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World Journal of Gastroenterology 2005年第45期11卷 7188-7191页

作者： Filiz Akyüz Nuray Polat Sabahattin Kaymakoglu Nevzat Aksoy Kadir Demir Fatih Besisik Selim Badur Yilmaz Cakaloglu Atilla (O|¨)kten department of gastroenterohepatology department of Microbiology

AIM： To evaluate whether the cytokine responses in liver and serum differ in chronic hepatitis C patients with normal and high alanine aminotransferase （ALT） levels. METHODS： Thirty-three （16 with normal ALT level as group 1 and 17 with elevated ALT level as group 2） patients infected with genotype lb hepatitis C virus （HCV） were examined. Liver infiltrating lymphomononuclear cells （LILMCs） were isolated from liver biopsy by collagenase type 1 and stimulated with phytohemagglutinin and interleukin 2 （IL-2）. IL-10, IL-12, interferon gamma （IFN-γ） and tumor necrosis factor alpha （TNF-α were determined in serum and LILMCs by ELISA. RESULTS： Serum cytokine levels were similar in both groups （P〉0.05）. Stimulated IFN-γ and TNF-α levels in LILMCs were increased in both groups. IL-12 and IL-10 levels stimulated with IL-2 were higher in group 1 than in group 2 （P = 0.023）. Histological activity index （HAI） and stage had a negative correlation with TNF-α and IFN-γ levels in group 2. CONCLUSION： Increased T-helper type 2 （Th2） cytokine response may regress inflammatory and biochemical activity. Progression of histological abnormalities in persons with elevated ALT probably depends on insufficient Th2 cytokine response, which does not balance Th1 cytokine response.

关键词： Liver cytokines HCV, ALT

Viral and host causes of fatty liver in chronic hepatitis B

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World Journal of Gastroenterology 2005年第20期11卷 3056-3059页

作者： Emin Altiparmak Seyfettin K(o|¨)klü Mesut Yalinkilic Osman Yüksel Bahattin Cicek Ertugrul Kayacetin Tülin Sahin department of gastroenterohepatology Yüksek Ihtisas Hospital Sihhiye Ankara Turkey

AIM: To investigate the viral and host causes of fatty liver in chronic hepatitis B patients and the role of fat deposits in liver ***: A total of 164 patients (113 males and 51 females, average age 35±11.3 years, and range 10-62 years) with previously untreated chronic hepatitis B were included in the study. The patients were divided into two groups depending on the result of liver biopsy: group without steatosis (100 patients with ＜5% hepatosteatosis) and group with steatosis (64 patients with ＞5% hepatosteatosis). The groups were compared in terms of gender, body mass index (BMI), liver enzymes (ALT, AST, ALP, GGT), cholesterol, triglyceride, HBeAg, viral load, and histological findings. In the group with steatosis, the patients were subdivided depending on the degree of steatosis into mild group (45 patients with 5-24% steatosis), and severe group (19 patients with ＞25% steatosis). RESULTS: In the group of chronic hepatitis B with steatosis, the mean age, BMI, cholesterol, and triglyceride levels were significantly higher than those in the group without steatosis (P＜0.05). Steatosis was found in 53 (46.9%) of male patients and 11 (22%) of female patients (P＜0.05). No significant difference was found in the positivity of ALT, AST, ALP, GGT, HBeAg, viral load, histological activity index (HAI) and stage between the two groups (P＞0.05). In the group with severe steatosis, the BMI was significantly higher than that in the group with mild steatosis (P＜0.05). No significant difference was found in the other parameters between the groups (P＞0.05). CONCLUSION: Steatosis in chronic hepatitis B appears to be a result of metabolic factors of the host rather than the effect of viruses. Steatosis is unrelated to the HAI and degree of fibrosis, which are considered as the histological indicators of liver damage.

