Students' perceptions of the impact of nutrition policies on dietary behaviors

Poor dietary habits, rising rates of overweight students, and lack of oversight of vending contracts prompted the Los Angeles Unified School District (LAUSD) to develop and implement 2 of the most comprehensive nutrition policies in the country. The Healthy Beverage Resolution and Obesity Prevention Motion limit the types of and access to beverages and snacks on school campuses. This study used qualitative and quantitative methods to document the development, implementation, and impact of the LAUSD nutrition policies. Questionnaires were administered to 399 12th-grade students in 2 LAUSD high schools to determine knowledge of the policies, perceptions of the impact of the policies on student dietary behaviors, and attitudes toward the policies and the school nutrition environment. Over one half of all students indicated that the policies impacted the foods and beverages they consumed at school, whereas only about one fifth indicated the policies impacted what they ate or drank at home/outside of school. However, for those students who indicated the policies had an impact, they reported they ate or drank fewer of the banned items both at school and at home/outside of school. These results point to the need for additional research to determine if school policies impact student behaviors outside of the school setting. Removing unhealthy food items from schools may not be enough to improve student's overall dietary behaviors. A coordinated multilevel approach including nutrition education, physical education, and parental involvement along with policies and modifications in food service is recommended.

Role of Classroom Teachers in Nutrition and Physical Education

Nutrition education and physical education in schools is increasingly being explored as a way to prevent childhood overweight and to promote healthy eating and physical activity habits behaviors. Classroom teachers are often responsible for providing this education. The current study examined the roles and perspectives of elementary school teachers regarding student nutrition, nutrition education, and physical education. Data is from a 2001-2002 study of the Los Angeles Unified School District (LAUSD) Nutrition Network. Analyses were based on 78 structured interviews with elementary school teachers. Results showed that teachers perceive their role in nutrition education as teachers, role models, advocates, and motivators. Teachers integrate nutrition education into existing subject areas, and believe that nutrition education results in greater knowledge and healthier food choices. However, teachers report that too little time is spent on nutrition education. Results of this study also indicate that classroom teachers are often responsible for physical education (PE). Teachers believe PE has a positive effect on the school community and on student fitness, but the effect is limited due to lack of structure and lack of time in PE class. Teachers report barriers to both nutrition education and physical education, including other classes taking up too much time, limited teacher training, and a lack of adequate equipment and facilities. Findings suggest that more resources including teacher training, time, curricula and textbooks, and equipment need to be allocated for nutrition education and physical education at the elementary school level.

[Resection of the pancreatic head and duodenum for the Crohn's disease of the duodenum]

The Crohn's disease rarely affects duodenum. The symptoms are unspecific and its diagnostic process may be difficult. Patients with complications-stenoses and fistules, are indicated for surgical treatment. According to literature, there is no straightforward agreement on the surgical treatment strategy. In most cases, non-resection procedures are indicated. The authors describe a case of a patient suffering from the Crohn's disease of his duodenum and chronic pancreatitis, which was managed using a radical procedure--hemipancreatoduodenectomy.

Detektion pulmonaler Rundherde mit der Ultra-low-dose-CT im Rahmen der onkologischen Nachsorge

PURPOSE

To evaluate the value of an ultra-low-dose CT protocol (ULD-CT) in the dectection of lungnodules in follow-up of cancer patients.

MATERIAL AND METHODS

Between April and August 2003, 72 consecutive patients with a history of malignancy were prospectively examined on a single-slice helical CT scanner (Aquilion, Toshiba) with ULD-CT (120 kV, 5 mAs, D-eff 0.12 mSv) and regular-dose CT (R-CT) (120 kV, 150 mAs, D-eff 4.8 mSv). The ULD-CT examinations were independently evaluated by two radiologists. Afterwards, consensus reading of the ULD-CT and R-CT examinations was done. Individual nodules were classified benign (benign calcifications) and non-benign. The studies were classified in 4 subgroups: 1) non-benign nodule evident; 2) non-benign nodule probable; 3) non-benign nodule possible, but not likely; 4) no-non benign nodule.

RESULTS

ULD-CT detected 180 nodules in 47 patients, while R-CT showed 168 nodules in 39 patients. The sensitivity of ULD-CT was 87 % in detecting nodules regardless of size and 94 % in detecting nodules > or = 5 mm. Regarding the prediction of a case with non-benign nodules (subgroups 1 to 3), the sensitivity of ULD-CT was 94 % and the specificity 75 %.

