A survey of attitudes of clinicians towards the diagnosis and treatment of mild cognitive impairment in Australia and New Zealand

OBJECTIVES: The aim of the study was to assess the attitudes of clinicians to the diagnostic construct of mild cognitive impairment (MCI), their approach to relaying the diagnosis to patients and families, and recommended treatment and follow-up. METHOD: An anonymous questionnaire was sent out to 503 members of the Australian Society for Geriatric Medicine (ASGM) and New Zealand Geriatrics Society (NZGS), of whom 163 replied. RESULTS: Most responders (83%) had diagnosed MCI. About 70% rated the importance of separating MCI from dementia, or MCI from normal cognition, as 4 or 5 on a scale from 1 (not very important) to 5 (very important). Most responders reported that they would inform their patients and families of a diagnosis of MCI, and used that term. A minority used the term "early Alzheimer's disease," but 44% of NZGS members used other terms to relay the diagnosis compared to 13% of ASGM members. Follow-up was most often recommended at 6-12 months. Non-pharmacological treatment (such as mental stimulation strategies) was recommended most often, followed by no treatment. CONCLUSIONS: The diagnostic entity of MCI appears to have a general acceptance among those who responded to the survey, and the term has gained use in clinical practice. Most clinicians are recommending follow-up, recognizing the high risk for progression. Treatment recommendations do not favor pharmaceuticals, reflecting the current evidence for lack of effect.     

Reevaluating the incidence of pervasive developmental disorders: impact of elevated rates of detection through implementation of an integrated system of screening in Toyota, Japan

Aim:  Although recent epidemiological studies on the pervasive development disorders (PDD) appear to be reporting higher rates of incidence than previously believed, great variation in the reported figures suggests a need for review of the methodology involved. As such, a survey on the incidence of PDD was conducted and compared with data from a previous survey to examine the effects of screening and diagnostic methodology on incidence.
Methods:  The incidence of pervasive developmental disorders was surveyed in all children (12 589) born between January 1994 and December 1996 in Toyota, Japan.
Results:  Incidence was 1.81% and the ratio of boys to girls was 2.80. Definitive diagnoses were made between 13 months and 7 years 2 months, the average age at diagnosis being 3 years 4 months. Among the cases of PDD, children with normal or borderline intelligence amounted to 66.4%, mild mental retardation (MR) 17.5%, moderate MR 10.3% and severe MR 5.8%.
Conclusion:  An approximately 11-fold increase was noted in prevalence of PDD compared to a previous survey two decades ago, and two main factors were believed to account for this apparent sharp increase. First, inclusion of high-functioning subjects detected during infancy, and second, higher rates of diagnosis resulting from an integrated process of screening.     

Occult hepatitis B virus infection as a risk factor for hepatocellular carcinoma in patients with chronic hepatitis C in whom viral eradication fails.

Aim: Recent studies have suggested that an occult hepatitis B virus (HBV) infection negative for HBsAg but positive for HBV-DNA contributes to hepatocellular carcinoma (HCC) development in patients with chronic hepatitis C. Some follow-up studies have suggested the clinical importance of occult HBV infections in HCC development even after interferon (IFN) therapy, but a recent study denies the significance of the impact of occult HBV infection. Focusing on HCC development in patients in whom hepatitis C virus (HCV) eradication by interferon (IFN) therapy had failed, we conducted this study in order to assess the impact of occult HBV infections on HCC development in these patients. Methods: We enrolled 141 patients with chronic hepatitis C (histological stage F2 or F3) who were seropositive for HCV-RNA even after IFN therapy. Serum HBV-DNA was assayed using the real-time polymerase chain reaction. During follow-up, ultrasonography and/or computed tomography (CT) were performed at least every 6 months to monitor HCC development. Results: The cumulative incidence rates of HCC were 8.9%, 25.7% and 53.7% at 5 years, 10 years and 15 years, respectively, after IFN therapy. Multivariate analysis indicated that low platelet counts (<12 x 10(4)/mm(3)), occult HBV infection, high ALT levels (>/=80 IU/L) after IFN therapy and the staging of liver fibrosis were important independent factors affecting the appearance of HCC. Conclusions: Occult HBV was a risk factor for HCC development in patients with chronic hepatitis C in whom HCV eradication had failed. Therefore, patients with chronic hepatitis C with occult HBV should be monitored carefully for HCC after IFN therapy.     

