Elastography Point Quantification in the evaluation of liver fibrosis in NAFLD patients

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease. Several non-invasive approaches to stage liver fibrosis in NAFLD patients are being developed. Elastography Point Quantification (ElastPQ) is a non-invasive method to assess liver fibrosis measuring liver stiffness. We evaluated the diagnostic performance of ElastPQ for identifying different degrees of fibrosis in NAFLD patients. We compared ElastPQ with other non-invasive tests and identify the best liver stiffness cut offs for every fibrosis stage. ElastPQ was performed in a training cohort of patients with biopsy-proved NAFLD, liver serum tests and Transient Elastography (TE). The diagnostic performance of ElastPQ was evaluated using AUROC and compared with TE, Fibrosis-4 score, NAFLD fibrosis score and AST/ALT. ElastPQ was performed in a validation cohort in order to validate the data. 106 patients with NAFLD were enrolled. The median stiffness values using ElastPQ was 4.69 kPa (2.82-29.86). The mean liver stiffness divided for category of fibrosis stage were: 4.18 kPa (mild fibrosis F0-1), 4.49 kPa (significant fibrosis F2), 6.89 kPa >(advanced fibrosis F3) and 12.14 kPa (cirrhosis F4). In multivariate analysis, liver stiffness was associated with the fibrosis stage (ß=2.987; p<0.001). The AUCs for the association with significant, advanced fibrosis and cirrhosis were 0.783 (95%IC 0.693-0.857), 0.855 (95%IC 0.773- 0.916) and 0.897 (95%IC 0.822-0.947), respectively. Diagnostic performance of ElastPQ compared to TE, resulted non-inferior in evaluating significant fibrosis (p=0.956), advanced fibrosis (p=0.171) and cirrhosis (p=0.773). ElastPQ had a higher diagnostic performance compared to FIB-4, NFS and AAR. The best fibrosis cuts off identified in the training cohort (80 patients enrolled) were 5.22 kPa, 6.3 kPa and 9.61 kPa respectively for fibrosis >F2, >F3 and F4. ElastPQ is a promising technique for liver fibrosis evaluatio

Pseudoaneurysm of the splenic artery mimicking a solid lesion

A 64-year-old man presented to the hospital because of hematemesis; on admission, he had weakness and pale skin, tachycardia and hypotension. Laboratory tests revealed severe anemia (hemoglobin 7.8 g/dL); liver, renal and pancreatic function tests were normal. An upper digestive endoscopy revealed a gastric ulcer of the cardia, treated with metallic clips and adrenalin injection. The patient was treated with fluids and was transfused with three units of red blood cells. In the previous two months, due to the presence of bloating and diarrhea, associated with abdominal distension, a colon-computed tomography (CT) revealed a large retroperitoneal hypodense mass, 53x37 mm in size, without contrast enhancement localized between the body and the tail of the pancreas and the stomach, near the splenic artery and without signs of infiltration. To better define the mass, endoscopic ultrasound and biopsy were performed; however histopathology of multiple biopsies was not diagnostic, because of the presence of necrotic tissue and inflammatory cells. Since hematemesis recurred, the patient underwent a second upper digestive endoscopic examination, but no source of bleeding was found. Then a new contrast enhanced CT was performed that showed a size reduction of the mass, the presence of blood in the stomach and a small pseudoaneurysm of the splenic artery. Because of these findings an angiograpghic study was carried out; angiography confirmed a splenic artery pseudoaneurysm that was successfully embolized with metal microcoils

Prevalence and predictors of Lymphogranuloma venereum in a high risk population attending a STD outpatients clinic in Italy

