Quality of life in patients and caregivers after aneurysmal subarachnoid hemorrhage: a Flemish population study

Background and aims

Aneurysmal subarachnoid hemorrhages (aSAH) have high mortality and morbidity. However, the impact on Quality of Life (QoL) of patients remains poorly documented, and data on primary caregiver burden is even scarcer.

Methods

This is a single center, cross-sectional study performed at the Antwerp University Hospital, Belgium. We included aSAH patients during follow-up at the outpatient clinic and assessed the QoL, by using the Stroke Specific Quality of Life scale (SSQoL). Caregiver burden was evaluated by the Caregiver Strain Index (CSI). The aSAH severity and functional outcome (at 90 days) were assessed, respectively, by mFisher score and modified Ranking Scale (mRS). Statistical analysis was performed using SPSS version 27.

Results

In total, 22 aSAH patients were included, on average 15.5 (range 4–45) months after the aSAH. The SSQoL score was 3.7 ± 0.7, with a mean psychosocial domain score of 3.2 ± 0.8 and physical domain of 4.2 ± 0.8. Psychosocial factors, especially decreased energy levels and cognitive impairment, had a negative impact on the QoL (p = 0.02 en p = 0.05). No association was found between QoL and mFisher, nor between QoL and mRS. Fifteen primary caregivers completed the CSI. Only 3 (20%) of them reported a high care burden (CSI > 6), although changes in daily life and personal plans were reported, respectively, by 73% (n = 11) and 67% (n = 10) of caregivers. We only found a correlation between the mFisher score and CSI (p = 0.01).

Conclusion

Our results emphasize that there is an important psychosocial impact on the QoL of patients after aSAH, and their primary caregivers. More research is warranted.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13760-022-02085-x.

Olmesartan-induced enteropathy treated with budesonide

Olmesartan, an angiotensin receptor blocker, is a widely spread antihypertensive drug. Seronegative villous atrophy of the small intestine due to olmesartan use was first described in 2012. We present a new case of olmesartan-induced enteropathy and compare it to recent literature. This case might suggest a use of budesonide for treatment.

Detection of human papilloma virus (HPV) genomes by the primed in situ (PRINS) labelling technique

Primed in situ Labelling, a technique based on primer mediated DNA synthesis, has become a useful tool in cytogenetics, especially for chromosome mapping, banding and the investigation of sequence organization in fresh metaphase preparations. Its application in the routine surgical pathology laboratory has been hampered by the fact that the technique did not work on paraffin-embedded, formalin-fixed tissue. We investigated cervical biopsies (n = 20) with morphological signs of HPV infection and found that the PRINS method is at least as sensitive as a classical in situ hybridization assay for detecting HPV DNA in paraffin-embedded, formalin-fixed tissue. In all investigated cases (n = 20), HPV DNA was found by both methods. The PRINS method was able to demonstrate HPV DNA not only in superficial koilocytotic squamous cells but also in non-koilocytotic cells in the deeper spinous cell layers, and even in some basal cells. We describe an economical protocol using conventional consensus HPV oligonucleotide DNA primers. The described method is rapid (approximately 3 hours) and easy to perform for screening and subtyping HPV infection in the routine surgical pathology laboratory.

Detection of SV40 like viral DNA and viral antigens in malignant pleural mesothelioma

This study investigated the presence of simian vacuolating virus 40 (SV40) deoxyribonucleic acid (DNA) in malignant pleural mesothelioma, non-neoplastic mesothelium and pleural carcinoma metastasis and correlated these data with immunohistochemistry for SV40 viral antigens. The novel Primed In Situ (PRINS) method was applied to detect the presence of SV40 DNA in situ in tissue sections of malignant mesothelioma (n = 25), non-neoplastic mesothelium (n = 30) and pleural carcinoma metastasis (n = 30). Immunohistochemistry with an SV40-specific antibody was applied for detection of the SV40 viral antigen in the same material. SV40 DNA and expression of one of the viral proteins (small t-antigen) was found in approximately 60% of the investigated mesothelioma cases in contrast to non-neoplastic mesothelium and carcinoma metastasis that were negative for both SV40 DNA and SV40 viral antigens. These results suggest that simian vacuolating virus 40 deoxyribonucleic acid may be biologically active as there was also immunoreactivity for simian vacuolating virus 40 viral antigen in those cases positive for simian vacuolating virus 40 deoxyribonucleic acid with the primed in situ reaction. Simian vacuolating virus 40 viral deoxyribonucleic acid and antigens may be potential markers for neoplastic mesothelium that may prove useful in the rather difficult histopathological differential diagnosis between malignant mesothelioma and reactive mesothelium or pleural carcinoma.

