Orthostatic Hypotension and Associated Factors among Home Care Clients Aged 75 Years or Older - A Population-Based Study

OBJECTIVES

The aim of this study was to examine orthostatic hypotension (OH) and associated factors among home care clients aged 75 years or older.

DESIGN

Non-randomised controlled study.

SETTING AND PARTICIPANTS

The study sample included 244 home care clients aged 75 years or older living in Eastern and Central Finland.

MEASUREMENTS

Nurses, nutritionists and pharmacists collected clinical data including orthostatic blood pressure, depressive symptoms (15-item Geriatric Depression Scale GDS-15), nutritional status (Mini Nutritional Assessment MNA), drug use, self-rated health, daily activities (Barthel ADL Index and Lawton and Brody IADL scale) and self-rated ability to walk 400 metres. Comorbidities were based on medical records.

RESULTS

The prevalence of OH was 35.7% (n = 87). No association between OH and the number of drugs used or causative drug use and OH was found. In univariate analysis, coronary heart disease, systolic and diastolic blood pressure in a sitting position and lower mean MNA scores were associated with a risk of OH. Multivariate analysis showed that lower mean MNA scores (OR 1.140, 95% CI: 1.014-1.283) appeared to be independently connected to a risk of OH.

CONCLUSION

One-third of the home clients had OH and it was associated with lower MNA scores.

Ultrasonography as a Guiding Method in Breast Micro-Calcification Vacuum-Assisted Biopsies

Purpose: To assess the visibility of breast micro-calcifications using ultrasonography (US) and the accuracy and clinical usefulness of vacuum-assisted biopsy (VAB) using US guidance (USVAB) as compared to stereotactic guidance (SVAB). Materials and Methods: The study material comprised 158 retrospectively reviewed micro-calcification cases examined with US before VAB. The pre-biopsy US positivity frequency distributions were calculated, and the sensitivity, specificity and accuracy of VAB determined by comparing VAB histology with the surgical pathology or a 12-month follow-up. Results: 158 US examinations yielded 80 positive and 78 negative results. US positivity correlated to a large size and a suspicious BI-RADS category of the calcifications. USVAB was performed in 49 cases with 61 % malignant, 12 % high-risk and 27 % benign results. The percentages for the 109 SVAB cases were 40 %, 28 % and 32 %, respectively. Specimen radiography demonstrated calcifications in 48 of the 49 (98 %) USVAB cases and in 107 of the 109 (98 %) SVAB cases. The overall accuracy of VAB was 94 % (USVAB 98 %, SVAB 94 %), the sensitivity was 88 % (USVAB 97 %, SVAB 83 %), and the specificity was 100 %. The higher sensitivity of USVAB was due to an accumulation of atypical hyperplasia diagnoses in the SVAB group. The final diagnosis was invasive ductal carcinoma in 21 US-positive and in 4 US-negative cases. Conclusion: Approximately 50 % of mammographically detected micro-calcifications could be detected with ultrasonography. US was found to be a valuable alternative guidance method for vacuum-assisted biopsy of micro-calcifications with a technical success rate and diagnostic accuracy well comparable to the stereotactic method.

Ultrasound-guided percutaneous thoracoabdominal biopsy: Efficacy, cost-effectiveness and safety

This review will discuss the benefits and disadvantages of ultrasound-guided percutaneous fine-needle aspiration and cutting needle biopsies. Clinical efficacy, cost-effectiveness, some controversies and safety will be reviewed.

Dynamics of contrast enhancement in MR imaging and power Doppler ultrasonography of solid breast lesions

Purpose: To evaluate the dynamics of contrast enhancement in solid breast lesions at contrast-enhanced MR imaging and power Doppler ultrasonography (US) and to compare the methods to histology and to each other.

Material and Methods: Forty breast lesions were prospectively examined with dynamic MR and power Doppler US. Time-signal intensity curves of enhancement were obtained for both methods. The shape of the curve was analyzed to be benign, indeterminate or malignant. The curves were also analyzed quantitatively by calculating the slope of the curve and the area under the curve (both methods), relative enhancement (MR), and time to peak (US). The lesions were divided into malignant lesions, fibroadenomas, and other benign lesions. The results were compared to histology.

