bluuebunny/crossref_metadata_2025 huggingface dataset:
Epiphyseal cartilage canal blood supply to the metatarsophalangeal joint of foals
Authors: OLSTAD K. , YTREHUS B. , EKMAN S. , CARLSON C. S. , DOLVIK N. I.
Published: December 2009

Reasons for performing study: It is presently unknown whether cartilage ischaemia plays any part in the pathogenesis of osteochondral fragmentation within the equine metatarsophalangeal joint, as no detailed studies on microcirculation in the area have been reported.

Objective: To describe the developmental pattern of the blood supply to the epiphyseal growth cartilage in the metatarso‐phalangeal joint of foals.

Methods: Eight Standardbred foals were sacrificed between birth and age 7 weeks to undergo a barium perfusion procedure to demonstrate vessels within growth cartilage canals of one hindlimb. The metatarso‐phalangeal joint was cleared in methyl salicylate and perfused vessels studied in the intact bones. The bones were sawed into 5 mm thick slabs, decalcified and radiographed. Selected slabs were cleared in methyl salicylate for a second time and examined at low magnification. The dorsal half of the sagittal ridge of the distal third metatarsal bone and the plantar half of the proximal phalanx were examined histologically.

Results: Regions of the epiphysis with thick cartilage contained a greater number of perfused vessels than regions with thin cartilage. The cartilage canal vessels were oriented either parallel or perpendicular to the underlying ossification front. Cartilage canal vessels were incorporated into the ossification front during growth and became reliant on a subchondral arterial source. Macroscopically visible lesions were not detected in the current group of foals. On histological examination, pathological changes consisting of an area of chondronecrosis surrounded by fibrovascular granulation tissue were found in sections from the lateral proximo‐plantar eminence of the proximal phalanx in the 7‐week‐old foal.

Conclusion: The same anatomical feature (traversing the ossification front to enter cartilage canals) reported to render vessels vulnerable to failure in the tarsus was also present in the metatarso‐phalangeal joint of foals.

Potential relevance: Osteochondrosis may occur by the same pathogenetic mechanism in the metatarso‐phalangeal joint as in the tarsus of foals.
Optimisation of the frequently sampled intravenous glucose tolerance test to reduce urinary glucose spilling in horses
Authors: TÓTH F. , FRANK N. , ELLIOTT S. B. , PERDUE K. , GEOR R. J. , BOSTON R. C.
Published: December 2009

Reasons for performing study: The frequently sampled i.v. glucose tolerance test (FSIGTT) is used to evaluate glucose and insulin dynamics in horses, but it has not been determined whether urinary glucose spilling (UGS) affects results.

Hypothesis: UGS occurs in horses during the FSIGTT and this problem can be minimised by adjusting the dextrose and insulin dosages used.

Methods: Six mature mares were included in this study. In the first phase, 6 FSIGTT procedures were performed in each horse to evaluate 6 different dextrose dosages. Six different insulin dosages were evaluated during the second phase of the study after administration of 300 mg/kg bwt dextrose. Area under the glucose (AUCg) and insulin (AUCi) curves were calculated and minimal model analyses performed. UGS was measured in the third and fourth phases of the study during the combined glucose insulin test and established FSIGTT. A new FSIGTT was developed and evaluated.

Results: Positive linear effects of dextrose dosage on AUCg, AUCi and acute insulin response to glucose were detected, with AUCg reaching a plateau at doses 200 mg/kg bwt. Insulin dosage had an inverse linear effect on AUCg, but other values remained unaffected. UGS occurred during all 3 tests and was the highest for the established FSIGTT and the lowest for the new FSIGTT. The type of FSIGTT performed did not affect minimal model results.

Conclusions: Results indicate that the dextrose dosage of 300 mg/kg bwt used in the established FSIGTT is too high. UGS can be reduced by lowering the dextrose dosage to 100 mg/kg bwt.

Potential relevance: A new FSIGTT involving the administration of 100 mg/kg bwt dextrose followed by 20 mu/kg bwt insulin 20 min later is recommended for use in horses because this test provides adequate data for minimal model analysis while minimising UGS.
Changes in faecal bacteria associated with concentrate and forage‐only diets fed to horses in training
Authors: WILLING B. , VÖRÖS A. , ROOS S. , JONES C. , JANSSON A. , LINDBERG J. E.
Published: December 2009

Reasons for performing study: Diets rich in readily fermentable carbohydrates, fed traditionally to meet the increased energy requirements of the performance horse, are associated with a number of gastrointestinal disorders that involve disturbances in the intestinal microbiota, however, these changes are poorly understood.

Objectives: With the long‐term objective of improving intestinal health and to increase understanding of the relationship between diet and microbiota, the effect of feeding Standardbred horses a high‐energy forage‐only (F) diet was studied compared to a more traditional forage‐concentrate (C) diet on faecal microbiota.

Methods: Diets were fed in a cross‐over design to 6 mature geldings on a scheduled training regime, both periods consisting of 29 days. DNA was extracted from faecal samples collected at 4 time points from each period, bacterial 16S rRNA genes were amplified and community composition assessed by terminal‐restriction fragment length polymorphism, cloning and sequencing. Faecal pH and cultivable lactic acid bacteria (LAB) and enterobacteria were also assessed on the final collection day of each period.

