Tissue reactions to cemented hip sockets Histologic and morphometric autopsy study of 25 acetabula

To gain an insight into the tissue reactions leading to noninfectious loosening, 25 autopsy specimens of acetabula with well-fixed cemented sockets were analyzed histomorphologically and morpho-metricaliy. The mean duration of the implant was 7 (0.2-16) years.

With the exception of some focal direct bone-cement contacts, bone and cement were separated by a soft tissue membrane which increased in thickness with increasing duration of the implant. Necroses in the membrane were also commoner with advancing implant time. The soft tissue membranes developed increasingly dense infiltrates of histiocytes, mainly containing wear particles of the bone cement and—though less abundant—polyethylene. The cancellous bone adjacent to the soft tissue membrane showed an increasing histiocytic infiltration with an increasing duration of the implant. The trabecular bone showed remodeling with formation of a neocortical layer parallel to the border of the cement mantle.     

Stem cell mobilization by granulocyte colony-stimulating factor in patients with acute myocardial infarction: a randomized controlled trial

Context  Experimental studies and early phase clinical trials suggest that transplantation of blood-derived or bone marrow–derived stem cells may improve cardiac regeneration and neovascularization after acute myocardial infarction. Granulocyte colony-stimulating factor (G-CSF) induces mobilization of bone marrow stem cells. Objective  To assess the value of stem cell mobilization by G-CSF therapy in patients with acute myocardial infarction. Design, Setting, and Patients  Randomized, double-blind, placebo-controlled trial of patients diagnosed with ST-segment elevation acute myocardial infarction who had successful reperfusion by percutaneous coronary intervention within 12 hours after onset of symptoms in Germany between February 24, 2004, and February 2, 2005. Interventions  Patients were randomly assigned to receive subcutaneously either a daily dose of 10 µg/kg of G-CSF or placebo for 5 days. Main Outcome Measures  The primary end point was reduction of left ventricular infarct size according to technetium Tc 99m sestamibi scintigraphy performed at baseline and at 4 to 6 months after randomization. Secondary end points included improvement of left ventricular ejection fraction measured by magnetic resonance imaging and the incidence of angiographic restenosis. Results  Of the 114 patients, 56 were assigned to receive treatment with G-CSF and 58 were assigned to receive placebo. Treatment with G-CSF produced a significant mobilization of stem cells. Between baseline and follow-up, left ventricular infarct size according to scintigraphy was reduced by a mean (SD) of 6.2% (9.1%) in the G-CSF group and 4.9% (8.9%) in the placebo group (P = .56) and left ventricular ejection fraction was improved by 0.5% (3.8%) in the G-CSF group and 2.0% (4.9%) in the placebo group (P = .14). Angiographic restenosis occurred in 19 (35.2%) of 54 patients in the G-CSF group and in 17 (30.9%) of 55 patients in the placebo group (P = .79). The most common adverse event among patients assigned to G-CSF was mild to moderate bone pain and muscle discomfort. Conclusion  Stem cell mobilization by G-CSF therapy in patients with acute myocardial infarction and successful mechanical reperfusion has no influence on infarct size, left ventricular function, or coronary restenosis. Clinical Trial Registration  ClinicalTrials.gov Identifier: NCT00126100      

Primary localized amyloidosis of the urinary bladder: a case series of 31 patients

OBJECTIVE: To evaluate the presentation and prognosis of primary localized amyloidosis of the urinary bladder. PATIENTS AND METHODS: The medical records of 31 patients with primary localized amyloidosis of the urinary bladder were reviewed. Immunohistochemical amyloid typing was performed on bladder biopsy specimens from 27 patients. RESULTS: The median age of the 22 men and 9 women was 55 years. Twenty-four patients (77%) presented with gross hematuria (associated with irritative urinary tract symptoms in 6 patients), and 7 (23%) had only irritative lower urinary tract symptoms. Multiple bladder areas were involved in 20 patients (65%), a single area was involved in 8 (26%), and diffuse involvement was present in 3 (10%). Twenty-four patients had immunoglobulin light chain, and 3 had transthyretin-related amyloid. Local recurrences were common. None of the patients developed systemic amyloidosis. CONCLUSION: Primary localized amyloidosis of the urinary bladder can be easily confused with a neoplasm. Immunohistochemical amyloid typing is important. Transthyretin-related amyloid of the bladder requires no further work-up. Repeated work-ups for systemic amyloidosis are unnecessary for patients with light chain-related amyloidosis of the urinary bladder. Early eradication with fulguration or laser therapy is indicated. Cystoscopic follow-up is necessary.     

