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Recent results of laparoscopic surgery in inflammatory bowel disease

World Journal of Gastroenterology 2011年第9期17卷 1116-1125页

作者： Hermann Kessler jonas mudter Werner Hohenberger Department of Surgery University of Erlangen Department of Internal Medicine 1 GastroenterologyUniversity of Erlangen

Inflammatory bowel diseases are an ideal indication for the laparoscopic surgical approach as they are basically benign diseases not requiring lymphadenectomy and extended mesenteric excision;well-established surgical procedures are available for the conventional *** alterations and fragility of the bowel and mesentery,however,may demand a high level of laparoscopic experience.A broad spectrum of operations from the rather easy enterostomy formation for anal Crohn’s disease(CD)to restorative proctocolectomies for ulcerative colitis(UC)may be managed *** current evidence base for the use of laparoscopic techniques in the surgical therapy of inflammatory bowel diseases is *** limited to the terminal ileum has become a common indication for laparoscopic surgical *** severe anal CD, laparoscopic stoma formation is a standard procedure with low morbidity and short operative *** comparing conventional and laparoscopic bowel resections,have found shorter times to first postoperative bowel movements and shorter hospital stays as well as lower complication rates in favour of the laparoscopic *** complicated cases with previous surgery,abscess formation and enteric fistulas may be op-erated on laparoscopically with a low *** UC, restorative proctocolectomy is the standard procedure in elective *** demanding laparoscopic approach is increasingly used,however,mainly in major centers; its feasibility has been proven in various *** increased body mass index and acute inflammation of the bowel may be relative *** and longterm outcomes like quality of life seem to be equivalent for open and laparoscopic *** studies have proven that the laparoscopic approach to CD and UC is a safe and successful alternative for selected patients. The appropriate selection criteria are still under *** considerations are playing an important role for the co

关键词：肠道疾病手术方法腹腔镜炎症溃疡性结肠炎手术治疗标准程序技术因素

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New endoscopic approaches in IBD

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World Journal of Gastroenterology 2011年第1期17卷 63-68页

作者： Helmut Neumann Markus F Neurath jonas mudter Department of Medicine I University of Erlangen-Nuremberg91054 ErlangenGermany

Recent advances in endoscopic imaging techniques have revolutionized the diagnostic approach of patients with inflammatory bowel disease(IBD).New,emerging endoscopic imaging techniques visualized a plethora of new mucosal details even at the cellular and subcellular *** review offers an overview about new endoscopic techniques,including chromoendoscopy,magnification endoscopy,spectroscopy,confocal laser endomicroscopy and endocytoscopy in the face of IBD.

关键词：鸡传染性法氏囊病内窥镜成像技术细胞水平激光共聚焦诊断方法 IBD 可视化

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Cancer risk in IBD: How to diagnose and how to manage DALM and ALM

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World Journal of Gastroenterology 2011年第27期17卷 3184-3191页

作者： Helmut Neumann Michael Vieth Cord Langner Markus F Neurath jonas mudter Department of Medicine 1 Department of SurgeryUniversity of Erlangen-Nuremberg Ulmenweg 1891054 ErlangenGermany Institute of Pathology Klinikum Bayreuth GmbHPreuschwitzer Str. 10195445 BayreuthGermany Institute of Pathology Medical University of GrazAuenbruggerplatz 25A-8036 Graz Austria

The risk of developing neoplasia leading to colorectal cancer is significantly increased in ulcerative colitis (UC) and most likely in Crohn's disease. Several endoscopic surveillance strategies have been implemented to identify these lesions. The main issue is that colitisassociated neoplasms often occurs in flat mucosa, often being detected on taking random biopsies rather than by identification of these lesions via endoscopic imaging. The standard diagnostic procedure in long lasting UC is to take four biopsies every 10 cm. Image enhancement methods, such as chromoendoscopy and virtual histology using endomicroscopy, have greatly im- proved neoplasia detection rates and may contribute toreduced random biopsies by taking targeted "smart" biopsies. Chromoendoscopy may effectively be performed by experienced endoscopists for routine screening of UC patients. By contrast, endomicroscopy is often only available in selected specialized endoscopic centers. Importantly, advanced endoscopic imaging has the poten- tial to increase the detection rate of neoplasia whereas the interplay between endoscopic experience and interpretation of histological biopsy evaluation allows the physician to make a proper diagnosis and to find the appropriate therapeutic approach. Colitis-associated intraepithelial neoplasms may occur in flat mucosa of endoscopically normal appearance or may arise as dysplasia-associated lesion or mass (DALM), which may be indistinguishable from sporadic adenomas in healthy or non-colitis mucosa [adenoma-like mass (ALM)]. The aim of this review was to summarize endoscopic and histological characteristics of DALM and ALM in the context of therapeutic procedures.

