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World Journal of Gastroenterology 2007年第38期13卷 5116-5120页

作者： Michael Economou Grigoris Filis Zoi Tsianou John Alamanos Antonios Kogevinas Kostas Masalas Anna Petrou epameinondas v tsianos 1st Department of Internal Medicine and Hepato- gastroenterology Unit University of Ioannina School of Medicine Ioannina Greece Department of Hygiene and Epidemiology University of Ioannina School of Medicine Ioannina Greece

AIM: To assess the trends in the incidence of inflammatory bowel disease (IBD) over 23 years in the same area and to identify genetic factors related to incidence evolution. METHODS: Patients with IBD arising from North- western Greece were systematically recorded through the 1983-2005 period. Trends in disease incidence and genetic patterns related to CARD15 variants were documented and correlated. RESULTS: A total of 447 patients with IBD were recorded (23.5% Crohn’s disease, 72.7% Ulcerative colitis and 3.8% indeterminate colitis). Mean annual incidence rates of CD and UC were 0.9/100 000 (95% CI 0.1-1.7) and 2.7/100 000 (95% CI 1.7-4.1) inhabitants, respectively. There was a statistically significant increase of CD incidence (P variants over the study period. CONCLUSION: The incidence of CD in North-western Greece has risen disproportionately to that of UC in the 21st century. This is not related to alterations of genetic background though.

关键词： Inflammatory bowel disease Crohn's disease Epidemiology CARD15

Interferon-伪 plus lamivudine vslamivudine reduces breakthroughs, but does not affect sustained response in HBeAg negative chronic hepatitis B

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World Journal of Gastroenterology 2005年第37期11卷 5882-5887页

作者： Michalis Economou Spilios Manolakopoulos Thomas A Trikalinos Spyros Filis Sotiris Bethanis Dimitrios Tzourmakliotis Alec Avgerinos Sotiris Raptis epameinondas v tsianos Department of Gastroenterology Polyclinic General Hospital Athens Greece Hepato-Gastroenterology Unit Department of Internal Medicine University of Ioannina School of Medicine Ioannina Greece Department of Gastroenterology Polyclinic General Hospital Athens Greece Department of Hygiene and Epidemiology University of Ioannina School of Medicine Ioannina Greece Hepato-Gastroenterology Unit Department of Internal Medicine University of Ioannina School of Medicine Ioannina Greece 2~(nd) Department of Internal Medicine Propaedeutic Athens University Athens Greece 2~(nd) Department of Gastroenterology"Evangelismos" General Hospital Athens Greece 2~(nd) Department of Internal Medicine Propaedeutic Athens University Athens Greece

AIM： To investigate the efficacy of combination treatment of IFN-α and lamivudine compared to lamivudine monotherapy, after 24 mo of administration in HBeAgnegative hepatitis B patients. METHODS： Fifty consecutive patients were randomly assigned to receive IFN-α-2b （5 MU thrice per week, n = 24） plus lamivudine （100 mg daily） or lamivudine only （n = 26） for 24 mo. Patients were followed up for further 6 mo. The primary outcome was the proportion with sustained virological response （undetectable serum HBv DNA concentrations） and or sustained biochemical response （transaminase levels within normal range） at 30 mo （6 mo after the end of therapy）. Secondary end-points were timed from initial virological （biochemical） response to vBR （BBR, respectively） and the emergence of YMDD mutants across the two arms. RESULTS： Five of twenty-four （21%） patients in the combination arm vs 3/26 （12%） in the lamivudine arm had sustained response （i.e., normal serum transaminase levels and undetectable HBv DNA by PCR assay） 6 mo after treatment discontinuation. A reduction in the emergence of YMDD mutants and in the development of virological breakthroughs was observed in patients receMng combination treatment （10% vs46% , P= 0.01 and 14% vs46% , P= 0.03, respectively）. Time from initial virologic response to virologic breakthrough （vBR） was greater among initial responders receiving combination treatment compared to those receiving lamivudine （22.9 mo vs 15.9 mo, respectively; P = 0.005）.CONCLUSION： Our results demonstrate that IFN-α plus lamivudine combination therapy does not increase the sustained response, compared to lamivudine. However, combination therapy reduces the likelihood of vBR due to YMDD mutants and prolongs the time period until the breakthrough development.

