Gender-specific Characteristics of Social Factors Related to Frequency of Daily Conversation Among Community-dwelling Older Adults: A Cross-sectional Observational Study

Objectives

This study examined the social factors affecting the frequency of going out, and social isolation related to the frequency of daily conversation, stratified by gender.

Method

The participants comprised 1,016 community-dwelling older Japanese adults, who were categorized into four groups: those who are (1) not isolated socially and go out every day, (2) not isolated socially and do not go out every day, (3) socially isolated and go out every day, and (4) socially isolated and do not go out every day. We performed a logistic regression analysis to assess the relationship between the frequency of daily conversation and the four groups.

Results

Our multivariable logistic regression analysis (reference, group 1) showed that the coexistence of poor social factors significantly affected men (group 2: odds ratio [OR] 2.13 [1.10 to 4.12]; group 3: OR 2.92 [1.70 to 5.00]; and group 4: OR 4.28 [2.43 to 7.54]). For women, the frequency of going out was related to daily conversation only with social isolation group (group 2: OR 1.51 [0.77 to 2.98]; group 3: OR 2.42 [1.25 to 4.68]; and group 4: OR 3.81 [2.08 to 7.00]).

Conclusion

Our findings suggest that promoting daily conversations of community-dwelling older adults can help prevent related health adversities.

What is the optimal nutritional assessment tool for predicting decline in the activity of daily living among older patients with heart failure?

The clinical importance of nutritional management in activities of daily living (ADL) among older inpatients with heart failure (HF) is greatly increasing. We determined the optimal nutritional assessment tool that can predict ADL decline among older inpatients with HF. We prospectively investigated 91 inpatients aged ≥ 65 years with HF in an acute hospital. We measured their nutritional status at admission using nutrition indices: the controlling nutritional status (CONUT), the geriatric nutritional risk index, the prognostic nutritional index, and the mini nutritional assessment. Logistic regression analysis was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the relationships between the malnutrition status assessed by each nutritional index category and the ADL decline measured by the Barthel index (BI) in the univariate and multivariate analyses. Among the participants, 28.6% (n = 26; median age 81.5 years; 69.2% men) of the participants were included in the Reduced BI group and 71.4% (n = 65; median age 79.0 years; 67.7% men) in the Maintained BI group. The Reduced BI group showed a significantly higher CONUT value than the Maintained BI group, but there were no significant differences in other nutritional indices. In the multivariate logistic regression analysis, a higher CONUT score was associated with a significantly elevated risk of Reduced BI (adjusted OR 0.24; 95%CI 0.08-0.75; p = 0.014). We found that CONUT is an appropriate nutritional assessment tool for predicting ADL decline among older inpatients with HF in the early phase of hospitalization.

Detection of malignant hepatic tumors: comparison of gadolinium-and ferumoxide-enhanced MR imaging

OBJECTIVE

The purpose of our study was to compare how well gadolinium-enhanced and ferumoxide-enhanced MR imaging reveal malignant hepatic tumors.

SUBJECTS AND METHODS

Both gadolinium-enhanced and ferumoxide-enhanced MR imaging were separately performed in 53 patients with a total of 87 malignant hepatic tumors (57 hepatocellular carcinomas, 28 metastases, two cholangiocarcinomas). Thirty-one of the 53 patients had hepatic cirrhosis. Images were reviewed by three independent off-site observers. Observer performance was evaluated by means of sensitivity, specificity, and receiver operating characteristic curve analyses.

RESULTS

Gadolinium-enhanced MR imaging outperformed ferumoxide-enhanced MR imaging in sensitivity (81% versus 62%, p < 0.01) for malignant-tumor detection. Specificity was comparable (94%) between the two types of MR imaging. Area under receiver operating characteristic curve (A(z)) value was significantly higher with gadolinium-enhanced MR imaging than with ferumoxide-enhanced MR imaging in patients overall (A(z) = 0.896 versus 0.805, p < 0.001), in patients with cirrhosis (A(z) = 0.907 versus 0.807, p < 0.001), and in patients without cirrhosis (A(z) = 0.899 versus 0.834, p < 0.01). The superiority was enhanced in the subset of patients with cirrhosis.

