Characterization of Eyjafjallajokull volcanic ash particles and a protocol for rapid risk assessment.

On April 14, 2010, when meltwaters from the Eyjafjallajökull glacier mixed with hot magma, an explosive eruption sent unusually fine-grained ash into the jet stream. It quickly dispersed over Europe. Previous airplane encounters with ash resulted in sandblasted windows and particles melted inside jet engines, causing them to fail. Therefore, air traffic was grounded for several days. Concerns also arose about health risks from fallout, because ash can transport acids as well as toxic compounds, such as fluoride, aluminum, and arsenic. Studies on ash are usually made on material collected far from the source, where it could have mixed with other atmospheric particles, or after exposure to water as rain or fog, which would alter surface composition. For this study, a unique set of dry ash samples was collected immediately after the explosive event and compared with fresh ash from a later, more typical eruption. Using nanotechniques, custom-designed for studying natural materials, we explored the physical and chemical nature of the ash to determine if fears about health and safety were justified and we developed a protocol that will serve for assessing risks during a future event. On single particles, we identified the composition of nanometer scale salt coatings and measured the mass of adsorbed salts with picogram resolution. The particles of explosive ash that reached Europe in the jet stream were especially sharp and abrasive over their entire size range, from submillimeter to tens of nanometers. Edges remained sharp even after a couple of weeks of abrasion in stirred water suspensions.

A case-control study to estimate the impact of the Icelandic population-based mammography screening program on breast cancer death.

BACKGROUND: The Icelandic breast cancer screening program, initiated November 1987 in Reykjavik and covering the whole country from December 1989, comprises biennial invitation to mammography for women aged 40-69 years old. PURPOSE: To estimate the impact of mammography service screening in Iceland on deaths from breast cancer. MATERIAL AND METHODS: Cases were deaths from breast cancer from 1990 onwards in women aged 40 and over at diagnosis, during the period November 1987 to December 31, 2002. Age- and screening-area-matched, population-based controls were women who had also been invited to screening but were alive at the time their case died. RESULTS: Using conditional logistic regression on the data from 226 cases and 902 controls, the odds ratio for the risk of death from breast cancer in those attending at least one screen compared to those never screened was 0.59 (95% CI 0.41-0.84). After adjustment for healthy-volunteer bias and screening-opportunity bias, the odds ratio was 0.65 (95% CI 0.39-1.09). CONCLUSION: These results indicate a 35-40% reduction in breast cancer deaths by attending the Icelandic breast cancer screening program. These results are consistent with the overall evidence from other observational evaluations of mammography-based programs.

CYP17 promoter polymorphism and breast cancer risk in males and females in relation to BRCA2 status.

A T-C polymorphism in the promoter region of the CYP17 gene has been associated with male and female breast cancer risk as well as early-onset familial breast cancer. The potential role of this polymorphism was investigated in relation to breast cancer risk in Icelandic male and female carriers and noncarriers of a BRCA2 mutation. The study population consisted of 39 male and 523 female breast cancer cases and 309 male and 395 female controls. Of the cases, 15 males and 55 females carried a BRCA2 mutation. We did not find a significant association between male breast cancer risk and CYP17 genotypes. Among male breast cancer cases, the frequency of the CC genotype was higher among carriers of the 999del5 mutation (33.3%) than noncarriers (16.7%), although this difference also did not reach a statistical significance. No association was observed with breast cancer risk among females irrespective of menopausal status, stage of the disease or BRCA2 status. Our findings do not indicate a role for the CYP17 T-C polymorphism in female breast cancer, but a role in male carriers of a BRCA2 mutation could not be excluded because of the small sample size.

[A giant epiphrenic esophageal diverticulum in a patient with history of Zenker's diverticulum.].

A sixty-three years old man, post Zenker's diverticulectomy, presented with a giant epiphrenic esophageal diverticulum. The diverticulum, which was symptomatic and progressively enlarging, was successfully removed by simple excision.

Mammographic screening and mortality from breast cancer: the Malmö mammographic screening trial.

STUDY OBJECTIVE: To determine whether mortality from breast cancer could be reduced by repeated mammographic screening. DESIGN: Birth year cohorts of city population separately randomised into study and control groups. SETTING: Screening clinic outside main hospital. PATIENTS: Women aged over 45; 21,088 invited for screening and 21,195 in control group. INTERVENTIONS: Women in the study group were invited to attend for mammographic screening at intervals of 18-24 months. Five rounds of screening were completed. Breast cancer was treated according to stage at diagnosis. END POINT: Mortality from breast cancer. MEASUREMENTS AND MAIN RESULTS: All women were followed up and classed at end point as alive without breast cancer, alive with breast cancer, dead from breast cancer, or dead from other causes. Cause of death was taken from national mortality registry and for patients with breast cancer was validated independently. Mean follow up was 8.8 years. Altogether 588 cases of breast cancer were diagnosed in the study group and 447 in the control group; 99 v 94 women died of all causes and 63 v 66 women died of breast cancer (no significant difference; relative risk 0.96 (95% confidence interval 0.68 to 1.35)). In the study group 29% more women aged less than 55 died of breast cancer (28 v 22; relative risk 1.29 (0.74 to 2.25)). More women in the study group died from breast cancer in the first seven years; after that the trend reversed, especially in women aged greater than or equal to 55 at entry. Overall, women in the study group aged greater than or equal to 55 had a 20% reduction in mortality from breast cancer (35 v 44; relative risk 0.79 (0.51 to 1.24)). OTHER FINDINGS: In the study group 100 (17%) cancers appeared in intervals between screenings and 107 (18%) in non-attenders; 51 of these women died from breast cancer. Cancers classed as stages II-IV comprised 33% (190/579) of cancers in the study group and 52% (231/443) in the control group. CONCLUSIONS: Invitation to mammographic screening may lead to reduced mortality from breast cancer, at least in women aged 55 or over.

