Do therapists address ethnic and racial differences in cross-cultural psychotherapy?

Ethnic and racial differences between client and therapist affect therapy processes and outcomes, but little is known about the extent to which therapists have dialogues about their differences in therapy. A survey on this topic was completed by 689 APA-licensed psychologists with experience conducting cross-cultural therapy. Most psychologists reported having such discussions, but with less than half of their cross-ethnic/racial clients. Therapists and clients were equally likely to initiate discussions. Reasons for discussing differences varied greatly. Therapists consistently described themselves as comfortable with and skilled at these discussions, and reported that discussions facilitated therapy. Therapists who were female, older, nonminority, less experienced with diverse clients, and viewed training as an important factor were more likely to have discussions about differences. Results point to the need to better understand if, when, and how ethnic and racial differences should be addressed in therapy. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

Radioguided sentinel lymph node detection in vulvar cancer.

Lymph node status is the most important prognostic factor in vulvar cancer. Histologically, sentinel nodes may be representative of the status of the other regional nodes. Identification and histopathologic evaluation of sentinel nodes could then have a significant impact on clinical management and surgery. The aim of this study was to evaluate the feasibility and diagnostic accuracy of sentinel lymph node detection by preoperative lymphoscintigraphy with technetium-99 m-labeled nanocolloid, followed by radioguided intraoperative detection. Nine patients with stage T1, N0, M0, and 11 patients with stage T2, N0, M0 squamous cell carcinoma of the vulva were included in the study. Only three cases had lesions exceeding 3.5 cm in diameter. Sentinel nodes were detected in 100% of cases. A total of 30 inguinofemoral lymphadenectomies were performed, with a mean of 10 surgically removed nodes. Histological examination revealed 17 true negative sentinel nodes, 2 true positive, and 1 false negative. In our case series, sentinel lymph node detection had a 95% diagnostic accuracy, with only one false negative. Based on literature evidence, the sentinel node procedure is feasible and reliable in vulvar cancer; however, the value of sentinel node dissection in the treatment of early-stage vulvar cancer still needs to be confirmed.

Clinical and aetiological aspects in urticaria and angio-oedema.

BACKGROUND: Urticaria is a common disorder that affects as many as 20% of all people at some time during their lifetime. OBJECTIVES: To analyse the prevalence of various forms of urticaria according to an aetiological and clinical classification, we carried out a 4-year study in an outpatient clinic. METHODS: The study was carried out on 562 consecutive patients (178 males and 384 females; mean age 35.4 +/- 16), who had been referred to our unit for the study of urticaria and angio-oedema. Baseline investigations included: the patient's family and personal history of allergy; duration of symptoms, presence of associated symptoms and objective signs of the current episode; clinical, laboratory and instrumental investigations; assessment of response to antihistamine treatment. RESULTS: A family history of atopy was present in 35% of patients and a personal history of allergy in 24%. We subdivided urticaria and angio-oedema into several groups on the basis of their clinical and aetiological aspects. Of the 562 patients, 424 (76%) presented with ordinary urticaria (43 acute urticaria, 311 chronic urticaria, 70 episodic urticaria), 80 (14%) physical urticaria, 49 (9%) angio-oedema without weals, six (1%) IgE-mediated contact urticaria and three (0.5%) urticarial vasculitis. In 64 cases (11%) urticaria/angio-oedema was associated with one or more symptoms. We identified 394 cases (82%) of idiopathic urticaria, 42 (9%) of immunological urticaria, 29 (6%) of non-immunological urticaria and 17 (3%) of urticaria secondary to infections. Of the treated subjects, 54% showed a good response to treatment with antihistamines. CONCLUSIONS: Our data provide an overview of urticaria/angio-oedema in a large series of patients, based on clinical-aetiological aspects, and related to recent diagnostic guidelines.

Radiolabelled peptides and low molecular weight proteins in metabolic diseases.

