No abstract

• Acoustic radiation force impulse imaging provides ultrasonic shear wave velocity measurements. • SWV measurements were higher in patients with inflammation or fibrosis than NAFLD. • ARFI differentiates NAFLD from NASH in patients with morbid obesity. • Results suggest that ARFI can detect NASH in asymptomatic morbidly obese patients.

The value of intraoperative frozen-section biopsy of thyroid nodules (solitary or dominant in a multinodular goitre) was examined in patients who underwent fine-needle aspiration cytology (FNAC) for diagnosis before operation. A total of 170 consecutive patients were evaluated and classified according to whether the cytological diagnosis was benign, suspicious or malignant. In the benign group, diagnostic accuracy was 98 per cent for FNAC and 97 per cent for intraoperative biopsy. In those with suspicious cytology, diagnostic accuracy was 12 per cent for FNAC and 96 per cent for intraoperative biopsy. In those with malignant cytology there was 100 per cent accuracy for FNAC and 76 per cent for biopsy. Intraoperative biopsy by frozen section is useful in patients undergoing surgery for a thyroid nodule with a 'suspicious' cytology. It adds no information in patients with a diagnosis of malignancy following cytological assessment and is of limited use in those in whom a benign lesion is diagnosed.

Although fine-needle aspiration is being currently accepted as the most reliable method to select patients with thyroid nodules for surgery, controversy remains about the accuracy in distinguishing benign nodules. We present our results from 636 fine-needle aspirations performed from 1984 to 1989. Our article focuses on the value of cytologic expertise and repeated punctures for follow-up of benign nodules. We found annual figures for specificity and positive predictive value to increase steadily from 1984 to 1989, thus suggesting that the power of the test is proportional to the experience of the cytologist. We also state that the value of performing repeated punctures for the follow-up of unselected benign nodules is low.

We report the first case of hemophagocytic lymphohistiocytosis (HLH) induced by the monoclonal expansion of Epstein-Barr virus (EBV)-negative NK cells. Consanguinity of the patient's parents made it necessary to discard familial HLH in the patient and her sister with identical HLA markers and demonstrate that no cause other than the expansion of NK cells, which secrete high levels of gamma interferon, was inducing HLH in this patient. CASE REPORTA 17-month-old Ecuadorian girl was admitted to our hospital, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain, in September 2005, because of a fever and cytopenias (leukocytes, 11.6 ϫ 10 9 /liter; hemoglobin, 7.9 g/dl; platelets, 65 ϫ 10 9 /liter) which had persisted for over 3 weeks, splenomegaly (10 cm), hepatomegaly (5 cm), multiple adenopathies, purpura, and edema. The father and mother were cousins and healthy, the patient's gestation and birth had been normal, but recurrent fever episodes were reported from 3 months of age. The girl was vaccinated normally. Biochemical analysis showed normal values for fibrinogen (232 mg/dl; range, 150 to 450 mg/dl) and elevated levels of ferritin (278 ng/ml; normal range, 15 to 150 ng/ml) and triglycerides (311 mg/dl; normal range, 50 to 200 mg/dl). Serology demonstrated anti-cytomegalovirus