Paediatric dentist's ability to detect and diagnose dental trauma using 2D versus 3D imaging

BACKGROUND

Visualisation of the third dimension has been reported to increase effectiveness of correctly diagnosing traumatic dental injuries.

AIM

To assess the ability of paediatric dentists to detect and diagnose Traumatic Dental Injuries (TDI) using two different imaging modalities, intraoral radiographs (2D) and CBCT scans (3D). In addition, observer's confidence regarding the obtained diagnosis, using either technique, was assessed.

MATERIAL AND METHODS

Both 2D and 3D images of 20 dental trauma cases in children were presented in random order to a panel of thirteen paediatric dentists. Observers received instructions for the screening of the images for radiographic findings related to dental trauma, using structured scoring sheets for 2D and 3D images. Observed data were compared to those recorded by two experienced benchmark observers. A ten-point scale was used for assessing observer's confidence regarding their final diagnosis using 2D versus 3D images.

RESULTS

Performance of individual observers showed wide variation. Statistical significance was reached for correctly detected and correctly diagnosed findings (p = 0.02), in favor of 3D. Most of the observers reported comparable confidence using 2D and 3D, two observers were more confident using 3D and one observer was more confident using 2D.

CONCLUSIONS

Paediatric dentist's ability to detect and diagnose findings in patients with TDI was higher on 3D images. Most observers showed a similar confidence score of their diagnostic performance both on 2D and on 3D.

Mediterranean spotted fever, a diagnostic challenge in travellers

Mediterranean spotted fever or boutonneuse fever is caused by Rickettsia conorii and transmitted by the brown dog tick. The commonest symptoms are pyrexia, a maculopapular rash, lymphadenopathies and an inoculation eschar. Increasingly, it is recognised as a cause of serious illness in southern Europe. Rickettsial infections of the spotted fever group are rarely reported in Belgium. We report the case of a 20-year-old traveller returning from Morocco who presented with fever and a markedly swollen inguinal lymph node. Our case report illustrates the challenges rickettsioses can pose to physicians facing febrile travellers. Awareness of the epidemiology and the spectrum of clinical manifestations of this acute zoonosis can help physicians to promptly start appropriate empiric antibiotic therapy.

Phase II study of induction chemotherapy with cisplatin (Cis) and gemcitabine (Gem) followed by concomitant Cis-Gem and thoracic radiation (RTX) for unresectable locally advanced non-small cell lung cancer (LA-NSCLC)

7550

Background: In the CALGB Study Cis with Gem followed by concomitant chemoradiation for inoperable LA-NSCLC was effective, however with significant toxicity (E. Vokes et al; JCO 20: 2002). The aim of this study was to improve tolerability by reducing the Gem dose during radiotherapy and adding one cycle of induction chemotherapy. Methods: Patients with histological proven stage IIIA and IIIB NSCLC were included in this study from 8/04 to 9/07. All patients were to receive 3 induction cycles (21 days) of Cis 80 mg/m2 d1 plus Gem 1250 mg/m2 over 30 minutes d1, 8. After a 3 weeks rest period, 2 cycles of concomitant chemoradiation Cis 80 mg/m2 d1, Gem 300 mg/m2 d1, 8 and RTX (about 60 Gy; 5 times 1,8 Gy fractions / week) were given. Results: A total of 49 patients, median age 63.4 yrs, 73.5% male, with Karnofsky performance status 80/85/90/100: 16.3% / 2.0% / 49.0% / 32.7% were entered. Disease stage IIIA/IIIB: 28.6% / 71.4%. Median dose intensity during chemoradiation Gem 98.4%, Cis 99.0% and radiation median total dose was 63 Gy. Number of grade 3/4 toxicities during induction chemotherapy (N=49): neutropenia 9/9, thrombocytopenia 4/1. Acute grade 3/4 toxicities during chemoradiation phase (N=31): neutropenia 4/0, thrombocytopenia 5/1, radiation esophagitis 4/0 and radiation pneumonitis 1/0. No toxic death. Tumor Response Rate of enrolled patients was 22 (44.9%) (95% CI: 30.7–59.8). Conclusions: Concurrent Cis Gem chemoradiation after Cis Gem induction is an active treatment for LA-NSCLC with managable toxicity.

