Low dose CT in early lung cancer diagnosis: Prevalence data

PURPOSE: Lung cancer has a high mortality rate and its prognosis largely depends on early detection. We report the prevalence data of the study on early detection of lung cancer with low-dose spiral CT underway at our hospital. MATERIALS AND METHODS: Since the beginning of 2001, 519 asymptomatic volunteers have undergone annual blood tests, sputum tests, urinalyses and low-dose spiral CT. The inclusion criteria were age (=/> 55 years old), a history of cigarette smoking and a negative history for previous neoplastic disease. The diagnostic workup varied depending on the size and CT features of the nodules detected. RESULTS: At baseline, the CT scan detected nodules > 5 mm in 22% of subjects; the nodules were single in 42 and multiple in 71. In 53% of cases the findings were completely negative, while in 122 (23.4%) nodules with a diameter < 5 mm were detected. Six cases of lung cancer were identified, of which four were stage I, one stage was IIIB and one was stage IV with adrenal metastases. CONCLUSIONS: Our preliminary data on spiral CT as a potential new diagnostic tool for lung cancer screening, although less promising than the Japanese and ELCAP results, confirm the feasibility of the technique. Additional validation is, however, required.     

Method of patient dose evaluation in the angiographic and interventional radiology procedures

PURPOSE: The aim of this study was to evaluate the effective dose in interventional radiology and angiography procedures on the basis of the dose-area product (DAP), either measured or calculated using two different methods. MATERIALS AND METHODS: We studied 2072 examinations carried out on several X-ray systems both in angiography and in interventional radiology. Some of the systems were equipped with an on-board transmission chamber for DAP measurements; for these systems we took direct DAP measurements for each type of examination. For the systems without the dose measurement device, we used a portable transmission chamber, acquiring the data from a set of sampling frames. We then derived the dose values from the systems' dosimetry data and the information about each examination. To this end, the dosimetry of each x-ray system was done by measuring tube output in the different acquisition modes, backscatter factor and field-homogeneity factor. Survey data sheets were filled in after every examination indicating the exposure data (mean Kv, mAs, focus-skin distance and field size). These values combined with the dosimetric data were used to evaluate the DAP for each exam. Where possible, we compared the measured and calculated DAP values by assessing the percentage deviation between each pair of values. A similar comparison was made for the single examinations using a simplified calculation algorithm reported in the literature. For all the examinations for which we had adequate survey data sheets, we estimated the DAP and the entrance dose values and, with the aid of WinODS software, the effective dose. RESULTS: The direct measurements of DAP showed that, in interventional radiology and angiographic procedures, the variability in examination conditions leads to a wide range of possible patient doses even within the same examination type.The comparison between the measured and calculated DAP using our algorithm showed substantial agreement (mean difference 30%, maximum 80%). By contrast, using the algorithm proposed in the literature, we obtained deviations higher than 100%.An estimate of the effective dose for all the recorded examinations (2072) permitted evaluation of both magnitude and variability of patient doses in special radiology procedures such as angiography and interventional radiology. However, it should be noted that evaluations based on calculated DAP values may be as uncertain as those estimated for DAP, and that clearly the evaluations made for the examinations for which direct measurements are available are more accurate.In particularly 'invasive' examinations in terms of entrance dose, where the threshold limits for deterministic effects might possibly be exceeded, the equivalent doses to critical organs were also assessed. This analysis showed that in a small percentage of patients (5%) 2 Gy to the skin was exceeded in the areas exposed with possible transient erythema, while in fewer than 2% of patients, the 3 Gy limit for temporary epilation was exceeded. CONCLUSIONS: Many interventional radiology, especially haemodynamic, examinations have shown to give significant exposure to patients. The direct dose measurement method has shown to be the only method able to provide reliable information on such exposure.However, the authors believe that since the patient dose cannot be established in advance, even in terms of magnitude and since direct dose measurement cannot be performed on all patients, it is nonetheless interesting to be able to assess, at least semiqualitatively, the amount of the above doses.     

Feeding patterns of Triatoma longipennis Usinger (Hemiptera, Reduviidae) in peridomestic habitats of a rural community in Jalisco State, Mexico

