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alexandra nikita mediterraneo hospital - Breast MRI

Breast MRI

By | IN THE NEWS, MBC, MRI

Dr. Alexandra Nikita, Consultant Breast Radiologist, Mediterraneo Hospital

Breast MRI is a high-resolution imaging test for the examination of breast structures and is performed in addition to a mammography and breast ultrasound. It is a short, completely painless and harmless diagnostic test, during which the examinee does not receive any radiation.

In which cases is breast MRI indicated?

Breast MRI does not replace a mammography or breast ultrasound but is a complementary tool used in the following cases:

  • Screening in women at high risk of developing breast cancer. This includes women with a family history of breast or ovarian cancer (mother or sister who developed breast cancer before the age of 50, or more than one close relatives, including those on the examinee’s father side, with a history of breast or ovarian cancer),
  • Women with BRCA1 (Breast Cancer Type 1 susceptibility gene) and BRCA2 (Breast Cancer Type 2 susceptibility gene) mutations and women with a history of chest radiation therapy at the age of 10-30 years old. In any case, your radiologist or breast surgeon will review your family history and determine if a breast magnetic resonance imaging is appropriate for you.
  • To further investigate equivocal mammography findings. In rare cases, if a lesion detected on a mammogram cannot be adequately evaluated by MRI-guided localization, tomography, or ultrasound, magnetic resonance imaging is used to determine whether or not a biopsy is necessary,
  • To accurately determine the extent of the lesion in specific types of diagnosed cancer and exclude the presence of other foci in the same or the other breast, especially in dense breasts and in cases of young women with breast cancer. Breast MRI also investigates the possible presence of abnormal axillary lymph nodes,
  • In cases of a previous breast cancer surgery to investigate possible recurrence or development of new foci in the same or the other breast (method of choice),
  • To evaluate the mastectomy area after cancer treatment. Surgery scars and recurrent cancer may present some similarities on a mammogram and breast ultrasound. If a change in the mastectomy scar is detected, either via mammography or physical examination, magnetic resonance imaging can show if it is scar tissue or cancer recurrence,
  • To assess the response of the tumor to chemotherapy in cases where preoperative chemotherapy is necessary (neoadjuvant chemotherapy),
  • For the evaluation of breast implants and the investigation of their rupture.

mri mediterraneo hospital - Breast MRI

How is a breast MRI performed?

The examination is performed on an outpatient basis and lasts about 30′. The examinee is  placed in a prone position on the specially designed MRI scanner.

The comfort of the examinee during the whole process is important, because in that way she can remain calm and immobile for as long as necessary in order to complete the examination successfully.
The use of an intravenous contrast media (IV contrast) is necessary to investigate possible malignancy, because without it the examination presents insufficient results. If, however, the breast MRI is performed only to evaluate the breast implants, IV contrast is not required except in cases where inflammation in the area of the implant is investigated.

What are the disadvantages of a breast MRI?

The method has two main disadvantages: The first is the high rate of “false-positive” results, i.e. when the MRI reveals pathological findings that prove to be benign formations or areas of active glandular tissue. This is proven by a negative biopsy. The second disadvantage is the inability of the method to detect breast microcalcifications, suspicious for onset malignancy.

DIMOU 800Χ600 - 6 ways to treat chronic low back pain without surgery

6 ways to treat chronic low back pain without surgery

By | CENTER FOR PAIN MANAGEMENT, IN THE NEWS

Chronic back pain is defined as pain that persists for 12 weeks or more, even after an initial injury or acute back pain has been treated. About 20 percent of people with acute back pain develop chronic back pain with persistent symptoms within a year. Even if the pain persists, it does not always mean a medically underlying severe cause or a cause that can be easily identified and treated. In some cases, treatment successfully relieves chronic back pain. Still, in other cases, the pain persists despite medical and surgical treatment.

Common causes of chronic back pain

Chronic back pain is usually associated with advanced age. However, it may also be due to a previous injury. The most common causes of chronic back pain are:

  • vertebral arthritis, i.e., the gradual destruction of cartilage between the joints of the spine.
  • spinal stenosis, i.e., the narrowing of a part of the spinal canal that can cause pain due to pressure on the nerves in the area.
  • damage to the intervertebral discs (disc herniation, intervertebral disc degeneration).
  • myoperitoneal pain syndrome.