CONCLUSION

Gadolinium-enhanced MR imaging outperforms ferumoxide-enhanced MR imaging in revealing malignant hepatic tumors. Gadolinium-enhanced MR imaging is recommended, particularly for patients with cirrhosis.

MR imaging of intrahepatic cholangiocarcinoma with pathologic correlation

OBJECTIVE

The objective of this study was to determine the MR imaging features of intrahepatic cholangiocarcinoma.

MATERIALS AND METHODS

MR images of 50 patients with pathologically proven intrahepatic cholangiocarcinoma were reviewed retrospectively. T1- and T2-weighted spin-echo images were obtained in all patients. Contrast-enhanced T1-weighted imaging was performed in 25 patients. Signal intensity and enhancement pattern of the tumors were correlated with pathology findings. The frequency of central hypointense regions on T2-weighted images and the intrahepatic bile duct dilatation of several other hepatic tumor types were investigated. Results were compared with imaging results of cholangiocarcinoma.

RESULTS

On T2-weighted images, central hypo- and hyperintense regions were detected in tumors in 27 and 17 patients, respectively. Contrast-enhanced T1-weighted imaging revealed central hypointense areas exhibiting homogeneous, heterogeneous, and no enhancement in six, three, and five, respectively, of 14 patients. Regions of fibrosis displayed enhancement, whereas those of coagulative necrosis showed no enhancement. The signal intensity difference on T2-weighted images between the center and the edge of the tumor correlated well with the fibrotic ratio difference between those two areas corresponding to the MR image (Spearman's rank correlation test, r = 0.72, 95% confidence interval = 0.48-0.86). T2-weighted images revealed central hypointense regions in 16 of 34 instances of hepatic colorectal metastases. However, hypointensity was observed in only 26 of 234 other hepatic tumors. Intrahepatic bile duct dilatation was evident in 27 of 50 cases of cholangiocarcinoma but occurred in only a single case of 34 instances of hepatic colorectal metastases.

CONCLUSION

The combination of the signal intensity on T2-weighted images and the enhancement pattern on contrast-enhanced T1-weighted images showed good correlation with the pathologic findings of cholangiocarcinoma. The occurrence of a central hypointense area on T2-weighted images is not pathognomonic; however, this finding, which reflects severe fibrosis, appears to be a characteristic marker of intrahepatic cholangiocarcinoma. The presence of intrahepatic bile duct dilatation may indicate cholangiocarcinoma, although it is difficult to differentiate cholangiocarcinoma from hepatic colorectal metastasis.

Malignant hepatic tumor detection with ferumoxides-enhanced MR imaging with a 1.5-T system: comparison of four imaging pulse sequences

The purpose of our study was to compare observer performance in the detection of malignant hepatic tumors with ferumoxides-enhanced magnetic resonance (MR) images obtained with proton density-weighted spin-echo (SE), T2-weighted fast SE, T2*-weighted gradient-recalled-echo (GRE), and proton density-weighted echo-planar (EP) sequences. Ferumoxides-enhanced MR images obtained with the four sequences in 50 patients with 92 solid malignant and 64 nonsolid benign lesions were retrospectively analyzed. Image review was conducted on a segment-by-segment basis; a total of 397 liver segments was reviewed separately for solid and nonsolid lesions by three independent readers. Observer performance was evaluated with receiver operating characteristic analysis. Lesion-to-liver contrast-to-noise ratio was higher with SE and EP than with GRE and fast SE images for solid lesions (P < 0.05), and higher with fast SE and SE than with GRE images for nonsolid lesions (P < 0.01). Proton density-weighted SE and T2-weighted fast-SE images were superior to T2*-weighted GRE and proton density-weighted EP images for detection of malignant hepatic tumors. T2-weighted fast SE images were the best for detection of nonsolid lesions. T2-weighted fast SE images that were comparable to proton density-weighted SE images for solid tumor detection, that were the best for nonsolid lesion detection, and that had an acquisition time of one third to half of that of SE imaging may be able to replace SE images for ferumoxides-enhanced liver imaging.

