Primary leiomyosarcoma of bone

Sixteen cases of primary leiomyosarcoma of bone are described. The patients, 11 males and 5 females, ranged in age from 9 to 74 years. The annual incidence of this tumor in Sweden was calculated to be 0.09 cases per million. This figure was obtained by reviewing a Swedish series of spindle cell sarcomas of bone of which one quarter (11/44) were diagnosed by us as primary leiomyosarcoma. The diagnosis was based on light- and electron-microscopic examinations using the same criteria as for leiomyosarcoma of soft tissues. Thirteen tumors were located in a long bone of an extremity (nine close to the knee joint) and three in the central skeleton. Radiographically, all the tumors presented as a purely osteolytic lesion, and three patients had sustained a pathologic fracture. In four of six cases angiography suggested malignancy by revealing hypervascularity, irregular tortuous vessels, and diffuse contrast opacification. Contrast-enhanced computed tomography, performed in two cases, showed hypervascular areas within the tumors. Scintigraphy showed a marked increase in radionuclide uptake in all five cases studied. The clinical behavior indicates that primary leiomyosarcoma of bone is highly malignant. Eight patients had died of the tumor and, of the eight patients who were alive at follow-up, two had metastases, and one had been operated on three times for a cutaneous metastasis, which had recurred locally twice. The remaining five patients had been continuously free of disease for 6.5 to 12.3 years.     

Intergenerational class mobility and cardiovascular mortality among Swedish women: A population-based register study

Class inequalities in cardiovascular disease (CVD) mortality are well documented, but the impact of intergenerational class mobility on CVD mortality among women has not been studied thoroughly. We examined whether women's mobility trajectories might contribute to CVD mortality beyond what could be expected from their childhood and adult social class position. The Swedish Work and Mortality Data Base provided childhood (1960) and adulthood (1990) social indicators. Women born 1945–59 (N = 791?846) were followed up for CVD mortality 1990–2002 (2019 deaths) by means of logistic regression analysis. CVD mortality risks were estimated for 16 mobility trajectories. Gross and net impact of four childhood and four adult classes, based on occupation, were analysed for mortality in ischemic heart disease (IHD), stroke, other CVD, – and all CVD. Differences between the two most extreme trajectories were 10-fold, but the common trajectory of moving from manual to non-manual position was linked to only a slight excess mortality (OR = 1.26) compared to the equally common trajectory of maintaining a stable non-manual position (reference category). Moving into adult manual class resulted in an elevated CVD mortality whatever the childhood position (ORs varied between 1.42 and 2.24). After adjustment for adult class, childhood class had some effect, in particular there was a low risk of coming from a self-employed childhood class on all outcomes (all ORs around = 0.80). A woman's own education had a stronger influence on the mortality estimates than did household income. Social mobility trajectories among Swedish women are linked to their CVD mortality risk. Educational achievement seems to be a key factor for intergenerational continuity and discontinuity in class-related risk of CVD mortality among Swedish women. However, on mutual adjustment, adult class was much more closely related to CVD mortality than was class in childhood.     

Identifying Factors Associated with Good Health and Ill Health

Background  

Work-related health research has traditionally focused on identifying risks rather than determinants of good health. Our knowledge of variation in ill health is thus greater than our understanding of such variations in good health.     

Bleeding complications during warfarin treatment in primary healthcare centres compared with anticoagulation clinics

Objectives. To examine determinants of bleeding complications during warfarin treatment in an unselected patient population and evaluate possible differences in safety between specialized anticoagulation clinics and primary healthcare centres. Design. Prospective cohort study. Data were collected with an admission form and medical records were scrutinized in order to pursue all adverse events. Differences between groups were estimated with a t-test and chi-squared test, and univariate and multivariate Cox regression analysis. Setting. All patients treated and monitored with oral anticoagulation in primary healthcare centres and specialized anticoagulation clinics in the Sundsvall and Skellefteå region (northern Sweden) during a five-year period. Subjects. A total of 2731 patients corresponding to 5044 treatment years. Main outcome measures. Bleedings were classified as fatal or major. Major bleedings were defined as an event causing admission, prolonged in-hospital care or death. Results. In total 195 major bleedings occurred corresponding to 3.9% per treatment year, including 34 fatal events (0.67% per treatment year). Patients monitored at the two specialized anticoagulation clinics combined had a major bleeding frequency of 4.1% as compared with 3.9% at primary healthcare units. The frequency of fatal haemorrhage was 0.57% and 0.76%, respectively. The rate of major and fatal bleeding was age related with an increase of 4% and 5%, respectively, per year. Conclusions. There was no difference in bleeding complications between patients monitored at primary healthcare centres and specialized anticoagulation clinics. Age was continuously and independently associated with bleeding risk. These study data indicate the need to exercise caution in treatment of the elderly.     

