Lung attenuation measurements in healthy young adults.

0.05 at VC10%/VC90%). CONCLUSIONS: Lung attenuation during inspiration was lower at the MC level than at the top, but higher on expiratory scans. No sex-related differences were found. Lung attenuation decreases with age on expiratory scans. This seemed to be of more importance than the amount of pack-years of smoking. A relationship with lung function parameters is not uniformly proven

Lung density measurements in spontaneous pneumathorax demonstrate air trapping.

PURPOSE: Idiopathic spontaneous pneumothorax (SP) is the result of leakage of air from the lung parenchyma through a ruptured visceral pleura into the pleural cavity. This rupture is thought to be caused by an increased pressure difference between parenchymal airspace and pleural cavity. We hypothesize that rather peripheral airway inflammation leads to obstruction with check valve phenomena and by that to airtrapping in the lung parenchyma, which precedes spontaneous pneumothorax. SETTING: University hospital. MATERIALS AND METHODS: Forty-one matched healthy volunteers (21 smokers and 20 nonsmokers), and 41 patients with SP (21 patients with and 20 patients without bullae) underwent spirometrically controlled high-resolution CT density measurements with automatic contour tracing at 10% and at 90% of vital capacity. RESULTS: Patients with SP showed lower mean lung density (MLD) values and higher percentages of Hounsfield units (HU) below - 900 HU (pixel index [PI]) compared to the healthy volunteers on expiratory scans. This enhanced airtrapping phenomenon is seen in both the SP lung (MLD, p = 002; PI, p = 0.01) and the contralateral lung (MLD, p = 0.009; PI, p = 0.05) compared to the control subjects. The difference with control subjects is independent of smoking behavior and bullae. CONCLUSIONS: Peripheral airway obstruction with airtrapping was found, and it is supposed to play an important role in the pathogenesis of spontaneous pneumothorax. (aut. ref.

Effects of 10 years of growth hormone (GH) replacement therapy in adult GH-deficient men

OBJECTIVE: GH-deficient adults have changes in body composition, bone mineral density (BMD) and lipid profile that can be altered by GH substitution. However, long-term data on GH substitution (up to 10 years of follow-up) are limited. DESIGN: The effects of 10 years of GH replacement therapy on BMD, body composition, bone parameters, serum lipids and glucose metabolism were studied. PATIENTS: Twenty-three childhood-onset GH-deficient men (mean age at baseline 28.6 years) were studied during 10 years of GH substitution therapy. A group of 19 age-matched healthy men served as a control group for BMD measurements at baseline and after 10 years. RESULTS: BMD of the lumbar spine increased during the 10 years of GH therapy. Bone markers and BMD in the hip increased during the first 5 years of GH therapy, but were not different from baseline after 10 years. BMD changes over time in the lumbar spine and femoral neck were significantly different in the patients compared to the controls. After 10 years the difference between the groups had decreased, but BMD was still higher in the controls than in the patients. Lipid profile had improved after 10 years of GH therapy, but body mass index (BMI), waist-hip ratio (WHR), fasting glucose and glycosylated haemoglobin (HbA1c) had increased compared to baseline. CONCLUSIONS: This long-term follow-up study found that 10 years of GH substitution in GH-deficient men causes sustained improvements in BMD in the lumbar spine and lipid profile but not in body composition

Lung attenuation measurements in healthy young adults.

