Biochemical and ultrasound aspects in chronic viral hepatitis C patients.

AIM: Biochemical and ultrasound investigations in patients with chronic hepatitis C on a 48-week anti-viral regimen. MATERIAL AND METHODS: A group of 6 patients, 4 women and 2 men, age range 24-61, were evaluated at the beginning of therapy and compared after 48 weeks of peginterferon alfa-2a and peginterferon alpha-2b regimen at doses established by the National Treatment Program approved by the Romanian National Health Insurance House. RESULTS: ALT and AST levels have decreased in all patients. The viral load was undetectable in two patients, both females, after 48 weeks of therapy. Ultrasound images showed a decrease in size of the right and left hepatic lobes and portal vein diameter after 48 weeks. CONCLUSIONS: Inhibition of virus by interferon and ribavirin resulted in the reduction of inflammatory phenomena and regenerative fibrosis noticed after a very long period of time (at least 48 weeks). Further studies performed on larger patient groups are needed in order to better describe all these changes.

Spiral enteroscopy--a novel method for the management of small bowel diseases--case report and description of technique.

Small bowel diseases are associated with difficult management. Recently, new methods such as single or double balloon enteroscopy and capsule endoscopy have been implemented for the investigation of small bowel, but none is perfect. Spiral enteroscopy seems to be an alternative primising technique for the diagnosis and therapy of small bowel diseases. We report two cases in which spiral enetroscopy was useful both for diagnosis and therapy. One was the case of a man with repeated digestive bleeding of unknown cause and spiral enteroscopy helped for diagnosis and treatment with argon plasma coagulation of the vascular lesions. The later was a patient with Gartner Syndrome with multiple duodenal and intestinal polyps and spiral enteroscopy allowed small bowel evaluation. In conclusion, this novel method seems to allow a rapid and efficient diagnosis of small bowel diseases.

[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.

[The relationship between bile reflux and symptoms in patients with gallstones before and after cholecystectomy]. / Influenta refluxului biliar asupra simptomatologiei la pacientii cu litiaza biliara veziculara pre- si postoperator.

UNLABELLED: Many hypotheses affirm that postcholecystectomy syndrome is caused by alterations in bile flow due to the loss of the reservoir function of the gallbladder. We aimed to establish the relationship between postcholecystectomy symptoms and bile reflux. MATERIAL AND METHOD: Thirty patients with gallstones were included in the study. All patients underwent combined ambulatory pH and bile monitoring (Bilitec). Three months after cholecystectomy, the tests were repeated. RESULTS: Before surgery, the median (interquartile range) total time pH < 4 was 2.8% (0.2-14%) and bilirubin absorbance > 0.14 was 4.1% (0-17%). After cholecystectomy, the median total time pH < 4 was 3.7% (1.5 %-11.4%) and bilirubin absorbance > 0 14 was 13.25% (5.30%-26.5%). The correlation between total time pH < 4 and total time bilirubin absorbance > 0.14 for all patients was good: r = 0.55, p < 0.001. Before surgery 65.03% of symptoms were not associated with neither acid nor bile reflux and postcholecystectomy 37.87% of symptoms were associated with bile reflux and 36.95% without any reflux. Cholecystectomy determines increased biliary reflux compared to the patients with gallstones. Related to gallstones, after cholecystectomy dyspeptic complains are more often related to bile reflux. CONCLUSION: Although cholecystectomy itself does cause increased biliary reflux, in most patients with significant duodenogastric reflux symptoms were not correlated with biliary reflux.

[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.

[Radiofrequency ablation of malignant liver tumours]. / Ablatia prin radiofrecventa a tumorilor maligne hepatice.

Both primary and secondary liver tumors are common problems. Hepatocellular carcinoma (HCC) is a tumor with rapid progression and poor prognosis. The standard in the treatment of liver tumors is surgical resection. The majority of patients with primary or metastatic hepatic tumors are not candidates for resection because of tumor size, location near major intrahepatic blood vessels precluding a margin-negative resection, multifocality, or inadequate hepatic function due to coexistent cirrhosis. Only 20-30% of patients undergoing potentially curative liver resection will not suffer from tumor recurrence. Radiofrequency ablation (ARF) is an evolving technology used to treat patients with non-removable primary and metastatic hepatic cancers. ARF produces coagulative necrosis of tumor through local tissue heating. Liver tumors are treated percutaneously, laparoscopically, or during laparotomy using ultrasonography to identify their position and guide the ARF needle electrode. The indications, treatmentplanning, and limitations of hepatic ARF must be defined. ARF of hepatic malignancies is a safe and promising technique to produce coagulative necrosis of non-removable hepatic malignancies. Experience with this treatment is not yet rich enough to establish long-term outcomes.

[Endo-Lap method in the management of biliary lithiasis (gallbladder and common bile duct)]. / Metoda Endo-Lap în tratamentul litiazei biliare (veziculare si a caii biliare principale).

AIM: To present the results of the biliary endoscopic approach (ERCP) followed by laparoscopic cholecystectomy (LC) in the management of biliary lithiasis (gallbladder and common bile duct--CBD). PATIENTS AND METHOD: From 1997 to March 2003 37 patients with biliary lithiasis were treated by endoscopic sphincterotomy (ES) with stone extraction, followed after 24-48 hours by LC. The indications for ERCP were presence of an obstructive jaundice (n=32) and a dilated CBD at the ultrasound examination (n=5). RESULTS: Selective biliary cannulation was obtained in 35 (94.6%) cases, in all of them with successful papillotomy. Stones were found in all patients. CBD clearances for calculi (from 1 to 8) was obtained in 33 of 35 patients (94.3%), the rest of 2 being managed by open laparotomy. Antibiotics were administrated in all patients. Laparoscopic cholecystectomy was performed after 24-48 hours, with one conversion (3%). Postoperative morbidity was 12.1%: 2 transitory pancreatic reactions and 2 wound infections. CONCLUSION: Endo-Lap method is a useful management alternative for combined gallbladder and CBD lithiasis. It has all the advantages of the two mini-invasive procedures (fast recovery, short hospitalization, low costs) and a less postoperative morbidity in patients with high risk.

[Diagnosis of gastric cancer on endobiopsies using the WHO classification]. / Aplicarea clasificarii OMS în evaluarea carcinomului gastric diagnosticat pe endobiopsie.

Gastric cancer (GC), one of the most frequent malignancies can be early detected on endobiopsies. Our aim was to evaluate histologically the GC on endobiopsies, using WHO 2000 and Lauren classifications. The study included 2424 gastric endobiopsies, routine processed; sections stained with HE, Giemsa, PAS and AB. GC was diagnosed in 451 cases (19%), mostly in men (311 cases--69%). The highest incidence was in 60-69 year-old aged patients (34%). Using Lauren classification, 279 cases were included in diffuse type (62%), 167 intestinal-type (37%) and 5 (1%) mixed type. Each of these three types were also histologically analyzed considering the WHO classification. We pointed out that GC can be diagnosed histologically on endobiopsy specimens, although it is difficult to diagnose the GC--mixt type, due to reduced size of endobiopsies. Lauren classification (including the two major types: diffuse and intestinal) is very useful, especially if correlated with histological criteria of WHO classification.