Interrelations between hepatic stellate cells and immune system cells in patients with hepatocellular carcinoma.

OBJECTIVE: Our aim was to identify potential correlations between activated hepatic stellate cells (HSCs) and immune system's cells in patients with viral C hepatocellular carcinoma, by quantifying the percentage of activated HSCs, T-lymphocytes, natural killer cells and B-lymphocytes, in three distinct regions: tumor, transition area and the vicinity tissue (2-5 mm). PATIENTS AND METHODS: We prospectively included 20 samples prelevated at necropsy from patients with HCC and C viral infection. We assessed the percentage of alpha-smooth muscle actin (α-SMA), CD45RO, NK1 and CD20 expression using immunohistochemistry and a semi-quantitative scoring method. RESULTS: We found an inverse correlation between the number of α-SMA-positive HSCs and the number of NK1-positive cells in tumor (p=0.0007), in the transition area/tumor capsule (p=0.024) and in the vicinity tissue (p=0.038). Regarding T-lymphocytes, we have also identified an inverse correlation with the number of α-SMA-positive HSCs in tumor (p=0.0036), in the transition area/tumor capsule (p=0.034) and in the vicinity tissue (p=0.047). We found no correlation between the number of activated HSCs and the number of CD20-positive cells in all three examined areas. CONCLUSIONS: The analysis of HSCs activity within specified areas of tumoral liver tissue may lead to new perspectives in early diagnosis of relapses and in the development of future neoadjuvant therapies.

Hepatocellular carcinoma and metabolic diseases - histological perspectives from a series of 14 cases.

Hepatocellular carcinoma (HCC) represents a major health burden, as curative methods only apply to a select small portion of the affected population. Screening programs are ineffective in the absence of established underlying conditions such as viral hepatitis or alcohol abuse resulting in liver cirrhosis. Thus, overweight or obese, diabetic patients as well as non-alcoholic fatty liver disease (NAFLD) cases are often overlooked as potential candidates for HCC development. Current diagnostic methods for HCC are restricted to non-invasive imaging tests; however, the need for accurate predictive or therapeutic markers make histological studies a necessity; the latest guidelines and recommendations demand an increased effort in obtaining pertinent data from immunohistochemical investigations. Our aim was to retrospectively evaluate a series of patients with common symptoms and manifestations of metabolic syndrome who underwent liver biopsy after imaging revealed suspicious liver masses. We describe the major findings of both common histological evaluation and microvessel density evaluated by positive CD34 immunostaining.

Gastrointestinal stromal tumors - a clinical-morphological study on 15 cases.

AIM: The authors present their experience in addressing the gastrointestinal stromal tumors (GIST). MATERIALS AND METHODS: 15 GISTs operated in the last five years (2008-2013) were analyzed. RESULTS: The preoperative diagnosis was difficult: established by clinical examination and CT in two cases; imagistic accidental discovery in four cases and revealed by evolving complications in nine cases (gastrointestinal bleeding in four cases and bowel obstruction in five cases). CT may be useful in the preliminary estimation of the tumor extent. Tumor location was: stomach four, duodenum one, small bowel seven, and colon three. Pathological examination set the main criteria for assessing the risk of recurrence and indication for adjuvant therapy: the tumor size, the histological type (spindle cell nine, epithelioid four, and mixed two) and the mitosis rate, while the immunohistochemistry examination established the correct diagnosis (positivity for CD117 and CD34) and criteria of aggressiveness (positivity for Ki67). All cases were operated, the surgical procedure being chosen according to the tumor location and stage. Adjuvant therapy with Imatinib 400 mg/day was performed in the 12 cases with high risk of recurrence. The therapeutic outcome was: a postoperative morbidity rate of 13.3%, four patients cured, one local recurrence under Imatinib therapy, a mortality rate of 6.6% and 10 patients in different phases of adjuvant therapy. CONCLUSIONS: GIST has been imposed over the last decade as the main type of non-epithelial tumor of the digestive tract. The preoperative imagistic investigations can be very useful for setting the surgical strategy. The improvement of the mitotic index and/or Ki67 labeling index (LI) determination could render more accurate the scales for prognostic assessment. The two steps algorithm - surgery + adjuvant therapy - still remains the only option to make this dangerous condition a curable one.

