Weekend Hepatitis News;One in 12 people worldwide are living with chronic hepatitis B or C.

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Hepatitis: A silent killer
By Meena Sreenivasan
Peter Chan, 55, is what we'd call a walking miracle. He falls under the one percentage of individuals who no longer have Hepatitis B after suffering many years of infection. He was 30 when he was first diagnosed with chronic hepatitis B.
"It was only after I read an article about hepatitis in New Straits Times that I had a better understanding of the disease. My father died of liver cancer and my siblings had jaundice at some point or another. Based on the information given in the write-up, I knew I was a likely candidate for hepatitis B.
Although I had no symptoms, I decided to get tested, to be on the safe side, and found that I was infected," says Chan.
He began treatment immediately and in the beginning stage, he had to inject the medication himself daily for a few months. After a few years, he moved on to oral medication for a period.
Today, Chan is completely free of the virus and is testament to the importance of early detection through awareness.
"I had to make certain lifestyle changes, like giving up alcohol totally as I didn't want to risk any liver damage," he adds. He goes for regular check-ups and urges everyone to go for hepatitis screening.
"Hepatitis is a silent killer as there are no symptoms. Once the symptoms show, it's too late. So you need to be aware of the disease and go and get yourself tested," he advises.
When you meet C. Chia, you will not be able to tell he is a Hepatitis C patient. The 66-year-old looks as fit as a fiddle when he walks into the room for the interview. Scheduled to fly to the United States later in the day, he speaks about his journey with Hepatitis C.
"I was diagnosed with hepatitis C in 2005. I was shocked because I had gone in for a regular heart examination and came out discovering I had hepatitis C," he relates.
Sometime in 1979, Chia had to have blood transfusion after suffering from stomach ulcers. Six years later, in 1986, he again had a transfusion. He believes the blood transfusions would have been the most likely cause of his contracting hepatitis C. Testing for hepatitis C only became available worldwide in the early 1990s.
"By the time I found out I had hepatitis C, it was 20 years later and my liver was already in the early stage of cirrhosis," he says.
He began treatment immediately and six months after completion, Chia was completely cured of the virus. He still undergoes regular blood tests and ultrasound of his liver as advised by his doctor. "I would never have known I had hepatitis C had I not gone for my heart exam. So my message to people out there is to get tested, especially if you are at any risk of getting it. The earlier you get diagnosed, the earlier you can treat it," he advises.
"People don't really know what hepatitis is," says Professor Dr Rosmawati Mohamed, consultant hepatologist (liver specialist) at University of Malaya Medical Centre. She is also the executive council member of the Coalition To Eradicate Viral Hepatitis In Asia Pacific (CEVHAP).
"It is caused by viruses. There are five types: Hepatitis A to E. As many as two billion people have been exposed, although not all of them are chronic.
What is alarming is that 75 per cent are in Asia.
One in four will end up with serious liver disease but what is an important fact is that hepatitis is cancer-causing. The time frame of progression is about 30-50 years before you end up with liver damage and, most of the time, there are no symptoms. It is a silent disease," she adds.
According to Dr Rosmawati, five per cent of our population have hepatitis B.
"We can do something about reducing the prevalence,'' she says fervently. "If you look at the worldwide figure, a large part of the population has not yet been diagnosed or screened. Only one per cent is diagnosed."
Sadly, the burden of hepatitis B and C is in Asia. Dr Rosmawati says it is very important for those who have been infected for sometime, and after they have been assessed, to seek treatment.
As we approach World Hepatitis Day on July 28, we are reminded of a condition that is far more prevalent than HIV and cancer. The figures show that one in 12 people worldwide are living with chronic hepatitis B or C. It kills 150 million people each year globally and yet, it is largely neglected for one simple reason - most of those infected don't even know that they carry the virus.
"This is something we want to highlight on World Hepatitis Day. We will be having a nationwide campaign for six weeks, beginning June 15 to July 30 that will involve 26 participating centres in every state of the country. Free hepatitis B and C testing will be available and non-invasive tests will also be available for people who already diagnosed with hepatitis," she says.
Dr Rosmawati stresses that, in this part of the world, the most common way hepatitis B is transmitted is from mother to child. As such, vaccination of newborns play an important role.
"For the first time, we are offering huge screenings in both the northern and southern regions, with 12 out of 14 states participating in the campaign. We want to spread the message to people that if they know they have hepatitis, effective and immediate treatment is available. Some will achieve a cure and will be able to eradicate the virus completely.
The campaign tagline is Know Your Liver, B Aware and C A Doctor.
Dr Rosmawati says: "We would like to request everyone to get their liver tested. If it is already infected, they need to get it treated. Public understanding is of utmost importance at this stage and much needs to be done as one of the key issues identified at CEVHAP's inaugural meeting in Taipei last October was low patient and public understanding of the disease and its implications." For details on the nationwide campaign, visit http://www.myhepatitisday.com/
Viral infection of the liver
Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic diseases. The virus is transmitted not through casual contact but through contact with the blood or other bodily fluids of an infected person.
About two billion people worldwide are infected with the virus and about 350 million live with chronic infection. An estimated 600,000 people die each year due to the acute or chronic consequences of hepatitis B. About 25 per cent of adults who are chronically infected during childhood will die of liver cancer or cirrhosis (scarring of the liver) caused by the chronic infection.
The hepatitis B virus is 50 to 100 times more infectious than HIV. A vaccine has been available since 1982 and is 95 per cent effective in preventing infection and its chronic consequences. It is the first vaccine against a major human cancer

