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Concise review: Interferon-free treatment of hepatitis C virus-associated cirrhosis and liver graft infection

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World Journal of Gastroenterology 2016年第41期22卷 9044-9056页

作者： Nina Weiler Stefan Zeuzem Martin-Walter Welker Univer-sitatsklinikum Frankfurt medizinische klinik 1 60590 Frankfurt Germany

Chronic hepatitis C is a major reason for development of cirrhosis and hepatocellular carcinoma and a leading cause for liver transplantation. The development of direct-acting antiviral agents lead to(pegylated) interferon-alfa free antiviral therapy regimens with a remarkable increase in sustained virologic response(SVR) rates and opened therapeutic options for patients with advanced cirrhosis and liver graft recipients. This concise review gives an overview about most current prospective trials and cohort analyses for treatment of patients with liver cirrhosis and liver graft recipients. In patients with compensated cirrhosis Child-Pugh-Turcotte(CTP) class A, all approved agents are safe and SVR rates do not significantly differ from patients without cirrhosis in general. In patients with decompensated cirrhosis CTP class B or C, daclastasvir, ledipasvir, velpatasvir, and sofosbuvir are approved, and SVR rates higher than 90% can be achieved. Especially for patients with a model of end stage liver disease score higher than 15 and therefore eligible for liver transplantation, data is scarce. Reported SVR rates in patients with cirrhosis CTP class C are lower compared to patients with a less severe liver disease. In liver transplant recipients with a maximum of CTP class A, SVR rates are comparable to patients without LT. Patients with decompensated graft cirrhosis should be treated on an individual basis.

关键词： hepatitis C Cirrhosis Liver transplantation direct antiviral agents Interferon-free antiviral treatment

Open label trial of granulocyte apheresis suggests therapeutic efficacy in chronically active steroid refractory ulcerative colitis

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World Journal of Gastroenterology 2005年第44期11卷 7001-7006页

作者： Wolfgang Kruis Axel Dignass Elisabeth Steinhagen-Thiessen Julia Morgenstern Joachim M(o|¨)ssner Stephan Schreiber Maurizio Vecchi Alberto Malesci Max Reinshagen Robert L(o|¨)fberg Evangelisches Krankenhaus Kalk medizinische klinik für Hepatologie und Gastroenterologie medizinische klinik und Poliklinik Ⅱ medizinische klinik Dep of Int Medicine IRCCS Ospedale Policlinico Istituto Clinico Humanitas Innere Medizin Karolinska Institute at the IBD unit

AIM： To study the efficacy, safety, and feasibility of a granulocyte adsorptive type apheresis system for the treatment of patients with chronically active ulcerative colitis despite standard therapy. METHODS： An open label multicenter study was carried out in 39 patients with active ulcerative colitis （CAI 6-8） despite continuous use of steroids （a minimum total dose of 400 mg prednisone within the last 4 wk）. Patients received a total of five aphereses using a granulocyte adsorptive technique （Adacolumn, Otsuka Pharmaceutical Europe, UK）. Assessments at wk 6 and during follow-up until 4 mo comprised clinical （CAI） and endoscopic （EI） activity index, histology, quality of life （IBDQ）, and laboratory tests. RESULTS： Thirty-five out of thirty-nine patients were qualified for intent-to-treat analysis. After the apheresis treatment at wk 6, 13/35 （37.1%） patients achieved clinical remission and 10/35 （28.6%） patients had endoscopic remission （CAI〈4, EI〈4）. Quality of life （IBDQ） increased significantly （24 points, P〈0.01） at wk 6. Apheresis could be performed in all but one patient. Aphereses were well tolerated, only one patient experienced anemia. CONCLUSION： In patients with steroid refractory ulcerative colitis, five aphereses with a granulocyte/ monocyte depleting filter show potential short-term efficacy. Tolerability and technical feasibility of the procedure are excellent.

