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Mucosa-associated lymphoid tissue lymphoma simulating Crohn’s disease:A case report

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World Journal of Clinical Cases 2020年第8期8卷 1454-1462页

作者： Ieva Stundiene Vaidota Maksimaityte valentina liakina Jonas Valantinas Centre of Hepatology Gastroenterology and DieteticsFaculty of MedicineVilnius UniversityVilnius 03101Lithuania Department of Chemistry and Bioengineering Faculty of Fundamental ScienceVilnius Gediminas Technical UniversityVilnius 10223Lithuania Clinic of Gastroenterology Nephrourology and SurgeryFaculty of MedicineVilnius UniversityVilnius 03101Lithuania

BACKGROUND Differential diagnosis between extranodal marginal zone lymphoma of mucosaassociated lymphoid tissue and inflammatory bowel disease is mainly based on histopathologic evaluation of intestinal biopsies,although there is no single definitive diagnostic investigation and that circumstance can lead to misdiagnosis in particular *** we present a rare,ulcerative form of marginal zone lymphoma which mimics the Crohn’s disease(CD)of upper digestive *** SUMMARY A 50-year-old man was presented with recurrent episodes of malaise and melena also weight *** of the small bowel demonstrated an ulcer in the ***,biopsies showed lymphoplasmacytic *** of CD was *** treatment consisted of prednisone and azathioprine and was followed by azathioprine 100 mg per day with good clinical response in the following 2 years until *** this time the results of endoscopic biopsies derived from proximal wall of stomach revealed Helicobacter pylori-negative marginal zone lymphoma of the gastric *** confirmed atypical CD20-positive cell *** on these biopsies,marginal zone lymphoma of mucosa-associated lymphoid tissue was ***,the contact with the patient was lost until one year later he was hospitalized with nausea,vomiting and severe pain because of gastrointestinal *** months later after laparotomy,the patient was treated with a course of *** remission was observed following 6 cycles of *** This case report highlights the clinical relevance of knowledge and awareness of marginal zone lymphoma simulating CD.

关键词： Crohn disease Mucosa-associated lymphoid tissue lymphoma Rare diagnosis Gastrointestinal diseases Thiopurines Case report

Multi-organ IgG4-related disease continues to mislead clinicians: A case report and literature review

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World Journal of Clinical Cases 2020年第15期8卷 3267-3279页

作者： Sandra Strainiene Lukas Sarlauskas Ilona Savlan valentina liakina Ieva Stundiene Jonas Valantinas Clinic of Gastroenterology Nephrourology and SurgeryCentre of HepatologyGastroenterology and DieteticsInstitute of Clinical MedicineVilnius UniversityVilnius 01513Lithuania Clinic of Internal Diseases Family Medicine and OncologyCentre of Internal DiseasesInstitute of Clinical MedicineVilnius UniversityVilnius 01513Lithuania Department of Chemistry and Bioengineering Faculty of Fundamental ScienceVilnius Gediminas Technical UniversityVilnius 10223Lithuania

BACKGROUND Immunoglobulin G4-related disease(IgG4-RD)is a multisystemic mass forming immune-mediated disease that affects almost every organ and is a diagnostic challenge for every *** is a lack of adequate epidemiological data worldwide,and evidence-based treatment recommendations are not yet *** report the first case of IgG4-RD from Lithuania and the Baltic Sea region presented with thyroiditis,orbital myositis,orbitopathy,uveitis,scleritis,sialadenitis,autoimmune pancreatitis and *** SUMMARY A 54-year-old Caucasian male was admitted to our tertiary Centre complaining of severe weight loss,diarrhoea,abdominal pain,salivary gland swelling,sicca symptoms and *** examination,bilateral palpable masses in the projection of major salivary glands,severe protrusion of the left eyeball and cachexia were *** patient was previously diagnosed with autoimmune thyroiditis and endocrine *** magnetic resonance imaging(MRI)of the head revealed enlarged extraocular muscles indicating orbital *** biopsy from the salivary gland mass indicated *** MRI showed signs of autoimmune pancreatitis,and a serological test revealed the elevated serum IgG4 *** patient was then diagnosed with IgG4-RD and successfully treated with *** was a significant clinical,serological and radiological improvement after one month of treatment and no signs of relapse within twenty ***,it took almost 18 years and the efforts of eight different medical specialists to establish the correct *** A comprehensive approach to the patient is essential to improving the recognition of rare immune system conditions,such as IgG4-RD.