Background: High-resolution computed tomography (HRCT) attenuation measurements may be more sensitive in finding early emphysematous changes in relatively young subjects than lung function measurements. Objectives: To define lung attenuation parameters in smokers and never-smokers. Methods: A prospective comparative study in a university hospital setting was designed with 20 healthy smoking and 20 nonsmoking volunteers. Attenuation measurements on spirometrically controlled HRCT at three levels in the upper half of the lungs at 10% and 90% of vital capacity (VC10% and VD90%) were done, and lung function measurements were performed. Results: Mean lung attenuation (MLD) and pixel index (PI) were correlated with lung function and smoking history. Small attenuation differences in the left and right lung were found but no sex-related differences. At main carina (MC) level, the PI was higher at VC90% (p < 0.0001) but lower at VC10% (p < 0.01) compared to the apex. Age correlated with attenuation parameters at VC10%, whereas for pack-years no correlation was found. There were attenuation correlations with VC (PI: R = 0.31, p < 0.05 at VC10%/90%), residual volume (MLD: R = -0.31, p < 0.05 at VC10%), and total lung capacity (PI: R = 0.31, p < 0.05 at VC10%/VC90%). Conclusions: Lung attenuation during inspiration was lower at the MC level than at the top, but higher on expiratory scans. No sex-related differences were found. Lung attenuation decreases with age on expiratory scans. This seemed to be of more importance than the amount of pack-years of smoking. A relationship with lung function parameters is not uniformly proven. (aut. ref.

A 6-years-old boy with hyperammonaemia: partial N-acetylglutamate synthase deficiency or portosystemic encephalopathy?

We describe a 6-year-old boy admitted with lethargy and somnolence. Laboratory tests showed hyperammonaemia (arterial level 186 μmol/1) and slightly elevated prothrombin time. The patient was treated with sodium benzoate, lactulose and a protein-restricted diet. This resulted in an insufficient decrease in blood ammonia levels. Metabolic investigations were unrevealing apart from a slightly elevated urinary glutamine concentration. Liver tissue showed steatosis and mildly decreased activity of N-acetylglutamate synthase suggesting partial deficiency. Treatment with N-carbamyl glutamate did not affect serum ammonia levels. Colour Doppler sonography and MR angiography demonstrated a patent ductus venosus. After surgical ligation of the ductus venosus, serum ammonia levels returned to normal and mental and motor performance improved markedly. Conclusion: In late onset hyperammonaemia, partial N-acetylglutamate synthase deficiency and portocaval shunt should be ruled out

Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition.

Contains fulltext : 58587.pdf (publisher's version ) (Open Access)BACKGROUND: The value of regular surveillance for breast cancer in women with a genetic or familial predisposition to breast cancer is currently unproven. We compared the efficacy of magnetic resonance imaging (MRI) with that of mammography for screening in this group of high-risk women. METHODS: Women who had a cumulative lifetime risk of breast cancer of 15 percent or more were screened every six months with a clinical breast examination and once a year by mammography and MRI, with independent readings. The characteristics of the cancers that were detected were compared with the characteristics of those in two different age-matched control groups. RESULTS: We screened 1909 eligible women, including 358 carriers of germ-line mutations. Within a median follow-up period of 2.9 years, 51 tumors (44 invasive cancers, 6 ductal carcinomas in situ, and 1 lymphoma) and 1 lobular carcinoma in situ were detected. The sensitivity of clinical breast examination, mammography, and MRI for detecting invasive breast cancer was 17.9 percent, 33.3 percent, and 79.5 percent, respectively, and the specificity was 98.1 percent, 95.0 percent, and 89.8 percent, respectively. The overall discriminating capacity of MRI was significantly better than that of mammography (P<0.05). The proportion of invasive tumors that were 10 mm or less in diameter was significantly greater in our surveillance group (43.2 percent) than in either control group (14.0 percent [P<0.001] and 12.5 percent [P=0.04], respectively). The combined incidence of positive axillary nodes and micrometastases in invasive cancers in our study was 21.4 percent, as compared with 52.4 percent (P<0.001) and 56.4 percent (P=0.001) in the two control groups. CONCLUSIONS: MRI appears to be more sensitive than mammography in detecting tumors in women with an inherited susceptibility to breast cancer

Tumor characteristics and detection method in the MRISC screening program for the early detection of hereditary breast cancer.

Contains fulltext : 52475.pdf (publisher's version ) (Closed access