Mammographic features and risk of breast cancer death among women with invasive screen-detected cancer in BreastScreen Norway 1996-2020.

OBJECTIVES: We explored associations between mammographic features and risk of breast cancer death among women with small (<15 mm) and large (≥15 mm) invasive screen-detected breast cancer. METHODS: We included data from 17,614 women diagnosed with invasive breast cancer as a result of participation in BreastScreen Norway, 1996-2020. Data on mammographic features (mass, spiculated mass, architectural distortion, asymmetric density, density with calcification and calcification alone), tumour diameter and cause of death was obtained from the Cancer Registry of Norway. Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (CI) for breast cancer death by mammographic features using spiculated mass as reference, adjusting for age, tumour diameter and lymph node status. All analyses were dichotomised by tumour diameter (small versus large). RESULTS: Mean age at diagnosis was 60.8 (standard deviation, SD=5.8) for 10,160 women with small tumours and 60.0 (SD=5.8) years for 7454 women with large tumours. The number of breast cancer deaths was 299 and 634, respectively. Mean time from diagnosis to death was 8.7 (SD=5.0) years for women with small tumours and 7.2 (4.6) years for women with large tumours. Using spiculated mass as reference, adjusted HR for breast cancer death among women with small tumours was 2.48 (95% CI 1.67-3.68) for calcification alone, while HR for women with large tumours was 1.30 (95% CI 1.02-1.66) for density with calcification. CONCLUSIONS: Small screen-detected invasive cancers presenting as calcification and large screen-detected cancers presenting as density with calcification were associated with the highest risk of breast cancer death. CLINICAL RELEVANCE STATEMENT: Small tumours (<15 mm) presented as calcification alone and large tumours (≥ 15 mm) presented as density with calcification were associated with the highest risk of breast cancer death among women with screen-detected invasive breast cancer diagnosed 1996-2020. KEY POINTS: • Women diagnosed with invasive screen-detected breast cancer 1996-2020 were analysed. • Small screen-detected cancers presenting as calcification alone resulted in the highest risk of breast cancer death. • Large screen-detected cancers presenting as density with calcification resulted in the highest risk of breast cancer death.

[Clinical radiological evaluation of teeth-part 2 : Caries, inflammatory dental changes and important differential diagnoses]. / Klinisch-radiologische Beurteilung der Zähne ­ Teil 2 : Karies, entzündliche Zahnveränderungen und wichtige Differenzialdiagnosen.

Inflammatory diseases of the teeth and periodontium are widespread and are frequent secondary diagnoses in head and neck examinations. Periapical inflammation can be the cause of sinusitis or abscess formation in the oral and maxillofacial region. Early detection is important for the patient's course of treatment. For further diagnostics, a dental presentation should be carried out. Dental radiological examinations, such as panoramic radiographs and dental films are used for specific diagnostics. This article is intended to provide an overview of the different stages of caries, the most important inflammatory dental changes and their most frequent differential diagnoses.

[Clinical radiological evaluation of teeth-part 1 : Anatomy and anomalies]. / Klinisch-radiologische Beurteilung der Zähne ­Teil 1 : Anatomie und Anomalien.

Radiological assessment of the teeth and periodontium is often left to the dentist. Nevertheless, it is useful to know the anatomy and possible anomalies of the teeth in order to correctly assess pathological processes in both projection radiographic and slice imaging. Dental radiological examinations, such as panoramic slice imaging (PSA) and dental film are used for targeted diagnostics. In the case of incidental findings, a dental presentation should be made for further clarification. This article first provides an overview of the anatomy and anomalies of teeth.

Does it matter for the radiologists' performance whether they read short or long batches in organized mammographic screening?

