Validity of an online 24-h recall tool (myfood24) for dietary assessment in population studies: comparison with biomarkers and standard interviews.

BACKGROUND: Online dietary assessment tools can reduce administrative costs and facilitate repeated dietary assessment during follow-up in large-scale studies. However, information on bias due to measurement error of such tools is limited. We developed an online 24-h recall (myfood24) and compared its performance with a traditional interviewer-administered multiple-pass 24-h recall, assessing both against biomarkers. METHODS: Metabolically stable adults were recruited and completed the new online dietary recall, an interviewer-based multiple pass recall and a suite of reference measures. Longer-term dietary intake was estimated from up to 3 × 24-h recalls taken 2 weeks apart. Estimated intakes of protein, potassium and sodium were compared with urinary biomarker concentrations. Estimated total sugar intake was compared with a predictive biomarker and estimated energy intake compared with energy expenditure measured by accelerometry and calorimetry. Nutrient intakes were also compared to those derived from an interviewer-administered multiple-pass 24-h recall. RESULTS: Biomarker samples were received from 212 participants on at least one occasion. Both self-reported dietary assessment tools led to attenuation compared to biomarkers. The online tools resulted in attenuation factors of around 0.2-0.3 and partial correlation coefficients, reflecting ranking intakes, of approximately 0.3-0.4. This was broadly similar to the more administratively burdensome interviewer-based tool. Other nutrient estimates derived from myfood24 were around 10-20% lower than those from the interviewer-based tool, with wide limits of agreement. Intraclass correlation coefficients were approximately 0.4-0.5, indicating consistent moderate agreement. CONCLUSIONS: Our findings show that, whilst results from both measures of self-reported diet are attenuated compared to biomarker measures, the myfood24 online 24-h recall is comparable to the more time-consuming and costly interviewer-based 24-h recall across a range of measures.

Duodeno-pancreatic neuroendocrine tumours.

Duodeno-pancreatic neuroendocrine tumours (DP-ETs) are increasingly diagnosed today due to the widespread use of modern imaging methods. Duodeno-pancreatic endocrine tumours should be treated by radical surgical resection, which offers a high chance for cure when the disease is localized. A high index of suspicion is required in these patients for the presence of a multiple endocrine neoplasia type syndrome. We present four patients with DP-ET surgically treated at our department between 2000 and 2004. Histological/immunohistochemical diagnosis was somatostatin-producing tumour in the first patient, oncocytic endocrine tumour positive for neurone-specific enolase and focally for chromogranin in the second patient, glucagonoma and pancreatic polypeptide-producing endocrine pancreatic tumour in the third patient, and gastrin, somatostatin, calcitonin, insulin and adrenocorticotropic hormone (ACTH)-producing tumour in the fourth. The second patient died 6.5 years following surgery due to disseminated disease.

Influenza A encephalopathy, cerebral vasculopathy, and posterior reversible encephalopathy syndrome: combined occurrence in a 3-year-old child.

Encephalopathy is an uncommon complication of childhood influenza infection, typically recognized during influenza epidemics. Imaging hallmarks include characteristic thalamic lesions, thalamic necrosis and hemispheric edema. We describe a child with acute influenza A associated necrotizing encephalopathy with MR angiographic evidence of significant cerebral vasculopathy and a hemispheric edema pattern consistent with PRES. This case reinforces that significant cerebral vasculopathy can accompany influenza infection and that influenza is a likely trigger for PRES.

Neuropathic bladder dysfunction in patients with motor complete and sensory incomplete spinal cord lesion.

STUDY DESIGN: A retrospective study of patients with motor complete spinal cord lesion and somatosensory preservation (American Spinal Injury Association (ASIA) impairment scale B). OBJECTIVE: To determine whether neuropathic bladder dysfunction is more or less severe with more or fewer complications in patients with somatosensory preservation. SETTING: 2nd Department of Physical and Rehabilitation Medicine, Neuropathic Bladder Unit, National Rehabilitation Center, EIAA, Athens, Greece. METHODS: The classification of spinal cord injured patients was determined according to ASIA protocol. All patients underwent urodynamics and retrograde cystography, with a follow-up period of at least 18 months. The study sample consisted of 154 patients: 28 ASIA B patients compared with 126 ASIA A patients. We analyzed 140 traumatic and 14 nontraumatic lesions for (1) specific type of neuropathic bladder, (2) detrusor overactivity volume and pressure, (3) bladder compliance, (4) vesicoureteric reflux, (5) formation of bladder stones, (6) method of bladder emptying and (7) daily dose of anticholinergics needed to achieve safe bladder function. We also studied the presence of spasticity, autonomic dysreflexia and pain syndrome. RESULTS: Statistically significant differences were found between ASIA A and B patients in daily dose of anticholinergics needed to achieve safe bladder function, in the incidence of incontinence episodes and in formation of bladder stones. CONCLUSION: Patients with somatosensory incomplete lesion of spinal cord seem to have an advantage in the management of neuropathic bladder dysfunction (fewer anticholinergics needed, fewer incontinence episodes and fewer bladder stones).

