Expression of Selected Genes and Circulating microRNAs in Patients with Celiac Disease.

Background and Objectives: Celiac disease (CD) is an immune-mediated enteropathy with characteristic intestinal alterations. CD occurs as a chronic inflammation secondary to gluten sensitivity in genetically susceptible individuals. Until now, the exact cause of the disease has not been established, which is why new studies have appeared that address the involvement of various genes and microRNAs (miRNAs) in the pathogenesis. The aim of the study is to describe the expression of selected genes (Wnt family member 3, WNT3; Wnt family member 11, WNT11; tumor necrosis factor alpha, TNFα; mitogen-activated protein kinase 1, MAPK1; AKT serine/threonine kinase 3, AKT3; phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha, PIK3CA; and cyclin D1, CCND1) and miRNAs (miR-192-5p, miR-194-5p, miR-449a and miR-638) in adult patients with CD. Materials and Methods: In total, 15 patients with CD at diagnosis (newly diagnosed), 33 patients on a gluten-free diet (GFD) for at least 1 year and 10 controls (control) were prospectively included. Blood samples were evaluated by quantitative real-time polymerase chain reaction (qRT-PCR). Results: The results show that TNFα, MAPK1 and CCND1 were significantly overexpressed (p = 0.0249, p = 0.0019 and p = 0.0275, respectively) when comparing the newly diagnosed group to the controls. The other genes studied in CD patients were mostly with high values compared to controls, without reaching statistical significance. Among the miRNAs, the closest to a statistically significant value was miR-194-5p when the newly diagnosed group versus control (p = 0.0510) and GFD group versus control (p = 0.0671) were compared. The DIANA and miRNet databases identified significant functional activity for miR-449a and miR-192-5p and an interconnection of miR-194-5p and miR-449a with CCND1. Conclusions: In conclusion, genes and circulating miRNAs require further studies as they could represent important biomarkers in clinical practice.

Atherosclerotic splenic artery aneurysm in a decompensated cirrhotic patient.

Splenic artery aneurysm is a rare condition with potential lethal complications. If associated with severe diseases, the diagnosis and management may be challenging. Usually, ultrasound examination is the first step in the diagnosis, and the specific ultrasound features suggest the diagnosis. When combined with contrast-enhanced ultrasound examination, the accuracy of ultrasound increases and can therefore rule out some severe complications. We present the case of a patient hospitalized with decompensated cirrhosis in whom the ultrasound examination revealed the presence of a high-risk splenic artery aneurysm. However, the treatment decisions were profoundly influenced by the liver disease complications.

Fecal transplantation indications in ulcerative colitis. Preliminary study.

BACKGROUND AND AIMS: Fecal microbiota transplantation is used with success in persistent (more than two episodes) Clostridium Difficile Infection; it has also gained importance and started to be used in inflammatory bowel disease. There are theoretical arguments that justify its use in ulcerative colitis or Crohn's disease. Based on our clinical cases we tried to evaluate the indications of fecal microbiota transplantation young patients with ulcerative colitis and multiple relapses, in which biological or immunosuppressive treatment were ineffective. METHODS: Five patients with moderate-severe ulcerative colitis or Clostridium Difficile infection who ceased to have a therapeutic response to biological therapy, were given fecal microbiota transplant as an alternative to biological therapy and/or immunosuppression. Fecal microbiota transplant was administered via colonoscopy using healthy donors from their family. RESULTS: The results were favorable and spectacular in all patients and complete remission was achieved for at least 10 months. Clinical remission was achieved in all patients. Endoscopic appearance of ulcers in patients improved. In 2 patients the effect of the fecal microbiota transplant diminished after 10-12 months and the tendency to relapse appeared (3-4 stools/day, blood streaks present sometimes in the stool). Reintroduction of systemic therapy or immunosuppression demonstrated that patients regained the therapeutic response to these treatments, and remission was maintained. CONCLUSION: Fecal microbiota transplantation can be used as salvage therapy in patients refractory to biological therapy, as elective therapy in clostridium difficile infection or as an alternative therapy in young patients with multiple relapses who have reservations regarding biological or immunosuppressive treatment.

Splenic cystic lymphangioma with atypical ultrasound findings.

