Pancreatic Pseudocyst with Splenic Artery Erosion, Retroperitoneal and Splenic Hematoma

The erosion of the peripancreatic vascular structures is a rare but life-endangering complication of pancreatic diseases. We report a female patient with a multicompartmentalized pancreatic pseudocyst that eroded the splenic artery resulting in a retroperitoneal and splenic hematoma with hemodynamic instability which required emergency laparotomy with splenectomy, partial cystectomy, ligation of the splenic artery at the level of the vascular erosion, cholecystectomy (lithiasis), and multiple drainage. The postoperative course was difficult (elevated level of platelets, pancreatic fistula) but eventually favourable, with no abdominal complaints and no recurrence at 2-year follow-up. The case shows that the pancreatic pseudocysts may present with acute hemorrhagic complications with life-endangering potential and significant postoperative morbidity

UTILITATEA ŞI SEMNIFICAŢIA MARKERILOR SEROLOGICI IMUNI AI INFLAMAŢIEI LA PACIENŢII CU COLITĂ ULCERATIVĂ

INTRODUCTION: The recent advance in the area of diagnostic testing is focusing on serologic immune markers: atypical perinuclear anti-neutrophil citoplasmic antibody (pANCA) and anti-Saccharomyces cervisiae antibody (ASCA), and her utility in differentiating between ulcerative colitis (UC), Crohn’s disease (CD) and indeterminate colitis (IC). The aim of this study was to investigate the diagnostic value of pANCA and ASCA in inflammatory bowel diasease (IBD) diagnosis and for the differential diagnosis of UC from CD.MATERIAL AND METHOD: A prospective study was conducted in 31 patients with new or established diagnoses of UC (n=15), CD (n=9) or IC (n=7) and also controls (n=7). Antibodies status has been measured with ELISA. A definitive diagnosis was reached using conventional techniques (colonoscopy or ileoscopy).RESULTS: Sensitivity and specificity of pANCA for UC diagnosis was 66.67% and 77.78%, respectively; and ASCA for CD: 20% and 22.22%, respectively. The combined use of these two markers gave changes in diagnosis accuracy: pANCA+/ASCA- in UC and pANCA-/ASCA+ in CD: 75% and 72.73%, respectively. In phase II, for 23 of 38 patients a definitive diagnosis was reached using conventional techniques (colonoscopy and ileoscopy). In IC group, after 1-year follow-up, a definitive diagnosis was reached in 5 of the 7 patients.CONCLUSION: The combined use of atypical pANCA and ASCA test results substantially affects pretest-posttest probability in distinguishing UC from CD in patients with IBD. This may be of help in patients in whom distinction between CD or UC is not obvious with the classic diagnostic tools. Key words: Ulcerative colitis, Crohn’s disease, Indeterminate colitis, perinuclear anti-neutrophil citoplasmic antibody , anti-Saccharomyces cervisiae antibody.INTRODUCERE: Progresele recente în domeniul testelor de diagnostic se concentrează asupra markerilor serologici imuni: anticorpii anti-citoplasmatici neutrofilici perinucleari (pANCA) și anticorpii anti-Saccharomyces cervisiae (ASCA) precum și utilitatea lor în diferențierea colitei ulcerative (CU), de boala Crohn (BC) și de colita nedeterminată (IC). SCOPUL acestui studiu a fost de a investiga valoarea diagnostică a pANCA și ASCA în diagnosticul BII și diferențierea CU de BC.MATERIAL ȘI METODĂ: Am efectuat un studiu prospectiv pe un lot de 31 de pacienți nou-diagnosticați sau cu diagnostic stabilit de CU (n=15), BC (n=9) sau IC (n=7), precum și un grup de control (n=7). Determinarea anticorpilor a fost realizată cu teste ELISA. Diagnosticul definitiv a fost stabilit utilizând metode convenționale (colonoscopie sau ileoscopie).RESULTATE: Sensibilitatea și specificitatea pANCA pentru diagnosticul de CU a fost 66,67%, respectiv 77,78%; pentru ASCA (în BC): 20%, respectiv 22,22%. Determinarea combinată a celor 2 markeri a determinat modificări în acuratețea stabilirii diagnosticului: pANCA+/ASCA- în CU și pANCA-/ASCA+ în BC: 75% și respectiv 72,73%. În faza II, la 23 din 38 pacienți diagnosticul difinitiv a fost stabilit utilizând tehnici convenționale (colonoscopie și ileoscopie). În lotul cu IC, după 1 an de urmărire, diagnosticul difinitiv a fost stabilit la 5 din 7 pacienți.CONCLUZII: Utilizând determinarea combinată a pANCA și ASCA, rezultatele testelor influențează substanțial probabilitatea pretest-postest pentru diferențierea CU de BC la pacienții cu BII. Aceste determinări ar putea fi utile la pacienții la care diferențierea dintre BC și CU nu poate fi stabilită prin metode clasice de diagnostic. Cuvinte cheie: Colită ulcerativă, Boala Crohn, Colită nedeterminată, Anticorpii anti-citoplasmatici neutrofilici perinucleari, Anticorpii anti-Saccharomyces cervisiae

Pancreatic Pseudocyst with Splenic Artery Erosion, Retroperitoneal and Splenic Hematoma

The erosion of the peripancreatic vascular structures is a rare but life-endangering complication of pancreatic diseases. We report a female patient with a multicompartmentalized pancreatic pseudocyst that eroded the splenic artery resulting in a retroperitoneal and splenic hematoma with hemodynamic instability which required emergency laparotomy with splenectomy, partial cystectomy, ligation of the splenic artery at the level of the vascular erosion, cholecystectomy (lithiasis), and multiple drainage. The postoperative course was difficult (elevated level of platelets, pancreatic fistula) but eventually favourable, with no abdominal complaints and no recurrence at 2-year follow-up. The case shows that the pancreatic pseudocysts may present with acute hemorrhagic complications with life-endangering potential and significant postoperative morbidity

