Comparison of digital systems and conventional dental film for the detection of approximal enamel caries

Objectives

The aims of this study were (1) to compare the accuracy of the detection of approximal enamel caries lesions using three intraoral storage phosphor plate digital systems and one conventional film-based radiographic system; and (2) to determine whether there is a correlation between the histological and radiographic measurements of enamel caries.

Methods

160 approximal surfaces were radiographed under standardized conditions using three storage phosphor stimulable systems (DenOptix and Digora FMX with white and blue plates), and one film system (Insight film). 17 observers scored the images for the presence and depth of caries using a 4-point scale. The presence of caries was validated histologically (gold standard). Two-way analysis of variance was used to test the differences in sensitivity, specificity and overall accuracy (TP + TN). The data from the radiographic and histological measurements were statistically analysed by Spearman’s rank correlation coefficient.

Results

Two-way analysis of variance and the post hoc t-test demonstrated that Digora (white plate) had higher specificity and overall accuracy values than DenOptix (P = 0.021); there was no statistically significant difference among the other imaging modalities (P > 0.05). There was no significant correlation between the histological depth measurements and the radiographic measurements from Digora (blue plate) (P = 0.43), Digora (white plate) (P = 0.15), DenOptix (P = 0.17) and Insight film (P = 0.06).

Conclusions

The results suggest that (1) the performance of the three storage phosphor image plate systems was similar to that of the Insight film for detection of approximal enamel caries, and (2) the increase in histological depth of enamel caries was not significantly correlated with radiographic measurements.     

PREDICT: a new UK prognostic model that predicts survival following surgery for invasive breast cancer

Introduction  

The aim of this study was to develop and validate a prognostication model to predict overall and breast cancer specific survival for women treated for early breast cancer in the UK.     

Strukturiertes Mammakarzinom-Früherkennungsprogramm

Background and aim

Approximately 10?% of the cases of breast cancer in Germany have a hereditary or familial background. Because the tumors in this patient group often have an early onset and due to the type more often show an aggressive growth pattern, an intensified screening program makes an important contribution to early recognition and successful treatment of such tumors.

Material and methods

The screening program consists of magnetic resonance imaging, ultrasound and if necessary mammography, because mammography screening alone is insufficient in this patient group. The exact examination intervals are risk-adapted. Due to the special imaging characteristics of the tumors in this at risk collective, an excellent expertise of the radiologists involved and quality assurance measures are absolutely necessary.

Results and discussion

A multidisciplinary treatment should be carried out by gynecologists, human geneticists, psychologists, pathologists and radiologists in specialized centers. Using this screening program a survival advantage for the patients can be achieved.     

Strategies to reduce pulmonary complications after esophagectomy

Esophagectomy,the surgical removal of all or part of the esophagus,is a surgical procedure that is associated with high morbidity and mortality.Pulmonary complications are an especially important postoperative problem.Therefore,many perioperative strategies to prevent pulmonary complications after esophagectomy have been investigated and introduced in daily clinical practice.Here,we review these strategies,including improvement of patient performance and technical advances such as minimally invasive surgery that have been implemented in recent years.Furthermore,interventions such as methylprednisolone,neutrophil elastase inhibitor and epidural analgesia,which have been shown to reduce pulmonary complications,are discussed.Benefits of the commonly applied routine nasogastric decompression,delay of oral intake and prophylactic mechanical ventilation are unclear,and many of these strategies are also evaluated here.Finally,we will discuss recent insights and new developments aimed to improve pulmonary outcomes after esophagectomy.     

Revising care to meet maternal needs post birth: an overview of the hospital to home postnatal study

There have been limited improvements in care and support for women post-birth despite publication of National Institute of Health and Clinical Excellence (NICE) guidelines for routine postnatal care (NICE 2006). NICE recommendations included that care should be individualised to women's physical and psychological health needs, the content of care should be relevant to the time of recovery post birth and information should be offered regarding life-threatening conditions and more commonly experienced morbidity. A study was conducted in one maternity unit informed by a quality improvement approach to implement NICE guidance. Revisions were introduced to hospital systems and processes relevant to the continuum of pregnancy, birth and beyond to improve individualised care and women's views of this.     

Volumetric quantification of the effect of aging and hormone replacement therapy on breast composition from digital mammograms

Objective

To assess the physiological changes in breast composition with aging using volumetric breast composition measurement from digital mammograms and to assess the effect of hormone replacement therapy (HRT).

Methods

A total of 764 consecutive mammograms of 208 non-HRT using women and 508 mammograms of 134 HRT-using women were analyzed using a volumetric breast composition assessment software (Quantra™, Hologic Inc.). Fibroglandular tissue volume (FTV), breast volume (BV), and percent density (PD) were measured. For statistical analysis, women were divided into a premenopausal (<46 years), a perimenopausal (46–55 years), and a postmenopausal (>55 years) age group. More detailed graphical analysis was performed using smaller age brackets. Women using HRT were compared to age-matched controls not using HRT.

Results

Women in the postmenopausal age group had a significantly lower FTV and PD and a significantly higher BV than women in the premenopausal age group (FTV: 77 vs. 120 cm³, respectively; PD: 16% vs. 28%, respectively; BV 478 vs. 406 cm³, respectively; p < 0.01 for all). Median FTV was nearly stable in consecutive mammograms in the premenopausal and postmenopausal age groups, but declined at a rate of 3.9% per year in the perimenopausal period. Median PD was constant in the premenopausal and postmenopausal age groups and declined at a rate of 0.57% per year in the perimenopausal age group. BV continuously increased with age. Women using HRT throughout the study had a 5% higher PD than women not using HRT (22% vs. 17%, respectively; p < 0.001).

Conclusions

Accurate knowledge of normal changes in breast composition are of particular interest nowadays due to the importance of breast density for breast cancer risk evaluation. FTV and PD change significantly during the perimenopausal period but remain relatively constant before and thereafter. Median total breast volume consistently increases with age and further contributes to changes in breast density. HRT use is associated with a significantly higher PD.