Pleural and peripheral lung lesions: comparison of US- and CT-guided biopsy

PURPOSE

To retrospectively compare the outcome of computed tomography (CT) and ultrasonography (US) guidance when sampling a consecutive series of peripheral lung or pleural lesions.

MATERIALS AND METHODS

Institutional review board approval was obtained, and the informed consent requirement was waived. From January 2000 to August 2011, 711 thoracic biopsies were performed at two institutions. Among these, 273 lesions in 273 patients (115 men, 158 women; mean age, 65 years ± 11 [standard deviation]; 86 pleural lesions; 187 pulmonary lesions) had pleural origin or were peripherally located in the lung with a small amount of pleural contact. These lesions were sampled with either CT (170 patients; mean age, 64 years ± 12; 55 pleural lesions, 115 peripheral pulmonary lesions) or US (103 patients; mean age, 67 years ± 10; 31 pleural lesions, 72 peripheral pulmonary lesions) guidance by using an 18-gauge modified Menghini needle. Procedure duration, postprocedural pneumothorax or hemorrhage, and sample adequacy were recorded. Fisher exact test, log-rank test, and Mann-Whitney U test were performed.

RESULTS

No significant difference was found for patient age (P = .741), sex (P = .900), lesion size (P = .206), or lesion origin (P = .788). Median time was 556 seconds for CT-guided biopsy (25th percentile, 408 seconds; 75th percentile, 704 seconds) and 321 seconds for US-guided biopsy (25th percentile, 157 seconds; 75th percentile, 485 seconds) (P < .001). Postprocedural pneumothorax was observed in 25 of 170 (14.7%) CT-guided procedures and in six of 103 (5.8%) US-guided procedures (P = .025); hemorrhage occurred in two of 170 (1.2%) CT-guided procedures and in one of 103 (1.0%) US-guided procedures (P = .875). Technical success was achieved in 100 of 103 US-guided procedures (97.1%) and in 164 of 170 CT-guided procedures (96.5%) (P = .999).

CONCLUSION

With pleural or peripheral lung lesions, US guidance is comparable to CT guidance in terms of sample accuracy, while allowing for a significant reduction in procedure time and postprocedural pneumothorax and being free from ionizing radiation.

Gene variants with suicidal risk in a sample of subjects with chronic migraine and affective temperamental dysregulation

BACKGROUND

Risk factors for suicide are at least partially heritable and functional polymorphisms of targeted genes have been suggested to be implicated in the pathogenesis of this phenomenon. However, other studies examining the association between specific gene variants and suicide revealed inconsistent findings. We aims to evaluate the possible association between MAO-A3, CYP1A2*1F and GNB3 gene variants, hopelessness and suicidal risk in a sample of subjects with chronic migraine and affective temperamental dysregulation.

METHODS

56 women were genotyped for MAO-A3, CYP1A2*1F and GNB3 gene variants. Participants were also assessed using Beck Hopelessness Scale (BHS), the Temperament Evaluation of the Memphis, Pisa, Paris and San Diego-Autoquestionnaire (TEMPS-A), and the Suicidal History Self-Rating Screening Scale (SHSS).

RESULTS

Patients with higher total scores on affective dysregulated temperaments are more likely to have higher BHS (11.27+/=5.54 vs. 5.73+/=3.81; t19.20 = -3.57; p < 0.01) and higher SHSS total scores (4.79+/=3.31 vs. 1.05±2.31; t17.74 = -3.90; p < 0.001) than those with lower total scores. 67% of patients in the dysregulated group has BHS total scores >= 9 indicating high levels of hopelessness. No association was found between MAO-A3, CYP1A2*1F and GNB3 gene variants and suicidal risk as assessed by BHS and SHSS.

CONCLUSIONS

This study did not sustain the association between MAO-A3, CYP1A2*1F and GNB3 gene variants and increased suicidal risk in patients with chronic migraine and affective temperamental dysregulation. Further studies investigating the gene-environment interaction or focusing on other genetic risk factors involved in suicidal behaviour are needed.  

