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Background and Aim: Inflammatory bowel disease (IBD) has been associated with genetic and environmental factors, including urban living. IBD was rare in the Israeli Bedouin community 30 years ago. Over recent decades, a large proportion of this community has undergone a transition from a nomadic to a western lifestyle. Our aim was to carry out an updated evaluation of the clinical and epidemiological features of IBD in the Bedouin sector of southern Israel., Methods: All Bedouin patients with a known diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) were included in the retrospective study., Results: The cohort included 31 CD patients and 31 UC patients. The mean age of the patients at diagnosis was 29±10.9 and 35±17.5 years for CD and UC, respectively. The prevalence rate for CD was 15.5/100,000 and the incidence rate was 0.8-3.55/100,000. Fourteen of the CD patients (45%) had ileal disease and 64.5% had inflammatory disease behavior according to the Montreal classification. Eleven of the CD patients (35%) were treated with anti-TNF-α and 26% had undergone surgery. Over the previous decade, the prevalence of UC was 14/100,000 and the incidence was 0.5-2.39/100,000. Eighteen UC patients (58%) had left-sided colitis. Three (9.7%) had undergone total colectomy for severe disease., Conclusion: We found an increased prevalence of IBD in the Bedouin population, associated with their change in lifestyle over previous decades. However, the prevalence is still markedly lower than that in other population groups. A high percentage of patients were treated with anti-TNF-α and/or surgery.

Background: IL28B genotype predicts response to treatment against HCV with pegylated interferon/ribavirin (PR) and impacts on the outcome of therapy including telaprevir (TVR). This study aimed to determine the influence of the favourable IL28B genotype on early viral kinetics during therapy with TVR/PR in HIV-HCV-coinfected patients., Methods: All HIV-HCV genotype 1 coinfected subjects who received TVR/PR for at least 4 weeks were included from populations prospectively followed in 22 centres throughout Germany, Switzerland and Spain., Results: Of the 129 subjects included, 38 (29.5%) presented with IL28B genotype CC and 94 (72.9%) were treatment-experienced. A total of 96 (73.8%) patients showed undetectable plasma HCV RNA at treatment week (W)4: 30 (78.9%) of the IL28B-CC carriers and 65 (71.4%) of the non-CC carriers (P=0.377). Among treatment-naive patients, proportions of undetectable HCV RNA among IL28B-CC versus non-CC carriers were 8/9 (88.9%) versus 3/9 (33.3%; P=0.016) and 14/17 (82.4%) versus 11/18 (61.1%; P=0.164) at W2 and W4. The decrease of HCV RNA at W2 and W4 was similar among the IL28B carriers., Conclusions: IL28B genotype does not predict W4 response to TVR/PR in HIV-HCV-coinfected patients, regardless of their treatment history. However, there is evidence of an impact on response during the first weeks in treatment-naive patients.

In-stent restenosis (ISR) remains a significant limitation despite the considerable previous clinical and investigative emphasis on the problem. Complications arising from the interaction of stent materials with the surrounding vessel wall as well as from the mechanical forces developing after implantation, play an important role in the development of ISR. To investigate the relation between mechanical factors and stent structural integrity, and to identify any structural weakness points on the geometry of commercially available Stainless Steel and Cobalt-Chromium stents, accelerated pulsatile durability tests were carried out in a simulated physiological environment. Potential spatial variations in the mechanical properties on stent struts and their role in the observed premature failures of the stent devices during operation were also examined. Fretting wear and fatigue-induced fractures were found on stent surfaces after exposure to cyclic loading similar to that arising in vivo. Nanoindentation studies performed on various locations along the stent struts have shown that the hardness of specific stent locations significantly increases after mechanical expansion. The increase in hardness was associated with a reduction of the material's ability to dissipate energy in plastic deformations, therefore an increased vulnerability to fracture and fatigue. We conclude that the locations of fatigue fractures in stent struts are controlled not only by the geometrically-driven stress concentrations developing during cyclic loading but also by the local material mechanical changes that are imparted on various parts of the stent during the deployment process., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Erdheim-Chester disease (ECD) is a rare inflammatory syndrome in which systemic infiltration of non-Langerhans cell histiocytes occurs in different sites. Both the etiology and pathophysiology of ECD are unknown, but CD68 positive CD 1a/S100 negative cells are characteristic. The presentation of ECD differs according to the involved organs. This case report describes a patient with ECD and the gastrointestinal manifestations and unique endoscopic appearance as seen in gastroscopy and colonoscopy with histological proof of histiocyte infiltration of the lamina propria. The clinical and endoscopic findings of this unique case, to our knowledge, were never described before, so were the features of the gastrointestinal involvement in this disease.

