Mammographic surveillance of asymptomatic breast cancer relatives in general practice: rate of re-attendance and GP- and patient-related barriers

BACKGROUND: Several guidelines have been formulated for mammographic screening of breast cancer relatives. No studies have examined the adherence of GPs and their patients to these recommendations. OBJECTIVES: We aimed to determine the rate of re-attendance of breast cancer relatives for mammographic screening requested by GPs and specify the barriers for non-attending follow-up mammography. METHODS: The study included all asymptomatic women aged 35 years or older with a first-degree family history of breast cancer, referred for mammography to our department of radiology by their GP between 1 January 1992 and 1 September 1994. Reasons for not re-attending mammography within 2 years were obtained by sending a questionnaire to GPs and, if necessary, telephone calls to GPs or their patients. The questionnaire was accompanied by a reminder, in which we advised re-attendance. The number of women who still underwent repeated mammographic screening within the 2 months following the reminder was determined. RESULTS: In 123 out of 234 patients (52.6%) follow-up mammography had been performed within 2 years. Barriers to undergoing follow-up mammography were GP-related in 70.3% of cases and patient-related in 29.7%. Of the 111 non-re-attenders, 52 (47.7%) still underwent follow-up mammography within 2 months after the reminder. This examination was performed more often if the barriers to re-attendance were GP-related rather than patient-related (57.7% versus 24.2%, 95% confidence interval (CI) 13.0- 53.9). Significantly more patients re-attended after the reminder if the GP-related barrier was an insufficient retrieval system rather than disagreement with mammography guidelines (81.3% versus 20.0%, 95% CI 40.4-82.0). CONCLUSIONS: Many breast cancer relatives did not undergo regular mammographic screening. Non-re-attendance resulted from a limited degree of acceptance and implementation of the screening recommendations by physicians as well as reluctance of the patient to adhere to such recommendations. A reminder, generated by a radiology department, may increase the performance of follow-up mammography.      

Chlorination of drinking water in Spain and bladder cancer

Objectives: Drinking water chlorination generates trihalomethanes and other by-products with mutagenic and carcinogenic properties in animal experiments. Epidemiological studies have associated trihalomethanes to an increased risk of bladder cancer. We evaluate trihalomethane levels in four Spanish areas and calculate the bladder cancer risk attributable to this exposure.Methods: Trihalomethanes have been analysed in 111 drinking water samples from four Spanish areas using gas chromatography. Water utilities were contacted and information on drinking water consumption in Spain has been collected. We reviewed the epidemiological studies that assess the association between bladder cancer risk and exposure to chlorination by-products. Attributable risk was calculated on the basis of these levels, mortality data per area and risk estimates obtained from the literature.Results: Mediterranean areas present the highest levels of trihalomethanes with 81, 80, 61 and 52 μg/l in Sabadell, Alicante, Barcelona and Manresa respectively. Lower levels are found in Tenerife and Asturias with 7 and 20 μg/l respectively. The bladder cancer attributable risk in high trihalomethane exposure areas may be, on average, around 20%.Conclusions: The trihalomethane levels found are high compared to those of other European Union countries. In the high exposure areas, drinking water chlorination may generate a considerable number of bladder cancer cases. These estimations have to be carefully interpreted and verified with more extensive studies.     

Mechanisms for the Release and Redistribution of 2,4,5,2',4',5'-Hexachlorobiphenyl (6-CB) from Hepatic Tissues in the Rat

Mechanisms for the Release and Redistribution of 2,4,5,2',4',5'-Hexachlorobiphenyl(6-CB) from Hepatic Tissues in the Rat. RAU, L. A., AND VODICNIK,M. J. (1986). Fundam Appl. Toxicol. 7, 494-501. The translocationof 6-[¹⁴C]CB from rat hepatic tissues to various media was studiedemploying in situ hepatic perfusion and primary hepatocyte culturetechniques. 6-[¹⁴C]CB release from the hepatic tissues of femalerats pretreated with 2 µCi 6-CB was dependent on the relativeproportion of perfusate buffer components. Approximately 10%of hepatic 6-CB was released into buffer containing either 4%BSA or 4% BSA and 100 mg/dl exogenous human very low densitylipoproteins (VLDL). 6-CB release was significantly increasedunder simulated hyperhpidemic conditions (400 mg VLDL/dl). Releasedeclined when BSA was eliminated or replaced with Dextran. Thedistribution of 6-CB between the triacylglycerol (TG)-rich VLDLand the protein buffer components was found to be dependenton the ratio of TG:protein. Under hyperlipidemic perfusate conditions,approximately 83% of the 6-CB associated with the BSA fraction.Under normolipidemic conditions, 99% of the 6-CB associatedwith BSA. The concentration of 6-CB in TG was greatly increasedunder hyperlipidemic conditions. Thus, 6-CB distribution undersimulated normolipidemic conditions could not be explained bysaturation of the VLDL fraction. Approximately 15% of 6-CB wasreleased from hepatocytes prepared from late pregnant or age-matchedcontrol rats. Eighty percent of 6-CB was associated with VLDLsecreted from hepatocytes. The TG:protein ratio in culture mediawas approximately 1:6 while ratios of 1:20 or 1:600 occurredin the perfusion studies. These data suggest that 6-CB may bereleased from hepatic tissues in association with newly synthesizedTG, but that once in the circulation, its distribution is dependenton the ratio of TG to protein present.     

