Virological suppression does not prevent the development of hepatocellular carcinoma in HBeAg-negative chronic hepatitis B patients with cirrhosis receiving oral antiviral(s) starting with lamivudine monotherapy: Results of the nationwide HEPNET. Greece cohort study
Papatheodoridis G.V.,National and Kapodistrian University of Athens |
Manolakopoulos S.,National and Kapodistrian University of Athens |
Touloumi G.,National and Kapodistrian University of Athens |
Vourli G.,National and Kapodistrian University of Athens |
And 7 more authors.
Gut | Year: 2011
Objective: To evaluate the risk and predictors of hepatocellular carcinoma (HCC) in HBeAg-negative chronic hepatitis B patients of the large HEPNET.Greece cohort study who received long-term oral antivirals starting with lamivudine monotherapy. Design: Retrospective analysis of HCC incidence in HBeAg-negative chronic hepatitis B patients from a retrospective-prospective cohort who were treated with nucleos(t)ide analogue(s) starting with lamivudine monotherapy for ≥12 months. Setting: A nationwide network of liver centres. Patients: 818 patients were included: 517 with chronic hepatitis B only; 160 with compensated cirrhosis; 56 with decompensated cirrhosis; 85 with unclassified disease severity. Interventions: All patients were treated with nucleos(t)ide analogue(s) starting with lamivudine monotherapy. Main outcome measures: Development of HCC. Results: During a median follow-up of 4.7 years, HCC developed in 49 (6.0%) patients. The 5-year cumulative incidence of HCC was higher in patients with cirrhosis than in those with chronic hepatitis B only (11.5% vs 3.2%, respectively; p<0.001). HCC developed in 0.7%, 6.7% and 11.7% of patients <50, 50-60 and >60 years old, respectively (p<0.001). Virological on-therapy remission did not significantly affect the incidence of HCC in all patients or those with cirrhosis, but it showed a trend for lower HCC incidence in patients with chronic hepatitis B only (p=0.076). In multivariate analysis, age, gender and cirrhosis were independently associated with HCC risk regardless of virological remission. Conclusions: Long-term therapy with nucleos(t)ide analogue(s) starting with lamivudine monotherapy does not eliminate HCC risk in HBeAg-negative chronic hepatitis B. The risk of HCC is particularly high in patients with cirrhosis, who should remain under HCC surveillance even during effective therapy. Older age and male gender remain independent risk factors for HCC, while virological on-therapy remission does not seem to significantly reduce the overall incidence of HCC.
Ekmektzoglou K.,National and Kapodistrian University of Athens |
Samelis G.,Hippokration General Hospital of Athens |
Karagiannis S.,Kifissia General and Oncology Hospital |
Zografos G.,National and Kapodistrian University of Athens |
Xanthos T.,National and Kapodistrian University of Athens
Acta Gastro-Enterologica Belgica | Year: 2012
Ulcerative colitis (UC), a chronic and relapsing idiopathic inflammatory disease of the colon, although not associated with an increased mortality compared to the general population, has a substantial morbidity leading to sizable health care costs, as it carries an increased risk for development of colorectal cancer (CRC). The pathophysiology behind this carcinogenic pathway is multifactorial. This review summarizes the major pathogenetic steps from which the inflamed colonic epithelium is transformed to a dysplastic and/or cancerous one. The role of the inflammatory and immune system, the oxidative stress generated as well as the genomic stability observed in UC-associated CRC is presented so as to provide a more spherical view of the tumorigenic process and, if possible, offer new diagnostic approaches for the early detection of CRC.
