Acoustic structure quantification (ASQ): a new tool in sonographic examination of liver lesions in hepatic alveolar echinococcosis

Purpose

Qualitative and quantitative acoustic structure quantification (ASQ) is a new, noninvasive sonographic imaging method based on B-mode. This prospective clinical pilot study aims to answer the question whether delineation and measurement of liver lesions in hepatic alveolar echinococcosis (HAE) can be improved by ASQ. Furthermore, this is the first pilot study to explore how ASQ parameters in HAE lesions develop.

Methods

A total of 24 patients (male = 13/female = 11, mean age = 52 years (16–85), mean disease duration = 68 months (1–334)) with HAE were examined with ASQ using a Toshiba Aplio 500 unit. ASQ parameters were measured in HAE liver lesions and in adjacent non-tumor parenchyma. Quantitative analysis was performed offline using ASQ quantification software.

Results

Subjectively parasitic tumors in HAE appear more prominent in color-coded ASQ imaging, but the size of lesions measured in ASQ mode does not differ from size measurements in B-mode. Median focal disturbance ratio (FD ratio) in lesions was 3 (0.1–3), compared with 0.5 (0.1–1.8) in surrounding liver parenchyma (p < 0.0001). Statistical comparison of other ASQ parameters (mode, average, standard deviation) shows results that are similarly significant with p values between p < 0.0001 and p < 0.0018.

Conclusion

ASQ is a promising sonographic method for examination and quantification of structural changes of liver parenchyma in HAE lesions.     

Comparison of localized proton NMR signals of skeletal muscle and fat tissue in vivo: Two lipid compartments in muscle tissue

In vivo ¹H NMR spectra of small volumes-of-interest (VOI) were localized in human soleus muscle (8 ml) and compared with volume selective spectra of subcutaneous fat tissue and femoral yellow bone marrow (2 ml). All examinations were performed by the double spin echo (PRESS) localization technique. To provide comparability, spectra of different tissues were recorded using identical sequence timing. Clearly improved resolution of the lipid signals of muscle tissue was obtained using long echo times TE > 200 ms. The spectra of muscle tissue exhibit lipid signals that stem from two compartments with a difference of their resonance frequencies of about 0.2 ppm (Larmor frequency difference 12-13 Hz at 1.5 T). The existence of two fatty acid compartments is supported by measurements of the relaxation times and line shape analysis. Both compartments contain fatty acids or triglycerides with similar composition. Probably one compartment corresponds to fat cells within muscle tissue, the other compartment with lower Larmor frequency is located within muscle cells.     

Effect of an anthralin-containing hydrocolloid dressing in psoriasis vulgaris

We investigated the effect of hydrocolloid dressings on the clearing of chronic plaque psoriasis. In comparison to a short-contact therapy with anthralin alone, following application of a hydrocolloid dressing accelerated the clearing of the plaques. This effect was significant after 3 weeks of therapy. A considerable improvement was achieved by the application of a hydrocolloid dressing containing anthralin. For this purpose anthralin in concentrations of 0.02 to 0.20 mg/cm2 was applied to the dressing immediately after it had been solved in acetone. The acetone was evaporated, and the anthralin was left on the dressing in a homogenous layer. In our study, the difference to short-contact anthralin was significant after 1, 2, 3, and 4 weeks of therapy. We conclude that this new way of anthralin application is suitable for the treatment of psoriasis and has therapeutical as well as technical advantages over a treatment with anthralin ointments.     

Chronic subdural haematomas and anticoagulation or anti-thrombotic therapy.

Eighty-one cases of chronic subdural haematomas (CSDH) admitted to the neurosurgical unit of the Royal Hobart Hospital, Tasmania, Australia, over a 5-year period were reviewed. The use of anticoagulant therapy as a causative agent in the development of CSDH was investigated. We suspected a high incidence of anticoagulant or anti-thrombotic therapy. We found that anticoagulant therapy was used by a significant percentage of CSDH patients. In the patient group presenting to our unit the risk of developing a CSDH was at least 42.5 times higher in warfarinised patients and also increased for patients on aspirin, although this risk could not be quantified.     

