Effect of Helicobacter pylori eradication on hepatic steatosis, NAFLD fibrosis score and HSENSI in patients with nonalcoholic steatohepatitis: a MR imaging-based pilot open-label study.

CONTEXT: Limited clinical data suggest Helicobacter pylori (Hp) infection may contribute to nonalcoholic fatty liver disease (NAFLD) pathogenesis. OBJECTIVES: The effect of Hp eradication on hepatic steatosis (magnetic resonance imaging), nonalcoholic fatty liver disease fibrosis score and HSENSI (Homocysteine, serum glutamic oxaloacetic transaminase, Erythrocyte sedimentation rate, nonalcoholic steatohepatitis Index) in nonalcoholic steatohepatitis patients. METHODS: Thirteen adult patients with biopsy-proven nonalcoholic steatohepatitis, asymptomatic for gastrointestinal disease, underwent 13C urea breath test; Hp positive patients received eradication therapy until repeat test become negative. Hepatic fat fraction, standard biochemical tests and calculation of nonalcoholic fatty liver disease fibrosis score and HSENSI were performed at baseline and month 12. RESULTS: Hepatic fat fraction was similar for between and within group comparisons. Nonalcoholic fatty liver disease fibrosis score showed a non-significant trend towards decrease in Hp(+) [-0.34 (-1.39-0.29) at baseline and -0.24 (-0.99-0.71) at month 12; P = 0.116], whereas increase in Hp(-) group [-0.38 (-1.72-0.11) and -0.56 (-1.43-0.46), respectively; P = 0.249]. HSENSI was significantly decreased only in Hp(+) group [1.0 (1.0-2.0) at baseline and 1.0 (0-1.0) at month 12; P = 0.048]. CONCLUSIONS: Hp eradication had no long-term effect on hepatic steatosis, but showed a trend towards improvement in nonalcoholic fatty liver disease fibrosis score and HSENSI. These results warrant larger studies with paired biopsies.

EFFECT OF HELICOBACTER PYLORI ERADICATION ON HEPATIC STEATOSIS, NAFLD FIBROSIS SCORE AND HSENSI IN PATIENTS WITH NONALCOHOLIC STEATOHEPATITIS: a MR imaging-based pilot open-label study / O efeito da erradicação do Helicobacter pylori na esteatose hepática, no escore de fibrose na DHNA e o HSENSI em pacientes com esteatohepatite não alcoólica: um estudo piloto aberto baseado em ressonância magnética

Context Limited clinical data suggest Helicobacter pylori (Hp) infection may contribute to nonalcoholic fatty liver disease (NAFLD) pathogenesis. Objectives The effect of Hp eradication on hepatic steatosis (magnetic resonance imaging), nonalcoholic fatty liver disease fibrosis score and HSENSI (Homocysteine, serum glutamic oxaloacetic transaminase, Erythrocyte sedimentation rate, nonalcoholic steatohepatitis Index) in nonalcoholic steatohepatitis patients. Methods Thirteen adult patients with biopsy-proven nonalcoholic steatohepatitis, asymptomatic for gastrointestinal disease, underwent 13C urea breath test; Hp positive patients received eradication therapy until repeat test become negative. Hepatic fat fraction, standard biochemical tests and calculation of nonalcoholic fatty liver disease fibrosis score and HSENSI were performed at baseline and month 12. Results Hepatic fat fraction was similar for between and within group comparisons. Nonalcoholic fatty liver disease fibrosis score showed a non-significant trend towards decrease in Hp(+) [-0.34 (-1.39-0.29) at baseline and -0.24 (-0.99-0.71) at month 12; P = 0.116], whereas increase in Hp(-) group [-0.38 (-1.72-0.11) and -0.56 (-1.43-0.46), respectively; P = 0.249]. HSENSI was significantly decreased only in Hp(+) group [1.0 (1.0-2.0) at baseline and 1.0 (0-1.0) at month 12; P = 0.048]. Conclusions Hp eradication had no long-term effect on hepatic steatosis, but showed a trend towards improvement in nonalcoholic fatty liver disease fibrosis score and HSENSI. These results warrant larger studies with paired biopsies. .

