Athanasios Tsamandas

Hepatitis caused by the herbal remedy Teucrium polium L.

Herbal remedies have become increasingly popular throughout the globe as a result of disappointment with conventional medicines and also of the alleged belief that herbal preparations are basically harmless. On the other hand, their effects can be exceedingly potent or even lethal if used improperly. Drugs and other chemicals account for less than 5% of cases of jaundice or acute hepatitis and smaller number of cases of chronic liver disease. Drug reactions can mimic any hepatobiliary disease, posing a diagnostic challenge for physicians and pathologists. Hepatotoxicity generally occurs after approximately 2 months of ingestion and consists of a non-specific hepatitis, which usually runs a benign course. Typical features include anorexia, nausea, abdominal pain, and jaundice associated with a marked elevation in serum aminotransferases. We present a case of acute hepatitis in a 70-year-old farmer, using Teucrium polium (golden germander) as hypoglycaemic aid. The patient presented only with jaundice, after 1 months consumption of large quantities of this herb in a tea form.

Lapatinib-induced hepatitis: A case report

Lapatinib is an inhibitor of the tyrosine kinases of human epidermal growth factor receptor type 2 (HER2) and epidermal growth factor receptor type 1, with clinical activity in HER2-positive metastatic breast cancer. We present here a 60 year-old patient with metastatic breast cancer who presented with jaundice and increased serum aminotransferase levels and who had been treated with lapatinib for the previous 14 days. Laboratory tests excluded other causes of acute liver injury. Liver biopsy revealed lesions compatible with drug-induced hepatotoxicity. Bilirubin and liver enzymes returned to normal within three months of lapatinib discontinuation. Lapatinib should be included among the causes of drug-induced hepatitis.

Evaluation of zotarolimus-eluting metal stent in animal ureters.

BACKGROUND AND PURPOSE Drug-eluting stents proved to minimize neointimal hyperplasia in coronary vessels. Hyperplastic reaction is the most common unwelcome event related to the use of metal mesh stents in the ureter. We evaluated the effect of zotarolimus-eluting stent (ZES) Endeavor Resolute in the porcine and rabbit ureter. MATERIALS AND METHODS A ZES and a bare metal stent (BMS) were inserted in each ureter of 10 pigs and 6 rabbits. The insertion was performed by the retrograde approach. CT was used for the evaluation of porcine ureters while intraoperative intravenous urography (IVU) was used for rabbit ureters. The follow-up included CT or IVU every week for the following 4 weeks for pigs and 8 weeks for rabbits. Renal scintigraphies were performed before stent insertion and during the third week in all animals. Optical coherence tomography (OCT) has been used for the evaluation of the luminal and intraluminal condition of the ureters with stents. Histopathologic examination of the these ureters embedded in glycol-methacrylate was performed. RESULTS Hyperplastic reaction was present in both stent types. BMSs in seven porcine ureters were completely obstructed while porcine ureters with ZES stents had hyperplastic tissue that did not result in obstruction. Two rabbit ureters with BMS stents were occluded while no ZES was associated with ureteral obstruction. The function of the seven porcine renal units and the two rabbit units with obstructed ureters with stents was compromised. The OCT revealed increased hyperplastic reaction in the ureters with BMS stents in comparison with those with ZESs. Although, hyperplastic reaction was present in all cases, pathologic examination revealed significantly more hyperplastic reaction in BMSs. CONCLUSION ZESs in the pig and rabbit ureter were not related to hyperplastic reaction resulting in stent occlusion. These stents were related to significantly lower hyperplastic reaction in comparison with BMSs while inflammation rates were similar for both stent types.

Prion protein expression and the M129V polymorphism of the PRNP gene in patients with colorectal cancer.

The prion protein, PrPC, is known mostly for its involvement in neurodegenerative spongiform encephalopathies. However, a role for this molecule in cancer is becoming increasingly recognized partly because it promotes cell proliferation and inhibits apoptosis. Moreover, the codon 129 polymorphism (M129V) of the PRNP gene (the PrPC‐encoding gene) has been associated with neurodegenerative disease development and severity, while no information is available regarding its role in colorectal cancer (CRC) incidence and disease progression. We have previously reported that expression levels of PRNP may have a prognostic value in CRC, suggesting a role for the prion protein in CRC. The aim of this study was to investigate retrospectively the possible role of M129V and PrPC expression in patients with CRC. The M129V single nucleotide polymorphism was genotyped by real time polymerase chain reactions in 110 patients with CRC and 124 healthy donors. Moreover, protein expression was assessed by immunohistochemistry in 68 patients with CRC. Allele frequencies were similar in patients and healthy controls indicating that the M129V polymorphism is not a risk factor for CRC. Furthermore, it did not correlate with any clinicopathological parameters. By contrast, PrPC expression was highly elevated in neoplastic compared to normal tissue and differed depending on the primary site. Interestingly, protein levels were correlated with disease recurrence (P = 0.007). Conclusively, PrPC overexpression may constitute a prognostic marker for disease recurrence and potentially a new target for anticancer therapy. However, further studies are needed to evaluate prospectively the role of PrPC expression in patients with CRC.

