D1S80 (pMCT118) allele frequencies in a Malay population sample from Malaysia

The D1S80 allele frequencies in 124 unrelated Malays from the Malaysian population were determined and 51 genotypes and 19 alleles were encountered. The D1S80 frequency distribution met Hardy-Weinberg expectations. The observed heterozygosity was 0.80 and the power of discrimination was 0.96. Received: 17 June 1996 / Received in revised form: 16 October 1996     

Frequencies for five short tandem repeat (STR) systems in a population from North Poland

A population study of unrelated individuals from North Poland (Gdansk area) was carried out to investigate the allele distributions of the five STR systems HUMCD4, HUMFES/FPS, HUMVWA31, HUMTH01 and ACTBP2. PCR products were separated on horizontal non-denaturing polyacrylamide gels followed by silver staining. For all STR systems analysed the distribution of observed phenotypes did not deviate from Hardy-Weinberg equlibrium. A comparison of allele distributions between Polish and other European Caucasian population samples is presented. Received: 15 August 1996 / Received in revised form: 8 October 1996     

Increase in utilization of percutaneous renal artery interventions by medicare beneficiaries, 1996-2000

OBJECTIVE: Our purpose was to review data from Medicare physician claims to ascertain differences in annual volumes of renal artery interventions versus surgery and differences in utilization of renal artery interventions among geographic regions according to physician provider type between 1996 and 2000. MATERIALS AND METHODS: We analyzed claims submitted to Medicare in 1996, 1998, and 2000 and extracted claims for renal artery angioplasty, stent placement, or bypass surgery. Analyses were performed for percutaneous renal artery interventions categorized by Centers for Medicare & Medicaid Services (CMS) geographic region and physician provider type. RESULTS: Between 1996 and 2000, the total volume of renal revascularization (surgical and percutaneous) increased 62%, from 13,380 to 21,660 procedures. The annual volume of renal artery surgery decreased 45% in 2000, compared with the volume in 1996. Annual volumes of renal artery angioplasty and stent placement increased 2.4-fold in 2000 compared with those in 1996. Most growth in percutaneous renal artery interventions is attributed to added provision by cardiologists, who increased their annual volume 3.9-fold. More than a threefold difference in rates of use of renal artery interventional procedures across CMS regions was found. In the Southeast region, the volume of renal artery interventions by cardiologists increased more than 15-fold. CONCLUSION: Among Medicare beneficiaries, the volume of percutaneous renal artery interventions is increasing rapidly, whereas the volume of renal artery surgery is declining. Most growth in percutaneous renal artery revascularization is attributed to increased performance by cardiologists; explosive growth in annual procedure volume by cardiologists occurred in some regions. Marked disparity in use among CMS regions was found.     

Extradural spinal meningioma: MRI

We report a case of extradural spinal meningioma with pathologically proven features of malignant transformation. The MRI findings of extradural spinal meningioma and differences in the findings from intradural meningiomas are discussed. Received: 16 August 1996 Accepted: 19 August 1996     

Occurrence and trends in ski injuries in Norway

OBJECTIVES: To provide an overview of ski injuries in Norway and to describe the changes between 1990 and 1996. METHODS: All ski injuries (7966) treated at four hospitals providing health care to a defined population of about 11% of the Norwegian population were registered prospectively from 1990 to 1996. For this study, 6462 injuries sustained in cross country skiing, downhill skiing, telemark skiing, and snowboarding were selected for further analysis. RESULTS: The relative distribution of ski injuries by type of skiing changed significantly from 1990 to 1996 (p<0.001). Injuries from snowboarding showed the highest relative increase, and those sustained during downhill skiing showed a decline. The proportion of fractures in all types of skiing increased during the study period (p=0.001). The proportion of injuries to knee/lower leg decreased and the proportion to the forearm/wrist/hand increased during the study period (p=0.03). The mean age of the injured skiers differed significantly among the different types of skiing activity (p<0.001): cross country skiers were the oldest followed by telemark skiers, downhill skiers, and snowboarders. CONCLUSIONS: Ski injury surveillance results in early detection of changes in temporal injury trends, allowing timely adjustment of injury prevention strategies. Injuries from snowboarding are on the increase in Norway, warranting more effective injury prevention measures.


