Activated Hepatic Stellate Cells (Ito Cells) - Marker of Advanced Fibrosis in Chronic Viral Hepatitis C: A Pilot Study.

BACKGROUND AND AIMS: The aim of this study is to determine whether activated hepatic stellate cells (HSCs) may represent a prognostic marker of progressive liver fibrosis in chronic viral hepatitis C (VHC) before antiviral therapy. The possible correlation between HSCs immunohistochemical features, histopathological aspects and clinical data before therapy were also studied. METHODS: This retrospective pilot study was conducted on 27 liver biopsies from VHC patients before antiviral therapy. HSCs's immunohistochemical analysis used the antibodies alpha-smooth muscle actin (α-SMA), glial fibrillary acidic protein (GFAP) and vinculin. We correlated immunopositive HSCs with HCV load, liver stiffness (LS), fibrosis stage and necro-inflammatory degree before treatment. Also, we assessed the association between liver fibrosis after therapy, the sustained virological response at 12 weeks after therapy (SVR 12) and the type of therapy. RESULTS: HSCs were increased in VHC patients compared to controls, mainly in the intermediate and periportal lobular regions. α-SMA and vinculin HSCs correlated positively with fibrosis stage (p=0.044), (p=0.028). Furthermore, α-SMA and vinculin HSCs were associated with LS (p=0.027), (p=0.002) and viral load (p=0.021), (p=0.006), but not with necro-inflammation degree. GFAP HSCs inversely correlated with fibrosis stage (r= -0.475), LS (r= -0.422) and HCV load (r= -0.517), but positively with necro-inflammation degree (p=0.038). Liver fibrosis post therapy correlated positively with SVR12 (p<0.001) and the type of therapy (p=0.006) and SVR12 correlated positively with treatment's type (p=0.002). CONCLUSIONS: Activated HSCs may represent a marker of increased liver fibrosis in VHC. Different immunohistochemical markers can detect various HSCs subpopulations involved in the evolution of VHC and liver fibrosis.

Real-Time Contrast-Enhanced-Guided Biopsy Compared with Conventional Ultrasound-Guided Biopsy in the Diagnosis of Hepatic Tumors on a Background of Advanced Chronic Liver Disease: A Prospective, Randomized, Clinical Trial.

We aimed to compare contrast-enhanced-guided liver biopsy (CEUSLB) and ultrasound-guided liver biopsy (USLB) in the diagnosis of focal liver lesions (FLLs) developed on a background of advanced chronic liver disease (ACLD). Between 2011 and 2019, patients diagnosed with liver tumors on a background of ACLD were evaluated for inclusion in the study. Patients were randomly assigned to the CEUSLB or USLB group. In total, 144 patients were randomly assigned to either CEUSLB (n = 79) or USLB (n = 65). Overall, in the CEUSLB group, the sensitivity was significantly better (94.74% vs. 74.6%, respectively; p = 0.001). Both the fragment length of the biopsy specimen and the single puncture success rate were statistically higher in the CEUSLB group (p = 0.022 and p = 0.0006, respectively). There was no difference in terms of major or minor complications (p = 0.682). CEUSLB is a feasible technique that increases the diagnostic sensitivity for liver tumors developed in ACLD.

Fatal Whipple's disease with severe mental manifestations on relapse - case report and brief advances update.

We present the case of a 51-year-old male admitted for asthenia, fatigability, nausea, inappetence, weight loss, watery diarrhea, lower limb paresthesia and diagnosed after further investigations with Whipple's disease (WD). The evolution was favorable under antibiotic therapy but after a period of time the patient was no longer compliant to the treatment and psychotic manifestations, general status alteration and finally the decease occurred. WD is a condition caused by Tropheryma whipplei (TW) bacterium in people with altered macrophage degrading capacity and it is lethal without early treatment.

Malignant endometriosis of the abdominal wall.

Endometriosis is a disease represented by the presence of extra uterine endometrial tissue. It is a rare condition, and malignant transformation is seldom. We report a case with clear cell adenocarcinoma oncogenesis on abdominal wall scar that appeared after years of a caesarian section. After diagnosis, surgical treatment was performed twice, due to the fact that the margins were infiltrated with tumor cells, with replacement of the defect with a polypropylene mesh. The patient was cured and discharged with a favorable prognostic. To the best of our knowledge, there are few reported cases of clear cell adenocarcinoma arising from abdominal wall endometriosis. It is a rare condition that appears mostly after abdominal surgical interventions that clinicians must be aware. KEY WORDS: Abdominal wall, Endometriosis, Cesarean section, Clear cell adenocarcinoma, Malignant transformation.

An atypical case of focal nodular hyperplasia. Problems of imagistic diagnosis.

Focal nodular hyperplasia (FNH) is a hepatic disease first described in 1958. The existence of an accessible and minimally invasive imagistic investigation to establish the diagnosis in a large number of cases would be desirable, especially because once diagnosed, the disease needs no treatment. We present the case of a young woman with long term use of oral contraceptives in which the diagnosis of FNH was established at a routine ultrasound. Evolution of disease during the pregnancy and the atypical imagistic aspect of liver lesions raised many problems of differential diagnosis.

Contrast enhanced ultrasound and computer tomography diagnosis of solid and mixed pancreatic tumors - analysis of confounders.

