Clinical-evolutional particularities of the cryoglobulinemic vasculitis in the case of a patient diagnosed with hepatitis C virus in the predialitic phase

Hepatitis C virus (HCV) represents a fundamental issue for public health, with long term evolution and the gradual appearance of several complications and associated pathologies. One of these pathologies is represented by cryoglobulinemic vasculitis, a disorder characterized by the appearance in the patient’s serum of the cryoglobulins, which typically precipitate at temperatures below normal body temperature (37°C) and dissolve again if the serum is heated. Here, we describe the case of a patient diagnosed with HCV that, during the evolution of the hepatic disease, developed a form of cryoglobulinemic vasculitis. The connection between the vasculitis and the hepatic disorder was revealed following treatment with interferon, with the temporary remission of both pathologies and subsequent relapse at the end of the 12 months of treatment, the patient becoming a non-responder. The particularity of the case is represented by both the severity of the vasculitic disease from its onset and the deterioration of renal function up to the predialitic phase, a situation not typical of the evolution of cryoglobulinemia. Taking into account the hepatic disorder, the inevitable evolution towards cirrhosis, and the risk of developing the hepatocellular carcinoma, close monitoring is necessary

A rare case of extrahepatic cholangiocarcinoma – a multidisciplinary approach

Department of Radiology and Medical Imaging, Department of Rheumatology, Departament of Gastroenterology, University of Medicine and Pharmacy of Craiova, Craiova, Romania, The IVth Congress of Radiology and Medical Imaging of the Republic of Moldova with international participation, Chisinau, May 31 – June 2, 2018Background: Bile duct carcinoma is an extremely aggressive and rare primary hepatobiliary malignancy affecting nearly 1-2/100,000 people in most countries in Europe. Biliary tract malignancies located in the distal third of the common bile duct (CBD) account for approximately 17-18% of all cholangiocarcinomas. This report aims to provide a step-by-step evaluation of a rare case of cholangiocarcinoma. Content: The current report focuses on a 65-year-old male patient who was presented to the emergency department with signs and symptoms suggestive for a biliary tract obstruction. An intense cooperation between multiple departments was required in order to perform a complete and accurate evaluation of the patient. Initially, the patient underwent an abdominal Ultrasonography (US), followed by an abdominal and pelvic Computed Tomography (CT), which revealed an intraductal tumor affecting the distal CBD. Furthermore, the patient underwent an endoscopic retrograde cholangiopancreatography (ERCP) in order to provide tissue samples and to perform a dilatation of the CBD in the affected area. The histopathology report confirmed the malignant nature of the lesion describing it as an adenocarcinoma. The surgeons performed a pancreaticoduodenectomy (Whipple procedure), managing to achieve negative tumor resection margins. However, the patient developed several complications that required multiple surgical reinterventions. Conclusions: This report presents a fully investigated less common type of cholangiocarcinoma, highlighting the principles of diagnosis and management as well as of a multidisciplinary approach in such patients

How to Sample the Unreachable: Transbronchial Biopsy

Transbronchial biopsy (TBBx) or bronchoscopic lung biopsy (BLBx) should be a diagnosis tool for focal peripheral lesions and for diffuse lung disease in every bronchoscopic suite around the world. The main advantage of this procedure is that it avoids open lung surgery for peripheral lung biopsy. The procedure is usually safe and can be done in an outpatient setting with moderate sedation, but life-threatening complications can occur, so a proper evaluation of the risk benefits ratio should be carefully analyzed before the intervention. There is no need for guidance in diffuse peripheral lesions, but for localized peripheral lesions, the diagnostic yield of TBBx is significantly higher with fluoroscopic guidance. In this chapter, we assess the utility, indications, and contraindication of this technique, as well as its clinical applications and complications

Correlaciones de la función diastólica en pacientes con cirrosis hepática alcohólica

