Esophageal foreign body impaction as a presentation of underlying eosinophilic esophagitis

Introduction. Eosinophilic esophagitis (EoE) is a rare pathology characterized by chronic inflammation with mucosal eosinophilic infiltrate of the esophagus. The clinical symptoms vary according to the age group, from recurrent abdominal and thoracic pain, vomiting, dysphagia, food impaction and gastroesophageal reflux symptoms refractory to treatment with proton pump inhibitors. In the recent years, different studies suggest that EoE is now the leading cause of food impaction in the adult population. Case presentation. A 30-year-old female, without a pathological personal history, was admitted with symptoms of esophageal food impaction. Upper endoscopy revealed esophageal rings and the bolus impacted in the lower esophagus. Biopsy samples were obtained from several different locations, including areas away from the site of food impaction. Histopathologic examination revealed esophageal mucosal eosinophilic infiltrate >15 eosinophils per high-power field. Proton pump inhibitor (PPI) therapy, twice-daily dosing for 8 weeks was administered, as the first line treatment. Conclusions. Consensus guidelines for the diagnosis of EoE require symptoms of esophageal dysfunction, 15 or more eosinophils per high-power field on microscopic examination of esophageal biopsy after 8 weeks on a high-dose proton pump inhibitor (PPI), and the absence of alternative causes of eosinophilia

Gastrointestinal bleeding in patients admitted to the intensive care unit

Introduction. Gastrointestinal bleeding is a life-threatening condition, with a mortality depending on the cause and severity. The objective of this study was to retrospectively evaluate the epidemiological, clinical and evolutionary aspects of a series of patients diagnosed with gastrointestinal bleeding, admitted to the Intensive Care Unit of the Clinical Emergency Hospital of Bucharest, Romania. Material and methods. A retrospective, descriptive study was carried out, of patients diagnosed with upper and lower gastrointestinal bleeding, admitted to the Intensive Care Unit of the Clinical Emergency Hospital of Bucharest, Romania, between January 1st, 2013 – December 30th, 2018. The clinical variables were collected in a database designed exclusively for the study. Results. We observed that most of the cases were bleedings situated above the Treitz’s angle; the most frequent causes were peptic ulcer disease, followed by variceal hemorrhage and erosive gastroduodenitis. The three most frequent causes of upper gastrointestinal bleeding in our series were peptic ulcer disease, variceal hemorrhage and erosive gastroduodenitis. The global mortality due to gastrointestinal bleeding was 9.8%, with all cases occurring in the group of patients with upper gastrointestinal bleeding. Conclusions. It should be noted that in the group of patients who died, all had hemorrhagic shock at the time of admission, a fact that occurred only in 23% of the cases who survived. This highlights the prognostic value of the hemorrhagic shock on admission

Endoscopic management of corrosive esophageal stenosis by temporary stent placement

Introduction. Ingestion of corrosive substances often causes serious damage to the upper gastrointestinal mucosa, occasionally perforation and, in rare cases, death. Most of these events are accidental, especially in children and the elderly, and voluntary (for suicidal purposes) in adults. If the patient survives the acute episode, the long-term complications are mainly esophageal and/or gastric stenosis and esophageal cancer after 1-2 decades of evolution. Endoscopic treatment of benign esophageal stenosis consists of dilation with Savary bougies and dilation balloon, esophageal stent assembly, with the purpose of restoring esophageal luminal patency. Superior digestive endoscopy plays an important role in the evaluation of benign esophageal stenosis in terms of the severity and the extent of stenosis. Case presentation. We present the case of a 47-yearold patient admitted to our clinic for dysphagia for solid and semi-solid foods. Endoscopy revealed an esophageal stricture due to the voluntary ingestion of caustic substance with suicidal purpose, 9 months before presentation. After multiple sessions of endoscopic dilatation with Savary bougies, an esophageal stent was placed, that solved patient’s dysphagia. Conclusions. Post-caustic esophageal stenosis is a common cause of dysphagia in patients with ingestion of corrosive substances. Patients can benefit from endoscopic esophageal stent placement treatment