OBJECTIVE: To analyze the association between radiologists' performance and image position within a batch in screen reading of mammograms in Norway. METHOD: We described true and false positives and true and false negatives by groups of image positions and batch sizes for 2,937,312 screen readings performed from 2012 to 2018. Mixed-effects models were used to obtain adjusted proportions of true and false positive, true and false negative, sensitivity, and specificity for different image positions. We adjusted for time of day and weekday and included the individual variation between the radiologists as random effects. Time spent reading was included in an additional model to explore a possible mediation effect. RESULT: True and false positives were negatively associated with image position within the batch, while the rates of true and false negatives were positively associated. In the adjusted analyses, the rate of true positives was 4.0 per 1000 (95% CI: 3.8-4.2) readings for image position 10 and 3.9 (95% CI: 3.7-4.1) for image position 60. The rate of true negatives was 94.4% (95% CI: 94.0-94.8) for image position 10 and 94.8% (95% CI: 94.4-95.2) for image position 60. Per 1000 readings, the rate of false negative was 0.60 (95% CI: 0.53-0.67) for image position 10 and 0.62 (95% CI: 0.55-0.69) for image position 60. CONCLUSION: There was a decrease in the radiologists' sensitivity throughout the batch, and although this effect was small, our results may be clinically relevant at a population level or when multiplying the differences with the number of screen readings for the individual radiologists. KEY POINTS: • True and false positive reading scores were negatively associated with image position within a batch. • A decreasing trend of positive scores indicated a beneficial effect of a certain number of screen readings within a batch. • False negative scores increased throughout the batch but the association was not statistically significant.

Time of day and mammographic reader performance in a population-based breast cancer screening programme.

OBJECTIVES: To analyse how reader performance varied by time during the day in a population-based breast cancer screening programme. METHODS: A total of 2,937,312 readings from 148 radiologists and 1,468,656 women were included in this study from Norway. Number and percentages of mammographic readings, positive scores, true and false positive readings, true and false negative readings, sensitivity and specificity were presented for categories of time of day and for each day of the week. Multilevel mixed effect logistic regression models with restricted cubic splines were fitted to the data, and used to predict the odds ratio of the different performance measures. RESULTS: The following distribution was found for the performance measures during the study period: true positive: 12,463 (0.4%); false positive: 128,419 (4.4%); true negative: 2,794,636 (95.1%); and false negative: 1794 (0.06%). The percentage of positive readings (true positive and false positive) was highest before lunch and in the early afternoon (4.9%): false positive was highest in both periods (4.5%) and true positive was highest in the early afternoon (0.5%). The percentage of true negative was highest in the evening (95.6%), and of false negative was highest at lunchtime (0.07%). This corresponds to a gradually decreasing predicted sensitivity throughout the day. The opposite was observed for specificity. CONCLUSIONS: Screen-reading early versus late during the day resulted in higher sensitivity, although at the cost of specificity. Despite small differences in the performance measures during the day, the results may be important in the discussion of optimal management of screening programmes.

[Chronic nonbacterial osteomyelitis : Imaging and differential diagnoses]. / Chronische nichtbakterielle Osteomyelitis : Bildgebung und Differenzialdiagnosen.

Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disease in childhood and adolescence with a preference for the female gender. It is manifested with multiple osseous lesions, with a predilection for the metaphyseal end zones of the long bones of the lower extremities. These bone lesions usually occur multifocally, can recur and develop a different appearance depending on the bone structure affected. Patients present with a longer disease history, changing clinical symptoms and unspecific paraclinical signs. Magnetic resonance imaging (MRI) is the imaging of choice and particularly as a whole body examination can speed up the diagnosis and is an important component of follow-up controls. Differential diagnoses include numerous inflammatory, benign and malignant bone diseases. Therefore, it is essential to know the diagnosis of CNO and to take it into consideration in cases of an unclear inflammatory bone process in young patients.

[Weaning Unit of the University Medicine Greifswald - Institutional Structure and Weaning Results from Prolonged Ventilation over 10 Years]. / Weaningzentrum Greifswald ­ Struktur und Ergebnisse bei der Entwöhnung von der Langzeitbeatmung über zehn Jahre.

