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The interaction of our immune system with breast cancer (BC) cells prompted the investigation of tumor-infiltrating lymphocytes (TILs) and targeted, tumor antigen-specific immunotherapy.Correlation between TILs and pathological complete response (pCR) after neoadjuvant systemic therapy (NACT). Tumor-specific antigens (TSAs) in HER2+ and triple negative BC and establishment of TSA-specific therapies within the interdisciplinary TILGen study.Illustration of the TILGen study design. Assessment of TILs and correlation with pCR within this BC study.pCR was achieved in 38.4% (56/146) and associated with estrogen receptor/progesterone receptor negative (ER-/PR-) and HER2+ tumors. Lymphocytic predominant BC (LPBC) was found in 16.4% (24/146), particularly in ER-/PR- (ER-: 27.3% vs. ER+: 9.9%, PR-: 22.3% vs. PR+: 8.2%), large, and poorly differentiated BC. TILs were significantly correlated with pCR in multivariate analysis. In LPBC, pCR was achieved in 66.7%, whereas it was 32.8% in non-LPBC.First results confirm the influence of the human immune system on the response to NACT in HER2+ and triple negative BC. TSA-specific immunotherapy might improve the outcome in BC patients but there is an urgent need for comprehensive studies to further investigate this issue.

Mammography is the central diagnostic method for clinical diagnostics of breast cancer and the breast cancer screening program. In the clinical routine complementary methods, such as ultrasound, tomosynthesis and optional magnetic resonance imaging (MRI) are already combined for the diagnostic procedure. Future developments will utilize investigative procedures either as a hybrid (combination of several different imaging modalities in one instrument) or as a fusion method (the technical fusion of two or more of these methods) to implement fusion imaging into diagnostic algorithms. For screening there are reasonable hypotheses to aim for studies that individualize the diagnostic process within the screening procedure. Individual breast cancer risk prediction and individualized knowledge about sensitivity and specificity for certain diagnostic methods could be tested. The clinical implementation of these algorithms is not yet in sight.

The aim of this study was to evaluate the quality standard of the nationwide breast ultrasound training program of the German Society of Ultrasound in Medicine (DEGUM) through objective parameters.10 quality criteria, based on the recommendations of The National Association of Statutory Health Insurance Physicians (KBV), were defined for this study. All training units of the DEGUM received a questionnaire. The questionnaires and training material were analyzed.All units met the required criteria pertaining to the trainer's qualification, duration per training course and the maximum number of participants per ultrasound machine. Only 1 course did not fulfill the required 50 % practical training time. The requirements to participate in the graduate course (200 self-made and documented cases) were not clearly conceived and a defined training log could be improved.DEGUM breast ultrasound training offers trainees a high level of education based on the requirements of the KBV. Despite the high quality of training, the content of course announcements could be improved and an official and structured educational index could be meaningful.

The dynamic decrease in inspiratory capacity (IC) during exercise with restriction of tidal volume (VT) is known as dynamic hyperinflation (DH) and is described mostly in patients with COPD differentiating between a "hyperinflator" and a "non-hyperinflator". Recent studies have revealed DH in patients with idiopathic pulmonary arterial hypertension (iPAH), but the influence of the DH on the reduced exercise capacity with exertional dyspnoae is still being debated.We analysed flow-volume curves during cardiopulmonary exercise testing (CPET) in idiopathic PAH (n = 19), in COPD (n = 17), in idiopathic pulmonary fibrosis (IPF) (n = 19) and a control group (n = 30). We measured IC at rest and during maximal exercise and furthermore ventilation, VT and oxygen uptake (VO2 peak). In iPAH a right heart catheter test and a 6-minute walk test (6MWT) were performed, also the B-type naturetic peptide (BNP) and the NYHA/WHO functional class were determined.The IC decreased significantly in 11 PAH "hyperinflators" (PAH-H) (Δ IC: - 0.34 ± 0.14 L, p0.001) compared to 8 PAH "non-hyperinflators" (PAH-NH) (Δ IC: 0.08 ± 0.2 L). COPD patients exhibited a characteristic hyperinflation pattern with a decrease in IC throughout exercise (Δ IC: - 0.61 ± 0.3 L, p0.001), while patients with IPF (Δ IC: 0.03 ± 0.15 L) and the control group responsed to exercise with a non-hyperinflator pattern (Δ IC: 0.1 ± 0.2 L). Both PAH collectives showed a reduced IC/TLC, while VT/IC was elevated with a decreased peak VO2 and max. performance compared to the control group. Correlations of the IC rest/max (L) were shown in PAH-H and PAH-NH with the VO2 peak, max. performance and VT.The analysis of flow-volume curves during CPET can indentify DH in a subgroup of patients with iPAH. The DH contributes significantly but slightly to the development of exertional limitations and dyspnoe in a subgroup of iPAH. Further studies with a larger sample size will be required to definitively measure the impact of the DH seen in these patients.

