Hyposplenism, Hashimoto's Autoimmune Thyroiditis and Overlap Syndrome (Celiac Disease and Autoimmune Hepatitis Type 1).

Hyposplenism is associated with autoimmune diseases, inflammatory bowel disease, severe celiac disease, autoimmune thyroiditis, untreated HIV infection and chronic graft-versus-host disease. The aim of this study was to review the existing data on hyposplenism associated with celiac disease and Hashimoto's autoimmune thyroiditis. Our research was based on a clinical case concerning a 41-year-old female who presented with asthenia, fatigue, dyspepsia and chronic diarrhea. The medical history revealed autoimmune Hashimoto's thyroiditis, type 2 diabetes, fatty liver disease, chronic gastritis and thrombocytosis. Multiple investigations showed hyposplenism and complex autoimmune dysfunction with positive serum markers for celiac disease and type 1 autoimmune hepatitis along with minor symptomatology. The intestinal symptomatology of celiac disease is often hid by hypothyroidism-associated autoimmune thyroiditis. Asymptomatic or minimally symptomatic celiac disease associated with Hashimoto's autoimmune thyroiditis is diagnosed by biomarkers. Hyposplenism in celiac disease can occur regardless of the disease stage, latent or symptomatic.

Deep vein thrombosis during long-term surveillance of patients with liver transplantation.

BACKGROUND: In the European Liver Transplant Registry, there are 137,863 liver transplantations recorded. Forty-one percent of patients survived 20 years after liver transplantation in the European countries. From 1988, when the US database for liver transplantation was created, to 2006, there are more than 56,000 liver transplants. Almost 80% of the liver transplant recipients survived 5 years after transplantation. The incidence of deep vein thrombosis (DVT) in the European population is 70-140/100.000 person-years. Cancer, paresis, immobilization, thrombophilia, inflammatory bowel disease, replacement hormonal or contraceptive therapies are associated with an increased risk of occurrence DVT or complications. The incidence of DVT in long-term surveillance of liver transplant recipients is unknown. Immunosuppressive therapy, thrombophilia abnormalities, hepatitis C and hepatocellular carcinoma recurrence, renal insufficiency, malignant tumours, obesity and diabetes were associated with DVT in long-term post-liver transplantation. The reported maximum time between liver transplantation and DVT was 210 days. AIM: The aim of the study is to update existing data in the literature regarding the occurrence and management of deep vein thrombosis in liver transplant patients over the long-term surveillence period. CONCLUSIONS: There are no specific guideline recommendations regarding acute DVT treatment in long-term surveillance after liver transplantation. Low molecular weight heparin (LMWH), unfractionated heparin (UFH) and vitamin K antagonist (VKA) are the anticoagulants used in specific complications post-transplantation. The safety and the efficacy of direct anticoagulants in liver transplantation recipients need to be assessed in future trials. Given that long-term survival of liver transplantation is much improved, complications associated with transplantation and ageing require appropriate cardiovascular guidelines.

B-type natriuretic peptides in pregnant women with normal heart or cardiac disorders.

Pregnancy is characterized by complex physiological changes of the cardiovascular system. B-type natriuretic peptides, represented by the bioactive molecule (BNP) and its inactive amino terminal fragment (NT-proBNP) are important biomarkers used in the management of the heart failure. Besides cardiac causes, BNP can grow in other noncardiac conditions such as pregnancy. The levels of natriuretic peptides during pregnancy have been the subject of multiple studies, whether it is a normal pregnancy, or there are pre-existing or developed cardiac conditions during pregnancy. It depends on the stage of pregnancy and comorbidities: obesity, preeclampsia, pre-existing cardiomyopathies or peripartum cardiomyopathy. High levels of NT-proBNP in pregnancy are associated with increased risk of cardiovascular events and involve careful supervision of pregnancy, including imaging procedures.

Diuretics, first-line antihypertensive agents: are they always safe in the elderly?

INTRODUCTION: Diuretics are frequently recommended as antihypertensive agents. Some of the main side effects of diuretic therapy are hypokalaemia and hyponatremia. The objective of the study was to describe the frequency of hyponatremia in a group of elderly hypertensive patients treated with diuretics. METHOD: The study included 202 elderly hypertensive patients (over 65 years old), treated with diuretics at least 4 weeks before hospitalization, consecutivly admitted in the Internal Medicine Clinic of the Clinical Emergency Hospital of Bucharest during a period of 4 months. RESULTS: The distribution by sex: 103 (52.28%) men and 94 (47.71%) women. The mean age of the patients was 72 ± 8 years. Incidence of hyponatremia was 24.87% (49 patients) in the whole group. From the 49 hyponatremic patients, 31 (63.26%) were women and 18 (36.73%) men. The distribution by age of hypertensive hyponatremic female patients was: between 65-70 years old--4 patients (12.90%), between 70-75 years old--7 patients (22.58%), over 75 years old--20 patients (64.51%). The distribution by age of hypertensive hyponatremic male patients was: between 65-70 years old--3 patients (16.66%), between 70-75 years old--2 patients(11.11%), over 75 years old--13 patients (72.22%). Most of the patients affected (73.46%) used a thiazide-type diuretic, the other 26.54% being on loop diuretics. CONCLUSIONS: Elderly hypertensive patients were more likely to develop hyponatremia after age 75. Female patients had a higher frequency of hyponatremia than male patients. The main cause of hyponatremia in patients treated with diuretics was thiazide.

