The abnormal prostate: MR imaging at 1.5 T with histopathologic correlation

Thirteen patients with biopsy-proved adenocarcinoma were prospectively examined with magnetic resonance (MR) imaging with use of a 1.5-T superconducting magnet. All patients subsequently underwent radical prostatectomy and careful, axial, histologic mapping of prostatic disease. Histologic findings were recorded on serial, axial diagrams to ensure precise pathologic correlation with the MR images. MR permitted identification of eight of 12 (67%) adenocarcinomas as hypointense foci (relative to the surrounding, higher intensity, peripheral zone); but tumor volume was under-estimated with MR imaging in five of eight cases (63%). Nodules of prostatic hyperplasia were identified correctly in only one of nine patients (11%). These findings suggest that, despite that fact that high field strength MR imaging currently does not depict all pathologic foci within the prostate, it may be of predictive value in the differential diagnosis of prostatic abnormalities when their locations are demonstrable.     

Family care for the mentally ill: a new perspective.

Family care has been a subject of controversy since large numbers of discharged psychiatric patients have been placed in these homes. The debate has centered on whether such community facilities offer a meaningful alternative in caring for the mentally ill. Findings of a study dealing with the quality of care in the homes and factors deemed responsible for these conditions provide a new perspective on the dilemma.     

Reduction of patient exposure by use of heavy elements as radiation filters in diagnostic radiology

The effect on patient exposure of x-ray filters made of heavy elements has been studied in excretory urography and lumbar spine examinations. Several elements with atomic numbers between 62 and 74 were tested in experiments using radiographic phantoms and in patient studies. A holmium filter reduced skin exposure by more than 50% in excretory urography. Similar results were obtained with ytterbium and tungsten in lumbar spine studies.     

Halitosis amongst students in tertiary institutions in Lagos state

BackgroundHalitosis is defined as a noticeable unpleasant odor from the mouth. It is a medico-social problem that affects a significant number of people around the world. Research reveals that nearly 50% of the adult population has halitosis.ObjectivesTo determine level of awareness of halitosis and prevalence of the condition amongst students in tertiary institutions as a baseline survey.MethodsFor this project, 100 students from three tertiary institutions in Lagos state were chosen: University of Lagos, Lagos State University, Ojo campus and Yaba College of Technology. A semi-structured questionnaire and practical testing/diagnostic tool were utilized. Data collected was collated and analyzed using Microsoft Excel 2007 and SPSS statistical software.ResultsMost of the respondents were single and Christian. Level of awareness of halitosis was high. Results showed that 15%, 2% and 22% from UNILAG, LASU and YCT respectively said they had halitosis. Using the diagnostic tool, 6%, 8% and 2% respectively were positive for halitosis.ConclusionsThere is high level of awareness of halitosis among the respondents. The prevalence of the disorder is low, however, it is recommended that enlightenment campaigns be mounted in schools to improve level of awareness and treatment seeking.     

New variant of von Willebrand disease type II with markedly increased levels of von Willebrand factor antigen and dominant mode of inheritance: von Willebrand disease type IIC Miami

A variant of von Willebrand disease (vWD) was identified in six members of a kindred spanning four generations. The proband was a 46-year-old woman with a lifelong history of bleeding, a prolonged bleeding time (> 15 minutes), markedly elevated von Willebrand factor (vWF) antigen (vWF:Ag = 2.09 U/mL), slightly reduced ristocetin cofactor activity, and a plasma vWF multimer pattern similar to that of vWD type IIC. Similar findings were observed in her three children, mother, and brother. In affected family members, platelet and plasma vWF multimer patterns were discrepant with higher molecular weight multimers observed in platelet vWF. Following a 1-Des-amino-8-D-arginine vasopressin (DDAVP) challenge, the proband failed to normalize her bleeding time even though vWF: Ag rose by 70% and higher molecular weight multimers were increased slightly. Genetic studies were consistent with autosomal dominant inheritance of a mutation within the vWF gene. By sequencing of cloned genomic DNA, mutations were excluded in exons 4, 5, 14, and 15, which encode regions of the vWF propeptide proposed to be important in multimer biosynthesis. Mutations also were excluded in exons 28 to 31, which encompass the known mutations that cause vWD types IIA, IIB, and B. This new variant of vWD, characterized by autosomal dominant inheritance, a qualitative defect that resembles vWD type IIC, and increased plasma vWF:Ag, was tentatively designated vWD type IIC Miami.     