关键词： Interferon Lamivudine Hepatitis B Combination therapy

Steatosis and steatohepatitis in postmortem material from Northwestern Greece

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World Journal of Gastroenterology 2010年第31期16卷 3944-3949页

作者： Christos D Zois Gerasimos H Baltayiannis Anna Bekiari Anna Goussia Peter Karayiannis Michalis Doukas Demetrios Demopoulos Antigoni Mitsellou Theodoros vougiouklakis vasiliki Mitsi epameinondas v tsianos 1st Department of Internal Medicine and Hepato-Gastroenterology Unit Medical SchoolUniversity of Ioannina Laboratory of Pathology Medical SchoolUniversity Hospital of Ioannina Department of Medicine Hepatology Sec-tionDivision of MedicineImperial College LondonVariety Wing Floor DSt.Mary's Campus Norfolk Place London W2 1PGLondonUnited Kingdom Department of Forensic Medicine and Toxicology Medical SchoolUniversity of Ioannina

AIM: To determine the prevalence of steatosis and steatohepatitis in a series of autopsies in Northwestern Greece. METHODS: Liver biopsy material from a total of 600 autopsies performed over a period of 2 years (2006-2008) to def ine the cause of death was subjected to histological examination. Patient demographic data were also collected. Tissue sections were stained with different dyes for the evaluation of liver architecture, degree of fibrosis and other pathological conditions when necessary. RESULTS: Satisfactory tissue samples for histological evaluation were available in 498 cases (341 male, 157 female) with a mean age of 64.51 ± 17.78 years. In total, 144 (28.9%) had normal liver histology, 156 (31.3%) had evidence of steatosis, and 198 (39.8%) had typical histological findings of steatohepatitis. The most common causes of death were ischemic heart disease with or without myocardial infarction (43.4%), and traffic accidents (13.4%). CONCLUSION: A high prevalence of steatosis and steatohepatitis was detected in postmortem biopsies from Northwestern Greece. Since both diseases can have serious clinical consequences, they should be considered as an important threat to the health of the general population in Greece.

关键词： Fatty liver Non-alcoholic liver disease Steatosis Steatohepatitis Autopsy

Diagnosis and endoscopic treatment of esophago-bronchial fistula due to gastric heterotopy

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World Journal of Gastrointestinal Endoscopy 2010年第4期2卷 138-142页

作者： Konstantinos H Katsanos Dimitrios K Christodoulou Sevasti Kamina Kosmidou Maria Evangelia Lambri Stavroula Theodorou Konstantinos Tsampoulas Mitsi vasiliki epameinondas v tsianos Department of Internal Medicine and Hepato-Gastroenterology Unit University Hospital of IoanninaIoannina 45110Greece Department of Pathology University Hospital of IoanninaIoannina45110Greece Department of Radiology University Hospital of IoanninaIoannina 45110Greece

Heterotopic gastric mucosa patches are congenital gastrointestinal abnormalities and have been reported to occur anywhere along the gastrointestinal tract from mouth to *** of heterotopic gastric mucosa include dysphagia,upper gastrointestinal bleeding,upper esophageal ring stricture,adenocarcinoma and fistula *** this case report we describe the diagnosis and treatment of the first case of esophago-bronchial fistula due to heterotopic gastric mucosa in mid esophagus.A 40-year old former professional soccer player was referred to our department for treatment of an esophago-bronchial *** examination of the biopsies taken from the esophageal fistula revealed the presence of gastric heterotopic *** decided to do a non-surgical therapeutic endoscopic procedure.A sclerotherapy catheter was inserted through which 1 mL of ready to use synthetic surgical glue was applied in the fistula and it closed the fistula opening with excellent results.