We evaluated LGV prevalence and predictors in a high risk population attending a STI Outpatients Clinic in the North of Italy. METHODS: A total of 108 patients (99 MSM and 9 women), with a history of unsafe anal sexual intercourses, were enrolled. Anorectal swabs and urine samples were tested for Chlamydia trachomatis (CT) DNA detection by Versant CT/GC DNA 1.0 Assay (Siemens Healthcare Diagnostics Terrytown, USA). RFLP analysis was used for CT molecular typing. RESULTS: L2 CT genotype was identified in 13/108 (12%) rectal swabs. All LGV cases were from MSM, declaring high-risk sexual behaviour and complaining anorectal symptoms. Patients first attending the STI Outpatient Clinic received a significant earlier LGV diagnosis than those first seeking care from general practitioners or gastroenterologists (P\u2009=\u20090.0046). LGV prevalence and characteristics found in our population are in agreement with international reports. Statistical analysis showed that LGV positive patients were older (P\u2009=\u20090.0008) and presented more STIs (P\u2009=\u20090.0023) than LGV negative ones, in particular due to syphilis (P\u2009&lt;\u20090.001), HIV (P\u2009&lt;\u20090.001) and HBV (P\u2009=\u20090.001).Multivariate logistic regression analysis revealed that HIV and syphilis infections are strong risk factors for LGV presence (respectively, P\u2009=\u20090.001 and P\u2009=\u20090.010). CONCLUSIONS: Even if our results do not provide sufficient evidence to recommend routine screening of anorectal swabs in high-risk population, they strongly suggest to perform CT NAAT tests and genotyping on rectal specimens in presence of ulcerative proctitis in HIV and/or syphilis-positive MSM. In this context, CT DNA detection by Versant CT/GC DNA 1.0 Assay, followed by RFLP analysis for molecular typing demonstrated to be an excellent diagnostic algorithm for LGV identification

Italy-Japan agreement and discrepancies in diagnosis of superficial gastric lesions.

The agreement between Italian and Japanese endoscopists and pathologists on endoscopic and histopathological diagnoses of superficial gastric lesions is verified with the use of Paris and Vienna classifications. The correlations between Paris endoscopic types and Vienna histopathological categories is high in both the independent Italian and Japanese evaluations. However, the agreement between Italian and Japanese endoscopists is moderate due to the difficult evaluation of the height of the lesions, in particular when they are mixed. The agreement on the size of the lesions is fairly good. The probability of the same allocation to the Vienna categories of a single case is 87 per cent, disagreements remaining in dysplasia grading, between dysplasia, not only high-grade but also low-grade, and in situ carcinoma, and on cancer invasion of the lamina propria. The results indicate that use of the Paris and Vienna classifications has reduced the discrepancies between Western and Japanese endoscopists and pathologists in the diagnosis of these lesions

Effect of Colic Vein Ligature in Rats with Loperamide-Induced Constipation

Introduction. Medical treatment in chronic constipation is not always successful. Surgery is indicated in unresponsive selected severe cases. This study presents the distal venous colic ligation in rat as a novel surgical approach. Materials and Methods. 16 rats (study group) were evaluated in 3 phases of 6 days each: A (normal conditions), B (loperamide-induced constipation), and C (colic vein legation) and compared with rats treated in phase C with PEG 4,000 (control group). Blood biochemical and physiological parameters, daily fecal water content (FWC), and histological analysis were performed in all study phases. Results. No biochemical and physiological parameters changes were observed. FWC decreased in phase B and increased in phase C in both groups with a grow up to 2.3-fold in study group compared to control (P < 0.0001). Moreover, in study group, a high number of colonic goblet cells were detected (phase C versus phase B: P < 0.001) while no differences were registered in control. Conclusion. By ligature of the colic vein in constipated rats, an increase in FWC and goblet cells higher than in PEG treated rats was detected. The described surgical procedure appeared effective, simple, and safe; further studies in animal models, however, are necessary to assess its clinical applicability

A primitive neuroendocrine liver tumour?

The aim of the present report is to present a possible primitive case of a neuroendocrine tumour (NET) of the liver. During a routine ultrasound examination, a 51-year-old woman was diagnosed with a lesion in the second segment of the liver, suggestive of a metastasis. A well differentiated neuroendocrine carcinoma (G2, Ki67 = 4.4%) was identified by liver biopsy, positive for chromogranin, synaptophysin and neuron specific enolase. An additional extensive examination aimed at finding the primitive lesion was unsuccessful and PET with 68Gallium revealed a single liver lesion. A left lobectomy was performed, but 15 months later a second liver lesion with the same characteristics as the previous one was observed and was surgically treated, followed by therapy with octreotide LAR 30 mg. A four-year follow-up did not show evidence of a different primitive NET: therefore, while it is improbable that a metastatic G2 primitive tumour would not have presented in the 4-year period, a diagnosis of primitive NET of the liver was made. The paper gives the opportunity of describing an unusual case of a primitive liver neuroendocrine tumour and of presenting the successful treatment of both surgery and cytoreductive pharmacological therapy

