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PubMed1994

Screening for early ovarian cancer.

There are 20,000 new cases of ovarian cancer per year and over 12,000 deaths in the United States. Seventy percent of women with ovarian cancer have advanced disease at diagnosis, and 5-year survival is less than 30%. Earlier diagnosis is essential to improve prognosis. Risk factors include age, race, ovulation, and family history. New techniques for possible earlier diagnosis include endovaginal color flow ultrasound (US) and measurement of a serum tumor marker, CA 125. CA 125 is only 25% sensitive for early disease and is nonspecific: In premenopausal women, more than 90% of findings are false-positive. Endovaginal color flow US provides superb morphologic detail of malignancy such as mural nodules and solid vascularized components. Low impedance flow has been reported in many cancers but may also be seen in benign masses and in luteal flow. There are technical and economic impediments to earlier diagnosis of ovarian cancer, and more sensitive and specific tumor markers may be required. Current techniques may show only acceptable cost-effectiveness in women at elevated risk by virtue of a family history of the disease.

Antigens, Tumor-Associated, Carbohydrate↗

PubMed2003

[Factors influencing quality of mammograms].

Due to its outstanding role for screening and diagnosis of breast cancer, optimizing the quality of mammographies was in the main focus of interest within the past two decades. However, there exist additional, non-technical factors influencing diagnostic confidence of mammograms, which were usually not part of discussions concerning mammographic image quality. Nevertheless, these non-technical factors are of great interest into the female population. Information and instruction of the patient prior to mammography helps to increase the compliance of the patient during mammography, and thus not only cooperation during examination is optimized, but also cooperation in the screening program. Furthermore, timing the examination within the first part of the menstrual cycle and regarding specific patient-related factors can decrease pain and discomfort during mammography, which will increase image quality.

Austria↗

PubMed1989

Experience with neonatal screening for congenital hypothyroidism in Hungary.

The experience obtained in one of two Hungarian screening centers for congenital hypothyroidism (CH) is reported which is based on the examinations of dried blood samples tested with the aid of TSH-RIA developed in this laboratory. During the past six years (1982-88) and CH was diagnosed in 54 cases out of a total of 306,265 newborns (prevalence: 1:5470). The recall rate because of increased TSH values was 0.28-0.29% within the last two years. The triple of this had to repeat for technical reasons (imperfect samples, borderline results). Within the last year the treatment of diagnosed infants with L-thyroxine was started at the average age of 13 days. The history of three missed cases is briefly reported. Four out of 54 patients (7.4%) died in infancy. Since the pituitary sensitivity for TSH suppression by replacement doses of L-thyroxine appeared to be decreased in several cases, the control of free thyroxine levels is preferred to avoid the clinical hypo- or hyperthyroidism. The shortening of the present three days TSH RIA method, the extension of systematic examination of TSH binding antibodies and psychological studies are in progress.

Congenital Hypothyroidism↗

PubMed2005

Implementation of the European protocol for quality control of the technical aspects of mammography screening in Bulgaria.

The results from the national pilot project on implementation of the European protocol for the quality control (QC) of the technical aspects of mammography screening as well as the European protocol for dosimetry in mammography in Bulgaria are presented. A QC programme for mammography equipment and a standardised measurement protocol were created. The full QC programme was tested on four mammography units of different types and ages. A national survey was performed for entrance surface air kerma (ESAK) on 20 units using a 45 mm PMMA standard phantom. Average glandular dose (AGD) was calculated using the conversion coefficients from the European dosimetry protocol. The survey demonstrated considerable differences in the technical condition of the mammography units that resulted in varying image quality. The measured values of ESAK showed significant variations. Doses for approximately 45% of the units were found to be below the European reference level. The values for AGD ranged from 0.35 to 3.47 mGy. The main problems found were film processing, optical density (OD) control settings and AEC adjustment. The results showed the importance of film OD measurements parallel to dose measurements. The X-ray mammography in the country needs optimisation. Comprehensive quality assurance programme should be adopted in all departments covering permanent QC of the equipment, image quality and breast dose.

Breast↗

PubMedDate not supplied

Three new contaminants detected in postmortem blood samples.

