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BACKGROUND: Assessing the diagnostic value of liver ultrasound image computerized analysis (USICA) for hepatic fibrosis (HF) staging in respect to the “gold standard” provided by liver biopsy (LB). METHODS: Two-hundred twenty-eight patients with chronic hepatopathies were prospectively enrolled in the study. All the patients underwent LB and abdominal ultrasound (US). For quantitative US assessment of HF, an image analysis software was developed and 3 parameters were extracted by wavelet processing of the region of interest: mHLlivermHHliver, mHLlivermLLliver, and mHLlivermHLspleen. To assess the relevance of each feature, the support vector machine (SVM) classifiers were employed to discriminate between the 2 severity classes (i.e., incipient F1-F2 vs advanced F3-F4 fibrosis). The statistical significance of the HF staging was assessed using SVM classifiers, in terms of sensitivity (Se), specificity (Sp), and receiver operating characteristic (ROC) curves. RESULTS: A cut-off value of 0.342 of mHLlivermHHliver allowed the discrimination between the incipient and advanced HF with 79.5% Se and 77.4% Sp, at an area under receiver operating characteristic (AUROC) value of 0.867 (P ˂ .001). CONCLUSION: The proposed USICA using wavelet filter parameters proved to be an innovative method that is useful for the initial non-invasive evaluation and quantification of HF, with the advantages of simplicity, short calculation time, accessibility, and repeatability. The mHLlivermHHliver parameter has demonstrated good accuracy in distinguishing incipient and advanced HF and can be considered an effective non-invasive imaging marker for the assessment of HF in patients with chronic hepatic disease.

Aim: Endoscopic ultrasound (EUS) has become an indispensable method for diagnosis in gastroenterology and new indications for EUS continue to emerge. However, there are limited data regarding the accuracy of EUS-guided biopsy of hepatic focal lesions. The aim of this study was to assess the diagnostic yield of EUS-guided fine needle aspiration (FNA) of focal liver lesions.Material and methods: We conducted a prospective study in which patients with focal liver lesions, detected by transabdominal ultrasound and computed tomography or magnetic resonance imaging, underwent EUS-guided FNA to determine the diagnostic yield of the procedure.Results: In 47/48 of patients, the results of EUS-FNA were positive for malignancy, while in one case the acquired fragment was insufficient for appropriate histological analysis. Diagnostic yield was 0.98. In 83% of the cases biopsies were taken from the left lobe and in 17% from the right lobe with the same technical success rate. The most common diagnosis was metastatic adenocarcinoma of the pancreas (26% cases) followed by cholangiocarcinoma (17% cases). Concurrent sampling of other sites in addition to the liver and/or primary tumor was realized in 35% of the cases, with results that correlated with the liver biopsy and with the primary tumor biopsy. We reported no immediate or long-term complications in any of the patients.Conclusions: EUS guided fine needle aspiration/biopsy of focal liver lesions is safe, provides a very high diagnostic accuracy and should not be considered only as a rescue method after failure of percutaneous guided biopsies.

Background and aims. Liver cancer is one of the most common cause of deaths from cancer. Hepatocellular carcinoma (HCC) was reported at a frequency of 7% of patients with autoimmune hepatitis (AIH) - related cirrhosis in 1988. We aimed to provide a systematic literature review on the frequency of HCC in patients with AIH, after the discovery of hepatitis C virus (HCV), in order to avoid any possible confounding etiology. Methods. A literature search of the PubMed database between 1989-2016 was performed, using the relevant keywords “hepatocellular carcinoma” and “autoimmune hepatitis”. We followed the PRISMA statement guidelines during the preparation of this review. Results. Eleven studies (n=8,460 patients with AIH) were retained for the final analysis. HCC was diagnosed in 0-12.3% of the AIH patients included in these studies. The overall occurrence of HCC in patients with AIH was estimated in two studies, at 5.1% and 6.2%, respectively. In patients with AIH and cirrhosis, the percentage of HCC varied between 0.2%-12.3%. The proportion of HCC in patients with AIH without cirrhosis was estimated at 1.03%. The percentage of cirrhosis in AIH patients varied from 18.7% to 83.3% in Japan, and from 12% to 50.2% in the other areas. The mean follow-up of the patients with AIH was of 10 years. Conclusions. The development of HCC in patients with AIH appeared to be similar before and after the discovery of HCV, and it was mainly associated to cirrhosis. The number of patients developing cirrhosis in relation with AIH was impressive. The long evolution of AIH to cirrhosis and, eventually, to HCC, has been be suggested.