In some cases, it is difficult to identify the cause of chronic back pain. Suppose the source of the pain is not known or cannot be treated. In that case, the best option is for the patient to work with the doctor to reduce the pain’s exacerbations and treat it with non-surgical treatments.

Non-surgical treatments for chronic back pain

  1. Injectable treatments

They are used when the source of the pain is known and sometimes help rule out specific causes of back pain if the treatment does not work. Minimally invasive treatments include epidural steroid infusion, intrathecal steroid infusion, and transdermal neurolysis using radiofrequency ablation.

Injectable steroids are artificial synthetic drugs similar to cortisol, a natural hormone produced in the adrenal glands and brain. Steroids help reduce pain and inflammation and are used to treat various inflammatory diseases and painful conditions, including intervertebral disc herniation.

Epidural steroid infusion is a low-dose injection of anti-inflammatory drugs and analgesics into the lower back (waist) to relieve pain in the legs or abdomen. The drug is injected into an area called the epidural space. By reducing inflammation, epidural steroid injections can significantly help reduce pain. Epidural steroid infusion can be a treatment and a way of differentially diagnosing the source of pain in the lumbar structures when in doubt.

On the other hand, intrathecal injection of steroids is the direct injection of the same substances into the nerve foramen, i.e., at the point of exit of the nerve root from the spine.

Also, transdermal neurolysis using radiofrequency is an effective method of treatment. Many modern studies support reducing or even disappearing back pain after radiofrequency ablation (RFA) of the tiny sensory nerves located near the vertebral joints. It is a minimally invasive method aimed at destroying nerve cells by applying an electric field on a tissue. In this way, denervation is achieved (by cauterization or cold field), with consequent pain relief. Transdermal neurolysis using radio frequencies has evolved dramatically in recent years.

Injectable treatment can lead to remission or even elimination of pain for some time. Still, it is not a permanent solution and is used in combination with other therapies.

  1. Pharmacological treatments

Analgesics, anti-inflammatory drugs, muscle relaxants and other medications can be used to control chronic back pain. However, most are accompanied by side effects and are not intended for long-term use. Opioid analgesics are generally not recommended as monotherapy or as the first treatment for a patient before trying other medicines. It is also not recommended to be used as a long-term treatment. Many of them are addictive and do not address the underlying cause of back pain. They should only be prescribed after a thorough examination by a specialist and if other medicines have not been shown to be effective for the patient. In recent years there have been many clinical studies on the beneficial effects of natural anti-inflammatory drugs. It is essential that health professionals, especially those involved in the treatment and management of chronic pain, be fully informed on the various dietary supplements available to form a successful treatment plan with or without conventional medicine.

  1. Physiotherapy

Exercise is the foundation for treating chronic back pain. It is one of the first treatments that the patient should try under the guidance of a doctor and physiotherapist with experience in the spine. However, the same exercises are not suitable for all patients. The exercises should be individualized and adapted according to the patient’s symptoms and condition. It also seems important to maintain an exercise routine at home for the success of the treatment.

Physiotherapy for chronic back pain may include:

  • training to maintain proper posture
  • testing of pain tolerance limits
  • Stretching exercises and flexibility exercises
  • Aerobic Exercise
  • trunk strengthening
  1. Alternative therapies

Acupuncture, massage, biofeedback therapy, laser therapy, electrical nerve stimulation and other non-surgical treatments for the spine can also help treat chronic back pain.

  1. Nutrition

Some diets favor inflammatory processes in the body, especially those high in fat, processed carbohydrates and processed foods. Consult your doctor to see if your diet contributes to chronic back pain and how you can change it. Maintaining a healthy weight could also help reduce back pain by reducing the strain on the spine.

  1. Lifestyle change

The patient with chronic back pain must accept certain limitations in their daily life and adapt. He must learn to “listen” to their body and adjust the rhythm accordingly to daily activities. It is also good to observe which activities may aggravate the pain and to avoid them as much as possible. This can help reduce pain but also prevent the progression of the underlying pain-related condition. Another necessary lifestyle change is smoking cessation. Nicotine has been shown to aggravate pain and delay its healing.

