Editor's Choice
This quarter's edition of the British Medical Bulletin contains the usual fascinating cross-section of new ideas in medicine and biomedical science.
We begin, however, with a systematic review on Magnetic Resonance Imaging Versus Arthroscopy in the Diagnosis of Knee Pathology (Page 5) by Crawford, Walley, Bridgman and Nicola Maffulli from Keele University in the UK.
They make the point that MRI is considered of great aid in the diagnosis of knee lesions. Most diagnostic studies comparing MRI and arthroscopy have shown good diagnostic performance in detecting lesions of the menisci and cruciate ligaments. Nevertheless, arthroscopy has remained the reference standard for the diagnosis of internal derangements of the knee, against which alternative diagnostic modalities should be compared. They took the ‘Gold standard’ to be arthroscopy, and undertook a systematic review of magnetic resonance imaging and arthroscopy in the diagnosis of internal derangements of the knee.
They found that MRI is highly accurate in the diagnosing of meniscal and ACL tears. It is the most appropriate screening tool before therapeutic arthroscopy. It is preferable to diagnostic arthroscopy in most patients because it avoids the surgical risks of arthroscopy. The results of MRI differ for medial and lateral meniscus and ACL, with only 85% accuracy. They conclude that study design characteristics should also be taken into consideration whenever a study on MRI assessing its diagnostic performance is designed or reviewed.
There follows a systematic review on Cardiac Adaptation to Training in Endurance Athletes (page 25) by Montero, Peinado, Di Salvo, Pigozzi and Nicola Maffulli from Madrid in Spain, Rome in Italy and Keele University.
They make the point that changes in echocardiographic measurements as a consequence of training and detraining in elite or subélite athletes have not been comprehensively studied.
In a systematic review of the literature they showed a positive overall effect size on a number of echocardiographic outcomes following training. However, the heterogeneity of the studies and the lack of sensitivity of the echocardiography technique do not allow us to show unequivocally that adaptation to endurance training of people with highly trained hearts stem from increments of diastolic diameter of the left ventricle and the lateral wall of the left ventricle.
The next review is on Minimally Invasive Hip Arthroplasty (page 37) by Mahmood, Zafar, Majid, Nicola Maffulli and Thompson from Keele University in the UK.
They systematically reviewed the published literature and to assess the methodology of studies comparing the surgical outcomes in minimally invasive hip arthroplasty with the routine approach. Thirty six studies met their inclusion criteria giving details of 6434 hip arthroplasties, 78.5% of which were implanted using MIHA techniques. The only statistically significant outcome was a reduction in length of hospital stay (P = 0.02). No significant difference was noted between the two groups with respect to operating time, blood loss, dislocation and revision rates, neurological injury and incidence of peri-operative fracture. The studies were of low quality, with patient number, follow-up time and validated outcome measures being the weakest areas.
They conclude that, at present, there is a lack of quality evidence to advocate the expansion of MIHA. The better designed studies suggest that it should be limited further to recognized expert centres.
Next, we have a systematic review on HIV, HIV treatment and their effects on fats, glucose and lipids (page 49) by Effrossyni Gkrania-Klostas and Angelos-Emmanouil Klostas from the Department of Infectious Diseases at Addenbrooke's Hospital in Cambridge and Ipswich Hospital.
They say that since the advent of effective antiretroviral therapy, infection with the human immunodeficiency virus has been transformed, in the Western world, to a chronic disease associated with a variety of metabolic complications. Their review provides a brief summary of our current understanding of the epidemiology, clinical presentation and therapeutic approaches of what is termed "the HIV-associated lipodystrophy syndrome" and of HIV associated lipid and glucose metabolic abnormalities.
They show that specific medications and medication classes increase the lipoatrophy and lipodystrophy risk. A change of treatment strategy may be beneficial in improving adipose tissue deposition. The effects of HIV on metabolism offer new insights into cardiovascular disease pathogenesis.
This is followed by a fascinating review on Investigating Emotion in Moral Cognition: A review of evidence from functional neuroimaging and neuropsychology (page 69). by Young and Koenigs from the Department of Psychology and Cognitive Neuroscience Section at Harvard University in the USA.
They make the point that human moral decision-making has long been a topic of philosophical debate, and, more recently, a topic for empirical investigation. Central to this investigation is the extent to which emotional processes underlie our decisions about moral right and wrong. Neuroscience offers a unique perspective on this question by addressing whether brain regions associated with emotional processing are involved in moral cognition. The authors conducted a narrative review of neuroscientific studies focused on the role of emotion in morality. Specifically, they described evidence implicating the ventromedial prefrontal cortex (VMPC), a brain region known to be important for emotional processing.
