Isolation of Streptomycin-Resistant Erwinia pyrifoliae in Korea

As a black shoot blight disease-causing agent, Erwinia pyrifoliae was first reported in 1995 in Korea. A total of 101 isolates of E. pyrifoliae were isolated from samples showing bacterial symptoms collected from apple and pear orchards between 2020 and 2021. These isolates were screened for streptomycin resistance, with one from an orchard in Gwangju showing resistance at 100 μg/ml streptomycin. This streptomycin-resistant E. pyrifoliae (EpSmR) isolate was identified via polymerase chain reaction amplification of the strA/strB gene and an internal region of the ribosomal rpsL gene containing codon 43. EpSmR has a point mutation that altered this codon from lysine (AAA) to threonine (ACA). The strA and strB genes were not identified in EpSmR. EpSmR showed a high resistance to streptomycin (>50,000 μg/ml). This is the first study reporting EpSmR, which emerged due to a mutation in codon 43 of the rpsL gene.

Primary irritation index and safety zone of cosmetics: retrospective analysis of skin patch tests in 7440 Korean women during 12 years

BACKGROUND

Cosmetics are products used over long periods by the public, and their safety is very important. Several types of human tests are used widely for the evaluation of cosmetics including single patch tests, in-use tests, human repeated insult patch test (HRIPT). However, there is no clear and well-defined published objective and standardized criteria for primary skin irritation in regard to the large variety of cosmetic products.

METHODS

This study analysed human patch tests conducted from May 2001 to December 2012 with 4606 materials of prototype or finished cosmetic products on 7440 normal Korean women aged 18-60 years. The tested products were patched under occlusion for 24 or 48 h, and skin tolerance was assessed twice at 30 min and 24 h after patch removal using a 5-step scale according to the CTFA guidelines.

RESULTS

Human patch tests for cosmetics were performed of 4606 cases, and 30-33 subjects participated in each case. The response in each case was calculated based on total subject number, skin reaction intensity and the number of respondents. The calculated response was standardized using the z-score, and a safety zone was provided in terms of human primary irritation in accordance with the human skin reaction evaluation criteria and usage or formula of cosmetics.

CONCLUSIONS

This study established the safety criteria for irritation in the cosmetics field.

Differentiation between peri-anastomotic inflammatory changes and local recurrence following neoadjuvant radiochemotherapy surgery for colorectal cancer using visual and semiquantitative analysis of PET-CT data

AIM

The aim of this study was to evaluate the usefulness of visual and semiquantitative [¹⁸F]fluorodeoxy-glucose (FDG) positron emission tomography-computed tomography (PET-CT) data for the diagnosis of peri-anastomotic colorectal cancer recurrence, taking into account the time period between surgery and [¹⁸F]FDG PET-CT scanning.

METHODS

The study population consisted of 70 patients who had prior preoperative radiochemotherapy and surgical resection of the primary tumor and who underwent whole body [¹⁸F]FDG PET-CT scanning for the detection of recurrent disease. Visual and semiquantitative (SUV(max)) analysis of [¹⁸F]FDG uptake at the peri-anastomosis was performed. The final diagnosis was based on pathological proof or clinical and/or imaging follow-up data.

RESULTS

On visual reading, 27 patients exhibited increased [¹⁸F]FDG uptake at the peri-anastomosis. Of these, 11 (41%) patients had a local tumor recurrence and 16 (59%) had no recurrent tumor. Among the 43 patients without increased [¹⁸F]FDG uptake at the peri-anastomosis, none had local tumor recurrence. On semiquantitation, SUV(max) in patients with and without a local recurrence overlapped. However, when the time period between surgery and [¹⁸F]FDG PET-CT scanning was taken into account, overlap of SUV(max) was mainly observed within a postoperative period of ≤12 months; thereafter, a threshold SUV(max) of 3.2 discriminated between benign and malignant lesions in all but one patient.

CONCLUSION

In our series, visually increased [¹⁸F]FDG uptake at the peri-anastomosis was 100% sensitive but non-specific (73% specificity) for the diagnosis of local tumor recurrence. On the other hand, normal [¹⁸F]FDG uptake at the peri-anastomosis precluded a local tumor recurrence (a negative predictive value of 100%). In addition, semiquantitative (SUV(max)) analysis of [¹⁸F]FDG uptake at the peri-anastomosis may increase specificity (up to 97%), while preserving maximum sensitivity, if the postoperative period is >12 months.

