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Pancreatic duct guidewire placement for biliary cannulation in a single-session therapeutic ERCP

World Journal of Gastroenterology 2011年第15期17卷 1989-1995页

作者： dimitrios xinopoulos Stefanos P Bassioukas dimitrios Kypreos dimitrios Korkolis Andreas Scorilas Konstantinos Mavridis dimitrios Dimitroulopoulos Emmanouil Paraskevas Gastroenterology Unit Hellenic Anticancer Institute "Saint Savvas"Hospital of Athens 171 Alexandras Avenue GR 11522 Greece First Surgical Department Hellenic Antican-cer Institute "Saint Savvas" Hospital of Athens 171 AlexandrasAvenue GR 11522 Greece Department of Biochemistry and Molecular Biology University of Athens University Campus Ilissia GR 15701 Greece

AIM: To investigate the technical success and clinical complication rate of a cannulated pancreatic duct with guidewire for biliary access. METHODS: During a five-year study period, a total of 2843 patients were included in this retrospective analysis. Initial biliary cannulation method consisted of single-guidewire technique (SGT) for up to 5 attempts, followed by double-guidewire technique (DGT) when repeated unintentional pancreatic duct cannulation had taken place. Pre-cut papillotomy technique was reserved for when DGT had failed or no pancreatic duct cannulation had been previously achieved. Main outcome measurements were defined as biliary cannu-lation success and post-endoscopic retrograde cholangiopancreatography (ERCP) complication rate. RESULTS: SGT (92.3% success rate) was characterized by statistically significant enhanced patient outcome compared to either the DGT (43.8%, P < 0.001), pre-cut failed DGT (73%, P < 0.001) or pre-cut as first step method (80.6%, P = 0.002). Pre-cut as first step method offered a statistically significantly more favorable outcome compared to the DGT (P < 0.001). The incidence of post-ERCP pancreatitis did not differ in a statistically significant manner between either method (SGT: 5.3%, DGT: 6.1%, Pre-cut failed DGT: 7.9%, Pre-cut as first step: 7.5%) or with patients' gender. CONCLUSION: Although DGT success rate proved not to be superior to SGT or pre-cut papillotomy, it is considered highly satisfactory in terms of safety in order to avoid the risk of a pre-cut when biliary therapy is necessary in difficult-to-cannulate cases.

关键词：插管法胰腺炎胆道导丝胆管造影治疗会话

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Immunohistochemical localization of glutathione S-transferase-pi in human colorectal polyps

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World Journal of Gastroenterology 2008年第26期14卷 4179-4184页

作者： Eleni Gaitanarou Eleni Seretis dimitrios xinopoulos Emmanuel Paraskevas Niki Arnoyiannaki Irene Voloudakis-Baltatzis Department of Electron Microscopy-Cell Biology "G. Papanicolaou" Research Center of Oncology and Experimental Surgery"Agios Savvas" Anticancer Hospital of Athens Athens 11522Greece Department of Electron Microscopy-Cell Biology "G. Papanicolaou" Research Center of Oncology and Experimental Surgery"Agios Savvas" Anticancer Hospital of Athens Athens 11522Greece Department of Gastroenterology "Agios Savvas" Anticancer Hospital of AthensAthens 11522Greece Department of Gastroenterology "Agios Savvas" Anticancer Hospital of AthensAthens 11522Greece Department of Pathology of the Regional Anticancer-Oncologic Hospital of Athens "Agios Savvas" Athens 11522Greece Department of Electron Microscopy-Cell Biology "G. Papanicolaou" Research Center of Oncology and Experimental Surgery"Agios Savvas" Anticancer Hospital of Athens Athens 11522Greece

AIM:To investigate the distribution of the placental form of glutathione-S-transferase (GST) in colon polyps in order to evaluate the role of GST-pi in these tissues. METHODS: Sixteen polyp tissues removed at colonoscopy were examined. Tissues were investigated histologically and ultrastructurally. GST-pi expression was also analysed immunohistochemically, using peroxidase anti-peroxidase (PAP) method and immunogold labelling method, for light and electron microscope respectively. RESULTS: All polyp tissues examined were adenoma of low, mild and high-grade dysplasia as shown in the histopathological reports. Nevertheless, the examination of the above specimens with electron microscope revealed that 3 of 9 adenoma of mild dysplasia had ultrastuctural features similar to high-grade dysplasia adenoma. GST-pi was variably expressed in adenoma, with the lowest relative levels occurring in low-gradeadenoma and the highest levels found in high-grade adenoma. GST-pi was located mainly in undifferentiated epithelial cells. GST-pi positive particles were found in the cytoplasm and especially in the nucleus adjacent to the nuclear membrane of these cells. CONCLUSION:The overexpression of GST-pi in mildgrade adenomas with significant subcellular changes and in the majority of high-grade dysplasia adenoma suggests that this might be related to the carcinogenetic proceeding. Immunohistochemical localization of GST-pi in combination with ultrastructural changes indicate that GST-pi might be a sensitive agent for the detection of preneoplastic transformations in adenoma.

