Concomitant lung and intestinal tuberculosis - case report.

Tuberculosis (TB) is responsible for one in five deaths for young women (between 15-44 years old). Almost 9 million persons are diagnosed with TB each year and around 2 million deaths are due to TB or TB complications. Abdominal TB has no specific clinical symptoms, no imagistic and no specific laboratory tests, all these making the diagnosis more difficult. Most often, clinical, radiographic, and histopathological (HP) aspects in TB enteritis are nonspecific and may suggest cancer or inflammatory bowel disease. We present the case of a 42-year-old male patient, with intestinal and lung TB presenting as intestinal obstruction to emphasize the importance of clinical suspicion and histopathology for final diagnosis. Chest and abdomen computed tomography (CT) evidenced a few left-sided pulmonary nodules and wall thickening of some parts of the small and large bowel. Also, CT evidenced nearby mesenteric lymphadenopathy. He was admitted in the Department of Surgery and later confirmed with intestinal TB. Because of modified chest radiography, further investigations identified Mycobacterium tuberculosis in the sputum. Final diagnosis was concomitant lung and intestinal TB confirmed by sputum and histopathology. The patient received proper anti-tuberculous treatment and his condition improved after the first month. The physician treating the organ is the one that should establish the diagnosis of extra-respiratory TB; however, treatment and later follow-up are multidisciplinary. TB should always be suspected in any patient with nonspecific symptoms. The TB case is defined according to disease localization, bacteriological or HP confirmation, therapeutic history and human immunodeficiency (HIV) infection status.

Liver steatosis associated with chronic hepatitis C.

Hepatic steatosis is a common histological finding in chronic liver diseases. One of the pathological entities in which hepatic steatosis has been found is chronic hepatitis C. The prevalence of steatosis in these patients ranges from 40% to 86%, with an average of 55%, which is two times higher than the steatosis seen in adults uninfected with hepatitis C. Many studies have shown that hepatic steatosis is a medical condition that may progress to steatohepatitis, progressive hepatic failure, hepatic cirrhosis, and is a risk factor for development of hepatocellular carcinoma. We have proposed to evaluate the severity of steatosis in patients with chronic hepatitis C and to correlate it with necroinflammatory processes and fibrosis. We included 259 patients diagnosed with chronic hepatitis C and proven histological steatosis. Age of patients with hepatic steatosis varied from 20 to 69 years. Most cases of steatosis associated with chronic hepatitis C (47.87%) were diagnosed in the age group 50-59 years. Of 259 patients, 141 (54.44%) were female and 118 (45.56%) male. Slight steatosis was identified in 130 cases (50.19%), moderate fatty changes were present in 54 (20.85%) patients and severe steatosis in 75 (28.96%) patients. The appearance of steatosis was macrovesicular and predominantly affected the third zone of the hepatic lobe. Most cases of hepatic steatosis were associated with necroinflammatory activity and low and moderate fibrosis. Cases of marked steatosis associated with intense activity accounted for about 10%, while marked steatosis was associated with severe fibrosis in less than 5% of cases.

Role of intrahepatic innervation in regulating the activity of liver cells.

Liver innervation comprises sympathetic, parasympathetic and peptidergic nerve fibers, organized as either afferent or efferent nerves with different origins and roles. Their anatomy and physiology have been studied in the past 30 years, with different results published over time. Hepatocytes are the main cell population of the liver, making up almost 80% of the total liver volume. The interaction between hepatocytes and nerve fibers is accomplished through a wealth of neurotransmitters and signaling pathways. In this short review, we have taken the task of condensing the most important data related to how the nervous system interacts with the liver and especially with the hepatocyte population, how it influences their metabolism and functions, and how different receptors and transmitters are involved in this complex process.

Dendritic cells and hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) represents a major health burden in the modern world. Because current treatment options for HCC are capable of providing good survival rates to only a limited number of patients, new therapeutic opportunities should be looked upon. The particularities of dendritic cells (DC) populations existing in the liver, and their consecutive selective activation of certain immunotolerant T-cell subgroups, account for the high success rate of allogeneic hepatic transplantation, currently the most efficient treatment for HCC. The particularities of dendritic cells (DCs) populations existing in the liver, and their consecutive selective activation of certain immunotolerant T-cell subgroups, account for the high success rate of allogeneic hepatic transplantation for HCC. These molecular mechanisms also open new paths towards cancer preventing and cancer curative vaccines, as well as successful immunotherapy. Our aim was to summarize the main aspects of the biology of DCs populations, especially those present in the liver, and to draw attention to their current and future roles in the curative treatment of hepatocarcinoma.

Gastric eosinophilia--clinical and morphological correlations.

Eosinophils of the gastrointestinal tract are involved in the host immune response that occurs in the presence of the pathogens in the digestive lumen, taking part in maintaining the homeostasis of the gastrointestinal epithelium. Their involvement in inflammatory processes of chronic gastritis is less known. In our study, we identified the presence of eosinophils in chorion gastric mucosa (lamina propria) in over 34% of chronic gastritis. Eosinophils were more numerous in atrophic gastritis with intestinal metaplasia. More than 65% of chronic gastritis associated with Helicobacter pylori also had eosinophils in the gastric mucosa.

