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Liver cirrhosis is characterized by remodeling leading to nodules that are difficult to discern from hepatocellular carcinoma (HCC). Alpha-fetoprotein (AFP) serum levels are used for the screening for HCC, with limited success. We evaluated angiopoietin-2 as a serum marker in patients with cirrhosis and with HCC.In a retrospective study, we measured angiopoietin-2 serum levels in 131 patients with HCC, 180 patients with cirrhosis, and 40 healthy controls. We also determined AFP serum levels in patients with HCC and compared the test characteristics of both serum markers. The expression patterns of angiopoietin-2 were determined by in situ hybridization in healthy and cirrhotic livers as well as in HCC.Angiopoietin-2 serum levels were elevated in patients with liver cirrhosis (P0.0001) compared with healthy controls. Levels were further elevated in patients with HCC compared with healthy controls (P0.0001) and cirrhotic patients (P0.0001). The combination with AFP measurements led to improved discrimination between HCC and cirrhosis. Angiopoietin-2 message was present in tumor cells of HCCs but was absent from hepatocytes of cirrhotic and healthy livers. In cirrhosis, message was detected within the strands of fibrous tissue.Serum angiopoietin-2 levels are elevated in patients with cirrhosis, implicating a possible role of the angiopoietin-Tie-2 system for neoangiogenesis in cirrhosis. Serum levels are further elevated in patients with HCC, suggesting the potential use of angiopoietin-2 as a marker for the detection of cirrhosis and HCC.

Background CTLA4 is an inhibitory receptor expressed on a subset of T lymphocytes. Single nucleotide polymorphisms of the CTLA4 gene have been implicated in autoimmune diseases, including autoimmune hepatitis and primary biliary cirrhosis. In reverse form, CTLA4 variations are associated with chronic infections such as chronic hepatitis B. Methods CTLA4 variations - 318C > T and + 49A>G were analyzed in 2366 patients with chronic liver disease of various etiologies, including 323 patients with chronic hepatitis B virus (HBV) infection, 1181 patients with chronic hepatitis C virus infection, 180 patients with primary biliary cirrhosis, and 127 patients with autoimmune hepatitis, as well as 202 healthy control individuals. Genotyping was performed by melting curve analysis. Results The - 318C>T variation was underrepresented in patients with chronic HBV infection compared with healthy controls (14.6 vs. 25.7%, P= 0.002) and with patients with chronic liver disease of other origin (14.6 vs. 20.7%, P=0.011). Patients with cryptogenic cirrhosis also showed a lower frequency of the - 318T allele than healthy controls (12.0 vs. 25.7%, P=0.014). No association of the + 49G >A variation was found with any diagnosis, including autoimmune hepatitis and primary biliary cirrhosis. Conclusion We describe the association of the CTLA4 -318C>T variation with chronic HBV infection and cryptogenic cirrhosis but find no association of the +49G>A variation with autoimmune liver disease.

In the present paper, the influence of the port shape and suction arrangement on the overall performance of a twin screw compressor is investigated. Two suction variants were investigated by means of CFD for a compressor characterized by a rotor diameter of 163 mm, which allowed in-depth analyses and flow visualizations, confirmed by the experimental investigation carried out on the actual compressor.

Summary The case of a 65-year-old man having a large gastric tumor for about 6 years, revealed echographically, is reported. A well delimited consistent white-grey tumor of 8 X 6 x 2.5 cm occurring in the anterior wall of the stomach that extended to the peritoneal cavity was surgically found. Histologically it showed leiomyomatous zones with fascicular spindle cells and sometimes with perinuclear vacuolizations, which were actin-reaction positive but S-100 protein negative. These zones alternated with large compact benign osteochondromatous zone. The uncertain origin of this uncommon tumor was discussed. We have not found any references to such gastric tumors.

Background: Sleep apnoea syndrome (SAS), one of the main medical causes of excessive daytime sleepiness, has been shown to be a risk factor for traffic accidents. Treating SAS results in a normalized rate of traffic accidents. As part of the COST Action B-26, we looked at driving license regulations, and especially at its medical aspects in the European region. Methods: We obtained data from Transport Authorities in 25 countries (Austria, AT; Belgium, BE; Czech Republic, CZ; Denmark, DK; Estonia, EE; Finland, FI; France, FR; Germany, DE; Greece, GR; Hungary, HU; Ireland, IE; Italy, IT; Lithuania, LT; Luxembourg, LU; Malta, MT; Netherlands, NL; Norway, EC; Poland, PL; Portugal, PT; Slovakia, SK; Slovenia, SI; Spain, ES; Sweden, SE; Switzerland, CH; United Kingdom, UK). Results: Driving license regulations date from 1997 onwards. Excessive daytime sleepiness is mentioned in nine, whereas sleep apnoea syndrome is mentioned in 10 countries. A patient with untreated sleep apnoea is always considered unfit to drive. To recover the driving capacity, seven countries rely on a physician's medical certificate based on symptom control and compliance with therapy, whereas in two countries it is up to the patient to decide (on his doctor's advice) to drive again. Only FR requires a normalized electroencephalography (EEG)-based Maintenance of Wakefulness Test for professional drivers. Rare conditions (e.g., narcolepsy) are considered a driving safety risk more frequently than sleep apnoea syndrome. Conclusion: Despite the available scientific evidence, most countries in Europe do not include sleep apnoea syndrome or excessive daytime sleepiness among the specific medical conditions to be considered when judging whether or not a person is fit to drive. A unified European Directive seems desirable. (C) 2007 Elsevier B.V. All rights reserved.

