Accuracy of ultrasound diagnosis of nonalcoholic fatty liver disease in patients with classes II and III obesity: A pathological image study.

Liver biopsy is the gold standard method to diagnose nonalcoholic fatty liver disease (NAFLD). However, ultrasound is widely recommended as the first-line imaging test for individuals with suspected NAFLD. This study aimed to estimate the accuracy of ultrasound as a screening test for NAFLD compared to liver biopsy in a cohort of patients with class II and III obesity undergoing bariatric surgery. This retrospective study included patients undergoing Roux-en-Y gastric bypass in southern Brazil between 2010 and 2019 who were screened for NAFLD with both ultrasound and liver biopsy. All samples were collected by a core biopsy needle and were analyzed by the same pathologist. Sensitivity, specificity, and positive and negative predictive values of ultrasound were estimated. The final database included 227 patients, mostly female (84%) and white (83.6%), with a mean age of 42.5 ± 10.2 years and a mean preoperative body mass index of 49.5 ± 8.4 kg/m2. A total of 153 subjects (67.4%) were diagnosed with NAFLD through liver biopsies: 41 (18%) had fatty liver and 112 (49.3%) had nonalcoholic steatohepatitis. Ultrasound sensitivity was 88.9% and specificity was 44.6%. Positive and negative predictive values were 76.8% and 66.0%, respectively. Positive likelihood ratio was 1.6 (95% CI 1.30-1.98), and negative likelihood ratio was 0.25 (95% CI 0.15-0.42). Therefore, approximately three every four subjects with an ultrasound suggesting NAFLD were true positives. Ultrasound showed a good sensitivity in detecting NAFLD in patients with class II and III obesity.

Transarterial Embolization and Percutaneous Ethanol Injection as an Effective Bridge Therapy before Liver Transplantation for Hepatitis C-Related Hepatocellular Carcinoma.

Background. Transarterial chemoembolization alone or in association with radiofrequency ablation is an effective bridging strategy for patients with hepatocellular carcinoma awaiting for a liver transplant. However, cost of this therapy may limit its utilization. This study was designed to evaluate the outcomes of a protocol involving transarterial embolization, percutaneous ethanol injection, or both methods for bridging hepatocellular carcinomas prior to liver transplantation. Methods. Retrospective review of all consecutive adult patients who underwent a first liver transplant as a treatment to hepatitis C-related hepatocellular carcinoma at our institution between 2002 and 2012. Primary endpoint was patient survival. Secondary endpoint was complete tumor necrosis. Results. Forty patients were analyzed, age 58 ± 7 years. There were 23 males (57.5%). Thirty-six (90%) out of the total 40 patients were within Milan criteria. Complete necrosis was achieved in 19 patients (47.5%). One-, 3-, and 5-year patient survival were, respectively, 87.5%, 75%, and 69.4%. Univariate analysis did not reveal any variable to impact on overall patient survival. Conclusions. Transarterial embolization, ethanol injection, or the association of both methods followed by liver transplantation comprises effective treatment strategy for hepatitis C-related hepatocellular carcinoma. This strategy should be adopted whenever transarterial chemoembolization and/or radiofrequency ablation are not available options.

Acute and subchronic toxicity evaluation of poly(ε-caprolactone) lipid-core nanocapsules in rats.

Owing to concerns over the effects of the physicochemical properties of nanoparticles and their interaction with biological systems, further investigation is required. We investigated, for the first time, the toxicity of lipid-core nanocapsules (LNCs) containing a polymeric wall of poly(ε-caprolactone) and a coating of polysorbate 80 used as drug delivery devices (~245nm) in Wistar rats after single- and repeated-dose treatments. The suspensions were prepared by interfacial deposition of the polymer and were physicochemically characterized. Toxicological effects were determined after single doses of 18.03, 36.06, and 72.12 × 10(12) LNC/kg and repeated doses of 6.01, 12.02, and 18.03 × 10(12) LNC/kg for 28 days by ip administration. The results for both the treatments showed no mortality or permanent body weight changes during the experiments. A granulomatous foreign body reaction was observed in the liver and spleen of higher dose groups in acute and subchronic treatments. Most of the hepatotoxicity and nephrotoxicity markers were within the reference values and/or were similar to the control group. However, a slight alteration in the hematologic parameters was observed in both the studies. Thus, to verify a possible methodological influence, we performed an in vitro test to confirm such influence. These findings are in agreement with earlier reports regarding no appreciable toxicity of biodegradable polymeric nanoparticles, indicating that LNC might be a safe candidate for drug delivery system. Furthermore, the results presented in this study are important for health risk assessment and to implement strategies for testing biodegradable polymeric nanoparticles.

Transjugular liver biopsy: histological diagnosis success comparing the trucut to the modified aspiration Ross needle

BACKGROUND: Transjugular liver biopsy is an alternative procedure for patients who present contraindications to standard percutaneous procedure. AIM: To compare the rate of histological diagnosis obtained on transjugular liver biopsy with an automated trucut needle and with a modified Ross needle. PATIENTS / METHOD: Eighty-five patients with suspicion of chronic liver diseases and presenting contraindications for percutaneous liver biopsy (coagulopathy, massive ascites, morbid obesity, or chronic renal problems) were submitted to 89 transjugular liver biopsies between March 1994 and April 2001 at ''Hospital São José, Irmandade da Santa Casa de Misercórdia'', Porto Alegre, RS, Brazil. Thirty-five patients underwent 36 biopsies with an automated trucut needle, and 50 patients underwent 53 biopsies with a modified Ross needle. RESULTS: Histological diagnosis was reached in 32/35 subjects submitted to transjugular liver biopsy with the trucut needle (91 percent) and in 35/50 (70 percent) submitted to biopsy with the modified Ross needle. Specimens obtained with the trucut needle were significantly larger and less fragmented than those obtained with the Ross needle. CONCLUSION: Transjugular liver biopsy with the automated trucut needle allowed a higher rate of histological diagnosis when compared to the modified Ross needle in patients with suspicion of chronic liver diseases

Transjugular liver biopsy: histological diagnosis success comparing the trucut to the modified aspiration Ross needle.

