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| 1 | Extensively drug-resistant bacteria are an independent predictive factor of mortality in 130 patients with spontaneous bacterial peritonitis or spontaneous bacteremia显示文摘AIM: To evaluate the epidemiology and outcomes of culture-positive spontaneous bacterial peritonitis(SBP) and spontaneous bacteremia(SB) in decompensated cirrhosis.METHODS: We prospectively collected clinical, laboratory characteristics, type of administered antibiotic, susceptibility and resistance of bacteria to antibiotics in one hundred thirty cases(68.5% males) with positive ascitic fluid and/or blood cultures during the period from January 1, 2012 to May 30, 2014. All patients with SBP had polymorphonuclear cell count in ascitic fluid > 250/mm3. In patients with SB a thorough study did not reveal any other cause of bacteremia. The patients were followed-up for a 30-d periodfollowing diagnosis of the infection. The final outcome of the patients was recorded in the end of follow-up and comparison among 3 groups of patients according to the pattern of drug resistance was performed.RESULTS: Gram-positive-cocci(GPC) were found in half of the cases. The most prevalent organisms in a descending order were Escherichia coli(33), Enterococcus spp(30), Streptococcus spp(25), Klebsiella pneumonia(16), S. aureus(8), Pseudomanas aeruginosa(5), other Gram-negative-bacteria(GNB)(11) and anaerobes(2). Overall, 20.8% of isolates were multidrug-resistant(MDR) and 10% extensively drugresistant(XDR). Health-care-associated(HCA) and/or nosocomial infections were present in 100% of MDR/XDR and in 65.5% of non-DR cases. Meropenem was the empirically prescribed antibiotic in HCA/nosocomial infections showing a drug-resistance rate of 30.7% while third generation cephalosporins of 43.8%. Meropenem was ineffective on both XDR bacteria and Enterococcus faecium(E. faecium). All but one XDR were susceptible to colistin while all GPC(including E. faecium) and the 86% of GNB to tigecycline. Overall 30-d mortality was 37.7%(69.2% for XDR and 34.2% for the rest of the patients)(log rank, P = 0.015). In multivariate analysis, factors adversely affecting outcome included XDR infection(HR = 2.263, 95%CI: 1.005-5.095, P = 0.049), creatinine(HR = 1.125, 95%CI: 1.024-1.236, P = 0.015) and INR(HR =1.553, 95%CI: 1.106-2.180, P = 0.011).CONCLUSION: XDR bacteria are an independent lifethreatening factor in SBP/SB. Strategies aiming at restricting antibiotic overuse and rapid identification of the responsible bacteria could help improve survival. | Alexandra Alexopoulou Larisa Vasilieva Danai Agiasotelli Kyriaki Siranidi Sophia Pouriki Athanasia Tsiriga Marina Toutouza Spyridon P Dourakis | 2016 | World Journal of Gastroenterology2016，22，15： | 19 |
| 2 | Simultaneous development of diabetic ketoacidosis and Hashitoxicosis in a patient treated with pegylated interferon-alpha for chronic hepatitis C显示文摘Classical interferon-alpha has been shown to be correlated with the development of a variety of autoimmune disorders. A 38 year-old female patient developed simultaneously diabetic ketoacidosis and hyperthyroidism 5 mo following initiation of treatment with pegylated interferon-α and ribavirin for chronic hepatitis C. High titers of glutamic acid decarboxylase, antinuclear and thyroid (thyroid peroxidase and thyroglobulin) antibodies were detected. Antiviral treatment was withdrawn and the patient was treated with insulin for insulin-dependent diabetes mellitus and propranolol for hyperthyroidism. Twelve months after cessation of pegylated interferon-α therapy the patient was euthyroid without any medication but remained insulin-dependent. | Aspasia S Soultati Spyridon P Dourakis Alexandra Alexopoulou Melanie Deutsch Athanasios J Archimandritis | 2007 | World Journal of Gastroenterology2007，13，8： | 15 |
