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Background Tuberculosis (TB) incidence declined in Portugal in recent decades, but trends differ between regions and population subgroups. We investigated these differences to inform prevention and control programmes. Methods We extracted TB notifications from the Portuguese National TB Surveillance System (SVIG-TB) in 2010–2017, disaggregated by region, age group, country of birth and HIV status. We calculated notification rates using denominators from the Portuguese National Institute of Statistics and the Joint United Nations Programme on HIV/AIDS and performed stratified time series analysis. We estimated interannual decline percentages and 95% confidence intervals (CI) using Poisson and binomial negative regression models. Results The overall TB notification rate decreased from 25.7 to 17.5/100,000 population from 2010 to 2017 (5.2%/year) in Portugal. Interannual decline did not differ significantly between regions, but it was smaller amongst non-Portuguese nationals (-1.57% [CI: -4.79%, 1.75%] vs -5.85% [CI: -6.98%, -4.70%] in Portuguese nationals); children under five years of age (+1.77% [CI: -4.61%, 8.58%] vs -5.38% [CI: -6.33%, -4.42%] in other age groups); and HIV-negative people (-6.47% [CI: -9.10%, -3.77%] vs -11.29% [CI; -17.51%, -4.60%] in HIV-positive). Conclusions The decline in TB notification rates in Portugal during the study period has been steady. However, the decline amongst non-Portuguese nationals, children under five years of age and non-infected-HIV patients was lower. No significant differences were observed between regions. Changes in TB epidemiology in specific risk groups and geographical areas should be closely monitored to achieve the objectives of the End TB Strategy. We recommend intensifying screening of TB in the subpopulations identified.

ObjectivesYoung people are a critical target group for sexually transmitted infections (STI) surveillance due to their particular behavioural and social related vulnerability. The aim of this study was to describe the epidemiological characteristics and trends in the incidence of gonorrhoea, syphilis, HIV and venereal lymphogranuloma (LGV) among 15–24-year-olds in Barcelona, and to determine factors associated with HIV coinfection.DesignWe performed a population-based incidence study covering the 2007–2015 period.ParticipantsAll new cases of STI—HIV, gonorrhoea, infectious syphilis and LGV—notified to the epidemiological surveillance system in Barcelona between 2007 and 2015. 1218 cases were studied: 84.6% were men, 19.3% were 15–19 years old and 50.6% were born in Spain. Among men, 73.7% were men who have sex with men (MSM); among women, 85.6% were women that have sex with men.Primary and secondary outcomesIncidence of HIV, gonorrhoea, infectious syphilis and LGV. HIV coinfection.ResultsThere was an increase in the incidence of gonorrhoea, from 1.9 cases per 10 000 people in 2007 to 7.6/10 000 in 2015 (p10 sexual partners (ORa=4.11, 95% CI 1.53 to 11.01) or STI diagnosis during the previous 12 months (ORa=2.06; 95% CI 1.13 to 3.77).ConclusionsThe incidence of gonorrhoea and syphilis among 15–24-year-olds increased, while HIV infection remained stable but with a high incidence among MSM. Being MSM, having sex with multiple partners and having a diagnosis of an STI in the previous 12 months were factors associated with HIV coinfection.

A fundamental goal in cancer research is to understand the mechanisms of cell transformation. This is key to developing more efficient cancer detection methods and therapeutic approaches. One milestone towards this objective is the identification of all the genes with mutations capable of driving tumours. Since the 1970s, the list of cancer genes has been growing steadily. Because cancer driver genes are under positive selection in tumorigenesis, their observed patterns of somatic mutations across tumours in a cohort deviate from those expected from neutral mutagenesis. These deviations, which constitute signals of positive selection, may be detected by carefully designed bioinformatics methods, which have become the state of the art in the identification of driver genes. A systematic approach combining several of these signals could lead to a compendium of mutational cancer genes. In this Review, we present the Integrative OncoGenomics (IntOGen) pipeline, an implementation of such an approach to obtain the compendium of mutational cancer drivers. Its application to somatic mutations of more than 28,000 tumours of 66 cancer types reveals 568 cancer genes and points towards their mechanisms of tumorigenesis. The application of this approach to the ever-growing datasets of somatic tumour mutations will support the continuous refinement of our knowledge of the genetic basis of cancer.

Objective To compare the pharmacokinetic profile of gadobutrol versus Gd-DTPA in dynamic contrast-enhanced MRI (DCE-MRI) in patients with breast cancer. Secondary objectives included comparing the safety profiles and diagnostic efficacy of the two contrast agents for detecting additional malignant lesions. Material and methods This retrospective observational study included 400 patients with histologically confirmed breast cancer; 200 underwent DCE-MRI with Gd-DTPA (Magnevist ® ) and 200 underwent DCE-MRI with gadobutrol (Gadovist ® ). Pharmacokinetic parameters and signal intensity were analyzed in a region of interest placed in the area within the lesion that had greatest signal intensity in postcontrast sequences. We compared the two groups on pharmacokinetic variables ( K trans , K ep , and V e ), time-signal intensity curves, and the number of additional malignant lesions detected. Results The relative signal intensity (enhancement) was higher with gadobutrol than with Gd-DTPA. Washout was lower with gadobutrol than with Gd-DTPA (46% vs. 58.29%, respectively; p = 0.0323). Values for K trans and K ep were higher for gadobutrol ( p = 0.001). There were no differences in the number of histologically confirmed additional malignant lesions detected ( p = 0.387). Conclusions Relative enhancement is greater with gadobutrol, but washout is more pronounced with Gd-DTPA. The number of additional malignant lesions detected did not differ between the two contrast agents. Both contrasts are safe.