关键词： Steroid Refractory colitis Ulcerative colitis Granulocyte Apheresis

Role of genetic disorders in acute recurrent pancreatitis

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World Journal of Gastroenterology 2008年第7期14卷 1011-1015页

作者： Volker Keim medizinische klinik Ⅱ Universittsklinikum LeipzigDeutschlandGermany

There was remarkable progress in the understanding of the role genetic risk factors in chronic pancreatitis. These factors seem to be much more important than thought in the past. The rare autosomal-dominant mutations N29I and R122H of PRSS1 (cationic trypsinogen) as well as the variant N34S of SPINK1 (pancreatic secretory trypsin inhibitor) are associated to a disease onset in childhood or youth. Compared to chronic alcoholic pancreatitis the progression is slow so that for a long time only signs of acute-recurrent pancreatitis are found. Only at later time points (more than 10-15 years) there is evidence for chronic pancreatitis in the majority of patients. Acute recurrent pancreatitis may therefore be regarded as a transition state until definite signs of chronic pancreatitis are detectable.

关键词： Genetic disorders Acute recurrent pancreatitis

EFFECTS OF LEUKOTRIENE D4 AND ITS SPECIFIC ANTAGONIST L-660, 711 ON ISOLATED RAT HEART WITH CHRONIC MYOCAROIAL INFARCTION

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Chinese Medical Journal 1995年第3期 72-73页

作者： H Han S Neubauer P Gaudron K Hu G Ertl medizinische Universitats klinik. Wurzburg Medizinische Universitats Klinik. WurzburgMedizinische Universitats Klinik. WurzburgMedizinische Universitats Klinik. WurzburgMedizinische Universitats Klinik. Wurzburg

Coronary reserve is reduced in residual myocardium after myocardial infarction and endogenous vasoconstrictors

关键词： LTD ON ISOLATED RAT HEART WITH CHRONIC MYOCAROIAL INFARCTION EFFECTS OF LEUKOTRIENE D4 AND ITS SPECIFIC ANTAGONIST L-660

Die　selektive　Sklerosierung　der　Vena　coronaria　ventriculi　─eine　neuartige　Therapie　der　Osophagusvarizenblutung

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Journal of Huazhong University of Science and Technology(Medical Sciences) 1996年第1期16卷 36-40页

作者：叶启发戴植本裘法祖刘效恭 Abteilung für Chirurgie Tongji Klinik Tongji Medizinische Universität Wuhan Chirurgische klinik Medizinische Universität Xian China

Patienten beiderlei Geschlechts mit portaler Hypertension bei Leberzirrhose wurden nach erfolgloser endoskopischer Behandlung einer akuten sophagusvarizenblutung operiert. 134 Flle waren als posthepatitische, 62 als schistosomatische und 25 als bilire Leberzirrhosen diagnostiziert. Das wichtigste bei unserem Operationsverfahren ist: Darstellung der V. coronaria ventriculi in der Mitte der kleinen Kurvatur und Kanlierung der beiden Venensegmente. Nach Setzen von Klemmen 5 cm pr- und 5 cm postkardial und in der Korpusmitte Sklerosierung des kranialen V. coronaria-Segmentes mit α-Octyl-Cyanoacrylat und Venenligatur; Messung des portalvensen Druckes im kaudalen Segment. Die selektive Sklerosierung der V. coronaria ventriculi (SSVCV) wurde bei 18 Fllen als prophylaktischer, bei 106 Fllen als notfallmβiger und bei 98 Fllen als elektiver Eingriff durchgefhrt, und bei allen Patienten konnte die Varizenblutung gestillt werden. 219 Patienten berlebten , 3 Patienten verstarben an Leberversagen 24 Stunden postoperativ. Bei 189 operierten Patienten der Gruppe zeigte sich bei der Durchleuchtung, Rntgenkontrastfllung und Endoskopie, daβ die sophagusvarizen 3-6 Monate nach der SSVCV eine offensichtliche Verbesserung aufwiesen. Die postoperative Untersuchung nach 1 bis 2 Jahren zeigte, daβ die sophagusvarizen nicht mehr ezistierten. Bei 182 operierten Patienten hat sich beim Follow-up im Zeitraum von 6 1/2 Jahren bis 7 1/2 Jahren ergeben, daβ nach der Operation keine Blutung mehr aufgetreten ist.

