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Ischemic colitis:Clinical practice in diagnosis and treatment

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World Journal of Gastroenterology 2008年第48期14卷 7302-7308页

作者： Angeliki Theodoropoulou ioannis e koutroubakis Gastroenterology Unit Veni- zelion General Hospital of Heraklion Department of Gastroenterology University Hospital Heraklion

Ischemic colitis is the most common form of ischemic injury of the gastrointestinal tract and can present either as an occlusive or a non-occlusive form. It accounts for 1 in 1000 hospitalizations but its incidence is underesti- mated because it often has a mild and transient nature. The etiology of ischemic colitis is multifactorial and the clinical presentation variable. The diagnosis is based on a combination of clinical suspicion, radiographic, endo- scopic and histological findings. Therapy and outcome depends on the severity of the disease. Most cases of the non-gangrenous form are transient and resolve spontaneously without complications. On the other hand, high morbidity and mortality and urgent operative intervention are the hallmarks of gangrenous ischemic colitis.

关键词： Colon ischemia Intestinal blood flow Isch-emic colitis Thrombosis

Stimulating erythropoiesis in inflammatory bowel disease associated anemia

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World Journal of Gastroenterology 2007年第36期13卷 4798-4806页

作者： Georgia Tsiolakidou ioannis e koutroubakis Department of Gastroenterology University Hospital Heraklion Crete Greece

Anemia is a frequent complication in patients with inflammatory bowel disease (IBD), and is associated with decreased quality of life and increased rate of hospitalization. The primary therapeutic targets of IBD- associated anemia are iron deficiency and anemia of chronic disease. An important prognostic parameter of the success or failure of therapy is the outcome of the underlying disease. Iron deficiency should be appropriately managed with iron supplementation. However, the use of oral iron therapy is limited by several problems, the most important being gastrointestinal side effects leading occasionally to disease relapse and poor iron absorption. Intravenous iron preparations are more reliable, with iron sucrose demonstrating the best efficacy and tolerability. Treatment with erythropoietin or darbepoetin has been proven to be effective in patients with anemia, who fail to respond to intravenous iron. Patients with ongoing inflammation have anemia of chronic disease and may require combination therapy comprising of intravenous iron sucrose and erythropoietin. After initiating treatment, careful monitoring of hemoglobin levels and iron parameters is needed in order to avoid recurrence of anemia. In conclusion, anemia in the setting of IBD should be aggressively diagnosed, investigated, and treated. Future studies should define the optimal dose and schedule of intravenous iron supplementation and appropriate erythropoietin therapy in these patients.

关键词： Anemia Crohn’s disease erythropoiesis erythropoietin Iron Ulcerative colitis

Thrombosis and inflammatory bowel disease-the role of genetic risk factors

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World Journal of Gastroenterology 2008年第28期14卷 4440-4444页

作者： Georgia Tsiolakidou ioannis e koutroubakis Department of Gastroenterology University Hospital Heraklion CreteHeraklion 71110Greece

Thromboembolism is a significant cause of morbidity and mortality in patients with inflammatory bowel disease （IBD）. Recent data suggest thromboembolism as a disease-specific extraintestinal manifestation of IBD, which is developed as the result of multiple interactions between acquired and genetic risk factors. There is evidence indicating an imbalance of procoagulant, anticoagulant and fibrinolitic factors predisposing in thrombosis in patients with IBD. The genetic factors that have been suggested to interfere in the thrombotic manifestations of IBD include factor V Leiden, factor Ⅱ （prothrombin, G20210A）, methylenetetrahydrofolate reductase gene mutation （MTHFR, 6777T, plasminogen activator inhibitor type 1 （PAI-1） gene mutation and factor X Ⅲ （val34leu）. In this article we review the current data and future prospects on the role of genetic risk factors in the development of thromboembolism in TBD.

