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Angiotensin-receptor blockers as therapy for mild-to-moderate hypertension-associated non-alcoholic steatohepatitis

World Journal of Gastroenterology 2009年第8期15卷 942-954页

作者： eugen florin georgescu Reanina Ionescu Mihaela Niculescu Laurentiu Mogoanta Liliana Vancica Department of Internal Medicine 2 Filantropia University Hospital Str. Constantin Brancusi nr. 3 Craiova 200136 Romania Department of Internal Medicine University of Medicine and Pharmacy of Craiova Str.Petru Rares 4 Craiova 200349 Romania Department of Pathology University of Medicine and Pharmacy of Craiova Str.Petru Rares 4 Craiova 200349 Romania Department of Pathology Filantropia University Hospital Str. Constantin Brancusi nr. 3 Craiova 200136 Romania

AIM: To evaluate insulin resistance, cytolysis and nonalcoholic steatohepatitis (NASH) score (NAS) using the Kleiner and Brunt criteria in 54 patients with NASH and mild-to-moderate hypertension, treated with telmisartan vs valsartan for 20 mo. METHODS: All patients met the NCEP-ATP TM(standard dose 20 mg o.d., n = 28). Treatment had to be taken daily at the same hour with no concomitant medication or alcohol consumption allowed. Neither the patient nor the medical staff was aware of treatment group allocation. Paired liver biopsies obtained at inclusion (visit 1) and end of treatment (EOT) were assessed by a single blinded pathologist, not aware of patient or treatment group. Blood pressure, BMI, ALT, AST, HOMA-IR, plasma triglycerides (TG) and total cholesterol (TC) were evaluated at inclusion and every 4 mo until EOT (visit 6). RESULTS: At EOT we noticed a significant decrease in ALT levels vs inclusion in all patients and this decrease did not differ significantly in group T vs group V. HOMA-IR significantly decreased at EOT vs inclusion in all patients but in group T, the mean HOMA-IR decrease per month was higher than in group V. NAS significantly diminished at EOT in all patients with a higher decrease in group T vs group V. CONCLUSION: Angiotensin receptor blockers seem to be efficient in hypertension-associated NASH. Telmisartan showed a higher efficacy regarding insulin resistance and histology, perhaps because of its specific PPAR-gamma ligand effect.

关键词：非酒精性脂肪性肝炎中度高血压血管紧张素Ⅱ 受体阻滞剂治疗组胰岛素抵抗指数病毒性肝炎患者代谢综合征

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Ischemic colitis and large bowel infarction:A case report

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World Journal of Gastroenterology 2012年第39期18卷 5640-5644页

作者： eugen florin georgescu Doina Carstea Daniela Dumitrescu Ramona Teodorescu Andrei Carstea Department of Internal Medicine 1/Gastroenterology Filantropia University Hospital of Craiova200136 CraiovaRomania Department of Cardiology Filantropia University Hospital of Craiova200136 CraiovaRomania Department of Radiology University of Medicine and Pharmacy of Craiova200349 CraiovaRomania

Ischemic bowel disease results from an acute or chronic drop in the blood supply to the bowel and may have various clinical presentations, such as intestinal angina, ischemic colitis or intestinal infarction. Elderly patients with systemic atherosclerosis who are symptomatic for the disease in two or more vascular beds have multiple comorbidities and are particularly at risk. The clinical evolution and outcome of this disease are difficult to predict because of its pleomorphic aspects and the general lack of statistical data. In this paper, we present the case of a patient who was monitored in our unit for six years. For this patient, we encountered iterative changes in the clinical pattern, beginning with chronic "intestinal angina" and finishing with signs of acute mesenteric ischemia after an episode of ischemic colitis. This evolution is particularly rare in clinical practice, and the case is instructive because it raises discussions about the natural history of the condition and the thera-peutic decisions that should be made at every stage of the disease. An important lesson is that ischemic bowel disease should always be considered in patients who have multiple risk factors for atherosclerosis and have experienced recurrent "indistinct" abdominal symptoms.In these cases, aggressive investigation and therapeutic decisions must be taken whenever possible. Despite an absence of standardized protocols, angiographic evaluation and revascularization procedures have beneficial outcomes. Current advances in endovascular therapy, such as percutaneous transluminal angioplasty with stenting, should be increasingly used in patients with chronic mesenteric ischemia. Such therapy can avoid the risks that are associated with open repair. However, technical difficulties, especially in severe stenotic lesions, frequently occur.

关键词：大肠杆菌结肠炎缺血病例报告动脉粥样硬化介入治疗临床表现血管成形术

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Intestinal pseudo-obstruction:An uncommon condition with heterogeneous etiology and unpredictable outcome

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World Journal of Gastroenterology 2008年第6期14卷 954-959页

作者： eugen florin georgescu Ion Vasile Reanina Ionescu Filantropia University Hospital from Craiova Department of Internal Medicine 2 University of Medicine and Pharmacy of Craiova Romania Departmental Emergency University Hospital from Craiova Department of General Surgery 2 University of Medicine and Pharmacy of Craiova Romania

Intestinal pseudo-obstruction (IPO) either acute or chronic is a condition including features of intestinal ileus in absence of mechanical obstruction. Our paper presents such a rare case of idiopathic IPO in a 53-year-old male patient with recurrent episodes of pseudo-obstruction, which were successfully resolved by anticholinesterase agents, motilin agonists or colonic decompression. However, the patient finally underwent total colectomy. Huge colonic dilatation was identified intraoperatorily, while histology showed a neuropathic variant of chronic intestinal pseudo-obstruction. Etiologic mechanisms and current therapeutic methods are reviewed in this paper, which concludes that IPO is a condition in which conservative treatment usually fails. Total colectomy with ileoanal pouch may be the only solution in these situations.

关键词：肠功能障碍抗胆碱酯酶促胃动素病原学

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