KP1/CD68 expression in malignant neoplasms including lymphomas, sarcomas, and carcinomas.

Expression of KP1/CD68 macrophage-associated antigen in a series of 840 selected malignant neoplasms, including immunomorphologically characterized cases of non-Hodgkin's lymphoma (NHL) (434), Hodgkin's disease (HD) (115), soft tissue sarcoma (147), carcinoma (49), and other tumors (95), was examined. KP1 expression was detected in a significant number of NHLs (107 of 434; 24.7%), most of them (65 of 107; 60.7%) of the diffuse small cell subtype. Only 14 of the 155 large cell lymphomas, compared to 10 of the 51 Ki-1/CD30+ anaplastic large cell (ALC) lymphomas examined, were KP1 positive. Conversely, none of the T-lineage NHL--other than Ki-1/CD30+ ALC lymphomas--or the HD cases tested was labeled by KP1 antibody. Among the other neoplasms tested, KP1 was reactive with a variable proportion of cases of malignant fibrous histiocytoma (19 of 24; 79.2%), malignant schwannoma (8 of 22; 36.4%), liposarcoma (3 of 9; 33.3%), leiomyosarcoma (8 of 37; 21.6%), cutaneous or metastatic melanoma (51 of 73; 69.9%), and renal cell carcinoma (3 of 5; 60%). These results indicate that KP1 shows a relatively wide spectrum of immunoreactivity with malignant neoplasms of presumed non-histiocyte origin, thus arguing against its expected specificity and high value in diagnostic pathology. Although the significance of KP1 expression by some subsets of NHLs remains to be elucidated, its close association with B-cell NHLs, mostly of the diffuse small cell type, should stimulate further pathologic and clinical investigations.

A psychosomatic approach to idiopathic recurrences of anterior uveitis.

We examined 60 patients affected by idiopathic recurrent anterior uveitis and studied the relevance of stressful life events and psychological distress in relation to relapses of the disease. The results were statistically insignificant when compared to the control groups. We found that neither life events nor psychological distress played a contributory role in this disease.

A multicenter investigation of consultation-liaison psychiatry in Italy. Italian C-L Group.

In order to evaluate the extent and quality of consultation-liaison (C-L) activity in Italy, a multicenter investigation was conducted in 17 general hospitals. All of the hospitalized patients referred to C-L psychiatry during a 1-year period were assessed by means of a specific instrument (Patient Registration Form, PRF-SF). Of 518,212 patients, 4182 were referred to C-L services (referral rate = 0.72%). Typical consultations were for female patients (60.1%), admitted to medical wards (71.5%), aged 55-75 years. Most interventions were carried out within 2 days; a minority (22%) were urgent requests. Gastrointestinal and cardiovascular disorders, and unexplained medical symptoms were the most frequent ICD-9 somatic diagnoses at admission. One-third of the patients were not informed of having been referred to C-L and half of them had a lifetime history of psychiatric disturbances. Most frequent ICD-10 psychiatric diagnoses were neurotic, stress-related, and somatoform syndromes (33.1%), affective syndromes (19.4%), and organic mental syndromes (10.7%). Two-thirds of the patients were given only one consultation whereas the reminder received two to four follow-up visits. The rate of transfer to psychiatric wards was low (2.1%). Psychopharmacological treatment was suggested in 65% of cases, and 75.5% of the patients were referred to community psychiatric care at discharge. The implications of the findings are discussed.

[Psychological assistance in organ transplantation]. / L'assistenza psicologica nei trapianti d'organo.

The aim of this report is introducing with a series of psychological, psychiatric and psychosocial problems, that can arise, at every point, in the procedure of organ transplantations. Different areas of intervention are considered: the assistance to the patients and their families during the pre- and post-operative periods; the evaluation of transplant recipients' quality of life; ethical and psychological problems of living kidney donation; psychosocial support to donors' families; the training of the intensive therapy units to entertain relationships with donors' relatives; the delicate psychological aspects of transplantation during childhood. The sense of awareness about these matters is growing in Italy too, and many initiatives of psychological and psychiatric help are being developed in collaboration with several transplantation centres.

Nonadherent behaviors after solid organ transplantation.