High-resolution ultrasound of the extrinsic carpal ligaments

Thanks to its intrinsic high spatial resolution, ultrasound is an ideal imaging modality for examining very thin, superficial structures, and this makes it very helpful in the evaluation of extrinsic carpal ligaments. These structures, which arise from the radius and ulna and insert on the carpal bones, are extremely important for wrist stability. Previous studies have assessed the use of ultrasound to study the extrinsic carpal ligaments in cadavers, healthy asymptomatic subjects, and patients with rheumatoid arthritis. In the present report, we review the normal anatomy, biomechanics, and ultrasound appearance of these ligaments.

Preliminary ultrasound evaluation of the rotator cable in asymptomatic volunteers()

PURPOSE

To characterize the rotator cable high-resolution ultrasound appearance in asymptomatic shoulders of volunteers of different age.

MATERIALS AND METHODS

IRB approval and volunteers' written consent was obtained. Excluding subjects with known shoulder affections, we screened 24 asymptomatic volunteers. Supraspinatus and infraspinatus tendons high-resolution ultrasound evaluation was performed according to standard scan protocols, further excluding shoulders with partial/full-thickness cuff tears. Thus, we studied 24 shoulders in 12 young volunteers (age range 21-39 years, mean age 33 ± 8 years) and 21 shoulders in 11 elderly volunteers (age range 62-83 years, mean age 75 ± 45 years). For each shoulder, we noted rotator cable visibility and its thickness and width. Fisher's and U Mann-Whitney statistics were used.

RESULTS

Rotator cable was less frequently detected in young than in elderly volunteers (5/24 vs. 11/21 shoulders; P = 0.034). When detected, rotator cable was significantly thicker in young (range 1.2-1.5 mm, mean thickness 1.3 ± 0.1 mm) than in elderly (range 0.9-1.4 mm, mean thickness 1.2 ± 0.1 mm) volunteers (P = 0.025), while its width was not significantly different in young (range 4.5-7.1 mm, mean 5.6 ± 1.1 mm) compared to elderly (range 2.5-7.1 mm, mean 4.2 ± 1.4 mm) volunteers (P = 0.074) although a tendency can be highlighted.

CONCLUSIONS

Ultrasound demonstrated the different consistency of rotator cable in young and elderly asymptomatic patients, with high interobserver reproducibility.

Gender-related differences concerning anger expression and interpersonal relationships in a sample of overweight/obese subjects

OBJECTIVES

Obesity and overweight are relevant public health issues. They are frequently associated with increased disability, enhanced morbidity and mortality and are often comorbid with several psychological/psychiatric conditions. The aim of the present study was to explore gender-related differences concerning anger expression and interpersonal relationships in a sample of overweight/obese subjects.

MATERIALS AND METHODS

The convenience sample consisted of 40 overweight/obese subjects (18 women, 22 men) who were administered self-report questionnaires to assess eating disorders (EDI-2), anger levels (STAXI) and self/other perception as a measure of interpersonal relationships (9AP).

RESULTS

Women had higher scores on the EDI-2 subscales of Bulimia (7.22 vs. 2.20: z=7.61; p<.001), Body Dissatisfaction (15.56 vs. 12.14: z=1.88; p=.03), Interoceptive Awareness (9.89 vs. 5.28: z=4.06; p<.001), Ineffectiveness (11.00 vs 5.22: z=4.91; p <.001) and Perfectionism (6.33 vs. 3.26: z=4.13; p<.001) compared to norms. The overweight/obese men departed from the norms on fewer subscales. Both women and men tended to turn feelings of anger in toward themselves, suppressing their anger. Also, women obtained lower scores for Self Empathy (29.06 vs. 40.15: z = - 2.30; p = .01) and Other Empathy (16.44 vs. 27.10: z =- 2.00; p= .02) whereas overweight/ obese men obtained lower scores for Other Empathy (20.77 vs. 28.47: z=-2.00; p=.02).