The potential value of a pictorial atlas for aid in the visual diagnosis of 123I FP-CIT SPECT scans

The aim of our study was to evaluate the value of a pictorial atlas of 123I FP-CIT SPECT images for aid in the visual diagnosis.

PATIENTS, MATERIALS, METHODS

Sixty patients, of whom 20 were clinically diagnosed as 'non-parkinsonian' and 40 as having Parkinson's disease or any related disorder, were included in the study. An atlas consisting of 12 123I FP-CIT SPECT images was constructed first. Validity of the atlas was investigated by performing a receiver operating characteristic (ROC) analysis with the clinical diagnosis as the gold standard. The remaining 48 SPECT images were visually assessed twice by 5 observers, first with and secondly without consulting the atlas, or vice versa. The added value of the atlas was investigated by comparing the diagnostic accuracy and the interobserver variability for both methods.

RESULTS

ROC analysis performed on the atlas yielded an area under the curve of 1 for a threshold discriminating between clinically non-parkinsonian and parkinsonian patients that was situated between image 4 and 5 of the atlas. For the diagnostic accuracy, we found that the area under the ROC curve was systematically higher if observers had access to the atlas compared to when they had not (Wilcoxon's test, p<0.05). Also, the interobserver variability was significantly lower when observers used the atlas when compared to when they did not (p = 0.05).

CONCLUSION

Diagnostic accuracy was significantly higher and interobserver variability significantly lower if observers had access to the atlas compared to when they had not. Hence, having a pictorial atlas available may facilitate the visual assessment of 123I FP-CIT SPECT scans.

Comprehensive analysis of ERCC, XPD, and XRCC polymorphisms: Association with clinical outcomes in patients with advanced gastric cancer

4649

Background: Platinum-DNA adducts are repaired by nucleotide excision repair (NER) pathway, in which genes of the excision repair cross-complementation 1 (ERCC1), xeroderma pigmentosum group D (XPD) and X-ray repair cross-complementing group (XRCC) have an important role. The purpose of this study was to investigate the relationship between single nucleotide polymorphisms (SNPs) of these genes and the clinical outcomes to combination chemotherapy of 5-FU and oxaliplatin in advanced gastric cancer (AGC). Methods: We searched SNPs of NER pathway genes from database of the International Hapmap Project. Tagging SNPs and halpotype blocks were founded by linakage disequilibrium and haplotype analysis. Whole blood samples were obtained from the patients before chemotherapy. DNA was extracted from the peripheral blood mononuclear cells and the genotyping was performed by SNaPshot methods. Seventy three metastatic or relapsed AGC patients received modified FOLFOX-6 as a first-line palliative chemotherapy and were analyzed. Results: By searching the database of the International Hapmap Project, we found 17 SNPs in ERCC, 69 SNPs in XPD, 78 SNPs in XRCC. We found that some SNPs played a role as a tagging SNP and belonged to haplotype block (5 tapping SNPs and one haplotype block in ERCC, 8 tapping SNPs and two haplotype blocks in XPD, 9 tapping SNPs and two haplotype block in XRCC). Tagging SNPs were analyzed and matched with clinical significance. Among the 22 tagging SNPs of NER pathway genes, only XPD-C156A SNP (rs238406) showed clinical correlation. AA genotype of XPD C156A showed higher response rate (CC: CA: AA= 29.2%: 43.3%: 63.2%, p=0.083) and toxicities (neutropenia of grade 3 or 4) (CC: CA: AA= 4.3%: 3.2%: 21.1%, p=0.060) than CC or CA genotypes. Conclusions: Our results suggest that some SNPs of ERCC, XPD and XRCC showed linkage disequilibrium and belonged to haplotype blocks. And XPD-C156A SNP showed clinical correlation in AGC patients treated with modified FOLFOX-6 regimen. These findings require independent prospective confirmation.

[Table: see text]

Revisiting normal 51Cr-ethylenediaminetetraacetic acid clearance values in children

PURPOSE

Normal (51)Cr-ethylenediaminetetraacetic acid (EDTA) clearance values as a function of age were published a number of years ago. These values were based on data from children with a normal left to right ratio and a normal appearance on DMSA scintigraphy, despite the presence of an acute renal infection. At that time, the authors were unaware that hyperfiltration is a common phenomenon in patients with acute renal infection and that their normal values could have been significantly overestimated. The present work therefore aimed to re-appraise these normal values.

