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Chronic radiation proctopathy: A practical review of endoscopic treatment

World Journal of Gastrointestinal Surgery 2016年第2期8卷 151-160页

作者： Luciano Lenz Rachel Rohr Frank Nakao ermelindo Libera Angelo Ferrari fleury medicina e saue Centro de Medicina Diagnatica SaPaulo 04513-100 Brazil endoscopy Unity Universidade Federal de SaPaulo SaPaulo 04513-100 Brazil endoscopy Unit Hospital Israelita Albert EinsteinSao Paulo 04513-100 Brazil

Chronic radiation proctopathy(CRP) is a troublesome complication of pelvic radiotherapy. The most common presentation is rectal bleeding. CRP symptoms interfere with daily activities and decrease quality of life. Rectal bleeding management in patients with CRP represents a conundrum for practitioners. Medical therapy is ineffective in general and surgical approach has a high morbidmortality. endoscopy has a role in the diagnosis,staging and treatment of this disease. Currently available endoscopic modalities are formalin,potassium titanyl phosphate laser,neodymium:yttrium-aluminum-garnet laser,argon laser,bipolar electrocoagulation(BiCAP),heater probe,band ligation,cryotherapy,radiofrequency ablation and argon plasma coagulation(APC). Among these options,APC is the most promising.

关键词： endoscopic treatment Radiation proctopathy Proctitis Argon plasma coagulation Cryotherapy Radiofrequency ablation Formalin Laser Bipolar probe Pelvic radiotherapy

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Anti-rods/rings autoantibody generation in hepatitis Cpatients during interferon-α/ribavirin therapy

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World Journal of Gastroenterology 2016年第6期22卷 1966-1974页

作者： Gerson Dierley Keppeke S John Calise edward KL Chan Luis eduardo C Andrade Rheumatology Division Escola Paulista de MedicinaUniversidade Federal de São PauloSP 04023-062Brazil Department of Oral Biology University of FloridaGainesvilleFL 32610-0424United States 3 Immunology DivisionFleury Medicine and Health Laboratories São PauloSP 04102-050Brazil

Chronic inflammation associated with hepatitis C virus(HCV) infection can lead to disabling liver diseases with progression to liver cirrhosis and hepatocellular carcinoma. Despite the recent availability of more effective and less toxic therapeutic options, in most parts of the world the standard treatment consists of a weekly injection of pegylated interferon α(IFN-α) together with a daily dose of ribavirin. HCV patients frequently present circulating non-organ-specific autoantibodies demonstrating a variety of staining patterns in the indirect immunofluorescence assay for antinuclear antibodies(ANA). Between 20% to 40% of HCV patients treated with IFN-α and ribavirin develop autoantibodies showing a peculiar ANA pattern characterized as rods and rings(RR) structures. The aim of this article is to review the recent reports regarding RR structures and anti-rods/rings(antiRR) autoantibody production by HCV patients after IFN-α/ribavirin treatment. Anti-RR autoantibodies first appear around the sixth month of treatment and reach a plateau around the twelfth month. After treatment completion, anti-RR titers decrease/disappear in half the patients and remain steady in the other half. Some studies have observed a higher frequency of anti-RR antibodies in relapsers, i.e., patients in which circulating virus reappears after initially successful therapy. The main target of anti-RR autoantibodies in HCV patients is inosine-5'-monophosphate dehydrogenase 2(IMPDH2), the rate-limiting enzyme involved in the guanosine triphosphate biosynthesis pathway. Ribavirin is a direct IMPDH2 inhibitor and is able to induce the formation of RR structures in vitro and in vivo. In conclusion, these observations led to the hypothesis that anti-RR autoantibody production is a human model of immunologic tolerance breakdown that allows us to explore the humoral autoimmune response from the beginning of the putative triggering event: exposure to ribavirin and interferon.

关键词： Rods and rings autoantibodies Hepatitis C ribavirin Interferon-α

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efficacy and safety of endoscopic prophylactic treatment with undiluted cyanoacrylate for gastric varices

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World Journal of Gastrointestinal endoscopy 2014年第6期6卷 254-259页

作者： Matheus Cavalcante Franco Gustavo Flores Gomes Frank Shigeo Nakao Gustavo Andrade de Paulo Angelo Paulo Ferrari Jr ermelindo Della Libera Jr Digestive endoscopy Unit Division of GastroenterologyFederal University of Sao Paulo endoscopy Division Fleury Medicina e Saúde endoscopy Division Hospital Israelita Albert Einstein

AIM:To evaluate the efficacy and safety of undiluted N-butyl-2 cyanoacrylate plus methacryloxysulfolane(NBCM)as a prophylactic treatment for gastric varices(GV)***:This prospective study was conducted at a single tertiary-care teaching hospital between October 2009 and March *** with portal hypertension(PH)and GV,with no active gastrointestinal bleeding,were enrolled in primary prophylactic treatment with NBCM injection without lipiodol *** diagnosis of GV was based on endoscopy and confirmed with endosonography(eUS); the same procedure was used after treatment to confirm eradication of *** puncturing the GV with a regular injection needle,1 mL of undiluted NBCM was injected intranasally into *** injection was repeated as necessary to achieve eradication or until a maximum total volume of 3 mL of NBCM had been *** were followed clinically and evaluated with endoscopy at 3,6 and 12 *** follow-ups were performed *** main outcome measures were efficacy(GV eradication),safety(adverse events related to cyanoacrylate injection),recurrence,bleeding from GV and mortality related to GV ***:A total of 20 patients(15 male)with PH and GV were enrolled in the study and treated with undiluted NBCM *** 2(10%)patients had no esophageal varices(eV); 18(90%)patients were treated with endoscopic band ligation to eradicate eV before inclusion in the *** patients were followed clinically and endoscopically for a median of 31 mo(range:6-40 mo).eradication of GV was observed in all patients(13 patients were treated with 1 session and 7 patients with 2 sessions),with a maximum injected volume of 2 mL *** patient had GV recurrence,confirmed by eUS,at 6-mo follow-up,and another had late recurrence with GV bleeding after 35 mo of follow-up; overall,GV recurrence was observed in 2 patients(10%),after 6 and 35 mo of follow-up,and GV bleeding rate was 5%(1 patient).Mild epigastric pain was r

关键词： Gastric varices Primary prevention endoscopy Gastrointestinal Cyanoacrylates Gastrointestinal hemorrhage

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