Results: Diet F resulted in a microbial composition that was more stable between sampling periods and had lower counts (P<0.05) of cultivable LAB and specifically members of the Streptococcus bovis/equinus complex. Motile and swarming Lactobacillus ruminis was present in all horses on diet C and not in horses on diet F. Diet C also resulted in the increase (P<0.05) in members of Clostridiaceae cluster III and a concomitant reduction (P<0.05) in an unknown group of Bacteroidales.

Conclusions and potential relevance: The greater microbial stability and reduction in LAB and members of the Streptococcus bovis/equinus complex on diet F indicate an opportunity to develop feeding strategies that support equine health and welfare. Novel changes identified in the faecal microbiota that resulted from carbohydrate inclusion merit further investigation.
Imaging and histological features of central subchondral osteophytes in racehorses with metacarpophalangeal joint osteoarthritis
Authors: OLIVE J. , D'ANJOU M.‐A. , GIRARD C. , LAVERTY S. , THEORET C. L.
Published: December 2009

Reasons for performing study: Marginal osteophytes represent a well known component of osteoarthritis in man and animals. Conversely, central subchondral osteophytes (COs), which are commonly present in human knees with osteoarthritis, have not been reported in horses.

Objectives: To describe and compare computed radiography (CR), single‐slice computed tomography (CT), 1.5 Tesla magnetic resonance imaging (MRI), and histological features of COs in equine metacarpophalangeal joints with macroscopic evidence of naturally‐occurring osteoarthritis.

Methods: MRI sequences (sagittal spoiled gradient recalled echo [SPGR] with fat saturation, sagittal T2‐weighted fast spin echo with fat saturation [T2‐FS], dorsal and transverse T1‐weighted gradient‐recalled echo [GRE], and sagittal T2*‐weighted gradient echo with fast imaging employing steady state acquisition [FIESTA]), as well as transverse and reformatted sagittal CT, and 4 computed radiographic (CR) views of 20 paired metacarpophalangeal joints were acquired ex vivo. Following macroscopic evaluation, samples were harvested in predetermined sites of the metacarpal condyle for subsequent histology. The prevalence and detection level of COs was determined for each imaging modality.

Results: Abnormalities consistent with COs were clearly depicted on MRI, using the SPGR sequence, in 7/20 (35%) joints. They were identified as a focal hypointense protuberance from the subchondral plate into the cartilage, at the palmarodistal aspect (n = 7) and/or at the very dorsal aspect (n = 2) of the metacarpal condyle. COs were visible but less obvious in 5 of the 7 joints using FIESTA and reformatted sagittal CT, and were not identifiable on T2‐FS, T1‐GRE or CR. Microscopically, they consisted of dense bone protruding into the calcified cartilage and disrupting the tidemarks, and they were consistently associated with overlying cartilage defects.

Conclusions: Subchondral osteophytes are a feature of osteoarthritis of equine metacarpophalangeal joints and they may be diagnosed using 1.5 Tesla MRI and CT.

Potential relevance: Central subchondral osteophytes on MRI represent indirect evidence of cartilage damage in horses.
Study of laryngopharyngeal pathology in Thoroughbred horses in southern California
Authors: DIAB S. , PASCOE J. , SHAHRIAR M. , READ D. , KINDE H. , MOORE J. , ODANI J. , UZAL F.
Published: December 2009

Reasons for performing study: There is increasing anecdotal evidence among horse owners, trainers and equine clinicians of a high prevalence of subepiglottic ulcers, suggested to have a negative effect on racing performance.

Objectives: To provide a prevalence study and pathological characterisation of laryngopharyngeal lesions with emphasis in the subepiglottic area and, in particular, subepiglottic ulcers.

Methods: The study was carried out on 91 Thoroughbred racehorses received forpost mortemexamination from 4 major Southern California racetracks. The most common reason for submission was catastrophic musculoskeletal injury, but others include sudden death, laminitis, colic, colitis, neurological disorders, pleuropneumonia and arytenoid chondropathy. Laryngopharyngeal specimens were collected and examined grossly; selected cases were also examined histopathologically.

Results: Thirteen horses (14.3%) had at least one type of laryngopharyngeal abnormality, 7 horses (7.7%) had lesions in the subepiglottic soft tissues, including 4 subepiglottic ulcers, 2 soft palate ‘kissing lesions' and one 'subepiglottic scar’. Eight horses (8.8%) had lesions elsewhere in the laryngopharynx, including mucosal ulcerations, arytenoid chondropathy, epiglottic entrapment and partial absence of arytenoid cartilage.

Conclusions and potential relevance: Lesions in the subepiglottic area were among the most prevalent in this study, suggesting that an important percentage of laryngopharyngeal abnormalities may be missed during routine endoscopy of the standing horse, which often does not include the examination of subepiglottic tissues. Pathologically, subepiglottic ulcers were chronic‐active with viable hyperplastic epithelial margins, suggesting that proper healing and re‐epithelialisation should occur with appropriate treatment. In most cases, the lesions observed do not necessarily indicate a clinical problem and more extensive prevalence studies and correlation between abnormalities found and performance are needed to assess the clinical relevance of subepiglottic soft tissue lesions accurately.
Computed tomography of the upper cheek teeth in horses with infundibular changes and apical infection
Authors: VERAA S. , VOORHOUT G. , KLEIN W. R.
Published: December 2009

Reasons for performing study: Infundibular changes are frequently encountered computed tomographic studies of the equine maxillary cheek teeth but the possible importance of this finding is not known. Infundibular caries is a possible cause for pulpitis and apical infection in some horses.

Objectives: To study the relationship between the 2 pathologies and the frequency of changes.