The increasing importance of intensive care medicine including mechanical ventilation has been accompanied by the demand of weaning opportunities for patients undergoing prolonged mechanical ventilation. Consequently, specialised clinical institutions, focusing on the weaning from mechanical ventilation, have been established since the 1980 s.The present article illustrates the structural development and results of such a specialised institution at the University Medicine Greifswald, using data of 616 patients collected within the past ten years (2006 - 2015). Across the years, a shift in the underlying disease leading to mechanical ventilation can be found, with rising numbers of patients suffering from pneumonia/sepsis and declining numbers of patients who underwent cardiac surgery in advance. The days with mechanical ventilation outside (p = 0.004) and within the investigated institution (p = 0.02) are significantly declining. The percentage of successfully weaned patients increased from 62.7 % (2006 - 2010) to 77.3 % (2011 - 2015), p < 0.001. Consecutively, the percentage of patients who remained mechanically ventilated decreased from 16.4 % to 9.6 % (p < 0.001) and the share of in-hospital deceased patients significantly declined from 20.9 % to 13.0 % (p < 0.001). Furthermore, the one-year-survival after hospital discharge in successful weaned patients was 72 percent. The present data, collected at the University Medicine Greifswald are quite comparable to data of other German institutions that are specialised on weaning from mechanical ventilation.

Moraxella catarrhalis induces CEACAM3-Syk-CARD9-dependent activation of human granulocytes.

The human restricted pathogen Moraxella catarrhalis is an important causal agent for exacerbations in chronic obstructive lung disease in adults. In such patients, increased numbers of granulocytes are present in the airways, which correlate with bacteria-induced exacerbations and severity of the disease. Our study investigated whether the interaction of M. catarrhalis with the human granulocyte-specific carcinoembryonic antigen-related cell adhesion molecule (CEACAM)-3 is linked to NF-κB activation, resulting in chemokine production. Granulocytes from healthy donors and NB4 cells were infected with M. catarrhalis in the presence of different inhibitors, blocking antibodies and siRNA. The supernatants were analysed by enzyme-linked immunosorbent assay for chemokines. NF-κB activation was determined using a luciferase reporter gene assay and chromatin-immunoprecipitation. We found evidence that the specific engagement of CEACAM3 by M. catarrhalis ubiquitous surface protein A1 (UspA1) results in the activation of pro-inflammatory events, such as degranulation of neutrophils, ROS production and chemokine secretion. The interaction of UspA1 with CEACAM3 induced the activation of the NF-κB pathway via Syk and the CARD9 pathway and was dependent on the phosphorylation of the CEACAM3 ITAM-like motif. These findings suggest that the CEACAM3 signalling in neutrophils is able to specifically modulate airway inflammation caused by infection with M. catarrhalis.

ATP-Evoked Intracellular Ca²âº Signaling of Different Supporting Cells in the Hearing Mouse Hemicochlea.

Hearing and its protection is regulated by ATP-evoked Ca(2+) signaling in the supporting cells of the organ of Corti, however, the unique anatomy of the cochlea hampers observing these mechanisms. For the first time, we have performed functional ratiometric Ca(2+) imaging (fura-2) in three different supporting cell types in the hemicochlea preparation of hearing mice to measure purinergic receptor-mediated Ca(2+) signaling in pillar, Deiters' and Hensen's cells. Their resting [Ca(2+)]i was determined and compared in the same type of preparation. ATP evoked reversible, repeatable and dose-dependent Ca(2+) transients in all three cell types, showing desensitization. Inhibiting the Ca(2+) signaling of the ionotropic P2X (omission of extracellular Ca(2+)) and metabotropic P2Y purinergic receptors (depletion of intracellular Ca(2+) stores) revealed the involvement of both receptor types. Detection of P2X2,3,4,6,7 and P2Y1,2,6,12,14 receptor mRNAs by RT-PCR supported this finding and antagonism by PPADS suggested different functional purinergic receptor population in pillar versus Deiters' and Hensen's cells. The sum of the extra- and intracellular Ca(2+)-dependent components of the response was about equal with the control ATP response (linear additivity) in pillar cells, and showed supralinearity in Deiters' and Hensen's cells. Calcium-induced calcium release might explain this synergistic interaction. The more pronounced Ca(2+) leak from the endoplasmic reticulum in Deiters' and Hensen's cells, unmasked by cyclopiazonic acid, may also suggests the higher activity of the internal stores in Ca(2+) signaling in these cells. Differences in Ca(2+) homeostasis and ATP-induced Ca(2+) signaling might reflect the distinct roles these cells play in cochlear function and pathophysiology.

[Whole-body ferromagnetic detector systems in clinical MRI]. / Ganzkörperferrodetektorsysteme in der klinischen MRT.

