Improved cancer detection in automated breast ultrasound by radiologists using Computer Aided Detection.

OBJECTIVE: To investigate the effect of dedicated Computer Aided Detection (CAD) software for automated breast ultrasound (ABUS) on the performance of radiologists screening for breast cancer. METHODS: 90 ABUS views of 90 patients were randomly selected from a multi-institutional archive of cases collected between 2010 and 2013. This dataset included normal cases (n=40) with >1year of follow up, benign (n=30) lesions that were either biopsied or remained stable, and malignant lesions (n=20). Six readers evaluated all cases with and without CAD in two sessions. CAD-software included conventional CAD-marks and an intelligent minimum intensity projection of the breast tissue. Readers reported using a likelihood-of-malignancy scale from 0 to 100. Alternative free-response ROC analysis was used to measure the performance. RESULTS: Without CAD, the average area-under-the-curve (AUC) of the readers was 0.77 and significantly improved with CAD to 0.84 (p=0.001). Sensitivity of all readers improved (range 5.2-10.6%) by using CAD but specificity decreased in four out of six readers (range 1.4-5.7%). No significant difference was observed in the AUC between experienced radiologists and residents both with and without CAD. CONCLUSIONS: Dedicated CAD-software for ABUS has the potential to improve the cancer detection rates of radiologists screening for breast cancer.

Sunscreen use, wearing clothes, and number of nevi in 6- to 7-year-old European children. European Organization for Research and Treatment of Cancer Melanoma Cooperative Group.

BACKGROUND: Previous epidemiologic studies have suggested that sunscreen use is associated with an increased risk of melanoma skin cancer. Because high nevi (mole) count in adults is a strong predictor of melanoma, we conducted a study examining the number of nevi in 6- to 7-year-old European children, according to their sunscreen use. METHODS: Whole-body and site-specific counts of nevi 2 mm or larger were performed in 631 children in their first year of primary school in four European cities. Independently, parents were interviewed regarding sun exposure, sunscreen use, and physical sun protection of their child. RESULTS: After adjustment for sun exposure and host characteristics (e.g., skin phototype, eye color), the relative risk for high nevus count on the trunk was 1.68 (95% confidence interval [CI] = 1.09-2.59) for the highest level of sunscreen use and 0.59 (95% CI = 0.36-0.97) for the highest level of wearing of clothes while in the sun. The sun protection factor had no effect on nevus counts despite a high median value of 17.4. Sunburn number was not associated with nevus count. The highest risk associated with sunscreen use was found among children who had never experienced sunburn. CONCLUSIONS: In white, European children, sunscreen use appears to be associated with development of nevi, probably because it allows longer sun exposures. Wearing clothes may be an effective way to prevent proliferation of nevi. Since a high nevus count is a strong predictor of melanoma, sunscreen use may be involved in melanoma occurrence because it may encourage recreational sun exposure.

Sun exposure and sun protection in young European children: an EORTC multicentric study.

Most European children experience exposure to the sun during the summer holidays. The aim of this study was to examine the behaviour of European children when in the sun during their holidays. In 1995-1997, a total of 631 young children were recruited during a multicentric study in Belgium, Germany, France and Italy. For each holiday period from birth, parents gave detailed information on sun exposure and child behaviour. Predictors and trends over time of sun protection were investigated. Forty percent of children were exposed to sunlight in the first and 86% in the sixth year of life. At the same time, the number of children who experienced sunburns rose from 1 to 23%. In the whole period of 6 years, only 8% of children always wore trousers and shirt when in the sun, while 25% children always used a sunscreen. The proportion of sun-exposed children who used sunscreen was stable with age (approximately 50%), while those who always wore trousers and shirts dropped from 46% (1st year) to 19% (6th year). Multinomial logistic regression showed that sunscreen use, but not the wearing of clothes was associated with sun-sensitivity. In summary, sun exposure increases steadily, while sun protection decreases in the first 6 years of life in our cohort of children. In this cohort, use of a sunscreen was much more frequent than the wearing of clothes and a reduction in sun exposure.

In vivo monitoring of fructose metabolism in the human liver by means of 31P magnetic resonance spectroscopy.