We analyzed triatomine blood feeding patterns to evaluate the role of peridomiciles in Trypanosoma cruzi transmission at the rural village of Tepehuaje de Morelos at Jalisco State, Mexico (1999). A total of 206 bugs were collected in 11 out of 26 households (42.3%). Nymphs predominated in the collections (64.9% of the total). Except for one Triatoma barberi female, a species that belongs to the protracta species complex, all adults were Triatoma longipennis, a species of the phyllosoma complex. Triatomines were exclusively present in peridomestic sites mainly piles of tiles and bricks, and none were found indoors. Overall infection rate was 56.6% and no significant differences (P > 0.05) were observed between nymphs and adults or males and females. Identified blood meals were chicken (29.4%), opossum (20.9%), pig (24.5%), murid (20.9%), dog (3.5%), and armadillo (0.7%). No gut content reacted against anti-human, anti-bovine, anti-rabbit, and anti-cat sera. In contrast to fifth nymphs and adults, 87% of the small nymphs fed on one host, indicating that they are less mobile than other stages. Most fifth nymphs and adults fed on domestic hosts, while small nymphs mainly fed on opossum and murid. Infection blood-meal indexes were around 50% for single meals on opossum and murid, stressing their importance as trypanosome donors. Peridomiciles in Tepehuaje could be regarded as interaction sites among domestic and wild and synanthropic mammals and triatomines, which would facilitate circulation of the same T. cruzi strains between domestic and sylvatic cycles. Stone-made walls and building materials, which hold synanthropic rodents and opossums, should be considered as targets for vector control measures.     

Vertical forces in labial and lingual orthodontics applied on maxillary incisors--a theoretical approach

Theoretical and experimental biomechanical analyses explain most labial orthodontics (LaO); however, lingual orthodontic (LiO) biomechanical principles are rarely introduced. The objective of this study was to apply basic biomechanical considerations in understanding the influence of maxillary incisor inclination and to compare the effect of labial vs lingual intrusive/extrusive forces on tooth movement. Basic anatomic and geometric hypotheses were assumed, ie, tooth length (crown and root), location of the center of resistance, and crown thickness. Incisor inclination as related to a perpendicular line to the occlusal plane (OP) varied between -35 degrees (retroclination) and 45 degrees (proclination). A 0 degrees inclination was defined as a tooth position with its long axis perpendicular to the OP. The buccolingual moment for characterizing root movement was calculated for an applied force perpendicular to the OP. The results showed that when using LaO, an extrusion force resulted in labial root movement from a retroclination of 20 degrees up to a proclination of 45 degrees. In LiO, labial root movement occurred only when the tooth was proclined more than 20 degrees. In all other tooth inclinations, lingual root movement occurred. The opposite tooth movement occurred when an intrusive force was applied. Application of a vertical force has different clinical effects on tooth movement with labial and lingual appliances. Application of a lingual force is more complicated, and its effect on tooth movement depends on bracket position and initial tooth inclination.     

Efficacy of pulsed radio frequency energy therapy in temporomandibular joint pain and dysfunction

This randomized double-blind study evaluated the effectiveness of pulsed radio frequency energy therapy (PRFE) in patients with temporomandibular joint arthralgia. Forty subjects (age range 22 to 55 yrs.) were assigned randomly into two equal groups: (1) Experimental group received PRFE using the Energex unit (Energex, Inc. Emerson, New Jersey) and (2) Control group received PRFE placebo treatment using a sham device. Both groups received six applications to the TMJ area over two weeks. Data were analyzed for the following times: baseline, first and second follow-up visits. Numerical Rating Scale scores for TMJ pain showed a significant reduction over time for the experimental group (mean = 6.13 to 3.05, p < 0.001). There was also a significant effect for the controls (mean = 5.35 to 4.20, p = 0.01). The effect for experimental subjects was a mean reduction of 3.07 versus 1.15 for controls. The significant reduction in controls was attributed to the placebo effect. The experimental group showed a significant increase in mouth opening (mean = 34.95 to 41.70 mm, p = 0.002), right lateral movement (mean = 7.85 to 10.80 mm, p = 0.001) and left lateral movement (mean = 7.65 to 10.85 mm, p < 0.0001). No significant (p > 0.1) change in the control group occurred for mouth opening (mean = 38.50 to 39.65 mm), right lateral movement (mean = 8.60 to 8.75 mm) and left lateral movement (mean = 8.50 to 8.80 mm). No side effects were reported during the treatment and the two week follow-up. These results suggest strongly that PRFE is a safe and effective treatment for TMJ arthralgia as well as for increasing mandibular range of motion.     

Clinical and microbial evaluation of dental scaling associated with subgingival minocycline in chronic periodontitis subjects

The aims of this double-blind randomized clinical trial were to evaluate the presence of periodontal pathogens and the clinical response of periodontal pockets treatment to scaling and root planing (SRP) associated with subgingival minocycline (SM). A total of 36 subjects, 26 to 60 years old (40.7 +/- 9.1), who had been previously diagnosed with chronic periodontitis, were included in the present study. Eighteen subjects were selected for the test group (TG), who were treated with SRP plus SM (new treatment), and 18 subjects for the control group (CG) who received SRP plus vehicle (current treatment). Two homologous sites in each subject with a probing depth (PD) > or = 6 mm were chosen. To evaluate the clinical response after treatment, PD was measured at baseline and at 90 days. Microbiological evaluation was performed to detect 7 periodontal pathogens using polymerase chain reaction at baseline, 30, and 120 days. A mean reduction in PD of 2.8 and 2.1 mm was observed in the TG and CG, respectively. At baseline, P. gingivalis was the most prevalent organism in both test (65.8%) and control (48.6%) groups. After 120 days it fell to 30.8% in TG and to 23.1% in CG. There were no statistically significant differences between the test and control groups concerning PD (p > 0.05 by Wilcoxon test) or presence of periodontal pathogens (p > 0.05 by Wilcoxon and chi-square; p > 0.01 by Signal test). The results observed showed that the new treatment was as effective as the current treatment in reducing periodontal pathogens and PD among chronic periodontitis subjects.     

