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A case of successful management with splenectomy of intractable ascites due to congenital dyserythropoietic anemia type II-induced cirrhosis

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World Journal of Gastroenterology 2006年第5期12卷 818-821页

作者： Themistoklis Vassiliadis Vassilia Garipidou Vassilios Perifanis Konstantinos Tziomalos oiga giouleme Kalliopi Patsiaoura Michalis Avramidis Nikolaos Nikolaidis Sofia Vakalopoulou Ioannis Tsitouridis Antonios Antoniadis Panagiotis Semertzidis Anna Kioumi Evangelos Premetis Nikolaos Eugenidis 2~(nd) Propedeutic Department of Internal Medicine Aristotle University of ThessalonikiHippokration General HospitalThessalonikiGreece Department of Pathology Hippokration General HospitalThessalonikiGreece Department of Radiology Papageorgiou General HospitalThessalonikiGreece Organ Transplant Unit Aristotle University of ThessalonikiHippokration General HospitalThessalonikiGreece Department of Hematology Papageorgiou General Hospital Thessaloniki Greece Hematology Laboratory Aghia Sophia Children's HospitalAthensGreece

The congenital dyserythropoietic anemias comprise a group of rare hereditary disorders of erythropoiesis, characterized by ineffective erythropoiesis as the predominant mechanism of anemia and by characteristic morphological aberrations of the majority of erythroblasts in the bone marrow. Congenital dyserythropoietic anemia type II is the most frequent type. All types of congenital dyserythropoietic anemias distinctly share a high incidence of iron loading. Iron accumulation occurs even in untransfused patients and can result in heart failure and liver cirrhosis. We have reported about a patient who presented with liver cirrhosis and intractable ascites caused by congenital dyserythropoietic anemia type II. Her clinical course was further complicated by the development of autoimmune hemolytic anemia. Splenectomy was eventually performed which achieved complete resolution of ascites, increase of hemoglobin concentration and abrogation of transfusion requirements.

关键词： Portosystemic shunt Hemosiderosis Splenectomy Intractable ascites Congenital dyserythropoietic anemia type Ⅱ

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Is diabetes a causal agent for colorectal cancer? Pathophysiological and molecular mechanisms

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World Journal of Gastroenterology 2011年第4期17卷 444-448页

作者： Olga giouleme Michael D Diamantidis Marios G Katsaros Department of Gastroenterology First Propedeutic Department of Internal Medicine Aristotle University of Thessaloniki AHEPA General Hospital

The possible relationship between diabetes mellitus (DM) and colorectal cancer (CRC), concerning pathophysiological and molecular mechanisms is highlighted in this review. The most recent and complete articles and developments in this particular field were thoroughly reviewed. Common risk factors, such as obesity, sedentary lifestyle, and Western diet between DM and CRC, led to the theory that DM might be a causal agent for CRC development. Various studies have connected type 2 DM and CRC, either proximal or distal, in both sexes. Additionally, chronic insulin treatment has been linked with increased colorectal tumor risk among type 2 diabetic patients. Interestingly, elevated hemoglobin A1c has been proven to be an independent predictor of aggressive clinical behavior in CRC patients. These mechanisms include the insulin-like growth factor-hyperinsulinemia theory and the participation of oncogenic intracellular signaling pathways. Furthermore, it has been proposed that Cox-2 inhibitors might have a role in decreasing the incidence of CRC. Finally, the use of statins to reduce the risk for colon cancer in patients with diabetes has remained controversial. Diabetic patients over 50 should receive counseling regarding their elevated risk for CRC, and screening colonoscopy should be recommended before initiating insulin therapy. However, there are no current guidelines, and this strategy is not yet applicable to some countries, as the corresponding risk would not allow screening colonoscopy to be adopted. There is strong evidence to indicate that DM is a causal agent for CRC development. This conclusion provides new impetus for re-evaluating CRC screening worldwide.