CONCLUSIONS

Overweight/obese subjects have a tendency to turn feelings of anger inward on to themselves together with impaired interpersonal relationships, especially in women. An adequate clinical assessment in all obese individuals trying to identify the contribution of psychological factors to the perceived distress is critical.

Ultrasound-guided treatment of meralgia paresthetica (lateral femoral cutaneous neuropathy): technical description and results of treatment in 20 consecutive patients

OBJECTIVES

The purposes of this study were to describe a technique for treatment of meralgia paresthetica (lateral femoral cutaneous neuropathy) using ultrasound guidance and to report the results of treatment.

METHODS

Twenty consecutive patients (7 male and 13 female; age range, 23-66 years; mean, 39 years) with meralgia paresthetica confirmed by electromyography were treated with perineural injection of 1 mL of methylprednisolone acetate (40 mg/mL) and 8 mL of mepivacaine, 2%, under direct ultrasound guidance. Main outcome measures included the technical success of the procedure, visual analog scale score for the lateral femoral cutaneous nerve (pain, burning sensation, and paresthesia), and visual analog scale global quality of life score.

RESULTS

Technical success (successful nerve block at the distribution of the lateral femoral cutaneous nerve) was achieved in all patients. Five patients felt slight sharp pain during needle insertion. The symptoms in 16 patients (80%) diminished progressively after the first week. The 4 remaining patients (20%) required a further perineural injection. The symptoms disappeared in all patients 2 months after injection (mean visual analog scale score ± SD for lateral femoral cutaneous neuropathy at baseline, 8.1 ± 2.1; at 2 months, 2.1 ± 0.5; t = 6.2; P < .001). The mean visual analog scale quality of life scored decreased from 6.9 ± 3.2 to 2.3 ± 2.5 (t = 5.3; P < .002).

CONCLUSIONS

Treatment of meralgia paresthetica with ultrasound-guided perineural injections resulted in substantial symptom relief in most patients 2 months after injection. Randomized placebo-controlled trials of this treatment should be considered in the future.

Affective temperaments are associated with higher hopelessness and perceived disability in patients with open-angle glaucoma

AIM

The aims of the study were to study: (i) affective temperaments in open-angle glaucoma (OAG) patients with some degree of functional visual impairment; (ii) psychological well-being and perceived disability, and their associations with affective temperaments; and (iii) associations between visual impairment, affective temperaments and psychological well-being.

METHOD

Participants were 91 outpatients (39 women, and 52 men) with open-angle glaucoma (OAG) who were assessed for Visual Field Index, Mean Defect and Pattern Standard Deviation. Patients were also administered the Beck Hopelessness Scale, the TEMPS-A (Rome), the Gotland Male Depression Scale, the Emotional Well-being Scale, the Perceived Disability Questionnaire and the Suicidal History Self-Rating Screening Scale.

RESULTS

Open-angle glaucoma patients (compared with a non-clinical sample of university students) had higher scores on the TEMP-A dysthimic and hyperthimic traits and lower scores on cyclothimic, irritability and anxiety traits. Such temperament variability was not linked to differences in severity of glaucoma. We did not find strong evidence supporting the fact that measures of visual impairment were linked to emotional well-being and depression. However, logistic regression analysis revealed that patients may have different patterns related to their illness according to specific temperaments.

CONCLUSION

Patients with OAG may have different temperament profiles than non-clinical individuals. Such categorisation may be useful for predicting how they face the illness, for providing better care as well as for early recognition of mood disorders symptoms.

