Platelet indices in patients with de novo portal vein thrombosis and liver cirrhosis.

UNLABELLED: Platelet indices are markers of platelet reactivity used for thrombotic risk assessment in patients with cardiovascular diseases, and recently in venous thrombosis. AIM: To assess the diagnostic value of platelet indices in patients with non-malignant de novo portal vein thrombosis and liver cirrhosis. MATERIAL AND METHODS: We conducted a prospective, case-control study on patients admitted to a tertiary center in the interval January, 2010 - December, 2012. Included in the study were 54 patients with portal vein thrombosis (PVT) and 54 controls. Patients with known malignancy, sepsis, thrombophilia, on anticoagulant or antiaggregant therapy, acute or chronic inflammatory diseases, severe anemia, renal failure, acute coronary syndrome, and chronic pulmonary disease were excluded from the study. RESULTS: Both groups were comparable for baseline characteristics. Mean platelet volume, platelet distribution width (PDW) and plateletcrit were higher in the PVT group. In a multivariate logistic regression analysis, significant predictors of the presence of PVT were mean platelet volume (MPV), PDW, and procalcitonin (PCT). CONCLUSION: Our data suggest that increased platelet indices contribute to the prethrombotic state in liver cirrhosis and that larger platelets may play a specific role in thrombosis despite thrombocytopenia.

[Non-invasive evaluation of liver fibrosis in chronic hepatitis C].

Chronic hepatitis C (CHC) is a major public health concern, with around 180 million individuals affected worldwide. Liver fibrosis and its end-point cirrhosis are the main causes of morbidity and mortality in patients with CHC. Liver biopsy (LB) has traditionally been considered the "gold standard" for pre-treatment evaluation of liver fibrossis in patients with CHC. However, LB is an invasive procedure with several shortcomings (intra- and interobserver variability, sampling errors, expensive) and the risk of rare but potentially life-threatening complications (biliary peritonitis, hemo-peritoneum, and death in 1/10,000). The aforementioned shortcomings of LB have led to development of several non-invasive methods for the assessment of liver fibrosis in CHC. Among the non-invasive methods, Fibrotest and Fibroscan are the most widely used in our country and offer a viable alternative to LB for pre-treatment assessment of liver fibrosis in patients with CHC. This review aims to discuss the advantages and usefulness of non-invasive methods of liver fibrosis in CHC.

The risk of thrombotic events in patients with liver cirrhosis.

AIM: To evaluate the incidence and risk factors for thrombotic events (deep vein thrombosis and portal vein thrombosis) in patients with liver cirrhosis. MATERIAL AND METHODS: we studied patients diagnosed with liver cirrhosis admitted in our department between January 2010-December 2011, which were divided in two groups: liver cirrhosis with thrombotic events and without thrombotic events. RESULTS: we included 3108 patients, the incidence of deep vein thrombosis was 0.99% and portal vein thrombosis was 1.51%, the incidence of all thrombotic events was 2.5%. In the univariate analysis serum albumin was significantly lower in cases than controls, and MELD score, mean platelet volume were higher in cases than controls. The presence of sepsis and diabetes mellitus were demonstrated like risk factors by the univariate analysis. In multivariate analysis, albumin level< 3mg/dl (HR=1.65, CI 1.10-2.51, p=0.018) and MELD score >13 (HR=2.94, CI 1.61-5.47, p=0.001) remained independently predictive of thrombotic events. CONCLUSIONS: The incidence of thrombotic events in patients with liver cirrhosis was 2.5%. Low serum albumin and high MELD score could predict the development of thrombotic events in patients with liver cirrhosis.

Familial syndromic papillary thyroid carcinoma report of two cases.