BACKGROUND AND AIM: The effectiveness of any treatment depends not only on the choice of therapy, but also, to a large extent, on the patient's active cooperation. Adherence to medical prescriptions and particularly to immunosuppressive therapy is crucial to prevent medical complications that negatively influence graft function and patient survival after organ transplantation. The aim of this study was to assess, among patients who underwent solid organ transplantation, nonadherent behaviors (NAB) to immunosuppressive therapy, to correct lifestyle, and to general medical prescriptions. MATERIALS AND METHODS: We evaluated patients who underwent solid organ transplantation from March 2008 to June 2009. All participants completed an anonymous 15-item questionnaire to assess NAB. RESULTS: We enrolled 218 organ transplant patients: 103 liver, 50 kidney, 52 heart, and 13 lung. There were 152 men and the overall age was 52.2 ± 0.8 years (mean ± standard deviation [SD]) time from transplantation, 83.6 ± 4.5 months (mean ± SD). Overall 37.9%, 38.8%, and 12.8% of patients reported nonadherence to immunosuppressive therapy, to correct lifestyle, and to general medical prescriptions, respectively. Considering nonadherence to immunosuppressive therapy and to general prescriptions, the percentage of kidney transplant patients who referred NAB was significantly lower compared with other organ transplant patients (P = .008 and P = .04, respectively). Nonadherent patients to immunosuppressive therapy and to general medical prescriptions displayed a longer interval from transplantation compared with adherent patients (P = .02 and P = .03, respectively). Among patients nonadherent to the correct lifestyle, the rates of men and of patients with disability pension were significantly higher compared to adherent patients (P = .001 and P = .002, respectively). CONCLUSIONS: Poor adherence to medical prescriptions and to adequate lifestyle is common among organ transplant patients, especially those who have undergone liver transplantation. Psychoeducational interventions for transplanted patients and their families are needed to improve adherence.

Longitudinal prospective study on quality of life and psychological distress before and one year after liver transplantation.

BACKGROUND: The impact of liver disease and medical complications on quality of life (QOL) and psychological distress before and after liver transplantation (LT) is a matter of growing interest. METHODS: In a longitudinal prospective study, perceived QOL (LEIPAD Quality of Life test) and psychological distress (Brief Symptom Inventory, BSI) were assessed in 25 cirrhotic patients when they were listed for LT and 1, 3, 6 and 12 months after LT. Patients were also evaluated for medical complications and blood levels of immunosuppressive agents. RESULTS: Overall QOL and psychological distress improved significantly and rapidly in most domains from the first month and up to a year after LT. Medical complications and immunosuppressive agents did not correlate with any changes in QOL and psychological distress after LT. When patients were divided according to liver disease etiology: 1. HCV patients listed for LT had worse QOL levels than the group of patients as a whole or the alcoholic liver disease (ALD) patients; 2. HCV patients reported a significant improvement in QOL only 6 and 12 months after LT, and still suffered more psychological distress 12 months after surgery; 3. in ALD patients, overall QOL and psychological distress improved significantly at all follow-up points after LT; 4. HCV patients reported a worse QOL and greater psychological distress 1 and 3 months after LT than the group as a whole or the ALD patients (p < 0.05). CONCLUSIONS: Liver transplantation improves QOL and psychological distress in most recipients, but not in the early stages after LT in patients transplanted for HCV cirrhosis.

[Critical aspects of communication in intensive care]. / Aspetti critici della comunicazione in terapia intensiva.

The poor quality of interpersonal communication is the main reason for the dissatisfaction intensive care patients and their family members often experience. Yet interpersonal communication is considered an important means of conveying information, providing psychological support, and preventing conflicts which can arise when communication is ineffective and information is misunderstood. Good communication is, therefore, an essential part of therapy. This study examines the factors that can hinder communication between clinicians, patients and their family members and the strategies needed to overcome the obstacles to good communication. The results of the study showed that training in the development of relational skills and communicative competence within the intensive care setting should be directed towards the promotion of decision-making processes shared among medical personnel, patients and their family members. In this way, conflict can be reduced and the quality of medical care improved.