Mobile geriatric rehabilitation is an outpatient rehabilitative treatment in which a multidisciplinary team treats elderly patients at home. This kind of treatment has been performed in rare cases in Germany but there are no data available on the effectiveness in patients with severe cognitive and functional impairment.In a retrospective study design the data of all patients who had participated in mobile geriatric rehabilitation between 1 September 2009 and 23 May 2011 were evaluated. Before treatment a comprehensive geriatric assessment was performed and after treatment an assessment of mobility and activities of daily living (ADL). After 6 months a random sample of 20 patients were contacted by telephone to check the ADL.A total of 87 patients were treated between 1 September 2009 and 23 May 2011. The median age was 83 years and 56 % of the patients lived in nursing homes. Only 24 % of the patients had MMSE scores 23 points, 77 patients completed the treatment with an assessment and in these patients the ADL could be improved significantly (Barthel index at the beginning 36.2 points and on completion 50.9 points, p 0.001). The Barthel index 6 months after treatment was only 1.25 points lower compared to the assessment at the end of the treatment. Significant improvement after therapy could also be demonstrated in the mobility assessment (timed up and go test, Tinetti mobility score and Esslinger transfer scale).The results of this non-randomized and non-blinded trial indicated the efficacy of mobile geriatric rehabilitation. In functionally and cognitively impaired elderly patients ADL and mobility can be improved. These effects seem to persist for at least for 6 months.

In the surgical treatment of acetabular fractures via a ventral approach the hip joint is not visible. Hip arthroscopy can be an alternative tool instead of 3-D fluoroscope-based navigation to exclude intra-articular perforation of the screws.

More than half of the patients hospitalised with stroke suffer from sleep-disordered breathing and 5 - 10 % of patients with newly diagnosed obstructive sleep apnea (OSA) have a history of stroke. Epidemiological studies have shown that untreated OSA is an independent risk factor for stroke. Various pathophysiological mechanisms may contribute to the development of stroke in these patients (i. e., OSA-associated arterial hypertension, atherosclerosis, atrial fibrillation, paradoxical embolism through a patent foramen ovale and disturbed cerebrovascular reactivity). Co-existent OSA has a negative impact on both the recovery of neurological functions and the survival of patients with stroke. On the other hand, CPAP therapy has beneficial effects on the incidence and recurrence of stroke in OSA and also on the clinical outcome of those patients who are victims of stroke.

The general gap in the BIRADS lexicon between lesion description and categorization leads to very different recommendations in clinical breast radiology. This is particularly true for breast MRI. The third consensus meeting of course directors in breast imaging aimed at an increase in standardization of breast MRI.Between 166 and 344 participants in the audience (A) and 9 and 13 expert panel participants (P) took part in an electronic wireless voting system. The audience consisted of 98% radiologists and 2% gynecologists (A: n=295; P: n=12: radiologists 92%/gynecologists 8%). Of all participants, 62% had more than 10 years of experience in breast imaging and only 9% had less than 3 years of experience (P: 100%10 years of experience). The day before 44, clinically relevant, though unresolved questions were formulated by the expert panel. For the evaluation a distinction was made between answers with a great majority (75%), simple majority (50-75%) and no majority (50%) as well as answers from the expert panel and answers from the audience.Of 44 questions, all but two were answered with simple or great majority.Technique, reporting and clinical use are becoming more and more accurately defined in MRI of the breast and MR-guided interventions. The third consensus meeting of this kind gained numerous answers and thus enables recommendations for didactic as well as clinical routine work.

