Volume 4 Issue 2
Xiangyi Gao, Maureen Madar, Xingyi Shi and Qiongqiong Zhou*
The incidence rate of stomach cancer is much higher in some regions, such as Asia, and part of Europe, than the rest of the world. The epidemiological studies showed there may be a strong correlation between Helicobacter pylori (H. pylori), a type of gastritis-causing bacteria, and the carcinogenesis of gastric cancer. Although the precise mechanism is not fully understood yet, it is generally accepted that H. pylori may cause gastric cancer by inflammation, mutation and stimulation of cell proliferation. This review summarizes the mechanisms of how this bacterium may stimulate cell proliferation, cause mutations, thus to trigger stomach cancer.
Cite this Article: Gao X, Madar M, Shi X, Zhou Q. Current Insights of H. Pylori Infection on Gastric Cancer. Int J Hepatol Gastroenterol. 2018; 4(2): 045-048.
Published: 30 August 2018
Research Article: Results of Thirteen Years Prospective Study of Diagnostics and Treatment of Amatoxin Intoxication in Slovakia
S. Dluholucky1,2*, M. Knapkova1, K. Kralinsky4, L. Skladany4, D. Kapusta4 and M. Snitkova2,3
The paper presents results of the prospective study of diagnosis and treatment of Amatoxin Intoxications (AI) during the period from 2004 to 2016 in the Slovak Republic.
Methods: AI diagnosis was suspected by/ suggested by mycological history, clinical course and confirmed by definition of amanitins in serum (ATOs) and in urine (ATOu) ELISA. The therapeutic protocol, designated and used by the authors since 1978, was recommended for hospitals treating confirmed AI patients. The study evaluated the diagnostic validity of ATOs and ATOu, the dynamics of ATOu levels after initiation of treatment and results of selected AI parameters and mortality - in relation to the protocol of treatment chosen for treating hospital.
Results: During 13 years of study 520 cases have met the anamnestic and clinical criteria of AI. In 418 of them the ATO levels were below the limit of positivity and AI was excluded. In 102 cases the ATO results confirmed AI and the treatment followed. While ATOu levels reliably reflect the severity of AI in the ranging from 6 to 60 hours since ingestion, ATOs levels were positive only up to six hours since ingestion of mushroom, thus their diagnostic value was limited. After start of the treatment ATOu levels drop below cut-off limit in the first 24 hours. The treatment protocol with mega dose of Penicillin (PNC) Plus Silibinin (PP group) was applied in eighty nine AI patients, and the protocol with the silibinin, without PNC (LP group) was applied in 13 patients. Five patients out of 102 died of confirmed AI, two of them immediately after admission and initiation of treatment as Acute Kidney Injury (AKI). Other three patients were from LP group because of the possible allergy to PNC in their history. Mortality in PP group was 2,25%, and mortality of LP group 23,05% - significantly higher in LP group ( p = 0,00058).
Conclusions: The identification of ATOu ELISA within the time ranging from 6 to 60 hours since ingestion of mushroom with 100% certainty confirms and/or excludes AI, while ATOs positivity is up to 6 hours since ingestion and hence its diagnostic value is limited. Early vigorous treatment using the recommended protocol REELDADCOM assures the survival of AI patients without any sequelae. A similar protocol using only silibinin as an antidote is not fully effective in severe form of AI and the liver transplantation is the last lifesaving modality. Early vigorous treatment using the recommended protocol REELDADCOM assures the survival of AI patients without any sequelae. A similar protocol using only silibinin as an antidote was not fully effective in severe forms of AI and the liver transplantation may be the last life-saving modality.
Keywords: Amanita phalloides; ELISA amanitin test; Diagnosis and treatment protocol
Cite this Article: Dluholucky S, Knapkova M, Kralinsky K, Skladany L, Kapusta D, Snitkova M. Results of Thirteen Years Prospective Study of Diagnostics and Treatment of Amatoxin Intoxication in Slovakia. Int J Hepatol Gastroenterol. 2018; 4(2): 036-044.
Published: 29 July 2018
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