Correlative imaging of the liver and hepatobiliary system

Many imaging techniques can be used to assess the liver and hepatobiliary system. Each modality has individual strengths and limitations, which usually vary depending on the specific clinical situation. This review discusses several specific common clinical situations where imaging of the liver and biliary system is necessary and describes the various imaging options. Space-occupying liver lesions are discussed, and particular attention is paid to the assessment of liver metastasis, hepatoma, and incidentally discovered liver lesions such as hemangioma, adenoma, and focal nodular hyperplasia. The value of ultrasound, computed tomography, magnetic resonance imaging, and scintigraphic techniques in this patient population is described. Isolated sulfur colloid hepatic scintigraphy is not of great value in the evaluation of these patients. Therefore, this review describes in some detail the value of physiological liver scintigraphy, including gallium and iminodiacetic acid (IDA) scanning as well as dynamic flow imaging of the liver such as hepatic artery perfusion scintigraphy and tagged red cell scintigraphy. Imaging of the biliary tree also is described. The roles of ultrasound and scintigraphy are compared and contrasted as related to the diagnosis of acute cholecystitis, common duct obstruction, and postoperative complications.     

"Mother-baby" biliary endoscopy: the University of Chicago experience

Recoverin is a calcium-binding protein expressed in retinal photoreceptors. It appears to delay the termination of the phototransduction cascade by blocking the phosphorylation of photoexcited rhodopsin. The goal of this study was to determine if recoverin mRNA and protein are expressed in cultured human Y79 retinoblastoma cells, so that this cell line could be used as a model to study the mechanism of recoverin gene expression in the retina. A cDNA encoding human recoverin was PCR cloned and used for prokaryotic expression of recoverin protein. Polyclonal antibodies raised against pure recombinant recoverin were used for western blotting and immunocytochemistry of Y79 cells grown as attachment cultures in the presence of the differentiating agents dibutyryl cyclic AMP (dbcAMP) or butyrate. Northern blot analysis was performed on mRNA extracted from Y79 cells that were also treated with the differentiating agents. In Y79 cell monolayer cultures, recoverin was immunolocalized to the cell cytoplasm, and immunoreactivity was increased dramatically by the addition of 2 mM butyrate to the culture medium. Butyrate treatment also caused an increase in the development of neurite-like cellular processes. Addition of 4 mM dbcAMP resulted in a moderate increase in both recoverin immunoreactivity and number of cellular processes. Western and northern blots of butyrate and dbcAMP-treated Y79 cell cultures demonstrated an increase in recoverin protein and RNA expression, respectively, comparable with that observed with immunocytochemistry. These data suggest that, under the influence of the differentiating agent butyrate, Y79 cells exhibit an increase in expression of the photoreceptor protein recoverin and a concomitant morphological differentiation toward a neuronal phenotype.     

Therapeutic abortion and its psychological implications: the Canadian experience

Approximately 9 months after a legal therapeutic abortion, 188 Canadian women were interviewed. One half were single and the rest were married, separated or divorced. They were matched closely for a number of demographic variables with control women who had not had abortions. Neurotic disturbance in several areas of personality functioning was assessed from questionnaire responses. Out of 27 psychological scales, differences between the abortion and control groups were found on only 3: in general, women who had had abortions were more rebellious than control women, abortion tended to be associated with somewhat greater depression in married women, and single women who had had abortions scored higher on the shallow-affect scale. However, all the personality scores were well within the normal range. Perceived social support was strongly associated with favourable psychological reactions after abortion. Use of contraceptives improved greatly after the abortion, when over 90% of women reported using contraceptives regularly.     

Therapeutic change and the experience of joy: Toward a theory of curative processes.

This article builds an argument for a line of psychotherapy research aimed at uncovering the universal curative processes of change that can occur in many different circumstances, not only in psychotherapy. On the basis of theories and findings from psychological research on happiness, the experience of joy is regarded as a core indicator of therapeutic change leading to an increase in intrapsychic resources and life satisfaction. By studying experiences that trigger joy, a number of curative processes can be identified with a high potential for explaining why and how psychotherapy works. Hypothetical links between these curative processes and therapeutic interventions and conditions are explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic strategies in the treatment of esophageal cancer: our experience

Esophageal cancer has a poor prognosis. The Authors in reviewing esophageal carcinogenis stress the importance of an early diagnosis to improve surgical results and compare their experience with those of other Authors.     