The phenomenon of spasticity: a pathophysiological and clinical introduction to neuromodulation therapies.

Spasticity is part of the complex clinical picture which results from the upper motor neuron impairment. The underlying mechanisms that produce the automatic overactivity of the muscle groups may manifest themselves as either passive movements dependent on the exerted velocity or persistent muscle overactivity in the form of spastic dystonia. The therapeutic management of spasticity is closely related to the aims of rehabilitation; these include avoidance of complications, restoration of movement, re-education of motion and gait, development of self-dependency, and social integration, as well as modification and reorganization of the cortical brain map. The latter is achieved through long-term learning processes which are subserved by new neurophysiological dynamics. and the mechanisms of neuroplasticity which develop during neural regeneration.

The importance of neurorehabilitation to the outcome of neuromodulation in spasticity.

The neuromodulation specialist who is involved in the management of spasticity should not be interested only in the technical aspects of the implantation of a device. It is important that (s)he has a sound understanding of all aspects of this serious disability in order to determine appropriately whether an ablative or a neuromodulatory intervention (intrathecal baclofen administration, spinal cord stimulation, peripheral nerve stimulation) is best for the patient. It is also important that s(he) is able to collaborate effectively with the physiatrists, othopaedic surgeons, neurologists, physiotherapists, neuropsychologists, and care counselors. In this article, we review our approach to the neurorehabilitation of patients with spasticity due to multiple sclerosis, spinal cord injury, cerebrovascular disease or head injury and, on the basis of our experience, we highlight the importance of the integrated management that combines both rehabilitation and neuromodulation methods in order to ensure the maximum benefits for the patients.

Management and rehabilitation of neuropathic bladder in patients with spinal cord lesion.

The patients with spinal cord lesion (SCL) develop problems of urination due to impaired neural control of the lower urinary tract, such as incontinence or retention; these conditions constitute risks for the upper urinary tract and should be treated appropriately over the various phases of the disease. The therapeutic approach in the acute and subacute post-traumatic phase is of particular importance for the early and late management of the subsequent urinary disturbances. When the rehabilitation program is completed, it is estimated that deficiencies in sphincter control have greater impact on personal and social life of individuals than the movement disability. Currently, as the number of sufferers from SCLs is constantly increasing, medical science faces two great challenges: (i) to develop and apply modern treatment modalities in the framework of advanced neurorehabilitation programs, and (ii) to provide well-organized follow-up management. All efforts should be directed towards the functional integrity of the upper urinary tract and the acquirement of the greatest possible independence for the patient.

Bone loss and mechanical properties of tibia in spinal cord injured men.

AIM: The effects of Spinal Cord Injury (SCI) on bone in paralyzed areas are well documented but there are few data for the importance of the level of injury in the decrease of mechanical strength in paralyzed legs. The aim of the present study was to describe bone loss of the separate compartments of trabecular and cortical bone in spinal cord injured men and to compare possible changes in mechanical properties of tibia with the neurological level of injury. MATERIALS AND METHODS: Fifty men were included in this study: 39 had complete SCI in chronic stage. As chronic stage, we considered paraplegia >1.5 years (yrs). Men were separated as follows: Group A (18 men, high paraplegia: Thoracic (T)4-T7 level, mean age: 33 yrs, duration of paralysis: 5.9 yrs) and group B (21 men, low paraplegia: T8-T12 level, mean age: 39 yrs, duration of paralysis: 5.6 yrs) in comparison with 11 healthy men as a control group (C) of similar age, height, and weight. None of the subjects was given bone acting drugs. The neurological profile of each patient was assessed according to the American Spinal Injury Association (ASIA). All subjects were measured by peripheral quantitative computed tomography (pQCT). Measurements were performed at the tibia with a Stratec XCT 3000 (Stratec Medizintechnik, Pforzheim, Germany) scanner. The distal end of the tibia was used as an anatomical marker. The bone parameters, bone mass density (BMD) trabecular, BMD total, BMD cortical, and cortical thickness have been measured at 4% and 38%, respectively, of the tibia length proximal to this point, and the periosteal and endocortical was measured at 14% of the tibia. We calculated stress strain index (SSI), a bone strength estimator derived from the section modulus, and the volumetric density of the cortical area at 14% (SSIPol2) and 38% (SSIPol3) of the tibia length proximal to the distal end of the tibia. RESULTS: In both groups A and B most bone mass parameters were statistically decreased in comparison with controls. In each group we calculated the median deltaSSI(3-2) (SSIPol3 - SSIPol2). In the paraplegic groups Spearman correlation coefficient between duration of paralysis and deltaSSI(3-2) was in group A: r=-0.178, p=N.S. and group B: r=0.534, p=0.027, respectively. CONCLUSION: Despite the similar paralytic effect on bone in all paraplegic patients in our study and because of the non-significant duration of paralysis between paraplegic groups (p=0.87), the two paraplegic groups act differently in mechanical properties of the tibia. In addition, group A patients in respect to the level of injury, are susceptible to autonomic dysreflexia as a result of the disruption of the autonomic nervous system pathways. These results suggest that neurogenic factors are influencing geometric bone parameters.

