Feasibility of radiological markers in idiopathic normal pressure hydrocephalus.

BACKGROUND: Various radiological markers have been proposed for diagnostics in idiopathic normal pressure hydrocephalus (iNPH). We examined the usefulness of radiological markers in the diagnostics and prediction of shunt response in iNPH. METHOD: In this retrospective cohort study, we evaluated brain CT or MRI scans of 390 patients with suspected iNPH. Based on a 24-h intraventricular pressure monitoring session, patients were classified into a non-NPH (n = 161) or probable iNPH (n = 229) group. Volumes of cerebrospinal fluid compartments (lateral ventricles, sylvian and suprasylvian subarachnoid spaces and basal cisterns) were visually assessed. Disproportionally enlarged subarachnoid spaces, flow void, white matter changes, medial temporal lobe atrophy and focally dilated sulci were evaluated. Moreover, we measured quantitative markers: Evans' index (EI), the modified cella media index, mean width of the temporal horns and callosal angle. RESULTS: iNPH was more likely in patients with severe volumetric disproportion between the suprasylvian and sylvian subarachnoid spaces than in those without disproportion (OR 7.5, CI 95 % 4.0-14.1, P < 0.0001). Mild disproportion (OR 2.6, CI 95 % 1.4-4.6, P = 0.001) and narrow temporal horns (OR per 1 mm 0.91, CI 95 % 0.84-0.98, P = 0.014) were also associated with an iNPH diagnosis. Other radiological markers had little association with the iNPH diagnosis in the final combined multivariate model. Interestingly, EI was higher in non-NPH than iNPH patients (0.40 vs. 0.38, P = 0.039). Preoperative radiological markers were not associated with shunt response. CONCLUSIONS: Visually evaluated disproportion was the most useful radiological marker in iNPH diagnostics. Narrower temporal horns also supported an iNPH diagnosis, possibly since atrophy was more pronounced in the non-NPH than iNPH group.

Moderate/severe Depression (MADRS) Can Affect the Quality of Life and Outcome Among Patients Admitted to Breast Cancer Diagnosis Unit.

AIM: The Montgomery-Asberg Depression Rating Scale (MADRS) is one of the most widely used examiner rating instruments for screening, diagnosis and measuring the severity of depression. However, the long-term predictive value of the MADRS in patients admitted to the breast cancer diagnosis unit (BCDU) is unknown. PATIENTS AND METHODS: In the Kuopio Breast Cancer Study women with breast symptoms were evaluated for the total MADRS score before any diagnostic procedures. The relapse-free survival (RFS) was calculated from the time of diagnosis to the time of first relapse including local relapse, contralateral breast cancer (BC) or metastatic disease. The overall survival (OS) was assessed as the time from the date of diagnosis to the date of last follow-up or death of the patient. The effect of the MADRS on the RFS and on the OS were calculated by Kaplan-Meier survival analysis and the difference between groups was assessed by the log-rank test. The RFS and OS were estimated for the study groups with the low MADRS score (<25) versus the high MADRS score (≥25). The end-point of our study was to determine differences in long-term outcome and in MADRS score in breast cancer (BC), benign breast disease (BBD) and healthy study subjects (HSS). RESULTS: In the Cox proportional hazard model the total MADRS score significantly predicted the 25 year RFS and OS in the HSS, BBD and BC groups combined (HR=2.26, p=0.006; HR=2.46, p=0.008, respectively), and in the Kaplan-Meier survival analysis with the log-rank test the total MADRS score predicted the 25 year RFS and OS in the HSS, BBD and BC groups combined (p=0.005; p=0.006, respectively). CONCLUSION: The moderate/severe depression (MADRS) can affect the quality of life and outcome among patients admitted to the BCDU.

Beck Depression Inventory as a Predictor of Long-term Outcome Among Patients Admitted to the Breast Cancer Diagnosis Unit: A 25-year Cohort Study in Finland.