关键词： IgG4-related disease Autoimmune pancreatitis Sialadenitis Orbitopathy Autoimmune thyroiditis Case report Literature review

Menstrual cycle abnormalities in women with inflammatory bowel disease and effects of biological therapy on gynecological pathology

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World Journal of Clinical Cases 2023年第21期11卷 4989-4995页

作者： Vaidota Malinauskiene Anastasija Zuzo valentina liakina Edita Kazenaite Ieva Stundiene Clinic of Gastroenterology Nephrourology and SurgeryInstitute of Clinical MedicineFaculty of MedicineVilnius UniversityVilnius 01513Lithuania Faculty of Medicine Vilnius UniversityVilnius 01513Lithuania Department of Chemistry and Bioengineering Faculty of Fundamental SciencesVilnius TechVilnius 10223Lithuania

Inflammatory bowel disease(IBD)is a chronic condition that affects young individuals in their reproductive *** may have long-term implications on their reproductive,sexual,and mental *** has been related to menstrual ***,the administration of biological therapy can also result in gynecological issues in addition to the disease *** purpose of this review was to present potential menstrual cycle problems in patients with IBD,as well as the impact of adalimumab and other anti-tumor necrosis factor medications on gynecological pathology.

关键词： Menstrual disorders Inflammatory bowel disease Adalimumab Infliximab Anti-tumor necrosis factor-α

Management of Flood syndrome:What can we do better?

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World Journal of Gastroenterology 2021年第32期27卷 5297-5305页

作者： Sandra Strainiene Milda Peciulyte Tomas Strainys Ieva Stundiene Ilona Savlan valentina liakina Jonas Valantinas Clinic of Gastroenterology Nephrourology and SurgeryCentre of HepatologyGastroenterology and DieteticsInstitute of Clinical MedicineVilnius UniversityVilnius 03104Lithuania Clinic of Anesthesiology and Reanimatology Centre of AnesthesiologyIntensive Care and Pain ManagementInstitute of Clinical MedicineVilnius UniversityVilnius 03104Lithuania Department of Chemistry and Bioengineering Faculty of Fundamental ScienceVilnius Gediminas Technical UniversityVilnius 10223Lithuania

Approximately 20%of cirrhotic patients with ascites develop umbilical *** patients usually suffer from multisystemic complications of cirrhosis,have a significantly higher risk of infection,and require accurate surveillance–especially in the context of the coronavirus disease 2019 *** rupture of an umbilical hernia,is an uncommon,life-threatening complication of largevolume ascites and end-stage liver disease resulting in spontaneous paracentesis,also known as Flood *** syndrome remains a challenging condition for clinicians,as recommendations for its management are lacking,and the available evidence for the best treatment approach remains *** this paper,four key questions are addressed regarding the management and prevention of Flood syndrome:(1)Which is the best treatment approach–conservative treatment or urgent surgery?(2)How can we establish the individual risk for herniation and possible hernia rupture in cirrhotic patients?(3)How can we prevent umbilical hernia ruptures?And(4)How can we manage these patients in the conditions created by the coronavirus disease 2019 pandemic?

关键词： Umbilical hernia rupture Ascites Cirrhosis Flood syndrome COVID-19 Literature review

Liver cirrhosis and left ventricle diastolic dysfunction: Systematic review

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World Journal of Gastroenterology 2019年第32期25卷 4779-4795页

作者： Ieva Stundiene Julija Sarnelyte Ausma Norkute Sigita Aidietiene valentina liakina Laura Masalaite Jonas Valantinas Vilnius University Institute of Clinical MedicineClinic of GastroenterologyNephrourology and SurgeryVilnius UniversityVilnius LT-03101Lithuania Vilnius University Institute of Clinical MedicineClinic of Internal diseasesFamily medicine and OncologyVilnius UniversityVilnius LT-03101Lithuania Vilnius University Institute of Clinical MedicineClinic of Cardiology and AngiologyVilnius UniversityVilnius LT-03101Lithuania Vilnius Gediminas Technical University Faculty of Fundamental SciencesDepartment of Chemistry and BioengineeringVilnius LT-10223Lithuania

