News

15.12.15
Interventional Oncology: The rapidly evolving specialization in cancer therapy

Written by Dedes Ioannis MD, PhD, Interventional Radiologist - Interventional Oncologist, Interventional Radiology Department,  European Interbalkan Medical Center, Athens Medical Group

Why is interventional oncology the rapidly evolving specialization in cancer treatment? The results of 15 years of experience in the management of cases at the Department of Digital Angiography of the Interbalkan Medical Center of Thessaloniki, are presented by its head Dr. John Dedes, member of the Cardiovascular and Interventional Radiology Society of Europe (CIRSE) specialized in Interventional Radiology-Interventional Oncology (Frankfurt University Clinic) and a post-graduate (Germany, Great Britain, USA). His article:

“Interventional Oncology (IO) provides via minimally invasive methods targeted therapy of a cancer tumor, with the assistance of guided imagery and innovative techniques, thus minimizing the possibility of injury to healthy organs. Generally, it offers assistance to patients who can not have surgery either because of their compromised clinical condition, or because the size, location or tumor number (tumor foci) does not allow it. Also it gives prospect in patients where standard chemotherapy doe not have the desired effect.

Treatments are performed in two ways:

A) Intra-Arterial: By use of a microcatheter on the digital angiogram, chemotherapeutic drugs are effused directly into the tumor in high concentrations and embolism (obstruction with microspheres) of the arteries that supply blood to the tumor is performed, leading gradually to the shrinkage and necrosis of the tumor. It is usually regional (eg. intra-arterial chemoembolization of the liver).

B) Transdermal: With the patient on the CT, a thin needle electrode is positioned in the tumor. This caused overheating (burning 60-100 C) of the tumor within a few minutes (e.g. cauterization with radio frequency (RF) or microwaves (MW) of foci in the liver, lungs, kidneys).

Thus IO treatments are applied in the treatment of unresectable primary tumors of the liver (hepatocellular cancer, cholangiocarcinoma), lung (non small cell) or secondary tumors (liver and lung metastases) from other primary cancers such as colon, stomach, lung, kidney, ovarian, melanoma, sarcoma, neuroendocrine tumors, breast and others, where conventional treatments do not have the desired response. They are always done with the consent of the treating oncologist.

Also drainage and angioplasty of cholangioma offer significant aid in patients with obstructive jaundice. IO advantages include a good quality of life offered to patients with minimal intervention, less pain, fewer side effects and quick recovery. It contributes to increased life expectancy, while most treatments require one day of hospitalization

In several patients combination therapies are applied with chemoembolization and cauterization having spectacular results, as I announced in my speech at the world congress of (IO) in New York in May (WCIO 2015). Some patients with non-invasive hepatocellular carcinoma and a life expectancy of a few months, today surpass a survival of 10 years with a good quality of life.

06.12.15
Myasthenia Gravis (MG): The Role of Surgery

Written by Dahabreh Jubrail MD,PhD Thoracic Surgeon, Director of Thoracic Surgery Department, Athens Medical Center

The term Myasthenia Gravis concerns an autoimmune disease of the nervous tissue, resulting in weakness and fatigue of muscles and it has an incidence on the population of 2,5 to 20 cases per 100.000 people per year.

Women are affected more often in the 2nd - 3rd decades of life, while men in the 6th decade of life. Myasthenia is not inherited under the laws of Mendel, but members of a family with a myasthenic person are 1000 times more likely to develop myasthenia, compared to the general population.

Cause

The appearance of symptoms of myasthenia are attributed to impaired function of the neuromuscular junction, that is the point of transfer of the neuromuscular stimulation and this is attributable to the occupation of acetylcholine receptors by autoimmune antibodies. Acetylcholine is the substance that causes muscle contraction. The amount of acetylcholine secretion is normal, while the number of receptors is reduced and in addition these receptors are occupied by autoimmune antibodies. 12%-17% of patients with general myasthenia do not have antibodies against acetylcholine receptors.

Symptoms

The most common symptoms are blepharoptosis and diplopia, difficulty in chewing, swallowing and speech articulation. A percentage of 10% have weakness of the lower extremities. Muscle weakness is mild in the morning, with progressive deterioration throughout the day. Also, opthalmic symptoms worsen while reading, when watching television for many hours and while driving in direct sunlight.