Glutathione S-transferase expression in malignant mesothelioma and non-neoplastic mesothelium: an immunohistochemical study

Expression of the glutathione S-transferase (GST) subclasses alpha, mu and pi was investigated immunohistochemically in 20 normal or hyperplastic mesothelium and in 57 malignant mesothelioma cases. These results were correlated with survival and also with P-170 glycoprotein expression. Nearly all the non-neoplastic mesothelium cases were positive for GST alpha and pi. About half of the non-neoplastic cases were positive for mu. Twenty-nine (51%) malignant mesotheliomas were positive for at least one of the GST species; 21 (37%) showed immunoreactivity for alpha, 18 (31.5%) for mu and 21 (37%) for pi. A total of 54 mesothelioma cases displayed immunoreactivity for the P-170 glycoprotein. For GST pi and GST mu, a statistical significance between expression and increased survival was found (respectively P = 0.012 and 0.024) while for GST alpha no significance was found. The results of this study demonstrate that expression of GST pi correlates positively with increased survival in malignant mesothelioma. It is also concluded that, in mesothelioma, GST and P-170 glycoprotein may contribute to the resistance to cytotoxic drugs frequently observed in these tumours. No correlation between GST and P-170 expression was demonstrated.

Immunoreactivity for p53 and mdm2 and the detection of p53 mutations in human malignant mesothelioma

Previous immunohistochemical studies on malignant mesothelioma with antibodies recognizing both the wild and the mutant types of the p53 protein have shown immunoreactivity in 25-70% of cases. This study was designed to determine whether there is immunoreactivity for p53 and mdm2 protein in malignant mesothelioma and to correlate p53 expression with the detection of mutations in p53 at DNA level. In 10 of 15 cases there was immunoreactivity for p53. In 6 of these cases immunoreactivity for mdm2 was also detected. In one p53-immunonegative case, a mutation of the p53 gene resulting in a stop codon was found. These results suggest that mdm2 might be involved in the inhibition of p53 in malignant mesothelioma. Also, these data suggest the existence of other proteins than mdm2 that may associate with p53.

Immunoreactivity for c-fos and c-myc protein with the monoclonal antibodies 14E10 and 6E10 in malignant mesothelioma and non-neoplastic mesothelium of the pleura

We studied immunoreactivity for c-fos protein and c-myc protein in malignant mesothelioma (36 cases) and non-neoplastic pleural mesothelium (45 cases) using the murine monoclonal antibodies 14E10 and 6E10. All malignant mesotheliomas and cases with non-neoplastic mesothelium exhibited not only nuclear but also cytoplasmic immunoreactivity for c-fos and c-myc protein in the majority of mesothelial cells. There was no statistically significant difference between the various mesothelioma subtypes or between neoplastic and non-neoplastic mesothelium for c-fos protein immunoreactivity (p > 0.05). There was statistically significant difference between neoplastic and non-neoplastic mesothelium for c-myc protein immunoreactivity (p < 0.01). We conclude that immunoreactivity for c-fos and c-myc protein is present in both non-neoplastic and neoplastic mesothelium, but that a higher proportion of neoplastic mesothelial cells are immunoreactive for c-myc protein when compared with non-neoplastic mesothelium.

