Diagnostic performance of ultrasound attenuation imaging for assessing low-grade hepatic steatosis.

OBJECTIVES: To investigate the diagnostic performance of attenuation imaging (ATI) for the assessment of low-grade hepatic steatosis using liver biopsy as the reference standard. METHODS: The study included 57 potential donor candidates for living liver transplantation who underwent ATI, transient elastography (TE), and liver biopsy for evaluation of hepatic steatosis between February 2020 and April 2020. The attenuation coefficient (AC) from ATI and the controlled attenuation parameter (CAP) from TE were measured for each participant in a random and blind manner. The histologic hepatic fat fraction (HFF) was graded (S0, < 5%; S1, 5-33%; S2, 33-66%; S3, > 66%). The accuracy of ATI for diagnosing hepatic steatosis was compared with that of CAP using ROC analysis. Correlations between AC and HFF were evaluated, and factors affecting AC were determined by linear regression analysis. RESULTS: The median HFF was 3% (range: 0-35%), with 31 (54.4%), 24 (42.0%), and 2 (3.5%) participants being graded as S0, S1, and S2, respectively. The AUCs for the ROCs of AC and CAP for the detection of hepatic steatosis were 0.808 (95% CI: 0.682-0.900) and 0.829 (95% CI: 0.706-0.916), respectively, with the difference not being statistically significant (p = 0.762). AC showed 61.5% of sensitivity and 90.3% of specificity. AC was positively correlated with HFF (p < 0.001). HFF was the only factor significantly affecting AC. CONCLUSIONS: ATI showed moderate sensitivity and high specificity in the diagnosis and quantification of hepatic steatosis in low-grade steatosis without fibrosis. Only HFF significantly affected AC. KEY POINTS: • Attenuation imaging showed moderate sensitivity and high specificity performance in the diagnosis and quantification of hepatic steatosis in low-grade steatosis without fibrosis. • The diagnostic performance of the attenuation coefficient by attenuation imaging did not significantly differ from that of the controlled attenuation parameter by transient elastography in quantifying low-grade steatosis. • The histopathologically determined hepatic fat fraction was the only factor significantly affecting the attenuation coefficient.

[Asymptomatic Synchronous Tuberculosis Involving Stomach and Small Bowel in Immunocompetent Patient].

Gastrointestinal tuberculosis that is not an unusual form of extrapulmonary tuberculosis and it is usually associated with immunocompromised condition that may present with clinical symptoms including fever, weight loss or pain. Terminal ileum and cecum are the common sites of involvement, but involvement of the stomach is rare. Furthermore, synchronous tuberculosis involving both the stomach and lower gastrointestinal tract has been reported in very few cases. Herein, we report a case of incidentally detected synchronous tuberculosis involving both the stomach and terminal ileum that was successfully treated by antituberculosis therapy in an asymptomatic immunocompetent patient.

[A Case of Paradoxical Reaction Development during Antituberculosis Therapy].

Paradoxical reaction during antituberculosis therapy is defined as aggravation of preexisting tuberculous lesions or the development of new lesions. A 24-year-old female college student diagnosed with abdominal and pulmonary tuberculosis presented with fever and abdominal pain after having been treated with antituberculosis agents for 4 months. Tuberculous mesenteric lymphadenitis was suspected on abdominal CT scan and enlarged necrotic abscess was also present. These findings were considered to be due to paradoxical reaction rather than treatment failure during antituberculosis treatment. Although laparoscopic bowel adhesiolysis and abscess drainage were performed, high fever and severe abdominal pain did not improve. However, the patient eventually made a completely recovery after corticosteroid therapy combined with antituberculosis agents. Herein, we report a case of paradoxical reaction which developed in a patient with abdominal and pulmonary tuberculosis during antituberculosis therapy.

Proinflammatory cytokine IL-1 ß polymorphisms in sudden sensorineural hearing loss.

The cause and pathogenesis of sudden sensorineural hearing loss (SSNHL) remain unknown. IL-1ß is one of the most powerful inflammatory cytokines. The aim of this study was to evaluate the relationships between interleukin-1 ß (IL-1ß) gene polymorphisms (-511 C/T and +3953 C/T) in patients with SSNHL. One hundred two patients affected by SSNHL and 595 controls were genotyped for IL-1ß gene polymorphisms. The polymorphisms were analyzed by polymerase chain reaction amplification and DNA fragment separation via electrophoresis. Compared to controls, the IL-1ß (+3953) T allele increased the relative risk of SSNHL in subjects with IL-1ß (-511) TT genotype (p = 0.022, OR = 9.111, 95% CI = 1.441-57.618). In this study, polymorphisms in the IL-1ß -511 and IL-1ß +3953 loci were assessed for evidence of association with SSNHL. From this assessment, a significant difference in carriage of both the IL-1ß -511 T allele and the IL-1ß +3953 T allele was observed between SSNHL and controls. This suggests that the IL-1ß -511 and +3953 loci may play an important role in the etiopathogenesis of SSNHL.

Resorption of labial bone in maxillary anterior implant.