关键词： Diabetes mellitus Colorectal cancer Molecular oncogenic pathways Screening

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Growing challenge of post-liver transplantation non-alcoholic fatty liver disease

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World Journal of Transplantation 2022年第9期12卷 281-287页

作者： Maria Styliani Kalogirou Olga giouleme Gastroenterology and Hepatology Division of the Second Propedeutic Department of Internal Medicine Hippokration General HospitalMedical SchoolAristotle University of ThessalonikiThessaloniki 54642Greece

Non-alcoholic fatty liver disease(NAFLD)is one of the leading causes of chronic liver disease,cirrhosis,and hepatocellular carcinoma worldwide,with an estimated prevalence of 25%.Post-liver transplantation(LT)recurrent or de novo hepatic steatosis is a common complication in recipients,irrespective of transplantation *** factors for graft steatosis mainly include obesity,immunosuppression,donor steatosis,and genetic *** transplant recipients are at high risk of developing insulin resistance,new-onset diabetes,and posttransplantation metabolic syndrome that is highly associated with immunosuppressive ***-LT NAFLD is often underdiagnosed due to the poor sensitivity of most routine imaging *** gold standard for the diagnosis of hepatic steatosis is liver biopsy,which is,however,limited to more complex cases due to its invasive *** is no approved pharmacotherapy in *** modification remains the cornerstone in NAFLD *** treatment strategies in post-LT NAFLD include lifestyle modifications,pharmacotherapy,bariatric surgery,and tailored ***,these approaches originate from recommendations in the general population,as there is scarce data regarding the safety and efficacy of current management strategies for NAFLD in liver transplant *** prospective studies are required to achieve tailored treatment for these patients.

关键词： Non-alcoholic fatty liver disease Steatohepatitis Hepatic steatosis Liver transplantation Cirrhosis Metabolic syndrome

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Hyperhomocysteinemia in ulcerative colitis is related to folate levels

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World Journal of Gastroenterology 2005年第38期11卷 6038-6042页

作者： Petros Zezos Georgia Papaioannou Nikolaos Nikolaidis Themistoclis Vasiliadis Olga giouleme Nikolaos Evgenidis Division of Gastroenterology Department of Haematology

AIM: To study the prevalence and clinical significance of hyperhomocysteinemia (hHcys), an independent factor for arterial and venous thrombosis, in a group of patients with ulcerative colitis (UC).METHODS: Fasting homocysteine (Hcys), folate, and vitamin B12 serum levels were measured in 40 UC patients and 50 healthy controls. Clinical data regarding UC were ***: Median serum Hcys levels in UC patients were similar to those in controls (12.26 μmol/L vs 12.32 μmol/L), but the prevalence of hHcys was higher in UC patients than in controls (30% vs 10%, P= 0.028). UC significantly increased the risk of hHcys (adjusted odds ratio: 4.125;95% CI: 1.26-13.44). Multivariate regression analysis showed that male sex, folate and vitamin B12 deficiency or lower serum values were significant independent predictors of higher Hcys levels in UC patients (r2 = 0.4; P＜0.001).CONCLUSION: hHcys is common in UC patients and it is related to folate and vitamin B12 deficiency or lower serum values. It would be reasonable for patients with UC to receive folate and vitamin B complex supplements as a prophylactic measure.

关键词： Folate Homocysteine Hyperhomocysteinemia Thrombosis Ulcerative colitis Vitamin B12

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Elevated plasma von Willebrand factor levels in patients with active ulcerative colitis reflect endothelial perturbation due to systemic inflammation

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World Journal of Gastroenterology 2005年第48期11卷 7639-7645页

作者： Petros Zezos Georgia Papaioannou Nikolaos Nikolaidis Themistoclis Vasiliadis Olga giouleme Nikolaos Evgenidis Division of Gastroenterology Department of Haematology

AIM: To evaluate the plasma von Willebrand factor (vWF) levels in patients with ulcerative colitis (UC) and to investigate their relationship with disease activity,systemic inflammation and coagulation ***: In 46 patients with ulcerative colitis (active in 34 patients), clinical data were gathered and plasma vWF levels, markers of inflammation (ESR, CRP, and fibrinogen) and thrombin generation (TAT, F1+2, and D-dimers) were measured at baseline and after 12 wk of treatment. Plasma vWF levels were also determined in 52 healthy controls (HC). The relationship of plasma vWF levels with disease activity, disease extent, response to therapy, acute-phase reactants (APRs) and coagulation markers (COAGs) was ***: The mean plasma vWF concentrations were significantly higher in active UC patients (143.38±63.73%) than in HC (100.75±29.65%, P = 0.001)and inactive UC patients (98.92±43.6%, P = 0.031).ESR, CRP and fibrinogen mean levels were significantly higher in active UC patients than in inactive UC patients,whereas there were no significant differences in plasma levels of D-dimers, F1+2, and TAT. UC patients with raised APRs had significantly higher mean plasma vWF levels than those with normal APRs (144.3% vs 96.2%,P = 0.019), regardless of disease activity. Although the mean plasma vWF levels were higher in UC patients with raised COAGs than in those with normal COAGs,irrespective of disease activity, the difference was not significant (141.3% vs 118.2%, P = 0.216). No correlation was noted between plasma vWF levels and disease extent. After 12 wk of treatment, significant decreases of fibrinogen, ESR, F1+2, D-dimers and vWF levels were noted only in UC patients with clinical and endoscopic ***: Our data indicate that increased plasma vWF levels correlate with active ulcerative colitis and increased acute-phase proteins. Elevated plasma vWF levels in ulcerative colitis possibly reflect an acutephase response of the perturbed e

