The diagnostic accuracy of US, CT, MRI and 1H-MRS for the evaluation of hepatic steatosis compared with liver biopsy: a meta-analysis

OBJECTIVE: To meta-analyse the diagnostic accuracy of US, CT, MRI and (1)H-MRS for the evaluation of hepatic steatosis. METHODS: From a comprehensive literature search in MEDLINE, EMBASE, CINAHL and Cochrane (up to November 2009), articles were selected that investigated the diagnostic performance imaging techniques for evaluating hepatic steatosis with histopathology as the reference standard. Cut-off values for the presence of steatosis on liver biopsy were subdivided into four groups: (1) >0, >2 and >5% steatosis; (2) >10, >15 and >20%; (3) >25, >30 and >33%; (4) >50, >60 and >66%. Per group, summary estimates for sensitivity and specificity were calculated. The natural-logarithm of the diagnostic odds ratio (lnDOR) was used as a single indicator of test performance. RESULTS: 46 articles were included. Mean sensitivity estimates for subgroups were 73.3-90.5% (US), 46.1-72.0% (CT), 82.0-97.4% (MRI) and 72.7-88.5% ((1)H-MRS). Mean specificity ranges were 69.6-85.2% (US), 88.1-94.6% (CT), 76.1-95.3% (MRI) and 92.0-95.7% ((1)H-MRS). Overall performance (lnDOR) of MRI and (1)H-MRS was better than that for US and CT for all subgroups, with significant differences in groups 1 and 2. CONCLUSION: MRI and (1)H-MRS can be considered techniques of choice for accurate evaluation of hepatic steatosi

Tamoxifen in treatment of hepatocellular carcinoma: a randomised controlled trial

Background Results from small randomised trials on tamoxifen in the treatment of hepatocellular carcinoma (HCC) are conflicting, We studied whether the addition of tamoxifen to best supportive care prolongs survival of patients with HCC. Methods Patients with any stage of HCC were eligible, irrespective of locoregional treatment. Randomisation was centralised, with a minimisation procedure accounting for centre, evidence of disease, and time from diagnosis. Patients were randomly allocated best supportive care alone or in addition to tamoxifen, Tamoxifen was given orally, 40 mg per day, from randomisation until death. Results 496 patients from 30 institutions were randomly allocated treatment from January, 1995, to January, 1997. Information was available for 477 patients. By Sept 15, 1997, 119 (50%) of 240 and 130 (55%) of 237 patients had died in the control and tamoxifen arms, respectively. Median survival was 16 months and 15 months (p=0.54), respectively, No differences were found within subgroups defined by prognostic variables. Relative hazard of death for patients receiving tamoxifen was 1.07 (95% CI 0.83-1.39). Interpretation Our findings show that tamoxifen is not effective in prolonging survival of patients with HCC

The clinical significance of occult HBV infection in acute delta virus hepatitis in a case of immunosuppressive therapy for non-Hodgkin lymphomas.

Chemotherapy may induce virus B reactivation in patients carriers of HBsAg. The clinical significance of occult B virus (HbcAB positive patients) is still uncertain then it is not clear if chemotherapy may be dangerous also in the case of patients carriers of HBcAB. The evidence reported in this case report on one hand supports the idea of a significant role of occult B virus and on the other suggests the possibility that chemotherapy might be dangerous also in carriers of occult B virus

Which clinical and sonographic parameters may be useful to discriminate NASH from steatosis?

