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Background Granulomatous and lymphocytic interstitial lung disease (GLILD) is a life-threatening complication in patients with common variable immunodeficiency (CVID), but the optimal treatment is unknown. Objective Our aim was to determine whether rituximab with azathioprine or mycophenolate mofetil improves the high-resolution computed tomography (HRCT) chest scans and/or pulmonary function test results in patients with CVID and GLILD. Methods A retrospective chart review of clinical and laboratory data on 39 patients with CVID and GLILD who completed immunosuppressive therapy was performed. Chest HRCT scans, performed before therapy and after the conclusion of therapy, were blinded, randomized, and scored independently by 2 radiologists. Differences between pretreatment and posttreatment HRCT scan scores, pulmonary function test results, and lymphocyte subsets were analyzed. Whole exome sequencing was performed on all patients. Results Immunosuppressive therapy improved patients' HRCT scan scores (P Conclusions Immunosuppressive therapy improved the radiographic abnormalities and pulmonary function of patients with GLILD. A majority of patients had sustained remissions.

Resumen Antecedentes La presencia de fibrosis hepatica es el denominador comun de numerosas enfermedades cronicas del higado que pueden evolucionar a fibrosis y a hepatocarcinoma. Las mas importantes por su frecuencia son las hepatitis virales y el higado graso no alcoholico, cuya prevalencia aumenta en proporciones epidemicas. La biopsia hepatica, aun cuando imperfecta, continua siendo el estandar de oro que tiende a ser reemplazado en muchas situaciones clinicas por metodos de imagen no invasivos. Objetivos Describir la experiencia obtenida en nuestro departamento de imagen con la tecnica de elastografia por resonancia magnetica, analizar y comentar los resultados publicados por otros autores en la literatura reciente en gastroenterologia, hepatologia y radiologia, complementada con una busqueda en PubMed de los ultimos 10 anos. Resultados y conclusiones La elastografia por resonancia magnetica es un metodo no invasivo y eficaz, cuyos resultados tienen concordancia con la biopsia hepatica, presenta superioridad sobre los metodos de elastografia por ultrasonido debido a que evalua un volumen mucho mayor de tejido hepatico y muestra la distribucion de las lesiones que, a menudo, es heterogenea. La mayor ventaja del protocolo de resonancia magnetica descrito estriba en cuantificar en la misma sesion, ademas de la fibrosis, el contenido de grasa y de hierro, lo cual se realiza en una exploracion dirigida especificamente a este fin, en un tiempo de 25 min y a un costo-beneficio favorable para el paciente y la institucion.

Background The presence of liver fibrosis is the common denominator in numerous chronic liver diseases that can progress to fibrosis and hepatocellular carcinoma. Most important, with respect to frequency, are viral hepatitis and non-alcoholic fatty liver disease, the prevalence of which is increasing in epidemic proportions. Liver biopsy, albeit imperfect, continues to be the criterion standard, but in many clinical situations tends to be replaced with noninvasive imaging methods. Objectives The aim of the present article was to describe our imaging department experience with magnetic resonance elastography and to analyze and discuss recently published results in gastroenterology, hepatology, and radiology from other authors in the literature, complemented with a PubMed search covering the last 10 years. Results and conclusions Magnetic resonance elastography is an efficacious, noninvasive method with results that are concordant with liver biopsy. It is superior to ultrasound elastography because it evaluates a much greater volume of hepatic tissue and shows the often heterogeneous lesion distribution. The greatest advantage of the magnetic resonance protocol described is the fact that it quantifies fibrosis, fat content, and iron content in the same 25 min examination specifically directed for that purpose, resulting in a favorable cost-benefit ratio for the patient and/or institution.