Background: Prenatal and postnatal exposure to air pollution has been linked to cognitive impairment in children, but very few studies have assessed its association with attentional function. Objectives: To evaluate the association between prenatal and postnatal exposure to nitrogen dioxide (NO2) and attentional function in children at 4–5 years of age. Methods: We used data from four regions of the Spanish INMA—Environment and Childhood—Project, a population-based birth cohort. Using land-use regression models (LUR), we estimated prenatal and postnatal NO2 levels in all of these regions at the participants' residential addresses. We assessed attentional function using the Kiddie-Conners Continuous Performance Test (K-CPT). We combined the region-specific adjusted effect estimates using random-effects meta-analysis. Results: We included 1298 children with complete data. Prenatal exposure to NO2 was associated with an impaired standard error of the hit reaction time (HRT(SE)) (increase of 1.12 ms [95% CI; 0.22 a 2.02] per 10 μg/m3 increase in prenatal NO2) and increased omission errors (6% [95% CI; 1.01 to 1.11] per 10 μg/m3 increase in prenatal NO2). Postnatal exposure to NO2 resulted in a similar but borderline significant increase of omission errors (5% [95% CI; =0.99 to 1.11] per 10 μg/m3 increase in postnatal NO2). These associations did not vary markedly between regions, and were mainly observed in girls. Commission errors and lower detectability were associated with prenatal and postnatal exposure to NO2 only in some regions. Conclusions: This study indicates that higher exposure to ambient NO2, mainly during pregnancy and to a lesser extent postnatally, is associated with impaired attentional function in children at 4–5 years of age., This study was funded by grants from the Instituto de Salud Carlos III (Red INMA G03/176; CB06/02/0041 and PI031615; PI041931; PI041112; PI041436; PI041509; PI042018; PI051079; PI051052; PI060867; PI061213; PI070314; CP1100178; PI081151 incl. FEDER funds; PS0900090 incl. FEDER funds; PI0902311 incl. FEDER funds; PI0902647 incl. FEDER funds; PI1102591 incl. FEDER funds; PI1102038 incl. FEDER funds; PI131944 incl. FEDER funds; PI132032 incl. FEDER funds; PI1302429 incl. FEDER funds; PI1302187 incl. FEDER funds; PI140891 incl. FEDER funds; PI141687 incl. FEDER funds and MS13/00054), Generalitat de Catalunya-CIRIT 1999SGR 00241, Fundació La marató de TV3 (090430), Department of Health of the Basque Government (2005111093, 2009111069 and 2013111089), the Provincial Government of Gipuzkoa (DFG06/002 and DFG08/001), Convenios anuales con los ayuntamientos de la zona del estudio (Zumarraga, Urretxu, Legazpi, Azkoitia y Azpeitia y Beasain), from UE (FP7-ENV-2011 cod 282957 and HEALTH.2010.2.4.5-1), from the European Research Council under the ERC Grant Agreement number ERC-AdG 2010 GA#268479 – the BREATHE project, from the Conselleria de Sanitat of Generalitat Valenciana (AP212/11, 002/008, 012/009, 013/2009, 014/009, 015/008, 016/009, 021/007, 021/008, 023/008 and 024/007) and from Obra Social Cajastur/Fundación Liberbank and Universidad de Oviedo. ISGlobal is a member of the CERCA Programme, Generalitat de Catalunya.

Background: Adult T cell acute lymphoblastic leukemia (T-ALL) is a rare disease that affects less than 10 individuals in one million. It has been less studied than its cognate pediatric malignancy, which is more prevalent. A higher percentage of the adult patients relapse, compared to children. It is thus essential to study the mechanisms of relapse of adult T-ALL cases. Results: We profile whole-genome somatic mutations of 19 primary T-ALLs from adult patients and the corresponding relapse malignancies and analyze their evolution upon treatment in comparison with 238 pediatric and young adult ALL cases. We compare the mutational processes and driver mutations active in primary and relapse adult T-ALLs with those of pediatric patients. A precise estimation of clock-like mutations in leukemic cells shows that the emergence of the relapse clone occurs several months before the diagnosis of the primary T-ALL. Specifically, through the doubling time of the leukemic population, we find that in at least 14 out of the 19 patients, the population of relapse leukemia present at the moment of diagnosis comprises more than one but fewer than 108 blasts. Using simulations, we show that in all patients the relapse appears to be driven by genetic mutations. Conclusions: The early appearance of a population of leukemic cells with genetic mechanisms of resistance across adult T-ALL cases constitutes a challenge for treatment. Improving early detection of the malignancy is thus key to prevent its relapse. The authors would like to thank the Asociación Española Contra el Cáncer (AECC) for financially supporting this project (GC16173697BIGA). N.L.-B. acknowledges funding from the European Research Council (consolidator grant 682398) and the ERDF/Spanish Ministry of Science, Innovation and Universities–Spanish State Research Agency/DamReMap Project (RTI2018-094095-B-I00). S. G work is supported by the European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement No. 754510. I. S is supported by FPI fellowship from Spanish Ministry of Economy and Competitiveness (project reference SAF2015-66084-R). V.G-H. is supported by the AECC (project reference GC16173697BIGA-9). IRB Barcelona is a recipient of a Severo Ochoa Centre of Excellence Award from the Spanish Ministry of Economy and Competitiveness (MINECO; Government of Spain) and is supported by CERCA (Generalitat de Catalunya).

SummaryCancers arise through the acquisition of oncogenic mutations and grow through clonal expansion1, 2. Here we reveal that most mutagenic DNA lesions are not resolved as mutations within a single cell-cycle. Instead, DNA lesions segregate unrepaired into daughter cells for multiple cell generations, resulting in the chromosome-scale phasing of subsequent mutations. We characterise this process in mutagen-induced mouse liver tumours and show that DNA replication across persisting lesions can generate multiple alternative alleles in successive cell divisions, thereby increasing both multi-allelic and combinatorial genetic diversity. The phasing of lesions enables the accurate measurement of strand biased repair processes, the quantification of oncogenic selection, and the fine mapping of sister chromatid exchange events. Finally, we demonstrate that lesion segregation is a unifying property of exogenous mutagens, including UV light and chemotherapy agents in human cells and tumours, which has profound implications for the evolution and adaptation of cancer genomes.

There is conflicting evidence about factors associated with failure to complete treatment (FCT) for latent tuberculosis infection (LTBI). We aim to identify the geographic, sociodemographic, and medical factors associated with FCT in Portugal, highlighting the two main metropolitan areas of Porto and Lisbon. We performed a retrospective cohort study including LTBI patients that started treatment in Portugal between 2013 and 2017. We calculated adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) using multivariable logistic regression to identify geographic, sociodemographic, and medical factors associated with FCT. Data on completion of treatment were available for 15,478 of 17,144 patients (90.3%). Of those, 2132 (13.8%) failed to complete treatment. Factors associated with FCT were being older than 15 years (aOR, 1.65 (95% CI = 1.34–2.05) for those aged 16 to 29), being born abroad (aOR, 2.04 (95% CI = 1.19–3.50) for Asia; aOR, 1.57 (95% CI = 1.24–1.98) for Africa), having a chronic disease (aOR, 1.29 (95% CI = 1.04–1.60)), alcohol abuse (aOR, 2.24 (95% CI = 1.73–2.90)), and being intravenous drug user (aOR, 1.68 (95% CI = 1.05–2.68)). Three-month course treatment with isoniazid plus rifampicin was associated with decreased FCT when compared with 6- or 9-month courses of isoniazid-only (aOR, 0.59 (95% CI = 0.45–0.77)). In Lisbon metropolitan area, being born in Africa, and in Porto metropolitan area, alcohol abusing and being intravenous drug user were distinctive factors associated with FCT. Sociodemographic and medical factors associated with FCT may vary by geographical area and should be taken into account when planning interventions to improve LTBI treatment outcomes. This study reinforces that shorter course treatment for LTBI might reduce FCT. Mònica Guxens is funded by a Miguel Servet II fellowship (CPII18/00018) awarded by the Spanish Institute of Health Carlos III. The rest of the authors have declared no funding.

