[A case of the prune belly syndrome]. / Consideratii asupra unui caz de sindrom prune belly.

Rare heterogeneous syndrome, the prune belly syndrome was first described in 1839 and associates the agenesis of the abdominal musculature with other complex malformations of the genitourinary tract and bilateral cryptorchidism. In this plurimalformative context, the main evolutive problem is represented by the chronic renal insufficiency. The work presents a new case of prune belly syndrome which through its clinical evolutive aspects joins the category of classical cases published in literature.

Incidence and evolutive tendency of intestinal metaplasia in chronic gastritis.

The histologic examination of 556 gastric biopsies performed in patients with chronic gastritis, revealed the presence of intestinal metaplasia in 81 cases (14.5%). This was correlated with the evolutive stage of gastritis, the maximum incidence being observed in the case of gastric atrophy (24.7%). The iterative examination of the patients with intestinal metaplasia, allowed the determination of its evolutive tendency. After an average period of 5 years, the occurrence of gastric malignoma was observed in 5 cases (6.3%) thus confirming the oncogenic risk of intestinal metaplasia and justifying the careful "surveillance" of these cases.

The value of echocardiography in the early diagnosis of myocardial impairment due to connective tissue diseases.

The study comprised 14 patients with systemic lupus erythematosus (SLE) and 12 patients with diffuse scleroderma. Echocardiography ascertained 5 cases of congestive and 1 case of restrictive cardiomyopathy among the patients with SLE, as well as 6 cases with restrictive cardiomyopathy among those with scleroderma. The authors specify two important echocardiographic variables: the E-septum distance and the septal and wall motion after amyl-nitrite test, which reveal the intrinsic contractile properties of the myocardium, allowing an early diagnosis of myocardial impairment, as well as the selection of patients for an efficient treatment with vasodilator drugs.

Study of gastroesophageal reflux by determination of endoesophageal pH using the Heidelberg telemetering capsule.

Gastroesophageal reflux (GER) was determined by recording the endoesophageal pH using the Heidelberg telemetering capsule in 60 patients with various esogastroduodenal diseases. Gastroesophageal reflux was found present in 29 patients (48.3%). The nature (acid in 27 cases, alkaline in 2 cases) as well as the degree of reflux (score 1-6.5) could also be determined by this method. Radiologically reflux could only be detected in 12 out of the 29 patients (41.6%) of whom 9 with hiatal hernia. Only 62% of the GER cases were symptomatic, this being in agreement with the high scores and with the presence of esophagitis confirmed histologically. In chronic ethanol consumers (24 cases) the incidence of GER was increased (70.8%) suggesting the role of alcohol in the relaxation of the lower esophageal sphincter. In conclusion this method proved useful for the detection and quantification of GER.

Serum gamma-glutamyltranspeptidase assay in the detection of alcohol consumers and in the early and stadial diagnosis of alcoholic liver disease.

Gamma-glutamyltranspeptidase (GGTP) assay, clinical and morphologic investigations were performed in three groups of subjects: 1) 128 healthy subjects, exposed to high alcoholic risk; b) 97 chronic alcohol consumers, hospitalized; c) 87 patients with alcoholic liver disease (ALD) morphologically confirmed. The GGTP assay was positive in 80% of the drinkers; the values varying according to the amount and the duration of alcohol consumption. The correlation index between the GGTP values and the morphologic aspects was 0.51 for chronic drinkers with ALD. The positivity degree of this test and the anatomo-clinical aspects of liver injury were well correlated, maximum values corresponding with severe liver damage. Our results show the value of GGTP assay in the detection of chronic alcoholics and of ALD.

The hepatic component in alcoholic encephalopathy.

In a group of 34 chronic alcohol addicts with neuropsychic manifestations--alcoholic encephalopathy (AE)--and 9 subjects with chronic non-alcoholic liver diseases, biochemical (ammonemia, pyruvicemia, lactacidemia), enzymatic (gamma-glutamyltranspeptidase (gamma-GPT)) and morphological assays were carried out comparatively with conventional liver investigations. Alcoholic liver disease was found present in 16 patients (47%). A peculiar biochemical profile was observed in subjects with hepato-alcoholic encephalopathy: ammonemia 191.3 +/- 70.3 gamma %, pyruvicemia 2.7 +/- 0.82 mg %, lactacidemia 15.76 mg % and gamma-GPT 80.5 U/l, as compared with ammonemia 121 +/- 33.5 gamma %, pyruvicemia 2.74 +/- 1.2 mg %, lactacidemia 16.65 mg % and gamma-GPT 42.6 U/l in AE without hepatic disease, and in non-alcoholic liver diseases in which ammonemia was 88.6 gamma % (in chronic hepatitis) and 126.3 gamma % (in hepatic cirrhosis). Thus, coexisting involvement of the liver and presence of portal-systemic shunts in AE can be estimated by the assay of certain biochemical and enzymatic parameters.