Screening with magnetic resonance imaging, mammography and ultrasound in women at average and intermediate risk of breast cancer.

BACKGROUND: The addition of MRI to mammography and ultrasound for breast cancer screening has been shown to improve screening sensitivity for high risk women, but there is little data to date for women at average or intermediate risk. METHODS: Two thousand nine hundred and ninety-five women, aged 40 to 65 years with no previous history of breast cancer were enrolled in a screening program, which consisted of two rounds of MRI, ultrasound and mammography, one year apart. Three hundred and fifty-six women had a CHEK2 mutation, 370 women had a first-degree relative with breast cancer (and no CHEK2 mutation) and 2269 women had neither risk factor. Subjects were followed for breast cancer for three years from the second screening examination. RESULTS: Twenty-seven invasive epithelial cancers, one angiosarcoma and six cases of DCIS were identified over the four-year period. Of the 27 invasive cancers, 20 were screen-detected, 2 were interval cancers, and five cancers were identified in the second or third follow-up year (i.e., after the end of the screening period). For invasive cancer, the sensitivity of MRI was 86%, the sensitivity of ultrasound was 59% and the sensitivity of mammography was 50%. The number of biopsies incurred by MRI (n = 156) was greater than the number incurred by mammography (n = 35) or ultrasound (n = 57). Of the 19 invasive cancers detected by MRI, 17 (89%) were also detected by ultrasound or mammography. CONCLUSIONS: In terms of sensitivity, MRI is slightly better than the combination of mammography and ultrasound for screening of women at average or intermediate risk of breast cancer. However, because of additional costs incurred by MRI screening, and the small gain in sensitivity, MRI screening is probably not warranted outside of high-risk populations.

Selenium as a marker of cancer risk and of selection for control examinations in surveillance.

Publication is summarization of existing data being results of literature review and our experience on usefulness of selenium as a diagnostic marker selection for control examinations in surveillance and as a marker of patients with high risk of cancers.

Relationship between Initial Lens Transparency and Ocular Circulation in Adolescents with Type-1 Diabetes Mellitus, Unstable Glycaemia and Lipid Parameters.

BACKGROUND: The aim of this study was to determine the relationships between lens opacity, vascular and lipid factors and retrobulbar blood flow parameters in type-1 diabetic (DM) adolescents. MATERIAL/METHODS: Glycated haemoglobin (HbA1c), total cholesterol (TCH), high- and low-density cholesterol, triglycerides (TG) and apolipoprotein B (ApoB) were determined in 28 patients with (DM-1) and without (DM-0) lens opacity and 18 controls. In the ophthalmic, central retinal (CRA) and temporal posterior ciliary (TPCA) arteries, the systolic (PSV), end-diastolic and mean blood flow velocities as well as pulsatility and resistance (RI) indices were measured. RESULTS: Ten (35.71%) diabetic patients exhibited lens opacification. Higher TG and TCH levels in the DM-1 group and HbA1c level in the DM-0 and DM-1 groups were observed (P≤0.05). Diabetic patients had lower PSV and higher RI within CRA and TPCA (P≤0.05). Significant correlations between biochemical and blood flow parameters were found. CONCLUSIONS: Glycaemic and lipid factors may play a vasoconstrictive role in retrobulbar endotheliopathy.

The evaluation of primary stenting of sirolimus-eluting versus bare-metal stents in the treatment of atherosclerotic lesions of crural arteries.