CLINICAL/METHODICAL ISSUE: In spite of technical and organizational measures, ferromagnetic objects still find their way into the magnetic resonance imaging (MRI) room and can cause severe injuries. STANDARD RADIOLOGICAL METHODS: A detailed patient education and MRI safety training for personnel are necessary to avoid MRI incidents with ferromagnetic objects. METHODICAL INNOVATIONS: Whole body ferromagnetic detection systems should increase patient safety and minimize risks for personnel and MRI equipment in the clinical routine. PERFORMANCE: In a clinical MRI setting, a screener system used for outpatients and inpatients (n = 400) identified unknown ferrous objects in 2 % of the cases. In two of these cases patients were found to be in possession of unknown foreign ferrous objects. Furthermore, a door guard system only used for outpatients (n = 2500) detected unknown ferromagnetic objects in 0.3 % of the cases. ACHIEVEMENTS: The number of ferrous objects that are unknowingly brought into the scanner room can be reduced with a whole body ferromagnetic detection system. For an optimal benefit of the system a ferrous-free environment and perfectly ferrous-free clothing for the medical personnel are necessary. In the clinical routine, the benefit of the system is limited particularly for immobile patients who have to remain in a horizontal position. PRACTICAL RECOMMENDATIONS: A whole body ferromagnetic detection system can complement but not replace patient education and MRI safety training.

[Value of non-IOP lowering therapy for glaucoma]. / Stellenwert der "nicht Augendruck senkenden Glaukomtherapie"

It is well established that an IOP reduction improves, on average, the prognosis of all types of glaucoma. It is also known, however, that even an ideal IOP does not stop progression in all patients. The insight into the pathogenesis of glaucomatous damage leads to new therapeutic approaches. Whilst most of these new avenues of treatment are still in the experimental phase, others, such as magnesium, Ginkgo, salt and fludrocortisone are already used by some physicians. Blood pressure dips can be avoided by intake of salt or fludrocortisone. Vascular regulation can be improved either locally by carbonic anhydrase inhibitors or systemically with magnesium or with low doses of calcium channel blockers. A number of other food ingredients such as polyphenolic flavonoids occurring in tea, coffee, dark chocolate or red wine and anthocyanosides found in bilberries have potential antioxidative effects. The oxidative stress at the level of the mitochondria can be reduced by Ginkgo biloba. Experimentally, glaucomatous optic neuropathy can be prevented by inhibition of astrocyte activation, either by blockage of epidermal growth factor receptor or by counteracting endothelin. Glaucomatous optic neuropathy can also be prevented by nitric oxide-2 synthase inhibition. Inhibition of matrix metalloproteinase-9 inhibits apoptosis of retinal ganglion cells and tissue remodelling. Up-regulation of heat shock proteins protects the retinal ganglion cells and the optic nerve head.

Controlled intra- and transdermal protein delivery using a minimally invasive Erbium:YAG fractional laser ablation technology.