Mechanism of HCV's resistance to IFN-alpha in cell culture involves expression of functional IFN-alpha receptor 1
Sibnarayan Datta, Sidhartha Hazari, Partha K Chandra, Maria Samara, Bret Poat, Feyza Gunduz, William C Wimley, Hansjorg Hauser, Mario Koster, Cristophe Lamaze, Luis A Balart, Robert F Garry and Srikanta Dash
Virology Journal 2011, 8:351 doi:10.1186/1743-422X-8-351Published: 14 July 2011
Abstract (provisional)

The mechanisms underlying the Hepatitis C virus (HCV) resistance to interferon alpha (IFN-alpha) are not fully understood. We used IFN-alpha resistant HCV replicon cell lines and an infectious HCV cell culture system to elucidate the mechanisms of IFN-alpha resistance in cell culture. The IFN-alpha resistance mechanism of the replicon cells were addressed by a complementation study that utilized the full-length plasmid clones of IFN-alpha receptor 1 (IFNAR1), IFN-alpha receptor 2 (IFNAR2), Jak1, Tyk2, Stat1, Stat2 and the ISRE- luciferase reporter plasmid. We demonstrated that the expression of the full-length IFNAR1 clone alone restored the defective Jak-Stat signaling as well as Stat1, Stat2 and Stat3 phosphorylation, nuclear translocation and antiviral response against HCV in all IFN-alpha resistant cell lines (R-15, R-17 and R-24) used in this study.

Moreover RT-PCR, Southern blotting and DNA sequence analysis revealed that the cells from both R-15 and R-24 series of IFN-alpharesistant cells have 58 amino acid deletions in the extracellular sub domain 1 (SD1) of IFNAR1. In addition, cells from the R-17 series have 50 amino acids deletion in the sub domain 4 (SD4) of IFNAR1 protein leading to impaired activation of Tyk2 kinase. Using an infectious HCV cell culture model we show here that viral replication in the infected Huh-7 cells is relatively resistant to exogenous IFN-alpha. HCV infection itself induces defective Jak-Stat signaling and impairs Stat1 and Stat2 phosphorylation by down regulation of the cell surface expression of IFNAR1 through the endoplasmic reticulum (ER) stress mechanisms. The results of this study suggest that expression of cell surface IFNAR1 is critical for the response of HCV to exogenous IFN-alpha
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.
.
Anemia is not predictive of sustained viral response in HCV-liver transplant recipients treated with peg-interferon and ribavirin
Abstract
In the immune competent setting, antiviral therapy-related anemia has been recently shown to be associated with sustained viral response (SVR). We aimed to assess whether the same occurs in liver transplantation (LT).
In order to test this, 164 LT patients {75% men, 55 years (range: 35-75) infected with HCV (87% genotype 1a or 1b)} with recurrent hepatitis C (advanced fibrosis in 64%) treated with peg-interferon (pegIFN) and ribavirin (RBV) between 2002-2010 were included. Baseline immuosuppression consisted of tacrolimus (Tac) in 56%.
Mycophenolate mofetil (MMF) was used in 15%. Anemia was defined as haemoglobin (Hb) below 10 g/d. Significant anemia was present when Hb drop was higher than 5 g/dl. Seventy percent and 40% developed anemia and significant anemia, respectively. Erythropoietin was used in 61%. Factors independently associated with significant anemia, included low estimated creatinine clearance (RR:0.97, 95% CI: 0.95-0.99; p=.03), longer time from LT to therapy (RR: 1.001, 95% CI:1.000-1.001; p=.002), high baseline viremia (RR:3.2, 95% CI:1.3-8.1, p=.01), cyclosporine (CsA)-based immunosuppression (RR:0.4, 95% CI:0.2-0.99; p=.049), and use of MMF (RR:3.4, 95% CI: 1.1-10.7; p=.03).
An SVR occurred in 42%; factors associated with SVR were baseline variables (younger recipient and donor age, infection with non-1 genotypes, body mass index, mild fibrosis) and on-treatment factors related to adherence or viral kinetics.
Anemia resulted in RBV dose reductions but was not associated with viral response at any time point.
In conclusion, in LT patients anemia is a very frequent complication during antiviral therapy associated with increased RBV dose reduction but not with SVR. Predictors of anemia include MMF or CsA immunosuppression, high viremia and renal insufficiency.
Liver Transpl, 2011. © 2011 AASLD.