The aim of this retrospective clinical study was to compare the diagnostic accuracy of the novel 50 µm FFDM (full-field digital mammography) system (DR) with an established 70 µm system (DR) in the differential diagnosis between benign and malignant clusters of microcalcification (n=50) (BI-RADS™ classification 4/5) and to assess the possible incremental value of the 50 µm pixel-pitch on specificity.From March 2009 to September 2009, 50 patients underwent full-field digital mammography (FFDM) (detector resolution 70 µm) (Novation, Siemens, Erlangen, Germany). As there were suspicious signs of microcalcification classified with BI-RADS™ 4/5 after diagnosis and preoperative wire localization, control images were made with the new FFDM system (detector: resolution 50 µm) (Amulet, Fujifilm, Tokyo, Japan) with the same exposure parameters. The diagnosis was determined after the operation by five radiologists with different experience in digital mammography from randomly distributed mediolateral views (monitor reading) whose results were correlated with the final histology of all lesions.Histopathology revealed 19 benign and 31 malignant lesions in 50 patients after open biopsy. The results of the five readers showed a higher sensitivity of the new FFDM system (80.0%) in the ability to recognize malignant microcalcification in comparison to the established system (74.8%). The specificity (75.8 versus 71.6%) was slightly higher for the new system but these results were not statistically significant (p0.001). Considering the diagnostic accuracy, the new system (detector: resolution 50 µm) was also slightly superior to the well-known system (detector: resolution 70 µm) (80.1% versus 76.4%).Our study has shown that the new full-field digital mammography system using the novel detector compared with the already established FFDM system with respect to the assessment of microcalcification is at least equivalent.

The article describes an experimental phantom study of a system for digital full field mammography with a new digital detector with a double plate of pure selenium.The experiments were carried out with the new full field digital mammography system Amulet from FujiFilm. This system has a new detector (18×24 cm(2)) on the basis of highly purified amorphous selenium (a-Se) with a pixel size of 50 µm. The x-rays are converted into electric signals in the first plate which are read into the second plate with the help of an optical switch and demonstrated in the form of an image. In this way a better pixel size/volume and signal-to-noise ratio should be achieved. The object of the investigation was the Wisconsin Mammographic Random Phantom, Model 152 A (Technical Performance Mo/Mo, 28 kV, 100 mAs). Five investigators with different experiences in mammography each received three images on a monitor with different random positions of the simulated lesions in the phantom for assessment. The detection rates were compared under the same conditions with the results of two other full field digital mammography systems.The median detection rate for all images and investigators for the new doubled plated a-Se detector with optical switch was 98.7%. For both other systems with a-Si or and a-Se detectors the detection rate was 89.8% or 97.3%, respectively. There were no significant differences in the detection rate of the simulated breast lesions for all three systems considering the interobserver and intraobserver variation.The first phantom study for the detection of simulated breast lesions with the new full field digital mammography system Amulet demonstrates equivalent results with the other systems used in the clinical routine. The trend towards superiority of the new system has to be confirmed in further clinical studies.

Obstructive sleep apnea (OSA) is caused by repetitive collapse of a narrow upper airway during sleep with the main risk factor being obesity. Apneas are followed by hypoxia, sympathetic activation, intrathoracic pressure swings and arousals. In most animal studies, only the cyclical pattern of hypoxia characteristic of OSA is simulated, however, more complex models have also been developed which additionally reflect the other pathophysiological changes associated with sleep-disordered breathing. These models have contributed to a deeper understanding of the cardiovascular and metabolic consequences of OSA. From other experiments the concept of the pharynx behaving like a collapsible tube, i. e. a Starling resistor, has emerged. Finally, the neurotransmitter modulation of upper airway muscle tone has been elucidated by using IN VIVO microdialysis of the caudal medulla of rats. It is hoped that findings from animal studies will in the future impact on the management of patients with OSA, in particular if they are non-compliant with CPAP therapy.