The aim of the study was (i) to investigate the feasibility of using fractional laser ablation to create micropore arrays in order to deliver proteins into and across the skin and (ii) to demonstrate how transport rates could be controlled by variation of poration and formulation conditions. Four proteins with very different structures and properties were investigated - equine heart cytochrome c (Cyt c; 12.4 kDa), recombinant human growth hormone expressed in Escherichia coli (hGH; 22 kDa), urinary follicle stimulating hormone (FSH; 30 kDa) and FITC-labelled bovine serum albumin (FITC-BSA; 70 kDa). The transport experiments were performed using a scanning Er:YAG diode pumped laser (P.L.E.A.S.E.®; Precise Laser Epidermal System). The distribution of FITC-BSA in the micropores following P.L.E.A.S.E.® poration was visualised by using confocal laser scanning microscopy (CLSM). Porcine skin was used for the device parameter and CLSM studies; its validity as a model was confirmed by subsequent comparison with transport of Cyt c and FITC-BSA across P.L.E.A.S.E.® porated human skin. No protein transport (deposition or permeation) was observed across intact skin; however, P.L.E.A.S.E.® poration enabled total delivery after 24h of 48.2±8.9, 8.1±4.2, 0.2±0.1 and 273.3±30.6 µg/cm(2) for Cyt c, hGH, FSH and FITC-BSA, respectively, using 900 pores/135.9 cm(2). Calculation of permeability coefficients showed that there was no linear dependence of transport on molecular weight ((1.6±0.3), (0.1±0.05), (0.08±0.03) and (0.9±0.1)×10(-3) cm/h, for Cyt c, hGH, FSH and FITC-BSA, respectively); indeed, a U-shaped curve was observed. This suggested that molecular weight was not a sufficiently sensitive descriptor and that transport was more likely to be determined by the surface properties of the respective proteins since these would govern interactions with the local microenvironment. Increasing pore density (i.e. the number of micropores per unit area) had a statistically significant effect on the cumulative permeation of both Cyt c (at 100, 150, 300 and 600 pores/cm(2), permeation was 11.2±2.4, 15.3±11.8, 33.8±10.5 and 51.2±15.8 4 µg/cm(2), respectively) and FITC-BSA (at 50, 100, 150 and 300 pores/cm(2), it was 58.5±15.3, 132.6±40.0, 192.7±24.4, 293.3±76.5 µg/cm(2), respectively). Linear relationships were established in both cases. However, only the delivery of FITC-BSA was improved upon increasing fluence (53.3±22.5, 293.3±76.5, 329.6±11.5 and 222.1±29.4 µg/cm(2) at 22.65, 45.3, 90.6 and 135.9 J/cm(2), respectively). The impact of fluence - and hence pore depth - on transport will depend on the relative diffusivities of the protein in the micropore and in the 'bulk' epidermis/dermis. Experiments with Cyt c and FSH confirmed that delivery was dependent upon concentration, and it was shown that therapeutic delivery of the latter was feasible. Cumulative permeation of Cyt c and FITC-BSA was also shown to be statistically equivalent across porcine and human skin. In conclusion, it was demonstrated that laser microporation enabled protein delivery into and across the skin and that this could be modulated via the poration parameters and was also dependent upon the concentration gradient in the pore. However, the role of protein physicochemical properties and their influence on transport rates remains to be elucidated and will be explored in future studies.

K+ depolarization evokes ATP, adenosine and glutamate release from glia in rat hippocampus: a microelectrode biosensor study.

BACKGROUND AND PURPOSE: This study was undertaken to characterize the ATP, adenosine and glutamate outflow evoked by depolarization with high K(+) concentrations, in slices of rat hippocampus. EXPERIMENTAL APPROACH: We utilized the microelectrode biosensor technique and extracellular electrophysiological recording for the real-time monitoring of the efflux of ATP, adenosine and glutamate. KEY RESULTS: ATP, adenosine and glutamate sensors exhibited transient and reversible current during depolarization with 25 mM K(+) , with distinct kinetics. The ecto-ATPase inhibitor ARL67156 enhanced the extracellular level of ATP and inhibited the prolonged adenosine efflux, suggesting that generation of adenosine may derive from the extracellular breakdown of ATP. Stimulation-evoked ATP, adenosine and glutamate efflux was inhibited by tetrodotoxin, while exposure to Ca(2+) -free medium abolished ATP and adenosine efflux from hippocampal slices. Extracellular elevation of ATP and adenosine were decreased in the presence of NMDA receptor antagonists, D-AP-5 and ifenprodil, whereas non-NMDA receptor blockade by CNQX inhibited glutamate but not ATP and adenosine efflux. The gliotoxin fluoroacetate and P2X7 receptor antagonists inhibited the K(+) -evoked ATP, adenosine and glutamate efflux, while carbenoxolone in low concentration and probenecid decreased only the adenosine efflux. CONCLUSIONS AND IMPLICATIONS: Our results demonstrated activity-dependent gliotransmitter release in the hippocampus in response to ongoing neuronal activity. ATP and glutamate were released by P2X7 receptor activation into extracellular space. Although the increased extracellular levels of adenosine did derive from released ATP, adenosine might also be released directly via pannexin hemichannels.

Inhaled hydrogen sulfide induces suspended animation, but does not alter the inflammatory response after blunt chest trauma.