The aim of this paper is to evaluate the spatial glandular volumetric tissue distribution as well as the density measures provided by Volpara™ using a dataset composed of repeated pairs of mammograms, where each pair was acquired in a short time frame and in a slightly changed position of the breast. Materials and methods We conducted a retrospective analysis of 99 pairs of repeatedly acquired full-field digital mammograms from 99 different patients. The commercial software Volpara™ Density Maps (Volpara Solutions, Wellington, New Zealand) is used to estimate both the global and the local glandular tissue distribution in each image. The global measures provided by Volpara™, such as breast volume, volume of glandular tissue, and volumetric breast density are compared between the two acquisitions. The evaluation of the local glandular information is performed using histogram similarity metrics, such as intersection and correlation, and local measures, such as statistics from the difference image and local gradient correlation measures. Results Global measures showed a high correlation (breast volume R = 0.99, volume of glandular tissue R = 0.94, and volumetric breast density R = 0.96) regardless the anode/filter material. Similarly, histogram intersection and correlation metric showed that, for each pair, the images share a high degree of information. Regarding the local distribution of glandular tissue, small changes in the angle of view do not yield significant differences in the glandular pattern, whilst changes in the breast thickness between both acquisition affect the spatial parenchymal distribution. Conclusions This study indicates that Volpara™ Density Maps is reliable in estimating the local glandular tissue distribution and can be used for its assessment and follow-up. Volpara™ Density Maps is robust to small variations of the acquisition angle and to the beam energy, although divergences arise due to different breast compression conditions This work was partially funded by the Ministry of Economy and Competitiveness of Spain grant under project reference DPI2015-68442-R and by Universitat de Girona by UdG grant MPCUdG2016/022. Eloy Garcıa holds a FPI grant BES-2013-065314. Oliver Diaz is funded by the SCARtool project (H2020-MSCA-IF-2014, reference 657875), a research funded by the European Union within the Marie Sklodowska-Curie Innovative Training Networks

Background To determine the risk of hospital readmission and associated factors in patients with a positive sample for multidrug-resistant microorganisms (MRM) and to analyze whether there is a higher risk of hospital readmission with some of the more common MRM. Methods Retrospective cohort study (2012–16) performed in a tertiary-care teaching hospital in Barcelona. Patients were divided into two groups, depending on the presence or absence of an MRM-positive sample during hospital admission. Logistic regression models were used to estimate the risk of hospital readmission in the first 30 and 90 days, and the first year for patients with an MRM-positive sample compared with those without. The models were stratified by the presence or absence of an MRM-positive sample and by grouped Charlson comorbidity index. Results We included 983 patients with an MRM-positive sample and 39 323 patients without. The risk of hospital readmission in the first 30 days was 41% higher in admitted patients with an MRM-positive sample (95%CI=1.17 to 1.69) than in those without. Stratified models showed similar results to the overall results for all Charlson comorbidity index groups. When the models were stratified by the presence of an MRM-positive sample, methicillin-resistant Staphylococcus aureus showed the highest risk of readmissions within the more common MRM [103% (95%CI=1.10 to 3.75)]. Conclusion MRMs seem to be an important risk factor for hospital readmissions both among patients with and without comorbidities. Specific types of MRM may represent a higher risk for hospital readmissions than other MRMs, depending on the particular environment or hospital.

Objectives To evaluate the morphokinetic, pharmacokinetic, and diffusion characteristics of triple-negative breast cancers on magnetic resonance (MR) imaging and to analyze whether there is a relation between these parameters and the time to progression. Material and methods This was a retrospective observational study of a consecutive series of 100 patients with histologically confirmed triple-negative breast cancer studied at our center between January 2005 and December 2010. We reviewed the findings on MR locoregional extension studies, the histological findings, and the follow-up of patients until August 2014. Results The most common MR findings for these tumors were a rounded mass (47.3%), well-defined borders (53.7%), ring enhancement (46.2%), type 3 curves (50.5%), hyperintensity within the tumor on T2-weighted sequences, high ADC values (1.04 × 10 −3 mm 2 /s), and increased capillary permeability (Kep) (0.94 min −1 ). No significant association was observed between the morphokinetic or pharmacokinetic characteristics and the time to progression. The in situ component in the surgical specimens was high, although its expression was low. During follow-up, 25% of patients had metastases, with a predilection for the visceral organs, and survival was low. Conclusion Tumors with the triple-negative phenotype mostly presented in MR as rounded tumors with well-defined borders and ring enhancement. We found no significant association between the morphokinetic or pharmacokinetic characteristics and the time to progression.

Breast density is a strong risk factor for breast cancer. In this paper, we present an automated approach for breast density segmentation in mammographic images based on a supervised pixel-based classification and using textural and morphological features. The objective of the paper is not only to show the feasibility of an automatic algorithm for breast density segmentation but also to prove its potential application to the study of breast density evolution in longitudinal studies. The database used here contains three complete screening examinations, acquired 2 years apart, of 130 different patients. The approach was validated by comparing manual expert annotations with automatically obtained estimations. Transversal analysis of the breast density analysis of craniocaudal (CC) and mediolateral oblique (MLO) views of both breasts acquired in the same study showed a correlation coefficient of ρ = 0.96 between the mammographic density percentage for left and right breasts, whereas a comparison of both mammographic views showed a correlation of ρ = 0.95. A longitudinal study of breast density confirmed the trend that dense tissue percentage decreases over time, although we noticed that the decrease in the ratio depends on the initial amount of breast density This work was partially funded by the Spanish R+D+I grant no. TIN2012-37171-C02-01

The main objective of this article is to review the various radiological findings that appear in mammography, ultrasound and magnetic resonance after conservative surgery and radiotherapy for breast cancer, and in particular lesions mimicking malignancy. Identification of the benign changes and their progression frequently associated with conservative treatments will enable physician to provide the optimal follow-up to these patients, and allow the different patterns of local recurrence to be detected early. Diagnostic Radiology Department teaching files were used to select the most illustrative images. © 2012 SESPM. Published by Elsevier Espana, S.L. All rights reserved.

Background. Longer and more frequent dialysis sessions have demonstrated excellent survival and clinical advantages, while online haemodiafiltration (OL-HDF) provides the most efficient form of dialysis treatment. The aim of this study was to evaluate the beneficial effects of a longer (nocturnal) and more frequent (every-other-day) dialysis schedule with OL-HDF at the same or the highest convective volume. Methods. This prospective, in-centre crossover study was carried out in 26 patients, 18 males and 8 females, 49.2 6 14 years old, on 4–5 h thrice-weekly post-dilution OL-HDF, switched to nocturnal every-other-day OL-HDF. Patient inclusion criteria consisted of stable patients with good vascular access and with good prospects for improved occupational, psychological and social rehabilitation. Patients were randomly assigned into two groups: Group A received the same convective volume as previously for 6 months followed by a higher convective volume for a further 6 months, while Group B received the same schedule in reverse order. Results. Nocturnal every-other-day OL-HDF was well tolerated and 56% of patients who were working during the baseline period continued to work throughout the study with practically no absenteeism. The convective volume was 26.7 6 2 L at baseline, 27.5 6 2 with the unchanged volume and 42.9 6 4 L with the higher volume. eKt/V increased from 1.75 6 0.4 to 3.37 6 0.9. Bicarbonate, blood urea nitrogen (BUN) and creatinine values decreased, while phosphate levels fell markedly with a 90% reduction in phosphate binders. Blood pressure and left ventricular hypertrophy (LVH) improved and the use of anti-hypertensive drugs decreased. In both groups, BUN, creatinine and b2-microglobulin reduction ratios improved. Different removal patterns were observed for myoglobin, prolactin and a1-acid glycoprotein. Conclusions. Nocturnal every-other-day OL-HDF could be an excellent therapeutic alternative since good tolerance and occupational rehabilitation, marked improvement in dialysis dose, nutritional status, LVH, phosphate and hypertension control and a substantial reduction in drug requirements were observed. In this crossover study, different removal patterns of large solutes were identified.