关键词： Crohn's disease Factor Ⅴ Leiden Genetics Thrombosis Ulcerative colitis

Multipotent role of platelets in inflammatory bowel diseases:A clinical approach

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World Journal of Gastroenterology 2014年第12期20卷 3180-3190页

作者： evangelos Voudoukis Konstantinos Karmiris ioannis e koutroubakis Department of Gastroenterology Venizelion General Hospital Department of Gastroenterology University Hospital Heraklion

There is evidence that inflammatory bowel diseases (IBD) combine both inflammation and coagulation in their pathogenesis and clinical manifestations. Although platelets (PLT) are well known for their role in hemostasis, there are a rising number of studies supporting their considerable role as inflammatory amplifiers in chronic inflammatory conditions. IBD are associated with several alterations of PLT, including number, shape, and function, and these abnormalities are mainly attributed to the highly activated state of circulating PLT in IBD patients. When PLT activate, they increase in size, release a great variety of bio-active inflammatory and procoagulant molecules/particles, and express a variety of inflammatory receptors. These inflammatory products may represent a part of the missing link between coagulation and inflammation, and can be considered as possible IBD pathogenesis instigators. In clinical practice, thrombocytosis is associated both with disease activity and iron deficiency anemia. Controlling inflammation and iron replacement in anemic patients usually leads to a normalization of PLT count. The aim of this review is to update the role of PLT in IBD and present recent data revealing the possible therapeutic implications of anti-PLT agents in future IBD remedies.

关键词： Anemia, Crohn’ s disease, Platelets, Thrombocytosis, Ulcerative colitis

Solid extraintestinal malignancies in patients with inflammatory bowel disease

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World Journal of Gastrointestinal Oncology 2021年第12期13卷 1956-1980页

作者： Anastasia Mala Kalliopi Foteinogiannopoulou ioannis e koutroubakis University Hospital of Heraklion Heraklion 71110CreteGreece Department of Gastroenterology University Hospital of HeraklionHeraklion 71110CreteGreece

Malignancies constitute the second cause of death in patients with inflammatory bowel diseases(IBD),after cardiovascular *** it has been postulated that IBD patients are at greater risk of colorectal cancer compared to the general population,lately there has been evidence supporting that this risk is diminishing over time as a result of better surveillance,while the incidence of extraintestinal cancers(eICs)is *** could be attributed either to systemic inflammation caused by IBD or to long-lasting immunosuppression due to IBD *** seems that the overall risk of eICs is higher for Crohn’s disease patients and it is mainly driven by skin cancers,and liver-biliary cancers in patients with IBD and primary sclerosing *** aims of this review were first to evaluate the prevalence,characteristics,and risk factors of eICs in patients with IBD and second to raise awareness regarding a proper surveillance program resulting in early diagnosis,better prognosis and survival,especially in the era of new IBD treatments that are on the way.

关键词： extraintestinal malignancies Crohn’s disease Ulcerative colitis Thiopurines Anti-tumor necrosis factor

Role of scintigraphy in inflammatory bowel disease

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World Journal of Gastroenterology 2009年第22期15卷 2693-2700页

作者： Maria I Stathaki Sophia I Koukouraki Nikolaos S Karkavitsas ioannis e koutroubakis Department of Nuclear Medicine University Hospital of Heraklion Department of Gastroenterology University Hospital of Heraklion

The diagnosis of inflammatory bowel disease(IBD) depends on direct endoscopic visualization of the colonic and ileal mucosa and the histological study of the obtained *** and scintigraphic methods are mainly used as an adjunct to *** this review,we focus on the diagnostic potential of nuclear medicine *** value of all radiotracers is described with special reference to those with greater experience and more satisfactory ***-99m hexamethylpropylene amine oxime white blood cells remain a widely acceptable scintigraphic method for the diagnosis of IBD,as well as for the evaluation of disease extension and ***,pentavalent Tc-99m dimercaptosuccinic acid has been recommended as an accurate variant and a complementary technique to endoscopy for the follow-up and assessment of disease *** emission tomography alone or with computed tomography using fluorine-18 fluorodeoxyglucose appears to be a promising method of measuring inflammation in IBD patients.

关键词： Crohn's disease Technetium-99m pentavalent dimercaptosuccinic acid Intestinal inflammation Scintigraphy Ulcerative colitis

Is there a role for Tc-99m (V) DMSA scintigraphy in ischemic colitis?

