Baby's first bites: a randomized controlled trial to assess the effects of vegetable-exposure and sensitive feeding on vegetable acceptance, eating behavior and weight gain in infants and toddlers.

BACKGROUND: The start of complementary feeding in infancy plays an essential role in promoting healthy eating habits. Evidence shows that it is important what infants are offered during this first introduction of solid foods: e.g. starting exclusively with vegetables is more successful for vegetable acceptance than starting with fruits. How infants are introduced to solid foods also matters: if parents are sensitive and responsive to infant cues during feeding, this may promote self-regulation of energy intake and a healthy weight. However, the effectiveness of the what and the how of complementary feeding has never been experimentally tested in the same study. In the current project the what and how (and their combination) are tested in one study to determine their relative importance for fostering vegetable acceptance and self-regulation of energy intake in infants. METHODS: A four-arm randomized controlled trial (Baby's First Bites (BFB)) was designed for 240 first-time Dutch mothers and their infants, 60 per arm. In this trial, we compare the effectiveness of (a) a vegetable-exposure intervention focusing on the what in complementary feeding; (b) a sensitive feeding intervention focusing on the how in complementary feeding, (c) a combined intervention focusing on the what and how in complementary feeding; (d) an attention-control group. All mothers participate in five sessions spread over the first year of eating solid foods (child age 4-16 months). Primary outcomes are vegetable consumption, vegetable liking and self-regulation of energy intake. Secondary outcomes are child eating behaviors, child anthropometrics and maternal feeding behavior. Outcomes are assessed before, during and directly after the interventions (child age 18 months), and when children are 24 and 36 months old. DISCUSSION: The outcomes are expected to assess the impact of the interventions and provide new insights into the mechanisms underlying the development of vegetable acceptance, self-regulation and healthy eating patterns in infants and toddlers, as well as the prevention of overweight. The results may be used to improve current dietary advice given to parents of their young children on complementary feeding. TRIAL REGISTRATION: The trial was retrospectively registered during inclusion of participants at the Netherlands National Trial Register (identifier NTR6572 ) and at ClinicalTrials.gov ( NCT03348176 ). Protocol issue date: 1 April 2018; version number 1.

Measles, mumps, rubella and VZV: importance of serological testing of vaccine-preventable diseases in young adults living with HIV in Germany.

Measles, mumps, rubella (MMR) and varicella zoster virus (VZV) infection can cause serious diseases and complications in the HIV-positive population. Due to successful vaccination programmes measles, mumps and congenital rubella syndrome has become neglected in Germany. However, recent outbreaks of measles have occurred from import-associated cases. In this cross-sectional study the serostatus for MMR and VZV in 2013 HIV-positive adults from three different university outpatient clinics in Bonn (n = 544), Cologne (n = 995) and Munich (n = 474) was analysed. Sera were tested for MMR- and VZV-specific immunglobulin G antibodies using commercial immunoassays. Seronegativity was found in 3% for measles, 26% for mumps, 11% for rubella and 2% for VZV. Regarding MMR, 35% of patients lacked seropositivity against at least one infectious agent. In multivariable analysis younger age was strongly associated with seronegativity against all four viruses, measles, mumps, rubella (P < 0·001, P < 0·001 and P = 0·001, respectively) and VZV (P = 0·001). In conclusion, there is high need for MMR and VZV vaccination in people living with HIV in Germany born in 1970 or later. Thus, systematic MMR and VZV antibody screening and vaccination should be implemented in the HIV-positive population to prevent serious disease and complications of vaccine-preventable diseases.

Reducing contrast medium volume and tube voltage in CT angiography of the pulmonary artery.

