Leiomyomas in pregnancy: sonographic study

With ultrasound monitoring, analysis of the behavior of uterine leiomyomas (fibroids) and their impact on the course of pregnancy was undertaken in a group of 113 patients. Fibroid size changes were analyzed on the basis of trimesters. In the second trimester, smaller fibroids increased in size, whereas larger fibroids decreased in size. In the third trimester, a decrease in size was documented regardless of initial size. The most common patterns of echotexture were hypoechoic, heterogeneous, and echogenic rim. The development of a heterogeneous pattern or anechoic/cystic spaces on a follow-up study was accompanied in seven of ten patients by severe abdominal pain, compared with 12 cases of abdominal pain in 103 patients without such echotexture changes. Although the number of patients was small, the development of these patterns apparently indicates significant degeneration of the fibroid. Fibroids located in the lower uterine segment were accompanied by a higher frequency of cesarean section and retained placenta. Fibroids located in the uterine corpus were more frequently associated with early abortions. Multiple fibroids were accompanied by a higher frequency of malpresentation and premature contractions compared with cases with one or two fibroids.     

Using the theory of planned behaviour to develop an assessment of attitudes and beliefs towards prosthetic use in amputees

Purpose:?To develop a questionnaire based on the theory of planned behaviour (TPB) to predict prosthetic use.

Method:?In part one, 31 amputees over 50 years of age with peripheral arterial disease completed attitude items containing 27 bipolar adjectives and open-ended questions on behavioural, normative and control beliefs relating to using the prosthesis. Academic, clinical and patient experts (n?=?12) identified bipolar adjectives with best face validity. In part two, 15 amputees completed three behavioural format questions relating to prosthetic use and were asked to indicate the easiest to answer.

Results:?Following the completion of the attitude items by the amputees and the expert panel review, 5 items remained (Cronbach's alpha?=?0.87) with corrected item-total correlations ranging from 0.43 to 0.83. Modal behavioural beliefs concerned mobility (46.5%), independence (25.6%) and participation restrictions (16.3%), normative beliefs concerned family (33.3%), NHS staff (31.7%), friends (19.1%) and other patients (15.9%) and control beliefs concerned stairs (21.1%), slippery/rough surfaces (28.9%), disabled facilities (54.8%) and people helping (22.6%). In relation to part 2, an exact numerical report of hours and days of prosthetic use was found easiest to answer (73%).

Conclusions:?Based on this qualitative and quantitative development work, the questionnaire contains five attitude items, six behavioural, eight normative, eight control belief items and two self-report questions of the behaviour.     

Perception of anatomical structures in digitally filtered and conventional panoramic radiographs: a clinical evaluation

Objectives

The aims of the study were to compare subjective image quality of clinical images obtained with a storage phosphor plate (SPP)-based digital and conventional film-based panoramic system for the visualization of various anatomical structures and to evaluate the effect of various processing algorithms on image interpretation.

Methods

Panoramic radiographs were taken in 42 patients both with film and with a SPP system. SPP images were treated with shadow, sharpen, negative, greyscale sigma and greyscale exponential filters. Four observers subjectively evaluated films and unfiltered and filtered SPP images for the visibility of anatomical structures with various radiodensities as well as for overall image quality on a three-point rating scale. The statistical methods used were Kruskal–Wallis, odds ratio analysis and Cohen''s kappa.

Results

No statistically significant difference was found between film and unfiltered digital images except for low-contrast structures (P > 0.05). Film images were preferred for the visibility of low-contrast structures (P < 0.05). Best overall image quality was obtained with sharpened images (P < 0.05) followed by films and unfiltered digital images. Among all filtered images, sharpened ones received the highest ratings for the visibility of all anatomical structures (P < 0.05). The intra- and interobserver agreement ranged between moderate and substantial and between fair and moderate, respectively.

Conclusions

Film and unfiltered SPP-based panoramic images performed equally well in terms of overall quality; however, films were best for the perception of low-contrast structures. The sharpening filter may be recommended for enhancing SPP panoramic images to improve the visual perception of most of the anatomical structures as well as overall quality.     

