New insight into the role of NT-proBNP in alcoholic liver cirrhosis as a noninvasive marker of esophageal varices.

AIM: To investigate the association between plasma concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and formation of esophageal varices. METHODS: Thirty-five patients with alcoholic cirrhosis were divided into three groups according to the Child-Pugh classification: grade A (n=11, 32%), B (n=12, 34%), and C (n=12, 34%). System hemodynamic parameters were measured using sphygmomanometry, electrocardiography, and echocardiography. NT-proBNP was analyzed by using an electrochemiluminiscence sandwich immunoassay. RESULTS: The presence of esophageal varices was associated with a higher serum NT-proBNP level, with a cut-off value of <101 pg/mL (sensitivity, 87.60% and specificity, 72.73%; P<0.001). CONCLUSIONS: NT-proBNP was found to be a marker of the presence of esophageal varices, but not a marker of progression of liver cirrhosis. In cirrhotic patients, NT-proBNP value <101 pg/mL was shown to be a valuable noninvasive parameter in predicting the presence of varices.

[Ultrasonography in the diagnosis of nonalcoholic fatty liver disease]. / Ultrazvuk u dijagnostici nealkoholne masne bolesti jetre.

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in Western countries. Although no specific studies have been performed, the estimated prevalence of NAFLD in Croatia correlates with the prevalence in other countries, ranging from 20% to 40%. It encompasses a histological spectrum that ranges from simple steatosis to steatohepatitis, which can progress to cirrhosis in up to 20% of patients. Unfortunately, accurate noninvasive modalities for diagnosing nonalcoholic steatohepatitis (NASH) and monitoring disease progression or regression are unavailable. Therefore, liver biopsy remains the gold standard in diagnosing NASH but it is also associated with risks and possible sampling errors. Since liver biopsy cannot be performed as a screening method to detect NAFLD in general population, abdominal ultrasonography as a noninvasive modality has been widely used. Although sonographic characteristics of NAFLD were first described 20 years ago, larger studies have been conducted over the past few years as a result of the rising interest in NAFLD among investigators. The aim of these studies was to simplify the diagnosis of NASH. Abdominal ultrasonography has been shown to have a sensitivity of 60%-94% and specificity of 84%-95% for detecting fatty liver and it is used as a screening method in patients with incidental elevation of liver enzymes. Ultrasonographic scoring system developed by Hamaguchi et al. included hepatorenal echo contrast, liver brightness, deep attenuation, and vascular blurring. Score > or = 2 corresponded to NAFLD with a high, 92% sensitivity and 100% specificity, and a high level of intraobserver reliability.The inability to distinguish different forms of NAFLD and staging hepatic fibrosis limits the use of ultrasonography as a stand alone modality for detecting NAFLD. In the future, serum markers together with advancements in imaging modalities may potentially diminish or obviate the need of liver biopsy.

[Endoscopic ultrasonography in the diagnosis of choledocholithiasis]. / Znacenje endoskopskog ultrazvuka u dijagnostici koledokolitijaze.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) has been considered a gold standard in the diagnosis of choledocholithiasis; however, the incidence of complications is high. In literature reports, the morbidity rate ranges from 5% to 19% and mortality rate from 0.1% to 1.3%, therefore an effective but less invasive new method of diagnosing choledocholithiasis is required. In a number of trials, endoscopic ultrasonography (EUS) has been shown to be a less invasive method with excellent sensitivity of 94% and specificity of 95%. The aim of this study was to estimate the sensitivity and specificity of EUS in patients with suspected choledocholithiasis and to establish its role in the algorithm for diagnosing choledocholithiasis. PATIENTS AND METHODS: Patient files were retrospectively reviewed in 209 patients with a clinical picture and ultrasonography findings suggestive of choledocholithiasis, admitted to Sestre milosrdnice University Hospital during a six-month period (Sep 1, 2007 - Feb 29, 2008) and submitted to ERCP within 72 hours of admission. RESULTS: In 125 patients with abdominal ultrasonography findings suggestive of choledocholithiasis (biliary obstruction without clear evidence of calculi), EUS was performed before ERCR. Choledocholithiasis or biliary sludge was identified in 66 (62.3%) patients, 29 (27.3%) patients were free from biliary abnormalities, and 11 (10.4%) patients had stenosis of different etiology. In 64 of 66 (96.9%) patients, the diagnosis was confirmed by ERCP. Another two (3.1%) patients had no evidence of choledocholithiasis on ERCP. There were no complications related to EUS. CONCLUSIONS: EUS is an effective method for diagnosing choledocholithiasis with a sensitivity and specificity comparable to ERCP. Therefore, it is reasonable to use EUS as the first method of choice in patients with suspected choledocholithiasis.

Epithelial and stromal expression of syndecan-2 in pancreatic carcinoma.

UNLABELLED: The aim of the study was to determine the expression and prognostic role of syndecan-2 in patients with pancreatic adenocarcinoma. PATIENTS AND METHODS: Syndecan-2 expression and its relationship with established prognostic features were assessed in a series of 53 patients with pancreatic ductal adenocarcinoma. RESULTS: Epithelial expression was observed in 23 (43.4%) and stromal in 30 (56.6%) pancreatic carcinomas, respectively. In normal pancreatic tissue, the epithelial expression was moderate or strong in single or small clusters of acinar cells and negative in ductal cells. Normal pancreatic stroma did not express syndecan-2. Statistical analysis showed that stromal expression had no influence on survival but epithelial expression was positively correlated with survival time, and patients with higher epithelial syndecan-2 expression had a distinctly longer survival (p=0.029). CONCLUSION: Our results support a potential role for syndecan-2 in pancreatic carcinogenesis and cancer progression. Moreover, expression of syndecan-2 might serve as a prognostic marker.