Georgios Kalambokis

Publications (28)109.14 Total impact

• Article: Response to savarino et Al.

  Georgios Kalambokis, Epameinondas V Tsianos
  The American Journal of Gastroenterology 06/2011; 106(6):1172. · 7.28 Impact Factor
• Article: Endotoxaemia in the pathogenesis of cytopenias in liver cirrhosis. Could oral antibiotics raise blood counts?

  Georgios Kalambokis, Epameinondas V Tsianos
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  ABSTRACT: Cytopenias are frequently observed in patients with cirrhosis and are associated with increased morbidity. In particular, thrombocytopenia can impact routine care of patients with cirrhosis by potentially postponing or interfering with diagnostic and therapeutic procedures including liver biopsy and medically indicated or elective surgery. The pathogenesis of cytopenias in cirrhosis remains largely unknown. Historically, the concept of hypersplenism has long been associated with the cirrhosis-related hematological disorders but was never proven. On the other hand, intestinal bacterial overgrowth and altered gut permeability in cirrhotic patients lead to increased translocation of bacteria and endotoxin into the portal circulation. The impaired phagocytic function of the reticuloendothelial system together with the portosystemic shunting allow endotoxin to reach the systemic circulation and high concentrations of circulating endotoxin are found in cirrhotic patients even with no clinical evidence of infection and correlate with the severity of liver disease. Endotoxin activates monocytes and promotes the release of proinflammatory cytokines. Indeed, serum levels of interleukin-1, interleukin-6, tumor necrosis factor-α, and interferon-γ are elevated in patients with cirrhosis in proportion to the severity of liver disease. Endotoxaemia stimulates the vascular production of nitric oxide (NO) directly or indirectly via the cytokine cascade, and correlates with serum NO metabolite levels in cirrhosis. Several lines of evidence strongly suggest that endotoxaemia may reduce peripheral blood counts either directly or through the release of cytokines and NO. Previous studies in experimental models of cirrhosis and cirrhotic patients have demonstrated that long-term administration of oral antibiotics such as trimethoprim-sulfamethoxazole, norfloxacin, and rifaximin can reduce bacterial translocation and circulating levels of endotoxin, TNF-α, IL-6, and NO. We hypothesize that endotoxaemia plays a pivotal role in the pathogenesis of cytopenias in cirrhosis and that intestinal decontamination could raise peripheral blood counts by the suppression of endotoxaemia and the inhibition of cytokine and NO production.
  Medical Hypotheses 01/2011; 76(1):105-9. · 1.39 Impact Factor
• Article: Thrombocytopenia associated with chronic liver disease: effects of rifaximin on platelet count.

  Georgios Kalambokis, Epameinondas V Tsianos
  The American Journal of Gastroenterology 12/2010; 105(12):2705-7. · 7.28 Impact Factor
• Article: Splenic marginal zone lymphoma in a patient with chronic hepatitis B.

  Leonidas Christou, Georgios Kalambokis, Maria Bai, Sevasti Kamina, Epameinondas V Tsianos
  Journal of gastrointestinal and liver diseases: JGLD 12/2009; 18(4):511-2. · 1.81 Impact Factor
• Article: Polymyalgia rheumatica associated with neck surgery.

  Georgios Kalambokis, Leonidas Christou, Ekaterini Siaplaoura, Epameinondas V Tsianos
  Southern medical journal 11/2009; 102(11):1190-1. · 0.92 Impact Factor
• Article: Multiple myeloma presenting with pyomyositis caused by community-acquired methicillin-resistant Staphylococcus aureus: report of a case and literature review.

  Georgios Kalambokis, Areti Theodorou, Paraskevi Kosta, Epameinondas V Tsianos
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  ABSTRACT: Pyomyositis is infrequently reported in patients with multiple myeloma. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is emerging as an important cause of soft tissue infections, including pyomyositis. Here, we report on the first case of CA-MRSA pyomyositis in a patient with multiple myeloma and review the relevant literature.
  International Journal of Hematology 07/2008; 87(5):516-9. · 1.27 Impact Factor
• Article: Significant improvement of portopulmonary hypertension after 1-week terlipressin treatment.