METHODS

In a first step, in order to verify the previous results, the same type of population was selected, namely patients with present or past urinary tract infection but normal images and a normal left to right ratio on DMSA scintigraphy. In a second step, the selection was based on patients who had had no recent urinary tract infection. In both series, a single blood sample method was used for the evaluation of (51)Cr-EDTA clearance.

RESULTS

In the first group of patients, the results obtained were almost identical to those previously published. In the second group of patients, the results were significantly lower: after 2 years of age, the mean GFR value was 104 ml/min/1.73 m(2) (10th and 90th percentiles 81 and 135 ml/min/1.73 m(2), respectively), compared with 117 ml/min/1.73 m(2) in the first group.

CONCLUSION

The data of the second group are probably more representative of the true normal GFR values and can be applied to the entire paediatric population.

How to Interpret a Deterioration of Split Function?

OBJECTIVE

A drop of split renal function often constitutes a criterion for pyeloplasty in hydronephrosis since it is considered as representing deterioration of the affected kidney. The aim of this work was to determine, in a selected population of patients with a drop of split function of at least 5%, if the evolution of single kidney glomerular filtration rate (SKGFR) was parallel to the one of split renal function.

METHODS

From a large data basis, we found retrospectively only 29 children (10 below and 19 above two years of age at first examination) having had at least two Tc-99m mertiatide (Tc-99m MAG3) renographic explorations for various urological diseases, with a decrease of split function of at least 5% between the two examinations. Evolution of split function was compared to evolution of SKGFR obtained by means of the combination of Tc-99m MAG3 split function and overall glomerular filtration rate as given by the chromium Cr 51 ethylenediamine tetraacetic acid (EDTA) clearance.

RESULTS

For the group above two years of age, SKGFR increased or remained stable in 63% of the cases, while in the children less than 2 years of age, a decrease of SKGFR was never observed, according to the maturation of overall GFR in this age group. Thus, the decrease of split function was not necessarily associated with a similar decrease of SKGFR.

CONCLUSION

In patients with unilateral or bilateral urological disorders, deterioration of split renal function does not necessary correspond to a loss of function of the affected kidney. SKGFR often modifies the interpretation of split function.

Optimised tracer-dependent dosage cards to obtain weight-independent effective doses

PURPOSE

The aim of this study was twofold: firstly, to determine whether the European Association of Nuclear Medicine (EANM) dosage card results in weight-independent effective doses or weight-independent count rates; secondly, to determine whether one dosage card is sufficient for 95 different radiopharmaceuticals, and, if not, how many cards we reasonably need to take into account inter-tracer variability.

METHODS

Normalisation factors for count rate and effective dose were calculated as a function of body weight, with 70 kg as standard. Calculations were performed, using whole-body absorption fractions and MIRDOSE 3 software, for seven anthropomorphic phantoms and ten radionuclides. An analytic function for both relations was proposed. Normalisation factors for effective dose for 95 radiopharmaceuticals were investigated using cluster analysis.

RESULTS

Normalisation factors for count rate and effective dose can be estimated accurately as a function of body weight W by (W/70)a holding only one parameter, called the a value. The a values for 95 radiopharmaceuticals were classified into three clusters (nA=7, nB=76, nC=12). Cluster A contains tracers for renal studies. Cluster B contains all remaining tracers, except iodine-labelled tracers for thyroid studies and 89Sr for therapy, which belong to cluster C.

CONCLUSION

Correction factors proposed by the EANM task group mainly correct for effective dose. They are very similar to the factors obtained for cluster A. Using the EANM factors for tracers belonging to clusters B and C results in significantly higher effective doses to children. We suggest using three tracer-dependent dosage cards for which the correction factors have been calculated to obtain weight-independent effective doses.

Registration accuracy of 153Gd transmission images of the brain

PURPOSE

The aim of the study was to determine the accuracy of non-rigid nine-parameter image registrations based on 153Gd transmission computed tomography (TCT) images as compared with those based on 99mTc-ethyl cysteinate dimer (ECD) images and to assess whether normalised mutual information (NMI) or count difference (CD) should be used.

METHODS

TCT and ECD data were acquired in 25 randomly selected patients. Emission images were registered to an ECD template with a CD cost function. The same registration parameters were applied to the transmission images to create a TCT template. All TCT images were registered to the TCT template and the same registration parameters were applied to the ECD images. The procedure was repeated with NMI as cost function. Accuracy of both ECD-based and TCT-based registrations was assessed by comparing the normalisation parameter values and regional activities in the spatially normalised ECD images, using a mixed-model analysis of variance (ANOVA). Scheffe post hoc tests were performed.