In this study, aflatoxin B1 (AFB1) toxicity toward the earthworm Eisenia fetida (Savigny 1826) was evaluated in contact paper test systems containing distilled water and ethanol or 20 to 400 μg/ml of AFB1 over 72 h of exposure. The results indicated that AFB1 could induce significant damage to earthworms (coiling, curling, excessive mucus secretion, clitellum swelling) at greater than 75 μg/ml. Moreover, AFB1 had harmful effects on E. fetida (degenerative changes such as bulging of the clitella regions) at levels higher than 150 μg/ml. The calculated LD50 was 168.5 μg/ml. These findings confirm that E. fetida and standardized methods based on this organism (OECD 207 1984) are applicable and useful in mycotoxin related toxicity studies.

Introduction: Despite improvements in the conventional preoperative tools used for staging of gastric cancer, their accuracy still needs to be improved. Laparoscopy has the potential to visualize and characterize the tumor, the peritoneal cavity and the lymph nodes and thus to better select patients for the optimal treatment strategy. Material and Method: Patients with gastric cancer staged initially with contrast enhanced computer tomography and endoscopic ultrasound were also evaluated by laparoscopy and laparoscopic ultrasound in a distinct preoperative staging procedure. The perioperative data was recorded in a prospective database and was used to decide within the multidisciplinary team the optimal treatment protocol for each patient. The database was retrospectively reviewed for this study. Results: Among the 20 CT-scan M0 patients analyzed, peritoneal carcinomatosis was detected in 15% of the cases. In other 15% of patients laparoscopy upstaged the tumor and directed the patient towards neoadjuvant chemotherapy. Laparoscopic guided percutaneous core biopsies settled the definitive diagnosis in 3 further cases. In total, laparoscopic staging brought important information in 65% of cases and changed the treatment plan in 30% of patients. Conclusions: In the era of neoadjuvant chemotherapy, laparoscopy has the potential to overcome some of the limitations of the conventional staging methods and offers additional informations which finally change the treatment plan in as much as a third of patients with gastric cancer.

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in Western countries. It affects about 1 billion individuals worldwide. While people with simple steatosis have no higher risk of death than the general population, people with non-alcoholic steatohepatitis are at increased risk of death compared to general population. Current management for NAFLD includes diet and lifestyle changes, management of underlying metabolic risk factors and pharmacological therapies. The objective of therapy is to prevent the complications. The problem with dietary and lifestyle interventions is that they are hard to implement. Compliance is the key. Until now, there is still no approved drug for the treatment of NAFLD. Insulin resistance is the main target of pharmacological therapy, but the question that we ask ourselves as physicians is who should receive medical treatment among NAFLD patients and for how long.

Location of small gastric or colorectal tumors during a laparoscopic procedure is often imprecise and can be misleading. There is a real need for a compatible and straightforward tool that can be used intraoperatively to help the surgeon in this regard. We emphasize in the present work on the fabrication of a new and innovative inductive proximity switch architecture, fully compatible with laparoscopic surgery and with direct application in precise localisation of bowel tumors. An electromagnetic detection probe optimized for laparoscopic surgery and preconditioned for sterilisation was designed and constructed. Various metallic markers designed to be attached to the gastrointestinal mucosa were used for detection by the probe, from standard endoscopic and laparoscopic haemostatic clips to other custom made tags. Experiments were performed in dry and wet-lab experimental laboratory environment using ex-vivo segments of calf's small bowel and colonic surgical specimens from human patients. The dry-lab detection range varied considerably depending on the metallic component of the tags, from 0.5 mm for the endoscopic hemostatic clip to 3.5 mm for the 0.9 mm thickness stainless-steel custom tags. The latter was actually detectable from the serosal side of the fresh colonic surgical specimens in 85% of the attempts if the scanned area was less than 150 cm2 and less than 2 mm of fat was interposed between the probe and the bowel. The newly designed system has the potential to discover metallic tags attached to the bowel mucosa for precise intraoperative laparoscopic location of digestive tumors. Further work is in progress to increase the sensitivity and detection range of the system in order to make it fully compatible with the clinical use.

Aims: There are few data on the use of endoscopic ultrasound (EUS) for the biopsy of suspected malignant lesions of the lung. The main objective of this study was to evaluate the performance of transesophageal EUS fine needle aspiration (EUSFNA) for the diagnosis of paraesophageal lung tumors and also for the confirmation of metastatic sites of lung cancer during the same procedure.Material and methods: We performed a retrospective study in a tertiary care unit including 19 patientswith paraesophageal lung tumors referred to our department for a lung biopsy. Transesophageal EUS-FNA was performed using a linear echoendoscope and 22G needles.Results: In all 19 patients with suspected lung tumors the confirmation of the malignant disease was achieved. Pathological examination revealed 16 cases of non-small cell lung cancers, 2 small cell lung cancers and one case of lung metastases. Diagnostic yield of lung EUS-FNA was 1, with no post-procedural complications. In 7 cases, we performed also biopsies of suspected metastasis and all biopsies revealed the same histopathological type as the primary tumor.Conclusions: Our study supports the use of this minimally invasive technique for paraesophageally locatedlung tumors and demonstrates that EUS-FNA is safe and has an excellent diagnostic yield.