Value of the Thymus gland in Myasthenia

The relationship of the thymus with myasthenia has been known for many year,s without being completely clarified yet. 10% -20% of patients with MG have a thymus tumor, 20% -30% of patients have myasthenia and 70% of patients have hyperplasia of the thymus gland. Anatomically, the thymus gland is located in the upper anterior mediastinum and during adulthood, it regresses is completely replaced by fat. Islets of thymic tissue are found scattered within the pro-pericardial fat at a percentage of 72%, while in the anterior cervical region this percentage reaches 32%. This knowledge is crucial in deciding the surgical technique to be applied in the case of thymectomy and this is directly related to the effectiveness of thymectomy.

Treatment of Myasthenia Gravis

Treatment of MG includes administration of drugs against acetylcholinesterases, administration of immunosuppressive drugs, plasmapheresis, administration of immunoglobulin, administration of new drugs and thymectomy. The goals of treatment are individualized, taking into account the severity of the disease, the patient's age, the incidence of the disease in daily activity as well as the likelihood and degree of compliance with treatment. Patients with myasthenia, without a tumor or hyperplasia of the thymus gland, are a special category of patients and thymectomy in these patients is indicated under certain conditions. According to the American Academy of Neurology, thymectomy in patients without thymoma is proposed as an option, with the aim to increase the possibility of complete remission of symptoms or improvement thereof.

Thymectomy

The thymectomy is performed at centers specialized in the treatment of myasthenia. According to the classification of the Myasthenia Gravis Foundation of America, the best prognostic factors, for thymectomy are myasthenia gravis and the short duration of the occurence of the disease before thymectomy. A patient with Myasthenia undergoing thymectomy doubles the probability of achieving remission of the disease without the use of medication, has 1,6 times the possibility of being asymptomatic and 1,7 times the possibility of improving his symptoms.

There are several studies supporting the efficacy of thymectomy in pure opthalmic myasthenia and thymectomy has the major advantage of providing rapid and sustained remission of symptoms, often without the need for administration of drugs.

Surgical techniques

The surgical techniques of thymectomy are transcervical, intrasternal, thoracoscopic and robotic techniques. Today, there is an increased use of minimally invasive surgical techniques, as these have fewer complications, less pain and a lower probability of causing a myasthenic crisis. Moreover, these techniques have better cosmetic results and a shorter duration of hospitalization.

Thymectomy is contraindicated in patients who are negative for antibodies to acetylcholine receptors and at the same time do not have a thymus tumor and hyperplasia of the thymus. Likewise, it is contraindicated in any patient where the extent of penetration is such that it makes the tumor unresectable and when there is unresectable metastatic disease. Finally, it is not indicated as the first treatment of myasthenic crisis.

Myasthenia and pregnancy

The evolution of myasthenia during pregnancy is unpredictable. 11% of myasthenic pregnancies present a remission of symptoms, 39% present elation while 50% have unchanged symptoms. The percentage of newborns exhibiting transient myasthenia reaches 21%.

Results of thymectomy

The recent study of the Mount Sinai hospital of New York, announced at the American Annual Congress of Thoracic Surgery in April 2015, included 1.000 patients, where 19% presented a complete remission of symptoms for at least a year after thymectomy, 58% had a stable clinical condition, while 7% of the patients noted deterioration of the disease. In view of the international data, transcervical and alternative thoracoscopy, robotics or intrasternal thymectomy are recommended for patients with myasthenia without thymoma or with thymoma of up to 3,5 cm. In myasthenia with thymoma> 3,5 cm and less than 5 cm, robotics or thoracoscopy and alternative intrasternal thymectomy are recommended. Finally, when there is a sizable thymoma or thymic carcinoma with penetration of adjacent tissues with or without myasthenia intrasternal thymectomy is proposed.

The role of thymectomy is especially significant in the treatment of myasthenia, even when it concerns myasthenia without existence of a thymoma. Thymectomy holds a position in the treatment of opthalmic myasthenia and is indicated in the treatment of myasthenia after recurrence of symptoms. The progress of science will lead to improvement of the quality of life of patients with MG and reduce the need for thymectomy.