AIM: to describe two cases of familial papillary thyroid carcinoma. MATERIAL AND METHODS: patients were investigated by fine needle biopsy, MRI imaging and tumor biopsy, (first case) and histological examination of colonic and thyroid tumors (first case) and histological examination of thyroid tumor (second case). RESULTS AND DISCUSSION: case presentation: first case, 68 years old man had a colonic polyposis (attenuated form with only a few polyps) and a thyroid nodule. After hemicoleCtomy for a supposed colonic carcinoma with liver and lung metastases, histological examination revealed no malignant colonic disease. Two month later the diagnosis of invasive thyroid tumor with lymph node metastases was made, but only an open biopsy was done because tumor invasiveness demonstrated on MTI imaging. The biopsy identified a papillary thyroid carcinoma. Case 2: the son of the patient (30 years old) without known diseases was invited to be assessed for thyroid disease. Ultrasound examination discovered a large nodule with microcalcifications. Microscopic examination done after total thyroidectomy revealed a cribriform morular variant of papillary thyroid carcinoma, a variant that is known to be associated with FAP. Radioiodine ablation was made followed by suppressive thyroxine treatment. In the second case adenomatous polyposis was not found yet. In our knowledge these are the first cases of familial thyroid papillary carcinomas in our setting. Familial history allowed an earlier diagnosis and a good management of the disease in the second case. CONCLUSIONS: according to the literature and our first experience, screening for thyroid cancer must be done in all patients with FAP and in those with a FAP proband in the family.

[The role of capsule endoscopy in suspected Crohn's disease]. / Rolul videocapsulei endoscopice în boala Crohn suspectata.

Capsule endoscopy (CE) revolutionized the small bowel examination. We emphasize the role of CE in suspected Crohn's disease, studying 24 investigations performed in the Institute of Gastroenterology and Hepatology. The global diagnostic yield was 54%, the specific diagnostic yield for Crohn's disease was 37.5%, the specificity was 100% and the retention rate was 4.1%. For maximum accuracy and efficiency, unitary administration and diagnostic criteria are needed, and for minimising the risk of complications, specific prior investigations would be suitable.

[High levels of sterigmatocystin in patients with chronic liver diseases]. / Detectarea sterigmatocistinei la pacientii cu boala ii hepatica cronica.

UNLABELLED: Sterigmatocystin (STC) is a wide spread mycotoxin produced by Aspergillus fungi, with hepatotoxic and carcinogenetic proprieties. OBJECTIVES: To determine the STC concentration in blood and urine from patient with liver cirrhosis (LC) and hepatocellular carcinoma (HCC), with correlation with liver function parameters. MATERIAL AND METHODS: The study enrolled 166 patients divided in three groups: control--55 patients (27M, 28F); LC--58 patients (31M, 27F); HCC--53 patients (26M, 27F). 20 ml of blood and 50 ml of urine were collected from each patient and liver enzymes and alfa-fetoprotein (AFP) were measured. STC was determined by high performance liquid chromatography, with concomitant detection in ultraviolet and fluorescence. RESULTS: STC was detected in 26.2% of samples, more frequently in LC and HCC groups (p < 0.001). STC mean values were 0.014 ng/ml and 0.005 ng/ml in blood, respective urine of controls, rising to 0.626 ng/ml (p = 0.003) respective 1.053 ng/ml (p = 0.049) in LC and 2.02 ng/ml in blood (p < 0.0001) and 9.39 ng/ml in urine (p = 0.003) in patients with HCC. There is a perfect correlation between serum and urinary levels of STC in controls (r = 1), that become weak in patients with LC (r = 0.48) and insignificant in HCC (r = 0.15). AFP values were significantly correlated with STC concentration in patient with HCC, in both blood (r = 0.31) and urine (r = 0.84). CONCLUSIONS: STC values in patients with LC and HCC were significantly higher compared to controls. Strong positive correlation of STC with AFP in patients with liver cancer suggested a possible role of this mycotoxin in pathogenesis of the disease.

Single-balloon enteroscopy following videocapsule endoscopy for diagnosis of small bowel tumors: preliminary experiences.