Samelis G.F.,Hippokration General Hospital of Athens |
Ekmektzoglou K.A.,Hippokration General Hospital of Athens |
Tsiakou A.,Hippokration General Hospital of Athens |
Konstadoulakis M.,National and Kapodistrian University of Athens
Hepato-Gastroenterology | Year: 2011
Background/Aims: There is little information in the literature on the use of bevacizumab (BV) combination chemotherapy in multiple lines with regimens including irinotecan and oxaliplatin, in metastatic colorectal cancer (mCRC) patients with disease progression. The aim of this small retrospective institutional study is to compare the efficacy and safety of the continuation of BV in combination with various chemotherapeutic agents, within the framework of multiple line therapy in progressed mCRC patients. Methodology: Our retrospective study included 21 patients with mCRC that had received at least one course of irinotecan-based or oxaliplatin-based chemotherapy with BV before disease progression. BV treatment was continuously dispensed after disease progression. Sub-group analysis was performed in terms of age, site of metastases, spread and co-morbidity. Results: The median overall survival (OS) was 23+ months (range 4-51 months) with no statistically significant differences between the aforementioned subgroups of patients, except from the subgroup according to spread (p=0.044). Time to progression was 17 months. Anemia (all grades) was reported in 33.3% of the patients, while hemorrhage and thrombosis were reported in 28.6% and 14.3%, respectively. Conclusions: Multiple line treatment in advanced colorectal cancer, including BV combined with standard chemotherapy, may improve OS with an acceptable toxicity profile in patients with mCRC after disease progression. © H.G.E. Update Medical Publishing S.A.
Lobo M.D.,Queen Mary, University of London |
Sobotka P.A.,ROX Medical |
Sobotka P.A.,Ohio State University |
Stanton A.,Royal College of Surgeons in Ireland |
And 17 more authors.
The Lancet | Year: 2015
Background: Hypertension contributes to cardiovascular morbidity and mortality. We assessed the safety and efficacy of a central iliac arteriovenous anastomosis to alter the mechanical arterial properties and reduce blood pressure in patients with uncontrolled hypertension. Methods: We enrolled patients in this open-label, multicentre, prospective, randomised, controlled trial between October, 2012, and April, 2014. Eligible patients had baseline office systolic blood pressure of 140 mm Hg or higher and average daytime ambulatory blood pressure of 135 mm Hg or higher systolic and 85 mm Hg or higher diastolic despite antihypertensive treatment. Patients were randomly allocated in a 1:1 ratio to undergo implantation of an arteriovenous coupler device plus current pharmaceutical treatment or to maintain current treatment alone (control). The primary endpoint was mean change from baseline in office and 24 h ambulatory systolic blood pressure at 6 months. Analysis was by modified intention to treat (all patients remaining in follow-up at 6 months). This trial is registered with ClinicalTrials.gov, number NCT01642498. Findings: 83 (43%) of 195 patients screened were assigned arteriovenous coupler therapy (n=44) or normal care (n=39). Mean office systolic blood pressure reduced by 26.9 (SD 23.9) mm Hg in the arteriovenous coupler group (p<0.0001) and by 3.7 (21.2) mm Hg in the control group (p=0.31). Mean systolic 24 h ambulatory blood pressure reduced by 13.5 (18.8) mm Hg (p<0.0001) in arteriovenous coupler recipients and by 0.5 (15.8) mm Hg (p=0.86) in controls. Implantation of the arteriovenous coupler was associated with late ipsilateral venous stenosis in 12 (29%) of 42 patients and was treatable with venoplasty or stenting. Interpretation: Arteriovenous anastomosis was associated with significantly reduced blood pressure and hypertensive complications. This approach might be a useful adjunctive therapy for patients with uncontrolled hypertension.
PubMed | Connolly Hospital, East Sussex Healthcare NHS Trust, Wales Heart Research Institute, ROX Medical and 14 more.
Type: Journal Article | Journal: Journal of the American Heart Association | Year: 2016
Options for interventional therapy to lower blood pressure (BP) in patients with treatment-resistant hypertension include renal denervation and the creation of an arteriovenous anastomosis using the ROX coupler. It has been shown that BP response after renal denervation is greater in patients with combined hypertension (CH) than in patients with isolated systolic hypertension (ISH). We analyzed the effect of ROX coupler implantation in patients with CH as compared with ISH.The randomized, controlled, prospective ROX Control Hypertension Study included patients with true treatment-resistant hypertension (office systolic BP 140mmHg, average daytime ambulatory BP 135/85mmHg, and treatment with 3 antihypertensive drugs including a diuretic). In a post hoc analysis, we stratified patients with CH (n=31) and ISH (n=11). Baseline office systolic BP (17718mmHg versus 16917mmHg, P=0.163) and 24-hour ambulatory systolic BP (15916mmHg versus 15411mmHg, P=0.463) did not differ between patients with CH and those with ISH. ROX coupler implementation resulted in a significant reduction in office systolic BP (CH: -2921mmHg versus ISH: -2231mmHg, P=0.445) and 24-hour ambulatory systolic BP (CH: -1420mmHg versus ISH: -1315mmHg, P=0.672), without significant differences between the two groups. The responder rate (office systolic BP reduction 10mmHg) after 6months was not different (CH: 81% versus ISH: 82%, P=0.932).Our data suggest that creation of an arteriovenous anastomosis using the ROX coupler system leads to a similar reduction of office and 24-hour ambulatory systolic BP in patients with combined and isolated systolic hypertension.URL: http://www.clinicaltrials.gov. Unique identifier: NCT01642498.
