Fish intake interacts with TM6SF2 gene variant to affect NAFLD risk: results of a case-control study.

PURPOSE: Non-alcoholic fatty liver disease (NAFLD) is a complex disease, resulting from a variety of genetic and environmental factors. The aim of this case-control study was to evaluate the effect of selected genetic polymorphisms, nutrition aspects and their interaction on the risk of NAFLD. METHODS: The sample consisted of 134 patients with NAFLD and 217 controls. Disease was diagnosed by liver ultrasound and volunteers were clinically and nutritionally assessed. Food groups were extracted from a 172 food-item FFQ questionnaire. Three genetic polymorphisms were assessed: PNPLA3 rs738409, TM6SF2 rs58542926 and GCKR rs780094. RESULTS: We replicated the effect of previously reported risk factors for NAFLD, such as elevated liver enzymes, obesity and metabolic syndrome. Food groups rich in simple sugars, fat and especially saturated fat were positively associated with NAFLD risk, whereas food groups rich in polyunsaturated fatty acids were reversely associated with the possibility of developing the disease (p < 0.05). Only the PNPLA3 genetic variant was statistically significantly associated with the disease (padditive = 0.015). However, it was found that a one-portion increase in fish intake increased the risk of NAFLD in carriers of the risk allele of TM6SF2 rs58542926 polymorphism compared to non-carriers, after adjusting for age, gender, energy intake, pack-years, PAL, TM6SF2 genotype and fish consumption (ORdominant = 1.503, 95% CI 1.094-2.064). CONCLUSIONS: Fish intake exerts an additive effect on NAFLD risk for carriers of the TM6SF2 polymorphism. This novel finding provides further rationale on the need for personalized nutritional advice, based on the genetic background of NAFLD patients.

Intensive care unit outcomes following orthotopic liver transplantation: single-center experience and review of the literature.

BACKGROUND/AIM: Orthotopic Liver Transplantation (OLT) is the treatment of choice for patients with end stage liver disease, acute liver failure, hepatocellular carcinoma and metabolic disorders. As a result of improvement in surgical and anesthesiological skills, advanced understanding of transplant immunology and better critical care management of complications, patients survive longer after liver transplantation. It has been gradually achieved one-year survival rates of 80-90%. During the early post-operative period, all patients undergoing OLT are admitted to the intensive care unit, as they need a management of both preexisting patient's conditions and post-operative complications, usually due to either adverse intra-operative or post-operative events. The purpose of this review is the detailed recording, understanding and interpretation of immediate post-operative complications occurred in patients undergoing OLT, in intensive care unit. This could help to improve patient's treatment and reduce the incidence of complications, with further reduction of morbidity-mortality and cost. We also present our experience from the first 32 OLT patients from Liver Transplantation Unit of Laiko General Hospital, the only Liver Transplantation Unit in Athens. MATERIALS AND METHODS: This literature review was performed using the MEDLINE database. The key words were; Orthotopic liver transplantation; intensive care unit; post-operative complications; outcomes. One hundred-sixteen articles published in English until 2018 were used. We also use all the results from our 32 patients from our Liver Transplantation Unit during the period 07/2006 to 07/2009. RESULTS: All patients undergoing OLT admitted to the intensive care unit for a period of time, depending on the occurrence of post-operative complications. The incidence of primary failure ranges between 2-14%, whereas post-operative bleeding ranges between 7-15%. The treatment is usually conservative, although surgical repair may need in 10-15%. Acute renal failure post-operative is not an infrequent problem too, and has been reported to occur in 9% to 78% of cases. Acute rejection normally occurs 7-14 days after OLT. Additionally, the delay of the weaning from mechanical ventilation in the immediate post-operative period could increase the complications. Infectious complications are quite common almost from the first post-operative day in intensive care unit. CONCLUSIONS: Prolonged intensive care stay could increase the complications post-operative Infectious complications, renal and respiratory impairment are among the most common causes of early post-transplant morbidity and mortality.

Percutaneous US-guided liver biopsy in focal lesions using a semiautomatic device allowing to perform multiple biopsies in a single-pass.

