A simple score predicts future cardiovascular events in an inception cohort of dialysis patients.

Vascular calcifications are very common in dialysis patients and have been shown to be associated independently with outcome. However, all of these studies used prevalent patients on dialysis since many years. We investigated vascular calcifications in an inception cohort of dialysis patients and followed them for cardiovascular disease outcomes during an average observation period of 66 months. One hundred and fifty-four Caucasian dialysis patients were enrolled in one Austrian dialysis center. Standardized plain radiographs from the pelvis and calves were carried out in all patients at the start of dialysis therapy. Vascular calcifications were assessed by a single radiologist. At the start of renal replacement therapy, 67.5% of the patients showed vascular calcifications. During follow-up, 29.9% of patients suffered a cardiovascular event. An additive 'vascular risk score', constructed from the presence of vascular calcifications and/or previous cardiovascular events before the start of dialysis treatment, showed the strongest independent association with cardiovascular events in the Cox regression model adjusted for various risk factors. The presence of each of these two conditions was associated with a hazard ratio of 2.03 (95% confidence interval 1.19-3.46) and a hazard ratio twice as high if both conditions were present. In summary, vascular calcifications on plain X-rays of pelvis and calves are largely present in incident dialysis patients. A history of a cardiovascular event in the predialysis period together with vascular calcifications at the beginning of dialysis therapy is a more powerful predictor of a cardiovascular event than age, smoking, diabetes, or other traditional risk factors.

[Advanced breast biopsy instrumentation (ABBI) experiences and critical comments]. / Advanced Breast Biopsy Instrumentation (ABBI) Erfahrungen und kritische Bemerkungen.

UNLABELLED: Advanced breast biopsy instrumentation (ABBI) experiences and critical comments. PURPOSE: To describe our three-years' experience with advanced breast biopsy instrumentation (ABBI). MATERIALS AND METHODS: Considering lesion size, type and location as well as patient specific criteria 89 patients were selected for an ABBI. The documented data like duration, complication and change of the procedure, size of the lesions and biopsy cannulas, histologic outcome and further treatment were analysed retrospectively. RESULTS: ABBI was successful in 63 of 89 patients. Cancer was found in 18 patients (29 %) with a surgical re-excision to achieve tumour-free margins in 89 %. 45 patients had benign lesions (71 %) with a benign to malignant ratio of 2.5 : 1. ABBI was unsuccessful or had to be replaced by other biopsy techniques in 26 patients (29 %). In four of these patients the localization needle was already placed. Analysing the three-year period ABBI frequency dropped each year with an overall reduction of 63 %. Despite a good benign to malignant ratio the surgical re-excision rate in cancer patients is disappointing. Although using precise selection criteria for ABBI the rate of failed biopsies and changeover to another biopsy procedure was too high. The reduction of ABBI procedures during the three-year period is assumed to be an expression of the negative experiences with the method but also a refusal of the assigning colleagues to use ABBI. CONCLUSION: For the evaluation of suspected breast lesions ABBI is too invasive and too expensive. On the other hand ABBI is too ineffective as a therapeutic tool to remove suspected lesions. Therefore it is not warranted to use ABBI instead of other concurrent biopsy techniques.

The value of intraoperative angiography in surgery of intracranial aneurysms: a prospective study in 126 patients.

The value of intraoperative digital subtraction angiography in surgery for intracranial aneurysms, the benefits and cost-effectiveness are a matter of discussion. We prospectively studied 126 patients with 144 aneurysms, most on the anterior intracranial circulation, who underwent clipping and intraoperative angiography. Follow-up was 28.4 +/- 13.1 months. We tried to work out the indications for intraoperative angiography of the anterior circulation and its cost-effectiveness. In 10.3 % of patients (9 % per aneurysm) unexpected findings were shown by intraoperative angiography: inadequately clipped aneurysms in 10 (7.9 %), a completely unclipped aneurysm in one (0.8 %) and occluded major arteries in two (1.6 %). A broad neck was a variable of statistical significance for inadequate clipping or stenosis or occlusion of an adjacent vessel. There was a strong trend for aneurysms more than 15 mm in diameter to be "risky". Their site was not a predictive factor. We believe that intraoperative angiography is indicated in surgery not only on large and giant aneurysms, but also broad-based aneurysms of the anterior cerebral circulation regardless of their size. It is cost-effective compared to postoperative angiography. The rate of stroke in our hands was 0.8%.

Effects of iodinated contrast agents in MR imaging.

PURPOSE: To investigate the effects of iodinated contrast agents in MRI. MATERIAL AND METHODS: Twenty patients were examined with MRI immediately, 8 and 24 h after lumbar myelography. Signal intensities and calculated T1- and T2-relaxation times of different iodinated contrast agents, a dilution row of iopamidol, and a mixture of CSF and iotrolan were compared with physiological saline solution using different T1- and T2-weighted sequences. 1H-spectroscopy was performed with several solutions containing iodine or other substances. RESULTS: A fluid-fluid level of the CSF existed in the lumbar dural sac in all patients immediately after lumbar myelography with a non-ionic iodinated contrast agent. Increased signal intensity on T1-weighted and decreased signal intensity on T2-weighted sequences was found for all contrast agents, as well as for the dilution row, compared with physiological saline solution. The structure of the side chains of the contrast agents is responsible for the T1- and T2-shortening effect. CONCLUSION: It is important to be aware of the effect of iodinated contrast agents in MRI. To avoid misinterpretation of atypical findings, MRI of the spine should not be performed earlier than 24 h after myelography.

[Excessive lobular calcifications in a lobular carcinoma in situ Type A combined with a lobular carcinoma in situ Type B and an intraductal carcinoma in situ]. / Exzessive lobuläre Verkalkungen bei einem Carcinoma lobulare in situ Typ A kombiniert mit einem Carcinoma lobulare in situ Typ B und einem intraduktalen Carcinoma in situ.

Differential diagnosis of excessive lobular calcifications of the breast can be difficult, especially if they are polymorphous in character. In those cases good cooperation between radiologist, surgeon and pathologist is of importance. We present a case in which we could find three types of noninvasive carcinomas combined with polymorphous lobular calcifications.