CRP and the Prognosis of Patients with Cirrhosis.

The theory of vasodilation partially explains the development and progression of liver cirrhosis and is completed by the theory of inflammation. C-reactive protein (CRP) is used as a surrogate marker of inflammation in studies; however, there is not sufficient data that would reflect the role of this protein in cirrhosis yet. The objective of this study was to determine the use of CRP value in the prognosis of patients with cirrhosis. In "Material and method" section we described a clinical prospective trial with 102 participants represented by patients with cirrhosis of various etiologies in a tertiary hospital, each monitored throughout a period of 12 months after the collection of CRP. The results showed that the mean CRP value was 0.7+/0.09 mg/dL (CI 0.59-0.90) in patients who did not decompensate throughout the trial and 1.58+/0.4 mg/dL (CI 1.76-2.30) in those who did decompensate, with a statistically significant difference (p=0.045). In rehospitalized patients versus those without any hospitalization, the mean CRP values were 1.35 mg/dL and 0.8 mg/dL, respectively (p=0.032). The increased values of this parameter were positively correlated with the number of hospitalizations (rs=0.35, p=0.05). A CRP value below the threshold of 0.62 mg/dL indicates a smaller probability of future decompensation in liver cirrhosis patients. The conclusion of this study is that CRP influences the secondary endpoints, including cirrhosis decompensation and patient rehospitalization. It can be added to the existing studies.

Malignancy and mortality of colorectal polyps.

OBJECTIVES: To evaluate the rate of morbidity and mortality associated with colorectal polyps after the next 8-years period of endoscopic polypectomy, in a high risk managed care population. MATERIAL AND METHOD: Cohorts of 77 subjects with benign neoplasms were identified with a colonoscopy in 1999. Three groups of subjects: benign neoplasms with polypectomy, benign neoplasms without polypectomy, and no neoplasms were evaluated. Five years recurrence rates (1999-2004) of benign or new malignant colorectal neoplasms were identified: for the benign determined for the baseline benign neoplasms with polypectomy and no neoplasm groups neoplasm without polypectomy, only rates for malignancy were observed. Malignancy was evaluated with immunohistochemical p53 (tumor protein 53) and PCNA (Proliferating Cell Nuclear Antigen) staining pattern. Over the next 8 years 2004-2012 were evaluated the mortality and the recurrence rate of the benign polyps. RESULTS: 77 subjects were enrolled in our study; 71.4% were diagnosed with benign and 2.5% with malignant neoplasms. The 5-years cumulative incidence rates of malignant colorectal neoplasms in the no neoplasm (n = 20) and benign neoplasm groups (n = 55) were (n = 1) 5% and ( n = 10) 18.1%, respectively (p < 0.005). A lower 5-years malignancy rate was observed in benign neoplasms group with polypectomy (12%) compared to the benign neoplasm group without polypectomy (33.3%) (p < 0.05). The 8-years mortality rate was compared into benign recurrent polyps group and into malign group: the lower 8-years mortality rate was observed into benign polyp no neoplasm group (0%) and into benign recurrent polyps group (40%); the highest rate was observed into neoplasm group (100%). CONCLUSIONS: The high recurrence rate of benign colorectal neoplasms and a higher incidence of colorectal cancer in subjects at high risk-history of benign colorectal neoplasm-highlight a healthcare opportunity for surveillance and/or interventions to reduce the morbidity associated with colorectal neoplasms.

Composite diffuse large B-cell lymphoma and follicular B-cell lymphoma - case report and review of literature.

Composite lymphoma refers to the co-occurrence of two or more morphologically and immunophenotypically separate lymphomas in the same topographic site at the time of clinical presentation. It is an infrequent type of lymphoid neoplasm, present in lymphoid tissue and may be due to the existence of two genetically related neoplasms such as transformation of a single lymphoma into another more aggressive lymphoma or be due to the presence of two clonally unrelated lymphomas. This paper is presenting a case of diffuse non-Hodgkin large B-cell lymphoma with areas of low grade and high grade follicular non-Hodgkin B-cell lymphoma in a retroperitoneal lymph node and spleen of an 62 year old woman. Histopathological examination and immunohistochemistry features proved the diagnosis of composite lymphoma.