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Hepatotoxicity induced by cyproterone acetate:A report of three cases

World Journal of Gastroenterology 2006年第46期12卷 7551-7555页

作者： Ioanna Savidou Melanie Deutsch Aspasia S Soultati Dimitrios Koudouras Georgia Kafiri spyridon p dourakis 2nd Department of Medicine University of Athens Medical School Hippokration General Hospital 114 Vas Sofias Avenues 11527 Athens Greece Department of pathology Hippokration General Hospital Greece

Cyproterone acetate (CpA) is a steroidal synthetic progestagen and anti-androgenic compound widely administered in prostate cancer which has been evidentially correlated with a severe hepatotoxic potency. Three male patients aged 78-83 years are presented, in whom severe hepatotoxic reactions emerged after CpA administration. patients were treated with CpA at the doses of 200-300 mg/d for malignant prostate disease for 3-12 mo prior to the acute manifestation of the hepatic disease. Clinical features compatible with mixed hepatocellular and cholestatic liver disease including jaundice, white stools and dark urine, manifested in all three cases whereas encephalopathy and ascites were present in two of the patients. Other primary causes of hepatotoxicity (alcohol consumption and viral hepatitis) were also verified in two cases, and in those patients biopsy findings revealed the presence of cirrhotic lesions in liver parenchyma. Discontinuation of the therapeutic agent led to the amelioration of the clinical profile in all the patients whereas a patient died 40 d after hospital admission due to sepsis, despite acute liver disease improvement. The current article highlights the hepatotoxic potency of a widely administered therapeutic agent and illustrates the importance of clinical surveillance especially in patients with previous hepatic diseases. Three relevant cases are reported and a review of the published literature is made.

关键词： Cyproterone acetate Drug induced hepatotoxicity prostate cancer Idiosyncratic drug reaction Hepatomitogen action

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Extensively drug-resistant bacteria are an independent predictive factor of mortality in 130 patients with spontaneous bacterial peritonitis or spontaneous bacteremia

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World Journal of Gastroenterology 2016年第15期22卷 4049-4056页

作者： Alexandra Alexopoulou Larisa Vasilieva Danai Agiasotelli Kyriaki Siranidi Sophia pouriki Athanasia Tsiriga Marina Toutouza spyridon p dourakis Department of Internal Μedicine Hippokration Hospital Medical School National and Kapodistrian University of Athens 11527 Athens Greece Department of Microbiology Hippokration Hospital 11527 Athens Greece

AIM: To evaluate the epidemiology and outcomes of culture-positive spontaneous bacterial peritonitis (SBp) and spontaneous bacteremia (SB) in decompensated ***: We prospectively collected clinical, laboratory characteristics, type of administered antibiotic, susceptibility and resistance of bacteria to antibiotics in one hundred thirty cases (68.5% males) with positive ascitic fluid and/or blood cultures during the period from January 1, 2012 to May 30, 2014. All patients with SBp had polymorphonuclear cell count in ascitic fluid > 250/mmp>3p>. In patients with SB a thorough study did not reveal any other cause of bacteremia. The patients were followed-up for a 30-d period following diagnosis of the infection. The final outcome of the patients was recorded in the end of follow-up and comparison among 3 groups of patients according to the pattern of drug resistance was ***: Gram-positive-cocci (GpC) were found in half of the cases. The most prevalent organisms in a descending order were Escherichia coli (33), Enterococcus spp (30), Streptococcus spp (25), Klebsiella pneumonia (16), S. aureus (8), pseudomanas aeruginosa (5), other Gram-negative-bacteria (GNB) (11) and anaerobes (2). Overall, 20.8% of isolates were multidrug-resistant (MDR) and 10% extensively drug-resistant (XDR). Health-care-associated (HCA) and/or nosocomial infections were present in 100% of MDR/XDR and in 65.5% of non-DR cases. Meropenem was the empirically prescribed antibiotic in HCA/nosocomial infections showing a drug-resistance rate of 30.7% while third generation cephalosporins of 43.8%. Meropenem was ineffective on both XDR bacteria and Enterococcus faecium (E. faecium). All but one XDR were susceptible to colistin while all GpC (including E. faecium) and the 86% of GNB to tigecycline. Overall 30-d mortality was 37.7% (69.2% for XDR and 34.2% for the rest of the patients) (log rank, p = 0.015). In multivariate analysis, factors adversely affecting

