Thrombophilia is a term used to describe clinical situations characterized by increased blood coagulation properties and it is re-lated with increased risk of venous thromboembolic disease. Genetic background of thrombophilia includes as major factors the deficiencies of Proteins C, S, Antithrombin III as well as the Activated Protein C Resistance and Prothrombin 20210A mutations. As minor but clinically important genetic factors for thrombophilia have been identified the Fibrinogen Gamma Chain, the MTHFR mutations and the presence of non-O blood type. We performed an up-to-date literature review on the topic of thrombophilia genetic research and we report a synopsis of im-portant genetic research data for the daily clinical practice.

Hepatocellular carcinoma (HCC) is the predominant histological type, accounting for 70-85% of total liver cancers. Chronic HBV infec-tion is the most prevalent cause of HCC, following by chronic HCV infection. Despite many treatment options for patients with HCC, the mortality rate remains high making HCC the third leading cause of cancer-related death worldwide. Prognostic algorithms, such as the Barcelona Clinic Liver Cancer (BCLC) classification, have been introduced in routine clinical care. Although current clinical stag-ing systems provide a rough framework of prognostic classification and treatment decision for HCC, identification of prognostic bi-omarkers could further enhance outcome prediction and treatment selection. A high level of C-reactive protein (CRP) at the time of diagnosis predicts poor long-term survival of patients with HCC. The neutrophil:lymphocyte ratio (NLR) is an independent predictor for prognosis in patients with HCC. The elevation of NLR indicates that host immunity remains low. A decrease in the number of CD4? cytotoxic T lymphocytes (CTLs) is closely associated with progressive stages of HCC and poor survival. A high expression level of SALL4, an oncofetal gene, has a worse prognosis in patients with HCC. Future studies, based on large prospective cohorts, are re-quired to validate their prognostic value before they can be translated into clinical use.

Introduction: To retrospectively evaluate accuracy of MSCT for localization of adhesions in patients with small bowel obstruction in reference to surgical findings. Furthermore to evaluate different contrast applications to localize the adhesion. Methods: Between 2006 and 2008, 89 consecutive patients with surgically confirmed adhesive small bowel obstruction under-went abdominal CT and subsequent surgery. Three gastrointestinal radiologists performed blinded, independent and retrospec-tive review of the CT scans. Initial evaluation was performed on axial scans and after 4 weeks delay on axial scans with coronal reformations. To specify the location of an adhesion the abdomen was divided in 6 quadrants. Reference standard for the locali-zation was the surgical finding during operation. Results: Intraoperative results showed adhesions in 52.8% in the pelvis. Second most common in the upper middle part (19.1%). Accuracy of localization in the axial images by three radiologists was 73% and 81.3% when combined axial images with coronal reformations. No significant difference was seen for different contrast media applied. Conclusions: Patients presenting with clear clinical signs of ileus should be treated conservatively whenever possible due to a high in-house mortality when undergoing surgery. In case of surgery, small bowel obstruction is mainly due to adhesions or peri-toneal carcinomatosis and mostly located in the pelvis. Radiological imaging before operation is not always necessary. The be-nefit of MSCT is to exclude other differential diagnosis or complications. If a CT scan is performed, combined axial images with coronal reformations should be preferred and contrast media should be applied orally and intravenously.

Background: Traditionally, management of breast abscess involves incision and drainage; however this is associated with need for general anaesthesia, prolonged healing time, hospitalisation, regular dressing, difficulty in breast feeding, and possible unsatisfac-tory cosmetic outcome. Objectives: To compare aspiration and surgical drainage among abscesses less than 3cms and those larg-er than 3cms in terms of avoiding hospitalization and general anesthesia, allowing lactating women to continue breast feeding, achieving better cosmesis, and causing less discomfort/pain. The study will in addition try to evaluate patients? satisfaction with cosmesis and their perception of pain using the visual analogue scale to rate pain in the clinical setting. Methods and materials: After informed consent patients underwent pre-treatment USG and were assigned to either aspiration or incision and drainage group firstly on the basis of patient?s own preference and with the patient?s consent. The groups were further stratified by size of abscess (<3cms or >3 cms). Depending on ultrasound findings following procedures were followed: 1) Aspiration only -for abscess size up to 3cms- Group I, 2)Incision and drainage- for abscesses up to 3 cms- Group II 3) Aspiration + irrigation with normal saline+ reaspiration with instillation of 1gm cloxacillin -for abscesses over 3cms- Group III. (Skin sensitivity to cloxacillin was tested prior to procedure). 4) Incision and drainage for abscesses over 3cms- Group IV Results: Our study revealed that for abscesses less than or equal to 3cms, US guided aspiration alone was an effective tool, whereas abscesses over 3 cms were treated best with surgical drainage. Analysis showed that larger abscesses are associated with greater pain upon aspiration while VAS scores were lesser for smaller abscesses suggesting that aspiration is better tolerated in smaller abscesses. Duration of hospital stay was significantly more for surgical drainage group.