Results: In the subjective analysis of the MR curve in differentiating between benign and malignant lesions the accuracy was 90%. The MR curve also enabled differentiation between fibroadenomas and malignancies. The accuracy of the US curve was 38%. Quantitatively, statistically significant differences were found using all the MR variables, except between malignancies and fibroadenomas. Using the US variables, no significant difference was found between the groups.

Conclusion: The dynamics of contrast-enhanced MR were reliable in the differential diagnosis of solid breast lesions, but contrast-enhanced power Doppler US was of limited value.

B-Mode, power doppler and contrast-enhanced power doppler ultrasonography in the diagnosis of breast tumors

Purpose: To investigate the role of B-mode and unenhanced and enhanced power Doppler ultrasonography (US) in differentiating solid breast lesions, and to find out whether morphologically different tumors differ in terms of vascularity.

Material and Methods: Sixty-five lesions, indeterminate or suggestive of malignancy after mammography were prospectively examined with B-mode and unenhanced and enhanced power Doppler US. The lesions were classified as benign, indeterminate or malignant at B-mode, and as benign or malignant at power Doppler US. The results were compared to the histologic diagnoses. Vascularity was analyzed also quantitatively to find out whether threshold values for differential diagnostics could be set.

Results: The sensitivity, specificity, and overall accuracy of the morphologic evaluation were 100%, 10%, and 57%, respectively. Rounded lesions were more vascular than spiculated lesions, but vascular assessment was only helpful when it supported a benign morphology. In quantitative analysis, due to the overlap between the benign and malignant lesions, no threshold values could be set.

Conclusion: Morphologic criteria were useful in characterizing malignant lesions, but the large proportion of indeterminate findings decreased the specificity of US. Neither unenhanced, nor enhanced power Doppler US was able to improve diagnostic accuracy.

Male Malignant Phyllodes Breast Tumor After Prophylactic Breast Radiotherapy and Bicalutamide Treatment: A Case Report

Phyllodes tumor in male breast is an exceptionally rare neoplasm with only few published case reports. Herein, we present a case of malignant phyllodes tumor in male breast nine years after prophylactic breast 10 Gy radiotherapy and after nine year bicalutamide treatment. The imaging findings of the tumor and pathological correlation are also presented.

Factors associated with life satisfaction in a 6-year follow-up of depressive out-patients

BACKGROUND

The major goal of mental health services is to improve mental health and thus also life satisfaction. However, studies assessing factors associated with life satisfaction during recovery from depression are lacking.

METHODS

A 6-year natural follow-up of 121 depressive out-patients was carried out with questionnaires at baseline, 1/2, 1, 2 and 6 years completed. A structured diagnostic interview was conducted. Throughout the follow-up, clinical status was assessed with several psychometric scales for life satisfaction (LS), depression (BDI, HDRS), hopelessness (HS), functional ability (GAF, SOFAS) and general psychopathology (SCL).

RESULTS

Men and women did not differ in their improvement in life satisfaction. Altogether, 77% of the patients at baseline and 22% at the end were dissatisfied. Life satisfaction on 6-year follow-up was associated with baseline lower interpersonal sensitivity (SCL subscale) and concurrently being loved by someone as well as with baseline and concurrent good self-rated health and wealth. The satisfied were better off in terms of all clinical variables, regardless of the measurement time. Depressive symptoms and hopelessness were the strongest concurrent clinical correlates of LS after 6 years.

CONCLUSIONS

Mental health was strongly related to life satisfaction throughout the follow-up, while most of the non-clinical factors were not. Alleviating depression and interpersonal sensitivity and supporting social networks should be focused on in psychiatric treatment in order to improve life satisfaction among depressive patients.

Imaging findings and accuracy of core needle biopsy in mucinous carcinoma of the breast

BACKGROUND

Diagnosis of mucinous carcinoma can be difficult due to its benign appearance on mammograms and ultrasonographic (US) images. In the light of the rather scarce literature, core needle biopsy (CNB) has proved useful in diagnosing mucinous lesions.

PURPOSE

To assess mammographic, US, and CNB findings of mucinous breast tumors and to correlate them with final histology obtained in therapeutic surgery.

MATERIAL AND METHODS

From 2000-2006, 25 mucinous carcinomas detected with CNB were surgically removed. The mammography, US, and CNB results were analyzed and correlated with final histology.

