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Pituitary hormone circadian rhythm alterations in cirrhosis patients with subclinical hepatic encephalopathy

World Journal of Gastroenterology 2008年第26期14卷 4190-4195页

作者： Dimitrios Velissaris menelaos karanikolas Andreas Kalogeropoulos Ekaterini Solomou Panagiotis Polychronopoulos Konstantinos Thomopoulos Chrissoula Labropoulou-Karatza Department of Anaesthesiology and Intensive Care Medicine University Hospital of PatrasRion 26500Greece Department of Anaesthesiology and Intensive Care Medicine University Hospital of Patras Rion 26500Greece Department of Internal Medicine University Hospital of PatrasRion 26500Greece Department of Radiology University Hospital of Patras Rion 26500Greece Department of Neurology University Hospital of Patras Rion 26500Greece

AIM:To analyze pituitary hormone and melatonin circadian rhythms, and to correlate hormonal alterations with clinical performance, hepatic disease severity and diagnostic tests used for the detection of hepatic encephalopathy in cirrhosis. METHODS:Twenty-six patients with cirrhosis were enrolled in the study. Thirteen patients hospitalized for systemic diseases not affecting the liver were included as controls. Liver disease severity was assessed by the Child-Pugh score. All patients underwent detailed neurological assessment, electroencephalogram (EEG), brain magnetic resonance imaging (MRI), assays of pituitary hormone, cortisol and melatonin, and complete blood chemistry evaluation. RESULTS: Pituitary hormone and melatonin circadian patterns were altered in cirrhosis patients without clinical encephalopathy. Circadian hormone alterations were different in cirrhosis patients compared with controls. Although cortisol secretion was not altered in any patient with cirrhosis, the basal cortisol levels were lowand correlated with EEG and brain MRI abnormalities. Melatonin was the only hormone associated with the severity of liver insufficiency. CONCLUSION: Abnormal pituitary hormone and melatonin circadian patterns are present in cirrhosis before the development of hepatic encephalopathy. These abnormalities may be early indicators of impending hepatic encephalopathy. Factors affecting the human biologic clock at the early stages of liver insufficiency require further study.

关键词： Liver cirrhosis Minimal hepatic encepha-Iopathy Circadian rhythms Melatonin Pituitary hormones

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Laparoscopic cholecystectomy: A report from a single center

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World Journal of Gastroenterology 2006年第24期12卷 3887-3890页

作者： Konstantinos Vagenas Stavros N Karamanakos Charalambos Spyropoulos Spyros Panagiotopoulos menelaos karanikolas Michalis Stavropoulos Department of Surgery School of Medicine University of PatrasRion University Hospital26500 PatrasGreece Department of Anaesthesiology and Critical Care Medicine School of Medicine University of PatrasRion University Hospital26500 PatrasGreece

AIM： To review and evaluate our experience in laparoscopic cholecystectomy. METHODS： A retrospective analysis was performed on data collected during a 13-year period （1992-2005） from 1220 patients who underwent laparoscopic cholecystectomy. RESULTS： Mortality rate was 0%. The overall morbidity rate was 5.08% （n = 62）, with the most serious complications arising from injuries to the biliary tree and the cystic artery. In 23 （1.88%） cases, cholecystectomy could not be completed laparoscopically and the operation was converted to an open procedure. Though the patients were scheduled as day-surgery cases, the average duration of hospital stay was 2.29 d, as the complicated cases with prolonged hospital stay were included in the calculation. CONCLUSION： Laparoscopic cholecystectomy is a safe, minimally invasive technique with favorable results for the patient.

关键词： Laparoscopy Cholecystectomy Minimallyinvasive

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