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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_3096"
                     title="MRI Performs Poorly in Infant Abuse Detection (CME/CE)"
                     score="0.006"
                     href="http://www.medpagetoday.com/Pediatrics/DomesticViolence/tb/21801?impressionId=1283456819663"
                     
      &lt;p&gt;Whole-body MRI failed to reliably detect highly specific metaphyseal lesions and rib fractures and therefore cannot replace radiography in evaluating potential abuse in young children, a new study concluded.&lt;/p&gt;
&lt;p&gt;Of 37 classic metaphyseal lesions, 64.8% were seen on the radiographic summary skeletal survey, 5.4% were seen on whole-body MRI, and 29.7% were seen with both techniques, according to Jeannette M. Perez-Rossello, MD, and colleagues from Harvard Medical School in Boston.&lt;/p&gt;
&lt;p&gt;Agreement between radiography and MRI for the metaphyseal lesions was poor, with a concordance rate of only 29% (&amp;#954;= &amp;#8722;0.11, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.12), the researchers reported in the September &lt;em&gt;American Journal of Roentgenology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Metaphyseal lesions and rib fractures are responsible for 90% of infant abuse fatalities other than those resulting from head injuries, they noted.&lt;/p&gt;
&lt;p&gt;Whole-body MRI has been used to detect skeletal lesions in children with cancer, dermatomyositis, and other conditions, and a few reports have considered its use in suspected child abuse.&lt;/p&gt;
&lt;p&gt;But MRI has not been compared directly with the standard high-detail skeletal survey, so Perez-Rossello&apos;s team retrospectively reviewed the imaging findings of 21 infants younger than one year.&lt;/p&gt;
&lt;p&gt;Of 167 fractures or areas of signal intensity, 40.7% were seen on radiography, 31.7% on MRI, and 27.5% on both.&lt;/p&gt;
&lt;p&gt;Whole-body MRI had high specificity, at 95%, but low sensitivity (40%), the researchers reported.&lt;/p&gt;
&lt;p&gt;The radiographic skeletal survey found 33 rib fractures and MRI found 32 areas of signal abnormality in the rib area, but the concordance rate was only 41% (&amp;#954; = &amp;#8722;0.41, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.004), and sensitivity for MRI was low, at 57%.&lt;/p&gt;
&lt;p&gt;Radiography was superior for detecting rib fractures and, unlike MRI, could determine location and whether healing had occurred.&lt;/p&gt;
&lt;p&gt;However, MRI was able to detect additional soft tissue injuries, which in some cases led to further imaging studies that detected healing and occult fractures.&lt;/p&gt;
&lt;p&gt;The ability to detect healing fractures and injuries of different ages is often considered crucial in child protection evaluations and criminal investigations, the researchers noted.&lt;/p&gt;
&lt;p&gt;So whole-body MRI may be a useful supplement to the skeletal survey in certain cases, particularly when there may be soft-tissue injuries, they wrote.&lt;/p&gt;
&lt;p&gt;Specific injuries that were detected by MRI in this series included muscle edema, joint and pleural effusions, and a liver laceration.&lt;/p&gt;
&lt;p&gt;The primary limitation of this study was that the radiographic skeletal survey was the sole reference standard used for fracture identification; scintigraphy was done in only one case.&lt;/p&gt;
&lt;p&gt;There also were technical limitations associated with the use of whole-body MRI in infants, including positioning difficulties and the presence of devices such as pulse oximeters that can cause signal artifacts.&lt;/p&gt;
&lt;p&gt;Moreover, small bone size and marrow characteristics can result in missed fractures or increased signal intensities.&lt;/p&gt;
&lt;p&gt;Replacing radiography with MRI as a screening tool, the researchers stated, would have missed seven abused infants.&lt;/p&gt;
&lt;p&gt;&quot;Reliance on [whole-body] MRI for global skeletal assessment would likely result in failure to identify these critical indicators of inflicted injury, placing abused infants and other children in an environment at risk for preventable morbidity and mortality,&quot; they concluded.&lt;/p&gt;
&lt;p&gt;But refinements in MRI, such as improved signal-to-noise and spatial resolution, may permit wider use in the future, they added.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors declared that they have no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3064"
                     title="Canadian Reactor to Resume Production of Medical Isotopes"
                     score="0.004"
                     href="http://www.medpagetoday.com/Radiology/NuclearMedicine/tb/21739?impressionId=1283456819663"
                     