关键词： Chronic hepatitis B Steatosis

Renal aspergillosis in a liver transplant patient: A case report and review of literature

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World Journal of Clinical Cases 2018年第16期6卷 1155-1159页

作者： Brigita Smolovic Batric Vukcevic Damir Muhovic Marina Ratkovic Faculty of Medicine University of Montenegro department of gastroenterohepatology Clinical Center of Montenegro department of Nephrology and Hemodialysis Clinical Center of Montenegro

BACKGROUND Aspergillosis is a frequent invasive fungal infection in liver recipients(affecting 1%-9.2% of all patients), second only to candidiasis. Significant risk factors for invasive aspergillosis in liver recipients include corticosteroid therapy, neutropenia, T-cell dysfunction, renal failure and requirement for renal replacement therapy. Aspergillus infection usually affects the lungs of liver recipients, with hematogenous dissemination occurring in 50%-60% of cases. Renal involvement is rare and is considered to occur in 0.4% of all cases of invasive *** SUMMARY This paper describes a case of a liver recipient presenting with a newly formed renal mass a year after liver transplantation. The patient underwent liver transplantation due to alcoholic liver cirrhosis, with preoperative corticosteroid therapy and postoperative immunosuppressants(tacrolimus and mycophenolate mofetil). His 1-year follow-up was uneventful, with a satisfying graft function and lack of any symptoms. During a routine follow-up abdominal ultrasound, he was diagnosed with a renal tumor. The renal ima-ging findings were inconclusive(with a differential diagnosis to renal cell carcinoma), while the computed tomography(CT) of the chest showed scar tissue in the lungs suggestive of previous inflammation. The patient underwent radical nephrectomy, with histopathological analysis showing renal aspergilloma, yielding postoperative treatment with voriconazole. His follow up was uneventful, and the chest CT did not show any change in pulmonary lesions. This case illustrates the possibility of aspergillosis affecting the lungs of liver recipients, subsequently affecting the kidney and forming an *** Clinicians should be aware of aspergilloma mimicking solid organ tumors in organ recipients.

关键词： Aspergillosis Immunosuppression Liver transplantation Nephrectomy Renal tumor Case report

Non-alcoholic fatty liver disease: What has changed in the treatment since the beginning?

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World Journal of Gastroenterology 2014年第39期20卷 14219-14229页

作者： Bülent Baran Filiz Akyüz Division of gastroenterohepatology Department of Internal Medicine Istanbul University Istanbul Faculty of Medicine Capa 34093 Istanbul Turkey

Non-alcoholic fatty liver disease(NAFLD) is an umbrella term to describe the entire spectrum of this common liver disease. In patients with NAFLD, especially those with non-alcoholic steatohepatitis(NASH), most often have one or more components of the metabolic syndrome, but this is not universal. Although most patients with NAFLD share many clinical features, only a subset of patients develops significant liver inflammation and progressive fibrosis. On the other hand, not all patients with NASH exhibit insulin resistance. NASH can be seen in patients who are lean and have no identifiable risk factors. Many clinical studies have tried numerous drugs and alternative medicine, however, investigators have failed to identify a safe and effective therapy for patients with NASH. As summarized, the heterogeneity of pathogenic pathways in individual patients with NASH may warrant the development of an individualized treatment according to the underlying pathogenic pathway. The differentiation of pathogenetic targets may require the development of diagnostic and prognostic biomarkers, and the identification of genetic susceptibilities. At present, evidence-based medicine provides only a few options including life-style modifications targeting weight loss, pioglitazone and vitamin E in non-diabetic patients with biopsy-proven NASH.