Perrillo R.,Baylor University |
Hou J.,Nanfang Hospital |
Papatheodoridis G.,Hippokration General Hospital of Athens |
Manns M.,Hannover Medical School
Antiviral Therapy | Year: 2010
International treatment guidelines for hepatitis B emphasize alanine aminotransferase (ALT) and serum HBV DNA thresholds, but strict adherence to these markers might lead to missed opportunities in some patients with acquisition in early life. Clinical trials have used improvement in liver histology, rate of hepatitis B e antigen seroconversion and sustained HBV DNA suppression as primary end points. These are potentially short-term end points because HBV infection can not be eradicated and delayed relapses might occur. The closest end point to a clinical cure of disease is the loss of hepatitis B surface antigen (HBsAg). The ability of interferon to stimulate the immune response of the host might explain the higher rate of early HBsAg clearance when compared with nucleoside analogues. Early studies suggest that combination therapy with interferon and long-term treatment with nucleoside analogues might lead to an even higher rate of HBsAg seroconversion. Measuring HBsAg concentration during therapy might provide an early indication that a durable virological response, including HBsAg clearance, is likely to occur. Thus far, this has been best studied using interferon. The relationship of this phenomenon to viral genotype will be discussed. There is a need for more flexible on-treatment criteria for hepatitis B. HBsAg clearance remains the best therapeutic end point, but is not readily achievable with current treatments. Future treatment paradigms should take into account the duration as well as the extent of viraemia, place less reliance on the ALT level to indicate the extent of liver injury and consider the possibility that maintenance therapy can prevent liver disease complications. ©2010 International Medical Press.
Doulami G.,Hippokration General Hospital of Athens |
Triantafyllou S.,Hippokration General Hospital of Athens |
Natoudi M.,Hippokration General Hospital of Athens |
Albanopoulos K.,Hippokration General Hospital of Athens |
And 3 more authors.
Obesity Surgery | Year: 2015
Introduction: There is a strong association between obesity and gastroesophageal reflux disease (GERD). GERD-related questionnaires have been developed in order to objectify symptoms. However, none of them has been tested in obese population. Purpose: The purpose of this study is to evaluate if GERD score and GERD-Health-Related Quality of Life (HRQL) can reflect severity of the disease and screen obese patients for GERD preoperatively. GERD’s impact on the quality of life of obese patients is being assessed with the use of EORTC-QLQ C30. Patients-Methods: Obese patients during their preoperative evaluation were recruited regardless of the presence of GERD symptoms. A targeted GERD symptom history was obtained. Patients completed GERD score, GERD-HRQL, and EORTC-QLQ C30, and then, a 24-h multichannel intraluminal impedance pHmetry (MIIpH) was conducted. Results: Forty-seven consecutive obese patients with mean age 39.91 years and mean BMI 46.94 kg/m2 were included in the study. GERD score and GERD-HRQL have a positive linear correlation with DeMeester score (p = 0.001 and p < 0.001, respectively). EORTC QLQ-C30 does not correlate with DeMeester score. Conclusions: GERD-related questionnaires could be used in obese population as preoperative screening tool for GERD. However, our results indicate that the quality of life of obese patients is not affected by the existence of GERD. © 2015, Springer Science+Business Media New York.
