The role of capsule endoscopy in the detection of small bowel disease.

Videocapsule endoscopy (VCE) can identify lesions in the small bowel which would otherwise be hard to detect. We have selected 53 patients with digestive symptoms in which upper and lower endoscopy had provided no findings. Patients were classified into three groups, based on their main indication for VCE exploration: group one--obscure gastrointestinal bleeding (OGIB); group two--unspecific abdominal symptoms; group 3--monitoring of a prior known pathology. We found that VCE has high predictive values, sensibility and specificity in the diagnosis of OGIB. VCE was also useful in the detection and extent evaluation of lesions in Crohn's and celiac disease. VCE is also able to detect tumors of the small bowel with sufficient accuracy, and can be used to monitor patients with hereditary pre-malignant diseases such as FAP. There were few light adverse effects and no major complications. We conclude that VCE is a safe and effective procedure for the detection of small bowel lesions.

Axillary and perianal leiomyosarcoma: report of two cases.

Soft tissue leiomyosarcoma is a relatively rare malignant tumor. It may be difficult to be distinguished from gastrointestinal stromal tumors and Schwann cell neoplasms. To make a correct identification of soft tissue leiomyosarcoma, immunostaining with several smooth muscle differentiation markers (actin, calponin and desmin), and negative staining results with S100 (to rule out Schwann cell neoplasm), c-kit and CD34 (to rule out gastrointestinal stromal tumors) is needed. Prompt diagnosis and referral are desirable, since the size of the tumor at presentation is a continuous variable for the risk of local recurrence and metastatic disease. Chemosensitivity varies according to the tumor subtype, and the tumor grade, the patient's age, performance status, and the timing of metastatic disease further influence the likelihood of a response and survival. Chemotherapy is palliative for most patients with unresectable or metastatic disease. Ifosfamide and doxorubicin are routinely used in this setting; doxorubicin as a single agent is considered the drug of choice.

Videocapsule endoscopy and single balloon enteroscopy: novel diagnostic techniques in small bowel pathology.

Videocapsule endoscopic (VCE) exploration represents a major breakthrough in non-invasive imagistic, especially of the small bowel. Our study group consisted of 29 initial subjects admitted in the 1st Internal Medicine and Gastroenterology Clinic at the Emergency County Hospital of Craiova between June 2008 and March 2009. We have excluded a number of eight subjects from the VCE-group, as their pathology represented an absolute contraindication for capsule ingestion. The remaining 21 patients (11 men - 52.38% vs. 10 women - 47.61%) underwent videocapsule diagnostic investigation followed by single balloon enteroscopy with biopsy or surgical removal, where case. Large resection cups were histologically prepared in the Pathology Department of the Emergency County Hospital of Craiova. We performed a statistical analysis of the data using Fisher's Exact Test, which is applicable to small numbered lots. In five cases (23.80%) VCE investigation did not reveal any abnormalities. Five (23.80%) cases had non-tumoral pathology, all of them being inflammatory lesions. We found tumoral lesions in 11 (52.38%) cases: five (23.80%) benign and six (28.57%) malign. We found that inflammatory lesions predominantly affected subjects in the 15-30 and 30-45 years intervals (p=0.00103), whereas tumoral lesions are positively correlated with old age, predominantly affecting the 45-60 and above 60-year-old groups (p=0.00216). VCE combined with SBE open new frontiers for small bowel exploration. Histology remains the single most accurate test for establishing the nature of a lesion.

Crohn disease or intestinal fistulising tuberculosis? Diagnosis difficulties in a case treated with infliximab and corticosteroids.