关键词： Spontaneous bacterial peritonitis Spontaneous bacteremia Multidrug-resistant bacteria Extensively drug-resistant bacteria Susceptibility to antibiotics

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predicting utility of a model for end stage liver disease in alcoholic liver disease

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World Journal of Gastroenterology 2006年第25期12卷 4020-4025页

作者： Aspasia S Soultati spyridon p dourakis Alexandra Alexopoulou Melanie Deutsch Larissa Vasilieva Athanasios J Archimandritis 2nd Department of Internal Medicine University of Athens Medical School Hippokration General Hospital114 Vas Sofias AvenuesAthens 11527Greece

AIM： To validate the statistic utility of both the Maddrey Discriminant Function score and the Model for End-Stage Liver Disease as predictors of short term （30 d and 90 d） mortality in patients with alcoholic hepatitis and to assess prognostic factors among clinical characteristics and laboratory variables of patients with alcoholic hepatitis. METHODS： Thirty-four patients with the diagnosis of alcoholic hepatitis admitted to Hippokration University Hospital of Athens from 2000 to 2005 were assessed in the current retrospective study and a statistical analysis was conducted. RESULTS： 30- and 90-d mortality rates were reported at 5.9% （2/34） and 14.7% （5/34）, respectively. Significant correlation was demonstrated for the Model for End- Stage Liver Disease （p30 = 0.094, p90 = 0.046） and the Maddrey Discriminant Function score （p30 = 0.033, p90 = 0.038） with 30- and 90-d mortality whereas a significant association was also established for alanine aminotrans- ferase （p = 0.057）, fibrin degradation products （p = 0.048） and C-reactive protein （p = 0.067） with 90-d mortality. For 30-d mortality the Area Under the Curve was 0.969 （95%CI： 0.902-1.036, p = 0.028） for the Model for End-Stage Liver Disease score and 0.984 （95%CI： 0.942-1.027, p = 0.023） for the Maddrey Discriminant Function score with the optimal cut off point of 30.5 （sensitivity 1, specificity 0.937） and 108.68 （sensitivity 1, specificity 0.969）, respectively. Accordingly, for 90-d mortality the Area Under the Curve was 0.762 （95%CI： 0.559-0.965, p = 0.065） for the Model for End-Stage Liver Disease score and 0.752 （95%CI： 0.465-1.038, p = 0.076） for the Maddrey Discriminant Function score with the optimal cut off point of 19 （sensitivity 0.6, specificity 0.6） and 92 （sensitivity 0.6, specificity 0.946）, respectively. The observed Kaplan Meier survival rates for different score-categories were compared with logrank tests and higher score values were correlated with a lower survival. CONCLUSION： Equivale

关键词： Alcoholic liver disease Alcoholic hepatitis Maddrey discriminant function score Model for end-stage liver disease score

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Simultaneous development of diabetic ketoacidosis and Hashitoxicosis in a patient treated with pegylated interferon-alpha for chronic hepatitis C

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World Journal of Gastroenterology 2007年第8期13卷 1292-1294页

作者： Aspasia S Soultati spyridon p dourakis Alexandra Alexopoulou Melanie Deutsch Athanasios J Archimandritis 2nd Department of Internal Medicine University of Athens Medical School Hippokration General Hospital 114 Vas Sofias Avenues Athens 11527 Greece

Classical interferon-alpha has been shown to be correlated with the development of a variety of autoimmune disorders. A 38 year-old female patient developed simultaneously diabetic ketoacidosis and hyperthyroidism 5 mo following initiation of treatment with pegylated interferon-α and ribavirin for chronic hepatitis C. High titers of glutamic acid decarboxylase, antinuclear and thyroid (thyroid peroxidase and thyroglobulin) antibodies were detected. Antiviral treatment was withdrawn and the patient was treated with insulin for insulin-dependent diabetes mellitus and propranolol for hyperthyroidism. Twelve months after cessation of pegylated interferon-α therapy the patient was euthyroid without any medication but remained insulin-dependent.

