Incretin mimetics as a novel therapeutic option for hepatic steatosis.

BACKGROUND: Fat accumulation in the liver or non-alcoholic fatty liver disease (NAFLD) is regarded as a key pathogenic factor and component of the metabolic syndrome. It was reported that administration of the incretin mimetic exenatide reversed hepatic steatosis in an obese mouse model. We had the opportunity to study the effect of additional exenatide administration on liver fat content in a patient with type 2 diabetes. CASE REPORT: A 59-year-old male with poorly controlled type 2 diabetes was treated with exenatide in addition to metformin monotherapy. Following 44 weeks of exenatide therapy, mean the liver fat measured by liver spectroscopy declined from 15.8% to 4.3%. This dramatic decrease in liver fat was accompanied by significant beneficial changes in several cardiovascular disease risk factors and improvement of all liver enzymes, in particular alanine aminotransferase, the most important marker of liver steatosis. CONCLUSION: This case report suggests that the incretin mimetic exenatide decreases hepatic fat accumulation and may play a role in the future treatment of NAFLD, and the associated insulin resistance and cardiovascular risk factors in an ever-growing high-risk population.     

Use of Antibiotic Prophylaxis in Ear Surgery

A prospective, double-blind, randomized, placebo-controlled study was performed to evaluate the effect of antibiotic prophylaxis in ear surgery. The present study reports on the results of 750 patients, half of whom received cefuroxime for 1 day, the other half, placebo. All postoperative infections occurring within 2 weeks after the intervention were recorded, together with several preoperative and perioperative parameters. It is concluded that exploratory tympanoplasties (including stapedotomy) and “dry perforation” tympanoplasties should be considered “clean” operations according to the American National Research Council and do not benefit from antibiotic prophylaxis. On the other hand, tympanoplasties performed on draining ears and on ears with cholesteatoma should be considered “dirty” operations for which antibiotic prophylaxis may decrease the postoperative infection rate by factor 3. All postoperative infections healed without sequels under proper treatment, except for three that resulted in graft necrosis-one in the placebo group and two in the cefuroxime group. In consequence, prophylaxis may not be mandatory in the dirty group, although the authors advocate its use for the sake of patient and surgeon comfort.     

Clinical achievements of the EORTC Lymphoma Group and aspects of future group strategy

Since 1964, the EORTC Lymphoma Group has conducted nine consecutive randomized phase III trials on early-stage Hodgkin lymphoma aimed at increasing efficacy while decreasing short- and long-term toxicities. Event-free and overall survival significantly improved from about 50% and 70%, respectively, in the early years to over 80% and 90%, respectively, more recently. Identification of prognostic subgroups appeared to be a successful method to tailor treatment strategies. Radiotherapy fields have become more restricted whereas chemotherapy has become standard. Early PET-CT has been introduced to investigate the possibility of treatment adaptation. Longitudinal quality-of-life assessment has become an integral part of our studies. An ongoing study focuses on the rehabilitation and quality of long-term survival in all 6658 Hodgkin lymphoma patients treated in EORTC trials since the earliest beginning. In advanced stages overall outcome has improved as well with 10-year survival rates of over 75%.