Cancer, vitamins, and plasma lipids: prospective Basel study.

In the Basel study (BS) (1960-73) on cardiovascular and peripheral arterial diseases, a mortality follow-up was completed for the period 1965-80. Of the 4,224 men at risk for these diseases, 531 died. The causes of death were established from the death certificates and classified into 8 groups. For each case 2 age- and sex-matched controls were selected and compared with the corresponding cases with regard to the various variables obtained at the three examinations (1960, 1965, 1971). This report dealth with cancer mortality, plasma lipids, plasma vitamins, alcohol and cigarette consumption, and intake of milk and citrus fruits. The results were all obtained at the second follow-up examination (BS III, 1971-73). Cancer of the lung, stomach, large bowel, and all other sites were treated separately. The average follow-up from BS III until death varied from 3.7 years (other sites) to 4.9 years (cancer of the lung). Of 129 cancer deaths, the highest incidence was found for cancer of the lung (38) followed by stomach (19) and large bowel, (15) and the remainder (57) was for other sites. Plasma lipids did not differ significantly among cases and controls. However, the lowest values were observed in colorectal cancer and gastric carcinoma (mean cholesterol, 213 mg/dl). beta-Carotene was significantly lower in cancer cases of the lung than in controls (14.8 micrograms/dl vs. 23.7; P less than .05). It was also low in gastric cancer cases (13.0 micrograms/dl). Vitamin A was below average only in cases with gastric cancer (difference due to the small number not significant). Vitamin C was consistently lower in cancer cases than in controls. The lowest value was found for cancer of the stomach and corresponded to a below-average consumption of citrus fruits. Vitamin E was low in cancer of the colon. Plasma lipids correlated strongly with vitamin E (tau = 0.5) and to a lesser extent with vitamin A (tau = 0.25). beta-Carotene correlated poorly with beta-lipoproteins (low-density and very low-density lipoproteins) but significantly with total cholesterol. Smoking was inversely related, as was alcohol consumption, to the beta-carotene level. From these results, the conclusion was that vitamins influence carcinogenesis in humans.

Human epithelial teratocarcinoma cells (P3): radiobiological characterization, DNA damage, and comparison with other rodent and human cell lines.

Survival parameters and immediate DNA damage induced by 60Co gamma rays, 50-kVp X rays, and Janus fission-spectrum neutrons in human epithelial P3 cells (derived from an embryonic teratocarcinoma) are compared with those for Chinese hamster lung V79 cells. DNA damage caused by X and gamma irradiation, measured by alkaline elution methods, is the same in both cell types, whereas the P3 cells are about two times more sensitive (as measured by Do ratios of the final survival curve slope) to the lethal effects of these radiations than are the V79 cells. Human P3 cells are also more sensitive to the lethal effects of fission-spectrum neutrons than V79 cells. Survival experiments with split radiation doses and hypertonic salt treatment indicate that both P3 cells and V79 cells can recover from radiation-induced damage efficiently.

Increased radiosensitivity of normal tissue fibroblasts in patients with acquired immunodeficiency syndrome (AIDS) and with Kaposi's sarcoma.

Fibroblasts cultured from skin biopsies of patients with AIDS and Kaposi's sarcoma were found to be more radiosensitive than fibroblasts from non-HIV-infected-sources. This supports clinical observations of overt sensitivity to radiotherapy in some AIDS patients with Kaposi's sarcoma.

[Magnetic resonance tomography (MRT) of the knee joint: meniscus, cruciate ligaments and hyaline cartilage]. / Magnetresonanztomographie (MRT) des Kniegelenks: Meniskus, Kreuzbänder und hyaliner Gelenkknorpel.

The use of MRT for diagnosing injury to the meniscus, the cruciate ligaments and hyaline cartilage was evaluated retrospectively in 82 knee joints without any knowledge of operative findings. In 49 cases the results were verified by arthroscopy and in 33 cases by arthrotomy. Sensitivity, specificity and diagnostic accuracy of MRT for meniscus lesions was 73.9%, 96.9%, and 94.6%. Corresponding values for lesions of the anterior cruciate ligament were 88.9%, 96.6%, and 94.7%, and for lesions of the hyaline cartilage 62.6%, 96.1%, and 87.9%, respectively. In addition to its high specificity, MRT proved accurate in excluding lesions of the meniscus (97.1%) of the anterior cruciate ligament (96.6%) and of hyaline cartilage (88.8%). A negative finding on MRT therefore makes the presence of a lesion of the meniscus, cruciate ligaments of cartilage unlikely. In such cases one is justified in delaying the use of arthroscopy or arthrotomy.

Ruptured spleen in children--15-year evolution in therapeutic concepts.

