Various aspects of Contrast-enhanced Ultrasonography in splenic lesions - a pictorial essay.

Spleen pathology is rare in comparison with other abdominal organs, but often its lesions occur in complex pathological contexts, with systemic involvement. Although the lesions could be discretely symptomatic, their evolutionary potential might be severe. Conventional B-mode and Doppler ultrasound are the first-line imaging methods in spleen assessment, but frequently they do not allow the characterization of focal splenic abnormalities. Contrast-enhanced ultrasound (CEUS) is fast, safe, easy to perform, non-irradiating and can be used in patients with renal failure. By highlighting splenic macro and micro-vascularization, CEUS significantly increases the detection rate and allows the characterization of vascular (infarction, ischemia, thrombosis) and traumatic lesions, with high diagnostic accuracy. Additionally, ectopic splenic tissue can be identified with high accuracy. The method improves both the detection and characterization of splenic nodules, but some limitations still remain, especially in the differential diagnosis between malignant and some benign lesions. This article aims to portray aspects of CEUS imaging in various splenic pathologies using clinical examples from our experience and to review the CEUS contribution in the diagnosis of splenic lesions.

New therapeutical indications of ursodeoxycholic acid.

Until the 1980s the role of bile acids in the initiation of liver injury in man was only suspected on the basis of the toxicity of whole bile and bile salts, and of studies showing elevations in serum and tissue levels of bile salts in liver diseases. The beneficial effects of ursodeoxycholic acid (UDCA) in primary biliary cirrhosis have provided the first firm evidence that bile acids may in some way be related to injury in man. There are many questions regarding the hepato-protective effect of UDCA that should be addressed in the near future. In particular, we do not know how chronic cholestasis induces liver fibrosis and if UDCA can prevent or counteract this process. Most cholestatic diseases have an immune pathophysiological basis. We must learn much more about the impact of cholestasis and bile acids on the immune system, particularly on endogenous or exogenous peptide presentation in cells exposed to high concentrations of bile components. We have seen that the trafficking of transporters in hepatocytes may be affected by bile acids; efforts must be made to learn more about this important issue. Finally, structural analogues of UDCA or combinations of drugs should be studied, in order to determine if better therapeutic efficacy could be obtained.

Predictive Factors for Coronary Artery Disease among Peritoneal Dialysis Patients without Diabetic Nephropathy.

OBJECTIVES: Scientific literature indicates that the risk of coronary heart disease morbidity and death among peritoneal dialysis patients exceeds risk observed in non-renal patients. The aims of this study were to establish the independent predictors associated with increased risk of coronary heart disease in peritoneal dialysis patients without diabetic nephropathy. MATERIALS AND METHODS: A number of 116 end-stage renal disease patients without diabetic nephropathy undergoing peritoneal dialysis were evaluated for coronary heart disease and predictive risk factors were investigated and identified. Also intima-media thickness measurements, as an early sign of atherosclerosis, were analyzed in a subset of patients in correlation with a number of traditional and non-traditional cardiovascular risk factors. RESULTS: The study sample was found to be characterized by a high prevalence of traditional risk factors: hypertension (95.7%), dyslipidemia (93.1%) and metabolic syndrome (58.6%), but also of dialysis-related risk factors: inflammation (82.8%) and anemia (55.2%). Independent variables found to be associated in regression analysis with coronary heart disease were: age, smoking status, nephroangiosclerosis, albumin, C-reactive protein and iPTH levels. Intima-media thickness was significantly higher in patients with coronary heart disease, values greater than 0.89 mm being associated with increased risks for coronary heart disease, acute coronary syndrome and cardiovascular death. CONCLUSIONS: The prevalence of traditional cardiovascular risk factors in these peritoneal dialysis patients is extremely high, but there are also some other factors involved, especially malnutrition and inflammation. Age higher than 55 years, smoking, albumin less than 3.5 g/dl, iPTH less than 150 pg/ml and nephroangiosclerosis were associated with highest odds ratio for coronary heart disease. An increasing CRP levels was associated with an increasing gradient for coronary heart disease risk.

The role of cytokines in non-alcoholic steatohepatitis. A review.

The pathogenesis of NASH is being unraveled by studies of animal models and humans with this disorder. The necro-inflammatory component of NASH appears to be modulated by interactions among various factors (for example cytokines, hormones, neurotransmitters) that regulate the biological activity of TNF- and other proinflammatory (Th-1) cytokines. Hepatic necroinflammation is necessary, but not sufficient, for progression to cirrhosis. Factors such as leptin inducible factors (for example, noradrenaline), that regulate the activity of profibrogenic cytokines, such as IL-10 and TGF-beta, dictate the extent of fibrosis that occurs during liver injury. A better understanding of how these and other soluble and cell associated factors regulate the phenotypes of different types of liver cells should help us to develop rationale treatments for NASH and other disorders in the metabolic syndrome.