关键词： Autoimmune thyroiditis Insulin dependent diabetes mellitus pegylated interferon-alpha Chronic hepatitis C

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Modern diagnostic approaches to cholangiocarcinoma

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Hepatobiliary & pancreatic Diseases International 2012年第4期11卷 349-359页

作者： Larisa E Vasilieva Stefanos I papadhimitriou Spyros p dourakis Second Department of Internal Medicine University of Athens Medical SchoolHippokration General Hospital114 Vas Sofias AvenueAthens 11527Greece Molecular Cytogenetics Unit Haematology Laboratory"G.Genimatas" Regional General HospitalAthensGreece

BACKGROUND:Cholangiocarcinoma is a very aggressive tumor with poor ***,early diagnosis and surgical resection are of paramount *** diagnosis is difficult because access to the tumor is not *** is possible only for intrahepatic cholangiocarcinoma,which accounts for 10% of *** brush cytology from endoscopic retrograde cholangiopancreatography(ERCp) has a high specificity of 100% but unfortunately a low sensitivity of 30%.In this review we briefly describe new diagnostic techniques applicable to ERCp brush cytology specimens and targeting the genetic background of the disease,in particular fluorescence in situ hybridization(FISH) and digital image analysis(DIA).DATE SOURCES:The pubMed database up to 2011 was used for the retrieval of relevant *** search terms FISH,fluorescence in situ hybridization,DIA,digital image analysis and cholangiocarcinoma were *** original and review articles were ***:FISH identifies cells with chromosomal abnormalities,mainly numerical aberrations,using a mixture of fluorescencelabeled *** offers a higher sensitivity than routine cytology,retaining a high level of *** DIA criterion for malignancy is demonstration of *** technique increases the sensitivity to 40%,but the specificity remains *** data from application to other tumors suggest that combination of FISH and DIA may be of further ***:The new techniques offer a significantly enhanced diagnostic efficacy in the evaluation of ERCp brush *** from contributing to a more timely diagnosis,their wider application to cholangiocarcinoma may also facilitate the genetic study of the disease and add to our understanding of oncogenesis at the molecular level,with the prospect of identifying targets for novel therapeutic interventions.

关键词： cholangiocarcinoma fluorescence in situ hybridization digital image analysis

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Translation and validation of the Greek chronic liver disease questionnaire

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World Journal of Gastroenterology 2010年第46期16卷 5838-5844页

作者： Zoi Kollia Evridiki patelarou Victoria Vivilaki Eleni Kollia Florentia Kefou Ioannis Elefsiniotis Spyros p dourakis Hero Brokalaki Department of Internal Medicine Faculty of NursingUniversity of Athens Department of Nursing University Hospital of Heraklion Department of Midwifery SEYPTEI of Athens Department of Nursing Hippokration General Hospital of Athens Department of Nursing Naval Hospital of Athens 2nd Department of Internal Medicine Medical SchoolUniversity of Athens

AIM:To translate into Greek and validate the chronic liver disease questionnaire (CLDQ).METHODS:Two hundred and six consecutive adult patients with the diagnosis of a chronic liver disease from 2 general hospitals in Athens were enrolled in the study from May to September *** order to assess their quality of life (QOL) the CLDQ was *** instrument was translated from English,back translated and reviewed in focus groups within the framework of a large multicenter *** measurements that were performed included:2 independent sample t tests,oneway analysis of variance,reliability coefficients,explanatory factor analysis using a varimax rotation and the principal components ***:One hundred and twenty five (61%) patients were men,half were aged 40-59 years and > 33% were > 60 years *** the patients,48 (23%) were hospitalized and 97 (47%) were cirrhotic according to the Child-pugh *** internal consistency of the Greek CLDQ version using Cronbach's alpha coefficient was found to be *** factor analysis identified 7 domains accounting for 65% of the variance of CLDQ items and only partially overlapping with those found in the original *** area under the receiver operating characteristics curve was calculated at 0.813 and the logistic estimate for the threshold score of 167.50 provided a sensitivity of 74.3% and a specificity of 71.6% for the ***:Our data confirmed the validity of the Greek version of the CLDQ in identifying the QOL among patients with chronic liver disease.