AIM: The Beck Depression Inventory (BDI) is one of the most widely used instruments for measuring the severity of depression. However, there has been no prospective study to investigate the long-term outcome in patients admitted to Breast Cancer Diagnosis Units. PATIENTS AND METHODS: In the Kuopio Breast Cancer Study, women with breast symptoms were evaluated for total BDI score before any diagnostic procedures were carried out. The relapse-free survival (RFS) was calculated from the time of diagnosis to the time of first relapse including local relapse, contralateral breast cancer (BC) or metastatic disease. The overall survival (OS) was assessed as the time from the date of diagnosis to the date of last follow-up or death of the patient. The effect of the BDI on the RFS and on the OS were calculated by the Kaplan-Meier survival analysis and the difference between the groups was assessed by the log-rank test. The RFS and OS was estimated for the study groups with a low BDI score (<8) versus those with a high BDI score (≥8). The end-point of our study was to determine differences in long-term outcome and in BDI score in individuals with BC, benign breast disease (BBD) and in healthy study subjects (HSS). RESULTS: In the Cox proportional hazard model, the total BDI score significantly predicted the 25-year RFS and OS in the HSS, BBD and BC groups combined (Hazard Ratio=1.87, p=0.039; Hazard Ratio=1.98, p=0.048, respectively), and in the Kaplan-Meier survival analysis with the log-rank test, the total BDI score predicted the 25-year RFS and OS in the HSS, BBD and BC groups combined (p=0.043; p=0.036, respectively). CONCLUSION: The BDI is a significant predictor of long-term outcome among patients admitted to the Breast Cancer Diagnosis Unit in Finland.

Does the Rectus Sheath Block Analgesia Reduce the Inflammatory Response Biomarkers' IL-1ra, IL-6, IL-8, IL-10 and IL-1ß Concentrations Following Surgery? A Randomized Clinical Trial of Patients with Cancer and Benign Disease.

AIM: To evaluate whether the post-surgery placement of the rectus sheath block analgesia (RSB) reduces the inflammatory response following surgery. The main hypothesis of our study was to find any correlation between patients' pain experience, numeric rating scale (NRS) postoperatively and concentrations of inflammatory response biomarkers, such as interleukin-1 receptor antagonist (IL-1ra), IL-6, IL-8, IL-10, IL-1ß, in patients with benign disease and cancer. PATIENTS AND METHODS: Initially, 46 patients with midline laparotomy were randomized to the placebo group (n=11) and to one of the three active groups; single-dose (n=12), repeated-dose (n=12) and continuous infusion (n=11) RSB analgesia groups. Plasma concentrations of high-sensitivity C-reactive protein (hs-CRP) and five interleukins (IL-1ra, IL-6, IL-8, IL-10, IL-1ß) were measured at three time points; just before, immediately after and 24 h after operation. The primary end-point was to compare plasma concentrations of the hs-CRP and five interleukins in the placebo group and in the three different RSB analgesia groups in patients with benign disease and cancer. RESULTS: The placebo group and three active groups were similar in terms of demographic variables and perioperative data. Of the anti-inflammatory cytokines, patients in the continuous infusion group had significantly higher IL-10 median values postoperatively than the three other study groups (p=0.029). In addition, patients in the three active groups combined had significantly higher IL-10 median values immediately after operation than the placebo group (p=0.028; in all patients with benign disease and cancer). There is a significant correlation between the individual values of NRS and IL-10 values postoperatively in the placebo group and the three active groups separately (r=0.40, p=0.03) and also a significant correlation between the individual values of the NRS scale and IL-1ß values postoperatively in the placebo group and the three active groups separately (r=0.38, p=0.04). CONCLUSION: Placement of RSB analgesia does not significantly reduce the inflammatory response biomarkers' concentrations in patients with benign disease or cancer patients. A new finding in the present work is a significant correlation in the NRS scale versus plasma concentrations of anti-inflammatory cytokine IL-10 and pro-inflammatory cytokine IL-1ß postoperatively suggesting that inflammation and pain are related.

Suicidal Ideation Versus Hopelessness/Helplessness in Healthy Individuals and in Patients with Benign Breast Disease and Breast Cancer: A Prospective Case-control Study in Finland.

