ABSTRACT
BACKGROUND: Insulin resistance is a significant risk factor for hepatic fibrosis in patients with both non-alcoholic fatty liver disease (NAFLD) and chronic hepatitis C (CHC), either directly or by favouring hepatic steatosis. Several methods are available to assess insulin resistance, but their impact on this issue has never been evaluated. AIMS: To determine the relative contribution of steatosis, metabolic abnormalities and insulin resistance, measured by different basal and post-load parameters, to hepatic fibrosis in CHC and in NAFLD patients. METHODS: In 90 patients with CHC and 90 pair-matched patients with NAFLD, the degree of basal insulin resistance (by the homeostasis model assessment, (HOMA)) and post-load insulin sensitivity (by the oral glucose insulin sensitivity (OGIS) index) was assessed, together with the features of the metabolic syndrome according to Adult Treatment Panel III definition. Data were correlated with hepatic histopathology. RESULTS: The prevalence of basal insulin resistance (HOMA values >75th percentile of normal) was 23.3% in CHC patients and 57.8% in NAFLD, but it increased to 28.8 and 67.8% when measured by post-load insulin resistance (OGIS <25th percentile). In a multivariate model, after adjustment for age, gender and body mass index, OGIS was a predictor of severe fibrosis in CHC and in NAFLD patients, independently of steatosis. An OGIS value below the cut-off of the 25th percentile increased the likelihood ratio of severe fibrosis by a factor of 1.5-2 and proved to be a more sensitive and generally more specific test than HOMA-R for the identification of subjects with severe fibrosis both in NAFLD and in CHC. CONCLUSIONS: Post-load insulin resistance (OGIS <9.8 mg/kg/min) is associated with severe hepatic fibrosis in both NAFLD and CHC patients, and may help identify subjects at risk of progressive disease.
Subject(s)
Fatty Liver/complications , Hepatitis C, Chronic/complications , Insulin Resistance/physiology , Liver Cirrhosis/etiology , Adult , Body Mass Index , Fatty Liver/metabolism , Fatty Liver/pathology , Female , Genotype , Hepacivirus/genetics , Hepatitis C, Chronic/genetics , Hepatitis C, Chronic/metabolism , Humans , Liver/pathology , Liver Cirrhosis/metabolism , Liver Cirrhosis/pathology , Male , Middle Aged , Prospective Studies , Risk Factors , Severity of Illness IndexSubject(s)
Short Bowel Syndrome/therapy , Acidosis/drug therapy , Acidosis/etiology , Bacterial Infections/drug therapy , Bacterial Infections/etiology , Bicarbonates/therapeutic use , Breast Feeding , Catheters, Indwelling/adverse effects , Diarrhea, Infantile/drug therapy , Diarrhea, Infantile/etiology , Follow-Up Studies , Humans , Infant, Newborn , Intestinal Obstruction/surgery , Male , Metronidazole/therapeutic use , Milk, Human , Neomycin/therapeutic use , Parenteral Nutrition , Ranitidine/therapeutic use , Short Bowel Syndrome/complications , Sodium/therapeutic use , Sodium Bicarbonate , Treatment Outcome , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , VomitingABSTRACT
Vertebral abnormalities and anorectal and tracheoesophageal defects are the main manifestations in the VATER/VACTERL association. Radial defects vary from radial aplasia to thumb duplication. Heart and renal defects are reported with lower frequency. Additional malformations, such as the laryngeal stenosis described in the present patient, may expand the phenotype of the association. The wide spectrum of congenital abnormalities confirms the high clinical variability of VATER/VACTERL association which seems to be due to a disruption of blastogenesis.
Subject(s)
Esophageal Atresia/genetics , Heart Septal Defects, Ventricular/genetics , Laryngostenosis/genetics , Tracheoesophageal Fistula/genetics , Humans , Infant, Newborn , Lung/abnormalities , Male , Phenotype , Syndrome , Terminology as TopicABSTRACT
The authors evaluated the usefulness of the psychological therapy in addition to usual diet treatment. Fifty subjects with severe obesity, have been randomly assigned to two different treatment groups: a) diet; b) diet plus psychotherapy. At the end of the study only the patients treated with diet plus psychotherapy showed any highly significant body weight reduction and a better diet adherence.
Subject(s)
Obesity/therapy , Psychotherapy , Adult , Combined Modality Therapy , Female , Humans , Male , Middle Aged , Obesity/diet therapyABSTRACT
AA. report a case history about a 3 month old female baby affected by bilateral pyelo-ureteric obstruction by fungus ball, presented as urine ascites because of fissure in renal pelvis and successfully treated by surgery. In spite of disobstruction and subsequent medical treatment, the obstruction relapsed and a second operation was necessary. This time a bilateral nephrostomy was done allowing irrigation with anti-candida drugs. This case has to be considered unusual because of the age of the patient, the clinical presentation as ascites, the bilateral affection, the tendency to relapse after disobstruction, and the successful treatment after the second operation.