'Humanized' Mice - A New Way To Study Side Effects Of New Drugs Before They Reach Clinical Trials
14 July 2011
Despite the fact that mice are very commonly used in biomedical research, not much help has been gained by their use in the testing of new drugs. The reason for this is that a mouse's liver reacts differently to drugs as...[read article]


Healthy You

Lifestyle Changes Pay Off in Non-Alcoholic Fatty Liver Disease
NEW YORK (Reuters Health) July 15, 2011 — Weight loss or increased physical activity "consistently" reduce liver fat and improve glucose control and insulin sensitivity in patients with non-alcoholic fatty liver disease (NAFLD), according to a systematic review of published studies.
"Limited data also suggest that lifestyle interventions may hold benefits for histopathology," Dr. Michael Trenell and colleagues from Newcastle University, Newcastle upon Tyne, United Kingdom report in a paper in the Journal of Hepatology, available online now.
NAFLD, they note in their paper, is a "serious and growing clinical problem" affecting an estimated 20% to 33% of the adult population, depending on criteria and country.
Diet and physical activity are often recommended in patients with NAFLD, despite a lack of systematic evaluations of the efficacy of this approach.
This prompted Dr. Trenell and colleagues to search Medline, Scopus, and the Cochrane Controlled Trials Register for studies looking at the effect of diet, physical activity, and/or exercise modification in adults with NAFLD.
"The outcome markers of interest were indicators of steatosis, histological evidence of inflammation and fibrosis, and glucose control/insulin sensitivity," they wrote in their paper.
The analysis included 23 studies. Seven had control groups, but only six were randomized. Eleven groups received diet-only interventions, two received exercise-only, and 19 received diet and physical activity/exercise. The interventions lasted from one to six months. The physical activity interventions consisted largely of moderate intensity aerobic activity.
Overall, the studies reviewed show that a range of lifestyle modifications are effective in reducing elevated intrahepatic triacyglycerol concentration (IHTAG) – the first step in the development of steatohepatitis, liver fibrosis, liver cirrhosis and hepatocellular carcinoma.
Overall, reductions in body weight averaged 4% to 14% and resulted in statistically significant IHTAG reductions of 35% to 81%. The magnitude of change correlated strongly with the amount of weight lost.
The reviewed studies also "consistently showed reductions in liver fat and/or liver aminotransferase concentration," the investigators say, "with the strongest correlation being with weight reduction."
In most of the studies, glucose control and/or insulin sensitivity improved after lifestyle intervention.
Five studies reported changes in histopathology and all showed a trend toward decreased inflammation. In two studies, this was statistically significant, the researchers report. "Changes in fibrosis were less consistent with only one study showing a significant reduction," they add.
There was, however, considerable heterogeneity across studies in specific interventions and assessment methods employed and diagnostic criteria for NAFLD applied.
In addition, monitoring of adherence to diet or exercise was often limited, and no study employed objective measures of physical activity such as accelerometers. Instead, they all used questionnaires. Dietary assessments were not reported in enough detail to assess likely accuracy.
"Given the clinical impact of NAFLD and the lack of therapies for its management, developing effective, reproducible lifestyle interventions is crucial," the investigators conclude.
Unfortunately, published studies to date looking at lifestyle interventions in adults with NALFD "do not allow clear differentiation of the effects of physical activity relative to diet, or the importance of diet composition," they write.
They suggest future studies employ "accurate methods to establish the most effective means of producing a sustained reduction in liver fat, necroinflammation, and, if possible, fibrosis and report their interventions, including objective indicators of adherence, in sufficient detail to be readily translatable to clinical practice."
J Hepatol. Published online July 4, 2011.
Authors and Disclosures
Journalist
Megan Brooks
Megan Brooks is a freelance writer for Reuters Health.Disclosure: Megan Brooks has disclosed no relevant financial relationships.

