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Differentiation of malignant and benign proximal bile duct strictures: The diagnostic dilemma

World Journal of Gastroenterology 2008年第32期14卷 5032-5038页

作者： Jaap Jacob Kloek Otto Marinus van Delden Deha Erdogan Fibo Jan ten Kate Erik Anthoni Rauws Olivier Robert Busch Dirk Joan Gouma Thomas Mathijs van Gulik Department of Surgery Academic Medical Center University of Amsterdam Department of Radiology Academic Medical Center University of Amsterdam Department of Pathology Academic Medical Center University of Amsterdam Department of Gastroenterology Academic Medical Centre University of Amsterdam

AIM: To identify the criteria for the differentiation of hilar cholangiocarcinoma (HCCA) from benign strictures. METHODS: A total of 68 patients underwent resection of lesions suspicious for HCCA between 1998 and 2006. The results of laboratory investigations, imaging studies and brush cytology were collected. These fi ndings were analyzed to obtain the fi nal diagnosis. RESULTS: Histological examination of the resected specimens confirmed HCCA in 58 patients (85%, group Ⅰ) whereas 10 patients (15%, groupⅡ) were diagnosed to have benign strictures. The most common presenting symptom was obstructive jaundice in 77% patients (79% group Ⅰvs 60% group Ⅱ P = 0.23). Laboratory findings showed greater elevation of transaminase levels in group Ⅰcompared to group Ⅱ The various imaging modalities showed vascular involvement exclusively in the malignant group (36%,P < 0.05). Brush cytology was positive for malignant cells in only 50% patients in group Ⅰ whereas none in group Ⅱ showed malignant cells. CONCLUSION: Despite improvements in imaging techniques, 10 patients (15%) with a presumptive diagnosis of HCCA were ultimately found to have benign strictures. Except for vascular involvement which was associated significantly with malignancy, there were no conclusive features of malignancy on regular imaging modalities. This uncertainty should be taken into account when patients with a suspicious lesion at the liver hilum are considered for resection.

关键词： Biliary stricture Hilar cholangiocarcinoma Benign Radiological Vascular involvement cholangio

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Autoimmune gastritis presenting as iron deficiency anemia in childhood

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World Journal of Gastroenterology 2014年第42期20卷 15780-15786页

作者： Cristina Gon?alves Maria Emília Oliveira Ana M Palha Anabela Ferr?o Anabela Morais Ana Isabel Lopes Gastroenterology Unit Pediatric Department University Hospital Santa Maria Lisbon Academic Medical Centre Pathology Department University Hospital Santa Maria Lisbon Academic Medical Centre Hematology Unit Pediatric Department University Hospital Santa Maria Lisbon Academic Medical Centre

AIM: To characterize clinical, laboratorial, and histological profile of pediatric autoimmune gastritis in the setting of unexplained iron deficiency anemia investigation.

关键词： Autoimmune gastritis Iron deficiency anemia Children

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Early-onset gastric cancer:Learning lessons from the young

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World Journal of Gastrointestinal Oncology 2010年第2期2卷 59-64页

作者： Anya N Milne G Johan A Offerhaus Department of Pathology University Medical Centre Utrecht Department of Pathology Academic Medical CentreUniversity of Amsterdam

There is by no means a clear-cut pattern of mutations contributing to gastric cancers,and gastric cancer research can be hampered by the diversity of factors that can induce gastric cancer,such as Helicobacter pylori infection,diet,ageing and other environmental *** are unquestionably riddled with genetic changes yet we are faced with an unsolvable puzzle with respect to a temporal *** is postulated that inherited genetic factors may be more important in early-onset gastric cancer (EOGC) than in gastric cancers found in older patients as they have less exposure to environmental ***,therefore,could provide a key to unravelling the genetic changes in gastric *** cancers occurring in young patients provide an ideal background on which to try and uncover the initiating stages of gastric *** review summarizes the literature regarding EOGC and also presents evidence that these cancers have a unique molecular-genetic phenotype,distinct from conventional gastric cancer.

