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[The possibilities of the psychophysiologic eye-hand test in screening cerebrovascular insufficiency].

The medical and technical basis of the psychophysiological eye-hand test has been developed. The authors' experience with this tool for cerebrovascular insufficiency (CVI) diagnosis has been generalized studying 250 factory workers and 27 patients with vascular encephalopathy. The study has shown the eye-hand test to be a method of screening CVI with sensitivity 91%, specificity 88%, and accuracy 90%.

Adult↗

[Industrial hygienic complex examinations of places of employment of elderly workers in telecommunication technics].

Authors examinated conditions on 76 places of employment of elderly women by means of a screening methode, an estimated findings in comparison to design standards under consideration of special aspects of aged workers. In regard of work organization, physic strain, demands to sense organs and the exposition of environment factors conditions were acceptable. Imperfections in plase dimensions, lighing and laps organization induced 139 detailled straffs. Directions of the examinated enterprise till now many things improved in conformity with this study.

Age Factors↗

The role of the reference radiologist. Estimates of inter-observer agreement and potential delay in cancer detection in the national breast screening study.

The Canadian National Breast Screening Study (NBSS) is a randomized controlled trial to assess the effect of screening on breast cancer mortality. The NBSS designated a single reference radiologist who blindly reviewed over the course of the study 5200 randomly selected two-view mammographic examinations of women not known to have breast cancer. He also reviewed 575 screening-detected breast cancer (SBC) cases and 102 interval breast cancer (IBC) cases. All cancers were histologically proven. As a result of the reviews, comments on inter-observer agreement, interpretation, and technical quality were conveyed on an ongoing basis to radiologists appointed to 15 NBSS screening centers. Agreement of the reference radiologist with center radiologists was better for breast cancer cases (kappa = 0.511, P less than .002) than for those not known to have breast cancer (kappa = 0.307, P less than .002). Observer error and technical problems led to delayed detection in 22% of SBCs and 35% of IBCs. Another 11% of SBCs and 58% of IBCs were probably mammographically occult. No similarly comprehensive review of mammography during a screening program has been published. Suggestions arising from the NBSS review were sometimes resisted by center radiologists. Measures are suggested which might facilitate acceptance of recommendations arising from audit mechanisms in mammography screening programs, thereby enhancing opportunities for mammographic excellence.

Breast Neoplasms↗

Mammography at reduced doses: present performance and future possibilities.

Reduced dose mammography is assessed with the aid of very recent work. It is concluded that there are technical and clinical reasons for believing that the reduced dose systems and their interpreters should perform more effectively than their predecessors. Review of known technologic achievements suggests a possible 6 to 7 reduction factor from present screen-film mammography dose levels without sacrificing image quality. Reasonable estimates of representative doses presently achieved by both xeroradiography and screen-film systems are given. The screen-film value is about 3 times higher than some previous estimates for these systems.

Adult↗

[An analysis of the technical equipping of the X-ray mammography service in the Russian Federation during 2001-2002].

The condition of total X-ray mammography equipment in the Russian Federation is analyzed in the paper. A method for assessing the needs in such equipment is described. The conclusion is that 1800 mammographs would satisfy the needs in equipment for mammary-gland screening within the Russian Federation, while only 700 units are now in use.

Diagnostic Equipment↗

Role of computerized tomography in the diagnosis of acoustic neuromas.

Computerized tomography has manifest usefulness in the roentgenologic identification of intracranial masses, and acoustic neuromas are no exception. Nonetheless, traditional roentgenographic examinations for the workup of acoustic neuromas should not yet be completely discarded in favor of this new modality. Computerized tomography scanning is an insensitive and unreliable technique for delineating the size and configuration of the internal acoustic canals. With current technology, it will not reliably show neuromas less than 1.5 cm in cross-sectional dimension. Technical artifacts may also contribute to false-negative and though rare to false-positive findings. The false-negative rate will be unacceptably high in the presence of small lesions if this technique is treated as a definitive examination rather than a screening one. Though uncommon, it may also be negative in the presence of relatively large lesions.

Humans↗

Knowledge and participation of general practitioners in cervical cancer screening: survey in a French pilot area.

