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At least 1,621 records · Page 90Linked to original sources
PubMed2000

Breast tumor vascularity identified by contrast enhanced ultrasound and pathology: initial results.

Quantifiable measures of vascularity obtained from contrast enhanced color flow images were correlated with pathologic vascularity measurements in ten female patients with a solid breast mass. Each patient received Levovist Injection (Berlex Laboratories Inc., Montville, NJ). Color flow images pre- and post-contrast were obtained using an HDI 3000 unit (ATL, Bothell, WA) before removing the mass for pathologic vascularity assessments. Image-processing techniques were used to obtain both the ultrasound and pathologic vascularity measurements. Multiple linear regression found significant correlations for ultrasonic vascularity measurements post contrast and pathology (P = 0.02 and 0.06). No correlations were found between pre-contrast ultrasound and pathology. In conclusion, post-contrast ultrasonic flow measures provide a non-invasive measure of breast tumor neovascularity. However, the patient population is small, and until further patients are analyzed, these conclusions are preliminary.

Breast Neoplasms↗
PubMed2001

The premotor region essential for rapid vertical eye movements shows early involvement in Alzheimer's disease-related cytoskeletal pathology.

The rostral interstitial nucleus of the medial longitudinal fascicle (riMLF) contains premotor neurons essential for the generation of rapid vertical eye movements. The Alzheimer's disease (AD)-related cytoskeletal changes and beta-amyloid deposits in this nucleus were examined in 30 autopsy cases and compared to the involvement of three associated nuclei - Edinger-Westphal nucleus, nucleus of Darkschewitsch and interstitial nucleus of Cajal. The riMLF displays slight cytoskeletal alterations already in the early stages in the development of the cortical cytoskeletal pathology (cortical NFT/NT-stages I-II, representing the preclinical phase of AD). In the cortical NFT/NT-stages III-IV (i.e. incipient phase of AD), the cytoskeletal pathology in the riMLF is pronounced and in stages V-VI (i.e. clinical phase of AD) it is severe. The progression of the cytoskeletal pathology in the riMLF correlates significantly with the cortical NFT/NT-stages I-VI that reflect the clinical course of AD. Isolated beta-amyloid deposits appear in the riMLF for the first time in the final beta-amyloid stage. In the Edinger-Westphal nucleus, in the nucleus of Darkschewitsch and most markedly in the interstitial nucleus of Cajal, the pathological changes were significantly less severe than those in the riMLF. In the event that the cytoskeletal pathology impairs the function of the premotor neurons of the riMLF, one would predict a progressive slowing of vertical saccades corresponding to the advancing cortical NFT/NT-stages.

Aged↗
PubMed2001

Preoperative PSA velocity and doubling time do not predict adverse pathologic features or biochemical recurrence after radical prostatectomy.

OBJECTIVES: To improve the accuracy of predicting pathologic stage and biochemical recurrence after radical prostatectomy (RP), we sought to determine whether preoperative prostate-specific antigen (PSA) velocity and doubling time predict adverse pathologic features or biochemical recurrence following RP. We also sought to determine if there were racial differences in preoperative PSA velocity and doubling time. METHODS: A total of 331 patients underwent RP at the West Los Angeles VA Medical Center between November 1991 and March 2000. Of these patients, 86 had two or more preoperative PSA values that were at least 12 months apart. Patients were analyzed to determine whether preoperative PSA velocity or doubling time was predictive of adverse pathologic features, including positive surgical margins, capsular penetration, seminal vesicle invasion, or biochemical recurrence. Additionally, PSA velocity and doubling time were compared among white, black, Hispanic, and Asian men. RESULTS: Preoperative PSA velocity and doubling time were not predictive of positive surgical margins, capsular penetration, or seminal vesicle invasion (P >0.30). In addition, there was no association between PSA velocity or doubling time and pathologic stage or surgical Gleason score (P >0.36). Preoperative PSA velocity (P = 0.581) and doubling time (P = 0.528) were not predictors of biochemical recurrence following RP. There were no racial differences in preoperative PSA velocity (P = 0.715) or doubling time (P = 0.662). CONCLUSIONS: Neither preoperative PSA velocity nor doubling time was a predictor of adverse pathologic findings or biochemical recurrence after RP. In addition, there was no difference in PSA velocity or doubling time between the races studied.