     

Frequencies of the five PCR-based genetic markers LDLR, GYPA, HBGG, D7S8 and GC in the population of Asturias (North Spain)

Allele and genotype frequencies of the loci LDLR, GYPA, HBGG, D7S8 and GC (PM loci) were investigated in a population sample of 215 unrelated individuals from Asturias (North Spain). Multiplex amplification and simultaneous typing of the five loci was carried out using the polymarker PCR amplification and typing kit. All loci met Hardy-Weinberg expectations. The Asturian sample does not differ significantly from other Caucasians, but significant differences were observed between this population and SW Hispanic, Afro-american and Korean populations. Received: 30 September 1996 / Received in revised form: 12 November 1996     

Population study of the STRs HUMCD4 and HUMF13A1 in Catalonia (Northeast Spain)

Allele and genotype frequencies were determined in a population sample from Catalonia (Northeast Spain) for two short tandem repeat loci (HUMCD4 and HUMF13A1), using the polymerase chain reaction (PCR). After denaturing PAG electrophoresis, 6 alleles were identified for HUMCD4 in a sample of 157 unrelated individuals, and 11 alleles for HUMF13A1 in a sample of 141 individuals. No deviation from Hardy-Weinberg equilibrium was found. The HUMCD4 and HUMF13A1 loci demonstrated a heterozygosity of 0.6815 and 0.7305 respectively. Received: 24 June 1996 / Received in revised form: 6 November 1996     

MRI in carcinomatous encephalitis

We report a rare case of miliary brain metastases presenting with symptoms similar to encephalitis (“carcinomatous encephalitis”). Contrast-enhanced MRI demonstrated miliary metastases more distinctly than other imaging methods and reproduced the pathological features. Received: 28 March 1996 Accepted: 29 April 1996     

Musculoskeletal biopsy: utilization and provider distribution in the United States Medicare population

RATIONALE AND OBJECTIVES: Physicians from many specialties perform musculoskeletal biopsy. Using the Medicare database, we sought to determine which specialties represent the physicians who are performing the majority. MATERIALS AND METHODS: Using the CMS physician supplier procedure summary master file for 1996-2003, we extracted all claims for biopsy procedure codes (including marrow aspiration, muscle biopsy, percutaneous bone biopsy, and open surgical biopsy) categorized by provider specialty, and we analyzed procedure volumes. RESULTS: Since 1996, the rate of utilization of percutaneous bone biopsy has remained stable. In 2003, marrow aspiration was most commonly performed by hematology/oncology (80,038, 57%), followed by medical oncology (23,428, 17%); radiologists performed 755 (0.5%). Muscle biopsies were predominantly performed by radiologists (4,761, 40%), followed by neurosurgery (591, 5%). Percutaneous bone biopsy was mostly performed by radiologists (14,830, 53%), but orthopedic surgeons, neurosurgeons, and hematology/oncology specialists performed a large minority (6,879, 2,296, and 1,048 respectively; in aggregate, 37%). From 1996 to 2003, radiologists performed 71% more muscle biopsies (2,788 to 4,761) and 60% more percutaneous bone biopsies (9,259 to 14,830). Although most specialties are performing fewer percutaneous bone biopsies (e.g., oncologists: 7,217 to 1,048, -85%), orthopedic surgeons are performing 247% more (1,983 to 6,879) and neurosurgeons are performing 2,343% more (94 to 2,296). CONCLUSION: Excluding marrow aspiration, radiologists perform the majority of percutaneous bone biopsies, and the volume is increasing in the U.S. Medicare population. The overall volume has remained relatively stable from 1996 to 2003; although medical specialties are performing fewer, the volume performed by surgeons is increasing rapidly.     

