Our results emphasize that HSA-derived structural indices of proximal femoral structure may be an important index of greater fragility in patients with alcoholic cirrhosis.

The aim of the study was to assess the clinical performance of the model combining areal bone mineral density (aBMD) at spine and microarchitecural texture (TBS) for the detection of the osteoporotic fracture. The Eastern European Study is a multicenter study (Serbia, Bulgaria, Romania and Ukraine) evaluating the role of TBS in routine clinical practice as a complement to aBMD. All scans were acquired on Hologic Discovery and GE Prodigy densitometers in a routine clinical manner. The additional clinical values of aBMD and TBS were analyzed using a two steps classification tree approach (aBMD followed by TBS tertiles) for all type of osteoporotic fracture (All-OP Fx). Sensitivity, specificity and accuracy of fracture detection as well as the Net Reclassification Index (NRI) were calculated. This study involves 1031 women subjects aged 45 and older recruited in east European countries. Clinical centers were cross-calibrated in terms of BMD and TBS. As expected, areal BMD (aBMD) at spine and TBS were only moderately correlated (r (2) = 0.19). Prevalence rate for All-OP Fx was 26 %. Subjects with fracture have significant lower TBS and aBMD than subjects without fracture (p < 0.01). TBS remains associated with the fracture even after adjustment for age and aBMD with an OR of 1.27 [1.07-1.51]. When using aBMD T-score of -2.5 and the lowest TBS tertile thresholds, both BMD and TBS were similar in terms of sensitivity (35 vs. 39 %), specificity (78 vs. 80 %) and accuracy (64 vs. 66 %). aBMD and TBS combination, induced a significant improvement in sensitivity (+28 %) and accuracy (+17 %) compared to aBMD alone whereas a moderate improvement was observed in terms of specificity (+9 %). The overall combination gain was 36 % as expressed using the NRI. aBMD and TBS combination decrease significantly the number of subjects needed to diagnose from 7 for aBMD alone to 2. In a multi-centre Eastern European cohort, we have shown that the use of TBS in addition to the aBMD permit to reclassified correctly more than one-third of the overall subjects. Furthermore, the number of subjects needed to diagnose fell to 2 subjects. Economical studies have to be performed to evaluate the gain induced by the use of TBS for the healthcare system.

Intrahepatic cholestasis of pregnancy (ICP) is a gestation-specific liver disorder, defined most often as the onset of pruritus, usually from the third trimester of pregnancy, associated with abnormal liver test results and/or increased total serum bile acids and spontaneous relief after delivery. The 21-year-old patient was admitted to our ward in the 11th week of pregnancy due to raised liver enzymes. The first onset of pruritus and jaundice appeared a month before hospitalization. Immunology tests and Toxoplasma gondii were negative. We excluded viral etiology, while alpha-1-antitrypsin, serum and urine copper levels, and thyroid hormones were within the reference values. The patient denied she had taken any medicines and herbal preparations before and during pregnancy. Total bile acids in the serum were significantly elevated (242 μmol/L). The abdominal ultrasound revealed a regular finding. Liver biopsy suggested a cholestatic liver disorder. After a presentation of all risks, the patient decided to stop the pregnancy. After a month, the hepatogram was within the reference values. Very rarely an ICP can occur in early pregnancy (first trimester), which calls for close monitoring. The risk of serious adverse fetal outcomes and spontaneous preterm delivery is proportional with increased levels of maternal serum bile acid.

SummaryBackground: Metabolic bone disease in patients with chronic liver disease is called hepatic osteodystrophy and is primarily a sequel to osteopenia/osteoporosis, and rarely secondary to osteomalacia. The aim of this work was to define the influence of vitamin D 3 and parathyroid hormone (PTH) in the pathogenesis of hepatic osteodystrophy, as well as the predictive significance of biochemical bone markers. Methods: This prospective study included 58 male patients with alcoholic (49) and viral (9) cirrhosis. The concentrations of serum vitamin D 3 , PTH, osteocalcin and b-carboxy-terminal cross-linked telopeptide of type I collagen (b-CTX) were determined. Bone density was measured by dual energy X-ray absorptiometry in the L1-L4 spinal segment and the femoral neck. Results: Lower bone mineral density (BMD) was measured in 41 patients (70.7%). There was no significant correlation between PTH and vitamin D 3 values and T score in the femoral neck (p=0.51; p=0.063) and lumbar spine (p=0.49; 0.064). Also, no significant correlation was found between the osteocalcin values in lumbar spine BMD (p=0.944) and femoral neck (p=0.161), or with b-CTX values and BMD in the lumbar spine (p=0.347) and femoral neck (p=0.73). Statistically significant difference was confirmed between the stage A osteocalcin (p=0.000) and b-CTX (p=0.008) values in relation to advanced stages B and C.

Introduction. Thrombosis of splanchnic blood vessels is one of the most difficult complications and most frequent causes of death in patients with myeloproliferative disorders. Case Outline. We report a 48-year-old man with recurring haemorrhage from the upper digestive tract. Doppler ultrasonography of the portal system revealed a thrombosed portal vein, with marginal flow of 10 cm/s. Peroral fiber panendoscopy of the oesophagus showed III-IV degree varices together with varices in the stomach fundus. Blood count revealed thrombocytosis (Pt. 900 x 109/l), and haematological analysis led to the diagnosis of essential thrombocythaemia. However, two years after the established diagnosis, the patient was hospitalized again for bleeding from esophageal varicosity. During haemorrhage, anticoagulant therapy was discontinued. Eight days after anticoagulant discontinuation, mesenterial thrombosis and small intestinal gangrene developed. Surgical intervention was carried out, including resection of 2.5 m of the small intestine. In spite of intensive postoperative therapy, the lethal outcome ensued. Conclusion. The bleeding from oesophageal and/or gastric varicosity is often the presenting manifestation of up to that time undetected myeloproliferative disease. The following question still remains open: should anticoagulant therapy be continued in the phase of acute bleeding of these patients?