03.12.15
The first surgery to treat atrial fibrillation with the newest third generation cryoablation system from Athens Heart Center of Athens Medical Center

Last November, the interventional electrophysiologists,Dimitrios Tsiachris and Sotiria Stambola performed the first successful surgeries in Greece for the treatment of atrial fibrillation with the novel cryoablation system of 3th generation in the special unit of Atrial Fibrillation of the Athens Heart Center in the Athens Medical Center.

Atrial fibrillation is an abnormality in heart rate and the most often reported heart arrhythmia, whereas chronic atrial fibrillation may result in heart failure and stroke. In Greece, patients are estimated at 100,000. In this context, the Atrial Fibrillation Unit of Athens Heart Center, the first standard unit in Greece, aims at the holistic management of the disease, covering the entire range of pharmaceutical and interventional methods.

Thanks to the new cryoablation technology of pulmonary veins, the operations carried out at the Athens Medical Center have very good results, they are safer and shorter. Patients stay in the hospital overnight and return home the next day and the day after to their work. Indicatively, it is noted that the success of these operations exceeds 80%.

Ablation of atrial fibrillation is performed when drugs fail, and in some cases are even the first treatment option, particularly in young patients.

"In Atrial Fibrillation Unit, patients can undergo these procedures are selected based on the appropriate initial laboratory examinations. The sooner we operate, the more efficient ablation of the disease. “Especially in young patients, we can provide a complete cure,"says Dimitrios Tsiachris, Director of the Laboratory of Electrophysiology and Pacing of Athens Heart Center in Athens Medical Center and Instructor of these contemporary interventions in Greece and internationally.

26.11.15
Athens Medical Centre: Total hip arthroplasty revision with a minimally invasive technique

Significant number of successful operations with the ASI technique

The Large Joints of Athens Medical Centre, with Director Mr. Ioannis Tsarouchas has successfully performed a significant number of problematic total hip arthroplasty revisions, through the minimally invasive ASI (Anterior Supine Intermuscular) technique. Patients undergoing this surgery ascertain the multi-annual smooth functioning of their prosthesis and maintain a high quality of life.

Total hip arthroplasty is one of the most successful surgical operations in orthopaedics. However, a significant number of patients undergoing revision (second surgery/ reoperation) because of mechanical problems (loosening or wear of the prosthesis, misplacement), microbial infection or fracture near the prosthesis. In several of these patients, the revision many not lead to the desired results, and thus it will be required to undergo a revision surgery for the second, third, or even fourth time. It should be noted that hip revision surgeries require large incisions, severe injuries of soft tissues and significant blood loss, while they are accompanied by increased rate of complications as compared to the initial operation.

The innovative ASI method is the most modern minimally invasive method, and it is used with great success in cases where the revision of the acetabular component is necessary. Some of the key advantages of the ASI method include minimisation of postoperative dislocations risk, elimination of postoperative leg length discrepancies risk, as well as access to the old prosthesis, and the placement and orientation of the new with greater ease and reliability. At the same time, recovery time is reduced, and complications accompanying the long recovery period following extensive access to the hip are avoided, while no transfusion is required.

“Athens Medical Centre performs with great success the innovative ASI technique also in revision cases, sparing patients from postoperative discomfort. In this context, we have achieved impressive patient recovery, demonstrating in practice the commitment of the Athens Medical Group to constantly stand one step ahead” said Mr. Ioannis Tsarouchas, Director of Large Joints Clinic of Athens Medical Centre.

17.11.15
Athens Medical Centre: Robotic treatment of genital prolapse

Athens, November 17, 2015 - The Urologic Department of the Athens Medical Centre performs with great success the specialised laparoscopic and robotic method with the “daVinci” system for the treatment of genital prolapse in women. To date, more than 120 cases have been successfully treated at Athens Medical Centre - a figure that is a milestone for minimally invasive urology.

This is a particularly successful technique, combining open surgery’s effectiveness with the benefits of a minimally invasive method. It repairs all 3 types of prolapse (cystocele, uterine prolapse, rectocele), achieving the positioning of multiple sutures to support the mesh through the fully coordinated, accurate and stable movements of the robotic arm.