Objective: To evaluate the concordance between intraoperative ultrasound (IOUS) and abdominal ultrasound (US) for the characterization of focal liver lesions in patients with colorectal cancer, and to evaluate the way in which IOUS influences the initially established hepatic surgical protocol based on abdominal US only., Method: In this prospective study 73 patients with colorectal cancer and focal liver lesions found during IOUS were included. Abdominal US and IOUS findings were compared. The initially established hepatic surgical protocol based on abdominal US only was recorded. All patients in whom IOUS influenced this protocol and the way in which this was influenced were recorded., Results: Of the 73 patients, 41 (56.2%) had focal liver lesions classified as malignant by IOUS. In 26 of the 73 patients (35.6%), there were discordances between abdominal US and IOUS. IOUS influenced the operative protocol in 9 of the 73 patients included in the study (12.3%), and in 8 of the 41 patients with malignant lesions (19.5%). IOUS influenced the operative protocol by cancelling the preoperative hepatic surgery decision by evidencing the additional multiple malignant focal liver lesions, following the classification of some lesions as benign or by demonstrating the non-resectable character of other lesions. IOUS also determined unplanned hepatic resections by detecting resectable malignant lesions undiagnosed by abdominal US, and extended or limited the scheduled hepatic surgery based on abdominal US only., Conclusions: There were inconsistencies between IOUS and abdominal US, therefore in patients with colorectal cancer IOUS provided additional information about focal liver lesions. IOUS influenced the operative protocol and consequently, unnecessary liver surgery was avoided. Also, IOUS identified malignant resectable liver lesions which were undetected by abdominal US.

Introduction: The factors involved in the progression of liver disease towards decompensated cirrhosis are not completely elucidated. It seems that bacterial translocation (BT) from the gut to the systemic blood flow has an important role in the disease progression, but literature data are controversial. Our objectives were to evaluate the presence of BT in patients with chronic HCV infection and to assess the correlation between BT and liver fibrosis stages and inflammatory state., Methods: We conducted a cross-sectional study on patients with chronic HCV infection in a tertiary care hospital between January and July 2013. Blood samples were collected for aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyl transpeptidase (GGT), total cholesterol, low density lipoprotein (LDL) cholesterol, triglycerides, platelets, lipopolysaccharide (LPS) and tumor necrosis-alpha (TNFα). Plasma LPS were measured by ELISA (Kamiya Biomedical Company Seattle, SUA) and TNFα by DIAsource ImmunoAssay (Louvain-la-Neuve, Belgium) kits. Liver fibrosis was evaluated by means of FibroMax (BioPredictive, Paris, France) in all patients., Results: We enrolled 116 patients with CHC, with a sex ratio M/F of 0.55 and a median age of 54 (45-61) years. Most of the patients (32) had compensated cirrhosis (F4). LPS levels were higher in patients with mild fibrosis--median value of 60.34 (32-91.7) ng/mL, than in cirrhotic patients--median value 40.39 (20.2-74.4) ng/mL (p = 0.051). We found no statistical correlation between LPS levels and fibrosis (p = 0.068) or TNFα levels (p = 0.097) CONCLUSIONS: There was BT in patients with CHC but it was not correlated with liver fibrosis stages or systemic inflammation. This may suggest that LPS evaluation may not be the best technique to assess baterial translocation, but further studies are needed.

Objective: To evaluate by various tools the prognosis of the polyvascular patients (defined as the presence of more than one affected vascular bed), who also associate chronic obstructive pulmonary disease., Material and Methods: Fifty-eight patients discharged after an episode of acute cardiorespiratory failure were examined at 3 month-intervals for 1, 2 and 3 years (2010-2012). The following were performed: physical examination, biochemical and hematological tests, spirometry, electrocardiography, transthoracic echocardiography, brain computer tomography or magnetic resonance imaging. All patients in our study were smokers with chronic pulmonary obstructive disease. Treatment relied on the European recommendations for cardiac pathology and associated medical conditions., Results: A favorable clinical course was noticed in compliant patients. Patients with metabolic syndrome and/or old stroke, and peripheral arterial disease have a poor prognosis. A strong link seems to exist between systolic function of the right ventricle and cardiovascular mortality. The association of this condition to ischemic heart disease modifies the right ventricle hemodynamics., Conclusions: Polyvascular patients in acute cardiorespiratory failure have a mortality of 36% in the first 3 weeks. After 3 years, 86% of the patients survive. The modern methods of diagnosis and treatment allow improving the quality of life and increasing its duration.