Stigmatization of schizophrenia as perceived by nurses, medical doctors, medical students and patients

Stigmatization of schizophrenia is widespread and its genetic explanation may potentially increase the stigma. The present study investigated whether seeing schizophrenia as a genetic or environmental disorder might influence perceived beliefs towards people with schizophrenia and whether social stigmatizing attitudes were differently perceived the 202 subjects who were recruited. Perceived social stigmatizing attitudes were compared among participants who read two vignettes depicting a person with schizophrenia. Then, the Standardized Stigmatization Questionnaire (SSQ) was administered. A genetic explanation of schizophrenia was more frequently associated with stigmatizing attitudes. Also, there were higher levels of perceived stigmatization in medical students and medical doctors than in other groups based on their social experience or background. However, the sample size was small and this was a non-experimental design; also the SSQ would benefit from more cross-validation. About half of the participants perceived stigmatizing social attitudes. Finally, considering schizophrenia as a genetic disorder influenced participants perception of other people's beliefs about dangerousness and unpredictability and people's desire for social distance.

MR imaging of the brachial plexus: comparison between 1.5-T and 3-T MR imaging: preliminary experience

OBJECTIVE

To compare 1.5-T and 3-T magnetic resonance (MR) imaging of the brachial plexus.

MATERIALS AND METHODS

Institutional review board approval and informed consent were obtained from 30 healthy volunteers and 30 consecutive patients with brachial plexus disturbances. MR was prospectively performed with comparable sequence parameters and coils with a 1.5-T and a 3-T system. Imaging protocols at both field strengths included T1-weighted turbo spin-echo (tSE) sequences and T2-weighed turbo spin-echo (tSE) sequences with fat saturation. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) between muscle and nerve were calculated for both field strengths. The visibility of brachial plexus nerve at various anatomic levels (roots, interscalene area, costoclavicular space, and axillary level) was analyzed with a four-point grading scale by two radiologists. MR imaging diagnoses and pathological findings were also compared qualitatively.

RESULTS

SNR and CNRs were significantly higher on 3-T MR images than on 1.5-T MR images (Friedman test) for all sequences. Nerve visibility was significantly better on 3-T MR images than on 1.5-T MR images (paired sign test). Pathological findings (n = 30/30) were seen equally well with both field strengths. MR imaging diagnoses did not differ for the 1.5- and 3-T protocols.

CONCLUSIONS

High-quality MR images of the brachial plexus can be obtained with 3-T MR imaging by using sequences similar to those used at 1.5-T MR imaging. In patients and healthy volunteers, the visibility of nerve trunks and cords at 3-T MR imaging appears to be superior to that at 1.5-T MR imaging.

Antidepressants in unipolar and bipolar depression and increased suicidal risk: Is there scientific evidence?

Introduction

Suicidal behavior represents a major public health issue. There has been a controversy concerning the possible increased risk of suicidal behaviour in some depressed patients treated with antidepressants and whether antidepressants affect the risk of suicidality among patients with major affective disorders is still matter of debate.

Objectives

To investigate the real impact of SNRIs in treating patients with unipolar and bipolar disorder.

Aims

Recently we aimed to evaluate the efficacy of duloxetine versus venlafaxine in the acute treatment of unipolar and bipolar depression.

Methods

In a non randomized controlled trial, we recruited 62 participants as consecutive outpatients (41 men; 21 women) affected by unipolar and bipolar depression treated either with duloxetine and venlafaxine.

Results

More patients treated with duloxetine had a positive response to treatment and remission both for depression (HAMD17 response: 90.3% vs 0.0%; p < .001; HAM-D17 remission: 48.4% vs 0.0%; p < .001), and anxiety (HAM-A response: 90.3% vs 6.5%; p < .001; HAM-A remission: 71.0% vs 6.5%; p < .001) than controls. Patients treated with duloxetine were also more likely to show a decrease in HAM-D17 suicidality (100% vs 45.2%; < .001) and an increase in the quality of life (SF-36 percentage of improvement: 6.35 [SD = 9.66 vs -2.58 [9.98]; p < .001) than controls.