Reliability of Greek version Gross Motor Function Classification System.

The Gross Motor Function Classification System for Cerebral Palsy (GMFCS), a reliable and valid system, has been widely utilized for objective classification of the patterns of motor disability in children with cerebral palsy. The objective of this study was to produce a Greek version of the instrument, with the same construct as the original one and to investigate the reliability of application of the Greek version GMFCS. Translation and back translation was made by two of the authors, one of whom did not know the original English text. The final translation was fixed by consensus. Two physicians were trained and given practice in the use of the GMFCS and its application to clinical documentation. The raters classified children with cerebral palsy according to GMFCS - Greek version. The reliability was assessed with the weighted kappa statistic. The sample consisted of 47 boys and 47 girls, mean age 5.4 years. The overall weighted Kappa was 0.80 (95% CI=0.67-0.94). Weighted Kappa for level I was 0.91 (95% CI=0.74-1.09), for level II, 0.78 (95% CI=0.62-0.95), for level III, 0.85 (95% CI=0.68-1.02), for level IV, 0.85 (95% CI=0.67-1.03) and for level V, 0.84 (95% CI=0.66-1.03). The inter-rater reliability was lowest at level II. Percent agreement was 75%. Results of this study suggest that GMFCS - Greek version can be used reliably to classify patients with CP from clinical documentation. These results further support use of the GMFCS in clinical settings and for research. Investigation is needed to further assess the reliability and to determine the validity of the Greek version of the GMFCS.

Investigation of vesicoureteral reflux with colour Doppler sonography in adult patients with spinal cord injury.

The aim of the study was to evaluate prospectively the performances of colour Doppler sonography for detection of vesicoureteral reflux in adult patients with neurogenic bladder due to spinal cord injury. One hundred eighty-seven adult patients who had developed neurogenic bladder due to spinal cord injury underwent retrograde cystography and sonographic evaluation by B-mode and colour flow Doppler sonography (CFDS). Results of both examinations were analyzed independently by two radiologists. Representative images of the sonographic evaluations were recorded on videotape and CD-Rom. CFDS detected reflux in 20 ureters while retrograde cystography revealed vesicoureteral reflux (VUR) in 25 ureters of a total of 374 ureters, which were examined by both methods. Sonography detected all cases of grades IV and V of reflux, 7 of 8 (87.5%) of grade III, 5 of 6 (83.3%) of grade II, and 4 of 7 (57.14%) of grade I. There were 6 false-positive and 5 false-negative findings with Doppler examination compared with retrograde cystography. Therefore, sensitivity and specificity of sonographic examination were 80 and 98.28%, respectively, with a positive predictive value of 76.92%. Colour flow Doppler sonography can play an important role in detection of VUR in spinally injured adult patients with neurogenic bladder and can be an effective imaging tool for follow-up.

Patellar fractures associated with medial-third bone-patellar tendon-bone autograft ACL reconstruction.

Patella fractures following anterior cruciate ligament (ACL) reconstruction are a recognized but rarely reported complication. To our knowledge, 24 reports of patella fractures after ACL reconstruction using the central-third patella-tendon autograft have been reported in the literature. Patellar fractures associated with the use of the medial-third bone-patellar tendon-bone autograft have not been reported. This article describes four cases of patellar fractures in 478 ACL reconstructions between 1992 and 1999, using the medial third of the patellar tendon graft. All of them were transverse fractures of the patella but only one was displaced. All patients suffered local injury to the donor knee between 2 and 4 months postoperatively. No significant differences in the final outcome were noticed between the cases complicated with patellar fracture and those with uncomplicated ACL reconstructions.

Radioscaphocapitate ligament of the wrist: volar filling defect during radiocarpal arthrography.

