Background: Road traffic accidents are one of the most frequent causes of death and permanent disability among young people in the western world. Road traffic safety and the efforts for its improvement has been a subject of public debate especially in Greece, a country with the most elevated number of road accidents in European Union. The goal of the study was to examine the road acci-dent trends in Greece with the objective to assess the social-economic changes that occurred in the country over the last two dec-ades. Material and methods: The design of the study was based on the data collection of all road vehicle accidents occurred in Greece be-tween 1994 and 2011. Results: In the period 1994-2011, there was a reduction of 16,20% in road accidents, while there was a decline in fatalities (17,47%) as well as in serious injuries (20,02%). Moreover, the 2008 economic crisis for unclear reasons assisted to the reduction of road death toll (14,20%). Conclusion: The sharp decrease, which was observed in the number of road accidents and of their consequent fatalities, was caused due to the implementation of increased law enforcement strategies, the upgraded of the motorway infrastructures and the effect of the economic crisis.

Η εκτίμηση του HER2 σε γαστρικά καρκινώματα παρουσιάζει ορισμένες διαφορές σε σύγκριση με την αντίστοιχη εκτίμηση καρ-κινωμάτων μαστού, οι οποίες συσχετίζονται με τη σχετικά συχνή ανομοιογενή κατανομή των HER2 θετικών κυττάρων στα καρ-κινώματα στομάχου, τη συχνή ανάγκη εκτίμησης του HER2 σε περιορισμένο υλικό γαστρικής βιοψίας, καθώς και με την ανεύ-ρεση βασικοπλάγιας θετικότητας των νεοπλασματικών κυττάρων. Εφαρμόζονται τεχνικές ανοσοϊστοχημείας και τεχνικές in situ υβριδισμού και η χρήση σαφώς προσδιορισμένων κριτηρίων είναι απαραίτητη. Παράλληλα, είναι σημαντική η συμμετοχή των εργαστηρίων σε εξωτερικά προγράμματα εξασφάλισης ποιότητας.

Introduction: The aim of the study was to investigate the role of percutaneous cholecystostomy before laparoscopic cholecystectomy in gangrenous and phlegmonous cholecystitis. Patients and Methods: Medical records of 100 patients submitted to cholecystectomy with a definitive diagnosis of severe acute cholecystitis were reviewed. The surgical outcomes of 40 patients submitted to cholecystostomy (PC + Cholecystectomy Group) prior to cholecystectomy were compared to those of 60 patients submitted directly to cholecystectomy (Cholecystectomy Group). Results: No differences were found in the rate of first intention laparoscopic cholecystectomy, conversion rate of laparoscopy, the duration of cholecystectomy, post-operative complications, in-hospital mortality and post-operative stay. A higher rate of pre-operative adverse events, longer time lapses since admission to cholecystectomy and longer overall post-operative stays were observed in the PC + cholecystectomy group. Significant failure of cholecystostomy in resolving the acute clinical picture was found in cases of gangrenous cholecystitis. Cholecystostomy allowed resolution of acute phase in phlegmonous cholecystitis but no benefits of pre-operative cholecystostomy were observed in these cases. Conclusion: Percutaneous pre-operative cholecystostomy appears to be of limited utility in patients with severe acute cholecystitis candidate for cholecystectomy.

The only curative treatment for esophageal cancer is surgical resection. Multiple approaches have been described for esophagecto-my, which can be grouped under two major categories; either transthoracic or transhiatal. The main controversy rests on whether transthoracic esophagectomy provides superior oncological outcomes than transhiatal approach. A numerous clinical trials and me-ta-analyses demonstrated that transhiatal esophagectomy is favorable in terms of pulmonary complications, chyle leakage, and wound infections. By contrast, transthoracic approach is favorable in terms of cardiac complications, vocal cord paralysis, and anas-tomotic leakage. These studies failed to detect any significant differences in the patient survival between the two procedures. Transhiatal esophagectomy has a similar oncologic effectiveness as the extensive surgery. With regard to long- term outcomes, there is some evidence that transthoracic approach offers superior five- year survival rate in a sub- group of patients with limited number of involved lymph nodes. Experience of the surgeon and hospital is likely to be a more important factor than is the type of approach selected. Survival impact of chemo-radiotherapy remains controversial, although it was demonstrated a significantly better survival of patients showing response to chemo-radiotherapy than that of patients showing no response to these treatments.

