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Clinical considerations and therapeutic strategy for sigmoid volvulus in the elderly:A study of 33 cases

World Journal of Gastroenterology 2007年第6期13卷 921-924页

作者： Michael Safioleas Constantinos Chatziconstantinou Evangelos Felekouras Michael Stamatakos ioannis papaconstantinou Anastasios Smirnis Panagiotis Safioleas Alkiviades Kostakis 2~(nd) Department of Propedeutic Surgery School of Medicine Athens University Laiko Hospital Greece Department of Radiology Laiko Hospital Athens Greece 1~(st) Department of Surgery School of Medicine Athens University Laiko Hospital Greece

AIM： To evaluate different types of treatment for sigmoid volvulus and clarify the role of endoscopic intervention versus surgery. METHODS： A retrospective review of the clinical presentation and imaging characteristics of 33 sigrnoid volvulus patients was presented, as well as their diagnosis and treatment, in combination with a literature review. RESULTS： In 26 patients endoscopic detorsion was achieved after the first attempt and one patient died because of uncontrollable sepsis despite prompt operative treatment. Seven patients had unsuccessful endoscopic derotation and were operated on. On two patients with gangrenous sigrnoid, Hartmann＇s procedure was performed. In five patients with viable colon, a sigmoid resection and primary anastomosis was carried out. Three patients had a lavage ＂on table＂ prior to anastomosis, while in the remaining 2 patients a diverting stoma was performed according to the procedure of the first author. Ten patients were operated on during their first hospital stay （3 to 8 d after the deflation）. All patients had viable colon; 7 patients had a sigmoid resection and primary anastomosis, 2 patients had sigrnoidopexy and one patient underwent a near-total colectomy. Two .patients （sigmoidectomy- sigmoidopexy） had recurrences of volvulus 43 and 28 mo after the initial surgery. Among 15 patients who were discharged from the hospital after non-operative deflation, 3 patients were lost to follow-up. Of the remaining 12 patients, 5 had a recurrence of volvulus at a time in between 23 d and 14 mo. All the five patients had been operated on and in four a gangrenous sigmoid was found. Three patients died during the 30 d postoperative course. The remaining seven patients were admitted to our department for elective surgery. In these patients, 2 subtotal colectomies, 3 sigmoid resections and 2 sigmoidopexies were carried out. One patient with subtotal colectomy died. Taken together of the results, it is evident that after 17 elective operations

关键词： Volvulus Celiotomy Large bowel obstruction Decompression Sigmoidectomy

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Risk factors for gastroesophageal reflux disease and analysis of genetic contributors

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World Journal of Clinical Cases 2018年第8期6卷 176-182页

作者： Alexandra Argyrou Evangelia Legaki Christos Koutserimpas Maria Gazouli ioannis papaconstantinou George Gkiokas George Karamanolis Department of Basic Medical Sciences Laboratory of BiologySchool of MedicineNational and Kapodistrian University of Athens 2nd Department of General Surgery "Sismanoglion" General Hospital of Athens 2nd Department of Surgery School of MedicineNational and Kapodistrian University of Athens Gastroenterology Unit 2nd Department of SurgerySchool of MedicineNational and Kapodistrian University of Athens

Gastroesophageal reflux disease(GERD) is a common gastrointestinal disorder with an increasing prevalence. GERD develops when the reflux of stomach contents causes troublesome typical and atypical symptoms and/or complications. Several risk factors of GERD have been identified and evaluated over the years, including a considerable amount of genetic factors. Multiple mechanisms are involved in the pathogenesis of GERD including:(1) motor abnormalities, such as impaired lower esophageal sphincter(LES) resting tone, transient LES relaxations, impaired esophageal acid clearance and delayed gastric emptying; and(2) anatomical factors, such as hiatal hernia and obesity. Genetic contribution seems to play a major role in GERD and GERD-related disorders development such Barrett's esophagus and esophageal adenocarcinoma. Twin and family studies have revealed an about 31% heritability of the disease. Numerous single-nucleotide polymorphisms in various genes like FOXF1, MHC, CCND1, anti-inflammatory cytokine and DNA repair genes have been strongly associated with increased GERD risk. GERD, Barrett'sesophagus and esophageal adenocarcinoma share several genetic loci. Despite GERD polygenic basis,specific genetic loci such as rs10419226 on chromosome 19, rs2687201 on chromosome 3, rs10852151 on chromosome 15 and rs520525 on the paired related homeobox 1 gene have been mentioned as potential risk factors. Further investigation on the risk genes may elucidate their exact function and role and demonstrate new therapeutic approaches to this increasingly common disease.

