[Cavernomas of the central nervous system : Observational study of 111 patients]. / Kavernome des Zentralnervensystems : Verlaufsbeobachtung bei 111 Patienten.

PURPOSE: The prevalence of cavernomas (cavernous hemangioma) is 0.1-0.7%. Cavernomas are often found as an incidental finding within the framework of magnetic resonance imaging (MRI) examinations in mainly young and healthy patients. In the literature, the reported risk of hemorrhage varies greatly and is sometimes higher than that of aneurysms, which is surprising given that cavernomas are part of the low blood pressure system. After the diagnosis the medical practitioner and the patient have to decide on the further therapy, either surgical removal or the strategy of watchful waiting (conservative treatment). The aim of our study was to determine the frequency of bleeding of cavernomas and the consequences and to determine the satisfaction of patients with treatment. All these aspects should make the therapeutic decision easier for medical practitioners. MATERIAL AND METHODS: The study included all patients who were treated in the military hospital in Ulm during the period 2002-2012 and with the diagnosis of one or more cavernomas of the central nervous system (CNS) detected by MRI. This resulted in a total number of 111 patients. We recorded the epidemiological data and analyzed all cavernomas with respect to the location, size, treatment, side effects, etc. Furthermore, all included patients were sent a comprehensive questionnaire about symptoms, course of the disease and the quality of life. The response rate was 38%. All the collected data were analyzed with respect to the various aspects. RESULTS: Depending on the definition of a bleeding event of a cavernoma and selection of the observational period, the probability of a hemorrhage risk ranged from 1.3% to 5.9% per patient year. This relatively high proportion is, however, put into perspective by the mostly mild consequences of a bleeding event. Many cavernomas, which were detected as an incidental finding showed signs of previous bleeding but the patients remained free of symptoms. Additionally, there was no patient in this collective who suffered serious consequences due to a bleeding event. Of the patients with temporal cavernomas 45% had symptomatic epilepsy. The results of the patient survey were heterogeneous. Some patients stated that in retrospect they would not choose surgical treatment again. CONCLUSION: As a result of our findings we think it is important to critically look at the indications for surgical removal of cavernomas and special attention must be paid to informed consent of the patient. The frequent appearance of temporal cavernomas and their propensity to epileptic seizures is an essential aspect, which certainly influences the therapeutic decision. Although cavernomas are a venous malformation in the low blood pressure system, the determined frequency of hemorrhage was 5.9%, which was higher than expected but which is confirmed by other studies. Reports on severe sequelae of cavernoma bleeding are also rare in the literature, which relativizes the resulting danger of the relatively high probability of hemorrhage.

Road traffic noise and annoyance--an increasing environmental health problem.

Traffic noise, which is steadily increasing, is considered to be an important environmental health problem. The aim of this study was to estimate the degree of annoyance and sleep disturbance related to road traffic noise in residential settings in an urban community. The study is based on a questionnaire on environmentally related health effects distributed to a stratified random sample of 1000 individuals, 19-80 years old, in a municipality with heavy traffic in the county of Stockholm. The response rate was 76%. The individual noise exposure was estimated using evaluated noise dispersion models and local noise assessments. Frequent annoyance was reported by 13% of subjects exposed to Leq 24 hr >50 dBA compared to 2% among those exposed to <50 dBA, resulting in a difference of 11% (95% Confidence Interval (CI) 7%, 15%). Sometimes or frequently occurring sleep disturbance was reported by 23% at Leq 24 hr >50 dBA and by 13% at levels <50 dBA, a difference of 11% (95% CI 4%, 18%). A positive exposure- response relation was indicated for annoyance as well as for sleep disturbances when classifying the individuals into four different exposure categories (< 45, 46- 50, 51-55 and >55 dBA Leq 24 hr). There was some habituation to noise for problems related to sleep but not for annoyance. The prevalence of both annoyance and sleep problems was higher when bedroom windows were facing streets. People living in apartments had more sleep problems compared to people living in detached or semi-detached houses. In conclusion traffic noise exposure, even at low levels, was associated with annoyance and sleep disturbance. Access to a quiet side seemed to be a major protective factor for noise related problems.

Increased prevalence of hypertension in a population exposed to aircraft noise.