Introduction: Several studies have reported that cytokines secreted by adipose tissue (adipokines) may be linked to HIV replication. The aim of the study was to evaluate the relationship between HIV replication and serum levels of adipokines, in a Caucasian HIV-infected population of men and women undergoing complex antiretroviral therapy., Methods: A cross-sectional study was conducted in an unselected sample of 77 HIV-1-positive patients. Serum adipokines levels were measured including circulating adiponectin, leptin, resistin, tumor necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6). Patients were divided into two groups: Group 1 - with undetectable viral load and Group 2 - with persistent HIV viral replication. Differences between groups ? were tested using independent-sample t-test for Gaussian variables and Mann-Whitney-Wilcoxon test for non-parametric variables. Pearson's chi-squared test was used for correlation analysis., Results: A total of 77 patients (age range: 17-65, mean: 32.5 years) including 44 men (57.1% men, age range: 17-63 years, mean: 34.1 years) and 33 women (42.9% women age range: 19-65 years, mean: 30.3 years) were included in the study. TNF-alpha had significantly higher serum levels in patients with detectable viral load (16.89 vs. 9.35 pg/mL), (p=0.043), but correlation analysis lacked statistical significance. Adiponectin had median serum levels of 9.22 ìg/mL in Group 1 vs. 16.50 ìg/mL in Group 2 but the results lacked statistical significance (p=0.059). Higher leptin, IL-6 and resistin serum levels were noted in patients with undetectable HIV viral load, without statistical significance., Conclusions: The present study reported higher TNF-alpha serum levels in patients with persistent HIV viral load. We found no statistically significant correlations between adiponectin, leptin, resistin and IL-6 and HIV viral load in our Caucasian HIV-positive study population, undergoing antiretroviral therapy.

Unlabelled: Six gastrojejunocolic fistulae were recorded at our service between 1995-2005. All the fistulae occurred in men who had gastric resection performed for duodenal ulcer., Method: Diarrhea, weight loss, postprandial pain and fecal breath were the clinical findings present in descending frequency. Preoperative diagnosis was possible in 5 patients by endoscopy and barium contrast studies. In five patients the option was a one-stage procedure with revision gastrectomy and segmental resection of the transverse colon. In one case simple dismantling of the fistula was performed., Results: Although in two patients anastomotic leakage developed no mortality was recorded.

Introduction: Despite significant progress, the management of acute colonic obstruction still remains a challenging problem. The purpose of this study was represented by the evaluation of the clinical results of different techniques of resection for malignant colorectal (primary or staged) obstruction., Methods: We performed a non-randomized clinical study. 590 patients with malignant colorectal occlusion who underwent surgery treatment an 3rd Surgical Clinic Cluj-Napoca between 1996-2005 were included., Results: Patients with large bowel obstruction underwent one-stage primary resection with anastomosis in 267 cases or staged interventions in 323 cases. The groups were matched in: age, sex, comorbidities, tumor staging, serum preoperative levels of hemoglobin and proteins. The analysis of mortality and morbidity following surgical treatment for large bowel obstruction returned no significant difference among the two groups (p > 0.05). Moreover, the presented results showed a higher incidence of mortality (11.45% vs 9.33 %), morbidity (25.38% vs 14.6%) and increased hospitalization period (p = 0.029) among the patients that undergone seriate resections., Conclusions: One stage primary resections with anastomosis of the large bowel can be performed safely in case of emergency whenever patient comorbidities and local conditions do not stand as major restrictions.

Introduction: The radical treatment of the gastric cancer consist in large gastric resections and lymphadenectomy. Resection line involvement at microscopic histopathological examination (R1) could change prognostic unfavorable., Material and Methods: They were 135 patients with gastric cancer operated between 2006-2007, with radical gastric resections and lymphadenectomy. In 3 patients with early gastric cancer and 23 patients with different stages of cancers, histopathological examination showed resection line involvement. From this study were eliminated the patients with stage IV cancers in whom resections were palliative., Results: Incidence of positive resection line involvement was 19,25%. 88,46% of the tumors were staged pT2 and pT3 and the majority was poorly differentiated or undifferentiated (G3 and G4). Lymphatic involvement (pN1 or pN2) was demonstrated in 18 (69,23%0 patients with R1. Perioperative complications were encountered in 15,38% of this patients, with 7,69% mortality., Conclusions: Presence of tumoral tissue at resection line level could decrease survival in this patients. Therapeutic protocol in patients with resection line involvement (re-laparotomy with re-resection or surveillance) must be establish in accordance with several factors: T and N category, risks of another surgical interventions, patients acceptance.

Reactivation of hepatitis B virus is a complication of chronic or HBV infection in patients with malignancies, especially hematological disorders, under cytotoxic or immunosuppressive therapy. The immunosuppression favors HBV replication with the massive infection of hepatocytes. Once immunity is restored when chemotherapy therapy is discontinued, a rapid, immune-mediated destruction of the infected hepatocytes ensues, clinically manifested as hepatitis, liver failure or even death. We report a case of HBV reactivation in a patient with B cells non-Hodgkin lymphoma, with HBsAg negative and protective titre of anti-HBs, after 5 months of combined chemotherapy. Currently, there are no data to support routine pre-emptive anti-HBV therapy in patients with negative HBsAg and undetectable viremia before the initiation of chemotherapy. The case presented in this paper is included in the group of patients that is studied in LIMFOVIR Grant (convention no 41012/2007). This research grant is funded by the National Center of Programs Management, program 4 - Partnerships in Priority Fields. The grant is coordinated by the National Institute of Infectious Diseases Prof. Dr. Matei Bals, Bucharest. The grant team include also the Emergency University Hospital Bucharest, Hematology Department, the "Carol Davila" University of Medicine and Pharmacy, Bucharest, the "Victor Babeş" National Institute of Research and Development, the Institute of Electrotechnical Research, Bucharest and the Polytechnic University, Bucharest. The manager of the grant is Associated Professor dr. Victoria Aramă.

