ASSESSMENT OF ADRENOCORTICAL DYSFUNCTION IN PATIENTS WITH STABLE LIVER CIRRHOSIS.

INTRODUCTION: Relative adrenal insufficiency (RAI) is common in the setting of critical illness as well as in hemodynamically instable cirrhotic patients with sepsis. Several studies have also shown that RAI is frequent in patients with stable cirrhosis without sepsis. The aim of this study was to prospectively assess the incidence of RAI in patients with stable cirrhosis. PATIENTS AND METHODS: Forty-seven patients with hemodynamically stable liver cirrhosis without sepsis were prospectively included. RAI, assessed by using low dose-short Synacthen test (LD-SST), was defined as either a basal total cortisol concentration below 3.6 µg/dL or a peak total serum cortisol ≤ 16 µg/dL at 30 min after stimulation. RESULTS: RAI was present in 10 (21.3%) of 47 cirrhotic patients. Peak cortisol level was negatively correlated with the severity of cirrhosis evaluated by Child-Turcotte-Pugh (CTP) (r=-0.46; P=0.001) and Model for End-Stage Liver Disease (MELD) (r=-0.51; P=0.001) scores. The frequency of RAI increased from CTP-A (10%) to CTP-B (30%) to CTP-C (60%). CONCLUSION: RAI diagnosed by LD-SST is frequent in patients with stable cirrhosis and is related to the severity of liver disease. Further studies are needed to define clinical importance of RAI in stable cirrhotic patients.

DEPRESSION--A FELLOW TRAVELER WITH SYSTEMIC LUPUS ERYTHEMATOSUS.

Systemic lupus erythematosus (SLE) is a chronic multisystem inflammatory disorder that occurs primarily in women of childbearing age, immunologic abnormalities being a prominent feature of the disease. Psychiatric disorders frequently coexist, depression being the most common mood disorder in neuropsychiatric lupus. This literature review was performed through searching MEDLINE database for full-text English-language articles--original research, systematic review and updates published in the last five years (2010-2015), using the keywords "depression and systemic lupus erythematosus". The main outcomes identified were prevalence and predictors of depression in various cultural and ethnic groups, depression-related clinical issues (suicidal ideation, cognitive impairment, altered body image, sleep and sexual disturbances, influence of SLE treatment), and influence on quality of life. A multidisciplinary approach that takes into account the polymorphism and individual variability of the SLE clinical manifestations helps to improve early detection of depression, which is responsible for the increased risk of comorbidities, suicidal attempts, decreased treatment adherence, and impaired quality of life. Physicians across all specialties involved in the care for lupus patients should be aware of the major prevalence of this condition, while helping patients to cope with their disabling disease.

Ebstein's anomaly.

Ebstein's anomaly is a rare congenital heart disease, accounting for less than 1% of all congenital heart diseases, characterized by a wide clinical, electrocardiographic, echocardiographic, anatomic and prognostic polymorphism. The disease can be fatal since birth or may remain asymptomatic until adulthood, sometimes being associated with septal defects, transposition of great vessels, preexcitation syndromes, or left ventricular noncompaction. The genetic changes underlying this syndrome are not fully known, but in the cases associating left ventricular nonompaction a mutation in MYH7 gene encoding the beta-myosin heavy chain was recently detected. The authors present 2 cases of Ebstein's anomaly with different onset and course and discuss the current clinical, electrocardiographic and echocardiographic criteria used for prognostic stratification of Ebstein disease in relation to international literature.

Anomalous impurity segregation and local bonding fluctuation in l-Si.

Anomalous impurity redistribution after a laser irradiation process in group-IV elements has been reported in numerous papers. In this Letter, we correlate this still unexplained behavior with the peculiar bonding character of the liquid state of group-IV semiconductors. Analyzing the B-Si system in a wide range of experimental conditions we demonstrate that this phenomenon derives from the non-Fickian diffusion transport of B in l-Si. The proposed diffusion model relies on the balance between two impurity states in different bonding configurations: one migrating at higher diffusivity than the other. This microscopic mechanism explains the anomalous B segregation, whereas accurate comparisons between experimental chemical profiles and simulation results validate the model.

[Splenic hydatic cyst. Observations upon 38 cases of splenic echinococcosis]. / Chistul hidatic splenic. Observatii asupra a 38 de cazuri de echinococoza splenica.

15 patients with spleen hydatic cysts have been operated between 1986-1998, in percentage of 4.6% from the total number of hydatic cysts--8 females and 7 males with mean age of 44 years (17-70). They have been admitted for abdominal pain (66.6%) and at the clinical examination they presented a cystic tumor at the level of the spleen. In all the patients we performed splenectomy. In conclusion the hydatic cyst of the spleen is rare, but possible, the treatment being only surgical.