et al., [Background]: Osteoarthritis is the most prevalent joint disease and a frequent cause of joint pain, functional loss, and disability. Osteoarthritis often becomes chronic, and conventional treatments have demonstrated only modest clinical benefits without lesion reversal. Cell-based therapies have shown encouraging results in both animal studies and a few human case reports. We designed a pilot study to assess the feasibility and safety of osteoarthritis treatment with mesenchymal stromal cells (MSCs) in humans and to obtain early efficacy information for this treatment. [Methods]: Twelve patients with chronic knee pain unresponsive to conservative treatments and radiologic evidence of osteoarthritis were treated with autologous expanded bone marrow MSCs by intra-articular injection (40×10 cells). Clinical outcomes were followed for 1 year and included evaluations of pain, disability, and quality of life. Articular cartilage quality was assessed by quantitative magnetic resonance imaging T2 mapping. [Results]: Feasibility and safety were confirmed, and strong indications of clinical efficacy were identified. Patients exhibited rapid and progressive improvement of algofunctional indices that approached 65% to 78% by 1 year. This outcome compares favorably with the results of conventional treatments. Additionally, quantification of cartilage quality by T2 relaxation measurements demonstrated a highly significant decrease of poor cartilage areas (on average, 27%), with improvement of cartilage quality in 11 of the 12 patients. [Conclusions]: MSC therapy may be a valid alternative treatment for chronic knee osteoarthritis. The intervention is simple, does not require hospitalization or surgery, provides pain relief, and significantly improves cartilage quality.

Introduction The spontaneous pneumomediastinum is an extremely rare condition. We hereby present a case of this pathology. Clinical case 17 year-old man who suffered a low-energy motorcycle accident and came into the emergency department complaining of headache and neck pain. Physical examination showed echolalia and retrograde amnesia and crepitation on the anterior and right lateral part of the neck. No other physical signs were found. Plain radiographs and a CT-scan showed air in the right jugular vein. With the diagnosis of spontaneous pneumomediastinum, the patient remained under observation. With rest and analgesia the patient improved within the next hours and was discharged without any complication. The case is presented and the literature is reviewed. Conclusions Spontaneous pneumomediastinum is a normally benign pathology that tends to resolve favorably without any treatment.

To (a) determine the diagnostic validity of axillary ultrasound (AUS) in pT1 tumours and whether fine-needle aspiration (FNA) improves its diagnostic performance, and (b) determine the negative predictive value (NPV) of AUS in a simulation environment (cutoff: two lymph nodes with macrometastases) in patients fulfilling American College of Surgeons Oncology Group (ACOSOG) Z0011 criteria. This retrospective multicentre cross-sectional study analysed diagnostic accuracy in 355 pT1 breast cancers. All patients underwent AUS; visible nodes underwent FNA regardless of their AUS appearance. Sentinel node biopsy and axillary lymph node dissection (ALND) were gold standards. Data were analysed considering micrometastases ‘positive’ and considering micrometastases ‘N negative’. The simulation environment included all patients fulfilling ACOSOG Z0011 criteria. Axillary involvement: 22.8 %; AUS sensitivity: 46.9 % (Nmic positive)/66.7 % (Nmic negative); AUS+FNA sensitivity: 52.6 % (pNmic positive)/72.0 % (pNmic negative). In the simulation environment, AUS had 75.0 % sensitivity, 88.9 % specificity and 99.2 % NPV. AUS has moderate sensitivity in T1 tumours. As ALND is unnecessary in micrometastases, considering micrometastases ‘N negative’ increases the practical impact of AUS. In patients fulfilling ACOSOG Z0011 criteria, AUS alone can predict cases unlikely to benefit from ALND. • AUS+FNA can predict axillary involvement, thus avoiding SNB. • Not all patients with axillary involvement need ALND. • Axillary tumour load determines axillary management. • AUS could classify patients according to axillary load.

The physiological changes which take place during pregnancy and lactation could make evaluating breast lesions difficult for both for the clinical physician and radiologist. Lactating adenoma, a benign breast lesion which presents itself as a solid palpable mass, is among those specific lesions which might appear during such periods. Herein we present two cases, along with a discussion of management, radiological findings and differential diagnosis. Pertinent bibliography is also reviewed.

Prospective studies focusing on the relationship between diabetic retinopathy and the presence of microalbuminuria are lacking. The objective of the present study was to determine the potential relationship between both forms of diabetic microangiopathy by means of a five-year long prospective study in which 104 patients with type 1 diabetes mellitus and with no retinal involvement at the beginning of the study were included. At the end of the study four groups of patients emerged: group 1, made up of 63 patients without both retinal involvement and microalbuminuria; group 2, made up of 17 patients with both retinopathy and microalbuminuria; group 3, with 16 patients with retinopathy but without microalbuminuria, and group 4, with eight patients with microalbuminuria only. In the statistical study, a direct significance was observed for both increased levels of HbA1c and total cholesterol; and a reverse significance for increased levels of HDL-cholesterol as well as the presence of diastolic arterial hypertension, for group 2 (patients with both retinopathy and microalbuminuria). For group 3, increased levels of triglycerides and evolution time (patients with retinopathy but without microalbuminuria) were significant. In the present study we conclude that microalbuminuria is not a good marker for diabetic microangiopathy defined as renal and retinal involvement, although its presence prompt us to watch more frequently the ocular fundus in diabetic patients.

Primary non-Hodgkin's lymphoma (NHL) of the breast are rare and represent less than 0.6% of all mammary malignancies. Secondary involvement of the breast in patients with diffuse disease occurs more frequently. The radiologic features of breast lymphoma are nonspecific, and the diagnosis is based on histologic criteria. We present the MR-imaging features of a case of primary NHL of the breast.

Mediastinoscopic injuries to the tracheobronchial tree are rare. We report 2 (0.1%) cases of injury to the right main bronchus in 1743 mediastinoscopies. Both injuries, of 1 cm and 0.3 cm in size, were caused by the bipolar scissors used at initial staging mediastinoscopy and at remediastinoscopy. The larger lesion was sutured through a bi-valved mediastinoscope, and fibrin glue was spread over the suture line; the smaller one was covered with haemostatic tissue. No complications such as pneumomediastinum, pneumothorax, or mediastinitis occurred. Bipolar scissors should be used with caution. Mediastinoscopic repair of injuries to the right main bronchus is possible and should be attempted before relying to thoracotomy.