| 3 | Cholangiocarcinoma:A 7-year experience at a single center in Greece显示文摘AIM: To evaluate survival rate and clinical outcome of cholangiocarcinoma.METHODS: The medical records of 34 patients with cholangiocarcinoma,seen at a single hospital between the years 1999-2006,were retrospectively reviewed.RESULTS: Thirty-four patients with a median age of 75 years were included.Seventeen (50%) had painless jaundice at presentation.Sixteen (47.1%) were perihilar,15 (44.1%) extrahepatic and three (8.8%) intrahepatic.Endoscopic retrograde cholangiography (ERCP) and/or magnetic resonance cholangiography (MRCP) were used for the diagnosis.Pathologic confirmation was obtained in seven and positive cytological examination in three.Thirteen patients had co-morbidities (38.2%).Four cases were managed with complete surgical resection.All the rest of the cases (30) were characterized as non-resectable due to advanced stage of the disease.Palliative biliary drainage was performed in 26/30 (86.6%).The mean follow-up was 32 mo (95% CI,20-43 mo).Overall median survival was 8.7 mo (95% CI,2-16 mo).The probability of 1-year,2-year and 3-year survival was 46%,20% and 7%,respectively.The survival was slightly longer in patients who underwent resection compared to those who did not,but this difference failed to reach statistical significance.Patients who underwent biliary drainage had an advantage in survival compared to those who did not (probability of survival 53% vs 0% at 1 year,respectively,P = 0.038).CONCLUSION: Patients with cholangiocarcinoma were usually elderly with co-morbidities and/or advanced disease at presentation.Even though a slight amelioration in survival with palliative biliary drainage was observed,patients had dismal outcome without resection of the tumor. | Alexandra Alexopoulou Aspasia Soultati Spyros P Dourakis Larissa Vasilieva Athanasios J Archimandritis | 2008 | World Journal of Gastroenterology2008，14，40： | 3 |
| 4 | Modern diagnostic approaches to cholangiocarcinoma显示文摘BACKGROUND:Cholangiocarcinoma is a very aggressive tumor with poor survival.Therefore,early diagnosis and surgical resection are of paramount importance.Its diagnosis is difficult because access to the tumor is not easy.Biopsy is possible only for intrahepatic cholangiocarcinoma,which accounts for 10% of cases.Routine brush cytology from endoscopic retrograde cholangiopancreatography(ERCP) has a high specificity of 100% but unfortunately a low sensitivity of 30%.In this review we briefly describe new diagnostic techniques applicable to ERCP brush cytology specimens and targeting the genetic background of the disease,in particular fluorescence in situ hybridization(FISH) and digital image analysis(DIA).DATE SOURCES:The PubMed database up to 2011 was used for the retrieval of relevant articles.The search terms FISH,fluorescence in situ hybridization,DIA,digital image analysis and cholangiocarcinoma were used.Both original and review articles were used.RESULTS:FISH identifies cells with chromosomal abnormalities,mainly numerical aberrations,using a mixture of fluorescencelabeled probes.FISH offers a higher sensitivity than routine cytology,retaining a high level of specificity.The DIA criterion for malignancy is demonstration of aneuploidy.This technique increases the sensitivity to 40%,but the specificity remains low.Preliminary data from application to other tumors suggest that combination of FISH and DIA may be of further benefit.CONCLUSIONS:The new techniques offer a significantly enhanced diagnostic efficacy in the evaluation of ERCP brush specimens.Apart from contributing to a more timely diagnosis,their wider application to cholangiocarcinoma may also facilitate the genetic study of the disease and add to our understanding of oncogenesis at the molecular level,with the prospect of identifying targets for novel therapeutic interventions. | Larisa E Vasilieva Stefanos I Papadhimitriou Spyros P Dourakis | 2012 | Hepatobiliary & Pancreatic Diseases International2012，11，4： | 2 |