关键词：结肠直肠息肉腺瘤电子显微镜免疫组织化学

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Herpes simplex virus type 1 in peptic ulcer disease: An inverse association with Helicobacter pylori

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World Journal of Gastroenterology 2005年第42期11卷 6644-6649页

作者： Klisthenis Tsamakidis Efstathia Panotopoulou dimitrios Dimitroulopoulos dimitrios xinopoulos Maria Christodoulou Alexandra Papadokostopoulou Ioannis Karagiannis Elias Kouroumalis Emmanuel Paraskevas Department of Gastroenterology "Agios Savvas" Anticancer Hospital Athens Greece Papanicolaou Research Center of Oncology and Experiment Surgery Athens Greece Department of Gastroenterology University Hospital Heraklion Crete Greece

AIM: To assess the frequency of herpes simplex virus type Ⅰ in upper gastrointestinal tract ulcers and normal mucosa with the modern and better assays and also with a larger number of well characterized patients and controls and its relationship to Helicobacter pylori(H pylori).METHODS: Biopsy specimens from 90 patients (34 with gastric ulcer of the prepyloric area and 56 with duodenal ulcer) were evaluated. Biopsies from 50 patients with endoscopically healthy mucosa were considered as the control group. The method used to identify herpes simplex virus-1 (HSV-1) was polymerase chain reaction.H pylori was detected by the CLO-test and by histological method.RESULTS: Herpes simplex virus-1 was detected in 28 of 90 patients with peptic ulcer (31%) [11 of 34 patients with gastric ulcer (32.4%) and 17 of 56 with duodenal ulcer (30.4%)] exclusively close to the ulcerous lesion.All control group samples were negative for HSV-1.The likelihood of H pylori negativity among peptic ulcer patients was significantly higher in HSV-1 positive cases than in HSV-1 negative cases (P = 0.009). Gastric ulcer patients with HSV-1 positivity were Strongly associated with an increased possibility of Helicobacter pylori negativity compared to duodenal ulcer patients (P= 0.010).CONCLUSION: HSV-1 is frequent in upper gastrointestinal tract ulcers but not in normal gastric and duodenal mucosa. There is an inverse association between HSV-1 and H pylori infection.

关键词：疱疹病毒胃溃疡幽门螺杆菌细菌感染

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Successful en bloc resection of primary hepatocellular carcinoma directly invading the stomach and pancreas

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World Journal of Gastroenterology 2009年第9期15卷 1134-1137页

作者： Dimitris P Korkolis Chrysanthi Aggeli George D Plataniotis Emmanuel Gontikakis Helen Zerbinis Nikitas Papantoniou Dimitris xinopoulos Nikiforos Apostolikas Perikles P Vassilopoulos Department of Surgical Oncology Hellenic Anticancer Institute"Saint Savvas"HospitalAthens 14561Greece Department of Gastroenterology Hellenic Anticancer Institute"Saint Savvas"HospitalAthens 14561Greece Department of Surgical Pathology Hellenic Anticancer Institute"Saint Savvas"HospitalAthens14561Greece

Multivisceral surgical resection for cure was successfully performed in a 70-year-old man suffering from a primary hepatocellular carcinoma(HCC)associated with direct invasion to the stomach and pancreas.The patient presented with gastric outlet obstruction,upper abdominal pain and a history of chronic liver disease due to hepatitis B virus(HBV)infection.Upper gastro-intestinal(GI)endoscopy revealed an infiltrating tumor protruding through the gastric wall and obliterating the lumen.Computer tomograghy(CT)and magnetic resonance imaging(MRI)scan demonstrated a 15-cm tumor in the left lateral segment of the liver with invasion to the stomach and pancreas.Alpha-foetoprotein (AFP)levels and liver function tests were normal.The patient underwent an en bloc left hepatectomy,total gastrectomy,distal pancreatectomy with splenectomy and radical lymphadenectomy.Pathology revealed a poorly differentiated,giant cell HCC involving the stom-ach and pancreas.Disease-free margins of resection were achieved.The patient's postoperative course was uneventful.Sixteen months after surgery,he has norecurrence or distal metastasis.Direct invasion of HCC into the GI tract is rarely encountered.Complete surgical resection should be considered in selected patients with an appropriate hepatic functional reserve.

