Serious diabetes-specific emotional problems in patients with type 2 diabetes who have different levels of comorbid depression: a Polish study from the European Depression in Diabetes (EDID) Research Consortium.

OBJECTIVE: Depression is a common psychiatric problem in patients with type 2 diabetes (DM2). A common view is that the burden of having DM2 contributes to the development of depression in DM2. Aim of the present study was to compare the levels of diabetes-specific emotional problems of DM2 patients with diagnosed depression with those with a subclinical form of depression and those without depression. METHODS: A cross-sectional study was conducted in 101 DM2 patients (51 men and 50 women, mean age = 63,17; SD = 10,74) who completed a standardized, structured psychiatric diagnostic interview (MINI), the Beck Depression Inventory, the Hamilton Depression Rating Scale as well as the Problem Areas in Diabetes (PAID) scale (a 20-item measure, with an overall scale measuring diabetes-related emotional distress and four subscales [negative emotions, treatment-related problems, food-related problems, lack of social support]). RESULTS: A depression diagnosis was made in 35% (n = 35) of the participants, 24% (n = 24) had a subclinical form of depression, 42% (n = 42) were not diagnosed with any kind of depressive disorder. Diabetes-specific emotional problems were most common in DM2 patients with a depressive disorder (significantly highest PAID score: 39) compared to patients with subclinical depression or no depression. In the group of non-depressed patients, only 14% agreed to have four or more (somewhat) serious diabetes-specific problems. In those with subclinical depression, this percentage was 42% and in those with a depressive disorder 49% (P < 0.001). CONCLUSIONS: Diabetes-related emotional problems are particularly common among DM2 patients with comorbid clinical depression and to a lesser extent in patients with subclinical depression, compared to non-depressed DM2 patients. Male diabetes patients with a depressive disorder are particularly vulnerable to develop high levels of diabetes-specific emotional distress. Major differences between the three groups mainly concern the diabetes-specific problems connected with the illness.

Predictors of prostate carcinoma: accuracy of gray-scale and color Doppler US and serum markers.

PURPOSE: To determine the accuracy of detecting prostate cancer by using (a) gray-scale and color Doppler transrectal ultrasonography (US), (b) serum and excess prostate-specific antigen (PSA) levels, and (c) targeted and sextant transrectal US-guided biopsy. The relationship between US-detected neovascularity and tumor biologic activity was also evaluated. MATERIALS AND METHODS: Between 1995 and 1999, 544 patients with elevated PSA levels and/or abnormal digital rectal examination underwent transrectal US-guided sextant biopsy and targeted biopsy of US abnormalities. Sensitivity, specificity, and accuracy of gray-scale US, color Doppler US, targeted biopsy, and PSA and excess PSA were calculated. RESULTS: Gray-scale US depicted 78 (41.1%) of 190 cancers, whereas color Doppler US depicted 30 (15.8%) additional cancers. Targeted biopsy was used to detect 108 (56.8%) cancers, whereas sextant biopsy was used to detect 82 (43.2%) additional cancers. Although US-visible cancers had a higher Gleason grade than did cancers discovered at sextant biopsy (P <.05), 25 of the 66 cancers identified with sextant biopsy alone were Gleason grade 6 or higher. Color Doppler US-depicted hypervascularity correlated with biologically aggressive tumors. Excess PSA was normal in 58 (30.5%) cancers, with an accuracy of 67.3%, resulting in better prediction of prostate tumors than with serum PSA level alone. CONCLUSION: Gray-scale transrectal US, even coupled with color Doppler US, is inadequate for prostate carcinoma screening; therefore, targeted biopsy should always be accompanied by complete sextant biopsy sampling.

MRI isolation of infected renal cyst in autosomal dominant polycystic kidney disease.

The use of gadolinium-enhanced magnetic resonance (MR) to isolate an infected renal cyst in the setting of autosomal dominant polycystic kidney disease (ADPKD) has not been previously described. A case in which T1- and T2-weighted and gadolinium-enhanced MR images were used to identify a single purulent cyst in a patient with ADPKD is herein presented. We suggest that gadolinium-enhanced MR be considered useful in the evaluation of ADPKD patients with suspected infected cyst.

One-step needle aspiration and lavage for the treatment of abdominal and pelvic abscesses.

