Rabia Ergelen

Arterial stiffness in patients with non-alcoholic fatty liver disease is related to fibrosis stage and epicardial adipose tissue thickness

OBJECTIVE Non-alcoholic fatty liver disease (NAFLD) is associated with atherosclerosis and reduced vascular compliance. The purpose of this study was to examine the relationships between arterial stiffness measures, the histological severity of NAFLD, and epicardial fat thickness (EFT). METHODS A total of 100 patients with biopsy-proven NAFLD and 50 age- and sex-matched controls were enrolled. The histological severity was assessed in all NAFLD patients. Measurements of arterial stiffness [pulse-wave velocity (PWV) and augmentation index (AIx)] were carried out using a Mobil-O-Graph arteriograph system. EFT was assessed by means of echocardiography. RESULTS Compared with controls, NAFLD patients had significantly higher PWV and AIx values. Stepwise linear regression analysis demonstrated that the liver fibrosis score and EFT were independent predictors of both PWV and AIx values in NAFLD patients. CONCLUSIONS Patients with NAFLD have an increased arterial stiffness, which reflects both the severity of liver fibrosis and increased EFT values.

Noninvasive detection of hepatic steatosis in patients without ultrasonographic evidence of fatty liver using the controlled attenuation parameter evaluated with transient elastography.

Objective Although ultrasound is a useful technique for detecting hepatic steatosis, it cannot provide a precise determination of hepatic fat content. A novel attenuation parameter named controlled attenuation parameter (CAP) has been developed to process the raw ultrasonic signals acquired by Fibroscan. The aim of this study was to determine the percentage of hepatic steatosis in apparently healthy Turkish individuals using the proposed diagnostic cut-off points for CAP. In addition, we sought to investigate the association of CAP with the traditional risk factors for nonalcoholic fatty liver disease in a screening setting. Materials and methods In the present study, 102 Turkish individuals without evidence of fatty liver on ultrasound and normal aminotransferase levels underwent CAP measurements by means of Fibroscan. Results The mean (SD), median (minimum−maximum), and 5th and 95th percentile values of CAP values in this cohort of 102 individuals were 206.99 (48.12), 210.5 (100.0−314.0), 113.4 and 280.2 dB/m, respectively. Using the cut-offs of 222, 238, and 283 dB/m for CAP, there were 39 (38.2%), 23 (22.5%), and five (4.9%) individuals out of 102 who had at least 10% steatosis despite normal liver findings on ultrasound. After allowance for potential confounders, CAP was independently associated with BMI (&bgr;=0.39, t=3.5, P<0.001) and the number of metabolic syndrome criteria (&bgr;=0.24, t=2.1, P<0.05). Conclusion These results hold promise for early noninvasive detection of hepatic steatosis on the basis of CAP assessment.

A comparison of FibroMeter™ NAFLD Score, NAFLD fibrosis score, and transient elastography as noninvasive diagnostic tools for hepatic fibrosis in patients with biopsy-proven non-alcoholic fatty liver disease

Abstract Background: Noninvasive markers that purport to distinguish patients with non-alcoholic fatty liver disease (NAFLD) with fibrosis from those without must be evaluated rigorously for their classification accuracy. Herein, we seek to compare the diagnostic performances of three different noninvasive methods (FibroMeter™ NAFLD score, NAFLD Fibrosis score (NFSA), and Transient Elastrography [TE]) for the detection of liver fibrosis in NAFLD patients. Methods: A total of 88 patients with biopsy-proven NAFLD were included. The Kleiner system was used for grading fibrosis in liver biopsies. The FibroMeter™ NAFLD score was determined using a proprietary algorithm (regression score). The NFSA score was calculated based on age, hyperglycemia, body mass index, platelets, albumin and serum aminotransferase levels. TE was performed using the Fibroscan apparatus. Results: The sensitivities/specificities for the FibroMeter™ NAFLD score, NFSA, and TE for the diagnosis of significant fibrosis (F2 + F3 + F4 fibrosis) were 38.6%/86.4%, 52.3%/88.6%, and 75.0%/93.2%, respectively. The areas under the receiver operating characteristic curves of TE were significantly higher than those of both the FibroMeter™ NAFLD score and NFSA. No significant differences were found between the FibroMeter™ NAFLD score and NFSA for the detection of significant and severe fibrosis, although the diagnostic performance of the FibroMeter™ NAFLD score was higher than that of the NFSA score for cirrhosis. Conclusions: In summary, TE showed the best diagnostic performance for the noninvasive assessment of liver fibrosis in NAFLD patients. The diagnostic performances of the FibroMeter™ NAFLD score and NFSA did not differ significantly for the detection of both significant and severe fibrosis.

