Chronic active hepatitis presenting with Mirizzi syndrome

A 57-year-old woman is described suffering from chronic active hepatitis and cirrhosis of the liver which presented with obstruction to the common hepatic duct by a gallstone impacted in the neck of the gallbladder.     

Magnetic resonance imaging.

Magnetic Resonance Imaging is the latest diagnostic tool to have a significant impact on patient management. Magnetic Resonance Imaging, or MRI, has been available for over six years but has only in the last 18 months become readily available to many more hospitals in Great Britain. MRI scanners have been purchased by large specialist hospitals but the arrival of mobile MRI scanners has made the technology available to smaller hospitals and groups. The impact of MRI for all clinicians and especially surgeons is great and the following text will outline the advantages of MRI and mobile MRI.     

Health-related quality of life in patients with neuroendocrine tumors: an investigation of treatment type,disease status,and symptom burden

Introduction

Neuroendocrine tumors (NETs) are malignant solid tumors arising in hormone-secreting tissue. They have historically been very difficult to treat, and advanced NETs are considered incurable. Surgery is the only potentially curative treatment option, though research is ongoing, investigating the efficacy of targeted therapies combined with more traditional chemotherapies. Frequent bowel movements and episodes of flushing are the most common symptoms.

Methods

The present study reports data from an anonymous patient survey of 663 eligible NET patients, identified with the assistance of patient advocacy groups. This study investigated the impact of treatment (surgery alone; surgery plus somatostatin analogue; other treatments) on quality of life (QOL). Finally, we investigate whether recurrent disease results in poorer QOL compared to disease treated curatively with surgery and remaining in remission.

Results and discussion

Results suggest that increased frequency of bowel movements and presence of any flushing symptoms are correlated with decreased quality of life. Treatment groups differed on most Patient Reported Outcomes Measurement Information System (PROMIS) global health and PROMIS-29 scores, including physical function, fatigue, pain, social function, and general physical and mental health, with the surgery group reporting significantly better scores than the other groups (effect size of differences ranged from 0.28 to 0.54). This may be possibly due to effective symptom control reached for these patients through surgery alone. After adjustment for carcinoid syndrome, the association with the treatment group disappeared for all domains except physical functioning. In terms of disease status, patients with recurrent disease reported poorer physical, social, and mental functions. Depression scores were similar between groups; however, patients with recurrent disease reported significantly higher anxiety compared to those with no current NET. Physical functioning was even more markedly different between groups, with recurrent NET patients reporting significantly impaired overall physical function, impaired sleep, and significant fatigue compared to those with no current NET. To our knowledge, this is the first study to comprehensively examine the effect of treatment group, disease status, and symptom burden on the quality of life in NET patients in a large sample. Limitations and future research directions are discussed.

     

Endogenous IL-33 enhances Th2 cytokine production and T-cell responses during allergic airway inflammation

IL-33 is an IL-1-related cytokine which has been implicated in T(h)2-associated biology and allergic diseases in humans and mice. IL-33 stimulates T(h)2 cells, mast cells, eosinophils, basophils, iNKT cells and circulating CD34(+) stem cells to proliferate and produce pro-allergic cytokines such as IL-5 and IL-13. IL-33 mediates its cytokine effects through a receptor consisting of ST2 and IL-1RAcP. Whereas IL-1RAcP is ubiquitously expressed, ST2 expression is cell-type restricted and determines responsiveness to IL-33. Studies employing ST2-deficient mice have reported variable results on the role of this receptor, and consequently IL-33, with regards to allergic lung inflammation. In this study, we demonstrate that IL-33 is important for allergic lung inflammation. Intra-nasal administration of IL-33 triggered an immediate allergic response in the airways, and more importantly, we show that endogenous IL-33 contributes to airway inflammation and peripheral antigen-specific responses in ovalbumin-induced acute allergic lung inflammation using IL-33-deficient mice. Our results suggest that IL-33 is sufficient and required for severe allergic inflammation in the lung and support the concept of IL-33 as a therapeutic target in allergic lung inflammation.     

Standardization of the 5-word test in a group of 191 normal subjects aged 50 to 90 years

INTRODUCTION: The 5-word test (5WT) is a serial verbal memory test with semantic cuing. It allows to estimate cued learning, free recall, and cued recall of 5 words during immediate and delayed recalls (5 min later). The 5WT is proposed to rapidly evaluate memory of aging people. It has shown its sensitivity and its specificity in identifying patients with Alzheimer's disease (AD). OBSERVATIONS: We report the constitution of a sample of 191 French speaking normal subjects, aged from 50 to 90 years, in four age classes (50 years, 60 years, 70 years, 80 years) and three education levels. Total Score, Total Weighted Score, Free Delayed Recall, Delayed Recalls Total (memory score), and Free Recalls Total appear to be the best scores to appreciate the memory performance of the normal subjects. A Total Score of 10 was obtained in 74.9 p.cent of the subjects. No immediate nor delayed intrusions were recorded. In spite of the absence of an explicit consign, the recalled words were often ordered as they were in the list. CONCLUSION: The 5WT is a simple and reliable test for investigating memory in elderly people above 50 years old.