OBJECTIVE: This retrospective study was undertaken to show the efficacy and safety of one-step needle aspiration and lavage for the treatment of nonenteric, nonpancreatic abdominal and pelvic abscesses. MATERIALS AND METHODS: Eighty-two nonconsecutive patients (age range, 4-81 years old) with 97 abdominal and pelvic abscesses were treated over 16 years with a one-step percutaneous needle aspiration and lavage technique. Abscesses were drained with sonographic or CT guidance in a single session. An 18-gauge needle was used for aspiration and repeated saline lavage; no drainage catheter was left in place. For collections that appeared multiloculated, needle repositioning and repeated aspiration and lavage were performed during the single session. All patients received i.v. antibiotics. RESULTS: Eighty-seven (90%) of 97 abscesses in 72 of 82 patients were successfully treated, including 17 (85%) of 20 abscesses that were multiloculated. The only two complications were transient sepsis in one patient and hemorrhage in one patient that resolved with transfusion and conservative treatment. Needle aspiration and lavage failures were associated with diffuse peritonitis, occult malignancy, unsuspected enteric communication, and a dropped surgical clip. CONCLUSION: Percutaneous needle aspiration and lavage can be a safe, effective alternative to the more conventional treatment of prolonged catheter drainage. In selected patients, including certain patients with multiloculated abscesses, one-step needle aspiration and lavage should be considered as the initial method of treatment.

[Coefficient of linear correlation between levels of fibrinogen, antithrombin III, thrombin-antithrombin complex and lipid fractions in women exposed chronically to carbon disulfide]. / Wspólczynniki korelacji liniowej miedzy stezeniami fibrynogenu, antytrombiny III, kompleksów trombina-antytrombina a frakcjami lipidowymi u kobiet narazonych na przewlekle dzialanie dwusiarczku wegla.

The authors examined 65 women, aged 22-58 years. They were derived from two industrial populations of different production profiles, and divided into three groups. Group I--the control group--was composed of 20 women, mean age 44.5 +/- 12.02 years, employed in the DANA Enterprise, Szczecin, not exposed to carbon disulfide; Group II--the group studied--comprised 22 women, mean age 42.5 +/- 4.95 years, employed in the WISKORD Enterprise, Szczecin, chronically exposed to carbon disulfide at the concentration of 9.36-23.4 mg/m2; and Group III--included 23 women, mean age 46.7 +/- 8.81 years, suffering from diabetes mellitus II. The study reveals that carbon disulfide exerts significant adverse effect on plasma lipid fractions, and induces changes in the coagulation system, creating the risk of ischaemic diseases.

Transrectal US in male infertility: spectrum of findings and role in patient care.

PURPOSE: To determine the findings at transrectal ultrasound (US) in infertile men with low-volume azoospermia and to evaluate its role in patient care. MATERIALS AND METHODS: Transrectal US was performed on 276 infertile men with a mean age of 34 years (range, 24-52 years) who had documented low ejaculate volumes and azoospermia. RESULTS: Of the 276 men, 70 (25.4%) had no anatomic abnormalities. In the remaining patients, abnormalities included congenital bilateral absence of the vas deferens in 94 (34.1%) patients; bilateral occlusion of the vas deferens, seminal vesicles, and ejaculatory ducts by calcification or fibrosis in 43 (15.6%) patients; unilateral absence of the vas deferens in 31 (11.2%) patients; obstructing cysts of the seminal vesicles, vas deferens, ejaculatory ducts, or prostate in 26 (9.4%) patients; and ductal obstruction secondary to calculi in 12 (4.4%) patients. CONCLUSION: Transrectal US is a safe and accurate method for evaluating the distal male reproductive tract that helps identify patients with potentially correctable causes of infertility.

Ectopic pregnancy: prospective study with improved diagnostic accuracy.

STUDY OBJECTIVE: To assess the utility of ultrasonography, quantitative serum beta-human chorionic gonadotropin (beta-hCG) level, history, and physical examination in the diagnosis of ectopic pregnancy (EP) in the emergency department. METHODS: We prospectively studied 481 consecutive pregnant patients who presented to an urban ED with first-trimester abdominal pain or vaginal bleeding. History, physical examination findings, quantitative beta-hCG values, sonography findings, surgical findings, and final diagnosis were collected after patient enrollment in the study. We assessed the proportions of pregnant patients experiencing pain or bleeding with EPs versus those with abnormal and normal intrauterine pregnancies (IUPs). RESULTS: Pregnant women with abdominal pain or vaginal bleeding received beta-hCG values; positive radioimmunoassays prompted ultrasonography; indeterminate ultrasonography findings resulted in admission. Thirteen percent of patients had confirmed EPs; 99.5% of patients discharged from the ED had documented IUPs. Transvaginal sonography in the ED established EP or IUP in 75%. For EP detection, sonography is 69% sensitive and 99% specific. Single beta-hCG levels are useful in predicting EP; a beta-hCG value of 1,000 mIU/mL or lower shows a fourfold higher risk of EP. History and physical examination do not reliably diagnose or rule out EP; of EP patients, 9% reported no pain and 36% lacked adnexal tenderness. CONCLUSION: To prevent delayed diagnosis of EP in urban centers, pregnant women with abdominal pain or vaginal bleeding require evaluation by transvaginal ultrasonography. Indeterminate ultrasonography findings necessitate further evaluation. A beta-hCG level of 1,000 mIU/mL or lower should heighten suspicion of EP.