RESULTS

Ninety-six percent of the mucinous carcinomas (24/25) were visible with US. All except two of the 24 tumors were solid masses. All the mixed-type lesions (group 2) were hypoechoic and had irregular or lobulated margins and heterogeous internal echotexture. The US features were more variable among the 14 pure mucinous carcinomas (group 1) and the six US visible mucinous carcinomas with cancerous cells outside the tumor (group 3). Fifty-seven percent of group 1 and 50% of group 3 tumors had clearly lobulated or irregular margins. Fifty-seven percent of group 1 and 67% of group 3 cancers were hypoechoic. A vast majority of these tumors had heterogenous echotexture. Seventy-one percent (17/24) of the lesions visible with US had posterior acoustic enhancement. Eighty percent (20/25) of the mucinous carcinomas were classified as BI-RADS 4 lesions in US. All the lesions with images available were visible on mammograms, where most of the tumors were seen as a high-density circumscribed lesion and classified as BI-RADS 4 lesions, while none were classified as BI-RADS 1, 2 or 5. The sensitivity and positive predictive value of CNB regarding mucinous carcinoma was 100%.

CONCLUSION

CNB was found to be a highly reliable diagnostic tool for diagnosing mucinous carcinoma in this selected material. US findings of pure mucinous carcinoma were variable, however, all reached BI-RADS 4 category. The presence of posterior acoustic enhancement beneath a solid breast lesion should raise suspicion of mucinous carcinoma. Most of the tumors appeared as BI-RADS 4 lesions in US and in mammography thus making both a useful tool for raising a suspicion of malignancy in mucinous cancers.

Ultrasonography-guided core needle biopsy in differential diagnosis of papillary breast tumors

BACKGROUND

Papillary lesions of the breast are considered diagnostically challenging for various reasons. A relatively high malignancy rate in final pathological analysis has in many cases necessitated excision of these lesions, regardless of core needle biopsy (CNB).

PURPOSE

To assess mammographic, sonographic, and CNB findings of papillary lesions, and to correlate them with final histology obtained by surgical excision.

MATERIAL AND METHODS

From 2000-2006, 29 benign and 19 malignant papillary tumors examined with CNB were surgically removed. Mammographic, sonographic, and CNB results were analyzed and correlated with final histology.

RESULTS

On ultrasonography (US), 69% (20/29) of the benign lesions were solid and 31% (9/29) were cystic, and 47% of the malignant lesions (9/19) were solid and 53% (10/19) were cystic. The mammographic findings were nonspecific, although most of the malignant tumors (67%, 12/18) were categorized as BI-RADS 4 lesions. The sensitivity, specificity, and positive predictive value of the core needle biopsy histology was 32% (6/19), 100% (29/29), and 100% (6/6), respectively, for papillary carcinoma. A negative predictive value of 91% (21/23) for malignancy and 48% (11/23) for either atypia or malignancy was shown. Of the lesions with CNB diagnosis of benign papillary lesion with atypia, 58% (11/19) turned out to be malignant and 11% (2/19) were benign on surgery.

CONCLUSION

The probability of malignancy is low when the CNB result shows a benign papillary lesion with no atypia. However, the only way to reliably diagnose atypical papillary lesions is to surgically remove all papillary tumors, irrespective of the CNB result. Differentiation between benign and malignant lesions or malignant noninvasive and invasive tumors is not possible based on sonographic or mammographic appearance.

Ultrasonography and core needle biopsy in the differential diagnosis of fibroadenoma and tumor phyllodes

BACKGROUND

The diagnosis of phyllodes tumors of the breast is challenging due to many similarities with common fibroadenomas.

PURPOSE

To determine the diagnostic accuracy of core needle biopsy in diagnosing phyllodes tumors and to analyze the ultrasonographic (US) features of phyllodes tumors and fibroadenomas.

MATERIAL AND METHODS

From 1999 to 2003, 1010 breast lesions underwent imaging-guided core needle biopsy. Of these, 57 fibroadenomas and 12 phyllodes tumors were removed surgically. The US and needle biopsy results of a total of 64 lesions (52 fibroadenomas and 12 phyllodes tumors) were further analyzed, compared, and correlated with surgical histological results.

