Comparison of two test-objects for daily quality control of the technical aspects of mammography screening units.
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Biomedical subjects
Publications and source records attributed to H Mol.
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The programme "Europe against cancer" stimulated, among other activities, breast screening activities in the member states. From the beginning, it was clear that a rigorous and efficient approach required the highest possible quality of the three major components of a breast screening programme: the medical performance (correct positioning, training of the medical staff, double reading of the mammograms and feedback from the pathologist and the epidemiologist), the organisation (attendance rate, data base) and the quality of the imaging process (compliance of the image quality and the breast dose with the CEC document of 1990). The first part of this paper will be limited to the latter component and the second part to the subject of correct positioning of the breast.
In this paper the first results of the application in Belgium of the European protocol for the technical quality control of mammography screening are presented. Twelve mammography screening units were submitted to an acceptance test: one fourth complied with the criteria after a second visit. A daily quality control procedure has been run since eighteen months. The most important detected problems are given and discussed. The European Commission, in the framework of "Europe Against Cancer", recently published the "European Guidelines for Quality Assurance in Mammography Screening" (1). In another contribution (2), a brief overview of the important appendix "European Protocol for the Quality Control of the Technical Aspects of Mammography Screening" was given. In this paper the first results for the application of this protocol in Belgium are presented.
A case of food borne infection among a hundred inhabitants of a home for the old aged, caused by Clostridium perfringens (Clostridium welchii) following consumption of a filled veal roll is reported.
A case of food poisoning in a 45-year-old man, caused by enterotoxin C produced by Staphylococcus aureus following the consumption of porc-fricandeau is reported. The findings are discussed on the basis of data from the literature on abscesses in slaughtered animals.
Dapsone is frequently used as a bacteriostatic drug in the treatment of mastitis, endometritis and footrot (necrotic pododermatitis). The farmer usually obtains this drug by 'non-ethical' channels. A regular scheme of checking the milk for residues of sulphonamides will be introduced in 1986. The sensitivity of the test is approximately 25 ppb for Dapsone. This will result in lower milk price in the case of positive tests. In healthy animals, it is shown that intramuscular treatment with 35 grammes (+/- 70 mg/kg-1 body weight) of Dapsone results in residues of Dapsone and its metabolite monoacetyldapsone above this detection level for more than 6 1/2 days. Within 5 days after oral treatment with 48.75 grammes (+/- 100 mg/kg-1 body weight) and 2 1/2 days after single intramammary treatment with 0.8 grammes, the concentrations of residues detected dropped below 25 ppb. The other well-known metabolite diacetyldapsone was only present in detectable quantities in the first milkings after oral treatment.
The results of studies in 1984 and 1985 on the incidence of residues of sulphonamides in raw tank milk showed that, from 2 to 11 per cent milk was contaminated with Dapsone in the Netherlands. In 1984 sulphadimidine was found to be present in approximately six per cent of the samples of tank milk. In 1985, residues of Dapsone were detected, in approximately six per cent of the milk destined for consumption.
It is estimated that in the Netherlands several hundreds of thousands of patients are affected with food-borne diseases or poisoning each year. Though the symptoms are usually mild and mortality is low, the financial impact on society is enormous. The consumer is hardly aware of this fact and the--substantial--government efforts to achieve prevention are not very effective. In view of the present state of science, it should be possible to ensure the consumer of safe food on the market, which may be eaten without any risk after sound preparation. The origin, magnitude and effects on society of this complex problem are studied in the present review. An attempt is made to evaluate the possibilities of reducing the morbidity of food-borne diseases, regarded by the World Health Organization as the most important problem in public health after diseases of the respiratory tract in the coming decades. Particular attention is paid to the role to be played by the authorities in these efforts to reduce morbidity.
Freshly excised human liver specimens (77) were investigated echographically and histologically. The echography was concerned with the acoustic parameters: speed of sound, impedance, several attenuation parameters, and the texture parameters: reflectivity and the signal to noise ratio. It was found that the speed and impedance, the attenuation parameters, and the texture parameters did not correlate with each other. The major correlation between histologic parameters was found for the focal collagen content to the parenchymal content (r = -0.72). The most important correlations of the acoustic parameters to the histologic ones were: attenuation slope to the focal collagen content (r = +0.63) and the reflectivity to the water content (r = -0.55). The most significantly separating acoustic parameters in the comparison of normal livers from focal tumours were found to be the speed, the attenuation slope, the reflectivity, and the signal to noise ratio. A Fisher discriminant analysis revealed a specificity of 91% and a sensitivity of 83% of the separation of tumours from normals when the speed of sound and two parameters of the frequency dependence of the attenuation were considered.
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Residues of identifiable antibiotics were found to be present in approximately 8.1 per cent of 999 bovine udders. In order to form an opinion on the consequences to consumers, the extent to which using milk-gland tissues results in the presence of detectable antibiotic residues in meats, was studied. For this purpose, 797 samples of meats were examined for antibiotic residues during the period from August to December 1976. The samples came from all over the country. Having been screened, the positive samples were examined by high-voltage electrophoresis on agar gel. The number of samples found to contain antibiotic residues could not be neglected. The results of these studies show that incorporating udder tissues in meats and meat-containing products is not acceptable without closer examination. It is doubted whether the decision to pass udders as fit for human consumption after palpation, incision and inspection is a correct procedure.
During the period from August to December 1976, 239 bovine udders were examined for their microbiological quality. Counts were made of the total number of aerobes, anaerobes, Enterobacteriaceae, coliform micro-organisms and staphylococci positive for coagulas and DNA-ase. The udders were examined for the presence or absence of Salmonella, E. coli and haemolytic streptococci. In addition, the Enterobacteriaceae were identified. The udders examined were from animals brought up for slaughter from all over the country. The studies were designed to examine whether udders are suited as raw material for products to be consumed by human individuals. The number of pathogenic bacteria isolated was found to be considerable and the average bacterial counts were rather high. The studies showed that the bacterial content of mammary-gland tissues has an adverse effect on the quality of raw meats made from these tissues so that they are not aceptable from the point of view of public health. Even when they are used as raw material for heated products, the risk of food poisoning caused by toxin produced by staphylococci cannot be entirely ruled out.
Two hundred bulk milk samples drawn from milk collected in cans, which came from cows at stable at 40 farms in the Food Inspection District Utrecht, were examined for Staphylococcus aureus, by means of Baird-Parker's medium. Cultures obtained were phage typed with international, bovine, and additional Dutch phage series. About 60% of the isolated strains were found to be of human origin and about 20% of bovine origin. Isolated strains appeared to be farm specific. Approximately 70% of the farms supplied bulk milk containing 0.08-1.3X10(4) coagulase and DNAse positive staphylococci/ml. The conclusion is inescapable that this type of bulk milk still represents a latent hazard for human health.
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The presence of markedly varying numbers of coagulase-positive staphylococci per gram (less than 10(2) -- greater than 10(6)) of cheese made from raw milk is reported. In twenty cases, the strains isolated from the cheese were examined for their ability to produce toxins. Eight strains were found to produce toxin A, no toxin being isolated from cultures of the twelve other strains. In two cases, the studies were done because of food poisoning which had probably been caused by the cheese. The number of staphylococci was more than 10(6) in one case (cheese about four weeks old) and approximately 1.5 x 10(4) in another (matured cheese). Subsequent studies showed that rather large amount of enterotoxin A were present in the second cheese. The first cheese was not examined for the presence of toxin.
A new method for the determination of the coagulase and DNA-ase activity of staphylococci is described. The method enables the analyst to test large numbers of strains for this microorganism without the loss of time involved in the conventional technique.