In hereditary haemorrhagic teleangiectasia (HHT) can be accompanied by pulmonary arteriovenous vascular malformations (PAVM). Pulmonary hypertension (PH) is regarded as a rare pulmonary manifestation.We non-invasively assessed the pulmonary circulation in 20 patients with HHT using standard resting echocardiography including contrast studies. In 14 patients a mutation in the endoglin gene was present. The other 6 patients carried a mutation in the Alk-1 gene.We identified 4 patients with manifest PH, among them 2 patients (both with endoglin mutations) with concurrent thromboembolism, and 2 patients (both with Alk-1 mutations) with hepatic manifestations of HHT. Two patients required specific pulmonary vasoactive therapy with sildenafil and bosentan, respectively. Another patient received embolisation therapy for hypercirculatory PH due to hepatic arteriovenous malformations. Pulmonary arteriovenous malformations were found in 8 patients (7 with endoglin, and 1 with Alk-1 mutations), among them were 2 patients with PH.Patients with HHT should undergo echocardiographic screening for PAVM as well as PH. When PH is detected, other conditions such as hepatic or thromboembolic diseases should be considered, regardless of the underlying genetic defect.

The World Health Organization counts the increase in obesity as one of the most important public health challenges of the 21 (st) century. In Germany the prevention of obesity among children and adolescents currently holds a high priority on the political public health agenda. There is, however, relatively little empirical evidence for the development of obesity prevalence among adolescents. The objective of this work is to analyse data relating to juvenile obesity in Bavaria and to study its relevance for the health of adolescents.The basis for this work is a representative survey among adolescents in the age group 12-24 years. Available are data from three time periods (1995, 2000, 2005). The data were calculated descriptively as well as in relation to the impact of obesity on general health with multiple binary logistic regression analysis.The obesity prevalence among Bavarian adolescents of the age group 12-24 years has steadily increased from 1995 (2.1%) to 2000 (3.1%) and to 2005 (4%). The obesity prevalence grows with age; it shows a clear social gradient which has become stronger from 2000 to 2005. Obesity as well as the feeling of being overweight emerges from the regression analysis as independent factors influencing the general health.Data from medical checks at primary school enrolment in various German regions indicate that obesity in children of that age is no longer increasing. Among adolescents, however, obesity is still growing. This would recommend an age-specific monitoring of this development.

The updated 2008 German Guideline for Early Detection of Breast Cancer provides evidence-based and consensus-based recommendations of the knowledge gained by the German Society for Surgery and the German Society of Plastic, Aesthetic, and Reconstructive Surgeons together with 29 professional societies, associations, and nonmedical organizations. The guideline is meant to assist physicians, healthy women, and patients in medical decisions with recommendations regarding the diagnostic chain in early detection of breast cancer. In addition to these recommendations, the guideline also includes descriptions of quality assurance for resources, procedures, outcomes, and evaluation using a set of quality indicators. It updates the previous version from 2003. The guideline's recommendations are presented. They are described in detail in the full publication (in German) Geburtsh Frauenh 2008; 68:251-261. The long version of the Guideline, methods report, and evidence report are available on the internet at www.awmf-leitlinien.de (reg. no. 077/001) with free access.

Digital mammography has extensively replaced conventional film screen mammography and is now the standard in combination with soft copy reading in clinical as well as screening mammography. Large international multicenter studies demonstrate an equivalent or superior detection rate of breast cancers by digital in comparison to conventional mammography especially in dense breasts, premenopausal and perimenopausal women and women less than 50 years old. Computer-aided detection (CAD) is important for the experienced investigator (increased specificity). Digital mammography also offers further options, such as tomosynthesis, digital contrast-enhanced mammography and the combination of digital mammography and ultrasound. The future in breast diagnosis will be the fusion of images from different digital systems.