关键词： Gastric heterotopy Esophago-bronchial fistula Ectopic gastric mucosa Heterotopic gastric mucosa Esophagus Esophageal fistula therapy

Promoter methylation status of hMLH1,MGMT,and CDKN2A/p16 in colorectal adenomas

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World Journal of Gastroenterology 2010年第28期16卷 3553-3560页

作者： vasiliki Psofaki Chryssoula Kalogera Nikolaos Tzambouras Dimitrios Stephanou epameinondas tsianos Konstantin Seferiadis Georgios Kolios Laboratory of Clinical Chemistry University of Ioannina Medical School45500 IoanninaGreece Laboratory of Biochemistry University Hospital of IoanninaLeoforos S.Niarchou45500 IoanninaGreece Hepatogastroenterology Unit of Internal Medicine University Hospital of IoanninaLeoforos S.Niarchou45500 IoanninaGreece Laboratory of Pathology University Hospital of IoanninaLeoforos S.Niarchou45500 IoanninaGreece

AIM:To investigate aberrant DNA methylation of CpG islands and subsequent low-or high-level DNA microsatellite instability(MSI)which is assumed to drive colon carcinogenesis. METHODS:DNA of healthy individuals,adenoma(tu-bular or villous/tubulovillous)patients,and colorectal carcinoma patients who underwent colonoscopy was used for assessing the prevalence of aberrant DNA methylation of human DNA mismatch repair gene mutator L homologue 1(hMLH1),Cyclin-dependent kinase inhibitor 2A(CDKN2A/p16),and O-6-methylguanine DNA methyltransferase(MGMT),as well as their rela- tion to MSI. RESULTS:The frequency of promoter methylation for each locus increased in the sequence healthy tissue/adenoma/*** showed the highest frequency in each *** and CDKN2A/p16 presented a statistically significant increase in promoter methylation between the less and more tumorigenic forms of colorectal adenomas(tubular vs tubullovillous and villous adenomas).All patients with tubulovillous/villous adenomas,as well as all colorectal cancer patients,showed promoter methylation in at least one of the examined *** findings suggest a potentially crucial role for methylation in the polyp/adenoma to cancer progres- sion in colorectal *** and methylation seem to be interdependent,as simultaneous hMLH1, CDKN2A/p16,and MGMT promoter methylation was present in 8/9 colorectal cancer patients showing the MSI phenotype. CONCLUSION:Methylation analysis of hMLH1,CD- KN2A/p16,and MGMT revealed specific methylation profiles for tubular adenomas,tubulovillous/villous adenomas,and colorectal cancers,supporting the use of these alterations in assessment of colorectal tumorigenesis.

关键词： Promoter methylation Microsatellite instability Human DNA mismatch repair gene mutator L homologue 1 O-6-methylguanine DNA methyltransferase Cyclin-dependent kinase inhibitor 2A

Relationship between serum b2-microglobulin levels and virological breakthrough in HBeAg-negative chronic hepatitis B patients,under long-term treatment schedules including lamivudine

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World Journal of Gastroenterology 2005年第13期11卷 1922-1928页

作者： Ioannis S.Elefsiniotis Antonios Moulakakis Konstantinos D.Pantazis Irene Glynou Ioannis Ketikoglou Elena vezali Helen Kada epameinondas tsianos Department of Internal Medicine Department of Microbiology Department of Hepatogastroenterology

AIM: Predictive value of serum b2-microglobulin (b2m)levels for virological breakthrough (vB) in HBeAg-negative chronic hepatitis B (CHB) patients under long-term treatment schedules including lamivudine (LAM).METHODS: Serum b2m levels were calculated during treatment in 25 CHB patients under long-term LAM monotherapy (group A) and 12 patients under initial interferon plus LAM treatment followed by LAM monotherapy (group B), using the MEIA technology. We used Cox proportional hazard models in order to investigate the association between serum b2m levels and ***: Seven of 25 patients (28%), 9/25 (36%) and 14/25 (56%) from group A and 0/12, 2/12 (16.6%) and 3/12 (25%) from group B exhibited vB at months 12, 24 and 36 of treatment, respectively. All patients, from both groups, who did not show vB exhibited b2m elevation in mo 3. The duration of b2m elevation was significantly longer in the virological responder's subgroup from group A than the non-responder's one (7.3±2.6 vs 3.8±3.4 mo,P = 0.02). In comparison to group A patients whose b2m levels were increased at 3 mo, patients whose b2m levels were decreased had 4.6 times higher risk of experiencing vB (RR = 4.6, P = 0.024). When baseline variables were simultaneously included in the same Cox model, decreased b2m status was still associated with increased risk of vB (RR = 12.2, P = 0.03).CONCLUSION: In HBeAg-negative CHB patients under either long-term LAM monotherapy or initial combination treatment, serum b2m levels at 3 mo of treatment,compared to baseline ones, might be a predictor of risk for vB.

