Thomas Karlas

• Professor
• Consultant at Leipzig University

Purpose Obesity and type 2 diabetes (T2DM) are major risk factors for hepatic steatosis. Diet or bariatric surgery can reduce liver volume, fat content, and inflammation. However, little is known about their effects on liver function, as evaluated here using the LiMAx test. Methods In the MetaSurg study (RCT on the effects of different Roux-en-Y g...

Introduction: The accurate distinction between benign and malignant biliary strictures (BS) poses a significant challenge. Despite the use of bile duct biopsies and brush cytology via endoscopic retrograde cholangiopancreaticography (ERCP), the results remain suboptimal. Single-operator cholangioscopy can enhance the diagnostic yield in BS, but it...

Background This research investigates the determinants of circulating FGF21 levels in a cohort reflecting metabolic disease progression, examining the associations of circulating FGF21 with morphology and function of adipose tissue (AT), and with metabolic adjustments following metabolic surgery. Methods We measured serum FGF21 in 678 individuals...

LINKED CONTENT This article is linked to Siddiqi et al paper. To view this article, visit https://doi.org/10.1111/apt.18118

Background Attenuation coefficient (AC) and shear-wave speed (SWS) are established US markers for assessing patients with metabolic dysfunction-associated steatotic liver disease (MASLD), while shear-wave dispersion slope (DS) is not. Purpose To assess the relationship between the multiparametric US imaging markers DS, AC, and SWS and liver histopa...

This continuing medical education article highlights the central role of transcutaneous sonography in diagnosing parenchymal pancreatic diseases. It emphasizes the importance of in-depth knowledge of sonographic imaging of organ anatomy and a structured examination methodology, particularly for identifying acute and chronic pancreatitis and related...

Pyogenic liver abscesses (PLA) are life-threatening disorders and require immediate treatment, but structured evidence is sparse and treatment guidelines are not established. In a retrospective observational study of 221 adult PLA patients (mean age 63 years, 63% men) treated between 2013 and 2019 at the Leipzig University Medical Center, we charac...

Objective: This research aims to uncover the factors influencing circulating FGF21 levels in a cohort mimicking metabolic disease progression, examining its relationship with adipose tissue (AT) morphology and function. It also investigates FGF21 level changes post-metabolic surgery, predictive factors, and their links to metabolic adjustments. Met...

Purpose Ultrasound-guided biopsy of focal liver lesions (FLL) is a well-established procedure with crucial impact on therapeutic decisions. The safety and accuracy depend on needle type, tumour location and comorbidities. Modern oncological concepts often require large tumour specimens which may increase the procedural risk. Materials and methods...

Background and Aims Steatotic liver disease (SLD) is generally considered to represent a hepatic manifestation of metabolic syndrome and includes a disease spectrum comprising isolated steatosis, metabolic dysfunction‐associated steatohepatitis, liver fibrosis and ultimately cirrhosis. A better understanding of the detailed underlying pathogenic me...

Background & Aims There is a need to reduce the screen failure rate (SFR) in metabolic dysfunction‐associated steatohepatitis (MASH) clinical trials (MASH+F2‐3; MASH+F4) and identify people with high‐risk MASH (MASH+F2‐4) in clinical practice. We aimed to evaluate non‐invasive tests (NITs) screening approaches for these target conditions. Methods...

As an extension of the clinical examination and as a diagnostic and problem-solving tool, ultrasound has become an established technique for clinicians. A prerequisite for high-quality clinical ultrasound practice is adequate student ultrasound training. In light of the considerable heterogeneity of ultrasound curricula in medical studies worldwide...

Zusammenfassung Die Simulation diagnostischer und therapeutischer Prozeduren nimmt in der medizinischen Aus- und Weiterbildung einen wachsenden Stellenwert ein und ist auch für das Erlernen von Ultraschallverfahren zunehmend relevant. In der vorliegenden Übersichtsarbeit werden die verschiedenen Simulationsstufen der Ultraschallmethodik und deren t...

Purpose Ultrasound (US) represents the primary approach for abdominal diagnosis and is regularly used to guide diagnostic and therapeutic interventions (INVUS). Due to possible serious INVUS complications, structured training concepts are required. Phantoms can facilitate teaching, but their use is currently restricted by complex manufacturing and...