The treatment of acute lung injury and septic complications after blunt chest trauma remains a challenge. Inhaled hydrogen sulfide (H2S) may cause a hibernation-like metabolic state, which refers to an attenuated systemic inflammatory response. Therefore, we tested the hypothesis that inhaled H2S-induced suspended animation may attenuate the inflammation after pulmonary contusion. Male Sprague-Dawley rats were subjected to blunt chest trauma (blast wave) or sham procedure and subsequently exposed to a continuous flow of H2S (100 ppm) or control gas for 6 h. Body temperature and activity were measured by an implanted transmitter. At 6, 24, or 48 h after trauma, animals were killed, and the cellular contents of bronchoalveolar lavage (BAL) as well as cytokine concentrations in BAL, plasma, and culture supernatants of blood mononuclear cells, Kupffer cells, splenic macrophages, and splenocytes were determined. Hydrogen sulfide inhalation caused a significant reduction in body temperature and activity. The trauma-induced increase in alveolar macrophage counts was abrogated 48 h after trauma when animals received H2S, whereas the trauma-induced increase in neutrophil counts was unaltered. Furthermore, H2S inhalation partially attenuated the mediator release in BAL and culture supernatants of Kupffer cells as well as splenic cells; it altered plasma cytokine concentrations but did not affect the trauma-induced changes in mononuclear cell culture supernatants. These findings indicate that inhaled H2S induced a reduced metabolic expenditure and partially attenuated inflammation after trauma. Nevertheless, in contrast to hypoxic- or pathogen-induced lung injury, H2S treatment appears to have no protective effect after blunt chest trauma.

Immunophenotypic patterns of T-cell activation in neuroinflammatory diseases.

OBJECTIVES: We aimed to gain insights into the pathogen-specific differences in early adaptive immune responses following central nervous system infections with Borrelia burgdorferi and viral pathogens by studying the immunophenotypic patterns of T-cell activation. Moreover, we wished to determine whether the expression of T-cell activation markers reflects disease activity in multiple sclerosis (MS). METHODS: Proportions of cerebrospinal fluid T-cells expressing the markers HLA-DR, CD25 and CD38 were determined in patients with MS (n = 40), acute viral meningomyeloradiculoneuritis (VID, n = 26), early neuroborreliosis (NB, n = 23) and non-inflammatory neurologic diseases (n = 51) by using flow cytometry. In relapsing-remitting MS, disease activity was assessed by clinical examination and magnetic resonance imaging. RESULTS: For each of the surface markers that were examined, significant differences in T cell proportions were found between patient groups. The proportion of HLA-DR+ T cells was higher and that of CD25+ T cells lower in NB compared with VID. These differences were attributable only to the early phase of the disease (< or = 6 days after symptom onset). Among MS patients, there was a trend for higher proportions of T cells expressing activation markers in patients with gadolinium-enhancing lesions. CONCLUSIONS: The decreased CD25 expression in NB may reflect immunomodulatory effects of B. burgdorferi facilitating persistent infection. Larger prospective studies of T-cell activation markers for ascertaining the association between cellular markers and clinical surrogates of disease activity in MS are warranted.

Investigating the effects of estradiol or estradiol/progesterone treatment on mood, depressive symptoms, menopausal symptoms and subjective sleep quality in older healthy hysterectomized women: a questionnaire study.

Clinical studies have documented that estrogen treatment often ameliorates mood disturbances and depressive symptoms occurring during the menopausal transition. The relevance of gonadal hormones for mood and well-being in healthy older nondepressed women is less well understood. Fifty-one healthy hysterectomized women (mean age 64) participated in a placebo-controlled double-blind study on the effects of gonadal hormones on cognition. They received either estradiol (2 mg estradiol valerate), estradiol plus progesterone (100 mg micronized progesterone) or placebo. Mood, well being, menopausal symptoms, depressive symptoms and subjective sleep quality were measured at baseline and after 4 and 24 weeks of treatment using three questionnaires. Thirty-five women could be included into the final analysis. Strong increases in estradiol and progesterone levels occurred in response to the treatment. The two hormones, however, had no effects on mood, well-being, menopausal symptoms, sleep quality and depressive symptoms. The current small study suggests that older healthy nondepressed hysterectomized women do not react with positive or negative mood changes to estradiol or estradiol/progesterone treatment.

The impact of bilateral sagittal split osteotomy on mandibular width and morphology.

