Effects of common chronic medical conditions on psychometric tests used to diagnose minimal hepatic encephalopathy.

Many chronic medical conditions are accompanied by cognitive disturbances but these have only to a very limited extent been psychometrically quantified. An exception is liver cirrhosis where hepatic encephalopathy is an inherent risk and mild forms are diagnosed by psychometric tests. The preferred diagnostic test battery in cirrhosis is often the Continuous Reaction Time (CRT) and the Portosystemic Encephalopathy (PSE) tests but the effect on these of other medical conditions is not known. We aimed to examine the effects of common chronic (non-cirrhosis) medical conditions on the CRT and PSE tests. We studied 15 patients with heart failure (HF), 15 with end stage renal failure (ESRF), 15 with dysregulated type II diabetes (DMII), 15 with chronic obstructive pulmonary disease (COPD), and 15 healthy persons. We applied the CRT test, which is a 10-min computerized test measuring sustained attention and reaction time stability and the PSE test, which is a paper-pencil test battery consisting of 5 subtests. We found that a high fraction of the patients with HF (8/15, 0.002) or COPD (7/15, p = 0.006) had pathological CRT test results; and COPD patients also frequently had an abnormal PSE test result (6/15, p < 0.0001). Both tests were unaffected by ESRF and DMII. Half of the patients with HF or COPD had psychometrically measurable cognitive deficits, whereas those with ESRF or DMII had not. This adds to the understanding of the clinical consequences of chronic heart- and lung disease, and implies that the psychometric tests should be interpreted with great caution in cirrhosis patients with heart- or lung comorbidity.

Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group.

The MUSA (Morphological Uterus Sonographic Assessment) statement is a consensus statement on terms, definitions and measurements that may be used to describe and report the sonographic features of the myometrium using gray-scale sonography, color/power Doppler and three-dimensional ultrasound imaging. The terms and definitions described may form the basis for prospective studies to predict the risk of different myometrial pathologies, based on their ultrasound appearance, and thus should be relevant for the clinician in daily practice and for clinical research. The sonographic features and use of terminology for describing the two most common myometrial lesions (fibroids and adenomyosis) and uterine smooth muscle tumors are presented.

Alpha-ketoglutarate metabolism by cytochrome-containing anaerobes.

During growth in the presence of tracer amounts of exogenously supplied alpha-keto[1-14C]glutarate (AKG) or alpha-keto [5-14C]glutarate, cytochrome-containing Bacteroides fragilis strain 2044 and Bacteroides vulgatus strain 8482 incorporated extremely small amounts of radioactivity into cell macromolecules and protoheme. Under identical conditions, Bacteroides "l" strain 7CM and Bacteroides buccae strain J1 incorporated substantial label from [5-14C]AKG, but not [1-14C]AKG, into cellular macromolecules and protoheme. Bacteroides succinogenes strain S85 incorporated radioactivity from both [1-14C]AKG and [5-14C]AKG into cell macromolecules, but only label from [5-14C]AKG appeared in protoheme. Selenomonas ruminantium strain HD1 and Butyrivibrio fibrisolvens strain D1, both of which are devoid of cytochromes, incorporated substantial label from both [1-14C]AKG and [5-14C]AKG into cell macromolecules, but failed to incorporate label from either position into protoheme. Bacteroides ruminicola sp. brevis strain GA33 incorporated label from both [1-14C]AKG and [5-14C]AKG into both cell macromolecules and protoheme. A substantial portion of the heme synthesized by this organism may be formed by the "plant" pathway involving the intact use of the AKG carbon skeleton. Major differences exist in the manner and extent of AKG utilization among cytochrome-containing anaerobes and between these organisms and bacteria devoid of cytochromes obtained from similar environments.