Conclusions

Among SNRIs, based on our results, duloxetine is more effective in reducing anxiety and suicidal ideation. Both duloxetine and venlafaxine were safe and tolerated, and both may be successfully used in unipolar and bipolar depression.

FC14-04 - Tobacco smoking and suicidal ideation and planning in schoolchildren 12–15 years old from ten low- and middle-income countries: impact of cultural differences

Objective

The authors examined the association between tobacco smoking and suicidal ideation and planning in schoolchildren from 10 countries in Africa, the Americas, and the Western Pacific region.

Method

Data were collected through the Global school-based Student Health Survey (GSHS), a collaborative surveillance project between the World Health Organization (WHO), the United Nations, UNICEF, UNESCO, UNAIDS, and the US Centers for Disease Control and Prevention (CDC). Suicidal ideation and planning, tobacco smoking, and drug and alcohol use were included in loglinear models to analyze, separately for each sex, higher order interactions among suicidality and regional and country differences.

Results

Schoolchildren who reported suicidal ideation and/or suicidal planning had a higher risk of smoking cigarettes even after controlling for drug and alcohol misuse. Furthermore, analyses indicated higher order interactions between suicidal ideation and planning and countries belonging to different regions with different exposure to tobacco smoking among schoolchildren.

Conclusion

Future studies analyzing the mechanism and sequencing of the relationship among suicidal ideation and tobacco smoking should explore cultural factors.

Affective temperaments, white matter hyperintensities and suicidal risk in patients with mood disorders

Introduction

Patients with white matter hyperintensities (WMHs) may be at higher risk for affective disorders and suicidal behaviour and affective temperaments may play a significant role in mood disorders.

Objectives, aims, methods

Recently, we conducted a study in a sample of 247 patients with major affective disorders consecutively admitted as psychiatric inpatients.

Results

We found that those with higher dysthymia and lower hyperthymia were more likely to have higher BHS scores, more WMHs, higher MINI suicidal risk, and more recent suicide attempts than patients with higher hyperthymia and lower dysthymia. Previously, we have reported that depressive, cyclothymic, irritable and anxious temperaments are risk factors whereas the hyperthymic temperament is a protective factor for suicidal behaviour, at least for suicide attempters. This is in line with recent genetic studies showing that the short allele of serotonin transporter gene promoter (5-HTTLPR) was significantly related to depressive, cyclothymic, irritable and anxious temperaments (but not to the hyperthymic temperament) and individuals with the short allele of the 5-HTTLPR and major affective disorders have more microstructural white matter abnormalities in specific brain regions.

Conclusions

In subjects with mood disorders, some temperament profiles in addition to WMHs presumably play a critical role in the emergence of hopelessness and suicidal behaviour. Differences among temperament profiles associated with WMHs may be used as biological markers for clinically grouping subjects at higher risk both for the emergence of mood disorders and suicidal behaviour (highly lethal suicide attempts) and this may have relevant implications for treatment.

Brachial plexus assessment with three-dimensional isotropic resolution fast spin echo MRI: comparison with conventional MRI at 3.0 T

OBJECTIVE

The purpose of our study was to determine whether a three-dimensional (3D) isotropic resolution fast spin echo sequence (FSE-cube) has similar image quality and diagnostic performance to a routine MRI protocol for brachial plexus evaluation in volunteers and symptomatic patients at 3.0 T. Institutional review board approval and written informed consent were guaranteed.

METHODS

In this prospective study FSE-cube was added to the standard brachial plexus examination protocol in eight patients (mean age, 50.2 years) with brachial plexus pathologies and in six volunteers (mean age, 54 years). Nerve visibility, tissue contrast, edge sharpness, image blurring, motion artefact and acquisition time were calculated for FSE-cube sequences and for the standard protocol on a standardised five-point scale. The visibility of brachial plexus nerve and surrounding tissues at four levels (roots, interscalene area, costoclavicular space and axillary level) was assessed.