Native bovine selenocysteine tRNA(Sec) secondary structure as probed by two plant single-strand-specific nucleases.

Two single-strand-specific nucleases, discovered in plants, have been used to investigate the secondary and tertiary structures of the native bovine liver selenocysteine tRNA(Sec). To check the possible influence of nucleotide modifications on these structures, we compared the results obtained with the fully modified tRNA to the unmodified transcript prepared by in vitro T7 transcription of the Xenopus laevis tRNA(Sec) gene. We found that the structures in solution of the native tRNA(Sec) and the transcript are very similar despite some differences in accessibility to the enzymatic probes. Indeed, the modified anticodon-loop of native bovine tRNA(Sec), containing 5-methylcarboxymethyluridine (mcm5U34) and N6-isopentenyladenosine (i6A37), is less accessible to Rn nuclease than that of the transcript: the intensity of bands representing cuts at A36 and A38 is much lower as compared to those of the transcript, whereas no cuts were found at the level of i6A37 in the anticodon loop of the native molecule. Surprisingly, the variable arm of the native molecule has been found to be more susceptible to single-strand-specific nuclease action, suggesting a looser structure of the variable arm in native bovine tRNA(Sec) than in the transcript.

Treatment of pelvic abscesses: value of one-step sonographically guided transrectal needle aspiration and lavage.

OBJECTIVE: The percutaneous treatment of pelvic abscesses has traditionally involved the placement of drainage catheters via a transgluteal, transrectal, or transvaginal route. These procedures are painful and prolonged. The goal of this study was to demonstrate the effectiveness of a one-step, single-puncture method for draining pelvic abscesses by use of a transrectal sonographically guided needle for aspiration and lavage instead of a two-step Seldinger technique for catheter placement. SUBJECTS AND METHODS: Thirty-three pelvic abscesses in 24 patients were drained by use of transrectal ultrasound guidance. All abscesses were initially seen on transrectal sonograms or CT scans and ranged from 2 to 11 cm in diameter. Abscesses were located in the prostate (n = five), seminal vesicles (n = five), pouch of Douglas (n = 21), and interloop (between bowel loops) (n = two). Causes of pouch of Douglas (cul-de-sac) abscesses included appendicitis (n = two), Crohn's disease (n = two), diverticulitis (n = three), trauma (n = six), HIV infection (n = two), complications of sigmoidectomy (n = one), complications of colectomy (n = one), pelvic inflammatory disease (n = two), and severe prostatitis (n = two). Interloop abscesses were attributable to HIV infection (n = one) and lymphoma (n = one). The procedure was performed without a cleansing enema or local anesthesia and required less than 30 min. An 18-gauge needle was inserted transrectally into the abscess cavity under transrectally guided sonography. The fluid collection was completely aspirated, and the cavity was lavaged with saline. Administration of antibiotics for 7-21 days, rather than prolonged catheter drainage, was used to treat residual infection. Resolution was documented after 7 days by sonography or CT examination. RESULTS: Transrectal aspiration was successful in treating 28 (85%) of the 33 pelvic abscesses in 21 (88%) of the 24 patients. Failure occurred in three patients, two with multiple abscesses and one with an enteric fistula for whom surgical drainage was subsequently required. The volume of aspirates ranged from 5 to 220 ml. There were no complications. CONCLUSION: Transrectal sonographically guided needle aspiration-lavage offers a one-step method for treating pelvic abscesses that does not require catheter placement or prolonged drainage. The procedure produces minimal discomfort and essentially no complications. Our results show that transrectal sonographically guided needle aspiration combined with antibiotic therapy is an effective treatment for pelvic abscesses.

Structural specificity of nuclease from wheat chloroplasts stroma.

A single-strand-specific nuclease from wheat chloroplasts (ChS nuclease) was tested as a tool for RNA secondary and tertiary structure investigations, using yeast tRNA(Phe) and yeast tRNA(Asp) as models. In tRNA(Phe) the nuclease introduced main primary cleavages at positions U33, A35 and A36 in the anticodon-loop and G18 and G19 in the D-loop. In tRNA(Asp) the main primary cleavages occurred at positions U33, G34 and U35 in the anticodon-loop and the lower one at position C20:1 in the D-loop. No primary cleavages were observed within the double-stranded stems. Because ChS nuclease has (i) a low molecular weight, (ii) a wide pH range of action (5.0 to 7.5) (iii) no divalent cation requirement in the reaction mixture and (iv) can be obtained as a pure protein in rather large quantities it appeared to be a very good tool for secondary and tertiary structural studies of RNAs.

Transrectal ultrasound screening for prostatic adenocarcinoma with histopathological correlation. Factors affecting specificity.

