Severe Fatty Infiltration Research Articles

Association of Doppler Wave Pattern of Hepatic Veins and Fatty Liver Disease Degree

The objective of this study was to document the progressive effects of fatty infiltration of the liver on hepatic veins (HVs) by measuring Doppler waveforms in groups of rats and dogs. All of the groups underwent hepatic B-mode and duplex Doppler sonography. B-mode fatty infiltration was classified into four degrees corresponding to increasing grades of hepatic echogenicity for all groups: (0) absent, (1) mild, (2) moderate and (3) severe fatty infiltration. Histograms were obtained in all dogs to standardise each grade of hepatic echogenicity and an increasing distribution of grey-levels was found according to the grade of fatty infiltration of the liver in obese dogs. The Doppler sonography spectra of HVs were classified into three groups: normal or triphasic waveforms, biphasic waveforms, and monophasic or flat waveforms. Obese dogs (60%) and rats (100%) with fatty infiltration of the liver presented biphasic or flat right HV Doppler waveforms more often than control dogs and rats, and these differences were statistically significant (p = 0.002 for dogs and p = 0.0028 for rats). None of the control dogs and rats had monophasic waveforms. These findings suggest there is an association between wave form pattern of hepatic veins and the degree of fatty liver disease.

Dimethyl fumarate protects pancreatic islet cells and non-endocrine tissue in L-arginine-induced chronic pancreatitis.

BackgroundChronic pancreatitis (CP) is a progressive disorder resulting in the destruction and fibrosis of the pancreatic parenchyma which ultimately leads to impairment of the endocrine and exocrine functions. Dimethyl Fumarate (DMF) was recently approved by FDA for treatment of patients with multiple sclerosis. DMF's unique anti-oxidant and anti-inflammatory properties make it an interesting drug to test on other inflammatory conditions. This study was undertaken to determine the effects of DMF on islet cells and non-endocrine tissue in a rodent model of L-Arginine-induced CP.MethodsMale Wistar rats fed daily DMF (25 mg/kg) or vehicle by oral gavage were given 5 IP injections of L-Arginine (250 mg/100 g×2, 1 hr apart). Rats were assessed with weights and intra-peritoneal glucose tolerance tests (IPGTT, 2 g/kg). Islets were isolated and assessed for islet mass and viability with flow cytometry. Non-endocrine tissue was assessed for histology, myeloperoxidase (MPO), and lipid peroxidation level (MDA). In vitro assessments included determination of heme oxygenase (HO-1) protein expression by Western blot.ResultsWeight gain was significantly reduced in untreated CP group at 6 weeks. IPGTT revealed significant impairment in untreated CP group and its restoration with DMF therapy (P <0.05). Untreated CP rats had pancreatic atrophy, severe acinar architectural damage, edema, and fatty infiltration as well as elevated MDA and MPO levels, which were significantly improved by DMF treatment. After islet isolation, the volume of non-endocrine tissue was significantly smaller in untreated CP group. Although islet counts were similar in the two groups, islet viability was significantly reduced in untreated CP group and improved with DMF treatment. In vitro incubation of human pancreatic tissue with DMF significantly increased HO-1 expression.ConclusionAdministration of DMF attenuated L-Arginine-induced CP and islet function in rats. DMF treatment could be a possible strategy to improve clinical outcome in patients with CP.

Effects of fat accumulation in the liver on hemodynamic variables assessed by Doppler ultrasonography.

To investigate the effect of various degrees of fatty liver infiltration on hepatic hemodynamics using Doppler ultrasonography. We included 40 patients with hepatic steatosis and 20 healthy volunteers. Hepatic steatosis was quantified by a chemical shift MRI. Hepatic artery peak systolic and end-diastolic velocity, resistance index (RI) and pulsatility index (PI), hepatic vein RI and PI, portal vein RI, PI, congestion index, and peak maximum velocity were evaluated by Doppler ultrasonography. The hepatic vein waveforms were classified as triphasic, biphasic, or monophasic. Kruskal-Wallis test was performed for comparing more than two groups. If significant differences were found, Mann-Whitney U test with Bonferroni correction was performed for pair-wise comparisons. Pearson &gch;(2) and Fisher's exact tests were used to compare categorical variables. According to MRI, 15 patients had mild, 14 patients had moderate, and 11 patients had severe fatty infiltration. Portal vein peak maximum velocity was median: 19.8 (range 12-33.3), 21.1 (8-41.8), 16.6 (10.6-24.9), and 29.2 (14.1-40.4) cm/s. Congestion index was 0.05 (0.02-0.16), 0.07 (0.01-0.17), 0.11 (0.06-0.24), and 0.05 (0.02-0.16). Hepatic artery RI was 0.75 (0.56-1.00), 0.66 (0.52-0.87), 0.83 (0.38-1.00), and 0.76 (0.48-2.76), and PI was 1.83 (0.90-3.13), 1.38 (1.04-2.63), 1.97 (0.86-2.90), and 1.82 (0.70-2.90) (p = .046 and p = .036) in the mild, moderate, severe steatosis, and control groups, respectively. The rate of triphasic hepatic vein waveforms was higher in controls than in patients with severe steatosis. Portal vein flow velocity decreases in severe hepatic steatosis when compared with controls.