A comparison was made of sirolimus-eluting stents and bare stents as an effective means of treatment of stenosis in crural arteries. Patients were randomly divided into two groups: (1) patients treated with sirolimus-eluting stents and (2) patients treated with bare stents. Each group consisted of 25 patients, and every patient had one stent implanted. All patients showed symptoms of ischemia of the peripheral arteries, classified according to the Rutherford scale into categories 3, 4, and 5. All patients were examined 24 h before and 24 h and 6 months after the intervention. The results were analyzed according to clinical, hemodynamic, and angiographic criteria. Technically, the procedure was successful in 100% of cases, and both groups presented an equal improvement in clinical and hemodynamic parameters. The follow-up angiographic examination demonstrated a significantly lower rate of restenosis among the sirolimus-eluting stent group (4, 16%) versus the bare stent group (19, 76%) (p < 0.001), with lower target lesion revascularization in 3 (12%) versus 14 (56%) (p < 0.05), respectively. Quantitative angiography demonstrated that all variables used to assess restenosis were superior for sirolimus-eluting stents 6 months after intervention: late lumen loss 0.46 +/- 0.72 versus 1.70 +/- 0.94 (p < 0.001) and minimal lumen diameter 2.25 +/- 0.82 versus 0.99 +/- 1.08 (p < 0.001). Results of this study reveal that the use of sirolimus-eluting stents decreases the risk of restenosis in comparison to standard stents.

Ocular circulation in systemic lupus erythematosus.

BACKGROUND: Mean vascular resistance in the retrobulbar arteries of SLE patients and the statistical relationship between its parameters and the presence of certain antibodies were determined. MATERIAL/METHODS: Forty-three eyes of 43 SLE female patients aged 46.28+/-8.45 years with disease duration of 10.03+/-7.96 years were examined. Physical and ophthalmic examinations with assessments of the immunological markers ANA/IgG-IgM, aCL, anti-beta2GPI, LA, and anti-dsDNA antibodies were performed. color Doppler imaging (CDI) was used in the OA, CRA, LPCA, and MPCA vessels. The vascular resistance indices (RIs) were compared with those of 43 eyes of 43 female controls. Covariance and multiple regression analysis with chi squared, Pearson, Shapiro-Wilk, and Levene tests were used in the statistical analysis (significance levels at p

Retinal vessel dynamic functionality in the eyes of asymptomatic patients with significant internal carotid artery stenosis.

BACKGROUND: The goal of this study was to assess the retinal microvascular function in asymptomatic patients with hemodynamically significant internal carotid artery stenosis (ICAS) and to assess the potential efficacy of carotid endarterectomy (CEA) for the improvement of vessel functionality. METHODS: Retinal vessel caliber and reactions to flicker stimulation were assessed in both eyes of 65 asymptomatic patients with unilateral hemodynamically significant ICAS and 34 healthy subjects. Subsequently, the recruited ICAS patients were referred for standard unilateral CEA procedure. The full ophthalmologic examination of both eyes and vessel analysis were performed 1 day before and 3 months after CEA. RESULTS: The venous responses to flicker stimulation were significantly lower in the EIS (eyes ipsilateral to stenosis) and ECS (eyes contralateral to stenosis) compared with those in the controls (P<0.0001 and P<0.0001, respectively). No changes were identified in retinal vascular flicker responses after CEA in both groups of eyes compared with the baseline values. We observed a decrease in CRVE (central retinal venular equivalent) after the CEA both in eyes ipsilateral (P=0.01) and contralateral (P=0.04) to CEA. Likewise, a decrease in CRAE (central retinal arteriolar equivalent) was identified in the eyes ipsilateral to CEA (P<0.001). CONCLUSIONS: This outcome strongly indicates that microvascular dysfunction is long-lasting despite the recovery of the flow in the carotid artery.

Predictive value of color Doppler imaging in an evaluation of retrobulbar blood flow perturbation in young type-1 diabetic patients with regard to dyslipidemia.

BACKGROUND: The aim was to examine blood flow velocity and vascular resistance in retrobulbar arteries in young type-1 diabetes (DM-1) patients. Statistical relationships between blood flow parameters and serum lipid levels (TCH, HDL, LDL, TG, ApoB) were also determined. MATERIAL/METHODS: Fifty-two eyes with diabetic angiopathy were examined (average age: 18.54 years). Color Doppler imaging (CDI) was performed in the ophthalmic (OA), central retinal (CRA), and temporal posterior ciliary (TPCA) arteries. The parameters PSV, EDV, MV, PI, and RI were compared with those of a control group (46 eyes). The Student's t, Shapiro-Wilk, and Mann-Whitney U statistical tests were used (p< or =0.01 and p< or =0.05 were considered significant). RESULTS: Significant decreases in PSV, MV, PI, and RI in the OA, CRA, and TPCA and negative correlations between TCH, LDL, and ApoB and decreased PI and RI in the OA as well as positive correlations between these parameters and EDV in the OA were found. Increased ApoB correlated with decreased PI and RI in the TPCA. There were no significant relationships between TG and HDL and the blood flow parameters. Elevated levels of HbA1c and dyslipidemia were confirmed. CONCLUSIONS: CDI is an effective method for detecting retinochoroidal circulation disorders in the early stage of diabetic angiopathy. The alterations in retrobulbar blood flow were characterized by significant decreases in PSV, MV, and RI in the CRA and PSV, MV, PI, and RI in the TPCA. Dysregulation of TCH, LDL, and ApoB was associated with vascular resistance fluctuation, mainly in the OA.