OBJECTIVES: To investigate whether there is a relation between residential exposure to aircraft noise and hypertension. METHODS: The study population comprised two random samples of subjects aged 19-80 years, one including 266 residents in the vicinity of Stockholm Arlanda airport, and another comprising 2693 inhabitants in other parts of Stockholm county. The subjects were classified according to the time weighted equal energy and maximum aircraft noise levels at their residence. A questionnaire provided information on individual characteristics including history of hypertension. RESULTS: The prevalence odds ratio for hypertension adjusted for age, sex, smoking, and education was 1.6 (95% confidence interval (95% CI) 1.0 to 2.5) among those with energy averaged aircraft noise levels exceeding 55 dBA, and 1.8 (95% CI 1.1 to 2.8) among those with maximum aircraft noise levels exceeding 72 dBA. An exposure-response relation was suggested for both exposure measures. The exposure to aircraft noise seemed particularly important for older subjects and for those not reporting impaired hearing ability. CONCLUSIONS: Community exposure to aircraft noise may be associated with hypertension.

Estimation of Nitrous Oxide Emissions from US Grasslands.

/ Nitrous oxide (N(2)O) emissions from temperate grasslands are poorly quantified and may be an important part of the atmospheric N(2)O budget. In this study N(2)O emissions were simulated for 1052 grassland sites in the United States using the NGAS model of Parton and others (1996) coupled with an organic matter decomposition model. N(2)O flux was calculated for each site using soil and land use data obtained from the National Resource Inventory (NRI) database and weather data obtained from NASA. The estimates were regionalized based upon temperature and moisture isotherms. Annual N(2)O emissions for each region were based on the grassland area of each region and the mean estimated annual N(2)O flux from NRI grassland sites in the region. The regional fluxes ranged from 0.18 to 1.02 kg N(2)O N/ha/yr with the mean flux for all regions being 0.28 kg N(2)O N/ha/yr. Even though fluxes from the western regions were relatively low, these regions made the largest contribution to total emissions due to their large grassland area. Total US grassland N(2)O emissions were estimated to be about 67 Gg N(2)O N/yr. Emissions from the Great Plains states, which contain the largest expanse of natural grassland in the United States, were estimated to average 0.24 kg N(2)O N/ha/yr. Using the annual flux estimate for the temperate Great Plains, we estimate that temperate grasslands worldwide may potentially produce 0.27 Tg N(2)O N/yr. Even though our estimate for global temperate grassland N(2)O emissions is less than published estimates for other major temperate and tropical biomes, our results indicate that temperate grasslands are a significant part of both United States and global atmospheric N(2)O budgets. This study demonstrates the utility of models for regional N(2)O flux estimation although additional data from carefully designed field studies is needed to further validate model results.

Health effects resulting from nitrogen dioxide exposure in an indoor ice arena.

We investigated an outbreak of acute respiratory illness among adolescent ice-hockey players in an indoor ice arena in Stockholm that had a propane-powered ice-resurfacing machine. We administered questionnaires to all players, as well as to a reference group that had played ice hockey in indoor arenas with electric ice-resurfacing machines. In the exposed group, 55 subjects (55.6%) experienced acute respiratory symptoms, compared with 4 (7.1%) in the reference group (relative risk = 7.8; 95% confidence interval = 3.0, 20.3). The risk for pulmonary symptoms increased as time spent on the ice increased. Levels of nitrogen dioxide up to 2358 microg/m3 (1250 ppb) were detected during simulated conditions of the incident. The most likely cause of the outbreak was the high level of nitrogen dioxide that resulted from poor ventilation and a malfunctioning ice-resurfacing machine. Propane-fueled ice-resurfacing machines should not be used in indoor ice arenas.

Radiographic results from the Minocycline in Rheumatoid Arthritis (MIRA) Trial.

OBJECTIVE: To assess radiographically determined disease progression in patients in the Minocycline in Rheumatoid Arthritis (MIRA) Trial. METHODS: A double blind, randomized, multicenter, 48 week trial of oral minocycline (200 mg/day) or placebo in 6 clinical centers in the United States. Patients include 219 adults with active RA previously receiving limited treatment with disease modifying drugs. Posteroanterior films of the hands from baseline and final visits, blinded for sequence, were read for erosions and joint space narrowing by trained observers. Outcomes included rate of disease progression (change/month) and percentage of patients with progression from baseline, newly involved joints, and newly erosive disease. RESULTS: Using intent-to-treat analyses, progression rates for erosions (0.11 +/- 0.42 minocycline, 0.17 +/- 0.41 placebo; p = 0.47) and joint space narrowing (0.16 +/- 0.55 minocycline and 0.23 +/- 0.71 placebo; p = 0.14) were similar. (Power 43% to detect a 50% difference.) Newly erosive joints occurred more frequently in the placebo group (44 vs 32%; p = 0.08), not a statistically significant difference. CONCLUSION: Radiographic measurement of disease progression using 4 measures failed to show a significant difference between minocycline and placebo treatment, although for all methods there was a trend toward treatment benefit, consistent with reported clinical results. A one year trial duration, high measurement variability, and slow rate of radiographic progression in this cohort may explain the low power to detect a treatment effect. The measurement that denoted "newly involved" joints was most sensitive in detecting change. In future trials longer term assessment (minimum 2 years) of radiographic changes and further comparison of measures of disease progression are warranted.