The procedure is short, as only 1- 2 days of hospitalisation are required, while the advantages include mimimal blood loss, limited postoperative pain, minimal recurrences with better preservation of the outcome over time as compared to other techniques from the sinus, zero rates of mesh infection and rejection, and preservation of good and healthy sex life.

“Over 50% of women who have had children show some degree of prolapse. Indeed, more than 200,000 prolapse operations are performed annually, while the possibility of prolapse and incontinence to occur in a woman-mother in her life reaches 11.1%.  The extensive experience of the urology team of Athens Medical Centre during the past 8 years makes it one of the leading ones in Europe, while it has benn officially recognised by the European Association of Urology”, stated the Director of Minimally Invasive Urologic Surgery Department of the Athens Medical Centre, Mr. George Kyriakou.

15.11.15
The most effective weapon in early diagnosis of breast cancer: Preventive Ultra-fast MRI Mammography

Written by Bondozoglou Nikolaos MD,PhD, Radiologist, Clinical Director of CT, MRI, PET/CT Department,  Athens Medical Center , Athens Medical Group

The Need for Better Presymptomatic Screening of the Breasts

Modern medicine requires individualized treatment, beyond therapy, both in the diagnosis and in the prevention of breast cancer. The treatment of breast cancer is determined by the individuality of each person and especially the degree of risk of that person for a specific disease. However, with regards to the early diagnosis of breast cancer, all women are treated to date in the same way: regular screening with mammography and ultrasound. The only thing that varies is the recommendation for the start and regularity of preventative screening for breast cancer. Although the benefit of mammography is proven, breast cancer remains the leading cause of cancer death in woman, and generally the first cause of death in women aged up to 50 years.

For this reason in recent years a public discussion has begun on the actual value of the method of early diagnosis of breast cancer. Although most experts agree that primarily mammography and to a lesser extent ultrasound saves lives from breast cancer, they do acknowledge the disadvantages of these tests. That they lose, that is, a significant number of early-stage cancers and lead some women to unnecessary treatments.

The Meaning of “Dense breast” in Mammography

The main reason why detection of an early cancer in mammography may be missed is the so-called dense breast. In mammography, dense breast appears as diffuse white. The tumor is also white, so it is difficult to detect.

In the US, at least 21 States apply today a specific law (Breast Density Notification Law), which states that women with dense breasts should be informed in writing of the reduced value of mammography and discuss with their doctor the benefits of a complementary examination for detection of breast cancer.

It is note that dense breast has no relation to the appearance or feel of the breast but is discovered only by specialists in mammography. It is important that women know the density of their breasts. In women with dense breasts, mammography may miss early-stage cancers. This is also evidenced by the fact that the highest percentage of cancers not detected in mammography are found in women aged 40-50 years, in whom dense breasts prevail. This category includes women that must be screened preventively for breast cancer, before undergoing IVF.

High Risk Groups for Breast Cancer

There are however other groups of women, for which existing traditional mammography and ultrasound screening do not suffice. This concerns women of high-risk for breast cancer based on family history or the presence of genes predisposed to the development of the disease. These women in particular should begin preventive screening earlier, since it has been established that breast cancer affects them earlier. Since 2009, it is recommended that screening of these women be supplemented with an annual MRI mammography, but in practice this is done only in a small number of women.

Another high risk group for breast cancer are women with breast prosthesis. The prostheses hide parts of the mammary gland on mammograms, leading to loss of significant pathologies through the application of conventional tests. However, these women may be also be effectively screened with MRI mammography.

Preventive Ultra-fast MRI Mammography

Today, a new application of MRI, preventive Ultra-fast MRI Mammography, aims to change the current preventive practice as it appears to be the test of maximum sensitivity in the early detection of breast cancer.

Aiming at the broader application of MRI mammography in the pre-symptomatic screening of breast cancer, in recent years Ultra-fast MRI Mammography has been tested, proposed and its application begun. Compared with mammography, with Preventive Ultra-fast MRI Mammography the detection of breast cancer is not based only on anatomical, but mainly on functional characteristics, and is not affected by the presence of dense breast. This results in the increased capacity of the detection of breast cancer and particularly in the early stages.