Aged↗
PubMed1997

Calculated prostate cancer volume: the optimal predictor of actual cancer volume and pathologic stage.

OBJECTIVES: A new clinical pretreatment quantity called the calculated prostate cancer volume has been defined. The correlation between the calculated parameter and the actual prostate cancer volume, and its ability to predict for pathologic Stage T3 disease in patients with clinically localized disease, is tested. METHODS: Prostate cancer volume measurements were obtained using a 3-dimensional computerized morphometric reconstruction technique on 104 whole-mounted radical prostatectomy specimens. The calculated prostate cancer volume was determined based on pretreatment clinical parameters (prostate-specific antigen [PSA], biopsy Gleason score, and prostate ultrasound volume). Linear regression was used to determine the Pearson correlation coefficients (r) between the PSA, the calculated prostate cancer volume, and the measured prostate cancer volume. Logistic regression multivariable analysis evaluating the predictive value of the pretreatment PSA, biopsy Gleason score, clinical stage, and calculated prostate cancer volume in predicting pathologic Stage T3 disease in patients with clinically organ-confined disease was performed. RESULTS: The calculated prostate cancer volume (r 0.71 to 0.96) was superior to PSA (r 0.12 to 0.67) in predicting the measured prostate cancer volume over a wide range (0.02 to 9.5 cm3) of cancer volumes. The calculated prostate cancer volume was the only significant predictor (P = 0.02) of pathologic Stage T3 disease in patients with clinical Stage T1 to T2 disease on multivariable analysis. CONCLUSIONS: The calculated volume of prostate cancer is superior to PSA in predicting both the pathologic prostate cancer volume and pathologic Stage T3 disease in patients with clinical Stage T1 and T2 disease. Therefore, it may be useful in determining the optimal candidates for radical prostatectomy.

Humans↗
PubMed1996

The role of free/total prostate-specific antigen ratio in the prediction of final pathologic stage for men with clinically localized prostate cancer.

OBJECTIVES: The combined use of total prostate-specific antigen (PSA), clinical stage, and Gleason score accurately predicts final pathologic stage for men with clinically localized prostate cancer. Recently, the free/ total PSA ratio has been proposed as an adjunct for early detection of prostate cancer. We examined the association between free/total PSA and pathologic stage. METHODS: In a prospective study, 301 consecutive men with clinically localized prostate cancer (average age 58.8 years, range 45-72) underwent a staging pelvic lymphadenectomy and radical prostatectomy. Total PSA and free PSA were measured from preoperative sera. Pathologic stage was determined as organ-confined (OC, n = 169), capsular penetration (CP+, n = 108), seminal vesicle involvement (SV+, n = 13) and lymph node involvement (LN+, n = 11). RESULTS: Overall, 292/301 (97%) of the free/total PSA values were < 25%, and thus suspicious for prostate cancer. Combination of total PSA, Gleason score, and clinical stage predicted well OC (P = 0.00001) and LN+ (P = 0.023); whereas, replacing total PSA with free/total PSA ratio did not improve the prediction of OC (P = 0.0007) nor LN+ (P = 0.03). CONCLUSIONS: The free/total PSA ratio cutoff point of 25% had high sensitivity for prostate cancer among a group of men with clinically localized disease. The free/total PSA ratio did not significantly improve the prediction of pathologic stage provided by total PSA when used alone or in combination with Gleason score and clinical stage. These preliminary data demonstrate that free/total PSA levels provide no additional information for pathologic stage prediction when combined with Gleason score and clinical stage in men with clinically localized prostate cancer.

Aged↗
PubMed1997

Role of prostate-specific antigen velocity in prediction of final pathologic stage in men with localized prostate cancer.