Intrapulmonary lymph nodes in the differential diagnosis of solitary pulmonary nodules: case report and review of the literature

A 49-year-old man was admitted for further investigation of a coin lesion with a diameter of 1 cm. He was a heavy smoker with no professional exposure. Since the percutaneous needle biopsy did not yield a definitive diagnosis, a thoracoscopy was performed. The solitary pulmonary nodule was found to be an intrapulmonary lymph node with anthracosilicotic pigment and a thoracoscopic wedge resection was performed. A review of the case reports in the period 1961-1993 shows that intrapulmonary lymph nodes could be more frequent than originally thought. All patients were smokers but professional exposure was not a constant finding. The differential diagnosis and management of the indeterminate solitary pulmonary nodule are discussed.

Detection of numerical chromosomal aberrations in paraffin-embedded malignant pleural mesothelioma by non-isotopic in situ hybridization

An in situ hybridization (ISH) study on paraffin sections of 13 malignant mesotheliomas was performed to detect numerical chromosomal aberrations with biotin-labelled DNA probes specific for the centromeric regions of chromosomes 1, 3, 6, 7, 11, and 17. All chromosomes contributed to numerical changes, which can be summarized as follows: first, a monosomy for chromosome 6 was found in one case; second, in five cases a trisomy for at least one chromosome was detected; and third, in seven cases a pentasomy or a higher polysomy was found for at least one chromosome. Although these data have to be confirmed on a larger group of patients, survival analysis of this group showed no significant difference between the first and second groups taken together and the third group. In this study no specific numerical chromosomal aberrations were identified. Nevertheless, numerical gains appear to be more frequent than has previously been shown by karyotype analysis.

Detection of human papillomavirus in cervical scrapings by in situ hybridization and the polymerase chain reaction in relation to cytology

A gynaecological out-patient population consisting of 200 patients aged 19-43 years (mean age 34.2 years) was screened for the presence of human papillomavirus (HPV) by the polymerase chain reaction and in situ hybridization on cervical scrapings. A novel method was applied for the detection of HPV in cervical cells by embedding them in a paraffin block before in situ hybridization was performed. This technique resulted in well preserved cytological morphology, easy performance and economy of probes. In eight of the 200 patients (4%), human papillomavirus DNA was revealed by the polymerase chain reaction. Subtyping revealed the presence of HPV serotype 16 DNA in three of these patients. In one patient HPV serotype 18 DNA was also present. The in situ hybridization assay was able to detect all those cases with a specific HPV serotype infection.

Immunoreactivity for bcl-2 protein in malignant mesothelioma and non-neoplastic mesothelium

Immunohistochemical study of bcl-2 protein immunoreactivity in human non-neoplastic mesothelium (44 cases) and in malignant mesothelioma (62 cases) using a murine monoclonal antibody (clone 124) showed cytoplasmic immunoreactivity for bcl-2 protein in five cases of malignant mesothelioma. Non-neoplastic mesothelium was not immunoreactive. Immunoreactivity for bcl-2 protein does not add useful prognostic information in malignant mesothelioma since survival times of bcl-2 positive and bcl-2 negative cases did not differ. Nevertheless, the detection of bcl-2 protein in malignant mesothelioma might be useful for the differentiation from reactive mesothelium.

A rare case of inflammatory pseudotumour of the bronchus, occurring in an achondroplastic woman

An inflammatory pseudotumour of the lung in an achondroplastic woman is described. The occurrence of both conditions in the same patient probably represents a coincidental finding. However, recurrent pulmonary infections, as frequently seen in achondroplasia, may be relevant, because a history of antecedent infection is noted in one third of cases of inflammatory pseudotumours. Despite extensive debridement of the pseudotumour by neodymium yttrium aluminium garnet (NdYAG) laser therapy, early recurrence occurred.

