Chondrex (YKL-40), a potential new serum fibrosis marker in patients with alcoholic liver disease.

OBJECTIVES: Chondrex (YKL-40) is a mammalian member of a protein family that includes bacterial chitinases. The pattern of its expression in certain tissues such as human liver or cartilage suggests a function in remodelling or degradation of extracellular matrix. The purpose of this study was to assess whether circulating YKL-40 might be a serum fibrosis marker in alcoholics. METHODS: Plasma YKL-40 was determined in 146 consecutive heavy drinkers (106 men, 40 women; mean age, 49.2 +/- 9.0 years). Liver biochemical parameters and serum fibrosis markers such as hyaluronate were also measured. Fibrosis and inflammation in liver biopsy were evaluated using a semi-quantitative scoring system. RESULTS: Plasma YKL-40 increased in parallel with the severity of fibrosis (P<0.00001). YKL-40 also increased in the presence of hepatic inflammation (P<0.01). Receiver operating characteristic curves of Chondrex revealed that a threshold of 330 microg/l gave a specificity of 88.5%; however, the sensitivity was only 50.8%. Only 11.5% of patients without severe fibrosis displayed a Chondrex plasma level above this threshold. A positive correlation was found between Chondrex and hyaluronate (r=0.40, P<0.0001), and a negative correlation was shown between Chondrex and the prothrombin index (r=-0.37, P<0.0001). CONCLUSIONS: The severity of liver fibrosis is associated with elevated circulating Chondrex levels. The overlap in YKL-40 values prevents use of Chondrex in a screening programme. High levels of Chondrex (above 330 microg/l) are predictive of severe liver fibrosis. Increased plasma YKL-40 may reflect the remodelling of liver fibrosis in alcoholics.

Non invasive prediction of severe fibrosis in patients with alcoholic liver disease.

OBJECTIVES: The aim of this study was to assess the diagnostic accuracy of noninvasive markers of liver fibrosis in alcoholic liver disease. PATIENTS AND METHODS: Fifty-four clinical and biochemical parameters including serum fibrosis markers (hyaluronate and transforming growth factor beta1) were analyzed in 146 consecutive heavy drinkers (106 men, 40 women; mean age 49.2 years). Following liver biopsy, fibrosis was evaluated using a semi-quantitative scoring system (no fibrosis (0) to severe fibrosis (3 + )). Multivariate analysis was performed to determine the markers that were best correlated with the fibrosis score. RESULTS: Fifty-nine patients (40.4 %) had severe fibrosis (3 +) while 87 (59.6 %) had no fibrosis or moderate fibrosis (0 to 2 +). In multivariate analysis, serum hyaluronate and the prothrombin index were the best markers for the prediction of severe fibrosis. Hyaluronate and the prothrombin index had a diagnostic accuracy of 91.1 % and 89.7 %, respectively in the whole population. Finally, a significant negative correlation was found between hyaluronate and the prothrombin index (r =- 0.86, P <0.0001). CONCLUSIONS: Using only hyaluronate and the prothrombin index, 9 out of 10 alcoholic patients can be correctly classified according to the severity of liver fibrosis.

[Suicidal Risk Scale]. / Echelle de Gravité des Conduites Suicidaires (EGCS).