AIM: To evaluate image quality after contrast medium (CM) and tube voltage reduction in computed tomography angiography (CTA) of the pulmonary artery. MATERIALS AND METHODS: Thirty-three patients referred for CTA of the pulmonary artery for suspected pulmonary embolism were included. Patients were randomly assigned to Protocol I (100 ml of 350 mg iodine/ml iodinated CM; n=16) or Protocol II (50 ml of 350 mg iodine/ml iodinated CM; n=17). Dual-energy CT (80 kV and 140 kV) was performed in all patients. An averaged weighted series equivalent to a 120 kV image acquisition was reconstructed. The mean attenuation value of CM was measured at eight positions in the pulmonary trunk and pulmonary arteries. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Qualitative assessment of the vascular enhancement was performed independently by two experienced radiologists using a three-point scale. Mean attenuation values, image noise, CNR, and SNR of images with 50 ml CM and images with 100 ml CM were compared and mean attenuation values, image noise, CNR, and SNR in 80 kV images and 120 kV images were compared. For qualitative analysis, interobserver variability was analysed using Cohen's kappa statistics. RESULTS: The mean attenuation values in Protocol I and Protocol II were not significantly different at 80 kV (634.6±168.3 versus 537.9±146.7 HU; p=0.088) and 120 kV (482.8±127.7 versus 410.4±106.0 HU; p=0.085). The mean attenuation value at 80 kV was significantly higher than the mean attenuation value at 120 kV in Protocols I and II (p<0.001). The CNR and SNR were higher at 120 kV than at 80 kV in both protocols (p=0.000-0.019); however, there were no significant differences in the CNR and SNR between both protocols (p=0.600-0.952). Qualitative (subjective) analysis showed no statistical significant difference between Protocols I and II (p=0.524-1.000). CONCLUSION: Low tube voltage (80 kV) CTA using 50 ml CM is not inferior to CTA at 120 kV using 100 ml CM.

A non-invasive cardiac output measurement as an alternative to the test bolus technique during CT angiography.

AIM: To investigate the association between a non-invasive cardiac output (CO) measurement and the scan delay, as derived from a test bolus injection protocol. The secondary objective was to determine which factors affect the relationship between the CO and scan delay. MATERIALS AND METHODS: Fifty-five patients referred for a contrast-enhanced (thorax-)abdomen CT examination were included in this feasibility study. A test bolus examination was performed prior to the abdominal CT. During the test bolus injection, the CO of the patient was measured using a non-invasive finger-cuff measurement. Associations were analysed using linear regression analyses. Age, gender, height, weight, and blood pressure were included as potential confounders. RESULTS: Linear regression analysis showed a negative and significant association between CO and delay. The regression formula was as follows: scan delay (seconds) = 26.8-1.6 CO (l/min), with a 95% CI between -2.3 and -1.0 (p<0.001). Weight appeared to be a confounder in this relation, and gender and blood pressure were effect modifiers. There was no interaction between scan delay and age, height and weight. CONCLUSIONS: There is a negative and significant association between the non-invasive CO measurement and the CT scan delay; however, to validate these findings a larger cohort study is needed to investigate whether the non-invasively determined scan delay is as accurate as the use of a test bolus.

Feasibility of a low concentration test bolus in CT angiography.

AIM: To investigate the feasibility of using a low-concentration test bolus in abdominal aorta computed tomography (CT) angiography (CTA). MATERIALS AND METHODS: In 10 patients referred for CTA of the abdominal aorta with a body mass index (BMI) ≤28 kg/m2, a standard test bolus of 10 ml contrast medium (CM; 350 mg iodine/ml) was compared with a low-concentration test bolus (5 ml CM; 350 mg iodine/ml; 1:1 diluted with saline) in terms of time to peak enhancement (tPE) and peak enhancement (PE). RESULTS: No significant differences were found between the standard and low-concentration test bolus in terms of tPE and PE. CONCLUSIONS: A low-concentration test bolus (5 ml, 1:1 diluted with saline) is feasible in patients with a BMI ≤28 kg/m2.

Low-dose CT angiography of the abdominal aorta and reduced contrast medium volume: Assessment of image quality and radiation dose.

