Endoscopic Treatment of Pancreatic Diseases

Endoscopic therapy has been increasingly recognized as an effective method of treatment in selected patients with pancreatic diseases. Various endoscopic procedures, classical and modified, are used for the complex treatment of acute and chronic pancreatitis, as well as their complications. In pancreatic carcinoma, some endoscopic methods are applied mainly as palliative measures. There are still open questions regarding the placing and timing of various endoscopic procedures in the multidisciplinary management approach of pancreatic diseases

Thyroglossal duct cyst carcinoma

Not required for Clinical Vignette

Kabuki Syndrome

Introduction: Kabuki syndrome is a rare genetic disorder characterized by mental retardation and typical facial appearance presented by long palpebral fissures with eversion of the lateral third of the lower eyelids and a broad depressed nasal tip. Other clinically heterogeneous symptoms are congenital heart defects, neurological and endocrinological problems, short stature and skeletal abnormalities, postnatal growth deficiency. The aim of the study is to present a rare disease and follow the diagnostic process and management.Materials and Methods: Articles about the syndrome were systematically reviewed.  Information about the condition was gathered by using print and digital sources.Results: Because of the low incidence of Kabuki syndrome worldwide, the diagnostic process, and in particular mentioning Kabuki syndrome in the differential diagnosis, is very difficult. There are some clinical criteria which have to be present to make the clinical diagnosis. There are specific criteria for the different age groups. The next step is cytogenetic and molecular analysis, which can confirm the exact type of mutation causing the disorder. The management of the condition includes all kinds of specialists, such as neurologists, cardiologists, endocrinologists, dentists and other, depending on the abnormalities of the certain individual. Psychological consultations can also be needed. A genetic consultation for the next pregnancy is recommended due to the possibility that the condition is inherited by the parents.Conclusion: It is thought that if the abnormalities that can cause problems in the future are properly treated in childhood age, the long-term prognosis is good. Life expectancy depends mostly on the cardiac problems and immunological complications

METABOLIC FACE OF CHRONIC HEPATITIS B AND C IN BULGARIA

It is well known that NAFLD, as well as diabetes mellitus (DM), correlated with the progression of liver fibrosis in chronic hepatitis C (CHC). The impact of NAFLD overlap in chronic hepatitis B (CHB) is not well established. Aim. In this study we compared the prevalence of NAFLD and related metabolic parameters in CHC and CHB, and their relationship with disease activity and fibrosis. Methods. The parameters of metabolic syndrome (MetS), glucose, insulin, HOMA-IR and histological features of steatosis / steatohepatitis were investigated in total of 700 patients with chronic viral hepatitis - CHB (n=334) and genotype 1 CHC (n=366). Glucose and insulin were also assessed during OGTT (60 and 120 min.) in 100 cases with CHB and 100 – with CHC. Results. Nonalcoholic metabolic related steatosis was more frequent (62% v/s 48%) and severe in CHC compared to CHB (p<0.01). MetS (51% v/s 33%), and DM OGTT (30% v/s 20%) were found also in higher frequency in CHC than in cases with CHB (р<0.001). In the both type hepatitis insulin resistance was associated with disease activity. In CHC, but not in CHB, a positive correlation between the degree of steatosis and the activity score was found (r = 0.322, p<0.05). In 70% of the cases with CHB and severe steatosis (>66%) HBV DNA was negative or <10 000 copies/ml. The advanced liver fibrosis (F3-F4) was associated with moderate or severe steatosis (CHC), as well as with the glucose levels, markers of insulin resistance, and presence of DM (p<0.001), but not with the other components of metabolic syndrome.In conclusion, nonalcoholic metabolic related steatosis, diabetes mellitus and insulin resistance are associated with the both viral hepatitis, but the prevalence is higher in chronic hepatitis C. The degree of steatosis correlates with the activity grade and stage of fibrosis only in patients with chronic hepatitis C. Insulin resistance and diabetes mellitus are associated with more advanced liver fibrosis in the both viral hepatiti