Background: Ileocolonoscopy represents the diagnostic standard in the work-up of patients with inflammatory bowel diseases (IBD). Patients are often reluctant to be colonoscoped because of the invasiveness and pain sensation during colonoscopy. Aims: To compare the usefulness of transabdominal ultrasound (US) and magnetic resonance imaging (MRI) in assessing disease extension and activity in patients with IBD restricted to the terminal ileum and large bowel. Patients and Methods: 61 patients with IBD [37 Crohn's disease (CD) and 24 ulcerative colitis (UC)] were prospectively studied. All patients underwent clinical and laboratory assessment, ileocolonoscopy, transabdominal sonography, and MRI within 5 days. Involved bowel segments were defined as those with bowel wall thickness >3 mm and increased Doppler signal on US or contrast enhancement of the bowel wall on MRI. To compare disease activity endoscopic, MRI and US findings were graded with newly developed scores. Results: The segment-by-segment analysis revealed an overall accuracy of 89% for US and 73% for MRI in identifying active IBD. The accuracy was better in patients with UC than in patients with CD for both US and MRI. The endoscopic activity index (EAI) correlated stronger with the US activity index (r = 0.884) than with the MRI activity index (r = 0.344). The correlation of US and MRI activity indices with EAI was better in patients with UC compared with patients with CD. All three imaging methods showed a significant correlation with clinical disease activity in patients with UC but not in patients with CD. Conclusion: This study provides strong evidence that US should be considered as a first-choice method for follow-up of patients with IBD of the terminal ileum and large bowel.

Background/Aims : Efficacy and safety of interferon-α (IFN-α)/ribavirin retreatment with or without amantadine sulphate were evaluated in non-responders with chronic hepatitis C. Methods : Two hundred twenty five consecutive non-responders to previous antiviral treatment(s) with IFN-α alone or in combination with ribavirin or amantadine were treated with IFN-α 2b 5 MU daily for 4 weeks, 5 MU tiw for 20 weeks, followed by 3 MU tiw for additional 24 weeks combined with ribavirin 1000–1200 mg/d. One hundred fifteen of 225 patients were randomized to receive amantadine sulphate 100 mg bid for 48 weeks. Treatment was discontinued in patients with detectable serum hepatitis C virus (HCV)-RNA at treatment week 24. Results : An overall sustained virologic response with undectable serum HCV-RNA levels was observed in 49/225 patients (22%). Patients infected with HCV-genotype non-1 ( P P =0.011) and only one previous antiviral treatment ( P =0.032) were more likely to respond to antiviral retreatment. There was a trend towards higher sustained virologic response rates in patients receiving triple retreatment compared with those treated with IFN-α/ribavirin alone (25 versus 18%, P =0.172). Conclusions : The addition of amantadine was well tolerated and led to an improvement of sustained virologic responses compared with retreatment with IFN-α/ribavirin alone, in particular in patients with low baseline viremia.

A 74 year old woman with symptomatic common bile duct dilatation and gastric outlet obstruction because of Waldenstroem’s macroglobulinaemia (WM) with nodal and duodenal involvement, underwent endoscopic retrograde cholangiography (ERC) …

Background: lleocolonoscopy still represents the diagnostic gold standard in the work-up of patients with inflammatory bowel diseases (IBD). Because of the necessity to clean the colon extensively and the invasive and often painful procedure, patients are often reluctant to be colonoscoped. The purpose of this study was to evaluate the usefulness of transabdominal ultrasound (US) and magnetic resonance imaging (MR1) to assess disease extension and seventy of the terminal ileum and colon in patients with IBD. Methods: Seventy consecutive patients with confirmed IBD (43 with Crohu's disease and 27 with ulcerative colitis) were included. Patients underwent clinical assessment, laboratory testing, ileocolonoscopy, US, and MRI within 5 consecutive days. Involved bowel segments were defined as those with bowel wall thickness > 3 mm assuming an increased Doppler signal on US or moderate contrast enhancement of the bowel wall on MRI. Endoscopy served as diagnostic gold standard. Severity of disease was graded wath newly developed scores for endoscopic, MRI, and US findings. Results: A segment-by-segment analysis revealed an overall accuracy of 89% for US and 73% for MRI in identifying active IBD lesions. The accuracy was higher in patients with ulcerative colitis (UC) compared to patients with Crohn's disease (CD) for both US and MRI (95% vs. 85% and 81% vs. 67%, respectively). The US activity index showed a strong correlation with the endoscopic activity index (EAI) (r = 0.884, p < 0.0009), whereas the MRI activity index did not correlate with the EA1 (r = 0.344, p = 0.007). Correlation of EAI with US and MRI activity index was better in patients with UC (r = 0.974, p = 0.0009 and r = 0.519, p = 0.009, respectively) than in patients with CD (r = 0.830, p < 0.0009 and r = 0.120, p = 0.482, respective). The extension and severity of inflammation as assessed on US and MRI varied according to location of affected bowel segment. All three imaging methods showed a significant correlation with clinical disease activity index in patients with UC but not in patients with CD. In addition, EA1 and US activity index showed a significant correlation with C-reactive protein in patients with UC. Conclusion: Trausabdominal ultrasound provides a reliable, cheap and safe tool to assess disease extension and activity in patients vath IBD and should be considered as a first-choice method for the follow up of patients with confirmed diagnosis of IBD.