A case of ectopic ACTH secretion

We report the case of a 48-year-old woman, with a rapidly progressing ACTH neuroendocrine tumour of the pancreas (PNET) and multiple liver metastases. The patient had previously suffered from a peptic ulcer which was responsive to PPI inhibitors and hypertension which was poorly controlled by therapy. Admitted to the hospital for severe asthenia and abdominal pain, she was diagnosed with poorly differentiated PNET with liver metastases, which were positive for synaptophysin, cytokeratin 7 and 9 and neuron specific enolase (NSE). Octreoscan scintigraphy was positive for somatostatin receptors in the pancreas and in two liver lesions. A rapidly progressive Cushing’s syndrome developed, presenting with the classical physical symptoms, hypokalemia and Lysteria monocytogenes meningitis. Ectopic ACTH production was confirmed and eventually the patient died from a septic shock within two months. The case reported focuses on the malignity and the rapid progression of an ACTH-producing PNET and calls attention to the possible fatal progression of these cases

An unsolved case of fever

Fever of unknown origin (FUO) is extremely difficult to diagnose. It is defined as an illness lasting more than 3 weeks with a temperature exceeding 38 °C on several occasions and with an uncertain diagnosis after 1 week of intensive investigations in the hospital. The major causes of FUO are infection, neoplasm, and collagen vascular disease, but the percentages of each of these categories are subject to change due to improvements in diagnostic capability. The diagnostic workup of FUO is complex and, to date, there is no consensus published in the literature regarding guidelines as to the correct approach. A number of diagnostic tests and numerous non-invasive and invasive procedures, which however sometimes fail to explain the fever, are often necessary. In about 20% of cases of FUO the diagnosis is never established. In this article the case of a young man with fever of unknown origin is presented, the cause of which remains undiagnosed, in order to illustrate the difficulties of the diagnostic process. A “watch and wait” approach seems to be acceptable in a clinically stable patient for whom no diagnosis can be made after extensive investigation, and the prognosis is likely to be good

Effect of Colic Vein Ligature in Rats with Loperamide-Induced Constipation

Introduction. Medical treatment in chronic constipation is not always successful. Surgery is indicated in unresponsive selected severe cases. This study presents the distal venous colic ligation in rat as a novel surgical approach. Materials and Methods. 16 rats (study group) were evaluated in 3 phases of 6 days each: A (normal conditions), B (loperamide-induced constipation), and C (colic vein legation) and compared with rats treated in phase C with PEG 4,000 (control group). Blood biochemical and physiological parameters, daily fecal water content (FWC), and histological analysis were performed in all study phases. Results. No biochemical and physiological parameters changes were observed. FWC decreased in phase B and increased in phase C in both groups with a grow up to 2.3-fold in study group compared to control (P &lt; 0.0001). Moreover, in study group, a high number of colonic goblet cells were detected (phase C versus phase B: P &lt; 0.001) while no differences were registered in control. Conclusion. By ligature of the colic vein in constipated rats, an increase in FWC and goblet cells higher than in PEG treated rats was detected. The described surgical procedure appeared effective, simple, and safe; further studies in animal models, however, are necessary to assess its clinical applicability

Liver and intestinal protective effects of Castanea sativa Mill. bark extract in high-fat diet rats

The effects of Castanea sativa Mill. have been studied in high fat diet (HFD) overweight rats. Natural Extract of Chestnut bark (Castanea sativa Mill.) (ENC®), rich in ellagitannins, has been studied in 120 male Sprague-Dawley rats, divided in four groups. Two groups were controls: regular (RD) and HDF diet. Two groups received ENC®(20 mg/kg/day): RD + ENC®and HFD + ENC®. At baseline and at 7, 14 and 21 days, weight gain, serum lipids, plasma cytokines, liver histology, microsomial enzymes and oxidation, intestinal oxidative stress and contractility were studied. HFD increased body weight, increased pro-inflammatory cytokines, induced hepatocytes microvescicular steatosis, altered microsomial, increased liver and intestinal oxidative stress, deranged intestinal contractility. In HFD-fed rats, ENC®exerted antiadipose and antioxidative activities and normalized intestinal contractility, suggesting a potential approach to overweight management associated diseases