BACKGROUND AND AIM: Small bowel tumors (SBTs), either benign or malignant, are rare, accounting for 3-6% of all digestive neoplasms. Videocapsule endoscopy (VCE) and double-balloon enteroscopy (DBE) have revolutionized the diagnosis and management of patients with small bowel diseases, including SBTs. A novel method using the single-balloon enteroscopy (SBE) has recently been developed. The aim of present study was to present our preliminary experience with SBE in patients with suspected SBTs on VCE examination. PATIENTS AND METHODS: Patients in whom VCE showed one or more lesions suggesting SBTs underwent SBE. RESULTS: Three patients (2 males, 1 female; mean age 52 +/- 11 years) underwent SBE, and then surgery. There were two gastrointestinal stromal tumors and one adenocarcinoma. Clinically, all patients had iron-deficiency anemia and abdominal pain, and one patient had episodes of nausea/ vomiting. SBE was well tolerated without adverse events. CONCLUSIONS: SBE is a safe procedure and overcomes the limitations of VCE. Both procedures are complimentary in patients with suspected SBTs. VCE should be used first for initial diagnosis, followed by SBE for histopathological confrmation of the diagnosis and, if necessary, endoscopic therapy.

[Capsule endoscopy role in diagnosis of small bowel tumors]. / Rolul videocapsulei endoscopice in diagnosticul tumorilor de intestin subtire--analiza unei serii.

UNLABELLED: Since the introduction of capsule endoscopy (CE), several studies suggested a higher frequency of small bowel tumors (SBTs) than previously reported. MATERIAL AND METHOD: We evaluated the prevalence, presentation and diagnostic work-up of SBTs in patients undergoing CE in a single referral center. During 2003 - 2009, 102 patients underwent CE. For each patient with suspected SBT at CE, with subsequent histological confirmation, we registered clinical and biological features, imaging methods performed and management. RESULTS: SBTs were detected in 4.9% of patients undergoing CE. The main indication for CE was obscure gastrointestinal bleeding. All patients had undergone, before CE, at least one procedure evaluating the small bowel. All patients had iron-deficiency anemia, some presented also other gastrointestinal symptoms. The main SBT type was gastrointestinal stromal tumor. Three patients underwent single-balloon enteroscopy; surgery was performed in all patients. No retention of capsule occurred. CE could be used as first choice as diagnostic tool when SBTs are suspected.

[Prevalence of delayed gastric emptying of solids in functional dyspepsia and its relationship to symptoms]. / Evaluarea prevalentei evacuarii gastrice intârziate a solidelor la pacientii cu dispepsie functionala si corelatia sa cu simptomatologia.

UNLABELLED: The relationship between functional dyspepsia and delayed gastric emptying of solids is still unclear. This study evaluated the prevalence of delayed gastric emptying of solids in functional dyspepsia patients and its relationship to dyspeptic symptoms. MATERIAL AND METHOD: 142 patients with functional dyspepsia were prospectively assessed, the solid gastric emptying was measured using 13C-acid octanoic breath test and the severity of six dyspeptic symptoms (postprandial fullness, early satiety, bloating, abdominal discomfort, nausea and vomiting) was scored. RESULTS: Gastric emptying of solids was delayed in 45 (31.7%) dyspeptic patients. Multivariate analysis showed that the presence and severity of nausea and vomiting were associated with delayed solid gastric emptying (p < 0.05). Female gender was also associated with the risk of delayed gastric emptying (p < 0.05). CONCLUSIONS: A subset of functional dyspepsia patients has delayed gastric emptying of solids. Female sex, the presence and severity of nausea and vomiting are independently associated with delayed gastric emptying of solids in these patients.

[Aflatoxin contamination of food: additional risk factor for chronic liver diseases]. / Contaminarea cu aflatoxine a alimentelor--factor suplimentar de risc pentru patologia hepatica cronica.

UNLABELLED: Aflatoxins are over all spread toxic metabolites of fungi, able to induce chronic liver damages. AIM: To establish the correlation between the degree of liver disease and risk of chronic intake of aflatoxin contaminated foods. MATERIAL AND METHOD: 123 patients divided in three groups (controls, chronic hepatitis and liver cirrhosis) completed a food frequency questionaire (FFQ) estimating the intake risk of foods with a high potential of contamination with aflatoxins and alcohol consumption. RESULTS: Frequent intake of high risk foodstuff was declared by 37% of the participants, without any differences between the three groups. Foods with a very high risk of contamination were more frequently consumed in rural areas (predominant maize and oily seeds), while in the urban areas spices and coffee prevailed. In countryside, the feeding risk decreased with the gravity of liver disease, but alcohol consumption was significantly greater. CONCLUSION: FFQ revealed a high risk of ingestion of aflatoxin contaminated foodstuff in general population, greater in rural areas. The risk of aflatoxin intake seems unreleated with the gravity of chronic liver disease.