A rare tumor revealed by abdominal trauma: case presentation.

Pseudomyxoma peritonei is a rare and poorly understood form of disease characterized by mucin deposits in the peritoneum. The term includes a broad range of neoplasms with different patterns of evolution, from benign to borderline or even to malignant lesions. The disease may be asymptomatic until advanced stages. We present the case of a 65-year-old patient who presented for pain in the right hemiabdomen, after a trauma by falling from small height. Abdominal imaging studies oriented the diagnosis to a traumatic disease. At laparotomy, a mucinous tumor attached to the right colon was discovered. The main particularity of the case is that the origin of the pseudomyxoma could not be identified.

Certitudes and controversies regarding the deleterious effects of low doses ionizing radiation.

The problem of the deleterious effects of ionizing radiation must be a constant preoccupation of the medical staff. We must never forget that radiations can cure (by increasing the diagnostic accuracy and by the benefic use of radiotherapy), but can also generate cancer and genomic instability. All the governments have the desire to use the "cheap" (it's cheap when you do not take into consideration all the spenditures regarding the monitorisation of radiation workers and the cost of decontamination) nuclear energy. We must underline, also, the fact that a too frequent exposure to ionizing radiation (especially by CT examinations) is generating undesired consequences, and that the direct irradiation and the bystander effect can create a genomic instability that is "transferred" to the following generation. As, nowadays, it is almost impossible to live in an environment devoid of risks, we must try to reduce them significantly.

Pancreatic cancer presenting with paraneoplastic thrombophlebitis--case report.

CONTEXT: The complex of symptoms in pancreatic cancer is vague, which often delays presentation and diagnosis. Thrombophlebitis is an unusual presentation of pancreatic cancer, which appears more frequent in the cancer of the body and tail of the pancreas. CASE REPORT: We present a case of a 52-years-old woman who was admitted to the hospital for a superficial thrombophlebitis. At the abdomen ultrasound screening, multiple liver masses, relatively well defined, with a hypo-echoic center and a hyper-echoic periphery, were identified. The head of the pancreas was normal, the body and the tail could not be seen very well due to flatulence. After computed tomography, the diagnosis was "Pancreatic tumor with multiple hepatic metastases (stage IV)". After the histopathological examination, 1250 mg/m2 of Gemcitabine was started on day 1 and 8 every 28 days, plus 100 mg/day of Erlotinib (Tarceva), every day. At the end of the seventh month of treatment, the patient suffered an irreversible ischemic cardiac event. CONCLUSION: Superficial thrombophlebitis can be the initial manifestation of the pancreatic cancer. Gemcitabine and erlotinib is now a FDA approved regimen for patients with metastatic pancreatic cancer. While the search for the best gemcitabine based backbone for advanced pancreatic cancer continues, studies of anti-angiogenic agents alone or in combination with traditional chemotherapy, should be undertaken, as they may improve overall survival in this group of poor prognosis patients.

Hepatocellular carcinoma with hepatic and pulmonary metastasis, inferior vena cava and left pulmonary artery thrombosis in a patient with asymptomatic hepatitis C. Case report.

During the virus C infection the presence of cirrhosis is the major risk factor for the development of hepatocellular carcinoma. In the absence of cirrhosis the estimated prevalence hepatocellular carcinoma ranged from 6.7% to 50.1%. We present the case of a 64 year-old-man admitted to the hospital with 3-days history of nespecific symptomatology. Screening abdominal ultrasound showed an enlarged liver with 4 parenchimatous nodules in the right lobe and malignant thrombosis of the inferior vena cava. Chest CT revealed multiple metastasis in both lungs and left pulmonary arterial thrombosis. The patient died 5 weeks later. The particularity of the case is the presence of the end-stage hepatocellular carcinoma in a patient with asymptomatic C virus infection.

[Echocardiographic evaluation of left ventricular diastolic dysfunction in patients with diabetes mellitus]. / Evaluarea ecocardiografica a disfunctiei diastolice de ventricul stâng la pacientii cu diabet zaharat.

The presence of diabetic cardiomyopathy, without any sign of hypertension, valvular or coronary artery disease, is related to diastolic dysfunction, an early sign of diabetic heart muscle disease. Doppler echocardiography evaluation should be performed for all patients with type 2 diabetes mellitus and microalbuminuria, in order to obtain a better management of this metabolic disease.