Metabolic syndrome, i. e., the combined occurrence of obesity, arterial hypertension, insulin resistance and dyslipidaemia (increased triglycerides, reduced HDL cholesterol), is associated with a marked increase in cardiovascular risk. The prevalence of metabolic syndrome in patients with obstructive sleep apnoea (OSA) is very high. Obesity is the main risk factor for OSA and OSA itself is now considered to be the most frequent cause of secondary arterial hypertension. Due to the confounding influence of obesity, the causal connection between OSA and metabolic disturbances is less well established, however, epidemiological data are at least in favour of an independent link between OSA and insulin resistance. It is known that CPAP therapy can ameliorate OSA-associated hypertension. In contrast, the effects of CPAP treatment on insulin resistance and dyslipidaemia have to be further elucidated by large, randomised interventional trials.

Over the last decade the pathophysiology of obstructive sleep apnea (OSA)-related cardiovascular disease has been further elucidated in animal models employing dogs and rats/mice. It was demonstrated that, under the conditions of chronic intermittent hypoxia (CIH), endothelial dysfunction, i. e., a reduction in endothelial-dependent vasorelaxation, occurs. Furthermore, animals were shown to develop arterial hypertension when subjected to CIH for some weeks. Other aspects of the cardiovascular morbidity linked to OSA such as pulmonary hypertension, heart failure and atherosclerosis were also found in these animal models. The common result of these studies is that, apart from sympathetic over-activity, an increased oxidative stress seems to play a key role in the development of OSA-associated cardiovascular disease. It is anticipated that animal studies will continue to enhance our understanding of the pathogenesis of these disorders.

Reduction of radiation exposure at an adequate image quality by optimizing the radiation quality for a new system of full-field digital mammography using a digital detector (a-Se).The investigations were performed using a digital mammography system Novation (Siemens, Erlangen). The system was constructed with a bimetal anode (molybdenum and tungsten) and the possibility of changing the filter (molybdenum/rhodium). The test object was the Wisconsin Mammography Random Phantom Model 152 A (Radiation Measurements Inc.) of which images were acquired using the digital technique with the tungsten anode and rhodium filter at different tube voltages (26-35 kV) and tube loads (40-100 mAs) and compared to images in the molybdan/molybdan molybdenum/molybdenum technique. To quantify the image quality, we used the detection rate of the simulated lesions in the phantom.Increasing the tube voltage significantly decreases the average glandular dose when using AEC (Automatic Exposure Control), i. e., constant detector dose. At the same time, the image quality decreases significantly with respect to the detection rate (26 kV, 1 mGy, 95.1 %; 35 kV, 0.7 mGy, 82.7 %). As a good compromise between the necessary diagnostic image quality and the lowest dose exposition, 28 kV and 60 mAs were selected for imaging with the tungsten/rhodium anode/filter combination. A further change to the tube load did not make sense because a decrease of 10 % resulted in a significant decrease in the detection rate while only a 2 % increase in detection rate was achieved for a 65 % increase in radiation exposure.The results of this phantom study demonstrate that the routine use of the tungsten anode in combination with a rhodium filter for full-field digital mammography with an a-Se detector in contrast to a molybdan/molybdan molybdenum/molybdenum anode/filter combination results in a reduction of the average glandular dose of up to 30 % without loss of diagnostic image quality.