The objective of this study was to assess the usefulness of stereotactic large-core needle biopsy (LCNB) in the management of nonpalpable breast lesions (NBL) and compare it with stereotactic fine-needle aspiration biopsy (SFNA) performed simultaneously in a significant number of cases. From November 1993 through June 1997, 510 consecutive patients with NBL underwent 14-gauge LCNB with 354 women undergoing simultaneous 21-gauge SFNA in the same lesion. Mammographic findings, lesion size, number of core biopsy specimens, complications and diagnoses of both techniques were analysed. Surgical biopsy, tumorectomy or mastectomy was indicated for malignancy or poor correlation between SFNA or LCNB results and clinical or radiological findings. Values of diagnostic accuracy of both LCNB and SFNA were determined. The ratio benign surgical biopsies/malignant surgical biopsies (BB/CB) of the series was calculated. A total of 171 patients underwent surgical treatment; in 31 (18.1 %) a benign process or atypical ductal hyperplasia was the final diagnosis. The ratio BB/CB was 0.22. Sensitivity and specificity were 93.2 and 100 %, respectively, for LCNB, and 77.2 and 92.3 %, respectively, for SFNA with cytological analysis. Large-core needle biopsy provides more accurate diagnosis than SFNA in the management of nonpalpable breast lesions and obviates a surgical diagnostic procedure in a significant number of cases.

The transcervical route is a traditional approach to the mediastinum for staging of non-small cell lung cancer, diagnosis of masses of unknown origin, and resection of the thymus. Also, the transcervical approach may be an adequate surgical access either alone or in combination with different techniques in the management of other mediastinal disorders. This procedure can be used to total removal of tumors located in the middle and anterosuperior mediastinum, such as cysts or ectopic parathyroid adenomas. Cervical and mediastinal debridement and drainage is the first therapeutic option and, sometimes, the only elective treatment in patients with descending necrotizing mediastinitis confined to the superior mediastinum. The transcervical approach is considered to be a safe and minimally invasive procedure, but a thoracic surgeon with experience in both open and endoscopic access to the mediastinum is required for success.

Ultrasound imaging is considered an important complementary technique for the screening of dense breasts. Detection of lesions at an early stage is a key step in which computerized lesion detection systems could play an important role in the analysis of US images. In this article, we propose adaptation of a generic object detection technique, deformable part models, to detect lesions in breast US images. The data set used in this study included 326 images, all from different patients (54 malignant lesions, 109 benign lesions and 163 healthy breasts). In terms of lesion detection, our proposal outperformed some of the most relevant approaches described in the literature; we obtained a sensitivity of 86% with 0.28 false-positive detection per image and an Az value of 0.975. In the detection of malignant lesions, our proposed approached had an Az value of 0.93 and a sensitivity of 78% at a 1.15 false-positive detections per image.

et al., [Background]: Osteoarthritis is the most prevalent joint disease and a frequent cause of joint pain, functional loss, and disability. Osteoarthritis often becomes chronic, and conventional treatments have demonstrated only modest clinical benefits without lesion reversal. Cell-based therapies have shown encouraging results in both animal studies and a few human case reports. We designed a pilot study to assess the feasibility and safety of osteoarthritis treatment with mesenchymal stromal cells (MSCs) in humans and to obtain early efficacy information for this treatment. [Methods]: Twelve patients with chronic knee pain unresponsive to conservative treatments and radiologic evidence of osteoarthritis were treated with autologous expanded bone marrow MSCs by intra-articular injection (40×106 cells). Clinical outcomes were followed for 1 year and included evaluations of pain, disability, and quality of life. Articular cartilage quality was assessed by quantitative magnetic resonance imaging T2 mapping. [Results]: Feasibility and safety were confirmed, and strong indications of clinical efficacy were identified. Patients exhibited rapid and progressive improvement of algofunctional indices that approached 65% to 78% by 1 year. This outcome compares favorably with the results of conventional treatments. Additionally, quantification of cartilage quality by T2 relaxation measurements demonstrated a highly significant decrease of poor cartilage areas (on average, 27%), with improvement of cartilage quality in 11 of the 12 patients. [Conclusions]: MSC therapy may be a valid alternative treatment for chronic knee osteoarthritis. The intervention is simple, does not require hospitalization or surgery, provides pain relief, and significantly improves cartilage quality.

A mediastinal enteric cyst is an uncommon entity which is rare in adults and usually found incidentally. In most cases the lesion is lined by gastrointestinal mucosa, and theories as to the origin of such lesions are diverse. We report an adult case of thoracic enteric cyst that presented with cardiac tamponade and for which histopathological examination revealed the presence of pancreatic tissue. Review of the literature yielded only 1 case of mediastinal enteric cyst with pancreatic tissue.

Ross syndrome is characterized by a triad of tonic pupil, areflexia and segmental hypohidrosis. Hypohidrosis may be accompanied by contralateral hyperhidrosis, probably due to a compensatory mechanism. We report a case of Ross syndrome with socially disabling left-sided hyperhidrosis. Sympathectomy of the second and third thoracic ganglia was performed with satisfactory results. With excellent results in primary hyperhidrosis and very low morbidity, thoracic sympathectomy is the definitive treatment for hyperhidrosis.

Detection of lesions in ultrasound imaging typically requires human analysis due to their complexity. Hence, computerized lesion detection methods could be used to help radiologists in this process due to the fact that an early detection reduces the death rate caused by breast cancer. In this paper we propose a first experiment of a feasibility study for adapting a generic object detection technique, Deformable Part Models (DPM), to detect lesions in breast US images without any kind of human supervision. This technique has been evaluated in different topics obtaining prominent results. Hence, we propose a first assessment of this methodology applied to lesion detection in US images. We used a data-set composed by 50 images, all from different patients (18 malignant lesions, 32 benign lesions and 50 healthy tissue regions). In terms of quantitative results for lesion detection, our proposal obtains a sensitivity of 82% with 0.51 false-positive detections per image and an A z value of 0.96, which proves the feasibility of the proposal.