  Georgios Kalambokis, Panagiotis Korantzopoulos, Spyros A Nikas, Areti Theodorou, Epameinondas V Tsianos
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  ABSTRACT: Cirrhosis associated with moderate and severe portopulmonary hypertension carries a poor prognosis. Optimal management has not yet been defined. Current treatment options, such as prostacyclin analogues, endothelin antagonists, and phosphodiesterase-5 inhibitors, are characterized by slow onset of action and various adverse effects, particularly in patients with advanced cirrhosis. Here, we report the significant reduction of pulmonary arterial pressure after 1-week terlipressin treatment in a patient with concomitant hepato-renal syndrome. Terlipressin could be a novel and safe treatment for portopulmonary hypertension.
  Journal of Hepatology 05/2008; 48(4):678-80. · 9.26 Impact Factor
• Article: Weil's disease in a patient with chronic viral hepatitis and history of alcohol abuse.

  Leonidas Christou, Georgios Kalambokis, Epameinondas V Tsianos
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  ABSTRACT: Clinical and laboratory diagnosis of severe leptospirosis (Weil's disease) may be difficult when other pathological processes that may cause similar clinical syndromes or affect immune response to infections coexist. In addition, the optimal management of the disease remains to be defined. We report on a case of Weil's disease, in which concurrent chronic hepatitis B virus infection and alcohol abuse caused diagnostic and therapeutic difficulties.
  Internal Medicine 02/2008; 47(10):933-7. · 0.94 Impact Factor
• Article: Concurrent development of spontaneous pyomyositis due to Staphylococcus epidermidis and Kikuchi-Fujimoto disease.

  Georgios Kalambokis, Georgios Economou, Spiros Nikas, Maria Bai, Evangeli Lampri, Paraskevi Kosta, Epameinondas V Tsianos
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  ABSTRACT: Staphylococcus epidermidis is a common cause of infections associated with prosthetic devices and immunocompromised patients. Spontaneous pyomyositis due to the above pathogen is very uncommon. Kikuchi-Fujimoto disease (KFD) is a subacute necrotizing lymphadenitis, first described in Japan. A T cell-mediated hyperimmune response to various pathogens in a genetically susceptible individual has been primarily been considered in its pathogenesis. We report a patient who developed spontaneous pyomyositis caused by S. epidermidis concurrently with KFD, and discuss the possibility of S. epidermidis infection being the stimulant of KFD.
  Internal Medicine 02/2008; 47(24):2139-43. · 0.94 Impact Factor
• Article: Association of liver cirrhosis related IgA nephropathy with portal hypertension.

  Georgios Kalambokis, Leonidas Christou, Dimitrios Stefanou, Evdokia Arkoumani, Epameinondas V Tsianos
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  ABSTRACT: A high incidence of IgA nephropathy has been reported in patients with liver cirrhosis, though, clinically evident nephrotic syndrome is very uncommon. Impaired hepatic clearance of circulating IgA immune complexes and subsequent deposition in renal glomeruli has been considered principally in the pathogenesis of liver cirrhosis associated IgA nephropathy. Here we report on a patient with cryptogenic liver cirrhosis and splenic vein thrombosis, who presented with nephrotic syndrome. Renal biopsy showed findings consistent with IgA nephropathy. Lower endoscopy showed features of portal hypertensive colopathy. Following initiation of propranolol and anticoagulant treatment to reduce portal pressure, a gradual decrease of proteinuria and hematuria to normal range was noted. The potential pathogenetic role of portal hypertension in the development of IgA nephropathy in cirrhotic patients is discussed.
  World Journal of Gastroenterology 12/2007; 13(43):5783-6. · 2.47 Impact Factor
• Article: Treatment of hepatic hydrothorax with vasoconstrictor drugs.

  Georgios Kalambokis, Epameinondas V Tsianos
  Scandinavian Journal of Gastroenterology 05/2007; 42(4):534. · 2.02 Impact Factor
• Article: Effects of a 7-day treatment with midodrine in non-azotemic cirrhotic patients with and without ascites.

