Updates in Diagnosis and Endoscopic Management of Cholangiocarcinoma.

Cholangiocarcinoma (CCA) is an adenocarcinoma originating from the epithelial cells of the bile ducts/hepatocytes or peribiliary glands. There are three types of cholangiocarcinoma: intrahepatic, perihilar and distal. CCA represents approximately 3% of the gastrointestinal malignancies. The incidence of CCA is higher in regions of the Eastern world compared to the Western countries. There are multiple risk factors associated with cholangiocarcinoma such as liver fluke, primary sclerosing cholangitis, chronic hepatitis B, liver cirrhosis and non-alcoholic fatty liver disease. Endoscopy plays an important role in the diagnosis and management of cholangiocarcinoma. The main endoscopic methods used for diagnosis, biliary drainage and delivering intrabiliary local therapies are endoscopic retrograde cholangiopancreatography and endoscopic ultrasound. The purpose of this review is to analyze the current data found in literature about cholangiocarcinoma, with a focus on the actual diagnostic tools and endoscopic management options.

Exceptional Liver Transplant Indications: Unveiling the Uncommon Landscape.

Liver transplantation represents the definitive intervention for various etiologies of liver failure and encompasses a spectrum of rare indications crucial to understanding the diverse landscape of end-stage liver disease, with significantly improved survival rates over the past three decades. Apart from commonly encountered liver transplant indications such as decompensated cirrhosis and liver cancer, several rare diseases can lead to transplantation. Recognition of these rare indications is essential, providing a lifeline to individuals facing complex liver disorders where conventional treatments fail. Collaborative efforts among healthcare experts lead not only to timely interventions but also to the continuous refinement of transplant protocols. This continued evolution in transplant medicine promises hope for those facing diverse and rare liver diseases, marking a paradigm shift in the landscape of liver disease management.

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.

Urinary tract infections in children: clinical and antimicrobial resistance data from Bucharest area, Romania.

INTRODUCTION: Urinary tract infections (UTIs) are among the most common bacterial diseases of childhood with an increased frequency in infants and young children. METHODS: We conducted a retrospective study of children diagnosed with UTI in the Alessandrescu-Rusescu National Institute for Mother and Child Health, Bucharest, Romania between January 2017 and December 2019. We evaluated the patients' clinical characteristics, laboratory parameters and the resistance profile of the identified uropathogens. RESULTS: A total of 264 children were included in the analysis. Females (71.6%, n=186) and infants (52.7%, n=139) were more commonly affected. The recurrence rate was 27.7% and was positively associated with the presence of renal malformations. Age under 1-year, increased leukocyte and neutrophil counts, and elevated C-reactive protein were associated with hospitalization. E. coli (80.3%, n=212) was the main etiological agent isolated, followed by Proteus mirabilis (9.8%, n=26) and Klebsiella spp. (6.4%, n=17). We identified increased resistance for all germs to common antibiotics used in pediatrics: ampicillin, amoxicillin/clavulanate, cefuroxime, ceftriaxone, and trimethoprim/sulfamethoxazole. CONCLUSIONS: We identified an increased resistance of uropathogens to antimicrobials commonly used in children. Reporting antimicrobial resistance from real-world clinical practice is necessary for accurate mapping and continuous updating of initial treatment recommendations until antibiogram results are received. In Romania and other countries, extensive studies are needed to follow up uropathogen resistance in both children and adults.