New Gene Identified for Restless Legs Syndrome
ScienceDaily (July 15, 2011) — People suffering from restless legs syndrome (RLS) experience unpleasant sensations in the legs at night for which the only remedy is movement. Now, an international consortium from Europe, Canada and the US has identified new genetic risk factors for the disease. Carriers of these risk variants have an increased likelihood of developing RLS. This finding, which will be published on July 14th in the open-access journal PLoS Genetics, presents new opportunities for future research of this disorder.
RLS is amongst the most common neurological diseases. Patients suffer from an urge to move and paresthesia -- tingling, prickling and numbness -- in the legs, occurring mainly in the evening or at night when the body is at rest. These sensations may only be relieved by moving or walking around, which may result in severe sleeping disorders, chronic sleep loss and daytime fatigue. In severe cases the disease can lead to depression and social isolation. The frequency of RLS increases with age: up to ten per cent of those above 65 years of age are affected, albeit in very different forms. Children can, however, also contract the disease.
For many years, the Institute of Human Genetics, Helmholtz Zentrum Munich and the Technische Universität Munich have been researching the origin of RLS, aiming to improve diagnostics and the treatment of patients. The consortium, led by Professor Juliane Winkelmann, has investigated more than 4,867 RLS patients and 7,280 control patients. The researchers analysed genetic sequence variants (SNPs) distributed over the entire genome and discovered two new genetic regions which play a role in the development of RLS. One of these regions is within a gene involved in regulating brain activity, TOX3. While it is known that increased TOX3 protein protects neuronal cells from cell death, the precise connection between TOX3 and RLS is as yet unknown.
These findings enable further investigation into the underlying mechanisms, which is prerequisite to the development of new treatments.

Surgeons Pioneer New Ways to Treat Diabetes
Released: 7/15/2011 4:10 PM EDT
Source: NewYork-Presbyterian Hospital/Columbia University Medical Center

