Should patients with asymptomatic wolff-parkinson-white pattern undergo a catheter ablation?

Many individuals with the Wolff-Parkinson-White electrocardiographic pattern are asymptomatic. Optimal manangement of these individuals is still a matter of debate. On the one hand, sudden cardiac death from ventricular fibrillation is a rare yet possible outcome in these individuals. On the other hand, there is a low risk of serious complication from electrophysiologic study and ablation. Given that the risk of these competing strategies is comparable, the decision needs to be individualized with considerable patient input.     

Should a liver biopsy be done in patients with subclinical chronically elevated transaminases?

In 10% of the patients with chronic abnormal alanine aminotransferase (ALT) levels no cause is found. The prognosis of this liver disease, the increased risk of liver fibrosis regardless of the types of histological lesions and the need for a liver biopsy are unknown. Nearly 50% of these cases are explained by non-alcoholic steatohepatitis (NASH). The aim of this study was to evaluate, in patients with accidentally detected chronically elevated ALT levels, the prevalence of fibrosis and NASH, and the clinical and biological factors associated with each entity. Retrospectively, 67 patients (mean age, 46.6 +/- 12.1 years; 45 males) were included. All patients had a liver biopsy and were hepatitis B virus, hepatitis C virus, human immunodeficiency virus seronegative without alcohol, drug, autoimmune or genetically induced liver disease, with ALT > N (the upper limit of normal). NASH was evaluated according to necroinflammatory lesions and fibrosis. Fibrosis was evaluated according to the METAVIR score. Statistical analyses were performed using Student's t test, the Mann-Whitney rank-sum test and the chi-square test. Fibrosis scores were: F0, 37.3%; F1, 32.8%; F2, 26.9%; F3, 1.5%; and F4, 1.5%. NASH was absent in 59.7% and present in 40.3%. Significant differences were observed between F < 2 and F > or = 2 fibrosis patients for aspartate aminotransferase (AST) and ALT and between patients with NASH or without for body mass index. Overall, the risk of F > or = 2 fibrosis was increased in patients with AST > N, ALT > 2N or AST > N and ALT > 2N. The prevalence of F > or = 2 fibrosis and NASH in patients with unexplained chronic abnormal ALT are 30% and 40%, respectively. Since the risk of F > or = 2 fibrosis is significantly increased in patients with AST > N and/or ALT > 2N, liver biopsy should be performed only in patients with AST > N or ALT > 2N.     

Celiac disease serology in patients with different pretest probabilities: Is biopsy avoidable?

AIM: To establish the diagnostic performance of sev-eral serological tests, individually and in combination, for diagnosing celiac disease (CD) in patients with different pretest probabilities, and to explore potential se- rological algorithms to reduce the necessity for biopsy. METHODS: We prospectively performed duodenal biopsy and serology in 679 adults who had either high risk (n = 161) or low risk (n = 518) for CD. Blood samples were tested using six assays (enzyme-linked immunosorbent assay) that dete...     

Should a radiological diagnosis of hepatocellular carcinoma be routinely confirmed by a biopsy? No

Modern multiphase diagnostic imaging allows diagnosis of hepatocellular carcinoma with high specificity in a large proportion of cases. Additional aspects of tumor biology also can be evaluated noninvasively through observation of tumor behavior (growth rate, satellites, vascular invasion) and other indicators of tumor biology (avid uptake of fluorodeoxyglucose, high circulating levels of tumor markers such as alphafetoprotein). Routinely requiring biopsy confirmation for diagnosis of HCC exposes many patients to unnecessary risk, may delay diagnosis, and in some cases leads to withholding of potentially beneficial treatment. Biopsy for assessment of tumor molecular markers is promising but remains investigational. When diagnosis of HCC is clinically evident by imaging criteria, tumor biopsy should not be required prior to initiating treatment.     

Should a radiological diagnosis of hepatocellular carcinoma be routinely confirmed by a biopsy? Yes

Hepatocellular carcinoma (HCC) represents approximately 85 to 90% of all primary liver cancers (PLC) and every year, more than 560,000 people are diagnosed as affected by this cancer.The identification of risk factors for HCC prompted the creation of screening and surveillance programs in patients affected by chronic liver diseases with the aim of detecting HCC nodules as soon as possible and provide effective and hopefully curative therapyA correct diagnosis is of paramount importance for the surveillance program as well as for the choice of the appropriate therapy. Both in the diagnosis of small HCC and in the choice of the therapy for locally advanced HCC the diagnosis must be certain.Improvements of the radiological imagine techniques have surely enhanced both early diagnosis and tumor staging, allowing a reasonably accurate diagnosis, but cannot provide the certainty that in clinical practice is essential for an adequate workout.Therefore, the histopatological definition of the tumor is imperative both for an appropriate therapy and for an accurate prognostic evaluation.