关键词： Coagulation Endothelial injury Inflammation Inflammatory bowel disease Ulcerative colitis von Willebrand factor

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Short vs long-course antibiotic therapy in adults with acute cholangitis:A systematic review,meta-analysis,and evidence quality assessment

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World Journal of Gastroenterology 2023年第19期29卷 3027-3039页

作者： Karampet Kasparian Chrysanthos D Christou Konstantinos Petidis Michail Doumas Olga giouleme Clinic of Oncology Gastroenterology and HematologyAlfried Krupp HospitalEssen 45131Germany Second Propedeutic Department of Internal Medicine Hippokration General HospitalAristotle University of ThessalonikiThessaloniki 54642Greece Department of Transplantation Surgery Hippokration General HospitalAristotle University of ThessalonikiThessaloniki 54642Greece

BACKGROUND Acute cholangitis(AC)constitutes an infection with increased mortality rates in the *** to new diagnostic tools and therapeutic methods,the mortality of AC has been significantly reduced *** initial antibiotic treatment of AC has been oriented to the most common pathogens connected to this ***,the optimal duration of the antibiotic treatment of AC is still *** To investigate if shorter-course antibiotic treatments could be similarly effective to long-course treatments in adults with *** This study constitutes a systematic review and meta-analysis of the existing literature concerning the duration of antibiotic therapy of AC and an assessment of the quality of the *** study was conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic Review and *** studies were included in the systematic review,and eight were eligible for *** to heterogeneous duration cutoffs,three study-analysis groups were formed,with a cutoff of 2-3,6-7,and 14 *** A total of 2763 patients were included in the systematic review,and 1313 were accounted for the *** mean age was 73.66±14.67 years,and the male and female ratio was 1:*** significant differences were observed in the mortality rates of antibiotic treatment of 2-3 d,compared to longer treatments(odds ratio=0.78,95% confidence interval:0.23-2.67,I2=9%)and the recurrence rates and hospitalization length were also not different in all study *** Short-and long-course antibiotic treatments may be similarly effective concerning the mortality and recurrence rates of *** conclusions cannot be extracted concerning the hospitalization duration.

关键词： Acute cholangitis Antibiotic Short-course Long-course Antimicrobial Treatment duration

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Pegylated IFN-α2b added to ongoing lamivudine therapy in patients with lamivudine-resistant chronic hepatitis B

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World Journal of Gastroenterology 2006年第15期12卷 2417-2422页

作者： Themistoklis Vassiliadis Kalliopi Patsiaoura Konstantinos Tziomalos Theodoros Gkiourtzis Olga giouleme Nikolaos Grammatikos Despoina Rizopoulou Nikolaos Nikolaidis Panagiotis Katsinelos Eleni Orfanou-Koumerkeridou Nikolaos Eugenidis 2nd Propaedeutic Department of Internal Medicine Aristotle University of Thessaloniki Hippokration General HospitalThessalonikiGreece Department of Pathology Hippokration General Hospital ThessalonikiGreece 4th Department of Internal Medicine Aristotle University of Thessaloniki Hippokration General HospitalThessalonikiGreece

