Contrast-enhanced MR imaging of breast lesions and effect on treatment.

PURPOSE: To assess the value of local staging with preoperative magnetic resonance imaging (MRI) in patients with suspect breast lesions and the effect on therapeutic approach. MATERIALS AND METHODS: Two hundred and four consecutive women with suspect breast lesions on clinical examination (CE) and/or mammography (MX) and/or ultrasound (US) underwent preoperative contrast-enhanced MRI. Detection of multifocal, multicentric and bilateral breast cancer by all three imaging modalities was evaluated. Results of preoperative breast MRI were discussed with the treating surgeons. The type of therapeutic change after preoperative MRI was marked on a questionnaire (none, additional fine needle aspiration, core biopsy, open biopsy, wider excision, mastectomy) and considered 'necessary' or 'unnecessary' using final histopathological results as gold standard. RESULTS: In 170 patients, breast cancer was diagnosed. MRI detected 96% of multifocal disease and 95% of multicentric disease, whereas MX depicted 37 and 18%, and US 41 and 9% of them, respectively. All bilateral breast cancers were seen on MRI; both MX and US detected 56%. Findings of more extensive disease and unsuspected multiple breast cancer foci identified on MRI only, changed the therapeutic approach correctly in 30.6% of breast cancer patients. Nine unnecessary wider excisions and three unnecessary FNA/core biopsies were performed because MRI overestimated the number or size of malignant lesions. CONCLUSION: Preoperative breast MRI is an important adjunct to conventional imaging in the loco-regional staging of breast cancer and a useful tool in treatment planning.

MR mammography in the pre-operative staging of breast cancer in patients with dense breast tissue: comparison with mammography and ultrasound.

The aim of this study was to determine whether pre-operative MR mammography could predict the extent of breast cancer in patients with dense breasts or whether dense parenchyma will lead to false-positive or inconclusive examinations. Sixty-seven patients with dense breasts with a malignant breast tumor planned for conservative surgery were reviewed. Detection rates of mammography, ultrasound, and MR mammography were studied, and the diameters of the lesions were measured and compared with pathological examination. Pathology revealed breast cancer in 65 patients. Sensitivity for detection of index lesions was 83% for mammography, 70.8% for ultrasound, and 98% for MR mammography. Mammography underestimated tumor extent in 37%, ultrasound in 40%, and MR in 12.5%. Of the 20 patients (31%) with multifocal or multicentric carcinoma, mammography detected the lesions in 35%, ultrasound in 30%, and MR in 100%, with a false-positive rate of 12.5, 14, and 23%. The MR mammography is more accurate in assessing tumor extent and multifocality in patients with dense breasts, but benign changes may lead to false-positive examinations.

Voiding habits and wetting in a population of 4,332 Belgian schoolchildren aged between 10 and 14 years.

OBJECTIVE: To determine the prevalence of daytime- with/without night-time wetting, in Belgium, in a group of 10 to 14 year old schoolchildren, and to study the voiding habits. SUBJECTS AND METHODS: A questionnaire of 41 questions was developed and completed by 4,332 parents at home. RESULTS: Wetting or soiling episodes were reported by a total of 528 (12%) of the children: monosymptomatic nocturnal enuresis by 62 (1%), daytime wetting with/without night-time wetting by 343 (8%), and faecal soiling by 123 (3%). We found significantly more girls in the wetting group, and the capacity to regularly postpone the voiding was significantly lower in this group. Significantly more children had nocturia in the group with wetting. CONCLUSIONS: Children with daytime wetting with/without night-time wetting have very often bladder-sphincter dysfunctions, which is in turn correlated with recurrent urinary tract infections. Eight percent of the 10 to 12 year old schoolchildren report daytime wetting with/without night-time wetting with some frequency. Surprisingly few parents, especially in the daytime wetting group, searched for medical help. Physicians and paediatricians should be encouraged to be more attentive to wetting in children and initiate discussion about urinary en faecal problems with parents and children.

Calcium, iron and zinc availability from weaning meals.