RESULTS

No significant differences were found between ECD/CD, ECD/NMI and TCT/CD, suggesting that ECD registration can be done with either CD or NMI, and that TCT registration using CD is equally as accurate as ECD registration. The accuracy of TCT registration with NMI was lower, with discrepancies occurring in the frontal inferior region and the cerebellum. The analysis of normalisation parameters indicated that z-scaling is underestimated and yz-rotation overestimated with TCT/NMI registration.

CONCLUSION

We conclude that ECD registrations with CD or NMI are as accurate as TCT registrations with CD and that TCT registrations with NMI should be avoided.

99mTc-MAG3 diuretic renography in children: a comparison between F0 and F+20

The aim of this work was to compare the quality of renal drainage obtained with two well-described procedures of diuretic renography (F+20 and F0 tests). We selected 36 clinically stable children, aged 10 days to 17 years, with unilateral (25) or bilateral (11) hydronephrosis, in whom both F+20 and F0 tests were successively performed. In all cases, a late image (PM) was acquired after micturition and after changing the position of the patient. The following parameters were calculated: the time to the maximum of the basic renogram (Tmax); and the normalized residual activity (NORA) and output efficiency (OE) at the end of the 20 min renogram, at the end of the furosemide test (35 min) and on the PM image. In F+20, the renal drainage was better on the PM image than at the end of the diuretic renogram, whereas, in F0, the renal drainage was better on the PM image than at the end of the 20 min diuretic renogram. When comparing F0 and F+20, both OE and NORA parameters revealed slightly better drainage at the end of the 20 min F0 renogram than at the end of the 35 min F+20 diuretic renogram. The drainage obtained on the late post-voiding image was comparable for both F0 and F+20 tests. In conclusion, the quality of drainage obtained during the F+20 and F0 procedures can easily be compared using both OE and NORA. A very similar quality of drainage was reached for both procedures when considering only the PM image. This PM view remains mandatory irrespective of the timing of the furosemide injection and despite the use of tracers with a high extraction rate.

Influence of early furosemide injection on the split renal function

The split renal function, obtained using Technetium 99m mercaptoacetyltriglycine renography, is currently considered as a robust, accurate and reproducible parameter, provided that it is calculated at a time when no escape of the tracer from the kidney has occurred. The question arises as to whether the simultaneous administration of furosemide with the tracer (F0 test) might accelerate the escape of the tracer, resulting in an underestimation of the split renal function. From a large database, we selected 36 clinically stable children in whom both F0 and F+20 (administration of furosemide 20 min after the tracer) diuretic renography had been performed. In all cases, the F+20 test preceded the F0 test. The mean interval between the two tests was 17 months. The split renal function was calculated on the basis of the 1-2 min background-corrected renal activity using the integral method, slope method and Rutland-Patlak plot. In order to evaluate the effect on the split renal function of an early escape of the tracer, the patients were analysed according to the T(max) value of the renogram for both the F0 and F+20 tests. For the F+20 test, all T(max) values were more than 3 min. For the F0 test, the T(max) value was more than 3 min in 53 kidneys and less than 3 min in 19 kidneys (unilateral in all 19 patients). For the F0 test, for the kidneys with a T(max) value of less than 3 min, there was a tendency to underestimate the split renal function, taking as reference the split renal function observed in the F+20 test. This observation, however, was only statistically significant for the slope method (P=0.03). There was a tendency for lower values with the Rutland-Patlak plot (P=0.07), but, for the integral method, no difference was observed (P=0.5). In conclusion, the simultaneous administration of furosemide with the tracer induces an early acceleration of renal transit. This should be taken into account when calculating the split renal function, for example by favouring the integral method.

[Methodological aspects related to the determination of the relative renal function using 99mTC MAG3]

The aim of the study was to evaluate three different methods for calculating the split renal function in patients with only one functioning kidney, keeping in mind that the split function should be zero on the side of the non-functioning kidney.

PATIENTS

We retrospectively selected 28 99mTc MAG3 renograms performed in children, 12 with unilateral nephrectomy, 4 with unilateral agenesis and 12 with a non-functioning kidney.

METHODS

A renal and perirenal region of interest (ROI) were delineated around the functioning kidney. The ROIs around the empty kidney were drawn symmetrically to the contralateral side. The split renal function was calculated using three different methods, the integral method, the slope method and the Patlak-Rutland algorithm.

RESULTS

For the whole group of 28 kidneys as well as for the three categories of patients, the three methods provided a split function on the side of the non-functioning kidney close to the zero value, regardless of whether the empty kidney was the left or the right one.