OBJECTIVES: Prostate-specific antigen (PSA) velocity prior to radical retropubic prostatectomy was evaluated to determine if men with a faster rate of rise in PSA have locally more extensive prostate cancer. METHODS: Of 368 men who underwent radical retropubic prostatectomy, 82 had two to seven PSA measurements between 1.3 and 6.7 years before prostate biopsy for evaluation of PSA velocity. PSA velocity and the pretreatment parameters of PSA, Gleason score, and T stage were evaluated as predictive parameters of pathologic stage. RESULTS: In men with pathologically organ-confined disease, PSA velocity was 1.12 ng/mL/yr; in non-organ-confined cases, it was 1.88 ng/mL/yr. There was a statistically significant relationship between a Gleason score of 7 and above and the pathologic extent of disease. There was no statistically significant relationship between T stage, the PSA at diagnosis, and PSA velocity with respect to final pathologic stage. CONCLUSIONS: PSA velocity is not a strong predictor of pathologic stage in men with localized prostate cancer.

Adult↗
PubMed1998

Observations on pathology trends in 62,537 prostate biopsies obtained from urology private practices in the United States.

OBJECTIVES: To evaluate pathology trends of 62,537 first-time prostate needle-core biopsies submitted by office-based urologists, processed at a single pathology laboratory. METHODS: Prostate biopsy cases obtained over a 2-year period were assessed. Patient information included age, digital rectal examination (DRE) status, and prostate-specific antigen (PSA) serum levels. Biopsy pathology results included the number of tissue samples per case, Gleason score, presence of Gleason grades 4 or 5, percent of biopsy length with evidence of cancer, number of samples with cancer per biopsy, and determination of DNA ploidy status using microspectrophotometry. RESULTS: Adenocarcinoma, suspicious lesions, and isolated high-grade prostatic intraepithelial neoplasia (PIN) were diagnosed in 38.3%, 2.9%, and 4.1% of the biopsies, respectively. For each serum PSA and age range assessed, the positive biopsy rate and incidence of critical pathologic features increased consistently. The average percentage of biopsy length with evidence of tumor, the percentage of cases with Gleason grades 4 or 5, and the percentage of cases with an abnormal DNA ploidy all decreased significantly over the 2-year period (P <0.01). CONCLUSIONS: The number of tissue cores and anatomic sites (locations) being sampled per biopsy are increasing. The tumor size detected and percentage of cases with Gleason grades 4 and 5 are decreasing. There has been a slight increase in the number of biopsies performed on men younger than 60 years of age and a slight decrease in biopsies performed on men older than 70 years of age. The decline in meaningful pathologic features observed in biopsies over time may be clinically relevant to improved disease management.

Aged↗
PubMed1999

Perineural invasion on prostate needle biopsy: an independent predictor of final pathologic stage.

OBJECTIVES: To examine the significance of perineural invasion (PNI) in predicting pathologic findings in patients treated by radical prostatectomy, because a recent study concluded that PNI on needle biopsy has no independent predictive value. METHODS: Between 1993 and 1998, radical prostatectomy was performed in 319 consecutive patients. Prostate needle biopsies were reviewed in all cases. We compared PNI with other preoperative parameters, including digital rectal examination, PSA, and biopsy Gleason score, for the ability to predict tumor stage. Clinical records and pathologic findings were reviewed for all cases. Tumor stage was defined as either pT2 (organ confined) or pT3 (extraprostatic extension and/or seminal vesicle invasion). RESULTS: The median age was 61.4 years (range 40 to 75.6). Seventy-two percent of the 95 men with nonpalpable disease and 67% of the 224 men with palpable disease had organ-confined prostate cancer on final pathologic staging. Of 205 men with a Gleason score on biopsy of 6 or less, 159 (78%) had organ-confined disease compared with 59 (52%) of 114 with a Gleason score of 7 to 9 (P <0.001, chi-square test). PNI was identified in 77 (24%) of 319 patients, with 83% specificity and 40% sensitivity for Stage pT3 disease (odds ratio 3.49). Of men with pT3 disease on final pathologic staging, 18%, 27%, and 56% had preoperative PSA levels of 0 to 4, more than 4 to 10, and greater than 10 ng/mL, respectively (P <0.001, Mantel-Haenszel chi-square test). On multivariate analysis, PNI (P = 0.0031), PSA (P = 0.0004), and Gleason score (P = 0.0003) independently predicted stage (pT3 disease). CONCLUSIONS: PNI is an important preoperative predictor of pathologic stage and should be reported when adenocarcinoma is diagnosed on prostate needle biopsies.