关键词： Single nucleotide polymorphisms Genetic risk loci Risk factors Gastroesophageal reflux disease Gastroesophageal reflux disease development

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Circadian variation in expression of G_1 phase cyclins D_1 and E and cyclin-dependent kinase inhibitors p16 and p21 in human bowel mucosa

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World Journal of Gastroenterology 2006年第13期12卷 2109-2114页

作者： John Griniatsos Othon P Michail Stamatios Theocharis Antonios Arvelakis ioannis papaconstantinou Evangelos Felekouras Emmanouel Pikoulis ioannis Karavokyros Chris Bakoyiannis George Marinos John Bramis Panayiotis O Michail 1st Department of Surgery Medical School University of AthensGreece Department of Forensic Medicine and Toxicology Medical School University of AthensGreece

AIM： To evaluate whether the cellular proliferation rate in the large bowel epithelial cells is characterized by circadian rhythm. METHODS： Between January 2003 and December 2004, twenty patients who were diagnosed as suffering from primary, resectable, non-metastatic adenocarcinoma of the lower rectum, infiltrating the sphincter mechanism, underwent abdominoperineal resection, total mesorectal excision and permanent left iliac colostomy. In formalinfixed and paraffin-embedded biopsy specimens obtained from the colostomy mucosa every six hours （00：00, 06：00, 12：00, 18：00 and 24：00）, we studied the expression of G1 phase cyclins （D1 and E） as well as the expression of the G1 phase cyclin-dependent kinase （CDK） inhibitors p16 and p21 as indicators of cell cycle progres- sion in colonic epithelial cells using immunohistochemical methods. RESULTS： The expression of both cyclins showed a similar circadian fashion obtaining their lowest and highest values at 00：00 and 18：00, respectively （P〈 0.001）. A circadian rhythm in the expression of CDK inhibitor proteins p16 and p21 was also observed, with the lowest levels obtained at 12：00 and 18：00 （P〈0.001）, respectively. When the complexes cyclins D1-p21 and E-p21 were examined, the expression of the cyclins was adversely correlated to the p21 expression throughout the day. When the complexes the cyclins D1-p16 and E-p16 were examined, high levels of p16 expression were correlated to low levels of cyclin expression at 00：00, 06：00 and 24：00. Meanwhile, the highest expression levels of both cyclins were correlated to high levels of p16 expression at 18：00. CONCLUSION： Colonic epithelial cells seem to enter the G1 phase of the cell cycle during afternoon （between 12：00 and 18：00） with the highest rates obtained at 18：00. From a clinical point of view, the present results suggest that G1-phase specific anticancer therapies in afternoon might maximize their anti-tumor effect while minimizing toxicity.

关键词： G1 phase proteins CDK inhibitors Cell proliferation Circadian rhythm

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Malignant carcinoid tumor of the cystic duct:a rare cause of bile duct obstruction

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Hepatobiliary & Pancreatic Diseases International 2009年第6期8卷 640-646页

作者： Evangelos Felekouras Athanasios Petrou Konstantinos Bramis Evangelos Prassas ioannis papaconstantinou Nikoleta Dimitriou Anastasia Pazaiti Christos Tsigris Athanasios Giannopoulos First Department of Surgery National and Kapodistrian University of AthensMedical SchoolLAIKON General Hospital