When is surgery for low back pain indicated?

The following are warning signs that surgery is needed if they are found to be related to the condition of the spine:

  • new or worsening bowel or bladder disorder
  • weakness of the limbs
  • gait and balance disorders
  • signs of increased reflexes

Surgery may also be a good option in treating chronic back pain if the cause of pain is known and confirmed by imaging techniques or if other treatments have not helped.

reflux 1 - Gastro-Esophageal Reflux Disease and its treatment

Gastro-Esophageal Reflux Disease and its treatment

By | GASTROINTESTINAL, IN THE NEWS

michail kourkoulos 300x300 - Gastro-Esophageal Reflux Disease and its treatmentDr Michail S Kourkoulos MSc FRCs, Laparoscopic GastroIntestinal and Bariatric Surgeon

Director of Upper GastroIntestinal and Antireflux Surgery, Mediterraneo Hospital

 

Gastro-Esophageal Reflux Disease (GERD) or Acid Reflux, is a chronic condition affecting 10-20% of the general population. It’s usually treated with diet and lifestyle modification, although frequently requiring further treatment with medication, and occasionally either endoscopic or surgical treatment methods. Below are the usual questions asked by GERD sufferers.

Which symptoms are suggestive of Gastro-esophageal reflux disease?

GERD presents with a variety of symptoms, caused by the pathological entry of gastric contents into the chest, to the point of mimicking coronary disease. It can present as regurgitation of food up to the mouth, or frequent vomiting. There can be respiratory problems or worsening asthma due to reflux of acid into the lungs. It can also cause halitosis and tooth decay due to chronic contact with acidic gastric contents. Most of these symptoms are worse at night due to sleeping horizontally, and after large meals.

What is the cause of GERD?

The most common cause is the presence of a hiatal hernia, which means that part of the stomach, along with the lower esophageal valve mechanism which under normal circumstances prevents reflux, is lying in the wrong anatomical part of the body, within the chest instead of the abdomen. Other causes include obesity, pregnancy which causes hormonal relaxation of the valve mechanism, medication such as cortisone and substances that lead to relaxation of the lower esophageal sphincter, as well as rare syndromes which cause either hyperacidity of the stomach, or esophageal dysfunction. GERD is usually worsened by increased body weight, eating habits and lifestyle. Symptoms can therefore be improved by weight reduction and lifestyle modification according to specialist guidance.

Is Gastro-Esophageal Reflux Disease dangerous?

Long term exposure of the esophagus to gastric acid can cause a wide range of problems. Initially there is chronic inflammation of the surface of the esophagus called esophagitis. If this is not dealt with, chronic intense inflammation can lead to stricture of the esophagus due to scarring, presenting as difficulty in swallowing solid foods. The most worrying complication of GERD is the development of Barrett’s Esophagus, a metaplastic transformation of the cells of the lining of the lower esophagus to another type which is also benign, but has a chance of malignant transformation and development of Lower Esophageal Adenocarcinoma if the symptoms are ignored.

What are the necessary dietary and lifestyle changes which help improve symptoms and reduce the possibility of further problems?

Weight loss is the most important change which leads to improvement of GERD symptoms. Avoidance of triggering foods is also very important. Coffee and chocolate contain substances which lead to relaxation of the lower esophageal sphincter, and avoiding them improves symptoms. The same applies for smoking. Fizzy drinks and beer expand the stomach due to release of CO2 gas, and increase the intragastric pressure causing the gastro-esophageal valve mechanism to open leading to worsening symptoms and therefore have to be avoided. Red wine also leads to reflux due to the flavonoids contained. It is also advised to avoid large meals, which once again lead to reflux via gastric distention. Spicy meals and certain foods such as tomato cheese and occasionally even apples worsen symptoms. It is advised to leave at least 3 hours between dinner and sleep, as a full stomach in a horizontal position will certainly cause reflux. Many patients use 2-3 pillows as a dependent position utilizes gravity to reduce reflux, although these tend to slip away during the night. My personal preference is elevating the top of the bed with either supports under the mattress or under the legs of the bed. Alternatively, there are purpose made wedge pillows that can be used.