Splenic lymphangiomas are rare benign tumors occurring more frequently in children. Because of their asymptomatic growth, splenic lymphangiomas are usually suspected based on incidental findings, the diagnosis relying on different imaging techniques and requiring histological confirmation. The rarity of the disease and its atypical imaging findings make the diagnosis of splenic lymphangiomas challenging. We describe the case of an isolated splenic cystic lymphangioma affecting an elderly female patient. The patient was asymptomatic and the blood tests were normal. The tumor appeared on gray-scale ultrasound as an inhomogeneous, mostly hyperechoic septated mass, which is atypical for a cystic lymphangioma. Contrast-enhanced ultrasound and contrast-enhanced computed tomography suggested the benign nature of the tumor and narrowed the diagnosis. The tumor received histopathological confirmation after splenectomy. Various CT and MRI findings in splenic lymphangiomas have been described, but very few reports regarding CEUS exist to this point.

Inflammatory myofibroblastic tumor of the gallbladder: imaging aspects.

Inflammatory myofibroblastic tumors (IMT) are rare benign lesions that may often be mistaken for malignancies due to their imaging resemblance. There are a limited number of case reports in the literature on the location at the level of the gallbladder. We present a case of IMT of the gallbladder that emphasizes the importance of conventional ultrasound as the primary method of detection, as well as the role of contrast-enhanced ultrasound and strain elastography in describing the lesion, thus contributing to the differential diagnosis.

Whipple's disease. Case report.

The paper reports the clinical case of a 58 -year-old male patient admitted for diarrhea (6-7 stools/day, diffuse abdominal pain, borborygma, weight loss (20 kgs in two years), asthenia and fatigue. Physical examination evidenced a poor nutritional state (body mass index 19 kg/m2). The abdomen was slightly distended. Biological tests evidenced moderate/severe anemia, hypoproteinemia and hypoalbuminemia. Endoscopic examination evidenced oedematous duodenal mucosa with white-yellowish deposits. Histology (HE stain) revealed the presence of foamy cells and the PAS-staining of the duodenal mucosa evidenced PAS-positive macrophages and numerous intracellular bacilli. Penicillin therapy 2 x 1 million U/day for 14 days, followed by tetracycline 4 x 250 mg/day improved the clinical picture, the patient had only one stool per day and gained weight. After 7 months of treatment the general condition was good and the patient had gained 17 kgs, the duodenal mucosa was normal. HE staining did not evidence foamy cells and no PAS-positive macrophages could be found.

Treatment of hepatocellular carcinoma in a tertiary Romanian center. Deviations from BCLC recommendations and influence on survival rate.

BACKGROUND & AIM: The Barcelona-Clinic Liver Cancer (BCLC) staging system is based on the results obtained in the setting of several cohort studies and randomized clinical trials. We have evaluated the applicability of the BCLC staging system and the effect of treatment allocation according to BCLC on the survival rate and prognosis in patients with hepatocellular carcinoma (HCC) in a tertiary center. METHODS: Treatment indications for 473 patients referred to our center with the diagnosis of HCC were retrospectively analyzed. Patients were split in three groups: a group treated according to BCLC recommendation, an overtreated group and an undertreated group. The survival rate was calculated using the Kaplan Meier method and compared using the log-rank test. RESULTS: Patients distribution according to BCLC staging system was: 17 patients (3.6%) in very early stage (O), 161 (34.0 %) in early (A), 140 (29.6%) in intermediate (B), 82 (17.3%) in advanced (C) and 73 patients (15.4%) in terminal stage (D). Only 275 patients (58.1%) from stage 0, A-D were treated according to BCLC. The mean survival rate in stage 0 and A was higher for patients receiving curative treatment in comparison with undertreated patients (41 vs 28 months, p< 0.05). Overtreated patients in stage B or C had a better survival than patients treated according to BCLC (25 months vs 21 months, p=0.973, and 28 months vs 4 months, p=0.308, respectively), without statistical significance. Patients in stage B and C treated according to BCLC recommendations had a better survival than those undertreated (21 months vs 13 months, p=0.002, and 4 vs 3 months, p=0.036, respectively). CONCLUSIONS: Deviations from BCLC recommendations occur in 40% of patients with HCC. Undertreatment results in a decreased survival of patients diagnosed with HCC. Overtreated BCLC-B and C patients have an increased survival in comparison with those treated with standard therapy.