Psychosocial experiences of foreign and native patients with/without pain

The psychosocial experiences of foreign/native primary care patients with/without pain were examined. The study comprised 328 foreign patients and 794 native patients who completed various scales (e.g. burnout). The design was cross-sectional and data were collected over 15 consecutive days at 20 randomly selected primary care centres. Pain patients were faring worse than pain-free patients concerning demographics/finances, depression, burnout and job demands/control/strain. Foreign pain patients had the worst situation of all patients. Foreign background was a risk factor for depression and burnout. Foreign pain patients also had a more severe clinical situation (e.g. disability) than native pain patients and being a foreign pain patient was associated with a higher risk of disability/the diagnosis of multiple pain. However, foreign background was not a pain risk factor. Female gender was a risk factor for pain and for complex/constant pain/disability. Variables such as sick leave were also important. The authors confirmed previous research and may have provided new insights into the experiences of foreign/native primary care patients with/without pain. However, further research appears necessary, not the least concerning the role of burnout as an antecedent to pain and the role of ethnicity.     

Amygdala Subregions Tied to SSRI and Placebo Response in Patients with Social Anxiety Disorder

The amygdala is a key structure in the pathophysiology of anxiety disorders, and a putative target for anxiolytic treatments. Selective serotonin reuptake inhibitors (SSRIs) and placebo seem to induce anxiolytic effects by attenuating amygdala responsiveness. However, conflicting amygdala findings have also been reported. Moreover, the neural profile of responders and nonresponders is insufficiently characterized and it remains unknown whether SSRIs and placebo engage common or distinct amygdala subregions or different modulatory cortical areas. We examined similarities and differences in the neural response to SSRIs and placebo in patients with social anxiety disorder (SAD). Positron emission tomography (PET) with oxygen-15-labeled water was used to assess regional cerebral blood flow (rCBF) in 72 patients with SAD during an anxiogenic public speaking task, before and after 6–8 weeks of treatment under double-blind conditions. Response rate was determined by the Clinical Global Impression-Improvement scale. Conjunction analysis revealed a common rCBF-attenuation from pre- to post-treatment in responders to SSRIs and placebo in the left basomedial/basolateral and right ventrolateral amygdala. This rCBF pattern correlated with behavioral measures of reduced anxiety and differentiated responders from nonresponders. However, nonanxiolytic treatment effects were also observed in the amygdala. All subgroups, including nonresponders, showed deactivation of the left lateral part of the amygdala. No rCBF differences were found between SSRI responders and placebo responders. This study provides new insights into the brain dynamics underlying anxiety relief by demonstrating common amygdala targets for pharmacologically and psychologically induced anxiety reduction, and by showing that the amygdala is functionally heterogeneous in anxiolysis.     

Genetic and biochemical characterization of a novel metallo-β-lactamase, TMB-1, from an Achromobacter xylosoxidans strain isolated in Tripoli, Libya

An Achromobacter xylosoxidans strain from the Tripoli central hospital produced a unique metallo-β-lactamase, designated TMB-1, which is related to DIM-1 (62%) and GIM-1 (51%). bla(TMB-1) was embedded in a class 1 integron and located on the chromosome. The TMB-1 β-lactamase has lower k(cat) values than both DIM-1 and GIM-1 with cephalosporins and carbapenems. The K(m) values were more similar to those of GIM-1 than those of DIM-1, with the overall k(cat)/K(m) values being lower than those for GIM-1 and DIM-1.