RESULTS

The median sonographic sizes of the phyllodes tumors and the fibroadenomas were 3.2 cm and 1.6 cm, respectively. At US, 58% of the phyllodes tumors (7/12) were classified as equivocal or suspicious of malignancy and 42% (5/12) as probably benign, while 54% of the fibroadenomas (28/52) were classified as probably benign and 46% (24/52) as equivocal. The sensitivity, specificity, and positive and negative predictive values of core needle biopsy histology regarding tumor phyllodes were 83%, 92%, 71%, and 96%, respectively.

CONCLUSION

Imaging-guided core needle biopsy was accurate in differentiating between fibroadenomas and phyllodes tumors. US classification was unreliable due to considerable overlap in the findings. Combined use of US feature analysis and needle biopsy may help to avoid the misinterpretation of phyllodes as fibroadenoma.

Breast sonography in localizing the cause of nipple discharge: comparison with galactography in 52 patients

OBJECTIVE

The purpose of this study was to evaluate breast sonography in localizing abnormalities in the discharging duct in patients with spontaneous nipple discharge.

METHODS

Fifty-two patients with unilateral bloody or serous nipple discharge and normal findings on palpation and mammography underwent breast sonography before surgical duct excision. The results of sonography were compared with the findings of galactography and histologic examination of the surgical specimen.

RESULTS

The final diagnosis was benign in 47 cases (90%) and malignant in 5 cases (10%). Sonography visualized an echogenic intraductal tumor in 36 (69%) of 52 cases, dilated duct(s) without an intraductal tumor in 6 cases (12%), and no abnormality in 10 cases (19%). Eighty percent of papillomatous lesions, 58% of other benign lesions, and 20% of malignant lesions were sonographically positive. The abnormal duct was surgically removed after methylene blue staining in 38 cases, after sonographically guided wire localization in 11 cases, after both wire localization and methylene blue staining in 1 case, and with review of the diagnostic galactographic images in 2 cases.

CONCLUSIONS

Sonography was found to be a valuable method for localizing intraductal abnormalities, especially papillomatous lesions, in patients with nipple discharge with no other clinical or radiologic findings. Preoperative sonographically guided wire localization can be used successfully instead of conventional methylene blue staining in cases with problems in cannulation of the discharging duct. Galactography remains the primary diagnostic method, especially in depicting malignant causes of nipple discharge, which may be seen only as duct dilatation on sonography.

Low-field versus high-field MRI in diagnosing breast disorders

We evaluated the performance of low-field MRI in breast disorders by comparing it with high-field MRI and biopsy results. Twenty-eight consecutive patients who were able to undergo two magnetic resonance examinations on following days were examined by high-field and low-field MRI. After T1-weighted sagittal images had been obtained a dynamic 3D axial study was performed followed by the acquisition of contrast-enhanced T1-weighted sagittal images. The images were analyzed separately by two radiologists paying attention to lesion morphology and enhancement kinetics. Six patients had problems in both breasts (34 breasts studied). The results were compared with biopsy results of 27 breasts. There were 16 malignant lesions, two fibroadenomas and nine other benign lesions. The inter-magnetic-resonance-scanner kappa value was 0.77 (substantial agreement), while the interobserver kappa value was 0.86 and 0.81 at low and high field, respectively (excellent agreement). The sensitivity was 100 and 100%, the specificity was 82 and 73% and the accuracy was 93 and 89% at low and high field, respectively. The mean lesion size was 2 cm and the smallest malignant lesion was 8 mm in diameter. Low-field MRI is a promising tool for breast imaging. Larger materials and smaller lesions are needed to evaluate its true sensitivity and specificity.

General practitioner's skills to perform limited goal-oriented abdominal US examinations after one month of intensive training

A training program of "limited goal-oriented abdominal sonography" for general practitioners (GPs) was planned, set up and tested. After 1 month of intensive training (about 100 examinations), four test subjects succeeded in technically performing examinations in four patients out of five patients, and were able to rule out or exclude fluid collections, aortic aneurysms and common gallbladder disease.

Dynamics of contrast enhancement in MR imaging and power Doppler ultrasonography of solid breast lesions

PURPOSE

To evaluate the dynamics of contrast enhancement in solid breast lesions at contrast-enhanced MR imaging and power Doppler ultrasonography (US) and to compare the methods to histology and to each other.