During the last decade there has been a tremendous effort to develop labelled peptides for diagnosis and therapy. The main goal has been to develop tumor imaging/therapeutic agents, as well as peptides directed to the study of thrombosis and infection. Relatively few efforts have been made to develop peptides directed to the study of metabolic diseases. Ideally, a peptide suitable for the study of metabolism should be constructed keeping in mind the following characteristics: a) preserved affinity constant, b) preserved or improved specificity for its binding site, c) increased biological half-life in comparison with the parent peptide, d) labelling with a g or positron emitter whose physical half-life fits with the biological half-life, e) strong binding of the nuclide to the molecule so that it cannot be released after internalization. In this paper some of the peptides or low molecular weight proteins along with some analogues which have been employed in experimental studies and in humans are reviewed, with major emphasis on amyloid seekers, insulin and leptin. Many of these radiopharmaceuticals have been labelled with iodine isotopes, however their in vivo application suffer of severe limitations due to rapid release of iodine after internalization. On the other hand, new perspectives are opened by new radiofluorination techniques, which offer the unique advantage to quantify organ uptake and kinetics, parameters which are of paramount importance in metabolic studies.

Radioguided surgery for gastrinoma: a case report.

AIMS AND BACKGROUND: Gastrinomas are the most common neuroendocrine tumors of the duodenopancreatic region. Surgical resection is the primary type of radical treatment. METHODS AND STUDY DESIGN: At the Institute of General, Gastrointestinal and Breast Surgery we treated a patient with a duodenal gastrinoma that was diagnosed and localized by means of selective celiac-mesenteric angiography and labelled octreotide scintigraphy. Surgery was performed using a radioguided technique; in this way we easily detected the small tumor and discovered another tracer-uptaking lesion that turned out to be a metastatic lymph node. RESULTS: Surgical resection is the ideal treatment for sporadic gastrinoma: it improves quality of life, prolongs survival, and reduces the incidence of metastases, with a modest percentage of complications and practically zero mortality. Meanwhile, medical treatment is being reevaluated, particularly in the case of metastatic disease or polyendocrine MEN1 syndrome. A fundamental aspect in the management of gastrinomas is tumor localization. Endoscopic ultrasonography and labeled octreotide scintigraphy (Ostreoscan) proved to be more effective than the usual imaging modalities. Intraoperative ultrasonography gastroscopy for duodenal transillumination and repeated measurement of blood gastrin levels should be performed intraoperatively in the surgical treatment of gastrinomas. CONCLUSIONS: The clinical application of radioguided surgery for tracer-uptaking endocrine tumors is still controversial. In our case the decision to use this method was influenced by the fear that the patient's obesity and the effects of previous surgery could hamper the identification of the small tumor.

153Sm-EDTMP radionuclide treatment of bony metastatic disease: a radiation protection evaluation.

The aims of the study were the identification and optimization of the radiation protection measures for in-patients who underwent palliative radionuclide therapy for bone metastases with 153Sm-EDTMP activities lower than 3 GBq. The suitability of the preventive procedures from the contamination of places and objects, and for the protection of the hospital staff, other patients and relatives from the danger of external radiation and internal contamination has been evaluated by carrying out a series of measurements both of superficial contamination inside the confinement room and of the dose near the treated patients. The results show that the contamination of the places and the objects close to treated patients is really low. The greatest risk of contamination depended on the management of the physiological waste that, therefore, should be collected and disposed as radioactive one. The measurements of external radiation show that nearby the confinement room the dose limit for public is not exceeded. The same is true for the dose limit of 3 mSv established for relatives who, when taking care treated patients, receive a dose lower than 20 microSv a patient. The fulfillment of the proposed radiation protection measures assures the containment of the risk of exposure and contamination for nursing and medical staff involved in radionuclide-based therapy.

Iodine deficiency and increased risk from radioactive iodine intake in nuclear medicine personnel.

Since the entity of the stable endogenous iodine pool is inversely related to the probability of thyroid uptake of radioactive iodine isotopes in subjects exposed for professional reasons to radioiodine intake, we evaluated the urinary iodine excretion, which is a reliable indicator of stable iodine daily intake, in 19 subjects of a nuclear medicine department. Seventeen out of 19 subjects showed a reduced iodine elimination < 150 mcg iodine per g of urinary creatinine, while the values of TSH and free fractions of T3 e T4 were within normal limits. Thyroglobulin levels were increased in 5 subjects only, all with reduced iodine excretion. Iodine deficiency is still present in several european areas and is responsible for several thyroid diseases including cancer; it is also responsible for increased thyroid dosimetry after accidental intake. According to Breuer, an increased radiation rate to bone marrow and ovaries is expected in subjects with a reduced endogenous iodine pool. On account of these results, we recommend to monitor the urinary iodine excretion in personnel exposed to the risk of radioiodine contamination and correct their dietary daily intake, thus reducing organ dosimetry not only in normal working conditions, but also in case of accidental internal contamination.

