The associations between illness perceptions and social rhythm stability on mood symptoms among patients with bipolar disorder.

BACKGROUND: The association between illness perceptions and the effectiveness of patients' illness-management strategies has been supported across a range of medical and psychiatric disorders. Few studies have examined these variables or their association in bipolar disorder (BD). This study examined the main and interactive associations between illness perceptions and one important illness management strategy - social rhythms stability on mood symptom severity in adults with BD. METHODS: A cross-sectional study with 131 patients with BD in Taiwan was conducted using clinician- and patient-rated mood symptoms, self-reported illness perceptions, and a measure of daily and nightly social rhythms. RESULTS: Illness perceptions were associated with mood symptom severity, but social rhythms were not. Unfavorable illness perceptions (e.g., beliefs of experiencing more BD symptoms, having stronger emotional responses to the illness) were associated with more severe mood symptoms. Favorable illness perceptions (e.g., beliefs of being able to understand and control the illness) were associated with less severe mood symptoms, with personal control as the strongest correlate of mood symptom severity. Finally, social rhythm stability moderated the relationship between unfavorable illness perceptions and clinician-rated manic symptoms. LIMITATIONS: The cross-sectional design limits our ability to make causal conclusions. Also, the effects pertain to patients in remission and may not generalize to more severely ill or hospitalized bipolar patients. CONCLUSIONS: This study indicates that in patients with BD, illness perceptions are associated with symptom severity. Interventions to enhance favorable IPs and reduce unfavorable IPs may improve mood outcomes, particularly when patients have adopted regular social rhythms.

[Care of Individuals With Bipolar Disorders].

Bipolar disorder (BD) is a severe mental illness that is characterized by chronicity, pervasive instability, and relatively high rates of recurrence and suicide. Current evidence supports that adverse circles among hereditary and genetic factors, neuroinflamation, and social rhythm constitute a crucial etiology. Pharmacological treatment is the first priority for BD patients during the acute stage. Pharmacological and psychosocial treatments should be combined during the maintenance stage in order to help patients self-manage medication, effectively control mood swings, enhance disease self-management and social functions, decrease the risks of relapse and re-hospitalization, and stabilize overall health. The present article firstly introduces the characteristics and etiological assumptions related to BD, the related evidence-based care models and their effects, and the early development of an evidence-based care model, the BalancingMySwing group, for BD patients in Taiwan. This article provides updated information to clinicians who are involved in caring for this population. Moreover, the existing data related to biological and psychosocial factors for BD in Taiwan is insufficient and developing individual-tailored psychosocial intervention is urgently needed. The authors hope that this article will elicit greater concern for this issue from policy decision-makers and healthcare providers.

Malignant fibrous histiocytoma presenting as hemoperitoneum mimicking hepatocellular carcinoma rupture.

Malignant fibrous histiocytoma (MFH) is a pleomorphic mesenchynal sarcoma. It is uncommonly arises primarily from the intra-peritoneal cavity. Primary peritoneal MFH with tumor bleeding and rupture is rare. We describe the imaging features of a 70-year-old patient presenting with ruptured hemorrhagic peritoneal MFH at subhepatic area, accompanied by massive hemoperitoneum, mimicking a ruptured pedunculated hepatocellular carcinoma. Computed tomography (CT) revealed a large heterogeneous enhanced subhepatic mass with adjacent liver, gallbladder and colon invasion. Tumor hemorrhage and rupture complicated with peritoneal seeding and massive bloody ascites were also detected. Angiography showed a hypervascular tumor fed by enlarged right hepatic arteries, cystic artery and omental branches of gastroepiploic artery. The patient underwent laparotomy for tumor resection, but the tumor recurred one month after operation. To our knowledge, the CT appearance of ruptured intraperitoneal MFH complicated by hemoperitoneum has not been previously described.

Balthazar computed tomography severity index is superior to Ranson criteria and APACHE II scoring system in predicting acute pancreatitis outcome.