Aim: Is it necessary to obtain gastric biopsies from every patient undergoing gastroscopy whose their results from gastric endoscopy is ?normal gastroscopy? Materials and Methods: This study includes 2486 patients referring to endoscopy unit with subtle GIS sypmtoms. All patients underwent standard upper gastrointestinal gastroscopy under conscious sedation following a 6-8 hour fast. A biopsy sample was taken from the prepyloric antrum of all patients found on gastroscopy to be totally normal, and the sample was sent for pathologic assessment. Helicobacter pylori (HP) positivity, neutrophil activity, inflammation and intestinal metaplasia were recorded Statistical analyses were performed using the chi-square test, and statistical significance was set at a P value patients with a normal gastroscopic diagnosis. When we sought to correlate high rates of HP positivity with other findings, we observed correlations with neutrophil activity and inflammation, but not with atrophy or metaplasia.Our results suggest the necessity of taking biopsies from patients with normal gastroscopy findings

Background and objectives: Diverse methods have been used to quantify pain. Visual analogic scales (VAS) are often used to measure the magnitude of postoperative pain. However, this method is subjective and depends on how the patients feel this pain, with an important influence of their anxiety status. Surgery stimulates a series of hormonal and metabolic changes that constitute the stress response, which have been determined as objective measurements of postoperative pain. The aim of this study is to correlate the subjective impression of pain, determined by VAS, with routinary biochemical measurements of postop-erative stress markers. Patients and Methods: A prospective observational study was performed. 100 consecutive patients undergoing elective chole-cystectomy for symptomatic gallstones were included. 24 hours after surgery a blood sample was extracted for haematological and biochemical analysis, and the patient was demanded to measure their pain perception with a VAS. Postoperative laboratory data were compared with preoperative ones and the difference was also correlated with VAS values. Results:A direct significant correlation was observed between pain measured by VAS and AST levels(p=0.009;Spearman 0.350) and ALT(p=0.008;Spearman 0.353), while an inverse correlation was determined with High Density Lipoproteins (HDL) lev-els(p=0.031,Spearman-0.319) and transferrin(p=0.008,Spearman-0.575). After determining the differences between pre-and postoperative values, the difference of AST and ALT levels still correlate with the pain measurement determined by VAS(AST: p=0.001;Spearman0.313 and ALT:p=0.001;Spearman0.328). Conclusion:Postoperative pain determined by VAS is directly correlated with AST and ALT levels and inversely correlated with HDL and transferrin ones. These variables may reflect objectively the postoperative pain after laparoscopic cholecystectomy.

The aim of this experiment study was the erythropoietin testing, on rat model and particularly on ischemia reperfusion protocol. The benefit or the non effect of that molecule was studied biochemically on blood alkaline phosphatase (ALP). Material and methods. 40 rats were used of mean weight 247,7 gr. ALP was measured on these time points: on 60 min after reperfusion (groups A and C), and on 120 min after reperfusion (groups B and D), A and B without but C and D with erythropoiet-in administration. Results. Erythropoietin administration decreased non significantly the ALP by 29.6 IU/L [-62.1305 IU/L - 2.930495 IU/L] (P= 0.0733), in accordance also with paired t-test (P=0.0767). Reperfusion time decreased non significantly the ALP by 16.2 IU/L [-49.73238 IU - 17.33238 IU/L] (P= 0.3343), in accordance also with paired t-test (P= 0.1848). Interaction of erythropoietin admin-istration and reperfusion time decreased non significantly the ALP levels by 14.67273 IU/L [-34.57132 IU/L - 5.22587 IU/L] (P= 0.1438). Conclusion. Erythropoietin administration, reperfusion time and their interaction have decreasing but not significant short ? term effects on ALP. Contradictory and also non-significant are the results using the predicted ALP values adjusted for rats weights. It seems that erythropoietin itself exerts a restorating influence on tissues on time, but this action is really much more retarded, as resulted by predicted ALP values, than that was thought.