Inducible nitric oxide synthase expression (iNOS) in chronic viral hepatitis and its correlation with liver fibrosis.

BACKGROUND: Nitric oxide (NO) production by the action of the inducible nitric oxide synthase (iNOS or NOS2) is increased in tissues that are stimulated by cytokine and endotoxins. The role of NO in the pathogenesis of chronic viral hepatitis is not fully understood but it seems that its overproduction is responsible for the pathological changes under inflammatory conditions. AIM: In this paper, we analyzed the correlation between immunohistochemical expression of iNOS and liver fibrosis in chronic viral hepatitis. MATERIALS AND METHODS: Liver biopsies from patients diagnosed with chronic viral hepatitis B and C were embedded in paraffin and further used for histological staining and immunohistochemical reactions to detect the expression of iNOS and TGF-ß1. The degree of liver fibrosis was established using special staining (trichromic Masson and Gömöri's silver impregnation). RESULTS: In samples with low degree of fibrosis, we observed a discrete positivity for iNOS in periportal hepatocytes and the immunohistochemical reaction for TGF-ß1 were limited to the endothelial cells of liver sinusoids and pro-inflammatory cells from the portal tracts. Positive reaction for TGF-ß1 increased with the degree of liver fibrosis, while the expression of iNOS was enhanced in hepatocytes, as well as in bile ducts and endothelial cells. CONCLUSIONS: Infection with hepatitis B and C viruses induces iNOS expression in hepatocytes, suggesting that NO overproduction might have an important role in progression of chronic viral hepatitis to cirrhosis.

Association between liver histology, carotid ultrasonography and retinal vascular changes in patients with nonalcoholic fatty liver disease (NAFLD).

INTRODUCTION: The prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing all over the world. NAFLD has been demonstrated to be associated with carotid artery atherosclerosis, evaluated using the intima-media thickness (IMT). In this article, we focused on the association between NAFLD, carotid parameters such as: intima-media thickness (IMT), pulsatility index (PI) and resistivity index (RI) as markers of subclinical atherosclerosis and the presence of retinal vascular disorders. PATIENTS AND METHODS: We compared carotid IMT, pulsatility and resistivity index evaluated by ultrasonography, in 10 patients with histological-proven NAFLD and retinal vascular changes (retinophotographies). RESULTS: The degree of hepatic steatosis, necroinflammation and fibrosis in NAFLD patients was strongly associated with the value of carotid IMT and also with PI and RI. Moreover, there seems to be a connection between the degree of NAFDL and the retinal vascular changes in patients with carotid atherosclerosis. CONCLUSIONS: These results suggest that the severity of liver histopathological lesions among NAFLD patients is strongly associated with carotid parameters: IMT, IP, IR and also with retinal vascular changes. Further controlled studies are needed to confirm the results.

Neuroimaging parameters in early open spina bifida detection. Further benefit in first trimester screening?

OBJECTIVE: Morphological investigation of the central nervous system (CNS) in fetuses with positive markers for open spina bifida (OSB) detection, visualized by ultrasound during the first trimester of pregnancy. MATERIALS AND METHODS: Data from fetuses that underwent routine first trimester ultrasound scan in our center during September 2007-March 2011 and presented abnormal aspects of the fourth ventricle, also referred as intracranial translucency (IT), provided the morphological support to evaluate CNS features. A neuro-histological study of posterior cerebral fossa illustrated anatomical features of the structures involved in the sonographic first trimester detection of neural tube defects. RESULTS: Abnormal IT aspects were found in OSB cases examined in the first trimester, but also in other severe cerebral abnormalities. Brain stem antero-posterior diameter (BS) and brain stem to occipital bone (BSOB) ratio may be more specific for OSB detection. Correlations between histological aspects of posterior brain fossa and ultrasound standard assessment have been made; highlighting the anatomical features involved by the new techniques developed for OSB early detection. CONCLUSIONS: Preliminary results show that modern sonographic protocols are capable to detect abnormalities in the morphometry of the posterior brain. First trimester fourth ventricle abnormalities should be followed by careful CNS evaluation because are likely to appear in OSB affected fetuses, but also in other CNS severe anomalies; in such cases, normal BS and BSOB ratio may serve as indirect argument for spine integrity, if specificity is confirmed in large series of fetuses.