Quality control of 99Mo/99Tcm generators: results of a survey of the Radiopharmacy Working Group of the Italian Association of Nuclear Medicine (AIMN).

A multicentre survey of the quality control of 99Tcm generators has been completed: 245 generators from seven different commercial sources were tested over a period of 2 years. The results indicate that the mean pH of the eluates was 5.8 +/- 0.6; the aluminium contents were typically < 10 ppm; the radiochemical purity was 99.8 +/- 0.4% and the median 99Mo content was 3.8 x 10(-4) percent. The elution profiles gave a volume of 1.9 ml to obtain 50% of the total eluted activity and of 4.9 ml to obtain 95%. Other radionuclide impurities and heavy metal breakthrough were evaluated by graphite furnace absorption spectrometry and inductively coupled plasma mass spectrometry. National guidelines for the standardization of radiopharmacy procedures are currently being compiled.

Scintigraphic imaging and turnover studies with iodine-131 labelled serum amyloid P component in systemic amyloidosis.

Radiolabelled serum amyloid P component (SAP) is a specific tracer for amyloid. Iodine-123 has ideal physical characteristics for scintigraphy but is expensive and not widely available. Here we report serial imaging and turnover studies in which we labelled SAP with iodine-131, a cheap alternative isotope which would be expected to yield poorer images but permit more prolonged turnover measurements. Imaging and plasma clearance and whole body retention (WBR) of tracer were studied for up to 7 days in ten patients with proven systemic AL amyloidosis and two patients in whom the diagnosis was suspected, after i.v. administration of about 37 MBq of 131I-SAP. Normal blood pool images were obtained in the latter two subjects and amyloidosis was subsequently refuted histologically. WBR at 48 h was <60% and 6-h plasma activity was >65% of the injected dose (i.d.). Among the other ten patients, amyloid deposits were identified in the spleen in eight cases, liver in five and kidneys in four; other sites that gave positive results included bone, joints and soft tissues, and the myocardium in one case. Up to 95% of the tracer localised into amyloid within 6-h, and the values for WBR became progressively more discriminating during the study period, exceeding the normal reference value (<25%) in all cases by day 7. The optimal imaging time was found to be between 24 and 48 h. The duration of the study enabled us to measure the tracer elimination half-life which was increased in all cases by up to tenfold. Follow-up studies performed after 2-24 months in four patients who were treated with iododoxorubicin showed regression of amyloid in one patient and a small increase in one case; in the other two patients the imaging and turnover studies were identical to baseline. Despite its unfavourable imaging characteristics, 131I-SAP produced diagnostic scans in every patient in this series and, coupled with the detailed turnover information, is adequate for monitoring disease progress.

Dialysis hypersensitivity: a fading problem?

Allergic-type reactions experienced by patients on chronic hemodialysis are frequently reported in the literature, often related to compounds released during the hemodialysis sessions, in particular ethylene oxide (ETO). In these studies, dialysis patients seem to have higher values of IgE than those observed in a reference population. The aim of our work was to investigate IgE-related parameters of 126 dialysis patients in comparison with two control groups composed of healthy subjects and predialysis patients. IgE values were not significantly different in nonallergic dialysis patients, with a geometric mean (X) of 27.5 kU/l, when compared to healthy controls (X = 38 kU/l) and predialysis subjects (X = 40.7 kU/l). Higher values of IgE (X = 74.1 kU/l) were detected in allergic dialysis patients. However, only 3 patients, all without detectable antibodies against ETO, complained of anaphylactic symptoms during dialysis sessions in a 4-year surveillance period. At variance, 6 symptom-free patients carried IgE antibodies against ETO (range 0.7-15 kU/l), usually with high total IgE. Our results suggest a reduced frequency of hypersensitivity reactions during dialysis sessions. Furthermore, uremia does not alter IgE reactivity in the predialysis period or after long-term maintenance dialysis treatment.

Serum type I and type III procollagen peptide levels in sarcoidosis.

