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| 1 | Autoimmune hepatitis,one disease with many faces:Etiopathogenetic,clinico-laboratory and histological characteristics显示文摘Autoimmune hepatitis(AIH) is an unresolving progressive liver disease of unknown etiology characterized byhypergammaglobulinemia,autoantibodies detection and interface hepatitis.Due to the absence of specific diagnostic markers and the large heterogeneity of its clinical,laboratory and histological features,AIH diagnosis may be potentially difficult.Therefore,in this in-depth review we summarize the substantial progress on etiopathogenesis,clinical,serological and histological phenotypes of AIH.AIH has a global distribution affecting any age,both sexes and all ethnic groups.Clinical manifestations vary from asymptomatic to severe or rarely fulminant hepatitis.Hypergammaglobulinemia with selective elevation of IgG is found in most cases.Autoimmune attack is perpetuated,possibly via molecular mimicry,and favored by the impaired control of T-regulatory cells.Histology(interface hepatitis,emperipolesis and hepatic rosette formation) and autoantibodies detection although not pathognomonic,are still the hallmark for a timely diagnosis.AIH remains a major diagnostic challenge.AIH should be considered in every case in the absence of viral,metabolic,genetic and toxic etiology of chronic or acute hepatitis.Laboratory personnel,hepato-pathologists and clinicians need to become more familiar with disease expressions and the interpretation of liver histology and autoimmune serology to derive maximum benefit for the patient. | Nikolaos K Gatselis Kalliopi Zachou George K Koukoulis George N Dalekos | 2015 | World Journal of Gastroenterology2015，21，1： | 36 |
| 2 | Sentinel node navigation surgery in gastric cancer: Current status显示文摘The theory behind using sentinel node mapping and biopsy in gastric cancer surgery, the so-called sentinel node navigation surgery, is to limit the extent of surgi-cal tissue dissection around the affected organ and subsequently the accompanied morbidity. However, ob-stacles on the clinical correspondence of sentinel node navigation surgery in everyday practice have occasion-ally alleviated researchers' interest on the topic. Only recently with the widespread use of minimally invasive surgical techniques, i.e., laparoscopic gastric cancer resections, surgical community's interest on the topic have been unavoidably reflated. Double tracer methods appear superior compared to single tracer techniques. Ongoing research is now focused on the invention of new lymph node detection methods utilizing sophisti-cated technology such as infrared ray endoscopy, flo-rescence imaging and near-infrared technology. Despite its notable limitations, hematoxylin/eosin is still the mainstay staining for assessing the metastatic status of an identified lymph node. An intra-operatively verified metastatic sentinel lymph node will dictate the need for further conventional lymph node dissection. Thus, laparoscopic resection of the gastric primary tumor combined with the appropriate lymph node dissection as determined by the process of sentinel lymph node status characterization represents an option for early gastric cancer. Patients with T3 or more advanced dis-ease should still be managed conventionally with resec-tion plus standard lymph node dissection. | Dimitrios Symeonidis George Koukoulis Konstantinos Tepetes | 2014 | World Journal of Gastrointestinal Surgery2014，6，6： | 9 |
| 3 | Risk of colorectal neoplasm in patients with acromegaly: A meta-analysis显示文摘AIM: To examine the risk of colorectal neoplasm in acromegalic patients by meta-analyzing all relevant controlled studies. METHODS: Extensive English language medical literature searches for human studies, up to December 2007, were performed using suitable keywords. Pooled estimates [odds ratio (OR) with 95% confidence intervals (CI)] were obtained using either the fixed or random-effects model as appropriate. Heterogeneity between studies was evaluated with the Cochran Q test whereas the likelihood of publication bias was assessed by constructing funnel plots. Their symmetry was estimated by the adjusted rank correlation test. RESULTS: For hyperplastic polyps the pooled ORs with 95% CI were 3.557 (2.587-4.891) by fixed effects model and 3.703 (2.565-5.347) by random effects model. The Z test values for overall effect were 7.81 and 6.984, respectively (P < 0.0001). For colon adenomas the pooled ORs with 95% CI were 2.486 (1.908-3.238) (fixed effects model) and 2.537 (1.914-3.364) (random effects model). The Z test values were 6.747 and 6.472, respectively (P < 0.0001). For colon cancer the pooled OR with 95% CI was identical for both fixed and random effects model (OR, 4.351; 95% CI, 1.533-12.354; Z = 2.762, P = 0.006]. There was no significant heterogeneity and no publication bias in all the above meta-analyses. CONCLUSION: Acromegaly is associated with an increased risk of colorectal neoplasm. | Theodoros Rokkas Dimitrios Pistiolas Panos Sechopoulos Georgios Margantinis Georgios Koukoulis | 2008 | World Journal of Gastroenterology2008，14，22： | 8 |
| 4 | Primary biliary cirrhosis in HBV and HCV patients:Clinical characteristics and outcome显示文摘AIM: To present the characteristics, management and outcome of patients with hepatitis B virus(HBV) or hepatitis C virus(HCV) infections concurrent with primary biliary cirrhosis(PBC).METHODS: Since January 2001 to September 2009,we retrospectively evaluated the medical records of all HBV(n = 1493) and HCV patients(n = 526) who are followed in our center for the presence of concurrent PBC. Seventeen patients identified with concurrent viral hepatitis and PBC(8 HCV and PBC; follow-up: 61 ± 37 mo and 9 HBV and PBC; follow-up: 57 ± 38 mo). PBC diagnosis was established if the patients met at least two of the following criteria: positivity for antimitochondrial antibody, elevated cholestatic enzymes and histological lesions of PBC.RESULTS: HCV or HBV diagnosis preceded that of PBC in most patients by many years. PBC diagnosis was based on the presence of antimitochondrial antibody and elevated cholestatic enzymes in all 17 patients,while one third(5/17; 29.4%) experienced severe pruritus many years before diagnosis. Patients with PBC and HBV were significantly younger at diagnosis of PBC compared to patients with PBC and HCV(56.1 ± 11.2vs 68.5 ± 10.3, respectively, P < 0.05). At initial clinical and histological assessment the majority of patients were cirrhotics(10/17; 58.8%) with the group of PBC and HCV carrying the highest frequency(87.5% vs33.3% in PBC and HBV; P < 0.05). The patients with HBV and concomitant PBC seem to have better outcome compared to those with HCV and PBC since none of the 6 non-cirrhotics with HBV and PBC developed cirrhosis during follow-up.CONCLUSION: PBC diagnosis in HBV or HCV patients is very difficult and usually delayed. Therefore, in any case, cholestasis should alert physicians to further search for PBC. | Eirini I Rigopoulou Kalliopi Zachou Nikolaos K Gatselis Georgia Papadamou George K Koukoulis George N Dalekos | 2013 | World Journal of Hepatology2013，5，10： | 7 |
| 5 | Cartilage oligomeric matrix protein: A novel non-invasive marker for assessing cirrhosis and risk of hepatocellular carcinoma显示文摘AIM: To assess serum cartilage oligomeric matrix protein(COMP) as a marker of cirrhosis and risk of progression to hepatocellular carcinoma(HCC). METHODS: A COMP enzyme-linked immunosorbentassay was used to test 187 patients with chronic liver diseases at the time point of first evaluation. The selected patients included 72 with chronic hepatitis B infection, 75 with chronic hepatitis C infection, 22 with primary biliary cirrhosis, 7 with autoimmune hepatitis type 1, and 11 with alcoholic liver disease. Demographic, biochemical, histological and clinical characteristics of the patients were recorded at the first evaluation. One hundred and forty-seven patients were followed for a median [interquartile range(IQR)] duration of 96.5(102) mo. The clinical, biochemical and histological data, as well as the development of cirrhosis, HCC according to internationally accepted criteria and in case of death, a liver-related cause during the follow-up period, were recorded at the electronic database of our clinic. COMP determination was also performed in 43 healthy individuals who served as the control study group.RESULTS: COMP positivity(> 15 U/L) was detected in 22%-36% among chronic liver disease groups. Strikingly, almost 83% of COMP-positive patients were cirrhotic