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The presence of the metabolic syndrome is a strong predictor for the presence of NASH (non-alcoholic steatohepatitis) in patients with NAFLD (non-alcoholic fatty liver disease). In the present study, we assessed LA (left atrial) deformation parameters in patients with NAFLD using 2D-STE (speckle tracking echocardiography) and to investigate if any changes exist between subgroups of the NAFLD. A total of 55 NAFLD patients and 21 healthy controls were included in the study. The diagnosis of NAFLD was based on liver biopsy. After patients were categorized into groups according to histopathological analysis (simple steatosis, borderline NASH, definitive NASH), all patients underwent echocardiography with Doppler examination. In the 2D-STE analysis of the left atrium, LA-Res (peak LA strain during ventricular systole), LA-Pump (peak LA strain during atrial systole), LA-SRS (peak LA strain rate during ventricular systole), LA-SRE (peak LA strain rate during early diastole) and LA-SRA (peak LA strain rate during atrial systole) were obtained. LA-Res, LA-Pump and LA-SRA were lower in the NAFLD group than in the control group. LA-Res was found to be significantly lower in NAFLD subgroups compared with healthy subjects (43.9± 14.2 in healthy controls compared with 31.4± 8.3 with simple steatosis, 32.8± 12.8 with borderline NASH and 33.8± 9.0 with definitive NASH). LA-Pump was significantly lower in the NAFLD group (18.2± 3.1 in healthy controls compared with 13.3± 4.7 with borderline NASH and 14.4± 4.7 with definitive NASH). There were significant differences in LA-SRA between healthy controls compared with simple steatosis and borderline NASH (-1.56± 0.36 compared with 1.14± 0.38 and 1.24± 0.32 respectively). Correlation analysis showed significant correlation of LA-Res values with E (early diastolic peak velocity)/Em (early diastolic mitral annular velocity) ratio (r= -0.50, P ≤ 0.001), with LAVI (LA volume index; r= -0.45, P ≤ 0.001) and with Vp (propagation velocity; r =0.39, P ≤ 0.001). 2D-STE-based LA deformation parameters are impaired in patients with NAFLD with normal systolic function. Although LA-Res and pump function parameters might be useful in estimating LV (left ventricular) filling pressure in the NAFLD patient group, it could not be used for differentiating the subgroups. [ABSTRACT FROM AUTHOR]

AIM: Besides nonalcoholic hepatosteatosis (NAFLD) with intracellular deposition of triglycerides in liver, accumulation of adipose tissue also in pancreas, which is seen usually in septa, attracts growing attention. In this study, we aimed to investigate the ultrasonographic (US) and clinical features of non-alcoholic pancreatic steatosis (NAPS) and compare with NAFLD.. MATERIAL & METHOD: The study group consisted of 345 consecutive patients referred to same radiologist for abdominal US. The demographic, anthropometric and laboratory data from medical records were retrospectively collected. The comparison between NAFLD and NAPS was done by these data including obesity, insulin resistance, cholecystolithiasis, lipid profile, and diabetes mellitus (DM). US grading of liver was evaluated as: Grade 0 with absence of any steatosis, Grade 1 (mild) steatosis indicate increased liver echogenicity with normal periportal and diaphragmatic visualisation. Grade 2 (moderate): diffuse increase in parenchymal echogenicity with blurred diaphragmatic and portal vein borders. Grade 3 (severe) steatosis has diffuse echogenicity with poor or no visualisation of portal vein borders, diaphragm and posterior lobes of liver. Similar grading for pancreatosteatosis is as follows: Grade 0 shows similar echogenicity as renal cortical level. Grade 1: mild fatty pancreas with an echogenicity definitely lower than retroperitoneal fat, Grade 2: moderate level image slightly lower than retroperitoneal fat, Grade 3:equal echogenicity with retroperitoneal fat.. RESULTS: Consecutive 345 patients composed of 220 (64%) females and 125 (36%) males had mean age 51±15 years. US evaluation showed 219 (63.5%) of patients had NAFLD and 227 (65,8%) had NAPS. Patients with NAFLD had normal pancreatic echogenicity in 20%, while no NAFLD was assessed in 23% of NAPS. Diabetic patients (n=84, 24%) had discordance of steatosis in NAFLD and NAPS in 19% of cases. Of 219 NAFLD patients 44 (20%) had elevated ALT and regarded as NASH. In these patients 23% had also normal pancreatic echogenicity. In 55% of both liver and pancreatic steatotosis cases (n=271, 79%) had discordance in grading. NAPS was more related with male gender, older age, cholecystolithiasis, hyperglycemia, insülin resistance. NAFLD was more related with obesity, hepatomegaly, Steatosis of both organs were related with DM, age, Body Fat Percentage (BFP), hyperglycemia, hypertriglyceridemia.CONCLUSION: In this study, pancreatosteatosis was not parallel in all aspects of hepatosteatosis by means of US, clinical, demographic and anthropometric features. Despite to grade 2-3 pancreatosteatosis, 28,7% of the cases had normal liver echogenicity. The difference in grading between steatotic cases in liver and pancreas had discordance as 55%. Thus, wide-range studies with operator independent measurements are needed to compare NAFLD and NAPS discordance to identify if any pathophysiological difference exist. [ABSTRACT FROM AUTHOR]