AIM: To determine the effect of using 80 kV tube voltage and a reduced amount of contrast medium on the image quality and radiation dose of computed tomography angiography (CTA) of the abdominal aorta. MATERIALS AND METHODS: Patients who were referred for a CTA examination of the abdominal aorta were included in this technical efficacy study. Thirty patients were divided randomly into two groups. Fifteen patients underwent a dual-energy CT (DECT) protocol (Group A). Fifteen patients were scanned with the use of an automated tube potential selection algorithm tool (Group B). In both protocols, a test bolus injection of 10 ml ioversol (350 mg iodine/ml) was used, followed by 20 ml of 1:1 saline-diluted contrast medium. Quantitative analysis comprised determination of the mean attenuation and contrast-to-noise ratio. Qualitative image analysis was performed independently by five radiologists. The estimated radiation dose in terms of CT dose index and effective dose was recorded and compared with a standard 120 kV protocol. RESULTS: In Group B, six patients underwent CTA at 80 kV, seven patients underwent CTA at 100 kV and two patients underwent CTA at 120 kV. The mean contrast-enhancement values of Group A (80 kV) and the 80 kV subgroup of Group B were 16.5% and 27.6% higher compared to the 100 kV subgroup of Group B, these differences were, however, not significant. There were no significant differences in mean image quality between groups. In patients undergoing CTA at 80 kV the effective dose decreased by up to 51.3% compared to a conventional 120 kV CTA protocol. CONCLUSIONS: The findings of this study support the hypothesis that 80 kV in CTA of the abdominal aorta can reliably be used with only 30 ml contrast medium in total and a 50% reduction in radiation dose. The overall image quality was diagnostically adequate; however, it appeared to be suboptimal in patients with a BMI above 28 kg/m(2).

[Lumbar back pain in patients with Parkinson's disease]. / Lendenwirbelsäulenschmerzen bei Patienten mit Morbus Parkinson.

BACKGROUND: Lumbar back pain is a frequent symptom in patients with advanced Parkinson's disease. We examined the effect of modification of the dopaminergic medication, x-ray-controlled lumbar spine injections and analgesics combined with physiotherapy. METHODS: The data from 50 patients with Parkinson's disease and lumbar back pain were retrospectively analyzed. A structured L-dopa test was performed with all patients, whereby the pain intensity and mobility were monitored before and after the administration of L-dopa. Dopaminergic medication was adjusted in patients who reported either a reduction in pain intensity (> 20%) and/or an improvement of measured mobility and X-ray controlled lumbar spine injections were conducted in patients who reported persistent pain. Analgesics were introduced or dosages were raised in patients who had already received lumbar spine injections and continued to report pain. All patients participated in a daily physiotherapy program. RESULTS: In the L-dopa test an improvement of mobility could be demonstrated in 40 patients and reduced pain intensity in 21 patients. In 37 patients with a positive L-dopa test the dopaminergic medication was adjusted. In 12 of these patients (24%) a decrease of pain intensity could be observed. Due to persisting back pain in 30 patients lumbar spine injections were conducted. Of these patients 17 (34%) had pain improvement. In 20 patients analgesics were applied and induced pain relief in 15 patients (30%). Overall 44 patients (88%) had an improvement in pain. DISCUSSION: Even in cases of severe lumbar spine pathology adjustment of dopaminergic medication should be tested in all patients with Parkinson's disease and lumbar back pain. In patients with persistent pain facet joint injections as well as analgesics may be helpful and should be tested according to the predominant pain characteristics.

GenomeRing: alignment visualization based on SuperGenome coordinates.