Eclipta alba ameliorates carbon tetrachloride-induced structural and functional changes in liver of mice

The aim of the present investigation was to evaluate the ameliorative effect of Eclipta alba extract against carbon tetrachloride (CCl4)–induced structural and functional changes in livers of mice. Healthy adult Swiss strain female albino mice were orally administered with CCl4 (826 mg/kg body weight/day, p.o.) alone and along with Eclipta alba extract (100, 200 and 300 mg/kg body weight/day, p.o.) for 30 days. The degree of protection was determined by measuring histopathological changes and lipid peroxidation in liver as well as activities of ALT, AST, ACP, ALP, LDH, γ-GT enzymes and bilirubin contents in serum of mice. The histopathological studies revealed severe necrosis, fatty infiltration, lymphocytic infiltration and fibrosis in liver of CCl4 treated mice. In addition, biochemical studies revealed a significant increase in lipid peroxidation. The enzymes activities as well as bilirubin contents in serum were significantly (p&lt;0.05) increased in CCl4 only treated mice when compared with the control group. However, co-treatment of CCl4 along with Eclipta alba extract showed significant reductions in activities of enzymes and bilirubin content as compared with CCl4 alone treated mice. The effects were dose-dependent (r = 0.9826 to 1). Carbon tetrachloride induced lipid peroxidation was significantly (p&lt;0.05) ameliorated in a dose-dependent manner. Histopathological changes were also ameliorated on treatment with Eclipta alba extract. The ameliorative effects of Eclipta alba on CCl4–induced hepatotoxicity could be due to its antioxidative property. The extract was found to be safe as evidenced by their high LD50.

Rotator cuff tears after 70 years of age: A prospective, randomized, comparative study between decompression and arthroscopic repair in 154 patients

Arthroscopic repair of rotator cuff tears leads to better clinical outcomes than subacromial decompression alone; however the former is rarely proposed to patients above 70 years of age. Our hypothesis was that arthroscopic repair would be superior to decompression in patient 70 years or older. The primary goal was to compare the clinical results obtained with each technique. The secondary goal was to analyze the effects of age, tendon retraction and fatty infiltration on the outcome. This was a prospective, comparative, randomized, multicenter study where 154 patients were included who were at least 70 years of age. Of the included patients, 143 (70 repair and 73 decompression) were seen at one-year follow-up; these patients had an average age of 74.6 years. Shoulders had a complete supraspinatus tear with extension limited to the upper-third of the infraspinatus and Patte stage 1 or 2 retraction. Clinical outcomes were evaluated with the Constant, ASES and SST scores. All scores improved significantly with both techniques: Constant +33.81 (P<0.001), ASES +52.1 (P<0.001), SST +5.86 (P<0.001). However, repair led to even better results than decompression: Constant (+35.85 vs. +31.8, P<0.05), ASES (+56.09 vs. +48.17, P=0.01), SST (+6.33 vs. +5.38, P=0.02). The difference between repair and decompression was not correlated with age; arthroscopic repair was also better in patients above 75 years of age (Constant, ASES and SST scores P<0.01). There was no significant correlation between the final outcomes and initial retraction: Constant (P=0.14), ASES (P=0.92), SST (P=0.47). The difference between repair and decompression was greater in patients with stages 0 and 1 fatty infiltration (Constant P<0.02) than in patients with stages 2 and 3 fatty infiltration (Constant P<0.05). There was a significant improvement in all-clinical scores for both techniques 1 year after surgery. Repair was significantly better than decompression for all clinical outcomes, even in patients above 75 years of age. The difference observed between repair and decompression was greater in patients with more retracted tears and lesser in patients with more severe fatty infiltration.

