ABSTRACT
Hepatic complications contribute to morbidity and mortality after allogeneic hemopoietic SCT. Liver Doppler ultrasound and elastography represent promising methods for pretransplant risk assessment and early detection of complications. Ultrasound (liver and spleen size, liver perfusion) and elastography (transient elastography (TE); right liver lobe acoustic radiation force impulse imaging (r-ARFI); left liver lobe ARFI (l-ARFI)) were prospectively evaluated in patients with indications for allo-SCT. Measurements were performed before and repeatedly after SCT. Results were compared with the incidence of life-threatening complications and death during the first 150 days after SCT. Of 59 included patients, 16 suffered from major complications and 9 of them died within the follow-up period. At baseline, liver and spleen size, liver perfusion, TE and r-ARFI did not differ significantly between patients with and without severe complications. In contrast, l-ARFI was significantly elevated in patients who later developed severe complications (1.58±0.30 m/s vs 1.37±0.27 m/s, P=0.030). After SCT, l-ARFI values remained elevated and TE showed increasing liver stiffness in patients with complications. The value of conventional liver ultrasound for prediction of severe SCT complications is limited. Increased values for TE and l-ARFI are associated with severe SCT complications and demand further evaluation.
Subject(s)
Abdomen/diagnostic imaging , Elasticity Imaging Techniques/methods , Hematopoietic Stem Cell Transplantation/adverse effects , Liver/diagnostic imaging , Adult , Aged , Allografts , Cohort Studies , Female , Graft vs Host Disease/diagnostic imaging , Humans , Male , Middle Aged , Risk Assessment , Spleen/diagnostic imaging , Ultrasonography, DopplerABSTRACT
BACKGROUND: In the more and more complex world of modern medicine, communication skills become increasingly important. Many physicians are however unaware of their difficulties in giving information in a clear and comprehensible way. This is especially true for breaking bad news. Keys for good communication consist in: careful preparation of the physical context of the interview; finding out how much the patient knows or suspects; giving the information in small amounts and a balanced way; responding to the patient's feelings and finally making a contract for the future.