MATERIAL AND METHODS

Forty breast lesions were prospectively examined with dynamic MR and power Doppler US. Time-signal intensity curves of enhancement were obtained for both methods. The shape of the curve was analyzed to be benign, indeterminate or malignant. The curves were also analyzed quantitatively by calculating the slope of the curve and the area under the curve (both methods), relative enhancement (MR), and time to peak (US). The lesions were divided into malignant lesions, fibroadenomas, and other benign lesions. The results were compared to histology.

RESULTS

In the subjective analysis of the MR curve in differentiating between benign and malignant lesions the accuracy was 90%. The MR curve also enabled differentiation between fibroadenomas and malignancies. The accuracy of the US curve was 38%. Quantitatively, statistically significant differences were found using all the MR variables, except between malignancies and fibroadenomas. Using the US variables, no significant difference was found between the groups.

CONCLUSION

The dynamics of contrast-enhanced MR were reliable in the differential diagnosis of solid breast lesions, but contrast-enhanced power Doppler US was of limited value.

Serum fatty acid composition predicts development of impaired fasting glycaemia and diabetes in middle-aged men

AIMS

Dietary fatty acid intake is reflected in serum fatty acid composition. Studies prospectively investigating serum fatty acids and development of impaired fasting glycaemia (IFG) or diabetes mellitus (DM) are largely lacking. We assessed the association of serum fatty acid composition with development of IFG or DM.

METHODS

Middle-aged normoglycaemic men (n = 895) participating in a prospective cohort study were followed up after 4 years.

RESULTS

At baseline proportions of serum esterified and non-esterified saturated fatty acids were increased and polyunsaturated fatty acids decreased in men who after 4 years had developed IFG (n = 56) or DM (n = 34). No differences in dietary fatty acid composition as recorded in 4-day dietary records were noted. In logistic regression analyses adjusting for age; obesity; and fasting lipid, glucose and insulin concentrations, men with proportions of non-esterified and esterified linoleate in the upper third had nearly half the risk for IFG or DM compared with the lower third. In covariate analyses, baseline non-esterified linoleate proportions were associated with changes in fasting insulin and glucose concentrations over the 4-year follow-up. Baseline esterified fatty acid composition was also associated with changes in insulin.

CONCLUSIONS

High serum linoleate proportions decreased the risk of developing IFG or DM in middle-aged men over a 4-year follow-up, possibly mediated in part by insulin resistance. These findings support recommendations to substitute vegetable fat for animal and dairy fat in the prevention of disturbances of glucose and lipid metabolism.

B-mode, power Doppler and contrast-enhanced power Doppler ultrasonography in the diagnosis of breast tumors

PURPOSE

To investigate the role of B-mode and unenhanced and enhanced power Doppler ultrasonography (US) in differentiating solid breast lesions, and to find out whether morphologically different tumors differ in terms of vascularity.

MATERIAL AND METHODS

Sixty-five lesions, indeterminate or suggestive of malignancy after mammography were prospectively examined with B-mode and unenhanced and enhanced power Doppler US. The lesions were classified as benign, indeterminate or malignant at B-mode, and as benign or malignant at power Doppler US. The results were compared to the histologic diagnoses. Vascularity was analyzed also quantitatively to find out whether threshold values for differential diagnostics could be set.

RESULTS

The sensitivity, specificity, and overall accuracy of the morphologic evaluation were 100%, 10%, and 57%, respectively. Rounded lesions were more vascular than spiculated lesions, but vascular assessment was only helpful when it supported a benign morphology. In quantitative analysis, due to the overlap between the benign and malignant lesions, no threshold values could be set.

CONCLUSION

Morphologic criteria were useful in characterizing malignant lesions, but the large proportion of indeterminate findings decreased the specificity of US. Neither unenhanced, nor enhanced power Doppler US was able to improve diagnostic accuracy.