Fractal analysis differentiation of nuclear and vascular patterns in hepatocellular carcinomas and hepatic metastasis.

Hepatocellular carcinoma (HCC) currently represents the fifth most common cancer worldwide, while being the third leading cause of cancer death. Fractal analysis is a novel tool used in quantitative and qualitative image assessment. Vascular patterns and cellular nuclei particularities in tumoral pathology make ideal candidates for this technique. Our aim was to apply fractal analysis in quantifying nuclear chromatin patterns and vascular axels in order to identify differences between images of primary HCC, liver metastasis (LM) and surrounding normal liver tissue. Formalin-fixed, paraffin-embedded tissue sections from 40 cases of HCC and 40 LM of various origins were used. We performed Hematoxylin staining for nuclear chromatin as well as immunohistochemical staining for vascular patterns. High-resolution images were captured; nuclear and vascular morphologies were assessed on binarized skeleton masks using the fractal box counting method. Analysis was performed using the free, public domain Java-based image processing tool, ImageJ, which provided the fractal dimensions (FDs) for each studied element. Statistical analysis was performed using the ANOVA test with Bonferroni post-tests and t-tests for paired samples. Fractal analysis of vascular patterns clearly differentiated between tumoral tissue and normal surrounding tissue (p<0.01). Further analysis of nuclear FDs improved the specificity of these results, providing clear differentiation between pathological and normal tissue (p<0.01). When comparing primary HCC images with metastatic formations, we encountered statistically significant differences in nuclear chromatin assessment. However, blood vessels had a higher FD in primary tumors when compared with liver metastasis (p<0.05) and also allowed for a differentiation between primary liver tumors with and without neurodifferentiation. Fractal analysis represents a potent tool for discriminating between tumoral and non-tumoral tissue images. It provides accurate, quantifiable data, which can be easily correlated with the pathology at hand. Primary and metastatic liver tissue can be differentiated to some extent, however further studies, possibly including other variables (cellular matrix for instance) are needed in order to validate the method.

Evidence for the involvement of TGF-ß1-CTGF axis in liver fibrogenesis secondary to hepatic viral infection.

Liver fibrosis is a nonspecific response to injuries, which implies the synthesis of an abnormal extracellular matrix (ECM). TGF-ß (transforming growth factor ß) is a cytokine involved in regulation of several important processes: cell development and differentiation, apoptosis, synthesis and degradation of ECM. CTGF (connective tissue growth factor) is a cysteine rich peptide that belongs to the CCN family of proteins and plays an essential role in the formation of blood vessels, bone and connective tissue. The purpose of this study was to assess TGF-ß1 and CTGF immunohistochemical expression in different stages of liver fibrosis secondary to chronic viral hepatitis. Liver biopsies from patients diagnosed with chronic viral hepatitis B and C were embedded in paraffin and further used for histological staining and immunohistochemical reactions to detect TGF-ß1 and CTGF. Liver sections stained with trichromic Masson for collagen staining and Gömöri's silver impregnation revealed various degrees of liver fibrosis, noted in the METAVIR scale from 1 to 4. Sections with discrete degrees of fibrosis revealed the positivity only in the endothelial cells of liver sinusoids and occasionally in proinflammatory cells from the portal tracts, the number of TGF-ß1-positive cells being directly proportional to the incidence of liver injury. Positive reaction for TGF-ß1 expanded to the cytoplasm of hepatocytes located nearby fibrosis bundles while increasing the parenchymal damage. The expression of CTGF was observed in the classical areas of the hepatic lobule, such as the perisinusoidal spaces around the portal tracts or central veins, but also in the hepatocytes surrounding the fibrotic areas. Regardless of the etiological factor of liver damage, activation of liver cells causes an increased synthesis of TGF-ß1 followed by a CTGF overproduction in various polymorphic hepatic structures, in accordance with the degree of fibrosis.

Steatosis and serum lipid patterns in patients with chronic viral hepatitis: differences related to viral etiology.