Quality of life and special issues in women with inflammatory bowel diseases

Introduction. The impact of inflammatory bowel diseases (IBD) on the quality of life (QoL) of patients is significant and it has important social and professional consequences. Materials and methods. We aimed to describe the patients’ perspective regarding the impact of IBD on their overall QoL and to evaluate the differences between men and women. An observational cross-sectional study, that included 180 patients with IBD in clinical remission, was conducted. All the patients completed a number of 3 questionnaires in order to evaluate the general aspects of their QoL. A separate questionnaire was created regarding gender-specific issues in women with IBD encounter. Also, particular features such as the incidence of anemia and osteoporosis among IBD patients were documented. The data obtained were analyzed and compared between the two gender-classified groups. Results. According to the Short Inflammatory Bowel Disease Questionnaire (SIBDQ), patients had a general perception of a good QoL, but the impact was higher in women. Fatigue and tiredness were severely perceived almost to the same degree regardless of their gender, whereas anxiety and unemployment were more present in men. No significant differences in women with IBD during the active disease and during disease remission were found. Conclusions. The overall quality of life of IBD patients is affected in many aspects, leading to the deterioration of their social and professional lives, for both men and women, but some aspects remain gender-specific and require a personalized standard of care

Primary non-Hodgkin’s lymphoma of the common bile duct presenting as obstructive jaundice: a case report

Introduction. Primary non-Hodgkin’s lymphoma of the extrahepatic bile duct presenting as obstructive jaundice is an extremely rare disease. Case presentation. We report a case of obstructive jaundice caused by primary non-Hodgkin’s lymphoma of the common bile duct (CBD), in a 67-year-old male patient. Our patient showed clinical evidence of obstructive jaundice, and tomography revealed a dilated common bile duct with the suspicion of intra ductal lithiasis. Endoscopic retrograde cholangiopancreatography (ERCP) was performed, with efficient drainage and clinical resolution of the obstructive jaundice. One month later, the patient presented the same clinical signs of obstructive jaundice, only this time the ERCP revealed common bile duct distal stenosis. The next step was to perform an echoendoscopy (EUS), that visualized a homogeneous mass at the common bile duct distal level and cholangiocarcinoma was suspected. Fine needle aspiration (FNA) of the lesion obtained tissue fragments for histological examination. The diagnosis was diffuse B-cell type non-Hodgkin’s lymphoma in the marginal area, and the patient was evaluated in the Oncology Department for chemotherapy. Conclusions. It is very important to differentiate primary non-Hodgkin’s lymphoma of the bile ducts from other causes of obstructive jaundice, as the treatment approach and prognosis are fundamentally different. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the definitive diagnosis technique, avoiding surgical interventions and the classic exploratory laparotomy

Contribution géographique à la classification des villes de la République populaire roumaine

Sandru Ion, Cucu Vasile, Poghirc Pompiliu. Contribution géographique à la classification des villes de la République populaire roumaine. In: Annales de Géographie, t. 72, n°390, 1963. pp. 162-185

Cardiovascular and Metabolic Consequences of Liver Transplantation: A Review

Liver transplantation (LT) is considered the curative treatment option for selected patients who suffer from end-stage or acute liver disease or hepatic malignancy (primary). After LT, patients should be carefully monitored for complications that may appear, partially due to immunosuppressive therapy, but not entirely. Cardiovascular diseases are frequently encountered in patients with LT, being responsible for high morbidity and mortality. Patients with underlying cardiovascular and metabolic pathologies are prone to complications after the transplant, but these complications can also appear de novo, mostly associated with immunosuppressants. Metabolic syndrome, defined by obesity, hypertension, dyslipidemia, and hyperglycemia, is diagnosed among LT recipients and is aggravated after LT, influencing the long-term survival. In this review, our purpose was to summarize the current knowledge regarding cardiovascular (CV) diseases and the metabolic syndrome associated with LT and to assess their impact on short and long-term morbidity and mortality