The aim of this study was to evaluate whether there is a correlation between peripheral blood expression of angiogenic transcriptional factors/receptors and colorectal cancer (CRC).Eighty six blood samples collected from patients with CRC (N=42), adenomas and/or hyperplastic polyps(AP, N=30) and individuals without colon pathology (control group/CTR, N=14) were used for this study. Twelve transcription factors and receptors were assessed by qRT-PCR in a case-control study. The molecules with a minimum of 30% differences in gene expression for CRC and AP compared to CTR were then analyzed separately for each sample. Gene expression was evaluated relatively to the CTR after normalization to the large ribosomal protein PO (RPLPO) housekeeping gene, and the differential expression between studied groups was assessed by ANOVA.Seven out of 12 genes presented differences in expression between 10-29% in CRC and/or AP compared to CTR. Considering the selection criteria, we further individually evaluated the levels of expression of 5 genes that had a minimum of 30% expression in the case-control study. Our data showed a significant up-regulation of platelet derived growth factor (PDGF) C in the blood of the patients with CRC compared to CTR (p=0.007). Likewise, clusterin (CLU) was significantly up-regulated both in CRC and AP groups compared to healthy subjects (p=0.01). For VEGFR1, PDGFRA and TGFB1 we didn't find significantly differential expression between any of the studied groups, even if increased levels were observed in both CRC and AP vs CTR.The results of our study indicated that increased blood level of PDGFC mRNA was associated with the presence of CRC (p=0.007). Additionally, high levels of circulating CLU mRNA were observed in both malignant and benign colorectal pathologies.

Aims: Non-invasive methods are required to diagnose presence and grading of esophageal varices in patients with he- patic cirrhosis and in this respect we have evaluated the role of transient elastography and abdominal ultrasound parameters. Material and methods: Cirrhotic patients were prospectively evaluated by transient elastography and Doppler ultrasound for diagnosis of presence and grading of esophageal varices, the results being compared with the findings of the esophagogas- troduodenoscopy. Results: Sixty patients with hepatic cirrhosis were analysed. The parameters that reached statistical signifi- cance for diagnosis of esophageal varices were: liver stiffness (LSM) > 15 kPa, hemodynamic liver index (PVr1) ≥ 0.66, portal vascular resistance (PVR) > 17.66 and splenoportal index (SPI) > 4.77. The only parameter that reached statistical power for the diagnosis of large esophageal varices was LSM at a cut-off value of 28.8 kPa. Conclusions: Assessment of LSM in patients with liver cirrhosis can predict both the presence of esophageal varices and of large esophageal varices. The PVr1, PVR and SPI Doppler indexes can be used to diagnose the presence of esophageal varices but have no role in the prediction of large esophageal varices. Further studies are required to confirm these results and offer a stronger clinical significance.

Aims: The purpose of this study was to analyze the diagnostic yield and accuracy of the ultrasound (US) guided core biopsy in a population of patients with osteolytic metastasis. Materials and methods: We performed a retrospective analysis of 16 consecutive cases of US-guided core biopsies of osteolytic lesions performed in our Ultrasound Unit, from January 2006 to May 2017. We used 18G or 16G Tru-cut needles coupled with automated biopsy guns. We procured a maximum number of two tissue specimens per patient.Results: We obtained a diagnostic yield and accuracy of 93.75% (15 of 16 patients) for US-guided core biopsy of osteolytic metastasis. Most of our cases were metastasis of adenocarcinomas (8 patients), squamous cell carcinomas (3 patients) followed by multiple myelomas (2 patients). Other pathologic lesions recorded were undifferentiated carcinoma (1 patient) and mesenchimal undifferentiated tumor (1 patient). The pathologic result was inconclusive in one patient.Conclusions: Our study supports the important diagnostic role of US-guided core biopsy for osteolytic bone metastasis. Two US-guided passages may be sufficient to procure a diagnostic tissue samples from osteolytic bone metastasis, if theirlength is at least 10 mm.