      &lt;p&gt;Canada&apos;s Chalk River reactor  --  a major source of medical isotopes  --  is back on line after more than year of repairs, according to Atomic Energy of Canada, which owns and operates the machine.&lt;/p&gt;
&lt;p&gt;The company said that the machine is now operating at full power and can once again produce isotopes.&lt;/p&gt;
&lt;p&gt;A company official told &lt;em&gt;MedPage Today&lt;/em&gt; that the reactor is &quot;moving toward normal operations&quot; and that a small quantity of the key isotope -- molybdenum-99 -- has already been harvested and is being processed.&lt;/p&gt;
&lt;p&gt;The reactor  --  which normally produces about a third of the world&apos;s supply of molybdenum-99  --  was taken off line in May 2009. The shutdown had nuclear medicine specialists scrambling. (See &lt;a href=&quot;http://www.medpagetoday.com/Radiology/NuclearMedicine/18495&quot; mce_href=&quot;http://www.medpagetoday.com/Radiology/NuclearMedicine/18495&quot; target=&quot;_blank&quot;&gt;Looming Isotope Shortage Has Clinicians Worried&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;The molybdenum is packed into so-called &quot;generators&quot; and, over about a two-week period, each generator delivers a supply of another radioactive substance, technetium-99m.&lt;/p&gt;
&lt;p&gt;Technetium-99m is used in more than 16 million nuclear imaging procedures every year in the U.S. alone for, among other things, sentinel node biopsies in cancer surgery, bone scans, and staging cancer patients.&lt;/p&gt;
&lt;p&gt;The Canadian shutdown was coupled for several weeks this year with the closing of one of the other major producers of the isotopes, the Petten facility in the Netherlands, which was shut down temporarily for maintenance.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_2806"
                     title="Breast Tumors Harder to Find in Younger Women (CME/CE)"
                     score="-0.009"
                     href="http://www.medpagetoday.com/HematologyOncology/BreastCancer/tb/21414?impressionId=1283456819663"
                     
      &lt;p&gt;Women in their 40s with breast cancer have tumors that are more difficult to detect with mammography, not faster growing tumors that manifest between imaging studies, a computer simulation of breast cancer suggests.&lt;/p&gt;
&lt;p&gt;Reduced detectability explained almost 80% of mammography&apos;s poorer sensitivity in women ages 40 to 49 compared with women in their 50s. A faster tumor volume doubling time accounted for the rest of the difference, according to an article published online in the &lt;em&gt;Journal of the National Cancer Institute&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The relative contributions remained similar in analyses that defined screening mammography&apos;s impact in terms of various tumor and clinical characteristics, including breast cancer mortality.&lt;/p&gt;
&lt;p&gt;&quot;Our results underscore the importance of continued efforts to improve technologies for early detection of breast cancer in younger women, particularly in women with dense breast tissue,&quot; Stephanie L. Bailey, PhD, of Stanford University, and co-authors wrote.&lt;/p&gt;
&lt;p&gt;Screening mammography reduces breast cancer mortality by about a third in women ages 50 to 69, but benefits in younger women remain open to debate. Some clinical trials have shown modest, nonsignificant reductions in mortality, and others have shown no benefit.&lt;/p&gt;
&lt;p&gt;Mammography&apos;s reduced impact in younger women has been attributed most often to two factors: a lower breast cancer incidence resulting in a smaller mortality benefit, and reduced sensitivity of screening mammography in younger women.&lt;/p&gt;
&lt;p&gt;In an effort to clarify the reasons for mammography&apos;s reduced sensitivity in younger women, Bailey and her co-authors performed a computer simulation analysis to quantify the relative impact of mammographic tumor detectability and tumor volume doubling time.&lt;/p&gt;
&lt;p&gt;They defined &quot;mammography threshold&quot; as the smallest-diameter tumor delineated by screening mammography and used the threshold values to determine tumor detectability. They used the resulting values to evaluate the outcomes of screening sensitivity, mean tumor size at diagnosis, lifetime gained, and breast cancer mortality.&lt;/p&gt;
&lt;p&gt;The authors considered four hypothetical screening situations to determine the effect of age-specific differences in mammography threshold and tumor doubling time on the outcomes. Women ages 40 to 49 had their own age-specific mammography threshold and doubling time or they were assigned one or both median values associated with women ages 50 to 69.&lt;/p&gt;
&lt;p&gt;In all scenarios, older women had annual screening mammography, whereas the screening interval for younger women was none, annual, or biennial.&lt;/p&gt;