Adult↗
PubMed1999

Vesicourethral anastomosis biopsy after radical prostatectomy: predictive value of prostate-specific antigen and pathologic stage.

OBJECTIVES: To assess the role of clinical parameters and pathologic stage in predicting a positive vesicourethral anastomosis (VUA) biopsy in patients with a rising prostate-specific antigen (PSA) level after radical prostatectomy. METHODS: Forty-five patients were referred for a rising PSA level after radical prostatectomy. Transrectal ultrasound evaluation included visualization of the VUA and VUA quadrant biopsies. The rate of positive biopsies (per core and per patient) was correlated with race, PSA level, and the radical prostatectomy pathologic stage. RESULTS: Overall, 53% of patients had a positive biopsy. In multivariate analysis, the dominant independent and synergistic clinical parameters determining positive biopsy rates were a PSA greater than 1 ng/mL at the time of biopsy and the pathologic stage (P = 0.04 and P = 0.02, respectively). Using a PSA cutoff point of 1.0 ng/mL, those patients with organ-confined disease and a PSA of 1.0 ng/mL or less showed no positive cancer cores (low-risk group). Conversely, 89% of patients with extraprostatic extension and a PSA greater than 1.0 ng/mL had a positive biopsy (P <0.01) (high-risk group). Patients with organ-confined disease and a PSA greater than 1.0 ng/mL or extraprostatic extension and a PSA 1.0 ng/mL or less (intermediate-risk group) had a significantly higher chance of having residual cancer than the low-risk group (P <0.025). CONCLUSIONS: The PSA level at the time of biopsy and the pathologic stage of the radical prostatectomy specimen were the strongest determinants of a positive biopsy. A combination of PSA and pathologic stage is useful for decisions regarding VUA biopsy. Patients with organ-confined disease and a PSA of 1.0 ng/mL or less do not appear to benefit from a VUA biopsy, and patients with extraprostatic extension and a PSA greater than 1.0 ng/mL have such a high probability (89%) of local recurrence at the VUA that biopsy may be unnecessary. It appears that VUA biopsy can be restricted to those patients with an intermediate risk (organ-confined disease with PSA greater than 1 ng/mL or extraprostatic extension with a PSA less than 1 ng/mL).

Aged↗
PubMed1996

Chest radiography in the initial episode of bronchospasm in children: can clinical variables predict pathologic findings?

STUDY OBJECTIVE: To determine whether historical or clinical variables can accurately discriminate among children, experiencing a first episode of bronchospasm, with chest radiography findings that are normal, consistent with reactive airway disease (RAD), or pathologic. METHODS: We assembled a prospective case series of patients in our tertiary, academic, pediatric emergency department. All patients aged newborn to 18 years presenting to the ED with their initial episode of wheezing were enrolled. RESULTS: Six hundred thirty-three patients presented to the ED during the study period. Pathologic radiographic findings were identified in 39 (6.2%). Radiographs revealing normal findings and evidence of RAD were noted in 25.4% and 68%, respectively. No single variable accurately predicted all pathologic radiographs. Discriminant function analysis identified nine variables, which we combined into a model. The model failed to accurately discriminate among patients with radiographs revealing evidence of a pathologic condition, normal chest findings, and RAD. CONCLUSION: No clinical variables, isolated or combined into a model, accurately identify patients with pathologic radiography findings. Continued use of chest radiography as a diagnostic intervention in the initial episode of childhood bronchospasm is recommended.

Adolescent↗
PubMed2003

[Prevalence of psychiatric pathology at a rural health centre].

