Liver cirrhosis and thyroid function: Friend or foe?

INTRODUCTION: The liver plays a central role in thyroid hormone metabolism, transport, and clearance. A normal function of both the thyroid gland and the liver is therefore necessary to maintain normal thyroid hormone levels and action. Data regarding thyroid function in patients with liver cirrhosis are scarce and variable. The most consistent finding is a decreased free triiodothyronine (fT3) level, which correlates with the severity of liver disease and has been proposed as a prognostic factor for liver-related complications. AIM OF THE STUDY: To evaluate thyroid hormone values in patients with stable liver cirrhosis and to compare them with healthy controls without liver disease. We also assessed the prevalence of thyroid autoimmunity and whether liver function tests correlated with thyroid function. MATERIAL AND METHODS: We performed a prospective case-control study in an endocrinological setting. Twenty-nine patients with stable cirrhosis (20 males and 9 females, mean age 60.97 ± 7.17 years) were included in the case group and 50 healthy subjects (22 males and 28 females, mean age 61.70 ± 13.00 years) in the control group. We excluded patients with confounding factors known to influence thyroid function. Levels of serum thyroid-stimulating hormone (TSH), fT3, free thyroxine (fT4) and anti-TPO-antibodies (TPO-Ab) were measured. These thyroid hormone values were compared in both groups. Biochemical indices of liver function (aspartate aminotransferase [AST], alanine aminotransferase [ALT], alkaline phosphatase [AP], gamma-glutamyl transpeptidase [GGT], INR, total bilirubin, and albumin levels) were correlated with thyroid function tests. RESULTS: fT3 en fT4 levels were significantly lower in patients with cirrhosis than in healthy subjects (p = 0.001 and 0.002, respectively). TSH levels were not statistically significantly different in the two groups. The level of TPO-Ab was not increased in patients with cirrhosis compared to healthy controls. fT3 correlated negatively with the Child-Pugh score. DISCUSSION: These results indicate that, compared to healthy controls, patients with cirrhosis have decreased fT3 and fT4 levels and comparable TSH levels and may be consistent with findings of limited acquired central hypothyroidism as observed in the non-thyroidal illness syndrome (NTIS). fT3 levels correlated negatively with Child-Pugh score, a measure of severity of liver dysfunction. We did not find an increased prevalence of thyroid autoimmunity in these patients.

The impact of one session of HF-rTMS on salivary cortisol in healthy female subjects.

Previous studies in healthy volunteers reported a possible impact of high frequency repetitive transcranial magnetic stimulation (HF-rTMS) on stress hormones, like cortisol. In this sham-controlled, "single blind", crossover study, we examined whether HF-rTMS had an effect on the hypothalamic-pituitary-adrenal (HPA) axis, by analysing salivary cortisol levels. Two studies were conducted. First, HF-rTMS on the left dorsolateral prefrontal cortex (DLPFC) was performed in 28 young healthy female volunteers. Second, in a comparable, but different group of 26 healthy females, HF-rTMS was performed on the right DLPFC. Salivary cortisol levels were assessed before, immediately after and 30 min after real and sham HF-rTMS. We found no support for the hypothesis that one single session of HF-rTMS on the left or the right DLPFC has an immediate or delayed impact on the HPA-axis, as measured by salivary cortisol. Although we controlled for several methodological problems in HF-rTMS research, the hypothesis that one single session of HF-rTMS on the left or on the right DLPFC can influence the HPA-axis in healthy volunteers was not supported.

Who will benefit from pelvic floor muscle training for stress urinary incontinence?

OBJECTIVE: The purpose of this study was to determine which patient characteristics are predictive of outcome before pelvic floor muscle training for stress urinary incontinence. STUDY DESIGN: This was an observational study at a single-center outdoor patient clinic in Brussels, Belgium, that comprised 447 women, aged 26 to 80 years (mean, 52.7 years), who had urinary stress incontinence. All the women received individual pelvic floor muscle training under the guidance of the same physiotherapist. Twenty-two patient characteristics were considered for outcome measurements. RESULTS: Forty-nine percent of the women considered their treatment to be successful; 51% of the women had experienced only some improvement, no change, or a worsening of their condition or had interrupted therapy. Three independent predictors of treatment failure were > or =2 leakages per day before treatment ( P < .0001), the chronic use of psychotropic medication ( P = .002), and a baseline positive stress test result at first cough ( P = .042). The odds were only 15% for an individual patient to be treated successfully when these 3 predictors were present. CONCLUSION: Pelvic floor muscle training is beneficial in one half of the patients who are treated in this manner. Two or more leakages per day at baseline and the chronic use of psychotropic medication significantly predicted therapy failure.