关键词： Gastric cancer Early-onset gastric cancer Helicobacter pylori

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Biliary drainage of the common bile duct with an enteral metal stent

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World Journal of Gastroenterology 2009年第19期15卷 2423-2424页

作者： Irene M Dek Bram DJ van den Elzen Paul Fockens Erik AJ Rauws Department of Gastroenterology and Hepatology Academic Medical CentreUniversity of Amsterdam1105 AZ AmsterdamThe Netherlands

In this case report we present an elderly patient who was referred to our hospital with recurrent episodes of cholangitis that persisted after placement of fi ve metal stents for a distal common bile duct(CBD) *** metal stents were endoscopically removed from the CBD by forceps after balloon dilatation of the papilla.A profoundly dilated CBD with sludge and concrements was *** ensure adequate bile drainage an enteral metal stent was inserted in the *** case shows that proximally migrated uncovered metal stents in the CBD can be safely removed endoscopically under certain *** suggest that in the case of a CBD drainage problem due to an extremely dilated CBD,placement of an enteral metal stent in the CBD could be considered,especially in patients who are unfi t for surgery.

关键词： Cholangitis Dilated common bile duct Endoscopic retrograde cholangiopancreatography Enteral metal stent Metal stent removal

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Dracunculiasis eradication-Finishing the job before surprises arise

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Asian Pacific Journal of Tropical Medicine 2012年第7期5卷 505-510页

作者： Benjamin Jelle Visser academic medical centre University of AmsterdamMeibergdreef 91105AZAmsterdamThe Netherlands

Dracunculiasis(Guinea worm disease) is a preventable waterborne parasitic disease that affects the poorest people living in remote rural areas in sub-Saharan African countries,who do not have access to safe drinking *** Guinea Worm Eradication Program,a 25-year old campaign to rid the world of Guinea Worm disease has now reached its final stage accelerating to zero cases in all endemic *** the 19th and 20th centuries,dracunculiasis was common in much of Southern Asia and the African *** overall number of cases has been reduced tremendously by≥99%,from the 3.32 million cases estimated to have occurred in 1986 in Africa to only I 797 cases reported in 2010 reported in only five countries(Sudan,Mali,Ethiopia,Chad and Ghana) and Asia free of the *** achievement is unique in its kind - the only previously eradicated disease is smallpox,a viral infection for which vaccination was possible - and it has been achieved through primary community-based prevention and health education *** efforts need to be taken in two countries,South Sudan(comprising 94%or I 698 out of 1 797 of the cases reported world-wide in 2010) and Mali because of frequent movements of nomads in a vast area inside and outside Mali’s *** factors favourable to dracunculiasis eradication are available including adequate financial resources,community and political support and high levels of *** there is no reason that this disabling parasitic disease cannot be eradicated soon before surprises arise such as new civil conflicts in currently endemic countries.

关键词： Dracunculiasis Guinea worm disease Eradication

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Juvenile polyposis syndrome

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World Journal of Gastroenterology 2011年第44期17卷 4839-4844页

作者： Lodewijk AA Brosens Danielle Langeveld W Arnout van Hattem Francis M Giardiello G Johan A Offerhaus Department of Pathology University Medical Centre Utrecht Department of Pathology Academic Medical Centre Division of Gastroenterology Department of Medicine The Johns Hopkins University School of Medicine

Juvenile polyposis syndrome is a rare autosomal dominant syndrome characterized by multiple distinct juvenile polyps in the gastrointestinal tract and an increased risk of colorectal *** cumulative life-time risk of colorectal cancer is 39% and the relative risk is *** polyps have a distinctive histology characterized by an abundance of edematous lamina propria with inflammatory cells and cystically dilated glands lined by cuboidal to columnar epithelium with reactive ***,juvenile polyposis syndrome is defined by the presence of 5 or more juvenile polyps in the colorectum,juvenile polyps throughout the gastrointestinal tract or any number of juvenile polyps and a positive family history of juvenile *** about 50%-60% of patients diagnosed with juvenile polyposis syndrome a germline mutation in the SMAD4 or BMPR1A gene is *** genes play a role in the BMP/TGF-beta signalling *** has been suggested that cancer in juvenile polyposis may develop through the socalled "landscaper mechanism" where an abnormal stromal environment leads to neoplastic transformation of the adjacent epithelium and in the end invasive *** of this rare disorder is important for patients and their families with regard to treatment,follow-up and screening of at risk *** clinician confronted with the diagnosis of a juvenile polyp should therefore consider the possibility of juvenile polyposis *** addition,juvenile polyposis syndrome provides a unique model to study colorectal cancer pathogenesis in general and gives insight in the molecular genetic basis of *** review discusses clinical manifestations,genetics,pathogenesis and management of juvenile polyposis syndrome.