Introduction Guidelines increasingly recommend the use of glucagon-like peptide-1 receptor agonists (GLP-1 RA) or sodium-glucose co-transporter-2 inhibitors (SGLT2i) to prevent cardiovascular and cardiorenal endpoints. Both drugs also show beneficial effects in nonalcoholic fatty liver disease (NAFLD). Preexisting GLP-1 RA and SGLT2i therapies are...

This study evaluated the impact of obesity on abdominal ultrasound diagnostics and assessed effect of high-performance ultrasound probes increased imaging quality. Lean and obese subjects (n = 40; 58% female) were categorized according to body mass index (BMI, 21 to 48 kg/m²). A highly standardized ultrasound examination of the abdomen was performe...

Introduction Fatty liver diseases (FLD), especially defined as metabolic dysfunction-associated FLD (MAFLD), is of growing importance for patients and health-care providers. Extrahepatic comorbidities, predominantly coronary artery disease (CAD), contribute to excess morbidity and mortality in FLD. Although the association of FLD and CAD is well kn...

Klebsiellen-Leberabszesse (KLA) sind als abgegrenzte Eiteransammlung im Lebergewebe aufgrund einer Infektion mit gramnegativen Bakterien der Gattung Klebsiella definiert ([Abb. 1]). Als „emerging infections“ erlangen insbesondere hypervirulente Klebsiella pneumoniae (hvKP) der Kapsel-Serotypen 1 und 2 (K1, K2) weltweit eine zunehmende Bedeutung, da...

LINKED CONTENT This article is linked to Lee et al papers. To view these articles, visit https://doi.org/10.1111/apt.17601 and https://doi.org/10.1111/apt.17627

Background: Histologically assessed liver fibrosis stage has prognostic significance in patients with non-alcoholic fatty liver disease (NAFLD) and is accepted as a surrogate endpoint in clinical trials for non-cirrhotic NAFLD. Our aim was to compare the prognostic performance of non-invasive tests with liver histology in patients with NAFLD. Met...

Purpose Blood flow dynamics represent a diagnostic criterion for many diseases. However, no established reference standard is available. In clinical practice, ultrasound pulsed-wave Doppler (PW-Doppler) is frequently used to assess visceral blood flow, despite its well-known limitations. A quantitative analysis of conventional color Doppler pattern...

Background: We evaluated the diagnostic accuracy of simple non-invasive tests(NITs) in NAFLD patients with type 2 diabetes(T2D). Methods: This was an individual patient data meta-analysis of 1780 patients with biopsy-proven NAFLD and T2D. The index tests of interest were FIB-4, NAFLD Fibrosis Score(NFS), APRI, liver stiffness measurement(LSM) by...

Zusammenfassung Die Ultraschalldiagnostik ist in vielen klinischen Situationen das Verfahren der ersten Wahl für die abdominelle Bildgebung. Neben dem Graustufenbild (B-Modus) und den klassischen Dopplerverfahren ermöglichen die kontrastmittelverstärkte Sonografie (CEUS), die Elastografie und die Fettquantifizierung eine multimodale Charakterisieru...

Klebsiellen-Leberabszesse (KLA) sind als abgegrenzte Eiteransammlung im Lebergewebe aufgrund einer Infektion mit gramnegativen Bakterien der Gattung Klebsiella definiert ([Abb. 1]). Als „emerging infections“ erlangen insbesondere hypervirulente Klebsiella pneumoniae (hvKP) der Kapsel-Serotypen 1 und 2 (K1, K2) weltweit eine zunehmende Bedeutung, da...

Background and aims Transient Elastography is a non-invasive, cost-efficient, non-ionizing, observer-independent and reliable method to detect liver fibrosis using Liver Stiffness Measurement (LSM) and the degree of fat accumulation in the liver using Controlled Attenuation Parameter (CAP). This study aims to derive reference values for both measur...

Die Ultraschalldiagnostik ist bei internistischen Akutsituationen vielfältig einsetzbar. In diesem Kapitel werden Grundlagen der Anwendung am Abdomen beschrieben und Hilfestellungen für den klinischen Alltag gegeben.

