Mammographic changes associated with raloxifene and tibolone therapy in postmenopausal women: a prospective study

Objective: The prolonged use of estrogen therapy is associated with a slightly increased risk of breast cancer. Alternative therapies that are effective in the prevention of menopause, having associated morbidities but no unwanted effects, are of primary interest in the pharmacologic research. The aim of this study was to evaluate the effect of two alternative to estrogens drugs, the selective estrogen receptor modulator raloxifene and the tissue-specific tibolone, on the mammographic appearance of the breast. Design: The study group comprised 131 postmenopausal women aged 41 to 67 years. The women were at least 2 years postmenopausal, free of climacteric symptoms, and at the time of entry to the study had not had therapy for at least 9 months. Women with risk factors for osteoporosis or cardiovascular disease were allocated either to tibolone (n = 56) or raloxifene (12 = 48) therapy. Women with no risk factors and women who either did not qualify for or denied treatment (17 = 27) served as controls. The study duration was 12 months. Women received a baseline mammogram before commencing therapy and a repeat mammogram at the end of the study period. Mammogram findings were classified according to the modified Wolfe criteria by two expert radiologists. Results: No difference was identified between groups with respect to baseline characteristics associated with breast cancer risk. Similarly, no difference was detected between groups concerning the modified Wolfe classification of baseline mammographic findings. In the tibolone group, 10.7% of the women showed an increase in breast density in the 12-month reevaluation. The respective figure in the raloxifene group was 6.3%, whereas no woman in the control group showed an increase in breast density. Differences in the increase in breast density between groups did not, however, reach statistical significance. Accordingly, 10.7% of women in the tibolone group and 18.8% of women in the raloxifene group exhibited involutionary changes in the repeat mammogram, whereas 25.9% of women in the control group revealed a decrease in breast density in the 12-month examination. The percentages were not significantly different between groups. Conclusions: Breast density as shown by mammography was stable in a majority of patients and changed in a minority of cases for both tibolone and raloxifene. In most patients, these drugs are not likely to interfere with mammogram interpretation. Larger long-term studies are needed to confirm the impact of prolonged tibolone or raloxifene administration on mammography

R2 relaxometry with MRI for the quantification of tissue iron overload in beta-thalassemic patients

Purpose: To evaluate the usefulness of a time-efficient MRI method for the quantitative determination of tissue iron in the liver and heart of beta-thalassemic patients using spin-spin relaxation rate, R2, measurements. Materials and Methods: Images were obtained at 1.5 T from aqueous Gd-DTPA solutions (0.106 - 8 mM) and from the liver and heart of 46 beta-thalassemic patients and 10 controls. The imaging sequence used was a respiratory-triggered 16-echo Carr-Pureell-Meiboom-Gill (CPMG) spin-echo (SE) pulse sequence (TR = 2000 msec, TEmin = 5 msec, echo spacing (ES) = 5 msec, matrix = 192 x 256, slice thickness = 10 mm). Liver iron concentration (LIC) measurements were obtained for 22 patients through biopsy specimens excised from the relevant liver segment. Biopsy specimens were also evaluated regarding iron grade and fibrosis. Serum ferritin (SF) measurements were obtained in all patients. Results: A statistically significant difference was found between patients and healthy controls in mean liver (P < 0.004) and myocardiurn (P < 0.004) R2 values. The R2 values correlated well with Gd DTPA concentration (r = 0.996, P < 0.0001) and LIC (r = 0.874, P < 0.0001). A less significant relationship (r = 0.791, P < 0.0001) was found between LIC measurements and SF levels. R2 measurements appear to be significantly affected (P = 0.04) by different degrees of hepatic fibrosis. The patients’ liver R2 values did not correlate with myocardial R2 values (r = 0.038, P < 0.21). Conclusion: Tissue iron deposition in P-thalassemic patients may be adequately quantified using R2 measurements obtained with a 16-echo MRI sequence with short ES (5 msec), even in patients with a relatively increased iron burden

Safety profile of sequential small caliber drug eluting bead chemoembolization (DEB-TACE): results in 237 patients

Purpose: To record complications of DEB-TACE performed with DC Bead of diameters 100-300 and 300-500 \u3bcm loaded with doxorubicin. Materials and Methods: Included are 237 patients treated with sequential DEB-TACE (3 sessions/6 month f-u). National Cancer Institute Common Terminology Criteria for Adverse Events (version 3.0) were used to categorize complications. Results: Results are reported on intention to treat. There were no periprocedural deaths. Thirty day mortality was 1.26% with same overall grade 5 complications, notably one periprocedural sepsis and 2 liver abscesses. One liver abscess was treated conservatively (considered Grade 2 complication). Grade 4 complications resulted in 1.68% (4/237) (irreversible liver failure that led to the discontinuation of TACE). Grade 2 liver function deterioration developed in 10 pts (4.2%) that led to protocol abortion in 1.68%. Cholocystitis was documented with ultrasound in 2.95 to 5.06% across the three sessions (all grade 2 complications). Pleural effusion was observed in 2.1 to 2.95% across treatments (only one was a grade 3 complication requiring drainage; 0.42%). There was 1 patient who developed laboratory pancreatitis (0.42%) and 1 limited GI bleeding not related to varices (0.42%). Overall Post Embolization Syndrome (PES) classified as grade 1 or 2 complication was observed in 60.75 to 85.65% across treatments \u2013 the lower rates achieved after routine preventive administration of non-steroidal analgesics for 5 days post treatment. Conclusion: This study shows that: 1) DEB TACE is safe with fewer complications compared to reported rates of conventional TACE, and 2) small calibres are safe and do not result in increased complication rates

Interventional spine procedures

Minimally invasive techniques for the treatment of some spinal diseases are percutaneous treatments, proposed before classic surgery. By using imaging guidance, one can significantly increase accuracy and decrease complication rates. This review report physiopathology and discusses indications, methods, complications and results of performing these techniques on the spine, including different level (cervical, thoracic, lumbar and sacroiliac) and different kind of treatments (nerve block, disc treatment and bone treatment). Finally the present article also reviews current literature on the controversial issues involved. (C) 2005 Elsevier Ireland Ltd. All rights reserved