关键词： Chronic disease Questionnaires Validation Quality of life Liver cirrhosis

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Impact of coronavirus disease 2019 on semen parameters

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Asian Journal of Urology 2022年第2期9卷 190-192页

作者： spyridon p.Basourakos peter N.Schlegel Department of Urology New York Presbyterian HospitalWeill Cornell Medical CenterNew YorkNYUSA

Dear editor,Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2),the virus responsible for the coronavirus disease 2019(COVID-19)pandemic,has been associated with hypogonadism in patients with acute infection[1].Angiotensin-converting enzyme 2(ACE2)receptor is regarded as the viral binding site that facilitates entry into host cells[2].Therefore,cells that express ACE2,such as spermatogonia,Leydig,and Sertoli cells,may be susceptible to SARS-CoV-2 infection[2].Testicular damage may possibly be caused directly by viral invasion or secondary to the generalized inflammatory response to COVID-19[3].Studies have demonstrated that viral shedding in the semen can take place during the recovery phase,even though SARS-CoV-2 is not present in the semen of all men with COVID-19[1,4].Herein,we describe the first case report of a male with longitudinal follow-up who experienced reversible cryptozoospermia after COVID-19.

关键词： ACE2 acute invasion

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Successful treatment of noncirrhotic portal hypertension with eculizumab in paroxysmal nocturnal hemoglobinuria: A case report

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World Journal of Hepatology 2019年第5期11卷 483-488页

作者： Alexandra Alexopoulou Iliana Mani Dina G Tiniakos Flora Kontopidou Ioanna Tsironi Marina Noutsou Helen pantelidaki Spyros p dourakis 2nd Department of Medicine Medical SchoolNational and Kapodistrian University of AthensHippokration General HospitalAthens 11527Greece Institute of Cellular Medicine Faculty of Medical SciencesNewcastle UniversityFramlington PlaceNewcastle NE2 4HHUnited Kingdom Department of pathology Aretaieion HospitalNational and Kapodistrian University of AthensAthens 11528Greece

BACKGROUND Idiopathic non-cirrhotic portal hypertension(INCpH)is mainly associated with thrombophilia in Western *** nocturnal hemoglobinuria(pNH)is a rare hematologic disease that manifests with hemolytic anemia,thrombosis,and peripheral blood *** and hepatic venous thrombosis were reported in pNH.A rare case of INCpH complicating pNH is *** SUMMARY A 63-year old woman with a 2-year past medical history of pNH without treatment was admitted because of jaundice and refractory ascites requiring large volume *** histology revealed portal venopathy with portal fibrosis and sclerosis,nodular regenerative hyperplasia,parenchymal ischemic changes,and focal sinusoidal and perivenular fibrosis without bridging fibrosis or cirrhosis,all indicative of *** flow cytometry confirmed pNH diagnosis and eculizumab treatment was *** condition was improved gradually,bilirubin was normalized 6 months following initiation of eculizumab,and 1 year later diuretics were *** Eculizumab improved intravascular hemolysis and reversed clinical manifestations of INCpH in a patient with paroxysmal nocturnal hemoglobinuria.