UNLABELLED: During the weaning period, solid foods are introduced in the diet to complement human milk or infant formula. Consequently, marginal deficiencies may easily develop because of inappropriate feeding and low bioavailability of nutrients. The objective of this study was to determine calcium, iron and zinc availability from weaning foods that contained a variety of ingredients but almost the same dietary fibre content, and to describe dietary factors that influence availability in a linear matter. Availability measurements from eight meals were made in vitro by a continuous-flow dialysis system with preliminary intraluminal digestion. Calcium, iron and zinc were analysed by flame atomic absorption spectrometry; ascorbic acid content was taken from food-composition tables; and macronutrient and mineral contents were obtained from the manufacturer. Calcium availability was higher in fruits (mean +/- SD, 39.2 +/- 4.1%) than vegetables (31.7 +/- 5.8%) (p < or = 0.001). Iron availability was marginally significant higher in vegetables (13.0 +/- 4.7%) than fruits (10.2 +/- 1.6%) (p = 0.027). Zinc availability showed higher availability in fruits (52.3 +/- 22.3%) than vegetables (22.1 +/- 5.6%) (p < or = 0.001). CONCLUSION: A major portion (47.8%) of the variance in calcium availability, as determined by multiple regression, could be explained by protein (p = 0.058, beta = -0.691). Major predictors of iron availability among the nutrients were iron content of the meal (p = 0.014, beta = -0.838), carbohydrates (p = 0.044, beta = -0.610) and dietary fibre (p = 0.235, beta = -0.285). Zinc availability was merely influenced by the protein (p = 0.010, beta = -0.876) and fat content of the meals (p = 0.295, beta = 0.255) in relation to other nutrients.

Reference values for plasma dipeptidyl-peptidase IV activity and their association with other laboratory parameters.

In blood, the exopeptidase dipeptidyl-peptidase IV (DPPIV; EC 3.4.14.5) is predominantly present in a soluble form in plasma/serum and as an activation antigen on the membrane of lymphocytes (CD26). It modifies some important biologically active peptides (neuropeptides, chemokines), and a regulatory role for DPPIV/CD26 in immune and endocrine processes has been demonstrated. The aim of this study was to determine reference values for plasma/serum DPPIV activity and to study the association of this activity with a series of biochemical and hematological parameters and baseline characteristics such as age, gender, blood pressure and body mass index. We studied 481 healthy subjects aged between 19 and 61 years. The group consisted of 213 men and 268 women equally divided between the different categories of age. Among the women, 127 were taking hormone therapy (contraception/hormone replacement) and 141 were not. A multiple regression model shows that DPPIV activity decreases significantly with age. The activity in women is slightly lower than in men. We observed an important association with liver, muscle and lipid metabolism-related parameters. In this model, no significant contribution of body mass index, blood pressure or hormone therapy could be stated.

Jaundice caused by a pancreatic mass: an exceptional presentation of Crohn's disease.

It is well known that Crohn's disease can involve the pancreas. However, granulomatous inflammation of the pancreas causing jaundice is extremely rare. In this report, we describe a patient presenting with jaundice in whom a Whipple procedure was performed because of the suspicion of a malignant pancreatic tumor. However, on histologic examination a benign granulomatous pancreatic mass was found. Further investigations revealed no other organ involvement and no underlying disease could be identified. Therefore, the tentative diagnosis of an idiopathic inflammatory pseudotumor was made. Only 6 months later, when the patient developed bloody diarrhea, Crohn's disease was diagnosed. This case stresses that, especially in young patients, Crohn's disease should be included in the differential diagnosis of benign common bile duct strictures even if no other symptoms of Crohn's disease are present.

Lower incidence of the upper respiratory tract infections among general practitioners as compared to their patients.

A retrospective cohort study suggest that general practitioners (GPs) run a significant reduced risk (more then 50%) to develop an upper respiratory tract infection (URTI) with fever compared to their patients. This difference can't be explained by variables such as gender, age, children and particularly young children, vaccination against influenza, presence of chronic illness or allergies, medication taken on a regular basis, smoking habits and regular physical exercise.

Associations of leptin with body fat distribution and metabolic parameters in non-insulin-dependent diabetic patients: no effect of apolipoprotein E polymorphism.