Solitary peripheral ciliated glandular papillomas of the lung: a report of 3 cases

We report 3 cases of solitary papillomas located in peripheral regions of the lung that are extremely rare in the literature. The patients were 75-year-old and 72-year-old men and a 53-year-old woman. One patient complained of recurrent hemoptysis. The other 2 had no symptoms, but abnormal nodular shadows were revealed by chest radiographs during a health check. The maximum diameters of the tumors were 1.0, 1.4, and 1.1 cm, respectively. The 3 tumors gave almost the same histologic findings. Papillomatous fronds lined by a stratified columnar epithelium were seen in the lumens of peripheral bronchi, bronchioles, or alveoli. The stratified columnar epithelium consisted of ciliated, mucous, and basal cells. The neoplastic epithelium extended to the alveolar region and showed a similar appearance to bronchioloalveolar or papillary type adenocarcinomas. For differential diagnosis, it is noteworthy that endobronchiolar papillomatous fronds constantly exist and spreading along alveolar walls is limited in adjacent alveoli in peripheral papillomas. The presence of ciliated cells and basal cells is considered an important finding to suggest benign character of the lesion.     

De novo autoimmune hepatitis following living-donor liver transplantation for primary biliary cirrhosis

Abstract:  Since first being described in 1998, de novo autoimmune hepatitis (AIH) after liver transplantation has been reported in several cases suffering from non-autoimmune liver diseases and primary biliary cirrhosis (PBC). Glutathione S-transferase (GST) T1 genotype mismatches between donor and recipient have also been suggested to constitute a risk factor for de novo AIH. Here, we report a 33-yr-old woman who presented complaining of marked fatigue and jaundice four yr after living-donor liver transplantation for PBC. On examination, transaminase levels were highly elevated and ANA and antimitochondrial antibody M2 were positive. Histological findings showed zonal necrosis with lymphoplasmacytic infiltration closely resembling AIH. She had pretreatment AIH score of 16 and 19 points after relapse of de novo AIH. Two color fluorescence in situ hybridization with X and Y chromosome-specific probes clearly revealed that the hepatocytes were of donor origin and lymphocytes were of patient origin. The GSTT1 genotype of the patient and the donor were the same null type, suggesting that mechanisms other than GSTT1 mismatches may exist in de novo AIH development. In conclusion, recipient immune cells attacked the allogeneic transplanted liver of the patient via de novo AIH, although the exact participation of autoimmune mechanisms is unclear.     

Effect of varicocelectomy on patients with unobstructive azoospermia and severe oligospermia

OBJECTIVES

To assess the treatment outcome and benefits after varicocelectomy in men with unobstructive azoospermia (UOA) and severe oligospermia (SO).

PATIENTS AND METHODS

The records were retrospectively evaluated for six patients with UOA and 54 with SO who had microsurgical inguinal varicocele ligation (mean age 33.3 years, sd 5.3). Fifty‐one (85%) had a unilateral left‐sided procedure (five of six with UOA, 46 of 54 with SO), and nine (15%) had a bilateral procedure.

RESULTS

After ligation, spermatogenesis was induced in two of the six men with UOA; the mean (sd ) sperm concentration increased from 2.3 (1.6) to 9.2 (12.6) million/mL (P < 0.001), but the sperm motility did not change significantly. Four (7%) of the 54 men with SO achieved paternity, with unassisted pregnancies.

CONCLUSIONS

Varicocelectomy resulted in the induction or enhancement of spermatogenesis for several men with UOA or SO; it seems to be a reasonable option in selected patients with UOA or SO.