Is there some form of treatment for improving symptoms until lifestyle changes take effect?

First line treatment for GERD symptoms consists of medications which reduce acidity of gastric contents, neutralize gastric acid, or protect the surface of the esophagus. The type, dosage and duration of treatment as well as any further investigation prior to its commencement, depend on the type, severity and duration of symptoms. Mild typical symptoms which improve with lifestyle changes alone do not require any further investigation, although this decision is best made by a specialist. The most common first line treatment is a 4–6-week trial of Proton Pump Inhibitors such as Omeprazole, Lansoprazole, Esomeprazole etc., alone or in combination with Gaviscon. In case of side effects, alternative medication can be used according to doctor’s guidance. Medical management reduces the acidity of refluxate and acid exposure of the esophagus, but does not treat the cause of reflux, which is dysfunction of the valve mechanism of the lower esophagus.

What happens if symptoms recur as soon as treatment stops?

Indeed, in many cases GERD symptoms reappear as soon as the above treatment is stopped. Should this happen, medication needs to be continued for life, at the lowest possible dose. There are no serious long-term effects from this type of medication, although there may be contraindications in certain conditions such as osteoporosis, as they may effect calcium absorption. There may also be side effects such as headache, bone and joint pains.

Is there another treatment option if medical management is ineffective, causes side effects, or the patient doesn’t  wish to take lifelong medication?   

In those cases, one can consider the possibility of Antireflux interventions or Surgery. It is necessary to perform meticulous investigation of reflux with a Barium Swallow, pH study and manometry. There is a choice of endoscopic techniques (Stretta, Esophyx etc), or Laparoscopic Antireflux Surgery (Laparoscopic Fundoplication, Linx procedure)

Who is the ideal specialist for advice regarding antireflux interventions?

The decision on the ideal interventional treatment should ideally be made by a Laparoscopic Surgeon with specialization in Gastrointestinal Surgery and a specialist interest in esophagogastric surgery, and experience in all antireflux endoscopic and surgical procedures

giannopoulou 768x576 1 - Diagnostic tests for the new coronavirus, SARS COV-2

Diagnostic tests for the new coronavirus, SARS COV-2

By | Covid 19, IN THE NEWS

Sars COV – 2 ( Covid – 19) emerged in 2020 as a global epidemic disease. In fact, quite a number of decades had followed since the last dispersion of a disease of such a magnitude.

It goes without saying that the scientific community and pharmaceutical industry have concentrated all their efforts on an attempt to intercept the transmission of the disease and as such it has certainly become a burning issue. To this purpose, talks concern the test tracing of the new Coronavirus. No doubt, one cannot stress enough the significance of diagnostic tests conducted after the patient has consulted their clinical doctor as it will determine the most suitable test for each patient’s case.

Currently the tests available today bear the following features:

  1. The Molecular test Real Time PCR
  • This test detects the presence of the virus in samples taken from the patient’s Oropharynx or Nasopharynx with a specific cotton swab. It is a quick and painless procedure which lasts a few seconds.
  • Real Time PCR, the gold standard method, is used for the diagnosis due to its ability to trace the virus’ genetic substance and thereby confirm the contamination.
  • Rt- PCR is also capable of tracing with precision the virus in its incubation period, way before clinical symptoms appear.
  • The test is conducted on a daily basis at the Central Laboratories at Mediterraneo Hospital. The results are ready within 24 to 48 hours.
  • For emergency cases there is a possibility of rapid Real Time PCR which can be completed within few hours.
  1. Serological Antibodies Test against Corona virus IgM/IgA/IgG.
  • The test detects antibodies which are produced by our immune system within a few days after the symptoms’ onset. That is why it is regarded as a contributory test rather than the main test to confirm the diagnosis of viral contamination.
  • Their presence can be detected in blood samples for weeks even months after recovery. Detection of IgM means recent infection, whereas IgG past infection.
  • For the time being, it is not known whether or not a patient acquires lifelong immunity after contact with the virus.
  • A blood sample is drawn for the test and is conducted on a daily basis at the Central Laboratories at Mediterraneo Hospital. The results are ready within 24 to 48 hours.
  1. Rapid Antigen Test
  • This is a quick test, as the name suggests, also known as lateral flow immunochromatographic assays (like pregnancy test).
  • The test focuses on qualitative detection of virus antigens in a sample collected with a cotton swab from the Nasopharynx or Oropharynx. This method is particular effective in large population groups and in cases where RT –PCR is not available.
  • It’s a low cost test, can be completed in 15 minutes in the laboratory. It lacks, however, the reliability that the molecular method PCR possesses. In other words the test is limited in sensitivity and tends to produce false negative results.
  • The test is conducted on a daily basis at the Central Laboratories at Mediterraneo Hospital. The results are ready within half an