Introduction: There are few established correlations between echocardiographic and biological parameters, and the severity of hepatic alcoholic disease; and even fewer prognostic correlations. Objective: The present study is aiming at establishing correlations between severity of hepatic alcoholic disease and cardiac structural and functional alterations, as well as their prognostic implications.Method: We investigated a group of 50 patients with liver cirrhosis of alcoholic etiology, classified by Child-Pugh score. Routine laboratory tests and transthoracic echocardiography were performed, NT-proBNP level was measured in each.Results: We found that patients with more severe liver dysfunction have a significantly worse diastolic profile. The peak early diastolic filling velocity of the left ventricle (E wave) was significantly higher, with lower tissue Doppler velocities at annular level and high ratio between E and e’, which point to the severity of the diastolic dysfunction. When comparing the indexed volumes of heart cavities, we did not find significant differences regarding left atrium indexed volume, left ventricle end-diastolic or end-systolic indexed volumes. Patients with Child class B liver disease had significantly lower levels of NT-proBNP.Conclusions: This study is revealing the significant association between diastolic dysfunction of the left ventricle and severity of the alcoholic liver cirrhosis, as well as the correlation between E/e’ ratio value, Child-Pugh class and also higher values of NT-proBNP. The benefit is that patients with alcoholic cirrhosis can be also classified according to the existence and severity of left ventricular diastolic dysfunction so that these patients could benefit from a stricter monitoring and closer follow-up. Introducción: Existen pocas correlaciones establecidas entre los parámetros ecocardiográficos y biológicos con la gravedad de la enfermedad hepática alcohólica, y aún menos parámetros asociados al pronóstico.Objetivo: Establecer la asociación entre la gravedad de la enfermedad hepática alcohólica y las alteraciones estructurales y funcionales cardíacas, así como sus implicaciones pronósticas.Método: Se investigó un grupo de 50 pacientes con cirrosis hepática de origen alcohólico, clasificados según la puntuación Child-Pugh. A todos los pacientes se les realizaron pruebas de laboratorio de rutina, determinación de los niveles de NT-proBNP, y ecocardiograma transtorácico. Resultados: Los pacientes con disfunción hepática más grave tuvieron un perfil diastólico significativamente peor. La velocidad máxima de llenado protodiastólico del ventrículo izquierdo (onda E) fue significativamente más alta, con velocidades inferiores en el Doppler tisular a nivel del anillo, y una relación E/e' elevada, lo que apunta a la gravedad de la disfunción diastólica. No se encontraron diferencias significativas con respecto a los volúmenes indexados de la aurícula izquierda y del ventrículo izquierdo en telediástole y telesístole. Los pacientes con enfermedad hepática en clase B de Child tuvieron niveles significativamente más bajos de NT-proBNP.Conclusiones: Existe asociación significativa entre la disfunción diastólica del ventrículo izquierdo y la gravedad de la cirrosis hepática alcohólica, así como entre el valor de la relación E/e', la clase de Child-Pugh y los valores más elevados de NT-proBNP. Los pacientes con cirrosis alcohólica también se pueden clasificar según la existencia y gravedad de la disfunción diastólica del ventrículo izquierdo, de modo que estos pacientes puedan beneficiarse de una evaluación más certera y un seguimiento más estrecho

Interleukin-4 receptor −3223C→T Polymorphism is Associated with Increased Gastric Adenocarcinoma Risk

BACKGROUND: Gastric cancer remains one of the most common types of cancer worldwide, with a large geographical variation in incidence and mortality rates. Cytokine polymorphisms are the most studied host polymorphisms and are associated with an increased risk of stomach cancer in many regions, but have not been studied extensively in Eastern European populations

IBD Monitor: Romanian National Mobile Application for Inflammatory Bowel Disease Personalized Treatment and Monitoring

Background: In the last 30 years, we have seen an increase in the incidence of inflammatory bowel disease (IBD). Most cases are diagnosed in the 2nd and 3rd decades of life, a population group that is most familiar with the latest innovations in technology. Patients want to obtain more information about their disease and have complete control over the pathology, while reducing physical meetings with their doctor. Starting from these ideas, the present study aimed to develop a mobile application (app) to support IBD patients on symptoms/events reporting and on treatment administration monitoring. Methods: A multidisciplinary team was created to document and develop the app requirements and design its functionality. The app was beta-tested by several IBD patients. Their feedback was used to further refine the app. Results: We developed connected apps for both smartphones and smartwatches, with dedicated sections for event reporting and medication administration reminders/reporting. Conclusions: The development of apps dedicated to IBD patients is still in early progress. By creating this app, we aim to improve the evolution and compliance of IBD patients and to obtain new information that will have a beneficial impact on the management of these patients and open the door for personalized medicine