Fatty liver disease in severe obese patients:Diagnostic value of abdominal ultrasound

AIM:To evaluate the sensitivity and specificity of abdominal ultrasound (US) for the diagnosis of hepatic steatosis in severe obese subjects and its relation to histological grade of steatosis. METHODS: A consecutive series of obese patients, who underwent bariatric surgery from October 2004 to May 2005, was selected. Ultrasonography was performed in all patients as part of routine preoperative time and an intraoperative wedge biopsy was obtained at the beginning of the bariatric surgery. The US and histological findings of steatosis were compared, considering histology as the gold standard. RESULTS: The study included 105 patients. The mean age was 37.2 ± 10.6 years and 75.2% were female. The histological prevalence of steatosis was 89.5%. The sensitivity and specificity of US in the diagnosis of hepatic steatosis were, respectively, 64.9% (95% CI: 54.9-74.3) and 90.9% (95% CI: 57.1-99.5). The positive predictive value and negative predictive value were, respectively, 98.4% (95% CI: 90.2-99.9) and 23.3% (95% CI: 12.3-39.0). The presence of steatosis onUS was associated to advanced grades of steatosis on histology (P = 0.016). CONCLUSION: Preoperative abdominal US in our series has not shown to be an accurate method for the diagnosis of hepatic steatosis in severe obese patients. Until another non-invasive method demonstrates better sensitivity and specificity values, histological evaluation may be recommended to these patients undergoing bariatric surgery.

Accuracy of abdominal ultrasound for the diagnosis of small bowel obstruction in the emergency department

BACKGROUND： Emergency physicians frequently encounter patients with acute small bowel obstructions （SBO）. Although computed tomography （CT） imaging is the current gold standard in the assessment of patients with suspected SBO in the emergency department, a few studies have examined the use of ultrasound as an alternative imaging technique. METHODS： We evaluated the accuracy of ultrasound performed in the ED by a variety of providers （physicians with various levels of training, physician assistants） compared to CT imaging in 47 patients with suspected SBOs. RESULTS： Our data demonstrated a sensitivity of 93.8% and a specificity of 93.3% when compared to abdominal CT, and a sensitivity of 94.3% and specificity of 95.2% using a composite endpoint of abdominal CT and discharge diagnosis. CONCLUSION： Ultrasound can play an important role in the identification of small bowe obstructions in ED patients.

Comparison of abdominal ultrasound,endoscopic ultrasound andmagnetic resonance imaging in detection of necrotic debris in walled-off pancreatic necrosis

Background:Walled-off pancreatic necrosis(WOPN)is an important complication of acute pancreatitis that is diagnosed by imaging modalities such as endoscopic ultrasound(EUS)or magnetic resonance imaging(MRI),which can clearly visualize necrotic debris.The effectiveness of abdominal ultrasound(USG)in detecting solid debris in WOPN is not clear.Methods:A total of 52 patients(37 males,mean age 38.9612.6 years)with symptomatic WOPN were prospectively studied using EUS,MRI and USG.These investigations were done at a mean of 11.765.5 weeks of onset of acute pancreatitis and within two days.Results:WOPN was detected by EUS&MRI in all patients,whereas USG could not detect it in 4(7.6%)patients(3 had predominantly solid WOPN,whereas one had air foci in WOPN).USG,MRI and EUS could detect solid debris in all patients with detectable WOPN.EUS and USG detected<10%debris in 10(20%)patients,whereas MRI detected<10%debris in 14(27%)patients.EUS and USG detected 10–40%debris in 33 patients whereas MRI detected 10–40%debris in 30(58%)patients.More than 40%debris was better characterized on EUS and MRI with both detecting>40%debris in 8 patients(15%)compared to 5(11%)patients having>40%debris on USG.EUS detected collaterals around WOPN that were not detected on USG or MRI.Conclusion:USG can characterize the majority of WOPN,with accuracy comparable to that of EUS/MRI.However its limitations are the inability to detect collaterals around WOPN and characterize collections with high solid content or air.

Effect of ginger on gastric motility and symptoms of functional dyspepsia

AIM:To evaluate the effects of ginger on gastric motility and emptying,abdominal symptoms,and hormones that influence motility in dyspepsia.METHODS:Eleven patients with functional dyspepsia were studied twice in a randomized double-blind manner.After an 8-h fast,the patients ingested three capsules that contained ginger(total 1.2 g) or placebo,followed after 1 h by 500 mL low-nutrient soup.Antral area,fundus area and diameter,and the frequency of antral contractions were measured using ultrasound at frequent intervals,and the gastric half-emptying time was calculated from the change in antral area.Gastrointestinal sensations and appetite were scored using visual analog questionnaires,and blood was taken for measurement of plasma glucagon-like peptide-1(GLP-1),motilin and ghrelin concentrations,at intervals throughout the study.RESULTS:Gastric emptying was more rapid after ginger than placebo [median(range) half-emptying time 12.3(8.5-17.0) min after ginger,16.1(8.3-22.6) min after placebo,P ≤ 0.05].There was a trend for more antral contractions(P = 0.06),but fundus dimensions and gastrointestinal symptoms did not differ,nor did serum concentrations of GLP-1,motilin and ghrelin.CONCLUSION:Ginger stimulated gastric emptying and antral contractions in patients with functional dyspepsia,but had no impact on gastrointestinal symptoms or gut peptides.