关键词：远端胰腺切除术原发性肝癌整块切除胃出口侵犯根治性淋巴结清扫术原发性肝细胞癌乙型肝炎病毒

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Long acting octreotide in the treatment of advanced hepatocellular cancer and overexpression of somatostatin receptors: Randomized placebo-controlled trial

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World Journal of Gastroenterology 2007年第23期13卷 3164-3170页

作者： D Dimitroulopoulos D xinopoulos K Tsamakidis A Zisimopoulos E Andriotis D Panagiotakos A Fotopoulou C Chrysohoou A Bazinis D Daskalopoulou E Paraskevas Liver Cancer Unit "Agios Savvas" Cancer Hospital Athens Greece Laboratory of Biostatistics Department of Nursing University of Athens Greece Hippokration Hospital University of Athens Greece Psychiatric Department "Agios Savvas" Cancer Hospital Athens Greece

AIM: To estimate if and to what extent long acting octreotide (LAR) improves survival and quality of life in patients with advanced hepatocellular carcinoma (HCC). METHODS: A total of 127 cirrhotics, stages A-B, due to chronic viral infections and with advanced HCC, were enrolled in the study. Scintigraphy with 111Indium labeled octreotide was performed in all cases. The patients with increased accumulation of radionuclear compound were randomized to receive either oral placebo only or octreotide/octreotide LAR only as follows: octreotide 0.5mg s.c. every 8 h for 6 wk, at the end of wk 4-8 octreotide LAR 20 mg i.m. and at the end of wk 12 and every 4 wk octreotide LAR 30mg i.m.. Follow-up was worked out monthly as well as the estimation of quality of life (QLQ-C30 questionnaire). Patients with negative somatostatin receptors (SSTR) detection were followed up in the same manner. RESULTS: Scintigraphy demonstrated SSTR in 61 patients. Thirty were randomized to receive only placebo and 31 only octreotide. A significantly higher survival time was observed for the octreotide group (49 ± 6 wk) as compared to the control group (28 ± 1 wk) and to the SSTR negative group (28 ± 2 wk), LR = 20.39, df = 2, P < 0.01. The octreotide group presented 68.5% lower hazard ratio [95% CI (47.4%-81.2%)]. During the f irst year, a 22%, 39% and 43% decrease in the QLQ-C30 score was observed in each group respectively.CONCLUSION: The proposed therapeutic approach has shown to improve the survival and quality of life in SSTR positive patients with advanced HCC.

关键词：肝细胞癌生长激素抑制素受体生活质量

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Solitary fibrous tumor of the liver expressing CD34 and vimentin:A case report

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World Journal of Gastroenterology 2008年第40期14卷 6261-6264页

作者： Dimitris P Korkolis Katerina Apostolaki Chrysanthi Aggeli George Plataniotis Emmanuel Gontikakis Dimitra Volanaki Maria Sebastiadou Dimitris Dimitroulopoulos Dimitris xinopoulos George N Zografos Perikles P Vassilopoulos Department of Surgical Oncology Hellenic Anticancer Institute"Saint Savvas" Hospital Department of Surgical Pathology Hellenic Anticancer Institute"Saint Savvas" Hospital Department of Gastroenterology Hellenic Anticancer Institute"Saint Savvas" Hospital Department of Surgery General Hospital of Athens

A case of a successfully treated solitary fibrous tumor (SFT) of the liver is reported.An 82-year-old female presented with left upper abdominal discomfort,a firm mass on palpation,and imaging studies revealed a large tumor,15 cm in diameter,arising from the left lobe of the liver.A formal left hepatectomy was performed.Microscopic evaluation showed spindle and fibroblast-like cells within the collagenous stroma.Immunohistochemistry disclosed diffuse CD34 and positive vimentin,supporting the diagnosis of a benign SFT.The patient remained well 21 months after surgery.SFT of the liver is a very rare neoplasm of mesenchymal origin.In most cases it is a benign lesion,although some may have malignant histological features and recur locally or metastasize.With less than 30 reported cases in the literature,little can be said regarding its natural history or the benefits of adjuvant radiochemotherapy.Complete surgical resection remains the cornerstone of its treatment.

关键词：肝肿瘤单体纤维肿瘤波形蛋白 CD34

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