关键词： Juvenile polyposis syndrome Hamartoma Colorectal cancer SMAD4 BMPR1A

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Systematic review: The placebo effect of psychological interventions in the treatment of irritable bowel syndrome

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World Journal of Gastroenterology 2017年第12期23卷 2223-2233页

作者： Carla E Flik Laura Bakker Wijnand Laan Yanda R van Rood André JPM Smout Niek J de Wit Department of General Practice Julius Centre for Health Sciences and Primary CareUniversity Medical Centre Utrecht Department of Psychiatry and Psychology St Antonius Hospital Department of Psychiatry University Medical Centre Department of Gastroenterology and Hepatology Academic Medical Centre

AIM To determine the placebo response rate associated with different types of placebo interventions used in psychological intervention studies for irritable bowel syndrome. METHODS Randomized controlled trials comparing psychological interventions(stress management/relaxation therapy(cognitive) behavioral therapy, short-term psychodynamic therapy, and hypnotherapy) for the treatment of adult patients with irritable bowel syndrome(IBS) diagnosed with the Manning or Rome criteria with an adequate placebo control treatment and reporting data on IBS symptom severity were identified by searching Pub Med, Embase, the Cochrane Library, CINAHL and Psyc INFO databases. Full-text articles that were written in English and published between 1966 and February 2016 in peer-reviewed journals were selected for the present review. Placebo interventions were considered to be adequate if the number of sessions and the amount of time spent with the therapist were the same as in the active treatment. The placebo response rate(PRR) was computed for IBS symptom severity(primary outcome measure) as well as for anxiety, depression and quality of life(secondary outcome measures). RESULTS Six studies, with a total of 555 patients met the inclusion criteria. Four studies used an educational intervention, whereas two studies used a form of supportive therapy as the placebo intervention. The PRR for IBS symptom severity ranged from 25% to 59%, with a pooled mean of 41.4%. The relative PRR for the secondary outcome measures ranged from 0% to 267% for anxiety, 6% to 52% for depression 20% to 125% for quality of life. The PRR associated with pharmacological treatments, treatment with dietary bran and complementary medicine ranged from 37.5% to 47%. Contrary to our expectations, the PRR in studies on psychological interventions was comparable to that in studies on pharmacological, dietary and alternative medical *** The PRR is probably determined to a larger extent by patient-re

关键词： Placebo effect Psychological interventions Irritable bowel syndrome Systematic review

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Results of percutaneous sclerotherapy and surgical treatment in patients with symptomatic simple liver cysts and polycystic liver disease

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World Journal of Gastroenterology 2007年第22期13卷 3095-3100页

作者： Deha Erdogan Otto M van Delden Erik AJ Rauws Olivier RC Busch Johan S Lameris Dirk J Gouma Thomas M van Gulik Department of Surgery Academic Medical Center University of Amsterdam The Netherlands Department of Radiology Academic Medical Center University of Amsterdam The Netherlands Department of Gastroenterology Academic Medical Center University of Amsterdam The Netherlands

AIM: To evaluate the results of the treatment of simple liver cysts (solitary and multiple) and polycystic liver disease (PLD) using percutaneous sclerotherapy and/or surgical procedures in a single tertiary referral centre. METHODS: Retrospective analysis of 54 patients referred for evaluation and possible treatment of simple liver cysts (solitary and multiple) and PLD, from January 1997 to July 2006. RESULTS: Simple liver cysts were treated in 41 pts (76/) with a mean size of 12.6 cm. The most common reason for referral was abdominal pain or discomfort (85/). Percutaneous sclerotherapy was performed as initial treatment in 30 pts, showing cyst recurrence in 6 pts (20/). Surgical treatment was initially performed in 11 pts with cyst recurrence in 3 pts (27/). PLD was treated in 13 pts (24/) with a mean size of the dominant cyst of 13 cm. Percutaneous sclerotherapy for PLD was performed in 9 pts with recurrence in 7 pts (77.8/). Surgical treatment for PLD was undertaken in 4 pts (30.8/) with recurrence in all. Eventually, 2 pts with PLD in the presence of polycystic kidney disease underwent liver-and kidney transplantation because of deterioration of liver and kidney function. CONCLUSION: The majority of patients with simple liver cysts and PLD are referred for progressive abdominal pain. As initial treatment, percutaneous sclerotherapy is appropriate. Surgical deroofing is indicated in caseof cyst recurrence after percutaneous sclerotherapy. However, the results of percutaneous sclerotherapy and surgical treatment for PLD are disappointing. Partial liver resection is indicated when there is suspicion of a pre-malignant lesion.