Background: Accumulating data suggest potential clinical relevant relationships between hepcidin-25 levels, iron stores, erythropoiesis effectiveness, and epoetin dose. The immunometric methods and mass spectroscopy are currently used to measure hepcidin-25, but no standard exists, and values, although similar in trends, differ in absolute value., Objective: To investigate hepcidin levels and their relationship with peripheral iron indices, inflammation, and anemia therapy in patients on hemodialysis (HD)., Methods: A cross-sectional study in 78 patients from a single HD center. Hepcidin-25 was measured with enzyme-linked immunosorbent assay (ELISA), using a commercial kit (Bachem, UK)., Results: Hepcidin-25 levels were similar to those previously reported in studies using the same antibody (median 113 [95% CI; 107-122 ng/mL]) and significant but weak correlations of hepcidin with transferrin (R2=0.06; p<0.04) and ferritin (R2=0.09; p<0.01) were found. A model of multiple regression analysis explained 57% of variation along hepcidin quartiles. Lower hepcidin levels were associated with higher transferrin levels (odds ratio 1.05 [1.01-1.09]), bigger iron doses (odds ratio 1.09 [1.02-1.15]), and an increased darbepoetin resistance index (odds ratio 4.3E+15 [11.15-1.6E+30]). An elevated serum C reactive protein was associated with increased hepcidin levels (odds ratio 0.70 [0.49-0.99]), while a higher ultrafiltration volume (odds ratio 4.30 [1.28-14.51]) and the male sex (odds ratio 0.04 [0.00-0.80]) were related to lower hepcidin levels., Limits: Cohort number and composition. Hepcidin-25 ELISA assay., Conclusion: A low hepcidin level in hemodialysis patients with high epoetin resistance index could be a useful marker of iron-restricted erythropoiesis, but confirmation by a therapeutical trial is necessary., (Copyright 2010 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Starting from the premise that abdominal tumours require very accurate assessment and staging, the study "DIASTAL" (laparoscopic diagnosis and staging of abdominal tumours) proposed to establish the effectiveness of laparoscopy in the diagnosis and resectability of these neoplasms. The aim of this study was to evaluate diagnostic laparoscopy for periampullary and pancreatic neoplasms., Methods: The clinical study was based on the analysis two different groups including 27 patients in total, in whom we used also diagnostic laparoscopy as a staging method., Results: The percentage of understaged patients after preoperative examinations was high in both groups range 59.09%-63.63%. Diagnostic laparoscopy reduced the number of unnecessary laparotomies., Conclusions: Diagnostic laparoscopy could lead to more accurate assessment of periampullary and pancreatic cancers, not only as a staging method but also as a minimally invasive surgical technique for palliation.

BACKGROUND. Laparoscopy and laparoscopic ultrasonography may assist in the more accurate staging of digestive cancers. We assessed the diagnostic value of staging laparoscopy in patients with cancers of lower esophagus, stomach, liver, biliary tract, pancreas and colon. MATERIAL AND METHOD. Extended staging laparoscopy, laparoscopic ultrasonography and peritoneal cytology were performed in 165 patients with primary digestive cancers, admitted between January 2006 and December 2008 at three tertiary referral hospitals participating in the study. Staging laparoscopy was immediately followed by open surgery in 63 patients without distant metastases or with uncertain primary tumor resectability, and in 20 colorectal cancer patients with resectable hepatic metastases. The sensibility, sensitivity and diagnostic accuracy of staging laparoscopy for distant metastases and tumor resectability were assessed against the findings on open surgery and the final pathological report. RESULTS. An unnecessary laparotomy was avoided in 36 of the 99 patients (36.4%) without distant metastases on imaging pre-therapeutic staging. The staging laparoscopy sensitivity for distant metastases varied between 66% and 100% and the diagnostic accuracy between 87% for the lower esophageal cancer and 100% for the biliary tract tumors. The overall morbidity of staging laparoscopy was 2.5% and the mortality 0. CONCLUSION. Staging laparoscopy avoids unnecessary laparotomies and changes the therapeutic plan in a significant number of patients. It can be performed just before the planned surgery or as a separate diagnostic procedure. The laparoscopy indications in digestive cancers are changing fast, with ongoing new developments in cancer treatment and laparoscopic technology.