Detection of hepatic steatosis using the controlled attenuation parameter: a comparative study with liver biopsy

Abstract Objective. Measurements of controlled attenuation parameter (CAP) with transient elastography (FibroScan®; EcoSens SA, Paris, France) may provide an accurate noninvasive assessment of hepatic steatosis. Herein, we prospectively determined the accuracy of liver fat quantification with CAP values in patients with chronic liver diseases and compare the results with those of histological assessment of steatosis as reference standard. Materials and methods. We enrolled 50 Turkish patients with various forms of chronic liver diseases. All patients underwent both CAP assessment and ultrasonography-guided liver biopsy. Results. On liver biopsy, 16 (32%) patients had S0, 12 (24%) had S1, 9 (18%) had S2, and 13 (26%) had S3. The CAP values increased significantly (p < 0.001) for each steatosis stage on liver biopsy: S0, 222 dB/m; S1, 250 dB/m; S2, 270 dB/m; and S3, 318 dB/m. A cutoff value of 257 dB/m could distinguish significant steatosis (S2–S3) from S0 (Sn 89%, Sp 83%, positive likelihood ratio 5.33, negative likelihood ratio 0.13, AUROC = 0.93). Multivariable analysis indicated that neither liver fibrosis (p = 0.58) nor disease etiology (p = 0.96) had a significant impact on the association between CAP and the stage of steatosis. Conclusion. The determination of CAP using transient elastography can represent an important step forward toward the goal of an “imaging liver biopsy”.

Measurements of serum procollagen-III peptide and M30 do not improve the diagnostic accuracy of transient elastography for the detection of hepatic fibrosis in patients with nonalcoholic fatty liver disease.

Background Transient elastography (TE) has recently emerged as an accurate noninvasive imaging method for the diagnosis of liver fibrosis in nonalcoholic fatty liver disease (NAFLD). Here, we tested whether adding serum measures of serum procollagen-III peptide (PIIIP) and caspase-cleaved cytokeratin 18 fragment (M30) to TE could improve its diagnostic accuracy in patients with biopsy-proven NAFLD. Patients and methods TE was performed in 87 patients with NAFLD. Serum PIIIP and M30 levels were determined by enzyme-linked immunosorbent assay. Liver histology was considered the gold standard. The diagnostic accuracies were assessed by measuring the area under the receiver operating curve. Results At histopathological examination, 34 patients (39.1%) had significant fibrosis (F2–F4) and 19 patients (21.8%) had advanced fibrosis (F3–F4). Both TE and serum M30 levels were independent predictors of fibrosis, whereas no association was found with PIIIP. No significant differences in terms of sensitivity and specificity for both significant and advanced fibrosis were evident for TE, serum M30, or their combination. Moreover, the area under the receiver operating curves of serum M30 combined with TE did not differ significantly from those of either test alone. Conclusion Both TE and serum M30 levels are accurate for the noninvasive diagnosis of fibrosis in NAFLD. However, their combination did not improve the overall diagnostic accuracy.

Not only type 2 diabetes but also prediabetes is associated with portal inflammation and fibrosis in patients with non-alcoholic fatty liver disease

AIMS Growing evidence suggests that not only type 2 diabetes (T2D) but also prediabetes (PD) is common in patients with non-alcoholic fatty liver disease (NAFLD). However, few data exist on how PD impacts the histological characteristics of NAFLD patients. In this exploratory study, we sought to investigate the associations of PD and T2D with the severity of the histological features in patients with NAFLD. METHODS The population consisted of 280 patients with biopsy-proven NAFLD. The associations of PD and T2D with the severity of histological features of NAFLD were analyzed using multiple logistic (or ordinal logistic) regression models after adjustment for confounding factors. RESULTS PD and T2D was noted in 102 (36.4%) and 92 (32.8%) of patients, respectively. Of the 92 patients with T2D, ten (10.9%) were diagnosed de novo after the OGTT. PD and T2D were significantly associated with more severe portal inflammation (P<0.01); the adjusted odds ratios (ORs) of PD and T2D for having a higher grade of portal inflammation were 1.8 [95% CI, 1.1, 3.2] and 2.6 [95% CI, 1.3, 5.8]), respectively. A similar relationship was observed for liver fibrosis (P<0.001); specifically, the adjusted ORs of PD and T2D for having a higher grade of hepatic fibrosis were 2.4 [95% CI, 1.3, 3.7] and 3.8 [95% CI, 1.9, 6.1]), respectively. CONCLUSION Not only T2D but also PD is independently associated with portal inflammation and fibrosis in NAFLD patients. PD may be useful as a clinical indicator of patients who are likely to have already more severe histological findings.

