Prostate cancer after heart transplantation: unicenter case-control study.

BACKGROUND: We have noted an unexpectedly high incidence of prostate cancer in our heart transplant recipients (HTR). METHODS: We conducted a retrospective review of patients after heart transplantation to investigate the prevalence, treatment, and outcome of prostate cancer diagnosed after systematic screening (study group). We compared them with case-matched HTR (control). RESULTS: Among 702 recipients, 15 patients had elevated prostate-specific antigen (PSA) levels. Fourteen cases of prostate cancer were diagnosed and treated. The median time between transplantation and prostate cancer diagnosis was 73 months. No patient was diagnosed in a locally advanced (>T2) or metastatic stage. Eleven patients (78.6%) received curative treatment. During follow-up (median, 44 months), 1 patient died from prostate cancer. The survival rate between the study and control groups did not differ. CONCLUSION: Routine PSA testing is recommended as a screening test for prostate cancer in patients after heart transplantation. We believe this could also result in detection of early stages of prostate cancer, thus allowing curative treatment, and achieving similar survival to other case-matched HTR with no prostate cancer.     

Polarized Light-Emitting Diode Magnification for Optimal Recipient Site Creation during Hair Transplant

Background. For several years, magnification has been used to separate follicular groupings from donor strips to minimize transection of hair follicles. There has been no discussion regarding the use of magnification to create recipient sites to limit transection of existing hair follicles in recipient zones.
Objective. The study was performed to evaluate the role of magnification when creating hundreds or thousands of recipient sites in patients with existing hair.
Methods. A 2× magnified polarized light-emitting diode (LED) for graft and recipient site creation (Syris Scientific, Gray, Maine) was used in 75 consecutive male and female patients. A team of four experienced surgical assistants and the author evaluated the device for graft creation, recipient site creation, and insertion of grafts.
Results. There was no perceived advantage in creating grafts or placing grafts compared with other magnification devices and traditional methods. There was less eye strain and greater ease in creating recipient sites using polarized magnification compared with traditional surgical lights and no magnification.
Conclusion. In an era of medications that slow or stop hair loss, magnification in recipient sites can reduce transection of existing hair follicles in recipient zones, leading to maximum density from a procedure. Further studies are needed to confirm the reduced transection rate of hair follicles and determine the ideal magnification. The use of magnification with LED polarized light in the recipient zone is an important new tool in hair transplant.     

Development and results of the Spanish registry of patients with alpha-1-antitrypsin deficiency

The Spanish registry of alpha-1 antitrypsin deficiency was founded in 1993 and became a member of the International Registry (AIR) in 1999. We describe the updating process following its incorporation into AIR and compare the data collected in the first period (1993–1999) and the second period (1999–2005), during which time patients were included exclusively by internet.The registry included 301 patients during period 1, 69% males and 46% had a history of smoking. Their mean age was 46 years (SD = 13) and 284 (94%) had the ZZ phenotype, 49% received augmentation therapy. During period 2, 161 new cases were included, 63% of whom were males with a mean age of 44 years (SD = 16). A total of 126 (78%) had the ZZ phenotype. Only 12% received augmentation therapy. A total of 462 different patients were included in both periods. Significant differences were observed in the number of cases with the SZ phenotype and the severity of FEV₁ impairment between the two periods.Implementation of an internet-based collection of data did not result in a lower rate of reporting to the registry. However, data from a significant number of patient included in period 1 could not be actualized in the new data base.     

The tuberous breast revisited.