BACKGROUND: Eighteen months after the beginning of a pilot cervical cancer screening program in a French district of 484,770 inhabitants, a survey was performed among general practitioners (GP). The aim was to assess their knowledge of the screening policy, the factors related to their participation, the difficulties they encounter and their training needs. METHODS: A random sample of 168 GPs was taken from a medical association file. Eighty-seven percent of the physicians agreed to be interviewed by phone. The questionnaire was standardized and made up of open questions. RESULTS: On the whole, screening policy was not well known to the GPs: 58 percent believed screening had to begin before age 21 and could be discontinued before age 61. Sixty percent of GPs declared that they provided women with written information, and 49 percent that they offered Pap smears to all women. Seventy-nine percent said that they took Pap smears, but 39 percent claimed they had difficulty mainly due to women's reluctance or to technical problems. Few GPs expressed training needs. Reported difficulties and expressed need for training increased with the physician's age. GP concern for public health activities increased their participation in the campaign. CONCLUSION: Pilot programs have to implement measures which can help GPs to deal with community care and screening activities since GP involvement is one of the essential conditions of successful organized screening.

Adult↗

A heterologous system for assembly of retroviral gene vectors: intracellular budding in yeast?

Mammalian retroviral gene vectors are of particular importance in gene therapy because of their efficient chromosomal integration and resulting stable maintenance of transgenes. These vectors are currently produced in mammalian cells, with low yield and at substantial expense. Therefore, a more efficient heterologous production system for retroviral vectors would be desirable. With their impressive track record in biotechnology, various yeast species appear like ideal organisms to generate retroviral vectors. Typically, retroviral vector particles emerge from mammalian cells after budding at the plasma membrane. However, in yeast, viral budding at the plasma membrane is blocked by the cell wall. At the same time, mass production of enveloped viral vectors in yeast protoplasts is technically challenging. Recent reports indicated the generation of infectious virions via intracellular budding for some combinations of retroviruses and mammalian cells. Relying on these data I hypothesise that a successful assembly of the retroviral transducing particles can be accomplished intracellularly inside yeast cells with a normal cell wall. Firstly, it is possible that some of the intracellular yeast compartments have all the necessary host factors that are required for successful RNA packaging, budding and maturation of infectious retroviral vector particles. Secondly, it might be possible to improve intracellular viral vector production by artificially targeting viral cores to bud at specific intracellular vesicular structures using appropriate targeting or retention signals. A suitable envelope protein, conferring infectivity and specific cellular tropism to the vector particles, can be expressed in yeast or, alternatively, 'bald' viral particles without envelope protein can be produced in yeast and later complexed with a desired envelope protein in vitro. Retroviral budding on yeast intracellular membranes can rely on the same host factors that are used by yeast retrotransposons driving intracellular formation of non-infectious virus-like particles. It is likely that optimal vector packaging system can be found as a result of the dedicated screening of the various retroviral vectors against an array of yeast species. The central implication of the hypothesis is that budding of retroviral vector particles inside yeast cells, with no need for obtaining and maintaining yeast spheroplasts or protoplasts, can be an efficient and economical method of mass production of these valuable gene therapy vectors.

Biotechnology↗

[Systematic bilateral aspiration biopsy in the screening of prostatic cancer].

Systematic fine-needle aspiration biopsies and core biopsies were simultaneously obtained on 200 patients with suspected prostatic cancer over a 12-month period. The technical aspect of cellular aspiration and fixation was carefully adjusted. 6 to 8 transrectal bilateral aspirations per patient were performed, and their results were compared to those of core biopsies guided on suspicious areas revealed by rectal examination or transrectal ultrasound. The sensitivity of aspiration for the diagnosis of prostatic cancer is 87%. The specificity is 95%, with a positivity in 3 cases of prostatic cancer in which core biopsy is negative. No cytologic specimen is inadequate for diagnosis. The correlation between cytologic and histologic patterns shows that the proportion of Gleason grade 2 decreases with the cytologic grade, whereas the proportion of Gleason grade 5 increases gradually. Both results show the importance of multiple sampling in the cytological procedure, and confirm the diagnostic value of prostatic fine-needle aspiration method.

Biopsy, Needle↗

[Does education influence the results of the Amsterdam Dementia-Screening Test (ADS)?].

