Correlation of ultrasound attenuation and histopathological parameters of the liver in chronic diffuse liver diseases

OBJECTIVE: In patients with chronic diffuse liver diseases two characteristic ultrasound patterns of bright liver, the low (DI) and the high (DII) attenuation types, are seen. Correlation was studied between liver attenuation and histopathological analysis of biopsy specimens of the same patients. METHODS: Ultrasound attenuation of the liver was measured quantitatively using a homogeneous tissue-equivalent reference phantom. Semiquantitative scores were used for histopathological analysis of biopsy specimens. RESULTS: One hundred and twenty-two patients were investigated; 40 of them showed a normal liver echopattern. The average attenuation was 0.68+/-0.03 dB/cm per MHz. Histopathological parameters were normal in most of the patients, except for four cases where a minimal amount of collagen and 14 cases where a subtle amount of lipid content could be detected, in three cases accompanied by some cells indicating inflammation. From 82 patients with bright liver, 47 showed the DI type. The average attenuation was 0.80+/-0.03 dB/cm per MHz. In all of these patients, significant increases of collagen content and inflammatory reaction were found. In 23 cases a negligible amount of lipid deposition could also be revealed. Thirty-five patients exhibited a DII-type bright liver. The average attenuation was 1.21+/-0.06 dB/cm per MHz. A significant amount of lipid deposition was detected in all cases. In 13 patients a minimal amount of collagen and in 14 patients some inflammatory cells were detected. CONCLUSIONS: In livers with a normal echopattern, none or minimal pathological changes were seen. In DI-type bright liver, connective tissue dominance exists, in DII-type bright liver lipid deposition dominance. On this basis it is proved that the diagnosis of a fatty liver can be established without biopsy, if no other indication for biopsy exists.     

Rating dysthymia: an assessment of the construct and content validity of the Cornell Dysthymia Rating Scale

BACKGROUND: Mason et al. developed the Cornell Dysthymia Rating Scale (CDRS), a 20-item clinician-rated inventory, and hypothesized that it may be superior to the commonly-used Hamilton Depression Rating Scale (HDRS) in assessing the symptoms of dysthymia, a form of chronic depression. The purpose of this study was to compare these instruments in an outpatient sample of dysthymic patients. METHOD: The CDRS and the HDRS and other inventories (including the Hopkins Symptom Check List (SCL)) were administered to 110 patients meeting DSM-IIIR diagnosis of dysthymia. RESULTS: There was a significant correlation between the CDRS and the HDRS at baseline and termination, indicating concurrent validity. Distributional statistics were compared for baseline and termination severity scores, showing that the CDRS has greater severity range scores than the HDRS. Furthermore, results of the DSM-IV Mood Disorders Field Trial suggest that the CDRS has better content validity than the HDRS when it comes to the dysthymic population. LIMITATIONS: The results are limited by the use of a homogeneous sample, the absence of observer ratings of divergent symptoms, and less than excellent validity of self-report divergent symptoms. CONCLUSIONS: Our results support the value of the CDRS in assessing symptoms of dysthymia.     

Symptoms,treatment and “dying peacefully” in terminally ill cancer patients: a prospective study

Goals The aims of this study were to describe the symptoms, their treatment during the final months of life of terminally ill cancer patients and to assess characteristics of the dying process.Patients and methods We used a prospective study design. From a representative sample of physicians who participated in a study of end-of-life decision making, we asked whether they were treating a patient with cancer whose treatment was no longer aimed at cure, whose life expectancy was probably longer than 1 week but no longer than 3 months and who would probably continue to be treated by the same physician until their death; 85 physicians completed a monthly questionnaire until patients deaths.Results Patients were confronted with an increasing amount of symptoms during the final months of their life. Fatigue, loss of appetite, dependency and feeling unwell were the most prevalent symptoms. Physical symptoms were more often treated than psychosocial symptoms. The number of medical disciplines involved in the patients care decreased in the period before death, but the number of informal caregivers increased; 73% of patients died peacefully. A peaceful death was impeded by feelings of anxiety and loneliness but promoted by the involvement of children in their patients care.Conclusion The results give insight into the nature of suffering and factors related to the dying process of terminally ill cancer patients. Attention to psychosocial well-being and to the need to be with loved ones appears to be essential for patients quality of life.     

