[108 cases of hepatic hydatid cyst]. / Studiul a 108 cazuri de chist hidatic hepatic.

The paper reports on 108 cases of hepatic hydatidosis, admitted to the clinic in the last 12 years, who wer subjected systematically to hepatic imagery, immunologic investigation at hydatic antigen, determination of eosinophil and hepatic biochemical exploration. All the cases were checked operatively. The females were predominant, 66.11%, the average age was of 42.88 +/- 11.94 years. The greatest part of the cases ranged within the 5th-7th age decades. The investigation shows that there exists, in Romania, an endemic region infested with Echinococcus tenia in the Danube zone. The most frequent contamination sources were the cats and dogs; only in 11.11% of the cases the patients were breeding animals. The most cases were discovered late and had an important hepatomegaly. The patients sought help from the physician an ailment in the right hypochondria in 52.78% of the cases, followed by fever (16.68%), biliary colic (12.96%), abdominal pain; (9.26%) and incidentally in 12.04% of the cases. The medium diameter of the hydatic cyst at its discovery was of 10.65% +/- 5.84/14.06 +/- 7.12 cm; only in 21.3% of the cases the diameter of the cyst was lower than 6 cm. The causes of the late diagnosis were: sporadic hepatic imagistic exploration; sensibility of scintigraphy was of 87.5% whereas that of echography was of 98% and that of the CT-scanning od 100%; other cause was due to the lack of immunologic tests at hydatic antigen; sensibility of hemagglutination inhibition is of 65% and that of contra-immunoelectrophoresis of 86%. Owing to the late discovery of the disease, a lethal evolution was recorded by rupture of the cyst and peritoneal inundation in a young patient of 29 years old. Hepatic echinococcosis was unilocular in 74.07% of the case, with predominance in the right lobe (67.5%). The complications rate was of 14.83%, with predominance of the suppuration (10.19%). The paper confirms the endemic state of the hydatic disease, in the Danubian zone of Romania and pleads for the necessity of improving the diagnosis by systematic application of the echographic examination and of better immunologic tests in the ambulatory.

[The dumping syndrome: its risk factors and evolution]. / Sindromul dumping: factori de risc si evolutie.

The paper reports on a comparative study of 24 cases of operated gastroduodenal ulcer, in which the dumping syndrome appeared at a short interval after the operation, and of a control lot of patients operated for ulcerous disease without complications. This study shows that the incidence of the dumping syndrome in the ulcerous patients operated is of 12.83%, predominant in gastric ulcer (15%). Among the factors favouring the development of the dumping syndrome, mention is made of subtotal gastric resection with Billroth II anastomoses, early surgical indication, and pre-existing neuroendocrine disturbances. Although the dumping syndrome causes weight loss, its evolution in time is benign and improving after 3 years, surveillance.

[The significance of lobular inflammation in chronic active hepatitis]. / Semnificatia inflamatiei lobulare în hepatita cronica activa.

Authors have performed an anatomo-clinico-biological comparison of two groups of hepatitis with lobular inflammation: group I with a simple lobular inflammation, called lobular hepatitis, and group II with a lobular inflammation associated with portal and periportal hepatitis, called chronic active hepatitis (CHA) with lobular hepatitis. Furthermore, a comparative study of these forms with a group of CHA without lobular inflammation was performed. Both forms of lobular inflammation appeared in young patients, the large majority of whom were infected with the hepatitis B virus; in 5 cases of CHA with lobular hepatitis the presence of the delta agent in the liver, possibly responsible of the lobular inflammation, was detected. The two forms of lobular hepatitis are differentiated by: the fivefold increase of ALAT over the normal value, with usually normal gamma-globulins and albumin, in the first group; in the lobular hepatitis, HBsAg was present in 33% of cases in the first group and in none of the patients of the second group, suggesting the integration of HBsAg within the hepatocytic genome; the clinical picture was generally asymptomatic in the first group and noisier, with hepatomegaly, in the second group; the period elapsed since the acute hepatitis was shorter in the first group (4-11 months) in 8 of 15 patients and longer in the second group. The clinical course of these forms of hepatitis if unforeseeable and the diagnosis is established on the basis of the morphological examination.

Study of the risk factors for upper digestive hemorrhage, determined by post-mortem investigations in 39 cases of liver cirrhosis.