关键词： Chronic hepatitis B Lamivudine Interferon virological breakthrough B2-microglobulin

肝硬化腹水患者中亚甲基蓝抑制一氧化氮的作用

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世界核心医学期刊文摘（胃肠病学分册） 2006年第3期2卷 11-11页

作者： Kalambokis G. Economou M. Fotopoulos A. E.v. tsianos 纪泛扑 Department of Internal Medicine Medical School of Ioannina 45110 Ioannina Greece.Dr

Increased endogenous nitric oxide production has been proposed as an important mediator of the peripheral arterial vasodilation and the hyperdynamic circulation in cirrhosis, whereas a decreased intrahepatic production of nitric oxide has been implicated in the pathogenesis of portal hypertension. The present study investigated the possible beneficial effects of methylene blue, which is a potent inhibitor of guanylate cyclase and nitric oxide synthase, on hyperdynamic circulation and renal function in cirrhotic patients with ascites together with the effects on portal hemodynamics. Twenty patients were evaluated at baseline and during 2 consecutive 4-hr periods after the administration of methylene blue at a dose of 3 mg/kg (10 patients) or placebo (10 patients). Mean arterial pressure, heart rate, cardiac output, systemic vascular resistance, plasma active renin, plasma aldosterone, plasma antidiuretic hormone, serum urea, serum creatinine, serum sodium, urinary flow rate, glomerular filtration rate, effective renal plasma flow, portal flow volume, and portal vein velocity were not modified by methylene blue or placebo. Urinary sodium excretion, fractional sodium excretion and serum nitric oxide levels were significantly decreased 4 hr after methylene blue administration (P vels over a further 4-hr period. It is concluded that methylene blue, at the dose used in the present study, has no effect on systemic and portal hemodynamics in cirrhotic patients with ascites. The reduction in renal sodium excretion, in the absence of changes in renal function and hemodynamics, suggests, at least partly, a direct antinatriuretic effect of methylene blue.

关键词：肝硬化腹水亚甲基蓝门静脉血流量门脉高压血清钠安慰剂动力循环体循环血管阻力活性肾素血

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奥曲肽在治疗肝硬化顽固性腹水中的作用

世界核心医学期刊文摘（胃肠病学分册） 2006年第6期2卷 59-59页

作者： Kalambokis G. Fotopoulos A. Economou M. tsianos E. v. 赵菊辉(译) 陈云茹(校) 不详 Medical School of Ioannina GR-45110 Ioannina Greece

Dietary sodium restriction and diuretic treatment have been shown to be effective in the treatment of ascites in the majority of cirrhotic patients. However, approximately 5 to 10%of patients develop refractory ascites, which is defined as ascites that does not respond to intensive diuretic therapy (diuretic-resistant) or ascites that cannot be controlled because the patient develops diuretic-induced complications that prevent the use of an effective diuretic dose (diuretic-intractable). Current therapeutic approaches for refractory ascites include repeated large-volume paracentesis and transjugular intrahepatic portosystemic shunting. In the present report, subcutaneous octreotide treatment improved renal function and hemodynamics and diuretic response in two patients with refractory ascites in line with a marked decrease in renin and aldosterone secretion. We consider that octreotide could be of value in the management of refractory ascites in cirrhotic patients.

关键词：肝硬化顽固性腹水治疗方法奥曲肽经颈静脉门体分流术利尿剂抵抗难治性腹水肝硬化腹水血流动力学血管紧张素腹水穿刺