Detection of Individual Prostate Cancer Foci via Multiparametric Magnetic Resonance Imaging

Background

Multiparametric magnetic resonance imaging (mpMRI) undoubtedly affects the diagnosis and treatment of localized prostate cancer (CaP). However, clinicians need a better understanding of its accuracy and limitations in detecting individual CaP foci to optimize management.

Contact eczema and epicutaneous tests--distribution of allergens and changes in the spectrum in Vienna

Thousands of contact antigens have been defined. It is, however, remarkable that only a small group of substances (15 to 20) have proved to be frequent or otherwise important causes of allergic contact dermatitis. In agreement with reports from comparable centres, metals are high up on the "hitlist" of frequent allergens (nickel 24%, cobalt 9%, chromates 6%), followed by ingredients of cosmetics and toiletries (fragrances 16%, balsam of Peru 10%, Kathon 5%), whilst already way back are topical medicines (neomycin 4%, parabens 3%, lanolin 2%, benzocaine 1%) and rubber additives (thiuram-mix 2% and carba-mix 1%). Almost all other substances lie below the 1% limit. There was only one remarkable exception in comparison with the results of most other European studies, namely thiomersal, which is widely distributed as a preservative in vaccines in Austria and climbed to second place, with a sensitization rate of 18%. Although the phenylborate mercurials (historic sensitizations due to topical antiseptics) still reached a surprisingly high incidence of 6%, there were hardly any cases of cross-sensitization with thiomersal. A comparison with the international literature illustrates Austria-specific trends and a change in the spectrum over the past years. Interpretation of patch testing requires great specialist knowledge and experience.     

More interventions do not necessarily improve outcome in critically ill patients

OBJECTIVE: The organizational structure of health care facilities has been shown to affect outcome in critically ill patients. We evaluated the association between structures, treatments and outcomes in a large cohort of critically ill patients. DESIGN: Prospective multicentre cohort study. PATIENTS AND SETTING: A total of 26,186 patients consecutively admitted to 31 intensive care units (ICUs) in Austria from January 1998 through December 2000. MEASUREMENTS AND RESULTS: The ICUs were divided into three groups according to the size and function of the hospital: community hospitals and specialized trauma centers (group A); central referral hospitals (group B); and teaching hospitals (group C). Group C patients exhibited a significantly higher risk-adjusted mortality (O/E ratio). Although severity of illness at admission in groups B and C was similar, group C patients received significantly more invasive diagnostic and therapeutic interventions throughout their ICU stay: For 7 of 10 invasive interventions identified, odds ratios for group C vs group B patients were significantly increased, even after adjustment for age, gender, severity of illness and reason for admission (odds ratios 1.2-13.1; all 95% CIs >1). Risk-adjusted multivariate analysis confirmed that six of these invasive interventions were independently associated with mortality. Furthermore, nurse-to-patient ratios did not differ between groups, leading to a significantly increased nursing workload in group C ICUs. CONCLUSIONS: Several invasive interventions were independently associated with increased mortality. Our results provide strong evidence that this association was responsible in part for the increased risk-adjusted mortality in group C patients.     

Möglichkeiten der Weichteilrekonstruktion bei Pseudarthrosen

Die Unfallchirurgie - Pseudarthrosen können als Komplikation einer vorhergegangenen operativen oder konservativen Frakturbehandlung oder nach elektiven Knocheneingriffen entstehen. Ihre...     

Avulsion fractures of the pediatric knee

Although avulsion fractures of the pediatric knee are uncommon, they are important injuries to recognize because they are frequently associated with adjacent soft-tissue and osteocartilaginous abnormalities. Related injuries, which include entrapment of soft-tissue structures, intra-articular fracture extension, and intra-articular loose bodies, can complicate or alter therapy. The most commonly affected soft-tissue structures include the cruciate ligaments, collateral ligaments and supporting tendons, and extensor mechanism and retinacula. The purpose of this pictorial essay is to review avulsion fractures of the pediatric knee and to highlight associated injuries.     

Safety and efficacy of therapeutic early onset granulocyte transfusions in pediatric patients with neutropenia and severe infections

BACKGROUND: Bacterial and fungal infections in profound neutropenia after chemotherapy are associated with high mortality despite appropriate antibacterial and antifungal treatment. Granulocyte transfusions are used as a therapeutic addendum, but concern regarding pulmonary reactions often results in delayed use in clinical practice. Accordingly, many patients are already at advanced stages of their infectious disease once granulocytes are transfused. Thus, a prospective Phase II trial was conducted to test the safety and efficacy of therapeutic early-onset granulocyte transfusions in immunocompromised children with neutropenia and severe infections. STUDY DESIGN AND METHODS: Twenty-seven children with hematologic disorder or malignancy and severe neutropenia with clinically and/or microbiologically documented severe infection unresponsive to standard treatment were included. They received granulocyte colony-stimulating factor (G-CSF)-elicited, crossmatched granulocyte concentrates every other day until complete recovery from infection was documented. RESULTS: A median of two granulocyte transfusions with a median of 8 x 10(8) granulocytes per kilogram of body weight were administered. All transfusions were well tolerated, and no pulmonary symptoms were observed. A total of 92.6 percent of our patients were able to clear their initial infection, and 81.5 percent were alive and without signs or symptoms of their infection 1 month later. All six children with aspergillosis cleared their infection. CONCLUSIONS: G-CSF-elicited, crossmatched granulocyte concentrates are a safe and efficient therapeutic addendum in immunocompromised children with prolonged neutropenia and severe infections. Early transfusion of granulocyte concentrates can lead to an overall response rate of 92.6 percent without adverse events. Randomized clinical trials with an early-onset design are required to determine appropriate clinical applications.     

Association between home working and mental health by key worker status during the Covid-19 pandemic. Evidence from four British longitudinal studies

Little is known about the relationship between homeworking and mental health during the Covid-19 pandemic and how it might differ by keyworker status. To understand this relationship, we use longitudinal data collected over three time points during the pandemic from three British cohort studies born in 1958 (National Child Development Study), 1970 (British Cohort Study) and 1989–90 (Next Step) as well as from a population-based study stratified by four age groups (Understanding Society). We estimate the association between life satisfaction, anxiety, depression, and psychological distress and homeworking by key worker status using mixed effects models with maximum likelihood estimation to account for repeated measurements across the pandemic, allowing intercepts to vary across individuals after controlling for a set of covariates including pre-pandemic home working propensities and loneliness. Results show that key workers working from home showed the greatest decline in mental health outcomes relative to other groups. Pre-pandemic homeworking did not significantly change the nature of such a relationship and loneliness slightly attenuated some of the effects. Finally, mental health outcomes varied across age-groups and time points. The discussion emphasises the need to pay attention to key workers when assessing the relationship between mental health and homeworking.