Lipid metabolism disorders related to viral etiology are described in chronic viral hepatitis, independent of age, gender and liver synthetic function. Steatosis is present, especially in chronic hepatitis C but also in chronic hepatitis B. Although liver biopsy is the gold standard in determining presence of steatosis, its presence can be determined by ultrasonographic examination as an initial screening test. Our aim in this study was to evaluate the presence of steatosis in chronic hepatitis B and C, to determine its frequency in both hepatitis type, and to explore possible relationships between presence of steatosis, lipid metabolism disorders and viral etiology. Our study lot included 66 patients, 36 subjects with chronic hepatitis C, and 30 with chronic hepatitis B. We only encountered significant levels of steatosis in the chronic hepatitis B sub-group. We found the average age, cholesterol, triglyceride, HDL-C, VLDL-C levels in the group with steatosis to be significantly higher than those in the group without steatosis (p < 0.05). Ultrasound reports of hepatic steatosis were particularly associated with histological inflammation, as well as fibrosis; however, the sensitivity and specificity of steatosis on ultrasound was poor when compared to steatosis on biopsy. Hepatic steatosis was significantly more frequent in chronic hepatitis C than in chronic hepatitis B. Severe inflammation and advanced fibrosis were more frequently found in HCV-infected patients with steatosis than in patients without steatosis.

Thyroid regional metastasis from a giant cell malignant fibrous histiocytoma of the larynx in a patient with history of trichinellosis and tuberculosis.

Sarcomas represent less than 1% of malignant laryngeal tumors and giant cell malignant fibrous histiocytoma is exceptionally rare. Diagnosis is histologically based and immunohistochemistry allows differentiation from other fibro-histiocytic neoplasms. We present the case of a 53-year-old male patient with positive medical history for trichinellosis and tuberculosis, and a laryngeal tumor invading the thyroid and causing respiratory distress by airway obstruction. Total laryngectomy and thyroidectomy were performed followed by thyroxine replacement therapy and radiotherapy. Histologically, the tumor consisted of spindle shaped cells with prominent mitoses, and abundant, osteoclast-like, multinucleated giant cells. Similar lesions were identified in the thyroid, adipose and muscular tissues. Parasitic elements were present in muscles. Tumoral cells showed positive immunostaining for Ki67 (40-50%) and vimentin and negative for AE1/AE3, CD31, S100 and myoglobin; the giant multinucleated cells were CD68-positive. Chronic infection might have had a pathogenic significance.

Ileal iterative spontaneous perforation from foreign body granuloma: problems of histopathologic diagnosis.

Spontaneous ileal perforation is a very rare cause of peritonitis. It occurs, in most of the cases, as a complication of Crohn's disease or intestinal tuberculosis. We present the case of a 23-year-old female patient with multiple surgical interventions during the last year, for iterative ileal spontaneous perforation with generalized peritonitis of which cause was initially assigned to intestinal tuberculosis. Actual episode of generalized peritonitis was determined once again by an ileal perforation of 5 mm at 70 cm from the ileo-cecal valve situated on a suture scar. Distally, a bowel stricture and a non-complicated Meckel's diverticulum were also noted. We performed an enterectomy including all three aforementioned lesions with end-to-end anastomosis. The histopathologic report revealed granulomatous giant-cellular inflammation in the margins of the perforation. The tuberculous etiology was questioned because of the negativity of the PCR-test and multiple recidives of perforation under specific anti-tuberculous medical therapy. The discovery of some rests of non-resorbable suturing material in a granuloma on an ancient enterorraphy scar in the resected specimen, finally established the cause. The granulomatous giant-cellular inflammation of foreign body is a rare cause of ileal perforation. The histopathologic differential diagnosis is difficult needing correlation with clinical data. Usage of resorbable suture material avoids that risk.

Crohn disease or intestinal fistulising tuberculosis? Diagnosis difficulties in a case treated with infliximab and corticosteroids.