Methods: The maxillary cheek teeth 108‐208, 109–209 and 110–210 of 25 horses were evaluated using computed tomography and both the prevalence of infundibular and apical infection changes as the possible link with apical infection evaluated statistically.

Results: The prevalence of infundibular changes was high in both normal and diseased teeth. Both apical infection and the occurrence of infundibular changes were more prevalent in 109–209 and 110–210. In spite of this, the 2 processes could not be linked to one another. No differences were noted between the left and right sides.

Conclusions: A direct relationship between the 2 processes was not established statistically and other underlying causes for the high occurrence of both apical infection and infundibular changes in diseased and normal 108‐208, 109–209 and 110210 are considered.
Type 2diabetes mellitus with pancreatic β cell dysfunction in 3 horses confirmed with minimal model analysis
Authors: DURHAM A. E. , HUGHES K. J. , COTTLE H. J. , RENDLE D. I. , BOSTON R. C.
Published: December 2009

Reasons for performing study: Type 2diabetes mellitus (T2DM) is diagnosed rarely in equine practice although it may be under‐recognised. A greater awareness of the condition and therapeutic considerations would be to the benefit of such cases presenting in practice. More investigation into the pharmacological management of these cases is needed.

Objectives: Three cases of diabetes mellitus were investigated using a specific test for insulin sensitivity and pancreatic β cell function in order to define accurately and characterise the existence of T2DM in all 3 subjects.

Methods: The insulin‐modified frequently sampled i.v. glucose tolerance test was performed in each case and the data so obtained were subject to minimal model analysis of insulin‐glucose dynamics. Cases were then monitored following treatment using a combination of dietary modification, metformin, glibenclamide and pergolide.

Results: Marked insulin resistance was identified in each case and, furthermore, severe pancreatic β cell dysfunction was present therefore classifying each case as end stage T2DM. Treatment was nevertheless associated with restoration of normoglycaemia in all cases.

Conclusions: T2DM in horses may be more common than generally considered. In some cases individuals may respond to therapy aimed at restoring insulin sensitivity and pancreatic function. Drugs used in other species for the treatment of T2DM have not yet been adequately tested in horses.

Potential relevance: T2DM should be considered as an important differential diagnosis in mature to elderly horses and ponies suffering from weight loss, polydipsia and polyuria. Clinicians should be encouraged to offer treatment and management advice when such cases are encountered.
Reproductive performance measures among Thoroughbred mares in central Kentucky, during the 2004 mating season
Authors: BOSH K. A. , POWELL D. , SHELTON B. , ZENT W.
Published: December 2009

Reason for performing study: To improve efficiency at the farm level, a better understanding of how farm management factors impact reproductive performance is important.

Objective: To assess reproductive efficiency and effectiveness among Thoroughbred mares in central Kentucky.

Methods: A cohort of 1011 mares on 13 farms in central Kentucky was followed during the 2004 mating and 2005 foaling season. Information on farm level practices was collected via interviews with farm managers. Reproductive records were collected for each mare mated to obtain information on mare characteristics. The influence of mare age and status (maiden, foaling, barren) on Days 15 and 40 post mating pregnancy rates, foaling rates and total effective length of the mating season were assessed. The influence of stallion book size on reproductive performance measures was also examined.

Results: Per season pregnancy rates on Days 15 and 40 post mating and live foal rate were 92.1, 89.3 and 78.3%, respectively. Per cycle rates for the same time periods were 64.0, 58.3 and 50.8%. There were no significant associations between stallion book size and reproductive performance outcomes. The mean s.d. interval from the beginning of the mating season to the last mating of the mare was 36.5 ± 26.1 days.

Conclusions: Mare age had a significant impact on efficiency of becoming pregnant, maintaining pregnancy and producing a live foal. Overall, fertility did not decrease among stallions with the largest book sizes. Total interval length of the mating season can be reduced if managers ensure maiden and barren mares are mated at the beginning of the season and foaling mares are mated at the earliest oestrus after acceptable uterine involution has been achieved.

Potential relevance: Measures identified in the study can be used by owners, farm managers and veterinarians to improve mare reproductive performance and identify parameters to assist with the implementation of effective culling practices.
Effects of endotoxaemia and carbohydrate overload on glucose and insulin dynamics and the development of laminitis in horses
Authors: TÓTH F. , FRANK N. , CHAMEROY K. A. , BOSTON R. C.
Published: December 2009

Reasons for performing study: Insulin resistance (IR) is a risk factor for pasture‐associated laminitis in equids and alimentary carbohydrate overload may trigger laminitis. Whether glucose metabolism responses to carbohydrate overload are more pronounced in insulin‐resistant horses requires further study.

Hypothesis: Horses pretreated with endotoxin to alter insulin sensitivity differ significantly in their glucose and insulin responses to carbohydrate overload.

Methods: Horses (n = 24) were divided into 3 groups. A lipopolysaccharide (LPS; n = 8) group that received endotoxin as an 8 h 7.5 ng/kg bwt/h i.v. continuous rate infusion, an oligofructose (OF; n = 8) group that received an infusion of saline followed by 5 g/kg bwt OF via nasogastric intubation, and a LPS/OF (n = 8) group that received LPS followed 16 h later by OF. Glucose and insulin dynamics were evaluated at ‐24 h and 48 h using the frequently sampled i.v. glucose tolerance test and minimal model analysis. Physical examinations and haematology were performed and the severity of laminitis assessed.