AIM: Acute pancreatitis (AP) is a process with variable involvement of regional tissues or organ systems. Multifactorial scales included the Ranson, Acute Physiology and Chronic Health Evaluation (APACHE II) systems and Balthazar computed tomography severity index (CTSI). The purpose of this review study was to assess the accuracy of CTSI, Ranson score, and APACHE II score in course and outcome prediction of AP. METHODS: We reviewed 121 patients who underwent helical CT within 48 h after onset of symptoms of a first episode of AP between 1999 and 2003. Fourteen inappropriate subjects were excluded; we reviewed the 107 contrast-enhanced CT images to calculate the CTSI. We also reviewed their Ranson and APACHE II score. In addition, complications, duration of hospitalization, mortality rate, and other pathology history also were our comparison parameters. RESULTS: We classified 85 patients (79%) as having mild AP (CTSI <5) and 22 patients (21%) as having severe AP (CTSI > or =5). In mild group, the mean APACHE II score and Ranson score was 8.6+/-1.9 and 2.4+/-1.2, and those of severe group was 10.2+/-2.1 and 3.1+/-0.8, respectively. The most common complication was pseudocyst and abscess and it presented in 21 (20%) patients and their CTSI was 5.9+/-1.4. A CTSI > or =5 significantly correlated with death, complication present, and prolonged length of stay. Patients with a CTSI > or =5 were 15 times to die than those CTSI <5, and the prolonged length of stay and complications present were 17 times and 8 times than that in CTSI <5, respectively. CONCLUSION: CTSI is a useful tool in assessing the severity and outcome of AP and the CTSI > or =5 is an index in our study. Although Ranson score and APACHE II score also are choices to be the predictors for complications, mortality and the length of stay of AP, the sensitivity of them are lower than CTSI.

Difficulty with diagnosis of malignant pancreatic neoplasms coexisting with chronic pancreatitis.

Chronic pancreatitis is a relatively common disease. We encountered two different cases of belatedly demonstrated pancreatic carcinoma featuring underlying chronic pancreatitis. The first case was one that was highly suspected as that of a malignancy based upon imaging study, but unfortunately, it could not be confirmed by intra-operative cytology at that time. Following this, the surgeon elected to perform only conservative bypass surgery for obstructive biliary complication. Peritoneal carcinomatosis was later noted and the patient finally died. The second case, a malignant mucinous neoplasm, was falsely diagnosed as a pseudocyst, based upon the lesion's sonographic appearance and associated elevated serum amylase levels. After suffering repeated hemoptysis, the patient was found to exhibit lung metastasis and peritoneal seeding. We reviewed some of the literature, including those studies discussing chronic pancreatitis predisposing to a malignant change. These two case analyses illustrate clearly that the diagnosis for such conditions, which is simply based upon imagery or pathological considerations may end up being one of a mistaken malignancy. Some of our suggestions for the treatment of such malignancies as revealed herein include, total pancreatomy for univocal mass lesion, and needle aspiration of lesion-contained tissue for amylase, CA199 and CEA levels for a suspicious cystic pancreatic mass.

Fatal thrombotic complications of hepatic cystic compression of the inferior vena: a case report.

Of 5% of patients who develop liver cysts, only 10-15% of them come for medical attention, typically because of dull right upper quadrant pain, abdominal bloating or early satiety. We treated a 77-year-old female with a rare complication of inferior vena cava thrombosis. The patient expired due to septic shock and multiple organ failure.

Anatomic and technical skill factor of gastroduodenal complication in post-transarterial embolization for hepatocellular carcinoma: a retrospective study of 280 cases.

AIM: To reduce the possibility of gastroduodenal complications. The purpose of this retrospective study was to survey the literature and compare and discuss the incidence of post-transarterial embolization (TAE) gastroduodenal complications. METHODS: We found reports describing 280 cases of hepatocellular carcinoma with TAE procedures done during the past 4 years and selected all of them for our study. Amongst these cases, 86 were suspected of suffering gastroduodenal complications within one month of post-TAE treatment. Fifteen of these cases were proved by pan-endoscopy to have gastroduodenal erosions or ulcerations. We reviewed the angiographic pictures in patient records to evaluate the possibility that anatomic and technical skill factors could explain the complications. RESULTS: Amongst the 15 cases, 9 were primary lesions of the antrum and prepylorus; 4 had duodenal ulcer or erosions; 2 had mid-body lesions; none showed a lesion at the fundus or cardia region. Three cases had not received TAEs using our ideal method, and may be associated with possible regurgitation of gel-foam pieces into the right or left gastric arteries. Two cases involved sub-selective embolization at a distal point on the hepatic artery; one case was found by angiography to have complete occlusion of the celiac trunk. CONCLUSION: Comparing our results with past cases of post-TAE gastroduodenal complications, we surmise that our relatively low incidence (5.3%) of gastric complications might be explained by our concerted efforts to improve our technical skills in multi-sequential, selective and super-selective approaches to the embolization of tumor vessels.

