Assessing Liver Stiffness by 2-D Shear Wave Elastography in a Healthy Cohort

The aim of this study was to assess the normal ranges of liver stiffness measurements (LSMs) in participants with healthy livers, using General Electric 2-D shear wave elastography (2-D-SWE-GE) compared with transient elastography (TE). We included 80 participants with healthy livers and without known liver disease, in whom liver stiffness was evaluated in the same session using two elastographic methods, TE and 2-D-SWE-GE. Reliable LSMs were defined for TE as the median of 10 measurements with a success rate of ≥60% and an interquartile range (IQR)?<?30%, and for 2-D-SWE-GE, as the median of 10 measurements acquired in a homogenous area and an IQR?<?30%. Participants with LSMs?>?6.5?kPa by TE were excluded. Reliable LSMs were obtained in 79 participants (98.7%) by means of 2-D-SWE-GE and in 80 participants (100%) by means of TE (p?=?0.9). The mean LSM obtained by 2-D-SWE-GE in our cohort of participants with healthy livers was 5.1?±?1.3?kPa, which was significantly higher than the LSM assessed by TE (4.3?±?0.9?kPa, p?<?0.0001). In 2-D SWE-GE, mean LSMs were significantly higher for men than for women, 5.9?±?1.2?kPa versus 4.7?±?1.2?kPa (p?=?0.0005). In conclusion, 2-D-SWE-GE has very good feasibility (98.7%) in healthy persons. The mean LSM determined by 2-D-SWE-GE in healthy participants was 5.1?±?1.3?kPa. LSMs obtained by means of 2-D-SWE-GE were higher than those obtained by TE in participants with healthy livers.     

Smoking status, disease duration, and educational level in females, are related to asthma school participation.

Limited data is available on those who do not want to attend an asthma school. Two hundred and forty-five asthmatics aged 18-65 yrs with an FEV1 >50% predicted who had been seen at our outpatient asthma clinic within the last 3 yrs were invited to participate in an asthma school. The patients were contacted by phone by a nurse, offered a 2 day asthma school without personal costs. Altogether 78% of those contacted answered positively. In a logistic regression analysis including sex, age, smoking status, educational level, asthma duration and own opinion of the disease, the-adjusted odds ratio (OR) for nonsmokers wanting to participate versus smokers was 4.0 (95% confidence interval (CI): 1.8-8.3). The corresponding figure for patients with a recent asthma attack was 3.4 (95% CI: 1.5-7.6) compared to those without. For every 10 yr duration of disease the OR for wanting to take part in the asthma school increased by 1.6 (95% CI: 1.0-2.3). When analysing males and females separately, highly educated females were less willing to take part, while an opposite tendency was present in males. In conclusion those interested in taking part in an asthma school were characterized by highly motivated nonsmokers with long duration of disease and with a recent asthma attack, and not being highly educated females.     

A Modified Raz Bladder Neck Suspension Operation (Transvaginal Burch)

A total of 36 female patients with genuine stress urinary incontinence underwent Raz needle suspension with fixation of suspension sutures to the iliopectineal ligament (transvaginal Burch procedure). By fixing suspension sutures to the iliopectineal ligament we expected to achieve a static suspension independent of everyday patient activities. Considering the small number of patients and limited followup, our results revealed continence in 80 to 85 percent of the patients after 3 years. We believe that fixation of suspension sutures to the iliopectineal ligament can favorably influence long-term results of needle suspension in the treatment of female stress urinary incontinence.     

Chromogranin A cell density in the large intestine of Asian and European patients with irritable bowel syndrome

Objective: Patients with irritable bowel syndrome (IBS) in Asia show distinctive differences from those in the western world. The gastrointestinal endocrine cells appear to play an important role in the pathophysiology of IBS. The present study aimed at studying the density of chromogranin A (CgA) cells in the large intestine of Thai and Norwegian IBS patients.

Methods: Thirty Thai IBS patients and 20 control subjects, and 47 Norwegian IBS patients and 20 control subjects were included. A standard colonoscopy was performed in both the patients and controls, and biopsy samples were taken from the colon and the rectum. The biopsy samples were stained with hematoxylin–eosin and immunostained for CgA. The density of CgA cells was determined by computerized image analysis.

Results: In the colon and rectum, the CgA cell densities were far higher in both IBS and healthy Thai subjects than in Norwegians. The colonic CgA cell density was lower in Norwegian IBS patients than in controls, but did not differ between Thai IBS patients and controls. In the rectum, the CgA cell densities in both Thai and Norwegian patients did not differ from those of controls.

Conclusions: The higher densities of CgA cells in Thai subjects than Norwegians may be explained by a higher exposure to infections at childhood and the development of a broad immune tolerance, by differences in the intestinal microbiota, and/or differing diet habits. The normal CgA cell density in Thai IBS patients in contrast to that of Norwegians may be due to differences in pathophysiology.     

The possible role of gastrointestinal endocrine cells in the pathophysiology of irritable bowel syndrome

Introduction: The etiology of irritable bowel syndrome (IBS) is unknown, but several factors appear to play a role in its pathophysiology, including abnormalities of the gastrointestinal endocrine cells. The present review illuminates the possible role of gastrointestinal hormones in the pathophysiology of IBS and the possibility of utilizing the current knowledge in treating the disease.

Areas covered: Research into the intestinal endocrine cells and their possible role in the pathophysiology of IBS is discussed. Furthermore, the mechanisms underlying the abnormalities in the gastrointestinal endocrine cells in IBS patients are revealed.

Expert commentary: The abnormalities observed in the gastrointestinal endocrine cells in IBS patients explains their visceral hypersensitivity, gastrointestinal dysmotility, and abnormal intestinal secretion, as well as the interchangeability of symptoms over time. Clarifying the role of the intestinal stem cells in the pathophysiology of IBS may lead to new treatment methods for IBS.     

Ultrasonography in diagnosing chronic pancreatitis: New aspects

The course and outcome is poor for most patients with pancreatic diseases.Advances in pancreatic imaging are important in the detection of pancreatic diseases at early stages.Ultrasonography as a diagnostic tool has made,virtually speaking a technical revolution in medical imaging in the new millennium.It has not only become the preferred method for first line imaging,but also,increasingly to clarify the interpretation of other imaging modalities to obtain efficient clinical decision.We review ultrasonography modalities,focusing on advanced pancreatic imaging and its potential to substantially improve diagnosis of pancreatic diseases at earlier stages.In the first section,we describe scanning techniques and examination protocols.Their consequences for image quality and the ability to obtain complete and detailed visualization of the pancreas are discussed.In the second section we outline ultrasonographic characteristics of pancreatic diseases with emphasis on chronic pancreatitis.Finally,new developments in ultrasonography of the pancreas such as contrast enhanced ultrasound and elastography are enlightened.