RESUMEN
RATIONALE: In the setting of open access endoscopy, the recognition of suggestive endoscopic features in the duodenum can select patients with probability of celiac disease (CD). This could add to the current efforts to increase the diagnostic rate of this disease. AIM: The aim of this study was to evaluate the diagnostic accuracy of these markers for CD in an adult population undergoing endoscopy, without a prior serological testing. METHODS AND RESULTS: Over a period of 3 years, between June 2012 and 2015, all the patients who underwent upper gastrointestinal endoscopy and presented one or more of the endoscopic markers consistent with CD, or those suspected for CD, irrespective of the presence of these markers, were included. Sensitivity, specificity, positive and negative predictive values were calculated for these markers in CD diagnosis. Among the 182 patients, 56.04% were females, with a mean age of 47.6 ± 13.9 years. 20/182 (10.99%) had a final diagnosis of CD. The presence of any endoscopic marker had a high sensitivity (95%) and a negative predictive value (98.41%). Bulb atrophy and reduced folds in the descending duodenum had a low diagnostic accuracy, while scalloping, mosaic pattern and fissures were highly specific for CD (98.77%, 99.38% and 98.77%) and their presence greatly increased the probability of CD, with a positive likelihood ratio of 24.3, 24.3 and 12.15, respectively. DISCUSSIONS: A wide set of endoscopic markers, including the duodenal bulb, were evaluated in this study. Our results showed that the endoscopy with a careful examination of the duodenum is a sensitive indicator for CD. ABBREVIATIONS: CD = celiac disease, GI = gastrointestinal, VA = villous atrophy, NSAID = nonsteroidal anti-inflammatory drug, Sn = sensitivity, Sp = specificity, PPV = positive predictive value, NPV = negative predictive value, AUC = area under the curve, ROC = receiver operating characteristics, WLE = white light endoscopy, NBI = narrow band imaging, tTG = tissue transglutaminase, EMA = anti-endomysial antibodies.
Asunto(s)
Biomarcadores/metabolismo , Enfermedad Celíaca/diagnóstico , Endoscopía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Imagen de Banda Estrecha , Curva ROCRESUMEN
Solitary pulmonary nodule represents a radiological entity with unknown prevalence in general population. As definition, solitary pulmonary nodule has 3 cm diameter or less and is surrounded by lung parenchyma, with no other abnormalities on the same chest X-ray or CT scan film. The differential diagnosis of the solitary pulmonary nodule includes over 100 conditions and the most frequent is lung cancer. Identification and correct management of the solitary pulmonary nodule opposes early detection and treatment of the lung cancer and the uselessness of a surgical procedure on a benign disease which needs no treatment. After analyzing 150 solitary pulmonary nodules resected and after comparing the results with the literature, given the fact that 48.66% of the nodules are malignant and 52.66% of the nodules have the maximum accepted dimensions (3 cm), the authors proposed an algorithm for solitary pulmonary nodule management adapted to Romania's accessibility to diagnostic procedures. As conclusion, the surgical resection of an indeterminate solitary pulmonary nodule (not certified as benign at CT scan or by biopsy) has an absolute indication and curative intention.
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Nódulo Pulmonar Solitario/diagnóstico , Nódulo Pulmonar Solitario/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Algoritmos , Niño , Diagnóstico Diferencial , Detección Precoz del Cáncer , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Rumanía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Hepatic actinomycosis is a pretty rare anatomo-clinical entity that often induces a wrong pre-operative diagnosis. By presenting a case of hepatic actinomycosis, apparently primitive and diagnosed pre-operatively as a neoplastic lesion, the authors discuss the diagnosis and treatment of this disease, mentioning that in the solid, tumoral forms, the hepatic resection is necessary. The authors consider that the post-operative addition of antibiotherapy (mega doses of penicillin) is useful for the eradication of inflammatory residual hepatic parenchyma as well as for the cicatrisation of the parietal fistulae.
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Actinomicosis/diagnóstico , Hepatopatías/diagnóstico , Hepatopatías/microbiología , Actinomicosis/terapia , Adulto , Antibacterianos/uso terapéutico , Diagnóstico Diferencial , Hepatectomía , Humanos , Hepatopatías/terapia , Neoplasias Hepáticas/diagnóstico , Masculino , Penicilina G/uso terapéutico , Resultado del TratamientoRESUMEN
It's presented a case of the successive metastases in the right orbit with starting point a malignant melanoma skin located under the right clavicle. It's discussed the raruty situation of the malignant melanomas skin metastases in the orbit.