The goal of this study was to explore the correlation between education and the results of five dementia screening tests. In a study of 551 consecutively enrolled psychogeriatric day care attendants individual differences in education explained only very small portions of variance (< or = 0.63%) in four tests (visual recognition memory, orientation, category fluency and alternating sequences) of the Amsterdam Dementia Screening Test, a standard neuropsychological battery. The only exception was graphical copying of two- or three-dimensional geometric designs, where education explained 6.25% of the variance in copying accuracy. The more education participants had (from incomplete or complete primary education, through extended primary education, lower technical and vocational training, and secondary to higher education), the better their copying performance was. There was however one exception, in that participants with secondary education copied designs significantly less accurately than participants with lower technical and vocational training. Differences in copying accuracy of subjects with higher versus lower educational attainment were largest for participants matched for high levels of cognitive function. More severe cognitive impairment attenuated education effects. Higher education did not protect against decline of copying performance as a consequence of increasing cognitive impairment. For each of three educational levels, premorbid copying performance was estimated by constructing a regression equation using an independent measure of cognitive functioning (in terms of visual recognition memory, orientation and category fluency) as the predictor variable. The results support the clinical utility of controlling for educational level when interpreting individual copying performance.

Aged↗

How to detect pheochromocytomas?--the diagnostic relevance of plasma free metanephrines.

Pheochromocytomas are chromaffin cell tumors, mostly originating from the adrenal medulla, and represent a rare cause of hypertensiondue to excessive production of catecholamines (norepinephrine and/or epinephrine). More than 10% occur in families with multiple endocrine neoplasia type II, von Hippel-Lindau disease, neurofibromatosis type I, and familial carotid body tumors. Since approximately half of the afflicted patients present without or with only episodic hypertension, detailed clinical evaluation and sensitive biochemical tests are mandatory for the diagnosis, which relies on the detection of increased catecholamine production. Commonly employed tests such as the measurement of free catecholamines in plasma and urine or of their metabolites, vanillylmandelic acid and total metanephrines (= free + conjugated normetanephrine and metanephrine) in urine, suffer from interference from external factors and sometimes low clinical sensitivity and/or specificity. Recent technical advances now allow us to measure plasma free (unconjugated) metanephrines, thus increasing clinical sensitivity and specificity to close to 100%. Plasma free metanephrines offer the following advantages for the detection of pheochromocytomas: (i) independence of short-term changes in catecholamine secretion which may result from change of posture, exercise or intraoperative stress, (ii) information on long-term increase of catecholamine production, (iii) tight correlation with tumor mass, and (iv) only minor interference from drugs. This method does not need time-consuming standardized procedures for blood sampling, which are a prerequisite for the determination of free catecholamines. In conclusion, it is therefore recommended to use plasma free metanephrines--after meticulous clinical screening--as the first-line biochemical test for detecting pheochromocytomas.

Adrenal Gland Neoplasms↗

Mitochondrial tRNA(Leu(UUR)) gene mutation diabetes mellitus in Chinese.

OBJECTIVE: To ascertain the prevalence and clinical features of mitochondrial tRNALeu(UUR) gene nucleotide (nt) 3243 A-->G mutation diabetes mellitus in Chinese and to establish the approaches for genetic diagnosis of this subtype of diabetes during routine daily clinical practice. METHODS: Mitochondrial nt 3243 A-->G mutation was screened among 207 unrelated non-insulin-dependent diabetes mellitus (NIDDM) patients by using polymerase chain reaction (PCR)/Apa I restriction endonuclease digestion. Samples with positive result were confirmed by DNA sequence analysis. Genetic and clinical analysis were carried out in family members of the proband with positive genetic diagnosis. RESULTS: Positive results were found in two subjects during screening of unrelated NIDDM patients, which account for 2.4%-11.1% of NIDDM subjects with uncommon clinical features (with early age-of-onset, with low body-mass-index and on insulin therapy) or with positive family history of diabetes consistent with or unable to exclude from maternal inheritance. Genetic diagnosis was positive in 10 out of 25 family members in the pedigrees of these two probands. CONCLUSIONS: Mitochondrial tRNALeu(UUR) gene nt 3242 A-->G mutation should be considered in diabetic patients with the above-mentioned clinical features. The genetic diagnosis in daily clinical practice can be performed with allele specific priming amplification, or PCR/Hae III or Apa I digestion which are technically simple to perform and diagnostically easy to define.

Adolescent↗

Effectiveness of newborn screening programs for congenital hypothyroidism: prevalence of missed cases.

