3-D reconstructed magnetic resonance imaging in localization of subdural EEG electrodes. Case illustration

We report an illustrative case of presurgical evaluation for epilepsy surgery, where the three-dimensional reconstructed magnetic resonance imaging played a pivotal role in determining the exact location of the subdural strip electrodes in temporomesial area. The tip of one the frontal strip electrodes was actually recording the temporopolar ictal activity. This contributed conclusively to the decision for surgical treatment and to the excellent outcome.     

Eleven-year trends of stroke in Turku,Finland

The Turku Stroke Register included stroke events at all ages during the years 1982-1992. The incidence of stroke declined in all age groups, even in the oldest one. An even steeper decline was observed in mortality from stroke. Ischemic strokes contributed most to the observed decline, while subarachnoid and intracerebral hemorrhage showed mainly flat trends. Flat trends were also observed for recurrent strokes. The absolute number of strokes remained stable through the study years, but the population above 75 years of age doubled. More than half of the strokes occurred in people aged 75 years or older, and three fourths of them occurred in women. The incidence and mortality rate of ischemic stroke declined steeply in all age groups. Due to an increase in elderly people in the background population, the total number of strokes remained stable. Thus, in spite of the observed declining trends in incidence, the need for stroke care has not diminished.     

The diabetes risk score: a practical tool to predict type 2 diabetes risk

OBJECTIVE: Interventions to prevent type 2 diabetes should be directed toward individuals at increased risk for the disease. To identify such individuals without laboratory tests, we developed the Diabetes Risk Score. RESEARCH DESIGN AND METHODS: A random population sample of 35- to 64-year-old men and women with no antidiabetic drug treatment at baseline were followed for 10 years. New cases of drug-treated type 2 diabetes were ascertained from the National Drug Registry. Multivariate logistic regression model coefficients were used to assign each variable category a score. The Diabetes Risk Score was composed as the sum of these individual scores. The validity of the score was tested in an independent population survey performed in 1992 with prospective follow-up for 5 years. RESULTS: Age, BMI, waist circumference, history of antihypertensive drug treatment and high blood glucose, physical activity, and daily consumption of fruits, berries, or vegetables were selected as categorical variables. Complete baseline risk data were found in 4435 subjects with 182 incident cases of diabetes. The Diabetes Risk Score value varied from 0 to 20. To predict drug-treated diabetes, the score value >or=9 had sensitivity of 0.78 and 0.81, specificity of 0.77 and 0.76, and positive predictive value of 0.13 and 0.05 in the 1987 and 1992 cohorts, respectively. CONCLUSIONS: The Diabetes Risk Score is a simple, fast, inexpensive, noninvasive, and reliable tool to identify individuals at high risk for type 2 diabetes.     

Automated image analysis of proliferating cells in carcinoma of the larynx

OBJECTIVE: To determine the role of cell proliferation neoplastic progression in the larynx and possibly derive criteria of clinical significance using automated quantitative image analysis. MATERIAL AND METHODS: In a retrospective study involving archival material, the occurrence and location, size, shape and staining intensity of proliferating cell nuclear antigen (PCNA)-positive cells (12,538 cells in total) were analyzed in squamous cell carcinoma (SCC), as well as in pre- and non-neoplastic conditions, using computer-assisted morphometry with reproducibility and sensitivity exceeding 99%. RESULTS: Immunohistochemically detectable PCNA-positive cells were located in the basal layer in non-neoplastic states, in well-differentiated SCCs in layers adjacent to the basal membrane and in poorly differentiated neoplasms in the neoplastic epithelial islets. An increased degree of dysplasia was associated with an increased number of PCNA-immunoreactive cells of increased nuclear size and staining intensity. There was a significant difference between carcinomas and dysplasia in terms of altered nuclear shape. With increasing malignancy of SCCs, nuclear shape alterations and PCNA staining intensity increased, whilst nuclear size decreased. CONCLUSIONS: Automated image analysis of cell populations allowed the identification of populations of malignant cells and provided information on the severity of preneoplastic and neoplastic conditions of use in studies of tumor behavior and with potential clinical application.     