UNLABELLED: Crohn disease represents an idiopathic inflammatory bowel disorder with possibility of local and extra intestinal complications. Infliximab therapy is one of major therapeutic alternatives but this treatment may by followed by several possible infections, especially the reactivation of a latent tuberculosis. We present a case of a 28-year-old patient who was admitted in our hospital with clinical signs of bowel obstruction. Colonoscopy revealed close stenosis al the level of splenic flexure. Surgery was soon performed for the imminence of occlusion and pathology has revealed chronic inflammatory infiltrate with lymphocytes and plasma cells, interpreted as Crohn disease complicated with stenosis. A treatment with prednisone 30 mg/day, ciprofloxacin 1000 mg/day administrated intermittently and sulphasalasine 3 g/day for one year was indicated but the patient develop external abdominal fistula. Infliximab therapy 5 mg/kg/dose was administered at two weeks interval, with initial good results after two doses. At two weeks after the second dose, the patient has presented fever and weight loss; abdominal CT-scan has revealed inflammatory adherences of right flexure of the colon with external fistula, resolved by surgery. The evolution was later complicated by right tibio-tarsian involvement, which imposed orthopedic intervention. Pathology has revealed bone tuberculosis and antibacillary therapy was initiated with good results. CONCLUSIONS: Bone tuberculosis may represent a rare evolutive modality at a patient with Crohn disease treated by Infliximab and corticoids. Infliximab therapy in a patient with immunosuppressant (previous corticotherapy, splenectomy) may activate a latent center of tuberculosis. Ciprofloxacin therapy may explain insidious modality of evolution by minor antibacillary effect.

Molecular bases of hepatic fibrogenesis - genetic and therapeutical implications in chronic viral C hepatitis.

Hepatitis C virus represents one of the major health problems of actual world, as almost 170 million of world population and 1 million persons in Romania are infected with HCV. Considering the increasing importance of HCV, it is imposed that we elucidate the molecular mechanisms, which are the base of hepatic fibrogenesis and potential targets for therapy, for diminishing progression to cirrhosis and avoid the appearance of complications. Activation of stellate cells is the main event in hepatic fibrosis. They also express almost all key components needed for the pathological degradation of matrix and that is why they play an important role not only in the production, but also in the degradation of the matrix. Recently, the worldwide research has also been oriented towards another type of cells with possible function in fibrogenesis and response to antiviral therapy: hepatic progenitor cells. The presence of hepatic progenitor cells in chronic C viral hepatitis is associated with severity of the disease, grade of fibrosis and the risk of hepatocarcinoma. Traditionally perceived as irreversible, reversibility of advanced fibrosis has been described recently in antiviral therapy trials for chronic C viral hepatitis. The favorable effect of interferon therapy on hepatic histology, including fibrosis, has been shown even in patients without sustained virusological response. During the last years, the advantages of the so-called support therapy using interferon have been demonstrated in patients with an increased rate in progression of fibrosis. Further research of the factors associated with progression of fibrosis will allow optimization of criteria for patient's antiviral therapy.

Correlations among the serum levels of some interleukins and the histopathological aspects in chronic viral hepatitis C.

UNLABELLED: PREMISES AND OBJECTIVES: The evolution of the infection with the hepatic virus C depends on the defense of the organism, found under the control of a network of cytokines and chemokines. The mechanisms that are causing both viral persistence as well as hepatic pathology are not entirely elucidated. We have proposed to study the amount in which different categories of cytokines are incriminated in the pathogenesis of the chronic liver disease, as well as the eventual correlations between the serum levels of these cytokines and certain histopathological aspects in the chronic viral hepatitis C. PATIENTS AND METHODS: Thirty-five patients with chronic viral hepatitis C (persistent - nine, active - 15, cirrhosis - 11) have been studied, constituting group P, and 20 healthy subjects constituting the reference group (R). In both groups have been determined the serum concentrations of some proinflammatory interleukins (TNF-alpha, IL-6, IL-8), and antiinflammatory (IL-10) cytokines, through the immunoenzymatic technique ELISA. Results. For the proinflammatory cytokines taken into consideration (TNF-alpha, IL-6, IL-8) increased serum values have been determined to the patients with chronic hepatitis C, the maximal level being observed to the patients active chronic hepatitis and cirrhosis (24/35 patients - 68.57%, 19/35 patients - 54.28% and, namely, 18/35 patients - 51.42%). The serum values of IL-10 are increased in 19/35 patients - 54.28%. The direct relationship among the increased levels of IL-10, the astringency of the inflammation and the hepatic functional insufficiency has been taken into consideration. CONCLUSIONS: The immune cellular answer has a fundamental role in the pathogenesis of the liver disease in the patients with chronic viral hepatitis C. The disequilibrium between the pro- and antiinflammatory cytokines participates to the installation of hepatic lesions of cytolysis and/or to the progression of fibrosis. The serum concentrations of the studied cytokines (TNF-alpha, IL-6, IL-8 and IL-10) are correlated to the histopathological spoilages of the liver.

