Fibromax and inflamatory markers cannot replace liver biopsy in the evaluation of non-alcoholic fatty liver disease.

BACKGROUND: To evaluate the performance of a non-invasive test (Fibromax™, Ferring Pharmaceutical, Saint-Prex, Switzerland) and inflamatory markers (IL-1ß, IL-6, IL-8, TNF-α, MCP-1) in the diagnosis and staging of patients with non-alcoholic fatty liver disease. METHODS: Patients older than 18 years with steatosis were prospectively evaluated at a tertiary hospital in southern Brazil. Liver biopsy, Fibromax™ test and inflamatory markers (IL-1ß, IL-6, IL-8, TNF-α, MCP-1) were performed. Measures of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were used, considering liver biopsy as the gold standard. RESULTS: Seventy-three Fibromax™ tests were analyzed. SteatoTest presented a sensitivity of 95.5% and PPV of 97.0% for the diagnosis of steatosis. NashTest obtained a sensitivity of 83.3%, specificity of 37.5%, PPV of 90.9% and NPV of 23.1% for the diagnosis of non-alcoholic steatohepatitis (NASH). FibroTest presented a sensitivity of 38.9%, specificity of 92.7%, PPV of 63.6% and NPV of 82.3% to evaluate advanced fibrosis. In the evaluation of patients with grade 2 and 3 steatosis, ROC analyses showed an area under the curve (AUROC) for SteatoTest of 0.68 (P=0.015). NashTest AUROC was 0.59 (P=0.417) for the evaluation of NASH. FibroTest AUROC was 0.79 (P<0.001) for advanced fibrosis. Kappa coefficient values for SteatoTest, NashTest and FibroTest were not statistically significant. Thirty-seven patients performed also analysis of the inflamatory markers, showing that patients with inflammatory activity grade 2-3 on liver biopsy had significantly higher levels of IL6 (P=0.016) and lower TNF-α (P=0.034), but there was no other difference when analysed fibrosis or steatosis. CONCLUSIONS: The Fibromax™ test and the inflamatory markers (IL-1ß, IL-6, IL-8, TNF-α, MCP-1) did not present a satisfactory performance to be considered a good alternative to replace liver biopsy in the evaluation of non-alcoholic fatty liver disease.

Evaluation of angiogenesis in 77 pituitary adenomas using endoglin as a marker.

Angiogenesis, a fundamental process for the development and growth of a tumor, is less expressive in adenomas than in the normal pituitary tissue. There is controversy about the behavior of angiogenesis as a function of hormonal secretion or other characteristics of pituitary tumors. Endoglin (CD105) is a proliferation-associated antigen on endothelial cells, as well as an endothelial progenitor cell marker. We used the anti-endoglin antibody, a glycoprotein expressed in endothelial cells and conjunctive tissue, as a new marker particularly associated with neovascularization, in order to determine microvascular density (MVD) in pituitary adenomas. There were 77 samples, 31 males and 46 females, carriers of micro- (n = 24) or macroadenomas (n = 53). No significant difference was found in MVD concerning the variables of age, clinical presentation, and immunohistochemical phenotype or tumor size. MVD in males (median 5.4) was significantly higher (P = 0.001) than in females (median 3.0). Cell proliferation, as evaluated by the MIB-1 antibody (a cellular proliferation index [Ki-67 antigen], which is present in all stages of the cellular cycle except for the resting cells), ranged from 0% to 19.58%. No correlation was found between MIB-1 and MVD. It is possible to infer that the lower MVD found in pituitary adenomas in females reflects an inhibitory estrogen action on TGF-beta1, a protein involved in vascular remodeling. Because of its role as a TGF receptor ligand, endoglin proved to be sensitive in detecting this gender difference in pituitary tumor angiogenesis.

Diastolic function study with conventional and pulsed tissue Doppler echocardiography imaging in acromegalic patients.

