Aromatase inhibitor-induced modulation of breast density: clinical and genetic effects.

BACKGROUND: Change in breast density may predict outcome of women receiving adjuvant hormone therapy for breast cancer. We performed a prospective clinical trial to evaluate the impact of inherited variants in genes involved in oestrogen metabolism and signalling on change in mammographic percent density (MPD) with aromatase inhibitor (AI) therapy. METHODS: Postmenopausal women with breast cancer who were initiating adjuvant AI therapy were enrolled onto a multicentre, randomised clinical trial of exemestane vs letrozole, designed to identify associations between AI-induced change in MPD and single-nucleotide polymorphisms in candidate genes. Subjects underwent unilateral craniocaudal mammography before and following 24 months of treatment. RESULTS: Of the 503 enrolled subjects, 259 had both paired mammograms at baseline and following 24 months of treatment and evaluable DNA. We observed a statistically significant decrease in mean MPD from 17.1 to 15.1% (P<0.001), more pronounced in women with baseline MPD ≥20%. No AI-specific difference in change in MPD was identified. No significant associations between change in MPD and inherited genetic variants were observed. CONCLUSION: Subjects with higher baseline MPD had a greater average decrease in MPD with AI therapy. There does not appear to be a substantial effect of inherited variants in biologically selected candidate genes.

Toxic shock syndrome: a retrospective study of 25 cases from Iowa.

We reviewed retrospectively the clinical records of 25 women ages 13 to 41 years who had diagnosed illnesses compatible wtih toxic shock syndrome (TSS). Cases occurred between January 1976 and October 1980. Fourteen confirmed TSS cases and 11 probable TSS cases were identified. In each case initial symptoms occurred in association with menstrual bleeding and tampon use. All patients were febrile. Hypotension occurred in 20 cases, but five patients with milder illness remained normotensive. An erythematous rash occurred in 20 cases. Desquamation occurred in convalescence in all but two cases. Complications included delirium or coma, acute renal failure, and respiratory distress syndrome. Thirteen patients had recurrences of TSS. S. aureus was isolated from the vagina or cervix in 75% of cases. There is a spectrum of severity associated with TSS. Strict diagnostic criteria established heretofore for epidemiologic studies of TSS may not be met by all cases of TSS.

Accuracy of three-dimensional measurements using cone-beam CT.

OBJECTIVES: Lesions causing intraosseous defects in the head and neck region are difficult to diagnose using two-dimensional radiography, and three-dimensional (3D) data provided by CT is useful but often difficult to obtain. Recently, cone-beam CT (CBCT) was made available, with the potential to become a practical tool in dentistry. However, there is limited evidence to prove that defect volume can be determined accurately. Therefore, this in vitro validation study aimed at establishing whether linear and 3D CBCT, using volumetric measurements, is accurate for determining osseous defect sizes. METHODS: Depth and diameter of simulated bone defects in (i) an acrylic block and (ii) a human mandible were blindly measured electronically by five examiners using CBCT. Linear measurements were compared with predetermined machined dimensions. Using software, volume extraction was performed by another examiner on the acrylic phantom and compared with known dimensions. Data were analysed using paired t-tests. RESULTS: Using the acrylic block, mean width accuracy was -0.01 mm (+/- 0.02 SE) and mean height difference was -0.03 mm (+/- 0.01 SE; P > 0.05). For the human mandible, mean width accuracy was -0.07 mm (+/- 0.02 SE) and mean height accuracy was -0.27 mm (+/- 0.02 SE; P < 0.01). Volume accuracy was -6.9 mm3 (+/- 4 SE) for automated calculations and -2.3 mm3 (+/- 2.6 SE) for the manual measurements (P < 0.001). CONCLUSIONS: CBCT has the potential to be an accurate, non-invasive, practical method to reliably determine osseous lesion size and volume. Further clinical validation will lead to a vast array of applications in oral and maxillofacial diagnosis.

Endocarditis caused by relatively penicillin-resistant Stomatococcus mucilaginosus.

We report a case of Stomatococcus mucilaginosus endocarditis in which the isolate was relatively resistant to penicillins and cephalothin. The patient was treated successfully with vancomycin and valve replacement.

An outbreak of cat-associated Q fever in the United States.

Q fever is usually acquired by contact with aerosols generated during parturition of domestic ungulates (e.g., sheep, cows, goats). In the maritime provinces of Canada, parturient cats have also been implicated in its transmission. A 66-year-old woman from eastern Maine developed high fever, rigors, headache, myalgias, pulmonary infiltrates, and elevated hepatocellular enzymes, and the diagnosis of acute Q fever was confirmed serologically. She and 14 other family members had attended a family reunion in Maine 2 weeks earlier, when they were exposed to a parturient cat. All 11 adults and older children attending the reunion developed symptoms consistent with acute Q fever. Serum samples were obtained from 10 who attended the reunion and 8 who did not attend. Titers greater than or equal to 1:64 to Coxiella burnetii were present in all who attended the reunion but in none of those who did not. Cat-associated Q fever should be considered when sporadic cases of the disease occur in the United States.