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Are pregnancy-associated hypertensive disorders so sweet?

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World Journal of Clinical Cases 2022年第28期10卷 10384-10386页

作者： costas thomopoulos Ioannis Ilias Department of Cardiology Elena Venizelou General and Maternity HospitalAthens GR-11521Greece Department of Endocrinology Elena Venizelou General and Maternity HospitalAthens GR-11521Greece

Worldwide,one in seven pregnancies is complicated by some form of diabetes,with a rising ***,hypertension is one of the main causes of morbidity and mortality for both the pregnant woman and the fetus and also contributes to premature *** a cohort study of pregnant women with diabetes,which was recently published in this journal,at least 84.5% of the subjects had *** rate of hypertension might be among the highest reported thus *** the medical literature,approximately 20% of women with diabetes during pregnancy have various pregnancy-associated hypertensive ***/ethnic differences,apparently,were not implicated in this elevated rate of hypertension:Although black and Hispanic women have a twofold higher rate of hypertension in pregnancy compared to white women,75% of the subjects in the study in question were ***,the impressive finding delivered by this large study,merits additional clarifications.

关键词： Pregnancy Hypertension Pre-eclampsia Diabetes gestational diabetes Human

Non-alcoholic fatty liver disease,diabetes medications and blood pressure

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World Journal of Diabetes 2021年第10期12卷 1809-1811页

作者： Ioannis Ilias costas thomopoulos Department of Endocrinology Diabetes and MetabolismElena Venizelou HospitalAthens 11521Greece Department of Cardiology Elena Venizelou HospitalAthens 11521Greece

New glucose-lowering agents reduce liver enzyme levels and blood pressure(BP).Whether this finding can be extended to non-alcoholic fatty liver disease(NAFLD)patients,in whom a bidirectional association of NAFLD measu... 详细信息

关键词： Antidiabetic drugs Blood pressure reduction Non-alcoholic fatty liver disease Sodium glucose cotransporter 2 Alanine aminotransferase Aspartate aminotransferase

Impact of SgLT2 inhibitors on major clinical events and safety outcomes in heart failure patients:a meta-analysis of randomized clinical trials

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Journal of geriatric Cardiology 2021年第10期18卷 783-795页

作者： george Bazoukis Stamatis S.Papadatos costas thomopoulos gary Tse Stefanos Cheilidis Konstantinos Tsioufis Dimitrios Farmakis Department of Cardiology Larnaca General HospitalLarnacaCyprus Department of Anatomy Histology and EmbryologyMedical SchoolUniversity of IoanninaIoanninaGreece Department of Cardiology Helena Venizelou HospitalAthensGreece Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease Department of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina University of Cyprus Medical School NicosiaCyprus First Cardiology Clinic Hippokration HospitalAthens UniversityAthensGreece

BACKgROUND Sodium-glucose co-transporter-2 inhibitors(SgLT2i)significantly reduce the risk of cardiovascular(CV)and renal adverse events in patients with diabetes mellitus,heart failure(HF)and/or chronic kidney *** performed a meta-analysis to explore the impact of several different SgLT2i on all-cause mortality,CV mortality,HF hospitalizations and the combined outcome CV death/HF hospitalization in HF patients across the spectrum of left ventricular ejection fraction(LVEF)*** A systematic search in MEDLINE database and Cochrane library through March 2021 was performed without *** clinical trials that provided data about the impact of SgLT2i on all-cause mortality,CV mortality,HF hospitalizations or the combined outcome of CV death/HF hospitalization in HF patients were included.A random effects model was used for calculating the effect *** Nine studies(n=16,723 patients,mean age:65.9 years,males:70.7%)were included in the quantitative *** to placebo,SgLT2i use was associated with 14%lower risk of all-cause mortality[hazard ratio(HR)=0.86,95%CI:0.78−0.94,I^(2)=0,P=0.0008],32%lower risk of HF hospitalizations(HR=0.68,95%CI:0.62−0.74,I^(2)=0,Pgarding the safety outcomes,our data revealed no significant differences between SgLT2i and placebo groups in drug related discontinuations,amputations,severe hypoglycemia,hypotension,volume depletion,ketoacidosis and genital *** contrast,a protective role of SgLT2i against placebo was found for serious adverse events and acute kidney *** In patients with HF,regardless of LVEF phenotype,all SgLT2i had an excellent safety profile and significantly reduced the risk of all-cause mortality,CV mortality,HF hospitalizations and CV deaths/HF hospitalizations compared to placeb