Spectrum of CT findings in pediatric patients after partial liver transplantation

Liver transplantation is an accepted therapy for patients with severe liver diseases. In pediatric liver transplantation, the application of reduced-size and split-liver transplantation has expanded the donor pool. The development of living related donor partial liver transplantation has further increased the availability of donors. Complications in patients after living related transplantation include hepatic arterial thrombosis, portal venous stenosis and thrombosis, hepatic venous stenosis, biliary stenosis or leak, biloma formation, fatty liver, extrahepatic fluid collection, posttransplantation lymphoproliferative disorder, and organ rejection. Ultrasonography is the primary imaging modality for evaluation of the vascular system of patients after liver transplantation, and computed tomography is useful to help diagnose hepatic parenchymal abnormalities including infarction, congestion, and fatty change; intrahepatic biliary damage; and extrahepatic disorders, including abnormal fluid collections, varicose veins, and lymphadenopathy.

Percutaneous ethanol injection for hepatocellular carcinoma originating in the caudate lobe

BACKGROUND/AIMS

Hepatocellular carcinoma originating in the caudate lobe is rare and the treatments for caudate hepatocellular carcinoma were thought difficult, because of its unique location at hepatic resection, or because of complex arterial supply at transcatheter arterial embolization. Percutaneous ethanol injection is an effective treatment for small hepatocellular carcinoma. The aim of this study was to assess the efficacy of percutaneous ethanol injection for hepatocellular carcinoma originating in the caudate lobe.

METHODOLOGY

During the past 4 years, 7 patients with 7 hepatocellular carcinomas originating in the caudate lobe underwent percutaneous ethanol injection as a curative treatment. The outcomes of percutaneous ethanol injection and the survival of the 7 patients were evaluated.

RESULTS

Percutaneous ethanol injection was successfully carried out with no severe complications in all patients. During follow-up periods local recurrence was noticed in a patient, that was treated with percutaneous ethanol injection again. Four patients had recurrence in other parts of the liver, who were treated with percutaneous ethanol injection alone or percutaneous ethanol injection and transcatheter arterial embolization. Six patients were alive for 12-55 months after percutaneous ethanol injection and 1 patient died of hepatic failure 15 months after the procedure.

CONCLUSIONS

Percutaneous ethanol injection was a safe and effective treatment, and it would be an alternative therapy for hepatocellular carcinoma originating in the caudate lobe.

Percutaneous ethanol injection for treatment of adrenal metastasis from hepatocellular carcinoma

OBJECTIVE

With the improved prognosis of patients with hepatocellular carcinoma, the likelihood of diagnosing adrenal metastasis has increased. We performed percutaneous ethanol injection for adrenal metastasis in seven patients and evaluated its efficacy.

CONCLUSION

Percutaneous ethanol injection was successfully performed in nine nodules in seven patients. During follow-up, six nodules in five patients showed no increase in size. Four patients were alive 6-28 months after injection, one patient died of hepatic failure, one of brain metastasis, and one of multiple metastases. Percutaneous ethanol injection can be an alternative treatment for adrenal metastasis of hepatocellular carcinoma.

Tumor staging of pancreatic adenocarcinoma using early- and late-phase helical CT

OBJECTIVE

We compared early-phase CT with late-phase CT in the evaluation of pancreatic adenocarcinoma.

MATERIALS AND METHODS

Both early- and late-phase CT images of 25 pancreatic adenocarcinomas were compared with surgical-pathologic findings. We evaluated tumor detectability, tumor size, and local tumor invasion.

RESULTS

Tumor detectability was 96% on early-phase CT imaging and 64% on late-phase CT imaging (p < .01). Sensitivity for anterior serosal invasion, retroperitoneal invasion, and arterial invasion on early-phase CT exceeded sensitivity on late-phase CT (p < .05). However, specificity for all factors on early-phase CT was less than or equal to specificity on late-phase CT. The grade of local tumor invasion on early-phase CT achieved better agreement with the surgical-pathologic results than did late-phase CT, especially for tumor size and retroperitoneal invasion.

CONCLUSION

Early-phase CT was better than late-phase CT in revealing tumors, tumor size, and retroperitoneal invasion.