UNLABELLED: Crohn disease represents an idiopathic inflammatory bowel disorder with possibility of local and extra intestinal complications. Infliximab therapy is one of major therapeutic alternatives but this treatment may by followed by several possible infections, especially the reactivation of a latent tuberculosis. We present a case of a 28-year-old patient who was admitted in our hospital with clinical signs of bowel obstruction. Colonoscopy revealed close stenosis al the level of splenic flexure. Surgery was soon performed for the imminence of occlusion and pathology has revealed chronic inflammatory infiltrate with lymphocytes and plasma cells, interpreted as Crohn disease complicated with stenosis. A treatment with prednisone 30 mg/day, ciprofloxacin 1000 mg/day administrated intermittently and sulphasalasine 3 g/day for one year was indicated but the patient develop external abdominal fistula. Infliximab therapy 5 mg/kg/dose was administered at two weeks interval, with initial good results after two doses. At two weeks after the second dose, the patient has presented fever and weight loss; abdominal CT-scan has revealed inflammatory adherences of right flexure of the colon with external fistula, resolved by surgery. The evolution was later complicated by right tibio-tarsian involvement, which imposed orthopedic intervention. Pathology has revealed bone tuberculosis and antibacillary therapy was initiated with good results. CONCLUSIONS: Bone tuberculosis may represent a rare evolutive modality at a patient with Crohn disease treated by Infliximab and corticoids. Infliximab therapy in a patient with immunosuppressant (previous corticotherapy, splenectomy) may activate a latent center of tuberculosis. Ciprofloxacin therapy may explain insidious modality of evolution by minor antibacillary effect.

The Role of Ultrasound in Assessing Hand Joints and Tendons in Psoriatic Arthritis.

INTRODUCTION: Psoriatic arthritis (PsA) is an inflammatory arthritis, usually involving peripheral joints, associated with cutaneous psoriasis, in the absence of rheumatoid factor and anti-citrullinated protein antibodies. MATERIAL AND METHODS: The study included 28 patients diagnosed with psoriatic arthritis according to CASPAR criteria, presenting pain or swelling of the small joints of the hands and wrists, hospitalized in the Department of Rheumatology of the Emergency Clinical County Hospital of Craiova during 2016-2018. RESULTS: In the 28 patients, a total of 840 joints were examined clinically and by ultrasound. From the clinical point of view, out of the total, 32 joints were swollen while 59 joints were tender. Dactylitis was evidenced in 20/280 examined digits upon physical examination. MUS revealed the presence of synovial proliferation in 108/840 sites (12.85%), with grade 1 synovitis in 4 joints (3.7%), grade 2 in 94 joints (87.03%) and grade 3 in 10 joints (9.25%). Out of 280 examined fingers 5.71% presented dactylitis, the third digit being the most commonly targeted. Grade 2 tenosynovitis was found in 40 of the examined tendons, whereas 8 tendons presented with grade 3 tenosynovitis. The most frequently involved were the flexor tendons of the digits (38 out of 40 tendons with inflammatory changes), followed by the extensor carpi ulnaris and flexor carpi radialis tendons. CONCLUSIONS: Ultrasound has proven its utility in assessing joint and tendon inflammation to a higher extent that clinically expected. Thus, MUS examination of hand joints may aid the clinician in diagnosing PsA, in evaluating the prognosis and the course of treatment.

Nonalcoholic fatty liver disease and metabolic syndrome: a concise review.

Non-alcoholic fatty liver disease (NAFLD) is a clinicopathological entity increasingly recognized as a major health burden in developed countries. In the last decade, several studies have independently provided evidence for a strong association between NAFLD and each component of the metabolic syndrome, including central obesity, hyperglycemia, dyslipidemia, and hypertension. This article focuses on epidemiological, clinical, pathogenic and therapeutic aspects, which link these two syndromes.

Glomerulopathies in locked-up persons. Histopathologic and clinic study.

The diseases of the urinary apparatus are frequently-enough inside the locked-up spaces of the penitentiaries. Among them, glomerulonephritis and pyelonephritis take a special place, by their late diagnosis and their lasting evolution. The authors clinically and paraclinically investigated a number of 214 locked-up male persons aged between 18-57 years, presenting various clinical forms of glomerulonephritis. Histopathological exams performed in 51 patients confirmed the diagnosis.

Evaluation of Gastric Carcinomas Histological Patterns in Relation to Tumors Aggressiveness Parameters.