关键词： patients clinical protective

Acute upper gastrointestinal bleeding in patients on long-term oral anticoagulation therapy: Endoscopic findings, clinical management and outcome

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World Journal of gastroenterology 2005年第9期11卷 1365-1368页

作者： Konstantinos C thomopoulos Konstantinos P Mimidis george J Theocharis Anthie g gatopoulou georgios N Kartalis Vassiliki N Nikolopoulou Department of Internal Medicine the First Department of Internal Medicine

AIM: Acute gastrointestinal bleeding is a severe complication in patients receiving long-term oral anticoagulant therapy. The purpose of this study was to describe the causes and clinical outcome of these patients. METHODS: From January 1999 to October 2003, 111 patients with acute upper gastrointestinal bleeding (AUgIB) were hospitalized while on oral anticoagulants. The causes and clinical outcome of these patients were compared with those of 604 patients hospitalized during 2000-2001 with AUgIB who were not taking warfarin. RESULTS: The most common cause of bleeding was peptic ulcer in 51 patients (45%) receiving anticoagulants compared to 359/604 (59.4%) patients not receiving warfarin (Pg could be found in 33 patients (29.7%) compared to 31/604 (5.1%) patients not receiving anticoagulants (P=0.0001). The majority of patients with concurrent use of non-steroidal anti-inflammatory drugs (NSAIDs) (26/35, 74.3%) had a peptic ulcer as a cause of bleeding while 32/76 (40.8%) patients not taking a great dose of NSAIDs had a negative upper and lower gastrointestinal endoscopy. Endoscopic hemostasis was applied and no complication was reported. Six patients (5.4%) were operated due to continuing or recurrent hemorrhage, compared to 23/604 (3.8%) patients not receiving anticoagulants. Four patients died, the overall mortality was 3.6% in patients with AUgIB due to anticoagulants, which was not different from that in patients not receiving anticoagulant therapy. CONCLUSION: Patients with AUgIB while on long-term anticoagulant therapy had a clinical outcome, which is not different from that of patients not taking anticoagulants. Early endoscopy is important for the management of these patients and endoscopic hemostasis can be safely applied.

关键词： AUgIB Anticoagulant therapy Endoscopy

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

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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

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

Effect of bombesin and neurotensin on gut barrier function in partially hepatectomized rats

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World Journal of gastroenterology 2005年第43期11卷 6757-6764页

作者： Stelios F Assimakopoulos Ilias H Alexandris Chrisoula D Scopa Panagiotis g Mylonas Konstantinos C thomopoulos Christos D georgiou Vassiliki N Nikolopoulou Constantine E Vagianos Department of Internal Medicine Department of Surgery Department of Pathology Department of Internal edicine Department of Biology

AIM： To investigate the effect of regulatory peptides bombesin （BBS） and neurotensin （NT） on intestinal barrier function in partially hepatectomized rats. METHODS： Ninety male Wistar rats were randomly divided into five groups： Ⅰ （n = 10）： controls, Ⅱ （n = 20）： sham operated, Ⅲ （n = 20）： partial hepatectomy 70% （PHx）, Ⅳ （n = 20）： PHx＋BBS （30 μg/kg/d）, Ⅴ （n = 20）： PHx＋NT （300 μg/kg/d）. groups IV and V were treated for 8 days before PHx and 48 h post surgery. At the end of the experiment, on day 10, intestinal barrier function was assessed by measuring endotoxin concentrations in portal and aortic blood. Tissue sections of the terminal ileum were examined histologically and villus density, mucosal thickness, mitotic activity and apoptosis in crypts were assessed. In addition, ileal mucosa was analyzed for DNA and protein content and microbiological analysis was performed in cecal contents. To estimate intestinal oxidative stress, lipid peroxidation was determined on tissue homogenates from terminal ileum. RESULTS： BBS or NT administration significantly reduced portal and systemic endotoxemia observed 48 h after partial hepatectomy. In hepatectomized rats （group Ⅲ）, a trend towards induction of mucosal atrophy was observed, demonstrated by the reduction of villus density, mucosal thickness, protein content and significant reduction of DNA, while these alterations were reversed by regulatory peptides administration. This trophic effect of BBS and NT was accompanied by induction of mitoses above control levels and a significant reduction of apoptosis in intestinal crypts. Intestinal lipid peroxidation was found significantly lower in PHx group and regulatory peptides exerted an antioxidant action, further decreasing this parameter of oxidative stress. The ：bacterial population of E. coli and aerobic gram （＋） cocci was increased in cecal content of hepatectomized rats, while this parameter was not affected by the administration of BBS or NT. CONCLUSION： gut regulatory pep