Three contaminants were identified during drug screening of postmortem blood samples which had been stored in glass bottles with a black rubber seal. Two of these contaminants, cyanoethyl dimethyldithiocarbamate and N-phenyl-2-naphthylamine, were found to come from the rubber seal of some bottles. The third contaminant was not a single compound but rather a mixture of aryl phosphates with a composition very similar to technical grade tritolyl phosphate. The origin of these phosphates is at present unknown.

2-Naphthylamine↗

PubMed1992

The evolution of mammography.

The history of mammography can be arbitrarily subdivided into three periods: The Age of Pioneers highlights the work of Salomon, Kleinschmidt, Warren, Vogel, Seabold, Gershon-Cohen, Leborgne, Egan, Gallager, Martin, Dodd, Strax and their colleagues; The Age of Technical Progress adds the names of Gould, Wolfe, and Gros and their co-workers; The Modern Era reflects the contributions of Price, Butler, Ostrum, Becker, Isard, Moskowitz, Sickles, Kopans, Homer, Tabár, and their associates. The ultimate success of mammography, the preeminent method of breast cancer screening, could not have been achieved without the intense vision, idealism, and scientific skill of its creators and nurturers. These investigators deserve a debt of gratitude that society can never adequately repay.

Breast Neoplasms↗

PubMed1976

[Investigation of the frequency of heterozygotes for galactose-1-phosphate-uridyl-transferase-deficiency(galactosemia) in the Vienna area. Comparison with the frequency of homozygotes found by newborn screening (author's transl)].

By routine newborn screening for galactose blood level elevations a great difference in the frequency of Galactosemia by transferase deficiency was observed between Eastern- and Western-Austria. This made enzymatic heterozygousity determinations desirable. At the same time it should be examined whether the frequency of homozygotes found by screening correlates with the frequency derived from the heterozygousity frequency. In a first step the region of Vienna was studied. 377 unselected blood samples were examined following BEUTLER-BALUDA's method. As technical control samples of 9 homozygotes and 12 heterozygotes as found by screening were examined but not included in the frequency study. Arranged following age groups a slight but significant decrease of enzym activity with increasing age could be confirmed (23,89 versus 21,99 U/g Hb). This, increasing the overlapping between normals and heterozygotes of different ages possibly should be kept in mind in individual heterzygousity determinations. The enzymatically determined frequency of heterozygotes was found to be twice as high as the frequency calculated from the frequency of biochemically detected but enzymatically proven homozygotes (1:53 versus 1:99). A comparison of the heterozygousity frequencies found in literature with the results of the most efficient (technically most reliable) screening programs shows that this discrepancy is great and general. Bases on heterozygousity frequencies the frequency of homozygotes found by screening programs seems to be at least 50% too low. Analysis of theoretical possibilities for loss of homozygotes by screening programs makes this explanation highly improbable. It seems more probable that the enzymatically determined heterozygotes frequency is too high by including still undefined allels or allel combinations which result in about half normal activity but not in disturbances resembling classical Galactosemia.

Age Factors↗

PubMed1988

Drug testing in the military--technical and legal problems.

The Armed Forces drug-testing program has been in operation since 1971. Since that time, its goals, capabilities, and methods of operation have undergone extensive evolution and change. As these laboratories developed, they helped to establish many of the currently accepted operating standards for drug screening. For laboratories considering entry into the business of drug screening, an examination of the evolution and current operation of the military laboratories will be of benefit. It will help to define the currently accepted standards and NIDA guidelines and assist them to avoid the types of problems that were encountered by the military laboratories.

Gas Chromatography-Mass Spectrometry↗

PubMed2000

Screening for colorectal cancer by faecal occult blood test: comparison of immunochemical tests.