at baseline, independently of cause of liver disease. Among the patients who developed HCC during follow-up, 73.7%(14/19) were COMP positive at baseline. COMP positivity was significantly associated with older age(P < 0.001), advanced fibrosis(P = 0.001) and necroinflammatory activity(P = 0.001), higher aspartate aminotransferase(P < 0.001), alanine aminotransferase(P < 0.02), γ-glutamyl transpeptidase(P = 0.003), alkaline phosphatase(P = 0.001), bilirubin(P < 0.05), international normalized ratio(P = 0.002) and alpha-fetoprotein levels(P < 0.02), and lower albumin(P < 0.001), and platelet count(P = 0.008). COMP levels [median(IQR)] were significantly higher in cirrhotics compared to non-cirrhotics [13.8(7.9) U/L vs 9.8(4.6) U/L, respectively; P < 0.001]. On multivariate logistic regression analysis, COMP-positivity was independently associated only with cirrhosis(OR = 4.40, 95%CI: 1.33-14.69, P = 0.015). Kaplan-Meier analysis showed that COMP positivity was significantly associated with HCC development(P = 0.007) and higher incidence of liver-related death(P < 0.001). CONCLUSION: Elevated COMP levels are strongly associated with cirrhosis and HCC progression. Serum COMP is a new promising non-invasive biomarker for HCC risk assessment in surveillance programs. | Gary L Norman Nikolaos K Gatselis Zakera Shums Christos Liaskos Dimitrios P Bogdanos George K Koukoulis George N Dalekos | 2015 | World Journal of Hepatology2015，7，14： | 7 |
| 6 | Primary biliary cirrhosis-specific autoantibodies in first degree relatives of Greek primary biliary cirrhosis patients显示文摘AIM:To determine the prevalence and significance of primary biliary cirrhosis (PBC)-specific autoantibodies in firstdegree relatives (FDRs) of Greek PBC patients. METHODS:The presence of antimitochondrial antibodies (AMA) and PBCspecific antinuclear antibodies (ANA) were determined using indirect immunofluores-cence assays, dot-blot assays, and molecularly based enzyme-linked immunosorbent assays in 101 asymp-tomatic for liver-related symptoms FDRs of 44 PBCpatients. In order to specify our results, the same investigation was performed in 40 healthy controls and in a disease control group consisting of 40 asymptomatic for liver-related symptoms FDRs of patients with other autoimmune liver diseases namely, autoimmune hepati-tis-1 or primary sclerosing cholangitis (AIH-1/PSC). RESULTS: AMA positivity was observed in 19 (only 4 with abnormal liver function tests) FDRs of PBC patients and none of the healthy controls. The preva-lence of AMA was significantly higher in FDRs of PBC patients than in AIH-1/PSC FDRs and healthy controls [18.8%, 95% confidence interval (CI):12%-28.1% vs 2.5%, 95% CI:0.1%-14.7%, P = 0.01; 18.8%, 95% CI:12%-28.1% vs 0%, 95% CI: 0%-10.9%, P = 0.003, respectively]. PBC-specific ANA positivity was observed in only one FDR from a PSC patient. Multivariate analysis showed that having a proband with PBC independently associated with AMA positivity (odds ratio: 11.24, 95% CI:1.27-25.34, P = 0.03) whereas among the investigated comorbidities and risk factors, a positive past history for urinary tract infections (UTI) was also independently associated with AMA detection in FDRs of PBC patients (odds ratio:3.92, 95% CI:1.25-12.35,P = 0.02). CONCLUSION:In FDRs of Greek PBC patients, AMA prevalence is significantly increased and independently associated with past UTI. PBC-specific ANA were not detected in anyone of PBC FDRs. | Theodoros A Zografos Nikolaos Gatselis Kalliopi Zachou Christos Liaskos Stella Gabeta George K Koukoulis George N Dalekos | 2012 | World Journal of Gastroenterology2012，18，34： | 4 |
| 7 | colorectal 癌症阶段特征上的 antiplatelet 治疗的影响显示文摘 AIM:To evaluate whether antiplatelet medication leads to an earlier stage colorectal cancer(CRC) diagnosis.METHODS:From January 2002 until March 2010,patients that presented to our institution with the initial diagnosis of CRC and were submitted to an open curative CRC resection or a palliative procedure were retrospectively reviewed.Exclusion criteria were the use of antithrombotic medication,i.e.,coumarins,and appendiceal malignancies.Data acquired from medical files included age,gender,past medical history,antithrombotic treatment received prior to endoscopic diagnosis,preoperative imaging staging,location