The therapeutic use of a phosphatide food concentrate in diseases of the hepatobiliary system

Our studies on phosphatide, a food concentrate, produced as a by-product during the extraction of an edible oil in the oil-extraction plants, showed its high efficacy in patients (n = 52) with abnormalities of the hepatobiliary system. The drug having more than 40 weight percent of phosphorus-containing lipids appeared to be efficacious not only in respect of the subjective status of the patients but also the functional state of the liver and paraments characterizing lipid metabolism.     

Cross-Cultural Equivalence and Validity of the Vietnamese MMPI-2: Assessing Psychological Adjustment of Vietnamese Refugees.

The cross-cultural equivalence and validity of the Vietnamese translation of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) were examined in a sample of 1st-generation Vietnamese refugees in the United States (N = 143). Respondents completed the Vietnamese MMPI-2, the Harvard Trauma Questionnaire, a measure of acculturation, and a demographic questionnaire. An inspection of MMPI-2 mean profiles and items showing extreme endorsement rates suggested that certain symptom tendencies and cultural values may be reflected in responses to some MMPI-2 items. Older age, lower acculturation, greater experienced premigration-postmigration traumas, and military veteran status were all associated with elevated MMPI-2 profiles, suggesting that the MMPI-2 functions in a reasonably equivalent and valid way in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hybrid rendering and virtual endoscopy of the auditory and vestibular system

A hybrid rendering method (color-coded 3D shaded-surface and volume display) with the possibility of virtual endoscopy using image data sets from HR-SCT was developed. To show the possible advantages and benefits of the improved rendering algorithm we have specifically highlighted the use in relation to the auditory and vestibular system. Postprocessing image visualization offers improved morphological analysis, and will benefit radiological diagnostics, medical education, surgical planning, surgical training and postoperative assessment.     

Early experience with the Varian Six Second body scanner in the diagnosis of hepatobiliary tract disease

Thirty-four patients with liver disease were studied with a research model of the Varian Six Second body scanner. Useful information was gained in patients with a variety of hepatic disorders. This scanner permits resolution of normal hepatic parenchymal detail which has not been reported previously and has reduced the streak artifacts originating from high- and low-CT objects which have been a major source of image degradation with other units.     

Experimental hepatobiliary fascioliasis in rabbits: a radiology-pathology correlation

RATIONALE AND OBJECTIVES: The authors sought to correlate the radiologic findings of hepatobiliary fascioliasis with pathologic features. METHODS: Serial ultrasound, computed tomography (CT), and magnetic resonance findings in seven rabbits with experimentally induced fascioliasis were obtained every other week. Direct cholangiogram was also obtained after the rabbits were killed. Radiology-pathology correlation was done in specimens. RESULTS: In the parenchymal phase (an acute phase of parenchymal invasion of a larva), CT showed subcapsular clustered areas of low attenuation. Magnetic resonance appearance was similar in shape but better than CT in characterizing the hemorrhagic nature of the lesion. Ultrasound findings were nonspecific in this phase. In the ductal phase (a stationary phase after residing in the bile duct), CT showed dilatation of central ducts with symmetric periportal hypoattenuation (periportal tracking). Magnetic resonance could not depict mild ductal dilatation. Ultrasound was most valuable in demonstrating the moving worm within the dilated duct. Pathologically, the hepatic parenchymal lesions consisted of a cluster of eosinophilic granulomas with hemorrhagic change (migratory tract of the flukes). Ductal changes were observed predominantly in the central bile ducts. Periportal lymphangiectasia was also noted. CONCLUSIONS: Computed tomography or magnetic resonance can demonstrate the characteristic evolutionary pattern of fascioliasis that reflects the unique life cycle of Fasciola hepatica. The role of ultrasound, although limited in the parenchymal phase, was most useful in the ductal phase in that it demonstrated the moving worms themselves.     