Gastric carcinomas are frequent tumors with variable growth patterns that may interfere with the evaluation of histopathological prognostic parameters of the lesions. In this study we analyzed the incidence and statistical relation of histological growth patterns depending on the prognostic parameters of gastric carcinomas for 95 cases. Pure forms were present in 82.2% of cases, from which more frequent subtypes were low grade tubular carcinomas and poorly cohesive with signet-ring cells carcinomas. Mixed forms were present in 17.8% of cases, with the highest incidence of tumors containing well differentiated tubular carcinoma and poorly differentiated papillary carcinoma areas. Analysis of the identified types and subtypes in relation to the histological prognostic parameters indicated significant differences regarding the tumor stage, the mixed subtypes being more frequent in advanced stages. Although mixed subtypes were more commonly associated with vascular and perineural invasion, the aspects were statistically insignificant. Together with tumor stage, the lymphovascular and/or perineural invasion should be taken into consideration as prognostic indicators in the postoperative management of gastric cancer.

Clinical and Ultrasound Assessment of Enthesis in Psoriatic Arthritis in a Romanian Cohort.

INTRODUCTION: Spondyloarthritis (SpA) is a group of chronic inflammatory disorders which includes ankylosing spondylitis (SA), psoriatic arthritis (PsA), reactive arthritis (ReA), arthritis associated with inflammatory bowel disease (IBD) and undifferentiated spondyloarthritis (uSpA). The enthesis, the area of insertion of the tendon, ligament or joint capsule onto the bone, can be characterized as a central feature in PsA. MATERIAL AND METHODS: The study included a number of 28 patients, 18 females and 10 males, with PsA hospitalized during 2016-2018 in the Department of Rheumatology of the Emergency County Hospital of Craiova. All the patients were diagnosed with psoriatic arthritis according to CASPAR criteria and had a history of entheseal pain, mandatory criteria for inclusion in the study. All patients underwent clinical examination, laboratory tests and musculoskeletal ultrasonography (MSUS). RESULTS: The Belgrade Ultrasound Enthesitis Score (BUSES) was not significantly associated either with ESR (p=0.536) or CRP (p=0.965) values. Furthermore, the clinical evaluation through the LEEDS enthesitis index (LEI) showed no significant association with ESR (p=0.067) or CRP (p=0.206). Despite MSUS and clinical findings, there was no significant correlation between disease activity in psoriatic arthritis (DAPSA) and BUSES (p=0,549) or LEI (p=0,197). However, clinical and echographic scores (BUSES and LEI) were significantly associated (p=0.001). CONCLUSIONS: Our study proved a significant correlation between LEI and BUSES, although in literature the evidence is contrasting. This is probably due to the fact that the majority of the patients had high disease activity which made the clinical assessment similar to the US. Further studies on more numerous groups of patients have to be conducted in order to debate the inconsistencies related to clinical and US examinations in patients with PsA.

Study of Histopatological Parameters of Gastric Carcinomas with Micropapillary Component.

Micropapillary carcinoma was recently identified as a carcinoma variant characterized by the presence of small clusters of tumor cells located in optically empty spaces. The study included a number of 14 cases represented by surgical excision specimens diagnosed with gastric carcinoma (tubular, papillary and signet-ring) which associated the micropapillary component in variable proportions. Regarding the low-grade tubular carcinomas, the micropapillary component represented less than 25% of the tumor, while in the high-grade tubular carcinomas and papillary carcinomas it represented 25-50%. Among signet-ring carcinomas, the micropapillary component had a percentage of over 50. The depth of invasion was frequently associated with T3 and T4 categories. Lymph nodes metastasis were found in ten cases and distant metastasis were present in three cases. Recognition of the micropapillary component associated with gastric carcinoma represents an aspect of great importance because it is frequently correlated with unfavorable prognosis parameters.

Hepatitis C Infection in Hemodialysis Patients.

Three centuries after the identification of hepatitis C virus (HCV), specialized literature has outlined the epidemiology, viral kinetics and clinical manifestations of this infection. A major cause of morbidity-mortality in patients with renal transplantation and in hemodialysis patients is HCV infection. In high seroprevalence countries, internal accounts are not uniform. The European trend is to decrease the incidence and prevalence of HCV in hemodialysis patients. In Europe, the prevalence of HCV infection among hemodialysis patients tends to be higher than that of the general population, but it is variable by region. Some studies indicate a decrease in incidence in parallel with prevalence in dialysis centers over the last 10 years, while others maintain a high incidence. In some countries, as is the case with Romania, both prevalence and incidence remain high, with the major route of transmission being nosocomial, probably due to limited resources for a rapidly growing dialyzed population. Some authors recommend more isolation measures to be taken in centers with high prevalence of infection.