Trends in the utilization of MR angiography and body MR imaging in the US Medicare population: 1993-1998

PURPOSE: To determine the trends in utilization of non-neurologic (ie, body) magnetic resonance (MR) imaging and of MR angiographic examinations performed from 1993 to 1998, the trends in non-radiologist participation in MR imaging, and the relative reimbursements for these examinations compared with those for all other noninvasive imaging studies performed in 1998. MATERIALS AND METHODS: By using the 1993, 1996, and 1998 nationwide Medicare Part B databases, utilization rates per 100,000 Medicare beneficiaries and physician reimbursements were determined for seven MR angiography and 14 body MR imaging CPT-4 (Current Procedural Terminology, version 4) codes. Medicare specialty codes were used to categorize physicians as radiologists or non-radiologists. RESULTS: The utilization rate per 100,000 Medicare beneficiaries for all 21 MR angiography and body MR imaging codes increased from 649 in 1993 to 1,253 in 1996 and to 1,876 in 1998--a 189% increase. These rates represented 0.55% of the total noninvasive imaging volume in 1998 and 2.8% of physician reimbursements. Musculoskeletal MR imaging utilization increased 142% from 1993 to 1998 compared with a 58% increase in the utilization of other body MR imaging studies. Non-radiologist participation in musculoskeletal MR imaging increased from 2.9% in 1993 to 3.6% in 1996 and to 5.6% in 1998. CONCLUSION: MR angiography and body MR imaging utilization rates increased substantially from 1993 to 1998. However, these studies still account for a minor fraction of all noninvasive imaging examinations performed and fees reimbursed. MR angiography and musculoskeletal MR imaging utilization has increased rapidly. Non-radiologist participation in musculoskeletal MR imaging is increasing.     

Systemic arterial air embolism and tension pneumothorax: two complications of transthoracic percutaneous thin-needle biopsy in the same patient

Systemic arterial air embolism and tension pneumothorax are two rare and severe complications of transthoracic fine-needle biopsy. We report on a patient who developed both complications during the same procedure and recovered successfully after resuscitation and hyperbaric oxygen therapy. Favourable outcome of systemic air arterial embolism has been reported infrequently in the literature. In our case tension pneumothorax may have influenced favourably the course of the illness due to collapse of distal airways and the reduction of the venous return to the heart from the affected side. Received: 25 October 1995; Revision received 29 March 1996; Accepted: 9 April 1996     

Unusual high signal intensity on MR images in a patient with multiple tendinous xanthomas

The MR features of a 57-year-old man with multiple tendinous xanthomas are reported. The lesions of the peroneus longus tendons and the Achilles tendons showed diffuse reticulated pattern, which is the typical MR finding of tendinous xanthomas. However, the lesions of the patellar tendons showed no diffuse pattern and contained focal regions of high signal intensity on T 1-weighted images suggesting the deposition of triglycerides. The regions showed high signal intensity on T 2-weighted images and moderate enhancement on contrast-enhanced T 1-weighted images suggesting the presence of associated inflammation. Received: 13 May 1996; Revision received: 19 August 1996; Accepted: 12 September 1996     

Castleman's disease in the neck: MRI

We describe a case of Castleman's disease in a 8-year-old-boy who presented with a slowly growing mass in the upper neck. MRI showed a well-defined homogeneous mass with nonspecific signal features. Unusual features were a kidney-bean shape and the deep location in the suprahyoid region, the mass originating in the left retropharyngeal space. Received: 7 August 1996 Accepted: 9 October 1996     

Gadolinium enhancement of the cerebrospinal fluid in a patient with meningeal fibrosis and cryptococcal infection

We describe the case of a 52-year-old man, with cryptococcal meningitis and meningeal fibrosis who had undergone ventricular shunting. Gd-DTPA-enhanced T1-weighted MRI revealed diffuse meningeal enhancement. Remarkably, there was enhancement of the pia mater and posterior fossa subarachnoid space. Received: 27 February 1996 Accepted: 4 July 1996     

Dilatation of deep medullary veins in cortical venous occlusion due to focal tuberculous leptomeningitis