OBJECTIVES: To find the prevalence of psychiatric pathology at a rural health centre and to compare the results with results from studies with a similar design. DESIGN: Two-stage crossover study of prevalence: first, detection and then, psychiatric pathology evaluation.Setting. El Marquesado Health Centre (Granada). Scattered rural population with low social and economic level and high percentage of elderly people. PARTICIPANTS: Simple randomised sample representing the population over 18. N=245; error alpha=5%. Sampling source: electoral register. MEASUREMENTS: GHQ-28 Goldberg Questionnaire, social and demographic data, and CAGE test. The CIS questionnaire for psychiatry was administered to those who exceeded the cut-off point (GHQ-28=5) and they were allocated a DSM IV diagnosis. If CAGE was>=2, damaging alcohol consumption was studied. If there was a prior diagnosis, the second stage was avoided. Measurements of prevalence with their exact confidence intervals were made. RESULTS: Prevalence of psychiatric pathology: 28.6% (34.5% in women and 22.6% in men). 30% of cases had two diagnoses. Anxiety disorders were the most common pathology (8.97%), representing 23.9% of the grouped diagnoses. Depression disorders had 8.16% prevalence; problematic consumption of substances, 6.12%. The most common isolated diagnosis was Dysthymia (9.78% of cases). Hidden psychiatric morbidity reached 40%. CONCLUSIONS: The prevalence of psychiatric pathology is very high. The most common disorders are those of anxiety, followed by depression and damaging alcohol consumption.

Adolescent↗
PubMed2000

DNA damage and apoptosis in the aged canine brain: relationship to Abeta deposition in the absence of neuritic pathology.

1. In addition to beta-amyloid (Abeta) deposition and cytoskeletal neuropathology, both the Alzheimer's disease (AD) and Down's syndrome (DS) human brain exhibit marked evidence of DNA damage, however, it is difficult to separate events that occur in conjunction with neurofibrillary pathology versus Abeta pathology in these systems. 2. In contrast, the aged canine brain exhibits the accumulation of Abeta into diffuse deposits similar to those found in early AD and DS in the absence of neurofibrillary pathology. Furthermore, Abeta deposition in canine brain is correlated with cognitive deficits. 3. In order to test the hypothesis that TUNEL labeling for DNA damage in AD is not simply a consequence of agonal artifacts, postmortem artifacts, or neurofibrillary pathology, and may be directly related to Abeta deposition, we examined Abeta immunoreactivity, PHF-1 immunoreactivity, and TUNEL labeling in this animal model. 4. These experiments reveal a relationship between the amount of DNA damage detected by TUNEL labeling and levels of Abeta deposition. Further, in animals with no TUNEL labeling, we detected no Abeta immunoreactivity. 5. These data support the hypothesis that TUNEL labeling in AD ans DS is not a consequence of agonal artifact, postmortem artifact, or tau pathology, and may be directly related to Abeta deposition and perhaps AD pathogenesis.

Aging↗
PubMed2000

Two distinctive antinociceptive systems in rats with pathological pain.

A common obstacle in clinical management of pathological pain is the poor response to opioid analgesics. We now report that delta9-tetrahydrocannabinol (delta9-THC)-induced antinociception remained effective in rats with pathological pain. The selective central cannabinoid receptor antagonist SR141716A, but not the generic opioid receptor antagonist naloxone, blocked the delta9-THC antinociception. Moreover, there is no cross-tolerance between the antinociceptive effects of morphine and delta9-THC in pathological pain states. The results indicate that delta9-THC antinociception is both effective and independent of opioid receptors in rats with pathological pain. Thus, the cannabinoid analgesic system may be superior to opioids in alleviating intractable pathological pain syndromes.

Analgesics, Non-Narcotic↗
PubMed2002

Dose-response relationship between probability of pathologic tumor control and glucose metabolic rate measured with FDG PET after preoperative chemoradiotherapy in locally advanced non-small-cell lung cancer.