Evaluation of the diagnostic value of breast specimen imaging with a digital mammographic system using a detector system with changeable pixel size compared to standard mode imaging in different monitor display modes.Using the digital mammographic system SenoScan (Fischer Imaging, Denver, USA), 50 diagnostic breast specimens with microcalcifications were visualized in both standard mode (pixel size 54 microm) and high resolution mode (pixel size 27 microm). The resulting radiographs were displayed 1:1 on a monitor. Standard mode images (pixel size 54 microm) were additionally displayed in a 2:1 mode. A total of 5 readers with different mammographic experience analyzed the type of the microcalcifications on the basis of the different display modes. The images were presented randomly. The findings were subsequently compared to the histology.The high resolution mode yielded slightly but not significantly better results than the standard mode on average for all 5 readers. Compared to a sensitivity of 80 % and a specificity of 72 % (PPV = 74 %, NPV = 78 %) in the standard mode, the high resolution mode provided a sensitivity of 86 % and a specificity of 74 % (PPV = 77 %, NPV = 83 %). The standard mode images on a 2:1 monitor display yielded 84 % and 74 % (PPV = 76 %, NPV = 82 %).The high resolution mode did not significantly increase the sensitivity and specificity of the microcalcification reading. A similar improvement was achieved by the 2:1 display mode, i. e. digital monitor zooming. For the clinical situation this means that there is no diagnostic advantage from using a high resolution target view with this mammographic system.

In the constantly evolving, increasingly important field of foot surgery, the question arises as to whether the incision types currently in use are adequate. Whether Langer's lines should be considered during the operative approach to the foot is examined here. The goal of the current study was to investigate the pattern of skin cleavage lines of cadaveric feet and to establish the optimal incision type for surgical approaches to the foot.Twelve feet from older deceased subjects were examined. The samples were fixed. The cleavage lines of the individual skin regions were outlined and evaluated. To emphasize the significance of the investigative findings, the cleavage lines and the current, relevant operative approaches were compared.Standard current approaches often ignore skin cleavage lines, understandably resulting in cosmetically unsatisfactory scars. A chart with ideal incision types for individual operations was created.The ideal incision should run parallel to skin cleavage lines. If this is not completely possible due to operative requirements, then at least a large part of the incision should follow these lines.

One or several short cycles of ischemia/reperfusion before (preconditioning) or after (postconditioning) a sustained coronary occlusion with subsequent reperfusion reduce the ultimate infarct size. The protection is potent, but limited to a narrow time frame. In animal experiments a complex signal transduction cascade was identified which results specifically in a reduction of reperfusion injury. There is evidence for both ischemic pre-and postconditioning in patients with coronary artery disease.

Cardiovascular diseases which are associated with an activation of the renin-angiotensin-system -- myocardial infarction, heart failure, hypertension -- often induce atrial fibrillation. The initiation and maintenance of atrial fibrillation is not only initiated by mechanical distension of the atria, but also by increased atrial expression of components of the renin-angiotensin-system, which initiate an inflammatory signal cascade and oxidative stress and in consequence myolysis and interstitial fibrosis. Ultimately, locally decreased conduction velocity and abbreviated refractory period facilitate reentry circuit(s) as an underlying pathomechanism of atrial fibrillation. In a meta-analysis, ACE inhibitors and AT (1) blockers, both reduce the relative risk of atrial fibrillation by about 30 %. Further prospective randomized clinical studies are required to establish final evidence.

To evaluate the diagnostic potential of the new vacuum-assisted method VacuFlash (VF) in clinical routine of breast diagnostics.From april 2002 to march 2003, the new sonographically guided vacuum-assisted system VacuFlash was used in 75 patients with a BI-RADS 5 lesion (analogue). The patients were aged between 31-75 yrs (median: 51 yrs), the size of the lesions measured 8-33 mm (median: 14 mm). 5 specimens were taken from each lesion.In 69 of the 75 lesions (92 %, respectively), malignancy was confirmed. In 8 lesions (8 %, resp.), we found a benign histology, confirmed by consecutive surgery.The new vacuum-assisted device VacuFlash is a technically perfected and applicable diagnostic method. Especially in the view of the cost it has to be compared with high-speed core cut biopsy, the hand-held Mammotome system and open surgical biopsy. High-speed core cut biopsy seems to be the standard procedure in diagnostic percutaneous breast intervention to clarify sonographically detected breast lesions.

