Increased risk of nonalcoholic fatty liver disease in patients with coeliac disease on a gluten-free diet: beyond traditional metabolic factors.

BACKGROUND: A gluten-free diet (GFD) is known to be associated with altered macronutrient intake and metabolic syndrome. Nonalcoholic fatty liver disease (NAFLD) is the hepatic hallmark of metabolic syndrome. The risk of NAFLD in patients with coeliac disease (CD) adhering to a GFD remains to be fully investigated; in particular, data from real-life clinical settings are lacking. AIM: To assess the prevalence and relative risk of NAFLD in CD patients treated with a GFD. METHODS: Case-control study, with prospective enrolment of CD outpatients following a GFD and controls. Patients were matched for demographic characteristics (age and gender) and metabolic risk factors (overweight, diabetes mellitus, total cholesterol, and triglycerides) using a 1:1 ratio. NAFLD was diagnosed according to the European Association for the Study of the Liver criteria. RESULTS: 202 CD patients and 202 controls were compared. The raw prevalence of NAFLD was 34.7% and 21.8% in the CD and control group, respectively (P = 0.006). Binary logistic regression confirmed an increased risk of NAFLD in the CD group (adjusted odds ratio = 2.90, 95% confidence interval: 1.64-5.15, P < 0.001). Additionally, the relative risk for NAFLD was notably higher in non-overweight CD patients (adjusted odds ratio = 5.71, 95% confidence interval: 2.30-14.19, P < 0.001). CONCLUSIONS: More than one-third of CD patients adhering to a GFD had concurrent NAFLD, accounting for a three-fold increased risk compared to the general population. Dietary advice provided using a patient-tailored approach should assist CD patients with NAFLD in achieving an appropriate nutritional intake whilst reducing the risk of long-term liver-related events.

Endocervical adenocarcinoma. Clinico-pathologic and histochemical study of 29 cases.

Twenty-nine women were treated for endocervical adenocarcinoma in the University of Bari in the years 1975-1981. The histological type was "endocervical" or "mucinous" in 12 patients (41.4%), "endometrioid" in 12 (41.4%), "clear cell" in 2 (6.9%), "adenosquamous" in 2 (6.9%), and "serous" or "papillary" in 1. Foci of papillary and endometrioid metaplasia were present in 2 adenocarcinomas of endocervical type. The following histochemical methods were used: PAS reaction, PAS reaction with diastase predigestion, Bleu Alcian at pH 2.5 and pH 1, mucicarmine, Toluidine Bleu at 0.3%. The "endocervical" type adenocarcinoma showed mucicarmine positive and PAS positive, diastase resistant material in the whole cytoplasm. This material was not metachromatic and Bleu Alcian positive only in the well differentiated forms. In the "endometrial" adenocarcinoma only in the apex of the glandular cells was PAS positive diastase resistant, Alcian and mucicarmine positive. "Clear cell" and "adenosquamous" carcinomas showed only few cytoplasmatic PAS positive, diastase sensitive granules (= glycogen). No positivity was present in the "papillary" or "serous" carcinomas. Our results permit us to unify the histological and the histochemical patterns of the cervical adenocarcinomas and those of the similar forms of the endometrium and of the ovary, and stress the common müllerian origin of these neoplasms.

Morphological changes of the ovarian surface epithelium in women with ovarian polycystic disease or endometrial carcinoma and a control group.

The ovarian surface epithelium and that of related inclusion cysts were studied in 50 women with ovarian polycystic disease and they were compared with our preceding observations performed on women with endometrial carcinoma (n = 50) and on women without any hyperplastic or neoplastic genital tract pathology (n = 50). In 16 women (32%) the ovarian epithelium with normal aspect was found on the surface of the ovary and in inclusion cysts. In the remaining 34 women (68%) surface papillomatosis, hyperplastic and metaplastic changes were present on the ovarian surface and/or in the inclusion cysts. These findings were similar to those observed in the group of women with endometrial adenocarcinoma, while the surface epithelium was often normal in the control group. Our observations confirm the hypothesis of a hormonal influence in the hyperplastic and metaplastic modifications of the ovarian epithelium and in the related common epithelial tumors of the ovary.

[Papillomatosis of the mitral valve as an unusual cause of myocardial ischemia. Description of a case and review of the literature]. / Papillomatosi della mitrale quale causa insolita di ischemia miocardia. Descrizione di un caso e revisione della letteratura.

Papilloma is a rare primary heart tumour; only 75 cases have been reported and most were casual findings at autopsy. We describe another case of this tumour in a 9 years girl. The neoformation had produced a picture of angina pectoris, followed by death due to an occluded left coronary orifice. To our knowledge, this is the first report of this type of tumour with electrocardiographic documentation.