The role of magnetic resonance imaging in diagnosis and management of breast cancer

A review of the literature on the current applications of breast magnetic resonance imaging (MRI) indications, their rationale and their place in diagnosis and management of breast cancer was given. Contrast-enhanced breast MRI is developing as a valuable adjunct to mammography and sonography. Its high sensitivity for invasive breast cancer establishes its superiority in evaluation of multifocality/multicentricity, tumor response to neoadjuvant chemotherapy, detection of recurrence, and staging. Emerging applications include spectroscopy, usage of new contrast agents, and MRI-guided interventions, including noninvasive treatment of breast cancer. Its potential benefit in screening high-risk women has yet to be established with prospective studies, particularly with regard to false positive results.     

Blood pressure patterns through consecutive pregnancies are influenced by body mass index

OBJECTIVE: The purpose of this study was to analyze the impact of parity and baseline body mass index on blood pressure levels in pregnancy. STUDY DESIGN: We studied a longitudinal historic cohort of 166 healthy pregnant women who gave birth in 2000 to a third child at the University Hospital of Lund; blood pressure measurements were obtained at each antenatal visit during the three consecutive pregnancies. RESULTS: The mean systolic and diastolic blood pressure levels were consistently higher during the first pregnancy at comparable weeks of gestation, significantly so during the third trimester. The body mass index correlated with diastolic blood pressure levels only in the first pregnancy, and the impact of parity on third trimester blood pressure levels was greatest in the women with a high body mass index. Age, smoking, change of paternity, or a short time interval between pregnancies did not influence blood pressure levels. CONCLUSION: The interrelationship among blood pressure levels, parity, and body mass index in normal pregnancy resembles the situation in hypertensive pregnancies, which implies common adaptive mechanisms.     

A Swedish population-based study on the relationship between the SF-36 and health utilities to measure health in hypertension

The aim of this study was to determine the relationship between a psychometric health-related quality-of-life instrument (the SF-36)-and two health utility measures [the time trade-off (TTO) and rating scale (RS) methods) among hypertensives in a general population. In the analyses were adjusted for co-morbidity. The study was based on a postal questionnaire that was sent to a random sample of 8000 inhabitants aged 20-84 years (response rate 68%) in Uppsala County, Sweden, in 1995. The results showed only a moderate correlation between the TTO and the RS methods. The different dimensions of SF-36 were overall lower correlated with the TTO method than with the RS method. Co-morbidity was not associated with the RS or the TTO method among hypertensives. The regression equations explained 58% of the variance in RS among hypertensives. The corresponding value for the TTO method was about 20%. In conclusion, our study found that among hypertensives the SF-36 is low to moderate correlated to the TTO and RS methods. Health utilities and psychometric measures represent different attributes of health. It is therefore important to be aware of the differences between psychometric and utility measures when interpreting results from studies using different methods. More work is needed to explicate if health utilities can be obtained from the SF-36.     

A gene in the telomeric HLA complex distinct from HLA-A is involved in predisposition to juvenile idiopathic arthritis

OBJECTIVE: Juvenile idiopathic arthritis (JIA) is associated with particular alleles at 3 different HLA loci: HLA-A, HLA-DR/DQ, and HLA-DP. These associations are independent of each other (i.e., they cannot be explained by the known linkage disequilibrium between alleles at these loci). The purpose of this study was to look for additional JIA susceptibility genes in the HLA complex. METHODS: One hundred two Norwegian JIA patients and 270 healthy individuals, all carrying the DQ4;DR8 haplotype, were investigated by scanning approximately 10 megabases of DNA covering the HLA complex with microsatellite polymorphisms. An expectation-maximization algorithm was used to estimate haplotype frequencies, and the distribution of microsatellite alleles on the high-risk DQ4;DR8 haplotype was compared between patients and controls, to exclude effects secondary to linkage disequilibrium with these susceptibility genes. RESULTS: Allele 5 at the microsatellite locus D6S265 (D6S265* 5), 100 kb centromeric of HLA-A, showed a strong positive association with the disease (odds ratio 4.7, corrected P < 10(-6)). Haplotype analysis demonstrated that the D6S265*5 association was not caused by linkage disequilibrium to the gene encoding HLA-A*02, which has previously been reported to be associated with JIA. Instead, our data suggested that a gene in linkage disequilibrium with D6S265*5, but distinct from HLA-A*02, is involved in the predisposition to JIA. CONCLUSION: We found that D6S265*5 could be a marker for an additional susceptibility gene in JIA which is distinct from A*02, adding to the risk conferred by DQ4;DR8.     