Proliferation in malignant mesothelioma as determined by mitosis counts and immunoreactivity for proliferating cell nuclear antigen (PCNA)

In order to assess its discriminating and prognostic value, we studied immunoreactivity for proliferating nuclear cell antigen (PCNA) in human malignant mesothelioma (31 cases) and in human non-neoplastic mesothelium (33 cases with reactive mesothelium and 20 cases of normal mesothelium) using the murine monoclonal antibody PC10. We also compared it with mitosis counts expressed as the mitotic volume index (MV index). There were differences between malignant mesothelioma, reactive mesothelium, and normal mesothelium for percentage of PCNA immunoreactive cells (mean +/- SD; 27 +/- 9, 9.5 +/- 5.1, and 3.6 +/- 1.6, respectively) and for their MV index (20.3 +/- 4.5, 9.4 +/- 2.1, and 3.6 +/- 0.6, respectively). The median actuarial survival was 10.1 months for patients with less than 25 per cent PCNA immunoreactive cells, 9.4 months for patients with less than 20 mitoses per mm2 of tumoural tissue, 5.9 months for patients with more than 25 per cent PCNA immunoreactive cells, and 5.3 months for patients with more than 20 mitoses per mm2 of tumoural tissue. Our results suggest that PCNA immunoreactivity is useful in discriminating between neoplastic and non-neoplastic mesothelium and that it may have prognostic value in malignant mesothelioma.

Differential immunohistochemical staining for retinoblastoma protein with the antibodies C15 and 1F8 in malignant mesothelioma

The results of an immunohistochemical study of retinoblastoma protein in human non-neoplastic mesothelium (40 cases) and in malignant mesothelioma (36 cases) using the antibodies 1F8 and C15 are reported. All cases of malignant mesothelioma and non-neoplastic mesothelium were immunoreactive in more than 75% of the mesothelial cells for retinoblastoma protein with the C15 polyclonal antibody. Immunoreactivity for retinoblastoma protein was virtually absent with the 1F8 monoclonal body in neoplastic cells of all investigated mesotheliomas. In contrast, stromal cells in these mesotheliomas and all cases with non-neoplastic mesothelium were immunoreactive with the monoclonal antibody 1F8 in more than 75% of the cells. These findings may be indicative for the presence of an abnormal retinoblastoma protein in malignant mesothelioma lacking an epitope coded for between exons 21-27.

Nodular sclerosing Hodgkin's disease of the thymus gland

An asymptomatic anterior mediastinal mass in a 22-year-old man proved to be nodular sclerosing Hodgkin's disease of the thymus gland. Complete excision was possible via a left posterolateral thoracotomy. Postoperative chemotherapy was given. Follow-up after 1 year showed no residual disease. Nodular sclerosing Hodgkin's disease is an uncommon tumor of the thymus gland and should be incorporated in the differential diagnosis of anterior mediastinal tumors. Multimodality treatment is advocated.

Immunohistochemical staining of ras oncogene product in neoplastic and non-neoplastic mesothelial tissues: immunoreactivity for N-ras and lack of immunohistochemical staining for Ha-ras and K-ras

Immunohistochemical staining of 36 malignant mesotheliomas and 45 cases of non-neoplastic mesothelium including 20 specimens with signs of hyperplasia were investigated using murine monoclonal antibodies directed against p21 ras protein, Ha-ras protein, K-ras protein, and N-ras protein. All cases of non-neoplastic mesothelium and the majority of the malignant mesotheliomas (78 per cent) showed cytoplasmic and often submembranous immunoreactivity in more than 50 per cent of the cells with both the pan-ras and N-ras antibody. No immunoreactivity was observed for Ha- and K-ras. There was no statistically significant difference with respect to immunoreactivity between neoplastic and non-neoplastic mesothelium or between the various mesothelioma subtypes.

Immunoreactivity for p53 protein in malignant mesothelioma and non-neoplastic mesothelium

The presence of p53 protein in non-neoplastic pleural mesothelium (40 cases) and in human malignant mesothelioma (36 cases) was assessed immunohistochemically using the antibodies DO7, CM-1, and PAb240. In a quarter of the malignant mesotheliomas, there was nuclear immunoreactivity for p53 protein with both the DO7 and CM-1 antibodies. There were no statistically significant differences between the various mesothelioma subtypes (P > 0.05). No immunoreactivity was found with the PAb240 antibody, suggesting absence of mutant-type p53 protein. Nonneoplastic mesothelium was not immunoreactive with any of the antibodies. We conclude that there is immunoreactivity for p53 protein in some mesotheliomas. p53 protein immunoreactivity could be used to discriminate between neoplastic and reactive mesothelium.