Leptin levels have been shown previously to be associated with anthropometric parameters such as the body mass index (BMI), total body fat, and subcutaneous fat. Since apolipoprotein E (apoE) polymorphism is known to be a genetic marker affecting the relationship between certain anthropometric and metabolic parameters, we evaluated whether the leptin level and/or associations between the leptin level and body composition in non-insulin-dependent diabetic patients could be determined by apoE polymorphism. In 171 type 2 diabetic patients (105 male and 66 female), body composition (BMI, waist to hip ratio [WHR], fat mass, and visceral fat) was measured and fasting blood samples were obtained to determine the apoE genotype, leptin, glucose, and insulin levels, and the lipid profile. The mean leptin level for the whole group was 11.7 +/- 9.3 ng/mL, with a significant difference (P < .001) between men (7.1 +/- 4.9 ng/mL) and women (19.0 +/- 10.1 ng/mL). No difference was found for leptin levels or anthropometric variables between the 3 different apoE genotypes (E3/E3 homozygotes, E2 carriers, and E4 carriers). Only low-density lipoprotein (LDL) cholesterol was significantly different between the 3 apoE subgroups. The correlations of leptin with anthropometric variables, especially visceral fat, tended to be different between the 3 apoE groups, but this was not independent and no effect was found after controlling for the other parameters in the model. A multiple regression model containing gender, subcutaneous fat, fasting glucose, triglycerides, and high-density lipoprotein (HDL) cholesterol explained 81% of the variance in leptin levels. We conclude that apoE polymorphism has no effect on the leptin level or its associations with other anthropometric and metabolic parameters.

Conventional retinal detachment surgery: technique, complications and results.

A uniform conventional technique, modified by Dr. Zivojnovic, was performed on 104 consecutive patients with rhegmatogenous retinal detachments including pseudophakic eyes (23.1%) and cases with preoperative proliferative vitreoretinopathy (PVR) A-C2 (21.2%). A prospective study of 59 variables in 104 cases shows the risk factors influencing the results after a minimum follow-up (F.U.) according to multivariate analysis: preoperative detached macula, vitreous loss during previous cataract surgery and duration of detachment. The anatomic (94.2% reattachment after external surgery) and functional results (69.2% V.A. > or = 0.5) are discussed as well as the complications.

Aspirin versus indomethacin treatment of patent ductus arteriosus in preterm infants with respiratory distress syndrome.

Indomethacin (Indo) is commonly used for treatment of patent ductus arteriosus (PDA) but has renal failure as a main side effect. Aspirin (ASA) is an alternative, but there are no controlled trials on its efficacy. We randomly assigned 75 premature infants suffering from respiratory distress syndrome (RDS) (mean gestational age: 29.6 +/- 2.5 wk, mean birth weight: 1295 +/- 464 g) (+/- SD) and on artificial ventilation at the start of the study (mean: 3.4 d of life), to either Indo (3 x 0.2 mg/kg/12 h) or ASA (4 x 15 mg/kg/6 h). PDA and degree of shunting were evaluated by echocardio-Doppler; side effects were carefully recorded. PDA closed in 35/38 patients from the Indo group (92%) and in 16/37 patients from the ASA group (43%) (p < 0.0001). Nineteen patients needed further treatment with Indo or surgery (17 in the ASA group and 2 in the Indo group). The only side effect observed was a decrease of uresis in the Indo group during 4 d post treatment (p < 0.01). Closing of PDA was positively correlated with gestational age, but not with time of starting Indo/ASA or grade of shunting. We conclude that ASA is not as effective in closing PDA as Indo, but has no adverse effect on uresis.

Horizontal transmission of hepatitis B virus.

In 1991-92, a cross-sectional survey in Flanders (Belgium) for hepatitis B virus (HBV) markers among 277 relatives of institutionalised mentally handicapped persons to evaluate the prevalence of hepatitis B and the risk of infection showed that relatives of an HBV positive resident were 7.6 times more likely to be infected than relatives of an HBV seronegative mentally handicapped person. HBV infection among the family members could be attributed in 83% to exposure to an HBV positive resident. This study demonstrated the importance of horizontal transmission among relatives of institutionalised mentally handicapped people, even if family contact is reduced to weekend and holiday activities. We recommend that HBV vaccination policy should be expanded to include relatives of institutionalised mentally retarded people.

Expression of c-erbB-2, c-myc, and c-ras oncoproteins, insulin-like growth factor receptor I, and epidermal growth factor receptor in ovarian carcinoma.