关键词：诊断程序 ALM 风险 IBD 溃疡性结肠炎管理癌症治疗程序

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What's new about inflammatory bowel diseases in 2011

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世界胃肠病学杂志：英文版 2011年第27期17卷 3177-3177页

作者： jonas mudter Department of Internal Medicine University of ErlangenUlmenweg 18Erlangen 91054 Germany

Inflammatory bowel diseases (IBD) are chronic disorders of the intestine with increasing incidence in Europe, Northern America and asiatic countries such as china. Thus, we have putted together these topic highlight a... 详细信息

关键词：慢性疾病肠道炎症鸡传染性法氏囊病亚洲国家发病机理 IBD 北美洲

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In vivo detection of mucosal healing-involved histiocytes by confocal laser endomicroscopy

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World Journal of Gastroenterology 2012年第32期18卷 4447-4449页

作者： Gheorghe Hundorfean Abbas Agaimy Mircea T Chiriac Walter GeiBdrfer Jochen Wacker Markus F Neurath jonas mudter Medical ClinicⅠ University of ErlangenNuremberg91054 ErlangenGermany Institute of Pathology University of Erlangen-Nuremberg91054 ErlangenGermany Microbiology Institute-Clinical Microbiology Immunology and HygieneUniversity of Erlangen-Nuremberg91054 ErlangenGermany Medical Clinic Ⅲ University of Erlangen-Nuremberg91054 ErlangenGermany

Histiocytes have a pivotal role in wound repair and intestinal epithelial recovery-the most important goal to sustain gut ***,an in vivo description of colonic histiocytes by confocal laser endomicroscopy(CLE) is ***,we report the case of a 45-yearsold male patient who was referred to our clinic with weight loss and a history of two consecutive Clostridium difficile colitis episodes,the latter cured 3 wk before present *** microbiology was *** colonoscopy showed atrophy and a light mucosal oedema in the distal *** on-going endoscopy,we performed a fluorescein-aided CLE which revealed large polygonal(histiocytes-like) cells with copious cytoplasm and large nuclei in the lamina propria of the sigmoid colon as well as regenerative epithelial *** assessment of biopsies from the same areas confirmed the endomicroscopical findings:Periodic acid-Schiff-and CD68-positive foamy histiocytes in the colonic lamina propria and an advanced epithelial *** stool microbiology was repeatedly negative and polymerase chain reaction-analysis from colonic biopsies could not detect any mRNA for Thropheryma whippleii and common pathogens,we interpreted this particular setting as a mucosal healing process after consecutive Clostridium difficile *** conclusion,by describing these colonic histiocytes,we highlight the clinical usefulness of CLE in describing the entity of histiocytes in vivo and in real-time during the process of post-infectious mucosal healing in the colon.

关键词：激光共聚焦组织细胞愈合过程肠黏膜内检测内镜梭状芽孢杆菌结肠镜

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First case report of exacerbated ulcerative colitis after anti-interleukin-6R salvage therapy

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World Journal of Gastroenterology 2015年第45期21卷 12963-12969页

作者： Raja Atreya Ulrike Billmeier Timo Rath jonas mudter Michael Vieth Helmut Neumann Markus F Neurath Markus F Neurath Medical Clinic 1 Friedrich-Alexander University Erlangen-Nürnberg Medical Department Hospital Ostholstein Institute of Pathology Klinikum Bayreuth

We present the case of a 53-year-old woman with long-standing ulcerative colitis and severe, steroid-dependent disease course unresponsive to treatment with azathioprine, methotrexate, anti-TNF antibodies(infliximab, adalimumab) and tacrolimus, who refused colectomy as a therapeutic option. As the pro-inflammatory cytokine interleukin-6(IL-6) had been identified as a crucial regulator in the immunopathogenesis of inflammatory bowel diseases, we treated the patient with biweekly intravenous infusions of an anti-IL-6R antibody(tocilizumab) for 12 wk. However, no clinical improvement of disease activity was noted. In fact, endoscopic, histological and endomicroscopic assessment demonstrated exacerbation of mucosal inflammation and ulcer formation upon anti-IL-6R therapy. Mechanistic studies revealed that tocilizumab treatment failed to suppress intestinal IL-6 production, impaired epithelial barrier function and induced production of pro-inflammatory cytokines such as TNF, IL-21 and IFN-γ. Inhibition of IL-6 by tocilizumab had no clinical benefit in this patient with intractable ulcerative colitis and even led to exacerbation of mucosal inflammation. Our findings suggest that anti-IL-6R antibody therapy may leadto aggravation of anti-TNF resistant ulcerative colitis. When targeting IL-6, the differential responsiveness of target cells has to be taken into account, as IL-6 on the one side promotes acute and chronic mucosal inflammation via soluble IL-6R signaling but on the other side also strongly contributes to epithelial cell survival via membrane bound IL-6R signaling.

关键词： Ulcerative colitis Interleukin-6 Epithelial barrie

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