NewYork-Presbyterian/Columbia Is Using Techniques From Weight-Loss Surgery to Improve Blood Glucose Levels and Correct a Major Complication of the Disease
Newswise — NEW YORK (July 15, 2011) -- Surgeons at NewYork-Presbyterian Hospital/Columbia University Medical Center are innovating new ways to treat diabetes using techniques from weight-loss surgery, including experimental procedures to improve blood glucose levels and address a major complication of the disease.
Sleeve Gastrectomy Corrects Diabetes Complication
NewYork-Presbyterian/Columbia may be the first to use sleeve gastrectomy -- a surgical technique first developed for weight-loss surgery -- in the treatment of gastroparesis, a diabetes-related condition in which the stomach is unable to empty its contents into the intestines. Early results have been promising.
Because patients with gastroparesis cannot move food properly through their digestive system, they may experience symptoms including pain, nausea, vomiting, abdominal bloating and malnutrition. Although a number of conditions may cause gastroparesis, by far the most common is diabetes. In this case, continued high blood sugar levels damage the vagus nerve, which controls the movement of food through the digestive tract.
Conventional treatments may include medical therapies, dietary changes and implantation of a gastric electrical stimulator, or "gastric pacemaker," a device that helps to control nausea and vomiting. If all of these fail to help, however, patients may have no choice but to receive nutrients through feeding tubes.
When four patients with gastroparesis were unable to receive gastric pacemakers, surgeons at NewYork-Presbyterian/Columbia performed sleeve gastrectomy to see if it might help.
The technique, also known as a gastric sleeve or vertical or longitudinal gastrectomy, reduces the stomach to approximately 30 percent of its original size, explains Dr. Melissa Bagloo, who leads the gastroparesis program at NewYork-Presbyterian/Columbia and is assistant professor of clinical surgery at Columbia University College of Physicians and Surgeons.
According to Dr. Bagloo, "We had previously observed that after sleeve gastrectomy, patients who had difficulty emptying their stomachs showed significant improvement in their digestion. We do not know precisely why this is: Sleeve gastrectomy may have the effect of 'resetting' the natural gastric pacemaker, or it may be that the smaller size of the stomach increases intragastric pressure so that it helps facilitate gastric emptying. There could also be other reasons why the surgery helps."
The four patients who underwent sleeve gastrectomy in 2010 all had diabetes with severe gastroparesis. For various reasons, they were not eligible to receive a gastric pacemaker. After surgery, two of the patients did very well right away, and the other two needed nutritional support for several months. "At six months after surgery, all four were eating and drinking and were no longer experiencing nausea or vomiting. For patients who faced the prospect of lifelong feeding tubes, the benefits of such a successful outcome cannot be overstated," says Dr. Bagloo.
Unlike implantation of a gastric pacemaker, sleeve gastrectomy leaves no foreign object in the body and does not require battery changes. Although other surgeries have been attempted in patients with gastroparesis, they are larger operations with significant risks, says Dr. Bagloo. "We believe that laparoscopic sleeve gastrectomy may be a less-invasive option that allows patients to eat normally and regain their quality of life."
No other medical center has reported using sleeve gastrectomy to treat gastroparesis. Based on the success in the initial four patients, NewYork-Presbyterian/Columbia is conducting further study. The Center for Metabolic and Weight Loss Surgery concurrently is developing a program that will offer all treatments, including gastric pacemakers and sleeve gastrectomy, for patients with gastroparesis.
Gastric Bypass Reverses Type 2 Diabetes
Surgeons at the Center for Metabolic and Weight Loss Surgery are offering weight-loss surgery for the treatment of Type 2 diabetes as part of an ongoing clinical trial. Their research has helped show that gastric bypass is a safe and effective way to treat the disease by improving blood glucose levels, reducing or even eliminating the need for medication and lowering risk for diabetes-related death.
"This breakthrough approach can put diabetes into remission for most patients and promises to transform the way we treat this disease," says Dr. Marc Bessler, director of the Center for Metabolic and Weight Loss Surgery at NewYork-Presbyterian/Columbia and professor of clinical surgery at Columbia University College of Physicians and Surgeons.
Diabetes surgery is also being studied at the Diabetes Surgery Center at NewYork-Presbyterian Hospital/Weill Cornell Medical Center under the direction of Dr. Francesco Rubino.
NewYork-Presbyterian Hospital/Columbia University Medical CenterNewYork-Presbyterian Hospital/Columbia University Medical Center, located in New York City, is one of the leading academic medical centers in the world, comprising the teaching hospital NewYork-Presbyterian and its academic partner, Columbia University College of Physicians and Surgeons. NewYork-Presbyterian/Columbia provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine, and is committed to excellence in patient care, research, education and community service. NewYork-Presbyterian Hospital also comprises NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork-Presbyterian/Morgan Stanley Children's Hospital, NewYork-Presbyterian Hospital/Westchester Division and NewYork-Presbyterian/The Allen Hospital. NewYork-Presbyterian is the #1 hospital in the New York metropolitan area and is consistently ranked among the best academic medical institutions in the nation, according to U.S.News & World Report. For more information, visit http://www.nyp.org/.
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Office of Public AffairsNewYork-Presbyterian Hospital/Columbia University Medical Center627 West 165th StreetNew York, NY 10032
tel: 212.305.5587fax: 212.305.8023email: pr@nyp.org

Researchers Discover Why Stored Blood May Become Less Safe for Transfusion as It Ages
Depending on the amount and age of the stored blood used, there is evidence that transfusion can lead to complications including infection, organ failure and death. New research from found that these complications are likely due to red blood cell breakdown during storage, implying that transfused blood may need to be stored in a different way.
– Wake Forest University7/15/2011 2:30 PM EDT