PURPOSE: In this study, we examined mandibular width before and 1 year after bilateral sagittal split osteotomy. PATIENTS AND METHODS: Forty-two patients (28 females and 14 males) underwent bilateral sagittal split osteotomy. Fifty-six points or angles on the lateral cephalogram and 15 points or angles in the posteroanterior cephalogram were obtained before surgery and 1 year after surgery. Mandibular width was measured on the posteroanterior cephalogram (from gonion to gonion [Go to Go]). Changes in mandibular width were also measured by monitoring changes in an angle formed between a constructed line along the outside of the left and right ascending rami of the mandible and the facial midline. Association of the mandibular width with a variety of standard skeletal parameters was calculated. RESULTS: Mandibular width increased from 99.7 +/- 7.2 mm (mean +/- SD) to 101.1 +/- 6.1 mm. It remained unchanged in 17 patients, increased in 23 patients, and decreased in 2 patients. Analysis revealed a significant inverse correlation of the changes in mandibular width with the changes in posterior facial height (P =.05) and a significant positive correlation with the angle formed by the facial midline and the left ascending ramus (P >.005). All other changes were not significantly correlated with the changes in mandibular width. Multiple regression analysis revealed that the change in posterior facial height is an independent parameter for the changes in mandibular width (P =.041 for mandibular width at Go-Go). CONCLUSIONS: This study establishes a clinically important association between frontal view parameters with parameters derived from lateral view analysis.

Risk factors, outcome, and treatment in subtypes of ischemic stroke: the German stroke data bank.

BACKGROUND AND PURPOSE: Data on risk factors for etiologic subtypes of ischemic stroke are still scant. The aim of this study was to characterize stroke subtypes regarding risk factor profile, outcome, and current treatment strategies. METHODS: We analyzed data from 5017 patients with acute ischemic stroke (42.4% women, aged 65.9+/-14.1 years) who were enrolled in a large multicenter hospital-based stroke data bank. Standardized data assessment and stroke subtype classification were used by all centers. RESULTS: Sex and age distribution, major risk factors and comorbidities, recurrent stroke, treatment strategies, and outcome were all unevenly distributed among stroke subtypes (P<0.001, respectively). Cardioembolism, the most frequent etiology of stroke (25.6%), was particularly common in the elderly (those aged >70 years) and associated with an adverse outcome, a low rate of early stroke recurrence, and frequent use of thrombolytic therapy and intravenous anticoagulation. Large-artery atherosclerosis (20.9%), the most common cause of stroke in middle-aged patients (those aged 45 to 70 years), showed the highest male preponderance, highest rate of early stroke recurrence, and highest prevalence of previous transient ischemic attack, current smoking, and daily alcohol consumption among all subtypes. The highest prevalence of hypertension, diabetes mellitus, hypercholesterolemia, and obesity was found in small-vessel disease (20.5%), which, in turn, was associated with the lowest stroke severity and mortality. CONCLUSIONS: Our results foster the concept of ischemic stroke as a polyetiologic disease with marked differences between subtypes regarding risk factors and outcome. Therefore, studies involving risk factors of ischemic stroke should differentiate between etiologic stroke subtypes.

[Lamellar keratoplasty with the excimer laser. Initial clinical results]. / Lamellierende Keratoplastik mit dem Excimerlaser. Erste klinische Ergebnisse.

If excimer laser techniques are used to prepare the bed of the recipient eye and to prepare the donor lenticule diameter and thickness, congruence of the cut surfaces will be optimal. MATERIALS AND METHODS. The preliminary in vitro investigations have already been reported. We now present the clinical results of three patients with circumscript corneal opacities, whom we treated with the lamellar keratoplasty in accordance with the calibration method we developed (follow-up 4-12 months). The lenticule thickness required varied between 320 and 415 microns, depending on the extent of the opacity. The lenticule was fixed with a suture for 9 months. RESULTS. All transplants healed without complications. The parts of the cornea treated with the laser did not show opacities in the "interface" or adjacent corneal layers. CONCLUSION. Besides optimal fit of the transplant, the absence of intrastromal opacities makes the instrument and apparatus requirement worthwhile. The clinical results are superior to those of conventional dissection methods. The absence of intrastromal opacities indicates that our method will be suitable for treating high-grade myopia. If possible, intrastromal treatment should be carried out after lamellation (LASIK).