This is a 15-year retrospective study of 64 pediatric surgical patients with traumatic rupture of the spleen from 1976 to 1990. The overall mortality was 14% (9/64). All non-survivors had severe multiple traumata and no fatalities were attributable to splenic injury. During the first 5 years of the study, the traditional surgical approach of immediate laparotomy and splenectomy was employed. During the next 5 years we practised laparotomy with subtotal splenectomy and repair. During the final 5 years conservative management with clinical and ultrasonographic monitoring became predominant (1 splenectomy, 4 repair, 23 conservative treatments). Among the 55 survivors, 11 had splenectomy, 14 had splenic repairs and 30 were treated non-operatively. All survivors had excellent outcomes and there was only one complication: a local abscess following splenic repair. Based on a very strict protocol in conservative management, the total amount of transfused blood could be reduced remarkably during the last period. Splenectomized patients received pneumococcal vaccine and prophylactic antibiotic coverage was prescribed for febrile episodes. None of the splenectomized patients experienced septic episodes or increased rates of infection. Based on our experience, ultrasonographically monitored conservative management is the treatment of choice in most patients with splenic injury in childhood.

One hundred pediatric femoral fractures: epidemiology, treatment attitudes, and early complications.

Analysis of 100 consecutive femoral fractures admitted to our institution revealed an incidence of about 1 fracture per 2,000 children per year. Epidemiologic data may help to promote prevention. Initial treatment was performed by many doctors, thus rendering guidelines to safe and cost-effective management indispensable. In the last decade, growing concern to reduce hospital stays and costs led to new approaches that replaced traction as a therapeutic principle. Today, we consider immediate spica casting a good option for the group 0-5 years old, whereas in the age group 5-12 years old elastic stable intramedullary nailing (ESIN) produces reliably good results. Minor complications were common and could be avoided partially, but they did not affect the good final outcome.

[Comparison between magnetic resonance imaging and arthroscopy for the diagnosis of knee meniscal lesions]. / Comparaison entre l'imagerie par résonance magnétique et l'arthroscopie pour le diagnostic des lésions méniscales du genou.

PURPOSE OF STUDY: The authors evaluated the use of MR-imaging of the menisci compared to arthroscopy considered as the gold standard by which all noninvasive imaging procedures of the knee have to be measured. MATERIAL AND METHODS: In a prospective study, we evaluated the use of MRI in 50 patients with clinically suspected disorders of the meniscus, followed by an arthroscopic examination by an experienced arthroscopist. MRI studies were performed after clinical evaluation and were interpreted by an experienced radiologist, who had no knowledge of the clinical findings. RESULTS: The accuracy of the diagnosis from MRI was 78 per cent for the medial meniscus (sensitivity 79 per cent and specificity 78 per cent) and 94 per cent for the lateral meniscus (sensitivity 50 per cent and specificity 98 per cent). The average age of the patients was 34 years, with a range from 3 to 73 years. The imaging studies revealed 9 false positive test and suggested that the meniscus was either degenerated or form in the horizontal plane. In all 9 menisci the abnormal MR imaging signal was limited to the posterior horns. The positive predictive value was 59 per cent and the negative predictive value was 94 per cent representing a moderate level of diagnostic certainty, both in patients who had a positive result and in those who had a negative result. High predictive negative value of MRI indicates that a negative MRI is quite reliable for meniscal lesions. DISCUSSION: Problems of MR-imaging are the popliteus tendon sheath and the transverse ligament. This ligament is seen in association with a large branch of the lateral inferior geniculate artery, and may be mistaken for a grade 3 signal intensity in the anterior horn of the lateral meniscus. CONCLUSION: A normal MRI allows to eliminate a meniscal lesion and so there is no need for a diagnostic arthroscopy. But with a pathologic MRI there is a risk to establish too often the diagnostic of a meniscal lesion rather then to identify structural modifications as a degeneration.

[Direct screwing in spondylolysis: results and observations on indications]. / Direktverschraubung bei Spondylolyse: Resultate und Uberlegungen zur Indikation.

Ten patients suffering from persisting low-back pain underwent direct repair of spondylolysis L5 with hook screws. At a follow-up three to four years after the operation, four patients showed good and six unsatisfactory results. Four patients had a secondary procedure. Average age was relatively high in the study group compared with the literature, and pain tended to be chronic. In five of the six patients with a poor clinical result, radiological consolidation of the lytic defect could not be demonstrated. We are discussing indications based on a literature review.

[Preoperative magnetic resonance tomography in chronic osteomyelitis of the extremities]. / Präoperative Magnetresonanztomographie bei der chronischen Osteomyelitis der Extremitäten.