关键词： Non-alcoholic steatohepatitis Pathogenesis Inflammation Fibrosis Life-style changes Pharmacologic treatment

Oral manifestation in inflammatory bowel disease:A review

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World Journal of Gastroenterology 2013年第46期19卷 8571-8579页

作者： Kamran B Lankarani Gholam Reza Sivandzadeh Shima Hassanpour department of Internal Medicine Healthcare Policy Research Center Shiraz University of Medical Sciences department of Internal Medicine Gastroenterohepatology Research Center Namazi Hospital Shiraz University of Medical Sciences gastroenterohepatology Research Center Namazi Hospital Shiraz University of Medical Sciences

Inflammatory bowel diseases (IBDs), including Crohn’s disease (CD) and ulcerative colitis, not only affect the intestinal tract but also have an extraintestinal involvement within the oral cavity. These oral manifestations may assist in the diagnosis and the monitoring of disease activity, whilst ignoring them may lead to an inaccurate diagnosis and useless and expensive workups. Indurated tag-like lesions, cobblestoning, and mucogingivitis are the most common specific oral findings encountered in CD cases. Aphthous stomatitis and pyostomatitis vegetans are among non-specific oral manifestations of IBD. In differential diagnosis, side effects of drugs, infections, nutritional deficiencies, and other inflammatory conditions should also be considered. Treatment usually involves managing the underlying intestinal disease. In severe cases with local symptoms, topical and/or systemic steroids and immunosuppressive drugs might be used.

关键词： Inflammatory bowel disease, Crohn’ s disease, Ulcerative colitis, Extra-intestinal manifestations, Pyostomatitis vegetans, Aphthous stomatitis, Cobblestoning, Mucogingivitis, Oral manifestation

Vanishing bile duct and Stevens-Johnson syndrome associated with ciprofloxacin treated with tacrolimus

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World Journal of Gastroenterology 2008年第29期14卷 4697-4700页

作者： Gokhan Okan Serpil Yaylaci Onder Peker Sabahattin Kaymakoglu Murat Saruc Dermatology department Acibadem Bakirkoy HospitalIstanbul 34140 Turkey mergency department Acibadem Bakirkoy HospitalIstanbul 34140 Turkey Pathology department Acibadem HospitalBakirkoy 34140 Turkey Division of gastroenterohepatology Istanbul University Istanbul Medical FacultyIstanbul 34140 Turkey gastroenterohepatology department Acibadem Bakirkoy HospitalIstanbul 34140 Turkey

Stevens-Johnson syndrome (SJS) is a serious and potentially life-threatening disease. Vanishing bile duct syndrome (VBDS) is a rare cause of progressive cholestasis. Both syndromes are mostly related with drugs. We report a case of a patient with ciprofloxacin-induced SJS and acute onset of VBDS, and reviewed the related literature. It is the fi rst case of ciprofloxacin-induced VBDS successfully treated with tacrolimus. This case reminds physicians of the importance of drug reactions, their severity, techniques for diagnosis and methods of management.

关键词： Stevens-Johnson syndrome Vanishing bileduct syndrome Ciprofloxacin Tacrolimus

Risk factors of gastroesophageal reflux disease in Shiraz,southern Iran

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World Journal of Gastroenterology 2007年第41期13卷 5486-5491页

作者： Mehdi Saberi-Firoozi Farnaz Khademolhosseini Maryam Yousefi Davood Mehrabani Najaf Zare Seyed Taghi Heydari gastroenterohepatology Research Center/department of Internal Medicine Nemazee HospitalSchool of MedicineShiraz University of Medical SciencesShirazIran department of Biostatistics School of Public HealthShiraz University of Medical SciencesShirazIran gastroenterohepatology Research Center/department of Internal Medicine Nemazee HospitalSchool of MedicineShiraz University of Medical SciencesShirazIran Department of BiostatisticsLorestan University of Medical SciencesKhoramabadIran

