Diagnostic significance of measurement of plasma transforming growth factor-beta 1[TGF-beta 1] level and efficacy of vitamin E in children and adolescents with obesity-related liver disease

Although non-alcoholic fatty liver [NAFL] histologically presents only steatosis, non alcoholic steatoheptitis [NASH] present fibrosis and inflammatory infiltration as well as stealosis. NASH sometimes progresses to liver cirrhosis, but it is not easy to distingvish this disease from NAFL by non-invasive examinations. Transforming growth factor- beta1 [TGF-beta1] is implicated in the development of liver fibrosis. Effective treatment for this disease has not been established. This study was designed to determine the diagnostic significance of measurement of plasma TGF-beta1 level in obese children and adolescents with fatty liver disease as well as to evaluate the efficacy of vitamin E treatment on the clinical course of the disease. Thirty-six obese children and adolescents [age 7-18 yrs] with elevated serum aminotransferase [ALT and AST] levels for more than 3 months with diffusely echogenic liver on ultrasonography and, without demonstrable cause for the abnormal chemistry, were diagnosed to have NAFL disease. They were histologically, 22 NAFL and 16 NASH. Clinical details, investigations including LFTs, serum lipid and alpha-tocopherol/ lipid arid plasma TGF-beta1 levels as well as histology were evaluated at admission and after treatment with oral vitamin E 300-900 IU daily. Serum ALT and AST levels were monitored monthly during treatment twenty age and sex matched healthy children served as controls. Results Duration of follow up was 3-8 months. Plasma TGF-beta1 levels were significantly elevated in NASH compared to NAFL patients and controls and decreased accompanied by an improvement in LFTs and histology following vitamin E treatment. Serum alpha-tocopherol/lipid levels were significantly decreased in patients than controls and significantly elevated following treatment. Measurement of plasma TGF-beta1 level represents a possible method of distinguishing between NAFL and NASH, and is also a good indicator of the efficacy of treatment for NASH. Vitamin E may have a beneficial therapeutic effect in children and adolescents with NASH

Accuracy of needle core biopsy in confirming the diagnosis of bone lesions

The material of this study included 30 patients with a provisional diagnosis of a bony lesion which needed confirmation. Their age was 6 - 65 years, average 27.6 years. There were 20 males and 10 females. The affected bones were the femur: 16 cases = 53.3%; the tibia: 4 cases = 13.3%; each of the fibula and iliac bone: 3 cases = 10%; humerus: 2 cases = 6.7%; each of the radius and the fifth metacarpal: 1 case = 3.3%. The provisional diagnosis was reached after clinical examination; imaging and laboratory investigations. It was malignant bone tumour: 12 cases = 40%; giant cell tumour: 4 cases = 13.3%; benign bone tumour: 8 cases = 26.7%; tuberculous osteitis: 2 cases = 6.7%; chronic pyogenic osteomyelitis: 4 cases = 13.3%. To confirm the provisional diagnosis the patient was given general anaesthesia to perform two procedures in the same sitting: first a needle core biopsy [NCB], then an open surgical biopsy after full exposure of the lesion. The biopsy specimens were blinded by being code-numbered differently in each case. The open biopsy was considered as the control. The .NCB gave a correct diagnosis in 27 cases or 90% of the cases of the whole material. The provisional diagnosis was proven by NCB and open biopsy in 26 cases or 86.7% of the whole material. In malignant bone tumours, giant cell bone tumours, tubercuIous osteitis and chronic pyogenic osteomyelitis, the NCB was successful in all cases in accurately confirming the diagnosis. However in benign bone tumours the NCB could give accurate diagnosis only in 5 out of 8 cases [62.5%]. It was concluded that the NCB had the same degree of diagnostic accuracy as the open biopsy in most bony lesions met with in this study, except in benign bone tumours