MOTIVATION: The number of completely sequenced genomes is continuously rising, allowing for comparative analyses of genomic variation. Such analyses are often based on whole-genome alignments to elucidate structural differences arising from insertions, deletions or from rearrangement events. Computational tools that can visualize genome alignments in a meaningful manner are needed to help researchers gain new insights into the underlying data. Such visualizations typically are either realized in a linear fashion as in genome browsers or by using a circular approach, where relationships between genomic regions are indicated by arcs. Both methods allow for the integration of additional information such as experimental data or annotations. However, providing a visualization that still allows for a quick and comprehensive interpretation of all important genomic variations together with various supplemental data, which may be highly heterogeneous, remains a challenge. RESULTS: Here, we present two complementary approaches to tackle this problem. First, we propose the SuperGenome concept for the computation of a common coordinate system for all genomes in a multiple alignment. This coordinate system allows for the consistent placement of genome annotations in the presence of insertions, deletions and rearrangements. Second, we present the GenomeRing visualization that, based on the SuperGenome, creates an interactive overview visualization of the multiple genome alignment in a circular layout. We demonstrate our methods by applying them to an alignment of Campylobacter jejuni strains for the discovery of genomic islands as well as to an alignment of Helicobacter pylori, which we visualize in combination with gene expression data. AVAILABILITY: GenomeRing and example data is available at http://it.inf.uni-tuebingen.de/software/genomering/.

B-1 and B-2 cell-derived immunoglobulin M antibodies are nonredundant components of the protective response to influenza virus infection.

We have studied the role of secreted immunoglobulin (Ig)M in protection from infection with influenza virus and delineated the relative contributions of B-1 versus B-2 cell-derived IgM in this process. Mice deficient in secreted IgM but capable of expressing surface IgM and secreting other Ig classes show significantly reduced virus clearance and survival rates compared with wild-type controls. Irradiation chimeras in which only either B-1 or B-2 cells lack the ability to secrete IgM show mortality rates similar to those of mice in which neither B-1 nor B-2 cells secrete IgM. Dependence on both sources of IgM for survival is partially explained by findings in allotype chimeras that broadly cross-reactive B-1 cell-derived natural IgM is present before infection, whereas virus strain-specific, B-2 cell-derived IgM appears only after infection. Furthermore, lack of IgM secreted from one or both sources significantly impairs the antiviral IgG response. Reconstitution of chimeras lacking B-1 cell-derived IgM only with IgM-containing serum from noninfected mice improved both survival rates and serum levels of virus-specific IgG. Thus, virus-induced IgM must be secreted in the presence of natural IgM for efficient induction of specific IgG and for immune protection, identifying B-1 and B-2 cell-derived IgM antibodies as nonredundant components of the antiviral response.

Trichodinids (Ciliophora: Trichodinidae) on Rocky-tidal Fishes from the Baja California Peninsula, Mexico.

Information regarding trichodinid ectoparasites on marine fishes of North America is relatively scarce. In this study, 5 ciliate species from the family Trichodinidae were found associated with 8 fish hosts from the rocky intertidal zone of the western coast of the Baja California Peninsula (BCP), Mexico. All of the host-parasite relationships recorded here are new. Furthermore, 3 of the trichodinid species found are recorded for the first time for Mexico. Trichodinids taxa do not show a noticeable distributional gradient along the BCP, which suggests a wide-continuous distribution of the species throughout the study area.

Dose reduction by automatic exposure control in multidetector computed tomography: comparison between measurement and calculation.

The aim of this study was to investigate the potential of dose reduction in multidetector computed tomography (MDCT) by current-modulated automatic exposure control (AEC) and to test the reliability of the dose estimation by the conventional CT dosimetry program CT-EXPO, when an average tube current is used. Phantom measurements were performed at a CT system with 64 detector rows for four representative examination protocols, each without and with current-modulated AEC. Organ and effective doses were measured by thermoluminescence dosimeters (TLD) at an anthropomorphic Alderson phantom and compared with those given by the calculation with CT-EXPO. The application of AEC yielded dose reductions between 27 and 40% (TLD measurements). While good linearity was observed between measured and computed effective dose values both without and with AEC, the organ doses showed large deviations between measurement and calculation. The dose to patients undergoing a MDCT examination can be reduced considerably by applying a current-modulated AEC. Dosimetric algorithms using a constant current-time product provide reliable estimates of the effective dose.