Ultrasonographic and histological analysis of atheromatous plaques in carotid arteries and apoplectic complications.

BACKGROUND: The aim of the study was to compare a computer assessment of carotid plaques with the quantity and distribution of inflammatory cells in the plaques and to find correlation with the incidence of cerebral stroke. MATERIAL/METHODS: The material consisted of 20 carotid plaques causing stenoses of internal carotid arteries ranging from 70 to 99%. USG images of the plaques were assessed by a computer-assisted program for image analysis. For each plaque a histogram was obtained for which the gray scale median (GSM), a measure of plaque echogenicity, was determined. Then the quantity and distribution of inflammatory cells in plaques taken during endarterectomy were assessed and these data were compared with the GSM and the incidence of stroke. Moreover, grouping of cases according to histometric variables was analyzed. RESULTS: Statistical analysis showed a considerable correlation between low GSM and the incidence of stroke. At the same time, a correlation between the presence of inflammatory cells on the edges of plaque with a low GSM was found and the analysis of clusters demonstrated a significant increase in the number of patients with strokes. CONCLUSIONS: The use of computer analysis of USG images allows determining the echogenicity of any carotid plaque and can be applied in clinical studies in which the aim is to find characteristic parameters for an unstable plaque.

Assessment of blood flow velocity in eyeball arteries in multiple sclerosis patients with past retrobulbar optic neuritis in color Doppler ultrasonography.

PURPOSE: The aim of the study was to evaluate blood flow velocity in eyeball arteries in affected and unaffected eyes in patients with past retrobulbar optic neuritis in the course of multiple sclerosis (MS). MATERIAL AND METHODS: Evaluation of blood flow velocity in 16 eyes of 16 patients with unilateral retrobulbar optic neuritis was performed in ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary artery (SPCA). In the arteries the following parameters have been assessed: peak systolic velocity (PSV), end-diastolic velocity (EDV), mean flow velocity (MV), indicators of peripheral vascular resistance such as Gosling Index (PI) and Pourcelot Index (RI). The obtained values have been compared to values of blood flow in the same arteries of the control group. Using Shapiro-Wilk test, mode of distribution of each parameter was analyzed. The statistic analysis has been done between group of affected eyeballs (group 1) and control group and between group of unaffected eyeballs (group 2) in multiple sclerosis patients and control group (13 individual, 26 eyes), regarding the age. The assessment was performed with the assistance of t-Student test, and in case of lack of normal distribution, by U Mann-Whitney test. Statistically significant difference was established when p value was below 0.05 (p < or = 0.05). RESULTS: Among the analyzed parameters of blood flow velocity, statistically significant disturbances in the examined eyeball arteries were found. The most significant disturbances of blood flow were found in CRA and SPCA. The affected parameters were: diminished MV velocity in OA; PSV, MV, RI in CRA and PSV, EDV, MV and RI indices in SPCA. The similar blood flow velocity disturbances were also found in unaffected eyeball arteries. CONCLUSIONS: In MS patients with past optic neuritis disturbances of ocular circulation can be observed. The statistically significant diminishing blood flow velocity parameters and vascular resistance indices in eyeball arteries may indicate alterations of blood flow. Lowering of systolic and mean velocities and resistance indices of blood flow are most expressed in CRA and SPCA. Reduction in blood flow parameters in the examined arteries occur both, in the eyes previously affected by past optic neuritis and in contra lateral, unaffected eyes.