Social predictors of adult asthma: a co-twin case-control study

BACKGROUND: Environmental factors are needed to explain the observed increase in the prevalence of asthma during recent decades, despite the existence of a recognised genetic component in asthma. A co-twin case-control study was undertaken to examine possible social risk factors for asthma. METHODS: Asthma diagnoses were based on register data of reimbursed asthma medication. During 17 years follow up of the Finnish twin cohort, 262 twin pairs discordant for incident asthma were identified. Conditional logistic regression for 1-1 matched data was used for risk calculation. RESULTS: The atopic twin had an increased risk of asthma compared with the non-atopic co-twin (RR 2.91, 95% CI 1.81 to 4.68). The more educated twin had a decreased risk of asthma compared with his/her twin sibling with less education (RR 0.45, 95% CI 0.23 to 0.86), and the twin who participated in conditioning exercise had a decreased risk of asthma compared with the more sedentary co-twin (RR 0.55, 95% CI 0.34 to 0.88). CONCLUSIONS: In addition to allergic diseases, educational level and physical activity are associated with adult onset asthma, which indicates a role for factors associated with life style.     

Personality and mood of former elite male athletes--a descriptive study

The purpose of this study was to describe the personality and mood of former athletes in middle and old age. The subjects were male athletes who represented Finland from 1920 to 1965 and male referents who were classified as healthy at 20 years of age. The athletes were classified into a total of five athlete groups (endurance, power/combat, power/individual, team, shooting) and one reference group. Four personality scales (extroversion, neuroticism, life satisfaction, and hostility) were used in a baseline questionnaire in 1985 (athletes N = 1040, referents N = 777). Anxiety and depression were assessed in a follow-up in 1995 (athletes N = 758, referents N = 578) with a shortened version of the BSI-53 symptom inventory. According to ANCOVA there were group differences in extroversion, neuroticism, and life satisfaction but not in hostility. Athletes who had participated in power/combat sports and team sports were more extroverted than referents. Endurance sport and shooting sport athletes had lower neuroticism scores than the referents. Endurance, power/combat, team and shooting sport athletes were more satisfied with their lives than were the referents. Discriminant analysis mainly supported these findings. Differences regarding depression were also statistically significant between the groups as referents were more depressed than endurance sport and team sport athletes. No group differences in anxiety were found. The subjects described in this study are unique in number of respects. Bearing in mind the limitations of the study subjects, it is concluded that former athletes differ from nonathletes in some personality characteristics and depression.     

The 12-month prevalence and risk factors for major depressive episode in Finland: representative sample of 5993 adults

OBJECTIVE: This study reports the 12-month prevalence of major depressive episode and its risk factors in a representative nationwide sample. METHOD: A random sample of non-institutionalized Finnish individuals aged 15-75 years (N = 5993) was interviewed in 1996. Major depressive episode during the last 12 months was assessed using the Short Form of the University of Michigan version of the Composite International Diagnostic Interview (the UM-CIDI Short Form). RESULTS: The population prevalence of major depressive episode was 9.3% [95% CI 8.5,10.0], and the age-adjusted prevalences for females and males were 10.9% [95% CI 9.7,12.0] and 7.2 [95% CI 6.2,8.2], respectively. In logistic regression analyses the factors associated with major depressive episode after adjustment for age were urban residency, smoking, alcohol intoxication and chronic medical conditions. In addition, being single and obese were found to be risk factors for males. CONCLUSION: The female to male risk ratio for major depressive episode was smaller than in many previous studies. The sex-specific risk factor associations warrant further investigation into sex differences in depression.     

Genetic predisposition, environment and cancer incidence: a nationwide twin study in Finland, 1976-1995