PURPOSE: The purpose of this study was to evaluate the amount of resorption and thickness of labial bone in anterior maxillary implant using cone beam computed tomography with Hitachi CB Mercuray (Hitachi, Medico, Tokyo, Japan). MATERIALS AND METHODS: Twenty-one patients with 26 implants were followed-up and checked with CBCT. 21 OSSEOTITE NT® (3i/implant Innovations, Florida, USA) and 5 OSSEOTITE® implants (3i/implant Innovations, Florida, USA) were placed at anterior region and they were positioned vertically at the same level of bony scallop of adjacent teeth. Whenever there was no lesion or labial bone was intact, immediate placement was tried as possible as it could be. Generated bone regeneration was done in the patients with the deficiency of hard tissue using Bio-Oss® (Geistlich, Wolhusen, Switzerland) and Bio-Gide® (Geistlich, Wolhusen, Switzerland). Second surgery was done in 6 months after implant placement and provisionalization was done for 3 months. Definite abutment was made of titanium abutment with porcelain, gold and zirconia, and was attached after provisionalization. Two-dimensional slices were created to produce sagittal, coronal, axial and 3D by using OnDemand3D (Cybermed, Seoul, Korea). RESULTS: The mean value of bone resorption (distance from top of implant to labial bone) was 1.32 ± 0.86 mm and the mean thickness of labial bone was 1.91 ± 0.45 mm. CONCLUSION: It is suggested that the thickness more than 1.91 mm could reduce the amount and incidence of resorption of labial bone in maxillary anterior implant.

Metronidazole-induced encephalopathy in a patient with liver cirrhosis.

Encephalopathy is a disorder characterized by altered brain function, which can be attributed to various causes. Encephalopathy associated with metronidazole administration occurs rarely and depends on the cumulative metronidazole dose, and most patients with this condition recover rapidly after discontinuation of therapy. Because metronidazole is metabolized in the liver and can be transported by the cerebrospinal fluid and cross the blood-brain barrier, it may induce encephalopathy even at a low cumulative dose in patients with hepatic dysfunction. We experienced a patient who showed ataxic gait and dysarthric speech after receiving metronidazole for the treatment of hepatic encephalopathy that was not controlled by the administration of lactulose. The patient was diagnosed as metronidazole-induced encephalopathy, and stopping drug administration resulted in a complete recovery from encephalopathy. This case shows that caution should be exercised when administering metronidazole because even a low dose can induce encephalopathy in patients with liver cirrhosis.

Thyroid storm and reversible thyrotoxic cardiomyopathy after ingestion of seafood stew thought to contain marine neurotoxin.

BACKGROUND: Thyroid storm and severe decompensated thyrotoxicosis are life-threatening diseases, requiring immediate treatment in an intensive care unit. Thyrotoxic heart disease is common in patients with hyperthyroidism; thyrotoxic cardiomyopathy with poor left ventricular systolic function is rare. Here, we report a patient who presented with severe decompensated thyrotoxicosis and reversible thyrotoxic cardiomyopathy after ingestion of a mixed seafood stew thought to contain tetrodotoxin or a related marine neurotoxin. SUMMARY: The patient was a 50-year-old woman who was seen at the emergency room of another hospital with altered mentality and flaccid quadriplegia after eating a mixed seafood stew. At the other hospital, she was diagnosed as having tetrodotoxin intoxication on the basis of her clinical presentation. The patient was placed on assisted ventilation and transferred to our hospital the following day because of persisting fever, tachycardia, and respiratory depression. Upon admission, thyroid storm was diagnosed on the basis of thyroid function tests (total triiodothyronine was 354 ng/dL, free thyroxine was 3.45 ng/dL, and thyroid-stimulating hormone was <0.01 mU/L) and clinical manifestations. On the third hospital day, she complained of chest discomfort and progressively worsening dyspnea. Echocardiography showed reduced left ventricular systolic function (left ventricular ejection fraction, 47%; left ventricular fractional shortening, 24.4%) with regional wall motion abnormality of anteroseptal wall and apex and diastolic dysfunction (grade 1, relaxation abnormality), suggesting thyrotoxic cardiomyopathy. She was treated with 10 mCi of radioactive iodine and methimazole, and her thyroid and cardiac function normalized. CONCLUSION: The patient reported here developed thyroid storm and cardiac decompensation shortly after a clinical event consistent with ingestion of marine neurotoxin. This adds to the list of stresses that have been associated with thyroid storm and emphasizes the need to fully evaluate patients who, on initial evaluation, appear to have only a single disorder.

Steroid combination therapy and detoxification enzyme gene polymorphisms in sudden sensorineural hearing loss patients.

OBJECTIVE: The purpose of this study was to evaluate the relations among the combined therapy with steroid and the detoxification enzyme gene polymorphisms in patients with sudden sensorineural hearing loss (SSNHL). The pathogenetic mechanism of inner ear dysfunction could involve an increase in lipid peroxidation and a decrease in cellular antioxidant defense. Glutathione S-transferases (GSTs) and cytochrome P450 (CYP) belong to a system of detoxification and antioxidant enzymes that have been demonstrated in the inner ear. STUDY DESIGN: A prospective study in patients with SSNHL. PATIENTS AND METHODS: All 441 subjects were genotyped for GSTM1, GSTT1, and CYP1A1 polymorphisms. The polymorphisms were analyzed by polymerase chain reaction amplification, restriction enzyme digestion, and deoxyribonucleic acid fragment separation by electrophoresis. RESULTS: No significant difference was observed between SSNHL patients and controls in 3 polymorphisms. However, the prevalence of the partial recovery group in patients with the CC genotype of CYP1A1 (22%) was higher than that in the complete recovery (7.4%) or no recovery group (12.5%) for the subjects classified according to modified Siegel's criteria but were not statistically significant. CONCLUSION: This is the first approach to analyze gene polymorphism and efficacy of clinical treatment of patients with SSNHL, although the observations do not confirm the effect of the GSTM1/T1 and CYP1A1 genotypes as a risk factor for SSNHL.