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Locoregional recurrence of breast cancer continues to be a significant clinical issue involving extensive examination programmes, modified oncologic therapy and advanced surgery. The latter includes tumour resection followed by reconstruction of the thoracic wall. The type of reconstruction depends on tumour location, depth, aetiology and whether the resection involves the stabilising osseous structures as summarised in this review. The treatment strategy is planned at multidisciplinary team conferences with the presence of relevant specialists to ensure evidence-based treatment of consistent quality.

Once a fragility fracture has occurred after the age of 50 years, 41-85% of patients will experience another fracture. Patients who present at hospitals with a fragility fracture would benefit from introduction of fracture prevention programmes, as these programmes have been shown to reduce the number of subsequent fractures, reduce mortality, and furthermore are cost-effective. This paper presents the evidence for implementation of fracture prevention programmes and how these can be introduced successfully.

A consanguineous Turkish couple was expecting their third child. Two years earlier their second child had died from a severe form of insulin-resistant diabetes causing Donohue's syndrome. A novel mutation (V335) in the insulin receptor gene was found to be disrupting the structure and function of the receptor. The parents, as well as their first child, were asymptomatic, heterozygous carriers. The family received genetic counselling, and chorion villus sampling was performed early in pregnancy. Genotyping showed that the child in utero was heterozygous for the mutation. Subsequently the mother gave birth to a healthy boy.

Fructose 1,6-bisphosphatase (FBPase) deficiency is an autosomal recessive disorder of gluconeogenesis. Here we describe a family from Morocco with parental consanguinity with three affected children. All were homozygous for a novel mutation in exon 5: 685 C-->T of the gene coding for the liver isoform of fructose 1,6-bisphosphatase (FBP1). The mutation changed the amino acid codon (Q229X) from a glutamine (CAG) in position 229 to a stop codon (TAG), which caused a shortening of the protein from the normal 338 amino acids to 228. The shortened protein lacks a major part of the active site and is therefore probably without enzymatic activity.

Attention-deficit hyperactivity disorder (ADHD) is a common psychiatric disorder occurring in approximately 3-6% of the population. The high prevalence of the disease and the fact that it has an onset early in life emphasise the importance of adequate treatment. This article focuses on the largest long-term treatment study of ADHD, the Multimodal Treatment study of Attention Deficit Hyperactivity Disorder (MTA), taking into consideration especially the limitations of the design and their impact on the outcome of the study. Primary among these is the fact that outcome was measured 4-6 months after the most intensive phase of behavioural treatment but while medication was still active. This may have had an impact on the study results, especially since the MTA study did not indicate a significant difference between combined and strictly pharmacological treatment.

Elastofibroma dorsi (EF) is a rare and benign connective-tissue tumour, typically localized between the lower part of the scapula and the chest wall. Two case stories of EF are presented. The etiology, symptoms, diagnostics and treatment are discussed.

Eleven hundred and thirty-eight patients suspected of carotid artery disease were examined prospectively by ultrasound-Doppler. In 39 cases, intra-arterial digital subtraction arteriography was performed as well as well and compared to ultrasound Doppler examination. The overall accuracy was 80% (kappa: 0.65). Discrimination between normal and diseased vessels could be made with an accuracy of 93% (kappa: 0.70) and the accuracy when separating vessels into greater or less than 50% stenosis was 88% (kappa: 0.74). Sources of error are discussed and the paper concludes that colour-Doppler examination is an accurate method for assessment of the carotid artery.

Traditionally, strain gauge technique is used in Denmark to measure ankle blood pressure, a method requiring both time and well-trained personnel. In a study involving 90 limbs in 45 patients, this method was compared with ultrasonic technique using a portable 5 MHz Doppler. The reproducibility of Doppler ankle pressure measurement was similar to that found in strain gauge based studies. Two consecutive measurements may differ by 20 mmHg or in terms of ankle-brachial index by 0.15 before this is considered significant. No systematic variation was found between the two methods. Increasing difficulties were encountered with the Doppler technique at pressures below 50 mmHg. It is concluded that Doppler is a good alternative to strain gauge for measurement of ankle blood pressure.

The ultrasound Doppler method for examination of the carotid artery is described. Out of a total of 370 patients examined with ultrasound Doppler for suspected arteriosclerosis in the carotid artery in 1988, 27 were also submitted to digital subtraction arteriography (DSA). The accuracy of the ultrasound examination was compared with DSA 90% (43/48) when differentiating between normal and affected carotid arteries, and 85% (41/48) when differentiating between stenoses of more than or less than 50%. All of the occlusions were correctly identified. It is concluded that ultrasound Doppler examination is an accurate method for diagnoses of stenosis in the carotid artery.