Low plasma lycopene concentration is associated with increased intima-media thickness of the carotid artery wall

Although a number of epidemiological studies have evaluated the association between ss-carotene and the risk of cardiovascular diseases, there has been little research on the role of lycopene, an acyclic form of ss-carotene, with regard to the risk of cardiovascular disease. We investigated the relationship between plasma concentrations of lycopene and intima-media thickness of the common carotid artery wall (CCA-IMT) in 520 middle-aged men and women (aged 45 to 69 years) in eastern Finland. They were examined from 1994 to 1995 at the baseline of the Antioxidant Supplementation in Atherosclerosis Prevention (ASAP) study, a randomized trial concerning the effect of vitamin E and C supplementation on atherosclerotic progression. The subjects were classified into 2 categories according to the median concentration of plasma lycopene (0.12 micromol/L in men and 0.15 micromol/L in women). Mean CCA-IMT of the right and left common carotid arteries was 1.18 mm in men and 0.95 mm in women with plasma lycopene levels lower than the median and 0.97 mm in men (P:<0.001 for difference) and 0.89 mm in women (P:=0.027 for difference) with higher levels of plasma lycopene. In ANCOVA adjusting for cardiovascular risk factors and intake of nutrients, in men, low levels of plasma lycopene were associated with a 17.8% increment in CCA-IMT (P:=0.003 for difference). In women, the difference did not remain significant after the adjustments. We conclude that low plasma lycopene concentrations are associated with early atherosclerosis, manifested as increased CCA-IMT, in middle-aged men living in eastern Finland.

Fish oil-derived fatty acids, docosahexaenoic acid and docosapentaenoic acid, and the risk of acute coronary events: the Kuopio ischaemic heart disease risk factor study

BACKGROUND

Previous findings concerning the serum levels of fish-derived (n-3) fatty acids and coronary heart disease are inconsistent. The purpose of this study was to investigate the association between the serum n-3 end-product fatty acids docosahexaenoic acid (DHA), docosapentaenoic acid (DPA), and eicosapentaenoic acid and the risk of acute coronary events in middle-aged men.

METHODS AND RESULTS

We studied this association in the Kuopio Ischaemic Heart Disease Risk Factor Study, a prospective population study in Eastern Finland. Subjects were randomly selected and included 1871 men aged 42 to 60 years who had no clinical coronary heart disease at baseline examination. A total of 194 men had a fatal or nonfatal acute coronary event during follow-up. In a Cox proportional hazards' model adjusting for other risk factors, men in the highest fifth of the proportion of serum DHA+DPA in all fatty acids had a 44% reduced risk (P=0.014) of acute coronary events compared with men in the lowest fifth. Men in the highest fifth of DHA+DPA who had a low hair content of mercury (</=2.0 microgram/g) had a 67% reduced risk (P=0.016) of acute coronary events compared with men in the lowest fifth who had a high hair content of mercury (>2.0 microgram/g). There was no association between proportion of eicosapentaenoic acid and the risk of acute coronary events.

CONCLUSIONS

Our data provide further confirmation for the concept that fish oil-derived fatty acids reduce the risk of acute coronary events. However, a high mercury content in fish could attenuate this protective effect.

Antioxidant Supplementation in Atherosclerosis Prevention (ASAP) study: a randomized trial of the effect of vitamins E and C on 3-year progression of carotid atherosclerosis

OBJECTIVES

To study the efficacy of vitamin E and C supplementation on the progression of carotid atherosclerosis, hypothesizing an enhanced preventive effect in men and in smokers and synergism between vitamins.

DESIGN AND SUBJECTS

Double-masked two-by-two factorial trial, randomization in four strata (by gender and smoking status) to receive twice daily either 91 mg (136 IU) of d-alpha-tocopherol, 250 mg of slow-release vitamin C, a combination of these or placebo for three years. A randomized sample of 520 smoking and nonsmoking men and postmenopausal women aged 45-69 years with serum cholesterol >/= 5.0 mmol L-1 were studied.

SETTING

The population of the city of Kuopio in Eastern Finland.

INTERVENTION

Twice daily either a special formulation of 91 mg of d-alpha-tocopherol, 250 mg of slow-release vitamin C, a combination of these (CellaVie(R)) or placebo for three years.

MEASUREMENTS

Atherosclerotic progression, defined as the linear regression slope of ultrasonographically assessed common carotid artery mean intima-media thickness (IMT), was calculated over semi-annual assessments.

RESULTS

The average increase of the mean IMT was 0.020 mm year-1 amongst men randomized to placebo and 0.018 mm year-1 in vitamin E, 0.017 mm year-1 in vitamin C and 0.011 mm year-1 in the vitamin combination group (P = 0.008 for E + C vs. placebo). The respective means in women were 0.016, 0.015, 0.017 and 0.016 mm year-1. The proportion of men with progression was reduced by 74% (95% CI 36-89%, P = 0.003) by supplementation with the formulation containing both vitamins, as compared with placebo.