AIMS: To assess whether the overexpression of five dominant oncogene encoded proteins is crucial to the pathogenesis of ovarian carcinoma and whether this provides any useful prognostic information. METHODS: The expression of the insulin-like growth factor 1 receptor (ILGFR 1), epidermal growth factor receptor (EGFR), and the c-erbB-2, c-ras, and c-myc products was studied by multiparameter flow cytometry in 80 patients with epithelial ovarian cancer for whom long term follow up was available. RESULTS: Overexpression of ILGFR 1, EGFR, c-erbB-2, c-ras and c-myc was found in, respectively, nine of 80 (11%), 10 of 80 (12%), 19 of 80 (24%), 16 of 80 (20%) and 28 of 80 (35%) ovarian carcinomas. The levels of expression of ILGFR 1, EGFR, c-erbB-2 and c-ras were significantly higher in the tumours of patients with recurrent or persistent disease after chemotherapy than in the tumours of patients at initial presentation (p < 0.02). Multivariate analysis showed that residual tumour (p < 0.001), FIGO stage (p = 0.002), EGFR overexpression (p = 0.030) and previous chemotherapy (p = 0.034) were independent variables for predicting survival. CONCLUSIONS: Overexpression of these oncoproteins only occurs in a small proportion of ovarian carcinomas but may have an important role in the progression of the disease.

Birthweight and socioeconomic status: a study in Kigali, Rwanda.

Data were collected on 6709 singleton livebirths occurring in the hospital of Kigali, Rwanda. An analysis of birthweights was carried out by socioeconomic status, parity and age of the mother. The mean birthweight was highest in the high socioeconomic group. An effect of maternal age and parity on birthweight was observed. Because of the strong association between socioeconomic status and birthweight, the incidence of low birthweight can be used as an indicator of socioeconomic development.

PIP: The association between birthweight and socioeconomic status was investigated in the 6707 singleton births that occurred in the hospital in Kigali, Rwanda, in a 2-year period. Socioeconomic status was defined according to whether the mother delivered at the fee-paying clinic (high group) or at the free public clinic (low group). To evaluate the effect of parity, the birthweight data were given separately for 1st-born children and 4th-born children. In addition, primiparae were divided into 2 groups: mothers younger than 20 years of age and those age 20 years and older. Overall, the incidence of low birthweight (under 2500 grams) was 17.5% in this survey. Before analyzing for socioeconomic status, the percentage of low birthweight infants in the 3 age/parity categories was: para 1, under 20 years, 28.9%; para 1, 20 years or over, 21.9%; and para 4, 12.0%. Women of the higher socioeconomic group delivered heavier infants than women of the lower group. The difference between the 2 socioeconomic groups was significant at the p0.001 level for the study group as a whole as for the different subgroups. Mean birthweight was 3.12 + or - 0.50 in the high socioeconomic group compared with 2.95 + or - 0.49 in the low socioeconomic group; the percentage of low birthweight infants was 11.5% in the former group and 18.9% in the latter group. Given the strong association observed in this study, it is suggested that the incidence of low birthweight can be used as an indicator of socioeconomic development.

The selenium status of Belgian population groups : I. Healthy adults.

A moderate level of selenium (Se) was demonstrated in the blood (123 ng/mL), erythrocytes (RBC) (161 ng/mL), and plasma (97 ng/mL) of 110 male and 54 healthy female Belgian adults by using hydride-generation atomic absorption spectrometry. These values agree well with those found in neighboring countries. The study is the first one to report on normal values for these parameters in Belgians.Glutathione peroxidase (GSH-Px) activity has also been assayed. The group in considered nondeficient. Neither the concentration of Se in blood, plasma, or RBC, nor the activity of GSH-Px in the latter, were related to age, sex, blood pressure, or smoking habits. Oral contraception was associated with elevated plasma Se levels as compared to controls (P<0.01).A statistically significant positive relationship existed between the Se concentrations in whole blood or in red blood cells and red blood cell GSH-Px activity (r=0.31,p<0.005).

The selenium status of Belgian population groups : II. Newborns, children, and the aged.

The selenium state of 40 elderly Belgian people, residing in geriatric homes, has been evaluated. Data are presented on the selenium (Se) contents of their blood, plasma, and erythrocytes. The activity of glutathione peroxidase (GSH-Px) has been assayed. All data were compared with those obtained for 164 young, working adults as presented in Part I of this study. Plasma selenium levels were significantly lower in the old (73 ng/mL) as compared to the young people (97 ng/mL), but erythrocyte Se levels (200 ng/mL) and GSH-Px activity were significantly higher.The selenium concentration in plasma during infancy has also been estimated. The results reveal a very low Se level during the first months of life, with a gradual increase with age. The results are discussed in the light of literature data.