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Melanoma/secundario , Neoplasias Orbitales/secundario , Neoplasias Cutáneas/patología , Adulto , Femenino , Humanos , Melanoma/diagnóstico , Melanoma/cirugía , Procedimientos Quirúrgicos Oftalmológicos/métodos , Neoplasias Orbitales/diagnóstico , Neoplasias Orbitales/cirugía , Reoperación , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/cirugíaRESUMEN
The aim was to evaluate the cellular immune response in atypical tuberculosis and granulomatous inflammation consistent with tuberculosis (TBC), negative histochemically for acid-fast bacilli and analysed by PCR for Mycobacterium tuberculosis (MT) detection in paraffin-embedded tissue. Thirty six samples of differently localized atypical tuberculous lesions and granulomatous tuberculoid lesions negative for acid fast bacilli and 4 positive cases on Ziehl-Nielsen stain were analysed by PCR for MT detection and were tested immunohistochemically (IHC) for the cellular immune response in the granulomas and perigranulomatous tissue. The samples selected were: 7 pulmonary and 33 extrapulmonary specimens, especially lymph nodes. Histologically, the atypical tuberculous lesions contained supurative necrosis, defective granulomas and cellular polymorphism. The epithelioid cells showed frequent mitoses. The immunoprofile of cells was polymorphous. L26 positive small lymphocytes were found in nodular lymphoid aggregates surrounding granulomas. A significantly increased number of positive UCHL1 cells were found in 33 out of the 40 analysed cases, with a larger percentage of CD4 positive T cells (81.8% of cases). CD44 was positive in multinucleated giant cells (17.5% of cases), epithelioid cells (60% of cases) and lymphocytes (30% of cases). CD68 was localized in multinucleated giant cells and epithelioid cells, in a 4%, respectively 62.5% of cases. The PCR was performed in all 40 cases; the tissue samples were heterogeneous (lung, lymph nodes, lever, nasopharynx, etc.) and needed a good quality extraction of DNA. Performing a control PCR for Beta Globin tested the extraction; a good result was obtained in 31 cases (77.5%); from these, 19 cases had amplification for IS 6110. The cellular immune response in the atypical tuberculous lesions was similar in cases with and without acid-fast bacilli, but positive for PCR. In the most cases with negative PCR reaction, it was due to a deficient fixation of the material. The T lymphocytes were numerous in all types of tuberculous granulomas, with the prominence of CD4 positive subtype. The immunoprofile of the epithelioid cells, positive for CD44 and CD68, presenting frequently mitoses suggests an activate state in a possible relationship to the T-cell-mediated immune response in tuberculosis.
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Granuloma/inmunología , Pulmón/microbiología , Tuberculosis Pulmonar/inmunología , Antígenos CD/inmunología , Células Epitelioides/inmunología , Células Epitelioides/microbiología , Células Epitelioides/patología , Femenino , Granuloma/diagnóstico , Granuloma/microbiología , Granuloma/patología , Humanos , Inmunohistoquímica , Macrófagos del Hígado/inmunología , Macrófagos del Hígado/microbiología , Macrófagos del Hígado/patología , Pulmón/inmunología , Pulmón/patología , Ganglios Linfáticos/inmunología , Ganglios Linfáticos/microbiología , Ganglios Linfáticos/patología , Linfocitos/inmunología , Masculino , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/aislamiento & purificación , Necrosis , Adhesión en Parafina , Reacción en Cadena de la Polimerasa , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/microbiología , Tuberculosis Pulmonar/patologíaRESUMEN
Hepatitis C virus (HCV) infection is of significant concern for recipients of blood and for patients who share resources such as hemodialysis machines. In many developing countries and in small peripheral laboratories, facilities and capabilities to perform ELISA assays may not be available. We evaluated two newly marketed rapid HCV serologic assays to determine their ability and suitability to detect antibodies to HCV in hemodialysis patients in Bucharest, Romania. Results indicated that both the Rapid HCV Ab assay (Clonatec, Paris, France) and the HCV-SPOT (Diagnostic Biotechnology, Singapore) detected HCV antibody in 23 of 27 patients. All 23 samples were also reactive by a routine HCV ELISA and were confirmed using a supplemental assay (HCV blot, Diagnostic Biotechnology, Singapore). Only one sample produced equivocal result by the Rapid HCV Ab assay. In this high prevalence population (90%), the use of recombinant or synthetic peptide rapid HCV assays has been successful in detecting confirmed positive cases of HCV and has shown excellent correlation with an ELISA screening assay. The tests are simple to perform, can be performed by individuals with minimal training, and have built-in quality control measures. We conclude that these tests may have important applicability in certain testing situations.
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Hepacivirus/inmunología , Anticuerpos Antihepatitis/análisis , Hepatitis C/diagnóstico , Ensayo de Inmunoadsorción Enzimática , Hepatitis C/epidemiología , Anticuerpos contra la Hepatitis C , Humanos , Prevalencia , Rumanía/epidemiologíaRESUMEN
Changes in some digestive enzymes (amylase, lipase, uropepsinogen) were studied in the serum and urine of one of the participants in the Soviet-Romanian seven-day space flight on the Soyuz 40-Saliut 6 complex. On the first day after landing it was found an increased total serum and urinary amylase, resulting from the separate increase of pancreatic and salivary amylase, determined by Skude and Ihse's method [14]. In both serum and urine, pancreatic amylase was found in higher amounts than the salivary one. Lipase was also increased. These modifications are in general in keeping with those recorded after different flights of similar duration and are part of the anabolic response. The pancreatic and salivary amylase were first investigated separately. Under the same conditions uropepsinogen was decreased, an unexpected result. Serum gastrin was increased, in agreement with a generally increased digestive activity.