Effect of carotid endarterectomy on retinal function in asymptomatic patients with hemodynamically significant carotid artery stenosis.

INTRODUCTION    The corrective effect of carotid endarterectomy (CEA) on impaired ophthalmic artery flow in patients with significant internal carotid artery (ICA) stenosis presenting with ocular ischemic syndrome (ie, symptomatic patients) is well established. However, there is no clear evidence regarding the efficacy of CEA for improvement of neuroretinal function in patients without symptoms of ocular ischemic syndrome. OBJECTIVES    We aimed to determine the effects of CEA on retinal function in asymptomatic patients with hemodynamically significant ICA stenosis. PATIENTS AND METHODS    We enrolled 46 patients with ICA stenosis referred for CEA. Full-field electroretinogram (ERG), pattern ERG, and pattern visual evoked potentials, as well as optical coherence tomography and ophthalmologic examination of both eyes were performed 1 day before and 3 months after CEA. We analyzed eyes ipsilateral (EIE) and contralateral (ECE) to CEA. RESULTS    We observed an increase in several ERG wave parameters in both eye groups, compared with baseline values: rod b-wave amplitudes (P <0.00001 for EIE and P = 0.0001 for ECE); rod-cone a-wave (P = 0.02 for EIE) and b-wave (P = 0.001 for EIE and P = 0.01 for ECE) amplitudes; cone single flash a-wave (P = 0.05 for EIE and P = 0.004 for ECE) and b-wave (P <0.0001 for EIE and P <0.0001 for ECE) amplitudes; cone 30-Hz flicker amplitudes (P = 0.0003 for EIE and P <0.0001 for ECE); and oscillatory potential wave index amplitudes (P <0.00001 for EIE). CONCLUSIONS    The amplitudes of the standard full-field ERG were significantly increased following CEA in EIE and, to a lesser extent, in ECE. Multimodality ERG may represent a unique tool for investigating the effects of carotid revascularization on neuroretinal function in asymptomatic patients with ICA stenosis.

Association between Asymptomatic Unilateral Internal Carotid Artery Stenosis and Electrophysiological Function of the Retina and Optic Nerve.

Purpose. This study was designed to assess retinal and optic nerve bioelectrical function in patients with unilateral asymptomatic but hemodynamically significant internal carotid artery stenosis (ICAS). Methods. Forty-two subjects with a diagnosis of unilateral ICAS and 34 controls were analyzed. Full-field electroretinogram (ERG), pattern electroretinogram (PERG), and pattern visual-evoked potentials, as well as optical coherence tomography and ophthalmological examination, were performed. Data analysis included eyes ipsilateral to ICAS (EIS) and eyes contralateral to ICAS (ECS). Results. Intraocular pressure was significantly decreased in EIS and ECS compared to that in the controls. In the macula, both the cube average thickness and cube volume values were significantly reduced both in EIS and ECS compared to those in the controls. Similarly, PERG P50 and N95 wave amplitudes were significantly smaller in EIS and ECS compared to those in the controls. The ERG rod b-wave and rod-cone a-wave amplitudes were decreased, and implicit times were significantly prolonged, whereas the OP wave index was reduced in EIS compared to that in the controls. No differences in IOP, OCT, or ERG and PERG parameters were identified between EIS and ECS. Conclusions. Our study demonstrated that retinal bioelectrical function is negatively affected by ICAS despite the absence of objective clinical signs and symptoms of ocular ischemia.

Tomographic Evaluation of Reparative Dentin Formation after Direct Pulp Capping with Ca(OH)2, MTA, Biodentine, and Dentin Bonding System in Human Teeth.

