6 research outputs found
Hepatic steatosis in morbidly obese patients undergoing gastric bypass surgery: assessment with open-system 1H-MR spectroscopy.
OBJECTIVE: The purpose of this study was to assess, with histopathologic control, the use of open-system 1-T (1)H MR spectroscopy for the evaluation of hepatic steatosis in morbidly obese patients undergoing gastric bypass surgery. SUBJECTS AND METHODS: Patients underwent (1)H MR spectroscopy (MRS) for the assessment of steatosis before and 3 months after surgery. Liver biopsy was performed during surgery. Hepatic steatosis was expressed as the ratio of fat peak area to cumulative water and fat peak areas. Histopathologic percentage of steatosis was graded as none (0-5%), mild (5-33%), moderate (33-66%), or severe (> 66%). The accuracy of (1)H-MRS and Spearman correlation coefficient were calculated. Differences between groups were assessed with the Wilcoxon signed rank and Mann-Whitney tests. RESULTS: The study included 38 patients (median age, 45.5 years; median body mass index, 47.7). Before surgery, median steatosis measured with (1)H-MRS was 5.8%. The accuracy of (1)H-MRS was 89% (32/36), and the (1)H-MRS findings correlated with the histopathologic assessment of steatosis (r = 0.85, p < 0.001). With (1)H-MRS, no steatosis was discriminated from mild steatosis (p = 0.011), mild was discriminated from moderate steatosis (p < 0.001), and moderate was discriminated from severe steatosis (p = 0.021). Three months after surgery, steatosis had decreased to 3.1% (p < 0.001). The prevalence of hepatic steatosis measured with (1)H-MRS decreased from 53% to 32%. CONCLUSION: In the care of morbidly obese patients undergoing assessment of hepatic steatosis and changes in steatosis after gastric bypass surgery, (1)H-MRS with an open 1-T MRI system is feasible. Measurements of hepatic fat with (1)H-MRS are accurate and correlate with clinical and histopathologic results
Current Status of Therapy in Autoimmune Liver Disease
Therapeutic strategies for autoimmune liver diseases are increasingly
established. Although proportionately uncommon, specialist centers have with
time refined the best approaches for each disease, based on an improved
understanding of the spectrum of presentation. The major treatment aims are to
prevent end-stage liver disease and its associated complications. As a result of
drugs such as ursodeoxycholic acid, predniso(lo)ne and azathioprine, both
primary biliary cirrhosis and autoimmune hepatitis are now less commonly
indications for liver transplantation. Unfortunately, the same inroads in
treatment efficacy have as yet not been made for primary sclerosing cholangitis,
although the recognition that a subset of patients may have a treatable
secondary sclerosing cholangitis (IgG4 related) is helping a proportion. With
better biological understanding, more specific interventions are expected that
will benefit all those with autoimmune liver diseases