The impact of elevated serum IgG4 levels in patients with primary sclerosing cholangitis

Background

Elevated IgG4 levels have been reported among patients with primary sclerosing cholangitis. Epidemiological data has only been provided from tertiary centres.

Aims

To investigate the prevalence of elevated IgG4 levels and to compare prognosis between patients with and without elevated IgG4 levels in serum in two European cohorts of patients with primary sclerosing cholangitis.

Methods

Serum IgG4-levels were measured in a consecutive series of patients from Berlin, and retrospectively collected in a population-based cohort from Sweden (total N = 345). Cox's proportional hazard analysis was used to calculate relative risks for liver-related death or liver transplantation and cholangiocarcinoma.

Results

Elevated IgG4 values were demonstrated in 10% of patients. A previous history of pancreatitis, combined intra- and extrahepatic biliary involvement and jaundice were independently associated with elevated IgG4 in multivariate analysis. IgG4 status was not associated with an increased risk for the combined endpoint liver-related death or liver transplantation or cholangiocarcinoma.

Conclusion

The prevalence of elevated IgG4 values among European patients with primary sclerosing cholangitis is similar to what previously has been reported from the United States. Elevated IgG4 was not associated with an increased risk of liver transplantation or liver-related death or cholangiocarcinoma.     

Persistence of depression in African American and Caucasian women at midlife: findings from the Study of Women Across the Nation (SWAN)

This study prospectively examined the course of depression in African American and Caucasian midlife women over an 11-year period. Racial differences in lifetime history of depression, severity of depressive symptoms and rates of depressive disorders at baseline, and persistence or recurrence of depression over an 11 year period were examined. Predictors of persistence/recurrence of depression were also examined. The sample was comprised of 423 midlife women enrolled in the Study of Women Across the Nation (SWAN) Mental Health Study (MHS). All participants completed baseline and annual assessments, which included self-reported measures of health, functioning, and psychosocial factors, and clinician administered assessments of psychiatric disorders. Logistic regression analyses were used to examine predictors of depression persistence/recurrence. Findings indicated that African American and Caucasian women did not differ significantly in rates of lifetime and baseline depressive disorders, or severity of depressive symptoms. Annual assessments revealed no significant differences between the groups in rates of persistent/recurrent depression. While African American and Caucasian women do not differ in recurrence of depression at midlife, factors associated with depression differed by race.     

Thin Slice Unenhanced Brain CT Can Detect Aneurysms Larger than 7 mm

Purpose:To evaluate the detection rate of intracranial aneurysms on reconstructed thin slice non enhanced CT (NECT) scans.Methods:NECT scans from 34 patients with 35 aneurysms and 35 individuals without aneurysms were collected. Thin slice maximum intensity projections of the NECT scans were reconstructed. One observer evaluated the native images twice with a time interval of six month between both passes with respect to the prevalence and location of an aneurysm. The size and location of the aneurysms were evaluated in corresponding CT-Angiography and Time of flight datasets. A logit regression analysis was performed with size and location as dependent variables. 2 × 2 tables were constructed. The sensitivity and false negative rate were calculated for aneurysms with 0–6.9 mm, 7–9.9 mm and 10–20 mm and the under the curve (AUC) was calculated.Results:The overall detection rate of the aneurysms was 63% for the first pass and 66% for the second pass in the reconstructed NECT scans. The detection rate of aneurysms is size dependent. The sensitivity to detect aneurysms with a size of 0–6.9 mm was 0.09 and 0.03, for aneurysms with a size of 7–9.9. mm was 0.8 and 0.7 and for aneurysms with a size of 10–20 mm was 0.92 for both passes.The AUC was 0.77 for the first pass and 0.78 for the second pass.Conclusions:NECT scans can be used to detect a significant proportion of intracranial aneurysms larger than 7 mm if properly displayed and reconstructed. These patients should receive further vascular imaging to prevent future aneurysm related subarachnoid hemorrhage.