CONCLUSION

We recommend the use of the integral method for the whole range of split renal function with 99mTc MAG3. No significant improvement was obtained by means of the more sophisticated Patlak-Rutland method.

[Transmission of examination results to patients: opinion of referring physicians and patients]

Patients frequently ask the nuclear medicine physician or the radiologist for conclusions at completion of a diagnostic procedure. The present study tried to assess opinions from both patients and referring physicians. Answers from both parties were grossly discordant: most of the referring physicians thought patients should not be given results of a diagnostic procedure by the nuclearist or radiologist an approach most of the patients disagreed with. Deontological guidelines of the official Belgian association do not authorize nuclear medicine physicians nor radiologists to give the patients any result directly; according to our data, this rule should be adapted.

Treatment of children with acute pyelonephritis: a prospective randomized study

The aim of this study was to compare, in children with acute pyelonephritis, the efficacy of 7 days' (group A) and 3 days' (group B) intravenous antibiotics, both followed by an oral treatment. Children were randomized after 3 days of intravenous treatment. Technetium-99m dimercaptosuccinic acid (DMSA) scintigraphy was performed within the first days after admission and repeated 6 months later. Total or partial persistence of renal abnormalities on the 6-month DMSA scintigraphy was used as the endpoint of the study. Among the 92 children included in the study, 87 were followed for at least 6 months (43 in group A and 44 in group B) and were eligible for analysis. Late DMSA was abnormal in 9 kidneys of group A and 12 kidneys of group B, representing respectively 24% and 44% of kidneys with abnormalities on the initial DMSA (difference statistically not significant). When the patients were stratified according to the delay of treatment, the percentage of patients with sequelae in group A was comparable, whether the delay was less or more than 1 week. In group B, the percentage of patients with sequelae was significantly higher (P<0.01) when the delay was more than 1 week.

Is deconvolution applicable to renography?

The feasibility of deconvolution depends on many factors, but the technique cannot provide accurate results if the maximal transit time (MaxTT) is longer than the duration of the acquisition. This study evaluated whether, on the basis of a 20 min renogram, it is possible to predict in which cases the MaxTT will exceed 20 min. Renograms of various shapes were simulated by convolution of a plasma disappearance curve and various created retention functions with a mean transit time (MTT) ranging from 3 to 23 min. The values of MaxTT were then derived from the created curves and compared to three parameters of transit measured on the renograms: the time to reach the maximum of the curve (Tmax), the output efficiency at 20 min (OE20), and the normalized residual activity at 20 min (NORA20). The proportion of retention functions (n=390) with MaxTT>20 min increased with increasing Tmax (e.g. 9% for 6< or =Tmax<10 min, and 34% for 11< or =Tmax<15 min), increasing NORA20 (e.g. 20% for 1.4< or =NORA20<3.0, and 84% for 3.0< or =NORA20<5.0) and decreasing OE20 (19% for 50% <OE20< or =75%, and 76% for 25% <OE20< or =50%). Use of Tmax, OE20 and NORA20 doesn't allow the differentiation of cases with a MaxTT longer or shorter than 20 min. Deconvolution can paradoxically only be used in cases of normal transit.

A survey of physicians' attitude towards women with postmenopausal bleeding

OBJECTIVE

To study how gynaecologist manage postmenopausal bleeding in women not using HRT. The impact on the physicians' attitude of risk factors for endometrial cancer and of the endometrial thickness was essentially accounted for.

METHODS

Two different case-types were defined by modifying the risk level of developing endometrial cancer. Also the level of endometrial thickness, assessed by ultrasound, was made to vary. In total four case-types were constructed. One case-type was sent at random to each Belgian gynaecologist (n=970).

RESULTS

Response rate: 55%. The proportion of physicians who would not investigate the patients' endometrium varied between 2% (high-risk patient with abnormal ultrasound) and 34% (low risk patient, normal ultrasound). Significant differences were observed in relation to the level of risk factors for endometrial cancer and in relation to endometrial thickness. No significant relationship was found between the choice of the method of endometrial investigation and the risk situation or the ultrasound result.

CONCLUSIONS

The attitude of Belgian gynaecologists towards postmenopausal bleeding is modified by the presence of risk factors and by the level of endometrium thickness. About one third of physicians would not further investigate the endometrium of a patient with a low risk profile and a normal endometrium as assessed by ultrasound.