UNLABELLED: Acromegaly is associated with myocardial hypertrophy and it can progress to diastolic and systolic dysfunction. PURPOSE: To evaluate diastolic function in acromegalic patients through conventional echocardiography (CD) and tissue Doppler imaging (TDI). METHODS: Seventeen acromegalic patients were submitted to CD and TDI, and early (E) and atriogenic (A) transmitral flow were evaluated in mitral, septal, and tricuspid regions. RESULTS: In comparison with controls the means of conventional (1.06), septal (1.01), and tricuspid (0.98) E/A ratio were significantly lower in acromegalic patients. E/A ratio <1.0 was demonstrated in 41% and 49% of acromegalics by DC and TDI, respectively, with no statistical difference among the two methods. An inverse linear correlation was shown between mitral E/A ratio and acromegalic age (r =-0.7). CONCLUSION: In this study, DC and TDI were equally effective in demonstrating diastolic dysfunction, a common finding in acromegalic patients.

Precocious puberty due to human chorionic gonadotropin secreting germinoma.

This study aims to report a rare case of precocious puberty (PP) due to a human chorionic gonadotropin (hCG)-producing germinoma located in the suprasellar region. A 10-year-old male patient presented with sexual precocity, headache, drowsiness, loss of appetite, and papilledema. Significant acceleration of bone age in relation to chronological age, high serum total testosterone levels, and hypopituitarism (unresponsiveness to stimulation test) were observed. Magnetic resonance imaging (MRI) of the brain showed a large suprasellar tumor and triventricular dilatation. High hCG levels were found in both blood and cerebrospinal fluid. Hormone replacement therapy and transcranial surgery associated with radiotherapy were performed, with complete regression of sexual characteristics and normal laboratory tests post-operatively. Clinical and laboratory findings, in addition to MRI scans, led to the diagnosis of an hCG-producing tumor and PP, which represents a rare report in the literature.

Acquired factor VIII and von Willebrand factor (aFVIII/VWF) deficiency and hypothyroidism in a case with hypopituitarism.

This article reports a female who presented with bleeding, acquired factor VIII and von Willebrand factor (aFVIII-VWF) deficiency, and central deficiency in the thyroid and adrenal axis (Sheehan's syndrome). After starting hormone replacement therapy, relief of bleeding manifestations was associated with correction of both FVIII and VWF to normal. This report draws attention to a rare association between the acquired form of von Willebrand disease and hypothyroidism of central origin.

Diferentes apresentações clínico-radiológicas da pneumonia por Mycoplasma pneumoniae / Mycoplasma penumoniae pneumonia: clinical and radiological features

Objetivo: Alertar sobre a grande variabilidade das manifestações clínicas e achados radiológicos das pneumonias por Mycoplasma pneumoniae na população pediátrica. Embora referida como uma entidade prevalente nesta faixa etária, muitas vezes têm o seu diagnóstico retardado em função da ausência de um padrão que possa ser considerado realmente clássico. Métodos: Os autores apresentam 5 casos de pneumonia por este agente em faixa etária pediátrica. Discutem a dificuldades diaagnósticas, as manifestações clínicas, os achados radiológicos e a evolução após a instituição da terapêutica. Os casos têm suas peculiaridades significativas confrontados com achados da literatura médica nos últimos 20 anos, obtidos através de uma pesquisa bibliográfica realizada no banco de dados da Medline acerca do tema. Resultados: Os 5 casos siituavam-se numa faixa etária entre 6 e 9 anos, caractisticamente de maior prevalência para o aparecimento da infecção. Em nenhum dos casos a possibilidade de infecção por mycoplasma foi considerada no manejo inicial. Pneumonia sinuso-aspirativa, tuberculose, asma brônquica de difícil controle estiveram entre as hipóteses diagnóticas inicialmente consideradas e posteriormente descartadas. À exceção de um, todos os outros casos referiram uso de antiboticoterapia prévia. Os achados radiológicos iniciais mais chamativos foram diferentes entre todo os casos apresentados: consolidações broncopneumônicas associadas à sinais de bronquite, consolidações broncopneumônicas grosseiras, efusão pleural paraneumônica, infiltrado intersticial com adenopatia para-hilar, consolidações broncopneumônicas com componente atelectásio. Após a instituição da terapêutica específica, a evolução foi favorável em todos os casos (clínica e radiologicamente). Conclusões: A penumonia por Mycoplasma pneumoniae constitui-se numa doença com formas de manifestações clínica bastante variável. Da mesma maneira, a investigação radiológica complementar pode exigir variados padrões de apresentação. Isso faz com que, mesmo sendo uma doença prevalente na faixa etária pediátrica, nem sempre seja primariamente considerada, levanddo a um retardo no seu diagnóstico e na instituição de uma terapêutica apropriada