CONCLUSIONS

Our study shows that a combined supplementation with reasonable doses of both vitamin E and slow-release vitamin C can retard the progression of common carotid atherosclerosis in men. This may imply benefits with regard to other atherosclerosis-based events.

Low serum folate concentrations are associated with an excess incidence of acute coronary events: the Kuopio Ischaemic Heart Disease Risk Factor Study

OBJECTIVE

To test the hypothesis that low serum folate concentrations are associated with an increased risk of acute coronary events in men free of prior coronary heart disease.

SETTING

Research Institute of Public Health, University of Kuopio, Kuopio, Finland.

DESIGN

Prospective study in a cohort of 734 men aged 46-64 y examined in 1991-1993 as part of the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD) and followed for 5 y and 3 months.

INTERVENTION

Acute coronary events during the follow-up period were obtained by national hospital discharge registry. Baseline serum folate concentrations were measured by radioimmunoassay.

RESULTS

During the follow-up, six (2.5%) men with higher serum folate concentrations (highest third>11.3 nmol/1) and 28 (5.7%) men with lower serum folate (two lowest thirds) developed an acute coronary event (P=0.008). In a Cox model adjusting for age, examination years, and plasma lycopene concentration, in men with higher serum folate concentrations the relative risk for an acute coronary event was 0.31 (95% CI 0.11-0.90, P=0.031) when compared with men with lower serum folates.

CONCLUSION

This prospective cohort study in middle-aged men from eastern Finland indicates that moderate-to-high levels of serum folate are associated with a greatly reduced incidence of acute coronary events.

Effect of an internal carotid stenosis on orbital blood velocity

PURPOSE

To examine how an internal carotid artery (ICA) stenosis influences the orbital blood velocity and to determine which velocity parameters are most useful.

MATERIAL AND METHODS

The study group comprised 94 randomly selected patients examined with orbital US; most of the patients had a carotid artery stenosis. There were 58 men and 36 women, ranging in age from 22 to 88 years with a mean age of 63.1 years. The ICA stenosis grade was determined with carotid US. Peak systolic (Vp) and end-diastolic blood velocities, systolic acceleration, mean velocity, pulsatile index (PI) and resistance index (RI) were measured within the central retinal artery (CRA) and the ophthalmic artery (OA), and peak velocity was measured within the central retinal vein (CRV). The area under the ROC curve was used to compare the outcome of diagnostic tests.

RESULTS

Only a severe (> or =80%) ICA stenosis decreased orbital blood velocity significantly, while milder stenoses did not cause significant flow decrease or side differences. According to ROC curve analysis, the threshold values giving the highest accuracy in detecting a > or =80% ICA stenosis were Vp < or =0.08 cm/s for the CRA and Vp < or =0.14 cm/s for the OA. The sensitivities for detecting a > or =80% ICA stenosis were 45% for Vp CRA and 60% for Vp OA. Systolic acceleration also decreased in severe stenoses, but RI, PI and velocity in the CRV did not correlate with ICA pathology. Reversal of OA flow was seen in 92% of ICA occlusion and in 47% of severe ICA stenosis.

CONCLUSION

Orbital Doppler combined with carotid Doppler can be helpful in the diagnosis of the ocular ischaemic syndrome and in the evaluation of whether the symptoms are related to occlusion of the ophthalmic or central retinal vessels or are a consequence of carotid artery stenosis.

Ultrasonography of invasive lobular breast carcinoma

PURPOSE

To review the US findings in invasive lobular breast carcinoma which is often difficult to diagnose clinically and mammographically.

MATERIAL AND METHODS

The mammographic and US findings in 63 cases of pure invasive lobular carcinoma diagnosed at our institution in 1990-1996 were reviewed retrospectively. The US findings were classified as positive, negative or indeterminate for malignancy.

RESULTS

Forty-nine of the 63 lobular carcinomas (78%, 95% CI 65.5-87.3%) were US-positive, and 51 (81%, CI 95% 69.1-89.8%) were mammography-positive. The US visibility of the carcinomas was affected by their palpability and mammographic appearance, and the radiographic density of the breasts. Indeterminate US findings (architectural distortion with acoustic shadowing) were visualized in 4 of the 10 cases that had asymmetric densities at mammography.