CONCLUSION

ULD-CT is a good diagnostic tool in detecting lung nodules > or = 5 mm. Radiation dose can be markedly reduced. A negative ULD-CT study excludes non-benign nodules in R-CT with a high probability. In case of a positive ULD-CT, R-CT can be immediately followed.

[The minimally invasive stabilization of the dorsal pelvic ring with the transiliacal internal fixator (TIFI)--surgical technique and first clinical findings]

The Trans Iliacal Internal Fixator (TIFI) is a minimally invasive technique for the stabilization of sacro-iliac joint ruptures and fractures lateral to the sacral ala or through the sacral foramen. In this study, 7.0 mm pedicle screws of the Universal-Spine-System (USS, Synthes) were inserted 1-2 cm on the cranial side of the posterior superior iliac spine and parallel to the superior gluteal line. The connecting bar was inserted subfascially and fixed with the locking head pedicle screws to form an fixed-angle construction. In a prospective study 31 patients with vertical shear injuries of the pelvis were treated with the TIFI. There were two wound infections and one loosening of a pedicle screw. None of the screws were incorrectly positioned and no neuro-vascular lesions were caused by the implant. 2 years postoperatively we found 50% good and excellent results for type C pelvic ring injuries. Early findings show that the TIFI is well suited to stabilization of sacro-iliac joint ruptures and fractures of the lateral sacrum. Closed reduction and minimally invasive insertion technique are possible. The implant leads to sufficient biomechanical stability but there is a very low intraoperative risk of neuro-vascular lesion.

[An inflammatory pseudotumor of the liver surrounding a foreign object]

The authors present a rare case of the fish bone migration from the upper GIT into the liver parenchyma. Furthermore, a possibility of the diagnostics and management of its rare complication- an inflammatory pseudotumor of the liver is presented. Based on the literature data, other possible complications of foreign objects in the liver parenchyma are listed, including their diagnostic and treatment options.

Technische Machbarkeit der Implantation eines Monorail-Stent-Systems in die Nierenarterien ohne vorherige Dilatation

PURPOSE

To evaluate the technical feasibility of the implantation of the monorail RX Herculink system into the renal arteries without pre-dilatation.

MATERIALS AND METHODS

Forty-two patients (mean age 71 years) from four centers with a total of 44 renal artery stenoses underwent implantation of the RX Herculink stent. The mean grade of the stenosis was 83.8 %, the mean length 7.5 mm. The stenoses were ostial in 38 cases and in immediate proximity to the ostium in 6 cases. The mean follow-up-period was 57 weeks (24 - 176 weeks).

RESULTS

In 42 cases, the implantation was successful without pre-dilatation. In 2 cases, pre-dilatation was carried out. In none of the cases, detachment of the stent from the balloon was observed. In one stenosis with a length of 17 mm, implantation of two stents was performed. In 9 cases, post-dilatation with a larger balloon or higher balloon pressure was necessary. Residual stenoses exceeding 30 % were not observed. Two patients developed local bleeding at the puncture site. During the follow-up, restenoses were observed in 5 stents after 26 to 126 weeks, which necessitated a second intervention in 3 cases (PTA in 2 cases, re-stenting in 1 case). The primary patency rate after 6 and 12 months was 0.92 +/- 0.056 according to Kaplan-Meier, the secondary patency rate after 6 and 12 months was 1.0 +/- 0.0.

CONCLUSION

Implantation of the RX Herculink stent system into the renal arteries without pre-dilatation is technically feasible and safe. Even without pre-dilatation, the stent-system can be advanced through the stenosis without detachment. The complication rate is low. Our clinical results are comparable to previous studies.

[A retrorectal cystic tumor--case reports]

Cystic retrorectal tumors are rare tumors with a risk potential for a malignant growth. Their diagnostics, location and decision on the surgical approach--abdominal, perineal or combined--are based on ultrasound, CT and MRI examination findings. A complete removal of the neoplasm without opening the wall of the cystic tumor is a pre-requisite for a good therapeutical result.