Mammographic breast cancer screening--a randomized trial in Malmö, Sweden.

A randomized trial is presented on the effect of repeated invitation to breast cancer screening with mammography on mortality from breast cancer. The invited group and the control group each consisted of approximately 21,000 women aged 45-69 yr at the start of the screening. The attendance rate was 74% at the first screening and 70% at the two subsequent screening rounds. The cancer detection rate was 7.5 per 1000 women examined in the first screening round and 2.2 and 2.0 per 1000 woman-years in the second and third screenings with an incidence of 0.9 in the intervals. The incidence in the control group was 2.7 per 1000 woman-years. The proportion of positive biopsies was 61% in the first screening round, 33% in the second, and 58% in the third. After the prevalence screening, the stage distribution was more favourable in the invited group (including non-attenders) than in the control group. In the two most recent periods of the programme, 62 out of 160 women with cancer (39%) in the invited group were in stage II-IV compared with 91 out of 159 (57%) in the control group. More than 60% of cancers detected at screening were either non-invasive or invasive with a diameter of 1 cm. The corresponding percentage in the control group was 27%. The importance of sampling bias is discussed. Although data on mortality still have to be awaited, the results so far clearly indicate a positive effect of screening.

Variants of pancreatic duct system of importance in endoscopic retrograde cholangiopancreatography. Observations on autopsy specimens.

A postmortem radiographic investigation of 330 pancreas specimens showed a total frequency of 10 per cent for the 3 variants of the pancreatic duct system, in which the main pancreatic duct drained to the minor duodenal papilla (type III). In no instance did the main duct drain into the duodenum distal to the major papilla, onto which the common bile duct drained as usual. In the most common variant, type III-B, a separate accessory duct drained part of the pancreatic head onto the major papilla. In the remaining cases either an analogous accessory duct existed, communicating with the main duct (type III-A) or no accessory duct at all (type III-C). The different features of the accessory and main duct systems of type III in the pancreatic head varied widely. In types III-A and III-B, the corresponding ventral and dorsal pancreatic primordia formed more or less of mainly the posterior and anterior parts of the pancreatic head, respectively.

Clustered breast calcifications.

In a consecutive series, clustered breast calcifications were classified according to their radiographic appearance. Rounded and 'cloudy' calcifications, and calcifications showing sedimentation were virtually always associated with benign disorders. All other types of clustered calcifications implied a substantial risk of carcinoma. Furthermore, calcifications appearing or increasing during an observation period (median 24 months) implied a larger risk than those remaining unchanged. Guidelines for the management of patients with clustered breast calcifications are given.

Arthrosis of the lunate-capitate joint.

Arthrosis of the lunate-capitate (LC) joint was investigated in 44 wrists from 36 patients. The symptomatology was uncharacteristic and most patients were examined because of pain, swelling or decreased function of the wrist. The LC arthrosis seemed to be secondary to trauma in most patients; 26 wrists had an increased distance between the lunate and scaphoid, indicating a rotatory luxation of the scaphoid; 5 had fracture of the scaphoid with pseudarthrosis; one had a radius fracture healed with volar and ulnar compression and 2 had penetrating trauma to the LC joint. The arthrosis was secondary to pathologic changes in the lunate in 3 patients; lunatomalacia in 2 and a cyst fracturing into the LC joint in one. In 7 wrists arthrosis was found in several carpal joints and the LC arthrosis was one of these.

Percutaneous injection of contrast medium into breast lesions for radiographic exclusion of malignancy.

Contrast medium was injected percutaneously into palpable breast lesions in 63 patients in order to demonstrate lactiferous ducts. Of 35 benign and mammographically definable tumours, 30 were successfully punctured and ducts were visualized in 20, while ducts were demonstrated in seven of 21 non-definable lesions. Ducts were seen in 10 of 13 fibroadenomas removed by surgery, in two of four hamartomas, and in two of three cases of mastitis. No ducts were seen in six solid, malignant tumours examined, while one intracystic papillary carcinoma showed filling defects caused by the malignant growth. It was concluded that the method is simple, and that the demonstration of ducts is an indication of the benign nature of a lesion.

Percutaneous nephrostomy. Aspects on clinical application.

During a 6-year-period percutaneous nephrostomy has been used for supravesical urinary diversion in 115 patients and 132 individual kidneys. The procedure proved to be a safe and effective alternative to operative nephrostomy in patients with urinary obstruction but may be used also in other urologic conditions.