of the tumor,surgical and final histopathological report.Patients that did not receive any antithrombotic medication prior to the endoscopic diagnosis comprised the control group of the study,while patients that were on antiplatelet medication comprised the antiplatelet group.Primary end point was a comparison of CRC stage in the two groups of the study.CRC presenting symptoms and the incidence of each cancer stage in the two groups were also evaluated.RESULTS:A total of 387 patients with the diagnosis of CRC were submitted to our department for further surgical treatment.Ninety-eight patients(25.32%),with a median age of 71 years(range 52-91 years),were included in the antiplatelet group,while 289(74.67%) patients,with a median age of 67 years(range 4190 years),were not in any thrombosis prophylaxis medication(control group).Thirty-one patients were treated with some kind of palliative procedure,either endoscopic,such as endoscopic stent placement,or surgical,such as de-compressive colostomy or deviation.Coronary disease(77.55%-76 patients),stroke recurrence prevention(14.28%-14 patients) and peripheral arterial disease(8.16%-8 patients) were the indications for the administration of antiplatelet treatment(aspirin,clopidogrel,ticlopidine or dipyridamole) in the antiplatelet group.All patients on aspirin treatment received a dosage of 100 mg/d,while the minimum prophylactic dosages were also used for the rest of the antiplatelet drugs.Investigation of an iron deficiency anemia(147 patients),per rectum blood loss(84 patients),bowel obstruction and/or perforation(81 patients),bowel habits alterations(32 patients),nonspecific symptoms,such as weight loss,intermittent abdominal pain and fatigue,(22 patients) or population screening(21 patients) were the indications for the endoscopic investigation in both groups.Bleeding,either chronic presenting as anemia or acute was significantly higher(P = 0.002) for the antiplatelet arm of the study(71 patients-72.4% of the antiplatelet group vs 160 patients-55.3% of the control group).The mean tumor,node and metastasis stage was 2.57 ± 0.96 for the control group,2.27 ± 0.93 for the antiplatelet group(P = 0.007) and 2.19 ± 0.92 for the subgroup of patients taking aspirin(P = 0.003).The incidence of advanced disease(stage Ⅳ) was lower for the antiplatelet group of the study(P = 0.033).CONCLUSION:The adverse effect of bleeding that is justifiably attached to this drug category seems to have a favorable impact on the staging characteristics of CRC. | Dimitrios Symeonidis Georgios Koukoulis Grigorios Christodoulidis Ioannis Mamaloudis Ioannis Chatzinikolaou Konstantinos Tepetes | 2012 | World Journal of Gastrointestinal Endoscopy2012，4，9： | 3 |
| 8 | Liposarcoma of the stomach: A rare case report显示文摘Liposarcoma is the most common soft tissue sarcoma and accounts for 15%-20% of all mesenchymal malignancies. The tumor occurs most frequently in the limbs, retroperitoneum and rarely has a visceral location. We report a case of a gastric liposarcoma in a male patient. A 68 years old male patient was admitted to hospital for abdominal discomfort and fullness lasting for a month. He reported rare episodes of vomiting. The CT examination revealed a large epigastric mass (8 cm x 4 cm) involving the lesser curvature of the stomach, in contact with the pancreas and gallbladder. Fatty areas within the mass were evident. A total gastrectomy together with cholecystectomy was performed. The histopathological diagnosis was a well differentiated liposarcoma. The patient did not undergo any adjuvant treatment, he is under close follow up and two years later he is disease free. We report this case due to the rarity of this tumor in the stomach (nine cases reported in the literature). | Konstantinos Tepetes Gregory Christodoulidis Michael E Spyridakis Maria Nakou George Koukoulis Konstantinos Hatzitheofilou | 2007 | World Journal of Gastroenterology2007，13，30： | 3 |
| 9 | Habib EndoHPB: A Novel Endobiliary Radiofrequency Ablation Device. An Experimental Study显示文摘 | Dimitris Zacharoulis Olga Lazoura Eleni Sioka Spyros Potamianos George Tzovaras Joanna Nicholls George Koukoulis Nagy Habib | 2013 | Journal of Investigative Surgery2013，，1： | 2 |