Purpose People with obesity often develop non-alcoholic fatty liver disease (NAFLD) and are at high risk of progression to non-alcoholic steatohepatitis (NASH). Few therapies are effective other than bariatric surgery. We therefore analyzed data from duodenal-jejunal bypass liner (DJBL) patients regarding steatosis, fibrosis, and NASH. Methods Con...

Background Escherichia coli (E. coli) is a common human pathogen, responsible for a broad spectrum of infections. Sites of infection can vary, but the hepato-biliary system is of particular concern due to the infection-associated formation of gallstones and the spread of pathogens from the bile ducts into the bloodstream. Case presentation The pre...

Patient-reported outcomes are important in nonalcoholic fatty liver disease (NAFLD). Pruritus is of special interest for evolving therapies with farnesoid X receptor (FXR) agonists. The aim of this study was to investigate the prevalence of pruritus in a real-life NAFLD cohort and analyze associations with anxiety and depression. Pruritus was asses...

Background and aims: Transient elastography [vibration-controlled transient elastography (VCTE)] noninvasively guides risk stratification in patients with nonalcoholic fatty liver disease (NAFLD). Patients with nonalcoholic steatohepatitis (NASH) and fibrosis can be identified using the FAST-score. The liver maximum function test (LiMAx) could be...

Chronic pancreatitis is characterized by recurrent inflammatory episodes. The diagnosis is based on the detection of pathognomonic morphological alterations by ultrasound-based methods as well as computed tomography and magnetic resonance imaging. In addition, imaging techniques play an important role for the differential diagnostics of potential c...

Background & aims: Probe choice (M or XL) in transient elastography can be made by the user's own measure of skin-to-liver-capsule distance (SCD) or with an automated tool (AUTO). We studied how AUTO depends on initial probe choice. Methods: Three fictive clinics were considered: The "M-first clinic" uses AUTO from the M probe, the "XL-first cli...

Background Pyogenic liver abscesses (PLAs) represent potentially life-threatening abdominal conditions that require immediate diagnosis and therapy. European and American incidence figures vary between one and 15 per 100,000 per year. Structured epidemiological data for European countries are not available. Objective To systematically characterize...

https://eacademy.escmid.org/escmid/2021/eccmid-2021/327636/lisa.zimmermann.epidemiology.of.pyogenic.liver.abscesses.in.germany.html?f=menu=14*browseby=8*sortby=2*media=3*speaker=863109

Objective Liver biopsy is still needed for fibrosis staging in many patients with non-alcoholic fatty liver disease. The aims of this study were to evaluate the individual diagnostic performance of liver stiffness measurement by vibration controlled transient elastography (LSM-VCTE), Fibrosis-4 Index (FIB-4) and NAFLD (non-alcoholic fatty liver dis...

Introduction Invasive liver abscess syndrome (ILAS) is caused by strains of hypervirulent Klebsiella pneumoniae (hvKp) and has emerged as the leading cause of liver abscesses in immuno-competent patients (L.K. Siu et al. Lancet Infect Dis 2012; 12: 881–87). ILAS is frequently associated with metastatic spread including the eyes, lungs, and the cent...

Hepatic steatosis is a commonly seen phenomenon in clinical practice and is the result of the accumulation of lipids in the hepatocytes. In most cases steatosis refers to nonalcoholic fatty liver disease (NAFLD), but it also occurs in other diseases of the liver parenchyma of a different etiology and is the result of the dysregulation of metabolic...

Background Diagnostic tools for liver disease can now include estimation of the grade of hepatic steatosis (S0 to S3). Controlled attenuation parameter (CAP) is a non-invasive method for assessing hepatic steatosis that has become available for patients who are obese (FibroScan XL probe), but a consensus has not yet been reached regarding cutoffs a...

Patients with type 2 diabetes (T2D) are at risk for non-alcoholic fatty liver disease (NAFLD) and associated complications. This study evaluated the performance of international (EASL-EASD-EASO) and national (DGVS) guidelines for NAFLD risk stratification. Patients with T2D prospectively underwent ultrasound, liver stiffness measurement (LSM) and s...

Background: This prospective multicenter study funded by the DEGUM assesses the diagnostic accuracy of standardized contrast-enhanced ultrasound (CEUS) for the noninvasive diagnosis of hepatocellular carcinoma (HCC) in high-risk patients. Methods: Patients at high risk for HCC with a histologically proven focal liver lesion on B-mode ultrasound wer...