Differential alteration of the nigrostriatal dopaminergic system in Wilson's disease investigated with [123I]ß-CIT and high-resolution SPET

Wilson's disease (WD) is a copper deposition disorder which can result in a number of extrapyramidal motoric symptoms such as parkinsonism. Therefore, this study was carried out to investigate, for the first time, nigrostriatal dopaminergic function in WD in relation to different courses and severity of the disease. Using high-resolution single-photon emission tomography (SPET) after administration of 2ß-carbomethoxy-3ß-(4[¹²³I]iodophenyl)tropane ([¹²³I]ß-CIT), striatal dopamine transporters (DAT) were imaged in 43 WD patients and a control group of ten subjects. From the SPET images, specific [¹²³I]ß-CIT binding ratios were obtained for the caudate heads, putamina and entire corpus striatum. In addition, to evaluate a putative dissociation between the caudate and putaminal [¹²³I]ß-CIT binding ratios, the ratio between these binding ratios was calculated (CA/PU ratio). The SPET data were compared with clinical data on the course of the disease (CD), the severity of neurological symptoms and the degree of hepatic alteration. Whereas the specific regional [¹²³I]ß-CIT binding ratios in patients with asymptomatic/hepatic CD did not differ from those in the control group (e.g. striatal ratios: 13.4Dž.0 vs 11.7DŽ.8), in patients with neurological CD the ratios were significantly reduced for all striatal substructures (P=0.003 after one-factor ANOVA). For the different subgroups a tendency was detected towards a stepwise decrease in the specific [¹²³I]ß-CIT binding ratios from pseudo-sclerosis CD (9.4DŽ.3), through pseudo-parkinsonian CD (9.1DŽ.1) to arrhythmic-hyperkinetic CD (8.5ǃ.6). However, these group differences reached significance only for the comparison with asymptomatic/hepatic CD (P=0.02). The CA/PU ratio was significantly higher in WD than in the control group (1.30ǂ.19 vs 1.11ǂ.08; P=0.003). Severity of neurological symptoms was significantly correlated with all specific regional [¹²³I]ß-CIT binding ratios (r=-0.49 to -0.57). For degree of liver alteration, significant correlations were obtained with the putaminal binding ratio (r=-0.37) and the CA/PU ratio (r=0.44). From these results is concluded that in WD the nigrostriatal dopaminergic function is compromised to varying extents. The degree of this presynaptic alteration of dopaminergic neurotransmission depends on the clinical course and severity of this copper deposition brain disorder and also varies in the different striatal substructures.     

Publication bias for CAM trials in the highest impact factor medicine journals is partly due to geographical bias

OBJECTIVE: To assess the presence of publication bias and its relation to geographical bias in clinical trials involving complementary and alternative medicine (CAM) published in the highest impact factor general medicine journals. STUDY DESIGN AND SETTING: All CAM clinical trials published in the four highest impact factor general medicine journals, Lancet and British Medical Journal (European), and New England Journal of Medicine and Journal of American Medical Association (U.S.), between 1965 and 2004 were abstracted using Medline. Three reviewers abstracted data from the individual studies. In a multivariate analysis, factors predictive of a positive study were assessed. RESULTS: A total of 259 studies met the inclusion criteria. CAM trials published in the European journals were significantly more likely to be positive compared to those published in the U.S. journals (76% vs. 50%, odds ratio [OR]=3.15, P<0.0001). Studies originating outside of the United States were significantly more likely to be positive compared to the U.S. studies (75% vs. 49%, P<0.0001). Adjusting for location and other variables in a multivariate model, the OR for European vs. U.S. journals to publish a positive CAM trial was 1.95 (P=0.11). CONCLUSION: Publication bias related to CAM trials among the highest impact factor general medicine journals is partly due to geographical bias.     

Complementary and alternative medicine: use and disclosure in radiation oncology community practice

Purpose  

The aims of this study were to evaluate the frequency of complementary and alternative medicine (CAM) use among radiation oncology patients, the coping strategies that influenced this use, and the rates of disclosure of CAM use to their healthcare providers.     

Scientific Impact Recognition Award: Molecular breast imaging: a review of the Mayo Clinic experience

Background

Molecular breast imaging (MBI) depicts functional uptake of targeted radiotracers in the breast using dedicated gamma cameras.

Methods

MBI studies were performed under several institutional protocols evaluating the use of MBI in screening and diagnosis.

Results

By using a single-head system, sensitivity for breast cancer detection was 85% (57 of 67) overall and 29% for tumors 5 mm or less in diameter. Sensitivity improved to 91% (117 of 128) overall and 69% for tumors 5 mm or less using a dual-head system. In 650 high-risk patients undergoing breast cancer screening, MBI detected 7 cancers, 5 of which were missed on mammography. In 24 of 149 (16%) breast cancer patients MBI detected additional disease not seen on mammography. The sensitivity of MBI was 88% (83 of 94) for invasive ductal carcinoma, 79% (23 of 29) for invasive lobular carcinoma, and 89% (25 of 28) for ductal carcinoma in situ.

Conclusions

MBI can detect invasive ductal carcinoma, ductal carcinoma in situ, and invasive lobular carcinoma. It has a promising role in evaluating the extent of disease and multifocal disease in the breast for surgical treatment planning.