Epicardial fat thickness and nonalcoholic fatty liver disease in obese subjects

Ectopic fat accumulation within the heart and the liver are linked to an increased cardiovascular risk. Ultrasound-measured cardiac and liver steatosis are easily accessible markers of intra-organ ectopic fat accumulation. The hypothesis that echocardiographic epicardial fat thickness is independently associated with nonalcoholic fatty liver disease (NAFLD) in obese subjects is tested. Sixty-two obese (BMI > 30 kg m⁻²) subjects with ultrasonographic evidence of NAFLD and 62 control obese subjects without history or signs of NAFLD underwent echocardiographic epicardial fat thickness measurement. Epicardial fat thickness was significantly higher (P < 0.01) in obese subjects with NAFLD when compared to those without NAFLD. Epicardial fat thickness was significantly higher (9.7 ± 0.2 vs. 8 ± 0.7 mm, P < 0.01) in subjects with severe (ultrasound score 3) than those with moderate (score 2) liver steatosis. Among waist circumference and BMI, epicardial fat thickness resulted in the best independent correlate of liver steatosis (R² = 0.77, P < 0.001). Our study suggests that epicardial fat is a good predictor of liver steatosis in obese subjects. Echocardiographic epicardial fat predicts ultrasound-measured fatty liver better than BMI or waist circumferences does. Patients with severe fatty liver infiltration presented with the highest amount of cardiac fat accumulation.

Fatty Infiltration and Rotator Cuff Atrophy

Moderate to severe fatty infiltration and rotator cuff atrophy are commonly associated with poor clinical outcomes and failed rotator cuff repair. Numerous animal and human studies have attempted to elucidate the etiology of fatty infiltration and rotator cuff atrophy. Mechanical detachment of the tendon in rotator cuff tears is primarily responsible. Suprascapular nerve injury may also play a role. CT, MRI, and ultrasonography are used to evaluate severity. The Goutallier staging system is most commonly used to evaluate fatty infiltration, and rotator cuff atrophy is measured using multiple techniques. The presence and severity of fatty infiltration have been associated with increasing age, tear size, degree of tendon retraction, number of tendons involved (ie, massive tears), suprascapular neuropathy, and traumatic tears. Fatty infiltration is irreversible and progressive if left untreated. Slight reversal of muscle atrophy has been noted after repair in some studies. Novel therapies are currently being evaluated that may eventually allow clinicians to alter the natural history and improve patient outcomes.

A comparative analysis of fatty infiltration and muscle atrophy in patients with chronic rotator cuff tears and suprascapular neuropathy

Little is known of the mechanisms that lead to the muscle changes associated with rotator cuff disorders. We have observed that the magnetic resonance imaging (MRI) appearance of fatty infiltration (FI) and muscle atrophy (MA) differ between chronic cuff tears and suprascapular neuropathy, suggesting different pathophysiology. This study compares the different MRI changes that occur in chronic cuff tears and suprascapular neuropathy. Two groups were retrospectively identified: (1) RCT group (20 shoulders): patients with chronic tears of the supraspinatus and/or infraspinatus without electromyographic (EMG) evidence of suprascapular neuropathy; (2) neuro group (17 shoulders): patients with EMG documented suprascapular nerve dysfunction and absence of a rotator cuff tear. Magnetic resonance arthrograms were analyzed for the degree of FI and MA, and the morphology of the muscle was assessed, in particular the muscle border, pattern of FI, and extent of involvement. The muscle changes that occur following chronic cuff tears differ from that following denervation secondary to suprascapular neuropathy, especially with respect to the muscle border, degree of perineural fat, and overall distribution of FI. Highly specific and characteristic morphological patterns of FI exist for both chronic cuff tears and suprascapular neuropathy. Chronic rotator cuff tendon tears and suprascapular neuropathy are both associated with FIand MA of the rotator cuff muscles. The pattern of FI is markedly different in the 2 situations. These findings have diagnostic potential and may serve as a basis for further research concerning type, severity, and evolution of FI under different conditions and after treatment.

