An atypical case of focal nodular hyperplasia. Problems of imagistic diagnosis.

Focal nodular hyperplasia (FNH) is a hepatic disease first described in 1958. The existence of an accessible and minimally invasive imagistic investigation to establish the diagnosis in a large number of cases would be desirable, especially because once diagnosed, the disease needs no treatment. We present the case of a young woman with long term use of oral contraceptives in which the diagnosis of FNH was established at a routine ultrasound. Evolution of disease during the pregnancy and the atypical imagistic aspect of liver lesions raised many problems of differential diagnosis.

Associated gastroduodenal artery aneurysm aortic aneurysm: the diagnostic contribution of contrast-enhanced ultrasound in correlation with computed tomography angiography.

Splanchnic aneurysms are rare conditions, with localization at the level of the gastroduodenal artery being encountered in only 1.5 % of the cases. Due to the high mortality risk, early detection and optimal treatment are required. We stress the importance of ultrasonography as a primary method of detection as well as the role of contrast-enhanced ultrasound in characterization of visceral aneurysms. Due to its noninvasive nature, the examination could be used for follow-up after therapeutic procedures or in cases were a curative intervention is not possible.

Comparative study of gallbladder motility in patients with chronic HCV hepatitis and with HCV cirrhosis.

AIM: To compare gallbladder (GB) emptying in patients with chronic hepatitis C and in those with HCV related cirrhosis. METHOD: 20 patients with HCV chronic hepatitis and 20 patients with HCV cirrhosis Child class A were enrolled in the study. The control group included 20 hospitalized patients free of liver disease. We excluded subjects with GB lithiasis or GB anomalies, and those with obesity and diabetes mellitus. In all patients, the following GB variables were measured: fasting volume (FV), minimal residual volume (RV), ejection fraction (EF), wall thickness and area under the emptying curve (AUC). The statistical analysis was performed using the Man-Whitney and Kruskal-Wallis tests and the Pearson correlation coefficient. RESULTS: In cirrhotic patients, the fasting GB volume (35.62 +/- 4.45cm3) and the residual volume (18.46 +/- 3.27cm3) were larger than in controls: 27.12 +/- 5.38cm3 and 7.28 +/- 3.15cm3, respectively (p < 0.00001). The GB EF was reduced in cirrhotics as compared to controls (p < 0.00001). The patients with HCV chronic hepatitis had a residual volume larger (14.18 +/- 6.11cm3 vs 7.28 +/- 3.15cm3; p = 0.0129), and an EF lower than controls (53.4 +/- 14.15cm3 vs. 72.76 +/- 9.96cm3) (p = 0.0005). The GB emptying curves showed a significantly slower emptying in cirrhotic and chronic hepatitis patients as compared to controls. We found a significant negative correlation in chronic hepatitis patients between EF, on one hand, and overweight and abdominal circumference, on the other. The GB wall was thicker in cirrhotics (5.1 +/- 0.32mm) as compared to controls (2.32 +/- 0.27mm) (p < 0.00001), and also in chronic hepatitis patients as compared to controls (p < 0.0001). CONCLUSION: A decrease in GB motility was present both in patients with HCV related cirrhosis and in those with chronic HCV hepatitis. This may be, partly, caused by an increase in GB wall thickness, and might be a risk factor for the development of gallstones.

Eosinophilic ascites in a patient with toxocara canis infection. A case report.

We report the case of a young female patient, admitted for a recent ascites of unknown origin. The acute onset was with colicky abdominal pain and peritoneal effusion, which led to the suspicion of perforated ulcer. A diagnostic laparoscopy was performed which showed free peritoneal fluid and normal abdominal viscera. At upper gastro-intestinal endoscopy, performed a few days later, patchy erythema in the antral region and duodenal edema were revealed. Duodenal biopsies showed marked eosinophilic infiltration. The ascitic fluid was straw coloured, sterile with 90% eosinophils. Eosinophilic gastroenteritis was suspected, but differential diagnosis required the exclusion of migrant parasites. The stool exams were negative but serology for Toxocara antibodies was positive. The treatment with albendazole (Zentel 400 mg twice a day for 5 days) led to the disappearance of signs and symptoms. The eosinophilic infiltrate of the gut was absent in duodenal biopsies taken two months later.

Education and management of patients with familial adenomatous polyposis. Are we making progress? A case report.

A 25-year-old male patient was admitted to our clinic for abdominal pain, diarrhea, intermittent rectal bleeding and weight loss. The family history revealed two deaths due to colorectal cancer (maternal grandmother and patient's mother). The colonoscopy showed hundreds of polyps throughout the colon, and an ulcerative rectosigmoidian tumor. The diagnosis was Familial Adenomatous Polyposis (FAP). Colectomy with ileorectal anastomosis was performed. Histopathological diagnosis revealed moderately differentiated adenocarcinoma. Adjuvant chemotherapy was carried out. The patient had three brothers, without clinical symptoms. They had a colonoscopic examination for screening. Two of them were diagnosed with adenomatous polyposis - the first with classic FAP and the other one with the attenuated type (AFAP). The diagnosis of FAP can be made on the basis of either clinical or genetic criteria. When the family history, clinical features, and pathological findings are classic, the diagnosis is straightforward. Screening and prophylactic surgery are effective to prevent colorectal cancer in patients with FAP. Lifelong regular surveillance is necessary to detect and manage extracolonic lesions.

Screening for familial colorectal cancer: the need for continuing education. A case report.

A 37 year old female patient was diagnosed with sigmoid colon cancer in our clinic five years ago (January 1998). The family history revealed three deaths due to colorectal cancer (maternal grandmother, mother's sister and patient's sister), and the patient's mother had been diagnosed with adenomatous polyps (endoscopically removed). Histopathological diagnosis was moderate / poorly differentiated adenocarcinoma. Resection of sigmoid colon was performed and adjuvant chemotherapy was carried out, with uneventful evolution. The patient was annually followed-up (colonoscopy, abdominal ultrasound, laboratory tests). The last admission was in January 2003. No recurrence or metastases were found. The patient's mother, who was admitted at the same time, had been diagnosed with urinary bladder tumor. Subjects with a personal or family history of colorectal cancer should routinely have a colonoscopy beginning from age 40 or earlier. It is important for such patients to be followed-up closely not only for recurrence or metastases, but also for detection and treatment of a second primary cancer at an early stage