Noninvasive Fibrosis Assessment in Chronic Viral Hepatitis C associated with End Stage Renal Disease.

INTRODUCTION: HCV is considered the most encountered viral infection that affect patients after hemodialysis sessions. Even though liver biopsy is considered the golden standard for hepatic diagnosis, additional methods have been used for assessing liver fibrosis. Transient elastography (TE) has evolved as a reference method in some European countries and allows the physician to carry out a fibrosis evaluation in a noninvasive, low-cost and rapid method. Our objective was to assess the efficacy of TE in staging patients with HCV liver disease associated with ESRD, thus choosing the correct moment to perform the procedure. MATERIALS AND METHODS: We included 34 patients known with ESRD within the regional Nephrology Clinic of Olt County Hospital and also having positive hepatitis C viral liver marker. TE was performed before and hemodialysis and data was analyzed. RESULTS: The patients where we have encountered significant changes were especially within the F0 and F1 stage with a decrease of fibrosis after hemodialysis. Thus, 7 patients which had no fibrosis (F0) went from 4,14±0,98kPa to 3,54±0,84 (p<0,05) and 12 patients from the F1 stage went from 6,22±0,39kPa to 5,47±0,58kPa. The other stages had no significant changes with F2 changing after hemodialysis from 8.03±0,62kPa to 7, 76±0,6kPa. CONCLUSIONS: TE represents a valuable tool for stiffness assessment and should be taken into considerations as a major option for ESRD patients with liver disease. However, more patients should be enrolled to strengthen this theory and thus providing more reliable results.

Antiviral therapy effects upon hepatitis C cholestatic syndrome.

Cholestasis includes, as a syndrome, all clinical and biological manifestations caused by the deficient or simply absent biliar secretion or caused by the obstruction of the biliary ducts. The hepatic cholestasis from the chronic hepatitis C (HC VHC) is a result of the altered interlobular biliary canalicules, caused by the modified cellular transport mechanisms and it is associated with a medium to severe degree of fibrosis. The aim of this study was to evaluate the efficiency of antiviral therapy in HC VHC patients. The study included a number of 37 HC VHC patients admitted at the Medical Department no. 1 of the Emergency County Hospital of Craiova; they were treated with Pegasys, 180 microg/week and Copegus, 1000 or 1200 mg/day, taking in consideration their weight, for 48 weeks and they were monitored for 24 weeks after the treatment. The following parameters were analyzed: direct bilirubine, total cholesterol, alkaline phosphatase, gamma-glutamiltranspeptidase and leucin-aminopeptidase. Under treatment, the clinical status caused by the cholestasis (pruritus, icteric syndrome, hemoragipary syndrome) was improved in six of the given cases (16.22%). Before therapy, the hepatic cholestasis was present in 20 patients (54.05%), and after treatment in 14 patients (37.83%). During therapy, the average values for all the monitored parameters decreased: direct bilirubine (0.38 +/- 0.18 mg/dl vs. 0.34 +/- 0.24 mg/dl, p = 0.0867), total cholesterol (198.53 md/dl vs. 183.16 mg/dl, p = 0.0808), alkaline phosphatase (236.99 +/- 79.09 iu/l vs. 227.82 +/- 87.59 iu/l, p = 0.0845), gamma-glutamiltranspeptidase (47 +/- 32.89 iu/l vs. 43.91 +/- 29.66 iu/l, p = 0.1509), and leucin-aminopeptidase (32.33 +/- 13.22 iu/l vs. 28.95 +/- 14.22 iu/l, p = 0.0038). Under antiviral treatment there was noticed an improvement of the cholestasis clinical status in a small number of cases. Antiviral therapy favorably influenced the liver cholestasis associated in patients with chronic hepatitis C in a rather small proportion. Under Interferon pegylate and Ribavirine treatment, low levels of direct bilirubine, cholesterol and enzymes were found. Hepatic cholestasis and, especially, the high serum values of gamma-glutamiltranspeptidase have a negative influence upon antiviral therapy, causing the low sustained virological response.