The natural history of nonalcoholic steatohepatitis (NASH) includes the passage through steatosis.To retrospectively evaluate the usefulness of sonographic parameters compared to histological diagnosis when differentiating steatosis from NASH.This retrospective study reviewed records of patients with steatosis from databases of our Departments, selecting only those who had been diagnosed by sonography and liver biopsy [64 males (63.82\%); 30 females (36.18\%)].Attenuation of the echo amplitude (P<0.05; odds ratio (OR): 3.43; confidence interval (CI): 1.02-11.57), focal fat sparing (P<0.05; OR: 3; CI: 1.02-11.88) and splenic diameter (P<0.05; OR: 1.66; CI: 1.04-3.26) were independent predictors of NASH. A significantly higher association of attenuation of the echo amplitude, enlarged splenic diameter, and presence of focal fat sparing was observed in NASH patients (P<0.01).It is very difficult to build a predictive system to distinguish NASH from steatosis based on sonographic scores. However, it is already possible to differentiate NASH from steatosis by combining 3 simple sonographic parameters: attenuation of the echo amplitude, enlarged splenic diameter, and presence of focal fat sparing

Resilienza, impatto antropico e Rischio nel sistema territoriale vesuviano.

Uno degli effetti più evidenti del processo di globalizzazione è rappresentato dalla pressione ambientale che si traduce sia nella compromissione degli equilibri eco-sistemici, sia in trasformazioni sociali e culturali che possono compromettere la stessa qualità della vita della popolazione. In tale ottica, la resilienza può, dunque, essere definita come la capacità di un territorio di reagire ad uno shock derivato da un impatto antropico estremamente stressante, per recuperare l’equilibrio iniziale. Questo lavoro parte dal presupposto che nel territorio vesuviano la resilienza debba confrontarsi con due diverse tipologie di stress: quella legata all’antropizzazione, che si è manifestata attraverso un convulso processo di urbanizzazione e di saturazione dello spazio e che ha condotto alla compromissione degli equilibri ambientali, e quella legata alla natura geologica dell’area, dunque al rischio vulcanico. Per rispondere a tali squilibri sono state attuate, come vedremo, diverse strategie territoriali. Se da un lato, l’istituzione del Parco Nazionale del Vesuvio ha rappresentato un tentativo di incrementare il grado di resilienza rispetto all’impatto antropico, dall’altro si è resa necessaria una pianificazione strategica per la mitigazione del rischio vulcanico che, sostanzialmente, si traduce in piani di evacuazione per ridurre al massimo il Valore Esposto, sia in termini di vite umane, che di risorse territoriali presenti, come vedremo, in misura maggiore proprio all’interno dei 18 comuni della “zona rossa”

Long-term liver histology improvement in patients with chronic hepatitis B and sustained response to interferon

A retrospective multicentre survey was conducted to evaluate, in patients with chronic hepatitis C, the long-term liver histological changes induced by interferon (IFN). A total of 112 patients (mean age 46.4 years) were studied. All patients had received a 6-12-month IFN-α course (6-18 MU/week) and had successively undergone clinical, biochemical and virological follow-up for at least 36 months (range: 36-76). In each patient, two liver biopsies had been performed: 1-6 months before treatment and, 12-76 months after its completion. In 87 patients with biochemical and virological sustained response persisting for 12 months after therapy, post-treatment liver necroinflammation and fibrosis mean(±SD) scores (Knodell index) were significantly lower than pretreatment scores (2.9 ± 2.2 vs 6.8 ± 2.9 and 0.8 ± 1.0 vs 1.2 ± 1.1, respectively; P 0.05). On an individual basis, necroinflammation decreased in 87% of sustained responders but only in 36% of relapsers (P < 0.001), whereas fibrosis decreased in 44% of sustained responders but only in 14% of relapsers (P < 0.001). In sustained responders with biopsies performed 12-23 months (n = 34), 24-35 months (n = 26) or more than 36 months (n = 27) after treatment, a progressive decrease of mean necroinflammatory score was observed (-2.6 ± 2.1, -4.1 ± 3.4 and -5.2 ± 3.7 points, respectively; P < 0.01). A similar pattern was observed in fibrosis score (-0.3 ± 0.6, -0.3 ± 0.7 and -0.7 ± 0.9 points, respectively; P < 0.05). Hence, among chronic hepatitis C patients treated with IFN, those with a 12-month sustained response, unlike those who relapse, have a long-term progressive reduction and, in some cases, a complete regression of liver histological damage