关键词： sophagusvarizenblutung selektive Sklerosierung Vena coronaria ventriculi α-Octyl-Cyano-acrylat

Positive predictors for gastroesophageal reflux disease and the therapeutic response to proton-pump inhibitors

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World Journal of Gastroenterology 2014年第14期20卷 4017-4024页

作者： Valentin Becker Stefan Grotz Christoph Schlag Simon Nennstiel Analena Beitz Bernhard Haller Roland M Schmid Alexander Meining Monther Bajbouj Ⅱ. medizinische klinik und Poliklinik Technische Universit?t München Institut für medizinische Statistik und Epidemiologie Technische Universit?t München

AIM: To identify objective and subjective predictors for the reliable diagnosis of gastroesophageal reflux disease (GERD) and the response to proton pump inhibitor (PPI) therapy.

关键词： Gastroesophageal reflux Gastroesophageal reflux disease Non-erosive reflux disease Impedance pH measurement Follow-up Therapy Proton pump inhibitor

Intraductal endoscopic radiofrequency ablation for the treatment of hilar non-resectable malignant bile duct obstruction

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World Journal of Gastrointestinal Endoscopy 2014年第1期6卷 13-19页

作者： Andrea Oliver Tal Johannes Vermehren Mireen FriedrichRust Jrg Bojunga Christoph Sarrazin Stefan Zeuzem Jrg Trojan Jrg Gerhard Albert medizinische klinik 1 Universittsklinikum Frankfurt

AIM: To evaluate the safety and technical success of endoscopic radiofrequency ablation(RFA) for palliative treatment of malignant hilar bile duct obstruction. METHODS: In this study, a recently CE and FDA-approved endoscopic RFA catheter was first tested in an ex vivo pig liver model to study the effect of electrosurgical variables on the extent of the area of induced necrosis. Subsequently, a retrospective analysis was conducted of all patients treated with endoscopic RFA for malignant biliary obstruction at our center between February 2012 and April 2013. All patients received an additional plastic stent implantation into the biliary tree following RFA. RESULTS: In the pig model, ablation time of 60-90 seconds using the bipolar soft coagulation mode at 8-10 watts with an effect of 8 was found to be the most feasible setting. Twelve patients(5 females, 7 males; mean age, 70 years) underwent 19 endoscopic RFA(range, 1-5) sessions. Deployment of RFA was successful in all patients. Systemic chemotherapy was administered in four patients. We observed biliary bleeding 4-6 wk after the intervention in three cases and two of these patients died: in one patient, spontaneous hemobilia occurred, whereas bleeding started during stent extraction in the other. In the third patient, bleeding was stopped by insertion of a non-covered self-expanding metal stent. Another three patients developed cholangitis during follow-up. Seven patients died during follow-up and median survival was 6.4 mo(95%CI: 0.05-12.7) from the time of the first RFA. CONCLUSION: Endoscopic RFA is an easy to perform and technically highly successful procedure. However, hemobilia possibly associated with RFA occurred in three of our patients. Therefore, larger prospective studies are needed to further evaluate the safety and efficacy of this promising new method.

关键词： Radiofrequency ablation Endoscopic retrograde cholangiopancreatography Endoscopy Cholangiography Bile duct cancer Cholangiocarcinoma

Endoscopic stent therapy in patients with chronic pancreatitis:A 5-year follow-up study

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World Journal of Gastroenterology 2013年第5期19卷 715-720页

作者： Andreas Weber Jochen Schneider Bruno Neu Alexander Meining Peter Born Stefan von Delius Monther Bajbouj Roland M Schmid Hana Algül Christian Prinz II medizinische klinik und Poliklinik Klinikum Rechts der IsarTechnische Universitt München81675 MünchenGermany II medizinische klinik Gastroenterologie und HepatologieHelios Klinikum WuppertalUniversitt Witten/Herdecke42283 WuppertalGermany