Accidentally ingested foreign body associated with liver actinomycosis: the diagnostic value of imaging.

Accidental ingestion of foreign bodies is a relatively common situation, in the large majority of cases being followed by an unobserved passing of the objects through the digestive tract and their elimination in about a week. We present a patient with liver actinomycosis developed in relation with a gastric (antral) perforation secondary to accidental foreign body ingestion. The complexity of the case raised many problems concerning the imaging diagnosis, especially due to the pseudotumoral aspect of the liver lesion, which extensively involved the retroperitoneal area, the stomach and the pancreas. However, the presence of an image suggesting a foreign body into the gastric wall, in correlation with clinical, biological, morphological and imaging studies solved the case.

Appendicitis associated with intestinal malrotation: imaging diagnosis features. Case report.

Intestinal malrotation is a rare pathological situation consisting of non-rotation or incomplete rotation of the primitive intestine. Due to the abnormal caecal position inflicted by malrotation, diagnosis of acute appendicitis is difficult. Ultrasonography (US) and Computed Tomography (CT) are relevant and complementary imaging techniques for establishing an otherwise elusive diagnosis. We present the case of 54 year old male presenting with nonspecific abdominal complaints in which US (standard and contrast enhanced) and CT scans identified acute appendicitis associated with malrotated caecum and ascending colon, located in the left hipocondrum.

The association between Helicobacter Pylori chronic gastritis, psychological trauma and somatization disorder. A case report.

Helicobacter Pylori is considered to be the agent responsible for peptic ulcers and gastritis, and its eradication represents a main objective in the treatment of digestive diseases. We present the case report of a female patient diagnosed with chronic Helicobacter Pylori infection, where symptoms manifested after the patient was raped. In the context of psychological trauma, digestive manifestations such as ulcer and gastritis were identified, greatly exacerbated as compared with the endoscopic and histological aspect of the gastric mucosa. The patient simultaneously developed a complex psychiatric pathology. The association between Helicobacter Pylori chronic gastritis, somatization and trauma is discussed.

Rapid recovery of a rectovaginal fistula with infliximab in a patient with Crohn's disease.

We present the case of a female patient diagnosed with colonic Crohn's disease, having a clinical evolution with many recurrences and in whom conventional therapy had failed. The patient was admitted in our department 4 years after the onset of the disease, with an altered general state, diarrhea, malnutrition, fever and fecaloid vaginal discharge. Investigations classified the patient in a severe activity flare of Crohn's disease (CDAI 329), complicated with a rectovaginal fistula. Infliximab therapy was initiated. The evolution was rapidly favorable and the fistula closed after 4 weeks of therapy.

Alkaline reflux esophagitis in patients with total gastrectomy and Roux en Y esojejunostomy.

BACKGROUND AND AIMS: Alkaline reflux esophagitis is a complication that might develop in patients with total gastrectomy. The aim of the study was to analyze the prevalence and severity of reflux esophagitis and the occurence of complications (Barrett's esophagus and esophageal stenosis) in patients with total gastrectomy and Roux en Y esojejunostomy. METHODS: 92 patients with total gastrectomy performed for gastric cancer were included in the study. None of the patients had esophagitis prior to gastrectomy. The patients were assessed clinically and endoscopically after a certain interval from surgery. RESULTS: An important number of patients (14 out of 92, 15.22%) had reflux esophagitis; 5.43% of the patients had also complications of reflux esophagitis (Barrett's esophagus and benign esophageal stenosis) and 6.52% had local tumor recurrence. Of the 14 patients with reflux esophagitis, the majority (9/14) had Los Angeles (LA) grade C esophagitis. The mean interval between surgery and the endoscopic evaluation was 4.43 years. Barrett's esophagus and benign stenosis were diagnosed after a longer period of time (10.33 and 8 years, respectively) as compared to reflux esophagitis (5.29 years). More than half of the esophagitis patients had reflux symptoms. CONCLUSIONS: Although Roux en Y esojejunostomy is a reconstructive technique which prevents the reflux, an important percentage of our patients developed alkaline reflux esophagitis. In most cases, the esophagitis was moderate or severe. Complications of alkaline reflux, i.e. benign stenosis and Barrett's esophagus, also occurred after longer periods of time (8 to 10 years) in a small percentage of patients.