PURPOSE: To determine the dose-response relationship between the probability of tumor control on the basis of pathologic tumor response (pTCP) and the residual metabolic rate of glucose (MRglc) in response to preoperative chemoradiotherapy in locally advanced non-small-cell lung cancer and to define the level of residual MRglc that corresponds to pTCP 50% and pTCP > or = 95%. METHODS AND MATERIALS: Quantitative dynamic 18F-2-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography was performed to measure regional MRglc at the primary lesion before and 2 weeks after preoperative chemoradiotherapy in an initial group of 13 patients with locally advanced NSCLC. A simplified kinetic method was developed subsequently from the initial dynamic study and used in the subsequent 16 patients. The preoperative radiotherapy programs consisted of (1) a split course of 42 Gy in 28 fractions within a period of 28 days using a twice-daily treatment schedule for Stage IIIA(N2) NSCLC (n = 18) and (2) standard once-daily radiation schedule of 45-63 Gy in 25-35 fractions during a 5-7-week period (n = 11). The preoperative chemotherapy regimens included two cycles of cisplatin, vinblastine, and 5-fluorouracil (n = 24), cisplatin and etoposide (n = 2), and cisplatin, Taxol, and 5-fluorouracil (n = 3). Patients free of tumor progression after preoperative chemoradiotherapy underwent surgery. The degree of residual MRglc measured 2 weeks after preoperative chemoradiotherapy and 2 weeks before surgery was correlated with the pathologic tumor response. The relationship between MRglc and pTCP was modeled using logistic regression. RESULTS: Of 32 patients entered into the study, 29 (16 men and 13 women; 30 lesions) were evaluated for the correlation between residual MRglc and pathologic tumor response. Three patients did not participate in the second study because of a steady decline in general condition. The median age was 60 years (range 42-78). One of the 29 patients had two separate lesions, and MRglc was measured in each separately. The tumor histologic types included squamous cell carcinoma (n = 9), adenocarcinoma (n = 13), large cell carcinoma (n = 6), and poorly differentiated carcinoma (n = 2). The extent of the primary and nodal disease was as follows: Stage IIB (T3N0M0), Pancoast tumor (n = 2); Stage IIIA, T2-T3N2M0 (n = 18); Stage IIIB: T1-T3N3M0 (n = 5) and T4N0M0 (n = 2); a second lesion, T1 (n = 1); and localized stump recurrence (n = 2). A pathologically complete response was obtained in 14 (47%) of the 30 lesions. The remaining 16 lesions had residual cancer. The mean baseline value of the maximal MRglc was 0.333 +/- 0.087 micromol/min/g (n = 16), and it was reduced to 0.0957 +/- 0.059 micromol/min/g 2 weeks after chemoradiotherapy (p = 0.011). The correlation between residual MRglc and pTCP was made using an increment value of 0.02 micromol/min/g between the maximal and minimal values of MRglc. A pathologically complete response was obtained in 6 of 6 patients with residual MRglc of < or = 0.050 micromol/min/g, 3 of 4 with < or = 0.070, 4 of 7 with < or = 0.090, 0 of 4 with < or = 0.110, 1 of 3 with < or = 0.130, and 0 of 6 with > or = 0.130 micromol/min/g. The fitted logistic model showed that residual MRglc corresponding to pTCP 50% and pTCP > or = 95% was 0.076 and < or = 0.040 micromol/min/g, respectively. CONCLUSION: The correlation between the gradient of residual MRglc after chemoradiotherapy and pTCP is an inverse dose-response relationship. Residual MRglc of 0.076 and < or = 0.040 micromol/min/g, representing pTCP 50% and pTCP > or = 95%, respectively, may be useful surrogate markers for the tumor response to radiotherapy or chemoradiotherapy in lung cancer.

Adult↗
PubMed2003

Pathological gambling severity is associated with impulsivity in a delay discounting procedure.

Research and clinical expertise indicates that impulsivity is an underlying feature of pathological gambling. This study examined the extent to which impulsive behavior, defined by the rate of discounting delayed monetary rewards, varies with pathological gambling severity, assessed by the South Oaks Gambling Screen (SOGS). Sixty-two pathological gamblers completed a delay discounting task, the SOGS, the Eysenck impulsivity scale, the Addiction Severity Index (ASI), and questions about gambling and substance use at intake to outpatient treatment for pathological gambling. In the delay discounting task, participants chose between a large delayed reward (US $1000) and smaller more immediate rewards (US $1-$999) across a range of delays (6h to 25 years). The rate at which the delayed reward was discounted (k value) was derived for each participant and linear regression was used to identify the variables that predicted k values. Age, gender, years of education, substance abuse treatment history, and cigarette smoking history failed to significantly predict k values. Scores on the Eysenck impulsivity scale and the SOGS both accounted for a significant proportion of the variance in k values. The predictive value of the SOGS was 1.4 times that of the Eysenck scale. These results indicate that of the measures tested, gambling severity was the best single predictor of impulsive behavior in a delay discounting task in this sample of pathological gamblers.