Synchronous diagnosis of signet ring cell colon carcinoma and transitional carcinoma of the left distal ureter.

The presence of synchronous multiple primary carcinomas, although recognized, remains very uncommon. Their etiopathogeny is unclear. The wide spread of imaging techniques currently facilitates diagnosis of simultaneous tumors. We present the rare case of a signet ring cell colon carcinoma coexisting with a transitional cell carcinoma (TCC) of the ureter, which debuted with symptoms of intestinal obstruction in a 75-year-old male patient, with no prior relevant history. Computed tomography showed signs of a tumor mass on the transverse colon, as well as left hydronephrosis with a tumor in the lower third of the ureter, which prompted for immediate emergency surgery. After the appropriate surgical maneuvers, tissue collected from both tumors underwent usual histological preparation and Hematoxylin-Eosin staining, as well as multiple immunostaining with a complex panel of markers. The patient had a favorable postoperative course and during a six-month follow-up, we did not detect any signs of illness.

Histopathological and immunohistochemical study of hepatic stellate cells in patients with viral C chronic liver disease.

OBJECTIVE: Our aim was to establish a correlation between hepatic stellate cells (HSCs) activity within different areas of hepatic tissue and the degree of liver fibrosis, necroinflammation, and steatosis in patients with viral C chronic liver disease. PATIENTS AND METHODS: We prospectively included 41 liver biopsies from patients with chronic hepatitis C or liver cirrhosis, prior to antiviral treatment. Our control group consisted of seven tissue samples, obtained from 10 to 38 weeks old embryos. We assessed the alpha-smooth muscle actin (α-SMA) expression using immunohistochemistry and a semi-quantitative scoring method. RESULTS: We found a strong correlation (p<0.0001) between the number of activated HSCs and the stage of fibrosis in all examined areas. Necroinflammatory activity was significantly correlated (p<0.05) with the number of activated HSCs in perivenular area (p=0.014) and intermediate area (p=0.018), and strongly correlated (p<0.0001) in periportal and portal tracts and fibrous septa areas. We found no correlation between the degree of steatosis and the number of activated HSCs in the perivenular area (p=0.25), intermediate area (p=0.166) and in the periportal area (p=0.154); however, in the portal tracts and fibrous septa area we observed a significant correlation (p=0.022). CONCLUSIONS: The analysis of HSCs activity within specified areas of liver tissue may lead to new perspectives in early diagnosis of liver fibrosis and in the development of future antifibrinogenic therapies.

Adverse effects of peg-Interferon and Ribavirin combined antiviral treatment in a Romanian hepatitis C virus infected cohort.

INTRODUCTION: Adverse effects appearing during combined peg-Interferon and Ribavirin antiviral treatment against chronic infection with the hepatitis C virus are a major cause for treatment failures and abrupt interruption. In the prospect of the imminent introduction of new direct acting antiviral agents, with demonstrated higher rates of adverse effects, our study aimed to assess the severity and incidence of several types of adverse effects in a cohort of genotype 1 infected Romanian patients. MATERIALS AND METHODS: We prospectively included a total of 150 patients (45 men), aged 25 to 64 years, who received combined peg-Interferon and Ribavirin antiviral treatment for chronic hepatitis C. Out of these, 145 patients also had liver biopsies prior to treatment initiation. We recorded their viral loads, hemoglobin values and thrombocyte counts, as well as any dermatological, psychiatric or constitutional adverse effect after twelve doses, eight and twelve months of treatment, with two follow-up examinations at three and six months after treatment completion. RESULTS: Viral loads significantly decreased after 12 doses of treatment, in the end a total of six patients (two men and four women) being declared non-responders. Hemoglobin values and thrombocyte counts significantly decreased during treatment (p<0.0001), with their values being restored to pre-treatment levels during the follow-up period. We did not find significant differences between the 12-doses, 8 and 12 months values during treatment (p>0.05). We recorded 43 cases (11 men and 32 women) presenting with rashes, drug eruptions and erythema. We only encountered grade 1 and 2 dermatological adverse effects. Psychiatric effects were present in 34 cases (10 men and 24 women, 22.6% of the group) and manifested as mild depressions, which did not require specific medication or antiviral dose adjustment. Patients also presented headaches (80.6%), fatigue (71.3%), nausea (47.3%), arthralgias (35.3%) and fever (30%). CONCLUSIONS: We did not encounter severe hematological adverse effects that would require Ribavirin dosage adjustments. Cutaneous and psychiatric adverse effects were also present in a significant number of patients; however, their severity did not influence the continuity or outcome of the antiviral treatment. Other constitutional effects were also present with no direct consequence on the course of treatment. Future agents employed in antiviral therapy shall require extensive monitoring of all adverse effects already acknowledged during dual combination therapy.

Psychosocial stress and liver disease status.