BACKGROUND:Carcinoid tumors of the extrahepatic biliary tree are extremely rare malignancies,accounting for 0.2%-2%of all gastrointestinal carcinoid tumors,while carcinoids of the cystic duct are an uncommon entity and an extremely unusual cause of bile duct ***:After an extensive literature review,we retrospectively analysed 61 cases of carcinoid tumor of the biliary tree as well as one additional case of a 60-yearold female with symptoms and laboratory/imaging examination findings compatible with those of a malignant biliary tract *** laparotomy,resection of the gallbladder and common bile duct was *** study revealed a well-differentiated neuroendocrine carcinoma of the cystic *** patient remained disease-free at 16 ***:Our presentation is the seventh case reported in the world *** to cholangiocarcinoma,analysis of the reviewed group indicates an increased incidence of extrahepatic carcinoid tumors in younger persons along with a slight female ***,the most common anatomic location is the common bile duct,followed by the perihilar region and the cystic *** is the most common *** surgery was realized in the majority of cases and longterm disease-free survival was achieved when surgery was ***:Carcinoid tumors obstructing the biliary tree are extremely difficult to diagnose preoperatively,and nearly impossible to differentiate from non-neuroendocrine *** surgery offers the only potential cure for both biliary carcinoids and cholangiocarcinoma,we recommend aggressive surgical therapy as the treatment of choice in every case of potentially resectable biliary tumor.

关键词： carcinoid tumor biliary tree cystic duct well-differentiated endocrine tumor

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Relation between common polymorphisms in genes related to inflammatory response and colorectal cancer

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World Journal of Gastroenterology 2006年第31期12卷 5037-5043页

作者： George Theodoropoulos ioannis papaconstantinou Evangelos Felekouras Nikolaos Nikiteas Petros Karakitsos Dimitris Panoussopoulos Andreas Ch Lazaris Efstratios Patsouris John Bramis Maria Gazouli 1st Propaideutic Surgical DepartmentHippocration University Hospital School of MedicineUniversity of AthensGreece 1st Surgical DepartmentLaikon University Hospital University of AthensGreece Department of PathologySchool of Medicine University of AthensGreece 2nd Propaideutic Surgical DepartmentLaikon University Hospital University of AthensGreece Department of CytopathologyUniversity General Hospital "Artikon" University of AthensGreece Department of BiologySchool of Medicine University of AthensGreece

AIM： To investigate the association between common single nucleotide polymorphisms （SNPs） in inflammatory response-related genes such as interleukin （IL）-6, IL-8, tumor necrosis factor α （TNFα）, peroxisome proliferators-activated receptor γ （PPARγ）, intercellular adhesion molecule-1 （ICAM-1） and the risk of colorectal cancer （CRC） in a group of Greek patients. METHODS： The study group consisted of 222 CRC patients and 200 healthy controls. Genotyping was performed using allele-specific PCR of PRC-RFLP and the results were confirmed by sequencing. We studied the association of SNPs in the IL-6 （-174G 〉 C）, IL-8 （-251T 〉 A）, TNFα （-308G 〉 A）, ICAM-1 （R241G and K469E）, and PPARγ （Pro12Ala） genes and the risk of CRC. RESULTS： The IL-6 -174G, R241 and K469 alleles of ICAM-1 were associated with increased risk of CRC （OR = 1.77, 95% CI： 1.34-2.34; OR = 1.83, 95% CI： 1.23-2.72; and OR = 1.35, 95% CI： 1.03-1.77 respectively）. The IL-8 and TNFα polymorphisms had no effect. Whereas the PPARγ Pro12 genotype was associated with increased risk of disease （OR = 1.78, 95% CI： 1.25-2.49）. CONCLUSION： The association between common SNPs in immunologic response-related genes and CRC is reported in the present study. Apart from shedding light on the mechanisms of malignancy initiation and progression, SNPs may improve appropriate screening for sub-populations at risk.