CD4+ CD56+ blastic tumor of the skin: cytogenetic observations and further evidence of an origin from plasmocytoid dendritic cells

We here report on a case of a blastic tumor, recently described to belong to a new entity sharing phenotypic similarities with blood derived plasmocytoid dendritic cells and formerly regarded as belonging to the group of natural killer cell lymphomas. Besides immunophenotypic characteristics such as the absence of T- cell markers and almost complete absence of markers of the myeloid lineage, these tumors express CD4, CD56 and CD123, the receptor for interleukin-3. Moreover, using the comparative genomic hybridisation technique, CGH, we demonstrate a gain of chromosome 7q, 22 and a loss of chromosome 3p and 13q. Since this type of hematologic disorder often shows its primary manifestation in the skin and often runs a rapidly fatal course, it is important to distinguish this from other types of primary cutaneous lymphomas.

Public awareness of risk factors and screening for colorectal cancer in Europe

Colorectal cancer (CRC) is the commonest site for malignancy in Europe. The Commissioner for Health wishes to promote screening for colorectal, breast and cervical cancer in Europe. The aim of this study was to assess public knowledge of CRC in Europe and likely take up of free screening. To this end 20710 members of the public from 21 European countries were interviewed by means of a regular survey amongst consumers (Omnibus survey) using 13 stem questions. Forty-eight per cent thought the population were at equal risk of CRC, only 57% were aware of age and 54% of family history as risk factors. Although 70% were aware of dietary factors, only 30% knew that lack of exercise might be a risk factor. Only 51% had knowledge of CRC screening but 75% were 'very', or 'quite interested, in taking up faecal occult blood (FOB) screening if offered free. Barriers to screening were lack of awareness of risk (31%), youth (22%) and an un-anaesthetic test (19%). There was a big cultural difference in willingness of the public to discuss bowel symptoms: there was a major barrier in Finland (91%), Britain (84%), Luxembourg (82%), Poland (81%) and Portugal (80%); less of a barrier in Spain (49%), Italy (44%) and Iceland (39%). In conclusion, the challenge of achieving high compliance for CRC screening must be a major objective amongst EU member states and non-aligned countries of Europe in the next decade, because it is known that the non-compliant group are those at greatest risk of death from CRC. This study has shown that awareness of CRC is low in Europe and that an educational programme will be essential to achieve high compliance for CRC screening as a means of reducing deaths from bowel cancer.

Molecular Cytogenetic Analysis of Chromosomal Breakpoints in the IGH, MYC, BCL6, and MALT1 Gene Loci in Primary Cutaneous B-cell Lymphomas

Chromosomal translocations affecting the IGH locus and various oncogene loci are recurrent in many types of systemic B-cell lymphomas. Hardly any data exist, however, on such translocations in primary cutaneous B-cell lymphomas (PCBCL). Here, a series of 29 PCBCL was investigated by interphase fluorescence in situ hybridization with probes for the IGH, MYC, BCL6, and MLT1 loci. None of the six follicle center cell lymphomas and nine marginal zone lymphomas showed evidence for any translocation affecting these loci. In contrast, 11 of 14 large B-cell lymphomas of the leg harbored breakpoints in at least one of the loci. Translocations involving the MYC locus were detected in six cases, five of them derived from a MYC/IGH juxtaposition and one from a translocation involving a non-IG gene partner. Rearrangements of the BCL6 locus were detected in five B-cell lymphomas of the leg, and involved IGH (two cases), IGL (one case), and non-IG genes (two cases). This study shows that large B-cell lymphomas of the leg display a pattern of chromosomal translocations similar to their systemic counterparts whereas primary cutaneous follicle center cell lymphomas and marginal zone lymphomas lack these typical chromosomal translocations.

Granulocyte colony-stimulating-factor-induced psoriasiform dermatitis resembles psoriasis with regard to abnormal cytokine expression and epidermal activation