Doppler Assessment of Hepatic Veins in Fatty Liver Disease

The goal of this study was to document the progressive effects of fatty infiltration of the liver on hepatic veins (HVs) by measuring Doppler waveforms in rats and dogs. It was used in two groups of animals: a) rats (10 healthy adult rats as controls, and a group of 10 rats had fatty infiltration of the liver) and b) dogs (a clinical group of 15 obese dogs and a control group of 10 healthy dogs). All of the groups underwent hepatic B-mode, duplex Doppler sonography and hepatic biopsy or cytology. B-mode fatty infiltration was classified into four degrees corresponding to increasing degrees of hepatic echogenicity for all groups: (0) absent, (1) mild, (2) moderate, and (3) severe fatty infiltration. The Doppler sonography spectra of HVs were classified into three groups: normal or triphasic waveforms, biphasic waveforms, and monophasic or flat waveforms. Obese dogs and rats with fatty infiltration of the liver presented abnormal right HV Doppler waveforms. There was a statistically significant difference in the waveforms of HV flow between the obese and control group of dogs. These findings are clinically relevant because changes in waveforms could be used as a tool to monitor fatty liver disease.

Reverse shoulder arthroplasty combined with a latissimus dorsi and teres major transfer for a deficit of both active elevation and external rotation. Results of 15 cases with a minimum of 2-year follow-up

Our aim was to assess the clinical and radiological outcomes of reverse shoulder replacements performed in association with a latissimus dorsi and teres major tendon transfer in cases of irreparable posterosuperior cuff tears including the teres minor tendon. Our hypothesis was that the tendon transfers would improve the clinical results of arthroplasty by restoring active external rotation. Fifteen procedures in 14 patients were performed through a single deltopectoral approach. Both tendons were fixed to the proximal anterolateral aspect of the humeral metaphysis. Mean age at the time of surgery was 67.5 years (range 53 to 82 years). All had severe cuff tear arthropathy (Hamada stage 3 or 4) and severe atrophy or fatty infiltration of the infraspinatus and teres minor on preoperative MRI or CT-scan (Goutallier stage 3 or 4). Preoperative and postoperative functions were assessed by Constant score. Satisfaction was assessed by the Simple Shoulder Test (SST). At follow up, radiographs were examined for radiolucent lines, osteolysis and scapular notching. The average follow-up after surgery was 33.2 months (range 24 to 60 months). The mean absolute Constant score improved significantly (P=10(-5)) from 23.7±11.5 preoperatively to 61.1±11.9 postoperatively. Forward flexion and external rotation with the arm at the side improved significantly, respectively from 64.7±35.6° preoperatively to 126±34.4° postoperatively (P<10(-5)) and from -8.7±21.3° to 27.3±12.2° (P<0.0005). Internal rotation was not affected. The mean SST improved from 1.9±1.6 points preoperatively to 7.6±1.8 points postoperatively (P<0.0005). Twelve patients were very satisfied or satisfied (including one with a bilateral procedure) and 2 were unsatisfied with the final result. At final follow-up, radiographs showed no radiolucent lines around the implants nor scapular notching. The combined procedure helped restoration of active elevation and external rotation in cases of massive cuff tear including the teres minor tendon. Therapeutic Level IV.

Assessment of Hepatic Fatty Infiltration Using Spectral Computed Tomography Imaging

The objective of this study was to investigate the feasibility of using monochromatic spectral computed tomography (CT) imaging to assess fatty infiltration in liver. With spectral CT imaging, phantoms with known fat concentrations were studied for scanning parameter optimization, then 52 patients enrolled into 4 groups (healthy, mild, moderate, and severe fatty infiltration) received abdominal scanning. Based on reconstructed monochromatic images, hepatic attenuation was analyzed, and dual-energy subtraction imaging (DESI) was created for quantifying fat infiltration. Corresponding to various hepatic fat infiltrations, 4 characteristic CT attenuation curve patterns were described. In DESI images, only fat and fatty components appeared bright. For livers without abnormal fat deposition, isolated bright pixels were visualized (% area = 0.5% ± 0.3%). With hepatic fat accumulation increasing, more bright pixels appeared in subtraction images with percentages of total liver area involved in 2.5%, 6.7%, and 13.4% of mild, moderate, and severe fat infiltration cases, respectively (P < 0.05). The corresponding CT values were as follows: 1.33, 2.53, 8.69, and 16.4 Hounsfield units (P < 0.01), which correlated with the % DESI area values (r = 0.9811). Spectral CT imaging is a promising method to quantitatively assess hepatic fat content and fatty infiltration with advantages compared with conventional CT imaging.