[Prevalence of Helicobacter pylori infection in patients with diabetes mellitus]. / Prevalenta infectiei cu Helicobacter pylori la pacientii cu diabet zaharat.

UNLABELLED: Helicobacter pylori (H. pylori) and diabetes mellitus are the most important causes of dyspepsia. The aim of this study was to evaluate the prevalence of H. pylori infection in patients with diabetes mellitus, and to assess whether the infection was associated with severity of dyspeptic syndrome and metabolic glycemic control. MATERIAL AND METHOD: 100 patients with diabetes mellitus type 1 and 2 (41 men and 59 women, mean age 58.59 ani) were included in our study. Each patient completed a self-report questionnaire to obtain information concerning the presence and severity of upper gastrointestinal tract symptoms. H. pylori status was confirmed by serological test and histophatology study of gastric biopsy or 13C-urea breath test. RESULTS: Prevalence of H. pylori infection was found not to be significantly higher in diabetics than in controls (70% vs 73% ). 49% H. pylori positive diabetics had type 2 insulinonecesitant diabetes mellitus, 27% had type 1 diabetes mellitus and 24% had type 2 diabetes mellitus, with no statistically significant difference (p > 0.05). We found no statistically significant difference in the symptoms score between H. pylori positive and H. pylori negative diabetic patients. The main value of HbA1 levels in H. pylori--infected diabetics was 7.31% and 7.47% in H. pylori non-infected diabetics, without significant difference. CONCLUSION: There was no statistically significant difference in the prevalence of H. pylori infection between diabetics and non-diabetics patients and no difference in the symptoms score between H. pylori positive and H. pylori negative diabetic patients. H. pylori in diabetics appears no influence glycemic status.

[High blood and urine concentration of hepatotoxic mycotoxins (aflatoxin B1, sterigmatocystin) in patients with liver cirrhosis]. / Detectarea micotoxinelor hepatotoxice la pacienti cu ciroza Hepatica.

UNLABELLED: Aflatoxins and sterigmatocystin are potent carcinogens, certainly involved in pathogenesis of liver cancer. AIM: To evaluate the risk of mycotoxin intake and to determine the presence of aflatoxin B1 (AFB1) and sterigmatocystin (STC) in patients with liver cirrhosis. MATERIAL AND METHOD: The study included 92 patients (33 controls, 59 liver cirrhosis) that completed a food frequency questionnaire (FFQ). Blood and urine samples were collected and mycotoxins determined by high performance liquid chromatography. RESULTS: 18.18% samples in controls and 72.88% in cirrhosis group presented detectable levels of mycotoxins. The mean values of AFB1 in blood were 0.7 ng/mL in controls and 1.67 ng/mL in test group (p = 0.11); STC presented 60 times higher levels in second group (p < 0.01). AFB1 presented a mean level of 1.2 ng/mL in urine of test group (not detected in controls); STC presented 256 time higher concentration in urine of cirrhotic patients, with a perfect correlation between blood and urine levels in control (r=1) and no correlation in test group (r = 0.05). There were no correlations between mycotoxin, liver enzymes, alpha-fetoprotein and mycotoxin intake risk estimated by FFQ. CONCLUSION: Most of the patients presented detectable levels of mycotoxins, significantly increased in cases with liver cirrhosis, probable due to a specific metabolic pattern.

13C-urea breath test for the diagnosis of Helicobacter pylori infection in bleeding duodenal ulcer.