Summation

  • If a patient is tested positive after a molecular test they need to notify their clinical doctor. It’s important that the required measures be taken in order to intercept further dissemination of the disease.
  • Alternatively one can consult the Internist at Mediterraneo Hospital who can deliver precise instructions for each case in question.
  • If a patient is tested negative for covid 19 after a molecular test, it is highly likely that they were not affected by the virus at all. However, a negative outcome could also mean that the virus could have been early in incubation period the moment that the testing sample was taken.

The aforementioned tests are all available at Mediterraneo Hospital Central Laboratories. To make an appointment, simply call 2109117000.

Your health and safety are completely ensured at the hospital as all precautionary measures are adopted.

 

georgia dragini - Georgia Dragini, The Lady of Mediterraneo Hospital

Georgia Dragini, The Lady of Mediterraneo Hospital

By | IN THE NEWS

The CEO of Mediterraneo Hospital, the private hospital located in Glyfada, in the wider area of the Athenian Riviera, talks about all the pioneering work of the hospital which makes it stand out from the crowd.

The Boutique Hospital is a completely new concept in the healthcare sector. What is the philosophy?

The inspiration came from boutique hotels, which are the contemporary perception of tourism and suit my philosophy perfectly. In the case of the hospital, the term boutique is translated into modern high-tech facilities, staffed with medical experts who provide personalized services. It is a model that opposes mass production, focusing on quality and taking into account the diverse needs of each patient.

You recently created the Mediterraneo First Care Polyclinic.

It is an extension of the boutique approach in another area of medical services, that of Primary Healthcare. An aesthetic multi-specialty clinic has been created within a historic Shopping Centre in Glyfada. Emphasis was given to a wide range of services including modern specializations that are complementary to those of the hospital. All this takes place in direct collaboration with the hospital, utilizing our own expertise in the selection of medical colleagues.

Which are the centers of excellence of Mediterraneo Hospital?

I would say that all of the departments of Mediterraneo function as centers of excellence, in the sense that they operate in line with international guidelines and are based on the best medical practices. If we focus on those departments offering holistic and innovative services, with a large volume of patients and significant clinical and academic work, I will mention the following departments: the Spinal Cord Neurosurgery Dpt, the Interventional Cardiology and Cardiac Surgery Dpt, the Interventional Pulmonology and Gastroenterology Dpt, the Acute Stroke Unit and the Breast Clinic. Within the next few months, we will be adding the standard Radiotherapy Unit to them.

Can patients from other countries receive medical care?

We have given great importance to catering to foreign patients. All of our staff speak English, additionally all diagnoses are made in English, and we have been certified for many years to ensure that all of our services are adapted to foreign patients’ needs.

1stpage 25 - SYNAPSE® 3D for the detection of lung tumors!

SYNAPSE® 3D for the detection of lung tumors!

By | IN THE NEWS, PULMONOLOGY

endo1 - SYNAPSE® 3D for the detection of lung tumors!Mediterraneo Hospital is the first Greek Hospital to install a FujiFilm Europe SYNAPSE® 3D system that allows for the mapping and exploration of suitable bronchial pathway, and has the ability to simulate virtual bronchoscopy to detect lung tumors, using elements collected from a CT scan. In conjunction with a complete Probe Radial Ultrasonic System, the team of Clinical Interventional Pulmonologists, Filippos Emmanouil & Nikolaos Koufos, now have new UNIQUE capabilities in accessing peripheral pulmonary lesions.

healthy eating mediterraneo hospital - Healthy eating for a healthy heart

Healthy eating for a healthy heart

By | IN THE NEWS, NUTRITION
Eugenia Eliadou, Clinical Dietitian at Mediterraneo Hospital

Making some changes to your diet could help reduce the risk of heart disease, especially if you’ve already had a heart attack (M.I.). We should eat foods in the right balance to ensure that we are getting the right amount of nutrients (vitamins, minerals, carbohydrates, fats and protein).

