Flexible endoscopy is enough diagnostic prior to loop ileostomy reversal.

PURPOSE: This study investigates whether contrast enema (CE) and flexible endoscopy (FE) should be performed routinely after low anterior resection (LAR) before ileostomy reversal. Additionally, the impact of previous anastomotic leakage (AL) on diagnostic test accuracy (DTA) was assessed. METHODS: This is a retrospective analysis of prospectively collected tertiary care data of two centers. Consecutive rectal cancer patients undergoing LAR with loop ileostomy formation were included. Before ileostomy reversal, all patients were assessed by CE and FE. DTA of FE and CE for asymptomatic AL in patients who had previously suffered from clinically relevant AL (group 1) compared with those without apparent AL after LAR (group 0) were assessed separately. RESULTS: Two hundred ninety-three patients were included in the analysis, 86 in group 1 and 207 in group 0. Overall sensitivity for detection of asymptomatic AL was 76% (FE) and 60% (CE). Specificity was 100% for both tests. DTA of FE was equal or superior to CE in all subgroups. Prevalence of asymptomatic AL at the time of testing was 1.4% in group 0 and 25.6% in group 1. CONCLUSION: Flexible endoscopy is the more accurate diagnostic test for the detection of asymptomatic anastomotic leaks prior to ileostomy reversal. Contrast enema showed no gain of information. In the group without complications after the initial rectal resection, 104 must be tested to find one leak prior to reversal. In those patients, routine diagnostic testing additional to digital rectal examination may be questioned.

Involvement of Oxidative Stress in COPD.

Chronic obstructive pulmonary disease (COPD) is a disease that affects the lungs and is defined by a variety of symptoms that combined with co-morbidities lead to a decline of the patients quality of life. The principal etiology of chronic obstructive pulmonary disease is smoking and air pollution that lead to oxidative and carbonyl stress. This review based on a search of PubMed, OxLIP+/SOLO (Bodleian Libraries) database (from 1991 to 2017) of relevant articles based on assessment of oxidative stress pathways involvement in COPD. Intracellular reactions that take place in organisms and aerobic cells have as by-products reactive oxygen species (ROS) and free radicals. Oxidative stress involved in pathogenesis of COPD is the result of lowered antioxidative potential combined with increased burden of oxidants. Molecular mechanisms underlying COPD pathways are not yet well understood, despite intensive research all over the world. A change in balance between Oxidants and antioxidants in the lungs as well as within the circulatory system, gene polymorphisms, and activation of transcription factors contribute to the molecular pathogenesis of COPD. Future research is needed in order to identify which patients will develop in time a susceptibility to damage caused by ROS and to determine if controlling ROS will have an effect on the progression of COPD.

Hyponatremia - unfavourable prognostic factor in hepatic cirrhosis.

Hyponatremia is defined by a level of Na in serum below or equal to 136 mEq/L while in hepatic cirrhosis it is classically considered as relevant only at a level of Na below 130 mEq/L. Hyponatremia frequently occurs in patients with end-stage hepatic disease. The frequency and severity are variable but it has been estimated that it occurs with a frequency of 57% in hospitalized patients with cirrhosis and in those on waiting lists for hepatic transplants. Signs and symptoms of hyponatremia are related to dysfunctions of the central nervous system, due to migration of the water from intravascular space to the brain cells, resulting in the occurrence of cerebral edema. Therapeutic options in hyponatremia are limited and are based on restriction of water consumption, exclusion of diuretics and vaptans. Hepatic transplant remains the only definitive treatment for end-stage hepatic diseases in which hyponatremia has occurred.

Hepatorenal Syndrome: Diagnosis and Treatment - newsreel.

Hepatorenal syndrome (HRS) is defined as renal failure that occurs in the presence of severe acute or chronic liver disease in the absence of underlying renal pathology. Due to the functional nature of the disease and the absence of specific diagnostic markers, HRS diagnosis is determined based on positive criteria associated with excluding other causes of renal failure in patients with liver cirrhosis and ascites. Differentiation from other types of acute or chronic renal disease is extremely difficult and therapeutic options are limited, prophylactic behavior is most appropriate in patients with severe hepatic disease and risk factors for the installation of hepatorenal syndrome. Highlighting all precipitating factors of acute renal insufficiency and therapeutic modalities in order to minimize adverse events is an important step in improving the follow-up of the patients with liver cirrhosis. The prognosis is reserved especially for type 1 HRS. Liver transplantation is the best option for patients without contraindications. The therapies introduced in recent years, such as vasoconstrictor drugs or transjugular intrahepatic portosystemic shunt are effective methods in the renal function improvement.

Study of Pulmonary Hypertension in Patients Suffering from Chronic Obstructive Pulmonary Disease.