The prevalence of hairy leukoplakia in HIV seropositive and HIV seronegative immunocompromised patients

The prevalence of hairy leukoplakia was determined among 176 symptomatic HIV seropositive patients seen at the outpatient department of the Institute of Tropical Medicine in Antwerp, Belgium. Moreover, systematic tongue biopsies were performed during postmortem examination of 21 patients with AIDS, 100 HIV seronegative immunocompromised patients with haematologic or other malignancies and 100 HIV seronegative non-immunocompromised patients who died at the University Hospital Antwerp. Hairy leukoplakia was observed in 52 (29.5%) of the outpatients, but only in one (5%) of the AIDS patients in the postmortem study (P = 0.03). An explanation for this difference may be that significantly more AIDS patients who died had received either acyclovir or ganciclovir during the 3 months prior to the postmortem examination than the HIV seropositive outpatients during the 3 months prior to examination. Hairy leukoplakia occurred more often in Caucasian homosexual men with HIV infection (38%) than among heterosexual Africans with HIV infection (17%) (P = 0.06). Hairy leukoplakia was observed in none of the HIV seronegative patients.

Immunoreactivity for the beta chain of the platelet-derived growth factor receptor in malignant mesothelioma and non-neoplastic mesothelium

The results of an immunohistochemical study of platelet-derived growth factor receptor (PDGF-R) beta chain in human non-neoplastic mesothelium (35 cases) and in malignant mesothelioma (33 cases) using a murine monoclonal antibody are reported. In approximately half of the malignant mesotheliomas, there was immunoreactivity in the cytoplasm of the neoplastic cells for the beta chain of the PDGF-R. In some cases, there was also membrane immunoreactivity. There were no statistically significant differences between the various mesothelioma subtypes. Immunoreactivity for PDGF-R beta chain was absent in non-neoplastic mesothelium.

Immunoreactivity for p-170 glycoprotein in malignant mesothelioma and in non-neoplastic mesothelium of the pleura using the murine monoclonal antibody JSB-1

The results of an immunohistochemical study of P-170 glycoprotein immunoreactivity in human non-neoplastic mesothelium (35 cases) and in malignant mesothelioma (33 cases) using the murine monoclonal antibody JSB-1 are reported. The majority of malignant mesothelioma cases exhibited cytoplasmic and membrane immunoreactivity in neoplastic cells. These findings are highly significant when compared with the absence of immunoreactivity in normal mesothelium.

An African patient with AIDS and linitis plastica

This is a case report about an African patient with AIDS who was diagnosed with a linitis plastica of the stomach. The evolution of this linitis plastica does not differ in any aspect from that in HIV-negative patients. The question remains unanswered whether there is a link between the HIV infection and the development of linitis plastica in this patient.

Immunohistochemical distribution patterns of epidermal growth factor receptor in malignant mesothelioma and non-neoplastic mesothelium

An immunohistochemical study of the epidermal growth factor (EGF) receptor in non-neoplastic pleural mesothelium (35 cases) and in human malignant mesothelioma (36 cases) was made, using a murine monoclonal antibody OM-11-951. All malignant mesotheliomas and non-neoplastic pleural biopsies exhibited a strong cytoplasmic immunoreactivity in mesothelial cells. Nuclear immunoreactivity was detected in mesothelial cells of all specimens of both malignant and non-neoplastic pleura. No statistically significant differences were found between malignant mesothelioma and non-neoplastic pleural mesothelium. There were differences, between the three subtypes of mesothelioma, in the number of cells that exhibited nuclear staining. Statistically significant differences were noted between the epithelial subtype and the mesenchymal subtype (P less than 0.005), epithelial subtype versus the mixed cell type (P less than 0.005) and between the mesenchymal component of the mixed cell type and the mesenchymal type (p less than 0.0005). We conclude that there is strong expression of EGF receptor in both malignant mesothelioma and in non-neoplastic pleural mesothelium. Different staining patterns are seen when comparing the different subtypes of mesotheliomas with each other. EGF receptor expression cannot be used to distinguish between malignant and benign mesothelium.