There are 3 important ways to help protect your heart, these are:

  • Eat oily fish
  • Reduce saturated fat and use monounsaturated fat
  • Eat more fruits and more vegetables

Follow the healthy eating plate:

Healthy eating for a healthy heart - Healthy eating for a healthy heart

 

The Nutritional Value Of Walnuts

By | IN THE NEWS, NUTRITION

NUTRITION 1 shutterstock 142886560 - The Nutritional Value Of WalnutsEugenia Eliadou, Clinical Dietitian at Mediterraneo Hospital

Walnuts have the highest value among dried nuts, as they protect the body from chronic diseases (cardiovascular and neurological diseases, as well as some forms of prostate and breast cancer). This is mainly due to their antioxidant and antithrombotic activity. Walnuts contain the highest amount of omega3 fatty acids from all other dried nuts, in the form of alpha-linoleic acid. Thirty grams of walnuts, correspond to about ¼ cup or a handful, and contain 2.5 grams of omega3 fatty acids.

Walnuts are rich in antioxidants, especially polyphenols. In walnuts there are unique antioxidants that are not found in other foods, such as quinone juglone, the telimagrandin (a rare tannin) and flavonol morin. That’s why they have powerful anti-inflammatory and antioxidant qualities. Polyphenols, according to studies, reduce tumor cell proliferation mainly in prostate cancer by mechanisms that are not fully defined yet.

During the past two decades, given the increased incidence of cardiovascular disease, several studies have set up to evaluate the effect of the ingredients found in walnuts. Due to their high content of the amino acid l-arginine, vitamin C and other components, walnuts reduce the ‘bad’ cholesterol (up to 15%) and blood pressure, two major risk factors for the occurrence of cardiovascular disease.

Walnuts are undoubtedly one of the healthiest foods and reinforce body health.

Consume about a handful per day as a snack or use in your cooking!

Pregnancy and nutritional guidelines

By | IN THE NEWS
Eugenia Eliadou, Clinical Dietitian at Mediterraneo Hospital

pregnancy1 - Pregnancy and nutritional guidelinesΑ woman who enters pregnancy in an inadequate nutritional status has a risk of having poor pregnancy performance, of depleting her own body stores of nutrients, and of entering lactation in a state of suboptimal nutritional status, which could deteriorate further as lactation progresses. Infants who are undernourished in the womb are at risk of a variety of adverse outcomes, ranging from low birth weight to severe mental and physical retardation and even death. The effects of undernutrition before pregnancy and during pregnancy and lactation, depends on the stage at which undernutrition occurs. Each stage of this part of the life cycle has specific tissue needs for nutrients and shortcomings in tissue supply of these nutrients may have undesirable consequences. The success of pregnancy is also affected by intake of substances such as alcohol, nicotine and drugs, the physical and emotional stresses to which she is subjected, and the presence of any infections or other diseases.

chicago mavrogenis 1 - Mediterraneo Hospital represented Greece at the international invasive endoscopy contest in Chicago!

Mediterraneo Hospital represented Greece at the international invasive endoscopy contest in Chicago!

By | ENDOSCOPY, IN THE NEWS

The Gastroenterology Department of Mediterraneo Hospital represented Greece at the World Cup of Endoscopy 2017 held at the American Digestive Disease Week 2017 in Chicago on 9-12 May. This is the most important scientific event in the field of gastroenterology with over 16,000 participants from around the world.

For the first time in the world was presented a colorectal obstruction case that was dealt with without surgery. Dr. Maurogenis Georgios and his colleagues (I. Tsevgas and D. Zachariadis) performed an endoscopic colopexy and colostomy on a patient with a heavy medical history that was not able to undergo surgery. Under moderate sedation and 24-hour hospitalization, endoscopy was successfully performed and high-risk surgery was avoided.

The presentation received positive feedback from the conference jury and was published in the June issue of the American Invasive Endoscopy Journal. VideoGIE

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