Journal Article↗
PubMed1999

The digital pathologies of chronic laminitis.

This review indicates that the patient-to-patient uniqueness commonly seen in chronic laminitis represents the variable presence of the digital pathologies. Although some degree of mechanical failure is always present, the secondary metabolic and growth dysplasias, vascular pathologies, and sepsis may or may not be evident. The presence and severity of these pathologies appear to have a more significant impact on the prognosis of individual cases than does the displacement of the distal phalanx. It should be reiterated that it is often the combined presence of these individual pathologies that gives rise to the patient that is totally refractory to treatment. In the absence of these pathologies, many horses with significant displacement of the distal phalanx are not in pain and are not in need of treatment. It thus follows that a key to the improved rehabilitation of difficult patients is focusing research on the physiopathology and diagnosis of these nonmechanical problems.

Animals↗
PubMed2004

[The auto-addictive hypothesis of pathological eating disorders].

The pathogenic role of self-addiction. Addiction to an endogenous chemical is a new paradigm termed 'self-addiction'. It may contribute to the development of certain habits, the pathological nature of which may set-in on the basis of this "self-addictive"dimension. Pathological eating habits could be inscribed in this perspective. Two extreme situations. In well-fed populations, the ingestion of food does not represent a limiting phase in the global feeding process. Its pathological management may, however, lead to two extreme situations: the absence of ingestion (anorexia) and excessive ingestion (bulimia). In favour of the self-addictive hypothesis. Eating disorders are associated with abnormal levels of endorphins and share clinical similarities with psychoactive drug abuse. The key role of endorphins has recently been demonstrated in animals with regard to certain aspects of normal, pathological and experimental eating habits (food restriction combined with stress, locomotor hyperactivity). The factors leading to pathological eating habits. Neurobiological bases for eating disorders and their durability have recently come to light in the recent implication of abnormalities in the recompense system in the onset of addiction. The endorphin self-addictive model in fact appears the most pertinent with regard to the clinical profile of eating habits and integrates the role of stress.

Behavior, Addictive↗
PubMed2004

[Diffuse idiopathic interstitial pneumonias. International multidisciplinary consensus classification by the American Thoracic Society and the European Respiratory Society, principal clinico-pathological entities, and diagnosis].

INTRODUCTION: The classification of the idiopathic interstitial pneumonias includes seven clinico-pathologic entities. The diagnosis is based on a multidisciplinary approach, integrating the clinical evaluation, the high-resolution computerised tomography, and the pathological pattern. STATE OF THE ART: A definitive diagnosis of idiopathic pulmonary fibrosis relies on the association of a suggestive clinico-radiological profile and a pathological pattern of usual interstitial pneumonia. Nonspecific interstitial pneumonia is a recently described clinico-pathologic entity, with a better prognosis than that of idiopathic pulmonary fibrosis. Cryptogenic organising pneumonia has been included in the group of idiopathic interstitial pneumonias because of its idiopathic and multifocal characteristics, although it does not predominate in the lung interstitium. Desquamative interstitial pneumonia and respiratory bronchiolitis with interstitial lung disease are rare entities with predominance in young smoking adults. Lymphoid interstitial pneumonia, usually encountered in the context of Sjögren's syndrome, is very rare in its idiopathic form. Acute interstitial pneumonia is responsible for idiopathic acute respiratory distress syndrome. PERSPECTIVES: The current classification of idiopathic interstitial pneumonias better defines the diagnostic criterias of each clinico-pathologic entity, and is expected to facilitate clinical research. CONCLUSIONS: This classification has clinical implications, with prognostic and therapeutic significance.

Anti-Inflammatory Agents↗