Erfassung der globalen Herzfunktion mit Real-time-trueFISP in einer Atemphase

Real-time multislice cine techniques lead to inaccurate results in ventricular volumes based on limited temporal resolution. The purpose of the study is to evaluate a real-time cine technique with parallel imaging algorithms in comparison to standard segmented techniques. Twelve patients underwent cardiac cine MRI using real-time multislice cine trueFISP. Temporal resolution was improved using parallel acquisition techniques (iPAT) and data acquisition was performed in a single breath-hold along the patients' short axis. Evaluation of EDV, ESV, EF and myocardial mass was performed and results compared to a standard segmented single-slice cine trueFISP. Combination of real-time cine trueFISP and iPAT provided a temporal resolution of 48 ms. Results of the multislice approach showed an excellent correlation to standard single-slice trueFISP for EDV (0.94, p <0.001), ESV (0.97, p <0.001) EF (0.99, p <0.001) and myocardial mass (0.93, p <0.001). No significant differences could be found. The use of parallel acquisition techniques (PAT) allow for a substantial improvement of temporal resolution in real-time cine MRI (<50 ms). Therefore these techniques enable an accurate and exact quantification of global ventricular function.     

Lay referral patterns involved in cardiac treatment decision making among middle-aged and older adults

PURPOSE: This study examined age and contextually related factors that are influential in lay referral patterns during cardiac treatment decision making. DESIGN AND METHODS: A complementary design was used. The Myocardial Infarction (MI) Onset Study identified demographic correlates of who sought medical care for 1,388 MI (heart attack) survivors. Thirty-five in-depth MI illness narratives explicated lay referral patterns. RESULTS: Data revealed a linear association between older age and reliance on another person to seek medical attention for cardiac symptoms, with gender also shaping lay referral patterns. Although spouses and children were the most frequently cited decision makers for older respondents, friends and other family members also influenced care-seeking decisions. Qualitative results substantiated and provided explanations for such patterns. IMPLICATIONS: Our results highlight the need for researchers to attend to the complex social processes of lay consultation and for health education messages to extend to venues where lay cardiac decisions are made, including the worksite and social gathering places such as religious institutions. Enhanced outreach includes tailoring health messages to elders and their significant others and casting a broader net to include nontraditional significant others.     

Hospitalized patients' views on in-ward psychological counseling

This qualitative study explores the feelings and beliefs of patients hospitalized in an orthopedic rehabilitation ward for receiving psychological help in that setting. Semi-structured interviews with 10 hospitalized patients were audiotaped, transcribed verbatim, and analyzed using interpretative phenomenological analysis (IPA). Themes of an approach-avoidance conflict towards receiving psychological help were identified, some of them unique to the hospital setting. Approach tendencies were associated with high psychological distress, awareness of free accessibility, and beliefs in body-mind relationship. Avoidance tendencies were associated with fears of psychotherapy, misconceptions, and perceived threats to one's independence and self-esteem. The implications of these findings for the provision of psychological counseling in hospital settings are discussed.     

Carcinosarcoma of the urinary bladder: dynamic contrast-enhanced MR imaging with clinical and pathologic correlation

OBJECTIVE: This article describes the MR imaging features of carcinosarcoma of the urinary bladder with clinical presentation and pathologic correlation in three adults. CONCLUSION: Carcinosarcoma of the urinary bladder is a rare and aggressive tumor that has a clinical presentation similar to that of transitional cell carcinoma of the bladder. Dynamic gadolinium-enhanced MR imaging features are discussed.     

The seroepidemiology of Lyme borreliosis in zoo animals in Germany

We conducted the first seroepidemiological study to evaluate the exposure of zoo animals to Borrelia burgdorferi s.l. in German zoos and wildlife parks. A total of 1487 individuals representing 148 ungulate and carnivore species belonging to 19 families were examined using a non-species dependent ELISA. Specific antibodies were detected in 154 (10.4%) animals; 168 (11.3%) sera produced borderline results. The percentage of seropositive individuals was related to species and origin (zoo), and increased with age of the animals. Sex and season did not influence seroprevalence. Examination of 600 ticks (Ixodes ricinus; caught from vegetation in the zoos) by darkfield microscopy and indirect immunofluorescence technique revealed infection rates within the range typical for Central Europe. The results substantiate that there is an infection risk for zoo animals. A differential diagnosis of Lyme borreliosis should be taken into account in case of suspicious clinical symptoms and possible contact to ticks.     

Value of various imaging modalities for diagnostic work-up of tumors of the adrenal gland

OBJECTIVE: This paper describes the value of various imaging modalities for diagnostic work-up of tumors of the adrenal gland. METHODS: Results of the literature are reviewed. An optimized examination protocol for computed tomography (CT) and magnetic resonance imaging (MRI) is shown for assessment and differentiation of unclear lesions of the adrenal gland. RESULTS: Measurements of attenuation in the native examination as well as delayed enhancement are the cornerstones in the CT diagnostics of tumors of the adrenal gland. In MRI, chemical-shift imaging and evaluation of signal characteristics in T1- and T2-weighted images are most important for characterization even in unclear cases. CONCLUSION: CT and MRI play the major role in imaging of adrenal gland tumors.Whereas CT is less expensive and widely available,MRI provides advantages in unclear cases because of the excellent tissue contrast and the superior characterization.     

Breast cancers among very young premenopausal women (United States)

Objective: To assess risk factors for breast cancer among very young compared to older premenopausal women. Methods: Between 1990 and 1992 a population-based case–control study conducted in Atlanta, GA, Seattle/Puget Sound, WA, and central NJ interviewed 3307 premenopausal women aged 20–54 years. Logistic regression models estimated adjusted relative risks (RR) and 95% confidence intervals (CI) for each of three 10-year age groups. Results: Among the youngest age group (<35 years, n = 545), significant predictors of risk included African-American race (RR = 2.66; 95% CI 1.4–4.9) and recent use of oral contraceptives (RR = 2.26; 95% CI 1.4–3.6). Although these relationships were strongest for estrogen receptor-negative (ER–) tumors (RRs of 3.30 for race and 3.56 for recent oral contraceptive use), these associations were also apparent for young women with ER+ tumors. Delayed childbearing was a risk factor for ER+ tumors among the older premenopausal women (p _trend < 0.01), but not for women <35 years in whom early childbearing was associated with an increased risk, reflecting a short-term increase in risk immediately following a birth. Family history of early-onset breast cancer was more strongly associated with risk among women <35 years (RR = 3.22) than those 45–54 years (RR = 1.51). Risk factors for premenopausal breast cancer not significantly modified by age at diagnosis included early age at menarche, low body mass index, and heavy alcohol consumption. Conclusion: These findings suggest the possibility that women who develop breast cancers at very young ages may be etiologically as well as clinically distinct.