Personality, psychophysical stress and myopia progression. A prospective study on 57 university students.

Personality profile, psychophysical stress and cycloplegic refraction were evaluated at the baseline (T0) and after 12 months (T1) in 57 university students comprising 39 myopes and 18 emmetropes/hyperopes (controls) whose age, sex distribution and academic results were comparable. At T0, a tendency toward a higher degree of anxiety, somatization and inadequacy was found in myopes in comparison with controls; however, only the anxiety state was different (Wilcoxon signed-rank test P < 0.001). Personality profiles, psychophysical stress and blood levels of cortisol, ACTH, GH, prolactin were similar in myopes and controls. The myopes were classified at T1 as either well-corrected (if their lenses corresponded to refractometer values of +/- 0.50 D and were worn full-time) or undercorrected (if their lenses were > or = 0.75 D with respect to refractometric values and/or were worn part-time). When the spherical cycloplegic values at T0 and T1 were compared, a myopic shift was revealed only in the undercorrected myopes (P < 0.001 in both eyes). These findings suggest that personality profile and psychophysical stress do not play a primary pathogenetic role in myopia. Undercorrection seems to accelerate the progression of myopia.

[Use of DSM-III R and other psychometric tests in consultation psychiatry. Consideration of 85 patients]. / Utilizzo del DSM-III R e di alcuni test psicometrici in psichiatria di liaison. Considerazioni su 85 pazienti.

DSM-III R diagnostic categories were used in 85 consecutive patients attending consultation at the Liaison Psychiatry Service of Padua University School of Medicine. The aim was to render the diagnosis as objective as possible. The same patients were asked to fill in three well-known self-rating scales (Eysenck Personality Inventory, Illness Behaviour Questionnaire, Symptom Rating Test) and the scores obtained were correlated with the diagnostic categories. In the Authors' opinion, the use of diagnostic instruments in the traditional psychiatric setting of the consultation allows a marked improvement in the understanding of the content of the prescription written by the referring physician. DSM-III R is an instrument which meets such requirements. The same cannot be said of the rating scales used, which were found less useful.

Changes in myopia, visual acuity, and psychological distress after biofeedback visual training.

The effects of auditory biofeedback training on myopia, visual acuity (VA), and psychological distress were evaluated in a controlled prospective study involving 55 mildly myopic (< or = -3.5 D) high school students. These myopes were divided into 2 groups, matched for age and dioptric defect: 33 were treated with visual training and 22 were not; 27 emmetropic subjects formed a further control group. Subjects were evaluated at the baseline (T0), at 10 weeks after the end of the treatment (T1), and after an interval of 12 months (T2) from the baseline for: (1) manifest and cycloplegic refraction, and the difference between them (cycloplegic tonus); (2) VA measured with a conventional optotype in all subjects, and also with a computer-generated optotype in the treated group; and (3) psychometric values and personality profile. At T2, myopia had significantly worsened both in the treated and in the control myopes; VA in the treated myopes appeared significantly improved when measured by the conventional optotype, but unchanged when measured by computer. Psychometric scores improved significantly in the treated myopes and in the emmetropic controls. Objectively the autorefractometer showed that 38% of the myopes had voluntary control of positive accommodation, i.e., the ability to increase spherical defect; no voluntary control of negative accommodation was observed. An increase in VA was associated with a significant increase in the foveation time (i.e., the period of time when the target is imaged on the fovea and the eye is motionless), and was partly attributable to a learning effect. In conclusion, biofeedback visual training had a positive effect on psychological distress and subjective VA improvement, but failed to reduce the existing myopia or delay its evolution.

[Bioethical interpretation of intensive care] . / Per una lettura in chiave bioetica delle terapie intensive.

The bioethical interpretation concerns both those receiving intensive care (IC) and the nature of the treatment itself. The principle of autonomy expressed in the doctor-patient relationship is achieved through the use of informed consent and may also be used in the unique context of patients in IC. Organ-function replacement treatment raises the ethical question of the definition and management of the limit to treatment. The appropriateness of IC can be defined by clinical and ethical criteria and aims to avoid inappropriately excessive treatment. In order to improve the decision-making process involving bioethical questions, the authors outline a number of working approaches: the use of informed consent even in IC, the possible role of Advanced Directives in IC, epidemiological studies, operator training.