Aims: Ultrasound (US) is a highly valuable imagistic tool used to guide numerous interventional procedures. The US guided bone lesions biopsy has not yet received a consensus or a guideline. We aimed to evaluate the evidence to support the US role in guiding bone lesions biopsies.Material and methods: A computer literature search of PubMed was conducted using the keywords “ultrasound” and “bone biopsy”, in order to detect relevant studies regarding the aim of our analysis. Records were screened for eligible studies and data were extracted and analyzed.Results: We included 23 studies (n=610 patients) in the final analysis. The specificity and diagnostic yield of US guided biopsy were very good (between 78-100%), depending on the type and dimensions of the bone lesions. The type of the biopsy – aspiration or cutting – influenced theresults. The studies which included larger groups showed a better performance for cutting needles (83.3-100% vs 50-80.5% for aspiration). The size of the bone lesion influences the diagnostic yield of the US guided bone biopsy. Most of the studies reported nil post-procedural complications.Conclusion: Core needle biopsy provided better diagnostic yield compared to fine needle aspiration. The number of the passages of the cutting needle biopsies in order to achieve the best diagnostic yield wasthree. Further studies are needed in order to standardize US-guided bone lesions biopsy and increase its role in the diagnosis algorithm of the bone lesions.

Adrenal gland ultrasonography is one of the corner stones of the abdominal ultrasonography examination for many medical specialties. The adrenal areas can be easily overlooked though adrenal gland pathology is diverse. We present the normal aspects and various transabdominal ultrasonography findings of the adrenal glands, both common and rare. Even though ultrasound examination is operator and patient dependent, we consider the examination of the adrenal glands very important, due to relatively frequent incidental detection of an adrenal mass.

Pleural ultrasonography (US) represents nowadays a useful diagnostic tool in the management of pleural diseases. Detection and evaluation of pleural effusions, pneumothorax and pleural-based lesions can be performed with US, which has the advantages of wide availability, low cost, absence of radiation exposure, and portability. It is the best method for guiding interventional procedures in the pleural space. It has also limitations, due to the interposition of bony parts of the thorax, subcutaneous emphysema and inability to visualize the mediastinal pleura. US of the thorax is an operator dependent technique demanding an experienced operator in order to obtain reliable results. This pictorial essay presents various ultrasound findings of the diseases which concern the pleura.

Burkitt’s lymphoma is an aggressive B-cell non-Hodgkin lymphoma. It is less common in adults accounting for less than 5% of non-Hodgkin lymphoma cases. Radiological methods (ultrasonography, computed tomography) are indispensable for the initial evaluation and appreciation of organ extension; complete diagnosis is confirmed by the histopathological examination.We present the clinical case and ultrasound imaging particularities of a young patient diagnosed with multisystem involvement Burkitt’s lymphoma, with rapid progressive evolution towards exitus.

The gold standard for the quantitative evaluation of steatosis is liver biopsy, but this is an invasive method. The recent trend is to investigate and develop novel non-invasive hepatic tissue evaluation methods, able to give performances close to biopsy, one of the possible solutions being ultrasound image analysis. Finding the most suitable descriptors of the histological tissue changes (invariant to the ultrasound device and patient) in this imaging modality is an important issue. Several such descriptors are reported in the literature, starting from simple intensity parameters to more sophisticated ones. Here we investigate the discrimination ability of the hepatic steatosis as opposed to healthy tissue by a set of computationally simple features, extracted from the gray level histogram of a small sized region of interest (ROI) positioned at three depths in the ultrasound hepatic image. The advantage of finding computationally simple features, as intensity histogram extracted features, can be the possibility to include their computation directly in ultrasound devices, provided they offer good tissue discrimination. The in-depth variations of some of the features investigated in this paper show a good discrimination in steatosis evaluation and quantification, close to the state of the art in the field.

Steady and persisting falls in gastric cancer (GC) mortality rates have been observed worldwide in the last 50 years, and in Romania too. Colorectal cancer (CRC) is presently the most frequent digestive neoplasia in the Western countries. An increase of CRC incidence and mortality rates has been reported recently in Eastern European countries, including Romania.Mortality data from GC and CRC, derived from population based mortality statistics, have been available on a national scale for 1955-2003. The data were identified from the statistics of the Ministry of Health (Bucharest, Romania) and of IARC/OMS (Lyon, France). GC and CRC mortality rates global and/or per gender were registered by time intervals. After 1995, only data on general mortality rates were available.Between 1955-59 and 1990-92, GC mortality rates/100,000 decreased from 33.14 to 17.70 in males and from 18.77 to 7.00 in females. Between 1995 and 2003, general mortality rates/100,000 from GC remained stable (17.54 and 17.74, respectively). Between 1955-59 and 1990-92, CRC mortality rates/100,000/gender increased from 4.65 to 10.10 in males and from 4.57 to 7.40 in females. Between 1995 and 2003, CRC general mortality rates/100 000 increased from 14.90 to 19.20.Our study reports opposite trends in GC and CRC mortality rates in the period under study, with GC declining and CRC increasing. A male predominance was registered in both neoplasms under study, more obvious in GC (male/female ratio: 2-3/1) than in CRC (male/female ratio: 1.5/1).