Advances in Noninvasive Biomarkers for Nonalcoholic Fatty Liver Disease.

Nonalcoholic fatty liver disease (NAFLD) currently represents one of the most common liver diseases worldwide. Early diagnosis and disease staging is crucial, since it is mainly asymptomatic, but can progress to nonalcoholic steatohepatitis (NASH) or cirrhosis or even lead to the development of hepatocellular carcinoma. Over time, efforts have been put into developing noninvasive diagnostic and staging methods in order to replace the use of a liver biopsy. The noninvasive methods used include imaging techniques that measure liver stiffness and biological markers, with a focus on serum biomarkers. Due to the impressive complexity of the NAFLD's pathophysiology, biomarkers are able to assay different processes involved, such as apoptosis, fibrogenesis, and inflammation, or even address the genetic background and "omics" technologies. This article reviews not only the currently validated noninvasive methods to investigate NAFLD but also the promising results regarding recently discovered biomarkers, including biomarker panels and the combination of the currently validated evaluation methods and serum markers.

Risk Predictors of Advanced Fibrosis in Non-Alcoholic Fatty Liver Disease.

The assessment of fibrosis in chronic liver diseases using non-invasive methods is an important topic in hepatology. The aim of this study is to identify patients with non-alcoholic fatty liver disease (NAFLD) and advanced liver fibrosis by establishing correlations between biological/ultrasound markers and non-invasively measured liver stiffness. This study enrolled 116 patients with non-alcoholic fatty liver disease, which were evaluated clinically, biologically, and by ultrasound. Liver fibrosis was quantified by measuring liver stiffness by shear wave elastography (SWE). Multiple correlation analysis of predictors of liver fibrosis identified a number of clinical, biological, and ultrasound parameters (BMI, blood glucose, albumin, platelet count, portal vein diameter, bipolar spleen diameter) that are associated with advanced liver fibrosis in patients with non-alcoholic fatty liver disease. The correlations between the degree of liver fibrosis and the risk values of some serological and ultrasound markers obtained in our study could be useful in clinical practice for the identification of advanced fibrosis in patients with NAFLD.

Cavernous liver hemangioma complicated with spontaneous intratumoral hemorrhage: a case report and literature review.

Hemangiomas, the most common benign tumors of the liver, have a prevalence of approximately 20% and are more frequent in women. According to previous studies, the size and location of the tumor are correlated with the appearance of symptoms and complications. Cases of hemangiomas complicated by spontaneous intratumoral hemorrhage have been rarely reported in the literature. Here, we report the case of a 70-year-old woman admitted for persistent upper abdominal pain. The patient showed signs of anemia, inflammatory markers and a transient increase in creatinine levels, which were corrected by conservative treatment. Our patient denied the previous use of estrogen derivatives, smoking or alcohol consumption. Native computed tomography identified a liver mass measuring 73×63 mm, located in segment IV and bulging out of the anterior contour of the liver. The mass was surgically removed by hepatic segmentectomy, and histopathological examination identified a cavernous hemangioma complicated by intratumoral hemorrhage. The postoperative outcome was favorable. After a literature review, we identified 19 other cases of hepatic cavernous hemangioma complicated by intratumoral hemorrhage reported worldwide.

Clinical, biological and epidemiological aspects of inflammatory bowel diseases in North-East Romania.

AIM: Inflammatory bowel diseases (IBD) are chronic conditions of unknown etiology with increasing incidence in South-East Europe. The epidemiological characteristics, clinical, biological and endoscopic profiles are very different worldwide, with little data existing from Moldova region. This study aims to characterize IBD in North-East Romania from the mentioned points of view. MATERIAL AND METHODS: All patients with Crohn's disease or ulcerative colitis (UC) admitted to a tertiary hospital during a three year interval were retrospectively analyzed in terms of epidemiological characteristics. All IBD patients hospitalized during 2010 were complexly analyzed by noting the type and form of disease, the biological picture, the clinical and endoscopic scores. RESULTS: UC represents 77% of all cases (one of the highest values of the recent studies). Age at onset is higher in the studied region, with the average over 40 years. In UC the forms of severity and extension are uniformly distributed, but in Crohn's disease there is a predominance of colonic forms and the number of complicated cases is high - over 50%. The parameters with the best correlation with endoscopic scores were the clinical Mayo score for UC, serum C-reactive protein and fibrinogen. CONCLUSIONS: There is a definite predominance of UC in North-East Romania, but Crohn's disease tends to present an increased number of complications. The age of onset of the two diseases is high. There is a good correlation between the clinical and biological scores with endoscopic activity, but without this assessment inflammation may be underestimated. Systematic exploration of the small bowel may increase detection of ileal manifestations.

[Surveillance of cirrhosis for hepatocellular carcinoma--clinical validation of new serological biomarkers for improved diagnosis]. / Validarea clinica a noi biomarkeri serologici în detectia precoce a hepatocarcinomului celular la pacientii cu ciroza hepatica.