OBJECTIVE: To compare two immunochemical faecal occult blood tests based on reversed passive haemagglutination (RPHA) or latex agglutination (Hdia) in a population based screening setting. METHOD: Hdia was interpreted according to three positivity thresholds: 100, 150, or 200 ng of haemoglobin/mg of specimen solution. A total of 5844 subjects were recruited into the study, from 17432 invited subjects aged 50-70. RESULTS: Positivity rates were 3.3% for RPHA, Hdia100 3.5%, Hdia150 2.5%, Hdia200 2.0%. Among subjects complying with the diagnostic work up, colorectal cancer (CRC) was detected in 19 subjects (17 RPHA positive, 16 Hdia100 positive, 15 Hdia150 positive, 14 Hdia200 positive) and high risk adenoma/s in 41 subjects (28 RPHA positive, 32 Hdia100 positive, 29 Hdia150 positive, 25 Hdia200 positive). The prevalence of screen positive CRC in the population was for RPHA 2.9 per thousand, Hdia100 2.7 per thousand, Hdia150 2.6 per thousand, Hdia200 2.4 per thousand. The prevalence of screen positive high risk adenomas in the population was for RPHA 4.8 per thousand, Hdia100 5.5 per thousand, Hdia150 5.0 per thousand, Hdia200 4.3 per thousand. CONCLUSION: Hdia100 was as sensitive as RPHA for cancer and high risk adenomas. As Hdia is less technically complex than RPHA, it is a valid alternative to the latter, provided that full automation of the development procedure is available. Increasing the positivity threshold of Hdia up to 150 or 200 ng of haemoglobin/mg of specimen solution is not advisable as the increase in specificity is too small to justify the corresponding decrease in the detection of screen positive cancers in the population.

Adenoma↗

PubMed1983

[Problems of tuberculosis in the world today].

A century after Robert Koch's discovery of the tubercle bacillus the world total of tuberculosis sufferers is estimated at 20 million, 10 million of whom are contagious. Contrary to a widespread opinion, tuberculosis has not regressed over the last 30 years because it chiefly affects the Third World, in which countries the population doubles every 20 or 25 years while economic resources remain static for the majority of the population. Tuberculosis will be a serious problem of world health in the year 2000. These facts should stimulate physicians to exploit the technical possibilities to the full, with stress upon detection and chemotherapy of tuberculosis. A health program will need to be established for these nations which will make it possible to identify and treat the maximum number of sources of infection. All the investigations and efforts at international cooperation in the field of tuberculosis should be directed towards improving or intensifying national antituberculosis programs.

Antitubercular Agents↗

PubMed1996

ACOG technical bulletin. Hemoglobinopathies in pregnancy. Number 220--February 1996 (replaces no. 185, October 1993). Committee on Technical Bulletins of the American College of Obstetricians and Gynecologists.

Hemoglobinopathies, while relatively uncommon among obstetric patients, can be associated with a variety of effects on the mother, fetus, or newborn. The effects range from absence of clinical disease to severe morbidity and death. Through the obstetrician-gynecologist's high index of suspicion based on clinical history and a close working relationship with a consultant hematologist, pregnancy outcome in patients with these disorders can be improved. Since most hemoglobinopathies are inherited as autosomal recessive conditions, screening, counseling, and prenatal diagnosis are important components of prenatal care for these women.

Anemia, Sickle Cell↗

PubMed1975

Thermography.

As thermographic equipment is improved and as physicians gain experience in its use, thermography gradually is gaining importance as a diagnostic aid in a wide range of disease processes. The technic is finding increasing acceptance in diagnosis of breast disease particularly as an adjunct to mammography. The American Cancer Society and the National Cancer Institute are in the process of establishing 20 demonstration centers for breast cancer detection using thermography, mammography, and physical examinations. Although all of the centers are not at present fully staffed with personnel experienced in thermographic interpretation, the project promises to give a better basis for cost estimates for screening with the thermography as compared to present systems. The technologic knowledge exists for the development of improved scanning infrared cameras with magnetic tape storage and dynamic display. These systems will lend themselves to quantitative measurements and semiautomatic interpretation which can improve the accuracy and reduce the cost of mass screening for breast cancer. Although additional clinical research is necessary, thermography has numerous applications in a variety of disease states. In the future, total body thermography may well become an important part of medical screening examinations.

Arthritis, Rheumatoid↗

PubMed1999

ICT filariasis test: a new screening test for Bancroftian filariasis.