Predictors of abnormal chest CT after blunt trauma: a critical appraisal of the literature.

AIM: To identify and to evaluate predictors that determine whether chest computed tomography (CT) is likely to reveal relevant injuries in adult blunt trauma patients. METHODS: After a comprehensive literature search for original studies on blunt chest injury diagnosis, two independent observers included studies on the accuracy of parameters derived from history, physical examination, or diagnostic imaging that might predict injuries at (multidetector row) CT in adults and that allowed construction of 2x2 contingency tables. For each article, methodological quality was scored and relevant predictors for injuries at CT were extracted. For each predictor, sensitivity, specificity, positive and negative likelihood ratio and diagnostic odds ratio (DOR) including 95% confidence intervals were calculated. RESULTS: Of 147 articles initially identified, the observers included 10 original studies in consensus. Abnormalities at physical examination (abnormal respiratory effort, need for assisted ventilation, reduced airentry, coma, chest wall tenderness) and pelvic fractures were significant predictors (DOR: 2.1-6.7). The presence of any injuries at conventional radiography of the chest (eight articles) was a more powerful significant predictor (DOR: 2.2-37). Abnormal chest ultrasonography (four articles) was the most accurate predictor for chest injury at CT (DOR: 491-infinite). CONCLUSION: The current literature indicates that in blunt trauma patients with abnormal physical examination, abnormal conventional radiography, or abnormal ultrasonography of the chest, CT was likely to reveal relevant chest injuries. However, there was no strong evidence to suggest that CT could be omitted in patients without these criteria, or whether these findings are beneficial for patients.

[Neuropathic pain following lesions of the infrapatellar branch of the femoral nerve : an important differential diagnosis in anterior knee pain]. / Neuropathische Schmerzen nach Läsion des R. infrapatellaris des N. femoralis : Wichtige Differenzialdiagnose chronischer Knieschmerzen.

We report on two patients with neuropathic knee pain following lesions of the infrapatellar branch of the femoral nerve due to knee joint replacement. In one patient, the neuropathic pain syndrome was complicated by the development of complex regional pain syndrome (CPRS II, causalgia). Patients exhibit a sharp, burning pain, often induced by exercise, and sensory impairment in the skin area supplied by the infrapatellar nerve. This nerve is a branch of the femoral nerve medial to the fascia lata and is responsible for the skin sensation of the anterior and medial part of the knee. Clinical features, anatomy, diagnostic methods and therapeutic options are reviewed.

[Functional diagnostics of mobility control, mobility stabilization and hypermobility. Reliability of clinical tests - results of a multicenter study]. / Funktionelle Diagnostik der Bewegungssteuerung, Bewegungsstabilisation und Hypermobilität. Reliabilität klinischer Tests - Ergebnisse einer Multicenterstudie.

BACKGROUND: Complex forms of musculoskeletal dysfunction are thought to be risk factors for the development of chronic pain syndromes of the locomotor system. Unfortunately there are insufficient data on the reliability and validity of clinical tests for musculoskeletal dysfunctions. METHOD: The intrarater and interrater reliability of clinical tests for hypermobility and for the stabilisation system were examined in a multicentre trial. A total of 68 patients in 6 centres were functionally examined by 2 examiners once (intrarater reliability) and by 1 examiner twice (interrater reliability). RESULTS: The tests for hypermobility showed good to very good reliability. The results for the stabilisation system were more variable whereby 23 tests showed a kappa-coefficient greater than 0.5 and 15 tests good to very good reliability. DISCUSSION: All tests for hypermobility and 23 tests for the stabilisation system are suitable for further evaluation. The broad range in test reliability might be explained by the differences in examiner skills demanded by each test. Therefore, dependent on their validity, some tests will be useful in specialized centres while others might be used in primary care.