UNLABELLED: Alpha-Fetoprotein (AFP) is a serological marker currently available for the detection of hepatocellular carcinoma (CHC). Its poor sensitivity renders it unsatisfactory for this purpose and suggests the need for additional biomarkers. Squamous cell carcinoma associated antigen (SCCA) is physiologically present in the skin and was recently detected in patients with CHC. Additionally, circulating immunoglobulin M complexes associated with SCCA (CICSCC) and AFP (CICAFP) have been identified in the blood of these patients. MATERIAL AND METHODS: The accuracy of the new biomarkers in detecting CHC was evaluated in 72 patients using an ELISA test. Sensitivity and specificity were determined for each marker alone and all markers combined for their ability to detect CHC and discriminate between CHC and hepatic cirrhosis (CH). RESULTS: The median AFP was 402.000 ng/mL (IQR 23.267-1210.000) in CHC and 4.950 ng/mL (IQR 3.213-11.678) in CH patients (p <0.0001). The median CICAFP was 68.276 AU/mL (IQR 14.913-150.000) in CHC and 16.910 (IQR 9.439-40.846) AU/mL in CH patients (p = 0.0171). The median SCCA was 0.587 IU/mL (IQR 0.354-1.349) in HCC and 0.427 IU/mL (IQR 0.178-0.531) in CH patients (p = 0.0191). The median CICSCC was 18,753 AU/mL at HCC (IQR 14.820-40.813) and 14.433 AU/mL (IQR 13.077-17.643) in HC patients (p = 0.0153). The AFP efficacy, as measured by the area under the curve (AUC), was 0.878 (95% CI= 0.780-0.943). For a cut-off value (diagnostic threshold) of 18.44 ng/mL, the sensitivity and specificity were 80% and 92.6%, respectively, and the positive predictive value (PPV) and a negative predictive value (NPV) were 94.7 and 73.5, respectively. For SCCA, AUC was 0.666 (95% CI 0.545-0.773) and the cut-off value was 0.533 IU/mL. The sensitivity and specificity were 55.6% 77.8%, respectively, and the PPV and NPV were 80.6 and 51.2, respectively. For AFP-CIC, AUC was 0.705 (95% CI 0.559-0.825) and the cut-off value was 73.51 AU/mL. Sensitivity and specificity were 50% and 88.9%, respectively, and PPV and NPV were 88.9 and 50, respectively. For SCC-CIC, AUC was 0708 (95% CI 0.563-0.828) and the cut-off value was 17.643 AU/mL. Sensitivity and specificity were 59.4% and 77.8%, respectively, and PPV and NPV were 82.6 and 51.9, respectively. CONCLUSION: This study suggests that using a combination of AFP, SCCA, CICSCC, and CICAFP in clinical practice may provide a new test which could increase accuracy ofCHC noninvasive diagnosis.

[Conventional ultrasound in the diagnosis of bile duct calculi]. / Aportul ecografiei conventionale în diagnosticul litiazei de cale biliara.

UNLABELLED: Transabdominal ultrasound (US) is one of the most useful methods in the diagnosis of biliary stones. AIM OF THE STUDY: To appreciate the value of US in the diagnosis of bile duct stones. MATERIAL AND METHOD: 989 patients, explored in the Institute of Gastroenterology and Hepatology Iasi by US compared with ERCP, MRCP, operative diagnosis and the final diagnostic. RESULTS: The sensitivity of US in the detection of bile duct stones was 78.39% and specificity was 72.22% in the first group of 650 patients, and bile duct stones were identified in 139 cases of 339 of the second group where US could not identify the cause of bile duct dilatations. DISCUSSION: The results were comparable with the most recent studies in the literature. CONCLUSION: US is an efficient method for the diagnosis of bile duct stones in many cases and remains the first step in the diagnosis.

Mucinous digestive tumors. Case reports and review of the literature.

We present three rare entities of mucinous tumors: appendiceal mucinous adenomas, enteroid mucinous cyst and pseudomyxoma peritonei, the latter as a developmental course or separate idiopathic etiology of mucinous tumors. We attempted to clarify the term of pseudomyxoma peritonei, a poorly understood condition, characterized by a diffuse intraperitoneal collection of gelatinous fluid with mucinous tumoral implants on the peritoneal surfaces. With this rare condition it is often difficult to establish the histological and developmental malignant or benign characteristics. We analyzed 4 patients admitted during the period of February 2000 - February 2002 in the First Surgical Clinic of St. Spiridon Hospital and in addition we referred to the current approach in the recent literature. In three of the four patients the diagnosis was possible preoperatively by imaging techniques and consequently they were operated by laparoscopic procedure for the complete removal of tumor cells at macroscopic level. We preferred to administrate chemotherapy accordingly to the malignant/ benign aspect, choosing the long term follow up of the patients to ward off the eventual relapse. We considered the future state of these cases to be uneventful, with a real chance of long term survival. In conclusion, the symptoms are not always specific, allowing errors in diagnosis. Imaging techniques offer real elements of diagnosis. Laparoscopic techniques could offer an oncologic approach with no less benefit compared to open surgery. This methodology also allows different surgery for a different pathology at the same time. The origin of these tumors is more frequently digestive and less ovarian.