Abstract: Background: Breast metastasis is an extremely rare phenomenon. While nearly every malignancy has been described to metastasize to the breast; melanoma, lymphoma and leukemia tend to be the most common. Among these primary tumors, melanoma metastasis represents a diagnostic pitfall for both the clinicians and histopathologists. Methods: We report a case of widely metastatic malignant melanoma with diagnostic difficulties in both clinical and histopathological evaluation. Thorax CT, Abdominal MRI, tumor marker screening and two biopsies were performed to conclude the primary. Results: In clinical evaluation, there were rapidly proliferating multiple nodular lesions at the skin, breasts, lungs, ovaries and peritoneum accompanied by only increased CA 125 in tumor marker panel. The initial biopsy performed from a skin nodule was concordant with a metastatic carcinoma suggesting breast as the primary. The diagnosis was made by immunohistochemical staining of the second biopsy performed from a breast nodule. Conclusion: Although no strict clinical criteria exist to differentiate a melanoma metastasis to the breast from a primary breast carcinoma atypically rapid growth, normal Ca 15-3 level, and a history of prior melanoma may be helpful. However, it may be still misdiagnosed in some cases even histopathologically if the immunohistochemical staining is not performed. [Copyright &y& Elsevier]

A letter to the editor is presented in response to the article which discusses the several side effects of psychostimulant and hallucinogen drug, 4- methyline dioxy-metamphetamine (MDMA) popularly known as "ecstacy" which includes hyperthermia, cerebral edema and hepatotoxicity.

Aim: To analyze the relationship between the serum lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) levels and clinical and histopathological features of biopsy-confirmed nonalcoholic fatty liver disease (NAFLD) patients., Methods: Fifty-three consecutive, biopsy-proven NAFLD patients (31 males and 22 females, mean age 42.5 ± 9.6 years) and 26 age- and gender-matched, healthy controls (14 males and 12 females, mean age 39 ± 10.7 years) were included. The patients with NAFLD were consecutive patients who had been admitted to the hepatology outpatient clinic within the last year and had been diagnosed with NAFLD as the result of liver biopsy. The healthy controls were individuals who attended the outpatient clinic for routine health control and had no known chronic illnesses. The histological evaluation was conducted according to the NAFLD activity scoring system recommended by The National Institute of Diabetes and Digestive and Kidney Diseases Nonalcoholic Steatohepatitis Clinical Research Network. The serum LOX-1 levels were measured using an ELISA kit (Life Science Inc. USCN. Wuhan, Catalog No. E1859Hu) in both patients and healthy controls. A receiver operating characteristic (ROC) curve analysis was used to identify the optimal cutoff value of LOX-1 and thereby distinguish between patients with nonalcoholic steatohepatitis (NASH) and healthy controls. A P-value < 0.05 was considered statistically significant., Results: NAFLD and healthy control groups were similar in terms of age and sex. NAFLD patients consisted of 8 patients with simple steatosis (15%), 27 with borderline NASH (51%) and 18 with definitive NASH (34%). Metabolic syndrome was found in 62.2% of the patients with NAFLD. The mean serum LOX-1 level in biopsy-proven NAFLD patients was 8.49 ± 6.43 ng/mL compared to 4.08 ± 4.32 ng/mL in healthy controls (P = 0.001). The LOX-1 levels were significantly different between controls, simple steatosis and NASH (borderline+definite) cases (4.08 ± 4.32 ng/mL, 6.1 ± 6.16 ng/mL, 8.92 ± 6.45 ng/mL, respectively, P = 0.004). When the cut-off value for the serum LOX-1 level was set at 5.35 ng/mL, and a ROC curve analysis was performed to distinguish between steatohepatitis patients and controls; the sensitivity and specificity of the serum LOX-1 level were 69.8% and 69.2%, respectively., Conclusion: The serum LOX-1 levels were significantly higher in NAFLD patients than in healthy controls. Additionally, the serum LOX-1 levels could differentiate between steatohepatitis patients and healthy controls.