UNLABELLED: Helicobacter pylori (H. pylori) is the main etiologic factor for duodenal ulcer (DU). Bleeding is still a frequent and sometimes severe complication, with unacceptable mortality despite modern therapeutic modalities. The importance of diagnosing and treating H. pylori infection in bleeding DU is underlined by the fact that eradication therapy is effective in preventing recurrent bleeding. The aim of this study was to evaluate the prevalence of H. pylori infection by means of 13C urea breath test (13C-UBT) in patients with bleeding DU. MATERIAL AND METHOD: Thirty-nine patients (25 men, 14 women) hospitalized with bleeding DU underwent emergency endoscopy and treated with intravenous proton pump inhibitors (PPIs), and a 13C-UBT was performed the day after the resuming oral feeding. RESULTS: Twenty-seven patients (19 men, 8 women) (69.3%) had a positive 13C-UBT. All patients received intravenous PPIs (22 pantoprazole, 17 esomeprazole) after emergency endoscopy (80 mg bolus + 8 mg/hour infusion/day) for 3-4 days. The time elapsed between admission and performance of 13C-UBT did not differ significantly between patients having a positive or negative 3C-UBT (5.6 vs 6.1 days). Eight of the twelve patients (66.6%) with a negative 13C-UBT had a repeated test two month later, and five of them became positive; therefore, H. pylori infection was finally detected in 32 (82%) out of 39 patients with bleeding DU. CONCLUSION: Most patients with bleeding DU have a positive 13C-UBT although they were taking PPIs.

[Colorectal cancer in Romania: epidemiological trends]. / Tendinte epidemiologice ale cancerului colorectal în România.

UNLABELLED: Traditionally, gastric cancer was considered the main digestive cancer. In Romania, in the last decade, the experts from all university centers noticed an alarming increase of colorectal cancer (CCR) incidence, the fraction gastric/colorectal cancer being now inversed. AIM: To study the epidemiological trends of CCR in Romania in different counties and to analyze the proportion of cases diagnosed in 4 traditional endoscopy units. METHODS: We have analyzed the CCR data from National Institute of Statistics (NIS) and those available from medical archives of 4 important GI units for establishing the annual incidence of CCR in all counties of Romania, and the distribution of CCR in relation with age and gender. We made a specific analysis of incidence trend in CCR for each county. RESULTS: The data obtained from NIS showed an increase of the number of new diagnosed cases of CCR in Romania from 2971 to 5185, which means an increase with 74.5% ; in incidence term means an increase from 13.5/100000 to 23.57. More than half (55.8%) of new cases of CCR were diagnosed in 14 counties (less than one third of population). A high frequency of CCR seems related to the report urban/rural, the economic development, the average income, but also the access to a Endoscopy Unit. The data collected from 4 university centers showed the same ascendant epidemiological trend. CONCLUSION: The incidence of CCR is in a continuous increase in Romania, the epidemiologic trends being similar with those recorded in Western Europe until 90th. In western countries, the increase awareness about CCR and methods of screening and early diagnosis determined a stabilization of incidence of CCR. Similar efforts of society and sanitary system are required in

Helicobacter pylori infection in patients with diabetes mellitus.

Data concerning the prevalence of Helicobacter pylori (H. pylori) in diabetic patients are scanty and controversial. The aim of this study was to evaluate the prevalence of H. pylori infection in patients with diabetes mellitus (DM), and to assess whether the presence of bacterium was associated with severity of dyspeptic symptoms and endoscopic findings in such patients. The study involved 42 patients (19 men, 23 women; mean age 55 years, range 34-75 years) with DM and dyspeptic symptoms. Sixteen patients (38%) were classified as having type 1 diabetes and 26 (62%) patients as having type 2 diabetes. All patients had chronic dyspepsia, and each patient has completed a self-report questionnaire to obtain information concerning the presence and severity of upper gastrointestinal tract symptoms. H. pylori status was confirmed by 13C-urea breath test (13C-UBT), and diabetic patients underwent upper gastrointestinal endoscopy. Twenty-six (61.9%) of patients with DM were positive for 13C-UBT. There were no statistically significant differences in the infection rate between patients with type 1 and type 2 diabetes, and the prevalence of H. pylori infection was not associated with the known duration of diabetes. There was no significant difference in the symptoms score between H. pylori-positive and H. pylori-negative diabetic patients, and endoscopic findings in patients with DM were in the same range with those found in dyspeptic subjects from the same region. In conclusion, H. pylori infection is not associated with DM, duration of diabetes, or severity of dyspeptic symptoms in patients with DM.