AIM： To investigate the role of pegylated-interferon （IFN）α-2b in the management of patients with lamivudineresistant chronic hepatitis B. METHODS： Twenty consecutive anti-HBe positive patients were treated with pegylated IFN α-2b （100 IJg sc once weekly） for 12 mo. There was no interruption in lamivudine therapy. Hematology, liver biochemistry, serum HBV DNA levels were detected by PCR, and vital signs were also assessed. Liver histology was assessed in some patients at entry and at wk 52 for comparison. RESULTS： Nine patients （45%） had a partial virological end-treatment response; seven patients （35%） showed complete virological end-treatment response. Eight patients （40%） showed biochemical end-treatment response. There was a trend for higher virological response rates in patients who had previously responded to IFN and relapsed compared to IFN non-responders （four out of seven patients vs none out of six patients, respectively; P=0.1）. Patients without virological endtreatment response showed significant worsening of fibrosis [median score 2 （range, 1 to 3） vs median score 3 （range, 1 to 4）], in the first and second biopsy respectively （P=0.014）, whereas necroinflammatory activity was not significantly affected. Patients with complete or partial virological end-treatment response did not show any significant changes in histological findings, possibly due to the small number of patients with paired biopsies （n = 5）. Nevertheless, after 12 mo of follow-up, only onepatient （5%） showed sustained virological response and only 2 patients （10%） showed sustained biochemical response. Two patients （10%） discontinued pegylated ]FN both after 6 mo of treatment due to flu-like symptoms. CONCLUSION： Pegylated IFNα-2b, when added to ongoing lamivudine therapy in patients with lamivudineresistant chronic hepatitis B, induces sustained responses only in a small minority of cases.

关键词： Pegylated interferon Lamivudine resistance HBeAg negative chronic hepatitis B Adefovir

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Effects of an active lifestyle on the physical frailty of liver transplant candidates

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World Journal of Transplantation 2022年第11期12卷 365-377页

作者： Ilias Marios Oikonomou Emmanouil Sinakos Nikolaos Antoniadis Ioannis Goulis Olga giouleme Maria Anifanti Georgios Katsanos Konstantina-Eleni Karakasi Georgios Tsoulfas Evangelia Kouidi Department of Transplant Surgery Aristotle University of ThessalonikiThessaloniki 54642Greece The Fourth Department of Internal Medicine Aristotle University of ThessalonikiThessaloniki 54642Greece The Second Propaedeutic Department of Internal Medicine Aristotle University of ThessalonikiThessaloniki 54642Greece Laboratory of Sports Medicine Aristotle University of ThessalonikiThessaloniki 57001Greece

BACKGROUND Liver transplantation is the most important therapeutic intervention for end-stage liver disease(ELD).The prioritization of these patients is based on the model for end-stage liver disease(MELD),which can successfully predict short-term ***,despite its great validity and value,it cannot fully incorporate several comorbidities of liver disease,such as sarcopenia and physical frailty,variables that can sufficiently influence the survival of such ***,there is growing interest in the importance of physical frailty in regard to mortality in liver transplant candidates and recipients,as well as its role in improving their survival *** To evaluate the effects of an active lifestyle on physical frailty on liver transplant *** An observational study was performed within the facilities of the Department of Transplant Surgery of Aristotle University of *** liver transplant candidate patients from the waiting list of the department were included in the *** that were bedridden,had recent cardiovascular incidents,or had required inpatient treatment for more than 5 d in the last 6 mo were excluded from the *** following variables were evaluated:Activity level via the International Physical Activity Questionnaire(IPAQ);functional capacity via the 6-min walking test(6MWT)and cardiopulmonary exercise testing;and physical frailty via the Liver Frailty Index(LFI).RESULTS According to their responses in the IPAQ,patients were divided into the following two groups based on their activity level:Active group(A,10 patients);and sedentary group(S,10 patients).Comparing mean values of the recorded variables showed the following results:MELD(A:12.05±5.63 vs S:13.99±3.60;P>0.05);peak oxygen uptake(A:29.78±6.07 mL/kg/min vs S:18.11±3.39 mL/kg/min;P<0.001);anaerobic threshold(A:16.71±2.17 mL/kg/min vs S:13.96±1.45 mL/kg/min;P<0.01);6MWT(A:458.2±57.5 m vs S:324.7±55.8 m;P<0.001);and LFI(A:3.75±0.31 vs

关键词： Liver transplantation Frailty Six-minute walk test Cardiopulmonary exercise testing Exercise therapy Observational study

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Enhanced recovery after surgery in liver transplantation:Challenges and feasibility

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World Journal of Transplantation 2022年第7期12卷 195-203页