Coffee protects against drug-resistant germs, study finds
People who consumed tea and coffee carried methicillin-resistant Staphylococcus aureus, or MRSA, in their noses half as often as those who didn’t, according to a study released in the Annals of Family Medicine.
Drinking tea and coffee may be linked to reducing antibiotic resistant bacteria carried by healthy people in their noses, a potential benefit of the beverages that baffled researchers.
People who consumed tea and coffee carried methicillin-resistant Staphylococcus aureus, or MRSA, in their noses half as often as those who didn’t, according to a study released in the Annals of Family Medicine.
MRSA can live in people’s noses without infecting them. It grows and multiplies there, in a process called colonization. Colonized people can spread MRSA to others or become infected through a break of the skin. It is considered a risk for contracting the infection, said Eric Matheson, the study author and a doctor in the department of family medicine at the Medical University of South Carolina in Charleston.
“Oral consumption, which is the way most of us drink our tea and coffee, does seem to help, but no one is sure why,” said Matheson in a telephone interview.
Coffee and tea may activate the immune system, or directly damage cells of the bacteria, Matheson said. Both also decrease iron absorption, and MRSA needs iron to grow.
Coffee has been linked in studies to a lower risk of prostate cancer, Parkinson’s disease, Type 2 diabetes, liver cancer, cirrhosis and gallstone disease, Harvard University researchers said in a May 17 analysis in the Journal of the National Cancer Institute. It also contains compounds that can reduce inflammation and regulate insulin.
Nose Swabs
Researchers in the study, of 5,000 people, swabbed bacteria from people’s noses to see if they carried MRSA and asked them to answer questions about their beverage consumption. Iced tea and soda had no effect on MRSA, the study found. That may be because the antimicrobial parts of coffee and tea are carried to the nose through steam, the authors wrote.
If the findings hold true in further studies, coffee and tea may prove inexpensive ways to keep MRSA to a minimum in the population, the authors wrote.
MRSA is the most common drug-resistant strain of bacteria, often acquired in hospitals, according to the U.S. Centers for Disease Control and Prevention. The hospital-acquired strain sickens about 90,000 people a year in the U.S. and kills about 15,000, according to the Atlanta-based CDC.

Related; Good News on Coffee -- This Time for Men Sandra Fryhofer, MD, describes a study that reports prevention against lethal prostate cancer with high consumption of coffee.
Medscape Internal Medicine, June 2011

For Your Reading Pleasure

Grand Rounds is a weekly summary of the best health blog posts on the Internet. Each week a different blogger takes turns hosting Grand Rounds, and summarizing the best submissions for the week.

Hosted This Week At InsureBlog;
Our theme this week is "Personal Responsibility" - only posts that address this issue have been included. I was quite impressed with the creativity that potential contributors brought to the table to make sure their posts fit the bill.

A few topics ;Glenn Laffel provocatively suggests that "folks with chronic diseases would tend, all things being equal, to take care of themselves somewhat better than ‘healthy’ folks, since they have been taught the tough lesson that their behavior is indeed linked to poor health outcomes." One would think so, notes Glenn, but "alas, that’s just not the case."

The always entertaining (and enlightening) Dr Roy Daviss asks "should patients take personal responsibility for how their health information is shared and with whom?" In answering the question, he notes the "risks and benefits of your data going through a Health Information Exchange (HIE)." And don't miss the lively conversation in the comments.

Finally, our own Bob Vineyard has the touching/disturbing story of a gentleman who took personal responsibility (perhaps) a bit too far.

Read All Submissions Here.............

Just For Fun

From ; Celebrity Diagnosis
Kim Kardashian's Medically Unnecessary Radiograph Refutes Report on Buttocks AugmentationBy: Michele R. Berman, MD July 12, 2011
Last week, I was watching Keeping Up With the Kardashians (it’s part of my job ) when they had a story about how sisters Khloé and Kourtney dared Kim Kardashian to ask her doctor to do an x-ray of her gluteal prominences. The indication for the test was not clinical but rather "forensic" -- the goal was to prove that Ms. Kardashian has a natural derriere and not cosmetic implants. The motivation for this diagnostic procedure arose when a tabloid published a rumor about how tragedy had struck Kim when one of her butt implants exploded!...continue reading and watch video if you dare...