BACKGROUND: Transjugular liver biopsy is an alternative procedure for patients who present contraindications to standard percutaneous procedure. AIM: To compare the rate of histological diagnosis obtained on transjugular liver biopsy with an automated trucut needle and with a modified Ross needle. PATIENTS / METHOD: Eighty-five patients with suspicion of chronic liver diseases and presenting contraindications for percutaneous liver biopsy (coagulopathy, massive ascites, morbid obesity, or chronic renal problems) were submitted to 89 transjugular liver biopsies between March 1994 and April 2001 at "Hospital São José, Irmandade da Santa Casa de Misercórdia", Porto Alegre, RS, Brazil. Thirty-five patients underwent 36 biopsies with an automated trucut needle, and 50 patients underwent 53 biopsies with a modified Ross needle. RESULTS: Histological diagnosis was reached in 32/35 subjects submitted to transjugular liver biopsy with the trucut needle (91%) and in 35/50 (70%) submitted to biopsy with the modified Ross needle. Specimens obtained with the trucut needle were significantly larger and less fragmented than those obtained with the Ross needle. CONCLUSION: Transjugular liver biopsy with the automated trucut needle allowed a higher rate of histological diagnosis when compared to the modified Ross needle in patients with suspicion of chronic liver diseases.

Biópsia hepática transjugular: contribuiçäo do radiologista para o diagnóstico histopatológico em hepatopatas com distúrbios de coagulaçäo e/ou ascite / Transjugular liver biopsy: radiologist's contribuition to histopathologic diagnosis in liver disease associated with coagulopathy and/or ascitis

A obtençäo de tecido hepático é essencial para o diagnóstico e tratamento para o diagnóstico e tratamento de muitas doenças do fígado. Em 1964, Dotter relatou estudos experimentais bem sucedidos com a técnica de biópsia hepática transjugular em cachorros. Desde entäo, vários grupos aperfeiçoaram o procedimento, tanto para a obtençäo de tecido hepático em pacientes que apresentam contra-indicaçöes à via percutânea, como para outras finalidades. No presente artigo, os autores fazem revisäo da biópsia hepática transjugular e descrevem sua experiência com o método. A partir da experiência dos autores e dos relatos encontrados na literatura, a técnica é apresentada e discutida, assim como suas indicaçöes, complicaçöes, desvantagens e resultados

Colestase neonatal - atraso no encaminhamento de crianças para diagnótico diferencial / Neonatal cholestasis: The delay in referring patients for differential diagnosis

Objetivo: O tratamento eficaz da atresia de vias biliares extra-hepáticas exige que a diferenciaçäo diagnóstica entre colestase neonatal de causa intra e extra-hepática seja realizada antes das primeiras oito semanas de vida. o objetivo do presente estudo foi avaliar a idade dos pacientes com colestase neonatal iternados em um hospital geral para diferenciaçäo diagnóstica da icterícia colestática. Métodos: Foram estudadas 49 crianças no Serviço de Pediatria do Hospital de Clínicas de Porto Alegre entre 1984 e 1991. O protocolo para esclarecimento diagnóstico seguido neste hospital inclui realizaçäo de cintilografia de vias biliares com Tc-99m DISIDA e posterior biópsia hepática, em cunha ou percutânea dependendo do resultado do teste cintilográfico...

Necrose hepática submaciça por propiltiouracil / Submassive hepatic necrosis caused by propylthiouracil

A hepatite induzida por propiltiouracil é rara. Os autores registram o caso de uma mulher branca de 32 anos que desenvolveu necrose hepática submaciça com hiperplasia nodular regenerativa após um ano de uso de propiltiouracil. Näo era alcoolista, näo era adita a drogas de uso endovenoso, näo tinha história de transfusäo de sangue ou derivados e os marcadores dos vírus A, B, C e citomegalovírus foram negativos. Foi hospitalizada por icterícia,ascitr, encefalopatia e durante a internaçäo desenvolveu possível peritonite bacteriana espontânea. Em virtude de evoluçäo desfavorável, foi submetida a transplante hepático

Perfil da mortalidade neonatal em Porto Alegre: revisäo de 715 casos de necrópsias / Profile of the neonatal mortality in Porto Alegre: review of 715 cases of necropsy

Para a programaçäo da assistência e educaçäo médica é fundamental o conhecimento dos tipos e freqüências de patologias que acometem a populaçäo neonatal da nossa regiäo. Com essa finalidade, os autores, revisaram 715 casos de necrópsias realizadas no HCPA, num período de dez anos, 75,2% dos casos eram provenientes de outros hospitais de Porto Alegre e o restante do próprio HCPA. Os resultados obtidos em relaçäo à mortalidade neonatal correspondem aos descritos na literatura, sendo que nos casos provenientes de outros hospitais de Porto Alegre predominaram: prematuridade (48,3%), doenças hematológicas (46,6%), membrana hialina (33,0%), doenças infecciosas (21,9%), sofrimento fetal (21,2%), mal formaçöes (16,2%), outras (9,4%); e no HCPA: prematuridade (62,7%), membrana hialina (38,4%), doenças hematológicas (36,2%), malformaçöes (24,3%), sofrimento fetal (15,9%),doenças infecciosas (13,6%), e outras (11,9%). Tais dados salietam as características terciárias do HCPA. Esses dados podem contribuir para o conhecimento das condiçöes de saúde de recém-nascidos em nosso meio