DNA fingerprints revealing common and divergent human DNA methylation patterns

We compared DNA fingerprints of different cell populations from the same individuals, after separate digestion with the isoschizomers MboI and Sau3A. Methylation differences were observed within every individual when comparing fingerprints of Sau3A- with MboI-digested DNA, and of Sau3A-digested sperm with somatic DNA. In some cases, differences were also detected between fingerprints of Sau3A-digested somatic DNA originating from various cell sources. Methylation patterns common to all cell populations examined, including the germline, were observed with a higher frequency than divergent ones. These 'common methylations' are most likely to find their origin during early embryogenesis.

The nature of the adherent hemopoietic cells in human long-term bone marrow cultures (HLTBMCs): presence of lymphocytes and plasma cells next to the myelomonocytic population

An immunological analysis of the nonmacrophage hemopoietic cells in the adherent layer of human long-term bone marrow cultures was performed in situ. It revealed not only the expected granulocytic and monocytic cells, but an important lymphoid population as well. The latter consisted of cells bearing the markers of mature T lymphocytes, B lymphocytes, and plasma cells. These cells were also present in the hemopoietic foci of the adherent layer, the so-called cobblestone areas. Although more CD8+ than CD4+ lymphocytes were generally present in the initial bone marrow inoculum, both the adherent layer and the nonadherent fraction disclosed a preponderance of CD4+ cells after a short period of culture. The majority of the lymphoid cells were present in the adherent layer, rather than in the nonadherent fraction of the cultures. The long-term presence of lymphoid elements in the adherent layer suggests their affinity for the bone marrow stroma and the possible enhancement of their persistence in vitro by contact with these cells.

Comparison of human long-term bone marrow cultures (HLTBMCs) established from fresh and post-cryopreservation bone marrow samples from living and cadaver donors

Human long-term bone marrow cultures (HLTBMCs) were established from thawed post-cryopreservation, as well as from cadaver donor bone marrow (BM) samples. The longevity was similar in the different series of HLTBMCs examined. CFU-GM could be cultured out of cadaver donor BM. This indicates that previously healthy people, under the conditions generally accepted as suitable for organ donation, could become suitable donors for allogeneic BM transplantation.

Human long-term bone marrow cultures (HLTBMCs) in myelomatous disorders

Human long-term bone marrow cultures (HLTBMCs) were established with bone marrow (BM) collected from five patients with myelomatous disorders (four with multiple myeloma, one with plasma cell leukemia). In all cases, up to at least 6 weeks of culture, there was a persistence of the monoclonal plasma cell population in the adherent layer of the culture. In some cultures proliferating plasma cells could be demonstrated by the Ki-67 monoclonal antibody. In all instances a paraprotein could be shown in the conditioned medium. This study demonstrates that malignant plasma cells, in analogy to their normal counterparts, have an affinity for the BM stroma and suggests that their long-term survival might be enhanced by their interaction with it.

A quantitative and dynamic study of endothelial cells and megakaryocytes in human long-term bone marrow cultures

The quantitative evolution of endothelial cells (ECs) in Dexter-type human long-term bone marrow cultures (HLTBMCs) was investigated. Using monoclonal antibodies directed against von Willebrand factor (vWF) and against membrane antigens (EN-4 and PAL-E), a low percentage--usually less than 1% of stromal cells--of ECs was detected in all confluent cultures established from 11 different bone marrow samples. Generally these cells are not associated directly with the areas of myelopoiesis ("cobblestone areas"). ECs cannot be demonstrated in the adherent layer of most young, non-confluent, and of some old, HLTBMCs. In some instances, morphological features suggestive of dynamic behavior were seen (sprouting, canal formation). In addition, a very low proportion of vWF-positive megakaryocytic cells was found in 4 of 11 cultures, always in direct contact with the stromal fibroblastic cells.