&lt;p&gt;The analyses showed that lower mammographic detectability accounted for 79% of the poorer sensitivity of screening mammography in the younger women, and a faster tumor doubling time accounted for the remaining 21%.&lt;/p&gt;
&lt;p&gt;The relative contributions of reduced mammography sensitivity and faster doubling time changed little when screening was evaluated in terms of mean tumor size at detection, lifetime gained, and breast cancer mortality.&lt;/p&gt;
&lt;p&gt;The sensitivity of screening mammography and the cancer mortality reduction attributable to screening had near-linear relationships in comparisons of annual or biennial screening with no screening.&lt;/p&gt;
&lt;p&gt;When comparing annual versus biennial screening, the largest reduction in breast cancer mortality attributable to screening was not related to the biggest gain in screening sensitivity and was affected more by mammographic tumor detectability than by tumor doubling time.&lt;/p&gt;
&lt;p&gt;The authors acknowledged some limitations in their study including the fact that their estimates on age-specific differences in mammography threshold and doubling time are subject to biases.&lt;/p&gt;
&lt;p&gt;They noted that they assumed missing data on screen-detected tumor sizes were randomly distributed and that their estimates could be different using a different definition of a screen-detected diagnosis.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors reported that they had no relevant disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_2737"
                     title="Childhood Cancer Survivors May Have Trouble Having Kids (CME/CE)"
                     score="-0.009"
                     href="http://www.medpagetoday.com/Radiology/TherapeuticRadiology/tb/21327?impressionId=1283456819663"
                     
      &lt;p&gt;Although more children are surviving a cancer diagnosis, their treatment may have unintended long-term effects on reproduction, a retrospective study found.&lt;/p&gt;
&lt;p&gt;Female survivors who had irradiation of the uterus and ovaries at a high dose when they were children had a significantly elevated risk of stillbirth or neonatal death during a subsequent pregnancy (RR 9.1, 95% CI 3.4 to 24.6), according to Lisa Signorello, ScD, of the International Epidemiology Institute in Rockville, Md., and colleagues.&lt;/p&gt;
&lt;p&gt;The association appeared confined to those who received radiation treatment before menarche, they reported online in &lt;em&gt;The Lancet&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The absolute risk of stillbirth or neonatal death was 3% overall.&lt;/p&gt;
&lt;p&gt;If the relationship were causal, the reason for the increased risk would be &quot;probably related to uterine damage,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;&quot;Careful management is warranted for pregnant women treated with high doses of pelvic irradiation before they have reached puberty,&quot; they concluded.&lt;/p&gt;
&lt;p&gt;There was no increased risk of an adverse outcome among the offspring of men who had had their testes irradiated after a childhood cancer diagnosis, &quot;which is reassuring not only for male survivors of childhood cancer but also for men exposed to ionizing radiation in occupational or other settings,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;Looking at the risk of stillbirth and neonatal death is an indirect means of assessing the potential transmission of germ line damage induced by radiation or chemotherapy after a cancer diagnosis.&lt;/p&gt;
&lt;p&gt;Signorello and her colleagues evaluated data from the Childhood Cancer Survivor Study. All participants were younger than 21 when they were initially diagnosed with cancer from 1970 to 1986. They were followed through 2002 with periodic questionnaires.&lt;/p&gt;
&lt;p&gt;The analysis included 1,148 men and 1,657 women who had survived at least five years after their diagnosis.&lt;/p&gt;
&lt;p&gt;There were 4,946 singleton pregnancies among the participants  --  either their own or, among the men, those they had sired. Of those, 93 (1.9%) ended in stillbirth or neonatal death; 3% of women and 2% of men reported a pregnancy ending in one of those two outcomes.&lt;/p&gt;
&lt;p&gt;Irradiation of the testes and pituitary gland in childhood was not associated with stillbirth or neonatal death. Neither was chemotherapy with alkylating drugs.&lt;/p&gt;
&lt;p&gt;The overall increased risk of stillbirth or neonatal death associated with uterine and ovarian irradiation was found only in women who had received radiation before menarche. That was true at both low doses of radiation (RR 4.7, 95% CI 1.2 to 19.0) and high doses (RR 12.3, 95% CI 4.2 to 36.0).&lt;/p&gt;
&lt;p&gt;&quot;We could not directly assess whether uterine damage (e.g., to the musculature, vasculature, or endometrium) or oocyte damage was the cause of the association with stillbirth or neonatal death, although we believe a uterine effect was most likely,&quot; Signorello and her colleagues wrote.&lt;/p&gt;