Characterization of small nodules by automatic segmentation of X-ray computed tomography images.

OBJECTIVE: To characterize the ability of an automatic lung nodule segmentation algorithm to measure small nodule dimensions and growth rates. METHODS: A phantom of 20 sets of 6 balls each (11 different nylon balls and 9 acrylic balls) of 1 to 9.5 mm in diameter, in foam, was imaged using x-ray computed tomography with slice thicknesses of 5, 2.5, and 1.25 mm, pitches of 3 and 6, and standard and lung resolution. Measurements consisted of volume and maximum in-plane cross-sectional areas and their derived maximum and effective diameters. Growth rates were simulated using pairs of groups of balls. RESULTS: Volume measurements overestimate volume, more so for thicker slices. For the largest balls, the error is 60% for 5-mm slices and 20% for 1.25-mm slices. Effective diameter calculated from volume better approximates actual diameter. For area measurements, errors are 0% to 5% for the largest balls, and the effective and actual diameters are closely matched. CONCLUSIONS: Below 5 mm in diameter, changes in volume should reach 100% for reliable indication of growth. Above 6 mm, the threshold for detecting change is on the order of 25% growth. Even under ideal conditions, results indicate the need for caution when making a diagnosis of malignancy on the basis of volume change.

A rosetta stone for coronary calcium risk stratification: agatston, volume, and mass scores in 11,490 individuals.

OBJECTIVE: We introduce stratification data for three methods (Agatston, volume, mass) obtained from one single patient population. MATERIALS AND METHODS: Measurements in 11,490 individuals scanned from 1999 to 2002 with electron-beam CT were used for this study. RESULTS: Our Agatston score ranges agree reasonably well with the Kondos values except for measurements in patients at the extreme ages, at which we sampled a wider age range and consequently had different biases of averages. Neither method is preferable because except for a small percentage of individuals near the dividing lines, stratification is the same for the three methods. When we matched them against a known "lesion" phantom, the Agatston and volume scores behave nonlinearly, and the latter grossly overestimates volume. The mass method is linear except for lesions near the edge of detectability and matches known volumes to within a small percentage. CONCLUSION: We provide validated risk stratification data for use with mass scoring methods.

Coronary calcium scoring: modelling, predicting and correcting for the effect of CT scanner spatial resolution on Agatston and volume scores.

The purpose of this study was to evaluate the impact of spatial resolution on coronary calcium scoring by x-ray CT, to assess the scoring performance of different CT scanners as they are operated in the field and to correct for the effects of CT scanner spatial resolution on coronary calcium scoring. A phantom consisting of five aluminium wires of known diameter in water was used to measure spatial resolution and to assess scoring performance. Fourteen CT scanners (three helical, two dual, two electron-beam and seven multi-detector) from four manufacturers were evaluated, some under different operating conditions. One scanner was monitored over a 3 month period and again 6 months later. Both spatial resolution and image pixel size significantly affect calcium scoring results. Spatial resolution can be measured with a precision of about 2%. Scanner spatial resolution ranged from 1 to 1.7 mm full-width-half-maximum (FWHM), and pixel size from 0.25 to 0.86 mm. Spatial resolution differences introduce systematic scoring differences that range from 38% to 1100% depending on wire size. Significant temporal variations in spatial resolution were observed in the monitored scanner. By correcting all the scanners to the same target spatial resolution, the standard deviation of individual scanners with respect to a mean value (the spread) can be reduced by 25-70% for different wires. In conclusion, scanner spatial resolution significantly affects calcium scoring and should be controlled for. Scanner performance can change over time. Under ideal conditions, CT scanners should be operated with a standard spatial resolution for calcium scoring. When this is not possible, post-processing correction is a viable alternative.

Scoliosis evaluation by direct digital radiography and computerized post-processing.

With the introduction of direct digital radiography into clinical practice, there are opportunities to provide faster and more reliable ways of performing traditional radiological tasks. A technique was developed for evaluating and measuring scoliosis, which involves the computerized stitching of a radiograph of the thoracic spine with a radiograph of the lumbar spine. A technique is provided for real-time, graphic feedback during the stitching process, as well as during calculation and display of the Cobb angle to ensure accuracy. Initial data indicates an accuracy within 1 to 2 degrees. The time required to stitch the two images and measure the Cobb angle is on the average of 5 minutes per case. Using computerized techniques of image stitching and angle calculation, with real-time graphical feedback, the task of scoliosis evaluation is more accurate, less time consuming, and prone to fewer human errors. The requirement for special film cassettes is also eliminated.