作者： Georgios Katsanos Konstantina-Eleni Karakasi Nikolaos Antoniadis Stella Vasileiadou Athanasios Kofinas Antonios Morsi-Yeroyannis Evangelia Michailidou Ioannis Goulis Emmanouil Sinakos Olga giouleme Ilias Marios Oikonomou George Evlavis Georgios Tsakiris Eleni Massa Eleni Mouloudi Georgios Tsoulfas Department of Transplantation Medical SchoolAristotle University of ThessalonikiHippokration General HospitalThessaloniki 54642Greece Intensive Care Unit National Health SystemHippokration General HospitalThessaloniki 54642Greece Fourth Department of Internal Medicine Hippokration General HospitalMedical School of Aristotle UniversityThessaloniki 54642Greece Second Propaedeutic Department of Internal Medicine Hippokratio General HospitalAristotle University ThessalonikiThessaloniki 54642Greece Nursing Department National Health SystemDepartment of TransplantationHippokration General HospitalThessaloniki 54642Greece

BACKGROUND Enhanced recovery after surgery(ERAS)started a revolution that changed age-old surgical stereotypical practices regarding the overall management of the surgical *** the last decade,ERAS has gained significant acceptance in the community of general surgery,in addition to several other surgical specialties,as the evidence of its advantages continues to *** of the last remaining fields,given its significant complexity and intricate nature,is liver transplantation(LT).AIM To investigate the existing efforts at implementing ERAS in *** We conducted a systematic review of the existing studies that evaluate ERAS in orthotopic LT,with a multimodal approach and focusing on measurable clinical primary endpoints,namely length of hospital *** All studies demonstrated a considerable decrease in length of hospital stay,with no readmission or negative impact of the ERAS protocol applied to the postoperative *** ERAS is a well-validated multimodal approach for almost all types of surgical procedures,and its future in selected LT patients seems promising,as the preliminary results advocate for the safety and efficacy of ERAS in the field of LT.

关键词： Enhanced recovery Enhanced recovery after surgery Recovery Liver transplantation Liver

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Resolution of non-alcoholic steatohepatitis by rosuvastatin monotherapy in patients with metabolic syndrome

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World Journal of Gastroenterology 2015年第25期21卷 7860-7868页

作者： Konstantinos Kargiotis Vasilios G Athyros Olga giouleme Niki Katsiki Evangelia Katsiki Panagiotis Anagnostis Chrysoula Boutari Michael Doumas Asterios Karagiannis Dimitri P Mikhailidis 2nd Prop. Department of Internal Medicine Medical School Aristotle University Hippocration Hospital Department of Pathology Hippocration Hospital Department of Endocrinology Hippocration Hospital Department of Clinical Biochemistry (Vascular Disease Prevention Clinic) Royal Free Campus University College London Medical School University College London Department of Surgery Royal Free Campus University College London Medical School

AIM: To investigate the effect of rosuvastatin monotherapy on non-alcoholic steatohepatitis(NASH). At present there is no effective treatment for non-alcoholic fatty liver disease or its advanced form ***: This prospective study included 20 biopsy proven patients with NASH, metabolic syndrome(Met S) and dyslipidaemia. Biochemical parameters of the blood of the patients and an ultrasonography of the liver were performed at baseline. Then patients receivedlifestyle advice and were treated for a 12 mo period with rosuvastatin(10 mg/d) monotherapy. Patients were re-evaluated during the study at 3 mo intervals, during which biochemical parameters of the blood were measured including liver enzymes. A repeat biopsy and ultrasonography of the liver were performed at the end of the study in all 20 patients. Changes in liver enzymes, fasting plasma glucose, serum creatinine, serum uric acid(SUA), high sensitivity C reactive protein(hs CRP) and lipid profile were assessed every 3 mo. The primary endpoint was the resolution of NASH and the secondary endpoints were the changes in liver enzyme and lipid ***: The repeat liver biopsy and ultrasonography showed complete resolution of NASH in 19 patients, while the 20 th, which had no improvement but no deterioration either, developed arterial hypertension and substantial rise in triglyceride levels during the study, probably due to changes in lifestyle including alcohol abuse. Serum alanine transaminase, aspartate transaminase, and γ-glutamyl transpeptidase were normalised by the 3rd treatment month(ANOVA P < 0.001), while alkaline phosphatase activities by the 6th treatment month(ANOVA, P = 0.01). Fasting plasma glucose and glycated haemoglobin were significantly reduced(P < 0.001). Lipid values were normalised by the 3rd treatment month. No patient had Met S by the 9th treatment month. Body mass index and waist circumference remained unchanged during the study. Thus, changes in liver pathology and function shou

关键词： Non-alcoholic fatty liver disease Non-alcoholicsteatohepatitis Metabolic syndrome Dyslipidaemia Rosuvastatin Fasting blood glucose Serum uric acid

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