AIM: To determine the prevalence and symptoms of gastroesophageal reflux disease (GERD) in a healthy general population in relation to demographic,lifestyle and health-seeking behaviors in Shiraz,southern Iran. METHODS: A total of 1978 subjects aged > 35 years who referred to gastroenterohepatology Research Center and who completed a questionnaire consisting of 27 questions for GERD in relation to demographic,lifestyle and health-seeking behaviors were included in this study for a period of five months. The validity and reliability of the questionnaire were determined. RESULTS: The prevalence of GERD was 15.4%,which was higher in females (17.3%),in rural areas (19.8%),and in illiterate subjects (21.5%) and those with a mean age of 50.25 years. The prevalence was significantly lower in subjects having fried food (14.8%),and fruit and vegetables (14.6%). More symptoms were noticed in subjects consuming pickles (22.1%),taking aspirin (21%) and in subjects with psychological distresses (27.2%) and headaches (22%). The correlation was statistically significant between GERD and halitosis (18.3%),dyspepsia (30.6%),anxiety (19.5%),nightmares (23.9%) and restlessness (18.5%). Their health seeking behavior showed that there was a significant restriction of diet (20%),consumption of herbal medicine (19%),using over-the-counter drugs (29.9%) and consulting with physicians (24.8%). Presence of GERD symptoms was also significantly related to a previous family history of the disease (22.3%).CONCLUSION: GERD is more common in females,rural and illiterate subjects and correlated with consumption of pickles,occurrence of headache,psychological distress,dyspepsia,halitosis,anxiety,nightmare and restlessness,and a family history of GERD and aspirin intake,but the correlation was negative with consumption of fat and fiber intake.

关键词： Reflux Risk factors Prevalence Southern Iran

Comparison of different diagnostic methods in infants with Cholestasis

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World Journal of Gastroenterology 2006年第36期12卷 5893-5896页

作者： Seyed Mohsen Dehghani Mahmood Haghighat Mohammad Hadi Imanieh Bita Geramizadeh department of Pediatric Gastroenterology Gastroenterohepatology Research Center of Nemazee Hospital Shiraz University of Medical Sciences Shiraz Iran department of Pathology Nemazee Hospital Shiraz University of Medical Sciences Shiraz Iran

AIM: To evaluate different methods in differentiating idiopathic neonatal hepatitis from biliary atresia. METHODS: Sixty-five infants with cholestatic jaundice and final diagnosis of idiopathic neonatal hepatitis and biliary atresia were studied prospectively from September 2003 to March 2006. A thorough history and physical examination were undertaken and the liver enzymes were examined. All cases underwent abdominal ultrasonography, hepatobiliary scintigraphy, and percutaneous liver biopsy. The accuracy, sensitivity, specificity and predictive values of these various methods were compared. RESULTS: There were 34 girls and 31 boys, among them 46 subjects had idiopathic neonatal hepatitis (age, 61 ± 17 d) and 19 had biliary atresia (age, 64 ± 18 d). The mean age at onset of jaundice was significantly lower in cases of biliary atresia when compared to idiopathic neonatal hepatitis cases (9 ± 13 d vs 20 ± 21 d; P = 0.032). The diagnostic accuracy of different methods was as follows: liver biopsy, 96.9%; clinical evaluation, 70.8%; ultrasonography, 69.2%; hepatobiliary scintigraphy, 58.5%; and liver enzymes, 50.8%.CONCLUSION: Our results indicate that clinical evaluation by an experienced pediatric hepatologist and a biopsy of the liver are considered as the most reliable methods to differentiate idiopathic neonatal hepatitis and biliary atresia.

关键词： Idiopathic neonatal hepatitis Biliary atresia Clinical evaluation Liver biopsy

Cyclic vomiting syndrome in children: Experience with 181 cases from southern Iran

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World Journal of Gastroenterology 2007年第12期13卷 1833-1836页

作者： Mahmood Haghighat Seyed Mohammad Rafie Seyed Mohsen Dehghani Gholam Hossein Fallahi Marzieh Nejabat department of Pediatric Gastroenterology/gastroenterohepatology Research Center of Nemazee Hospital Shiraz University of Medical Sciences Shiraz Iran department of Pediatric Neurology Shiraz University of Medical Sciences Shiraz Iran department of Pediatric Gastro-enterology/gastroenterohepatology Research Center of Nemazee Hospital Shiraz University of Medical Sciences Shiraz Iran department of Pediatric Gastro-enterology Tehran University of Medical Sciences Tehran Iran department of Pediatric Gastroenterology Shiraz University of Medical Sciences Shiraz Iran