"Psychosocial stress" is an increasingly common concept in the challenging and highly-demanding modern society of today. Organic response to stress implicates two major components of the stress system, namely the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. Stress is anamnestically reported by patients during the course of disease, usually accompanied by a decline in their overall health status. As the mechanisms involving glucocorticoids and catecholamines have been deciphered, and their actions on immune cell function deeper understood, it has become clear that stress has an impact on hepatic inflammatory response. An increasing number of articles have approached the link between psychosocial stress and the negative evolution of hepatic diseases. This article reviews a number of studies on both human populations and animal models performed in recent years, all linking stress, mainly of psychosocial nature, and the evolution of three important liver-related pathological entities: viral hepatitis, cirrhosis and hepatocellular carcinoma.

The accuracy of combined physical examination and ultrasonography for the detection of abdominal aorta aneurysm.

Atherosclerosis is the most frequent cause in the appearance of an abdominal aorta aneurysm (AAA) and plays an important role in his development. Most AAA does not cause any symptoms, especially when talking about elderly patients, however, many of those aneurysms can be detected during physical examination. Their detection is very important because the natural evolution and the major reason in treating AAA is their tendency to rupture. We present the case of an adult man with a complex clinical pathology, but not related to the AAA. The diagnosis of the AAA has been suspicion through palpation, and the abdominal ultrasound exam confirmed it. This case is particular interesting, as the AAA requires surgical intervention, while patient's health status was poor. An essential issue is establishing the importance of the AAA screening, when there are no symptoms present. For now, there are not satisfactory studies to be used as a guide.

Histopathologic and immunohistochemical aspects of the renal parenchyma in patients with glomerulonephritis developed in locked-up spaces.

A number of 38 renal biopsies and 13 necroptic pieces removed from 51 prisoners were available for our study. From 51 cases, 21 patients were diagnosed with actual chronic glomerulonephritis, 19 patients with non-specific chronic glomerulonephritis, four patients with renal amyloidosis, and seven patients with glomerulonephritis lesions associated to pielonephritis.

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.

The endoscopic and morphological forms of early gastric cancer.

The early gastric cancer is an endoscopic notion in which gastric cancer is strictly placed to mucosis and submucosis without extensive manifestations. It is the form with favorable prognosis and better survival at 5 and 10 years. Our study tries to systematize the debut forms of early gastric cancer and their association with the lesions with malignisation risk. We also try to evaluate the incidence of endoscopic and histopathologic forms of early gastric cancer found in an internal medicine division. Our study included 435 patients with gastric cancer endoscopic and histologic diagnosed. Statistically, 64.36% were men and 35.64% were women, the mean age 48 +/- 7 years. The endoscopic forms of early gastric cancer were type I: protruded in 19 cases, type II: superficially in eight cases, type III: excavated in six cases. Early gastric cancer is diagnosed with difficulty, it represents in 7.58% of the gastric cancer, being most frequently asymptomatic. The endoscopic forms frequently found in early gastric cancer in the population were type I: protruded and type IIa: superficially elevated. The histopathological examination is compulsory at this form of gastric cancer, while in advanced gastric cancer endoscopy is often sufficient for diagnosis. Analysing the histopathological results of cases diagnosed with early gastric cancer we found: 22 cases with intestinal type and 11 cases diffuse type. Microscopically, 15 were intramucosal and 18 had submucosal invasion. I and IIa lesions were predominantly located at the antrum and are histologically differentiated adenocarcinoma. Differentiated carcinoma frequently produces an elevated lesion and the border is well demarcated. There are frequent opportunities to detect gastric cancer in the early phase and the patient can expect a complete cure by the surgical operation or endoscopical mucosal resection.

The immunohistochemical profile of the adenocarcinoma of upper gastric pole.

Although gastric adenocarcinoma continue to be the second continues to be the second cause of death worldwide, its incidence and mortality appear to have decreased in recent decades. Despite this decline, adenocarcinomas from proximal stomach tend to be more frequent during the last three decade. Adenocarcinomas with this location it seems that are a different, specific subtype of gastric carcinoma. The purpose of this study was to clarify the differences between gastric adenocarcinomas from upper and distal gastric pole using the immunohistochemistry. For this reason, we investigate histopathological and immunohistochemically 77 cases of upper gastric pole adenocarcinoma selected from a number of 472 gastric tumors. The immunohistochemistry was performing only in 32 cases by ABC technique with the following primary antibodies: Cytokeratin 7, Cytokeratin 19, Epithelial Membrane Antigen (EMA), Carcinoembryonic Antigen (CEA), Lysozyme, Vimentin, p53 protein, CD34 and Ki67 antigen. The acquired results do not distinguish a peculiar immunohistochemically profile unlike distal gastric adenocarcinomas. Nevertheless, we pointed out the predominance of diffuse adenocarcinomas type according to Laurens classification, which immunohistochemically were strong positive to cytokeratins, EMA, CEA and lysozyme. Moreover, investigation of some antigens likes lysozyme, p53, Ki67 and CD34 seems to be useful for prognostic estimation of carcinoma with this topography.

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.