BACKGROUND: Ultrasound (US) is increasingly used for the detection of prostatic cancer, yet its specificity is low when used alone. A study was undertaken to examine the factors affecting the specificity of prostatic US. METHODS: Thirty-five intact prostates obtained at autopsy were studied in vitro by US, and the findings were correlated with those in histologic sections. RESULTS: US abnormalities were noted in 24 cases, but prostatic adenocarcinoma was diagnosed by US in only 5 of 12 proven cases. It appears that the US diagnosis of tumor is determined more by location than by size. Anterior and central tumors often are missed by US. Benign prostatic hyperplasia, which affects the transition zone, contributed to a false-positive or false-negative diagnosis of tumor in 10 of 35 cases. Other findings associated with abnormal US include abscesses, infarcts, and seminal vesicles embedded in the prostate. CONCLUSION: The specificity of prostatic US is low; it should not be used as an isolated test in screening the prostate for tumors.

Male infertility: role of transrectal US in diagnosis and management.

Ultrasound (US) has become crucial in the assessment of infertility of couples, in 50% of whom the male partner is responsible. Male infertility is caused by many diverse conditions, from reparable obstructive disorders to noncorrectable intrinsic testicular failure. During the past 4 years, a select group of 70 young infertile men with azoospermia or oligospermia and low ejaculate volume were examined with transrectal US. Twenty-six patients had congenital bilateral absence of the vas deferens, 11 had congenital unilateral absence of the vas deferens and contralateral obstructive pathology, 15 had additional abnormalities thought to be directly related to semen deficiencies, and 18 patients with other causes for semen deficiency and infertility had findings that were either normal or showed minor abnormalities. The delineation of congenital and obstructive abnormalities of the distal urogenital tract with transrectal US enables an accurate diagnosis of certain cases of male infertility and helps guide appropriate clinical and surgical management.

Endoscopic pulsed dye laser lithotripsy of gallbladder calculi in vivo.

We have evaluated the efficacy and safety of pulsed dye laser lithotripsy of gallbladder calculi using a percutaneous endoscopic technique in a porcine model. Fragmentation was readily achieved in vivo. Using a combination of laser lithotripsy and saline lavage, complete removal of all stone debris was feasible through a 24 F tract (N = 3). However, the degree of fragmentation required rendered removal through a smaller tract inefficient, a mean 53% of stone mass being retrievable through a 16 F tract (N = 11). Repeated laser activation at 1 mm from the gallbladder mucosa produced minimal injury, regardless of pulse energy. When the laser fiber was pressed against the mucosa, perforation of the gallbladder was possible at therapeutic pulse energy, but this did not lead to clinical sequelae. We conclude that the pulsed dye laser is a safe and effective means of fragmenting gallbladder calculi in vivo.

Application of a nuclease from rye nucleus for structural studies of plant ribonucleic acids.

A new nuclease (Rn) isolated from rye nucleus was applied for the structural studies of methionine initiator transfer ribonucleic acid and ribosomal 5S rRNA from yellow lupin seeds. The enzyme shows high specificity for some regions of both RNAs. The dihydrouridine and ribothymidine loops which are supposed to be involved in the tertiary interactions of the methionine initiator tRNA were hydrolysed. The anticodon loop is not digested at all. 5S rRNA was digested in single stranded regions (loops). The cleavage pattern of the tRNA and 5S rRNA obtained with Rn enzyme, suggests not only the high specificity toward single stranded regions, but also some dependence on their tertiary structure.

Percutaneous treatment of an intrahepatic abscess caused by a penetrating duodenal ulcer.

We present a well-documented case of duodenal ulcer that penetrated into the quadrate lobe of the liver with subsequent abscess and fistula formation. An accurate diagnosis depended on the use of ultrasound to identify the presence of an abnormal gas pattern in the liver which had been mistaken for bowel on computed tomography. Successful percutaneous drainage under ultrasound guidance was then accomplished. This is the first recorded case we can find in which percutaneous drainage combined with antibiotic and H2 blocker therapy was able to supplant the surgical treatment of liver abscess with an enteric fistula. The diagnosis and management of this condition are discussed. Special reference is made to the use of ultrasound to overcome a major pitfall in the use of computed tomography for diagnosing liver abscesses with fistula formation.

Pseudoomphalocele: pitfall in fetal sonography.

Compression of the fetal abdomen between the walls of the uterus or placenta can result in an appearance that mimics that of omphalocele on sonography. This may be caused by oligohydramnios or by a transient compression of the fetal abdomen with a normal amount of amniotic fluid. Four cases of pseudoomphalocele and one case of true omphalocele are presented.

Pancreatic cystosis in cystic fibrosis.

Two patients with cystic fibrosis and pancreatic cystosis are described who had complete replacement of the pancreas by multiple macroscopic cysts. The possible causes and clinical significance of this condition are discussed.