Telangiectasia Detection in Wireless Capsule Endoscopy Using the Color Slicing Technique.

Wireless capsule endoscopy represents a color imaging technology in the field of medical endoscopy that is extensively used to detect lesions of the human digestive tract. It is the golden standard in evaluating small bowel lesions, offering a set of digital snapshots difficult to get using other investigation methods. Its major drawbacks are the time consumed for image analysis and the burden for the physicians that must spot and classify lesions within more than 55000 images. This paper carries out a study on the detection of telangiectasia in the small bowel, based on an adapted color slicing technique applied not only on unique frames, but on series of successive frames, performing a global analysis suitable on partial sequences or entire wireless capsule endoscopy movies. We have quantified the extracted features and determined a weighting algorithm to find telangiectasia lesions. For frames containing potential lesions, we have determined features not only for the global image, but also for the normal mucosa surrounding the lesion extracted from the image. This approach allows the physician to see variations of parameters within a frame or a sequence that contains lesions. Experimental results prove that the algorithm is effective in detecting telangiectasia patterns of different images, with an accuracy of 93.88%, reducing thus the time spent for the analysis of the images acquired by wireless capsule endoscopy.

The Role of Early Diagnosis of Hepatorenal Cystic (HRC) Syndrome in Children-Clinical Trial.

The hepatorenal cystic (HRC) syndrome is a heterogeneous group of severe monogenic conditions that may be detected before birth. Effective programme evaluation of children with HRC syndrome is a systematic way to identify the renal and urinary tract malformations which represent the most common cause of end-stage renal disease (ESRD). We conducted a study involving 50 patients, who were between 3 months and 16 years of age, with multiple admissions in the Nephrology Department of "Maria Sklodowska Curie" Children Emergency Hospital from Bucharest, during 6 years (April 14th 2010-October 24th 2016), to evaluate the HRC syndrome. The admission symptomatology was mainly represented by the nephrology evaluation which was essential in the management of children's polycystic kidney disease. For example, a premature infant (gestational age=32 weeks) with positive heredo-collateral history (mother and grandmother were diagnosed with polycystic kidney disease), was tested positive for cystic renal disease after the fetal morphology was performed. It was also done a genetic determination for the presence of PKD1 and PKD2 mutations which are specific to autosomal dominant polycystic kidney disease-ADPKD. However, the genetic test was negative and a postnatal nephrological evaluation was performed using renal ultrasound. The image revealed autosomal recessive polycystic kidney disease-ARPKD. This study emphasizes the importance of an early diagnosis (prenatal, neontal, postnatal) correlated with the admission symptoms and also with the genetic diagnosis (mutations of PKD1 and PKD2).

Upper Gastrointestinal Bleeding - Initial Manifestation of Pancreatic Head Carcinoma.

Pancreatic head carcinomas are a rare cause of upper digestive bleeding and the diagnosis and the treatment of these pose particular problems. We selected 6 cases from a number of 283 patients who were hospitalized for surgery between January 2014 and December 2016 with signs of upper digestive bleeding with no varicose origin who were subsequently diagnosed with pancreatic head carcinomas. The diagnosis was established by endoscopic and surgical methods. The evolution of these patients was influenced by whether there was active digestive bleeding or history of digestive bleeding and the possibility of tumor resection. Four patients needed emergency surgery due to continuous bleeding or rebleeding. The resectability of the cephalo-pancreatic tumor was determined and then subsequently performed in two patients who had a favorable postoperative outcome, while in two patients the tumor resection was impossible. The other two patients with upper digestive haemorrhage responded favorable to drug therapy, and digestive endoscopy and CT explorations were negative. After a 5-month interval they presented with clinical signs of a pancreatic neoplasm with invasion into the common bile duct, unwanted weight loss, abdominal pain, and icterus of the sclera and skin. The surgical intervention resulted in the confirmation of locally advanced pancreatic head carcinomas and the performing of bilio-digestive derivations. Pancreatic head carcinomas may be associated with upper digestive tract haemorrhage due to duodenal or bile duct invasion. The clinical picture of these patients can vary from occult haemorrhage to severe upper digestive tract haemorrhage accompanied by hypovolemic shock.