| 10 | Malakoplakia of the colon associated with colonic adenocarcinoma diagnosed in colonic biopsies显示文摘Malakoplakia, typically involving the urinary tract, is an uncommon form of chronic in? ammation caused by chronic infections and characterized by accumulation of macrophages. It has also been found in many other sites such as the gastrointestinal tract, pancreas, liver, lymph nodes, skin, respiratory tract, adrenal gland, vagina and brain. We present a case of a 64-year-old man referred to our hospital with cachexia and radiologic evidence of metastatic tumor of the liver. Colonoscopy revealed a large malignant - appearing polypoid mass of the ascending colon and multiple distinct polyps throughout the rest of the colon. Biopsies of the ascending colon mass confirmed the diagnosis of adenocarcinoma. Histological examination of two of the other polyps revealed malakoplakia which was characterized by aggregates of granular histiocytes with Michaelis - Gutmann bodies and histochemically confirmed with periodic acid-Schiff and von Kossa stains. This is a rare case diagnosed on endoscopic samples. The majority of reported cases were found in surgical specimens. In addition, the endoscopic appearance of multiple polyps is unusual in malakoplakia. | F Karasavvidou SP Potamianos S Barbanis E Stathakis A Psychos AN Kapsoritakis G Koukoulis | 2007 | World Journal of Gastroenterology2007，13，45： | 2 |
| 11 | Bacterial translocation in patients undergoing major gastrointestinal surgery and its role in postoperative sepsis显示文摘Bacteria of the human intestinal microflora have a dual role.They promote digestion and are part of a defense mechanism against pathogens.These bacteria could become potential pathogens under certain circumstances.The term“bacterial translocation”describes the passage of bacteria of the gastrointestinal tract through the intestinal mucosa barrier to mesenteric lymph nodes and other organs.In some cases,the passage of bacteria and endotoxins could result in blood stream infections and in multiple organ failure.Open elective abdominal surgery more frequently results in malfunction of the intestinal barrier and subsequent bacterial translocation and blood stream infections than laparoscopic surgery.Postoperative sepsis is a common finding in patients who have undergone non-elective abdominal surgeries,including trauma patients treated with laparotomy.Postoperative sepsis is an emerging issue,as it changes the treatment plan in surgical patients and prolongs hospital stay.The association between bacterial translocation and postoperative sepsis could provide novel treatment options. | Christos Doudakmanis Konstantinos Bouliaris Christina Kolla Matthaios Efthimiou Georgios D Koukoulis | 2021 | World Journal of Gastrointestinal Pathophysiology2021，12，6： | 2 |
| 12 | Epidermal growth factor receptor expression in invasive thymoma显示文摘 | Henley JD Koukoulis GK Loehrer PJ Sr | 2002 | J Cancer Res Clin Oncol2002，128，3： | 1 |
| 13 | Primary amyloidosis and severe intrahepatie eholestatie jaundiee显示文摘 | Peters RA Koukoulis G Gimson A | 1994 | Gut1994，35，9： | 1 |
| 14 | Serum Osteoprotegerin and RANKL are not Specifically Altered in Women with Postmenopausal Osteoporosis Treated with Teriparatide or Risedronate: A Randomized, Controlled Trial显示文摘 | A. Anastasilakis D. Goulis S. Polyzos S. Gerou G. Koukoulis M. Kita A. Avramidis | 2008 | Horm Metab Res2008，，04： | 1 |
| 15 | Circulating adhesion molecules levels in type 2 diabetes mellitus and hypertension显示文摘 | Boulbou MS Koukoulis GN Makri ED | 2005 | Int J Cardiol2005，98，1： | 1 |
| 16 | Adhesion molecules and tumor metastasis 显示文摘 | Koukoulis GK Patriarca C Gould VE | 1998 | Hum Pathol1998，29，9： | 1 |
| 17 | Circulating adhesion molecules in type 2 diabetes mellitus and hypertension显示文摘 | Boulbou MS Koukoulis GN Makri ED | 2005 | Int J Cardio12005，98，： | 1 |
| 18 | Circulating adhe- sion molecules in type 2 disabetes mellitus and hypertension 显示文摘 | Boulbou MS Koukoulis GN Makri ED | 2005 | Int J CardioU2005，98，： | 1 |
| 19 | Adhesion molecules and tumor metastasis显示文摘 | Patriarca C Gould VE | 1998 | Hum Pathol1998，29，9： | 1 |
| 20 | Circulating adhesion molecules levels in type 2 diabetes mellitus and hypertension显示文摘 | Boulbou MS Koukoulis GN Makri ED | 2005 | Int J Cardiol2005，98，1： | 1 |
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