BACKGROUND Liver cirrhosis is a chronic hepatic disease which is associated with cardiovascular *** circulation in liver cirrhosis causes functional and structural cardiac *** prevalence of left ventricle diastolic dysfunction(LVDD)in cirrhotic patients ranges from 25.7%to as high as 81.4%as reported in different *** several studies the severity of diastolic dysfunction(DD)correlated with a degree of liver failure and the rate of dysfunction was higher in patients with decompensated cirrhosis compared with *** directions of comprehensive assessment of cardiac function in cirrhotic patients might provide a better prognosis for these *** To clarify the correlation between the severity of liver cirrhosis and left ventricle diastolic dysfunction in the existing *** Through January and February of 2019 at Vilnius University we conducted a systematic review of the global existing literature on the prevalence of left ventricle diastolic dysfunction in patients with liver *** searched for articles in PubMed,Medline and Web of science *** were selected by using adequate inclusion and exclusion *** interest was the outcome of likely correlation between the severity of cirrhosis[evaluated by Child-Pugh classes,Model For End-Stage Liver Disease(MELD)scores]and left ventricle diastolic dysfunction[classified according to American Society of Echocardiography(ASE)guidelines(2009,2016)],as well as relative risk of dysfunction in cirrhotic *** analyses were performed to evaluate the ratio and grades of left ventricle diastolic dysfunction with respect to cirrhosis *** A total of 1149 articles and abstracts met the initial search *** articles which met the predefined eligibility criteria were included in the final ***,1067 patients(out of them 723 men)with liver cirrhosis were evaluated for left ventricle diastolic dysf

关键词： Liver cirrhosis Left ventricle Diastolic dysfunction Correlation Echocardiography Systematic review

Gut microbiota contribution to hepatocellular carcinoma manifestation in non-alcoholic steatohepatitis

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World Journal of Hepatology 2022年第7期14卷 1277-1290页

作者： valentina liakina Sandra Strainiene Ieva Stundiene Vaidota Maksimaityte Edita Kazenaite Centre of Hepatology Gastroenterology and DieteticsClinic of GastroenterologyNephrourology and SurgeryInstitute of Clinical MedicineFaculty of MedicineVilnius UniversityVilnius 01513Lithuania Department of Chemistry and Bioengineering Faculty of Fundamental SciencesVilnius Gediminas Technical University(VILNIUS TECH)Vilnius 10223Lithuania Faculty of Medicine Vilnius UniversityVilnius 01513Lithuania Therapeutic and Radiological Department Antakalnis PolyclinicVilnius 10207Lithuania Department of Pathology Forensic Medicine and PharmacologyInstitute of Biomedical SciencesFaculty of MedicineVilnius UniversityVilnius 01513Lithuania

Recently,the gut microbiota has been recognized as an obvious active player in addition to liver steatosis/steatohepatitis in the pathophysiological mechanisms of the development of hepatocellular carcinoma(HCC),even in the absence of *** from clinical and experimental studies shows the association of specific changes in the gut microbiome and the direct contribution to maintaining liver inflammation and/or cancerogenesis in nonalcoholic fatty liver disease-induced *** composition of the gut microbiota differs significantly in obese and lean individuals,especially in the abundance of pro-inflammatory lipopolysaccharide-producing phyla,and,after establishing steatohepatitis,it undergoes minor changes during the progression of the disease toward advanced *** studies proved that the microbiota of obese subjects can induce steatohepatitis in normally fed *** the contrary,the transplantation of healthy microbiota to obese mice relieves ***,further studies are needed to confirm these findings and the mechanisms *** this review,we have evaluated well-documented clinical and experimental research on the role of the gut microbiota in the manifestation and promotion of HCC in nonalcoholic steatohepatitis(NASH).Furthermore,a literature review of microbiota alterations and consequences of dysbiosis for the promotion of NASH-induced HCC was performed,and the advantages and limitations of the microbiota as an early marker of the diagnosis of HCC were discussed.

关键词： Gut microbiota Hepatocellular carcinoma Non-alcoholic steatohepatitis Non-alcoholic fatty liver disease Microbiome

Effects of COVID-19 on the liver:The experience of a single center

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World Journal of Gastroenterology 2022年第39期28卷 5735-5749页

作者： valentina liakina Ieva Stundiene Gabriele Milaknyte Ramune Bytautiene Rosita Reivytyte Roma Puronaite Gintare Urbanoviciute Edita Kazenaite Centre of Hepatology Gastroenterology and DieteticsClinic of GastroenterologyNephrourology and SurgeryInstitute of Clinical MedicineFaculty of MedicineVilnius UniversityVilnius 01513Lithuania Department of Chemistry and Bioengineering Faculty of Fundamental SciencesVILNIUS TECHVilnius 10223Lithuania Faculty of Medicine Vilnius UniversityVilnius 01513Lithuania Clinic of Cardiac and Vascular Diseases Institute of Clinical MedicineFaculty of MedicineVilnius UniversityVilnius 01513Lithuania Institute of Data Science and Digital Technologies Faculty of Mathematics and InformaticsVilnius UniversityVilnius 01513Lithuania Department of Pathology Forensic Medicine and PharmacologyInstitute of Biomedical SciencesFaculty of MedicineVilnius UniversityVilnius 01513Lithuania

