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Pentoxifylline:A first line treatment option for severe alcoholic hepatitis and hepatorenal syndrome?

World Journal of Gastroenterology 2009年第25期15卷 3194-3195页

作者： Stelios F Assimakopoulos Konstantinos C Thomopoulos chrisoula labropoulou-karatza Department of Internal Medicine University Hospital of Patras Division of Gastroenterology Department of Internal MedicineUniversity Hospital of Patras

Although favourable results of pentoxifylline （PTX） used in treatment of severe alcoholic hepatitis patients with a Maddrey discriminant function score ≥ 32 have been previously reported, it is not currently recommended as a first line treatment for alcoholic hepatitis owing to lack of evidence for its efficacy as compared to the standard treatment with corticosteroids. In a very recent issue of World Journal of Gastroenterology, Dr. De BK and colleagues compared for the first time the two treatment modalities head to head in a randomized controlled study, demonstrating the advantage of PTX over corticosteroids in terms of patients＇ survival and risk-benefit profile. The advantage of PTX over corticosteroids in survival of patients with severe alcoholic hepatitis was found to be related to the prevention of hepatorenal syndrome in their study. This study raises the question of the use of PI-X as a standard treatment for severe alcoholic hepatitis. Considering the fact that PTX presented a spectacular efficiency in prevention of hepatorenal syndrome in their study as well as that previous studies have shown that this effect is possibly related to a primary renoprotective action because it is irrelevant of tumor necrosis factor-c~ synthesis inhibition or improved liver function, we tempted to speculate that PXT might be an effective option for prevention and/or treatment of hepatorenal syndrome complicating other forms of advanced liver disease. This attractive theory remains to be elucidated by pressing future studies in view of the lack of effective treatment modalities for hepatorenal syndrome.

关键词： Alcoholic hepatitis Pentoxifylline Hepatorenal syndrome Mortality

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Pituitary hormone circadian rhythm alterations in cirrhosis patients with subclinical hepatic encephalopathy

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World Journal of Gastroenterology 2008年第26期14卷 4190-4195页

作者： Dimitrios Velissaris Menelaos Karanikolas Andreas Kalogeropoulos Ekaterini Solomou Panagiotis Polychronopoulos Konstantinos Thomopoulos Chrissoula labropoulou-karatza Department of Anaesthesiology and Intensive Care Medicine University Hospital of PatrasRion 26500Greece Department of Anaesthesiology and Intensive Care Medicine University Hospital of Patras Rion 26500Greece Department of Internal Medicine University Hospital of PatrasRion 26500Greece Department of Radiology University Hospital of Patras Rion 26500Greece Department of Neurology University Hospital of Patras Rion 26500Greece

AIM:To analyze pituitary hormone and melatonin circadian rhythms, and to correlate hormonal alterations with clinical performance, hepatic disease severity and diagnostic tests used for the detection of hepatic encephalopathy in cirrhosis. METHODS:Twenty-six patients with cirrhosis were enrolled in the study. Thirteen patients hospitalized for systemic diseases not affecting the liver were included as controls. Liver disease severity was assessed by the Child-Pugh score. All patients underwent detailed neurological assessment, electroencephalogram (EEG), brain magnetic resonance imaging (MRI), assays of pituitary hormone, cortisol and melatonin, and complete blood chemistry evaluation. RESULTS: Pituitary hormone and melatonin circadian patterns were altered in cirrhosis patients without clinical encephalopathy. Circadian hormone alterations were different in cirrhosis patients compared with controls. Although cortisol secretion was not altered in any patient with cirrhosis, the basal cortisol levels were lowand correlated with EEG and brain MRI abnormalities. Melatonin was the only hormone associated with the severity of liver insufficiency. CONCLUSION: Abnormal pituitary hormone and melatonin circadian patterns are present in cirrhosis before the development of hepatic encephalopathy. These abnormalities may be early indicators of impending hepatic encephalopathy. Factors affecting the human biologic clock at the early stages of liver insufficiency require further study.

关键词： Liver cirrhosis Minimal hepatic encepha-Iopathy Circadian rhythms Melatonin Pituitary hormones

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Ultrasonography in differentiation between chronic viral hepatitis and compensated early stage cirrhosis

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World Journal of Gastroenterology 2008年第13期14卷 2072-2079页

作者： Panagiotis Iliopoulos Marianna Vlychou chrisoula karatza Spyros D Yarmenitis Maria Repanti Ioannis Tsamis Kostantinos Tepetes Department of Radiology "Agios Andreas" General Hospital Patras Greece Department of Radiology University of Thessaly Greece Department of Hepatology-Gastroenterology University of Patras Greece Department of Radiology University of Crete Greece Department of Pathology "Agios Andreas" General Hospital Patras Greece Department of Surgery University of Thessaly Greece