Background:Retroperitoneal sarcoma represent less than 15 % of all soft-tissue sarcomas. But dedifferentiated retroperitoneal liposarcomas are extremely rare tumor. Case Presentation: A 63-year-old female patient presented with complaints of pain and swelling of the left groin. Physical examination showed a 15 cm, solid, fixed incarcerated mass in left groin hernia sac. CT examination revealed an 18 x 18x 9cm lobular contour mass with fat density from the midline of the left kidney to the vicinity of the uterus. A complete mass excision and hernia repair was performed with polypropilene mesh. Pathological examination of the mass determined that it was a dedifferentiated retroperitoneal liposarcoma Conclusion:Retroperitoneal liposarcomas within an inguinal hernia sac have been reported in only five cases in the English medical journals. It is quite difficult to early diagnose retroperitoneal liposarcoma preoperatively due to the late onset of symptoms. Radical complete resection with a wide resection margin should be performed due to its positive effect on the rate of survival.

Carbohydrate Antigen 19-9 (CA 19-9) is frequently upregulated in cases of pancreatobiliary malignancy. Usually, increased con-centrations of CA 19-9 in a patient with obstructive jaundice indicates pancreatobiliary cancer. Herein we report a rare case of extremely elevated levels of CA 19-9 (10.922 IU/ml) and obstructive jaundice due to cholelithiasis and choledocolithiasis in a 52-year old Caucasian female. After surgical treatment, CA 19-9 concentrations decreased rapidly within normal levels and jaundice was subsided. We also provide a brief review of the literature on this controversial issue. Though rare, the possibility of benign biliary tract disease must be considered in patients with high concentration of CA 19-9.

Intestinal endometriosis has been found in 3%-37% of menstruating women and isolated ileal deposit is very rare (1%-7%). It is an infrequent cause of intestinal obstruction, ranging from 7% to 23% of all cases with intestinal involvement. We report our experience in a lady who presented with recurrent bouts of pain abdomen mimicking appendicitis and was found to have a mass in the right iliac fossa on diagnostic laparoscopy. In spite of conservative management she went on to develop acute intestinal obstruction and underwent emergency laparotomy and limited colonic resection. Histology of the resected spec-imen showed evidence of endometriosis.

An unusual case of elevated factor VIII levels and hyperhomocysteinemia as causative factors for the development of portomes-enteric vein thrombosis concurrently with splenic artery and vein thrombosis in a 76-year-old man is presented. The patient was in his normal state of health until 1 week before his Emergency Department visit when he began to experience generalized ab-dominal pain that got acutely worse over the last hours. He had no overt signs of peritonitis but complained of excruciating ab-dominal pain. A high index of clinical suspicion was raised for mesenteric ischemia. Urgent imaging studies revealed thrombosis in the superior mesenteric and portal veins concurrently with splenic artery and vein thrombosis and splenic infarcts. Additional-ly, the small intestinal wall was depicted thickened with edema of the root of its mesentery, with no however signs of intestinal gangrene, or perforation. The patient was successfully medically treated with low molecular weight heparin, followed by the administration of warfarin in a life-long basis, and pharmaceutical supplementation of folic acid, cobalamin and vitamin B6. He is doing well 4 years after the initial diagnosis.

Mesenteric cysts are rare intra-abdominal tumors with prevalence 1:100.000- 250.000 in hospital admissions. These are commonly located at the ileal mesentery, but they also can be found anywhere at the mesentery from the duodenum to the rectum. A 41-year-old Caucasian woman with vague abdominal discomfort and associated upper abdomen distention, during the last two years, without other symptoms as referred to our outpatient clinic with the diagnosis of liver cyst hydatid. Abdominal computed tomography and magnetic resonance imaging revealed a complicated cystic structure sizing 139x93x68 mm primarily diagnosed as cyst hydatid originating from left lobe inferomedial part of the liver and reaching to gluteal muscle inferomedially. Right subcostal laparotomy was performed. Exploration of abdominal cavity revealed a cystic mass sizing 15 cm localized between stomach, duodenum and transverse colon. Liver was completely normal. The cyst was total extirpation also simple enucleation. Postoperative course was normal and she was discharged at 4th postoperative day. Histopathology of the excised specimen was suggestive of mesenteric cyst.