Hepatocellular Carcinoma in Diabetic Patients - a Single Center Experience.

INTRODUCTION: Hepatocellular carcinoma (HCC) represents a major health concern worldwide; identifying risk factors and associated conditions that may lead to its development are therefore of utmost importance to the medical community. An association between diabetes mellitus (DM) and development of HCC on underlying liver conditions has been previously suggested. The aim of our study is to reveal possible significant statistical correlations between the two entities, which might warrant further study of the pathophysiological mechanisms behind this association. PATIENTS AND METHODS: We have prospectively included consecutive cirrhotic patients admitted to our medical clinic over a period of four years, between 2010 and 2014. Diagnostic was established using the EASL criteria. We have documented history of hyperglycemia and any changes of serum values in these patients, evaluating DM patients within the LC lot. From these patients we have selected all patients with imaging suggestive for HCC and established positive diagnosis on the criteria established in the latest EASL guidelines. We have used statistical tests to identify possible correlations between these pathologies. RESULTS: We have identified 2718 consecutive patients with LC and successfully included 2556. Of these, 164 also had HCC. A total of 371 patients had DM - 54 also had HCC while 317 remained cancer-free through our study period. We found positive correlations between the presence of DM and HCC. Subgroup analysis of the HCC cohort revealed a positive association between DM and liver cirrhosis and chronic hepatitis. We did not find positive relationships between DM and overall liver conditions, splenomegaly, hepatomegaly, other significant symptoms, substance abuse and main serum values. CONCLUSIONS: We have found several significant correlations between DM and underlying liver conditions in a HCC cohort. Our study, however, did not reveal other significant associations regarding these diseases. Further studies are required to determine the precise role this disease plays in the development and severity of liver diseases.

The Evaluation of Beta-2-Adrenoreceptors' Expression in Normal Peritumoral Tissue in Patients with Colorectal Adenocarcinoma.

INTRODUCTION: The aim of this study is to evaluate the expression of beta-2 adrenergic receptors in the normal peritumoral tissue at the colorectal level, just after the front tumor invasion, in patients with colorectal cancer. METHODS: In this study we analyzed normal peritumoral tissues belonging to 56 patients, who were diagnosed with colorectal adenocarcinoma. These tissues were fixed in paraformaldehyde and paraffinembedded. The immunohistochemical study was done on seriate slides following the hematoxylin and eosin staining, after diagnostic and grading. Correlations were made between beta-2-adrenoreceptors' expression in the normal peritumoral tissue and the clinical and histopathological parameters of the patients with colorectal cancer. RESULTS: There are positive correlations between the expression of beta-2-adrenoreceptors and feminine gender, age group under 50 years, tumor size under 5cm, tumor invasion T3-4 and tumor metastasis in regional lymph nodes N≥2. By analyzing the expression of beta-2-adrenoreceptors in peritumoral tissue depending on tumor grading one can notice that there are positive correlations between beta-2-adrenoreceptors' expression and poorly differentiated colorectal adenocarcinoma. CONCLUSIONS: Positive correlation between this type of receptors in normal glandular epithelium, in the vicinity of tumor invasion front of colorectal neoplasm, and certain clinicopathological features suggests the involvement of tumor microenvironment, which expresses them, in the pathogenesis of this neoplasm.

Endoscopical and histological features in bile reflux gastritis.