It has been shown that fructose metabolism in the human liver can be monitored quantitatively by means of 1H image-guided 31P MRS, implemented on a clinical MR imaging system equipped with surface coils and with appropriate data processing software. Temporal resolution of the 31P MRS measurements is of the order of 2 min.

Adrenoceptors and regulation of intestinal tone in the isolated colon of the mouse.

Adrenaline, noradrenaline, phenylephrine, dopamine, clonidine and apomorphine at low concentrations (from 10(-9) M to 10(-6) M) contracted the longitudinal muscle of the isolated distal colon of the mouse. Phentolamine, tetrodotoxin and indomethacin antagonized these contractile responses. Yohimbine antagonized them at lower concentrations than prazosin. Dopamine and clonidine had the same contractile activity on preparations from mice pretreated with 6-hydroxydopamine (6-OHDA). Isoprenaline (10(-9) to 3 X 10(-7) M) induced relaxations of the colon which were antagonized by propranolol. At higher concentrations, adrenaline and noradrenaline (from 3 X 10(-7) M), dopamine (from 3 X 10(-5) M), phenylephrine (from 3 X 10(-6) M) and apomorphine (from 10(-4) M) relaxed the colon. Clonidine (10(-6) to 3 X 10(-5) M) inhibited the spontaneous activity of the colon but never induced relaxations. At 10(-4) and 10(-3) M clonidine elicited contractions. Prazosin antagonized the inhibitory effect of phenylephrine and clonidine, a mixture of propranolol and prazosin antagonized the relaxations to adrenaline, noradrenaline and dopamine and unmasked contractions that were sensitive to yohimbine and tetrodotoxin. The relaxations induced by apomorphine and the contractions induced by clonidine (greater than 10(-6) M) were resistant to all these antagonists. Electrical field stimulation (1 ms, 2 Hz, 2-20 V) of the mouse colon induced contractile responses which increased with the frequency of the stimulus. After cessation of stimulation at 4 Hz a rebound contraction was generally observed, followed by a progressive decline in tone. In the presence of atropine, the contractile response to field stimulation was abolished and transformed into a rapid and sustained relaxation. A rebound contraction was always observed after cessation of stimulation. The responses to electrical stimulation (in the presence or absence of atropine) were abolished by tetrodotoxin. The rebound contractions were abolished by indomethacin. The relaxations induced in the presence of atropine were not modified by phentolamine, propranolol, guanethidine, methysergide, mepyramine, cimetidine or naloxone. Tetrodotoxin (from 3 X 10(-8) M) caused a sustained contraction of the colon with increased spontaneous activity. This contraction was not modified by atropine, phentolamine, propranolol, guanethidine, methysergide, mepyramine, cimetidine, naloxone, but was abolished by preincubation of the preparation with indomethacin. These results indicate that, at low concentrations, various sympathomimetics contracted the mouse distal colon by stimulating alpha 2 presynaptic adrenoceptors. The responses appeared provided intramural prostaglandin synthesis was unaffected. Higher concentrations of sympathomimetics induced relaxations by stimulation of postjunctional alpha 1- and beta-adrenoceptors. Electrical field stimulation of the mouse colon produced cholinergically mediated contractions or, in the presence of atropine, non-adrenergic non-cholinergic (NANC) relaxations followed by rebound contractions, provided prostaglandin synthesis was unaffected. 6 These data suggest that in the mouse isolated colon, muscle tone and contractility are regulated by 2 opposing mechanisms: (1) a neurogenic cholinergic activity and a local prostaglandin synthesis leading to an increase in muscle tone; (2) a neurogenic NANC inhibitory control the nature of which remains to be elucidated. alpha 2-Presynaptic receptors, when activated inhibit the neurogenic inhibitory control and liberate the mechanism by which muscle tone is increased, causing a contraction.

Evidence against VIP as the inhibitory transmitter in non-adrenergic, non-cholinergic nerves supplying the longitudinal muscle of the mouse colon.