Contexto Dados clínicos limitados sugerem que infecção por Helicobacter pylori (Hp) pode contribuir para a patogênese da doença hepática gordurosa não alcoólica. Objetivos Verificar o efeito da erradicação do Hp na esteatose hepática pela ressonância magnética, na pontuação da fibrose na doença hepática gordurosa não alcoólica e no HSENSI (homocisteína, transaminase glutâmico oxalacética no soro, taxa de sedimentação de eritrócitos, Indice NASH na esteatohepatite não-alcoólica) em pacientes com esteato-hepatite não alcoólica. Métodos Treze pacientes adultos com esteato-hepatite não alcoólica comprovada por biópsia, assintomáticos para a doença gastrointestinal, submetidos ao 113C teste respiratório da ureia 13C. Pacientes Hp positivos receberam terapia de erradicação até repetição do teste tornar-se negativa. A fração de gordura hepática, testes bioquímicos padrão e cálculo da pontuação da fibrose e esteatose hepática HSENSI foram realizados no início e no mês 12. Resultados A fração de gordura hepática foi similar entre e dentro das comparações entre os grupos. A pontuação da fibrose na doença hepática gordurosa não alcoólica mostrou uma tendência não significativa para diminuição no grupo Hp (+) [-0,34 (-1,39-0,29) no início do estudo e -0,24 (-0,99-0,71) no 12 mês; P = 0,116], enquanto aumentaram no grupo Hp (-) [-0.38 (-1,72-0,11) e -0,56 (-1,43-0,46), respectivamente; P = 0,249]. O HSENSI diminuiu significativamente apenas no grupo Hp (+) [1,0 (1,0-2,0) na linha de base e 1,0 (0-1,0) no 12º mês; P = 0,048]. Conclusões A erradicação do Hp não teve efeito ...

Primary mucosa-associated lymphoid tissue thyroid lymphoma: a rare thyroid neoplasm of extrathyroid origin.

Primary thyroid lymphoma is a rare malignancy, representing 2-8% of all thyroid malignancies and 1-2% of all extranodal lymphomas. The majority of cases concern non-Hodgkin's lymphoma of B cell origin, following by Hodgkin's disease, T cell lymphomas and rarely marginal zone B-cell mucosa-associated lymphoid tissue (MALT) lymphomas. MALT lymphomas have been associated with long-standing autoimmune Hashimoto's thyroiditis. We present the case of a 44-years-old woman with thyroid MALT lymphoma in the background of multinodular goiter of autoimmune origin.

Skeletal muscle insulin resistance in endocrine disease.

We summarize the existing literature data concerning the involvement of skeletal muscle (SM) in whole body glucose homeostasis and the contribution of SM insulin resistance (IR) to the metabolic derangements observed in several endocrine disorders, including polycystic ovary syndrome (PCOS), adrenal disorders and thyroid function abnormalities. IR in PCOS is associated with a unique postbinding defect in insulin receptor signaling in general and in SM in particular, due to a complex interaction between genetic and environmental factors. Adrenal hormone excess is also associated with disrupted insulin action in peripheral tissues, such as SM. Furthermore, both hyper- and hypothyroidism are thought to be insulin resistant states, due to insulin receptor and postreceptor defects. Further studies are definitely needed in order to unravel the underlying pathogenetic mechanisms. In summary, the principal mechanisms involved in muscle IR in the endocrine diseases reviewed herein include abnormal phosphorylation of insulin signaling proteins, altered muscle fiber composition, reduced transcapillary insulin delivery, decreased glycogen synthesis, and impaired mitochondrial oxidative metabolism.

Large adrenal oncocytoma with uncertain malignant potential: case report and review of literature.

OBJECTIVE: To report a case of oncocytoma, a relatively rare adrenal tumor, which most commonly is detected as an adrenal incidentaloma. METHODS: We present a case report, including laboratory, imaging, and pathologic findings, of a 47-year-old obese woman who had hypertension and an incidentally found large, left adrenal mass. RESULTS: On the basis of the hormonal evaluation, this mass was a nonsecreting adrenal tumor, which histologically proved to be an oncocytoma with borderline malignant characteristics. A collective analysis of the few cases of adrenal oncocytoma published in the medical literature showed that our case corresponded to the previously published cases in preponderant location (left side) as well as the general size (11.4 cm in the largest dimension) and weight (372 g). CONCLUSION: Adrenal oncocytoma should be included in the differential diagnosis of adrenal incidentalomas, especially if large tumors are detected. In addition, a longterm follow-up is suggested because there are no certain clues about the true potential of this tumor.

