[Acute disseminated encephalomyelitis presenting as an acute urinary febrile retention]. / Un cas d'encéphalomyélite aiguë disséminée post-infectieuse découvert devant une rétention vésicale fébrile.

INTRODUCTION: MRI should be performed in the presence of an acute febrile urinary retention, when septic and obstructive causes are eliminated. We report a case of post-infectious probable acute disseminated encephalomyelitis (ADEM) with a mostly spinal cord tropism of involving Campylobacter. CASE REPORT: A 32-year-old man with no medical history was admitted for an acute febrile urinary retention. He reported severe diarrhea 3 days before. Clinical course was then complicated by a progressive tetraparesis predominating in the lower limbs. Medullar MRI showed thoracic myelitis. A five-day course of intravenous corticosteroids allowed a full recovery of both the motor and urinary symptoms. Fecal culture isolated Campylobacter sp. Final diagnosis was post-bacterial ADEM. CONCLUSION: Clinical findings and MRI allow clinicians to suspect acute disseminated encephalomyelitis. This hypothesis implies to actively look for recent infections or vaccinations preceding the clinical presentation.

Clostridium difficile infection in patients with liver disease: a review.

Over the past two decades, there has been a dramatic worldwide increase in both the incidence and severity of Clostridium difficile infection (CDI). Paralleling the increased incidence of CDI in the general population, there has been increased interest in CDI among patients with liver disease, particularly in those with liver cirrhosis and post liver transplantation. MEDLINE and several other electronic databases from January 1995 to December 2014 were searched in order to identify potentially relevant literature. Patients with cirrhosis and liver transplant recipients are at high risk for the development CDI because of antibiotics and proton pump inhibitors use, frequent and prolonged hospitalization, immunosuppressant therapy, and multiple comorbidities. Enzyme immunoassay to detect C. difficile toxins A and B in stool remains the most widely used test for CDI diagnosis, although, more recently, polymerase chain reaction (PCR)-based assays have become the preferred diagnostic test in many laboratories. Metronidazole and vancomycin, given orally, have proved to be effective in the treatment of CDI. Both cirrhotic patients and liver transplant recipients with CDI have longer length of hospital stay, increased mortality, and higher healthcare costs than those without CDI. A rapid diagnosis and adequate therapy of CDI are of paramount importance to improve liver disease patients' outcome. The aim of this review is to provide up-to-date information on the epidemiology, risk factors, pathogenesis, treatment, and outcomes in liver disease patients with CDI.

Clostridium difficile infection and inflammatory bowel disease: what gastroenterologists and surgeons should know.

Over the past two decades there has been a dramatic increase worldwide in both incidence and severity of Clostridium difficile infection (CDI). Paralleling the rising incidence of CDI in the general population, there has been an even higher increase in the incidence of CDI among patients with inflammatory bowel disease (IBD). CDI may mimic a flare of IBD as symptoms and laboratory parameters are often similar, and therefore, screening for CDI is recommended at every flare in such patients. Enzyme immunoassay to detect Clostridium difficile toxin A and B in stool is still the most widely used test for CDI diagnosis despite its low sensitivity. Metronidazole for mild/moderate CDI,and vancomycin for severe CDI are the preferred agents for the treatment of infection. CDI has a negative impact both on short- and long- term IBD outcomes, increasing the need for surgery, as well as the mortality rate and healthcare costs. All gastroenterologists and surgeons should have a high index of suspicion for CDI when evaluating a patient with IBD flare, as prompt diagnosis and adequate treatment of infection improve outcomes. Measures must be taken to prevent spreading of infection in gastroenterology /surgery settings.

[Genetic susceptibility to cancer]. / Predispozitia genetica în cancer.

Hereditary predisposition is a common trait of many cancers. 15 to 20 percent of all cancers occur in individuals who have inherited a single gene alteration being members of families where multiple persons carry a high risk of developing cancer. Other than these so-called high penetrance genes which confer elevated risks of cancer development, there are many other genes that generate less dramatic but clinically important risks of cancer, often only if associated to specific exposures.

[The concordance and discordance of cardiovascular risk factors in a group of twin children]. / Concordanta si discordanta unor factori de risc cardiovascular, la un grup de copii gemeni.

The cross-sectional study of epidemiological screening type has permitted to evaluate some cardiovascular risk factors in two groups of monozygotic (MZ) and dizygotic (DZ) twins born between 1975-1990, in the town of Iasi. In the 89 MZ pairs and 112 DZ pairs, certain constitutional and behavioural cardiovascular risk factors have presented values of prevalence with statistical signification (p < 0.05) in terms of their age, sex, the urbanisation time and the educational level of their parents. In risk factors existence or absence to both of the twins have put into evidence, to the MZ, most enhanced values of concordance as regards: overweight (66.6%), excessive consumption of salt (56.9%), food with atherogenic risk (50.9%). The concordance values have been less in DZ compared to MZ concerning all the risk factors excepting compartmental type A (77.7%). By analysing the concordance variants, an preponderant influence of the environment has been noted in the studied MZ and heredity and environment influence in DZ. By measuring the arterial blood pressure values at the twins and the twins parents, a prevalence of the essential arterial hypertension is noticed to both of the twins, 6.2% in MZ pairs and 6.9% in DZ ones.

[The evaluation of a method for determining apolipoproteins as a sensitive indicator in assessing lipid metabolic disorder in a population at risk for essential arterial hypertension (EAHT)]. / Validarea metodei de dozare a apoliproproteinelor ca indicator sensibil de apreciere a dismetabolismului lipidic la populatia cu risc pentru hipertensiunea arteriala esentiala (HTAE).

The increased efficiency of epidemiological screening tests in determining the prevalence of risk factors carriers required the use of highly sensitive markers able at detecting early, in reversible stages, the disturbances in the lipid metabolism genetically induced or acquired during lifetime, known as major risk factors for essential hypertension and other cardiovascular diseases. The authors report the preliminary results of some investigations on the predictive value of apolipoproteins. Immunokits manufactured by BioMérieux--France were used. In 50 admitted patients with essential hypertension and family history of risk, high levels of apoA1 and apoB were recorded although cholesterol and other biological markers were within the normal. At the same time, in our case the apoB/apoA ratio was supraunitary, fact proving the validity of the method.