[Table: see text]

Sequencing of the coding exons of the LRP1 and LDLR genes on individual DNA samples reveals novel mutations in both genes

Five coding polymorphisms in de LRP1 gene, i.e. A217V, A775P, D2080N, D2632E and G4379S were discovered by sequencing its 89 exons in three test-groups of 22 healthy individuals, 29 Alzheimer patients and 18 individuals with different clinical and molecularly uncharacterized lipid metabolism problems. No genetic defect was evident in the LRP1 gene of any of the Alzheimer's disease (AD) patients, further excluding LRP1 as a major genetic problem in AD. Lipoprotein receptor related protein (LRP) A217V (exon 6) was clearly present in all groups as a polymorphism, while D2632E was observed only once in a healthy volunteer. On the other hand, LRP1 alleles A775P, D2080N, and G4379 were encountered only in patients with FH or with undefined problems of lipid metabolism. This finding forced one to also analyze the LDL receptor (LDLR) gene, for which a method was devised to sequence the entire region comprising LDLR exons 2-18. The resulting sequence contig of 33567 nucleotides yielded finally an exact physical map that corrects published and listed LDLR gene maps in many positions. In addition, next to known mutations in LDLR that cause FH, four novel LDLR defects were defined, i.e. del e7-10, exon 9 mutation N407T, a 20 bp insertion in exon 4, and a double mutation C292W/K290R in exon 6. No evidence for pathology connected to the LRP1 'mutations' was obtained by subsequent screening for the five LRP1 variants in larger groups of 110 FH patients and 118 patients with molecularly undefined, clinical problems of cholesterol and/or lipid metabolism. In three individuals with a mutant LDLR gene a variant LRP1 allele was also present, but without direct, obvious clinical compound effects, indicating that the variant LRP1 alleles must, for the present, be considered polymorphisms.

Association between coding variability in the LRP gene and the risk of late-onset Alzheimer's disease

We have sequenced the entire (89 exons) open reading frame of the LRP gene in 12 cases of Alzheimer's disease (AD) from Northern France. We have found no novel changes but confirm the occurrence of a polymorphism in exon 6 of the gene (A216V). This polymorphism is rare (2.8% of controls) and is in linkage equilibrium with previously reported polymorphisms. The V216 allele is negatively associated with the disease in a large case-controlled series. These data suggest that the LRP receptor may be involved in the pathobiology of AD, but the association that we report here cannot explain the previously reported genetic data implicating the LRP gene in AD. If the LRP gene is a major site of genetic variability leading to AD, there must be other biologically relevant variability in promoter or other regulatory elements of this large gene.

European sampling intercomparisons for aromatic and chlorinated hydrocarbons in workplace air

Thirty-eight laboratories of the EU Member States, representing government, manufacturers of personal samplers, industrial and university laboratories have participated in a quality assurance scheme which allows to evaluate errors associated with both the sampling and analytical step of personal sampling methods. State-of-the-art bias, within and between laboratory coefficients of variation for pumped and diffusive methods currently applied are discussed. The data enable verification of compliance of the method-laboratory combinations with EN 482 and quantification of errors, in specific related to the sampling step. The merits of the project regarding improved procedures and results are discussed in detail.