Simultaneous occurrence of hyperthyroidism and fistulizing Crohn's disease complicated with intra-abdominal fistulas and abscess: a case report and review of the literature.

INTRODUCTION: Fistula formation in patients with Crohn's disease is a common complication during the course of the disease. Perianal and enteroenteric are the most common forms of fistulas, whereas the involvement of the upper gastrointestinal tract with gastrocolic and duodenocolic fistulas represents an extremely unusual condition. Moreover, hyperthyroidism in association with Crohn's disease has been rarely described. CASE PRESENTATION: We present here a rare case of a 25-year-old male with simultaneous onset of hyperthyroidism and fistulizing Crohn's disease. Crohn's disease was complicated with intra-abdominal fistulas involving the upper gastrointestinal tract (duodenocolic, gastrocolic) and an intra-peritoneal abscess formation in the lesser sac. We describe the clinical presentation and therapeutic management of the patient including both medical treatment and surgical intervention. Despite intense medical treatment with total parenteral nutrition, antibiotics, aminosalicylates and corticosteroids the clinical course of the disease was suboptimal. Finally, the patient underwent laparotomy and right hemi-colectomy with ileo-transverse anastomosis performed, with simultaneous drainage of the abdominal abscess and primary closure of the upper gastrointestinal tract openings (gastric, duodenal and jejunal) at one stage operation. Although the surgical approach definitively cured the perforating complications of the disease (fistulas and abscess), the luminal disease in the colon remnant was still active and steroid-refractory. The subsequent successful treatment with infliximab, azathioprine and mesalazine resulted in the induction and maintenance of the disease remission. Thyrotoxicosis was successfully treated with methimazole and the hyperthyroidism has definitely subsided. CONCLUSION: The management of intra-abdominal fistulas in Crohn's disease is a complex issue, requiring a multi-disciplinary approach and 'tailoring' of the treatment to the individual patient's needs. Probably, a sensible approach involves early surgical intervention with prior optimization of the patient's general condition when feasible. Common autoimmune mechanisms are probably involved in thyroid dysfunction associated with Crohn's disease. Moreover, diagnosis and treatment of coexisting thyroid disorder in patients with Crohn's disease has a favorable impact in disease prognosis.

A novel germline mutation of the VHL gene in a Greek family with Von Hippel-Lindau disease.

Von Hippel-Lindau disease (VHL) is an autosomal dominant disorder, caused by mutations of the VHL gene showing a strong genotype-phenotype correlation. The present report concerns a 16-year-old girl with VHL (retinal, spinal cord and cerebellar haemangioblastomas and pancreatic cysts), her father (retinal and spinal cord haemangioblastomas) and the phenotypically healthy mother and younger brother and sister. DNA extraction, PCR and direct sequencing of the VHL entire coding and intronic flanking sequences, were performed according to standard procedures. In the index patient and her father a novel heterozygous germline was identified; nonsense mutation (p.145X) in exon 2 of VHL, leading to a truncated VHL protein lacking the last 66 amino acids. This is the first report of a novel VHL mutation in patients with VHL associated with haemangioblastomas and pancreatic cysts but not renal cell carcinoma.

Childhood acute pyelonephritis: comparison of power Doppler sonography and Tc-DMSA scintigraphy.

