Carcinoma of the breast: detection with MR imaging versus xeromammography

Detectability of breast cancer with magnetic resonance (MR) imaging versus xeromammography was quantitatively compared. MR images were obtained of breasts of 120 women who underwent xeromammography. T1 values were determined for masses larger than 2 cm. Cancer was histologically confirmed in 39 breasts and was considered excluded from 81 due to results of biopsy, cyst aspiration, or sonography or absence of change in xeromammographic findings over time. Images were blindly interpreted by three observers, and results were expressed as receiver operating characteristic curves. Detectability of breast cancer was substantially better with xeromammography than with MR imaging for all observers (P less than .03, 10(-6), and .001). On MR images, spiculation of a mass, distorted architecture, skin thickening, and nipple or skin retraction were specific but relatively insensitive indicators of cancer. Masses with smooth, distinct margins and signal intensity greater than that of fat on T2-weighted images were always benign. Other findings and T1 values were not diagnostically useful. The authors conclude that xeromammography is superior to MR imaging in detection of breast cancer.     

Acute myocardial ischemia: MR imaging with Mn-TP

Cardiac-gated magnetic resonance (MR) imaging was performed in rats to determine the effects of manganese ethylenediaminetetraphosphonate (TP). Ten normal rats received Mn-TP in a dose of 50 mumol/kg through a tail-vein injection. Spin-echo MR images were obtained before and every 10 minutes after Mn-TP injection for 1 hour. Cardiac signal intensity (SI) increased more than 70% after Mn-TP injection and remained nearly unchanged 1 hour after injection. Myocardial T1 was 517 +/- 49 msec in eight control rats and 282 +/- 61 msec (P less than .001) in six rats 81 +/- 0 minutes after injection. Nine rats underwent occlusion of the left anterior descending coronary artery prior to MR imaging. Images were obtained before and 15, 30, and 60 minutes after Mn-TP injection. In normal myocardium, SI increased up to 82% and remained elevated for 1 hour. In ischemic myocardium, SI rose 11%, leading to a marked contrast between the two tissue zones. T1 was also different in the two regions: In normal tissue, it was 206 msec +/- 54; in ischemic tissue, 338 +/- 82 (P less than .001). With T1-weighted MR imaging, Mn-TP showed a potential for delineating the jeopardized area after acute myocardial ischemia.     

Konstanz und Variabilität klinisch psychiatrischer Diagnosen über sechs Jahrzehnte

Zusammenfassung An den stationär behandelten Kranken der Psychiatrischen Universitätskliniken Freiburg und Heidelberg in den Zeiträumen 1900 bis 1960 und 1911 bis 1960 wird die relative Häufigkeit der Diagnose Schizophrenie, depressive Syndrome, reaktive Depression, Psychopathie und Manie untersucht. Unter den Parametern, von denen die Entwicklung der relativen Häufigkeit dieser Diagnosen abhängig ist, scheint die wissenschaftliche und diagnostische Auffassung der jeweiligen Klinikdirektoren die bedeutsamste Rolle zu spielen. Jedenfalls haben hier diagnostische Moden der psychiatrischen Diagnostiker einen wesentlich größeren Einfluß auf die von uns dargestellten Daten ausgeübt als die großen zeitgeschichtlichen Ereignisse wie etwa die beiden Weltkriege oder aber die Weltwirtschaftskrise mit Massenarbeitslosigkeit. Selbstverständlich geben unsere Ziffern nur eine grobe Orientierung und keine detaillierte Auskunft auf die Frage, inwieweit äußere Belastungen, ökonomische, soziale oder auch interpersonelle Faktoren als Ursachen oder Auslöser eines dieser Krankheitsbilder von Bedeutung sind. Aus unseren Untersuchungen kristallisiert sich der Eindruck heraus, daß es 1. Diagnosen gibt, die in ihrer relativen Häufigkeit vorwiegend von den, dogmatischen Auffassungen abhängen, die von den Klinikdirektoren vertreten und je nach dem Ausmaß ihrer innerklinischen Autorität in den Diagnosen realisiert werden (Depression, reaktive Depression, Schizophrenie). Die Entwicklung im Berichtszeitraum läßt erkennen, daß diese dogmatischen Einflüsse am Anfang des Jahrhunderts ihr Maximum erreichten und inzwischen deutlich im Schwinden begriffen sind. - 2. Andere Diagnosen sind weniger den speziellen Auffassungen der Klinikdirektoren unterworfen, sondern folgen einem allgemeinen Trend der psychiatrischen Lehre, beispielsweise die Psychopathie. - 3. Gibt es Diagnosen, die praktisch keine Abhängigkeit von den genannten Parametern zeigen. Bei diesen Syndromen ist offenbar das Erscheinungsbild relativ uniform und die Auffassung über ihre Ätiologie relativ einheitlich. Sie werden deshalb ohne allzu große Variabilität diagnostiziert (Manie).