Assessment of para-suicidal patients is one of the main tasks for the practitioner in an emergency unit. There are now any characteristics known as suicide risk factors, like drug or alcohol abuse, past history of suicides in the family, or psychiatric disorder. However though these characteristics are useful to define high-risk populations, they are not always relevant in personal assessment. The more relevant variables in this case are psychological. Unfortunately, there are very few assessment scales in this area, since scales are usually related to the prediction of suicide or para-suicide before the act. The only existing tool for assessment after the act is the Beck Suicidal Intent Scale (SIS, 1974), which assesses the wish to die. Therefore we propose a new scale for a global assessment of parasuicide: it is an eleven-items scale, divided in four sections. Each section assesses: (1) the parasuicide itself, with the wish to die, the way to die and precautions against intervention; (2) the patient himself, with the premeditation level, an affective disorder existing before the act, the means of future, and environment effect (in a sense of protection or risk); (3) the global impression after the psychiatric interview: the emotionalism level, and the trust in the patient attitude; (4) the patient history: alcohol or drug abuse, personal past-parasuicide. The scale construction was empirical, from clinical practice, but it encompasses the nine high-risk variables found by Motto and Bostrom (1990) in an analysis of prospective data from 3,005 psychiatric patients at risk for suicide, focusing on 38 persons who committed suicide within 60 days of evaluation. Our study has been conducted on a 77 sample of para-suicidal patients in the psychiatrist emergency unit of the Avignon Hospital. For each patient, the score from our scale was calculated by psychiatric nurses after their own interview, before psychiatric examination, about 12 or 24 hours after the entrance in the emergency unit. Then, patients were classified in four groups according to the psychiatrist decision and orientation: exit (n = 7), consultation (n = 34), hospitalization (n = 24), hospitalization under constraint (n = 12). These groups mean theoretically an increasing global gravity: it is possible for example to hospitalize a parasuicidal patient because he wants to die, even without depression. Or in an other case, if he has a very serious psychiatric disorder (for example affective or psychotic), with a low-lethality para-suicide. Moreover, for a 22 sub-sample patients, the score from Beck-SIS was also calculated. The scale scores comparison in the four groups were made by analysis of variance: there was a statistically significant difference between groups as whole and individually (p < 0.001). In the second analysis, we defined two subsamples: the first one contains the hospitalized patients (n = 36) and the second one, the non-hospitalized (n = 41) patients. Statistically, from the scale scores, it was possible to define a threshold above which all the patients were hospitalized, and an other one under which all patients were not hospitalized. Third, there was a good correlation between lethality scores in our scale (first section) and the Beck SIS scores (r = 0.91). In conclusion, our scale seems to be well correlated with global gravity meant by parasuicide, to assess correctly suicidal intent, and to provide reliable indicators for hospitalization. However, some aspects are still missing in this study: we did not compare any sub-score with other well-known scales, assessing depression or hopelessness. On the other hand, we couldn't obtain prospective data on all the patients after their parasuicide. The following steps will be to carry on with these studies, as well as with the replication of our results on larger samples.

[An exceptional cause of renal colic. Castleman's tumor. Lymphonodular angiofollicular hyperplasia]. / Une cause exceptionnelle de colique néphrétique. Tumeur de Castleman. Hyperplasie lymphonodulaire angio-folliculaire.

The case of a 38-year-old man with renal colic due to compression by an abdominopelvic mass is reported. Histologic examination of the mass led to the diagnosis of giant lymph node hyperplasia or Castleman disease. Surgical removal of the lesion ensured complete recovery with no recurrence after 32 months follow up. Giant lymph node hyperplasia usually develops in the mediastinum, but superficial and abdominopelvic forms are seen occasionally. Pathogenic hypotheses are discussed. Outcome is usually favorable following surgical excision but rare multifocal forms with a potentially poor prognosis have been reported.

Quantitative analysis of cellular proliferative activity in 35 T-cell non-Hodgkin's lymphomas. Use of proliferating cell nuclear antigen and Ki-67 (MIB-1) antibodies and nucleolar organizer regions.

OBJECTIVE: To analyze-cellular proliferation in non-Hodgkin's lymphoma (NHL) of T-cell origin using three variables available on histologic paraffin, dewaxed sections. STUDY DESIGN: The study group consisted of 35 T NHLs (22 low and 13 high grade). Two immunohistochemical methods established the percentage of cells expressing proliferating cellular nuclear antigen (PCNA), or PCNA index, and the Ki-67 antigen, or MIB-1 index. The third method quantified nucleolar organizer regions (NORs) with an image analyzer, giving the NOR area and number of NORs; an internal reference on lymphocytes was used. RESULTS: For the PCNA index, each subtype of low grade NHL demonstrated a difference as compared with high grade NHL except for angioimmunoblastic type NHL (AILD). The difference between the two grades became significant after including AILD-type NHL within high grade NHL (P = .02). The MIB-1 index gave similar results. The PCNA index and MIB-1 correlated (r = .55, P = .008). The relative NOR area and number of NORs differed significantly between the two grades (P < 10(-4) and P < 10(-2); the absolute NOR area differed to a lesser degree (P = .02), and no difference was observed for the absolute number of NORs (P = .07), stressing the importance of an internal reference. NOR areas and numbers correlated highly (r = .90 for relative and .78 for absolute variables, P < 10(-4)). No relation was found between PCNA and MIB-1 indexes. CONCLUSION: Correlations between these variables and grades of malignancy, between the two indices with each other and between the AgNOR variables with each other, including referring to internal lymphocytes, were reported for these T NHL-like tumors in studies on B NHL. The proliferative character of the AILD-type T NHL was in accordance with their worse prognosis. The absence of a correlation between PCNA or MIB-1 indices and NOR variables may reflect a biologic difference between B and T NHLs in a shorter cell cycle or more important functional activity in T NHL.