Congenital hepatic fibrosis: CT findings in 18 adults

PURPOSE: To evaluate the computed tomographic (CT) findings in adult patients with pathologically proved congenital hepatic fibrosis. MATERIALS AND METHODS: This was a retrospective review of congenital hepatic fibrosis cases identified at two institutions over the course of 8 years. Eight men and 10 women with an age range of 22-72 years (mean age, 39 years) were included. Contrast material-enhanced and unenhanced CT scans were obtained through the liver in all patients. Two radiologists evaluated size of and morphologic findings (atrophy or hypertrophy localized according to hepatic segments) in the liver; increased diameter or number of hepatic arteries at the hilum; presence of hepatic nodules, varices, spontaneous splenorenal shunts, and splenomegaly; and association with other hepatic ductal plate malformations and renal abnormalities. RESULTS: Sixteen patients had morphologic abnormalities in the liver, 15 had splenomegaly (three underwent splenectomy for portal hypertension), and 14 had varices or spontaneous splenorenal shunts. An enlarged hepatic artery and a tangle of abnormally enlarged arterial vessels were identified in five and four patients, respectively, and four of these nine patients had large benign regenerative nodules. Ten patients had renal abnormalities and nine had an associated ductal plate malformation. CONCLUSION: This retrospective study shows that certain findings (ie, liver morphologic and associated ductal plate abnormalities, varices, splenomegaly, and renal abnormalities) are frequently observed in combination in patients with congenital hepatic fibrosis.     

Living with pain: an existential focus

In the routine of a hospital, during my nursing practice of providing care to patients with pain, it was shown to me as reaching beyond a biological sphere included in an existential dimension. Something in this experience disturbed me and I felt the need to understand these people suffering from pain, asking how they understand their pain and what is the meaning of experiencing painful chronic situations. In the attempt to find a way to obtain such understanding, I searched for some ideas stemming from phenomenology. Then, I interviewed the subjects individually based on the central question: "How is your experience with pain? Tell me about this". After the analysis, I was able to understand that pain is a way to narrow the horizon of possibilities and transformations in existence. It is not only the physical body that is ill, but also life is affected in its various dimensions, fundamentally with regard to the family, work and self-relation world.     

Prevalence of hepatic hemangioma in patients with focal nodular hyperplasia: MR imaging analysis

PURPOSE: To evaluate the prevalence of hepatic hemangioma in a large population of patients with focal nodular hyperplasia (FNH) and to determine if the prevalence is higher than that in patients with other hepatic masses. MATERIALS AND METHODS: Over a period of 40 months, 247 patients with one or more hepatic masses underwent magnetic resonance (MR) imaging at our institution and met the inclusion criteria for this study. One hundred forty-eight patients received a diagnosis of FNH (study group). Ninety-nine patients had a lesion other than FNH and had no history of chronic liver disease (control group). Imaging findings of the main lesion and presence of associated hemangioma were investigated. chi2 analysis was used to determine if there was a statistically significant difference in the two groups regarding the number of patients with associated masses. RESULTS: Twenty-nine of 148 patients (20%) in the study group had FNH with one or more associated hepatic hemangiomas. Among the 99 patients in the control group, nine (9%) had an associated hemangioma. The prevalence of hemangioma was significantly higher (P <.02) in the study group than in the control group. The prevalence of hemangioma in patients with a solitary FNH lesion compared with that in patients with multiple FNH lesions was not significantly different. CONCLUSION: Patients with FNH are more likely to have an associated hepatic hemangioma than are those with another type of focal hepatic mass.     

Habitual physical activity in children and adolescents during school and free days

PURPOSE: The purpose of this study was to analyze habitual physical activity (HPA) of boys and girls from primary school to high school. METHODS: One hundred eighty-two schoolchildren and teenagers (6-20 yr) were studied at primary school (PS, N= 64), junior high school (JHS, N= 67), and senior high school (SHS, N= 51). HR was continuously monitored during the whole week to assess HPA during school days and free days. Total physical activity (TPA), low physical activity (LPA), moderate physical activity (MPA), and vigorous physical activity (VPA) were evaluated from the time spent each day above 50%HR reserve (HRR), below 50%HRR, between 50% and 70%HRR, and above 70%HRR, respectively. RESULTS: During school days, TPA decreased by 69% in male subjects (P< 0.05) and by 36% in female subjects (N= 0.058) from PS to SHS. In contrast, TPA did not vary significantly during free days (male subjects, PS: 62 +/- 37 min x d, SHS: 63 +/- 67 min x d; female subjects, PS: 75 +/- 59 min x d, SHS: 62 +/- 44 min x d ). Gender differences were only observed during school days at PS for TPA (male subjects: 121 +/- 37 min x d vs female subjects: 92 +/- 44 min x d, P< 0.05) and VPA (male subjects: 38 +/- 21 min x d vs female subjects: 18 +/- 12 min x d, P< 0.05). Male and female subjects were more inactive during free days than during school days at PS (P< 0.05). No effect of the type of day and gender was observed for all indices of HPA at high schools. CONCLUSIONS: Our results highlight the importance of taking into account the type of day (school day vs free day) in the analysis of children and adolescents' HPA.     

Modulation of P-glycoprotein-mediated multidrug resistance by flavonoid derivatives and analogues

Flavonoid derivatives were synthesized and tested for their ability to modulate P-glycoprotein (Pgp)-mediated multidrug resistance (MDR) in vitro. These compounds belong to various flavonoid subclasses, namely: chromones, azaisoflavones, and aurones. Among the investigated compounds, three showed potent reversing activity. 2-(4-methylpiperazin-1-ylcarbonyl)-5-hydroxychromone (4a), 5,7-dimethoxy-3-phenyl-4-quinolone (5), and 4,6-dimethoxyaurone (6) potentiated daunorubicin cytotoxicity on resistant K562 cells. They were also able to increase the intracellular accumulation of rhodamine-123, a fluorescent molecule which acts as a probe of P-glycoprotein-mediated MDR. This suggests that these compounds act, at least in part, by inhibiting P-glycoprotein activity. The most active compound, 5-hydroxy-2-(4-methylpiperazin-1-ylcarbonyl)chromone (4a) was found to be a powerful reversal agent, more potent than cyclosporin A, used as the reference molecule. No effect was observed on MRP transport nor on cell proliferation. Little apoptosis was induced on K562S cells with 4a compared to K562R, probably due to the extrusion of the compound by Pgp.