关键词： Simple liver cyst Polycystic liver disease Percutaneous sclerotherapy Deroofing Complications

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Current and future therapies for inherited cholestatic liver diseases

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World Journal of Gastroenterology 2017年第5期23卷 763-775页

作者： Wendy L van der Woerd Roderick HJ Houwen Stan FJ van de Graaf Tytgat Institute for Liver and Intestinal Research Academic Medical Center Department of Pediatric Gastroenterology Wilhelmina Children’s HospitalUniversity Medical Centre Utrecht Department of Gastroenterology and Hepatology Academic Medical CenterUniversity of Amsterdam

Familial intrahepatic cholestasis(FIC) comprises a group of rare cholestatic liver diseases associated with canalicular transport defects resulting predominantly from mutations in ATP8B1, ABCB11 and ABCB4. Phe-notypes range from benign recurrent intrahepatic cholestasis(BRIC), associated with recurrent cholestatic attacks, to progressive FIC(PFIC). Patients often suffer from severe pruritus and eventually progressive cholestasis results in liver failure. Currently, first-line treatment includes ursodeoxycholic acid in patients with ABCB4 deficiency(PFIC3) and partial biliary diversion in patients with ATP8B1 or ABCB11 deficiency(PFIC1 and PFIC2). When treatment fails, liver transplantation is needed which is associated with complications like rejection, post-transplant hepatic steatosis and recurrence of disease. Therefore, the need for more and better therapies for this group of chronic diseases remains. Here, we discuss new symptomatic treatment options like total biliary diversion, pharmacological diversion of bile acids and hepatocyte transplantation. Furthermore, we focus on emerging mutation-targeted therapeutic strategies, providing an outlook for future personalized treatment for inherited cholestatic liver diseases.

关键词： Familial intrahepatic cholestasis Progressive familial intrahepatic cholestasis Inherited liver disease ATP8B1 ABCB11 ABCB4 Biliary diversion Mutation-targeted therapy Personalized treatment

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Drug-induced autoimmune hepatitis:A minireview

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World Journal of Gastroenterology 2022年第24期28卷 2654-2666页

作者： Chin Kimg Tan Danielle Ho Lai Mun Wang Rahul Kumar Gastroenterology and Hepatology Changi General HospitalSingapore 529889Singapore Medicine academic Clinical Programme SingHealth Duke-NUS Academic Medical CentreSingapore 529889Singapore Section of Pathology Department of Laboratory MedicineChangi General HospitalSingapore 529889Singapore Pathology academic Clinical Programme SingHealth Duke-NUS Academic Medical CentreSingapore 529889Singapore

Drug-induced autoimmune hepatitis(DIAIH)is a specific phenotype of druginduced liver injury that may lead to the devastating outcome of acute liver failure requiring liver *** implicated in DIAIH include antimicrobials such as nitrofurantoin and minocycline,non-steroidal anti-inflammatory drugs,statins as well as anti-tumor necrosis *** clinical features of druginduced liver injury are indistinguishable from idiopathic autoimmune hepatitis(AIH)as both may have positive AIH-related autoantibodies,elevated immunoglobulin G,as well as similar histopathological *** patients who show no clinical improvement,or there is progressive liver injury despite cessation of the suspected drug,a liver biopsy should be considered,whereby the presence of advance fibrosis on histology favors the diagnosis of idiopathic *** treatment with corticosteroids may be required in patients with non-resolving liver injury.A typical clinical scenario supportive of DIAIH includes a history of drug exposure with spontaneous resolution of liver injury after drug withdrawal and the absence of relapse after rapid steroid *** this article we report two cases of DIAIH secondary to Sorafenib and Atorvastatin along with a review of currently available *** identification and treatment often lead to a favorable outcome in DIAIH.

关键词： Drug-induced liver injury Drug-induced autoimmune hepatitis Autoimmune hepatitis Review

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