Unlabelled: Between 1990 and 2006 in the III-rd Surgical Clinic Cluj-Napoca, 366 pacients with hepatic hydatid cyst were admitted and underwent surgery; 81 (22.13%) of them, who had a cyst-biliary comunication, were retrospectively reviewed: 52 (64.2%) had an occult communications and 29 (35.8%) had a frank intrabiliary rupture. The sex ratio was M/F=46/35 with a mean age of 44.5 years and with ages between 17 and 73 years. Choledochotomy, evacuation of parasitic material and lavage of the CBP were performed in all patients with frank intrabiliary rupture. In 25 patients, partial pericystectomy and choledochoduodenostomy/T-tube drainage of CBP was performed. Internal drainage by a Roux-en-Y pericystectojejunostomy and biliodigestive anastomosis was carried out in 2 patients, while other two patients underwent external drainage of cystic cavity and T-tube drainage of CBP. 15 patients (51.7%) had postoperative external bile leaks (fistulas). Occult communications were managed by partial pericystectomy +/- narrowing of the residual cavity (capitonage with an omentum flap or invagination of the fibrosis capsule margins into the cavity) in 35 patients (67.3%) while in 10 patients (19.2%) internal drainage by a Roux-en-Y pericystectojejunostomy was carried out. Regional resection of the liver was performed in 4 cases (7.7%) and external drainage of residual cavity in 3 patients (5.7%). 13 patients (25%) had postoperative external bile leaks (fistulas). The mean postoperative hospitalisation was 20 days with the range 5-85 days. The mortality rate was 2.4% (2 patients): one died due to septicemia and MOFS and the other due to pulmonary thromboembolism., Conclusion: Postoperative bile leaks (fistulas) fallowing conservative surgery of ruptured hydatid hepatic cyst into the biliary tract are not rare regardless of the type of rupture (frank or occult). Although the opening of the biliary duct is sutured, the risk of biliary fistulas is not clearly corelated with this approach; in such cases internal drainage provides a good alternative with low morbidity.

The aim of this study is to evaluate the morbidity and mortality in the surgical treatment of gastric cancer and the factors that could influencing them. We made a retrospective analysis of a group of 468 patients with gastric adenocarcinoma which have been operated in the 3RD Surgical Clinic-Cluj Napoca--01.01.1998-31.12.2003. We analyzed parameters related to patient, pTNM stage and type of treatment. Morbidity was significantly higher in these circumstances: elder patients, cases with lower serum levels of hemoglobin and total proteins, after Billroth II procedures; we found no significant differences of morbidity depending on gender, pTNM stage, type of intervention: simple or multiorgan resection, subtotal or total gastrectomy, radical or palliative procedure or only exploratory laparotomy, presence or absence of splenectomy or caudal pancreatectomy, D1 or D2 lymphadenectomy (in radical procedures), palliative resection or gastrojejunal bypass. Elder patients and male patients have had a mortality significantly higher; we found no significant differences of mortality depending on serum levels of hemoglobin and total proteins, pTNM stage, type of intervention: simple or multiorgan resection, subtotal or total gastrectomy, radical or palliative procedure or only exploratory laparotomy, presence or absence of splenectomy or caudal pancreatectomy, D1 or D2 lymphadenectomy (in radical procedures), type of restoring of the digestive continuity after subtotal gastrectomy, palliative resection or gastrojejunal bypass.

Method and Material: Between 1995 and 2005 a number of 98 antireflux laparoscopic procedures have been performed. The patients have answered to a 7 point questionnaire regarding the disappearance of specific gastro-esophageal symptoms, the necessity of medical adjuvant treatment as well as regarding the measure in which surgery brought a real subjective improvement. The average follow-up was 57 months (4.7 years)., Results: 43 laparoscopic patients have answered the questions. 10 patients had dysphagia, most of which had a spontaneous remission. Only 3 of those patients needed an endoscopic dilatation. Bloating was still possible for 33 of the patients. Retrosternal pain remained present for 14 patients. Intestinal transit disorders have showed up in 11 cases. Reflux persisted at a variable degree in 12 patients. Only 7 patients continue to follow a systematic drug treatment. 35 patients consider that the surgery has brought an improvement of their disease.

The aim of this study is to assess clinico-pathological parameters and find out the correlation between them and their possible prognostic value. We made a retrospective analysis of a group of 468 patients with gastric adenocarcinoma which were operated in the 3rd Surgical Clinic--Cluj Napoca--01.01.1998-31.12.2003. The median age was 62 years. Patients in pTNM 0 stage were significantly younger than the rest of patients, with an average of 7.5 years. The male/female ratio was 1.7:1, this ratio being significantly higher in cases with proximal gastric cancers. There was not found any significant correlation between the interval : onset of symptoms and surgery, and pTNM stage. The most frequent signs and symptoms were epigastric pain, weight loss, indigestion, fatigue, pallor and loss of appetite, each of them were found in more than 40% patients. Multivariate analysis of symptoms showed that weight loss (p=0.00638) was independently correlated to advanced pTNM stages. The number of signs and symptoms was significantly correlated to advanced pTNM stages (p=0.000026). This significant group of patients studied has maintained characteristics encountered in populations with higher incidence of gastric adenocarcinoma, men being more frequently affected, distal localization and intestinal histologic type being encountered more frequently.