Aim: To investigate the effect of human leukocyte antigen (HLA) DRB1 and DQB1 alleles on the inactive and advanced stages of chronic hepatitis B., Methods: Patient records at a single institution's hepatology clinic were reviewed. Demographic data, laboratory results, endoscopy results, virological parameters, biopsy scores and treatment statuses were recorded. In total, 355 patients were eligible for the study, of whom 226 (63.7%) were male. Overall, 82 (23.1%) were hepatitis B early antigen (HBeAg) positive, 87 (24.5%) had cirrhosis, and 66 (18.6%) had inactive disease. The presence of DQB1 and DRB1 alleles was determined by polymerase chain reaction with sequence-specific primers. The distribution of the genotyped alleles among patients with cirrhosis and patients with chronic active hepatitis was analyzed., Results: The most frequent HLA DQB1 allele was DQB1*03:01 (48.2%), and the most frequent HLA DRB1 allele was DRB1*13/14 (51.8%). DQB1*05:01 was more frequent in patients with active disease than in inactive patients (27% vs 9.1%; P = 0.002, Pc = 0.026). DRB1*07 was rare in patients with cirrhosis compared with non-cirrhotics (3.4% vs 16%; P = 0.002, Pc = 0.022). Older age (P < 0.001) and male gender (P = 0.008) were the other factors that affected the presence of cirrhosis. In a multivariate logistic regression analysis, DRB1*07 remained a significant negative predictor of cirrhosis (P = 0.015). A bioinformatics analysis revealed that a polymorphic amino acid sequence in DRB1*07 may alter interaction with the T-cell recognition site., Conclusion: This study demonstrates that HLA alleles may influence cirrhosis development and disease activity in Turkish chronic hepatitis B patients.

Aim: To investigate serum insulin-like growth factor-binding protein 5 (IGFBP-5) levels and intestinal IGFBP-5 expression in patients with Crohn's disease (CD)., Methods: We analyzed the serum concentrations and intestinal expression of IGFBP-5 in 42 patients with CD, of whom 26 had endoscopically or radiologically proven stricture formation. Nine of the 42 patients had active disease, with a Crohn's disease activity index > 150. Serum IGFBP-5 levels were analyzed in 20 healthy controls matched by sex and age to the CD patients. Serum IGFBP-5 was measured using an enzyme-linked immunosorbent assay. Intestinal tissue was obtained from patients through endoscopic biopsies. IGFBP-5 expression was detected using immunohistochemistry and was scored semiquantitatively., Results: The median serum IGFBP-5 concentrations of CD patients were significantly lower compared with healthy controls [median 7.2 (IQR: 5.5-11.3) ng/mL vs 11.3 (8.0-44.6) ng/mL, P < 0.001]. There was no significant difference between median serum IGFBP-5 levels in CD patients with or without stricture formation [6.9 (5.5-11.3) ng/mL vs 7.8 (5.3-10.1) ng/mL, P = 0.815]. The serum IGFBP-5 levels were not significantly different between patients with active disease and inactive disease [7.2 (6.5-7.6) ng/mL vs 7.2 (5.5-11.3) ng/mL, P = 0.890]. However, a significant correlation was observed between serum IGFBP-5 levels and platelet count (PLT) (r = 0.319, P = 0.0395). No significant correlation was found between tissue IGFBP-5 immunohistochemical staining intensity scores and serum IGFBP-5 levels. No significant difference was found when comparing the serum IGFBP-5 levels among the patients with different tissue IGFBP-5 staining scores (absent/very weak, weak, moderate or strong). There was a significant correlation between tissue IGFBP-5 staining scores and white blood cell count (r = 0.391, P = 0.01) and PLT (r = 0.356, P = 0.021)., Conclusion: Our results indicate that serum IGFBP-5 concentrations were lower in CD patients compared to healthy controls regardless of disease activity or the presence of stricture formation.