Neuromuscular features in Marfan syndrome

Marfan syndrome is a clinically and allelic heterogeneous, heritable connective tissue disorder with infrequently reported neuromuscular features. This study is the first to delineate these symptoms in a non-selected population. Neuromuscular involvement was evaluated in 10 Marfan patients through a standardized questionnaire, physical examination, nerve conduction study (NCS), needle electromyography (EMG), muscle ultrasound, laboratory investigation, and muscle biopsy. Existing neuroimages were screened for dural ectasia and spinal meningeal cysts. Twenty healthy controls with similar age distribution completed the questionnaire.
The results showed that various neuromuscular symptoms occur more frequently in the patients. Four older patients reported muscle weakness, five patients had a mild-to-moderate reduction in vibration sense, and all older patients mentioned mild functional impairments. NCS showed axonal polyneuropathy in four and EMG myopathic and neurogenic changes in all patients. Increased echo intensity and atrophy on muscle ultrasound was found in more than half of the patients. Muscle biopsies obtained in two patients showed myopathic changes in the older, female patient.
In conclusion, the majority of Marfan patients exhibited neuromuscular symptoms characterized as myopathy or polyneuropathy or both, and signs of lumbosacral radiculopathy, with symptoms being most pronounced in the older patients. Although meriting corroboration, these findings indicate a need to further the awareness of neuromuscular involvement in this population.     

Trends in tuberculosis incidence and their determinants in 134?countries

Objective

To determine whether differences in national trends in tuberculosis incidence are attributable to the variable success of control programmes or to biological, social and economic factors.

Methods

We used trends in case notifications as a measure of trends in incidence in 134 countries, from 1997 to 2006, and used regression analysis to explore the associations between these trends and 32 measures covering various aspects of development (1), the economy (6), the population (3), behavioural and biological risk factors (9), health services (6) and tuberculosis (TB) control (7).

Findings

The TB incidence rate changed annually within a range of ±10% over the study period in the 134 countries examined, and its average value declined in 93 countries. The rate was declining more quickly in countries that had a higher human development index, lower child mortality and access to improved sanitation. General development measures were also dominant explanatory variables within regions, though correlation with TB incidence trends varied geographically. The TB incidence rate was falling more quickly in countries with greater health expenditure (situated in central and eastern Europe and the eastern Mediterranean), high-income countries with lower immigration, and countries with lower child mortality and HIV infection rates (located in Latin America and the Caribbean). The intensity of TB control varied widely, and a possible causal link with TB incidence was found only in Latin America and the Caribbean, where the rate of detection of smear-positive cases showed a negative correlation with national incidence trends.

Conclusion

Although TB control programmes have averted millions of deaths, their effects on transmission and incidence rates are not yet widely detectable.     

Malignant biliary obstruction: intracavitary treatment with a high-dose- rate remote afterloading device

A new technique of intracavitary brachytherapy for malignant biliary obstruction is presented. The technique involves the use of a high-dose-rate remote afterloading device, which offers all the advantages of conventional brachytherapy with the added benefit that the dose can be delivered in a single treatment over a few minutes. The potential problems associated with conventional brachytherapy are thereby minimized.     

Human myeloma in vitro colony growth: interrelationships between drug sensitivity, cell kinetics, and patient survival duration

Ninety-seven patients with multiple myeloma evaluated serially had both a tritiated thymidine labeling index of bone marrow plasma cells (LI%) and in vitro myeloma stem cell culture performed. Thirty-three patients with myeloma colony growth had in vitro drug sensitivity testing carried out, 18 having in addition in vitro thymidine suicide determinations. The LI% and the likelihood of in vitro myeloma colony growth were highly correlated: the higher the LI%, the more likely was colony or cluster growth (p less than 0.001). The tritiated thymidine suicide of myeloma stem cells was usually very high. There was excellent correlation between in vitro and in vivo drug sensitivity. Both pretreatment drug resistance and selective sensitivity (e.g., interferon, bisantrene, methotrexate, vinblastine) at the time of relapse were accurately detected and correlated well with survival duration (p = 0.01 Wilcoxan). Although LI% and in vitro sensitivity were clearly independent variables, a high LI% (greater than 3%) plus in vitro resistance were associated with a subsequent survival duration of less than 6 mo. The studies allowed dissection of the complex interrelationship between cell kinetics and drug sensitivity.