Pathogenesis of B cell lymphoma in a patient with AIDS

Lymphoma occurs at increased frequency in patients with the acquired immunodeficiency syndrome (AIDS). We studied, using serologic and molecular techniques, one such lymphoma for (a) evidence of infection with human T lymphotropic virus, type III (HTLV-III), and Epstein-Barr virus (EBV), (b) monoclonal rearrangement of immunoglobulin and T cell receptor genes, and (c) rearrangement of the c-myc oncogene. Immunoglobulin and T cell receptor gene studies demonstrated that the tumor was of monoclonal B cell origin. Similar to cases of Burkitt's lymphoma unrelated to AIDS, there were DNA sequences in the lymphoma that hybridized to EBV-specific probes and demonstrated evidence of c- myc rearrangement. HTLV-III sequences were not detected in the malignant B cells. The pathogenesis of some B cell neoplasms in patients with the syndrome may involve transformation by EBV and deregulation of oncogene expression without direct infection of the malignant B cells by HTLV-III.     

Factors influencing the adoption of home telecare by elderly or chronically ill people: a national survey

Aims and objectives. The primary aim is to provide insight into client characteristics and characteristics of home telecare contacts, which may influence the adoption of home telecare. Secondary aim is to examine the applicability of four perceived attributes in Rogers’ diffusion of innovations theory, which may influence the adoption: relative advantage, compatibility, complexity and observability. Background. Western countries face strongly increasing healthcare demands. At the same time, a growing nursing shortage exists. The use of home telecare may be instrumental in improving independence and safety and can provide support to older and chronically ill people, but a precondition for its uptake is that clients consider it as a useful and helpful technological tool. Design. A survey conducted among clients of seven home care organisations in the Netherlands connected to a home telecare system. Methods. In 2007, a postal questionnaire was distributed to 468 older or chronically ill clients: 254 responded (54%). The data were analysed by regression techniques, employing a theoretical model. Results. This study showed that clients’ perceived attributes – relative advantage, compatibility, complexity and observability – have a significant effect on adoption of home telecare explaining 61% of the variance. The chance of adoption is higher when a client already receives long‐term personal and/or nursing care, he/she lives alone and when there are fixed daily contacts via the home telecare system. The perception of possible benefits can still be enhanced. Conclusions. The concept of perceived attributes, derived from Rogers’ diffusion of innovation theory, has been useful to explain clients’ adoption of home telecare. Relevance to clinical practice. Home care organisations can best focus on clients already in care and people living alone, in offering home telecare. Nurses, who aim to enhance the client’s adoption of home telecare, have to take into account clients’ perceived attributes of such new technology.     

TREATMENT GOALS IN IRRITABLE BOWEL SYNDROME

Irritable bowel syndrome (IBS) carries a considerable economic and social impact which may, in part, be due to inefficient diagnosis and inappropriate treatment choice leading to continued patient ill health and absenteeism. Even assuming that IBS can be diagnosed positively, using well-established symptom-based criteria, management difficulties remain. Thus, pharmacological treatment choice is still based on the single predominant symptom, and many currently available treatments are ineffective in the long term. A greater understanding of the pathophysiology of IBS may lead to the development of more effective treatments that can target the multiple symptoms present in IBS. A new understanding of the role of serotonin (5-HT) and specific receptors (5-HT₃ and 5-HT₄) found in the gastrointestinal (GI) tract has led to the development of serotonergic agents which have potential clinical benefits. Recent clinical trials suggest that 5-HT4 receptor partial agonists, in particular, may have the ability to offer multiple symptom relief, without the risk of significant adverse reactions.