Management of hepatic trauma: a 9-year experience in 's-Hertogenbosch.

BACKGROUND: In patients who sustain abdominal trauma the liver is the most frequently injured organ. Although treatment for haemodynamically unstable patients remains urgent surgery, there has been a shift of management in haemodynamacally stable patients towards non-operative management. We performed an outcome assessment of traumatic hepatic injury. METHODS: A retrospective study was performed to assess incidence, mechanisms, management and outcome of traumatic liver injury in the region of 's-Hertogenbosch, The Netherlands, in the period 1999-2007. RESULTS: A total of 47 patients were identified. Thirty-six patients had blunt hepatic trauma, eleven sustained penetrating hepatic injury. In 67% (n = 24) of the blunt hepatic trauma patients the initial intention was to treat non-operatively. Yet, two patients underwent explorative laparotomy after one and two days. In the penetrating liver trauma patients, 91% (n = 10) underwent urgent surgery. In total, 31 of 47 patients were treated conservatively. CONCLUSION: Blunt hepatic trauma is the most common cause of hepatic trauma. Most patients sustaining hepatic trauma can be managed conservatively at a dedicated ICU and/or surgical trauma ward.

[Radio frequency ablation therapy in the elderly breast cancer patient]. / Radiofrequente ablatiebehandeling van de oudere patiënte met een mammacarcinoom.

Breast cancer is an important health care problem, especially in the increasing elderly generation. Treatment of these fragile patients is a challenge for the clinician. Undertreatment has been linked to a higher percentage of recurrence and cancer related morbidity, while overtreatment leads to treatment related morbidity and mortality. Minimally invasive techniques do offer new opportunities for patients, who are no candidates for conventional surgery. The tumor lesion is treated locally and selective with minimal damage to surrounding tissue, yielding an adequate local tumor control. Radio frequency ablation technique seems an effective and safe method for treatment of the elderly patient with small (< 3 cm) breast cancer.

Altered neural inhibition responses to food cues after Roux-en-Y Gastric Bypass.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) surgery is a highly effective weight-loss intervention that often reduces preference and intake of high-energy foods. Research into the neural mechanisms behind this shift has mainly focused on reward processing of food cues. However, the ability to successfully control food intake and thereby weight-loss also depends on inhibitory control capacity. We investigated whether RYGB leads to alterations in neural inhibitory control in response to food cues. METHODS: A food-specific go/no-go task with pictures of high-energy (desserts) and low-energy foods (vegetables), was used to assess neural inhibition responses before and after RYGB with functional magnetic resonance imaging. Data from 18 morbidly obese patients (15 females; age 41 ±â€¯11 years; BMI 42 ±â€¯4 kg/m2 before; BMI 36 ±â€¯4 kg/m2 after) were analysed. Pre- and post-RYGB BOLD fMRI responses were compared for response inhibition towards high- and low-energy foods. Participants were tested in a satiated state. RESULTS: Response inhibition to high-energy foods was associated with increased activation of the right lateral prefrontal cortex (PFC), right medial PFC, dorsolateral PFC, right middle cingulate cortex and the right inferior frontal operculum (involved in inhibitory control), after compared to before surgery. Response inhibition to low-energy foods elicited diminished post- compared to pre-surgery responses in the left superior temporal pole, right parahippocampal gyrus and right hypothalamus (involved in metabolic control). CONCLUSION: Neural changes indicate improved response inhibition towards high-energy food cues, altered influence of metabolic control during response inhibition towards low-energy food cues and a more positive attitude to both high-energy and low-energy food after RYGB. Alterations in neural circuits involved in inhibitory control, satiety signalling and reward processing may contribute to effective weight-loss after RYGB.

[Characterisation of breast lesions with VTIQ elastography: a new elastography method to evaluate the stiffness of tissues]. / Mammatumoren karakteriseren met VTIQ-elastografie.