  Georgios Kalambokis, Andreas Fotopoulos, Michalis Economou, Konstantinos Pappas, Epameinondas V Tsianos
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  ABSTRACT: Splanchnic arterial vasodilatation has been causally related with hyperdynamic circulation and impaired natriuresis in advanced cirrhosis and has also been suggested to be responsible for the subtle sodium retention in pre-ascitic cirrhosis. This study evaluated the effects of a 7-day treatment with the alpha1-adrenergic agonist midodrine in non-azotemic cirrhotic patients with and without ascites. Thirty-nine cirrhotic patients were studied at baseline and 7 days after administration of oral midodrine 10mg, t.i.d. (11 without and 12 with ascites) or placebo (8 without and 8 with ascites). A significant increase in urine sodium excretion was noted after midodrine administration in patients without and with ascites, in line with significant increases in mean arterial pressure and systemic vascular resistance, and significant decreases in cardiac output and heart rate. Significant increases in glomerular filtration rate, filtration fraction, and urine volume and significant decreases in plasma renin activity and aldosterone were observed in patients with ascites. Placebo had no effect in any study group. The administration of midodrine for 7 days improves systemic haemodynamics and sodium excretion in non-azotemic cirrhotic patients without or with ascites. In patients with ascites, but not in those without ascites, these effects are associated with a suppression of the activity of the renin-angiotensin-aldosterone system, suggesting that the increase in natriuresis is related to the improvement in the effective arterial blood volume.
  Journal of Hepatology 03/2007; 46(2):213-21. · 9.26 Impact Factor
• Article: The effects of treatment with octreotide, diuretics, or both on portal hemodynamics in nonazotemic cirrhotic patients with ascites.

  Georgios Kalambokis, Michalis Economou, Paraskevi Kosta, Konstantinos Papadimitriou, Epameinondas V Tsianos
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  ABSTRACT: To evaluate the effects of diuretic treatment, octreotide, or both on portal hemodynamics in nonazotemic cirrhotic patients with ascites. Diuretics and octreotide have been associated with a decrease in portal pressure in cirrhotic patients, suggested to be mediated by plasma volume depletion and splanchnic vasoconstriction, respectively. However, liver cirrhosis is characterized by activation of the renin-angiotensin-aldosterone axis, which increases hepatic vascular resistance and is augmented or suppressed by diuretics or octreotide, respectively. Twenty nonazotemic cirrhotic patients with ascites were treated with furosemide and spironolactone. Of them, 10 (group 1) discontinued diuretic treatment for 7 days. Thereafter for 5 days, each patient received subcutaneous octreotide, 300 microg twice per day; ten of them (group 2) received the octreotide in addition to their usual diuretic treatment. Portal and systemic hemodynamics with Doppler ultrasound and endogenous vasoactive systems were evaluated while the patients received diuretics (both groups), after discontinuation of diuretics (group 1), and after octreotide administration (both groups). The withdrawal of diuretics did not alter portal hemodynamics, but it impaired systemic hemodynamics and suppressed the renin-aldosterone axis. The addition of octreotide to diuretic treatment but not octreotide alone improved portal and systemic hemodynamics. In both groups the initiation of octreotide administration suppressed the renin-aldosterone axis and plasma glucagon levels. In nonazotemic cirrhotic patients with ascites, the combination of diuretics and octreotide improves systemic hemodynamics and inhibits the diuretic-related component of the activated renin-aldosterone axis, which in turn augments the portal hypotensive effect of diuretic-induced plasma volume depletion.
  Journal of Clinical Gastroenterology 05/2006; 40(4):342-6. · 3.16 Impact Factor
• Article: Octreotide in the treatment of refractory ascites of cirrhosis.