关键词： Colorectal cancer Inflammation Single nucleotide polymorphisms

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Posterior reversible encephalopathy syndrome following sepsis in a Crohn's disease patient: A case report

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World Journal of Clinical Cases 2016年第4期4卷 103-107页

作者： ioannis papaconstantinou Dionysios S Mantzos Eirini Pantiora Marios K Tasoulis Sofia Vassilopoulou Gerassimos Mantzaris 2~(nd) Department of Surgery Aretaieio Hospital Medical School University of Athens 1~(st)Department of Neurology Eginition Hospital Medical School University of Athens 1~(st) Gastroenterology Department Evangelismos Hospital

Posterior reversible encephalopathy syndrome(PRES)is a clinico-ragiological syndrome presenting with neurological symptoms and characteristic radiologic *** occurs in the setting of various clinical conditions and requires prompt management of the causative factor for a full *** is a case report of a Crohn’s disease patient who developed PRES syndrome during a complicated post-operative *** the presence of multiple causative factors,sepsis was considered as the predominant *** prompt management,the patient recovered with no permanent neurological damage.

关键词： Crohn’s disease Sepsis Posterior reversible encephalopathy syndrome Diagnosis

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Fecal calprotectin measurement is a marker of shortterm clinical outcome and presence of mucosal healing in patients with inflammatory bowel disease

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World Journal of Gastroenterology 2017年第41期23卷 7387-7396页

作者： Athanasios Kostas Spyros I Siakavellas Charalambos Kosmidis Anna Takou Joanna Nikou Georgios Maropoulos John Vlachogiannakos George V Papatheodoridis ioannis papaconstantinou Giorgos Bamias Department of Gastroenterology University of Athens Medical School Laiko General Hospital Bioche-mistry Department Laiko General Hospital 2nd Department of Surgery University of Athens Medical School Areteion General Hospital

AIM To evaluate the utility of fecal calprotectin(FC) in predicting relapse and endoscopic activity during follow-up in an inflammatory bowel disease(IBD) *** All FC measurements that were obtained during a 3-year period from patients with inflammatory bowel disease in clinical remission were identified. Data regarding the short-term(6 mo) course of the disease were extracted from the medical files. Exclusion criteria were defined as:(1) An established flare of the disease at the time of FC measurement,(2) Loss to follow up within 6 mo from baseline FC measurement, and,(3) Insufficient data on file. Statistical analysis was performed to evaluate whether baseline FC measurement could predict the short term clinical relapse and/or the presence of mucosal *** We included 149 [Crohn's disease(CD) = 113, Ulcerative colitis(UC) = 36, male = 77] IBD patients in our study. Within the determined 6-month period post-FC measurement, 47(31.5%) had a disease flare. Among 76 patients who underwent endoscopy, 39(51.3%) had mucosal healing. Baseline FC concentrations were significantly higher in those who had clinical relapse compared to those who remained in remission during follow up(481.0 μg/g, 286.0-600.0 vs 89.0, 36.0-180.8, P < 0.001). The significant predictive value of baseline median with IQR FC for clinical relapse was confirmed by multivariate Cox analysis [HR for 100μg/g: 1.75(95%CI: 1.28-2.39), P = 0.001]. Furthermore, lower FC baseline values significantly correlated to the presence of mucosal healing in endoscopy(69.0 μg/g, 30.0-128.0 vs 481.0, 278.0-600.0, in those with mucosal inflammation, median with IQR, P < 0.001). We were able to extract cut-off values for FC concentration with a high sensitivity and specificity for predicting clinical relapse(261 μg/g with AUC = 0.901, sensitivity 87.2%, specificity 85.3%, P < 0.001) or mucosal healing(174 μg/g with AUC = 0.956, sensitivity 91.9%, specificity 87.2%, P < 0.001). FC was better than CRP in

关键词： Fecal calprotectin Biomarker Inflammatory bowel disease Mucosal healing Clinical outcome Relapse Ulcerative colitis Crohn’s disease

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Isotretinoin and ulcerative colitis: A case report and review of the literature

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World Journal of Gastrointestinal Surgery 2014年第7期6卷 142-145页

作者： ioannis papaconstantinou Anastasios Stefanopoulos Aspasia Papailia Christos Zeglinas ioannis Georgopoulos Spyridon Michopoulos Second Department of Surgery Aretaieion HospitalAthens 11528 Greece Department of Gastroenterology Tzaneio General HospitalPiraeus 18536 Greece Department of Gastrenterology General Hospital of Athens "Aleksandra"Athens 11528 Greece

This case report describes a case of ulcerative colitisthe onset of which occurred after the use of isotreti-noin for acne treatment. Our patient, a healthy maleyoung adult, after several months of isotretinoin use,developed gastrointestinal disorders and after thoroughmedical workup was diagnosed with ulcerative *** literature regarding a possible correlation betweenisotretinoin use and ulcerative colitis is scarce. Never-theless, recent epidemiological studies have shed morelight on this possible association.