&lt;p&gt;They acknowledged some limitations of the study, including the possibility that participants who had an adverse pregnancy outcome were more likely to report their pregnancies on the questionnaires and the exclusion of 15% of the potential cohort because of missing information.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was partially supported by grants from Westlakes Research Institute, the National Cancer Institute, and the Children&apos;s Cancer Research Fund.&lt;/p&gt;&lt;p&gt;The authors reported that they had no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_2743"
                     title="IAC: HPV Vaccine Effective in Men (CME/CE)"
                     score="-0.01"
                     href="http://www.medpagetoday.com/MeetingCoverage/IAC/tb/21335?impressionId=1283456819663"
                     
      &lt;p&gt;VIENNA  --  A quadrivalent vaccine against four strains of human papillomavirus was highly effective at reducing external genital lesions in men, a researcher said here.&lt;/p&gt;
&lt;p&gt;The vaccine was also effective at reducing the incidence of pre-cancerous lesions in the anal region among the study sub-population of men who have sex with men, according to Heiko Jessen, MD, of Praxis, a private medical clinic in Berlin.&lt;/p&gt;
&lt;p&gt;The vaccine  --  Gardasil, aimed at strains 6, 11, 16, and 18  --  also effectively reduced the risk of persistent infection with the same strain over time in all study participants, Jessen said at the International AIDS Conference here.&lt;/p&gt;
&lt;p&gt;The findings come from a large international randomized placebo-controlled trial that&lt;strong&gt; &lt;/strong&gt;involved 4,065 men, including 3,463 heterosexuals and 602 who reported having sex with men. They were given three doses of the drug or placebo - one at the start of the trial, and again at two and six months - and followed for 36 months.&lt;/p&gt;
&lt;p&gt;The vaccine is approved for use in women and girls, with the intention of reducing the incidence of the four strains, which have been linked to cervical cancer. But the four strains have also been associated with disease in men, including such things as anal and penile cancer, anal and penile intraepithelial neoplasia, and anogenital warts, Jessen said.&lt;/p&gt;
&lt;p&gt;Adverse events were recorded within 15 days of any vaccination, and there were no serious vaccine-related events reported, Jessen said, although site reactions were common in both arms of the trial.&lt;/p&gt;
&lt;p&gt;In terms of efficacy, the researchers found:&lt;ul&gt; &lt;li&gt;Three cases of external genital lesions - all of them condyloma - in the vaccine arm compared with 31 in the placebo arm, including 28 cases of condyloma, two of PIN1 and one of PIN2/3, yielding an efficacy rate of 90.4%. There was no penile cancer.&lt;/li&gt; &lt;li&gt;Among the men who have sex with men, those in the vaccine arm had five cases of anal intraepithelial neoplasia related to the four strains, compared with 24 in the placebo arm, for an efficacy rate of 77.5%. There were no cases of anal cancer.&lt;/li&gt; &lt;li&gt;In the vaccine arm, there were 15 cases of persistent infection - defined as the same HPV type found at an interval of at least four months. In contrast, there were 101 cases in the placebo arm, for an efficacy of 85.6%.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The vaccine was well tolerated, Jessen said, and efficacious in reducing disease related to HPV.&lt;/p&gt;
&lt;p&gt;The study is relevant for the future of HIV medicine because of links between HPV and such things as anal cancer, said Anton Pozniak, MD, of the Westminster and Chelsea Hospital in London, who was not part of the study but moderated the session at which it was presented.&lt;/p&gt;
&lt;p&gt;If a study could show that vaccinating men reduced the incidence of such diseases, it might be possible to persuade funding agencies that both sexes should be vaccinated, he told &lt;em&gt;MedPage Today&lt;/em&gt;, which in turn might reduce the risk of some HIV-related illnesses.&lt;/p&gt;
&lt;p&gt;The suggestion is plausible, he said, &quot;but we need to know if it does anything.&quot;&lt;/p&gt;
&lt;p&gt;His view was echoed by Pedro Cahn, MD, of Fundaci&amp;#243;n Huesped in Buenos Aires and a former president of the International AIDS Society. &quot;This is potentially of very great importance to men who have sex with men,&quot; he told &lt;em&gt;MedPage Today&lt;/em&gt;.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Jessen did not report study support or any potential conflicts. One of the authors is an employee of Merck &amp;amp; Co, which makes the vaccine.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>