The detection of internal mammary lymph nodal chain metastases in breast cancer using radiolabelled colloids

The authors report their studies of 39 lymphoscintigraphies performed on patients with breast cancer. They point out that interpretation of scintigraphic imaging must take into account the morphologic variations of the lymph nodes of the internal mammary chains (i.e. single central chain, single central lymph node) and the morphological difference in the symmetry of lymph nodes considered non-pathologic to avoid false positives. The authors retain that lack of visualization of a chain, conspicuous increase in size of a lymph node, asymmetry of pathologic development, or reduced uptake by one or more lymph nodes of the internal mammary chains must be interpreted as a sign of metastatic spread. The authors recommend lymphoscintigraphy as an effective technique in the screening of breast cancer patients for staging, follow-up, restaging, and planning of radiotherapy.     

Application of a Modified Healthy Eating Index (HEI-Flex) to Compare the Diet Quality of Flexitarians,Vegans and Omnivores in Germany

Interest in plant-based nutrition has steadily increased in the western world in the recent years. The number of people following a meat-reduced, flexitarian diet is growing continuously. However, little is known about the diet quality of flexitarians compared to vegans or omnivores. Therefore, in this cross-sectional study, the food intake of 94 participants aged between 25–45 years was recorded via a validated food frequency questionnaire and 28 self-designed questions about the consumption of plant-based alternatives. An adapted Healthy Eating Index, HEI-flex, was developed to evaluate the diet quality of flexitarians, vegans and omnivores. Higher score points (SP) of the HEI-flex are associated with higher compliance with the official diet recommendations (V_max = 100 SP). Finally, flexitarians scored significantly more highly when compared to omnivores (54 ± 8 vs. 47 ± 9 SP; p = 0.008) but lower than vegans (54 ± 8 vs. 61 ± 10 SP; p = 0.010). The results showed that the HEI-flex is a useful tool for assessing and comparing the diet quality of flexitarians, vegans and omnivores. Despite the consumption of highly processed plant-based alternatives, reduction in meat and meat products seems to be accompanied by increased overall diet quality.     

Forearm fractures in Malmo, Sweden: Changes in the incidence occurring during the 1950s, 1980s and 1990s

Between the 1950s and the 1980s, the incidence of forearm fractures increased in the city of Malmo. We have now collected data on all forearm fractures during 1991 and 1992 and compared them with previously published data from 1953-1957 and 1980-1981. During the 1990s, 1314 individuals with wrist fractures and 125 with shaft fractures were recorded. In men, we found a twofold increase in the standardized morbidity ratio (SMR) in the 1990s, compared with the 1950s. The 1990s, compared with the 1980s, showed a reduction in SMR to 0.85. In women, a comparison between the 1990s and the 1950s revealed a slight reduction in SMR, 0.9 during the 1990s. Comparison of the 1990s with the 1980s revealed a reduction in SMR to 0.7 after the age of 70 years. In individuals 60 years and older, we found a fivefold increase in the incidence of fractures of the shaft of the forearm, when comparing the 1990s with the 1980s. In women, the increase in incidence of wrist fractures appears to have been interrupted, when comparing the years 1991-1992 and 1980-1981. Among men, the incidence of wrist fractures appears to be increasing, even after the 1980s. The reduction in incidence among women may partly be explained by warmer winters during 1991 -1992.     

Nonoperatively treated burst fractures of the thoracic and lumbar spine in adults: a 23- to 41-year follow-up