AIMS. The aim of this study was to evaluate the leading causes of discrepancies between imaging studies [contrast enhanced ultrasound (CEUS) and contrast enhanced computer tomography (CECT)] diagnosis and histology in patients presenting to a tertiary referral center with previously detected pancreatic masses by standard abdominal ultrasound. METHODS. We performed a prospective longitudinal observational study on 76 patients with pancreatic masses: 57 (75%) patients with solid pancreatic tumors and 19 (25%) patients with cystic and mixed pancreatic masses. For each tumor the CEUS and CECT features were analyzed and compared with the final histological diagnosis. RESULTS. Testing the performance of CEUS and CECT in evaluating the benign or malignant etiology of pancreatic masses, we obtained a probability of 82% for CEUS and of 83% for CECT, for a randomly selected individual from the pancreatic tumor group to have an imaging result indicating suspicion for malignancy. We obtained discordances with the histopathological diagnosis in 25 (32.89%) patients for CEUS and in 23 (30.26%) patients for CECT. In multiple regression analysis, two variables independently influenced the discordance between the two imaging methods and histological conclusion: enhancement pattern and tumor nature (solid vs. cystic). CONCLUSIONS.CEUS and CECT showed a good diagnostic performance in differentiating benign from malignant pancreatic tumors. Enhancement pattern and tumor nature (solid vs. cystic) are independent confounders between imaging and histological diagnosis.

Added value of intravenous contrast-enhanced ultrasound for characterization of cystic pancreatic masses: a prospective study on 37 patients.

UNLABELLED: The aim of this study was to evaluate the added value of contrast-enhanced ultrasound (CEUS) in the pancreatic cystic mass (PCM) diagnosis by using a qualitative and quantitative analysis in order to make a relevant characterization. PATIENTS AND METHOD: Between December 2008 and November 2011, 37 patients with PCM discovered at ultrasound examination were prospectively followed. A qualitative and quantitative CEUS analysis was performed in order to differentiate etiologies of the PCM. In the quantitative analysis several parameters were followed: Peak Intensity (PI), Time to Peak (TTP), maximum ascending gradient (GRAD), Time to maximum gradient (TTG) and Area Under the Curve (AUC). Normalized ratios were also calculated. In all patients a definite cytological or histological diagnosis was obtained. RESULTS: Thirty-seven patients were studied: 12 with pancreatitis-associated pseudocyst and 25 with cystic tumors (10 serous cystic adenoma, 5 mucinous cystic adenoma, 6 cystadenocarcinomas, 2 solid pseudopapillary tumors and 2 intraductal papillary mucinous neoplasms). There was a significant difference of the nAUC and nTTP between pseudocyst and cystic tumors, p=0.03 and p=0.01, respectively. A normalized TTP value above 7 sec was suggestive for the diagnosis of pseudocysts with 79.16 % accuracy. There was a significant difference of nTTP and nTTG between the benign and malignant lesions. nTTP < 9 sec and nTTG < 8.5 sec rules out malignant cysts in almost 90% of cases. CONCLUSION: The CEUS is useful in the diagnosis of PCM. The quantitative analysis of the enhancement of the cystic wall may discriminate the different types of the PCM.

[Prophylactic CPAP versus therapeutic CPAP in preterm newborns of 28-32 gestational weeks]. / CPAP precoce versus CPAP terapeutic la prematurii de 28-32 saptamâni de gestatie.

UNLABELLED: Strategies in ventilation and in exposure to the oxygen that minimise lung injury improved the prognosis of the extremely low weight newborns. Avoiding intubation can prevent the reduction of mucociliary flow, injury of the mucosa and infection. Using early CPAP isn't unanimous; there are differences between studies in what are concerned: the beginning of the treatment, gestational age, methods. CPAP is used in the treatment of respiratory arrest of infants since 1971, initially endotracheal, than with different nasal instruments. The studies evaluate the benefits of prophylactic or curative CPAP. OBJECTIVES: To compare the necessity for mechanical ventilation and surfactant administration, complications and the period of hospitalisation in VLBW and ELBW, that were under prophylactic or curative CPAP. MATERIAL AND METHOD: We made a prospective study on 90 newborns, during january 2004 and june 2006, that were not intubated in the delivery room with no major malformations. Preventive CPAP was applied in the first half an hour after birth. therapeutical CPAP was applied only in infants with the necessity in oxygen over 40%, to maintain the saturation between 90 - 95%. Group A (curative CPAP) - 25 cases, the average for gestational age 30,30+/-2,45 weeks and for birth weight 1588,00+/-573,05. For group B the averages were: 30,08+/-2,30 weeks and 1508,50+/-400,83 grams. RESULTS: Surfactant was necessary in 40% of group A, over 23% in group B (p = 0,269). Mechanical ventilation in first 72 hours of life was necessary in 18 cases (72%) - A and in 35 cases (53,84%) - B. The necessity for CPAP in hours: 92,15+/-3,85 in group A, over 112,25+/-5,75 group B (p = 0,044). Complications we considered: PDA and cerebral hemorrhage. We had 8 cases (38%) of group A with PDA, significantly different of group B: 5 cases (7,69%). Cerebral hemorrhage was absent in 40% of group A and in 73,84% in group B (p = 0,11). CONCLUSIONS: CPAP is a non invasive method with benefits in the treatment of the respiratory arrest in preterm newborn of 28 - 32 gestational weeks. Using early CPAP may reduce: necessity for surfactant, mechanical ventilation and PDA.