Background: Cystic echinococcosis is a zoonotic infection caused by Echinococcus granulosus. This case report shows the difficulty in differential diagnosis in a patient with highly suspected hydatid disease. Case presentation: A 29-year-old Chinese woman presented with progressive abdominal distension. Imaging results revealed a large multicyst...

Wilson’s disease (WD) is an inherited disorder of copper metabolism that effects liver and brain function. Liver involvement presents as either acute liver failure or chronic hepatitis that may eventually progress to cirrhosis. Systematic data on the use of liver stiffness measurement (LSM) in WD are scarce due to the low prevalence of the disease....

Diagnosis and treatment of hematological disorders represent a complex field that may involve the liver and, hence, liver stiffness (LS). In affected patients, alterations in liver perfusion, drug-induced hepatoxicity, and malign infiltration can all modulate LS. Considering the low incidence of specific liver-related complications in the field of...

Liver stiffness (LS) is a tissue characteristic that reflects a combination of fibrosis stage, liver perfusion and inflammation, and is modulated by several technical confounders of the measurement technique. Liver steatosis results from metabolic alterations associated with diabetes mellitus and obesity. It is defined by the presence of lipid drop...

Background: Licensed therapies for nonalcoholic fatty liver disease (NAFLD) do not yet exist, but clinical trials are testing treatment options. Inclusion criteria often require liver biopsy showing fibrosis (F2/3) or cirrhosis (F4) and nonalcoholic steatohepatitis (NASH). However, histological criteria pose a serious obstacle for recruitment. Aims...

Allogeneic hematopoietic stem cell transplantation is the only curative option for a variety of diseases. Despite advances, it is associated with considerable morbidity and mortality, often involving liver complications. Liver disease can be characterized using ultrasound-based liver stiffness measurement. To assess its prognostic value, consecutiv...

In the original article, the affiliations were presented incorrectly. David Petroff is in fact the only author at affiliation 2. All other authors listed as being at affiliation 2 (Tina Weiße, Sebastian Beer, Franziska Gnatzy, Joachim Mössner, Michael Tröltzsch, Johannes Wiegand and Volker Keim) are in fact just at affiliation 1. These have now bee...

Introduction The prevalence of alveolar echinococcosis (AE) and cystic echinococcosis (CE) in Germany is increasing. The number of cases in northern and eastern regions is low, so there is little experience with regard to diagnosis and therapy. Objectives The objective of this paper was to evaluate the management of suspected and/or diagnosed echin...

Wir berichten über einen 40-jährigen Patienten, der zahnärztlich mittels Extraktion von tief zerstörten 3. Molaren und eines 1. Molaren sowie systematischer, geschlossener Parodontitistherapie versorgt wurde. Unmittelbar nach der zahnärztlichen Behandlung zeigte der Patient keinerlei Anzeichen für eine lokale oder systemische Infektion. Die Behand-...

Conventional ultrasound (US) is the first-line imaging method for abdominal pathologies, but its diagnostic accuracy is operator-dependent, and data storage is usually limited to two-dimensional images. A novel tomographic US system (Curefab CS, Munich, Germany) processes imaging data combined with three-dimensional spatial information using a magn...

Zusammenfassung Wir berichten über einen 40-jährigen Patienten, der sich mit Fieber, Druckschmerz im rechten Oberbauch, atemabhängigen rechtsseitigen Thoraxschmerzen und akuter Dyspnoe vorstellte. Bildgebend wurden größere Leberabszesse sowie ein ausgedehntes rechtsseitiges Pleuraempyem nachgewiesen. 16 Wochen zuvor hatte sich der Patient einer Zah...

The relevance of gastrointestinal manifestations of cystic fibrosis (CF) is increasing due to an improved life expectancy. We report on 2 adult patients with prior lung transplantation who presented with a severe inflammatory disorder of the ileocecal region. One patient underwent ileocecal resection; the second patient died after emergency surgery...

Rationale: Allogeneic haematopoietic stem cell transplantation (HCT) is the only curative option for a variety of malignant and non-malignant diseases and is increasingly used, even in elderly and medically unfit patients (pts). Despite advances, it is associated with considerable morbidity and mortality. Major obstacles to a successful outcome are...