A retrospective study of the causes and the risk factors for upper digestive hemorrhage (UDH) was carried out by post-mortem investigations in 39 consecutive cases of liver cirrhosis (LC), in comparison with a control group of 40 patients with LC, free of UDH. The patients' age and the disease duration in the cases with ruptured esophageal varices or with hemorrhagic erosive gastritis (the main causes of UDH in the group studied) were longer than in the controls. The causes of UDH were: rupture of esophageal varices (in 43.7% of the cases), hemorrhagic erosive gastritis (41%), both (10.2%), and active duodenal ulcer (5.1%). The frequency of small esophageal varices among the ruptured ones (23%) was higher than that detected by endoscopic studies (13-15%), owing to the peculiarities of the group investigated and to the methods of evaluation. Ascites can be considered a risk factor for UDH, as an expression of portal hypertensions. Liver carcinoma, jaundice, prothrombinemia, albuminemia, bilirubinemia and Child index are not risk factors for UDH, some of them reflecting only a longer evolution of the disease.

Study of the prognosis factors in liver cirrhosis.

In a prospective study carried out on a group of 1210 patients with liver cirrhosis (LC), the diagnosis was based on clinical, biological and histological criteria, as well as on the prognostic significance of 20 clinical, biochemical and histological parameters. The group, including 830 males (68.59%) and 380 females (31.41%), with an average age of 49.27 +/- 13.18 years, was studied during periods of 6 to 16 months, the initial investigations being periodically repeated. The statistical significance of the prognosis factors was studied by uni- and multivariative methods, according to the model of Cox, with the help of an IMB computer. The survival rate for the group studied ranged from 6 to 204 months, with an average period of survival of 38.29 months. The multivariative analysis demonstrated that the prognosis factor with a best correlation with the death power is ascites, which has additional predictive significance in association with encephalopathy and/or jaundice. The multivariative analysis selects as clinical factors of unfavourable prognosis the cholestasis, the hepatocytolytic syndrome, the syndrome of liver deficiency and the age over 50. The limits of the biochemical parameters with unfavourable significance were: bilirubinemia level greater than 3 mg%, ASAT/ALAT = 50.24/70.33 u.i., prothrombinemic index less than 50% and albuminemia greater than 3 g%. The multivariative method proved also superior in appreciating the interrelations of the prognostic factors, emphasizing the significance of the clinical parameters (ascites, encephalopathy, jaundice), while the multivariative analysis differentiated the biochemical prognosis factors (bilirubinemia, ASAT/ALAT, prothrombinemic index, albuminemia) and their level of significance.

[Acute alcoholic hepatitis]. / Hepatita acuta alcoolica.

In a group of 1,025 cases of alcoholic liver the authors detected 28 cases (2.73%) of acute alcoholic hepatitis on the basis of the morphologic examination, 75% were males, mean age 45 +/- 18 years. The mean amount of alcohol consumed daily was 106.7 g for a mean duration of 19.78 years. The hepatic lesional substrate was hepatic steatosis and cirrhosis in 7 cases (25%) and steatofibrosis in the other 14 cases (50%). The triggering factors were the abuse of alcohol in 27 cases and a pneumonia in the last case. The disease was characterized by fever, encephalopathy, hepatomegaly, hepatocytolytic-cholestatic syndrome. The evolution was dictated by the gravity of the background hepatic lesional substrate.

[The cholestasis syndrome. A critical evaluation of an exploratory strategy]. / Sindromul de colestaza. Evaluarea critica a strategiei de explorare.

The authors studied 160 cases of biliary stasis: 120 having intrahepatic cause (101 hepatic cirrhoses and 19 primitive biliary cirrhoses) and 40 extrahepatic cause (17 choledochal lithiases and 23 cancers of the pancreas head) and check up the diagnosis value of two investigation algorithms: echography, the first investigation, followed by hepatic biopsy puncture, if the intrahepatic biliary ducts are not dilated, or transhepatic cutaneous cholangiography if the intrahepatic biliary ducts are dilated in comparison with intravenous cholangiography in the first investigation. Echography has an increased diagnosis yield (96% sensitivity, 99% specificity), is cheap, noninvasive and is the first imaging exploration used in biliary stasis syndrome.

Anti-polymerized albumin antibodies-a test for the evaluation of hepatic function in HBs Ag-positive subjects.

