Occurrence of autoimmune chronic hepatitis in siblings

BACKGROUND: Autoimmune hepatitis is a chronic inflamatory disease of the liver of unknown etiology, characterized by the loss of tolerance against hepatic tissue, leading to the destruction of hepatic parenchyma. It predominantly affects females, and rarely occurs in the same family. CASE REPORT: In this paper we presented brother and sister with autoimmune hepatitis according to the criteria of the International Autoimmune Hepatitis Group. CONCLUSION: Because of a possible genetic predisposition to autoimmune hepatitis, the occurrence of the disease in a family member suggested the need to examine other family members.     

Liver hydatid disease: morphological changes of protoscoleces after albendazole therapy

BACKGROUND: Postoperative recurrence of the liver hydatid disease befalls approximately 10-30% of patients. Preoperative or postoperative therapy with albendazole in single therapeutic protocol (800 mg/d, within 28 days) indicated the need to evaluate the hydatid cyst liquid protoscoleces viability. Morphological changes of protoscoleces following the treatment with drugs are not well known. AIM: To estimate the viability of protoscoleces after preoperative or postoperative albendazole therapy, and their ability for cystic metamorphosis. METHODS: A prospective, randomized clinical trial included 30 patients with liver hydatid disease, treated with albendazole and surgically (I group), and 30 patients in the control group treated only surgically (II group). The concentration of albendazole and its active metabolite albendazole sulphoxide in the cysts contents were determined using HPLC. Estimation of protoscoleces viability was based on the established micromorphologic criteria, and compared between the patients treated with albendazole, and the patients treated only surgically. Biological assessment of the viability was performed on protoscoleces with uncertain signs of the disturbed viability (unchanged structure, evaginated, without movements) using intraperitoneal injection of 1 ml of protoscoleces prepared suspension to AO type of rats. RESULTS: The concentration of albendazole in cysts' contents ranged from 0 to 64.9 microg/ml, and of its active metabolite from 0.5 to 40.8 microg/ml. The presence of fully viabile protoscoleces in the albendazol treated patients was significantly lower than in the control group. A significant difference was noticed in the presence of disintegrated protoscoleces without movements in the albendazol treated group, compared to the control group. Biological assessment of the viability showed incapability of these protoscoleces for cystic metamorphoses. CONCLUSION: Low viability of parasites due to medicamentous therapy is very useful and important to surgeons, because the fertility of cysts is lower, and the risk of the disease recurrence is reduced.     

Prolonged survival of a female patient with total pelvic exenteration

BACKGROUND: To present a female patient who lived 5 years after total pelvic exenteration (TPE). CASE REPORT: The female patient underwent TPE due to retrovesicovaginal fistula as a consequence of locoregional irradiation after the operation for the malignoma of the vaginal part of the uterus. In the formation of Bricker conduit, the ureter antireflux was achieved by the application of the "tobacco sack muff" made of the intestines around the ureter. By the use of this technique, the occurrence of pyelonephritis, as the leading cause of death in such patients, was prevented. CONCLUSION: TPE is a hope for significantly prolonged survival of patients with advanced pelvic malignomas, or with a postirradiatiation fistula.     

Inducible nitric oxide synthase inhibition by mycophenolic acid

The focus of this review is the influence of an immunosuppressive xenobiotic drug mycophenolic acid on the induction of nitric oxide production in various cell types. The potential therapeutic significance of the cell-specific fine-tuning of nitric oxide release by mycophenolic acid, as well as the mechanisms behind the drug action are discussed.     

EGSNRC Monte Carlo study of the effect of photon energy and field margin in phantoms simulating small lung lesions

The dose distribution in small lung tumors (coin lesions) is affected by the combined effects of reduced attenuation of photons and extended range of electrons in lung. The increased range of electrons in low-density tissues can lead to loss of field flatness and increased penumbra width, especially at high energies. The EGSNRC Monte Carlo code, together with DOSXYZNRC, a three-dimensional voxel dose calculation module has been used to study the characteristics of the penumbra in the region of the target-lung interfaces for various radiation beam energies, lung densities, target-field edge distances, target size, and depth. The Monte Carlo model was validated by film measurements made in acrylic (simulating a tumor) imbedded in cork (simulating the lung). Beam profiles that are deemed to be acceptable are defined as those in which no point within the planning target volume (target volume plus 1 cm margin) received less than 95% of the dose prescribed to the center of the target. For parallel opposed beams and 2 cm cube target size, 6 MV photons produce superior dose distribution with respect to penumbra at the lateral, anterior, and posterior surfaces and midplane of the simulated target, with a target-field edge distance of 2.5 cm. A lesser target-field edge distance of 2.0 cm is required for 4 MV photons to produce acceptable dose distribution. To achieve equivalent dose distribution with 10 and 18 MV photons, a target-field edge distance of 3.0 and 3.5 cm, respectaively, is required. For a simulated target size of 4 cm cube, a target-field edge distance of 2, 2.5, and 3 cm is required for 6, 10, and 18 MV photons, respectively, to yield acceptable PTV coverage. The effect, which is predominant in determining the target dose, depends on the beam energy, target-field edge distance, lung density, and the depth and size of the target.     

Tuberculous orchiepididymitis diagnosed by nucleic acid amplification test: A case report

Symptoms of tuberculous orchiepididymitis in a 39-year-old male started with swelling of left scrotum, followed by fistula formation with suppurative discharge. There was no any improvement produced by antibiotics. Surgical extirpation of inflammatory destroyed testicle and epidydimis was performed. Presence of tubercle bacilli was not shown by bacteriological analysis of testicle tissue. Tuberculous etiology was suggested after histopathological examination of testis and epididymis. Exudate from surgical wound was examined on presence of Mycobacterium tuberculosis DNA. Etiology of orchiepididymitis was proved by positive assay and inflammatory process was completely cured by antituberculotics therapy. By this report it was clearly shown that sometimes only molecular methods could confirm etiology of inflammatory process.     

Menetrier's disease associated with ulcerative colitis

In this paper a 21 year old patient was presented with Ménétrier's disease, associated with ulcerative colitis. The first symptoms of ulcerative colitis occurred at the age of eleven, since when the patient has been conservatively treated several times because of the exacerbations of the disease. During control examinations presence of polyploid changes in stomach was discovered by upper endoscopy. Gastrectomy was suggested because the patient had excessive anemic syndrome which required weekly substitutional therapy with deplasmatic eritrocytes, as well as hypoproteinemia, while multiple polyploid changes suspect for malignancy were gastroscopically identified. Patient accepted surgical treatment, and was transferred to the Clinic of Surgery. Total gastrectomy was performed, and patohistological finding confirmed Ménétrier's disease. After two weeks, the patient was released from the hospital in good general condition, with regular clinical and laboratory findings.     

Scorpinone: a new natural azaanthraquinone produced by a Bispora-like tropical fungus

Scorpinone (1), 3-methyl-6,8-methoxy-2-aza-9,10-anthraquinone, has been isolated from the mycelium of a cultured sterile fungus of Caribbean origin. The structure was elucidated by X-ray crystallography, and 2D NMR spectral data have been assigned. The compound is one of very few known fungal azaanthraquinones.