Long-term durable response to lenalidomide in a patient with hepatic epithelioid hemangioendothelioma

Epithelioid hemangioendothelioma(EH)is a rare tumor arising from the vascular endothelial cells of soft tissue or visceral organs.The most common visceral site is the liver,where it is often involved in a multifocal man-ner known as hepatic EH(HEH).Surgical resection with curative intent represents the gold standard therapy.When surgery is not feasible,or in cases of metastatic disease,no standard medical treatment is currently indicated.In small series,drugs with anti-angiogenic activity(such as bevacizumab,sorafenib,thalidomide,and lenalidomide)have been proposed with promising results.We describe a 73-year-old man with multifocal non-resectable HEH treated with lenalidomide.Disease status was evaluated by abdominal ultrasound and magnetic resonance every four months.The patient was treated for a total of 39 mo with prolonged disease stabilization and,at the time of writing,is still under treatment with a good tolerance profile.During a short period of treatment discontinuation,the disease showed slight progression that immediately resolved after the reintroduction of lenalidomide.Lenalidomide may represent a valid treatment option for HEH due to its anti-angiogenic and antineoplastic activities.This preliminary result merits further study in a large series.

Non-invasive prediction of persistent villous atrophy in celiac disease

BACKGROUND Celiac disease(CD)is an immune-mediated enteropathy that is primarily treated with a gluten-free diet(GFD).Mucosal healing is the main target of the therapy.Currently,duodenal biopsy is the only way to evaluate mucosal healing,and noninvasive markers are challenging.Persistent elevation of anti-tissue transglutaminase antibodies(aTTG)is not an ideal predictor of persistent villous atrophy(VA).Data regarding prediction of atrophy using anti-deamidated gliadin peptide antibodies(aDGP)and abdominal ultrasonography are lacking.AIM To evaluate the ability of aTTG,aDGP,small bowel ultrasonography,and clinical and laboratory parameters in predicting persistent VA determined using histology.METHODS Patients with CD at least 1 year on a GFD and available follow-up duodenal biopsy,levels of aTTG and aDGP,and underwent small bowel ultrasonography were included in this retrospective cohort study.We evaluated the sensitivity,specificity,and positive and negative predictive values of aTTG,aDGP,small bowel ultrasonography,laboratory and clinical parameters to predict persistent VA.A receiver operating characteristic(ROC)curve analysis of antibody levels was used to calculate cut off values with the highest accuracy for atrophy prediction.RESULTS Complete data were available for 82 patients who were followed up over a period of four years(2014-2018).Among patients included in the analysis,women(67,81.7%)were predominant and the mean age at diagnosis was 33.8 years.Followup biopsy revealed persistent VA in 19 patients(23.2%).The sensitivity and specificity of aTTG using the manufacturer’s diagnostic cutoff value to predict atrophy was 50%and 85.7%,respectively,while the sensitivity and specificity of aDGP(using the diagnostic cutoff value)was 77.8%and 75%,respectively.Calculation of an optimal cutoff value using ROC analysis(13.4 U/mL for aTTG IgA and 22.6 U/mL for aDGP IgA)increased the accuracy and reached 72.2%[95%confidence interval(CI):46.5-90.3]sensitivity and 90%(95%CI:79.5-96.2)specificity for aDGP IgA and 66.7%(95%CI:41.0-86.7)sensitivity and 93.7%(95%CI:84.5-98.2)specificity for aTTG IgA.The sensitivity and specificity of small bowel ultrasonography was 64.7%and 73.5%,respectively.A combination of serology with ultrasound imaging to predict persistent atrophy increased the positive predictive value and specificity to 88.9%and 98%for aTTG IgA and to 90.0%and 97.8%for aDGP IgA.Laboratory and clinical parameters had poor predictive values.CONCLUSION The sensitivity,specificity,and negative predictive value of aTTG and aDGP for predicting persistent VA improved by calculating the best cutoff values.The combination of serology and experienced bowel ultrasound examination may achieve better accuracy for the detection of atrophy.

Gall Bladder Stone in a Tertiary Care Teaching Hospital in Mogadishu-Three Year Retrospective Study

Introduction: Gallstone disease, also known as gallbladder stones or GBS, is almost always asymptomatic but can result in a number of problems, including ascending cholangitis and obstructive jaundice. The frequency of gallbladder stones among patients who were sent for abdominal ultrasound at Mogadishu Somali Turkey Training and Research Hospital, Mogadishu, Somalia, during the period between January 2018 and June 2022 was assessed in this study. Methods: This is a record-based study that was carried out at the radiology department of Mogadishu Somali Turkey Training and Research Hospital on patients who were chosen for abdominal ultrasounds during the months of January 2018 and January 2022. The study focused on cases that occurred within those periods. Reports of abdominal ultrasounds served as the source of the collected data. Results: Records from 2352 patients are included in this study. They were divided into 451 (19.1%) males and 1901 (80.8%) females. Patients with GBS were present in 76.4 percent of cases. 73.2 percent of patients had big stones larger than 5 mm, while 53.4 percent of patients had several stones. GBS 1474 (77.5%) was substantially more common in females than in males (71.6%: 323/451) (P 0.008). The presence of small stones (less than 5 mm) was also shown to be significantly different between males and females (P = 0.015). Furthermore, compared with men, females had a considerably higher frequency of big GBS (5 mm) (P 0.015). Conclusion: In this study, it was discovered that females were significantly more likely than males to have GBS. Small stones were found much more frequently in the males. When compared to men, females had a considerably higher frequency of large GBS.