The short appendix vermiformis as a risk factor for colorectal cancer

The human appendix vermiformis is regarded as an evolutionarily vestigial organ, although it has presumptive immune system functions and appears to support beneficial bacterial gut flora, both of which could influence cancer progression. A review of the comparative anatomy of the mammalian appendix reveals a significantly longer appendix in herbivores than in carnivorous animals. The lengthier appendix vermiformis in herbivores has been associated with the presence of cellulose‐digesting bacteria that colonize the structure. In light of recent studies that have reported the digestion of small amounts of cellulose in humans and the preventive effects of a vegetarian diet on colon cancer, we conducted a retrospective study of abdominal CT scans of 60 colon cancer patients and 60 healthy people to investigate a possible relationship between colon cancer and appendix vermiformis length. The mean length of the appendix in cancer patients [65.178 mm ± 13.46 (SD)] was shorter than that in the healthy control group [101.99 mm ± 16.58 (SD)] and the difference was statistically significant (P < 0.001). Statistical analysis demonstrated that the ages of the cancer patient group and the control group did not differ significantly (P = 0.534). The results of the present study indicate that the appendix is not merely a vestigial structure or regressed lymphoid tissue, but rather an organ that could be critical in the development of colon cancer, whether as a result of congenital or acquired appendicular factors. Clin. Anat. 27:498–502, 2014.

A Case of Acute Myeloid Leukemia (FAB M2) with Inversion 16 Who Presented with Pelvic Myeloid Sarcoma.

Acute leukemias are the most common childhood cancer in all age groups. Acute myeloid leukemias (AML) constitute about 15–20% of acute leukemias. Fatigability, pallor, fever, and bleeding are the most common presenting symptoms of AML. Hepatosplenomegaly and lymphadenopathy are commonly encountered during physical examination. In rare instances eruptions due to skin involvement and localized tumor masses (myeloid sarcoma) may be found. Myeloid sarcoma is especially seen in AML-M2 subtype. By cytogenetic analysis, in AML-M2 subtype t(8;21) is often seen and it is more probable to find inversion 16 in AML-M4Eos subtype. Herein, we present a 15-year-old girl whose initial symptom was abdominal pain for three days and her pathological sign was a large abdominal mass which was verified by imaging studies and diagnosed as myeloid sarcoma by biopsy. On bone marrow examination, she had diagnosis of AML-M2 and by cytogenetic analysis inversion 16 was positive. She was treated with AML-BFM 2004 protocol and she is being followed up in remission on her ninth month of the maintenance therapy.

Is an interval appendectomy still necessary in perforated appendicitis with inflammatory mass/abcess

We reviewed our experience in non-operative management without an interval appendectomy (IA), for patients who presented with perforated appendicitis with an abcess or inflammatory mass from November 2012 to November 2017 retrospectively. The data included age, sex, duration of symptoms, presence of appendicolith/ abcess on CT imaging, WBC and CRP levels, antibiotic treatment, fever at presentation, percutan drainage procedure and complications, recurrent abscess, total length of hospitalization, follow-up period. A total of 32 patients were treated with nonoperative management during the study period. Nonoperative management without an IA was successful in 31 patients (96%). Study patients included were admitted to the surgical ward for observation. The mean age of the patients was 9.74±3.55 years. 19 male and 13 female patients were included in the study. The mean duration of symptoms was 8.75±4.69 days. The mean number of Ct scans was 1.21±0.42 per patient. Percutan drainage was performed in 10 patients. The mean of WBC levels at presentation was 19030.00±7192.24 cells/μL and CRP levels was 156.61±94.23 mg/dl. Intravenous piperacillin-tazobactam (Tazosin®, Pfizer, New York, NY) were given 400 mg/kg/day in four divided doses. Diet were started to the patients who were afebrile and had diminished abdominal pain during observation. The mean length of hospitalization was 13.03±5.82 days. The mean duration of follow-up period 34.65±20.48 months. Nonoperative management without IA is a preferable choice for perforated appendicitis with abcess or mass.

Ocular findings and blood flow in patients with Takayasu arteritis: a cross-sectional study

Background/aims Takayasu arteritis (TAK) is a chronic granulomatous vasculitis that can lead to ischaemic ocular complications. We aimed to document ocular complications, ocular blood flow and the association of them with systemic clinical findings in TAK. Material and methods We included 65 patients with TAK (60 female, 5 male, mean age: 41.8±12.9 years) and 30 healthy subjects (30 female, mean age: 39.0±7.5 years) in this study. All of the patients had a detailed rheumatological and ophthalmological evaluation. Ocular blood flow in ophthalmic artery (OA) and central retinal artery (CRA) was evaluated with colour Doppler ultrasonography. Results Hypertensive retinopathy was observed in 33.9%, and Takayasu retinopathy was observed in 6.2% of patients. Posterior subcapsular cataracts or a history of cataract surgery was seen in 15.4% of the cases. None of the patients experienced visual loss due to ischaemic or neovascular complications. Patients with TAK had increased resistivity index (RI) in ophthalmic artery (0.75 vs 0.66, p=0.002) and CRA (0.75 vs 0.67, p=0.001). Patients with hypertensive retinopathy had significantly longer disease duration (p=0.016). Ophthalmic artery RI was significantly higher in patients with ipsilateral radial artery pulselessness compared with patients without (0.77 vs 0.68, p=0.031). Conclusion This study reported the lowest prevalence of Takayasu retinopathy and is the only series without permanent visual loss. We documented for the first time that radial artery pulselessness can predict reduction of ipsilateral ocular perfusion. We believe that better management of TAK with current medications reduced ocular complication rates.