A publication in the Journal of Clinical Oncology, in 2014, showed that if 1000 women of moderate or slightly increased risk with a normal mammography and ultrasound of the breasts, are subjected to preventive Ultra-fast MRI Mammography 18 incipient, clinically significant breast cancers will be detected. If this additional preventive Ultra-fast MRI Mammography screening was not done the cancer would be detected later and probably in a more advanced stage.

A recent publication in the European Journal of Radiology, 2015, also showed significant sensitivity of detection of breast cancer with preventive Ultra-fast MRI Mammography. In the MRI department of the Athens Medical Centre we studied the effectiveness of this new Preventive Ultra-fast MRI Mammography examination, compared with conventional MRI mammography, in 100 women. The results were impressive as we proved that the Ultra-fast MRI Mammography examination detects breast cancer with the utmost sensitivity and there is consensus of the diagnosis between experienced specialists. Our results were announced at the 2015 European Congress of Radiology held in Vienna.

Bearing in mind our experience and the to date published data, we developed an examination that lasts for a few minutes, containing the sequences that detect breast cancer with the greatest sensitivity, but also limit recommendations for unnecessary biopsies.

Compared to conventional mammography, which is time consuming - it lasts for about half an hour - and requires, after it is done, analysis of hundreds of images by specialists, Preventive Ultra-fast MRI Mammography contains those sequences that detect breast cancer with maximum sensitivity in only three minutes. Essentially, we shorten the examination taking only the most important images that international experience has shown can reveal the image of breast cancer. Necessary, of course, conditions for the successful application of the new Preventive Ultra-fast MRI Mammography examination is the use of the latest MRI technology and, especially, medical experience in the field of MRI mammography.

Important advantages of Preventive Ultra-fast MRI Mammography is that it detects twice as many cancers compared to other tests, detecting breast cancer in the early stages, has no radiation, does not cause the unpleasant feeling of the pressure on the breasts, as is the case with classical mammography, while the huge reduction in examination time results in a significant reduction to its cost, which is at a similar level to other breast examinations.

In conclusion, Preventive Ultra-fast MRI Mammography has a much higher sensitivity of detection of breast cancer compared with other tests. The time and cost of Preventive Ultra-fast MRI Mammography is now at levels that allow for wider application. Preventive Ultra-fast MRI Mammography is the best complement to mammography in women with dense breasts, in woman with moderate and high-risk for breast cancer and in women with implants, while it is an examination of choice in younger women.

We can therefore say that we now have in our hands a new weapon to overcome the disadvantages of the past of regular monitoring for the treatment of breast cancer.

12.11.15
Total Hip Arthroplasty Revision

Writen by Vasileios Kon. Bitounis, MD Bristol, PhD, FRCS Ed Director Orthopaedic Surgeon at Athens Medical Centre

Total hip arthroplasty, as described and defined by the famous Professor of the University of Bristol, Iain Learmonth, was and is the 20th century’s surgery.

Forty years of research, technology and surgical experience by orthopaedics have made total hip arthroplasty safe, with excellent results and reduced complications. This has led surgeons to use total hip arthroplasty in younger and younger patients, resulting in the need for much longer lasting results for the patient and thus an increase in the number of arthroplasties that progressively fail and require revision.

Figure 1A: Significant bone destruction and dislocation of the LEFT hip (neglected case).
Figure 1B: Repair using the method of impaction grafting use of special cages with excellent repair.

Today, there are many different views on the way hip arthroplasty should be performed, with the interest mainly focused on access. Since all substantial questions have been answered. However, this is not an advancement, but rather it could be a possible cause of premature arthroplasty failure, and patients should be aware of this, as demonstrated by arthroplasty registration centres.

Figure 2A: Managed through the placement of a special femoral stem.
Picture 2B: Anatomic restoration

Hip arthroplasty revision is performed in cases where either arthroplasty shows early complications, such as dislocation and early loosening, or in cases of wear of arthroplasty materials, which in turn damages the underlying bone, and leads to prosthesis failure.

Hip arthroplasty revision may include either full prosthesis replacement or part thereof, while at the same time bone substratum preservation and improvement are attempted.

Therefore, this arthroplasty revision is a much greater surgical operation as compared to the initial arthroplasty. Arthroplasty revision requires great experience and it cannot be performed using the... cookbook method, i.e. “wait and see”.

