Participation in cervical cancer screening by age and region--a cohort study with a 3 1/2 year follow-up on 2,223,135 women in Bavaria.

OBJECTIVE OF THE STUDY: Cervical cancer rates are higher in Germany than in comparable European countries. While other European countries have implemented invitation programs, Germany relied on annual free access only. Are sufficient screening participation rates achieved? METHODS: We analyzed data from 2,223,135 Bavarian women between 2002/3 and 2005/4 in a retrospective cohort, to evaluate screening participation, frequency, age dependencies and regional differences. RESULTS: The highest screening participation was amongst women between 20 and 29 (54.6% had at least one visit after one year, 84% within three years) and decreased progressively with increasing age. Participation was lowest for women above 70 in rural areas (in some regions less than 20% had at least one screening within three years). CONCLUSION: Poor participation rates in general are unlikely to account for the high cervical cancer rates in Germany. Low participation rates in elderly women, particularly those in rural regions might contribute to the well-known peak of cervical cancer in elderly women.

The role of active metabolites in dihydrocodeine effects.

OBJECTIVE: The metabolism of dihydrocodeine to dihydromorphine, a high affinity mu-opioid receptor ligand in membrane homogenates, is catalyzed by CYP2D6. However, it is not clear whether an active CYP2D6 enzyme is required for opioid receptor-mediated effects in man after standard dihydrocodeine doses. METHODS: Whole cell opioid-receptor affinity and effects on cAMP accumulation of dihydrocodeine and its metabolites were determined in differentiated SH-SY5Y neuroblastoma cells. In a double-blind, 2-period, placebo-controlled randomized crossover pilot study the pharmacokinetics of dihydrocodeine (60 mg single dose) and its metabolites were examined in 5 phenotyped extensive (EMs) and 4 poor metabolizers (PMs) for CYP2D6, and pharmacodynamics were evaluated using a pain threshold model and dynamic pupillometry. RESULTS: Displacement binding and cAMP accumulation experiments showed clearly higher affinities (100- and 50-fold) and activities (180- and 250-fold) of dihydromorphine and dihydromorphine-6-glucuronide, respectively, whereas the other metabolites had similar or lower affinities and activities as compared to dihydrocodeine. The clinical study revealed no significant difference in plasma or urine pharmacokinetics between EMs and PMs for dihydrocodeine and its glucuronide. Dihydromorphine and its glucuronides were detectable in EMs only. A clear reduction of initial pupil diameters was observed up to 6 hours postdose in both PMs and EMs, with no obvious differences between CYP2D6 phenotypes. In the pain threshold model no effects were observed in either group. CONCLUSION: CYP2D6 phenotype has no major impact on opioid receptor-mediated effects of a single 60 mg dihydrocodeine dose, despite the essential role of CYP2D6 in formation of highly active metabolites.

Frozen shoulder.

Stiffness is a consistent but nonspecific symptom of primary frozen shoulder, a condition defined by restriction of passive motion in all planes without glenohumeral abnormalities on plain radiographs. Since the first description by Duplay in 1872, theories and descriptions of the lesions have varied over time and across authors, with the main target of the condition being reported as the subacromial bursa in some studies and the rotator interval in others. Recent publications have pointed out similarities with Dupuytren's contracture. Magnetic resonance imaging has helped to understand the lesions by showing a specific pattern of postgadolinium enhancement during the first few months after symptom onset. Pain relief is the main objective of therapy. Oral medications have not been adequately evaluated, with the exception of glucocorticoids, which hasten the resolution of nighttime pain to a modest degree. Intra-articular glucocorticoid injections are effective and are best performed under arthrographic control. It has been suggested that intra-articular glucocorticoid injections should be combined with joint capsule distension. An additional injection into the subacromial bursa has been found useful in patients with refractory pain. Motion range recovery is not always complete after 18 to 24 months and can be improved by physiotherapy. Methodological difficulties have precluded demonstration in formal studies of the undeniable benefits of physiotherapy. Joint capsule distension, and even more so arthroscopic capsulotomy with gentle mobilization, have provided promising results in patients with persistent stiffness, although the optimal time for performing these techniques remains to be determined.

Family therapy education for psychiatry residents : a pilot study of efficacy.

Teaching and clinical supervision of family therapy can enhance a resident's clinical skills and also promote movement from a linear, reductionistic type of thinking to a dynamic understanding of complex systems. Second-year postgraduate residents who completed a 10-month family therapy program were tested for their ability to understand family systems dynamics with the Family Therapy Assessment Exercise. Comparison of their test results before and after the program indicated significant improvement, which was entirely accounted for by improvement in the area of therapeutic skills.

Bone histology in adults with aseptic necrosis. Histomorphometric evaluation of iliac biopsies in seventy-seven patients.

UNLABELLED: We studied the bone histology by histomorphometric methods in transiliac bone-biopsy specimens from seventy-seven adult patients with aseptic osteonecrosis and normal kidney function. The trabecular bone volume, trabecular osteoid volume, trabecular osteoid surfaces, thickness index of osteoid seams, total resorption surfaces, calcification rate, tetracycline-labeled surfaces, and bone-formation rate at the basic multicellular unit level and at the tissue level were determined. Histological evidence of osteomalacia was found in nine patients, of whom four were alcoholics. In the remaining sixty-eight patients--fifteen treated with corticosteroids, twenty-nine alcoholics, and twenty-four who did not have any detectable etiological factor--a common histomorphometric profile was found. This consisted morphologically of a reduction in trabecular bone volume and in the thickness of osteoid seams, and dynamically of a reduction in calcification rate and in total labeled surfaces. All of these changes suggested a marked decrease in osteoblastic appositional rate and in bone-formation rate at the cell and tissue levels. This could induce a healing defect of microfractures and thus facilitate subchondral fractures. CLINICAL RELEVANCE: This histological study indicated that non-apparent bone disease--either osteoporosis or osteomalacia--may underlie aseptic osteonecrosis in almost all patients, and be found even when blood and urinary biochemical parameters, usually reflecting bone-remodeling, are normal. An iliac-crest bone biopsy with static and dynamic histomorphometric study is the appropriate method for detecting these abnormalities. These results are of importance for understanding the pathophysiological mechanisms underlying osteonecrosis as well as its prevention and treatment.