The NMR-MOUSE is an open and mobile sensor for measuring NMR relaxation parameters in organic matters. T1-measurements of the subcutaneous fatty tissue and the skin are reported.For the first time, the NMR-MOUSE was employed to measure the signal recovery following saturation of the skin and the subcutaneous fatty tissue of three patients, before and after administering a contrast agent.Despite a low signal-to-noise ratio, changes in the relaxation behaviour of the skin could be detected. Malignant tissue exhibits faster signal recovery than scar tissue and healthy tissue, which only show a small difference.Changes in the relaxation behavior can be monitored with the NMR-MOUSE. Before the clinical use of the NMR-MOUSE, sensitivity, sensor mounting device, and sensor tuning must be improved. Further investigations need to be performed on a statistically relevant number of patients.

Complementary diagnostic methods in early diagnosis of breast cancer are used to increase diagnostic accuracy and minimize unnecessary invasive diagnostic procedures. Aim of the following prospective, open multicenter clinical study was to define the value of high-frequency breast ultrasound with 13 MHZ transducers compared to standard breast ultrasound with 7.5 MHz.Data of 810 female patients, aged 45 to 60 years, with 819 suspicious breast lesions evaluated by four participating centres between October 1996 and December 1997. Standardised breast ultrasound was performed uniformly using a AU4 IDEA diagnostic ultrasound system by Esaote-Biomedica in addition to a standardised procedure of clinical examination and standard-2view-mammography. Analysis of all aquired data and the correlating histopathological findings was done by means of descriptive statistics on the basis of an access datafile (Version 2.0).The histopathological evaluation showed 435 benign and 384 malignant findings. Overall sensitivity and specificity of the clinical examination were 71.1 % and 88.9 % and for mammography 84.7 % and 76.5 %, respectively. Standard ultrasound with 7,5 MHz reached a sensitivity of 82,6 % and a specificity of 80.8 % high-frequency ultrasound with 13 MHz came to 87.2 % and 78.4 %, respectively. Regarding tumour size, mammography gave the highest sensitivity in detection of pre-invasive cancers (DCIS). High-frequency breast ultrasound (13 MHz) proved to have a higher diagnostic accuracy compared to standard breast ultrasound (7,5 MHz) regardless of tumour size. Sensitivity was especially improved in case of small invasive tumours (pT1a) with 78 % versus 56 %, respectively.We conclude that high-frequency ultrasound is a valueable additive tool especially in the diagnosis of small tumours, improving diagnostic safety and reducing unnecessary invasive diagnostic procedures.

Pulmonary hypertension (PH), i. e. an increase of mean pulmonary artery pressure above 20 mm Hg under resting conditions, can be observed in different forms of sleep-disordered breathing (SDB). In obstructive sleep apnea (OSA) the apnea-associated triggers of hypoxia and intrathoracic pressure swings lead to repetitive rises of pulmonary artery pressure during sleep. In 20 - 30 % of these patients daytime PH occurs. PH in the setting of OSA is usually mild and rarely causes clinically evident cor pulmonale. Effective CPAP therapy has a beneficial influence on pulmonary hemodynamics in OSA. Severe congestive heart failure (i. e. with a LVEF40 %) might provoke pulmonary venous hypertension and thereby stimulation of pulmonary stretch and irritant receptors. The ensuing hyperventilation leads to a decrease of pCO (2) levels below the apneic threshold and thus contributes to the emergence of Cheyne Stokes respiration (CSR) in up to one half of the affected patients. Patients suffering from advanced idiopathic pulmonary arterial hypertension (IPAH) might show a similar breathing pattern while asleep. Possible pathogenetic factors of the nocturnal periodic breathing occurring in end-stage IPAH are prolonged circulation times and hypocapnia. In conclusion, SDB might cause PH (OSA-associated PH). On the other hand, PH might lead to the development of SDB (CSR in congestive heart failure, periodic breathing in IPAH).

Digital mammography is the technology of the future in breast diagnosis. This article provides an overview of all digital mammography units admitted by the Food and Drug Administration (FDA), results of clinical studies, soft copy reading, CAD (computer aided detection), and presents an overview on possible further developments. It is obvious that clinical results are equivalent to conventional screen film mammography and digital mammography.