AIM OF THE STUDY: To determine the relation between sternal fracture and aortic rupture, causes, age groups and alcohol blood levels. METHODS: The population of this study (necrotomic material) includes 530 sternal fractures registered at Medical Examiners (Forensic) Department of Piraeus ?Greece, during the years 1983-2002 (20years), 376 males and 154 females, age from 1-93 years ( m.ag 47,68). RESULTS: Seventy two cases to 530 demonstrated coexistence sternal fracture to aortic rupture (13,58%).The main cause seem to be traffic accidents 80,38%, falls 16,76% and workers accidents 2,86%. These age groups 16-20 (7,5%), 21-25 (9,6%), 26-30 (9,0%), 36-40 (8,3%) και 71-75 (7,9%) demonstrated highest mortality. High alcohol blood levels was found at 153 to 530 cases (28,87%). The male population 133/153(86,93%), outnumber to female 20/153(13,07%). Highest mortality registered at age groups 21-25(50), 26-30(47), 36-40(43) and 71-75(41). The alcohol?s blood levels evidence after age groups 26-30(57,4%), 36- 40(48,8%), 41-45(43,8%) and 86-90(33,3%). The following years registered 1993-48 deaths, 1994-43deaths, 1997-42deaths and 1998-38deaths. CONCLUSIONS: Sternal fracture is strictly related to aortic rupture. The main cause seem to be traffic accidents. The male population (376) outnumber to female (154). Sternal fractures were registered all age groups more frequently at the age groups 21-25, 26-30, 36-40, 71-75 and 16-20. High alcohol blood levels was registered at 28,87% of the necrotomic material.

Σκοπός. To Σύνδρομο Βραχέος Εντέρου (ΣΒΕ) προκαλείται μετά από εκτεταμένη απώλεια της ανατομικής ή/και της λειτουργικής απορροφητικής επιφάνειας του λεπτού εντέρου και χαρακτηρίζεται από δυσαπορρόφηση, διάρροια, διαταραχές υγρών και ηλεκτρολυτών και τελικά υποσιτισμό. Σκοπός της παρούσας εργασίας ήταν να αξιολογήσει τη χρήση του Surgisis (Cook Biotech Inc), ενός ακυτταρικού βιοϋλικού που προέρχεται από τον υποβλεννογόνιο χιτώνα λεπτού εντέρου χοίρου και που έχει ήδη χρησιμοποιηθεί στην ιστομηχανική, ως ένα ικρίωμα για την αναγέννηση του λεπτού εντέρου σε ένα πειραματικό μοντέλο επι-μύων. Υλικό και μέθοδος. Χρησιμοποιήθηκαν 18 αλφικοί επίμυες, τύπου Wistar, στους οποίους τοποθετήθηκε κυλινδρικό μόσχευμα από Surgisis μήκους 2 cm, σε απομονωμένη έλικα ειλεού. Τα πειραματόζωα χωρίστηκαν σε 3 ομάδες (Ι, ΙΙ, ΙΙΙ) των έξι, θυσιά-στηκαν αντίστοιχα στις 8, 12 και 16 εβδομάδες μετεγχειρητικά και εξετάστηκαν μακροσκοπικά και ιστολογικά, προκειμένου να προσδιοριστεί ο βαθμός ανάπτυξης νέου εντερικού τοιχώματος στο μόσχευμα. Αποτελέσματα. Πέντε πειραματόζωα (1 στην ομάδα ΙΙ και από 2 στις ομάδες Ι και ΙΙΙ), απεβίωσαν λόγω χειρουργικών επιπλο-κών. Η κύρια αιτία θανάτου ήταν η περιτονίτιδα, είτε λόγω διαφυγής από την αναστόμωση, είτε λόγω ισχαιμικής νέκρωσης της απομονωμένης έλικας. Η μακροσκοπική εξέταση δεν έδειξε ούτε στένωση, ούτε συμφύσεις στην περιοχή γύρω από το μόσχευ-μα. Ιστολογικά, από την 8η εβδομάδα, τα μοσχεύματα καλύφθηκαν από πλήρη εντερικό βλεννογόνο με καλυκοειδή και απορ-ροφητικά κύτταρα, λάχνες και κρύπτες. Συμπεράσματα. Τα αποτελέσματα αυτά, αποδεικνύουν ότι το Surgisis μπορεί να φανεί χρήσιμο στην αύξηση της βλεννογονικής επιφάνειας του εντέρου και να αποτελέσει μια εναλλακτική λύση στην μελλοντική θεραπεία του Συνδρόμου Βραχέος Εντέρου