High-frequency ultrasound as a useful device in the preliminary differentiation of lichen sclerosus et atrophicus from morphea.

High-frequency ultrasound diagnostic equipment (HFUS) using probes with frequencies above 15-MHz has been utilized conventionally in preoperative assessments and postoperative follow-up of skin tumors. The advent of probes with even higher frequencies (up to 30-MHz) has widened the clinical applications of HFUS to inflammatory dermatoses which are histologically confined to the epidermis and upper dermis, such as psoriasis and atopic dermatitis. Ultrasound imaging has the advantage of being a noninvasive and relatively inexpensive technology that is quick and easy to perform. In addition, information obtained from HFUS is unique and useful for clinical diagnosis and evaluation for various skin disorders. We believe that HFUS has the potential to become a powerful tool for either clinical or investigative dermatology. Herein, we present a case of lichen sclerosus et atrophicus (LSA) to which we applied HFUS before skin biopsy and obtained substantial information for the differential diagnosis from morphea, and we reemphasize the usefulness of HFUS in studying the inflammatory skin disorders.

Mucinous cystadenocarcinoma of the breast coexisting with infiltrating ductal carcinoma.

A recently described and rare variant of breast carcinoma, mucinous cystadenocarcinoma (MCA), is reported in a 65-year-old post-menopausal woman. She presented with a gradually enlarged breast tumor. A well-circumscribed tumor measuring about 3 cm in diameter was noted in the mammographic and ultrasonographic examinations. The mammographic and ultrasonographic findings were indistinguishable from more common mucinous carcinoma (colloid carcinoma) of the breast. The gross appearance of the tumor was well-defined and cystic, consisting of abundant transparent to bloody mucin, as well as whitish solid parts. Microscopically, the tumor was characterized by abundant extracellular and intracellular mucin. It looked like a mucinous cystic neoplasm of the ovary and pancreas. Particularly, few microscopic foci of ordinary intermediate-grade infiltrating ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS) were observed around the main lesion in this case. A transition from ordinary DCIS to MCA in situ was found. It might indicate MCA derives from a metaplasia process of ordinary DCIS. MCA can be easily differentiated from mucinous carcinoma by quite different histologic and immunohistochemical findings. According to the previously reported and present cases, MCA of the breast more commonly affects elderly women and has a relatively favorable prognosis.

A case of atypical caudate lobe hemangioma mimicking hepatocellular carcinoma: CT and angiographic manifestations.

We report a case of caudate lobe hemangioma with an atypical CT enhancement pattern. In the present case, hemangioma exhibited a very subtle discontinuous peripheral rim enhancement at the post-enhanced arterial phase, and the peripheral enhanced zone had a moderately increased enhancement degree and with widened enhancement thickness during the portal-phase and delayed-phase. The slow enhancement rate for this caudate lobe hemangioma was due to sluggish perfusion by the small feeding arteries of caudate lobe branches as demonstrated by angiography.

Gastrointestinal stromal tumor: Computed tomographic features.

AIM: Gastrointestinal stromal tumor (GIST) is a rare type of cancer. Computed tomography (CT) is an imaging modality of choice for diagnosing GIST. The aim of this retrospective study was to review the CT imaging features of 17 GIST patients. METHODS: From 1995 to 2003, there were 47 patients with pathologically proven GISTs at our hospital. Of these, 17 patients underwent preoperative CT. We collected and analyzed these CT images. The CT imaging features included tumor diameter, number and location, tumor margin, location of metastasis, hounsfield units of tumor and effect of contrasts. In addition, we also recorded the surgical findings, including complications, tumor size and location for comparative analysis. RESULTS: The results showed that 12 (70%) tumors were located in the stomach and five (30%) were located in the jejunum mesentery. GISTs were extraluminal in 12 (70%) patients. The tumor margins of 13 (76%) tumors were well defined and irregular in four (24%). The effect of contrast enhancement on GIST CT imaging was homogenous enhancement in 13 (76%) and heterogeneous enhancement in four (24%). The hounsfield units (HU) were 30.41 +/-5.01 for precontrast images and postcontrast hounsfield units were 51.80 +/- 9.24. CONCLUSION: The stomach was the commonest site of GIST occurrence among our patients. The CT features of GIST were well-defined tumor margins, homogenous enhancement on postcontrast CT images.

