IS CARDIOVASCULAR DISEASE A RISK FACTOR IN THE DEVELOPMENT OF AXONAL POLYNEUROPATHY?

Objectives: To determine if cardiovascular disease may be a risk factor in the development of chronic idiopathic axonal polyneuropathy (CIAP). Methods: In this incidence case-control study, the prevalence of cardiovascular disease and risk factors in 97 patients with CIAP (mean age 67.5 (SD 7.9) years) and the prevalence of neuropathic features in 97 patients with peripheral arterial disease (PAD) (mean age 67.1 (SD 7.3) years) were investigated. The results were compared with those for 96 age and sex matched controls without diagnosed PAD or polyneuropathy (mean age 67.5 (SD 9.1) years). In a randomly chosen subgroup of 23. patients with CIAP, 42 patients with PAD, and 48 controls, an electrodiagnostic investigation was performed. Results: Patients with CIAP more often had manifest cardiovascular disease and cardiovascular risk factors than controls (stroke 18% v 6% of patients, odds ratio (OR) 3.2 (95% confidence interval (0) 1.8 to 5.9); heart disease 29% v 15%, OR 2.4 (95% Cl 1.2 to 4.9); family history of cardiovascular disease 42% v 21%, OR 2.8 (95% Cl (1.5 to 5.2); hypertension 56% v 39%, OR 2.0 (95% Cl 1.1 to I I 3.6); hypercholesterolaemia 46% v 21%, OR 3.3 (95% Cl 1.5 to 7.3); current smoking 38% v 23%, OR 2.1 (95% Cl I. I to 3.9)). The prevalence of cardiovascular disease and cardiovascular risk factors was lower than in patients with PAD. Patients with PAD more often had polyneuropathy than controls (15% v 5%, OR 3.3 (95% Cl 1.1 to 10.0)). There was a trend towards lower nerve conduction velocities and lower amplitudes on electrodiagnostic investigation compared with controls. Conclusion: This study shows that cardiovascular disease and CIAP often coexist, and therefore cardiovascular disease may be a cofactor in the development of CIAP.     

ARTHROSCOPIC EVALUATION AND MANAGEMENT OF MENISCAL INJURIES OF THE KNEE

50 cases of isolated meniscal injuries of the knee were evaluated and managed arthroscopically. 56% of the cases were in 25–35 year age group. In 80% of the cases military training and contact sports was the mode of injury. Maximum (42%) patients reported late (> 2 years) after the injury. On presentation, they had an average Lysholm knee score of 53.76. Medial meniscal lesion was seen in 74%. Commonest pattern of tear encountered was a longitudinal tear (40%). Depending on pattern and extent of lesion, partial meniscectomy (60%), subtotal meniscectomy (14%) and total meniscectomy (26%) were performed. Patients were followed up at six months and one year. The average Lysholm score at 6 months was 83.3 and at one year 79.5. At one year, the patient satisfaction level was 82% and patients who underwent partial meniscectomy had the best results.KEY WORDS: Arthroscopy, Meniscal tear     

Pre-diagnosis insulin-like growth factor-I and risk of epithelial invasive ovarian cancer by histological subtypes: A collaborative re-analysis from the Ovarian Cancer Cohort Consortium

Purpose

Biologic evidence suggests that the Insulin-like growth factor (IGF)-family may be involved in the etiology of epithelial invasive ovarian cancer (EOC). However, prospective studies investigating the role of IGF-I in ovarian carcinogenesis have yielded conflicting results.

Methods

We pooled and harmonized data from 6 case–control studies nested within the Ovarian Cancer Cohort Consortium to investigate the association between pre-diagnosis IGF-I concentrations and subsequent risk of EOC. We evaluated IGF-I concentrations and risk of EOC overall and by tumor subtype (defined by histology, grade, stage) in 1,270 cases and 2,907 matched controls. Multivariable conditional logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (CI).

Results

Doubling of IGF-I concentration was associated with significantly lower risk of overall EOC [OR_log2?=?0.82; CI 0.72–0.93]. We observed no heterogeneity by tumor characteristics (e.g., histology, p _het?=?0.62), menopausal status at blood collection (p _het?=?0.79), or age at diagnosis (p _het?=?0.60).

Conclusions

These results suggest that IGF-I concentrations are inversely associated with EOC risk, independent of histological phenotype. Future prospective research should consider potential mechanisms for this association, including, considering other members of the IGF-family to better characterize the role of IGF-signaling in the etiology of EOC.

     

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.     

Use of previous screening mammograms to identify features indicating cases that would have a possible gain in prognosis following earlier detection

False-negative screening mammograms generally refer to breast cancers that were overlooked or misinterpreted at screening. An important question is whether earlier detection could have made a difference in the prognosis of the women concerned. We reviewed screening and diagnostic mammograms of 234 screen-detected and interval cancer cases (aged 44-84 years) diagnosed between 1991 and 1996 in the Nijmegen breast cancer screening programme. A lesion was visible on 117 (50%) of the screening mammograms prior to the diagnosis of breast cancer. Fifty-one out of the 117 cancers had poor prognostic characteristics at diagnosis (i.e. N+ and/or T2+) and could potentially have benefited from an earlier diagnosis ('possible gain'). The 'possible gain' cases were more often characterised by architectural distortion (29 vs. 10%; P=0.01) or a high-density mass (25 vs. 13%; P=0.06) on the mammogram prior to diagnosis than the 58 'no gain' cases. Our study shows that architectural distortion and non-spiculated high-density masses on the mammogram prior to diagnosis are associated with a possible gain in prognosis. Earlier detection of the carcinomas preceded by these signs may well have an impact on breast cancer mortality and thus warrant extra attention in radiological practice.     

蒽环类药对白血病及淋巴瘤患儿的心脏毒性

蒽环类药对白血病及淋巴瘤患儿的心脏毒性翟力平吴吴长根马伴吟陈伟达蒽环类化疗药（包括阿霉素、柔红霉素）引起心脏毒性已经是众所周知，但由于在肿瘤治疗中的重要作用，至今尚无满意的药物可以替代。据认为对儿童心毒性更敏感。如何掌握儿童治疗与心毒性之间的关系，...     

Analysis of case-cohort data: a comparison of different methods

OBJECTIVE: The case-cohort design combines the advantages of a prospective cohort study and the efficiency of a case-control design. Usually a Cox proportional-hazards model is used for the analyses. However, adaptation of the model is necessary because of the sampling. We compared three methods that were proposed in the literature, which differ in weighting of study subjects: Prentice's, Barlow's, and Self and Prentice's method. STUDY DESIGN AND SETTING: In a cohort of 17,357 women we studied the relationship between body mass index and cardiovascular disease (n=821) with varying subcohort sizes (sampling fraction=0.005, 0.01, 0.05, 0.10, 0.15). RESULTS: Even with a sampling fraction of 0.01, all three methods showed identical estimates and standard errors (SE). With sampling fractions >or=0.10, results of the case-cohort analyses were similar to the full-cohort analyses. With simulations, the three methods provided different results if the full cohort is small (<1,250 subjects, subcohort=10%, 8% failures) or if the subcohort size was smaller than 15% (full cohort of 1,000 observations, 8% failures). The difference between the methods did not change with the number of failures or with different effect sizes. CONCLUSION: In the above-mentioned situations, the effect estimates and SE of Prentice's method most resembled the estimates of the full-cohort estimates.