INTRODUCTION: New materials can increase the efficiency of pulp capping through the formation of a complete reparative dentin bridge with no toxic effects. The present study involved tomographic evaluations of reparative dentin bridge formation after direct pulp capping with calcium hydroxide, mineral trioxide aggregate (MTA), Biodentine (Septodont, Saint Maur des Fossés, France), and Single Bond Universal (3M ESPE, Seefeld, Germany) in human teeth. METHODS: Forty-four caries-free, intact, human third molars scheduled for extraction were subjected to mechanical pulp exposure and assigned to 1 of 4 experimental groups depending on the pulp capping agent used: calcium hydroxide, MTA, Biodentine, or Single Bond Universal. After 6 weeks, the teeth were extracted and processed for cone-beam computed tomographic imaging and histologic examination. Tomographic data, including the density and volume of formed reparative dentin bridges, were evaluated using a scoring system. RESULTS: The reparative dentin formed in the calcium hydroxide, MTA, and Biodentine groups was significantly superior to that formed in the Single Bond Universal group in terms of thickness and volume. The dentin bridges in the Biodentine group showed the highest average and maximum volumes. The mean density of dentin bridges was the highest in the MTA group and the lowest in the Single Bond Universal group. CONCLUSIONS: The volume of reparative dentin bridges formed after direct pulp capping is dependent on the material used. Biodentine and MTA resulted in the formation of bridges with a significantly higher average volume compared with Single Bond Universal, and cone-beam computed tomographic imaging allowed for the identification of the location of dentin bridges.

Computer-assisted characterisation of a carotid plaque.

BACKGROUND: The aim of this study was to attempt an objective assessment of carotid plaque echogenicity by means of computer-aided technique and to determine the association between the echogenicity and the incidence of brain infarctions. MATERIAL/METHODS: 54 carotid plaques causing internal carotid artery stenosis within the range of 60 - 99% constituted the material for our studies. The images of the plaques obtained by means of USG were transferred to and saved on the computer. Using image analysis software, a histogram of each plaque was obtained. The grey scale median (GSM range 0 - 255) for each histogram, which was used as a measure of the plaque echogenicity, was determined. The value of GSM was assessed in patients who suffered from brain infarctions in the area of the stenosed artery and in patients without infarctions. RESULTS: The grey scale median associated with cerebral infarction was nearly two times lower in comparison with GSM of plaques found in patients without infarction. Among 30 plaques with GSM >35,only 5.5%were connected with brain infarction ,and 27.8%of the 24 plaques with GSM <35 were associated with brain infarction.No correlation with cerebral infarction was found for 50%of the plaques with GSM >35 and 16.7%of the plaques with GSM <35. CONCLUSIONS: The use of computer-aided method allows assessment of carotid plaque echogenicity and can be used for clinical studies aimed at evaluation of the correlation between carotid plaque type and a risk of ischemic stroke.

Colour Doppler ultrasound in preoperative assessment of the neck vessels in patients with tumours of the oral cavity and the neck region.

BACKGROUND: The aim of the study was not only to establish the applicability of color Doppler ultrasound of the neck vessels in patients with tumors of the oral cavity and the neck region but also to check whether the coexistence of sclerotic changes in the carotid arteries is essential in determination of the sequence of surgical procedure. MATERIAL/METHODS: Color Doppler ultrasound was performed on 110 patients, aged 15 -71 years with tumors of the oral cavity and the neck. The localization, size, echogenicity, as well as the tumor relationship to the surrounding structures and big vessels of the neck region was analyzed. RESULTS: Compression of the veins was observed in 27 cases, and of the arteries only in 20 cases. Infiltration of the jugular vein was observed in 8 patients, whereas infiltration of the carotid artery were seen only in 6 patients. Severe internal carotid artery stenosis, due to arteriosclerosis, was observed in 10 patients. Three persons were suggested to be operated on, first due to carotid artery stenosis, later on, due to the oral cavity tumor. CONCLUSIONS: It was found that color Doppler ultrasound is useful in deciding upon the method of treatment, while the examination of the neck vessels is helpful in establishing the sequence of surgical procedures in patients with tumors and coexisting arteriosclerosis.

[Relationship between estrogen, progesterone, total testosterone, androstenedione, and epidural growth factor in blood and breast cyst fluid]. / Ocena zaleznosci miedzy stezeniami estrogenów, progesteronu, testosteronu calkowitego, androstendionu i naskórkowego czynnika wzrostu w surowicy i plynie torbieli gruczolów piersiowych u kobiet.