Type I and type III are the most abundant collagens in the lung. The aim of our study was to compare type I and III procollagen peptides in sera of sarcoid patients. Sixty eight patients with sarcoidosis were studied (19 with newly recognized disease, 7 with relapsing disease, 15 with chronic disease, and 27 in stable remission). Thirty healthy volunteers served as controls. The levels of procollagen I and III peptides were determined by radioimmunoassay. Angiotensin-converting enzyme (ACE) level was evaluated by means of a colorimetric assay. In patients with newly recognized sarcoidosis, both serum procollagen I and III peptide levels were increased with respect to controls (p=0.0014 and p<0.00001, respectively). There was a poor correlation between levels of procollagen I and III (r=0.26), whereas there was a closer correlation between procollagen III and ACE (r=0.69). Procollagen I peptide level did not identify patients in roentgenological stage III. In conclusion, in patients with newly recognized sarcoidosis there is a significant increase in the serum level of procollagen I peptide. However, procollagen I peptide is not a marker of sarcoid patients with fibrosis, ie. stage III disease. Its clinical usefulness seems to be weaker than that of procollagen III peptide.

Cardiac and pleuropulmonary AL amyloid imaging with technetium-99m labelled aprotinin.

Antiproteases are known to be present in amyloid deposits. We evaluated the possibility of using an anti-serine protease (aprotinin) labelled with technetium-99m (TcA), usually employed as a cortical renal tracer, for the imaging of amyloid deposits. Because of the known high uptake of TcA by the kidneys, we limited our analysis to extra-abdominal amyloid localizations. We report the scintigraphic findings observed in 24 patients with light chain amyloidosis (AL) and one with a hereditary form who were known or suspected to have extra-abdominal involvement. Planar scans obtained 100min after i.v. TcA administration showed myocardial accumulation in 11 patients, pleuropulmonary accumulation in nine, pericardial accumulation in two and localization in the neck region (thyroid, salivary glands and tongue) in eight. TcA scintigraphy was negative in five patients without clinical or laboratory evidence of extra-abdominal involvement, as well as in 12 control group patients with cardiac and renal diseases. These preliminary results indicate TcA to be a low-cost, readily available radiopharmaceutical for imaging of extra-abdominal involvement in AL type amyloidosis.

Biochemical and functional markers of lung damage after bleomycin treatment.

Lung function tests, including spirometry, and pulmonary transfer factor for carbon monoxide (TLCO), serum angiotensin-converting enzyme (sACE), serum copper (sCU++) and serum procollagen III peptide (sPIIIP) were measured in 20 patients with metastatic testicular carcinoma, before and after treatment with cisplatin, bleomycin, vinblastine or etoposide. A significant decrease of TLCO, total lung capacity and vital capacity was observed at the end of the treatment. No recovery of pulmonary function had taken place 2 yrs after the last dose of bleomycin. This result suggests that bleomycin-induced lung damage is not completely reversible. Serum angiotensin-converting enzyme, remained unmodified, whilst sPIIIP was found to be significantly increased at the end of chemotherapy, but normal 2 yrs after the completion of chemotherapy. Serum Cu++ showed a tendency to decline. No significant correlation was found between sACE, sCu++ and sPIIIP and lung function tests in the follow-up period. These results question the possibility that these markers could be useful indicators of bleomycin-induced lung damage.

Cortical kidney scan evaluation in the follow-up of children with vesico-ureteric reflux.

We present the results obtained in the follow-up of 66 children with vesico-ureteric reflux (VUR) of different grades (111 refluxing renal units, RU; the VUR being bilateral in 47 children), employing the renal cortical agent 99mTc-aprotinin (TcA). Together with the visual inspection of the scan, we adopted a quantitative approach, expressing the results as the split percent uptake of the injected dose. The detection of morphological anomalies was more frequent in the cases of more severe reflux. Scars were noted in 38 RU, with a higher prevalence in more severe grades, except for grade V where severe impairment was more frequent. With regard to the amount of functioning parenchyma, the probability of a significant loss of nephrons (expressed by a low uptake of TcA), rose with the grades, although the higher grades were not invariably associated with parenchymal failure. The abnormality detection rate is higher by about 2:1 with the TcA scan than with other diagnostic modalities such as i.v. pyelography or echography. No differences were found between RU with or without scars as regards evolution over time; only when the TcA uptake at presentation was lower than 10% was the normal development of the RU likely to be hindered. From these data it can be concluded that early diagnosis is the key factor in the management of these children with VUR; the morpho-functional assessment with TcA uptake is probably the most effective technique for the detection of parenchymal abnormalities. In addition, the test has a high prognostic value, an uptake lower than 10% indicating an unfavourable prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Intraoperative radioimmunolocalization of colorectal cancer: a review.