Lumbar spine radiography: digital flat-panel detector versus screen-film and storage-phosphor systems in monkeys as a pediatric model

PURPOSE: To assess image quality and exposure dose requirements of a flat-panel detector system versus screen-film and storage-phosphor systems for radiographic depiction of the lumbar spine in Cynomolgus monkeys as a pediatric model. MATERIALS AND METHODS: Twenty Cynomolgus monkeys underwent anteroposterior radiography of the lumbar spine. The size and weight of these monkeys are comparable to those of infants 3-4 months of age. Images were acquired with speed class 400 screen-film, flat-panel, and storage-phosphor systems with identical exposure dose. All other conditions were matched exactly. Additional images were acquired with the flat-panel and storage-phosphor systems at exposure doses equivalent to speed classes 800 and 1600. All images were obtained at 66 kVp without antiscatter grid. Images were assessed independently by three radiologists for visibility of 60 anatomic structures by using a five-point confidence scale. Scores were calculated for the seven combinations of imaging mode and exposure dose and were compared by using the Friedman test. RESULTS: Scores were 1.70 (speed class 400), 1.97 (speed class 800), and 2.27 (speed class 1600) for the flat-panel system; 2.50 (speed class 400) for the screen-film system; and 2.58 (speed class 400), 2.77 (speed class 800), and 3.13 (speed class 1600) for the storage-phosphor system. Scores for the flat-panel system at speed classes 400 and 800 were significantly lower (indicating better visibility) than those of the screen-film and storage-phosphor systems (P <.05). CONCLUSION: The flat-panel system is superior to screen-film and storage-phosphor systems in lumbar spine radiography in monkeys. With the flat-panel system, exposure dose can be reduced by 75% without loss in image quality.     

Brachytherapy for prostate cancer: a systematic review of clinical and cost effectiveness

OBJECTIVES: Brachytherapy is emerging as a new treatment option for prostate cancer, and is increasingly being used in Europe and North America. METHODS: A systematic review of studies that compared clinical or cost effectiveness of prostate brachytherapy with radical prostatectomy or external beam radiation for patients with localised prostate cancer. RESULTS: No randomised controlled trials were identified, but five observational studies with comparable patient groups were included in the review. There were no valid data on overall or disease-free survival. There was no difference in disease-free survival based on PSA as a surrogate measure, or in rates of complications. No cost effectiveness studies were found. Based on Norwegian data, the one-year cost of the three treatment options seem fairly similar, while long term cost data are lacking due to lack of data on long term clinical outcome. CONCLUSION: The evidence on the clinical effectiveness of therapies for localised prostate cancer is scarce, but the outcome appears to be comparable for radical prostatectomy, external beam radiotherapy and brachytherapy.     

The validity of self-reported leisure time physical activity,and its relationship to serum cholesterol,blood pressure and body mass index. A population based study of 332,182 men and women aged 40-42 years

The importance of leisure time physical activity as a health indicator became more obvious after the results of large prospective studies were published. The validity of these results depends upon both the selection of the active individuals and to what extent self-reported physical activity reflects the individual's true activity. The purpose of this paper is to describe the changes in self-reported physical activity, and to assess the relation between this variable and other biological risk factors such as blood lipids, blood pressure and body mass index (BMI). This report also aims at corroborating the validity of self-reported physical activity by assessing the consistency of the associations between these biological risk factors and physical activity during a 25-years period. The basis for this analysis is a long lasting observational study with a questionnaire as the most important research instrument, in addition to physiological and biological factors such as BMI, blood pressure and blood lipids. The study population consists of 332,182 individuals, aged 40–42 from different counties in Norway who were invited to participate in health survey during 1974–1999. The objectives of this study are (1) to describe changes in self-reported physical activity from 1974 to 1999; (2) to assess the relation between physical activity and the biological variables; and (3) to corroborate the validity of the variable physical activity by assessing the consistency of the above analysis. The results of the analyses of association between decade of birth and self-reported physical activity show that physical activity among 40-aged individuals decreased during 1974–1999. This trend is stronger among the men. Multivariate analyses revealed differences in BMI and serum cholesterol between levels of self-reported physical activity, gender, smoking habits and decade of birth. The explained percentage of the total variance ranged from 6% for BMI to 7% for serum cholesterol. The similar shape of serum cholesterol and BMI according to physical activity indicates that the validity of self-reported physical activity has remained stable over these 25 years. Furthermore, the analysis of covariance showed that the slopes relating year of birth and serum cholesterol and BMI are parallel for self-reported physical activity thus the validity of the variable is confirmed.     

An automatic dose dispenser for microtablets--a new concept for individual dosage of drugs in tablet form

A new concept for individualising the dosage of drugs in solid form is presented. The principle is based on the use of standardised units (microtablets), each containing a subtherapeutic amount of the active ingredient. The required dose is fine-tuned by counting out a specific number of these units. The microtablets are counted electronically from the attached cassette by the automatic dispensing device. The individual dose is set and the dispenser counts and delivers the correct number of microtablets. The usefulness of the automatic dispenser concept and acceptability of the apparatus were evaluated in patients with Parkinson's disease (PD). After initial instruction on use of the dispenser, 20 patients operated it themselves. All patients were generally satisfied with their management of the automatic dispenser and most would be happy to use the device again. Further technical development is required before use in clinical practice, but the current prototype may be acceptable for some patients. It is concluded that the final version of the automatic dose dispenser concept will offer potential for improvement of drug administration for patients with PD or other diseases requiring individual dosage.