Magnetic resonance cholangiopancreatography of anatomic variants of the biliary tree in Taiwanese.

BACKGROUND AND PURPOSE: Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive method for evaluating the hepatobiliary system. This study investigated the anatomic variants of the biliary tree in Taiwanese using MRCP. METHODS: 170 patients with abdominal or liver diseases underwent diagnostic MRCP over the 29-month study period. We identified the type of biliary tree variants in 130 patients. RESULTS: The imaging findings showed that the most common biliary tree variants were type I and type IIA, which together comprised 70% of all variants. Type I is a triple confluence, which is an anatomy characterized by simultaneous emptying of the right posterior segment duct, right anterior segment duct, and left hepatic duct into the common hepatic duct. Type IIA involves drainage of the right posterior segment duct into the right anterior segment duct to form the right hepatic duct, and then confluence with the left hepatic duct to form the common hepatic duct. There was a mean percentage of 10 to 20% among the 7 types of variants identified. CONCLUSION: Comparison of these findings with previous investigation indicates that biliary tract structure shows racial and ethnic variation.

Initial otolaryngological manifestations of severe acute respiratory syndrome in Taiwan.

OBJECTIVE: To provide a clue for screening severe acute respiratory syndrome (SARS), a highly transmissible disease with health care workers at particular risk, in the early stage from an otolaryngological perspective. DESIGN: Prospective study. SETTING: Community hospital. PATIENTS: Between April 17 and April 26, 2003, 32 consecutive patients with SARS were encountered. Investigation consisted of local examination of ear, nose, and throat fields; palpation of the nuchal areas; and plain chest radiography. Analyses of throat swab samples using reverse transcription-polymerase chain reaction were conducted. RESULTS: Clinical manifestations included fever in 31 patients (97%), followed by cough, dyspnea, chill, headache, sore throat, diarrhea, rhinorrhea, and otalgia. Neither the pharyngeal wall nor the tonsillar area demonstrated hyperemia. There was no lymphadenopathy in the neck. Plain chest radiographs revealed consolidation in 25 (78%) of 32 patients. Results of reverse transcription-polymerase chain reaction analysis targeting the novel coronavirus present in throat swab samples were positive in 19 (66%) of 29 patients tested. Twenty-eight patients required supplemental oxygen, and 14 patients were intubated with mechanical ventilation. Twenty-eight patients survived and 4 patients died. CONCLUSIONS: When presented with a patient with flulike symptoms such as fever and/or cough, but no pharyngeal hyperemia or neck lymphadenopathy, physicians should be alerted to the possibility of SARS. In contrast, evidence of inflammatory signs in the otolaryngological field may explain the flulike symptoms, and serve as a differential diagnostic tool between influenza and SARS.

Double guidewire method: a novel technique for correction of migrated Tenckhoff peritoneal dialysis catheter.

Twenty-two consecutive patients with a continuous ambulatory peritoneal dialysis (CAPD) catheter malfunctioning due to catheter migration were treated with a novel radiological manipulation technique, the "double guidewire method." The first guidewire is used to correct the direction of the catheter tip and the second wire is used to anchor the CAPD catheter so that an ideal course of the catheter can be maintained during removal of the first guidewire. Immediate catheter repositioning was achieved in 19 of 22 patients, and durable repositioning success was achieved in 13 patients. In conclusion, the "double guidewire method" is a simple but effective technique for prolonging CAPD catheter life in patients with malfunction due to catheter migration.

Langerhans cell histiocytosis of the skull complicated with an epidural hematoma.

Langerhans cell histiocytosis (LCH) is a rare disorder that affects the pediatric population. LCH complicated with a neurologic deficit due to the presence of epidural involvement is a rare condition. We describe the CT imaging features in a 2-year-old boy who presented with drowsy consciousness resulting from an epidural hematoma caused by spontaneous bleeding in an LCH of the skull. CT is an excellent means of depicting the full extent of bony destruction and the nature of the process.