Sampling intercomparisons for aldehydes in simulated workplace air

Thirty one laboratories of various EU Member States have participated in two interlaboratory comparisons in order to assess errors of personal sampling methods associated with both the sampling and the analytical steps. In contrast to conventional quality control schemes, this project particularly focuses attention on the sampling and identification step; it is executed by means of sampling exercises and has included discussions on potential sources of error. In a sampling exercise, participants come to a central facility and perform measurements on synthetic workplace air in a laboratory installation. Concentration levels of formaldehyde, acrolein, glutaraldehyde and acetaldehyde between 0.1 and 2 times the limit value for workplace air were prepared at various humidity levels and with acetone, occasionally, as interferent. Sampling times varied from 1-4 h. The related analytical work is performed at the analyst's own laboratory. The intention is for each participant to determine the observed value of the delivered standard atmosphere using the sampling method of his own choice. Trueness (bias), precision and relative overall uncertainty of each method-laboratory combination is calculated and verified towards compliance with EN 482, which outlines minimum performance criteria. The first challenge involved the precise gas phase generation of the selected analytes in high air flows (up to 300 1 min-1) and calculating the true value only by direct reference to primary standards. This was accomplished by modifying the capillary dosage injection technique so that reactive compounds, like low molecular mass aldehydes, could be dosed with the same accuracy and precision as unreactive solvents. A permeation tube with high emission rate was developed for formaldehyde. Up to ten different sampling techniques were evaluated. The measurement methods used by the majority of the participants were based on pumped sampling on silica cartridges (or tubes) and glass fiber filters, coated with 2,4-dinitrophenylhydrazine. It was observed that for formaldehyde, and in some cases for acetaldehyde and glutaraldehyde, the majority of the method-laboratory combinations complied with an overall uncertainty of 30%. The results for acrolein, however, indicated a systematic negative bias, often larger than minus 50% of the true value, caused by the decomposition of the acrolein DNPH derivative in the presence of excess acid and excess DNPH.

Evaluation of iopentol (Imagopaque 350) in CT enhancement. A multi-centre monitoring trial assessing adverse events and diagnostic information--results from 1,823 patients in France

OBJECTIVES

To evaluate the safety and efficacy of iopentol 350 mg I/ml (Imagopaque/Ivépaque, Nycomed Imaging AS, Oslo, Norway), a monomeric non-ionic contrast medium for computed tomography, in a large population. To identify predictive factors for patient safety.

MATERIALS AND METHODS

One thousand eight hundred and twenty-three (1,823) patients from 48 centres in France were included during a 5-month period. Safety was evaluated by registering adverse events (AEs) reported by the patients, and data were analysed using a multiple factor model.

RESULTS

Only 2.6% of the patients experienced AEs other than discomfort. There were no serious AEs. Overall, AEs were more frequent in patients under 50 years of age, in women, and in patients who received contrast medium as a single bolus. Contrast enhancement was considered adequate or better in 98.9% of the patients. A large variation in discomfort (local warmth/chill or pain) frequency was seen between centres, ranging from 0% to 81%. This result implies that factors other than the CM influence the incidence of discomfort.

CONCLUSIONS

This first study in a large population shows that iopentol 350 mg I/ml is well tolerated and provides CT images of excellent, good or adequate quality in the vast majority of patients. Age, sex and injection procedure were shown to be independent predictors in the AE survey.

Tolerability and utility of mangafodipir trisodium injection (MnDPDP) at the dose of 5 mumol/kg body weight in detecting focal liver tumors: results of a phase III trial using an infusion technique

PURPOSE

To evaluate the tolerability of mangafodipir trisodium (MnDPDP) and its utility for enhancing the ability of magnetic resonance (MR) imaging to detect focal hepatic lesions compared with non-enhanced MR and contrast-enhanced computed tomography (CT).

MATERIALS AND METHODS

119 patients with focal hepatic lesions were examined by MR and by contrast-enhanced CT. MR was performed before and after the infusion of 5 mumol/kg MnDPDP, at a concentration of 10 mumol/ml. Histologic confirmation was obtained in 79 patients.