Psoriasis is a chronic inflammatory skin disorder characterized by accumulation of Th1-type T cells and neutrophils, regenerative keratinocyte proliferation and differentiation, and enhanced epidermal production of antimicrobial peptides. The underlying cause is unknown, but there are some similarities with the immunologic defense program against bacteria. Development of psoriasiform skin lesions has been reported after administration of granulocyte colony-stimulating factor (G-CSF), a cytokine induced in monocytes by bacterial antigens. To further investigate the relation between this type of cytokine-induced dermatitis and psoriasis, we analyzed the cutaneous cytokine profile [tumor necrosis factor-alpha (TNF-alpha), interferon-gamma, transforming growth factor-beta1 (TGF-beta1), interleukin-10 (IL-10), IL-12p35 and p40, and IL-8] and expression of markers of epidermal activation [Ki-67, cytokeratin-16, major histocompatibility complex (MHC) class II, intercellular adhesion molecule-1 (ICAM-1)] in a patient who developed G-CSF-induced psoriasiform dermatitis by using quantitative real-time reverse transcriptase-polymerase chain reaction and immunohistology. The histologic picture resembled psoriasis with regard to epidermal hyperparakeratosis and the accumulation of lymphocytes in the upper corium. CD8(+) T cells were found to infiltrate the epidermis which was associated with an aberrant expression of Ki-67, cytokeratin-16, MHC class II, and ICAM-1 on adjacent keratinocytes. As compared to normal skin (n = 7), there was an increased expression of TNF-alpha, IL-12p40, and IL-8, a decreased expression of TGF-beta1, and a lack of IL-10, similar to the findings in active psoriasis (n = 8). Therefore, G-CSF may cause a lymphocytic dermatitis that, similar to psoriasis, is characterized by a pro-inflammatory Th1-type cytokine milieu and an epidermal phenotype indicative of aberrant maturation and acquisition of non-professional immune functions.

Results of a surveillance programme for patients at high risk of malignant melanoma using digital and conventional dermoscopy

Patients with a high number of atypical naevi and a personal and/or family history of melanoma are at high risk of malignant melanoma. The objective of this study was to design a special documentation and surveillance programme using epiluminescence microscopy (ELM) and digital epiluminescence microscopy (DELM) to improve the surveillance of these patients. High-risk patients (n=212) were categorized by the number and phenotype of their naevi and their personal and family history of melanoma. Then patients were screened by the unaided eye, conventional photography, ELM and, in selected cases of atypia, DELM. Median follow-up was 18 months, and 2939 pigmented lesions were followed by DELM. Examination on the first visit identified 17 cutaneous melanomas. During the following observation period, another 17 melanomas were identified. Fifteen of these follow-up melanomas were exclusively identified based upon DELM. In these cases, subtle lesional changes occurred over time, and ELM diagnostic algorithms for differentiating benign melanocytic lesions from melanoma did not score a suspicion of melanoma. All melanomas, either pre-existing or developing during follow-up, were identified in an early, curable phase of tumour growth. We conclude that DELM follow-up for patients at high risk allows the early detection of melanomas that have not yet acquired melanoma-typical ELM features.

Patients with lymphatic metastasis of cutaneous malignant melanoma benefit from sentinel lymphonodectomy and early excision of their nodal disease

Early versus delayed excision of lymph node metastases is still being assessed in malignant melanoma. In the present retrospective, multicentre study, the outcome of 314 patients with positive sentinel lymphonodectomy (SLNE) was compared with the outcome of 623 patients with delayed lymph node dissection (DLND) of clinically enlarged lymph node metastases. In order to avoid the lead-time bias, survival was generally calculated from the excision of the primary tumour. Survival curves were constructed using the Kaplan-Meier product-limit estimate. Cox's proportional hazards model was used to perform a multivariate analysis of factors related to overall survival. Compared with SLNE and early performed complete lymph node dissection, DLND yielded a significantly higher number of lymph node metastases. Median and mean tumour thickness were nearly identical in the two therapy groups. The estimated 3-year overall survival rate was 80.1+/-2.8% (+/-standard error of the mean (SEM)) in patients with positive SLNs, and 67.6+/-1.9% in patients with DLND (5-year survival rates 62.5+/-5.5 and 50.2+/-5.4%, respectively). The difference between the two survival curves was statistically significant (P=0.002). Using multifactorial analysis, SLNE (P=0.000052), American Joint Committee on Cancer (AJCC) Breslow thickness category (P<0.000001), age (P=0.01) and gender (P=0.028) were independent predictors of overall survival. The location of the primary tumour (P=0.59) was non-significant. Considering only those centres with sufficient data for epidermal ulceration, this risk factor was also significant. In cutaneous malignant melanoma, early excision of lymphatic metastases, directed by the sentinel node procedure, provides a highly significant overall survival benefit.