Background: This study was conducted to determine postoperative(PO) pain control with use of bupivacaine-soaked sheet of ROC in the gallbladder bed and compared with port-site infiltration of bupivacaine after Laparoscopic Chole-cystectomy(LC). Methods: Total 60 pateints were divided in three groups. In Group A(n=23) Bupivacaine-soaked ROC was positioned in the Gallbladder bed. In Group B(n=18)Bupivacaine was infiltrated in trocars site before skin suturing. &Group C(n=19) was control group. Nature of pain either visceral, parietal or shoulder was assessed on VAS at 3, 6 & 24 hrs after surgery. Results: All patients (100%) demonstrated different intensities of visceral and parietal pain in all group. None of the patients had shoulder pain. Visceral pain was significantly less in group A as compare to group B & C (p <0.05). Vis-ceral Pain score for group A at 3,6 & 24Hrs assessment was 15.41% , 15.13% & 15.74% which was significantly less than group B (31.69%, 32.03% & 29.44%) & group C (47.63%, 47.66% & 50.53%). Parietal pain score for group B at 3, 6 & 24hrs assessment was 17.39%,13.81% & 15.56% ,which was less than group A(24.76%,28.30%&25.65%) & group C(47.63%,47.66% & 49.37%)(p<0.05). In Group A 8 patients (35%) required postoperative analgesics within 10 hrs in postoperative period, while in Group B 10 patients (56%) and Group C 19 patients (100%) required postoperative analgesic within 8 hrs in postoperative period. Conclusion:Bupivacaine with ROC in the Gallbladder bed is safe, technically simple, increases postoperative comfort and decreases postoperative analgesic requirement after LC as compare to trocar site infiltration.

Τα πρωτοπαθή σαρκώματα του γαστρεντερικού σωλήνα με κύριο εκπρόσωπο τους το λειομυοσάρκωμα, είναι σπάνιοι όγκοι (1-2% όλων των κακοήθων όγκων του πεπτικού), που εκδηλώνονται κυρίως με άτυπη συμπτωματολογία. Παρουσιάζεται η περί-πτωση ασθενούς της 7ης δεκαετίας της ζωής με ειλεο-ειλεεϊκό εγκολεασμό, λόγω της παρουσίας λειομυοσαρκώματος στην τελική μοίρα του ειλεού.

Background: Differential diagnosis of hepatic lesions, including hepatocellular carcinoma can be usually made by imaging, even in the emergency setting. The evolving techniques of endovascular management and embolization can be very useful for the conservative treatment of acute events in some patients, otherwise unfit for surgery. Case presentation: An 84-year-old lady presented with abdominal pain and hemorrhagic shock. After stabilization, an abdominal Computed Tomography was performed, showing active arterial bleeding from a liver nodule. Selective arterial embolization achieved control of the bleeding. After completing investigations the diagnosis of liver cirrhosis, chronic hepatitis C and hepato-cellular carcinoma was confirmed. She recovered completely after conservative treatment, and remains alive 1 year after the acute event. Conclusion: Selective arterial embolization is a safe and effective technique for the control of hemorrhagic lesions of the liver. It can avoid surgery in high risk patients and improve survival.

Background. Brunner?s gland hamartoma is infrequently encountered polypoidal lesion of the duodenum. It is an unusual cause of upper gastrointestinal hemorrhage. Most symptomatic cases present with occult hemorrhage or features of gastric outlet obstruc-tion. Massive upper gastrointestinal hemorrhage is rarely reported in the English literature Case presentation. We report two cases of Brunner?s gland hamartoma of the duodenum who presented with overt upper gastroin-testinal bleeding requiring more than two units of blood transfusion. In the first case, esophagogastroduodenoscopy revealed a large polypoidal lesion at the second part of the duodenum and in the second case polypoidal lesion was found in the first part of the du-odenum. There was no ulcer or bleeding at the time of upper GI endoscopy. Endoscopic polypectomy failed in both cases due to broad base of the lesion. Both cases were managed by open surgical excision. Histological examination of both polyps revealed Brunner?s gland hamartoma arising from the submucosa of the duodenum. Both the patients had an uneventful recovery and well at 60-month and 40-month follow-up respectively. Conclusion. Brunner?s gland hamartoma should be considered in the differential diagnosis of all polypoidal lesions of the duodenum. All symptomatic lesions and lesion larger than 2 cm should be removed either by endoscopy or by surgery

Peptic ulcer defines focal defects of submucosal tissue that might be seen in stomach but more frequently in duodenum. Increased secretion of acid is the main reason of duodenal ulc ers while decreased defensive mechanism lies under the formation of gastric ulcers. Nonsteroidal anti - inflammatory drugs (NSAID) and Helicobacter Pylori infection are the most important factors leading to peptic ulcer. In this study, we presented a case of a 74 year old female patient who was admitted by internal medicine clinic due to pneumonia and new onset resistance to an antihypertensive medication of amlod ipine besylate ( Norvasc R 5 mg ,Pfizer ). Gastric ulcer and a bolus of pills; which were accumulated in the base of that ulcer, were detected during esophagogastroduodenoscopy that was performed for epigastric pain and anemia. This case was presented to demonstrate that; in patients with peptic ulcer who were also receiving oral medications due to other diseases, probability of adherence to ulcer base may cause failure of oral treatment.