We report a case of surgically proven, focal left parietal tuberculous leptomeningitis. Occlusion of superficial cerebral veins in the affected area led to dilatation of medullary veins to drain the left parietal lobe. Deep medullary veins were clearly demonstrated on MRI and angiography. Received: 7 June 1996 Accepted: 10 December 1996     

Statistical analysis of data for three British ethnic groups from a new STR multiplex

Data have been collected from 602 Caucasians, 190 Afro-Caribbeans and 257 Asians of Indo/Pakistani descent who have been profiled using a new six locus short tandem repeat (STR) multiplex. The data have been analysed by conventional significance testing methods: the exact test, homozygosity, and conventional goodness of fit to Hardy-Weinberg proportions. Frequency tables are given and the expected performance in British forensic casework is discussed. Received: 19 June 1996 / Received in revised form: 9 September 1996     

Aberrant pancreas in the gallbladder wall

We present three cases of heterotopic pancreas in the gallbladder wall. The patients (all female) presented with abdominal pain. Ultrasonography revealed polypoid tumor with coexistence of lithiasis in two cases. All patients underwent cholecystectomy. Microscopy revealed chronic cholecystitis and cholesteatosis and heterotopic pancreatic tissue. Heterotopic pancreas in the gallbladder wall is a rare heterotopia, with 23 cases reported in the international literature. Received 21 March 1996; Revision received 4 September 1996; Accepted: 9 December 1996     

Multiple haemorrhagic brain metastases from papillary thyroid cancer

We report a 40-year-old woman, who initially developed cerebellar symptoms, with multiple hemorrhagic brain metastases from a papillary thyroid cancer. Intracranial masses gave heterogeneous high signal on T 1-weighted and T 2-weighted images, hemosiderin rims on the latter. Some of the tumors showed contrast enhancement. Metastatic thyroid cancer is a consideration in a patient with multiple hemorrhagic masses. Received: 20 February 1996 Accepted: 14 May 1996     

Recent rapid increase in utilization of radionuclide myocardial perfusion imaging and related procedures: 1996-1998 practice patterns.

PURPOSE: To evaluate cardiac nuclear medicine practice patterns in different physician specialty groups to better understand a recent rapid increase in utilization of radionuclide myocardial perfusion imaging (MPI) and certain supplementary examinations. MATERIALS AND METHODS: National Medicare Part B databases from 1996 and 1998 were used to evaluate utilization of four primary procedure codes for radionuclide MPI and two supplementary codes (add-on left ventricular wall motion or left ventricular ejection fraction). Utilization rates were calculated for cardiologists, radiologists, and other physicians. Other cardiac imaging for which radionuclide imaging might be substituted was similarly studied. RESULTS: Overall utilization rate of radionuclide MPI per 100,000 Medicare beneficiaries increased 19.1%, from 4,046 in 1996 to 4,820 in 1998 (P <.001). However, for cardiologists the rate increased from 1,771 to 2,413 (36.3%), whereas for radiologists it increased from 1,958 to 2,031 (3.7%) (P <.001 for both changes). Overall utilization rate of add-on codes increased 264% from 1,006 to 3,657 (P <.001). By 1998, the ratio of these add-on examinations to primary MPI was 0.94 among cardiologists compared with 0.53 among radiologists (relative risk, 1.77; 95% CI: 1.76, 1.78). Cardiologist-performed stress echocardiography and cardiac catheterization and coronary angiography increased by 24.2% and 8.7%, respectively. CONCLUSION: Growth in utilization of radionuclide MPI between 1996 and 1998 was almost 10 times higher among cardiologists than radiologists. Utilization of the two add-on codes increased even more dramatically. The greater use of MPI is not a substitute for other cardiac imaging.     

Sudden unexpected death due to Fournier’s gangrene

A 43-year-old Japanese male vagrant collapsed suddenly in a police station. The man was resuscitated in hospital but died about 13 h later. An autopsy revealed necrotizing fasciitis in the genitalia and lower abdominal wall. The man was considered to have died from endotoxic shock following on Fournier’s gangrene. Received: 16 July 1996 / Received in revised form: 23 December 1996