Giant malignant insulinoma

Insulinomas are the most common pancreatic neuroendocrine tumors. Most insulinomas are benign, small, intrapancreatic solid tumors and only large tumors have a tendency for malignancy. Most patients present with symptoms of hypoglycemia that are relieved with the administration of glucose. We herein present the case of a 75-year-old woman who presented with an acute hypoglycemic episode. Subsequent laboratory and radiological studies established the diagnosis of a 17-cm malignant insulinoma, with local invasion to the left kidney, lymph node metastasis, and hepatic metastases. Patient symptoms, diagnostic and imaging work-up and surgical management of both the primary and the metastatic disease are reviewed.

Altered expression of NFY-C and RORA in colorectal adenocarcinomas

NFY-C, a subunit of the transcription factor NFY, binds to the promoters of several eukaryotic genes, including cell cycle-related genes. RORA is a steroid hormone receptor implicated in a range of important cellular processes. We evaluated the expression of NFY-C and RORA in colorectal adenocarcinomas and normal colonic tissue. NFY-C expression was elevated in adenocarcinomas. Moreover, NFY-C mRNA levels correlated with time to disease progression, while NFY-C protein expression was significantly higher in metastatic disease. RORA expression was downregulated in CRC adenocarcinomas compared to normal controls and correlated with time to disease progression. The role of NFY-C and RORA in CRC merits further investigation.

Serum lipid profile and hepatic steatosis of adult beta-thalassaemia patients with chronic HCV infection

Objectives The aim of this study was to evaluate the serum lipid profile and to assess the prevalence of hepatic steatosis in adult beta-thalassaemic patients with chronic hepatitis C virus (HCV) infection. Methods Thirty-five adult HCV infected, multi-transfused, beta-thalassaemia patients (beta-HCV patients), 63 otherwise normal patients with chronic HCV infection (HCV patients) and 54 beta-thalassaemia patients without chronic viral hepatitis (beta patients) were studied. Total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, viral markers and liver histology were evaluated. Results Serum total cholesterol, HDL-C and LDL-C were found at significantly lower levels in beta-HCV and beta patients than in HCV patients. Triglyceride levels were significantly lower in the HCV group compared with the beta group. Nine (25.7%) of the 35 beta-HCV patients had mild hepatic steatosis. Thirteen (23.6%) of 55 HCV patients presented mild and 4/55 (7.3%) moderate hepatic steatosis. None of the beta group presented steatosis. When we compared beta-HCV and HCV patients with steatosis, we found that beta-HCV patients had a lower degree of steatosis (11.1±7% vs 22.9±17.2%, P=0.021). Multivariate logistic regression analysis showed that the only independent predictor associated with hepatic steatosis in beta-HCV and HCV patients was genotype 3a (OR, 3.61; 95% CI, 1.22–10.71, P=0.021). Conclusions Adult beta-thalassaemia patients, compared to other patients with chronic HCV infection, present lower cholesterol levels (total cholesterol, HDL, LDL) and similar frequency but a lower degree of hepatic steatosis. This difference in the degree of steatosis is most likely due to the higher prevalence of genotype 3a in the non-beta-thalassaemia group.

Metallic double pigtail ureteral stent usage during extracorporeal shock wave lithotripsy in the swine model: is there any effect on the ureter?

PURPOSE To examine the safety and compatibility of full-length metal ureteral stent usage with extracorporeal shock wave lithotripsy (SWL). METHODS Four Resonance ureteral stents and four special Resonance ureteral stents modified to contain thermocouples were placed unilaterally in eight pigs, with contralateral ureter of each pig serving as its own control. All pigs were subjected to the same SWL protocol in both their ureters. In the animals containing the modified stents, ureter temperature was monitored during treatment. The animals were sacrificed on days 1 and 15 after treatment, and both their ureters were histologically examined. RESULTS No statistically significant increase (mean increase of 0.5 degrees C, p > 0.05) of stent temperature was observed during treatment. No differences in histology were observed among ureters containing stents and control ureters at both days 1 and 15 after treatment. CONCLUSION SWL appears to be harmless for the ipsilateral ureter.

Ureteric response to abdominal radiotherapy and metallic double-pigtail ureteric stents: a pig model

To examine the safety and compatibility of full‐length metal ureteric stents with abdominal radiotherapy.

Optical coherence tomography provides images similar to histology and allows the performance of extensive measurements of drug-eluting metal stents in animal ureters

Optical coherence tomography (OCT) images and histology images of metal stents (MSs) inserted in animal ureters were compared, and the reliability of an OCT-based automated method for the performance of quantitative evaluation of ureteral MSs was evaluated. A zotarolimus-eluting metal stent (ZES) and a bare metal stent (BMS) were inserted in each ureter of ten pigs and six rabbits. OCT was performed in unobstructed stented ureters. Histopathologic examination of the stented ureters embedded in glycol-methacrylate took place. Quadrants of OCT images were compared to their respective histologic images by employing two independent observers who delineated different layers in the quadrants of OCT images and correlated them to the respective histologic quadrants. Manual (integrated OCT device software) and automated measurements of the OCT images using an automated strut detection method were compared. The observers highly agreed on the delineation of urothelium from the lamina propria and the lamina propria from the muscle layer of the ureteral wall. The algorithm measurements were similar to the manual measurements, and the algorithm proved to be reliable in the evaluation of ureteral MSs. Significantly higher endothelial hyperplasia of the BMSs in comparison to the ZESs was also quantitatively demonstrated by the strut detection method. OCT proved to be a reliable method for the evaluation of ureteral MSs. OCT provided images of the stented ureteral lumen similar to light microscopy quality. Measurements of the stented ureter are reliably performed by the automated strut detection method.