Results: Horses receiving LPS developed leucopenia and both LPS and OF induced clinical signs consistent with systemic inflammation. Insulin sensitivity significantly decreased (P<0.001) over time, but responses did not differ significantly among groups. Time (P<0.001) and treatment × time (P = 0.038) effects were detected for the acute insulin response to glucose, with mean values significantly increasing in LPS and LPS/OF groups, but not the OF group. Five horses in the LPS/OF group developed clinical laminitis compared with 0 and 2 horses in the LPS and OF groups, respectively.

Conclusions: Endotoxaemia and carbohydrate overload reduce insulin sensitivity in horses. Endotoxin pretreatment does not affect the alterations in glucose metabolism induced by carbohydrate overload.

Potential relevance: Insulin sensitivity decreases after carbohydrate overload in horses, which may be relevant to the development of pasture‐associated laminitis.
Subchondral cyst‐like lesions in the talus of four horses
Authors: Montgomery L. J. , Juzwiak J. S.
Published: December 2009

Subchondral cyst‐like lesions (SCLs) of horses have been found in various locations, but SCLs of the talus have been reported rarely. In this report, we describe 4 horses affected with a SCL of the talus. Each SCL was identified using digital radiography, and each horse was treated by intralesional injection of triamcinolone acetonide. Case details, history, findings during clinical and radiographic examination, treatment, and outcome of each horse are discussed.
Advanced twin abdominal pregnancy: diagnostic and therapeutic challenges
Authors: DASSAH EDWARD TIERU , ODOI ALEXANDER TAWIAH , OPOKU BAAFUOR KOFI
Published: December 2009

Abdominal pregnancy remains a diagnostic challenge despite the remarkable improvements and widespread availability of antenatal ultrasound. A case of advanced twin abdominal pregnancy that was diagnosed after failed induction of labor is presented highlighting the diagnostic and hemostatic challenges encountered. The role and limitations of antenatal ultrasound as well as the importance of adhering to basic ultrasound imaging principles are emphasized as a way of ensuring an early diagnosis and minimizing the devastating consequences associated with this rare variety of ectopic pregnancy.
Helicobacter pylori infection and hyperemesis gravidarum: a systematic review and meta‐analysis of case–control studies
Authors: SANDVEN IRENE , ABDELNOOR MICHAEL , NESHEIM BRITT–INGJERD , MELBY KJETIL K.
Published: December 2009

Objective. To summarize the evidence from epidemiological studies examining the association between Helicobacter pylori infection and hyperemesis gravidarum. Design. Systematic review and meta‐analysis of case–control studies. Material and methods. We searched the Medline/PubMed, Embase, Cinahl, ISI Web of Science and Biological Abstracts databases from 1966 to 17 June 2008 and finally Google Scholar. A total of 25 case–control studies were identified. Both fixed‐effect and random‐effect models were used to synthesize the results of individual studies. The Cochran Q, τ2 of between‐study variance and index of heterogeneity (I2) were used to evaluate heterogeneity. Heterogeneity between studies was examined by subgroup and random effect meta‐regression analyses. Publication bias was evaluated. Results. Publication bias was not observed. The random model pooled estimate was odds ratio = 3.32, 95 % confidence interval (CI): 2.25–4.90. A high heterogeneity was pinpointed (I2 = 80 %, 95 % CI: 65–89). Subgroup analysis and meta‐regression showed a weaker association in studies with a clear definition of hyperemesis gravidarum compared to studies without this condition, and weaker association in recent studies compared to earlier studies. Meta‐regression showed that these two study characteristics explained 40% of heterogeneity between studies. Conclusions. Exposure to H. pylori appears to be associated with an increased risk of hyperemesis gravidarum. The residual heterogeneity might have different reasons. Given the high prevalence of H. pylori, the public health consequence of H. pylori with regard to hyperemesis gravidarum may be important.
Predictors of term stillbirths in an inner‐city maternity hospital in Lagos, Nigeria
Authors: OLUSANYA BOLAJOKO O. , SOLANKE OLUMUYIWA A.
Published: December 2009

Objective. To determine the rates, pattern and correlates of term/viable stillbirths (gestational age ≥ 37 weeks and fetal weight ≥ 2,500 g). Design. Unmatched case‐control, cross‐sectional study. Setting. Inner‐city maternity hospital, Lagos, Nigeria. Methods. About two‐thirds of all documented stillbirths from 2005 to 2007 were analyzed to determine factors that correlated with viability by comparing term stillbirths first with pre‐term stillbirths and then with term live births using multiple logistic regression. Main outcome measures. Prevalence rates and adjusted odds ratios at 95% confidence intervals (CIs). Results. Of the total 7,216 deliveries over the three year period, there were 917 qualifying stillbirths out of which 404 (44.1%) were macerated and 13 (1.4%) were identified with congenital anomalies. Over half (57.0%) of the mothers with stillbirths had no antenatal care. Compared with pre‐term stillbirths, term stillbirths were significantly associated with multiparity (odds ratio (OR) 0.69; 95% CI 0.48–0.99), antepartum hemorrhage (OR 0.54; 95% CI 0.35–0.83), premature rupture of membranes (OR 0.26; 95% CI 0.14–0.52), hypertensive conditions in pregnancy (OR 0.60; 95% CI 0.39–0.92), cesarean section (OR 1.71: 95% CI 1.13–2.60), cephalopelvic disproportion (OR 3.56; 95% CI 1.43–8.86), prolonged/obstructed labor (OR 1.94; 95% CI 1.22–3.07), and congenital abnormalities (OR 0.20; 95% CI 0.05–0.79). Young maternal age (OR 2.50; 95% CI 1.22–5.14), lack of antenatal care (OR 1.57; 95% CI 1.22‐3.07), cord accidents (OR 29.63; 95% CI 14.23–61.71), and fetal distress (OR 5.30; 95% CI 3.35–8.38) emerged as additional risk factors when compared with term live births. Conclusions. While the uptake of antenatal care was generally poor, most factors associated with the unacceptably high proportion of viable stillbirths in this resource‐poor setting were identical to risk factors for total stillbirths and can be effectively managed with improved maternal education and obstetric care.
Serum glycodelin pattern during the menstrual cycle in healthy young women
Authors: BERSINGER NICK A. , BIRKHÄUSER MARTIN H. , YARED MENGISTU , WUNDER DOROTHEA M.
Published: December 2009