AIM: The aim of this study was to evaluate the safety and efficacy of percutaneous real-time ultra sound METHODS: One hundred and thirty-four consecutive percutaneous liver biopsies were performed in equal number of patients with focal liver lesions during a three-year period. All biopsies were performed with a single puncture, using a Tru-cat semiautomatic 18G needle (Precisa semi-automatic Tru-cut biopsy Device, HS Hospital Service, Italy) with removable inner stylet, under real-time US-guided. Two to five samples were obtained from each biopsy. In 12 cases an embolization of the biopsy track was performed. Thirty-two patients with hepatocellular carcinoma were followed for a period of 30-880 days for seeding. RESULTS: A total of 424 specimens were obtained from 134 biopsies. Evaluation of the biopsy specimens demonstrated that the 58.5% of them were >10 mm in length providing sufficient liver tissue for reliable histological diagnosis. The diagnosis was successful in 99.25% of the patients. No major complications or death occurred in our study group. Neither suspected nor confirmed tumor seeding was identified. CONCLUSION: Our results provide evidence that US-guided percutaneous liver biopsy using a semiautomatic 18G Tru-Cut needle with removable inner stylet can be performed with safety and efficacy in patients with focal liver lesions. Further-more, there are strong indications that the use of an introducer that remains in position during multiple cutting needle passes, protects normal tissue along the track and minimizes "seeding" and bleeding complications.

Diabetic muscle infarction after kidney and pancreas transplantation: case report and literature review.

Diabetic muscle infarction (DMI) is a rare, long-term complication of poorly controlled diabetes (typically of type I). DMI was first described in 1965 and more than 100 cases have been reported thereafter in the English literature. Usually, there is a coexistence with concomitant nephropathy, neuropathy, and retinopathy. The etiology remains uncertain, but appears to be attributable to diabetic microangiopathy and hypercoagulability and is believed that hypoxia-reperfusion injury is involved. DMI presents with sudden onset of pain associated with a tender mass in the thigh in most instances. The diagnosis is based on magnetic resonance imaging, which is not specific but highly indicative. Treatment is conservative with relapses occurring in 50% of the patients, but not necessarily in the same muscle group. We describe a case of DMI that occurred 4 months after simultaneous kidney and pancreas transplantation in one patient with type I diabetes mellitus and end-stage renal disease.

Wire localisation biopsy of non-palpable breast lesions: reasons for unsuccessful excision.

Surgical excision following needle-wire localization of nonpalpable, mammographically detected breast lesions is a very valuable diagnostic and therapeutic procedure. No further treatment is usually required after establishing an accurate histological benign diagnosis of indeterminate lesions on preoperative assessment. On the other hand, ductal carcinoma in-situ (DCIS) and early invasive cancer, properly excised, may sometimes require further management depending on specific histologic findings. An uncommon problem of this procedure is the failure to identify, localize or excise the breast lesion. In this review article, factors that contribute to the failed needle localization procedure are presented.

Surgical management of nipple discharge.

PURPOSE: Nipple discharge is reported in 2.5-3% of women with breast carcinoma. Breast carcinoma is found in approximately 8% of surgically treated patients presenting with bloody nipple discharge (ND). METHODS: In the present study 110 women with ND as a presenting symptom were examined. The discharge was spontaneous in 76 and elicited in 11 patients. RESULTS: After surgical intervention benign breast disease was found in 85% of patients. Thirteen women (15%) were found to have malignancy and underwent additional surgery. Cytology of the discharge was positive or suspicious for malignancy in only seven out of 13 patients found to have in situ or invasive carcinoma. CONCLUSION: Women with spontaneous, single duct ND, especially when it is darkish or bloody, should have cytological examination of the fluid and mammography according to their age or additional clinical findings. Most of them will require a microdochectomy, as the possibility of finding a carcinoma among those women is between 10-15%. However, single duct papilloma is the most common cause of bloody discharge.

Emphysematous cholecystitis. Review of five cases and report of septic musculoskeletal complications.

A variant of acute cholecystitis is emphysematous cholecystitis. Here in we reviewed useful clinical data of five cases of this entity. Clinical outcomes were uncomplicated for three patients who were treated with open cholecystectomy. But on the other hand we faced two septic musculoskeletal complications in two patients who were treated with percutaneous trans gallbladder drainage. We believe that we must be aware of musculoskeletal complications, whenever a patient with emphysematous cholecystitis is treated with percutaneous trans gallbladder drainage.

Open surgical biopsy for nonpalpable breast lesions detected on screening mammography.