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Summary The relative frequency of the diagnoses of Schizophrenia, Depression, Reactive Depression, Psychopathic Personality and Mania, given to in-patients treated at the University Psychiatric Clinics of Freiburg (1900–1960) and Heidelberg (1911–1960) was investigated. Among the factors responsible for variations in the frequency of these diagnoses, the scientific and clinical interpretations of the respective Psychiatrists-in-Chief seemed to play the most significant part. Such diagnostic fashions have had a greater influence, at least in our data, than contemporary events such as the two world wars or the great depression with its mass unemployment. These figures give, of course, only an overall picture and do not allow a detailed account of how far economic, social or interpersonal difficulties are important in causing any of these clinical pictures. We have the impression, from this investigation, that there are three types of diagnosis: - 1.Those which depend predominantly on the dogmatic interpretations of the Psychiatrists-In-Chief and which are more evident the greater his authority (Depression, Reactive Depression and Schizophrenia). These dogmatic influences were at a maximum at the beginning of the century and since then have clearly declined. - 2. Those, such as Psychopathic Personality, which were less affected by the Psychiatrist-In-Chief's interpretation but followed a more general trend in psychiatric teaching.- 3. Those, such as Mania, which showed hardly any dependence on the factors mentioned. The clinical picture of these diagnoses remained fairly constant and interpretations about their aetiology fairly uniform. Thus there was little variability in the frequency with which they were diagnosed.

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Résumé Chez les patients hospitalisés dans les cliniques universitaires de Fribourg et de Heidelberg pendant les périodes allant de 1900 à 1960 et de 1911 à 1960, le diagnostic révèle dans une relative majorité: schizophrénie, syndrome dépressif, dépression réactionnelle, psychopathie et manie. Parmi les paramètres dont dépend la fréquence relative de ces diagnostics, la conception scientifique et diagnostique des directeurs de cliniques semble jouer le rôle le plus important. Quoi qu'il en soit, les modes de diagnostic des psychiatres ont exercé une plus grande influence de base sur les périodes en question que les événements contemporains tels que les deux guerres mondiales ou bien la crise économique mondiale avec ses conséquences de chômage général. Il va sans dire que nos chiffres ne donnent qu'une orientation approximative et non pas une information détaillée sur la question suivante: jusqu'à quel point des facteurs extérieurs, économiques, sociaux ou aussi interpersonnels, sont-ils importants en tant qu'agents pathologiques déclenchant l'un ou l'autre de ces tableaux cliniques? - A la suite de nos recherches, nous sommes fixés sur l'impression que: - 1. Il est des diagnostics qui dépendent avant tout dans leur relative fréquence des conceptions dogmatiques qui tiennent des directeurs de cliniques et, suivant la mesure de leur autorité, se retrouvent dans ces diagnostics (dépression, dépression réactionnelle, schizophrénie). L'évolution pendant la période traitée dans le rapport général montre que ces influences dogmatiques atteignirent leur maximum au début du siècle et sont en train de disparaître nettement.- 2. D'autres diagnostics dépendent moins des interprétations particulières des directeurs de cliniques, mais suivent au contraire une tendance générale de la science psychiatrique, par exemple la psychopathie. - 3. Il est des diagnostics qui ne relèvent d'aucune influence des paramètres en question. Dans ces psychoses, le tableau d'apparition est évidemment relativement uniforme et l'interprétation de son étiologie unique. C'est pourquoi ces diagnostics sont établis dans l'ensemble sans grande variabilité (manie).

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Wir danken Herrn Prof. Dr. H.Ruffin für die Überlassung des Materials der Univ.-Nervenklinik Freiburg und für die Unterstützung unserer Untersuchungen.     

Dengue control in an urban area of Brazil: impact of the Family Health Program on traditional control

A study was performed in different areas of S?o José do Rio Preto which include the Family Health Program (FHP) and the Dengue Control Program, and the results of integration between the two programs were evaluated. In addition to other responsibilities, community health agents instructed residents on dengue control measures, encouraging the population to adopt the practices in areas with the FHP. Vector control agents were responsible for breeding site control and instructed local residents on the Dengue Control Program. From 2001 to 2003, surveys were conducted to measure residents' dengue control knowledge and practices. The proportions of residents in the FHP area that reported health services as a source of information increased significantly as compared to the other area. There were significant changes concerning the increase in information about the disease and reduction in vector breeding sites. The results show that integration between the programs is possible and could help optimize resources, avoiding duplicity of procedures and fostering greater community involvement in dengue control.