Noninvasive Liver Assessment in Adult Patients With Fontan Circulation Using Acoustic Radiation Force Impulse Elastography and Hepatic Magnetic Resonance Imaging.

BACKGROUND: Patients who have undergone the Fontan procedure are at risk of developing hepatic dysfunction. However, broad recommendations regarding liver monitoring are limited. The purpose of this study was to characterize the frequency of liver disease in adult Fontan patients using multimodality imaging (hepatic magnetic resonance imaging [MRI], acoustic radiation force impulse [ARFI] elastography, or hepatic ultrasound). METHODS: In a prospective cross-sectional analysis of adult patients palliated with a Fontan procedure, hepatic MRI, ARFI, and hepatic ultrasound were used to assess for liver disease. The protocol compared (1) varying prevalence of liver disease based on each imaging technique, (2) agreement between different techniques, and (3) association between noninvasive imaging diagnosis of liver disease and clinical variables, including specific liver disease biomarkers. RESULTS: Thirty-seven patients were enrolled. The ARFI results showed high wave propagation velocity in 35 patients (94.6%). All patients had some abnormality in the hepatic MRI. Specifically, 8 patients (21.6%) showed signs of chronic liver disease, 10 patients (27%) had significant liver fibrosis, and 27 patients (73%) had congestion. No correlation was found between liver stiffness measured as propagation velocity and hepatic MRI findings. Only 7 patients had an abnormal hepatic ultrasound study. CONCLUSIONS: There is an inherent liver injury in adult Fontan patients. Signs of liver disease were observed in most patients by both hepatic MRI and ARFI elastography but not by ultrasound imaging. Increased liver stiffness did not identify specific disease patterns from MRI, supporting the need for multimodality imaging to characterize liver disease in Fontan patients.

Colitis por citomegalovirus y fístula rectovaginal en paciente no inmunocomprometida / Cytomegalovirus colitis and fistule rectumvaginal in immunocompetent person

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Placenta hipermadura en período pretérmino: valor predictivo de alteraciones velocimétricas uteroplacentarias / Prediction of utero-placental velocimetry alterations by means of preterm hypermature placenta diagnosis

Objetivo: Valorar la incidencia de placenta hipermadura (PH) entre las semanas 28 y 37 en gestaciones de bajo riesgo (BR) y complicadas con estados hipertensivos del embarazo (EHE) o retraso de crecimiento intrauterino (RCIU). Establecer la capacidad predictiva de alteración velocimétrica uteroplacentaria (AVUP) de dicho signo ecográfico en cada uno de los grupos. Sujetos y métodos: Diseño observacional, prospectivo, longitudinal. Población constituida por 59 gestantes de BR (G1), 49 con EHE (G2) y 47 con RCIU (G3), con datación ecográfica antes de la 16S, a las que se realizó ecografía convencional en tres períodos (28-30S, 30-34S y 34-37S) y estudio velocimétrico uteroplacentario en el tercer trimestre. Resultados: Incidencia de PH por grupo y período y de AVUP: 0, 19, 58 por ciento (G1-AVUP: 19 por ciento); 14, 33, 69 por ciento (G2-AVUP: 37 por ciento); 11, 26, 57 por ciento (G3-AVUP: 45 por ciento). El aumento de la incidencia de PH en función de la edad gestacional fue significativo en los tres grupos, pero no entre ellos, excepto en el período 28-34S. Sensibilidad, especificidad, valores predictivos positivo y negativo y accuracy para predicción de AVUP: 100, 52, 32, 100, 61 por ciento (G1), 100, 48, 53, 100, 67 por ciento (G2) y 62, 50, 50, 62, 55 por ciento (G3). Hubo cuatro casos de abruptio placentae, todos en embarazos con AVUP y PH y tres muertes perinatales, dos secundarias a abruptio en casos con RCIU y una tercera en el G1 por accidente funicular, sin AVUP ni PH. No hubo diferencias significativas en la incidencia de cesárea por sufrimiento fetal ni de Apgar bajo en relación a la madurez placentaria. Conclusiones: a) La incidencia de PH aumenta con la edad gestacional tanto en gestaciones de BR como en EHE o RCIU. Por debajo de la 30S es excepcional en el primer grupo. b) La PH es un signo inespecífico de poco valor en embarazos complicados con RCIU, donde debe realizarse un estudio específico de la circulación uteroplacentaria, pero es útil como marcador ecográfico para AVUP en la gestación de BR y en EHE. c) La AVUP es un factor de riesgo para abruptio placentae. d) Como signo aislado, la PH no incrementa la incidencia de resultado perinatal adverso (AU)

Immunological diagnosis of human hydatid cyst relapse: utility of the enzyme-linked immunoelectrotransfer blot and discriminant analysis.

A discriminant technique was applied to the different serological patterns obtained by enzyme-linked immunoelectrotransfer blotting (EITB) and by conventional immunological tests, in order to differentiate the residual antibody patterns present in healed hydatidosis from the ones present in patients with active hydatidosis. For this purpose, specific antibodies against Echinococcus granulosus were detected by indirect hemagglutination, agglutination of latex particles, basophil degranulation, and EITB for 23 patients with active hydatidosis and 45 patients with surgically cured hydatidosis. Discriminant analysis of the different serological patterns obtained by EITB and conventional serology correctly classified 92.54% of patients (93.3% if the patients are differentiated according to the time elapsed since surgery). This method detected the presence of active hydatidosis in 95.6% of patients for whom abdominal ultrasonography had confirmed the presence of active hydatid cysts. The global specificity was 88.9%. The specificity was 97.1% for patients who had been operated on 3 years ago or more and 63.6% for patients with less time since surgery.

Immunological diagnosis of human cystic echinococcosis: utility of discriminant analysis applied to the enzyme-linked immunoelectrotransfer blot.

An enzyme-linked immunoelectrotransfer blot for the diagnosis of human hydatid disease was performed, and the different antibody responses were analyzed by a discriminant analysis. This multivariate technique gave us, first, a selection of the most important responses against Echinococcus granulosus infection and, second, a procedure for the classification of patients into two groups: patients with hydatid disease and patients without a history of hydatid disease. This method was applied to 67 patients, 25 with active hydatid cysts (24 hepatic and 1 pulmonary) and 42 without a history of hydatid disease and was compared with the results obtained by conventional serology: indirect hemagglutination, latex particle agglutination, and basophil degranulation. An immunoelectrotransfer blot coupled to a discriminant analysis was more sensitive than conventional serological diagnosis and detected 100% of patients with an active hepatic hydatid cyst with a specificity of 100%. This method, however, failed to detect an uncomplicated hyaline pulmonary hydatid cyst.

[Isolated retroperitoneal hydatid cyst. CT study. Apropos of a case]. / Kyste hydatique rétropéritonéal isolé. Etude TDM. A propos d'un cas.

A 30 year old patient with isolated retroperitoneal hydatid cyst was the first case of this type to be studied by CT scanning. Isolated retroperitoneal hydatid cyst is defined as any zone of hydatidosis occurring in the fatty tissue of the spaces lying behind posterior parietal peritoneum, without any parasitic foci in other organs. Differential diagnosis from other primary retroperitoneal cysts has been improved by the availability of modern imaging procedures: ultrasonography and CT scan.