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Hepatobiliary manifestations of hereditary hemorrhagic telangiectasia (HHT) are rare, but often involve cholestasis. We report here a case of HHT associated with cholestasis due to common bile duct stenosis. Attempted balloon dilation of the stenosis during endoscopic retrograde cholangiopancreatography (ERCP) resulted in hemobilia. Hemostasis was achieved by adjusting the nasobiliary drain. The aim of this report is to highlight the biliary manifestations of HHT and draw attention to an unusual complication of ERCP in this setting.

Several studies indicate that high levels of homocysteine (Hcy) and L-cysteine (L-Cys) are independent risk factors for cardiovascular disease. The validation and clinical application of an ultra HPLC method for analysis of Hcy and L-Cys is described. The reported method is simple, sensitive, rapid, precise, and less aggressive than other previously reported methods. The effect of the derivatization reaction time, pH, and organic solvent contents in the mobile phase are described and discussed. Optimized conditions resulted in excellent peak shapes. Results of method validation showed a good linearity (r(2) ≥ 0.993) over the investigated concentration ranges and were observed for both compounds. The LOD and LOQ were 0.05 μM and 0.15 μM for Hcy and 0.24 μM and 0.80 μM for L-Cys, respectively. Validation results proved that the method precision was good and the accuracy was satisfactory. This validated method was successfully applied in an epidemiological study to measure and compare the prevalence of Hcy and L-Cys high levels in plasma of Portuguese type 2 diabetic patients with and without angiopathy. The study results showed that prevalence of hyperhomocysteinemia and hypercysteinemia were at least two times higher in diabetic patients with angiopathy compared to diabetics without angiopathy.

Heart failure may lead to subclinical circulatory disturbances and remain an unrecognized cause of ischemic liver injury. We present the case of a previously healthy 40-year-old bodybuilder, referred to our Intensive-Care Unit of Hepatology for treatment of severe acute liver failure, with the suspicion of toxic hepatitis associated with anabolic steroid abuse. Despite the absence of symptoms and signs of congestive heart failure at admission, an anabolic steroid-induced dilated cardiomyopathy with a large thrombus in both ventricles was found to be the underlying cause of the liver injury. Treatment for the initially unrecognized heart failure rapidly restored liver function to normal. To our knowledge, this is the first reported case of severe acute liver failure due to an unrecognized anabolic steroid-induced cardiomyopathy. Awareness of this unique presentation will allow for prompt treatment of this potentially fatal cause of liver failure.

BACKGROUND: Carotenoids, vitamins (A, B2, C and E) and total folate are related to health promotion. However, there are still many food matrices for which the content of these compounds is not available. In order to fill this gap, traditional foods from Black Sea Area countries (BSAC) were analysed in order to investigate their potential health benefits. RESULTS: The most abundant carotenoid was β-carotene. Plum jam was the sample with the highest β-carotene content (608 μg 100 g−1 edible portion). The group of vegetables and vegetable-based foods contributed most to β-carotene content. Evergreen cherry laurel presented the highest L-ascorbic acid content (29.9 mg 100 g−1 edible portion), while the highest riboflavin and total folate contents were found for roasted sunflower seeds. Approximately 61% of the analysed samples showed quantifiable amounts of α-tocopherol but did not contain retinol. CONCLUSION: Despite the great variability in the content of carotenoids, vitamins and total folate, most of the analysed traditional foods from BSAC can be considered good sources of these compounds. Therefore, owing to their putative health benefits, the consumption of those with higher contents of these compounds should be encouraged and promoted. The research leading to these results received funding from the European Community’s Seven Framework Programme (FP7/2007-2013) under grant agreement n.º 227118.