Purpose: We analyzed the clinical results of different techniques of resection for malignant colorectal (primary or staged) obstruction., Methods: The subjects of this retrospective nonrandomized clinical study were 165 patients with malignant colorectal occlusion who underwent surgery treatment in our Department between 2002-2006. Patients with peritonitis or treated by means of permanent colostomy, palliative anastomosis, primary Hartman resection and rectal excision were excluded., Results: Patients with large bowel obstruction caused by obstructive malignant colorectal lesions underwent either one-stage primary resection with anastomosis (77 patients) or staged interventions (88 patients). There were no differences in age, sex, comorbidities, tumor staging, serum preoperative levels of hemoglobin and proteins between the two groups of patients defined by the different surgical techniques. Regarding mortality and morbidity following surgical treatment for large bowel obstruction no significant difference among the two groups (p > 0.05) or the fistula rate (p = 0.435) was obtained. Moreover, results showed a higher incidence of mortality (11.8% vs 7.8%), morbidity (13.6 vs 10.4) and increased hospitalization period (p = 0.03) among the patients that undergone series resections., Conclusions: One stage primary resections with anastomosis of the large bowel can be performed safely in case of emergency whenever patient comorbidities and local conditions do not stand as major restrictions.

Objectives: (1) to evaluate the effect of HAART on CMV viraemia in co-infected patients, in the absence of specific anti-CMV therapy; (2) to compare 2 molecular biology techniques for the detection and quantification of CMV-DNA in these patients., Methods: We present the preliminary data of an ongoing prospective research grant on newly diagnosed HIV seropositives, in a tertiary care hospital, during June 2006- June 2008. Clinical, virological (HIV and CMV viraemia) and immunological (CD4) screening was performed every 3 months. The CMV viraemia was performed by RoboGene Human Cytomegalovirus Quantification kit (aj Roboscreen). We retested all undetectable CMV viremia found in patients with CD4 <50/mmc, by CMV PCR kit (Qiagen Diagnostics). Both PCR reactions were performed on ABI Prism 7000 (Applied Biosystems)., Results: Up to date, our study has included 105 HIV-infected subjects, who were seropositive for anti-CMV IgG antibodies. Average follow-up was 18 months. CMV viraemia was found detectable in 21 cases at first visit and in other 5 at the second visit. 22 cases had CD4 <50/mmc, among which 14 had undetectable CMV viraemia. The results of both molecular biology techniques were widely the same. HAART was prescribed to 86% of the patients; all the patients having detectable CMV viraemia received HAART, but not any specific anti-CMV therapy. Under HAART, all the detectable CMV loads which were retested in time became undetectable at next visits, after a median of 16.5 weeks from the introduction of therapy., Conclusions: CMV viraemia detection was useful in early diagnosis of asymptomatic CMV infection. As opposed to transplant cases, molecular biology techniques for the detection and quantification of CMV-DNA in HIV-patients have not been standardized yet. In our study, the two kits RoboGene Human Cytomegalovirus (HCMV) Quantification kit (aj Roboscreen) and CMV PCR kit (Qiagen Diagnostics) were comparable. HAART made the reduction of CMV viral load, without any specific anti-CMV therapy. As in the case of other opportunistic infections, undetectable natural history of CMV infection seemed to have been improved by controlling HIV infection.

Background and Aim: Case selection criteria for resection of liver metastasis after colorectal cancer are still incompletely elucidated and represent a subject of great interest recently. Our aim was to evaluate 2-year survival after resection and to identify the survival risk and prediction factors in those cases., Methods: 63 patients diagnosed and undergoing liver resection for colorectal metastatic disease to the liver at the Surgical University Hospital No.3 (Cluj-Napoca, Romania) between 01.01.2002 and 31.12.2005 were included in the study. Exclusion criteria were: palliative treatment as well as surgical treatment performed in a different surgical centre. After the surgical treatment, patients were followed regularly using clinical assessment on a 3 monthly basis with abdominopelvic ultrasound or computerised tomography annually. The following variables were recorded: age, gender, coexisting medical diseases, blood tests results, tumour site, maximal tumour diameter after resection, duration of surgery, surgical procedure and the clinical outcome until last follow-up, including date of death where appropriate., Results: 2-year post-operative survival was 65.1%. In univariate analysis: age (< 65 vs > = 65 years, p = 0.041), metastasis number (< 3 vs > = 3 tumors, p = 0.049), maximal tumor dimension (< 3 vs > = 3 cm, p = 0.047), glutamine-oxaloacetic transaminase (GOT) preoperative level (< 42 vs > = 42 mg/dl, p = 0.018) were significant factors correlated to median survival time. However, non of the above mentioned factors presented independent prediction power in multivariate analysis (Cox regression, p < 0.05)., Conclusions: Our results support liver metastasis resection without prior case selection except for technically-operative criteria selection.