AIM： To evaluate the clinical presentation, response to prophylactic therapy and outcome of children with cyclic vomiting syndrome （CVS） in Shiraz, Iran. METHODS： During a period of 11 years （March 1994 to March 2005）, 181 consecutive children with a final diagnosis of CVS were evaluated, treated and followed in our center. Patients were randomized to receive either amitriptyline or propranolol as prophylactic treatments. RESULTS： There were 88 boys and 93 girls with mean age of onset of symptoms of 4.9 ± 3.3 years （range, neonatal period to 14 years）, the mean age at final diagnosis was 6.9 years （range, 1.5 to 14）, and the mean duration between the onset of the first attack and the final diagnosis of CVS was 2 ± 1.81 years （range, 1/6 to 8）. The mean duration of each attack was 4.26 days （range, from few hours to 10 d） and the mean interval between the attacks was 1.8 mo （range, 1 wk to 12 too）. The time of onset of the attacks was midnight to early morning in about 70% of cases. Amitriptyline was effective in 46 out of 81 （56%） patients （P 〈 0.001）. Propranolol appeared to have a superior action and was effective in 74 out of 83 （92%） patients （P 〈 0.0001）. CONCLUSION： There is a significant lag time between the onset of clinical symptoms and the final diagnosis of CVS in our area. In patients with typical clinical presentations of CVS, who are examined by an experienced physician, invasive workup is not necessary. Propranolol appears more effective than arnitriptyline for prophylactic use in children with CVS.

关键词： Cyclic vomiting syndrome Children Propranolol Amitriptyline

Prognostic value of von-Willebrand factor in patients with liver cirrhosis and its relation to other prognostic indicators

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World Journal of Hepatology 2022年第4期14卷 812-826页

作者： Elena Curakova Ristovska Magdalena Genadieva-Dimitrova Intensive Care Unit University Clinic for GastroenterohepatologySkopje 1000North Macedonia Faculty of Medicine Ss.Cyril and Methodius University in SkopjeSkopje 1000North Macedonia Hepatology department University Clinic for GastroenterohepatologySkopje 1000North Macedonia

BACKGROUND Von-Willebrand factor(vWF)disposes certain prognostic value in patients with liver cirrhosis,but its relation to other prognostic indicators has not been fully *** To analyze the relation between vWF and other prognostic indicators in cirrhotic patients and to evaluate its prognostic value for *** This analytic prospective study was carried out in a tertiary center and initially enrolled 71 patients with liver cirrhosis and portal *** analyzed the relation between vWF and the stage of the disease and several inflammatory and prognostic *** prospective analysis,performed on a sample of 63 patients,evaluated the association between the selected variables[vWF,Model for End-stage Liver Disease(MELD)score,C-reactive protein(CRP),ferritin,vitamin D,activated partial thromboplastin time,thrombin time,D-dimer concentration]and the survival time as well as their predictive value in terms of 3-mo,6-mo and 1-year *** vWF was significantly higher in patients with higher Child-Turcotte-Pugh class(P=0.0045),MELD group(P=0.0057),ferritin group(P=0.0278),and D-dimer concentration(P=0.0232).vWF significantly correlated with D-dimer concentration,ferritin,CRP,International Normalized Ratio,and MELD,Child-Turcotte-Pugh,Sequential Organ Failure Assessment,and CLIF-consortium organ failure(CLIF-C OF)***,MELD score,and CRP were significantly associated with death and were significant predictors of 3-mo,6-mo,and 1-year *** vWF unit significantly increased the probability for 3-mo mortality by 1.005 times(P=0.008),for 6-mo mortality by 1.006 times(P=0.005),and for 1-year mortality by 1.007 times(P=0.002).There was no significant difference between the diagnostic performance of vWF and MELD score and also between vWF and CRP regarding the 3-mo,6-mo,and 1-year *** In patients with liver cirrhosis,vWF is significantly related to other prognostic indicators and is a significant predict

关键词： von-Willebrand factor Cirrhosis Mortality C-reactive protein D-dimer