Assessment of pituitary adenoma volumetric change using longitudinal MR image registration

Introduction  

Change detection is a crucial factor in monitoring of slowly evolving pathologies. The objective of the study was to test a semi-automatic method applied on longitudinal MRI monitoring of volume change in pituitary macroadenomas.     

Lung function at 10 yr is not impaired by early childhood lower respiratory tract infections

The causal relationship between lower respiratory tract infections (LRIs) in early life and reduced lung function later in childhood is unsettled. Therefore, we assessed whether LRIs the first 2 yr of life influenced lung function development from birth to school age. In the prospective Oslo birth cohort, ‘the Environment and Childhood Asthma (ECA) study’ lung function was measured at birth in 802 infants by tidal flow volume loops and in 664 infants by passive respiratory mechanics and half yearly questionnaires, including LRI questions, were completed until 2 yr of age. The present study includes 607 children with information about LRIs the first 2 yr of life and successfully forced expiratory flow (FEF) volume measurements at the 10‐yr follow‐up assessment. At 10 yr of age, FEF at 50% of forced vital capacity (FEF₅₀) (mean 95% confidence interval) was reduced in children with at least one bronchiolitis (85.0, 80.6–89.5, p = 0.020) or bronchitis (86.2, 82.6–89.8, p = 0.030) or ≥3 LRIs (83.4, 78.1–88.8, p = 0.017) when compared with no LRIs (90.6, 88.8–92.5) by 2 yr of life. The effects were significant in girls only when stratifying for gender. Among girls with later bronchiolitis compliance of the respiratory system (3.64, 3.17–4.10 vs. 4.18, 3.98–4.37, p = 0.031) and the ratio of time to peak tidal expiratory flow to total expiratory time (t_PTEF/t_E) measured at birth was significantly reduced (0. 26, 0.23–0.29 vs. 0.32, 0.30–0.33, p = 0.005) when compared with children with no LRIs. Change in lung function from birth (by t_PTEF/t_E) to 10 yr of age was not significantly associated with LRIs the first 2 yr of life, and LRIs by 2 yr of life were not significantly associated with lung function at 10 yr of age in regression analyses including lung function at birth and other possible predictors of lung function at 10 yr. In our study, LRIs during the first 2 yr of life did not impair lung function development from birth until 10 yr of age.     

Medication overuse headache: a critical review of end points in recent follow-up studies

No guidelines for performing and presenting the results of studies on patients with medication overuse headache (MOH) exist. The aim of this study was to review long-term outcome measures in follow-up studies published in 2006 or later. We included MOH studies with >6 months duration presenting a minimum of one predefined end point. In total, nine studies were identified. The 1,589 MOH patients (22% men) had an overall mean frequency of 25.3 headache days/month at baseline. Headache days/month at the end of follow-up was reported in six studies (mean 13.8 days/month). The decrease was more pronounced for studies including patients with migraine only (−14.6 days/month) compared to studies with the original diagnoses of migraine and tension-type headache (−9.2 days/month). Six studies reported relapse rate (mean of 26%) and/or responder rate (mean of 28%). Medication days/month and change in headache index at the end of follow-up were reported in only one and two of nine studies, respectively. The present review demonstrated a lack of uniform end points used in recently published follow-up studies. Guidelines for presenting follow-up data on MOH are needed and we propose end points such as headache days/month, medication days/month, relapse rate and responder rate defined as ≥50% reduction of headache frequency and/or headache index from baseline.     

Autonomic and sensory symptoms and signs in incident,untreated Parkinson's disease: Frequent but mild

Although nonmotor symptoms are increasingly recognized as key features in Parkinson's disease (PD), the occurrence and severity of autonomic and sensory symptoms in patients with very early and untreated PD are poorly documented. Two hundred seven patients with newly diagnosed, untreated PD and 175 controls from the population‐based Norwegian ParkWest study were included. Postural blood pressure and olfactory function were measured and eight autonomic and sensory symptoms assessed using interview‐based rating scales. Autonomic and sensory symptoms were more frequent in patients compared with controls (mean number of symptoms 2.9 vs. 1.1; P < 0.001) and in the postural instability and gait difficulty motor‐subtype vs. tremor dominant subtype (mean 3.3 vs. 2.5; P = 0.008). In the patient group, reduced olfaction (59%), urinary problems (47%), increased saliva or drooling (42%), constipation (39%), and sensory complaints (34%) were the most frequent symptoms. Daily activities were not affected by these symptoms in 58% of the patients, and the influence on daily activities was rated as “mild” or less for all of these symptoms in 90%. A higher Hoehn and Yahr stage was associated with a higher number of autonomic and sensory symptoms and with the occurrence of gastrointestinal symptoms. Autonomic and sensory symptoms are common in patients with untreated, early PD although the severity of these symptoms is mild, with little or no influence on daily activities. The high prevalence of increased saliva or drooling close to the time of diagnosis is noteworthy and not described earlier. © 2010 Movement Disorder Society     

Colonoscopy without Sedation

The results of ambulatory 24-h esophageal pH monitoring in 67 patients with gastroesophageal reflux symptoms (endoscopic esophagitis, n = 44; normal endoscopy, n = 23) were compared with those of 27 normal subjects without reflux symptoms. Patients with reflux symptoms had significantly increased gastroesophageal reflux compared with normal subjects. Acid reflux time was significantly (p < 0.001) correlated with the severity of endoscopic esophagitis. Linear discriminant analysis was used to differentiate, for each reflux variable, between patients and controls. When the percentage of overall time at pH below 4 was used as a single determinant of gastroesophageal reflux, the sensitivity and specificity were 81% and 85%, respectively, with 4% as upper limit of normal. Pathologic reflux was found in 61% of the patients with negative endoscopy. Long-term ambulatory pH-metry is of clinical value in detecting pathologic reflux in symptomatic patients with negative endoscopy.     

Health status in patients at risk of inherited arrhythmias and sudden unexpected death compared to the general population

Background  

The possibilities in the molecular genetics of long QT syndrome (LQTS) and hypertrophic cardiomyopathy (HCM) has made family screening, with diagnostic and predictive genetic testing part of the health care offer in genetic counselling of inherited arrhythmias, potentially affecting the subjective health among these individuals. The study compared health status among patients at risk of arrhythmia because of family history or clinical diagnosis of LQTS and HCM with reference health status scores of the general population.     

Quality control in colorectal cancer screening: Systematic microbiological investigation of endoscopes used in the NORCCAP (Norwegian Colorectal Cancer Prevention) trial

Background  

Endoscopic colorectal cancer (CRC) screening is currently implemented in many countries. Since endoscopes cannot be sterilised, the transmission of infectious agents through endoscopes has been a matter of concern. We report on a continuous quality control programme in a large-scale randomised controlled trial on flexible sigmoidoscopy screening of an average-risk population. Continuously, throughout a two-year screening period, series of microbiological samples were taken from cleaned ready-to-use endoscopes and cultured for bacterial growth.