AIM: To assess the value of gray scale (GS) and colour Doppler ultrasonography (CDU) in differentiating the progression of chronic viral hepatitis (CVH) and compensated liver cirrhosis (CIR). METHODS: Seventy-two patients and 32 normal individuals who were used as controls were studied. Forty-four patients suffered from CVH and 28 from CIR. All patients were underwent to liver biopsy. Multiple qualitative and quantitative variables were studied in liver, portal vein (PV), hepatic artery (HA) and spleen with GS and CDU. On the basis of the obtained CDU data, several known indexes were calculated. In addition, alternative indices [PV diameter (D)/time average mean velocity (VTAM), HA/PV VTAM ratio] were calculated and studied. RESULTS: ROC analysis showed that PV congestion index, PV D/VTAM and HA/PV VTAM indices had the best sensitivity and specificity in discriminating CVH from CIR. Stepwise discriminant analysis showed that 88.9% of the originally grouped cases could be correctly classified by the three qualitative and four quantitative variables selected as statistically significant predictors. Among the CVH patients who underwent to biopsy, statistically significant changes were found in those at fibrosis stage 5 compared to fibrosis stages 1-4. CONCLUSION: Simple GS and CDU parameters discri-minate CVH from CIR. The alternative Doppler indexes can accurately differentiate chronic virus hepatitis from cirrhosis. These indexes can be used in monitoring chronic virus hepatitis and avoiding unnecessary biopsies.

关键词： Liver cirrhosis Virus hepatitis Portal hypertension Doppler ultrasonography

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Lapatinib-induced hepatitis: A case report

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World Journal of Gastroenterology 2011年第18期17卷 2349-2352页

作者： Stavros Peroukides Thomas Makatsoris Angelos Koutras Athanasios Tsamandas Adimchi Onyenadum Chryssoula labropoulou-karatza Haralabos Kalofonos Department of Medical Oncology University Hospital of Patras Department of Pathology University Hospital of Patras Department of Internal Medicine University Hospital of Patras

Lapatinib is an inhibitor of the tyrosine kinases of human epidermal growth factor receptor type 2 (HER2) and epidermal growth factor receptor type 1, with clinical activity in HER2-positive metastatic breast cancer. We present here a 60 year-old patient with metastatic breast cancer who presented with jaundice and increased serum aminotransferase levels and who had been treated with lapatinib for the previous 14 days. Laboratory tests excluded other causes of acute liver injury. Liver biopsy revealed lesions compatible with drug-induced hepatotoxicity. Bilirubin and liver enzymes returned to normal within three months of lapatinib discontinuation. Lapatinib should be included among the causes of druginduced hepatitis.

关键词： Lapatinib Hepatitis Hepatotoxicity Breast cancer Human epidermal growth factor receptor type 2

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Prevalence of anti-HAV antibodies in multitransfused patients with beta-thalassemia

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World Journal of Gastroenterology 2008年第10期14卷 1559-1563页

作者： Dimitrios Siagris Alexandra Kouraklis-Symeonidis Irini Konstantinidou Myrto Christofidou Ioannis Starakis Alexandra Lekkou Christos Papadimitriou Alexandros Blikas Nicholas Zoumbos Chryssoula labropoulou-karatza Department of Internal Medicine Patras University HospitalPatras 26504 Greece

AIM: To detect the prevalence of anti-HAV IgG antibodies in adult multitransfused beta-thalassemic patients. METHODS: We studied 182 adult beta-thalassemic patients and 209 controls matched for age and sex from the same geographic area, at the same time. Anti-HAV IgG antibodies, viral markers of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection were evaluated. RESULTS: Anti-HAV IgG antibodies were detected more frequently in thalassemic patients (133/182; 73.1%) than in healthy controls (38/209; 18.2%, P < 0.0005). When we retrospectively evaluated the prevalence of anti-HAV IgG antibodies in 176/182 (96.7%) thalassemic patients, whose medical history was available for the previous ten years, it was found that 83 (47.2%) of them were continuously anti-HAV IgG positive, 16 (9.1%) acquired anti-HAV IgG antibody during the previous ten years, 49 (27.8%) presented anti-HAV positivity intermittently and 28 (15.9%) were anti-HAV negative continuously. CONCLUSION: Multitransfused adult beta-thalassemic patients present higher frequency of anti-HAV IgG antibodies than normal population of the same geographic area. This difference is difficult to explain, but it can be attributed to the higher vulnerability of thalassemics to HAV infection and to passive transfer of anti-HAV antibodies by blood transfusions.

关键词： Hepatitis A virus Anti-HAV antibodies Beta-thalassemia Multiple transfusions Hepatitis C virus

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