PURPOSE: To determine whether a filling defect seen at radiocarpal arthrography represents the volar radioscaphocapitate ligament and to establish how frequently this finding is seen in patients referred for wrist arthrography. MATERIALS AND METHODS: Radiopaque markers were surgically placed along the borders of the radioscaphocapitate ligament in three cadaveric wrist specimens. Each cadaveric wrist was examined at arthrography. Seventy contrast material-enhanced wrist arthrograms were retrospectively reviewed for visualization of the radioscaphocapitate ligament. The arthrographic appearance of the ligament was compared with its reported appearance at dissection, radiography, and magnetic resonance arthrography. RESULTS: The cadaveric study, together with an analysis of the appearance of the ligament, confirmed that the radioscaphocapitate ligament can be seen as a filling defect at radiocarpal arthrography. Fifty-five (78%) of the 70 clinical arthrograms unequivocally demonstrated the radioscaphocapitate ligament. The ligament was most conspicuous early during the injection, especially with the wrist in ulnar deviation. CONCLUSION: The radioscaphocapitate ligament of the wrist can be visualized during routine radiocarpal arthrography. Future studies will need to determine whether abnormalities of the radioscaphocapitate ligament can be diagnosed at arthrography.

CT and MRI of pleomorphic xanthoastrocytoma: unusual biologic behavior.

OBJECTIVE: Our goal was to present three cases of pleomorphic xanthoastrocytoma (PXA) with unusual radiographic, clinical, and pathologic aspects. MATERIALS AND METHODS: The imaging findings in three patients with proven PXA were reviewed and correlated with clinical information and review of pathologic material. Two females and one male were studied, ranging in age from 8 to 42 years old. All patients underwent MRI with gadolinium (0.1 mmol/kg). Two of the patients had serial MR studies. CT scans with and without contrast agent were also available for two patients. The medical records for all three patients were reviewed. Radiographic findings were correlated with pathologic material obtained at surgery. RESULTS: Seizure disorder was the initial presentation in two patients. The third patient presented with a lytic lesion of the calvarium. Radiographic features showed rapid progression of disease over 3 months in one patient. Rapid tumor recurrence (within 7 months) without malignant transformation was proven in another patient. While typical pathological features of PXA were evident in two cases, a mixed tumor consisting of PXA and other tissue components was identified in the third case. CONCLUSION: Although generally regarded as a benign lesion in the literature, PXA has potential for aggressive behavior. Rapid tumor recurrence can occur without malignant transformation. Radiographic features may evolve over a short period of time. Dura and bony calvarium are not necessarily respected. PXA can occur as a separate entity or as a tumor of mixed components.

Lipids of developing dental plaque in caries-resistant and caries-susceptible adult people.

Dental plaque maturation in both caries-resistant (CR) and caries-susceptible (CS) subjects was accompanied by a decrease in total lipid content but was more pronounced with CR subjects; their plaque after 72 h contained 44.6 per cent less lipids than that of CS. At each stage of maturation, differences were also found in the proportion of lipid classes. In 24 h-plaque, the lipids of CR-group, although containing amounts of glycolipids and phospholipids similar to those of CS, contained 1.6 times less neutral lipids. The 48 h-plaque of CS subjects showed 2.5 times more neutral lipids, 1.2 times more phospholipids and 1.4 times less glycolipids. The 72 h-CR plaque contained 1.9 times less neutral lipids, 1.6 times more glycolipids and 1.3 times more phospholipids than CS-plaque. Among the neutral lipids in both groups, the changes with maturation were associated with decrease in free fatty acids and increase in triglycerides, cholesterol and cholesteryl esters. Phospholipids of CR-plaque contained less phosphatidylcholine and more phosphatidylethanolamine than CS-plaque. With plaque maturation both groups showed decreases in the glycolipids characteristic of saliva and an increase in the content of bacterial type of glycolipids. Plaque maturation is evidently accompanied by dynamic changes in lipids reflecting a shift from salivary to bacterial contribution.

Lipid composition of human labial salivary gland secretions.

Extraction of the dialysed and lyophilized labial saliva with chloroform/methanol yielded 423.8 +/- 73.0 micrograms of lipids/ml of saliva, a level 4-5 times higher than in the major salivary glands. Of the total lipids, 32.4 per cent were represented by neutral lipids, 44.6 per cent by glycolipids and 23.0 per cent by phospholipids. Neutral lipids had a high content of free fatty acids (43.8 per cent), cholesteryl esters (26.9 per cent) and triglycerides (15.4 per cent). The glycolipids consisted mainly of neutral (74.6 per cent) and sulphated (25.4 per cent) glyceroglucolipids, whereas phosphatidylethanolamine, phosphatidylcholine, sphingomyelin and phosphatidylserine accounted for 54.7 per cent of the total phospholipids.