B-mode ultrasound is used as an adjunct to mammography to differentiate between benign and malignant breast lesions. An additional ultrasound technique is elastography which can evaluate the stiffness of tissues. It is believed that malignant lesions are generally stiffer than benign lesions. Virtual touch tissue Quantification (VTIQ) is a new elastography method for measuring the stiffness of tissue. Because this method does not depend on the degree of compression, measurements are reliable and reproducible. VTIQ - in combination with ultrasonography - has the potential to characterise abnormalities in more detail. Adding elastography to regular B-mode ultrasound improves the diagnostic specificity without loss of sensitivity. This suggests that VTIQ might change patient management and avoid unnecessary biopsies. However, further research involving a greater variety of abnormalities and larger study populations is indicated.

Magnetic resonance imaging and mammography in women with a hereditary risk of breast cancer.

BACKGROUND: Although breast cancer screening is recommended to start at a younger age for women with a hereditary risk of breast cancer, the sensitivity of mammography for these women is reduced. We compared magnetic resonance imaging (MRI) with mammography to determine which is more sensitive and whether MRI could play a role in the early detection of breast cancer for these women. METHODS: We constructed a retrospective cohort of all breast MRI and mammography surveillance reports made in our department from November 1994 to February 2001. All of the 179 women in the cohort had received biannual palpation in addition to annual imaging by MRI, mammography, or both. The 258 MRI images and the 262 mammograms were classified with the use of the BI-RADS (i.e., Breast Imaging Reporting and Data System) scoring system, which has five categories to indicate the level of suspicion of a lesion. Receiver operator characteristic curves were generated for MRI and mammography, and the area under each curve (AUC) was assessed for the entire cohort of 179 women and for a subset of 75 women who had received both an MRI and a mammographic examination within a 4-month period. All statistical tests were two-sided. RESULTS: In the cohort of 179 women, we detected 13 breast cancers. Seven cancers were not revealed by mammography, but all were detected by MRI. For the entire cohort, the AUC for mammography was 0.74 (95% confidence interval [CI] = 0.68 to 0.79), and the AUC for MRI was 0.99 (95% CI = 0.98 to 1.0). For the subset of women who had both examinations, the AUC for mammography was 0.70 (95% CI = 0.60 to 0.80), and the AUC for MRI was 0.98 (95% CI = 0.95 to 1.0). CONCLUSION: MRI was more accurate than mammography in annual breast cancer surveillance of women with a hereditary risk of breast cancer. Larger prospective studies to examine the role of MRI in screening programs are justified.

Quality-of-life and body image impairments in patients with lymphedema.

The psychological and social consequences of chronic lymphedema are still often overlooked, as is the frequency with which they occur. Secondary lymphedema after mastectomy or breast-conservation procedures following the diagnosis of breast cancer is especially common and represents a substantial problem for those affected. The aim of this study was to investigate differences in body image and quality of life (QOL) between female lymphedema patients and trauma patients and to further monitor the changes in female lymphedema patients during three weeks of rehabilitation. This survey was conducted on 80 female patients at the State Hospital of Wolfsberg/Carinthia, Austria, 40 were trauma patients and the other 40 patients had some type of lymphedema, 20 of these patients were located in the general lymphedema ward and 20 in rehabilitation. The Frankfurt Body Image Questionnaire was used to determine body image, and the German version of the Short Form-36 Health Survey was used to determine QOL. The results indicate that female lymphedema patients are greatly affected in various areas of body image and QOL. Lymphedema patients show significantly lower body image scores in seven of nine areas compared to trauma patients. Female lymphedema patients also describe their QOL as being lower in the areas of general health perception, vitality and mental well-being. After rehabilitation, there were improvements in the evaluation of physical functioning and an increased acceptance of the body. Patients also showed a significant increase in health perception, vitality and mental health.