CONCLUSION

The sensitivity of US for lobular carcinoma was not statistically different from that of mammography. The methods were complementary, especially with regard to evaluating dense breasts and lesions which were difficult to assess clinically and mammographically.

Ultrasonography as a guidance method in the evaluation of mammographically detected nonpalpable breast lesions of suspected malignancy

PURPOSE

To evaluate the role of ultrasonography (US) as a method of guidance for fine-needle aspiration biopsy or preoperative wire localization in the demonstration of nonpalpable mammographically detected breast lesions.

MATERIAL AND METHODS

A total of 168 nonpalpable mammographically detected breast lesions were examined by means of high-resolution real-time US.

RESULTS

US depicted: 55% of all the lesions (92/168); 88% of the circumscribed densities (45/51); 80% of the stellate densities (35/44); 47% of the asymmetric densities (7/15); and 9% of the microcalcifications (5/58).

CONCLUSION

US was useful in guiding needle biopsy or wire localization in most of the circumscribed and stellate breast lesions, even in fatty breasts. However, with the equipment that is currently available, US was of no value in localizing microcalcifications.

Incorporation of n-3 fatty acids into plasma lipid fractions, and erythrocyte membranes and platelets during dietary supplementation with fish, fish oil, and docosahexaenoic acid-rich oil among healthy young men

The effects of n-3 fatty acid supplementation in the form of fresh fish, fish oil, and docosahexaenoic acid (DHA) oil on the fatty acid composition of plasma lipid fractions, and platelets and erythrocyte membranes of young healthy male students were examined. Altogether 59 subjects (aged 19-32 yr, body mass index 16.8-31.3 kg/m2) were randomized into the following diet groups: (i) control group; (ii) fish diet group eating fish meals five times per week [0.38 +/- 0.04 g elcosapentaenoic acid (EPA) and 0.67 +/- 0.09 g DHA per day]; (iii) DHA oil group taking algae-derived DHA oil capsules (1.68 g/d DHA in triglyceride form); and (iv) fish oil group (1.33 g EPA and 0.95 g DHA/d as free fatty acids) for 14 wk. The fatty acid composition of plasma lipids, platelets, and erythrocyte membranes was analyzed by gas chromatography. The subjects kept 4-d food records four times during the study to estimate the intake of nutrients. In the fish diet, in DHA oil, and in fish oil groups, the amounts of n-3 fatty acids increased and those of n-6 fatty acids decreased significantly in plasma lipid fractions and in platelets and erythrocyte membranes. A positive relationship was shown between the total n-3 polyunsaturated fatty acids (PUFA) and EPA and DHA intake and the increase in total n-3 PUFA and EPA and DHA in all lipid fractions analyzed. DHA was preferentially incorporated into phospholipid (PL) and triglyceride (TG) and there was very little uptake in cholesterol ester (CE), while EPA was preferentially incorporated into PL. and CE. The proportion of EPA in plasma lipids and platelets and erythrocyte membranes increased also by DHA supplementation, and the proportion of linoleic acid increased in platelets and erythrocyte membranes in the DHA oil group as well. These results suggest retroconversion of DHA to EPA and that DHA also interferes with linoleic acid metabolism.

Low-cost digital teleradiology

A teleradiology link based on standard personal computers and a flat-bed CCD scanner was tested. A 64 kbit/s dial-up digital ISDN telephone line was used for transmission. A total of 254 films (174 uncompressed, 80 compressed) were sent. Ninety-six per cent of the uncompressed images and 98% of the compressed images were considered technically acceptable. The total diagnostic agreement between the acceptable transmitted images and the original films was 98%. Image quality was sufficient for diagnosis in CT and conventional chest and bone radiographs. However, a 256-step gray scale of the scanner was not sufficient for demanding situations, such as overexposed images with a high contrast gradient. The average speed of transmission was 60 kbit/s, which was considered adequate. The tested system suggests that a teleradiology link based on standard personal computers and programs works in situations where instant consultation is needed. However, the image digitization time with the prototype system was quite long, and a better user interface is under development.

Ultrasound-guided percutaneous galactography

We present a new percutaneous ultrasound-guided galactography technique that may be used in patients in whom the conventional technique fails and breast ultrasonography show dilated ducts.