Habit learning and the genetics of the dopamine D3 receptor: evidence from patients with schizophrenia and healthy controls

In this study, the authors investigated the relationship between the Ser9Gly (SG) polymorphism of the dopamine D3 receptor (DRD3) and striatal habit learning in healthy controls and patients with schizophrenia. Participants were given the weather prediction task, during which probabilistic cue-response associations were learned for tarot cards and weather outcomes (rain or sunshine). In both healthy controls and patients with schizophrenia, participants with Ser9Ser (SS) genotype did not learn during the early phase of the task (1-50 trials), whereas participants with SG genotype did so. During the late phase of the task (51-100 trials), both participants with SS and SG genotype exhibited significant learning. Learning rate was normal in patients with schizophrenia. These results suggest that the DRD3 variant containing glycine is associated with more efficient striatal habit learning in healthy controls and patients with schizophrenia.     

Regression of glomerulosclerosis with high-dose angiotensin inhibition is linked to decreased plasminogen activator inhibitor-1

The potential and possible mechanisms for regression of existing glomerulosclerosis by angiotensin II type 1 receptor antagonist (AT1RA) and/or angiotensin I converting enzyme inhibitor (ACEI) were investigated. Adult male Sprague Dawley rats underwent 5/6 nephrectomy (Nx). Glomerulosclerosis was assessed by renal biopsy 8 wk later, and rats were divided into groups with equal biopsy sclerosis and treated for the next 4 wk until they were killed at 12 wk as follows: Control with no further treatment (CONT), high-dose AT1RA, high-dose ACEI, and varying AT1RA+ACEI combinations. Hypertension and proteinuria induced by 5/6 Nx were significantly decreased by all treatments, except high-dose ACEI, which showed persistent proteinuria. High-dose AT1RA and ACEI markedly decreased progression of sclerosis, with -2.3% average decrease in sclerosis from biopsy to autopsy in AT1RA versus 194% increase in CONT (P < 0.0001). Glomerulosclerosis regressed, with less severe lesions at the time when the rats were killed than at biopsy in 62% of AT1RA-treated and 57% of ACEI-treated rats. In contrast, only 17 to 33% of rats in combination groups had regression. Alternatively, these data might be viewed as reflecting halting of progression, as some groups had higher BP and proteinuria. However, this potential confounding effect does not negate the effects to achieve regression of sclerosis in these rats. Regression was not explained by changes in mRNA of TGF-beta1 and matrix metalloproteinase-2 and -9 but was linked to decreased tissue inhibitor of metalloproteinase-1 and plasminogen activator inhibitor-1. It is concluded that angiotensin inhibition mediates regression in part by effects on matrix modulation.     

Quantitative molecular urinary cytology by fluorescence in situ hybridization: a tool for tailoring surveillance of patients with superficial bladder cancer?

OBJECTIVE: To determine whether it is possible to stratify patients with superficial bladder cancer into low- and high-risk groups for tumour recurrence/progression based on the chromosomal pattern detected by fluorescence in situ hybridization (FISH) in one urine cytology specimen used for follow-up testing. PATIENTS AND METHODS: Voided urine samples from 47 consecutive patients with urinary tract neoplasms (13 with no history of urothelial malignancy and 34 under follow-up after complete transurethral resection of superficial urothelial carcinoma of the bladder) were evaluated by liquid-based cytology (ThinPrep(R), CYTYC Corp., Boxborough, MA, USA) and UroVysion FISH (Vysis-Abbott, Downers Grove, IL). RESULTS: Of the 34 patients under surveillance, the UroVysion test was negative in four, 17 had loss of 9p21 sequences either alone or combined with low-frequency trisomy/ies or tetrasomy/ies of chromosomes 3, 7 and 17 in single cells (low-risk FISH), and 13 also had complex aneusomies of the remaining chromosomes (high-risk FISH). One of the four FISH-negative neoplasms, four of the 17 low-risk FISH cases and five of the 11 informative high-risk FISH-positive patients developed recurrence. Progression occurred only in patients with high-risk FISH results, showing high-frequency complex chromosomal polysomies (four of 11). CONCLUSION: The results from this pilot study indicate that the UroVysion FISH test may help to individually assess the clinical behaviour of superficial bladder cancer, based on the chromosomal pattern of exfoliated tumour cells in follow-up urinary cytology. It might be of use to identify those patients likely to progress at earlier and curable stages of disease, and lengthen the surveillance period in those with persistent or recurrent low-risk disease.