Pulmonary hypertension (PAH) represents a frequent complication in patients suffering from chronic obstructive pulmonary disease (COPD), but the impact of accelerated inflammatory status on the pulmonary vascular bed is still insufficiently studied. OBJECTIVES: The study of the PAH's prevalence in patients suffering from COPD, its severity compared with lung function and the correlation with certain clinical, biological and functional parameters. MATERIAL AND METHOD: The study was performed on a group of 64 patients, average age 53 years, 42 of whom were men (65,62%), suffering from COPD who were admitted to the Emergency County Hospital Craiova, on the II-nd Medical Clinic, within a period of 18 months. When assessing the patients their clinical state was stable, without acute exacerbations items. The control group included 61 patients suffering from other diseases without inflammatory background, who were hospitalized in clinic in the same period. All the patients included in the study were evaluated by: physical examination, thoracic radiological examination, spirometry, inflammatory syndrome, echocardiography Doppler and oximetry. RESULTS: The results of the study show a prevalence of 54.6 % PAH and a statistically significant impact of age, duration of the disease, Sa O2, inflammatory status, which was quantified in the study by ESR, serum levels of CRP and serum level of TNF alpha over the risk of developing COPD in patients suffering from PAH. CONCLUSIONS: The occurrence and the severity of PAH in patients suffering from COPD seems to be correlated with their age, duration of the disease, Sa O2 and serum levels of inflammatory markers.

Fatal Evolution in the Pneumonia Caused by Diesel Fuel Aspiration - Case Report.

Aspiration pneumonia in infants emerges as a result of deglutition disorders, congenital malformations and severe gastroesophageal reflux. Hydrocarbon pneumonitis is caused by the accidental ingestion and aspiration of hydrocarbons into the body. In children, it can be seen as a result of both the lack of monitoring and the tendency for the exploration of the environment. The accidental ingestion of a large quantity is quite rare due to the bad taste of hydrocarbons. Initially, the central nervous system is the one affected, followed by the respiratory system, causing the chemical pneumonia (through direct injury of the lung). Furthermore, we shall present the case of an 18 month infant with severe trauma as a result of the accidental ingestion of diesel, followed by vomiting and who was brought late to the hospital. The pneumothorax that emerged as a complication was remitted after the treatment, but the initially chemical and then mixed pneumonia through bacterial overinfection led to the infant's death after 12 days of medical attention in the Anesthesia and Intensive Care Unit. The histopathological examination of the analyzed lung fragments did not point out any lipid or foam cells that are characteristic to this type of pathology, but which are not mentioned by the majority of toxicology textbooks and those of pathological anatomy, through the low rate of mortality and numerous factors that can lead to negative false results.

Assessment of Oxidative Stress Genes SOD2 and SOD3 Polymorphisms Role in Human Colorectal Cancer.

PURPOSE: The aim of this study was to ascertain the oxidative stress genes SOD2 and SOD3 polymorphisms in patients with colorectal cancer and to assess the possible involvement of these polymorphisms that might increase the risk for patients to develop malignant intestinal tumors. MATERIAL AND METHODS: A total number of 306 subjects were divided into two groups (109 colorectal cancer patients as the study group and 197 normal healthy individuals as the control group).We genotyped two polymorphisms, SOD2 - 201A>G (rs4880) and SOD3 - 896C>G (rs1799895), by allelic discrimination, with TaqMan RT-PCR specific probes. RESULTS: No significant differences were found with either of the polymorphisms when comparing the association between them and an increased risk of developing colorectal tumors. CONCLUSION: In Romanian population, the risk of developing colorectal cancer is not increased by SOD2 and SOD3 polymorphisms.

Study of the Etiological Spectrum of Spontaneous Bacterial Peritonitis in a Group of Patients Suffering from Liver Cirrhosis.

INTRODUCTION: Spontaneous bacterial peritonitis (SBP) represents the most severe and common infectious complication in patients suffering from liver cirrhosis. The objectives of the study were the evaluation of the risk factors responsible for the occurrence of the spontaneous bacterial peritonitis in a group of patients suffering from liver cirrhosis, the identification of the bacterial spectrum and assessing the response to antibiotic therapy. Material and method - The studied group included 64 patients suffering from liver cirrhosis, with an episode of SBP, who were admitted to the IInd Medical Clinic of the County Hospital of Craiova, within a period of 24 months. The control group included 61 patients with liver cirrhosis with an episode of decompensation of liver disease. The diagnosis of liver cirrhosis was established by using clinical, biological and imagistic criteria, and the SBP's diagnosis was based on cytological and bacteriological analysis of the ascites fluid. Patients suffering from hepatocellular carcinoma, portal vein thrombosis and other infectious conditions were excluded. The anamnesis, the duration of the disease, the alcohol intake, the complete clinical examination, the clinical, biological and imagistic evaluation were monitored. Results and conclusions - The most frequent etiology of SBP is represented in 67% of the cases by Gram negative germs, and thus, the antibiotic therapy will be orientated against this etiological segment. In what antibiotic sensitivity is concerned, most of the germs were sensitive to third generation cephalosporins, quinolones, carbapenems and vancomycin.

Ischemic and injured bowel evaluation by Fluorescence imaging.