Bancroftian filariasis can be detected by using the ICT Filariasis test kit which is composed of specific polyclonal and monoclonal antibodies to Wuchereria bancrofti antigen. Chromatographic reaction with serum or plasma shows a result within 5 minutes. When compared with 454 thick blood films (standard smear method) within the same study, the ICT Filariasis test had sensitivity = 100%, specificity = 96.37%, efficiency = 96.70%, predictive value positive (PVP) = 70.70%, predictive value negative (PVN) = 100%. Compared with 454 membrane filtration technic (MFT), the MFT had sensitivity = 95.10%, specificity = 99.50%, efficiency = 99.12%, PVP = 95.10%, PVN = 99.50%. When we compared capillary tube technic (CAP) with TBF, CAP showed sensitivity = 85.40%, specificity = 100%, efficiency = 98.68%, PVP = 100%, PVN = 98.60%. With the convenience, high sensitivity-efficiency, lack of cross-reactions, no night blood collection, single reagent and rapidity of the test, the ICT Filariasis test can be recommended for screening of Bancroftian filariasis, and is suitable for the confirmation of suspected cases in the field where microscopic diagnosis is not available.

Animals↗

PubMed1999

[Exposure to asbestos. Role of thoracic imagery in screening and follow-up].

Chest radiograph and computed tomography are the most appropriate imaging tools for detecting asbestos-related pleural and parenchymal disease due to their availability and performances. The cost and irradiation delivery of conventional chest X-rays are limited. Technical parameters and reading should be standardized. Digital chest radiograph will progressively replace conventional techniques but technical standards and performance data are lacking. Computed tomography, using spiral or conventional mode, explores the whole lung and pleura. High resolution computed tomography samples both lung and pleura but its sensitivity for parenchymal fibrosis detection is greater. Several methods can be employed and should be recommended to reduce radiation dose in spiral and high resolution computed tomography. Computed tomography is more sensitive and specific than chest radiograph in early detection of pleural plaques and parenchymal fibrosis but is not infallible. The error reading rate of chest radiograph for early detection of bronchial carcinoma is high. Computed tomography is more sensitive but lacks specificity and leads to detect a high rate of lesions the relation to asbestos exposure of which are difficult to establish. No scientific data are available to assess the contribution of imaging in early detection of mesothelioma.

Asbestosis↗

PubMed2001

European soil sampling guidelines for soil pollution studies.

The soil sampling guidelines used in European countries (ESSG), as kindly provided by the national institutions which participated in the project, have been recorded, studied, evaluated and presented in this paper. The aim has been to ascertain what soil sampling guidelines exist in Europe; to detect similarities and differences (comparable results), advantages and deficiencies; to identify incompatible strategies and evaluate how methodologies might affect data quality; to investigate sources of deviations or uncertainties; to improve comparability and representativeness of soil sampling; to investigate the need for harmonised sampling guidelines; and to develop suggestions for standard operating procedures (SOP). Soil sampling guidelines throughout Europe differ as to whether they are applied by law, or used throughout the country. In some countries these are ISO/DIS related or based (ISO 10381-1, 1995; ISO 10381-2, 1995), or are produced by a scientific society or a standardisation body. As far as sampling strategy is concerned, not all sampling guidelines clearly describe the sampling scale, the specifications for contamination risk precautions, the sampling plan and protocol structure and the pre-analysis treatment of the soil samples. The purpose for sampling, in descending order of frequency, is soil pollution, soil fertilisation, general soil monitoring, background risk assessment, or else it is not specified. The majority of countries do not sample the top organic matter separately. Sampling depth is either related to the morphogenetic horizon or to ad hoc sampling depth, which is not specified in all cases. They suggest mass- and volume-related soil sampling, while the sampling pattern is not presented in all national guidelines. The criteria for area, site, unit, sub-unit, and point selection are mainly based on pedology and land use, following the history and pre-screening information or geology, or is site related. Some guidelines suggest the division of sampling units into sub-units. The sampling pattern is mainly grid sampling, grid and random sampling, or not mentioned. Sampling density inside the sampling unit either varies greatly or it is not mentioned, while the size of the sampling unit varies widely. Most guidelines require the collection of composite instead of simple samples, while some prefer sampling soil profiles. In the European SSG many technical details and steps are either not defined or vary, while in the pre-analysis treatment quality assurance (QA) and quality control (QC) approaches are used either both in the lab and in the field, or only in the field, or are not mentioned. The common points and the points in which harmonisation could be started or achieved are discussed.