New drugs for pulmonary arterial hypertension have shown efficacy in randomized controlled trials. Endothelin receptor antagonists (ERA) and prostanoids are most important for clinical practice. Bosentan represents the first approved orally active therapy for PAH. Besides its hepatotoxicity it is mostly well tolerated. The first approved prostanoid, epoprostenol, is currently first choice only for decompensated right heart failure in PAH. It has to be delivered continuously intravenously and is prone to complications, side effects and very high costs. Alternatively, subcutaneous treprostinil can be applied. It is less risky and expensive but may cause local pain at the infusion site. Inhaled iloprost combines the features of a prostanoid with pulmonary and intrapulmonary selectivity. Alternatively, iloprost is being used as continuous intravenous infusion. The phosphodiesterase-5 inhibitor sildenafil was effective in two randomized controlled trials but has not been approved for PAH therapy.

To determine the diagnostic accuracy of microcalcifications and focal lesions in a retrospective clinical-histological study using high-resolution digital phosphor storage plates (hard copy) and full-field digital mammography (hard copy).From May 2003 to September 2003, 102 patients underwent digital storage plate mammography (CR), using a mammography unit (Mammomat 3000 N, Siemens) in combination with a high resolution (9 lp/mm) digital storage phosphor plate system (pixel size 50 microm) (Fuji/Siemens). After diagnosis and preoperative wire localization, full-field digital mammography (CCD) (DR) was performed with the same exposure parameters. The full-field digital mammography used a CCD-detector (SenoScan) (Fisher Imaging) with a resolution of 10 Ip/mm and a pixel size of 50 microm. Five investigators determined the diagnosis (BI-RADS I - V) retrospectively after the operation from randomly distributed mediolateral views (hard copy reading). These results were correlated with the final histology.The diagnostic accuracy of digital storage plate mammography (CR) and full-field digital mammography (CCD) (DR) was 73 % and 71 % for all findings (n = 102), 73 % and 71 % for microcalcifications (n = 51), and 72 % and 70 % for focal lesions (n = 51). The overall results showed no difference.Our findings indicate the equivalence of high-resolution digital phosphor storage plate mammography (CR) and full-field digital mammography (CCD) (DR).

Experimental phantom study for the detection of simulated lesions with five different digital and one conventional screen-film mammography system.Three radiographs were obtained at various configurations of the phantom with one conventional screen-film system (Mammomat 3000 N) (Siemens), five digital systems (high resolution computed radiography system [Fuji/Siemens], one a-Si detector [GE Medical Systems], two a-Se detectors [Siemens; Hologic / Lorad] and one CCD detector [Fischer Imaging]), applying the same exposure parameters. The Wisconsin Mammographic Random Phantom, Model 152 A, was used. Five investigators with different experience in mammography (3 months to more than 4 years) evaluated the 18 randomly selected radiographs.No significant differences were found in the detection rate of simulated breast lesions for conventional screen-film mammography (84.9 %), high resolution computed radiography (86.7 %) and digital mammography with an a-Si detector (89.8 %). Highly significantly better results (p0.001) were found with the two a-Se systems (97.3 %) and the CCD system (100 %).Conventional screen-film mammography can be replaced by high resolution computed radiography and digital mammography with a-Si-, a-Se- and CCD-detectors. This has to be confirmed in further clinical studies.

Breast cancer is the most common malignant tumor in women: almost 10 % will suffer from breast cancer during their life and almost half of these will die of it. The spectrum of radiologic methods for diagnosing breast cancer is wide, including X-ray mammography, ultrasound, magnetic resonance mammography, and minimally invasive biopsies. After long-lasting controversies, breast cancer screening using X-ray mammography has now been introduced in Germany, following the projects in the Netherlands and Sweden. However, assessing mammographic films under screening conditions requires skills distinctly different from those needed under clinical conditions. This first part of two covers the histopathological basics and X-ray mammography; the second will deal with ultrasound of the breast and magnetic resonance mammography.