BACKGROUND: The tuberous breast presents a problem for which many surgical solutions have been described. Current teaching describes how the tuberous breast deformity is the result of skin shortage as well as herniation of breast tissue through the nipple-areola complex. However, through careful clinical observation we now believe that the only abnormality present is herniation of breast tissue through the nipple-areola complex. METHODS: Using this principle, we have refined a one-stage surgical procedure that can be used to correct any type of tuberous breast deformity. Since 2001 we have performed our technique on a series of 13 tuberous breasts of widely varying appearances in eight patients (age 17-24 years) with a follow up varying between 3 and 56 months. Our new understanding of the tuberous breast deformity has also made it possible to develop an objective, reproducible method for defining the tuberous breast based on the degree of areola herniation. RESULTS: All patients reported high levels of satisfaction with the procedure. Assessment of the results by an independent panel of attending surgeons showed all results to be good/excellent. Moreover, the results have improved with time and no revisions have been needed. Our method of defining the tuberous breast (based on the ratio of areola herniation:areola diameter) enabled us to identify a cut-off to decide (objectively) when a breast was tuberous. This allowed us to anticipate when an areola reduction/tightening procedure would be necessary to avoid a 'double-bubble' deformity. CONCLUSION: We propose a one-stage surgical procedure which is applicable to all degrees of tuberous breast deformity. The results appear to confirm our theory that the only abnormality present in the tuberous breast is herniation of breast tissue through the nipple-areola complex. In patients with small breasts and a tuberous deformity, correction of the herniation changes the tuberous breast into a simple hypoplastic breast. The volume deficit can then be corrected by augmentation (if desired by the patient). In patients with sufficient breast volume, correction of the herniation alone will correct the deformity.     

Two great cardiac veins: demonstration by computed tomography, conventional coronary angiography, and during surgery

A 62-year-old man with typical angina pectoris was referredfor imaging of the coronary arteries to detect stenoses. Multislicecomputed tomography (CT) demonstrated significant     

A large mediastinal tumour?

A 72-year-old man with increasing shortness of breath and atypicalangina pectoris received a chest radiograph     

The oral health and treatment needs of community‐dwelling older people in a rural town in Western Australia

Objectives: The aim of this study was to assess, in a sample of older rural community‐dwelling Australians, their: oral health status, dental treatment needs, perceived barriers to access dental services and the prevalence and severity of dental anxiety. Methods: A cross‐sectional study of elderly rural Australians. Results: Eighty participants (mean age of 71.7 years) had a mean number of 0.69 (SD 1.6) decayed teeth, 15.72 (SD 13.3) missing teeth and 3.9 (SD 5.4) filled teeth. Forty‐one per cent were edentulous. Xerostomia was reported by 53% of the edentulous and 43% of the dentate. The average Corah Dental Anxiety Scale score was 8.72 (SD 3.8). Prevalence of dental anxiety was 15.6%. Two‐thirds needed dental treatment. Conclusions: Caries experience was lower than that reported in other studies. Reported barriers to use of dental services were long waiting times, lack of perceived dental need and costs.     

Synthesis and antimalarial activity of new atovaquone derivatives

In this paper we describe the design and synthesis of 18 derivatives of the antimicrobial atovaquone which were substituted at the 3-hydroxy group by ester and ether functions. The compounds were evaluated in vitro for their activity against the growth of Plasmodium falciparum, the malaria causing parasite. All the compounds showed potent activity, with IC₅₀ values in the range of 1.25–50 nM, comparable to those of atovaquone and much higher than chloroquine or quinine.     

Performance in population models for count data,part II: A new SAEM algorithm

Analysis of count data from clinical trials using mixed effect analysis has recently become widely used. However, algorithms available for the parameter estimation, including LAPLACE and Gaussian quadrature (GQ), are associated with certain limitations, including bias in parameter estimates and the long analysis runtime. The stochastic approximation expectation maximization (SAEM) algorithm has proven to be a very efficient and powerful tool in the analysis of continuous data. The aim of this study was to implement and investigate the performance of a new SAEM algorithm for application to count data. A new SAEM algorithm was implemented in MATLAB for estimation of both, parameters and the Fisher information matrix. Stochastic Monte Carlo simulations followed by re-estimation were performed according to scenarios used in previous studies (part I) to investigate properties of alternative algorithms (Plan et al., 2008, Abstr 1372 []). A single scenario was used to explore six probability distribution models. For parameter estimation, the relative bias was less than 0.92% and 4.13% for fixed and random effects, for all models studied including ones accounting for over- or under-dispersion. Empirical and estimated relative standard errors were similar, with distance between them being <1.7% for all explored scenarios. The longest CPU time was 95 s for parameter estimation and 56 s for SE estimation. The SAEM algorithm was extended for analysis of count data. It provides accurate estimates of both, parameters and standard errors. The estimation is significantly faster compared to LAPLACE and GQ. The algorithm is implemented in Monolix 3.1, (beta-version available in July 2009).