BACKGROUND: Tc 99m DMSA scintigraphy is regarded as the gold standard for the detection and localization of acute pyelonephritis (APN) in children. Power Doppler sonography (PD US) is a radiation-free and cost-effective technique that could be useful in the diagnosis of APN in children. OBJECTIVE: To compare the predictive value of PD US with DMSA scintigraphy in the diagnosis of APN in children. MATERIALS AND METHODS: A total of 74 neonates and children with clinical findings consistent with possible upper urinary tract infection were evaluated with PD US and DMSA scintigraphy. Children with anatomic (grey-scale) abnormalities were excluded. A total of 147 kidneys were examined within the first 48 h after the onset of symptoms. Each kidney was divided into three zones (upper, middle, and lower third). RESULTS: APN was diagnosed by PD US in 46 kidneys. Sensitivity and specificity for detecting APN using DMSA scintigraphy as the reference standard were 73.8% and 85.7%, respectively. There was good agreement between PD US and DMSA scintigraphy in the localization of lesions. CONCLUSION: In clinically suspected APN, PD US has acceptable specificity and sensitivity, if performed within the first 48 h and could be helpful in neonates and children under 3 months of age in whom the use of scintigraphy is generally discouraged.

Urinary lithogenic and inhibitory factors in preterm neonates receiving either total parenteral nutrition or milk formula.

UNLABELLED: The aim of this study was to evaluate prospectively the influence of nutrition on certain factors which may inhibit or promote nephrocalcinosis in two groups of preterm infants, receiving total parenteral nutrition (TPN) and special preterm milk formula respectively, but not furosemide. A total of 37 preterm infants, 15 on TPN and 22 fed a special preterm formula were studied at the end of the 1st, 2nd and 3rd weeks of life, at which time serum and 8 h urine specimens were collected. High ratios of urinary calcium to urinary creatinine (UCa/cr), urinary oxalate to urinary creatinine (Uox/cr) and urinary calcium to urinary citrate (UCa/cit) indicates an increased risk for nephrocalcinosis while high urinary citrate to urinary creatinine (Ucit/cr) ratio indicates protection. Uox/cr increased significantly (P<0.05) in those infants fed preterm formula, from the end of 2nd week of life and was two-fold higher than in the TPN group of preterm infants (P<0.01). Ucit/cr was higher throughout the study period in the formula fed than in the TPN preterm infants. UCa/cit was five-fold higher (P<0.01) in the TPN group, by the end of the 3rd week. Urinary calcium and magnesium was similar in both groups during the study period. Two of the infants studied (5.4%), one from each group, developed nephrocalcinosis. CONCLUSION: In preterm neonates on total parenteral nutrition, urinary oxalate -to-creatinine ratio (a potent lithogenic factor) was lower and urinary citrate -to-creatinine ratio (a lithoprotective factor) also lower than in formula fed neonates. The type of feeding (total parenteral nutrition or special preterm milk formula) seems to affect urinary oxalate and citrate but not calcium and magnesium in non-furosemide treated preterm infants during the first 3 weeks of life.

Symptomatic benign prostate hyperplasia: impact on partners' quality of life.

OBJECTIVES: Symptomatic benign prostate hyperplasia (BPH), besides affecting patients' quality of life through lower urinary tract symptoms (LUTS), and related acute events, may affect their partners' quality of life as well. The present study was focused on exploring partner morbidity in cases of symptomatic BPH patients being evaluated for surgical treatment. METHODS: The study group was comprised of 50 couples where male partners suffered from symptomatic BPH and was referred for further evaluation and, possibly, surgical treatment. Male subjects were asked to fill out the IPSS form, while the female partners were, separately, asked to fill out another structured questionnaire about 7 items (sleep disturbance, social disruption, performance of essential tasks, psychological impact, sex life, fear of cancer, fear of surgery). Data were analyzed in relation to the severity of symptoms (IPSS), patient's and partner's age, couple's age difference, marriage duration, mode and place of living. RESULTS: Partners' morbidity due to their husband's condition was comprised of sleep disturbance (28%); disruption of social life (30%) positively related to IPSS and negatively to the symptom duration; inability to take care of essential tasks outside and inside their house (8%); psychological burden (66%) positively related to the wife's age, the couple's age difference and the marriage duration; inadequate sex life (48%); fear of prostate cancer (62%); and fear of surgery (82%). CONCLUSIONS: Partners of patients with symptomatic BPH experience significant morbidity because of their husband's condition. The severity of patients' symptoms, however, is not always related to partners' morbidity. Partners should be adequately informed of the benign nature of the disease, as well as, the possible operating risks.