The aim of this retrospective clinical study was the analysis of histologic findings of nonpalpable breast lesions managed by open surgical biopsy. A series of 630 women underwent 664 preoperative localizations of nonpalpable, mammographically detected breast lesions during the last 10-year period. Indications for biopsy were (1) clustered microcalcifications, (2) solid mass, and (3) radiologic parenchymal distortion. The lesions were localized preoperatively using hook-wire methods, and all biopsies were performed under general anesthesia. Histopathology revealed carcinoma in 172 (25.9%) cases; noninvasive in 114 (66.3%) cases and infiltrating in 58 (33.7%) cases. The highest malignancy rate was found in cases with microcalcifications (112 carcinomas out of 323 cases, 34.7%). Lymph node invasion was present in 25% of patients with invasive cancers. The hook-wire localization of nonpalpable breast lesions is a simple, accurate and safe method for detection of early breast cancers. Frozen section is feasible and accurate in the majority of these lesions, and therefore, diagnostic and therapeutic one-step surgical procedures could be performed.

Breast arterial calcifications as an indicator of systemic vascular disease.

PURPOSE: To evaluate the association between mammographically detected arterial calcifications and systemic vascular disease. MATERIAL AND METHODS: The medical records of 77 women who had either breast arterial calcifications or underwent surgery for carotid stenosis, abdominal aortic aneurysm, or femoropopliteal bypass (study groups A and B) were evaluated and compared with 33 women without breast arterial calcifications (group C). Patients in both arms of the study underwent additional vascular tests or mammography. RESULTS: Currently available data indicate that there is a statistically significant correlation between the presence of arterial calcifications on the mammogram and atheromatosis of the carotid or femoral arteries. CONCLUSION: Screening mammograms might be useful in the detection of women at risk for systemic vascular disease.

Missed cancers on mammograms: causes and measures of prevention.

Mammographically missed breast cancers remain a major medical and legal issue. In order to clarify causes and methods of the limitations, we present the experience of our Unit on this field. During the years 1999 and 2000, 319 breast cancer patients were admitted for surgical treatment to our Unit. Their files were reviewed in order to identify cases with mammography-related delayed diagnosis. Thirty-three cases of mammographically missed cancers were found (10.3%). The usual reasons for the delayed diagnoses were: retrospectively visible cancers, in benign looking lesions no further action was taken, and lesions with a rather malignant appearance were reported as benign. Missed cancers could be reduced by simple measures such as the full assessment of breast patients with clinical, radiologic, and cytologic-histologic evaluation, the double screening of mammograms, and improvement of the mammographic equipment and technique.

Computer-aided preoperative diagnosis of microcalcifications on mammograms.

PURPOSE: To evaluate of a computer-aided method for differentiating malignant from benign clustered microcalcifications. MATERIAL AND METHODS: Our material was 350 suspicious microcalcifications on mammograms from 330 female patients who underwent breast biopsy (after hook wire localization and under mammographic guidance). The histologic findings were malignant in 140 cases (40%) and benign in 210 cases (60%). Those clusters were manually detected, computer-aided analyzed and quantitatively estimated. Besides computer analysis, 3 physicians-observers (2 radiologists and 1 breast surgeon) evaluated the malignant or benign nature of the clustered microcalcifications. The performance of the artificial network, each observer and the three observers as a group was evaluated by receiver operating characteristics (ROC) curves. RESULTS: Comparison of the ROC curves revealed the following AUC values (area under the curve): computer - 0.950, physician 1 - 0.815, physician 2 - 0.830, physician 3 - 0.830, and physicians as a group - 0.825. The results, compared by the student t-test for paired data, showed a statistically significant difference between computer analysis and physicians' performance, independently and as a group. CONCLUSION: Our study showed that computer analysis achieved statistically significantly better performance than that of physicians in the classification of malignant and benign calcifications.

Eosinophilic granuloma of the femur in an HIV-1-positive patient.

A case of eosinophilic granuloma in the right femur of an HIV-1-infected patient is described, and the possible pathogenetic role of HIV infection in eosinophilic granuloma formation is discussed.

Autoimmune thyroid disease in women with breast carcinoma.

AIMS: Estimation of prevalence of autoimmune thyroid disorders in Greek breast cancer patients (prospective study). METHODS: The prevalence of autoimmune thyroiditis was estimated in 310 Greek breast cancer patients, in 100 women with benign breast disease and in 190 women without any breast disease, by submitting them to clinical examination, ultrasound thyroid evaluation, serum thyroid antibody determination and fine needle aspiration (FNA) of the thyroid gland. RESULTS: Autoimmune thyroiditis was found in 136/310 (43.9%) breast cancer women: 95 were diagnosed by positive autoantibodies, 19 had positive FNA findings and 22 had both positive autoantibodies and positive FNA findings. In 117 cases, thyroid autoantibodies were positive (37.7% whereas the control groups had respective rates of 19% and 18.4% autoantibody positivity). CONCLUSIONS: There is evidence of high incidence of autoimmune thyroiditis in Greek breast cancer patients, increasing in relation to cancer stage.