BACKGROUND/AIM: The relation between suicidal ideation versus hopelessness/helplessness in healthy study subjects (HSS) and in patients with benign breast disease (BBD) and breast cancer (BC) has not been compared to date in a prospective study. We, therefore, investigated suicidal ideation versus hopelessness/helplessness in 115 patients. PATIENTS AND METHODS: In the Kuopio Breast Cancer Study, 115 women with breast symptoms were evaluated for hopelessness and helplessness versus suicidal/pessimistic thoughts before any diagnostic procedures were carried-out. RESULTS: In the self-rating score (SRS), hopelessness and the helplessness versus pessimistic thoughts were significantly correlated in the HSS, BBD and BC groups. In the SRS, the weighted kappa-values for hopelessness versus pessimistic thoughts in the BBD group were also statistically significant. There was also a significant positive correlation in the examiner-rating score (ERS) in the hopelessness versus pessimistic thoughts in the HSS, BBD and BC groups, as well as in the ERS, in the helplessness versus pessimistic thoughts in the HSS and BBD groups. In SRS, the hopelessness and the helplessness versus suicidal thoughts were significantly correlated in the HSS, BBD and BC groups. There was also a significant positive correlation in the ERS in the hopelessness versus suicidal thoughts in the HSS, BBD and BC groups, as well as in the ERS, in the helplessness versus suicidal thoughts in the BBD group. CONCLUSION: A new finding with clinical relevance in the present work is the agreement between hopelessness/helplessness versus suicidal/pessimistic thoughts in the self-rating and examiner-rating. In the breast cancer diagnostic Unit, the identification of suicidal ideation is essential in suicide prevention and it is important to assess and treat depression even though a subject reports little suicidal ideation.

Agreement between hopelessness/helplessness and Montgomery-Asberg Depression Rating Scale in healthy individuals and in patients with benign breast disease and breast cancer: a prospective case-control study in Finland.

BACKGROUND: The relation between scoring for hopelessness/helplessness and the Montgomery-Asberg Depression Rating Scale (MADRS) in healthy study subjects (HSS) and in patients with benign breast disease (BBD) and breast cancer (BC) has not been compared in a prospective study. We, therefore, investigated hopelessness and helplessness scores versus the MADRS in 115 patients. PATIENTS AND METHODS: In the Kuopio Breast Cancer Study, 115 women with breast symptoms were evaluated for hopelessness and helplessness, and for the MADRS before any diagnostic procedures were carried out. RESULTS: In the self-rating score (SRS), hopelessness/helplessness versus the MADRS were highly significantly positively correlated in the HSS, BBD and BC groups. In the SRS, the weighted kappa values for hopelessness/helplessness versus the MADRS in the HSS, BBD and BC groups were also statistically significant. There was also a significant positive correlation in the examiner-rating score (ERS) for hopelessness versus the MADRS in the HSS, BBD and BC groups and for helplessness versus the MADRS in the HSS, BBD and BC groups. The unweighted kappa values in the ERS for hopelessness versus the MADRS were statistically highly significant for the HSS, BBD and BC groups and those for helplessness versus the MADRS in the HSS and BBD groups were statistically significant. CONCLUSION: A new finding with clinical relevance in the present work is the agreement between hopelessness/helplessness scores and MADRS in the SRS and ERS. In the breast cancer diagnostic unit, the identification of hopeless/helpless persons is essential in suicide prevention and it is important to assess and treat hopelessness/helplessness even though an individual may report few depressive symptoms.

Emotional personality/proximity versus emotional authenticity in patient-physician communication in healthy study participants, and in patients with benign breast disease, and breast cancer: a prospective case-control study in Finland.