The Chronic Respiratory Disease Questionnaire (CRDQ), proposed by Guyatt et al, is a specific instrument used to assess quality of life in patients with chronic obstructive pulmonary disease (COPD). Our aim was to translate the questionnaire and validate it so that it could then be used as a measurement instrument in programs of respiratory rehabilitation. Sixty-five patients with COPD who were candidates for breathing therapy were enrolled in the study. Mean age was 64 +/- 7 years and all had severe air flow limitation, with FEV1 33 +/- 13% over reference values but not respiratory failure (pO2 70 +/- 10 mmHg). The questionnaire was subjected to a process of translation/back translation and disagreements over wording were discussed by a panel of bilingual speakers and the author himself. The validation process involved the following steps: 1) a comprehension study with a group of 5 patients, which revealed no special difficulties; 2) analysis of internal consistency or reliability by way of Crombach's alpha coefficient, which gave and overall score of 0.92 and area scores of 0.51 for dyspnea, 0.8 for fatigue, 0.86 for emotional factors and 0.84 for disease control, and 3) analysis of correlation between various lung function parameters and exercise test results (6 min of increasing effort and a stationary cycle), which showed weak but statistically significant correlations that were comparable to those found by the author of the original CRDQ.(ABSTRACT TRUNCATED AT 250 WORDS)

Mammographic density is strongly associated with breast cancer, being considered one of the most important risk indicators for the development of this type of disease. Likewise, the sensitivity of automatic breast lesion detection systems is significantly dependent on breast tissue characteristics. Therefore, the measurement of density is definitely useful for detecting breast cancer. The aim of this work is to adapt our previously developed automatic breast tissue density classification methodology for digitized mammograms to full-field digital mammograms (FFDM), as well as to evaluate the possible improvements and the classification results. After breast area extraction and peripheral enhancement, the method segments the breast area into fatty and dense tissue, then morphological and texture features from each class are extracted and finally FFDM are classified according to a standard qualitative criteria. Results show a strong correlation (κ=0.88) between automatic and expert assessments and a better classification correction percentage (CCP = 92%) compared to our earlier work.

Breast lesion boundaries have been mostly extracted by using conventional approaches as a previous step in the development of computer-aided diagnosis systems. Among these, region growing is a frequently used segmentation method. To make the segmentation completely automatic, most of the region growing methods incorporate automatic selection of the seed points. This paper proposes a new automatic seed placement algorithm for breast lesion segmentation on ultrasound images by means of assigning the probability of belonging to a lesion for every pixel depending on intensity, texture and geometrical constraints. The proposal has been evaluated using a set of sonographic breast images with accompanying expert-provided ground truth, and successfully compared to other existing algorithms.

espanolFundamento: La etiologia de la maloclusion puede ser multifactorial y dificil de clasificar durante el desarrollo del individuo. Los objetivos del estudio son conocer las caracteristicas de la maloclusion y su posible relacion con las alteraciones funcionales y los habitos orales. Metodos: Se estudio a 1.270 individuos representativos de la poblacion escolar de Cataluna; 596 ninos y 674 ninas de entre 6 y 14 anos. Se obtuvo informacion mediante registros clinicos y cuestionarios. Se trata de un estudio observacional descriptivo mixto transversal, llevado a cabo entre 2006 y 2007 a traves de un muestreo no probabilistica de conveniencia. Se ha realizado el calibrado de los examinadores. Resultados: Fueron incluidos 1051 escolares con una edad media de 9,32 anos. El 72,8% presenta segun Angle Clase I, 19,0% y 5,2% Clase II/1 y II/2 respectivamente y 2,9% Clase III. El habito onicofagia fue el mas frecuente con un 46,4%. El mayor nivel de limitacion funcional fue la hipertrofia amigdalar con un 21,2%. Existe relacion estadisticamente significativa entre maloclusion sagital y tipo de respiracion y movilidad lingual y entre maloclusion horizontal y tiempo de succion digital y movilidad lingual (p Conclusiones: El diagnostico de alteraciones funcionales y de habitos orales puede advertir de la presencia de maloclusion. EnglishBackground: Etiology of malocclusion may be multifactor and difficult to classify during the development of the individual. The aim of this study is to identify the malocclusion characteristics in a school student population and find the possible relation with functional and oral habit alteration. Material and method: 1270 individuals representative of the school population of Catalonia were studied: 596 boys and 674 girls between 6 and 14 years. Information was obtained through medical records and questionnaires. A mixed observational-descriptive transversal study has been done in the period between 2006 and 2007 that was selected by a non-probabilistic convenience sampling. Interexamination calibration was preformed. Results: 1051 schoolchildren were included in the study with a mean age of 9.32 years. 72.8% presented as Angle Class I, 19.0% and 5.2% Class II / 1 and II / 2, respectively and 2.9% Class III. Nail biting habit was the most frequent habit with 46.4%. The highest level of functional limitation was tonsils hypertrophy with 21.2%. There is a statically significant relationship between sagittal malocclusion and respiration type and tongue mobility, and between horizontal malocclusion and digital suction and tongue mobility (p Conclusions: The diagnosis of functional disorders and oral habits can be a warning of the presence of malocclusion.

Corporacio Sanitaria Parc Tauli, Sabadell (Barcelona), Spain. Corresponding author: Melchor Sentis, MD Breast Radiology Department UDIAT Centre Diagnos tic Corporacio Sanitaria Parc Tauli, Parc Tauli, S/N 08208 -Sabadell (Barcelona). Spain E -mail: msentis@tauli.cat Phone: +34 93 723 10 10 Fax: +34 93 717 50 67

Fat necrosis of the breast is a common benign inflammatory process resulting from injury to breast fat. The pathogenesis of fat necrosis helps to explain its imaging features, which range from benign to malignant-appearing findings. This article reviews the role of magnetic resonance mammography and other conventional imaging techniques in the differential diagnosis of fat necrosis.

The frequency of interval cancers (IC) can be an indicator inversely related to the quality of a breast screening programme. The objectives were to estimate the frequency of IC, to classify IC by posterior radiological review, and to describe the prognostic factors of these IC. The setting was the Sabadell-Cerdanyola Breast Cancer Screening Programme, in Northeast Spain. We developed a population-based study of the IC occurring in the first three rounds (1995-2001). The indicators used were the incidence rate of invasive IC per 10 000 women screened and the proportional incidence, stratified by age group, type of screening and the round, and the time elapsed since the last screening mammogram. A radiological informed consensus review was used to classify the IC. No specific pattern of incidence rates was evident with respect to age, type of screening, or round, although screening was generally more sensitive in women aged 60-69 years. The proportional incidence for the period 0-11 months was always under 30%. Twenty-one percent of 38 IC evaluated (95% CI: 8.0-34.0) were attributed to errors in the screening process (false negatives). No major differences in the prognostic factors of the 57 IC were identified on examining the radiological type or the time since the last screening mammogram. We observed a high frequency of IC from 12 months after screening. It is necessary to reach a consensus regarding the definition and the analysis of IC and to establish mechanisms that would allow all the malignant tumours diagnosed in the target population to be identified.