Portal vein anomaly associated with deviation of the ligamentum teres to the right and malposition of the gallbladder

PURPOSE

To develop a complete clinical picture of a portal vein anomaly associated with a rightward-deviated ligamentum teres.

MATERIALS AND METHODS

Three hundred twenty-seven consecutive living donor candidates for partial liver transplantation were evaluated for hepatic vascular abnormalities with computed tomography supplemented with intraoperative examinations. Special attention was given to the branching pattern of the portal system and the relative positions of the umbilical portion of the portal vein, the ligamentum teres, and the gallbladder.

RESULTS

Four donor candidates (1.2%) had a portal vein anomaly associated with a rightward-deviated ligamentum teres. In all four, the umbilical portion of the portal vein (and hence the ligamentum teres) was abnormal, lying above the gallbladder bed and giving off major branches to the right anterior segment. If unrecognized, these might have been ligated, leading to major complications in the donors.

CONCLUSION

A portal vein anomaly associated with a rightward-deviated ligamentum teres is an important clinical entity that is not as rare as indicated in the literature. This anomaly should be kept in mind during preoperative examination of the liver.

[Radiation therapy for non-small cell lung cancer with postoperative intrathoracic recurrence]

We reviewed patients with intrathoracic recurrence of non-small cell lung cancer after surgery, with reference to the feasibility of radiotherapy. The series consisted of 46 patients (39 males and 7 females) treated by radiotherapy from 1982 to 1995. Histology included squamous cell carcinoma (28 patients), adenocarcinoma (17), and large cell carcinoma (1). Clinical stage by UICC classification (1987) was as follows: stage I(2 patients), stage II(1), stage IIIa(13), stage IIIb(23), and stage IV(7). Recurrences were noted in bronchial stump (18 patients) and surgical scar (4). Metastases occurred in hilar-mediastinal lymphnodes (15), lung fields (7), and pleuropericardium (2). The mean interval from surgery to recurrence was 27 months. Delivered dose ranged from 45 to 80 Gy, and 19 patients received combined chemotherapy. Therapeutic results were as follows: complete response in 16 patients, partial response in 27, no response in 12 and progressive disease in 1, Overall 2- and 5-year survival rates were 17% and 11%, respectively, and 10 months in MST. On univariate analysis, significant prognostic factors were sex, stage at recurrence, recurrence pattern, performance status and initial response to radiotherapy, while multivariate analysis showed sex and initial response. From these data, we are encouraged by effective radiotherapy for postoperative intrathoracic recurrence of non-small cell lung cancer, especially in patients with stump or lymphnode recurrence.

[Experience in treatment of patients with locally advanced or recurrent breast cancer: intraarterial infusion chemotherapy combined with radiotherapy]

For the purpose of local control and breast conservation, intraarterial infusion chemotherapy combined with radiotherapy has been indicated in patients with locally advanced breast cancer both in primary and recurrent cases. The present series, evaluated during the past 4 years, consisted of 15 patients 35-83 years of age, with invasive ductal carcinoma, including 10 with primary breast cancer (stage IIIb: 1; IV: 9) and 5 with postoperative recurrence (stage IIIb: 2, IV: 3). Intraarterial chemotherapy is started, basically infusing ADM 50 mg, MMC 10 mg and CDDP 50 mg into the internal thoracic and/or subclavian artery 1-3 times, followed by reduction surgery (quadrantectomy: 4, wide resection: 2) and radiotherapy to the breast, supraclavicular, parasternal and cervical regions according to tumor extent. Local response after arterial infusion was CR: 2, PR: 10, NC: 3 (response rate: 73%). The response rate of distant metastases after arterial infusion was 73%. Of 10 patients with primary breast cancer, recurrence was noted in 1. Breast conservation was successful in 8 of 10 patients. One of them, in stage IIIb, has survived for 4.5 years with no evidence of disease and with breast conservation. Five patients with postoperative recurrence showed CR with no recurrence after intraarterial chemotherapy and radiotherapy. Acute skin reaction occurred in 6 patients, and was especially frequent in patients with postoperative recurrence (4 of 5). According to these results, combined therapy affords breast conservation even in patients with locally advanced breast cancer, and improves patient's QOL in stage IV.