Reproducibility of visual assessment on mammographic density.

Background: High mammographic density was an independent risk factor for breast cancer and has a higher associated risk than most other known risk factors. The reproducibility remains a major issue in assessment of breast parenchymal patterns. Misclassification of mammographic pattern can lead to significant underestimation of risk estimates.

Propylthiouracil induced C-ANCA positive agranulocytosis complicating Graves' thyrotoxicosis in pregnancy.

Background: Thionamide induced agranulocytosis is associated with the presence of anti-neutrophil cytoplasmic antibodies (ANCA) in some patients. This poses a particular challenge when it occurs during pregnancy.

Aims: To report a case of a 31-year-old woman with Graves' disease who presented at 11 weeks gestation with propylthiouracil induced agranulocytosis.

Endogenous thrombin potential for predicting risk of venous thromboembolism in carriers of factor V Leiden.

Measurement of endogenous thrombin potential (ETP) detects hypercoagulability and can be used to identify activated protein C resistance due to factor V Leiden (FVL). However, not all carriers of FVL suffer thrombosis and therefore we sought to determine if the test for ETP could be modified in such a way as to enable detection of FVL patients who were at increased risk of venous thromboembolism. Protac, an activator of both protein C and factor V, was incorporated into the traditional thrombin generation reaction and ratios (reaction with Protac:reaction without Protac) were calculated.

The homeless mentally ill - an audit from an inner city hospital.

Objective: To determine the proportion of those that are homeless attending the Mater Misericordiae Hospital's (MUH) psychiatric service, including those presenting to accident and emergency who were homeless, and to compare the homeless group with the non-homeless so as to obtain a profile of this group.

Methods: All adults over 16, referred for psychiatric assessment, attending A&E were included, as were those attending outpatient clinics, liaison consultations and inpatients in the psychiatric unit, in the six-month period from January to June 2003. Excluded were those who were under 16, who refused to participate, who did not speak English, those with a diagnosis of personality disorder and organic brain damage.

Circuit breakers for addiction.

The phenomenon of addiction is complex, although its expression clinically is relatively straightforward. There is a series of neurophysiological changes that mediate changes in the mesolimbic and mesocortical systems which in turn lead to disturbances in reward mechanisms. These then act to perpetuate the cycle of intoxication and reinforcement, withdrawal, craving and compulsive use.

Creating an integrated vision by collocating health organisations: herding cats or a meeting of minds?

The Brisbane South Centre for Health Services Integration (BSCHSI) initiative used a collocation strategy to integrate local service delivery across three different health organisations. Physical collocation was combined with validated integration strategies to improve organisational operations among five different work teams involving 90 different individuals. Enhanced communication, increased knowledge of collocating groups, and the development of collaboration and partnerships were key positive outcomes.

Laparoscopic instrument insulation failure: the hidden hazard.

Study Objectives: To determine the prevalence of insulation failure in gynecologic laparoscopic instruments and to assess the impact of routine static insulation failure testing

Design: Cross-sectional study (Canadian Task Force classification II-2).

Setting: Public tertiary teaching hospitals.

Intervention: Routine static insulation failure testing

Measurements And Main Results: Dichotomous assessment of instrument insulation failure.

Medical treatment of benign prostatic hyperplasia.

Pharmaceutical preparations are commonly used for benign prostate hyperplasia. This article reviews the current understanding of the natural history of the condition and the literature regarding medical treatment.

Identification of a novel single nucleotide polymorphism in the first tandem repeat sequence of the thymidylate synthase 2R allele.

Thymidylate synthase (TS) activity is an important determinant of response to chemotherapy with fluoropyrimidine prodrugs and its expression is largely determined by the number of functional upstream stimulatory factor (USF) E-box consensus elements present in the 5'regulatory region of the TYMS gene. Two known polymorphisms in this area, a variable number of tandem repeat (VNTR) consisting of 2 or 3 repeats (2R/3R) of a 28-bp sequence and a further G > C single nucleotide substitution within the second repeat of the 3R, result in genotypes with between 2 and 4 functional repeats in most humans. Here, we identify a further G > C SNP in the first repeat of the TYMS 2R allele, which effectively abolishes the only functional USF protein binding site in this promoter.

The use of the Zebris motion analysis system for measuring cervical spine movements in vivo.

The cervical spine exhibits the greatest range of motion among the spinal segments due to the complex interaction of its triplanar components of movement. As a result, measurement of movements of the cervical spine and of the various orthoses used in cervical spine injuries has proved difficult with no one method proving satisfactory. This paper uses the Zebris ultrasonic three-dimensional motion analysis system to measure flexion, extension, range of lateral bending, and range of axial rotation in five similar male and five similar female subjects with no history of neck injuries.