A61-year-old woman was treated for a ductal invasive carcinoma in the right breast (mastectomy, axillary dissection and chemotherapy in 1990, and breast reconstruction with submuscular Becker silicone outside ⁄ saline inside double lumen prosthesis in 1994). In 2002, she presented with a progressive shrinkage of the right breast volume since 2000, after a traffic accident. A rupture of the implant was suggested. For this reason, a magnetic resonance imaging examination with specific prosthesis sequences and contrast-enhanced dynamic study was performed, showing both intracapsular rupture (linguini sign) and silicone bleeds outside the implant capsule (Fig. 1a,b). Although contrast-enhanced magnetic resonance study showed no appreciable enhancement, there was an evidence of a right internal mammary node measuring 1 cm (Fig. 1c). The significance of the node was uncertain, but on clinical considerations (possible regional spread of breast cancer), this lymph node was excised at the same time as the breast implant removal. Pathologic examination identified an histiocytic infiltrate with multinucleated giant cells, vacuoles, and refractive material consistent with silicone lymphadenopathy (Fig. 2). Magnetic resonance imaging was repeated 12 months after the initial study and showed no implant complications (a single lumen entirely gelfilled prosthesis reimplantation) or contrast enhancement. However, a new right internal mammary node measuring 0.8 cm was demonstrated (Fig. 3). Because of the similarity of its appearance to that seen before, the node was not removed. On follow-up 12 months

Our goal was to compare in-phase (IP) and opposed-phase (OP) GRE and conventional SE sequences in T1-weighted (T1-W) imaging of the liver and to evaluate chemical shift GRE imaging in characterizing liver/lesions for fat content.IP and OP T1-W GRE with fast low angle shot (FLASH) technique and T1-W SE sequences were compared in 162 patients at 1.0 T. Chemical shift GRE imaging was used to characterize lesions with fat content. Two hundred sixteen lesions were analyzed in three groups of liver: (a) "normal" liver (n = 74 with 110 lesions); (b) cirrhotic liver (n = 76 with 85 lesions); and (c) fatty liver (n = 12 with 21 lesions). Liver/lesion contrast and liver/lesion contrast-to-noise ratio were assessed for lesion detectability. The percentage of signal intensity variation (SIV) between IP and OP images was used to characterize lesions for fat content.The OP GRE sequence had significantly higher contrast for normal and cirrhotic livers (p0.001), and the IP GRE sequence had significantly higher contrast and contrast-to-noise ratio for fatty liver (p0.001). There were no significant differences between OP, IP, and T1-W SE imaging in cirrhotic cases for contrast-to-noise ratio (p0.28). Chemical shift imaging detected fat in 21 lesions (9.7%, mean SIV, 191.1%) (sensitivity and specificity 100% when compared with fine needle aspiration cytology).OP GRE sequences could replace conventional SE sequences in T1-W imaging in nonfatty livers, whereas in fatty livers, T1-W SE sequences could be obviated, but both OP and IP sequences are necessary. Chemical shift imaging (OP and IP) can be used to accurately characterize lesions for fat content.

Thoracic splenosis is a rare occurrence that has usually been diagnosed by invasive procedures to allow a pathologic diagnosis to be reached. A firm diagnosis can now be made with the help of new, noninvasive imaging techniques. We report the case of a 34-year-old man with a history of severe thoracic-abdominal injury, including rupture of the spleen and left diaphragm. During computed tomography of the thorax related to a different diagnosis, nonspecific nodules were observed, although the patient was asymptomatic. A suspected diagnosis of thoracic splenosis was confirmed by technetium-99 sulfur colloid scintigraphy.

A case of angiomyolipoma of the liver in a 43-yr-old woman is reported. Findings on ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging techniques are presented and the usefulness of proton (fat/water) chemical shift FLASH imaging to confirm the presence of intratumoral fat is pointed out.

The authors have studied a girl, her sister and her mother who had a supernumerary marker chromosome in mosaicism. The marker was studied by cytogenetic methods and nonisotopic in situ hybridization with the single D22S9 DNA probe which maps to 22q11. The supernumerary chromosome was derived from chromosome 22 and it did not present the same morphology in all the cells. At least 5 distinct types of the marker chromosome were detected and some of them were probably derived from each other (dynamic mosaicism). The proposita had an MCA pattern consistent with mild cat eye syndrome, while her sister and her mother had some of the manifestations described in this syndrome. A specific correlation could be established between phenotype and karyotype. 16 refs., 6 figs.

AJR 2010; 195:W85 0361–803X/10/1951–W85 © American Roentgen Ray Society Use of Serum Progesterone Concentration for Timing Breast MRI Examinations and Avoiding FalseNegative Findings A 33-year-old woman with an extensive group of pleomorphic calcifications detected in her left breast at mammography underwent stereotactic-guided 9-gauge vacuum-assisted biopsy. The histologic study revealed high-grade invasive ductal carcinoma associated with high-grade ductal carcinoma in situ. We performed MR mammography to help determine the size and focality of the tumor. Because of the urgency of the case (a young woman with extensive carcinoma proposed for primary chemotherapy), the study was performed without regard to the timing of her hormonal cycle. Subtracted MR images showed extensive contrast enhancement of the upper outer quadrant of the left breast. Moreover, other ill-defined rounded contrast-enhancing areas in the upper and lower outer quadrants of the contralateral breast were seen (Figs. 1A and 1B). We suspected a bilateral lesion and performed selective second-look sonography of the right breast. The lower outer quadrant contrastenhancement correlated with a well-defined solid oval lesion measuring 1 cm in diameter. Histologic study after sonographically guided 14-gauge biopsy showed the lesion was benign. Other contrast-enhancing lesions had no correlation at sonography. To rule out a false-positive finding because of hormonal fluctuations, we questioned the patient about her menstrual cycles and discovered they were irregular. We read with interest the experience of Ellis [1] in timing breast MRI examinations in premenopausal women without cyclical menses. In particular, we noted the utility of serum progesterone concentrations in determining the follicular phase, which is the point in the menstrual cycle when normal glandular tissue is least affected by disproportionate enhancement. As a result, we rescheduled the patient for 5 days after her menstruation to determine her serum progesterone concentration and perform MRI-guided breast biopsy on the same day. The serum progesterone concentration was 0.53 ng/mL, corresponding with the follicular phase, and we repeated MR mammography with the aim of biopsying the lesion. The left breast findings did not vary from the previous study; however, in the right breast, only the previously biopsied lesion (with an artifact from a metallic marker deployed after the procedure) enhanced Figs. 1C and 1D), confirming the false-positive findings because of hormonal fluctuations and thus avoiding MRI-guided biopsy. We regularly perform MR mammography studies at our center, usually without regard to the timing of patients’ menstrual cycles, because of the low rate of false-positive findings and the difficulties involved in coordinating patients’ agendas. However, we appreciate the article by Ellis [1], and we believe that serum progesterone concentrations can be helpful in nonurgent cases of young women with dense breasts, such as in screening high-risk women, in whom progesterone determination may help avoid misdiagnosis, false-positive findings, and unnecessary biopsies, as in the current case. Sergi Ganau Melcior Sentis Lidia Tortajada UDIAT-CD Barcelona, Spain