Hypoglycaemic activity of commelina africana and ageratum conyzoides in relation to their mineral composition

Background

Many plants with antidiabetic properties probably act in part through their content of fibre, vitamins, bioactive or mineral content

Objectives

This study investigated the mineral, proximate, phytochemical compositions and hypoglycaemic effect of Commelina africana and Ageratum conyzoides extracts in diabetic rats, and the likely relationship between this property and the mineral, proximate and phytochemical compositions of the plants.

Methods

The plants were subjected to mineral, proximate composition and phytochemical analysis. Attempt was made to see (if any) the relationship between the hypoglycaemic effect and the mineral, proximate compositions and phytochemistry of the plants. Alloxan-induced diabetic animals were administered 500mg/kg body weight aqueous extracts of the plants and glibenclamide as the reference hypoglycaemic agent.

Results

Aqueous extract of Ageratum conyzoides reduced fasting blood glucose of experimental animals by 39.1% while Commelina africana reduced the same by 78.0%. Alkaloids, cardenolides, saponins, and tannins were detected in both plants. Anthraquinones was absent in C. africana but a trace of it was detected in A. conyzoides. The hypoglycaemic effect of Commelina africana was comparable with the reference hypoglycaemic agent. Ageratum conyzoides showed comparably weaker hypoglycaemic effect than exhibited by reference hypoglycaemic agent. Comparatively, Commelina africana had higher mineral concentrations (except Na) than Ageratum conyzoides.

Conclusions

Plants'' extracts minerals (magnesium, potassium and iron) and bioactive components (alkaloids and cardenolides) seemingly enhanced their hypoglycaemic effect. Furthermore, these minerals, alkaloids and cardenolides could be helpful in ameliorating complications of diabetes like hypertension and cardiovascular disease.     

Remarkable changes in the choice of timing to discuss organ donation with the relatives of a patient: a study in 228 organ donations in 20 years

Introduction  

We studied whether the choice of timing of discussing organ donation for the first time with the relatives of a patient with catastrophic brain injury in The Netherlands has changed over time and explored its possible consequences. Second, we investigated how thorough the process of brain death determination was over time by studying the number of medical specialists involved. And we studied the possible influence of the Donor Register on the consent rate.     

Prevalence of alveolar bone loss in healthy children treated at private pediatric dentistry clinics

Objectives

The purpose of this study was to evaluate the prevalence of alveolar bone loss (BL) in healthy children treated at private pediatric dentistry clinics in Brasília, Brazil.

Material and Methods

The research included 7,436 sites present in 885 radiographs from 450 children. The BL prevalence was estimated by measuring the distance from the cementoenamel junction (CEJ) to alveolar bone crest (ABC). Data were divided in groups: (I) No BL: distance from CEJ to ABC is ≤2 mm; (II) questionable BL (QBL): distance from CEJ to ABC is >2 and <3 mm; (III) definite BL (DBL): distance from CEJ to ABC ≥3 mm. Data were treated by the chi-square nonparametric test and Fisher''s exact test (p<0.05).

Results

Among males, 89.31% were classified in group I, 9.82% were classified in group II and 0.85% in group III. Among females, 93.05%, 6.48% and 0.46% patients were classified in Group I, II and III, respectively. The differences between genders were not statistically significant (Chi-square test, p = 0.375). Group composition according to patients’ age showed that 91.11% of individuals were classified as group I, 8.22% in group II and 0.67% in group III. The differences among the age ranges were not statistically significant (Chi-square test, p = 0.418). The mesial and distal sites showed a higher prevalence of BL in the jaw, QBL (89.80%) and DBL (79.40%), and no significant difference was observed in the distribution of QBL (Fisher’s exact test p = 0.311) and DBL (Fisher’s exact test p = 0.672) in the dental arches. The distal sites exhibited higher prevalence of both QBL (77.56%) and DBL (58.82%).

Conclusions

The periodontal status of children should never be underestimated because BL occurs even in healthy populations, although in a lower frequency.     

Two cases of Robertsonian translocations in oligozoospermic males and their consequences for pregnancies induced by intracytoplasmic sperm injection

Two case histories are presented documenting structural chromosome abnormalities in infertile males. The abnormalities were detected only after application of intracytoplasmic sperm injection (ICSI) was repeatedly unsuccessful or resulted in an abnormal pregnancy. A mosaic Robertsonian translocation 45,XY,der(13;13)(q10; q10)/46,XY,t(13;13)(p10;p10), der(13p;13p) incompatible with normal offspring was found in a male with extreme oligozoospermia after three subsequent ICSI treatments were unsuccessful and one had resulted in a spontaneous abortion. A second case involved a Robertsonian translocation 45,XY,der(13;14)(q10;q10) which was detected in a male with extreme oligozoospermia after ultrasound abnormalities were found in an ICSI-induced twin pregnancy. Amniocentesis showed an unbalanced 46,XY,+13,der(13;14)(q10;q10) karyotype in one twin and a Robertsonian 45,XX,der(13;14)(q10;q10) karyotype in the other twin. Chromosome analysis of males with abnormal sperm characteristics is advised prior to ICSI.      

Guidelines for the management of traumatic dental injuries. I. Fractures and luxations of permanent teeth

Crown fractures and luxations occur most frequently of all dental injuries. An appropriate treatment plan after an injury is important for a good prognosis. Guidelines are useful for delivering the best care possible in an efficient manner. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the current best evidence, based on literature research and professional opinion. In this first article of three, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.