Sensitivity analysis of cost factors for various therapy options in the treatment of follicular lymphoma

BACKGROUND: In Germany, patients with relapsed follicular non-Hodgkin's lymphoma do not all receive the same treatment. In this study, 3 therapy regimens were analyzed which were considered to be similar. With the goal of determining the treatment option with the lowest direct costs whilst maintaining the same degree of effectiveness, a cost analysis model was established and applied by way of example to the existing illness constellation. METHODS: The German doctors' fee scale (Einheitlicher Bewertungsmassstab, EBM) valid until 2005 served as the basis for the calculation of medical services within the scope of the present statutory health insurance guidelines. A virtual standard patient was constructed for the cost model and treated with the different therapy regimens. The incidences of individual adverse events described in literature served as the basis for the characterization of the average toxicity of the respective treatment methods. RESULT: The overall costs result from the sum of the treatment costs and the toxicity-related costs. The effect of additional interventions on the overall cost was also examined. CONCLUSION: Whereas the accompanying documentation of costs in clinical studies is organizationally complex and very tedious, the model applied here offers a reliable method of quantifying the costs of the different therapy regimens. It permits the comparison of different treatment alternatives, and it enables, by means of a cost variance analysis, the identification of cost drivers and less expensive measures within a therapy method.     

Diagnostik von Metamorphopsien bei Netzhauterkrankungen unterschiedlicher Genese

We investigated the ability of preferential hyperacuity perimeter (PHP) and Amsler grid testing to detect metamorphosia in patients with macular hole (MH), central serous retinopathy (CSR), epiretinal membranes (EM), intermediate AMD (iAMD), classic and occult choroidal neovascularization (CNV) due to AMD, and compared the results. A total of 147 patients (n =153 eyes) with classic (35 eyes) and occult (38 eyes) CNV, iAMD (13 eyes), MF (23 eyes), RCS (11 eyes), EM (13 eyes) and control group (20 eyes) were involved. All of these patients underwent corrected visual acuity and eye examinations inclusive of the Amsler grid. The PHP test was performed after pupil dilation. In all patients, fundus photography and optical coherence tomography (OCT) (Humphrey/Zeiss OCT III) were performed. In patients with CNV and CSR a fluorescein angiography was also performed. Metamorphopsia detection rates by Amsler grid and PHP were compared statistically. The sensitivity of PHP vs Amsler grid in detecting metamorphosia was 69% vs 85% in patients with MH, for CSR 64% vs 73%, EM 77% vs 100%, iAMD 85% vs 100%, classic CNV 83% vs 94% and occult CNV 81% vs 71%. The results for patients with occult CNV were significant (P =0.046), using the chi(2)-test. The PHP-test showed high sensitivity for diagnosing CNV. In occult CNV, PHP was superior to the Amsler grid in detecting metamorphopsia. In the other diseases involving the macular (MH, EM, CSR, iAMD), the detection rate and sensitivity of the Amsler grid was superior to PHP.     

Cohabitation reduces bulimic symptoms in young women

OBJECTIVE: This current study examines the relationship between cohabitation and changes in bulimic symptoms in young adults. METHOD: A sample of 2601 initially noncohabitating adolescents was followed over a 5-year period and growth curve analyses were conducted. RESULTS: Females who over the course of the study moved in with a partner had greater decreases in bulimic symptoms compared with female noncohabitators. This difference was highly significant, even if small in size. No such effect was found in males. When examining the frequency of bulimic behaviors in females, the most socially unacceptable bulimic behaviors were those most reduced by cohabitation, whereas less obtrusive bulimic behaviors were not reduced. CONCLUSION: The results give some indication that social control exercised in close relationships may account for decreased bulimic symptoms in female cohabitators. Further studies are needed to confirm the importance of social control and to examine how it affects symptom reduction.     

Polymorphisms of the endothelial nitric oxide synthase gene in breast cancer

Summary Nitric oxide (NO) is known to be critically involved in breast carcinogenesis. Genetic polymorphisms of the gene encoding for endothelial nitric oxide synthase (Nos3), the enzyme catalyzing the production of the NO, are known to predispose to malignant disease. Whether these polymorphisms also influence breast cancer risk is unknown. In the present case–control study, we ascertained 2 polymorphisms of the Nos3 gene cluster (Nos3 exon 7 Glu298Asp and a 27-base pair repeat in intron 4 of Nos3) in 269 Caucasian patients with breast cancer and 244 healthy controls using pyrosequencing and PCR, respectively. Presence of the exon 7 Nos3 polymorphism predisposed women to breast cancer (p=0.03, Odds ratio [95% Confidence Intervals]=1.9 [1.1–3.6]), but was not associated with any clinico-pathological parameters. No significant associations were ascertained with respect to the intron 4 Nos3 polymorphism. In our series, presence of the mutant exon7 Nos3 polymorphism was associated with an increased risk for breast cancer in Caucasian women.