Long-term effects of small doses of calcitriol in hemodialysis patients with moderate secondary hyperparathyroidism.

Prevention of secondary hyperparathyroidism (SHPTH) and treatment of the moderate cases by small p.os doses of Vitamin D has not been thoroughly investigated on the long term, while large doses of Vitamin D have been successful in the short term treatment of this entity. We administered calcitriol p.os 0.5-1.0 microgram, according to iPTH levels, after each dialysis session, in 19 patients (group A) for 36 months. They were ten men and nine women, 63 years old (43-81), with iPTH levels > 4N (419 +/- 185 pg/mL). Seven adenomas were found in five of them (group A1). Serum Ca, phosphate (P) and alkaline phosphatase (AP) were measured every 15-30 days. Serum iPTH and aluminum as well as echogram or scanning of the parathyroid glands were checked every 6 months. Ten additional dialysis patients, seven men and three women, 54.5 years old (36-68), non-significantly different to group A in iPTH levels (290 +/- 225 pg/mL) with three adenomas in two of them (group B1) received no calcitriol and served as controls (group B). Calcitriol treatment significantly lowered serum iPTH levels in group A patients (from 419 +/- 185 to 173 +/- 142 pg/mL, p < 0.0001, delta iPTH: -246 +/- 161 pg/mL); iPTH remained stable in group B patients (delta iPTH: +7.9 +/- 116 pg/mL) with an intergroup significant difference at P < 0.0001. All other parameters measured did not show any significant change. No significant correlation of iPTH to Ca, P or AP was found in A. Initial iPTH levels were higher in A1 and B1 patients and decreased by calcitriol in A1 group. Adenomas in A1 patients did not change in number and size in contrast to B1 where new adenomas appeared (5 patients, 10 glands). Small doses of vitamin D lower high iPTH levels and prevent parathyroid gland hyperplasia. Existing hypertrophy is stabilized under calcitriol treatment both morphologically and biologically.

Acute renal failure in an adult patient with Henoch-Schoenlein purpura after episode of macroscopic hematuria.

A case of severe prolonged acute renal failure with a histological picture of acute tubulointerstitial lesions in an adult patient with Henoch-Schoenlein purpura after an episode of macroscopic hematuria is described. The macroscopic hematuria lasted only for 5 days and the renal biopsy was performed 50 days after the end of the macroscopic hematuria. Restoration of renal function was not complete six months after the beginning of improvement. Fewer than 65 cases of acute renal failure due to tubulointerstitial nephritis in patients with glomerulonephritis and after episode of macroscopic hematuria have been described in the international literature. Only one of these patients was suffering from Henoch-Schoenlein purpura.

Hyperselective renal artery embolisation in the treatment of post-traumatic iatrogenic haematuria: report of two cases.

Angiography and selective renal artery embolisation were performed in two patients with post-traumatic iatrogenic kidney lesions and intractable haematuria. One patient presented after a nephrolithotomy with rupture of a segmental branch of the renal artery well demonstrated on selective angiography which showed intraparenchymal extravasion of contrast medium. The other presented after a renal biopsy with severe haematuria. Angiography performed 10 days later demonstrated an arteriovenous fistula at the site of the puncture. Hyperselective embolisation achieved immediate control of the haematuria in both patients, with maximal preservation of the renal parenchyma and maintenance of good renal function. At follow-up 12 months later, there had been no recurrence of the haematuria. These results suggest that transcatheter embolisation should be considered the method of first choice in renal trauma accompanied by intractable haematuria before any surgery is attempted.

Spleen size in beta-thalassaemia heterozygotes.

In 45 beta-thalassaemia heterozygotes and in 38 normal controls we determined by ultrasound tomography: (a) the surface of the projection of the spleen to thoracic and abdominal wall, (b) the maximum diameters of the organ, and (c) its volume. The volume of the spleen is significantly bigger in heterozygotes as opposed to normals (132.94 +/- 41.76 and 80.29 +/- 25.88, respectively). In 17.8% of heterozygotes a palpable spleen was found. The findings of this study lead to the hypothesis that in all heterozygotes the final volume of the organ is increased; however, in only 17.8% of them a palpable spleen is found.