RESULTS

There were no severe adverse events. Five patients reported mild adverse events related to the infusion. MnDPDP-enhanced SE T1 and GE T1 sequences revealed more focal lesions than the same sequences before contrast infusion in, respectively 22.6 and 36.1% of the cases, and fewer focal lesions in, respectively 5.9 and 1.7% of the cases. Contrast-enhanced MR demonstrated more focal lesions than the SE T2 sequence in 29.4% of cases and fewer lesions in 5.9% of cases. MnDPDP-enhanced MR revealed more nodules than CT in 31.1% of cases and fewer nodules in 13.4% of cases. The additional information provided by MnDPDP enhancement led to modification of management for 12 patients (10.1%).

CONCLUSION

MnDPDP is a well-tolerated contrast agent allowing better MR detection of focal hepatic lesions than non-enhanced MR or contrast-enhanced CT.

[Clinical evaluation of the tolerability of gadodiamide, a new nonionic contrast agent in MRI of the central nervous system]

Gadodiamide injection (Gd-DTPA-BMA) is a new non-ionic paramagnetic contrast agent for which the safety at the dose 0.1 mmol/kg was evaluated during a European multicentre study on a large population of adult patients who had an MR examination of the central nervous system with contrast medium. The safety analysis was performed on 2,102 patients by recording the adverse events observed during injection and up to 24 hours after the injection. Adverse events due or probably due to gadodiamide injection were observed in 102 patients (4.4%) with injection-site associated discomfort (heat, coldness, pain at the injection site) in 37 patients (1.8%) and adverse events other than discomfort (headache, nausea, vomiting) in 35 patients (3.1%). No adverse events of severe intensity or death were reported during the trial. Gadodiamide injection was shown to be safe and well tolerated and represents a non-ionic alternative to the current products in the field of MR imaging of the central nervous system.

Abdominal MRI using a negative contrast agent

A dose of 0.5 g of a negative oral contrast agent for labelling the bowel, was given to 40 patients in a clinical trial. Oral magnetic particles (OMP) consist of crystals of iron oxide with superparamagnetic properties, and are administered in 800 ml of a viscous suspension in order to obtain a uniform distribution. The aim of the study was to identify any adverse effects up to 1 week following ingestion, as well as the contrast distribution and effect, together with the induction of artifacts. A comparison of diagnostic value of the pre and postcontrast ingestion series was also performed. Vomiting followed ingestion in a single patient already nauseated and was the only adverse effect. Good contrast distribution and effect with no artifacts were present. The diagnostic information was greatly improved after OMP ingestion, and the diagnosis would not have been possible without the use of the contrast agent in 41% of the examinations.

Endobronchial tuberculosis mimicking lung cancer in elderly patients

We report four elderly patients with cough who were referred with the presumptive diagnosis of bronchial carcinoma based on chest X-ray and the macroscopic view on fibreoptic bronchoscopy, but whose final diagnosis was endobronchial tuberculosis. Chest X-ray showed atypical pulmonary infiltrates in three patients, but was normal in one. Bronchoscopic examination revealed ulcerative and/or stenotic lesions. Endobronchial tuberculosis should be considered in differential diagnosis, especially in the elderly.

Publications on clinical trials with X-ray contrast media: differences in quality between journals and decades

The objective of the present study was to investigate the quality of clinical trial publications on X-ray contrast media by use of a simple criteria list with 11 items. The publication quality in the 1960s, 1970s and 1980s and in five radiological journals was compared. One hundred and three articles retrieved from the literature and published in Br J Radiol (British), Acta Radiol (Scandinavian), Radiology (American), RöFo (German) and in Ann Radiol (French) were finally included. The adapted method seemed to be suitable for roughly assessing the quality of contrast medium publications. The present reporting standard has increased considerably since the 1960s, however a higher standard is still needed. Although the limited material gathered in our investigation does not allow unequivocal statements, the results indicate that the reporting standard of the 1980s in the selected American, British and Scandinavian radiological journals was somewhat better than in the German journal and better than in the French journal. Use of the present or other assessment methods is one tool to improve the reporting standard.