  Georgios Kalambokis, Andreas Fotopoulos, Michael Economou, Epameinondas V Tsianos
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  ABSTRACT: Dietary sodium restriction and diuretic treatment have been shown to be effective in the treatment of ascites in the majority of cirrhotic patients. However, approximately 5 to 10% of patients develop refractory ascites, which is defined as ascites that does not respond to intensive diuretic therapy (diuretic-resistant) or ascites that cannot be controlled because the patient develops diuretic-induced complications that prevent the use of an effective diuretic dose (diuretic-intractable). Current therapeutic approaches for refractory ascites include repeated large-volume paracentesis and transjugular intrahepatic portosystemic shunting. In the present report, subcutaneous octreotide treatment improved renal function and hemodynamics and diuretic response in two patients with refractory ascites in line with a marked decrease in renin and aldosterone secretion. We consider that octreotide could be of value in the management of refractory ascites in cirrhotic patients.
  Scandinavian Journal of Gastroenterology 02/2006; 41(1):118-21. · 2.02 Impact Factor
• Article: Beneficial haemodynamic and renal sodium handling effects of combined midodrine and octreotide treatment in a cirrhotic patient with large hepatic hydrothorax and mild ascites.

  Georgios Kalambokis, Andreas Fotopoulos, Michael Economou, Epameinondas V Tsianos
  Nephrology Dialysis Transplantation 12/2005; 20(11):2583. · 3.40 Impact Factor
• Article: Serum oligoclonal immunoglobulin bands in cirrhotic patients.

  Georgios Kalambokis, Georgios Kolios, Konstantinos Seferiadis, Epameinondas V Tsianos
  The American Journal of Gastroenterology 12/2005; 100(11):2602-3. · 7.28 Impact Factor
• Article: Tumor necrosis factor-alpha-related intraperitoneal release of CA 125 in cirrhotic patients with sterile ascites.

  Georgios Kalambokis, Ageliki Kostoula, Michalis Economou, Epameinondas V Tsianos
  Clinical Chemistry 12/2005; 51(11):2207-8. · 7.91 Impact Factor
• Article: Long-term anticoagulation therapy for a cirrhotic patient with recurrent deep venous thrombosis.

  Georgios Kalambokis, Evgenia Svarna, Epameinondas V Tsianos
  Journal of Gastroenterology and Hepatology 12/2005; 20(11):1803-4. · 2.87 Impact Factor
• Article: Terlipressin avoids hemodialysis in the treatment of refractory hyperkalemia associated with renal dysfunction in cirrhosis.

  Georgios Kalambokis, Haralampos Milionis, Moses Elisaf, Epameinondas V Tsianos
  The American Journal of Medicine 10/2005; 118(9):1051-2. · 5.43 Impact Factor
• Article: Effects of nitric oxide inhibition by methylene blue in cirrhotic patients with ascites.

  Georgios Kalambokis, Michalis Economou, Andreas Fotopoulos, Jihad Al Bokharhii, Pappas Christos, Kosta Paraskevi, Papadimitriou Konstantinos, Afroditi Katsaraki, Epameinondas V Tsianos
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  ABSTRACT: Increased endogenous nitric oxide production has been proposed as an important mediator of the peripheral arterial vasodilation and the hyperdynamic circulation in cirrhosis, whereas a decreased intrahepatic production of nitric oxide has been implicated in the pathogenesis of portal hypertension. The present study investigated the possible beneficial effects of methylene blue, which is a potent inhibitor of guanylate cyclase and nitric oxide synthase, on hyperdynamic circulation and renal function in cirrhotic patients with ascites together with the effects on portal hemodynamics. Twenty patients were evaluated at baseline and during 2 consecutive 4-hr periods after the administration of methylene blue at a dose of 3 mg/kg (10 patients) or placebo (10 patients). Mean arterial pressure, heart rate, cardiac output, systemic vascular resistance, plasma active renin, plasma aldosterone, plasma antidiuretic hormone, serum urea, serum creatinine, serum sodium, urinary flow rate, glomerular filtration rate, effective renal plasma flow, portal flow volume, and portal vein velocity were not modified by methylene blue or placebo. Urinary sodium excretion, fractional sodium excretion and serum nitric oxide levels were significantly decreased 4 hr after methylene blue administration (P < 0.05), to return toward basal levels over a further 4-hr period. It is concluded that methylene blue, at the dose used in the present study, has no effect on systemic and portal hemodynamics in cirrhotic patients with ascites. The reduction in renal sodium excretion, in the absence of changes in renal function and hemodynamics, suggests, at least partly, a direct antinatriuretic effect of methylene blue.
  Digestive Diseases and Sciences 10/2005; 50(10):1771-7. · 2.12 Impact Factor