Impact of partial liberalization of driver's license regulations on the driving behavior of people with epilepsy: experience from Croatia

Until 2005 Croatia had a driving ban for people with epilepsy (PWE) on antiepileptic therapy. To investigate the impact of partial liberalization of legislation, the results of polling performed in 1999 and 2009 were compared. The results revealed that in 1999, despite the driving ban, 46.9% of respondents had a driver's license, whereas in 2009, the majority of respondents with a driver's license (60.2%) fulfilled the requirement criterion of 2 years' remission. In both pollings, one-third of respondents answered that they were driving less often than other drivers. The rate of PWE who were driving was inversely proportional to the seizure rate. In 2009 a greater proportion stated that they drove motorcycles, and few PWE (<5%) declared they were driving more often than others. The inefficiency of rigid legislation and indicators of self-restraint of PWE may be arguments in favor of liberalization, but liberalization should be accompanied by appropriate education programs.     

Bone deposition,bone resorption,and osteosarcoma

Bone deposition and bone resorption are ongoing dynamic processes, constituting bone remodeling. Some bone tumors, such as osteosarcoma (OS), stimulate focal bone deposition. OS is the most common primary bone tumor in children and young adults. A complex network of genes regulates bone remodeling and alterations in its expression levels can influence the genesis and progression of bone diseases, including OS. We hypothesized that the expression profiles of bone remodeling regulator genes would be correlated with OS biology and clinical features. We used real‐time PCR to evaluate the mRNA levels of the tartrate‐resistant acid phosphatase (ACP5), colony stimulating factor‐1 (CSF1R), bone morphogenetic protein 7 (BMP7), collagen, type XI, alpha 2 (COL11A2), and protein tyrosine phosphatases zeta 1 (PTPRZ1) genes, in 30 OS tumor samples and correlated with clinical and histological data. All genes analyzed, except CSF1R, were differentially expressed when compared with normal bone expression profiles. In our results, OS patients with high levels of COL11A2 mRNA showed worse overall (p = 0.041) and event free survival (p = 0.037). Also, a trend for better overall survival was observed in patients with samples showing higher expression of BMP7 (p = 0.067). COL11A2 overexpression and BMP7 underexpression could collaborate to OS tumor growth, through its central role in bone remodeling process. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:1142–1148, 2010     

Slipped capital femoral epiphysis: an ultrastructural study before and after osteosynthesis

Background and purpose

Several different theories have been proposed to explain the pathogenesis of slipped capital femoral epiphysis (SCFE). Using transmission electron microscopy (TEM), we carried out an ultrastructural study of core biopsy specimens of the physis at various stages of the disease.

Methods

Core biopsies were performed in 6 patients with different forms of SCFE during the first operation, and in 3 of them when removing the osteosynthesis material before physeal closure. The specimens were prepared for TEM examination.

Results

In 6 specimens obtained at first surgery, a marked distortion of the physeal architecture was observed. In 2 of the 3 specimens obtained at removal of the osteosynthesis material, the physis showed a more normal organization.

Interpretation

The improvement of the pathological alterations observed in the 2 cases after surgical intervention leads us to consider the possibility that when the growth plate is stabilized directly by pinning or indirectly by creating more optimal loading conditions with an intertrochanteric osteotomy, the morpho-functional characteristics of the physis can be restored and its growth process may resume.     

Generation changes of Polish adolescents self-image (cohorts 1987 versus 2001)

AIM. To compare the self-image of adolescents over fifteen years in Poland (1987 versus 2001). METHODS. Participants were 1752 school students aged 16 to 17 years randomly selected from high school in Kraków (university town). Self-image was measured by the Offer Self-Image Questionnaire. MANOVA, ANOVAs and CFA were applied as statistical methods. RESULTS. Between 1987 and 2001 self-image changes toward a more positive self perceptions in 2001. Boys described themselves better on most scales. Girls score better on vocational and educational goals and superior adjustment. CONCLUSIONS. Self-image changes over time. It is influenced by macrosocial conditions. The research confirms the 5-factor model of self-image structure of the questionnaire and its intergenerational and inter-cultural stability.     

Early wheeze as reported by mothers and lung function in 4‐year‐olds. Prospective cohort study in Krakow

The purpose of the study was to check the hypothesis that early wheezing as reported by mothers would be associated with reduced lung function in 4‐year olds. Study participants were recruited prenatally, as part of a prospective cohort study on the respiratory health of young children exposed to various ambient air pollutants. After delivery, infants were followed over 4 years and the interviewers visited participants at their home to record respiratory symptoms every 3 months in the child's first 2 years of life and every 6 months in the 3rd and 4th years. In the 4th year of follow‐up, children were invited for standard lung function testing by spirometry quantified by forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV₁), and forced expiratory volume in 0.5 sec (FEV_0.5) levels. Out of 258 children attending spirometry testing 139 performed at least two acceptable exhalation efforts. Cohort children with acceptable spirometric measurements did not differ with respect to wheezing experience and exposure characteristics from those without. The study shows that episodic wheeze was reported in 28.1% of 4‐year olds, 6.5% had transient wheeze, and 4.3% had recurrent wheeze. There was an increased frequency of wheezing symptoms and their duration in transient and recurrent wheezers. Adjusted multivariable regression models for gender and height showed that children who reported more than two episodes of wheezing at any point over the follow‐up had FVC values lower by 120.5 ml (P = 0.016) and FEV₁ values lower by 98.3 ml (P = 0.034) compared to those who did not report any wheezing; children experiencing more than 10 wheezing days by age 4 showed FVC deficit of 87.4 ml (P = 0.034) and FEV₁ values of 65.7 ml (P = 0.066). The ratios of FEV₁/FVC%, and FEV_0.5/FVC% were neither associated with wheezing episodes nor wheezing days. In recurrent wheezers, lung function decrement amounted to 207 ml of FVC, 175 ml of FEV₁, and 104 ml of FEV_0.5. In conclusion, our findings show that wheezing experience during early postnatal life may be associated with lung function deficit of restrictive character in preschool children and detailed history of wheeze in early postnatal life, even though not physician‐confirmed, may help define the high risk group of children for poor lung function testing. Pediatr. Pulmonol. 2010; 45:919–926. © 2010 Wiley‐Liss, Inc.     

Subclinical Intestinal Inflammation in Patients with Crohn’s Disease Following Bowel Resection: A Smoldering Fire

Background/Aims  

Fecal lactoferrin is the direct expression of intestinal inflammation in Crohn’s disease (CD). The aim of this study was to analyze the in vivo intimate correlation between intestinal and systemic inflammation in CD patients in clinical remission following bowel resection. The secondary end point was to evaluate the prognostic value of lactoferrin levels and serum cytokines in terms of need of surgery for recurrence in these patients.     

Inverted left atrial appendage presenting as a large left atrial mass

Inverted left atrial appendage (ILAA) is a rare phenomenon. We describe a patient with mitral stenosis who presented with a homogenous mass in the left atrium, mimicking a large thrombus. The patient was sent to surgery and no thrombus was found; intraoperative examination by the surgeon revealed an ILAA. We briefly discuss the main features of this entity and also some aspects of the differential diagnosis.