BACKGROUND/AIM: The associations between emotional personality, proximity and authenticity in patient-physician communication during breast cancer (BC) consultations are rarely considered together in a prospective study. We, therefore, investigated emotional personality/proximity versus authenticity in patient-physician communication in healthy study subjects (HSS) and in patients with benign breast disease (BBD) and breast cancer (BC). PATIENTS AND METHODS: In the Kuopio Breast Cancer Study, 115 women with breast symptoms were evaluated regarding emotional personality, proximity and authenticity in their a patient-physician communication before any diagnostic procedures were carried-out. RESULTS: The emotional personality and the emotional proximity in patient-physician communication was highly significantly positively correlated in the BBD group. The kappa-values for emotional personality versus emotional proximity in the HSS, BBD and BC groups were statistically significant. There was also a highly significant positive correlation between emotional personality and emotional authenticity in the HSS, BBD and BC groups and the kappa values in the HSS, BBD and BC groups were statistically significant. There was a highly significant positive correlation between emotional proximity and emotional authenticity in the BBD group, and the weighted kappa-values in the BBD group were statistically significant. CONCLUSION: The results of the present study support a powerful link between emotional personality/proximity and emotional authenticity, and provides new information in patient-physician communication in the HSS, BBD and BC groups. This finding is of clinical importance, since during breast disease consultation, barriers to patient-physician communication may be associated with difficulties in early BC diagnosis in the breast cancer diagnostic unit.

The relation of hopelessness/helplessness versus beck depression inventory (BDI) in healthy individuals and in patients with benign breast disease and breast cancer: a prospective case-control study in Finland.

BACKGROUND/AIM: The relation between hopelessness/helplessness versus the Beck Depression Inventory (BDI) in healthy study subjects (HSS) and in patients with benign breast disease (BBD) and breast cancer (BC) has not been compared in a prospective study before. We, therefore, investigated hopelessness and helplessness versus the BDI in 115 patients. PATIENTS AND METHODS: In the Kuopio Breast Cancer Study, 115 women with breast symptoms were evaluated for hopelessness and helplessness versus the BDI before any diagnostic procedures were carried out. RESULTS: In the self-rating score (SRS), the hopelessness and the helplessness versus the BDI were highly significantly positively correlated in the HSS, BBD and BC groups. In the SRS, the weighted kappa values for hopelessness and helplessness versus the BDI in the HSS, BBD and BC groups were also statistically significant. There was also a significant positive correlation in the examiner-rating score (ERS) in the hopelessness versus the BDI in the BBD and BC groups and in the ERS in helplessness versus the BDI in the HSS and BBD groups. The unweighted kappa values in the ERS for hopelessness versus the BDI in the HSS and BBD groups were statistically highly significant and the unweighted kappa values in the ERS for helplessness versus the BDI in the BBD and BC groups were statistically significant. CONCLUSION: The results of this study support a powerful link between hopelessness and helplessness versus BDI in the self-rating and examiner-rating. This finding is of clinical importance since, in the breast cancer diagnostic unit, the patients with hopelessness/helplessness characteristics and high BDI score might be associated with a difficulty and delay in reaching BC diagnosis.

The self-rating score (SRS) versus the examiner rating score (ERS) in measuring helplessness in healthy individuals and in patients with benign breast disease and breast cancer: a prospective case-control study in Finland.

BACKGROUND: The self-rating score (SRS) versus examiner rating score (ERS) in measuring helplessness in healthy study subjects (HSS) and in patients with benign breast disease (BBD) and breast cancer (BC) has not been yet compared in a prospective study. We, therefore, investigated SRS versus ERS in 115 patients. PATIENTS AND METHODS: In an extension of the Kuopio Breast Cancer Study 115 women with breast symptoms were evaluated for hopelessness versus helplessness before any diagnostic procedures were carried-out. RESULTS: The SRS and the ERS for hopelessness were highly significantly positively correlated in the HSS, BBD and BC groups. The weighted kappa values for hopelessness between the SRS and the ERS in the HSS, BBD and BC groups were also statistically significant. There was also a significant positive correlation between the SRS and the ERS for helplessness in the HSS, BBD and BC groups. The weighted and unweighted kappa-values for hopelessness versus helplessness for the SRS in the HSS, BBD and BC groups were statistically significant. The Spearman correlation coefficients and both weighted and unweighted kappa values for hopelessness versus helplessness in the ERS in the HSS, BBD and BC groups were statistically significant. CONCLUSION: The results of this study support a specific link between hopelessness and helplessness attitude characteristics by SRS and ERS. This finding is of clinical importance, since in the BC and BBD groups, hopelessness/helplessness might be associated with a delay in BC diagnosis and have a negative impact on the adjustment and well-being of patients.