The main problem in modern arthroplasty is the deterioration of the bone, which grows around the implants. The main priority of arthroplasty revision is to preserve the bone substratum, aiming simultaneously to preserve joint function and to achieve a result that will last for many years.

Figure 3: A case in which impaction grafts were used both in the acetabulum and the femoral, and using a special custom acetabular prosthesis.​

The first factor of arthroplasty’s success is the accurate identification of the problem and the successful planning of the surgical operation.

This detailed preoperative study, often considered an academic exercise, in fact guides proper operation and facilitates the rational design of arthroplasty. Of course, surgeons should remember that hip injuries are always greater than those seen in X-rays.

The choice of the technique and materials to be used for hip arthroplasty should always depend on the patient's age, activity, and of course his expectations. But the decisive factor for successful joint arthroplasty is the underlying bone substratum, and the continuous need to use a bone graft.

This bone substratum strengthening technique was the main project of the signatory and it is called the technique of impaction grafting. The bone substratum strengthening technique was first used in the Netherlands by Bob Slouf, and perfected at the University of Bristol by Professor Ian Learmonth and the signer.

The aim of the method is the creation of bone substratum, which first allows arthroplasty’s revision when other methods have failed, and secondly it creates the conditions for performing further surgical operations, if required. ​

11.11.15
Pioneering minimally invasive discectomy of the Spine

The innovative, painless and bloodless technique of Transforaminal Discectomy (TESSYS)  for the treatment of an intervertebral herniated disk in the lumbar region of the spine, was presented at a two day training workshop for Greek and foreign Doctors from Romania, Bulgaria, Italy and Austria, at the Interbalkan Medical Center of Thessaloniki.

The Hospital, has been selected as a Reference and Training Center in Southeastern Europe, for the method of minimally invasive transforaminal discectomy by the parent company of endoscopic systems Joimax (Germany) and by Endofusion, it’s affiliate in Greece.

The results of the method were presented for the first time, with live transmission of the surgery which was performed by the certified Orthopaedic, partner of the Interbalkan Medical Center, Dr. Stelios Kapetanakis. During the two day workshop the anatomical and radiological approach of the TESSYS method and issues such as technical and technological support, advantages and disadvantages of the method, physiotherapy treatment, etc. were discussed. Also, Greek and foreign speakers presented their innovations in minimally invasive orthopedic surgery.

As emphasized by Dr. Stelios Kapetanakis, the technique TESSYS has been performed internationally in recent years, with great success. The Interbalkan Medical Center have already treated approximately 100 cases. The operation is performed in the operating theater with an excision of only 8 mm, under local anesthesia and monitored sedation, lasts about 30 minutes, while the patient is ambulant one hour after, and can leave the clinic the same day or the next day.  The surgery can be performed in all age groups, in patients that did not respond previously to conservative treatment methods. “Patients adjusts very quickly to their usual activities, which is very important. It is an economical, innovative, fast, non-invasive and painless method”, said Dr. Kapetanakis.

The work of conference was welcomed by the president of the Medical Association of Thessaloniki, Dr. Athanasios Exadaktylos, stating, among others: “Modern medicine means, doctors of a high standard and equipment of a high standard. Today, the private Health sector is much more efficient, faster and more economical than the public health sector. All the same, the non productive sector of ​​health can become productive.”

The scientific conference was held under the auspices of the Orthopaedic and Traumatology Association of Macedonia - Thrace. 

10.11.15
Innovative Bypass surgery in beating heart at Athens Medical Centre

A large number of successful operations has been already carried out one year after the opening of the Cardiac Surgery Clinic and Beating- Heart Surgery Center in Athens Medical Center, among these more than 120 mere coronary bypass surgeries. The clinic operates as a standard center, under the direction of the cardiothoracic surgeon Mr. Vasilios N. Kotsi, MD, where all heart surgical operations are performed with particular emphasis in beating-heart coronary artery surgery (bypass). At international level, these operations are carried out only by specialized cardiothoracic surgeons and at selected centers.