ResumenLa resonancia magnética con gadolinio para la evaluación de lesiones hepáticas es un método cada vez más utilizado en la práctica clínica, particularmente para pacientes con lesiones focales sospechosas, ya sean benignas o malignas. En el caso del carcinoma hepatocelular, el rendimiento diagnóstico de la resonancia magnética a través de protocolos «convencionales» y mediante la tomografía computarizada multidetector, que consiste en la evaluación de múltiples fases con contraste intravenoso, depende en gran medida del tamaño de la lesión, considerándose más certero en lesiones>2cm. Sin embargo, para aquellas lesiones de 1-2cm, el establecimiento de un diagnóstico definitivo es un verdadero reto, con valores de sensibilidad del 45-65%, aunque por lo general con una excelente especificidad (>95%). Además, si la lesión tiene un diámetro2cm. However, in lesions measuring 1-2cm, establishing the definitive diagnosis is a real challenge, with sensitivity values of 45-65%, but generally with excellent specificity (>95%). Furthermore, if the lesion has a diameter

Gadolinium-enhanced magnetic resonance for the evaluation of hepatic lesions is increasingly being used in clinical practice, especially in patients with suspicious focal lesions, whether benign or malignant. In regard to hepatocellular carcinoma, the diagnostic performance of magnetic resonance through the «conventional» protocols and multi-detector computerized tomography consisting of multiphase evaluation with intravenous contrast, largely depends on the size of the lesion. They are more reliable in lesions>2cm. However, in lesions measuring 1-2cm, establishing the definitive diagnosis is a real challenge, with sensitivity values of 45-65%, but generally with excellent specificity (>95%). Furthermore, if the lesion has a diameter

Aliment Pharmacol Ther 2010; 32: 244–253 Summary Background Obesity increases the risk for severe acute pancreatitis, although abdominal obesity may be a better prognostic marker. Aim To determine if a single anthropometric parameter best predicts severe acute pancreatitis and correlates with intra-abdominal fat. Methods Ninety-nine patients with acute pancreatitis were studied prospectively. Anthropometry included body mass index (BMI) and girths (umbilical/minimum waist, iliac/trochanter hip, thigh). Several waist-to-hip/waist-to-thigh ratios (WHR/WTR) were constructed. A CT-scan with calculation of cross-sectional abdominal fat areas was obtained in 37 cases. Results Severe acute pancreatitis occurred in 25 patients. Waist circumference (WC), WHR and WTR – all using the umbilical reference – most accurately predicted severe acute pancreatitis. Only umbilical WC was retained in multivariate analysis: the risk for severe acute pancreatitis increased 16% with every 1 cm (OR 1.16, 95%CI: 1.1–1.3). Abdominal obesity caused a 6-fold increase in risk. Umbilical WC correlated best with subcutaneous fat area (r = 0.791, P

To evaluate the accuracy of endoscopic ultrasound (EUS) to determine vascular invasion in patients with pancreatic cancer.Data were obtained prospectively from patients with a pancreatic lesion who underwent EUS, computed tomographic (CT) imaging, and surgery from March 2005 to March 2010.Fifty patients were included with a mean ± SD age 61 ± 11.5 years; 27 (54%) were women. The sensitivity, specificity, positive predictive value, and negative predictive value for EUS were the following: 61.1 (95% CI, 38.6-79.7), 90.3 (95% CI, 75.1-96.7), 78.6 (95% CI, 52.4-92.4), and 80 (95% CI, 64.1-90), respectively. The area under the curve for EUS and that for CT were 0.80 (95% CI, 0.68-0.92) and 0.74 (95% CI, 0.61-0.86), respectively. The positive predictive value for arterial invasion was 100% (95% CI, 61-100) for EUS and 60% (95% CI, 31.3-83.2) for CT. There were no complications associated with the EUS or the CT.Endoscopic US is a very good option to detect vascular invasion in patients with pancreatic cancer and is especially sensitive for arterial invasion. When it is available, we recommend that it be performed in addition to CT staging.

Tracheal varices (TV) are uncommon but can be an important source of massive or recurrent haemoptysis. We present a case of TV in a 32-year-old patient with a history of Glenn–Fontan surgery, for congenital tricuspid atresia, and portal hypertension owing to cardiac cirrhosis. We discuss TV presenting as tracheal nodules in the presence of extensive mediastinal collateral circulation.