Agriculture↗

PubMed1994

[Transfusion risks: importance of blood surveillance].

Transfusion risks result from the transfusion chain complexity and are due to human errors and limits of screening technics. Causes, mechanisms and manifestations of the main risks are mostly well known. Transfusion risks can be related to the donor, the blood donation or the transfusion act. The mechanisms are immediate or delayed. Environment can be a favorable factor. In France, rates of transfusion risks and the part of risk attributable to the environment are not known with accuracy because of the absence of a mandatory reporting system. The assessment of the existing prevention policies, essential for envisaging new actions, lacks rigour. The setting of means assessment and follow-up of transfusion safety as it was mentioned by the Comity of transfusion safety follow-up (L. Degos, A. Goudeau, R. Salamon) in november 1991, and in the law no. 93-5 of january 4, 1993 would allow the improvement of epidemiologic features of blood donation, blood use and transfusion risks.

Blood Banks↗

PubMed2003

Very low alpha-fetoprotein in Down syndrome maternal serum screening.

OBJECTIVE: To establish the frequency of very low maternal serum AFP and to differentiate congenital AFP deficiency from those diseases known to be associated with low AFP. METHODS: AFP values below 2 microg/L and borderline values up to 3 microg/L were retrospectively analysed in 839 773 singleton pregnancies included in a programme for routine screening of trisomy 21 maternal serum markers. RESULTS: Serum AFP was undetectable (< or =2 microg/L) in 8 cases, giving a frequency of 1/105 000. The calculated risk of Down syndrome was > or =1/250 in 5 cases. Fetal karyotype was normal. Seven of these pregnancies went to term (39-41 weeks) uneventfully, and birth weight was normal (3050-4110 g). In the 8th case, fetal death occurred at 35 weeks due to severe maternal diabetes. AFP levels between 2.1 and 3.0 microg/L were noted in 7 other cases. The calculated risk of Down syndrome was > or =1/250 in 5 cases, and fetal karyotype was normal. Pregnancies went to term in 4 cases (33-41 weeks), and birth weight was normal (3000-3380 g). In 3 cases, low hCG (<0.6 MoM) was associated with low AFP, and fetal death occurred at 15 to 16 weeks. CONCLUSION: Once technical errors have been excluded (repeat assay in a second run, calcium assayed to exclude the interference of EDTA for fluorimetric methods, dilution to exclude interfering antibodies, running on an alternative analyser, checking a second sample), very low second-trimester maternal serum AFP should prompt ultrasound examination in order to check fetal viability. Congenital AFP deficiency, an extremely rare disorder (1/100 000), should be suspected. It has no consequences for fetal and infant development, and parents should be reassured.

Adult↗

PubMed2002

Socio-cultural implications of changing organizational technologies in the provision of care.

Technology refers to inputs (machines, bureaucratic procedures, management strategies) organized to achieve specified outcomes. Such inputs and how they are used arise from socio-cultural conditions and in turn influence social behavior and values. Advances in medical technology are due to the high value populations place on health, emerging developments in science (also a cultural product). and from the opportunities and incentives the society gives to varying stakeholders. In the United States for example, the development and uses of medical technology are shaped by faith in marketplace competition, technological progress, activism, choice and consumerism. This constellation of values has resulted in very rapid growth and dissemination of hardware and related procedures whose costs pose significant financial dilemmas. In response, a range of management technologies have been developed to restrain the excesses of intervention but, because they are counter to many prevailing values and interests, they have led to much tension and a social backlash. Resolving these rationing tensions--which are rarely acknowledged as such--is a major challenge in American medical care and in much of the world. In the context of American social values, once new preventive or treatment technologies are introduced, they take patients on treatment trajectories that are difficult to control and which result in many being labeled with diagnoses they do not have and receiving interventions they do not need. Major efforts are under way to increase the sophistication of consumers of health care in a manner consistent with evidence-based medicine but these face significant barriers. Underlying what at first appears as simply technical barriers are the particular social and cultural influences on how people acquire and use information, the sources they trust and distrust, and the types of information they find credible and relevant to their situations. In short, the competition between new preventive and treatment technologies and managed care technologies is at its heart a culture war.

Attitude to Health↗