A number of 681 sera collected from hepatic patients and apparently healthy subjects (recruits and blood donors) were tested by immunodiffusion (ID) and hemagglutination (HA) for the presence of anti-polymerized albumin antibodies (AAA). AAA positivity was compared within the categories of patients and healthy subjects, grouped according to the presence of HBsAg. In most of the hepatic patients and healthy subjects both ID and HA were either positive or negative. However, in certain apparently healthy HGsAg carriers, the absence of AAA in ID was associated with high AAA titers in HA. These data point to the possibility of using AAA in order to differentiate an actually healthy HGsAg carrier from a HBsAg carrier with hepatic lesions.

The value of cimetidine in the treatment of gastroduodenal ulcer.

The therapeutic effects of 1 g/day cimetidine in short-term courses of 21 days have been tested by a double blind study in 20 patients, of which 17 with duodenal ulcer and 3 with both gastric and duodenal ulcerations, in comparison with a similar group of patients who received placebo. The symptomatology was characteristic in all the cases, X-ray presence of ulcer in 17 patients and indirect signs in 3, endoscopic examination positive. The total volume of ClH nocturnal secretion, as well as the basal and maximal hydrochloric secretions decreased, but the differences with respect to the initial values were not statistically significant; the inhibition of gastric acid secretion by cimetidine amounted to 40%; ulcer healing was noted in 3 out of 17 cases. The adverse effects were rare: sleeplessness in 6 cases, asthenia in 4, dry mouth in 3. The differences between the results of cimetidine administration and those in the placebo group had no statistical significance. It is concluded that a short-term course of 21 days is not sufficient to obtain healing of the gastric or duodenal ulcerations.

The renal involvement in scleroderma. A clinical and morphologic study.

The main clinical, biologic, immunologic and morphologic changes characteristic of the sclerodermic nephropathy have been investigated during a mean period of 3.8 years in 21 patients with scleroderma, 19 women and 2 men, with a mean age of 36.1 years. The results obtained have revealed the frequent (38.1%) and early renal involvement, with constant arteriolar and glomerular lesions. Proteinuria was the most frequent (28.6%) and early sign of renal damage. The urinary sediment was poor and the immunologic investigations unconclusive. Dosage of urinary proteins by sensitive techniques (immunoquantitation) and renal biopsy have proved to increase the accuracy of studies for the detection of sclerodermic nephropathy in its initial stage.

Autoantibodies against the basal cell layer: an association with chronic hepatitis B.

The presence of antibodies against the basal cells of squamous epithelium (BCL-Ab) was studied by indirect immunofluorescence in Rumanian and Swedish carriers of hepatitis B surface antigen (HBsAg), in patients with acute viral hepatitis (AVH), chronic liver diseases (CLD), and various other diseases, and in apparently healthy subjects. Titers of BCL-Ab greater than or equal to 40 were found in 8% of 320 HBsAg carriers, in 20% of 292 patients with CLD associated with HBsAg, and in 2% of 816 patients with HBsAg-negative CLD. BCL-Ab were not found in 167 patients with AVH, nor in 1389 patients with various nonhepatic conditions, nor in 344 apparently healthy subjects. These data indicate an association of BCL-Ab with CLD predominantly of hepatitis B etiology. Possibly hepatitis B virus may induce a form of liver metaplasia with the expression of an antigen with a specificity in common with the regenerative layer of basal cells in the squamous epithelium.

Anti-albumin antibodies in chronic liver diseases: diagnostic significance of these antibodies in patients with conventional or immunosuppressive therapy.

The two categories of anti-albumin antibodies (AAA), namely precipitins (AA-P) and agglutinins (AA-Aggl), were investigated in 260 patients with morphologically diagnosed chronic liver diseases (CLD). A parallelism was observed between AA-P titre and the severity of chronic hepatitis as revealed by clinical diagnosis. Thus, significant differences in AA-P titre were noticed between chronic persistent hepatitis (CPH) and chronic aggressive hepatitis (CAH) and between CAH and liver cirrhosis (LC). No correlation was found between AA-P positivity and either HBsAg presence or disease activity, maximum AA-P values being registered in decompensated, inactive LC. AA-P positivity was found associated with a higher degree of liver cell dysfunction. In every category of CLD a striking association was also observed between AA-P positivity and raised serum aspartate transaminase and bilirubin levels, thus suggesting a common pathogenic substrate, namely liver cell membrane damage. These correlations were also observed after immunosuppressive therapy which would argue for the maintenance of AA-P diagnostic value. AA-Aggl showed raised incidences and titres in CAH patients, the values decreasing in LC. Therefore, the main diagnostic value is attributed to AA-P.