关键词： paroxysmal nocturnal hemoglobinuria Idiopathic non-cirrhotic portal hypertension Eculizumab Case report

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Cholangiocarcinoma:A 7-year experience at a single center in Greece

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World Journal of Gastroenterology 2008年第40期14卷 6213-6217页

作者： Alexandra Alexopoulou Aspasia Soultati Spyros p dourakis Larissa Vasilieva Athanasios J Archimandritis 2nd Department of Medicine University of Athens Medical SchoolHippokration General Hospital

AIM： To evaluate survival rate and clinical outcome of cholangiocarcinoma. METHODS： The medical records of 34 patients with cholangiocarcinoma, seen at a single hospital between the years 1999-2006, were retrospectively reviewed. RESULTS： Thirty-four patients with a median age of 75 years were included. Seventeen （50%） had painless jaundice at presentation. Sixteen （47.1%） were perihilar, 15 （44.1%） extrahepatic and three （8.8%） intrahepatic. Endoscopic retrograde cholangiography （ERCp） and/or magnetic resonance cholangiography （MRCp） were used for the diagnosis. pathologic confirmation was obtained in seven and positive cytological examination in three. Thirteen patients had co-morbidities （38.2%）. Four cases were managed with complete surgical resection. All the rest of the cases （30） were characterized as non-resectable due to advanced stage of the disease. palliative biliary drainage was performed in 26/30 （86.6%）. The mean follow-up was 32 mo （95% CI, 20-43 too）. Overall median survival was 8.7 mo （95% CI, 2-16 mo）. The probability of 1-year, 2-year and 3-year survival was 46%, 20% and 7%, respectively. The survival was slightly longer in patients who underwent resection compared to those who did not, but this difference failed to reach statistical significance. patients who underwent biliary drainage had an advantage in survival compared to those who did not （probability of survival 53% vs 0% at 1 year, respectively, p = 0.038）. CONCLUSION： patients with cholangiocarcinoma were usually elderly with co-morbidities and/oradvanced disease at presentation. Even though a slight amelioration in survival with palliative biliary drainage was observed, patients had dismal outcome without resection of the tumor.

关键词： Cholangiocarcinoma Surgical resection palliative biliary drainage Survival

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Surface oxidation of Ni-cermet electrodes by CO_(2) and H_(2)O and how to moderate it

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Journal of Energy Chemistry 2022年第4期31卷 300-308页

作者： Dingkai Chen Mathias Barreau Thierry Dintzer Sylwia Turczyniak-Surdacka Fabrice Bournel Jean-Jacques Gallet spyridon Zafeiratos Institut de Chimie et procédés pour l’Energie l’Environnement et la SantéUMR 7515 CNRS-UdS25 Rue Becquerel67087 StrasbourgFrance Faculty of Chemistry Biological and Chemical Research CentreUniversity of WarsawŻwirki i Wigury 10102-089 WarsawPoland Faculty of Chemistry University of WarsawPasteura 102-093Poland Laboratoire de Chimie physique-Matière et Rayonnement Sorbonne UniversitéCampus CurieCNRS UMR 76144 place Jussieu75005 ParisFrance Synchrotron SOLEIL L’orme des MerisiersB.P.48Saint AubinGif-sur-Yvette Cedex 91192France

The oxidation of porous Ni-yttria-stabilized zirconia(YSZ)and Ni-gadolinia-doped ceria(GDC)ceramicmetal(cermet)electrodes in H_(2)O and CO_(2)atmospheres was studied by near-ambient pressure X-ray photoelectron spectroscopy(NAp-XpS).We show that the oxidation of nickel by the two gases is not similar,as is commonly believed,but it depends on the ceramic *** is vulnerable to oxidation in H_(2)O but it resists to CO_(2)in Ni-GDC,as compared to the Ni-YSZ *** by this observation we conceptualize and fabricate Ni-YSZ electrodes modified by ceria nanoparticles,which show significantly higher resistance to CO_(2)oxidation as compared with conventional Ni-YSZ *** preparation of tailormade cermet electrodes with identical bulk/mechanical characteristics but very different surface properties offers a promising fabrication strategy for high-performance and durability solid oxide electrolysis cells for CO_(2)conversion.

关键词： NAp-XpS CO_(2)electrolysis Nickel oxidation Solid oxide cells Ceria nanoparticles

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