Vasoactive intestinal peptide (VIP) had two types of effects on the longitudinal muscle of the mouse distal colon. At low concentrations (10(-8) M) VIP induced a contraction which seemed to be related to the production of prostaglandins as it was abolished after preincubation with indomethacin (10(-6) M). At higher concentrations (3 X 10(-8) and 10(-7) M) VIP induced relaxations which developed slowly and were related to stimulation of the adenylate cyclase activity of the smooth muscle cells. There is no evidence that VIP is the non-adrenergic, non-cholinergic transmitter released by electrical stimulation in this preparation and responsible for rapid relaxation of the smooth muscle.

Noninvasive imaging of left coronary arteriovenous fistula.

We investigated a patient with coronary arteriovenous fistula (CAVF) by two-dimensional echocardiography (2-DE), cardiac Doppler, cardiac catheterization and nuclear magnetic resonance (NMR). These investigations clearly showed the abnormal vascular structures. NMR is another valuable noninvasive and safe method of confirming the presence of a CAVF.

Melanoma and sunscreen use: need for studies representative of actual behaviours.

Experiments in rodents and humans have shown the ability of sunscreens to prevent UVB-induced skin cancers. Sunscreen use has thus become part of the panoply for melanoma prevention. However, results from epidemiological investigations indicate that sunscreen use could be a risk rather than a protective factor for melanoma. This article discusses possible explanations for discrepancies between experimental and observational results, suggesting that experiments did not reproduce usual human behaviours towards the sunlight. Also, marketing of sunscreens fosters unconsidered exposure to sunlight through associating sunscreen use to the acquisition of a 'safe suntan', or to the possibility to let children go naked into the sunlight without incurring sunburns. It has therefore been hypothesized that, because it prevents sunburn, sunscreen use allows prolonged exposure to sunlight. If this hypothesis holds, modern sunscreens with high protection factor could also represent a threat if their use is motivated by the desire of unrestricted exposure to sunlight. To explore this hypothesis, the design of a retrospective cohort study is presented, including children 5-7 years old, with the total body naevi count as principal endpoint. This study will have the opportunity to examine the qualities of modern sunscreens among young children.

The body site distribution of melanocytic naevi in 6-7 year old European children.

The number and size of melanocytic naevi are the main predictors of cutaneous melanoma. Naevus development per unit of skin surface is greatest during childhood. We assessed the body distribution of naevi 2-4.9 mm and > or = 5 mm in 649 European children aged 6-7 years old from Brussels (Belgium), Bochum (Germany), Lyon (France) and Rome (Italy). The numbers of naevi 2-4.9 mm and naevi > or = 5 mm were strongly correlated, especially on the trunk. For naevi 2-4.9 mm, the highest relative densities were found on the face, back, shoulders and the external surface of the arms. The lowest relative densities were found on the hands, legs, feet and abdomen. The relative density of naevi > or = 5 mm was higher on the trunk than on any other body site. Similar body distributions were observed in both sexes and at each centre. The body site distribution of naevi 2-4.9 mm seemed to parallel the usual sun exposure patterns of young European children. It is suggested that the development of naevi > or = 5 mm might be a marker of the vulnerability of melanocytes to the harmful effects of solar radiation. Vulnerability would be maximal on the back, and would decrease from proximal to distal skin areas, with melanocytes of the hands and feet having the lowest vulnerability. The number of naevi acquired on a specific area of skin would result from the combined effects of local vulnerability to solar radiation and local sun exposure history. The origin of acquired body site differences in the susceptibility of melanocytes to ultraviolet radiation is unknown, although it seems to parallel the body site density of sensory innervation.

Effect of adrenergic drugs on the isolated colon of Rhesus cynomolgus.

The effects of adrenaline, noradrenaline, isoprenaline and dopamine were studied on the longitudinal muscle of the ascending and descending colon of the rhesus monkey. All these drugs induced a relaxation of the preparation, dopamine being the less active agonist. The responses seem to be the result of beta 2-adrenoceptor stimulation since their inhibition by practolol (beta 1) is weaker than their inhibition by propranolol (beta 1 and beta 2 dopaminergic). There is no evidence for the presence of dopaminergic receptors in this preparation.

Effect of dopamine on dog distal colon in-vitro.

