Antiendomysial and antitissue transglutaminase antibodies in gluten-induced enteropathy

Although the gold standard for diagnosis of coeliac disease remains the small bowel biopsy, the broad spectrum and the non-specific nature of many of the clinical manifestations makes biopsy as the initial investigation impossible. So, much effort has been put into the identification of serological screening tests with adequate sensitivity and specificity. The aim of this study was to identify antiendomysial and antitissue-transglutaminase antibodies as serum markers of coeliac disease in a group of patients admitted in the 3rd Medical Clinic, 4th Medical Clinic and 1st Pediatric Clinic as well as in the general population. The study was made on serum samples collected from 64 persons, adults and children with or without documented coeliac disease. Antitissue transglutaminase (anti-tTG) antibodies were determined by the sandwich ELISA technique, using a commercial kit. Antiendomysium (EMA) antibodies were dosed by indirect immunofluorescence. Twenty-four subjects were positive for IgA anti-tTG and 23 for EMA. We found that IgA anti-tTG were 100% positive in patients with clinical suspicion of coeliac disease, the diagnosis being confirmed by biopsy. All, but two patients on a gluten-free diet had small or zero EMA levels. We also found that serum EMA levels correlated perfectly with the degree of histological alterations. A very good correlation was found between the serum concentrations of the two antibodies studied     

Central pancreatectomy--indications, technique, outcomes

Central pancreatectomy is a conservative resectional procedure indicated for benign and low malignant tumors located in the neck and/or body of the pancreas. We report our experience on 5 patients and some considerations about this surgical technique from medical literature.     

Screening for familial colorectal cancer: the need for continuing education. A case report

A 37 year old female patient was diagnosed with sigmoid colon cancer in our clinic five years ago (January 1998). The family history revealed three deaths due to colorectal cancer (maternal grandmother, mother's sister and patient's sister), and the patient's mother had been diagnosed with adenomatous polyps (endoscopically removed). Histopathological diagnosis was moderate / poorly differentiated adenocarcinoma. Resection of sigmoid colon was performed and adjuvant chemotherapy was carried out, with uneventful evolution. The patient was annually followed-up (colonoscopy, abdominal ultrasound, laboratory tests). The last admission was in January 2003. No recurrence or metastases were found. The patient's mother, who was admitted at the same time, had been diagnosed with urinary bladder tumor. Subjects with a personal or family history of colorectal cancer should routinely have a colonoscopy beginning from age 40 or earlier. It is important for such patients to be followed-up closely not only for recurrence or metastases, but also for detection and treatment of a second primary cancer at an early stage     

Recurrence of non-invasive intraductal papillary municious neoplasm seven years following total pancreatectomy

INTRODUCTIONIntraductal papillary mucinous neoplasm is an increasingly recognized disease with varying premalignant potential and unclear incidence, characterized by a mucin-producing epithelium and dilation of the pancreatic duct.PRESENTATION OF CASEWe present the first documented case of distant intestinal intraductal papillary mucinous neoplasm recurrence following total pancreatectomy for side-branch non-invasive borderline malignant intraductal papillary mucinous neoplasm.DISCUSSIONWe review the current literature in order to try and answer important questions regarding our ability to predict intraductal papillary mucinous neoplasm recurrence, our understanding of the potential for recurrence and what follow-up should be recommended to properly monitor recurrence after a benign, albeit borderline malignant, side-branch lesion resection.CONCLUSIONOur case report confirms that the low risk classification of an intraductal papillary mucinous neoplasm lesion even after total pancreatectomy does not always predict recurrence and that definitive prognostic factors of recurrence in the setting of non-invasive disease have yet to be identified. A vigilant long-term approach to follow-up may thus be required even in low risk cases     

Ethical issues in communication of diagnosis and end-of-life decision-making process in some of the Romanian Roma communities

Medical communication in Western-oriented countries is dominated by concepts of shared decision-making and patient autonomy. In interactions with Roma patients, these behavioral patterns rarely seem to be achieved because the culture and ethnicity have often been shown as barriers in establishing an effective and satisfying doctor–patient relationship. The study aims to explore the Roma’s beliefs and experiences related to autonomy and decision-making process in the case of a disease with poor prognosis. Forty-eight Roma people from two Romanian counties participated in semi-structured interviews, conducted by a research team from the University of Medicine and Pharmacy of Iasi. Participants were recruited among the chronically ill patients and caregivers. The Roma community opposes informing the terminal patients about their condition, the “silence conspiracy” being widely practiced. The family fully undertakes the right of decision making, thus minimizing the patient’s autonomy. We identified ethical dilemmas concerning autonomy, lack of patients’ real decision-making power, and paternalistic attitudes exerted firstly by the family and, on demand, by the physician. Instead, the Roma patient benefits from a very active support network, being accompanied at the hospital by numerous relatives. The patient’s right to make autonomous decisions promoted in the Western countries and stipulated by the Romanian law has diminished value in the Roma community. For the Roma, the understanding of dignity is not simply individual and personal, but it is closely related to their cultural particularities. Ignoring their cultural values could create conflicts between healthcare providers and community.     

Large multilocular serous cystadenoma of the pancreatic head

We present the case of an 88-year-old female, investigated for upper abdominal pain and upper abdominal mass, exhibiting at the computed tomography a large tumour located in the head of the pancreas, compressing the common bile duct and with uncertain preoperative diagnosis (benign/malign). The histopathological findings of the operative specimen (cephalic pancreatoduodenectomy) revealed a large serous multilocular cystadenoma. There are presented the clinical, imaging and pathological correlations in the present case, also analysing the limits of the imaging preoperative diagnosis and indications for surgery in cystic tumours of the pancreas.