Liatsos G.D.,Hippokration General Hospital of Athens |
Moulakakis A.,Hippokration General Hospital of Athens |
Ketikoglou I.,Hippokration General Hospital of Athens |
Klonari S.,Hippokration General Hospital of Athens
American Journal of Health-System Pharmacy | Year: 2010
Purpose. A case of a patient who developed thrombotic thrombocytopenic purpura (TTP) after consuming a weight-loss product containing green tea is reported. Summary. A 38-year-old, 68-kg Caucasian woman arrived at the emergency department with a one-week history of malaise, fatigue, and petechiae of the skin. She had no symptoms of infection and denied illegal drug use. Her medical history included hypothyroidism, for which she was treated with levothyroxine 150 μg daily for the past four years. She reported that she had been using a green tea preparation for the two months before admission to lose body weight. The daily preparation contained 200 mg of green tea extract 5:1, equivalent to 1 g of natural green tea. On clinical examination, the patient appeared acutely ill and was afebrile, with pallor, petechiae, and purpura of the extremities. Laboratory test results at the time of admission revealed that the patient had anemia and marked thrombocytopenia. A peripheral blood smear demonstrated a feature of microangiopathic hemolytic anemia. Immunoglobulin G autoantibodies against ADAM metallopeptidase with thrombospondin type 1 motif, 13 were detected. On hospital day 3, the patient appeared confused and exhibited aphasia that was initially transient but then recurrent. Brain computerized tomography did not exhibit focal pathology. Over the next few days, her neurologic symptoms subsided and her platelet count and hematocrit value gradually increased. Plasmapheresis was performed (12 procedures). Corticosteroid treatment was also initiated. After 20 days of hospitalization, the patient was discharged. Conclusion. A 38-year-old woman developed TTP after consuming a weight-loss product containing green tea extract for two months. Copyright © 2010, American Society of Health-System Pharmacists, Inc. All rights reserved.
Stathopoulos P.,Kat General Hospital Of Athens |
Theodossiades G.,Hippokration General Hospital of Athens |
Mourouzis C.,Kat General Hospital Of Athens |
Evangelou A.,University of Ioannina
British Journal of Oral and Maxillofacial Surgery | Year: 2011
The use of titanium implants and osteosynthesis materials in orthopaedics, neurosurgery, and maxillofacial surgery has increased considerably, and they may be retained in patients for a long time. We could find no papers in English that provided data about the effect of titanium osteosynthesis materials on platelet function, and the purpose of this study was to evaluate those effects. Platelet function was tested in 33 patients with titanium maxillofacial implants using the PFA-100 (platelet function analyser) system and these results were compared with those of a control group of 34 healthy volunteer blood donors. Platelet function was measured in each group using collagen/adrenaline and collagen/adenosine diphosphate (ADP) as agonists for assessment of platelet function. There were no significant differences between the groups (collagen/adrenaline p = 0.1, collagen/ADP p = 0.09). Titanium maxillofacial osteosynthesis materials have no significant effect on platelet function as assessed by the PFA-100 system. © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
PubMed | Hippokration General Hospital of Athens
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016
13561 Background: Bevacizumab (BV), a monoclonal antibody directed against vascular endothelial growth factor, provides a survival advantage (15.6 to 20.3 months) when added to first-line chemotherapy for metastatic colorectal cancer (metastatic CRC). Only a few trials have been conducted using BV as 2Sixteen patients with metastatic CRC refractory to first-line chemotherapy (oxaliplatin or irinotecan-based regimen) were enrolled. All patients, after progressing in first-line treatment, received the following regimen: BV: 5 mg/Kg* in 1000ml water for injection in 90min IV infusion plus irinotecan 125mg/mSix patients had partial responses (PRs) (37.5%), 4 patients had stable disease (SD) (25%) and the rest of the patients progressed (37.5%). The time to progression (TTP) was 6.4 months (range: 4-8), and the median survival was 9 (range: 5-12) months. The toxicity was mild and no toxic death was reported. Grade II toxicities were the following: epistaxis 4 patients (25%), anaemia 5 patients (31%), leukopenia 3 patients (18.7%), granulocytopenia 2 patients (12.5%) and 1 patient developed jaundice due to bile-duct obstruction.The bi-weekly administration of BV, irinotecan, leucovorin and 5-fluororacil is acceptable as 2