RESULTS

Image quality and nerve visibility did not significantly differ between FSE-cube and the standard protocol (p>0.05). Acquisition time was statistically and clinically significantly shorter with FSE-cube (p<0.05). Pathological findings were seen equally well with FSE-cube and the standard protocol.

CONCLUSION

3D FSE-cube provided similar image quality in a shorter acquisition time and enabled excellent visualisation of brachial plexus anatomy and pathology in any orientation, regardless of the original scanning plane.

High-resolution, three-dimensional, and contrast-enhanced ultrasonographic findings in diseases of the eye()

OBJECTIVES

To review the contrast-enhanced ultrasound (CEUS) and 3D ultrasound findings (3D-US) in various pathologies involving the eye and orbit and to compare them with high-resolution US (HRUS) findings.

BACKGROUND

CEUS is a valid diagnostic tool for study several districts. There are numerous pathological conditions of the eye in which CEUS can be very helpful or detrimental. IMAGE FINDINGS: We review a wide range of ocular lesions, traumatic (retinal and choroidal detachments) and malignant (choroidal melanoma, tumors inside and outside the muscle cone) evaluated alternatively with CEUS and 3D and compare these findings with those obtained with HRUS. Dysthyroid orbitopathy is not included in this review.

CONCLUSION

CEUS plays a central role in the differentiation of detached retina (vascular) and vitreous membranes (avascular). It is also helpful in the assessment of tumor of the eye, in planning treatment for choroidal melanoma, and in assessing orbital masses for neovascularization. HRUS is highly effective in the detection of traumatic and non-traumatic lesions of the eye, but it is less effective for the assessment of orbital lesions. The 3D module has increased the diagnostic value of CEUS. CEUS is cost-effective and can be used when CT and MR cannot be performed.

Suicide prevention among youths. Systematic review of available evidence-based interventions and implications for Italy

Suicide completion is a leading cause of death for children, adolescents, and young adults. There is evidence that the suicide rate for those aged 15 to 24 years has tripled since 1950, and suicide is now the second or third leading cause of death in this age group. Recent studies indicate that the incidence of suicide attempts among adolescents may exceed 10% annually. The role of caregivers and schools (as well as colleges and universities) is important in the assessment, management, and prevention of suicidal behaviour in children and youth. Recognition of risk factors for suicide is of paramount importance for prevention. Furthermore, a number of educational programs have demonstrated possible key roles in implementing suicide prevention strategies. As suicide is a problem of concern among Italian youths, this paper overviews current official statistical evidence of the phenomenon and suggests a national suicide prevention strategy based on a number of tools already involved in this field, especially in the USA.

The thickness of the A1 pulleys reflects the disability of hand mobility in scleroderma. A pilot study using high-frequency ultrasound

BACKGROUND

Hand involvement in scleroderma is a serious concern. Clinical tests to asses hand dysfunction are based on the experience of the clinician.

OBJECTIVE

To asses if utrasonographic (US) measurement of A1 pulley thickness may be used as an indicator of hand mobility in scleroderma.

MATERIALS AND METHODS

Institutional review board approval and patient informed consent was obtained. Twenty-eight patients affected suffering from scleroderma and 40 healthy controls were prospectively evaluated by two blinded radiologists with US, with a transducer operating at 17MHz. A1 pulley thickness was measured and correlated with the Hand Mobility in Scleroderma Test (HAMIS) and disease duration.

RESULTS

The thickness of the A1 pulley was greater in sclerodermic patients than in controls (p < 0.05). Intra and inter-observer agreement were better for ultrasound (0.94;0.88) than for HAMIS tests (0.71;0.70). A good correlation between pulley thickness, hand mobility and disease duration was found (r = 0.78, p < 0.018; r = 0.54, p < 0.05).

CONCLUSION

A1 pulley thickness measured on ultrasound correlates with hand mobility and disease duration. Ultrasound is an useful tool to evaluate hand disability in scleroderma.