Twin studies integrate genetic and environmental (including physical environment and life-style) information by comparing monozygotic and dizygotic twins for the occurrence of disease. Our objectives were to compare cancer incidence in twins with national rates and to estimate both the probability that co-twins of affected twins may develop cancer and the importance of genetic predisposition and environment in cancer development. The nationwide record linkage of the Finnish Twin Cohort Study, the Finnish Cancer Registry and the Central Population Register allowed the follow-up of 12,941 same-sexed twin pairs for incident primary cancers from 1976 to 1995. Zygosity was determined by use of a validated questionnaire in 1975. Methods included calculation of standardized incidence ratios and concordances and fitting of structural equation models. A total of 1,613 malignant neoplasms occurred in the cohort. The overall cancer incidence among twins resembled that among the general population. Monozygotic co-twins of affected twins were at 50% higher risk than were dizygotic co-twins. Based on genetic modeling, inherited genetic factors accounted for 18% (95% confidence interval 4-32%) of the liability in inter-individual variation in the risk of overall cancer, while non-genetic factors shared by twins accounted for 7% (0-16%) and unique environmental factors for 75% (65-85%). Our results appear to exclude a contribution greater than one-third for genetic predisposition in the development of cancer in the general population, thus pointing to the earlier confirmed substantial role of environment.     

Randomized, placebo-controlled trial of clodronate in patients with primary operable breast cancer.

PURPOSE: The development of bone metastases depends on tumor-induced osteoclastic resorption of bone, which may be inhibited by the antiosteolytic bisphosphonate clodronate. Given to patients with primary breast cancer, clodronate might reduce the subsequent incidence of bone metastases. PATIENTS AND METHODS: This double-blind, multicenter trial accrued 1,069 assessable patients with operable breast cancer between 1989 and 1995. All patients received surgery, radiotherapy, chemotherapy, and tamoxifen as required. Patients were randomized to receive oral clodronate 1,600 mg/d or a placebo for 2 years starting within 6 months of primary treatment. The primary end point was relapse in bone, analyzed on an intent-to-treat basis, during the medication period and during the total follow-up period (median follow-up, 2,007 days). Secondary end points were relapse in other sites, mortality, and toxicity. RESULTS: During the total follow-up period, there was a nonsignificant reduction in occurrence of bone metastases (clodronate, n = 63; placebo, n = 80; hazards ratio [HR], 0.77; 95% confidence interval [CI], 0.56 to 1.08; P =.127). During the medication period there was a significant reduction in the occurrence of bone metastases (clodronate, n = 12; placebo, n = 28; HR, 0.44; 95% CI, 0.22 to 0.86; P =.016). The occurrence of nonosseous metastases was similar (clodronate, n = 112; placebo, n = 128; P =.257), but there was a significant reduction in mortality (clodronate, n = 98; placebo, n = 129; P =.047) during the total follow-up period. CONCLUSION: Clodronate, given to patients with primary operable breast cancer, may reduce the occurrence of bone metastases, although this reduction was only significant during this medication period. There was a significant reduction in mortality.     

ADH4 gene variation is associated with alcohol and drug dependence: results from family controlled and population-structured association studies

We found strong associations between ADH4 gene variation and alcohol and drug dependence by the Hardy-Weinberg Disequilibrium (HWD) test and case-control association analysis in an initial study. The present study aimed to confirm these findings by controlling for population stratification and admixture effects to which the HWD test and case-control association methods may be vulnerable. In addition to 365 unrelated healthy controls and 560 unrelated cases in the initial study, we evaluated 104 small nuclear families with affected offspring who had diagnoses of alcohol and/or drug dependence. Seven single nucleotide polymorphisms (SNPs) at the ADH4 gene locus were genotyped in all subjects, and 38 unlinked ancestry-informative markers were also genotyped in unrelated cases and controls. Structured association analysis demonstrated that the genotypes of six ADH4 markers were associated with alcohol dependence, and all seven ADH4 markers were associated with drug dependence (P=10-0.047). Logistic regression analysis showed that: (i) the genotypes of SNP2 (rs1042363) were significantly associated with alcohol dependence and drug dependence (mainly cocaine dependence), and the genotypes of SNP3 (rs1126671) were also significantly associated with alcohol dependence and (ii) one seven-variant haplotype and one diplotype were significantly associated with alcohol dependence and other seven-variant diplotypes were significantly associated with drug dependence (including cocaine and opioid dependence). Transmission disequilibrium test, haplotype-based haplotype relative risk and genotype-based haplotype relative risk analyses all confirmed the association of the ADH4 markers with alcohol dependence and drug dependence. Using rigorous study designs that account for possible population stratification, these findings confirm and extend our original observations indicating that variation at ADH4 predisposes to alcohol and drug dependence.