A SEVERE CASE OF ACUTE NECROTIC PANCREATITIS CAUSED BY DUODENAL CYST DUPLICATION

Introduction. Duodenal duplication cyst (DDC) is a rare congenital malformation that appears in the embryonic development of the digestive tract. It is a benign condition usually diagnosed in infancy and early childhood, being a rare and difficult diagnosis in adult population. DDC is a recognized cause of duodenal obstruction, acute pancreatitis, obstructive jaundice and even digestive hemorrhage. Case presentation. We report the case of a young adult male with abdominal pain history, who presents with recurrent episodes of acute severe necrotic pancreatitis. The abdominal computed tomography scan revealed a Balthazar C necrotic pancreatitis with partial thrombosis of the splenic vein and a cystic mass in the second part of the duodenum. The endoscopic ultrasonography (EUS) established that the duodenal cystic lesion came from the second layer, meaning the submucosa. We performed endoscopic cystotomy with complete evacuation of the fluid content into the duodenum, with favorable clinical outcome. Conclusions. The particularity of the case is represented by the low incidence of this pathology and the rare form of presentation, meaning acute pancreatitis probably from pancreatic ductular hypertension caused by the DDC

RAISING TECHNOLOGY INDUCED SPATIAL DYNAMICS OF ANTIMICROBIAL RESISTANCE AND ZOONOTIC RISK IN E. COLI ISOLATED FROM SWINE

INTRODUCTION Swine are amongst the most important large-scale farmed meat animals, by which a partial coverage of the growing global food demand is managed. Moreover, low-input and organic swine farming continuously expand, proven its beneficial effect on animal welfare and meat quality. In both systems, swine represent a source of E. coli for people by direct contact and food products, the bacteria pathogenicity increasing with its antimicrobial resistance. AIM The study aimed at comparing the dynamics of antibiotic resistance of E. coli strains from pigs raised under intensive and extensive technologies, presuming that under extended antibiotic use on the industrial farm, the number of resistant strains will be higher, than on low-input homesteads located 5 and 10 km from this posing an increased risk for humans. MATERIAL AND METHODS The samples collected from healthy pigs on the industrial farm (n = 16) and the two homesteads (n = 12) were subjected to standard microbiological techniques (cultivation, identification by Vitek 2 system, Kirby-Bauer diffusion test against enrofloxacine, amoxycillin-clavulanic acid, methicillin, cloramphenicol, neomycine, oxytetracycline, cefquinome, tulathromycine, colistine) and MAR (multiple antibiotic resistance) index was calculated. E. coli represented 72% of identified bacteria. MAR index was the lowest on the intensive farm (0.56±0.14) and increased statistically non-significantly with distance (0.59±16, 5 km and 0.61±0.28, 10 km, respectively). CONCLUSION The results undermined the initial hypothesis, probably due to a more controlled use of antibiotics and increased awareness of personnel on the farm, versus uncontrolled human use of antibiotics and internal consumption of obtained meat in the homesteads. Thus, stricter antibiotic residue control and biosecurity measures are needed on small sized households along with rational antibiotic use on the industrial farm to lower the MAR index and implicitly the zoonotic risk posed by E. coli. The work was supported by grant ERANET Core Organic Co-fund ROAM Free #249 ⁄ 2021, European Union’s Horizon 2020 research and innovation programme PPILOW project under grant agreement N°816172

Hereditary Hemorrhagic Telangiectasia—A Case Series Experience from a Liver Transplant Center in Romania

Hereditary hemorrhagic telangiectasia (HHT) has significant morbidity due to multiorgan involvement and an unpredictable disease course. We analyzed the data of 14 patients diagnosed with HHT. The case series comprised 14 patients with a median age at presentation of 48 years old (41–74 years). In twelve patients (85.7%), the diagnosis was confirmed by using the Curacao Criteria. The most common reason for admission was epistaxis, with 9 patients (57%) presenting with nosebleed refractory to prolonged self-tamponade. The biochemical abnormalities identified were elevations in AP and gamma-GT; liver synthetic function was generally normal, even though 21% of patients had clinical or imaging findings for cirrhosis. Nosebleeds were the main reason for admission and significantly impacted quality of life through anemia and frequent hospital admissions. However, the visceral manifestations seemed to be more serious. The hepatic arteriovenous malformations (AVMs) appeared to remain asymptomatic or led to minimal changes for the majority of patients; some cases were associated with liver and biliary tract ischemia, necrosis leading to acute liver failure and even death. Hepatic AVMs can also lead to high-output heart failure due to arterio-venous shunting. The most frequent AVM was hepatic artery to hepatic vein, with secondary hepatic vein dilation and hemodynamic consequences