Effect of physicians opinion on patients' choice of treatment

BACKGROUND

While it is obvious that patients should be involved in the decision making process, questions arise as to whether it is feasible to inform them objectively.

OBJECTIVE

To assess the impact of the physician's opinion, on the choice of treatment, to the patient.

SETTING

We imagined a hypothetical case of a 55-years-old woman with a high risk of osteoporosis. Two patient information letters were written, containing valid scientific information, but reflecting two diverging physicians' opinions, giving the choice between two available medications for osteoporosis prevention: hormone replacement therapy (HRT) and a selective estrogen receptor modulator (SERM), raloxifene.

SUBJECTS

We submitted one of the letters (by lottery) to 58 nurses. They were asked to act as this potential patient, and to choose which treatment they preferred to have prescribed.

RESULTS

23/30 women receiving the version favouring the use of HRT, preferred HRT, 26/28 receiving the version favouring SERM preferred this treatment (Chi-Square Pearson 37.3; P<0.001).

CONCLUSION

The content of the information provided and its wording have a great influence on the patients' decision.

Opinion survey towards hormone replacement therapy in the prevention of coronary heart disease

BACKGROUND

Observational and experimental data underscore the cardioprotective effects of hormone replacement therapy (HRT). On the other hand, the randomised trial available, the 'Heart and Estrogen/Progestin Replacement Study (HERS)', showed no reduced risk of coronary heart disease (CHD), using HRT.

AIM

Opinion survey on the effect of HRT on CHD risk.

SETTING

Identification of articles on the related topic using a Medline search. Written survey of the authors' opinion towards HRT in relation to CHD.

RESULTS

Thirty-seven of the 108 principal authors responded. Among them, respectively, 16 (43%) and seven (19%) found that HRT has favourable effects on primary and secondary prevention, two (5%) and five (14%) that it had no effect, none (0%) and four ( 11%) that it had an unfavourable effect, seven (19%) and nine (25%) that it had both favourable and unfavourable effects, and nine (25%) and ten (27%), thought that there are not enough data. Considering a risk modification superior to 20% as clinically relevant, then 57% thought that HRT has a beneficial effect of on primary prevention and 30% on secondary prevention, while none of the responders considered that HRT has unfavourable effects on primary prevention and only 2% on secondary prevention of CHD.

CONCLUSION

Despite the negative results of the HERS study, about one-half of the responders still think that HRT has a beneficial effect on primary prevention of CHD and almost one-third on secondary prevention.

"Fellow gynaecologists, help your patients stop smoking!"

BACKGROUND

Age-adjusted mortality from lung cancer in American women has increased dramatically and has even exceeded breast cancer mortality. Gynaecologists, are often involved as primary actors in prevention strategies but may not be aware of this epidemic. This is especially true in Europe where, lung cancer mortality for women is three times lower than in the US.

OBJECTIVE

We aimed to investigate whether smoking data could explain the lower death rates found in Europe.

METHOD

Analysis of smoking and mortality data in different European countries.

RESULTS

European lung cancer mortality data shows a huge heterogeneity between countries (ranging from as low as 5/100,000 to 37/100,000). A strong correlation exists between the smoking prevalence in different countries, in women aged 55 years and more, and the mortality rates from lung cancer (R(2)=0.8; p<0.001). Smoking prevalence of younger women is much higher today than that of women over 55 years.

CONCLUSION

These data strongly suggest that the epidemic of lung cancer will explode in Europe during the next decades. Gynaecologists should be aware of this and spend the necessary time to inform women adequately about the dangers of smoking and help them to quit.

Interobserver reproducibility in reporting on 99mTc-DMSA scintigraphy for detection of late renal sequelae

This study was designed to evaluate the interobserver variability in reporting on 99mTc-dimercaptosuccinic acid (DMSA) scanning performed 6 mo after an acute episode of pyelonephritis for the detection of late renal sequelae.

METHODS

Forty-six children were selected, who had early and late DMSA studies for evaluation of acute pyelonephritic lesions as well as sequelae. Three observers reported independently and separately on the early and late DMSA scans and, in a second step, on the late scan in the presence of the early scan. Interobserver reproducibility was evaluated for the early DMSA scan, the late DMSA scan alone, and the late DMSA scan with the early scan for comparison.

RESULTS

Complete agreement between the three observers was reached in 75%, 78%, and 77% for the early DMSA scan, the late DMSA scan alone, and the late DMSA scan with the early scan for comparison, respectively.

CONCLUSION

Interobserver reproducibility was high and was comparable for both early and late DMSA scintigraphy.