Clinical trial program for iopentol. A new nonionic ratio 3.0 contrast medium with emphasis on clinical phases I and II

Iopentol is a new nonionic, water-soluble ratio 3.0 roentgen contrast medium (CM) for vascular use. The aim is to present the vascular clinical trial program for iopentol and to report the findings from the clinical phases I and II. The clinical program started with an intravenous (IV) safety and pharmacokinetic phase I trial (24 volunteers) and continued with six open, noncomparative phase II trials (61 patients) for studying cardiovascular and arterial tolerance (two trials in cardioangiography), venous tolerance (two trials in IV computed tomography [CT] enhancement), and cerebral and arterial tolerance (2 trials in cerebral arteriography). One volunteer in the phase I trial was excluded because of a vasovagal reaction following saline injection, and four patients were protocol deviators in cardioangiography. Mainly renal glomerular filtration of unmetabolized iopentol, close to 100% recovered after 24 hours in the urine, was found in the phase I study. No unexpected or severe contrast-induced reactions were encountered in phases I and II. Good diagnostic efficiency was obtained in phase II. As also expected, iopentol seemed to be well-tolerated. However, its relative efficiency and tolerance profile can only be documented from the ongoing comparative phase III trials.

Profiling of impurities in illicit amphetamine samples by high-performance liquid chromatography using column switching

A simple high-performance liquid chromatographic method, suitable for routine profiling of impurities in illegally produced amphetamine, has been developed. Amphetamine is dissolved in acetonitrile-citrate buffer (pH 3) (2:8) and injected directly without further sample pre-treatment. The impurities are enriched on-line on a C8 extraction column, while amphetamine and polar diluents are washed out with water. After washing for 1.5 min, a six-port valve is switched and an acetonitrile-0.2 M butylamine in water (pH 8) gradient elutes the impurities from the extraction column on to a C18 analytical column where they are separated. The compounds are monitored by UV detection at 220 and 254 nm. The total extraction and analysis time is 30 min. The method allows automated extraction and analysis to be performed.

Use of bonded-phase silica sorbents for rapid sampling of impurities in illicit amphetamine for high-performance liquid chromatographic analyses

A simple and rapid method has been developed for the extraction of impurities from illicit amphetamine samples using bonded-phase silica sorbents. The drug is dissolved in phosphate buffer (pH 7) and added to a C8 Bond Elut extraction column. The column is washed with water, and the impurities are then eluted with acetonitrile. The eluate is directly injected into the liquid chromatograph. This sample preparation technique has been compared with the traditional liquid-liquid extraction method. High-performance liquid chromatographic analysis of the impurities is carried out on a reversed-phase C18 column with an acetonitrile-water gradient as mobile phase. Peaks are monitored by UV detection at 220 and 254 nm. A series of seized amphetamine samples has been analysed, and the procedure gives detailed impurity patterns suitable for the comparison of samples. Compounds are identified by absorbance ratios (A220/A254).

Leuckart-specific impurities in amphetamine and methamphetamine seized in Norway

Samples of 28 amphetamine and 7 methamphetamine seizures, taken in Norway from 1975 to 1982, were examined. The amphetamine and methamphetamine contents varied from 9 to 99 per cent and from 9 to 72 per cent respectively. Impurities originating from the synthesis of the illicit samples were identified by gas chromatography combined with mass spectrometry. Special attention was paid to "Leuckart-specific" impurities, which could indicate that the Leuckart method of amphetamine and methamphetamine synthesis had been used. N-formyl-methamphetamine, a Leuckart-specific compound, was identified in all the investigated samples of methamphetamine seized in Norway. The Leuckart-specific impurities, 4-methyl-5-phenyl-pyrimidine and N-formyl-amphetamine, were identified in 79 per cent of the amphetamine samples.