In breast cyst fluid obtained from 50 patients age (47.1 +/- 2.3) sodium, potassium, oestrone (E1), oestradiol (E2) androgens, progesterone, (P) and Epidermal Growth Factor--EGF were determined. Markedly higher oestrogens, progesterone, testosterone, and EGF-levels were detected in cyst fluid than in blood. These data have confirmed previous results and have clearly shown that breast cyst fluid with high potassium (ratio K/Na > 1.0) contains more oestrogens, progesterone, testosterone, androstenedione and EGF than the group with low electrolyte ratio. This finding might be put in correlation with the fact that patients with high ratio K/Na may a higher risk of breast cancer than those with low electrolyte ratio.

Effect of primary correction of nasal septal deformity in complete unilateral cleft lip and palate on the craniofacial morphology.

PURPOSE: To assess the long-term effect of primary correction of the nasal septum during lip repair in unilateral complete cleft lip and palate on the craniofacial morphology. MATERIAL, SUBJECTS, METHODS: The study material consisted of 54 lateral cephalograms made at the ages 7-22, including 28 cephalograms of patients from a study group (aged 7-14 years) after a primary correction of the nasal septum during lip closure and 26 cephalograms of patients from a control group (aged 12-22 years) operated on without septal correction. All cephalograms have been analysed with regard to skeletal, dental and soft-tissue relationships. Data distribution has been checked using Shapiro-Wilk test (α = 0.05). Student t-test was used to compare values of normal distribution and for the latter - Mann-Whitney test. RESULTS: The comparison of all cephalometric values between the study and control groups revealed a statistically significant (α = 0.05) difference only for H (p = 0.0267), 1+: NB angle (p = 0.0175) and 1+: NA (mm) (p = 0.0249). Each of the three cephalometric measurements mentioned were greater in the study than in the control group. CONCLUSION: No negative effect from the primary nasal septum correction on maxillary development could be found in the study group.

From ophthalmologist to dentist via radiology.

BACKGROUND: The aim of this paper was to analyze the causes of orbital cellulitis in connection with covert dental changes as well as to establish the role of radiological procedures in the final diagnosis and further treatment of such cases. MATERIAL/METHODS: Thirty-two patients, aged 25-56, 22 women and 10 men were diagnosed and treated between January 2007 and April 2011 at the Pomeranian Medical University in Szczecin. The patients were examined in the infirmary of the ophthalmological department due to unilateral blepharo-oedema, abrupt pain and vision disturbances; in 5 cases, body temperature increased up to 37.8°C was observed. Next, the patients underwent conventional X-ray examinations of the orbit to exclude any foreign bodies in the eyeball, as well as pantomographies to evaluate the dental status. Visible periapical or periodontal changes in dentition were analyzed with intraoral X-rays with the use of DIGORA System 2.1. Changes found in 3 patients on pantomograms and connected with iatrogenic procedures were further evaluated with CT (64 lines and 128 layers) in frontal, sagittal and axial projections. Orbital disorders were also diagnosed by an ophthalmologist and radiologist with Doppler ultrasound (US) examinations. A linear transducer of 7.5-10 MHz to observe the morphology and vascularity of the eyeball was applied. RESULTS: IATROGENIC TREATMENT WAS THE CAUSE OF SINUSITIS AND CELLULITIS IN THREE CASES: incorrectly implanted dental implant in one case, root of the 3(rd) molar pushed into the sinus in the second case, and communication between the maxillary alveolar process and the sinus after extraction in case of the third patient. Asymptomatic periapical osteolysis, periodontal disease or dead teeth were found in all cases. Diagnosis of orbital cellulitis of dental origin was determined on the basis of clinical, radiographic and ultrasound findings. Ophthalmologic and dental treatment was applied simultaneously. CONCLUSIONS: Co-operation between ophthalmologists, radiologists and dentists is necessary during the treatment of such orbital diseases.

[Clinical and radiological evaluation of malignant metaplasia of benign primary bone tumors on the material of University Orthopaedic Department of Szczecin between 2002-2007]. / Ocena kliniczna i radiologiczna metaplazji zlosliwej pierwotnych lagodnych nowotworów kosci oraz zmian pseudonowotworowych w materiale Kliniki Ortopedii PAM w Szczecinie w latach 2002-2007.

