Nonalcoholic fatty liver disease: one entity, multiple impacts on liver health.

Nonalcoholic fatty liver disease (NAFLD) is very prevalent and now considered the most common cause of chronic liver disease. Staging the severity of liver damage is very important because the prognosis of NAFLD is highly variable. The long-term prognosis of patients with NAFLD remains incompletely elucidated. Even though the annual fibrosis progression rate is significantly higher in patients with nonalcoholic hepatitis (NASH), both types of NAFLD (nonalcoholic fatty liver and nonalcoholic steatohepatitis) can lead to fibrosis. The risk for progressive liver damage and poor outcomes is assessed by staging the severity of liver injury and liver fibrosis. Algorithms (scores) that incorporate various standard clinical and laboratory parameters alongside imaging-based approaches that assess liver stiffness are helpful in predicting advanced fibrosis.

Timing of radical cystectomy in Central Europe - multicenter study on factors influencing the time from diagnosis to radical treatment of bladder cancer patients.

INTRODUCTION: Time that passes between an unfavourable diagnosis to a radical cystectomy (RC) affects oncological outcomes in patients with bladder cancer. Unsatisfactory survival of patients after RC in Central Europe can potentially result from this factor. MATERIAL AND METHODS: The aim of this study was to assess the time interval between transurethral resection of the bladder tumor (TURBT) and RC in Central Europe and to identify clinical factors of possible delays. 941 consecutive patients who underwent RC in nine Central European urological centers were enrolled into the study. After the TURBT-RC time was calculated, selected clinical and pathological parameters were tested as potential factors influencing the timing of RC. RESULTS: On average, RCs were performed 73.8 days after TURBTs (median - 53, range 0-1587). In 238 patients (25.3%) the time exceeded 12 weeks. Patients with muscle-invasive cancer were operated earlier on than patients with nonmuscle-invasive cancer (67.6 vs.105.2 days, RR = 1.41, p = 0.00). In high volume centers (>30 RC per year) longer TURBT-RC intervals were observed (97.6 vs. 66.3 days, RR = 2.49, p = 0.00). Simultaneously, factors such as female sex (RR = 1.21), more advanced age of patient (>65 years, RR = 1.23), presence of concomitant CIS (RR = 2.43), grade of cancer cells (RR = 1.67) and final post-RC stage (RR = 1.51) had no statistically significant effect on the results (p >0.05). CONCLUSIONS: The mean time interval between the diagnosis and radical treatment of patients with bladder cancer in Central Europe is adequate. However, there are still a relatively high number of patients waiting for radical cystectomy longer than 8 weeks. A lower stage of disease as well as a higher case load within of a hospital may delay the surgery.

The role of ¹³C-methacetin breath test for the non-invasive evaluation of nonalcoholic fatty liver disease.

BACKGROUND & AIMS: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in many parts of the world. The ¹³C-methacetin breath test (MBT), a microsomal liver function test, enables quantitative evaluation of cytochrome P450-dependent liver function involved in NAFLD pathogenesis. The aim of our study was to evaluate the efficacy of MBT in differentiating patients with non-alcoholic steatohepatitis (NASH) from patients with simple steatosis (SS) and its ability to predict significant fibrosis in NAFLD patients. METHODS: We performed MBT in 64 patients with histologically proven NAFLD (ranging from SS to severe steatohepatitis) and in 20 healthy controls. Brunt scoring system for histological evaluation of NAFLD served as a reference. The correlation between MBT parameters and liver biopsy was tested using Spearman's coefficient. The overall validity was measured using the area under the receiver operating characteristic curve (AUROC) with 95%CI. RESULTS: ¹³C-MBT is a good tool for identifying patients with histologically proven NASH, with an AUROC of 0.824, 95% CI (0.723-0.926), a sensitivity of 95% and a specificity of 74%. The diagnosis accuracy of ¹³C-MBT for significant fibrosis (F ≥2) has a validity of 91% (95% CI, AUROC = 0.830-0.989) with higher sensitivity (90%) and specificity (81%). ¹³C-MBT values predicted better F3 or F4 fibrosis (AUROC were 0.936 and 0.973). CONCLUSION: Due to the impairment of microsomal function which occurs in NAFLD, ¹³C-MBT could be a reliable diagnostic and follow-up test for NAFLD patients.

Virtual cystoscopy--a surgical planning and guidance tool.

Image guided-surgery systems facilitates surgical planning phases of endoscopic procedures. In this paper, we used a software package for 3D surface model generation and vizualization of the urinary bladder, based on magnetic resonance (MR) cross sectional images of the pelvis. The patients group consisted in 6 patients diagnosed with urinary bladder tumour. They were submitted to MRI exam. Twelve consecutive cross sectional images of the pelvis were aquired (TR (repetition time) = 600 msec, TE (echo time) = 19 msec, slice thickness = 6 divided by 7 mm, FOV (field of view) = 36 cm. All these images were transferred to a personal computer running the 3DSlicer software. We obtained, for each patient, a 3D model of the pelvis including the urinary bladder. In This way, the surgical enviroment was simulated and we are able to investigate the bladder by virtual cystoscopy. The virtual endoscopy may be used as a tool in the preoperative training and in surgical planning.

Can we renounce performing the intravenous urography in the preoperative evaluation for ESWL treatment?

OBJECTIVE: Our aim was to perform a comparative study between IVP (Intra Venous Pyelography) and Doppler US (Ultras Sound) in assessing the normal renal function. The US assessment of the normal renal function consisted in the evaluation of ureteral flux. MATERIALS AND METHODS: The group of patients consisted in 79 patients with small size urinary stones (5-12 mm). Among them, 58 patients had pelvic stones and 21 patients had ureteral stones. The ultrasound system used in our study was a B&K Medical Panther 2002 equipped with a 3.5 MHz transducer. RESULTS: The sensibility in detecting ureteral flux in patients with pelvic stones and normal IVP was 100%. The sensibility in detecting uretheral flux in ureteral stones with IVP aspect of hydronephrosis was 65%. CONCLUSIONS: In cases of normal aspect of IVP the presence of uretheral flux assessed by ultrasound could substitute the IVP in the preoperative evaluation for ESWL treatment. In cases of hydronephrotic aspect of IVP, the concordance between results based on IVP and those based on Doppler US in good enough for proposing the Doppler US evaluation of renal function in obstructive stones as a new diagnostic imaging modality. Doppler US could be the method of choice for renal function pre ESWL evaluation mainly for patients with known intolerance to contrast media.

US and MRI in renal obstruction evaluation.

OBJECTIVE: To explore the renal obstruction using MRI (Magnetic Resonance Imaging) for anatomical evaluation and Doppler US (Ultra Sound) for functional evaluation. MATERIALS AND METHODS: Thirty-two patients with renal obstruction were investigated. The presence of renal obstruction was subsequently established by excretory urography or surgery. US studies were performed using a B&K Medical ultrasound system Panther 2002 equipped with 3 Mhz transducer. MR urography was done with a magnetic resonance imaging system 0.28T, Tomikon R28-Bruker, Germany. RESULTS: All 30 patients presented increased renal vascular resistance as determined by US evaluation (Resistive Index = 0.74 +/- 0.02). The MR urography proved dilated urinary collecting system in only 20 patients of the group. CONCLUSIONS: Doppler US has a very good sensitivity in detecting the renal obstruction before the dilatation of the collecting system be installed. Used together these methods (US and MR urography) are important for proving anatomical as well as functional changes in renal obstruction. Both methods could be useful mainly in patients with known intolerance to contrast media.