They showed that functional imaging studies demonstrated VMPC activation during tasks probing moral cognition. Studies of clinical populations, including patients with VMPC damage, reveal an association between impairments in emotional processing and impairments in moral judgement and behaviour. They conclude that considered together, these studies indicate that not only are emotions engaged during moral cognition, but that emotions, particularly those mediated by VMPC, are, in fact, critical for human morality.
Following this, we have a review on Endoscopic Ultrasound in Cancer Staging (Page 81) by Lennon and Penman from the Western General Hospital in Edinburgh.
They state that endoscopic ultrasound represents one of the most significant developments in endoscopy over the past 20 years. The development of curvilinear array echoendoscopes has expanded the applications of EUS, allowing real-time biopsy of suspicious masses or nodes.
They say that endoscopic ultrasound (EUS) is an integral part of the staging process of many upper gastrointestinal (GI) cancers as well as rectal cancer. They discuss the role of EUS in the identification and confirmation of malignancy in suspicious lesions, its role in tumour staging in upper and lower GI cancers as well as lung cancer and its therapeutic potential.
Next, a review of Trachoma (Page 99) by Matthew Burton from the International Centre for Eye Health in London.
He makes the point that trachoma is the commonest infectious cause of blindness worldwide. It afflicts some of the poorest regions of the globe, predominantly in Africa and Asia. The disease is initiated in early childhood by repeated infection of the ocular surface by Chlamydia trachomatis. This triggers recurrent chronic inflammatory episodes, leading to the development of conjunctival scarring. This scar tissue contracts, distorting the eyelids (entropion) causing contact between the eyelashes and the surface of the eye (trichiasis). This compromises the cornea and blinding opacification often ensues.
The World Health Organization is leading a global effort to eliminate Blinding Trachoma, through the implementation of the SAFE strategy. This involves Surgery for trichiasis, Antibiotics for infection, Facial cleanliness (hygiene promotion) and Environmental improvements to reduce transmission of the organism. Where this programme has been fully implemented it has met with some success. However, there are significant gaps in the evidence base and optimal management remains uncertain.
Finally, we have a review on the Detection of the Sentinel Lymph Node in Breast Cancer (page 117) by Somasundaram, Chicken and Keshtgar from the Royal Free and University College Medical School in London.
They state that axillary lymph node status for lymphatic staging in breast cancer is the best prognostic indicator and guide for systemic treatment. Sentinel lymph node (SLN) biopsy is a novel, minimally invasive technique for lymphatic staging proven to improve quality of life. The accurate detection of the SLN is paramount for the success of the procedure. They reviewed the relevant literature with regards to the different dyes and techniques used for the detection of SLN in breast cancer.
The highest identification rates and lowest false negative rates were achieved by using the combined blue dye and radiocolloid technique with pre-operative imaging using a gamma camera. There is a well-recognized learning curve to successfully perform SLN biopsy. A multidisciplinary approach and structured training is the key to the successful introduction of the technique.
CiteULike 
Connotea 
Del.icio.us What's this?
Related articles in BMB:
- Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: a systematic review
- Ruth Crawford, Gayle Walley, Stephen Bridgman, and Nicola Maffulli
BMB 2007 84: 5-23.[Abstract] [FREE Full Text] - Cardiac adaptation to training and decreased training loads in endurance athletes: a systematic review
- F. J. Calderón Montero, P. J. Benito Peinado, Valter Di Salvo, Fabio Pigozzi, and Nicola Maffulli
BMB 2007 84: 25-35.[Abstract] [FREE Full Text] - Minimally invasive hip arthroplasty: a quantitative review of the literature
- Ansar Mahmood, Mohammed S. Zafar, Ibrar Majid, Nicola Maffulli, and John Thompson
BMB 2007 84: 37-48.[Abstract] [FREE Full Text] - HIV and HIV treatment: effects on fats, glucose and lipids
- Effrossyni Gkrania-Klotsas and Angelos-Emmanouil Klotsas
BMB 2007 84: 49-68.[Abstract] [FREE Full Text] - Investigating emotion in moral cognition: a review of evidence from functional neuroimaging and neuropsychology
- Liane Young and Michael Koenigs
BMB 2007 84: 69-79.[Abstract] [FREE Full Text] - Endoscopic ultrasound in cancer staging
- A. M. Lennon and I. D. Penman
BMB 2007 84: 81-98.[Abstract] [FREE Full Text] - Trachoma: an overview
- Matthew J. Burton
BMB 2007 84: 99-116.[Abstract] [FREE Full Text] - Detection of the sentinel lymph node in breast cancer
- Santosh K. Somasundaram, Dennis W. Chicken, and Mohammed R. S. Keshtgar
BMB 2007 84: 117-131.[Abstract] [FREE Full Text]
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||