[Hemorrhagic intestinal lymphangioma --report of a case]. / Limfangiomul intestinal hemoragic--prezentare de caz.

This paper presents the case of a male patient, 57 years old, admitted to the hospital for upper digestive bleeding revealed by melena stools. The upper digestive endoscopy has not discovered the source of bleeding. Conventional medical therapy, with hemostatics, proton pump blockers and transfusion, failed to stop the bleeding, requiring emergency surgery for stopping the bleeding. The intraoperative exploration discovered three submucosal formations with dimensions between 0,5 and 0,75 cm, who ulcerated the jejunal mucosa, situated at 20-25cm from the duodeno-jejunal angle. The pathologic report described haemorrhagic intestinal lymphangioma. The excision of the sub-mucosal haemangioma stopped the bleeding.

Curative endoscopic ultrasound-assisted submucosal resection of a gastric stromal tumor.

Endoscopic submucosal resection has been proposed as a feasible alternative for the diagnosis and treatment of small submucosal tumors (< 3 cm), as compared to classic interventions (surgical intervention or frequent follow-up). Therapeutic options should be established after precise endoscopic ultrasound assessment of the tumor characteristics. We present the case of a 60 year-old patient, admitted to the Emergency Department for upper gastrointestinal (GI) bleeding. Upper GI endoscopy showed a submucosal tumor on the posterior gastric wall, with hyperemic covering mucosa, without central ulceration. Endoscopic ultrasound identified a 10-mm well-delimited hypoechoic lesion, with the origin in the third hyperechoic layer (submucosa). After injection of 1:10000 epinephrine in the submucosa, with subsequent elevation of the protrusive formation, we performed an endoscopic submucosal resection without any complications. Pathology exam showed a gastric stromal tumor with low mitotic activity, the endoscopic resection being considered curative. The absence of independent risk factors determined by ultrasound endoscopy (size > 3 cm, irregular margins, hyperechoic foci > 3 mm, cystic spaces > 4 mm, presence of intratumoral Doppler signal), as well as the low mitotic activity, permitted the subsequent follow-up of the patient. A control endoscopic examination performed after 4 weeks showed the healing of the post-resection ulceration. In conclusion, ultrasound endoscopy allowed the establishment of a correct presumptive diagnosis and the subsequent assistance of endoscopic submucosal resection, used for pathological confirmation and for curative endoscopic treatment.

Endoscopical and histological features in bile reflux gastritis.