39 patients with bone and joint infections of the extremities were examined with magnetic resonance imaging (MRI) in view of an operative procedure. Patients with hip affections and patients with nonoperative treatment were excluded; therefore, 21 patients including 12 post-traumatic and 9 hematogenous cases of chronic osteomyelitis form the study group. MRI findings were verified at operation. Typical MRI findings were: intraosseous abscess (n = 15), extraosseous abscess (n = 9), communication of both (n = 7), edema of bone marrow (n = 9), soft tissues changes (n = 6) and fluid-surrounded sequestrum (n = 6). 83% of the post-traumatic cases had an intraosseous abscess, 67% of the hematogenous cases an edema of bone marrow. MRI improves preoperative planning considerably by sensitive depiction of pathological findings in three planes. To obtain information about activity of the process, scintigraphy is needed in addition. In some cases computer tomography (CT) is helpful to find small sequestra.

Synovial chondromatosis of the glenohumeral joint: a rare condition.

The case of a 22-year-old man with synovial chondromatosis (SC) of the shoulder joint is described. A literature review confirmed that SC of the glenohumeral joint is very rare and that the etiology of the disease is still unknown. The diagnosis is often delayed, and the preferred form of management remains controversial. We consider magnetic resonance imaging (MRI) a valuable tool in detecting SC at an early phase and estimating the intrasynovial extent of the disease. Shoulder arthroscopy today represents an elegant treatment option for removing the chondromas and performing a partial synovectomy. It might, however, be insufficent in cases of involvement of the bicipital tendon sheath and other recesses of the joint.

Knee evaluation in two systems and magnetic resonance imaging after operative treatment of posterior cruciate ligament injuries.

We reviewed 30 patients operated on because of acute (n = 14) or chronic (n = 16) rupture of the posterior cruciate ligament (PCL) with an average follow-up time of 6.9 years. The clinical outcome was expressed using the OAK and the International Knee Documentation Committee (IKDC) evaluation forms. All patients had undergone posterior stress X-radiography, 14 patients had additionally undergone magnetic resonance imaging (MRI). OAK score showed good or excellent results in 93% of the acute and 38% of the chronic cases. The IKDC form, however, revealed nearly normal results in only 29% of the acute and 6% of the chronic cases. The length and thickness of the operated PCL on MRI correlated with the clinical result.

[Relevance of proton spin tomographic meniscus diagnosis in correlation with arthroscopy]. / Relevanz der kernspintomographischen Meniskusdiagnostik in Korrelation zur Arthroskopie.

Arthroscopy of the menisci is considered the gold standard by which all noninvasive imaging procedures of the knee are measured. In a prospective study we evaluated the use of MRI in 50 patients in whom a disorder of the meniscus was suspected clinically; this was followed by an arthroscopic examination by an experienced arthroscopist. The MR studies were performed after clinical evaluation and were interpreted by an experienced radiologist, who had no knowledge of the clinical findings. The accuracy of the diagnosis from MRI was 78% for the medial meniscus (sensitivity 79% and specificity 78%) and 94% for the lateral meniscus (sensitivity 50% and specificity 98%). The average age of the patients was 34 years, with a range of 3-73 years. The imaging studies revealed 9 false-positive tests and suggested that the meniscus was either degenerated or torn in the horizontal plane. In all 9 menisci the abnormal MR imaging signal was limited to the posterior horns. The positive predictive value was 59% and the negative predictive value was 94%, representing a moderate level of diagnostic certainty both in patients who had a positive result and in those who had a negative result. The high predictive negative value of MRI indicates that a negative MRI is quite reliable for meniscal lesions. The problem areas in MR imaging are the popliteal tendon sheath and the transverse ligament. This ligament is seen in association with a large branch of the lateral inferior geniculate artery and may be mistaken for a grade 3 signal intensity in the anterior horn of the lateral meniscus.

[Mortality and cause of death in a 20-year follow-up of the Basel study]. / Todesfälle und Todesursachen im 20-Jahres-Follow-Up der Basler Studie.

The results of a mortality follow-up in the Basle Study (BS) for the period 1965-1986 are presented, involving data of 4224 males and 936 females. The autopsy rate was 60% and allowed confirmation of the death certificates. The mortality rate of BS men is considerably higher (22% = 928 male) than that of the - on the average younger-females (9.2% = 87 female). In the male cohort the age-specific 10-year mortality is lower than in the general Swiss population due to a lower incidence of various diseases and accidents with fatal outcome and a lower incidence of cardiovascular death. On the other hand, a higher tumor incidence in the BS cohort from the age of 55 years on can be noted. This is mainly due to a higher frequency of lung cancer. With increasing duration of the follow-up the difference between the mortality of the general Swiss population and the BS participants diminishes. The higher tumor incidence observed could be explained by more accurate diagnoses in the BS group. Consequently, the Basel study cohort could-in relation to mortality data-be considered representative of the Swiss population.