The effects of dopamine, isoprenaline, adrenaline and noradrenaline in dog isolated colon strips were studied. All these drugs produced in the preparation relaxations which were inhibited by propranolol and sotalol or, in the case of noradrenaline, by a mixture of propranolol and phentolamine. A selective beta 1-adrenergic antagonist, practolol, had the same inhibitory effects on the relaxations induced by all the agonists, suggesting the existence of beta 1- and beta 2-adrenoceptor subtypes in the dog distal colon. There is no evidence for the presence of specific dopaminergic receptors in this preparation.

[Lipomatous hypertrophy of the interauricular septum. Morphological and electrocardiographical aspects]. / Hypertrophie lipomateuse du septum interauriculaire. Aspects morphologiques et électrocardiographiques.

The authors report a case of lipomatous hypertrophy of the interatrial septum diagnosed by echocardiography and confirmed by computerised tomography. The electrocardiogram showed an intra-atrial conduction defect considered to be virtually pathognomonic of this condition. The differential diagnosis and clinical implications of this abnormality, which is usually a fortuitous finding, are discussed in the light of recent publications. A precise diagnosis avoids confusion with other pathologies necessitating specific treatment such as intra-atrial thrombi and tumours.

[Use of plasmapheresis in a case of Graves' disease with malignant ophthalmopathy (author's transl)]. / Exophtalmie maligne traitée par échange plasmatique. Rapport d'un cas.

A short trial with high doses of prednisolone to treat a 62 year-old woman with malignant ophthalmopathy due to Graves disease yielded an unsatisfactory improvement after 5-6 days. The authors decided therefore to use plasmapheresis, 4 plasma exchanges of 2.5 liters each associated with prednisolone (80 ng/day) and azathioprine (100 mg/day). This therapeutic approach resulted in a spectacular improvement obtained after less than 2 weeks: normalization of thyroid function, improvement of all ophthalmological indices confirmed by radiology (C.A.T.) of the retroocular region. The rapid and important improvement obtained after such a short period of time is in favor or the major role of plasmapheresis in this combined therapy of malignant Graves' ophthalmopathy.

[Epidemiological aspects and surveillance of risky environments]. / Aspects épidémiologiques et surveillance des environnements à risque.

This short text concerns the epidemiological and factual aspects of the control of environment at risk for the health, especially the risks linked to cancers. The definitions of the carcinogens and the evaluation of their impact is shortly described. Strategies for a preventive approach are suggested and their application in the belgian context will be evaluated.

[Economic approach to breast cancer screening in Belgium]. / Approche économique du dépistage du cancer du sein en Belgique.

In Belgium, the breast cancer screening by mammography involves a great number of women. It is largely non organized and regarded to the small number of data, it is impossible to determine if this screening is utile and if it has a good "cost-benefit" ratio. This work studies the economical aspects of breast cancer screening in the belgian healthcare system. From information found in other countries, we build four models corresponding to an organized and spontaneous screening. We studied the total processes from screening to diagnosis, including the quality assurance and the evaluation of effectiveness in the organized models. We then applied the reimbursements of the belgian health insurance in the models and compared the costs. It appears that a screening for breast cancer must be organized to give a best "cost-effectiveness" ratio. Pilot projects should be the best way to study the best organization modalities in Belgium.

[Economic approach to breast cancer screening in Belgium]. / Approche économique du dépistage du cancer du sein en Belgique.

In Belgium, the breast cancer screening by mammography involves a great number of women. It is largely non organized and regarded to the small number of data, it is impossible to determine if this screening is useful and if it has a good "cost-benefit" ratio. This work studies the economical aspects of breast cancer screening in the belgian health care system. From information found in other countries, we build 4 models corresponding to an organized and a spontaneous screening. We studied the total processus from screening to diagnosis, including the quality assurance and the evaluation of effectiveness in the organized models. We then applied the reimbursements of the belgian health insurance in the models and compared the costs. It appears that a screening for breast cancer must be organized to give a best "cost-effectiveness" ratio. Pilot projects should be the best way to study the best organization modalities in Belgium.

A case of mediastinal teratoma with CT and MRI correlation.

A case of mediastinal teratoma is described with emphasis on its magnetic resonance aspect. All the components of the mass were well defined. The major interest of magnetic resonance imaging in this case consisted in the good delineation of the pericardium and visualization of the absence of pericardial invasion.