Bile reflux gastritis is due to an excessive reflux of duodenal contents into the stomach. The increased enterogastric reflux may provide the basis for increased mucosal injury. Bile reflux gastritis can appear in two circumstances: gastric resection with ablation of pylorus and primary biliary reflux due to the failure of pylorus. The aim of the study was to evaluate the endoscopical and histological changes caused by duodenal reflux on the gastric mucosa. The mucosal features were correlated with the risk factors involved in the development of bile reflux gastritis. Our study included 230 patients with alkaline reflux gastritis admitted in Medical Clinic no. 1, Emergency County Hospital Craiova. In all cases we performed an upper gastrointestinal endoscopy. Multiple biopsies were taken from gastric mucosa in 89 patients and the histological features were scored in accordance with the Sydney system. The average age of the patients with bile reflux gastritis was 58.387 years and the incidence of alkaline reflux gastritis was higher between 51 and 80 years. Reflux gastritis was noted to 138 males lpar;60%rpar; and 92 females (40%), ratio males/females was 1.5/1. The most frequent risk factors for bile reflux gastritis were gastric and biliary surgery. Alkaline reflux gastritis was observed in 167 cases (72.6%) after gastric surgery, consisting in gastric resection, pyloroplasty and gastroenteric-anastomosis. Gastroduodenal reflux after biliary surgery was noted in 17 cases (7.39%), 13 cases (5.69%) with cholecystectomy and four cases (1.73%) with biliary anastomosis. The average time interval from original operation to the discovery of the alkaline reflux gastritis was 14.91 years after gastric surgery and 15.29 years after biliary surgery. The commonest endoscopic alterations were: erythema of the gastric mucosa in 139 cases (64.43%), the presence of bile into the stomach in 133 cases (57.83%), the thicken of gastric folds in 22 cases (9.55%), erosions in 12 cases (5.22%), gastric atrophy in 12 cases (5.22%), petechiaes in five cases (2.17%), intestinal metaplasia one case (0.43%) and gastric polyp one case (0.43%). The histologic alterations observed from tissues collected during endoscopic examination were: chronic inflammation in 75 cases (84.06%), foveolar hyperplasia in 36 cases (40.44%), intestinal metaplasia in 31 cases (34.83%), acute inflammation in 16 cases (16.08%), Helicobacter pylori infection in 16 cases (16.08%), chronic atrophic gastritis in 12 cases (13.46%), gastric polyps in 12 cases (13.46%), dysplasia in 10 cases (11.23%), benign ulcerations in seven cases (3.04%), edema in six cases (6.74%) and neoplasia two cases (2.24%). Conclusions. Bile reflux gastritis was more frequent to male gender. The most frequent risk factors for alkaline reflux gastritis were gastric and biliary surgery. Reflux gastritis after gastric resection, pyloroplasty and gastroenteric-anastomosis were more frequent to male gender, while cholecystectomy and biliary anastomosis were predominantly to female gender. The average time interval from original operation to the discovery of the bile reflux gastritis was similar after gastric and biliary surgery. The commonest endoscopic alterations were: erythema of the gastric mucosa, the presence of bile into the stomach, thickens of gastric folds, erosions, gastric atrophy, petechiaes, intestinal metaplasia and gastric polyp. Acute inflammation, Helicobacter pylori infection, gastric polyps and benign ulcerations were more frequent in patients with bile reflux gastritis after gastric surgery, while edema and dysplasia were increased after biliary surgery.

Diagnostic particularities in primitive diffuse form hepatocellular carcinoma associated with portal vein thrombosis.

The diagnosis of primitive hepatocellular carcinoma, infiltrative form, arose on liver cirrhosis is often difficult because the imagistic investigations could not relevate the tumoral formation. We are presenting the case of a 56 years patient, diagnosed with viral B liver cirrhosis, in which the clinical symptomatology and laboratory investigations were leading to hepatocellular carcinoma, but the ultrasonography and CT scan could not confirm the malignant transformation. In these conditions we performed ultrasonographically guided biopsy from the liver parenchyma and visualized thrombus in portal vein lumen. Histopathological exam from the thrombus tissue samples confirmed hepatocellular carcinoma diagnosis.

[Cholesterol crystal embolisation in the course of treatment with low-molecular-weight heparins]. / Emboliile cu cristale de colesterol în cursul tratamentului cu heparine cu greutate moleculara mica.

Cholesterol crystal embolisation is a rare complication of anticoagulant treatment of ulcerative atheromatosis to the great arteries. The embolisation is susceptible to affect both, the somatic and the visceral territory; clinical diagnosis is difficult, mainly because of the similarity between the embolisation symptoms and those produced by a complication of primary disease. The diagnosis is certain when the pathological examination reveal the presence of cholesterol crystal in arteriolar lumen, surrounded by inflammatory- cellular reaction (foreign-body reaction). This paper presents three cases in which we noticed clinical manifestation suggestive for cholesterol crystal embolisation, at patients in treatment with low-molecular weight heparins. The complications which were reported in case of cholesterol crystal embolisation could be extremely severe, specially visceral embolisation, they may lead to patient's death.

Cytokines levels in prostate adenocarcinomas.

In this research, we determined the levels of IL-2, IL-6 and TNF-alpha at 60 patients with prostate adenocarcinomas situated in II, III and IV stages. The method used was ELISA quantitative. We observed that the IL-2 levels were normal in II stage, and the levels of IL-6 and TNF-alpha were lightly increased. In III and IV stages of prostate cancer the levels of IL-2 were very low and the levels of IL-6 and TNF-alpha were very increased. The high levels of pro-inflammatory cytokines are correlated with diseases evolution. The decrease of IL-2 levels in advanced prostate cancer goes to the decrease of immune response in prostate cancer.