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World Journal of Gastroenterology 2008年第35期14卷 5432-5435页

作者： Maria I Stathaki ioannis e koutroubakis Sophia I Koukouraki elias A Kouroumalis Nikolaos S Karkavitsas Department of Nuclear Medicine University Hospital of HeraklionHeraklion 71110CreteGreece Department of Gastroenterology University Hospital of HeraklionHeraklion 71110CreteGreece

AIM: To evaluate the role of pentavalent Tc-99m dimercaptosuccinic acid [Tc-99m (V) DMSA] in the diagnosis of ischemic colitis. MeTHODS: Fourteen patients with endoscopically and histologically confirmed ischemic colitis were included in the study. Tc-99m (V) DMSA scintigraphy was performed within 2 d after colonoscopy. Images were considered positive when an area of increased activity was observed in the region of interest and negative when no abnormal tracer uptake was detected. ReSULTS: In 3 out of the 14 patients, Tc-99m (V) DMSA images showed moderate activity in the bowel. The scintigraphic results corresponded with the endoscopic findings. In the other 11 patients, no abnormal tracer uptake was detected in the abdomen. CONCLUSION: Besides the limited number of patients, Tc-99m (V) DMSA could not be considered as a useful imaging modality for the evaluation of ischemic colitis.

关键词： Scintigraphy Technetium-99m pentavalentdimercaptosuccinic acid Ischemic colitis Intestinal ischemia Diagnosis

Recent advances in the management of distal ulcerative colitis

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2010年第2期1卷 43-50页

作者： ioannis e koutroubakis Department of Gastroenterology University Hospital Heraklion

The most frequent localization of ulcerative colitis(UC) is the distal *** treating patients with active distal UC,efficacy and targeting of the drug to the distal colon are key *** and rectal 5-aminosalicylic acid(5-ASA) preparations represent the first line therapy of mild-to-moderate distal UC for both induction and maintenance *** has been reported that many UC patients are not adherent to therapy and that noncompliant patients had a 5-fold risk of experiencing a *** findings led to the introduction of oncedaily oral regimens of 5-ASA as better therapeutic options in clinical practice due to improved *** formulations of mesalazine,including the multimatrix delivery system,and mesalazine granules,which allow once-daily administration,have been *** have been demonstrated to be efficacious in inducing and maintaining remission in mild-to-moderate distal UC in large clinical ***,existing data for distal UC are rather insufficient to make a comparison between new and classical 5-ASA *** seems that the new formulations are at least as effective as classical oral 5-ASA *** treatment options,in the case that 5-ASA therapy is not effective,include systemic corticosteroids,thiopurines(azathioprine or 6-mercaptopurine),cyclosporine,infliximab and *** combination of a prompt diagnostic work-up,a correct therapeutic approach and an appropriate follow-up schedule is important in the management of patients with distal *** approach can shorten the duration of symptoms,induce a prolonged remission,improve patient's quality of life,and optimize the use of health resources.

关键词： Aminosalicylates Azathioprine Infliximab mesalazine Ulcerative colitis

SeRVICe ATTRIBUTe-PROCeSS MATRIX： A TOOL FOR DeSIGNING AND MANAGING SeRVICeS

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Journal of Systems Science and Systems engineering 2007年第3期16卷 257-276页

作者： Vassilis A. GLIATIS ioannis e. MINIS Department of Financial and Management engineering Business School University of the Aegean 31 Fostini Str. 82100 Chios Greece Fax: +30 - 22710 - 35400

The growing importance of the service economy during the last 40 years has raised the need for new tools for designing and managing services. As a result, several authors have developed service classification systems, in order to better understand the nature of service operations and provide methods and tools to improve service efficiency and quality. This paper exploits the work resulting from service classification systems and identifies the principal attributes to be considered in service management. The tool introduced for this purpose is the Service Attribute-Process Matrix （SAPM）, which uses selected results from existing service classification schemes to investigate the importance of the significant service attributes to major processes of the service life cycle.

关键词： Classification of services service dimensions service concepts service design and management