关键词： Ulcerative colitis Isotretinoin Acne Inflammatory bowel disease Heroin addiction

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Solitary rectal cap polyp:Case report and review of the literature

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World Journal of Gastrointestinal Surgery 2012年第6期4卷 157-162页

作者： ioannis papaconstantinou Andreas Karakatsanis Xanthi Benia George Polymeneas Evanthia Kostopoulou Second Department of Surgical Aretaieion HospitalUniversity of AthensFaculty of Medicine76 Vas Sophias Av11528 AthensGreece Department of Pathology Faculty of MedicineUniversity of Thessaly41222 LarisaGreece

Rectal bleeding combined with the presence of a rectal mass has been traditionally associated with the presence of malignant *** polyposis is a relatively young and still undefined rare entity which mainly involves the *** is characterized by the presence of inflammatory *** this case report,we present a patient who was diagnosed with a solitary cap polyp of the rectum during the investigation of a bleeding rectal *** patient’s age and the absence of family history were not in favor of malignancy,despite the strong initial clinical *** confirmation of the diagnosis,the patient underwent a snare excision and remains *** polyposis,although rare,should be suspected and,when diagnosed,should be treated according to location,number of polyps and severity of symptoms.

关键词： Cap polyposis Inflammatory polyp Rectal mass

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Association of miR-146 rs2910164,miR-196a rs11614913,miR-221 rs113054794 and miR-224 rs188519172 polymorphisms with anti-TNF treatment response in a Greek population with Crohn's disease

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2017年第4期8卷 193-200页

作者： ioannis papaconstantinou Christina Kapizioni Evangelia Legaki Elena Xourgia George Karamanolis Antonios Gklavas Maria Gazouli 2^nd Department of Surgery Aretaieio HospitalMedical SchoolNational and Kapodistrian University of Athens Gastroenterology Department Tzaneion General Hospital Laboratory of Biology Medical SchoolNational and Kapodistrian University of Athens Gastroenterology Unit 2^nd Department of SurgeryAretaieio HospitalMedical SchoolNational and Kapodistrian University of Athens

AIM To investigate the correlation between rs2910164, rs11 614913, rs113054794, and rs188519172 polymorphisms and response to anti-TNF treatment in patients with Crohn's disease(CD). METHODS One hundred seven patients with CD based on standardclinical, endoscopic, radiological, and pathological criteria were included in the study. They all received infliximab or adalimumab intravenously or subcutaneously at standard induction doses as per international guidelines. Clinical and biochemical response was assessed using the HarveyBradshaw index and CRP levels respectively. Endoscopic response was evaluated by ileocolonoscopy at week 12-20 of therapy. The changes in endoscopic appearance compared to baseline were classified into four categories, and patients were classified as responders and nonresponders. Whole peripheral blood was extracted and genotyping was performed by *** One hundred and seven patients were included in the study. Seventy two(67.3%) patients were classified as complete responders, 22(20.5%) as partial while 13(12.1%) were primary non-responders. No correlation was detected between response to anti-TNF agents and patients' characteristics such as gender, age and disease duration while clinical and biochemical indexes used were associated with endoscopic response. Concerning prevalence of rs2910164, rs11614913, and rs188519172 polymorphisms of miR-146, miR-196a and miR-224 respectively no statistically important difference was found between complete, partial, and non-responders to antiTNF treatment. Actually CC genotype of rs2910164 was not detected in any patient. Regarding rs113054794 of miR-221, normal CC genotype was the only one detected in all studied patients, suggesting this polymorphism is highly rare in the studied *** No correlation is detected between studied polymorphisms and patients' response to anti-TNF treatment. Polymorphism rs113054794 is not detected in our population.

关键词： MicroRNA Crohn’s disease Polymorphisms Anti-TNF Biomarkers

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