MRI-guided endoscopy in the brain: a feasability study

Alterations of the plasma factors of hemocoagulation produced by injection of norepinephrine (NE) at progressively increasing doses over 14 days (the total dose ran 35 mg/kg of body mass) were studied in three groups of rats, i.e., animals bred at the low altitude of 760 m in Bishkek (group I), animals in-adapted (group II) and adapted to high altitude of the Tuya-Ashu pass (3200 m, Group III). By the 7th day of NE injection group-I developed a moderate hypercoagulation which persisted till the end of experiment. In adapted animals the high altitude exposure initiated hypocoagulation shifts which then gave place to hypercoagulation ones due to elevated activity of the procoagulant component of homeostasis. Maximally pronounced hypercoagulation charges were recorded in in-adapted rats (group II) and interpreted as a stress-reaction to natural hypoxia augmented by the stress-agent (NE). High altitude revealed greater defense-adaptive potential of the homeostatic system manifested as enhancement of the anticoagulation blood activity, e.g., increased ability to inactivate thromboplastin and thrombin, and fibrinolysis.     

Nursing across cultures: the Vietnamese client

Asian Americans are the most rapidly growing immigrant group in the United States today. Home care nurses will be caring for increasing numbers of patients originating from the Southeast Asian peninsula in the countries of Vietnam, Cambodia, and Laos. A Vietnamese case study explores some of the beliefs, values, and practices held by this group of Asian Americans. The case study highlights the problems that can occur when a nurse is unaware of the impact that culture has on a client from a different ethnic and cultural background. Six steps to provide culturally competent care are outlined.     

Use of Diprivan for digestive system endoscopy

After evaluation of the patient's clinical condition and appropriate premedication is seems reasonable to suggest for: 1. Endoscopic procedures involving the gastro-intestinal tract: slow, titrated induction, using 0.5 to 1 mg.kg-1 of propofol, until the required level of sedation has been achieved; this may or not be preceded by the injection of a low dose of midazolam (0.02 to 0.03 mg.kg-1) or of alfentanil (5 micrograms.kg-1); maintenance is achieved by bolus injections of 20 mg (up to 0.5 mg.kg-1); maintenance of spontaneous ventilation, with oxygen administration is the rule; SpO2 is monitored routinely; anaesthesia has to be performed according to the recommendations of the French Society of Anaesthesia and Intensive Care (SFAR) and the anaesthetist must be prepared to manage any incident during the endoscopy and the recovery period. 2. Procedures involving the biliary tract and the oesophagus, which require deeper anaesthesia: induction should again be titrated using a very slow infusion, with doses ranging from 0.9 to 2.2 mg.kg-1); the maintenance requires a continuous infusion, doses ranging from 4 to 6 mg.kg-1.h-1 when propofol is administered alone and from 4 to 12 mg.kg-1.h-1 when combined with an opioid; continuous oxygenation is necessary using a nasal airway; the need for intubation depends on the type of procedure and the status of the patient; the same monitoring devices and similar safety measures are required during and after procedure as for any anaesthetic or sedation, especially when it is performed in day-case patients or outside the operating theatre.     

Prevalence of Giardiasis: a study at upper-gastrointestinal endoscopy

The prevalence of giardiasis was assessed in 1000 consecutive adult patients undergoing upper-gastrointestinal endoscopy for the usually accepted indications. Patients with upper-gastrointestinal bleeding were excluded. The diagnosis was established by examination of duodenal aspirate and duodenal mucosal impression smears. In 21 patients (2.1%) trophozoites were detected both in the duodenal juice and stained mucosal impression smears. All were treated with metronidazole or tinidazole. In 14 of 16 patients who had subsequent duodenal intubation, eradication of the parasite was confirmed. In five patients previously existent abdominal pain disappeared with clearing of the parasite, and no other cause for their abdominal pain was discovered. A search for Giardia lamblia infestation may be a worthwhile additional procedure at the time of endoscopy when no other cause for abdominal pain is found.