Economic evaluation of a mammography-based breast cancer screening programme in Spain

The aim of the study was to perform a cost-effectiveness analysisof a breast cancer (BC) mammography screening programme, comparedto a do-nothing alternative, In Spain. Screening consisted ofa biennial mammography performed on all women 50–65 yearsold. A marginal analysis including women 45–49 years oldwas also performed. With the aid of a decision tree model, thenumbers of BC cases diagnosed through screening, BC cases missedby screening and false-positive BC cases were calculated. Costswere calculated by feeding local data into Markovian modelsand the cost-effectiveness ratio calculation was performed ina computer spread sheet. A sensitivity analysis was also conducted.Results were presented in ECUs of 1993. The cost-effectivenessratio per avoided death is 115,500 ECUs and per saved life year7,300 ECUs. Including women 45–49 years old in the programmeraises this ratio to 229,000 and 9,400 ECUs respectively. Thesensitivity analysis showed the efficacy of mammography, complianceof the programme and screening costs to be the more sensitivevariables.     

Management of congenital atresia of the external auditory canal

The management of a unilateral congenital atresia of the external auditory canal is nonuniform and debated. Various surgical approaches, timing, coordination with microtia repair, and variable hearing improvements all contribute to the debate regarding management of this entity. This paper outlines our craniofacial team approach to the congenital unilateral atresia and microtia in children. Selection criteria, timing of repair, coordination with microtia repair, surgical results, and pitfalls will be discussed. The results of surgery in 16 patients with unilateral congenital atresia of the external auditory canal and 2 children with bilateral atresia will be presented. Repair of the atresia was undertaken in children 5 years or older who had pneumatized mastoids and middle ears. Replacement of the malleus/incus complex with a partial ossicular reconstruction prosthesis improved closure of the air-bone gap. Drawbacks included meatal stenosis and deepithelization of the split thickness skin graft lining the external auditory canal. Repair of the unilateral congenital atresia is a demanding and challenging problem but one in which excellent results are achievable. (Otolaryngol Head Neck Surg 1997;116:580-4.)     

Balloon dilatation of a parotid duct stricture

This report describes the balloon dilatation of a post-traumatic parotid duct stricture. This proved to be a simple and successful interventional radiological procedure.     

Regeneration of native structure and biological activity by air oxidation of the reduced bovine trypsin inhibitor (Kunitz)*

Derivatives of the tetraguanidinated bovine trypsin-kallikrein inhibitor lacking up to four amino-acid residues have been prepared by Edman degradation of the amino-terminal Arg-Pro-Asp-Phe sequence. Comparative studies on the native inhibitor, tetraguanidinated inhibitor, and truncated sequences demonstrated that none of the four N-terminal amino-acid residues are essential for the regeneration of native structure and biological activity by air oxidation of the reduced molecule. However residues 2, 3, and 4, although to a different extent, are important for the protein stability and significantly affect the conformation of the tetraguanidinated inhibitor and the rate of the reactivation process. Removal of the terminal positive charge from Arg 1 by diazotization gave a fully active deaminated, tetraguanidinated inhibitor but the lack of the salt bridge interaction between the amino and the carboxyl terminus of the protein prevented the correct folding of the reduced molecule by air oxidation as shown by activity measurements and conformational studies. The stability constants and the standard free energies of binding of the complexes between trypsin and the different inhibitor derivatives have been determined.     

Bleeding Gastric Telangiectasa

Anemia and skin telangiectasia were the main presenting features of a patient with Raynaud's phenomenon, esophageal motor dysfunction, sclerodactyly and telangiectasia (REST) syndrome.
Diffuse gastric telangiectasia with chronic intermittent blood loss were responsible for the anemia. The multisystemic and progressive character of this collegenopathy in our patient is described and the endoscopic picture is presented.
Management difficulties and treatment alternatives are discussed.