| 5 | Translation and validation of the Greek chronic liver disease questionnaire显示文摘AIM:To translate into Greek and validate the chronic liver disease questionnaire (CLDQ).METHODS:Two hundred and six consecutive adult patients with the diagnosis of a chronic liver disease from 2 general hospitals in Athens were enrolled in the study from May to September 2008.In order to assess their quality of life (QOL) the CLDQ was applied.The instrument was translated from English,back translated and reviewed in focus groups within the framework of a large multicenter study.The measurements that were performed included:2 independent sample t tests,oneway analysis of variance,reliability coefficients,explanatory factor analysis using a varimax rotation and the principal components method.RESULTS:One hundred and twenty five (61%) patients were men,half were aged 40-59 years and > 33% were > 60 years old.Among the patients,48 (23%) were hospitalized and 97 (47%) were cirrhotic according to the Child-Pugh score.The internal consistency of the Greek CLDQ version using Cronbach's alpha coefficient was found to be 0.93.Exploratory factor analysis identified 7 domains accounting for 65% of the variance of CLDQ items and only partially overlapping with those found in the original version.The area under the receiver operating characteristics curve was calculated at 0.813 and the logistic estimate for the threshold score of 167.50 provided a sensitivity of 74.3% and a specificity of 71.6% for the model.CONCLUSION:Our data confirmed the validity of the Greek version of the CLDQ in identifying the QOL among patients with chronic liver disease. | Zoi Kollia Evridiki Patelarou Victoria Vivilaki Eleni Kollia Florentia Kefou Ioannis Elefsiniotis Spyros P Dourakis Hero Brokalaki | 2010 | World Journal of Gastroenterology2010，16，46： | 2 |
| 6 | Transarterial embolization of giant liver hemangiomas associated with Kasabach-Merritt syndrome:a case report显示文摘 | Malagari K Alexopoulou E Dourakis S | 2007 | Acta Radiol2007，48，6： | 1 |
| 7 | Hepatitis B virus reactivation in patients receivingchemotherapy for malignancies:role of precore stop-codon and basic core promoter mutations显示文摘 | Alexopoulou A Theodorou M Dourakis SP | 2006 | J Viral Hepat2006，13，9： | 1 |
| 8 | Pegylatied interferon-2b-associated autoimmue thrombocytopenia in a patient with chronic hepatitis C显示文摘 | Sevastianos VA Deutsch M Dourakis SP | 2003 | Am J Gastroenterol2003，98，3： | 1 |
| 9 | Glucagonoma syndrome: survival 21 years with concurrent liver- metastases 显示文摘 | Dourakis SP Alexopoulou A Georgousik K | 2007 | Am J Med Sci2007，334，3： | 1 |
| 10 | Thyroid abnormalities in chronic viral hepatitis and their relationship to interferon alfa therapy显示文摘 | Deutsch M Dourakis S Manesis EK | 1997 | Hepatology1997，26，1： | 1 |
| 11 | Hepatitis B virus reactivation in patients receiving chemotherapy for malignancies:role of precore stop-codon and basic core promoter mutations显示文摘 | Alexopoulou A Theodorou M Dourakis SP | | 0，，9： | 1 |
| 12 | Genetic heterogeneity of hepatitis viruses and its clinical significance显示文摘 | Alexopoulou A Dourakis SP | 2005 | Curr Drug Targets Inflamm Allergy2005，4，1： | 1 |
| 13 | Low T3 syndrome with asynchronous changes of TT3 and rT3 values in laparoscopic cholecystectomy 显示文摘 | Legakis IN Golematis BC Dourakis N | 1998 | Endocr Res1998，24，2： | 1 |
| 14 | Global stability of a higher order rational recursive sequence显示文摘 | Jaberi Douraki M Razzaghi M | 2006 | Appl Math Comput2006，，179： | 1 |
| 15 | Clinical Significance of Quantitative Anti - HBc IgM Assary in Acute and Chronic HBV infection 显示文摘 | HadziyannisSJ HadziyannisAS Dourakis S | 1993 | Hepato - Gastroenterol1993，40，： | 1 |
| 16 | Henoch-Schonlein purpura associated with Aloe vera administration 显示文摘 | Cholongitas E Katsoudas S Dourakis S | 2005 | European Journal of Internal Medicine2005，16，1： | 1 |
| 17 | Low T3 syndrome with-asynchronous changes of TT3 and rT3 values in laparoscopic cholecyst-ectomy显示文摘 | Legakis IN Golematis BC Dourakis N | 1998 | Endocr Res1998，24，2： | 1 |
| 18 | Intestinal pseudoobstruction and ureterohydronephrosis as the presenting manifestations of relapas in a lupus patient显示文摘 | Alexopoulou h Andrianakos A Dourakis SP | 2004 | Lupus2004，13，12： | 1 |
| 19 | Glucago- noma syndrome : survival 21 years with concurrent liver metastases 显示文摘 | Dourakis SP Alexopoulou A Georgousi KK | 2007 | Am J Med Sci2007，334，3： | 1 |
| 20 | Hepatitis B virus reactivation in patients receiving chemotherapy for malignancies : role of precore stopcodon and basic core promoter mutations 显示文摘 | Alexopoulou A Theodorou M Dourakis SP | 2006 | J Viral Hepat2006，13，9： | 1 |
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