Objective. Glycodelin (PP14) is produced by the epithelium of the endometrium and its determination in the serum is used for functional evaluation of this tissue. Given the complex regulation and the combined contraceptive and immunosuppressive roles of glycodelin, the current lack of normal values for its serum concentration in the physiological menstrual cycle, derived from a large sample number, is a problem. We have therefore established reference values from over 600 sera. Design. Retrospective study using banked serum samples. Setting. University hospital. Methods. Measurement of blood samples daily or every second day during one full cycle. Main outcome measures. Serum concentrations of glycodelin and normal values for every such one‐ or two‐day interval were calculated. Late luteal phase glycodelin levels were compared with ovarian hormones. Follicular phase levels were compared with stimulated cycles from patients undergoing in vitro fertilization. Results. Glycodelin concentrations were low around ovulation. Highest levels were observed at the end of the luteal phase; the glycodelin serum peak was reached 6–8 days after the one for progesterone. Late luteal glycodelin levels correlated negatively with the body mass index and positively with the progesterone level earlier in the secretory (mid‐luteal) phase in the same woman. No associations with other ovarian hormones were observed. Follicular phase glycodelin levels were higher in the spontaneous than in the in vitro fertilization cycles. Conclusions. Normal values taken at two‐ or one‐day intervals demonstrate the very late appearance of high serum glycodelin levels during the physiological menstrual cycle and their correlation with progesterone occurring earlier in the cycle.
Artifact reduction of susceptibility-weighted imaging using a short-echo phase mask
Authors: Ishimori Y. , Monma M. , Kohno Y.
Published: December 2009

Background: Susceptibility-weighted imaging (SWI) is utilized in magnetic resonance (MR) venography and other applications, but can include artifacts caused by the phase-masking process.

Purpose: To demonstrate risks of filter processes used in making phase masks for SWI, and to propose a simple method for reducing artifacts.

Material and Methods: Phase linearity related to echo time (TE) was evaluated for the original phase and high-pass-filtered phase using a CuSO4-doped water phantom. Effect of filter size of the Hanning window and background homogeneity were also evaluated in a phantom study. Use of a phase mask generated by data with differing magnitudes of TE was attempted in a human study. Shorter TE was used for making the phase mask, and the number of multiplications was increased. As short and long TEs were necessary simultaneously for phase mask and T2* contrast, a dual-echo technique was used.

Results: Linearity of TE and phase value collapsed, and an unexpected negative phase appeared in the high-pass-filtered phase. Using a short-TE phase mask, phase-aliasing artifacts were reduced and visibility of deep veins was equivalent to that under conventional methods with an increased number of multiplications.

Conclusion: Use of a short-echo phase mask in SWI is useful for reducing artifacts.
Breast magnetic resonance imaging findings in women treated with toremifene for premenstrual mastalgia
Authors: Oksa S. , Parkkola R. , Luukkaala T. , Mäenpää J.
Published: December 2009

Background: Toremifene, a selective estrogen receptor modulator, has been shown to be effective in alleviating premenstrual breast pain. However, the exact mechanism by which toremifene and related compounds work in premenstrual mastalgia is poorly understood.

Purpose: To find out if the effect of toremifene on breast would be detectable with dynamic magnetic resonance imaging (MRI).

Material and Methods: This randomized, double-blind crossover study was performed on women suffering from marked premenstrual mastalgia. Ten women were randomized to receive either toremifene (20 mg) or placebo from cycle day 15 until next menstruation for three menstrual cycles. After a washout period, the treatment was crossed over for three additional cycles. The MRI evaluations were performed premenstrually at the end of each treatment phase. Breast pain and quality-of-life scores were collected from one baseline cycle and from all the treatment cycles.

Results: Nine patients were evaluable for this analysis. Both the enhancement ratio and the maximum slope of enhancement tended to be smaller during the toremifene cycles as compared to placebo. On the left side, the difference in the maximum slope of enhancement between toremifene and placebo was statistically significant (median 5.150 [range 3.7–6.7] and 6.500 [range 4.9–9.5], respectively; P=0.047). T2 relaxation times as well as breast pain and quality-of-life scores were inconsistent.

Conclusion: Use of toremifene is associated with measurable changes in dynamic breast MRI findings in women with cyclic breast pain.
Prostate cancer detection: the value of performing an MRI before a biopsy
Authors: Shimizu T. , Nishie A. , Ro T. , Tajima T. , Yamaguchi A. , Kono S. , Honda H.
Published: December 2009

Background: In recent years, prostate-specific antigen (PSA) screening has been widely performed. As a result, patients who need to undergo a complete physical examination for an elevated PSA level have been rapidly increasing. Magnetic resonance imaging (MRI) examination has previously been reported to be effective for the detection of prostate cancer.