The specificity of this technique is that the use of extracorporeal circulation device (device simulating the heart and lungs) is prevented and the complications arising from its use. This means that the continuous function of the heart and lungs is kept, similarly to any other non-cardiac surgery. Advanced technological mechanisms stabilize parts of the heart,enabling the surgeon to operate, while the rest heart is still beating. In addition, special attention is given to the use of arterial grafts, which, according to the latest studies, provide better long-term outcomes. The grafts of choice, especially for the reperfusion of the left heart vascular network are the two pedicled mammary arteries and the radial artery. 

With this technique high- risk patients, such as diabetics renal patients, patients older than 75 years with atheromatous aorta, with left ventricular dysfunction, chronic obstructive pulmonary disease, with peripheral vascular disease, women and those on antiplatelet treatment after an acute coronary event, those who do not accept blood for religious reasons or require reoperation (Redo).

The results of operations, with this technique in Athens Medical Center, is comparable and in some cases better than the results of the respective large centers abroad. Patients who undergo the specific procedures remain six days in the hospital in total, ie 2-3 days less compared to international standards. Patients are electronically monitored using Telemetry, i.e with small portable devices with continuous electronic recording of ECG, arrhythmias, beats and oxygenation whether the patient is in decubitus or in move.

It should be noted that so far the results have not shown major complications such as myocardial infarction, respiratory infections, surgical wound infections and strokes, while internationally, the complication rate is 3-6%. On average, it has reduced the blood transfusion in less than one unit per patient, while the mortality rate was 1% and was due to non-cardiac causes, while abroad this figure ranges between 1.5% and 3%.

"The well-trained staff, the modern facilities of Athens Medical Center in the operating rooms , the intensive care unit and on the floor, with continuous telemetry and patient monitoring, ensure that there will be continuity in the excellent results of beating-heart surgery center" said Mr. Vasilios N. Kotsis, Director of Cardiothoracic Surgery Clinic of Beating-Heart Surgery Center.

30.10.15
Successful sex reassignment surgery at the Interbalkan Medical Center

Sex reassignment surgery, was performed at the Interbalkan Medical Center of Thessaloniki, with great success. A young 24 year old man, with confirmed sex disorder at an early age, underwent feminization surgery.

The surgery was performed by team of specialized and experienced surgeons, lasted 5 hours and included orchiectomy, penectomy, vaginoplasty, clitoroplasty, labiaplasty.

According to the plastic surgeon Dr. Prodromos Papaioannou, “the advantages of the surgical procedure followed are that, the range is anatomically perfect, there is a sense of the clitoris and possibility of an orgasm, while potential complications are limited (eg.: prevention of urethral stricture, good perfusion of flaps)" .

Before final sex reassignment surgery, feminization of the face of the young person was performed, where a brow lift was combined with a reduction of the forehead bone, reduction of the chin, reduction of the angle of the jaw and rhinoplasty.

The sex reassignment surgery at the Interbalkan Medical Center, was performed in accordance with the guidelines of the World Health Organization for transgender health and in full harmonization with Greek legislation. The religious application of international protocols is necessary, so as to protect individuals interested in reassignment of sex or reassignment of secondary sex characteristics. It strengthens the cooperation of doctors with different specializations, that can provide comprehensive health management. 

26.09.15
Non-Surgical Invasive treatment of Aortic valvular disease: Everything you want to know about the Transcatheter Aortic Valve Replacement

Written by George I. Papaioannou, MD, MPH, FACC, FSCAI Director of Interventional Cardiology, Catheterization Laboratory, Athens Medical Center

What severe stenosis of the aortic valve is

The aortic valve allows smooth passage of the oxygenated blood from the heart to the circulation of the whole body. Normally, the passage is made effortlessly with the contraction of the heart, while the closure of the valve prevents the retrograde flow of blood to the heart. Severe aortic valve stenosis occurs when, for various reasons, the aortic valve can not open and close properly. This causes a "thickening" of the heart muscle in order to "push" the blood in the circulation, and over time the "thinning" of the heart.Causes of aortic valve stenosis

Severe aortic valve typically correlates with the age and the deposition of calcium in the valve or in the annulus. Other causes are the history of rheumatic fever at an early age, congenital valve defect, previous chest radiation to the chest, medicines, rare metabolic or autoimmune diseases, hereditary hypercholesterolemia, end-stage renal failure.

