Hepatorenal index for grading liver steatosis with concomitant fibrosis.

INTRODUCTION: Ultrasonography is widely used as the first tool to evaluate fatty liver disease, and the hepatorenal index is a semi-quantitative method that improves its performance. Fibrosis can co-exist with steatosis or even replace it during disease progression. This study aimed to evaluate the influence of fibrosis on the measurement of steatosis using the hepatorenal index. MATERIALS AND METHODS: This cross-sectional study included 89 patients with nonalcoholic fatty liver disease and in whom liver fibrosis was determined by ultrasound elastography. The Pearson's correlation coefficient was used to compare between the results of the sonographic hepatorenal index and the quantification of steatosis using magnetic resonance spectroscopy as well the accuracy of detecting moderate to severe steatosis using sonography in two groups of patients: (A) without advanced fibrosis and (B) with advanced fibrosis. Advanced fibrosis was defined as a shear wave speed ≥ 1.78 m/s on ultrasound elastography. We calculated the area under the curve (AUC-ROC) to detect the ability of the hepatorenal index to differentiate light from moderate to severe steatosis in both groups. Moderate to severe steatosis was defined as a fat fraction > 15% on the magnetic resonance spectroscopy. The intra-observer variability was assessed using the Bland-Altman plot. RESULTS: Among patients, the mean age was 54.6 years and 59.6% were women, 50.6% had a body mass index ≥ 30 kg/m2, 29.2% had moderate to severe steatosis, and 27.2% had advanced fibrosis. There was a correlation between steatosis grading by ultrasonography and magnetic resonance in group A (0.73; P < 0.001), but not in Group B (0.33; P = 0.058). The AUC-ROC for detecting a steatosis fraction ≥ 15% was 0.90 and 0.74 in group A and group B, respectively. The intra-observer variability for the hepatorenal index measurements was not significant (-0.036; P = 0.242). CONCLUSION: The hepatorenal index is not appropriate for estimating steatosis in livers with advanced fibrosis.

Successful endovascular management of a traumatic aortic rupture in a pediatric patient: case report and literature review.

We report herein an 11-year-old pedestrian struck by a motorcycle, who suffered subdural hematoma and aortic rupture and developed traumatic pseudoaneurysm. He was treated conservatively for the first 24 hours and submitted to stent placement occluding the aneurysm neck. There were no recurrences in the post-procedure period and the child was discharged after 21 days without sequelae. This report also reviews trauma mechanisms and management of such threatening lesions in the pediatric population.

Conservative management of a grade V renal trauma associated with a grade III hepatic lesion: is it possible?

Conservative management of solid abdominal organ injuries has been increasing and challenging trauma surgeons. This case report describes a successful non-operative management of a grade V renal lesion associated to a grade III hepatic lesion. Such lesions have not been described in conjunction in the revised literature.