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Amyloidosis is a group of rare diseases in which a specific protein is deposited as aggregated interstitial fibrils that can compromise organ function and lead to death. More than 20 proteins form clinically relevant amyloid deposit. Primary amyloidosis consists in deposition of immunoglobulin light chains (AL). Secondary amyloidosis is due to excess of nonimunoglobulinic proteic material deposits (AA). The common clinical presentation form is the association between nephrotic syndrome, hepatomegaly, peripheral neuropathy, gastrointestinal tract involvement and heart failure. Cardiac involvement appears frequently in the end stage and it's very seldom as the only manifestation of the disease. The cardiac amyloidosis has a very poor prognosis. We present the case of a 54 year old patient admitted to our clinic for exertional dyspnoea, massive edemas and repetitive syncope. Although the patient was extensively investigated (including diagnostic laparoscopy), the key of diagnosis was the association between nephrotic syndrome, the ECG aspect and echocardiographical changes suggestive of an infiltrative cardiomyopathy, besides neuropathy and gastrointestinal tract disorders. The purpose of our presentation is to stress the importance of the correlation between ECG changes and the ultrasonography in order to diagnose an infiltrative cardiopathy. These findings, besides the extracardiac biopsies, are an important tool in the diagnosis of the cardiac amyloidosis. The biopsy of subcutaneous fatty tissue is a new, highly sensitive method with sensitivity 73% and specificity 90%, so that it can be used as a screening test in patients without any clinical symptom or organ dysfunction. Although the classical histological diagnosis is made by Congo red stains, the sensitivity of the diagnosis is higher by using negatively stained electron microscopy. [ABSTRACT FROM AUTHOR]

Background & Aims. Triple therapy with Peg-IFNs, Ribavirin and protease inhibitors raise the treatment success for hepatitis C up to 83%, but also bring together with the significantly higher rates of sustained virologic response (SVR) more side effects, interfering with patient's quality of life (QoL) and work productivity. We aimed to analyze the factors influencing the adherence and the QoL during triple therapy using Peg-IFNs, Ribavirin and protease inhibitors in 50 patients diagnosed with chronic hepatitis C with first line therapy failure. Multivariate Cox proportional hazards regression was used to analyze determinants of retreatment initiation and treatment compliance, according to patient features. Results: We identified as major drivers of retreatment initiation the younger age, the female gender, the urban provenience, the high income, and the psychiatric and alcohol or drugs abuse history. The adherence and the QoL during retreatment therapy were similar, despite the regimen used, and obvious lower in patients with history of previous abandon, drugs and alcohol abuse or hematologic/ psychiatric decompensation. A lower capacity to work and a temporary withdrawal from job necessary to continue the therapy were seen similar in patients taking Boceprevir/Telaprevir. Abandon of therapy without a known reason was more frequent in males, with alcohol and drugs intake history, from rural region, with low income, and with psychiatric disturbances in personal history. Conclusion. Physicians should focus to develop medical strategies or drugs to increase the adherence and to provide a better QoL for patients with chronic hepatitis C making antiviral therapy. [ABSTRACT FROM AUTHOR]

Celiac disease is a clinically heterogeneous disease characterized by an inadequate immunological response when patients with specific genetic phenotypes are exposed to gluten. This article presents a case of a young woman diagnosed in Gastroenterology Department of ' St. Andrew Apostle' Emergency Hospital of Constanta with celiac disease after multiple admissions into the hospital for unspecific symptoms such as pallor, fatigue, pirosis, weight loss and 1-2 soft stools/day. The history with period irregularities and infertility without a known cause, a recent unexplained bone fracture, the muscle weakness, neuropsychiatric symptoms characterized by sleep disturbances and irritability correlated with the biological features characterized by moderate feriprive anemia, Ca and Mg decreased level, thyroid autoimmune impairment and gastrointestinal symptoms raised the suspicion of an autoimmune disorder with multiple targets. The videcapsule endoscopy (VCE) revealed the specific pattern of the celiac disease: villous atrophy of jejunum, scalloping, absent folds and cobblestone mucosal pattern. Results were correlated with immunology tests results. The patient was transferred on a gluten free diet and the clinical and VCE controlsrevealed the healing of the jejunum mucosa. The VCE can be the tool for positive diagnosis of an unusual and heterogeneous celiac disease in patients with various symptoms without an apparent cause. [ABSTRACT FROM AUTHOR]