Invasive Ductal Carcinoma Developing in Pancreas With Severe Fatty Infiltration

Hori, Mika PhD; Onaya, Hiroaki MD, PhD; Takahashi, Mami PhD; Hiraoka, Nobuyoshi MD, PhD; Mutoh, Michihiro MD, PhD; Kosuge, Tomoo MD, PhD; Nakagama, Hitoshi MD, PhD Author Information

Involvement of inflammatory factors in pancreatic carcinogenesis and preventive effects of anti-inflammatory agents

Chronic inflammation is known to be a risk for many cancers, including pancreatic cancer. Heavy alcohol drinking and cigarette smoking are major causes of pancreatitis, and epidemiological studies have shown that smoking and chronic pancreatitis are risk factors for pancreatic cancer. Meanwhile, inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) are elevated in pancreatitis and pancreatic cancer tissues in humans and in animal models. Selective inhibitors of iNOS and COX-2 suppress pancreatic cancer development in a chemical carcinogenesis model of hamsters treated with N-nitrosobis(2-oxopropyl)amine (BOP). In addition, hyperlipidemia, obesity, and type II diabetes are also suggested to be associated with chronic inflammation in the pancreas and involved in pancreatic cancer development. We have shown that a high-fat diet increased pancreatic cancer development in BOP-treated hamsters, along with aggravation of hyperlipidemia, severe fatty infiltration, and increased expression of adipokines and inflammatory factors in the pancreas. Of note, fatty pancreas has been observed in obese and/or diabetic cases in humans. Preventive effects of anti-hyperlipidemic/anti-diabetic agents on pancreatic cancer have also been shown in humans and animals. Taking this evidence into consideration, modulation of inflammatory factors by anti-inflammatory agents will provide useful data for prevention of pancreatic cancer.

Clinical and Structural Results of Arthroscopic Repair of Isolated Subscapularis Tear

Even though the frequency of arthroscopic repair of isolated lesions of the subscapularis tendon has increased, few studies have presented clinical and anatomical outcomes of this treatment. We hypothesized that, after an arthroscopic repair, structural outcomes in the muscle have an influence on functional results. A retrospective study was performed on twenty-two patients who had undergone arthroscopic repair of an isolated tear of the subscapularis tendon and had a mean follow-up of thirty-six months. Patients were evaluated preoperatively and postoperatively with use of the Constant-Murley score, a subjective shoulder value, the lift-off test, the belly-press test, and magnetic resonance imaging or computed tomography arthrography. The results were compared with those of a cohort of thirteen patients who underwent open repair of the subscapularis tendon tear. In the arthroscopic group, the Constant-Murley score improved from a mean of 66 points preoperatively to a mean of 85 points postoperatively (p < 0.05). The subscapularis tendon was healed in 86% of the patients. Three patients (14%) had a partial rupture limited to the superior tendon. Postoperatively, progression of fatty infiltration of the subscapularis muscle was observed in 55% of the patients. Ten patients (45%) had a severe but localized fatty infiltration area of the subscapularis muscle related to the larger tears. Subjective and functional outcomes were not influenced by tendon-healing or postoperative fatty infiltration (p > 0.05). Clinical testing was significantly improved, but incomplete corrections remained frequent. Although open repair resulted in higher subjective shoulder scores and better strength scores, most other clinical parameters, postoperative subscapularis testing results, and structural outcomes were comparable between the arthroscopic repair and the open repair group. Arthroscopic repair of isolated subscapularis tears was associated with improved shoulder function and improved results on clinical testing. The tendon-healing rate was high but resulted in incomplete correction of the results of clinical testing. Progression of fatty infiltration in the subscapularis muscle was observed on magnetic resonance imaging but did not influence the clinical outcomes.

骨格筋でのみアミロイドの沈着を確認しえたアミロイドーシスの1例

A 75-year-old man was admitted to our hospital with progressive weakness in the lower extremities for 7 months. Immunoelectrophoresis of serum detected IgA λ type M protein and bone marrow examination detected an increase in monoclonal plasma cells, thus leading to a diagnosis of IgA λ type multiple myeloma. Subsequent muscular CT scan showed severe fatty infiltration of vastus lateralis muscles, and histopathological examinations of biopsied muscle specimens an abundance of abnormal "ring-fiber-like" appearance, positive staining by Congo red and the presence of anti-λ light chain antibody. This led to a diagnosis of amyloid myopathy. No depositions were seen in rectal mucosa, cardiac muscle, or sural nerve. The results of double immunohistochemical staining using anti-dystrophin antibody and anti-λ light chain antibody suggested the possibility of direct injury by amyloid to muscle fibers. The case presented here was thus amyloidosis confirmed by deposition of amyloid only in muscles. In conclusion, when amyloidosis is suspected and there is evidence of muscle injury, muscle biopsy should be performed.