A novel activation-induced cytidine deaminase gene mutation in a Tunisian family with hyper IgM syndrome

Mutations in activation-induced cytidine deaminase can cause an autosomal recessive form of hyper-IgM syndrome. We have examined a Tunisian family composed of six members: two healthy parents, their two healthy daughters and two affected sons. We found a homozygous transversion G to T in the two sons while heterozygosity for the mutation was found in all other family members. This alteration is localised in intron 2 at the +1 position resulting in defective splicing. Use of various intronic cryptic splice-sites led to expression of various aberrant mRNA species. Conclusion:This is a novel mutation found in the gene encoding for activation-induced cytidine deaminase in a Tunisian family with hyper-IgM type 2 syndrome. This alteration leads to the use of two cryptic splicing sites causing the formation of two different mRNA species.C. Fiorini and S. Jilani contributed equally to this work.     

Catecholaminergic polymorphic ventricular tachycardia: successful emergency treatment with intravenous propranolol

Catecholaminergic polymorphic ventricular tachycardia (VT) is a rare arrhythmogenic disorder, which may cause sudden death and whose relationships with mutations in cardiac ryanodine receptor gene have been recently established. The present article reports a catecholaminergic polymorphic VT case of a 9-year-old girl, without any previous history of syncope, who has been found unconscious while playing and referred comatose to pediatric intensive care unit. The electrocardiogram pattern showed runs of bidirectional and polymorphic VT degenerating into ventricular fibrillation, without QT interval abnormalities. Various attempts of cardioversion, lidocaine, and magnesium sulfate intravenous infusions were only partially effective. Owing to catecholaminergic polymorphic VT highly suggesting electrocardiogram pattern, intravenous propranolol was administered, achieving immediate VT interruption. Long-term nadolol therapy effectively prevented further arrhythmias, with no relapses up to 10 months later; a good neurologic recovery was also obtained. Genetic evaluation revealed in this patient-but not in relatives-a mutation in ryanodine receptor gene on chromosome 1.     

Recent developments and new applications of tandem mass spectrometry in newborn screening

PURPOSE OF REVIEW: To summarize recent developments in the field of newborn screening related to the use of tandem mass spectrometry as an analytic platform. RECENT FINDINGS: Novel inborn errors of metabolism with informative amino acid and/or acylcarnitine profiles have been characterized, increasing the complexity of the differential diagnosis of abnormal results. In addition, methods have been developed for the analysis in dried blood spots of steroids and lysosomal enzymes. Previously unrecognized genotype/phenotype correlations have been found among cohorts of patients whose conditions were diagnosed by screening rather than clinically. Several government entities and professional organizations have issued position statements on newborn screening, and worldwide outcome studies continue to underscore the clinical and financial benefits of expanded newborn screening. SUMMARY: Although it is done inconsistently, newborn screening in the United States is undergoing a rapid expansion driven by the introduction of tandem mass spectrometry in at least 34 state programs. This technology is also used to detect disease markers beyond acylcarnitines and amino acids, as both primary and second-tier tests. In addition to analytic improvements, there is a trend toward the development of joint programs not limited to contiguous geographic areas, often based upon public-private partnerships. This review will summarize several new developments in the field that have occurred since early 2003 and will mention others likely to occur in the near future.     

Influence of selected hormonal and lifestyle factors on familial propensity to ovarian cancer

AIM: To study the influence of established risk factors for ovarian cancer in women with a family history of ovarian and/or breast cancer. METHODS: Italian hospital-based case-control study. Cases were 1031 women with incident epithelial ovarian cancer and controls were 2411 women. Two "Adult life risk scores" (ALRS) were defined combining the effect of hormonal and lifestyle risk factors. RESULTS: Ovarian cancer risk increased with low number of children, late menopause, never or short oral contraceptive use, physical inactivity, rich red meat intake and low fish, pulse and vegetable intake. For hormonal factors, compared to women without a family history and low ALRS, the odds ratios (OR) was 1.77 for women without family history and high ALRS, 2.51 for women with family history and low ALRS and 5.99 for women with family history and high ALRS. The corresponding values for the lifestyle ALRS were 2.00, 2.24 and 7.43. CONCLUSIONS: Intervention on selected hormonal and lifestyle risk factors might be more important for women with family history of ovarian and/or breast cancer.