in emergency had been 8.3 (2-20). Therapeutic en block tumor resection with negative resection edges, with no obvious residual disease (Ro) had been achieved in 100 patients (75.2 %). Local recurrence of the disease occurred in 12 patients (9%). Survival has been better in patients with therapeutic en block resection with negative edges (Ro), in elective patients, in patients staging I-II, according to TNM-UICC 1987 classification and in patients who underwent postoperative chemotherapy. Conclusion: The factors which increase the percentage of local recurrence are related to the size and spreading of the tumor. Survival is higher in patients who had Ro tumor resection, scheduled operations, in those staging I-II according to TNM-UICC �87 classification and finally in patients who underwent postoperative chemotherapy.

Abstract: Scope: History of the definition of splenic rupture, analysis of the factors contributing to rupture on an already diagnosed splenic injury. Material and method: From 1/1/99 to 31/12/06, 48 patients had been hospitalized at the A� Surgery Department with splenic injury. The treatment type (conservative vs surgical) was based on the hemodynamic status, the degree of splenic injury according to AAST and the presence of other intra- or extra- abdominal injuries. At 26 patients the treatment was conservative and at the rest 22 surgical. 13 of the 26 conservatively treated patients belonged to AAST stage III. 4 of the 13 primary conservatively treated stage III patients presented organ rupture on day 6, 12, 18 and 20, resulting to a conversion of the initially conservative to a surgical treatment. These data presentation is followed by a history of the definition of splenic trauma and statistical analysis via x2 test and Cox model. Results: All patients who developed failure of the conservative treatment of an already diagnosed injured spleen were older than 50 years of age, had received at least 2 units of blood and had sub capsular haematoma over 60% on CT scan; they eventually developed rupture and active bleeding. Statistically, the relative risk of organ rupture on these patients was 5fold. Conclusion: Even if the patients� number is small, we may say that a number of stage III, according to Moore, patients, initially conservatively treated, have a 5fold relative risk of rupture with resulting surgery. These patients are over 50 years old, have received more than 2 blood units before rupture and eventually present with a large sub-capsular haematoma with capsular rupture and active bleeding.

Abstract: Scope: Presentation of 17 cases treated in A� Surgical Department of Rhodes General Hospital, regarding the synchronous presence of malignancies in different organs, the diagnosis of which had been made in a period shorter than 6 months and they were not metastases of other tumors. A short literature review on this interesting subject is also being attempted. Material and method: In period 1999-2005, 2857 patients had been admitted to the A� Surgical Department with GI symptomatology. Diagnostic investigation included: history, physical, laboratory testing and imaging. Abdominal ultrasound and CXR were performed on all patients, while gastroscopy and/ or colonoscopy were performed depending on the symptomatology. CT of the abdomen or of the chest was performed upon a tumor presence. Histology of the surgical specimens was undertaken by two separate pathologists. Follow-up was ranging between 1-72 months. Results: 173 (6%) of 2857 admitted patients were diagnosed with GIT cancer. 17 (9.8%) had synchronous tumors, which reflects 0.59% of the patients admitted with symptomatology from the GIT. An analytic distribution of synchronous tumors follows. The commonest combination is that of GI with urinary system. In 15 out of 17 patients the diagnosis was made in the same period of time, while in only 2 cases the diagnosis was established within a 4 to 5 months� interval. In 11 out of 17 patients the treatment was surgical. 4 out of 6 patients treated conservatively deceased, while 7 out of 11 patients treated surgically are still alive. Conclusion: History, physical examination and thorough paraclinical investigation contribute to the finding of a second tumor, thus explaining the high percentage (9.8%) of synchronous diagnosis in our material. What is also remarkable is the percentage (29.4%) of synchronous tumors in large intestine and urinary system. Their treatment should be based on surgical oncology. Upon their presence, there is no contraindication for their simultaneous treatment.

Abstract: Scope of the presentation is the comparative study of the results of inguinal hernia repair in patients who had their hernia surgically corrected employing randomly either Shouldice or Lichtenstein technique. Material and method: During the period 01/07/1999-31/12/2005 at A� Surgery Department, 605 patients have been treated surgically for inguinal hernia applying Shouldice or Lichtenstein techniques. The factors analyzed in this project have been patient�s age, hernia type and size, costs of the procedure, post-operative pain, time of return to daily activities and finally early and late complications. Patients with strangulated inguinal hernias, recurrent hernias and patients younger than 30 years of age have been excluded from the study. The post- operative follow up ranged from 1 to 80 months. Statistic analysis has been performed with x2 test. Results: Differences have been detected regarding the cost, which has been greater in patients where Lichtenstein technique had been employed as compared to that of the team which received Shouldice technique. Postoperative pain has been less in the group of Lichtenstein technique, the patients of which had earlier return to their daily activities. Later neuralgias had been more frequent in Lichtenstein group, while, finally, the recurrences had been more often when Shouldice technique was used. Conclusions: Shouldice and Lichtenstein techniques exert equally satisfactory results and are equally effective for hernia repair. It seems to be prudent in young patients with small gaps wall repair to be performed using the natural tissues. In those cases where inguinal wall repair is not possible using the normal tissues, it would be better to use types of meshes which may cause the least possible inflammatory reaction.

Abstract: Colorectal cancer is a disease with significant prevalence in the West World.This discussion attempts to provide information regarding the infrastructure, curriculum, preoperative and post-operative management, as well as the morbidity and mortality rates of patients diagnosed with colorectal cancer and treated in a Prefectural Hospital of the Greek NHS. The authors present the difficulties and pose suggestions for improving and optimising the medical care this large population of colorectal cancer patients living in a remote place receives.