Symptoms of severe aortic valve stenosis

The symptoms of severe aortic stenosis are associated with the inability of the heart to pump blood to the coronary vessels and the circulation, especially in cases of increased requirements such as in some physical effort.

These are:

·       Chest pain (angina)

·       Dizziness, feeling faint or fainting

·       Dyspnea

·       Palpitations

·       Weakness and fatigue

Incidence of aortic valve stenosis in population

Epidemiological studies have shown that the incidence of aortic stenosis increases with age. At the age of 75 years or more, one in eight people have moderate or severe aortic stenosis, and 4% of the population suffers from symptoms due to severe aortic stenosis. Especially as life expectancy increases, the incidence of the disease increases too. This is a major and growing public health problem.

When the aortic valve stenosis should be treated

Aortic valve stenosis is progressive and life threatening. Once the symptoms of heart failure occur, shortness of breath, chest pain or fainting, the life expectancy is reduced dramatically. Essentially, with the onset of symptoms, and if there is no treatment, one in two patients lives for two years and only one in five for five years.

Management of aortic valve stenosis

There is no drug therapy to reverse or slow the progression of aortic stenosis. Surgical aortic valve replacement is the treatment of choice today for its treatment. However, several patients either due to age or due to other medical conditions, are at high to prohibitive risk (usually higher than 20%) to surgical treatment. These patients can be treated with an alternative method: Transcatheter Aortic Valve Replacement (TAVI or TAVR).

What Transcatheter Aortic Valve Replacement (TAVI or TAVR) is

This is a surgery where the new tissue valve replaces the old one through a catheter (tube) via the femoral artery or the subclavian artery. The valve consists of a biological material attached to a stent made of steel. During valve implantation the stent is deployed in the wall between the heart and aorta. The new valve, attached onto the stent, is placed over the old one, which is compressed, allowing the normal passage of blood from the heart to the rest bloodstream.

Preparation

Before determining whether you qualify for Transcatheter Aortic Valve Replacement, the following tests are required and performed after admission and hospital stay for 1 day:

·       Electrocardiogram

·       Blood tests

·       Heart Ultrasound (Triplex)

·       Coronary angiography (Imaging of the heart arteries)

·       CT angiography of aorta and peripheral vessels

Upon these tests, the overall risk of the patient is assessed, while all data are given to the Heart Team for the indication of surgery and how the valve should be replaced.

Operation

The surgery is usually performed in the Catheterization laboratory, which is equipped with all necessary radiological equipment and supplies for the Transcatheter Aortic Valve Replacement. Exposure to radiation and contrast material is less than twenty minutes, while the total duration of surgery is one to two hours. When the access to the valve placement is the femoral artery, the patient is awake or in a light sedation. The Interventional Cardiologist performs a femoral artery puncture (local anesthesia in the area) and inserts a tube into it. Initially, the old valve is dilated with a balloon (valvuloplasty), and then, through a larger tube the valve is placed under fluoroscopy. When the access for the valve placement is the subclavian artery, the same operation is performed under general anesthesia.

Risks

It is important to remember that the percutaneous placement (replacement) of the aortic valve has clearly lower risks than the typical surgical treatment of aortic stenosis. For this reason, after all, this is the treatment of choice in patients at high surgical risk. Especially as the technique is improved, this will be also indicated in patients with lower risk. However, there are some risks during surgery, some more and others less serious. Based on the study data (2014) up to the present, the most common complications are of vascular origin (bleeding or "tearing" of the vessel used as a passage for inserting the valve), placement of a permanent pacemaker, atrial fibrillation, and rarely, stroke and/or death.

Recovery

After surgery, the patient is initially in the ICU for 24 hours and the total duration depends on the degree of recovery (usually 3-8 days). During hospitalization, the patient undergoes additional blood tests, chest X-ray, electrocardiogram and echocardiography. In the next 4-6 weeks retesting is performed and if all is well, examinations are performed every 6-12 months.

What will I gain from the surgery?

Treatment with the placement of the new valve immediately reduces the symptoms to the extent that they were due to aortic stenosis. It restores the normal operation of the valve and improves the overall function of the heart muscle. This potentially enhances the quality of life and life expectancy of the patient.