Supraspinatus rupture at the musclotendinous junction: an uncommonly recognized phenomenon

The majority of rotator cuff lesions involving the supraspinatus occur at or near the level of bone-tendon interface. We present a series of supraspinatus injuries at the musculotendinous junction. Between October 2002 and December 2009, we prospectively evaluated all patients presenting with an injury of the supraspinatus at the musculotendinous junction. Five patients (1 female and 4 males) were identified. Three patients had a clear history of trauma. All patients presented acutely with pain and muscular edema on T2 magnetic resonance imaging (MRI) sequences. Lesions were characterized as stretch injuries in 2 cases and complete rupture at the level of the musculotendinous junction in 3 cases. Electrodiagnostic studies were normal in all cases. All patients were treated nonoperatively. On clinical and radiological examination at an average of 24 ± 10 months (range, 10-38), 1 patient had complete clinical and radiological resolution, 1 improved, and 3 who complained of loss of function demonstrated severe fatty infiltration on MRI. Musculotendinous rupture of the supraspinatus is an unusual lesion of the rotator cuff. With incomplete injuries, recovery can be anticipated with nonsurgical management. However, in the case of a complete rupture with muscle retraction, nonoperative management leads to unsatisfactory outcomes.

Pharmacologic inhibition of the renin-angiotensin system did not attenuate hepatic toxicity induced by carbon tetrachloride in rats

The renin-angiotensin system (RAS) subserves vital physiological functions and also implicated in certain pathological states. Modulation of this system has been proposed in recent studies to be a promising strategy in treating liver fibrosis. We investigated the effect of the pharmacologic inhibition of RAS with angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in CCl(4)-induced liver injury with a view to ascertaining the chemopreventive benefit. Fifty-six Wistar albino rats were divided into eight experimental groups of seven rats/group. Groups 1-4 received normal saline (10 ml/kg), enalapril (0.6 mg/kg), losartan (1.4 mg/kg) and CCl(4) (80 mg/kg), respectively. Groups 5-8 were pretreated with enalapril (0.3 mg/kg), enalapril (0.6 mg/kg), losartan (0.7 mg/kg) and losartan (1.4 mg/kg) 1 hour before CCl(4) administration. Experiment lasted 11 days and dosing was via oral route. Rats were killed 24 hours after the last treatment. Serum activities of alkaline phosphatase, aspartate and alanine aminotransferases increased significantly (p < 0.05) by 46.0%, 90.6% and 122.3%, respectively, with severe hepatic centrilobular necrosis, fatty infiltration and increase in liver weight (p < 0.05) in the CCl(4)-treated rats. Enalapril (0.6 mg/kg) and losartan (1.4 mg/kg) significantly (p < 0.05) increased aspartate aminotransferase activity by 37.0% and 94.7% and produced mild centrilobular and periportal hepatic necrosis, respectively, with enalapril significantly (p < 0.05) increasing liver weight. Serum total cholesterol, triglyceride, albumin and total protein did not change significantly in these rats. Also, glutathione, malondialdehyde and uric acid levels were not significantly altered. Enalapril and losartan failed to attenuate liver injury associated with CCl(4) treatment. Although both drugs did not significantly alter serum biochemistry in the CCl(4)-treated rats, they however produced slight elevations in biomarkers of liver function and appear to worsen liver histopathology. Overall, the chemopreventive benefits of RAS inhibitors in liver disease remain doubtful and should be used with caution during hepatic dysfunction.

Non-alcoholic fatty liver disease: An early mediator predicting metabolic syndrome in obese children?