Bile reflux gastritis is due to an excessive reflux of duodenal contents into the stomach. The increased enterogastric reflux may provide the basis for increased mucosal injury. Bile reflux gastritis can appear in two circumstances: gastric resection with ablation of pylorus and primary biliary reflux due to the failure of pylorus. The aim of the study was to evaluate the endoscopical and histological changes caused by duodenal reflux on the gastric mucosa. The mucosal features were correlated with the risk factors involved in the development of bile reflux gastritis. Our study included 230 patients with alkaline reflux gastritis admitted in Medical Clinic no. 1, Emergency County Hospital Craiova. In all cases we performed an upper gastrointestinal endoscopy. Multiple biopsies were taken from gastric mucosa in 89 patients and the histological features were scored in accordance with the Sydney system. The average age of the patients with bile reflux gastritis was 58.387 years and the incidence of alkaline reflux gastritis was higher between 51 and 80 years. Reflux gastritis was noted to 138 males lpar;60%rpar; and 92 females (40%), ratio males/females was 1.5/1. The most frequent risk factors for bile reflux gastritis were gastric and biliary surgery. Alkaline reflux gastritis was observed in 167 cases (72.6%) after gastric surgery, consisting in gastric resection, pyloroplasty and gastroenteric-anastomosis. Gastroduodenal reflux after biliary surgery was noted in 17 cases (7.39%), 13 cases (5.69%) with cholecystectomy and four cases (1.73%) with biliary anastomosis. The average time interval from original operation to the discovery of the alkaline reflux gastritis was 14.91 years after gastric surgery and 15.29 years after biliary surgery. The commonest endoscopic alterations were: erythema of the gastric mucosa in 139 cases (64.43%), the presence of bile into the stomach in 133 cases (57.83%), the thicken of gastric folds in 22 cases (9.55%), erosions in 12 cases (5.22%), gastric atrophy in 12 cases (5.22%), petechiaes in five cases (2.17%), intestinal metaplasia one case (0.43%) and gastric polyp one case (0.43%). The histologic alterations observed from tissues collected during endoscopic examination were: chronic inflammation in 75 cases (84.06%), foveolar hyperplasia in 36 cases (40.44%), intestinal metaplasia in 31 cases (34.83%), acute inflammation in 16 cases (16.08%), Helicobacter pylori infection in 16 cases (16.08%), chronic atrophic gastritis in 12 cases (13.46%), gastric polyps in 12 cases (13.46%), dysplasia in 10 cases (11.23%), benign ulcerations in seven cases (3.04%), edema in six cases (6.74%) and neoplasia two cases (2.24%). Conclusions. Bile reflux gastritis was more frequent to male gender. The most frequent risk factors for alkaline reflux gastritis were gastric and biliary surgery. Reflux gastritis after gastric resection, pyloroplasty and gastroenteric-anastomosis were more frequent to male gender, while cholecystectomy and biliary anastomosis were predominantly to female gender. The average time interval from original operation to the discovery of the bile reflux gastritis was similar after gastric and biliary surgery. The commonest endoscopic alterations were: erythema of the gastric mucosa, the presence of bile into the stomach, thickens of gastric folds, erosions, gastric atrophy, petechiaes, intestinal metaplasia and gastric polyp. Acute inflammation, Helicobacter pylori infection, gastric polyps and benign ulcerations were more frequent in patients with bile reflux gastritis after gastric surgery, while edema and dysplasia were increased after biliary surgery.

The follow-up of the efficacy of antiviral therapy at patients with chronic hepatitis C.

Hepatitis C virus infection can cause progressive liver injury and lead to fibrosis and eventually cirrhosis. Peginterferon alfa-2a represents a significant advance in the treatment of patients with chronic hepatitis C. The aim of the study was to investigate the efficacy, safety and tolerability of the therapy with Peginterferon alfa-2a plus Ribavirin in patients with chronic hepatitis C. The study was made on a number of 37 patients with chronic hepatitis C, admitted in Medical Clinic no. 1, Emergency County Hospital Craiova. The diagnosis of chronic hepatitis was established by means of clinical, biological and morphological investigations. Patients received 180 mug subcutaneously of Pegasys, once weekly, along with either 1000 or 1200 mg/day of Copegus, depending on their weight, for 48 weeks, with 24 weeks of treatment -- free follow-up. We evaluated: sustained virological response, histological response and adverse events. All patients were monitored using blood tests, control of viremia and liver functional tests. Analysis viral response revealed that 11 patients (29.72%) achieved sustained virological response. Histological response was obtained in 20 cases (54.05%) with chronic hepatitis C. The adverse events for Pegasys and Copegus combination therapy were reported in 21 cases (56.72%). Antiviral therapy had positive effect on subjective symptoms in almost half of patients included in our study. An improvement of liver functional tests was noted in the most cases. A third of patients who received Peginterferon alfa-2a plus Ribavirin had sustained virological response. Histological response was noted both at patients with sustained virological response and with unsustained virological response. The side effects of the antiviral treatment are frequent and the severe ones, which require dose reduction, are present at a low number of patients.