Tuberculous meningitis (TBM) is a medical emergency. Early and accurate diagnosis is crucial for preventing morbidity and mortality. Our aim was to define the predictors of tuberculous rather than other causes of acute aseptic meningitis syndrome (AAMS). A retrospective study of 225 patients with AAMS admitted in a tertiary care infectious diseases center between 2001 and 2004 was performed. In order to assess the value of clinical and biological variables for the diagnosis of TBM, we compared the variables between two groups of patients, one with microbiologically documented TBM and one with certain non-TBM acute lymphocytic meningitis. The assessed variables had good specificities, but relatively low sensitivities, ruling in the diagnosis of TBM rather than ruling it out. The most reliable predictors in multivariate analysis were: duration of symptoms before admission > 7 days, altered clinical stage, CSF/blood glucose ratio < 0.5 and CSF protein concentration > 200mg/ml. Based on the multivariate model which retained four variables, the probability of TBM in a certain patient could have been increased from 17% to 99.9% when all variables were present, or decreased to 0% when all variables were absent. This study suggests that simple clinical and laboratory features are useful in diagnosing TBM in a high-prevalence region.

We have investigated the cellular and serum CK18 in 26 non-treated primary ductal invasive breast carcinomas. The soluble CK18 (TPS) was detected by chemiluminescent assay, and the cellular CK18 and PCNA expression by immunocytochemistry. Flow-cytometry was used to estimate the amount of DNA in malignant cells. There was a significant correlation between soluble CK18 and the pre-menopausal status (p < 0.05), characterized in our group by a PCNA estimated low proliferation index. We have also found a significant correlation between soluble CK18 and the DNA index (p < 0.01). The intracellular CK18 has correlated with the PCNA expression (p < 0.05), while no correlation could be found between cellular and serum CK18. The values of soluble CK18 may offer information about the treatment-induced cell death, if monitored, while isolated measurements should be interpreted cautiously. Elevated levels of serum CK18 in non-treated carcinomas may rather reflect a high tumor turn-over or perhaps a more intensive tumor cell killing.

The goal of the "Prospect" programme (sponsored by Pfizer) is to create possible evidence-based protocols related to the management of postoperative pain after certain type of surgical intervention (e.g. hernia repairs, hysterectomies, etc.). This article is introducing the protocol for laparoscopic cholecystectomy for both day-case and longer hospital admission cases. The protocol is designed for preoperative, intra and postoperative period, choosing only those measures which were effective for postoperative pain, published in the literature. We are also presenting an analyze of our 13,000 laparoscopic cholecystectomies, from "Prospect" protocol point of view, and what we should do to improve the management of postoperative pain.

The porcelain gallbladder is uncommon type of chronically inflamed gallbladder wall considered to be associated with a high frequency of adenocarcinoma and subsequently not suitable for a laparoscopic approach. In 12,000 patients chosen for a laparoscopic cholecystectomy 4 porcelain gallbladders were diagnosed. In 2 cases the laparoscopic approach was successful. One conversion was due to an unconfirmed suspicion of gallbladder cancer and the other one to a fistula between the gallbladder and the common bile duct. Patients with a preoperative diagnosis of porcelain gallbladder must not be excluded from the laparoscopic approach yet a low threshold for conversion must be maintained in those with a cancer suspicion.

Romania is an endemic region for hydatid cyst and has a high incidence of hepatic hydatid cysts. If the intrabiliary rupture is the most frequent complication encountered, rupture in the peritoneum is rare, with exact data not available. Between 1993-2002 160 patients with hepatic hydatid cysts were operated. Six of them had an intraperitoneal ruptured cyst. Ultrasound raised the suspicion of hepatic hydatid cyst ruptured in the peritoneum in 4 cases, in one case the intact cyst migrated in the lower abdomen were it was mistaken for an ovarian cyst. After a thorough lavage with hypertonic serum, the parasite was evacuated, the pericyst partially removed and the cavity collapsed with non-absorbable sutures. The postoperative course was uneventful. Prophylaxis with benzimidazolic drugs started days 2-3 PO. At a follow-up between 1-4 years no peritoneal hydatidosis was detected. In the intraperitoneal ruptured hydatid cyst the hypertonic serum and benzimidazolic drugs can be useful in preventing peritoneal seedings.

Unlabelled: HLA antigens are involved in inducing either susceptibility or resistance to different diseases. Many studies reported various associations between HLA antigens and tuberculosis, depending on race, ethnic group and geographic area., Aim: Our purpose was to identify HLA class I antigens inducing susceptibility to tuberculosis in population from North-Eastern Romania., Patients and Methods: The study group consisted of 50 tuberculosis patients and the control group included 90 healthy people. HLA-A and HLA-B antigens were determined using the CDC-NIH (complement-dependent-cytotoxicity-National Institute of Health) assay. A comparison was made between the frequency of HLA antigens expression in the two studied groups., Results: HLA-B18 and HLA-A29(19) were expressed more frequently in tuberculosis patients. The difference was statistically significant only for HLA-B18 antigen. HLA-B7 and -B61(40) antigens were expressed with statistically significant higher frequency in controls compared to tuberculosis patients. The frequency of other HLA-A and HLA-B antigens was either comparable in the two groups or without statistical significance. CONCLUSIONS We found a positive association between HLA-B18 antigen and tuberculosis, while HLA-B7 and HLA-B61(40) antigens seem to protect against the disease.