AIM: Although fluorescence has been proposed for estimation of bowel perfusion decades ago it is still not widely used. In emergency situations like mesenteric ischemia, fluorescence might give objective criteria to evaluate the perfusion and guide the decisions of surgeons. METHOD: The use of near-inrafrared angiography by PinPoint (Novadaq) in a serial of four emergency situations of acute mesenteric ischemia has been evaluated in a university hospital setting. RESULTS: The use of the near-infrared tool is in emergency situations easy to handle and little time-consuming. The angiography showed clearly the perfusion in regions that were not estimated as recoverable by the surgeons. In one of the cases a significant amount of bowel could be spared by use of the system. CONCLUSION: Although the assessment of the perfusion with the applied system is comprehensible, it would be desirable to evaluate a threshold level in order to further objectify it. While the surgeons who used the tool were subjectively assured by the expressiveness it would need a randomized and maybe experimental setting to evaluate objectively the amount of spared bowel length.

Cytopathological Aspects in the Bronchoalveolar Lavage Fluid in Chronic Obstructive Pulmonary Disease.

Chronic Obstructive Pulmonary Disease (COPD) is a clinical syndrome characterised by a slow progressive decline in expiratory airflow [1], a process that has gradually developed over the years. Studies of patients with COPD show an inflammatory process in the small airways [2]. The aim of this paper is to identify the cytopathological aspects of the liquids present in the bronchoalveolar lavage in patients with COPD. We were performed a descriptive analytical case-control and prospective study on forty patients with COPD and ten asymptomatic smokers (healthy smokers or patients at risk). The percentage of marcophage, the type of the dominant inflamatory cell, in the bronchoalveolar lavage (BAL) liquid was significantly higher at patients with mild and moderate COPD as compared to patients with severe and very severe COPD. In the present work, the percentage of the neutrophil in the BAL liquid was significantly higher at patients with severe and very severe COPD, as compared to the patients with mild and moderate COPD and to aparently healthy smokers. In conclusion, we can say that COPD is characterized by an inflammatory process located in the small airways with predominant participation of macrophages, the procentage of macrophages in BAL fluid variyng inversely proportional to the severity of the disease.

Acute trenant pneumonia of possible bacterial etiology.

A 48 years old, smoker (20 cigarettes/day), without known personal pulmonary antecedents, is presented in the emergency service accusing: dry cough, fever (38,8°C), chills, dyspnea at medium efforts, dizziness, symptoms occurred 4 days ago and gradually accelerated. Following the paraclinical tests two possible major differential diagnoses take shape: bacterial pneumonia and lung cancer. For the diagnosis of pneumonia pleads clinical appearance (fever, chills, cough) and the results of radiological examination. The diagnosis of bronchopulmonary tumor is denied by bronchoscopy, the PBTT which doesn't reveal tumor cells and clinically well evolution. The case is interpreted as a form of trenant bacterial pneumonia in slow resorption - for this pleads the favorable clinical and radiological evolution, broad-spectrum antibiotic therapy, balancing electrolyte.

[Pseudo-Meigs syndrome, a rare variant]. / Varianta rara de sindrom pseudo-Meigs.

The pseudo- Meigs syndrome is defined as a pelvic tumour, other than the ovarian fibroma complicated with ascites and hydrothorax that can be recovered after the tumour is surgically extirpated. The uterine leiomyoma is an extremely rare cause of this syndrome, only 24 cases have been recorded so far, most of them presenting hydropic degeneration or necrosis. The case exposed by us, a 50- year old obese,with nanism woman, presented clinical, biological and imaging characteristics of the syndrome; moreover, she had arterial high blood pressure for more than five years, fact that didn't need postoperative treatment. She was sent to the ER because she had severe respiratory insufficiency, arterial high blood pressure, tachycardia and, at the clinical examination, she presented massive right hydrothorax, ascites, and pelvic tumour. The biologic explorations (the benign cytology in the pleural liquid and ascites, CA-125 with ten times the normal value) and the imagery completed the picture of a Meigs/ pseudo-Meigs syndrome that implied the laparotomy. The H-P examination and the postoperative evolution confirmed the diagnosis. We presented this case in order to emphasize both its rarity and its real positive and differential diagnosis problems.

Intussusception of efferent intragastric loop after gastrojejunostomy--an exceptional cause of high occlusion and hematemesis.

Jejunogastric intussusception (GI) is an extremely rare complication of gastrojejunostomy (GJS) that may appear any time after surgical intervention. Less than 200 cases have been reported so far, on very small series. Young female, 32, who 12 years ago was operated for a gastroduodenal disease that she doesn't know many details about. She presented severe pain in the superior abdominal segment posteriorly irradiated, incoercible biliary nausea followed by hematemesis. The endoscopic, imaging and biological explorations suggested a huge gastric tumor that occupied the whole stomach and was bleeding diffusely. The rapid acute evolution asked for the urgent laparotomy that emphasized: soft tumour mass, intragastrically mobile without any scar at the stomach or duodenum level; adherent to the posterior of the stomach we discovered a ball of jejunal loops that couldn't be undone. The anterior gastrotomy sets the diagnosis: JGI of the efferent loops of a GJS. We hardly managed to reduce the intussusception, without resection, the loop being absolutely viable. In order to prevent a relapse, and because the anastomosis was not justified it was taken down. JGI in a patient presenting GJS must be taken into consideration in the presence of epigastric pain that would not cease, biliary nausea followed by hematemesis and rapid deterioration of general health status.