Similar reduction of cholesterol-adjusted Vitamin E serum levels in simple steatosis and non-alcoholic steatohepatitis

OBJECTIVES: Reduced vitamin E levels have been reported in patients with non-alcoholic steatohepatitis (NASH), but no conclusive data on patients with simple steatosis (SS) are available. Aim of this study was to investigate the association betweenserum vitamin E levels and SS. METHODS: A cohort of 312 patients with cardio-metabolic risk factors was screened for liver steatosis by ultrasonography (US). We reasonably classified as SS patients with US-fatty liver, normal liver function tests (LFTs) and with Cytokeratin 18 o246 mIU/ml. Liver biopsy was performed in 41 patients with US-fatty liver and persistent elevation of LFTs (46 months). Serum cholesterol-adjusted vitamin E (Vit E/chol) levels were measured. RESULTS: Mean age was 53.9±12.5 years and 38.4% were women. Non-alcoholic fatty liver disease (NAFLD) was detected at US in 244 patients; of those 39 had biopsy-proven NASH and 2 borderline NASH. Vit E/chol was reduced in both SS (3.4±2.0, Po0.001), and NASH (3.5±2.1, P=0.006) compared with non-NAFLD patients (4.8±2.0 μmol/mmol chol). No difference was found between SS and NASH (P=0.785). After excluding patients with NASH, a multivariable logistic regression analysis found that Vit E/chol (odds ratio (OR): 0.716, 95% confidence interval (CI) 0.602–0.851, Po0.001), alanine aminotransferase (ALT, OR: 1.093, 95% CI 1.029–1.161, P=0.004), body mass index (OR: 1.162, 95% CI 1.055–1.279, P=0.002) and metabolic syndrome (OR: 5.725, 95% CI 2.247–14.591, Po0.001) were factors independently associated with the presence of SS. CONCLUSIONS: Reduced vitamin E serum levels are associated with SS, with a similar reduction between patients with SS and NASH, compared with non-NAFLD patients. Our findings suggest that the potential benefit of vitamin E supplementation should be investigated also in patients with SS

Ecografia interventistica: indicazioni, apparecchiature e metodica

Collana Monografica Incontri di Oncologia Chirurgic

Significato clinico delle calcificazioni nei noduli tiroidei

Il valore predittivo delle calcificazioni tiroidee ecograficamente accertate e le loro eventuali caratteristiche suggestive di neoplasia sono state studiate in una serie di 175 pazienti operati (30 carcinomi papilliferi, 145 gozzi multinodulari). Le calcificazioni sono risultate molto più frequenti nei tumori che nei gozzi (40% vs 20,7% p<0,05), mentre le loro caratteristiche (dimensioni, numero, posizione nel nodulo e disposizione nel contesto ghiandolare) non sono risultate chiaramente differenti fra tumori e gozzi. La frequenza delle calcificazioni è stata significativamente più alta nei pazienti più anziani (età media 58,7±13,3 per i pazienti con calcificazioni v s 51,1±12,7 per i pazienti senza calcificazioni, p<0,001) e ciò potrebbe implicare che la loro insorgenza sia dipen - dente dalla durata di malattia. In conclusione, le calcificazioni possono essere un utile indicatore di rischio aumentato, da prendere in considerazione nel processo com - plessivo di “decision-making” chirurgico

Factors influencing the length of the incision and the operating time for total thyroidectomy

Background: The incision used for thyroid surgery has become shorter over time, from the classical 10 cm long Kocher incision to the shortest 15 mm access achieved with Minimally Invasive Video-Assisted Thyroidectomy. This rather large interval encompasses many different possible technical choices, even if we just consider open surgery. The aim of the study was to assess the correlation between incision length and operation duration with a set of biometric and clinical factors and establish a rationale for the decision on the length of incision in open surgery. Methods: Ninety-seven consecutive patients scheduled for total thyroidectomy were prospectively evaluated. All operations were performed by the same team and the surgeon decided the length of the incision according to his personal judgement. Patients who had previously undergone neck surgery were excluded. Results: The length of the incision was strongly correlated with gender, thyroid volume, neck circumference and clinical diagnosis and weakly correlated with the body mass index. Operation duration was only weakly correlated with gender and neck circumference. Multiple linear regression revealed that the set of factors assessed explained almost 60 % of the variance in incision length but only 20 % of the variance in operation duration. When patients were classified according to the distribution of their thyroid volume, cases within one standard deviation of the mean did not show a significant difference in terms of operation duration with incisions of various lengths. Conclusions: Although thyroid volume was a major factor in driving the decision with respect to the length of the incision, our study shows that it had only minor effect on the duration of the operation. Many more open thyroidectomies could therefore be safely performed with shorter incisions, especially in women. Duration of the operation is probably more closely linked to the inherent technical difficulty of each case

L’alcoolizzazione percutanea del plesso celiaco nel trattamento del dolore addominale: proposta di un nuovo approccio sotto guida ecografica

Il Giornale di Ultrasonologia 1991; 3: 17

L’alcoolizzazione del plesso celiaco nel trattamento del dolore da cancro del pancreas: proposta di un nuovo approccio sotto guida ecografica

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L’alcoolizzazione percutanea del plesso celiaco per il trattamento del dolore addominale: proposta di un nuovo approccio sotto guida ecografica

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