Purpose: To evaluate the detectability of prostate cancer by performing MRI before biopsy, and to evaluate the relationship between detectability with MRI and cancer location, Gleason score (GS), and tumor size.

Material and Methods: MRI was performed at 1.5 Tesla in 122 consecutive patients before biopsy. The detectability of prostate cancer, including sensitivity and positive predictive value (PPV) of transrectal ultrasonography (TRUS), T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI) ( b=2000 s/mm2), apparent diffusion coefficient (ADC) map, and biopsy, was calculated using whole-mount section histopathology as a gold standard. In addition, the relationship between the detectability on each MRI sequence and factors such as cancer location (peripheral zone vs. transition zone), GS 5–10, short-axis diameter (≤4 mm, 5–9 mm, ≥10 mm), and long-axis diameter (≤9 mm, 10–19 mm, ≥20 mm) were also evaluated.

Results: The sensitivities of TRUS, T2WI, DWI, ADC map, and biopsy were 26.9%, 41.2%, 56.7%, 57.7%, and 75.1%, respectively, and the PPVs of those modalities were 73.0%, 83.0%, 86.4%, 87.2%, and 91.5%, respectively. There was no correlation between the sensitivity of each MRI sequence and cancer location. The sensitivity of each MRI sequence increased as GS and short- and long-axis diameters of cancer lesions increased.

Conclusion: MRI before a biopsy has a high detectability of prostate cancer, particularly with tumor size of more than 5 mm in short-axis diameter or 10 mm in long-axis diameter.
Magnetic resonance imaging of breast cancer and correlation with prognostic factors
Authors: Chang Yun-Woo , Kwon Kui Hyang , Choi Deuk Lin , Lee Dong Wha , Lee Min Hyuk , Lee Hye Kyung , Yang Seung Boo , Kim Yongbae , Seo Dae Young
Published: December 2009

Background: Prognostic factors of breast cancer have been used for the prediction of clinical outcome or selection of patients for complementary treatment. Some of the imaging features of breast cancer, e.g. magnetic resonance imaging (MRI), are associated with these prognostic factors.

Purpose: To evaluate the relationship between dynamic enhanced MR features and prognostic factors of clinical outcome of breast cancer.

Material and Methods: A total of 136 patients with 151 breast cancers underwent 1.5T dynamic MR imaging with the use of a dynamic T1-weighted three-dimensional fast low-angle shot (FLASH) subtraction imaging technique. Morphological and kinetic analyses of MR features were evaluated using the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) MRI lexicon. Pathological prognostic factors were correlated with MR imaging characteristics, including tumor size, histological grade, lymph node status, expression of estrogen receptor (ER), expression of progesterone receptor (PR), expression of c-erbB2, determination of Ki-67 index, and microvascular density (MVD), using univariate and multivariate statistical analyses.

Results: Based on univariate and multivariate analyses, spiculated tumor margins correlated significantly with lower histological grade (I–II) and positive PR expression. Rim enhancement was significantly correlated with high histological grade, presence of axillary lymph node metastasis, large tumor size, increased Ki-67 index, and increased MVD. Early peak enhancement, as seen on the first scan after contrast medium injection, was correlated with negative ER expression.

Conclusion: The presence of a lesion with a spiculated margin may predict a relatively good prognosis, and the presence of a lesion with rim enhancement may predict a relatively poor prognosis.
Use of automatic tube current modulation with a standardized noise index in young children undergoing chest computed tomography scans with 64-slice multidetector computed tomography
Authors: Peng Yun , Li Jianying , Ma Daqing , Zhang Qifeng , Liu Yue , Zeng Jinjin , Sun Guoqiang
Published: December 2009

Background: The automatic tube current modulation (ATCM) technique is available on multidetector computed tomography (MDCT) scanners, and its dose reduction benefits in clinical applications have been documented primarily in adult patients.

Purpose: To evaluate the use of ATCM to reduce radiation dose while maintaining consistent image quality for young children undergoing 64-slice MDCT chest scans.

Material and Methods: Chest scans (120 kV, small-scan field of view, 5-mm image slice thickness) were performed for 50 consecutive young children (0.2–3 years) using 64-slice volume computed tomography (VCT) with ATCM method and a noise index (NI) of either 8 or 9, depending on the patient's age. The scanner automatically selected the actual tube current based on NI values and patient attenuation as determined by scout scans for the study group. Image quality and volume-weighted CT dose index (CTDIvol) values (measured with small-scan field of view and 16-cm diameter CTDI phantom) were compared with images from a control group of 50 children acquired earlier using a standard protocol with fixed tube current. Two experienced pediatric radiologists assessed image quality, including resolution, noise, and artifacts, on a five-point scale. Scores greater than or equal to 3 were considered to be clinically acceptable.

Results: The mean image quality score and CTDIvol for the study and control groups were 3.46 and 2.34±0.71 mGy, and 4.65 and 6.68±0.62 mGy, respectively. While there was a statistically significant decrease in image quality in the study group, all studies had acceptable image quality, and CTDIvol with ATCM was about 65% lower than that with fixed tube current. The average image noise for the control group was 4.78±0.58, versus 7.53±0.42 and 8.28±0.40 for children under and above 1 year of age, respectively, in the study group. Despite a higher average noise level, the study group with ATCM demonstrated a lower standard deviation of image noise.