关键词： Hepatectomy Rats Bombesin Neurotensin Intestinal barrier Apoptosis Oxidative stress

A rare etiology of post-endoscopic retrograde cholangiopancreatography pneumoperitoneum

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World Journal of gastroenterology 2008年第18期14卷 2917-2919页

作者： Stelios F Assimakopoulos Konstantinos C thomopoulos Sofia giali Christos Triantos Dimitrios Siagris Charalambos gogos Department of Internal Medicine School of Medicine University of Patras Patras 26110 Greece Division of gastroenterology Department of Internal Medicine School of Medicine University of Patras Patras 26110 Greece

Major complications of endoscopic retrograde cholangiopancreatography (ERCP) include pancreatitis, hemorrhage, cholangitis, and duodenal perforation. The occurrence of free air in the peritoneal cavity post- ERCP is a rare event (gy of pneumoperitoneum, in an 84-year-old woman with pancreatic cancer and a large hepatic metastasis, after ERCP with common bile duct stent deployment. Our patient developed, pneumoperitoneum due to air leakage from rupture of intrahepatic bile ducts and glisson’s capsule in the area of a peripheral large hepatic metastasis. The potential mechanism underlying this complication might be post- ERCP pneumobilia and increased pressure of intrahepatic bile ducts leading to rupture of intrahepatic bile ducts in the liver metastatic mass owing to neoplastic tissue friability. This case indicates the need for close clinical and radiological observation of patients with hepatic masses (primary or metastatic) subjected to ERCP. In such patients, avoidance of excessive air insufflation during ERCP and/or placement of a nasogastric tube for bowel decompression immediately after ERCP might be a reasonable strategy to prevent such unusual complications.

关键词： Endoscopic retrograde cholangiopancreatx ography Pneumoperitoneum Complications Pneumobilia Hepatic metastases

Acute upper gastrointestinal bleeding in operated stomach: Outcome of 105 cases

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World Journal of gastroenterology 2005年第29期11卷 4570-4573页

作者： Vassiliki N Nikolopoulou Konstantinos C thomopoulos george I Theocharis Vassiliki A Arvaniti Constantine E Vagianos Division of gastroenterology Department of Internal Medicine University Hospital Patras Greece Department of Surgery University Hospital Patras Greece

AIM: To compare the causes and clinical outcome of patients with acute upper gastrointestinal bleeding (AUgB) and a history of gastric surgery to those with AUgB but without a history of gastric surgery in the ***: The causes and clinical outcome were compared between 105 patients with AUgB and a history of gastric surgery, and 608 patients with AUgB but without a history of gastric ***: Patients who underwent gastric surgery in the past were older (mean age: 68.1±11.7 years vs 62.8±17.8 years, P= 0.001), and the most common cause of bleeding was marginal ulcer in 63 patients (60%). No identifiable source of bleeding could be found in 22 patients (20.9%) compared to 42/608 (6.9%) in patients without a history of gastric surgery (P = 0.003). Endoscopic hemostasis was permanently successful in 26 out of 35 patients (74.3%) with peptic ulcers and active bleeding or non-bleeding visible vessel. Nine patients (8.6%) were operated due to continuing or recurrent bleeding,compared to 23/608 (3.8%) in the group of patients without gastric surgery in the past (P= 0.028). Especially in peptic ulcer bleeding patients, emergency surgery was more common in the group of patients with gastric surgery in the past [9/73 (12.3%) vs 19/360 (5.3%), P = 0.025].Moreover surgically treated patients in the past required more blood transfusion (3.3±4.0 vs 1.5±1.7, P = 0.0001) and longer hospitalization time (8.6±4.0 vs 6.9±4.9 d,P = 0.001) than patients without a history of gastric surgery. Mortality was not different between the two groups [4/105 (3.8%) vs 19/608 (3.1%)].CONCLUSION: Upper gastrointestinal bleeding seems to be more severe in surgically treated patients than in non-operated patients.

关键词： Operated stomach Active bleeding Endoscopic hemostasis