BACKGROUND The coronavirus disease 2019(COVID-19)was perhaps the most severe global health crisis in living *** respiratory symptoms,elevated liver enzymes,abnormal liver function,and even acute liver failure were reported in patients suffering from severe acute respiratory disease coronavirus 2 ***,the precise triggers of these forms of liver damage and how they affect the course and outcomes of COVID-19 itself remain *** To analyze the impact of liver enzyme abnormalities on the severity and outcomes of COVID-19 in hospitalized *** In this study,684 depersonalized medical records from patients hospitalized with COVID-19 during the 2020-2021 period were ***-19 was diagnosed according to the guidelines of the National Institutes of Health(2021).Patients were assigned to two groups:those with elevated liver enzymes(Group 1:603 patients),where at least one out of four liver enzymes were elevated(following the norm of hospital laboratory tests:alanine aminotransferase(ALT)≥40,aspartate aminotransferase(AST)≥40,gamma-glutamyl transferase≥36,or alkaline phosphatase≥150)at any point of hospitalization,from admission to discharge;and the control group(Group 2:81 patients),with normal liver enzymes during ***-19 severity was assessed according to the interim World Health Organization guidance(2022).Data on viral pneumonia complications,laboratory tests,and underlying diseases were also collected and *** In total,603(88.2%)patients produced abnormal liver test *** and AST levels were elevated by a factor of less than 3 in 54.9%and 74.8%of cases with increased enzyme levels,*** in Group 1 had almost double the chance of bacterial viral pneumonia complications[odds ratio(OR)=1.73,P=0.0217],required oxygen supply more often,and displayed higher biochemical inflammation indices than those in Group *** differences in other COVID-19 complications or underlying disea

关键词： COVID-19 SARS-CoV-2 Liver enzymes Complications Underlying disease Disease severity

Complicated course of biliary inflammatory myofibroblastic tumor mimicking hilar cholangiocarcinoma:A case report and literature review

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World Journal of Clinical Cases 2021年第21期9卷 6155-6169页

作者： Sandra Strainiene Kotryna Sedleckaite Juozas Jarasunas Ilona Savlan Juozas Stanaitis Ieva Stundiene Tomas Strainys valentina liakina Jonas Valantinas Clinic of Gastroenterology Nephrourology and SurgeryInstitute of Clinical MedicineVilnius UniversityVilnius 01513Lithuania Vilnius University Faculty of MedicineVilnius 01513Lithuania Department of Radiology Nuclear Medicine and Medical PhysicsInstitute of Clinical MedicineVilnius UniversityVilnius 01513Lithuania Clinic of Anesthesiology and Intensive Care Institute of Clinical Medicine Vilnius UniversityVilnius 01513Lithuania Department of Chemistry and Bioengineering Faculty of Fundamental ScienceVilnius Gediminas Technical UniversityVilnius 10223Lithuania

BACKGROUND The inflammatory myofibroblastic tumor(IMT)is a rare,idiopathic,usually benign,mass-forming disease with myofibroblastic proliferation and a varying amount of inflammatory *** it can affect various organs,the biliary tract is a rare localization of primary IMT,clinically,endoscopically and radiologically imitating *** treatment options are based only on clinical practice *** SUMMARY A 70-year-old woman was referred to our center due to progressive fatigue,weight loss,abdominal pain,night sweats,and elevated liver *** resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography(ERCP)revealed proximal common hepatic duct and hilar biliary strictures extending bilaterally to lobular bile *** initial clinical,endoscopic and radiological signs were typical for hilar cholangiocarcinoma,histological examination showed no signs of *** total,8 biopsies using different approaches were performed(several biopsies from dominant stricture during ERCP and direct cholangioscopy;ultrasound-guided liver biopsy;diagnostic laparoscopy with liver and lymph node biopsies).Histological examination revealed signs of IMT,and the final diagnosis of biliary IMT was *** IMT is usually a benign disease,in our case,it was *** pharmacological treatment measures were *** patient still needs permanent stenting,suffers from recurrent infections and mechanical *** that,the patient already survived 24 *** IMT presenting with hilar biliary strictures is a unique diagnostic and clinical challenge as it is indistinguishable from cholangiocarcinoma,and there are no evidence-based treatment *** goal is to increase the understanding of this rare disease and its possible course.

关键词： Inflammatory myofibroblastic tumor Hilar cholangiocarcinoma Biliary strictures Recurrent cholangitis Case report Literature review