Can MRI help assess aggressiveness of endometrial cancer?

AIM: To identify potential magnetic resonance imaging (MRI) biomarkers to predict the aggressiveness of endometrial cancer. MATERIALS AND METHODS: Seventy-one patients with endometrial cancer who underwent MRI staging were analysed retrospectively. The signal intensity (SI) of the tumours was assessed on sagittal T2-weighted imaging (WI) and sagittal T1WI sequences). The depth of myometrial invasion, tumour grade and subtype, lymphovascular invasion, and microsatellite stability status were assessed histopathologically, and these findings were compared with MRI findings using logistic regression. The log-rank test was used to assess differences in survival among groups defined by different MRI measurements. RESULTS: Tumours with qualitative higher signal than that of normal myometrium on the late T1WI DCE image sequences were more likely to have lymphovascular space invasion (p<0.001). Tumours that had a higher SI tumour ratio (T1 post-contrast arterial/T1 precontrast) had a higher chance of being microsatellite stable (odds ratio 2.36). The SI ratio of the tumour to the myometrium showed that lower T2 tumour/T2 myometrial ratio correlated with ≥50% depth of myometrial invasion as determined by imaging (p=0.006). Endometrial tumours showing a SI of >209 on delayed T1WI sequences had longer recurrence-free survival than those with tumours showing a SI ≤209 (p=0.014). Tumour subtype and grade were not associated with MRI findings. CONCLUSION: The SI of endometrial cancer on MRI may be used to predict the aggressiveness of the tumour and microsatellite stability status. Further studies are needed to confirm these findings.

Psychiatric disorders in African American nursing home residents.

OBJECTIVE: High prevalence rates of psychiatric illness and high levels of behavioral disturbance have been reported in studies of nursing home residents; however, the populations evaluated have been predominantly Caucasian. The aims of the present study were to identify prevalence rates of psychiatric disorders and behavioral disturbances in a sample of African American nursing home residents. METHODS: The authors evaluated 106 African American nursing home residents, aged 65 and over, from a representative sample of nursing homes. The evaluation included informant interview with nursing home staff, cognitive assessment, and a psychiatric interview that included a physical and neurological examination. Consensus diagnoses were reached by using DSM-III-R criteria. RESULTS: Of the 106 subjects, 90% received at least one primary psychiatric diagnosis, and 71% had at least one behavioral problem; dementia was the most common psychiatric diagnosis (68%). Thirty -one percent of the patients were treated with neuroleptic medication; most of these patients received diagnoses of dementia or schizophrenia. Fifteen percent of the patients had been in physical restraints, which correlated with physical disability. CONCLUSIONS: The prevalence of psychiatric illness in this sample of African American nursing home residents is similar to that reported in previous studies with predominantly Caucasian populations. Behavioral disturbances, while commonly reported, were somewhat less frequent than reported in previous studies.

Optimal management of behavioural disorders associated with dementia.

Behavioural disorders occur with great frequency in patients with dementia. They are the major reason for admission of these patients to nursing homes. However, there have been few controlled trials of many of the commonly used drugs to guide therapy. To treat these conditions successfully, an adequate description of target symptoms of the behaviours to be corrected and a thorough investigation to identify precipitating causes are essential. Behavioural problems in dementia patients may results from physical illnesses, adverse drug effects, environmental changes, psychiatric syndromes (i.e. depression, delirium or psychosis) or the dementing illness itself. Therapeutic strategies should address the underlying cause whenever possible. Although pharmacological therapies are commonly employed, their efficacy is often modest and adverse effects can be quite significant. Ongoing reassessments are essential to maximise symptomatic benefits and minimise adverse effects. Several trials with different drugs are often necessary before an effective therapy is found. Anticholinergic adverse effects, which occur commonly with many antipsychotic and antidepressant medications, may worsen the cognitive and memory deficits that form the primary symptoms of dementia in these patients. This article summarises the use of the various psychoactive medications that target common behavioural disturbances, including agitation, psychosis, depression and sleep disturbances, in dementia patients. General guidelines regarding dosage, potential adverse effects and duration of therapy are discussed.

Efficacy of military antishock trousers in compensatory and decompensatory hemorrhagic hypotension.

The compensatory cardiovascular response to hemorrhage includes a baroreceptor-induced activation of the sympathetic nervous system resulting in an attempt to reestablish MAP through peripheral vasoconstriction. If the hypotension is not reversed this compensatory vasoconstriction will progress to a loss of vascular tone known as vascular decompensation. The primary purpose of the present study was to compare the effectiveness of military antishock trousers (MAST) applied during the compensatory and decompensatory stages of hemorrhagic hypotension. MAST pressures of 30, 50, 70, and 90 mm Hg were applied during control, compensation, and decompensation. The results showed that MAST pressures up to 90 mm Hg were ineffective at raising mean arterial blood pressure (MAP) when applied to normotensive dogs; MAP increased 62% when MAST were applied during compensation as the result of a significant augmentation of cardiac output (stroke volume and heart rate) with no change in TPR; and a modest increase in MAP from 40 to 55 mm Hg occurred when MAST pressure was increased to 70 mm Hg during decompensation, which was accounted for entirely on the basis of an increased total peripheral resistance with no significant change in CO.

The association between Apo E genotype and depressive symptoms in elderly African-American subjects.

In this study of 138 elderly subjects (112 without and 26 with dementia) obtained from a community sample of elderly African-American subjects, there were no significant differences in mean Geriatric Depression Scale scores by Apo E epsilon 4 status for dementia or nondementia subjects. Three subjects received a diagnosis of major depressive disorder. None of these subjects were Apo E epsilon 4-positive. These results do not support an association between depressive symptoms and Apo E allele status in this elderly African-American population.

Apolipoprotein E genotypes and Alzheimer's disease in a community study of elderly African Americans.

As part of a community-based study of Alzheimer's disease (AD) in the African-American population age 65 and over, we have determined apolipoprotein E (Apo E) genotypes in 85 subjects (31 AD patients and 54 controls). The epsilon 4 allele of Apo E was strongly associated with AD in this population sample. The epsilon 4 allele frequency in AD patients was 40.3% compared with 13.9% in the control group, and 22.6% of the AD patients were homozygous for this allele compared with 3.7% of the control subjects (p = 0.01). This study extends the association of Apo E-epsilon 4 and AD to nonwhite populations and provides further evidence that the observed allelic association is biologically relevant.