Conclusion: The z-axis ATCM method produces consistent image quality for young children undergoing 64-slice MDCT chest scans. With noise levels of NI=8 and 9 at 5-mm image slice thickness, one may obtain clinically acceptable images with significantly reduced radiation dose.
Spectrum of magnetic resonance imaging appearances of juvenile temporomandibular joints (tmj) in non-rheumatic children
Authors: Tzaribachev N. , Fritz J. , Horger M.
Published: December 2009

Background: Temporomandibular joints (TMJ) are frequently involved in children with juvenile idiopathic arthritis (JIA), and gadolinium-enhanced magnetic resonance imaging (MRI) is the only modality for an early diagnosis. However, only very few data exist on the appearance of contrast-enhanced MRI of normal juvenile TMJ.

Purpose: To define the spectrum of normal MRI findings of juvenile TMJ, and to assess a possible overlap with findings typical for active synovitis in JIA.

Material and Methods: 96 children (192 TMJ), 51 boys and 45 girls with a median age of 7.8 years (range 3–13 years), underwent a head MRI. The presence of autoimmune disease, including JIA, was excluded via chart history, available laboratory findings, and the absence of known typical pathological MRI changes (degree of synovial enhancement, hyperintense signal on T2-weighted images in the synovia or bone marrow, and morphologic changes of the mandibular condyle) of the TMJ affected by JIA.

Results: In 90 (94%) children, the TMJ showed no MRI abnormalities compatible with arthritis. In three children (3%), the only abnormal MRI finding was a small bilateral joint effusion. A further three children (3%) had a mild synovial enhancement seen on both axial and coronal MR planes in one child and only in the axial plane in the other two children. Signal hyperintensity on T2-weighted images and other corresponding characteristics of TMJ inflammation were lacking in all these six patients.

Conclusion: The vast majority of juvenile TMJ in non-rheumatic children shows no MRI abnormalities. Exceptions, including a discrete enhancement of the synovial membrane (3%) or small joint effusions (3%), can occur in a minority of patients, but none of them are accompanied by other signs of inflammation or morphological changes of the TMJ.
Revived nationalism versus European democracy
Authors: Vetta Theodora
Published: November 2009

Following the Belgrade riots after Kosovo's proclamation of independence in February 2008 and the rise of the nationalist Serbian Radical Party in elections since 2001, several analysts have portrayed Serbia as a highly divided and confused nation unable to choose between a European, urban, and cosmopolitan democrat identity and a patriarchal, peasant, and collectivists nationalist one. This article historicizes this widespread culture-talk by ethnographically grounding it in particular processes that constitute Serbia's trajectory toward free market economy and liberal democracy. The concept of class as an analytical tool appears accurate in trying to understand people's biographies and political choices. By deconstructing popular cultural stereotypes of Radikali, the article argues that nationalism provides a framework that resonates most with the material and symbolic needs of a wide range of population. In the absence of a strong institutionalized left, the political choices of "nationalism's supporters" are based more on rational choice than on identity quests and strategies of manipulation.
A new professional paradigm: whence and whither
Authors: Bean James R.
Published: December 2009

Medical professionalism is challenged by commercial conflicts, federal law and regulation, and a changing health care system. The profession must reaffirm its traditional role and transform into a larger social role, setting standards and preserving ethical principles in health care.
Congenital hydrocephalus and ventriculoperitoneal shunts: influence of etiology and programmable shunts on revisions
Authors: Notarianni Christina , Vannemreddy Prasad , Caldito Gloria , Bollam Papireddy , Wylen Esther , Willis Brian , Nanda Anil
Published: December 2009

Object

Hydrocephalus is a notorious neurosurgical disease that carries the adage “once a shunt always a shunt.” This study was conducted to review the treatment results of pediatric hydrocephalus.

Methods

Pediatric patients who underwent ventriculoperitoneal shunt surgery over the past 14 years were reviewed for shunt revisions. Variables studied included age at shunt placement, revision, or replacement; programmable shunts; infection; obstruction; and diagnosis (congenital, posthemorrhagic, craniospinal dysraphism, and others including trauma, tumors, and infection). Multiple regression analysis methods were used to determine independent risk factors for shunt failure and the number of shunt revisions. The Kaplan-Meier method of survival analysis was used to compare etiologies on the 5-year survival (revision-free) rate and the median 5-year survival time.

Results

A total of 253 patients were studied with an almost equal sex distribution. There were 92 patients with congenital hydrocephalus, 69 with posthemorrhagic hydrocephalus, 48 with craniospinal dysraphism, and 44 with other causes. Programmable shunts were used in 73 patients (other types of shunts were used in 180 patients). A total of 197 patients (78%) underwent revision surgeries due to shunt failures. The mortality rate was 1.6%. Age at first revision, the 5-year survival rate, and the median 5-year survival time were significantly less for both posthemorrhagic and craniospinal dysraphism than for either the congenital or “other” group (p < 0.05). The failure rate and number of revisions were not significantly reduced with programmable shunts compared with either pressure-controlled or no-valve shunts (p > 0.5).