Induction of nitric oxide synthase is a key determinant of progression to pulmonary injury in experimental pancreatitis.

Background: The immunomodulatory potential of nitric oxide provides prospective strategies to attenuate inappropriate inflammatory reactions. This study tested the hypothesis that inhibition of nitric oxide synthase (NOS) reduces end-organ injury in pancreatitis.

Methods: Pancreatitis was induced in male Sprague-Dawley rats by intraperitoneal (i.

Mycosis fungoides--a review of the management of 28 patients and of the recent literature.

Background: Mycosis fungoides is an uncommon cutaneous T-cell lymphoma characterized by malignant monoclonal proliferation of T-helper lymphocytes. Its course is variable with a potential for lymphatic and hematogenous involvement. We report the investigations, staging, treatment, follow-up, and outcome of 28 patients.

Vulval cancer, 1992-2002 audit--multidisciplinary care and prognostic factors.

Vulval carcinoma is becoming increasingly common. Thirty-four cases of vulval carcinoma were treated from 01/01/1992-31/12/2002. The mean age was 67, range (18-90).

Collecting duct carcinoma of the kidney: a case report with variable immunohistochemistry.

Background: Collecting duct carcinoma of the kidney is a rare tumour with distinctive clinical and histopathological features. Management of this malignancy remains a challenge because of advanced stage at presentation and aggressive clinical course.

Aims: We describe a case of Collecting Duct Carcinoma with variable immunohistochemistry and review the pathology and management.

Obstructive uropathy.

Recent study has increased the understanding of the physiological processes occurring in obstructive uropathy, in particular the role played by vasoactive mediators and cellular mechanisms. There is an emphasis on developing effective and less invasive means of detection and treatment of ureteric obstruction, although it remains to be determined how the techniques currently being assessed will impact on clinical practice.

Genetic variations in benzene metabolism and susceptibility to multiple myeloma.

We have previously shown that deficiency in the biotransformation enzyme glutathione-S-transferase theta (GSTT1) is a risk factor for multiple myeloma (MM). The present case-control study of 102 MM patients and 205 controls revealed a significant trend in increasing risk of MM with inheritance of multiple putative 'high risk' genetic variants in related pathways of benzene detoxification. Individuals who carried polymorphisms for GSTT1 null and/or high activity microsomal epoxide hydrolase (mEH 113YY+139HR or 113YY+139RR or 113YH+139RR) and/or low activity NAD(P)H:quinone oxidoreductase 1 (NQO1 187PS/SS) were 1.

Sitting posture affects pelvic floor muscle activity in parous women: an observational study.

Question: Do different sitting postures require different levels of pelvic floor and abdominal muscle activity in healthy women?

Design: Observational study.

Participants: Eight parous women with no pelvic floor dysfunction.

Outcome Measures: Bilateral activity of pelvic floor muscles (assessed vaginally) and two abdominal muscles, obliquus internus abdominis and obliquus externus abdominis, during three sitting postures.

Current strategies in overcoming resistance of cancer cells to apoptosis melanoma as a model.

Most anticancer agents mediate their effects through common pathways which induce apoptosis or in some cases necrosis of cancer cells. The apoptotic pathways are regulated by Bcl-2 family proteins, which include both pro- and anti-apoptotic members. Much is known about the interactions of these proteins involved in apoptosis and this information is being utilized in the development of new reagents that may be used to treat patients with cancers.

Surgical management of perforated peptic ulcer disease.

Background: Surgery for perforated peptic ulcer disease is one of the most common emergency procedures carried out in the western world. The role of postoperative empiric Helicobacter Pylori eradication therapy is controversial.

Methods: The clinical, operative and postoperative surveillance details of 84 consecutive patients who underwent surgery for perforated peptic ulcer were reviewed.

Coexistent cervical tuberculosis and metastatic squamous cell carcinoma in a single lymph node group: a diagnostic dilemma.

Primary cervical tuberculosis is uncommon, although its incidence has risen somewhat over the past few years. In this article, we describe a rare case in which the patient developed a dual pathology-cervical tuberculosis and a malignant squamous cell carcinoma-in a group of lymph nodes on one side of the neck. Initially, tuberculosis was diagnosed on the basis of histology and culture.

Vasospasm in glaucoma: clinical and laboratory aspects.

During the last decade, the presumed etiology of glaucoma has moved from a pure pressure concept to a combined mechanical and vascular theory. Evidence of a localized vascular insufficiency leading to perfusion deficits of ocular structures, including the optic nerve head, the retina, the choroid, and the retrobulbar vessels, is now clear. This article evaluates the role of vasospasm as the primary cause of such a vascular failure.