BACKGROUND CONTEXT: Several studies report a favorable short-term outcome after nonoperatively treated two-column thoracic or lumbar burst fractures in patients without neurological deficits. Few reports have described the long-term clinical and radiological outcome after these fractures, and none have, to our knowledge, specifically evaluated the long-term outcome of the discs adjacent to the fractured vertebra, often damaged at injury and possibly at an increased risk of height reduction and degeneration with subsequent chronic back pain. PURPOSE: To evaluate the long-term clinical and radiological outcome after nonoperatively treated thoracic or lumbar burst fractures in adults, with special attention to posttraumatic radiological disc height reduction. STUDY DESIGN: Case series. PATIENT SAMPLE: Sixteen men with a mean age of 31 years (range, 19-44) and 11 women with a mean age of 40 years (range, 23-61) had sustained a thoracic or lumbar burst fracture during the years 1965 to 1973. Four had sustained a burst fracture Denis type A, 18 a Denis type B, 1 a Denis type C, and 4 a Denis type E. Seven of these patients had neurological deficits at injury, all retrospectively classified as Frankel D. OUTCOME MEASURES: The clinical outcome was evaluated subjectively with Oswestry score and questions regarding work capacity and objectively with the Frankel scale. The radiological outcome was evaluated with measurements of local kyphosis over the fractured segment, ratios of anterior and posterior vertebral body heights, adjacent disc heights, pedicle widths, sagittal width of the spinal canal, and lateral and anteroposterior displacement. METHODS: From the radiographical archives of an emergency hospital, all patients with a nonoperatively treated thoracic or lumbar burst fracture during the years 1965 to 1973 were registered. The fracture type, localization, primary treatment, and outcome were evaluated from the old radiographs, referrals, and reports. Twenty-seven individuals were clinically and radiologically evaluated a mean of 27 years (range, 23-41) after the injury. RESULTS: At follow-up, 21 former patients reported no or minimal back pain or disability (Oswestry Score mean 4; range, 0-16), whereas 6 former patients (of whom 3 were classified as Frankel D at baseline) reported moderate or severe disability (Oswestry Score mean 39; range, 26-54). Six former patients were classified as Frankel D, and the rest as Frankel E. Local kyphosis had increased by a mean of 3 degrees (p<.05), whereas the discs adjacent to the fractured vertebrae remained unchanged in height during the follow-up. CONCLUSIONS: Nonoperatively treated burst fractures of the thoracic or lumbar spine in adults with or without minor neurological deficits have a predominantly favorable long-term outcome, and there seems to be no increased risk for subsequent disc height reduction in the adjacent discs.     

Biomaterials as Scaffold for Bone Tissue Engineering

Abstract Almost 20 years after the invention of tissue engineering, autogenous bone grafting has remained the favored strategy for the treatment of bone defects. As an alternative, a vast variety of bone substitutes has been developed and is available for clinical use. The ongoing search for bone substitutes, however, reflects the limitations imposed to both autogenous and allogenous bone grafts as well as to bone substitute materials. The concept of tissue engineering holds great promise for the future treatment of osseous defects. Research in this interdisciplinary field is carried out to find a way of producing biologic substitutes as functional tissue replacement. For this, functionally active cells are applied on supporting scaffolds under controlled stimulation with growth factors. Scaffolds are temporary matrices for bone growth and provide a specific environment and architecture for tissue development. Ideally, scaffolds favor cellular attachment, growth and differentiation in vitro and in vivo. Especially ceramics and biodegradable polymers are widely used and have been tested in various animal studies. Yet, to allow for precise production of specific custom-made scaffolds, rapid prototyping (RP) techniques have recently drawn a lot of attention. Using these methods scaffolds with a predefined, well-controlled internal and external architecture mimicking the structure of natural bone can be generated. Although biocompatibility of the materials used in the process and the structural resolution that can be technically achieved so far limit the range of use, rapid manufacturing techniques do offer great opportunities to generate suitable scaffolds for bone tissue engineering in the near future.     

Renal transplant dysfunction--importance quantified in comparison with traditional risk factors for cardiovascular disease and mortality.

BACKGROUND: Renal transplant recipients (RTR) mainly die of premature cardiovascular disease. Traditional cardiovascular disease risk factors are prevalent in RTR. Additionally, non-traditional risk factors seem to contribute to the high risk. The impact of renal dysfunction was compared with traditional risk factors for cardiovascular morbidity and mortality in 1052 placebo-treated patients of the ALERT trial. METHODS: All patients were on cyclosporine-based immunosuppressive therapy, follow-up was 5-6 years and captured endpoints included cardiac death, non-cardiovascular death, all-cause mortality, major adverse cardiac event (MACE), non-fatal myocardial infarction (MI) and stroke. RESULTS: A calculated 84 micromol/l increase in serum creatinine was needed to double the risk for cardiac death, an increase of 104 micromol/l to double the risk for non-cardiovascular death and an increase of 92 micromol/l to double the risk for all-cause mortality. MACE risk was doubled if serum creatinine was elevated by 141 micromol/l, age was increased by 23 years, or LDL-cholesterol by 2 mmol/l. Diabetes increased the incidences of cardiac death, all-cause mortality, MACE, stroke and non-fatal MI. A serum creatinine increase of approximately 130 micromol/l, or approximately 20 years increase in age was calculated as similar in risk for cardiac death, all-cause mortality and MACE, and comparable to risk of diabetes in RTR. CONCLUSION: An increase in serum creatinine of 80-100 micromol/l doubles the risk for cardiac death, non-cardiovascular death and all-cause mortality in RTR. An increase of 130 micromol/l in serum creatinine or approximately 20 years increase in age is comparable to risk of diabetes.