The study presents clinical and diagnostic problems in patients with malignant bone metaplasia. Material is composed of 13 patients treated surgically between april 2002 and august 2007. In three cases tumors were localised in tibia, in 5 patients around distal femur, in 2 in pelvis, in 2 in humerus and in 1 in lumbar spine. None of the patients has had recurrence by february 2006 r, 12 patients have been free of the disease so far. However, one individual diagnosed with giant cell tumor metaplasia to osteosarcoma did not accept proposed therapy. The authors have particularly emphasized thorough clinical and radiological evaluation and the need of team work before surgical procedure.

[The diagnostic value of oblique technique for periapical radiography and its usefulness in endodontic treatment]. / Wartosc diagnostyczna zdjec wewnatrzustnych wykonywanych w projekcji skosnej i ich zastosowanie w leczeniu endodontycznym.

The applicability of the intraoral X-rays in the oblique projection during the endodontic treatment is described in this study. The rules concerning the positioning of the X-ray tube, intraoral film and the examined tooth, necessary to obtain images in mesial and distal oblique projections are discussed. The usefulness of the aforementioned projections in visualizing the anatomy, anomalies as well as periapical changes of the dental roots and canals during the endodontic treatment is presented.

[Assessment of bone grafting mineralization in patients with alveolar clefts using digital radiography]. / Badanie mineralizacji przeszczepu kostnego u pacjentów z rozszczepami wyrostka zebodolowego za pomoca radiografii cyfrowej.

INTRODUCTION: The objective of the work was to assess the suitability of digital radiography with the option of tomosynthesis for the purpose of mineralization of bone, grafted to the alveolar cleft fissure. Moreover the assessment of the influence of the patients age on the operation date on the transplanted bone mineralization degree was carried out. Furthermore, an attempt to compare the density of the transplanted bone to the density of the bone on the opposite side was taken on the basis of pantomographs. Additionally, the level of oral cavity hygiene and its influence on mineralization of the bone transplant were discussed. MATERIAL AND METHODS: 27 patients with complete cleft lip and palate, who underwent operation of autogenic bone graft to alveolar process were investigated. During clinical examination, information about the patients age on their operation date were collected, and DMF and OHI indicators were defined. Control digital intraoral X-rays of all patients aimed at the cleft area were taken. Additionally, conventional pantomographs of 18 patients for orthodontic indications were taken. Relative values of the grafted and healthy bones were defined on the basis of the intraoral and pantomographic images with the use of software Digora (Soredex). RESULTS: The relative density of bone grafts, whose range was established by the means of the tomosynthesis option, and which was obtained through the analysis, was 87.8 and in the healthy bone (adjacent to transplant) - 149.2. The values of relative thickness of the transplanted and healthy bones were established on the basis ofpantomographs and proved to be lower than those obtained with the intraoral images. A statistical analysis of the intraoral images showed a substantial difference between the established values of the healthy and transplanted bones. In addition, the dependence between the degree of mineralization and the patients age on the day of the operation was observed. It was proven that the younger the patient was on that day, the higher the transplanted bone thickness was. Based on average values of DMF and OHI indicators, a high intensivity of caries was found in 78.3%, a good hygienic condition of the oral cavity in 78.3% and a satisfactory value in 21.7% of the cases. CONCLUSIONS: 1. Mineralization of the bone grafts to alveolar fissure, based on relative bone thickness obtained by use of an intraoral digital X-rays, differes significantly from the healthy bone. 2. Relative density of the bone grafts is highly dependent on the patient's age on the day of the operation: the younger the patient is, the better mineralization of the bones is. 3. Digital radiography with the option oftomosynthesis is very useful for establishing the scope of the bone grafts and, indirectly, for assessment of its mineralization. 4. Pantomography is not useful for assessment of density of bone grafts of cleft patients. 5. Cleft palate patients were found to have a good hygienic level and a high intensivity of caries. 6. A lowered relative thickness of bone grafts and a higher value of DMF indicator were observed in female patients.