The author reviews the background information and technical developments leading to newborn screening for congenital hypothyroidism as well as the effectiveness and problems of the programs during the past decade. The success of the programs in terms of prevention of mental retardation now is clear. It is also clear, however, that a significant number of affected infants, perhaps 8 to 10 per cent of the total, can be missed in the best of screening programs. Physicians must be aware of the possibility and alert to early clinical evidence of congenital hypothyroidism.

Congenital Hypothyroidism↗

[Retrospective evaluation of HBsAg, anti-HCV, anti-HIV and syphilis reagin antibody seropositivity in blood donors at the Trabzon Farabi Hospital].

Transfusion of blood and blood products is a widely used method for therapy in medicine, however it may result with the transmission of infectious agents from donor to recipient. In order to achieve safe blood transfusions and to minimize post-transfusion infections, several screening tests for infectious agents are routinely done all around the world as well as in our country. In this study, HBsAg, anti-HCV, anti-HIV and syphilis reagin antibody tests results have been retrospectively evaluated for 33.766 blood donors during January 1, 1997 to December 31, 2000 in Blood Center of Farabi Hospital, Black Sea Technical University. Testing for HBsAg, anti-HIV and anti-HCV has been done by using commercially available micro and/or macro enzyme immunoassays, and syphilis reagin antibody test by latex agglutination (RPR) method. The indeterminate results were confirmed by retesting of sera with microparticle enzyme immunoassay and Western blot methods. As a result, in 1331 (3.94%) subjects HBsAg, in 250 (0.74%) subjects anti-HCV, and in 161 (0.47%) subjects RPR were found positive. Twenty samples which have had the results in gray-zone for anti-HIV, have been found negative with the confirmation tests.

Adolescent↗

Screening for anemia in pregnancy with copper sulfate densitometry.

OBJECTIVE: The copper sulfate method of screening for anemia was evaluated to determine its accuracy in antenatal patients. METHODS: In an antenatal clinic in a tertiary referral center, which also serves a local urban black community, 100 antenatal patients were prospectively tested for anemia by Coulter hemoglobin analysis in comparison with the copper sulfate test. The respective accuracy and costs of the tests were evaluated. RESULTS: Once initial technical difficulties had been overcome, the copper sulfate test proved accurate in detecting a hemoglobin level < 10 g% in pregnancy (sensitivity 94%, specificity 95%, positive predictive value 80%, negative predictive value 99%). The cost of the copper sulfate test is estimated to be less than 0.3% that of the Coulter test. CONCLUSION: The copper sulfate test is accurate and inexpensive, and can be recommended for screening for anemia in pregnancy.

Anemia↗

[The technique and results of mammography].

In the field of mammography, technical progress has been achieved and successfully implemented in routine practice in the last few years. The diagnostic value of mammography has been re-assessed in numerous studies. Breast conserving therapy of breast carcinoma has posed new pre- and postoperative diagnostic tasks. The introduction of mammography into a future national breast cancer detection program will present a challenge for many mammographers in several aspects. Radio-epidemiological doubts about introduction of mammographic screening are in-substantial.

Breast Diseases↗

Analysis of quality assurance programmes for HIV screening in blood transfusion centres in Delhi.

The safety of blood transfusion has attained tremendous importance because of the problems posed by acquired immunodeficiency syndrome (AIDS) and other transfusion-transmissible diseases. While performing screening tests for human immunodeficiency virus (HIV) antibodies in donated blood is indispensable, it is also essential to introduce an effective quality assurance programme covering inspection of specimens, review of record-keeping, maintenance of equipment, and verification of results. We carried out an analysis of such quality assurance programmes during routine annual inspection of 11 blood transfusion centres in Delhi, India. The following parameters were studied: standardization of sample collection and handling; adherence to the recommended technical procedure; use of standard operating procedure; proper use of test reagents; laboratory record-keeping; proper handling of HIV-positive blood units; recording and communication of results; observation of safety guidelines; equipment quality control; and training of staff. A pretested closed-type questionnaire with a weighted scoring system was used for evaluation. Performance for each parameter was graded as follows: 76-100%, excellent; 51-75%, good; 26-50%, fair; and < 25%, poor. Centres were categorized according to the total score obtained for all parameters. Overall performance > 50% was considered satisfactory. Of the 11 centres, none was excellent overall, five were considered satisfactory, and six were unsatisfactory.

Blood Transfusion↗