Conclusions

Posthemorrhagic hydrocephalus and craniospinal dysraphism hydrocephalus had significantly earlier revisions than congenital and other etiologies. Programmable systems did not reduce the failure rate or the average number of shunts revisions.
Seasonal variations in frontoethmoidal meningoencephalocele births in Cambodia
Authors: Roux Franck-Emmanuel , Oucheng Ngiep , Lauwers-Cances Valérie , Draper Louisa , Cristini Christelle , Collogly Jim , Lauwers Frédéric
Published: December 2009

Object

Frontoethmoidal meningoencephalocele (fMEC) is relatively common in many Southeast Asian countries, with devastating aesthetic and social consequences for affected children. No cause has been detected to date. Among other factors, the authors of this paper attempt to identify a statistically significant difference in the spread of fMEC births throughout the year compared with other births. This seasonal variation in the incidence of fMEC births may provide clues to the causes of this condition.

Methods

From a group of 175 children with fMEC who underwent surgery at the authors' humanitarian institution (Children's Surgical Centre) in Phnom Penh between 2004 and 2008, 86 children were studied. These children were born at full term and had an accurately recorded date of birth. The birth dates of this fMEC group were compared with a group of > 15,000 other live births at one of the main maternity units in Phnom Penh in 2005 and 2006.

Results

Seasonal variation in incidence of fMEC by month of birth was highly statistically significant (p < 0.001), with the peak of births occurring in the dry season (between March and May). This is in contrast to the control group, in which there was an equal distribution of births throughout the year. More than 85% of the parents of children with fMEC who the authors treated were farmers, but this figure reflects the composition of the Cambodian population.

Conclusions

Uneven spread in the incidence of fMEC births throughout the year suggests that a seasonal factor during the wet season may be suspected in the pathogenesis of fMEC in Cambodia.
Cavernous hemangioma of the skull: surgical treatment without craniectomy
Authors: Nasrallah Ilya M. , Hayek Reyaad , Duhaime Ann-Christine , Stotland Mitchell A. , Mamourian Alexander C.
Published: December 2009

The authors report the case of a large cranial cavernous hemangioma that was treated using embolization and craniotomy with preservation of the outer cranial table. A 3-year follow-up demonstrated no recurrence. Results in this case suggest that cavernous hemangiomas of the cranium may be safely and effectively treated without craniectomy in some cases.
Going viral: fusiform vertebrobasilar and internal carotid aneurysms with varicella angiitis and common variable immunodeficiency
Authors: Daugherty Wilson P. , Clarke Michelle J. , Cloft Harry J. , Lanzino Giuseppe L.
Published: December 2009

Intracranial aneurysms in the pediatric population are relatively rare entities. Immunocompromised patients (often from HIV/AIDS or pharmacological immunosuppression) represent a significant fraction of children with cerebral aneurysms. One proposed mechanism of aneurysm formation in these patients is from direct infection of the affected arteries. In this study, the authors report on a case of a 14-year-old girl with common variable immunodeficiency with T-cell dysfunction and a CSF polymerase chain reaction test positive for varicella-zoster virus who underwent evaluation for carotid and basilar artery fusiform aneurysms.
Neurocognitive outcome and ventricular volume in children with myelomeningocele treated for hydrocephalus in Uganda
Authors: Warf Benjamin , Ondoma Solomon , Kulkarni Abhaya , Donnelly Ruth , Ampeire Miriam , Akona Joan , Kabachelor Collin R. , Mulondo Ronald , Nsubuga Brian Kaaya
Published: December 2009

Object

Despite lower failure and infection rates compared with shunt placement, it has not been known whether endoscopic third ventriculostomy/choroid plexus cauterization (ETV/CPC) might be inferior in regard to neurocognitive development. This study is the first to describe neurocognitive outcome and ventricle volume in infants with hydrocephalus due to myelomeningocele that was treated primarily by ETV/CPC.

Methods

The modified Bayley Scales of Infant Development (BSID-III) test was administered to 93 children with spina bifida who were 5–52 months of age. Fifty-five of these children had been treated by ETV/CPC, 19 received ventriculoperitoneal (VP) shunts, and 19 had required no treatment for hydrocephalus. Raw scores were converted to scaled scores for comparison with age-corrected norms. Ventricular volume was assessed by frontal/occipital horn ratio (FOR) calculated from late postoperative CT scans. The mean values between and among groups of patients were compared using independent samples t-test and ANOVA. The comparison of mean values to population normal means was performed using the single-sample t-test. Linear regression analyses were performed using BSID scores as the dependent variables, with treatment group and ventricular size (FOR) as the independent variables. Probability values < 0.05 were considered significant.

Results

. There was no significant difference in mean age at assessment among groups (p = 0.8). The mean scale scores for untreated patients were no different from normal (all p > 0.27) in all portions of the BSID (excluding gross motor), and were generally significantly better than those for both VP shunt–treated and ETV/CPC groups. The ETV/ CPC-treated patients had nonsignificantly better mean scores than patients treated with VP shunts in all portions of the BSID (all p > 0.06), except receptive communication, which was significantly better for the ETV/CPC group (p = 0.02). The mean FOR was similar among groups, with no significant difference between the untreated group and either the VP shunt or ETV/CPC groups. The FOR did not correlate with performance.

Conclusions

The ETV/CPC and VP shunt groups had similar neurocognitive outcomes. Neurocognitive outcomes for infants not requiring treatment for hydrocephalus were normal and significantly better than in those requiring treatment. The mean ventricular volume was similar among all 3 groups, and significantly larger than normal. There was no association between FOR and performance. Stable mild-to-moderate ventriculomegaly alone should not trigger intervention in asymptomatic infants with spina bifida.