Background: Accurate assessment of the extent of breast cancer with breast MRI (BMRI) yields additional findings (AF) that must be characterized in order to guide treatment. The aim of our study was to analyze the work-up of AF seen in pre-therapeutic BMRI and their impact on therapeutic approach and re-excision rates.Methods: From 07/2002 to 04/2007 we studied prospectively 465 consecutive patients with a diagnosis of breast cancer that underwent a pre-treatment BMRI to evaluate disease extent. BMRI studies were performed with a 1,0 and a 1,5 T magnet and coronal T2-weighted fast spin-echo and contrast-enchanced T1-weighted 3D gradient-echo sequences were evaluated. Post-processing included parametric, multiplanar reconstructions and maximum intensity projections. Fischer's scale was used to characterize additional lesions (AL). AL >5 mm were classified as: increase in tumor size, multifocal, multicentric and contralateral disease. AF that would potentially change therapeutic approach were re-evaluated with 2nd-look ultrasound (US), biopsied if found and/or marked with clips or with a radioisotope (ROLL). BI-RADS 3 lesions were followed up with BMRI. Gold standards were pathology reports and follow-up >2 years for benign lesions. Therapeutic change based on MRI findings was deemed correct in malignant AF and incorrect if pathology was benign. Re-excision rates and disease-free intervals were calculated.Results. A total of 280 AF were found in 222 (47,7%) patients. US studies were performed in 111 patients, in 99 of which the AL (89,1%) was found. 63 patients underwent biopsies and 48 of them (76,1%) were malignant. ROLL procedures were performed in 32 patients and malignancy rate was 65,6%. Follow-up BMRI studies for BI-RADS 3 lesions were performed in 42 patients (9%). BMRI found index lesions seen by mammography or US in 98,9% of the patients and did not find additional multifocal or multicentric disease in 10 patients, yielding a total negative predictive value of 96,7% for BMRI (6 invasive and 9 intraductal cancers). Therapeutic approach was changed in 107 patients (23%) and considered correct in 92 (86%) representing 19,7% of all patients and incorrect in 15 (14%) corresponding to 3,2% of the total. Re-excision due to positive margins during the first 6 months was performed in 39/323 patients treated with conservative surgery (re-excision rate of 12%). Mean follow-up was 48,4 months (m) (6,7-81,4 m) and mean disease-free interval was 45 m (6,7-81,4 m).Conclusion: Work-up of AF diagnosed in BMRI allows accurate treatment adjusted to disease extent in 96,8% of the patients. Additional work-up using US and close correlation with the rest of conventional modalities is the mandatory behaviour to ensure an integrated evaluation of AF. This policy allows a correct treatment in 86% of the patients with potential therapeutic change. Overtreatment was induced in 14% of these patients. Regarding the overall series of 465 patients submitted to BMRI, the 15 patients who were overtreated represent 3,2% of the total. The precision level of preoperative MRI in this scenario is clearly superior to conventional modalities when combined in an integrated multimodality approach. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4023.

Pycnogaster cucullata (Charp.) is a polytypic species of Tettigonioidea having XO and XY chromosomal races. In all populations of these races examined, several individuals were found carrying B chromosomes that may be of two morphological types, namely St and d. Although during diplotene the Bs appear almost completely condensed (positively heteropycnotic), and meiotic and mitotic metaphases only two grey intercalary C-bands can be shown. The utilisation of a silver impregnation method allowed us to distinguish the B-chromatin from the facultative heterochromatin of the neo X chromosomes, because both types of heterochromatin present a different condensation cycle during meiotic prophase. The presence of two Bs in nine individuals from the PEG population can be correlated with the simultaneous occurrence of several types of abnormalities affecting the A-chromosomes: spontaneous breakage, depression in the amount of effective pairing, germ line polysomy, endopolyploidy and micronuclei. These effects have also been observed in the individuals of PEG and another population carrying only one B but at a low frequency. While germ line polysomy may be essentially related to the presence and number of Bs (additive effect), determinant factors present in the genetic background cannot be excluded as contributing to the control of effective pairing.

To evaluate proton fat-water chemical shift fast low-angle shot magnetic resonance (MR) imaging for differentiation of fat-containing hyperechoic liver nodules from hyperechoic liver nodules without a fatty component.T1-weighted fast low-angle shot fat-water chemical shift gradient-echo MR imaging was performed in 96 patients without cirrhosis with 138 hyperechoic liver nodules. In-phase and opposed-phase breath-hold images were acquired. The percentage of signal intensity variation between in-phase and opposed-phase images and the spleen-to-lesion contrast ratio were used to differentiate liver nodules.Chemical shift MR images showed fat in 15 (11%) hyperechoic nodules (two angiomyolipomas and 13 nodular fatty infiltrations of the liver). The mean percentage of signal intensity variation between in-phase and opposed-phase images was 156% (standard error, 43.5%) in nodules with fat and -0.16% (standard error, 0.96%) in nodules without fat (P = .003). Spleen-to-lesion contrast was similar on in- and opposed-phase images in lesions without fat (mean difference, -0.0107; standard error, 0.012), whereas the mean difference in fat-containing nodules was 0.805 (standard error, 0.225; P = .003). The area under the receiver operating characteristic curve was 0.97 for signal intensity variation.Hyperechogenicity in certain liver nodules is caused by fat. Chemical shift MR imaging allows accurate differentiation between these and other hyperechoic lesions with no fat component.

PURPOSE: To assess the value of chemical shift gradient-echo (GRE) magnetic resonance (MR) imaging with the fast low-angle shot (FLASH) technique to detect fatty metamorphosis in hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Sixty-three cirrhotic patients with 69 HCCs underwent MR imaging at 1.0 T with chemical shift GRE technique. Both opposed-phase and in-phase FLASH imaging with breath holding was performed, and the percentage variation in signal intensity of the nodules between the two images was calculated. RESULTS: Chemical shift GRE imaging depicted fat in 10 HCCs (14%). In these cases, the percentage variation in signal intensity increased notably and was 88.6%-369.3% (mean, 174.7%), which indicated fatty content (sensitivity, 100%; specificity, 100% when compared with fine-needle aspiration cytology). In the remaining 59 nodules, the percentage of signal intensity variation ranged from 12.7% to -19.1% (mean, -4.0%). CONCLUSION: Chemical shift GRE MR imaging can be used to detect fatty me...

The main objectives were to describe the measures taken by women to detect breast disease prior to invitation to participate in a screening programme for breast cancer, and to identify factors related to non-participation in this programme. A cross-sectional study was designed at the Breast Cancer Early Detection Program of Sabadell-Cerdanyola (BCEDP), using data collected in interviews conducted face to face or over the telephone with 13 760 women participating in the programme and 280 non-participants. A total of 74.2% of the participants versus 70.4% of the non-participants reported having taken measures to detect breast disease, and 71.7% of the participants had undergone mammography versus 69.6% of the non-participants. Of the 10 057 women who had had mammograms, 58% had done so less than 2 years previously. Factors found to be associated to non-participation in the multivariate analysis were: higher level of education, higher occupational skills or working at home, self- or gynaecological examination of breasts, and having received hormone replacement therapy. Higher age group was the only factor that increased the probability of not having undergone mammography previously. Despite the high prevalence of prior measures to detect breast cancer and the similar prevalence between participating and non-participating women, this behaviour is much less prevalent in the group of women 60 years of age or older.