APORTUL CROMOENDOSCOPIEI CU MAGNIFICATIE IN DIAGNOSTICUL GASTRITEI ATROFICE, METAPLAZIEI INTESTINALE SI DISPLAZIEI

Atrophic gastritis, intestinal metaplasia (IM) and gastric dysplasia are premalignant states whose proper recognition and monitorization  leads to a more frequent detection of early gastric cancer.The aim of the study is to evaluate the contribution of the cromoendoscopy with magnification in diagnosing premalignant gastric lesions.Patients included in the study are among those who addressed the Clinic of Gastroenterology Mures County Hospital, who underwent upper gastrointestinal endoscopy (EDS) and cromoendoscopy with magnification (EMC). We used as statistical methods the chi-square test, considering a value of pGastrita atrofică, metaplazia intestinală şi displazia reprezintă stări premaligne gastrice, a căror recunoaştere şi dispensarizare corespunzătoare duce la detectarea mai frecventă a cancerului gastric precoce.Scopul studiului este de a evalua aportul adus de cromoendoscopia cu magnificaţie în diagnosticul leziunilor premaligne gastrice.Pacienţii incluşi în studiu sunt dintre cei care s-au adresat Clinicii de Gastroenterologie, Spitalul Clinic Judeţean Mureş, la care s-a efectuat endoscopia digestivă superioară (EDS) şi cromoendoscopia cu magnificaţie (CEM). Pentru prelucrarea datelor statistice am folosit testul chi pătrat, considerând o valoare a lui p<0,05 care atestă semnificaţia statistică a rezultatelor.Examinând rezultatele histopatologice obtinuţe prin biopsie, atât la EDS, cât şi prin ECM, am obţinut că, în cazul gastritei atrofice la nivel corporeal există între cele 2 metode de investigare o diferenţă statistic semnificativă de detecţie a leziunilor premaligne (p=0,0072). De asemenea, CEM s-a dovedit mai eficientă în decelarea MI la nivel antral (p=0,0325), cât şi la nivel corporeal (p=0,028), datorită prelevării de biopsii ţintite din ariile captante cu pit-pattern tubular.CONCLUZII. Cromoendoscopia cu magnificaţie îmbunătăţeşte decelarea metaplazieiintestinale şi displaziei.Cuvinte cheie: leziuni premaligne, endoscopie digestivă superioară convenţională,cromoendoscopia cu magnificaţie, pit-pattern

miR-155 and miR-21 as Diagnostic and Therapeutic Biomarkers for Ulcerative Colitis: There Is Still a Long Way to Go

(1) Elucidating the role of miRNAs (miRs) in ulcerative colitis may provide new insights into disease pathogenesis, diagnosis, treatment, and monitoring We aimed to investigate whether plasma levels of miR-21-5p and miR-155-5p may be used to differentiate between patients with organic disease such as ulcerative colitis (UC) and Clostridioides difficile infection (CDI), and patients with functional disease such as irritable bowel syndrome with diarrhea (IBS-D). (2) Serological samples were collected to quantify miR-155 and -21 expression, which was carried out through quantitative real-time polymerase chain reaction (qRT-PCR), from 84 patients: 34 with acute UC (group 1), 17 with CDI (group 2), and 33 with IBS-D (control group). (3) In this study, we found that the expression levels of miR-155-5p were almost the same for the two conditions and the control group (UC: 4.22 ± 1.61, CDI: 3.94 ± 1.62, IBS-D: 4.26 ± 1.26), with no significant differences either for ΔCt- or for ΔΔCt-derived parameters (p = 0.74 and p = 0.73, respectively). For miR-21, ΔCt levels presented significantly higher values among the ulcerative colitis group (p < 0.01), but the most important expression fold change was noticed in patients with CDI (UC:4.11 ± 8,46, CDI: 4.94 ± 9.68, IBS-D: 2.83 ± 5.41). (4) Circulating miR-155 and miR-21 were upregulated in UC, CDI, and IBS-D, but differentiation was not possible among them. But their involvement in the pathogenesis of the three diseases makes them suitable for improving the accuracy of diagnosis and facilitating the development of personalized treatment strategies

In Pursuit of Novel Markers: Unraveling the Potential of miR-106, CEA and CA 19-9 in Gastric Adenocarcinoma Diagnosis and Staging

Gastric cancer stands as the fourth leading cause of cancer-related deaths globally, primarily comprising adenocarcinomas, categorized by anatomic location and histologic type. Often diagnosed at advanced stages, gastric cancer prognosis remains poor. To address the critical need for accurate tumoral markers for gastric cancer diagnosis, we conducted a study to assess classical markers like CEA and CA-19-9 alongside the novel marker miR-106. Our investigation revealed distinct dynamics of these markers compared to non-cancerous groups, although no disparities were observed across different disease stages. Univariable and multivariable logistic regression analyses demonstrated that elevated levels of miR-106, CEA and CA 19-9 were predictive of a positive histopathological exam, with the respective odds ratios of 12.032 (95% CI: 1.948–74.305), 30 (95% CI: 3.141–286.576), and 55.866 (95% CI: 4.512–691.687). Subsequently, we utilized predicted probabilities from regression models to construct receiver operating characteristic (ROC) curves, identifying CA 19-9 as the optimal predictor for gastric adenocarcinoma diagnosis when considering age and gender, with an area under the curve (AUC) of 0.936 (p < 0.001). Hence, classical markers exhibit superior performance compared to the novel marker miR-106 in predicting gastric adenocarcinoma