Small intestinal bacterial overgrowth and nonalcoholic fatty liver disease.

The gut microbiota has recently been recognized as a major environmental factor in the pathophysiology of several human diseases. The anatomical and functional association existing between the gut and the liver provides the theoretical basis to assume that the liver is a major target for gut microbes. In the last decades, many studies have reported an altered composition of gut microbiota in patients with chronic liver diseases and liver cirrhosis, suggesting a progressively marked dysbiosis to be related to worsening of the liver disease. Modifications of microbiota result in alteration in providing signals through the intestine and bacterial products, as well as hormones produced in the bowel that affect metabolism at different levels including the liver. There is increasing evidence for a correlation between intestinal microbiota, bacterial translocation and hepatic steatosis. Intestinal microbiota affects nutrient absorption and energy homeostasis. Altered intestinal permeability may favor the passage of bacteria derived compounds into the systemic circulation, causing a systemic inflammatory state, characteristic of the metabolic syndrome. At present, an increasing number of studies indicate a close relationship between dysbiosis, defined as abnormal composition and the amount of intestinal bacteria (gut microbiota), intestinal permeability and some metabolic, inflammatory, degenerative and even psychiatric diseases. Microbiota pharmacological modulation seems to be a promising tool for a new therapeutic approach to non-alcoholic fatty liver disease and in prevention of cirrhosis. The following study aims to briefly discuss the role of microbiota disorder (dysbiosis), and in particular small intestinal bacterial overgrowth (SIBO), in the pathogenesis of nonalcoholic fatty liver disease (NAFLD).

[Klatskin tumor - a case report]. / Guz Klatskina - opis przypadku.

UNLABELLED: Cholangiocarcinoma (CCA) is the second most frequent liver malignancy, responsible for 10-15% primary liver cancers. This tumor is difficult to diagnose and characterized by high mortality rate. Extrahepatic CCA is a specific type known as Klatskin tumor. A CASE REPORT: The patient was admitted to the Clinic of Internal Medicine and Gastroenterology with intrahepatic cholestasis. Imaging revealed Bismuth type IV hilum tumor. Due to rare occurrence of this malignancy the patient was directed to the tertiary center. During surgical exploration radical treatment was abandoned as a result of tumor's advanced stadium. Histology evaluation revealed infiltrating adenocarcinoma. ERCP and biliary duct stenting was performed. The patient was qualified for paliative chemotherapy according to gemcytabine+cisplatine protocol (d1, d15 every 28 days). Posttreatment follow-up revealed total remission of the tumor.

[Endoscopic methods of non variceal upper gastrointestinal bleeding haemostasis--retrospective analysis]. / Endoskopowe tamowanie krwawien z górnego odcinka przewodu pokarmowego pochodzenia niezylakowego--analiza retrospektywna.

UNLABELLED: The upper gastrointestinal bleeding continues to be a significant therapeutic problem despite the progress in endoscopic treatment. Due to its dynamics, it may lead to an imminent danger to life or to a sudden necessity of surgical intervention. AIM OF THE STUDY: to evaluate the results of the treatment of the patients with upper gastrointestinal bleeding using the therapeutic endoscopy. MATERIAL AND METHODS: . The analysis of 214 histories of the diseases of the patients with the endoscopic methods of haemostasis for upper gastrointestinal bleeding aged 18-102, hospitalized in the 5th Military Clinical Hospital in Cracow between 2000 and 2008 was carried out. The injection, thermal and mechanical methods are being used during the endoscopic methods of haemostasis. In the research, injecting the bleeding area with a saline solution with adrenaline was applied as the endoscopic methods of haemostasis. Causes of bleeding, its intensity, location, a number of recurrences, deaths, necessity of surgical intervention, a number of blood substitutes transfusions and a number of endoscopic methods of haemostasis depending on age and sex were investigated. RESULTS: Most often, bleeding was caused by the gastric ulcers, located in stomach center along the greater curvature. Patients aged 66-79 suffered from bleeding most frequently; while the patients under 30 constituted the smallest group. Recurrences of bleeding were observed in 34 patients; they occurred equally often in gastric and duodenum ulceration. 14 patients required surgical procedures. CONCLUSIONS: On the basis of the performed analysis, it can be inferred that gastric ulceration, located in the stomach center along the greater curvature, constitutes the most frequent source from the upper gastrointestinal bleeding, and occurs more frequently in males than females, aged mainly 66-79. Endoscopic methods of haemostasis by injections with a saline solution with adrenaline proved to be a significantly effective method since only 6.54% patients required a surgical intervention.

[Endocrinological disorders in due to diseases of the pancreas]. / Zaburzenia wewnatrzwydzielnicze w przebiegu chorób trzustki.

During diseases of the pancreas not only extrasecretory but also intrasecretory disorders are observed. The disturbances are dependent on excessive or insufficient releasing of hormones which are physiologically secreted by the pancreas. The most common endocrine disorder, which develops in pancreatic diseases, is insufficient insulin production which leads to carbohydrates balance disorders. The occurrence of endocrine pancreatic tumors (insulinoma, gastrinoma) is visibly less common--2-10% of neoplasmy of the organ. In group of endocrine tumors of the pancreas are also observed some changes which are able to release the vase-active intestinal peptide (VIP-oma), glucagon tumors, carcinoid released serotonine and somatostatinoma. More over, low-differentiated endocrine carcinomas of the pancreas consist about 1% of all pancreatic tumors and 2-3% of the all endocrine tumors.

[Diverticular disease--the rules of management]. / Choroba uchylkowa--zasady postepowania.

Diverticular disease it is one from the most common disease, and the number of young people with this illness is increasing last time. It is connected with our life style: without physical activity and low-fiber diet. Main symptoms of diverticular disease can be mild (like: abdominal pain, flatulence, constipations or diarrhea) but can also be connected with serious complications (like perforation or bleeding). The aim of this article was assigning the rules of diagnostics and treatment both mild and severe causes of this illness. Methods of prevention were also presented.