Unlabelled: Miniinvasive treatment can be used in many early complications following laparoscopic cholecystectomy. In this article are analyzed the indications and the efficiency of these techniques., Material and Methods: We analyzed here a group of 9542 laparoscopic cholecystectomy operated in 9 years. The main postoperative complications were: bile leak (54 cases), haemorrhage (15 cases), subhepatic abscess (10 cases) and early diagnosed remnant lithiasis of CBD (11 cases). Miniinvasive techniques that were used were laparoscopic reinterventions (15 cases) and EST (22 cases)., Results: Classic reinterventions were practiced in 28.88% of cases with complications. Miniinvasive techniques were used in 42.2% of cases with complications: laparoscopic reinterventions (15 cases) for choleperitoneum, haemoperitoneum and subhepatic abscess and EST (22 cases) for prolonged bile leak on subhepatic drain and for early diagnosed remnant lithiasis of CBD. All cases were healed., Discussion: Along with a precise diagnosis and a good indication, the miniinvasive treatment of complications proved to have good results, converting the bad operative outcome into a postoperative success.

We analyse a series of 38 cases of gallbladder carcinoma. All cases presented gallbladder stones and IVB was the most frequent TNM stage--29 cases (76.31%). Preoperative diagnosis was made in 9 cases (23.69%), all of them by ultrasound examination. Resective procedures was possible in 8 cases (21%), whereas radical cholecystectomy was possible only in 3 cases (7.9%). The histological findings were: adenocarcinoma in 28 cases (73.67%), papillary adenocarcinoma in 3 cases (7.89%) and undifferentiated carcinoma in 7 cases (18.4%). We conclude that the late presentation due to the absence of specific symptoms and the poor diagnosis performance were responsible for the failure of detection in early stages and therefore for the poor prognosis of gallbladder carcinoma.

Unlabelled: The aim of the study was to identify HLA class I types associated with susceptibility to psoriasis among population of Northeast region of Romania., Patients and Methods: 27 psoriatic patients and 89 controls were typed serologically for HLA-A and HLA-B lymphocyte expression using CDC-NIH (complement dependent-cytotoxicity--National Institute of Health) method. The Terasaki plates used for HLA class I typing were prepared in our laboratory using antisera of known specificities., Results and Conclusions: psoriatic patients in the group of study frequently express HLA-B57 phenotype. The relative risk induced by this phenotype was highly statistically significant (p = 0.0016) while HLA-B13 was not associated with a significant risk for developing psoriasis in patients under study compared with controls (p = 0.48). Also, HLA-B27 (p = 0.96) and HLA-B44 (p = 0.99), reported by others to be associated with late psoriasis, do not meet (a particular) disease susceptibility between psoriatic patients under investigation.

The aim of the conservative treatment of postoperative external digestive fistulae is to obtain a reduction of the output, thus favoring spontaneous closure and shortening outcome. A retrospective comparative study has been performed on two groups of patients with postoperative anastomotic gastrointestinal and pancreatic fistulae. Group A included 18 cases (14 anastomotic, 4 pancreatic fistulae) receiving conventional treatment only. Group B included 25 cases (18 anastomotic and 7 pancreatic fistulae) in which Sandostatin was associated to conventional therapy, using daily doses ranging from 0.1 mg to 0.3 mg, administered after variable intervals after fistulas' occurrence. Duration of treatment ranged from 1 to 25 days. In group A, 27.77% of the cases were cured in comparison with group B in which the healing rate increased to 56%. Global hospital mortality rate was 25.58% (11 cases). In group A this was 44.44% (8 cases) in comparison with group B with 12% (3 cases) only. As a conclusion of our study, the use of Sandostatin is remarkable effective in the treatment of external digestive postoperative fistulae. Thus a doubling of healing rate and a reduction by 73% of mortality rate was achieved.

Arterial hypertension in adolescents was studied in a group of 899 school boys aged 15-18 years from the vocational school No. 48 of the Bucharest Transport Enterprise (ITB) and the secondary school No. 19 ITB. Essential arterial hypertension in the group investigated was found in proportion of 2.7%, a percentage comparable with that of other European countries (1-3%).

A total of 80 cultures of Bacillus cereus, isolated from food products, were studies to establish the behaviour to specific phages or the CAM set and the presence of lysogeny. A modern bacteriophage method was tested for the first time in the differentiatons of Bacillus cereus, which was so far studied mainly in the differentiation of Bacillus anthracis. Results showed that bacteriophagy with specific type phages as a method, though not absolutely precise, is dependable for the differentiation of Bacillus cereus. It can be used as a fast adjunct technique in the determination of B. cereus from the view point of its species. No lysogenic strains were established in the cultures investigated.