Although intraoperative radioimmunolocalization (IORIL) is gaining wider acceptance, several limits inhibit a more extensive clinical use. In this paper the following topics will be discussed: 1) the clinical approach, that is, the combined use of immunoscintigraphy and IORIL after a single MAb administration or the use of non-imaging 125 I MAb; 2) the detector type and its collimation and shielding; 3) the nuclides employed, and 4) the background problem. The clinical results of our and other groups show a sensitivity that is generally higher than 0.75 with a high positive predictive value. The detection rate of occult lesions is in the order of 20% of all explored sites. However, the current state of detector and MAb technology do not allow to achieve better results; probably the results can be improved by the use of bispecific MAb or the avidin-biotin system.

Radioimmuno-guided endoscopy (RIGE) in the detection of primary and recurrent rectal tumor.

The usefulness of radioimmunoguided endoscopy in the detection of primary and recurrent rectal cancer was investigated. Of the 15 patients included in our study, 4 with suspected primary rectal cancer were examined preoperatively, while the remaining 11 were studied after radical resection of rectal carcinoma with the aim of detecting local recurrence. Radioimmunoguided endoscopy was performed employing a hand-held gamma-detecting probe (mod. 2 Oris, France), after the administration of a 111In labeled monoclonal antibody to CEA. Radioimmuno-guided endoscopy results detected the presence of primary or recurrent periluminal cancer in seven cases. In four it modified the preoperative stage based on the findings of conventional investigation and it influenced the surgical decision in five cases. No toxicity was noted and none of the patients developed HAMAs.

Study of functional and biochemical indicators of subclinical lung damage in bleomycin-treated patients.

In 30 patients affected by testicular non-seminomatous cancer we evaluated pulmonary function tests before and after bleomycin-including combination chemotherapy. We paid particular attention to changes in diffusing lung capacity (DCO) and its two components, namely diffusing capacity of the alveolar-capillary membrane (Dm) and pulmonary capillary blood volume (Vc). In the same patients we also evaluated the behaviour of serum procollagen III aminopeptide (sP-III-P), assumed to be a biochemical equivalent to Dm, and of serum angiotensin converting enzyme (S-ACE), assumed to be a biochemical equivalent to Vc. We found that, after chemotherapy, patients showed a significant decline in several pulmonary function parameters, namely VC, TLC, and FEV1 (P < 0.0001, P = 0.0351, P = 0.0004, respectively), when compared to pre-treatment values. DCO was significantly impaired after chemotherapy (P < 0.0001), but with regard to its components, Vc values showed a significant decline (P = 0.0002), whereas Dm values were unchanged. Values of sP-III-P raised significantly after chemotherapy (P = 0.003), whereas S-ACE activity did not show any significant variation. When we looked at relationships between functional and biochemical parameter variations, the only significant correlation we found was between DCO and S-ACE (r2 = 0.112; P < 0.02). We conclude that in asymptomatic patients treated by bleomycin-including combination chemotherapy, DCO impairment is likely to occur because of a subclinical injury to pulmonary vessels, as suggested by Vc decline. Although the occurrence of pulmonary interstitial fibrosis after chemotherapy was excluded by chest X-ray examination and by stable values of Dm, sP-III-P elevation would suggest an accelerated type III collagen turnover in interstitial fibroblasts activated by bleomycin.

Radioimmunolocalization of pelvic recurrences from rectosigmoid cancer employing 111In anti-CEA F(ab')2.

Thirty-two immunoscintigraphic studies have been performed in 26 patients previously operated upon for rectosigmoid cancer, for an early detection of pelvic recurrence, employing 111In anti-CEA, F(ab')2. The sensitivity was 1, specificity 0.76 and accuracy 0.84, leading to a positive predictive value of 0.69 and a negative value of 1. The combined use of a non-imaging surgical probe in 6 of the 10 patients who underwent second look surgery, detecting the 111In radioactivity used for RIS, improved diagnostic accuracy, ruling out the presence of tumors in 3 patients with false positive RIS.