To investigate if non-alcoholic fatty liver disease (NAFLD) is an early mediator for prediction of metabolic syndrome, and if liver B-ultrasound can be used for its diagnosis. We classified 861 obese children (6-16 years old) into three subgroups: group 0 (normal liver in ultrasound and normal transaminases); group 1 (fatty liver in ultrasound and normal transaminases); and group 2 (fatty liver in ultrasound and elevated transaminases). We measured the body mass index, waist and hip circumference, blood pressure, fasting blood glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), whole-body insulin sensitivity index (WBISI), lipid profile and transaminases in all the participants. The risk of developing metabolic syndrome (MS) was assessed according to the degree of liver fatty infiltration based on the B-ultrasound examination. Among the 861 obese children, 587 (68.18%) were classified as having NAFLD, and 221 (25.67%) as having MS. The prevalence of MS in NAFLD children (groups 1 and 2) was 37.64% (221/587), which was much higher than that in non-NAFLD group (group 0, 12.04%) (P < 0.01). There were significantly higher incidences concerning every component of MS in group 2 compared with group 0 (P < 0.05). The incidence of NAFLD in MS patients was 84.61% (187/221), which was significantly higher than that of hypertension (57.46%, 127/221) and glucose metabolic anomalies (22.62%, 50/221), and almost equal to the prevalence of dyslipidemia (89.14%, 197/221). Based on the B-ultrasound scales, the presence of moderate and severe liver fatty infiltration carried a high risk of hypertension [odds ratio (OR): 2.18, 95% confidence interval (95% CI): 1.27-3.75], dyslipidemia (OR: 7.99, 95% CI: 4.34-14.73), impaired fasting glucose (OR: 3.65, 95% CI: 1.04-12.85), and whole MS (OR: 3.77; 95% CI: 1.90-7.47, P < 0.01). The state of insulin resistance (calculated by HOMA-IR and WBISI) deteriorated as the degree of fatty infiltration increased. NAFLD is not only a liver disease, but also an early mediator that reflects metabolic disorder, and liver B-ultrasound can be a useful tool for MS screening.

T1-weighted dual-echo MRI for fat quantification in pediatric nonalcoholic fatty liver disease

To determine in obese children with nonalcoholic fatty liver disease (NAFLD) the accuracy of magnetic resonance imaging (MRI) in assessing liver fat concentration. A case-control study was performed. Cases were 25 obese children with biopsy-proven NAFLD. Controls were 25 obese children matched for age and gender, without NAFLD at ultrasonography and with normal levels of aminotransferases and insulin. Hepatic fat fraction (HFF) by MRI was obtained using a modification of the Dixon method. HFF ranged from 2% to 44% [mean, 19.0% (95% CI, 15.1-27.4)] in children with NAFLD, while in the controls this value ranged from 0.08% to 4.69% [2.0% (1.3-2.5), P < 0.0001]. HFF was highly correlated with histological steatosis (r = 0.883, P < 0.0001) in the NAFLD children. According to the histological grade of steatosis, the mean HFF was 8.7% (95% CI, 6.0-11.6) for mild, 21.6% (15.3-27.0) for moderate, and 39.7% (34.4-45.0) for severe fatty liver infiltration. With a cutoff of 4.85%, HFF had a sensitivity of 95.8% for the diagnosis of histological steatosis ≥ 5%. All control children had HFF lower than 4.85%; thus, the specificity was 100%. After 12 mo, children with weight loss displayed a significant decrease in HFF. MRI is an accurate methodology for liver fat quantification in pediatric NAFLD.

Some Previously Neglected Examples of Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy and Frequency of Its Various Reported Manifestations

Four patients are described with either parchment-like thinning or partial but extensive myocyte depletion with severe fatty or fibrofatty infiltration of the free wall of the right ventricle in its outflow tract, including 2 previously reported patients who also had focal parchment-like thinning of the left ventricular free wall. Three had documented ventricular tachycardia, and the remaining patient had sudden death as his first and only manifestation of heart disease. Three patients had severe heart failure: in 1, it was fatal, and the other 2 underwent cardiac transplantation. Necropsy cases of parchment-heart syndrome before 1980 are reviewed, as well as large series of cases with arrhythmogenic right ventricular dysplasia (ARVD) reported subsequently. It is suggested that ARVD is not an ideal name for this condition, because malignant ventricular arrhythmias are not universal, the left ventricular free wall and/or ventricular septum are sometimes involved, and the name "ARVD" neglects the fact that severe heart failure may be prominent in these patients. The right ventricular wall can be thin or parchment-like, or it may not be thinned but consist mainly of adipose tissue with or without focal fibrous tissue and a few islands of myocytes. Nevertheless, because the name "ARVD" has been commonly used and recognized for >30 years, it is probably best retained for this condition.