AIM:This study analyzed clinical long-term outcomes after endoscopic therapy,including the incidence and treatment of relapse. METHODS:This study included 19 consecutive patients(12 male,7 female,median age 54 years)with obstructive chronic pancreatitis who were admitted to the 2nd Medical Department of the Technical University of *** patients presented severe chronic pancreatitis(stageⅢ°)according to the Cambridge *** majority of the patients suffered intermittent pain attacks.6 of 19 patients had strictures of the pancreatic duct;13 of 19 patients had strictures and *** first endoscopic retrograde pancreatography(ERP)included an endoscopic sphincterotomy, dilatation of the pancreatic duct,and stent *** first control ERP was performed 4 wk after the initial intervention,and the subsequent control ERP was performed after 3 mo to re-evaluate the clinical and morphological *** follow-up was performed annually to document the course of pain and the management of *** course of pain was assessed by a pain scale from 0 to *** date and choice of the therapeutic procedure were documented in case of relapse. RESULTS:Initial endoscopic intervention was successfully completed in 17 of 19 *** 17 patients reported partial or complete pain relief after endoscopic *** therapy failed in 2 patients. Both patients were excluded from further *** failed patient underwent surgery,and the other patient was treated conservatively with pain *** of 19 patients were followed after the successful completion of endoscopic stent *** of 17 patients were lost to *** patient was not avail-able for interviews after the 1st year of *** patients died during the 3rd year of *** both patients chronic pancreatitis was excluded as the cause of *** patient died of myocardial infarction, and one patient succumbed to *** three patient

关键词： Chronic pancreatitis Pain Stent therapy Endoscopic retrograde cholangiopancreatography Pancreaticolithiasis

Self-expanding metal stents for the palliation of malignant gastric outlet obstruction in patients with peritoneal carcinomatosis

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World Journal of Gastroenterology 2016年第43期22卷 9554-9561页

作者： Christoph Rademacher Matthias Bechtler Steffen Schneider Bettina Hartmann Johannes Striegel Ralf Jakobs medizinische klinik C Klinikum der Stadt Ludwigshafen Department of Statistics/Stiftung IHF Institut für Herzinfarktforschung

AIM To evaluate the efficacy of self-expanding metal stents(SEMS) for the palliation of malignant gastric outlet obstruction in patients with and without peritoneal carcinomatosis(PC).METHODS We performed a retrospective analysis of 62 patients who underwent SEMS placement for treatment of malignant gastroduodenal obstruction at our hospital over a six-year period. Stents were deployed through the scope under combined fluoroscopic and endoscopic guidance. Technical success was defined as successful stent placement and expansion. Clinical success was defined as an improvement in the obstructive symptoms and discharge from hospital without additional parenteral nutrition. According to carcinomatosis status, patients were assigned into groups with or without evidence of peritoneal *** In most cases, obstruction was caused by pancreatic(47%) or gastric cancer(23%). Technical success was achieved in 96.8%(60/62), clinical success in 79%(49/62) of all patients. Signs of carcinomatosis were identified in 27 patients(43.5%). The diagnosis was confirmed by pathology or previous operation in 7 patients(11.2%) and suspected by CT, MRI or ultrasound in 20 patients(32.2%). Presence of carcinomatosis was associated with a significantly lower clinical success rate compared to patients with no evidence of peritoneal disease(66.7% vs 88.6%, P = 0.036). There was no significant difference in overall survival between patients with or without PC(median 48 d vs 70 d, P = 0.21), but patients showed significantly longer survival after clinical success of SEMS placement compared to those experiencing clinical failure(median 14.5 d vs 75 d, P = 0.0003).CONCLUSION Given the limited therapeutic options and a clinical success rate of at least 66.7%, we believe that SEMS are a reasonable treatment option in patients with malignant gastric outlet obstruction with peritoneal carcinomatosis.

关键词： Gastric outlet obstruction Self-expanding metal stents Peritoneal carcinomatosis Palliation Endoscopy