Treating myopia with acoustic biofeedback: a prospective study on the evolution of visual acuity and psychological distress.

OBJECTIVE: The effects of a visual training technique on changes in myopia, visual acuity, and psychological distress were studied in a controlled prospective study. METHOD: A group of 33 female students with myopia < or = 3.50 diopters (D) underwent visual training using an acoustic biofeedback technique. A group of 22 female students with myopia and a group of 27 students with emmetropia formed the two control groups, matched for school, age, sex, and refractive error. Manifest and cycloplegic refraction, visual acuity, personality profile (CPI), and psychological distress (SCL-90) were measured at the baseline (T0), at 10 weeks (T1), and after 12 months (T2). RESULTS: At T2, myopia significantly progressed both in the treated and in the untreated students with myopia. Visual acuity improved only in the treated myopia group (despite refraction objectively being worse). No differences were found among the personality profiles in the three groups. All items indicative of psychological suffering improved in the group treated for myopia whose visual acuity was ameliorated. CONCLUSIONS: The visual training technique led to no improvement in objective measures of visual acuity, but did lead to an improvement in one relatively subjective measure of visual acuity and a parallel improvement in psychological conditions. The students with myopia who were treated consequently had a greater sense of general well-being.

The impact of liver disease and medical complications on quality of life and psychological distress before and after liver transplantation.

BACKGROUND/AIM: The impact of liver disease and medical complications on quality of life (QOL) and psychological distress before and after orthotopic liver transplantation (OLT) is a matter of growing interest. METHODS: Perceived QOL (LEIPAD Quality of Life test) and psychological distress (Brief Symptom Inventory, BSI) were assessed in 40 cirrhotic patients listed for OLT (Group A) and in 101 liver transplant recipients (Groups B to G=0-6, 7-12, 13-24, 25-36, 37-48, 49-60 months post-OLT). Patients were also evaluated for medical complications, blood levels of immunosuppressive agents and recurrence of liver disease. RESULTS: QOL and psychological distress were significantly better in most of the post-OLT groups than in cirrhotic patients. Among post-OLT patients, a significantly worse QOL was perceived at 13-24 months (Life Satisfaction: Group D vs G, p=0.024; Cognitive Functioning: Group D vs F, p=0.024), while significantly greater psychological distress was detected at 7-12 months (Anxiety and Interpersonal Sensitivity: Group C vs Group B, p=0.032 and p=0.023, respectively). Medical complications and immunosuppressive therapy did not influence QOL or psychological distress after OLT. Within 6 months after OLT, patients with HCV recurrence showed significantly greater Depression (p=0.023), Anxiety (p=0.038), Phobic Anxiety (p=0.001), and Paranoid Ideation (p=0.033) than anti-HCV negative patients. CONCLUSIONS: Liver transplantation improves psychological distress and most, but not all, QOL domains. Recurrent HCV infection is associated with greater psychological distress.

The effect of recurrence of HCV infection of life after liver transplantation.

The present study evaluated the quality of life (QOL) of adult cirrhotic patients before orthotopic liver transplantation (OLT), the effect of OLT on QOL in the long-term and the effect of HCV recurrence within medical complications on QOL. Three groups of patients were studied: 19 pre-OLT, 33 during the first year post-OLT and 41 1 to 5 years post-OLT. The patients completed questionnaires on QOL and underwent liver function tests, immunosuppressive drug blood level determinations and medical complications evaluation. Somatization and depression and anxiety scores improved significantly during the first year post-OLT compared with pre-OLT, but they worsened again during the 1-5-year period post-OLT. Physical functioning and life satisfaction scores improved significantly during the first year post-OLT completed with pre-OLT and the improvement persisted 1-5-year during the period post-OLT. Patients with HCV recurrence compared with patients without HCV recurrence during the first year post-OLT showed a significant worsening of most of the domains of QOL. In conclusion, OLT improved most of the domains of QOL by the end of the first post-transplant year, though the improvements did not all persist in the long-term. Recurrence of HCV infection plays a major role in the impairment of QOL after OLT.