HLA-DRB1 genes and disease severity in rheumatoid arthritis. The MIRA Trial Group. Minocycline in Rheumatoid Arthritis.

OBJECTIVE: To examine the effect of alleles encoding the "shared"/"rheumatoid" epitope on rheumatoid arthritis (RA) disease severity in patients who participated in the minocycline in RA (MIRA) trial. METHODS: Of 205 patients with a week-48 visit, blood was available for typing of HLA-DRB1 and HLA-DQB1 in 174 (85%) and successfully completed in 169 (82%). Baseline erosions were used to assess disease severity and new erosions at the last visit served as a proxy for progression. RESULTS: At baseline, there was no association between the presence of erosive disease or rheumatoid factor status and the dose of rheumatoid epitope (homozygous, heterozygous, none) or the specific alleles identified. At the final visit, a gradient was observed for the 3 allelic subgroups (and their gene doses) in the occurrence of new erosions among the Caucasian placebo-treated, but not the minocycline-treated, patients. A treatment group/HLA-DR4 epitope interaction was demonstrated in multivariate analyses. Approximately two-thirds of African-American patients did not have the rheumatoid epitope. CONCLUSION: HLA-DRB1 oligotyping may be useful in predicting the progression of disease in some Caucasian patients. Our study corroborates the infrequency of the epitope among African-American patients with RA.

Nitrogen dioxide pneumonitis in ice hockey players.

Exposure to the toxic gases carbon monoxide and nitrogen dioxide (NO2) in indoor ice arenas occasionally occurs and may result in severe symptoms. The gases are produced by ice resurfacing machines operating on hydrocarbons, and in certain conditions toxic levels accumulate. The damage to lung tissues caused by NO2 may not be evident until after a latency time of 1/2-2 days. The role of corticosteroids in the treatment is controversial, but there are clinical experiences as well as experimental data supporting their use. We report two cases of toxic pneumonitis, with delayed onset, due to NO2 exposure during an ice hockey game in an indoor arena. Signs and symptoms were cough, dyspnoea, haemoptysis, hypoxaemia and reduced peak expiratory flow. Chest radiographs showed parenchymatous infiltrative lesions and alveolar consolidation. Both patients were treated with high doses of corticosteroids by inhalation and orally or intravenously. Their condition rapidly improved and pulmonary function was restored.

Michigan Health Care Data Corporation. The first and only statewide voluntary health data system in the US.

To continue its mission of providing information to improve understanding of health care in Michigan and to aid in planning and decisionmaking, the Michigan Health Care Data Corporation needs to achieve several things. The following is a look at its history and structure, MSMS participation, public reports, and future expectations.

Long-term comparison of the electrical characteristics of polyurethane and polyethylene insulated ventricular leads.

Two types of pacing leads with different insulation material, polyurethane, and polyethylene, were followed for 44 months with respect to their electrophysiological characteristics and complications. In 48 patients, 32 polyurethane leads (Lifeline 493-03) and 16 polyethylene leads (EMT 588 D) were implanted and connected in all cases to the same type of programmable ventricular inhibited (VVI) pulse generator (Programalith, Pacesetter). There was a significant fall during the follow-up in lead impedance with the polyurethane leads (495 +/- 62 to 444 +/- 58 ohms, P less than 0.01), whereas the corresponding measurements for the polyethylene leads were essentially unchanged (360 +/- 58 to 378 +/- 71 ohm, ns). The energy of the stimulation threshold tended to increase in the polyurethane group, whereas an opposite tendency was observed in the polyethylene group. Pacing and/or lead failures were not observed in any case. The observed fall in impedance with the polyurethane leads was seemingly of no clinical significance.