The role of magnetic resonance imaging in the diagnosis of breast cancer

MR mammography is a highly sensitive (> 98%) and slightly lower specificity (> 80%) method of detecting breast cancer. The sensitivity of MR mammography in detecting low or medium grade DCIS is lower than in detecting inva­sive carcinomas and high grade DCIS. Achieving the high efficacy of MR mammography is only possible with a very good quality MR examination; this however is not always easy to accomplish. According to EUSOBI 2015 recommendations, the indications for breast MRI are: screening women with a high risk of breast cancer; preoperative staging of newly diagnosed breast cancer; evaluating the response to neoadjuvant chemotherapy; occult primary breast carcinoma (searching for breast cancer in patients with metastases and negative mammography and breast ultrasound); suspected local recurrence whenever needle biopsy proves impossible; assessing breast implants; further characterisation of equivocal lesions found by mammography/breast ultrasound, whenever needle biopsy proves impossible. The introduction of Digital Breast Tomosynthesis (DBT) and contrast-enhanced spectral mammography (CESM) into daily clinical practice in the recent years has created the need to re-analyse the indications for MR mammography and to develop a new breast cancer diagnostic imaging algorithm

Rola mammografii metodą rezonansu magnetycznego w diagnostyce raka piersi

Mammografia MR jest metodą o wysokiej czułości (> 98% ) i niższej swoistości (> 80%) w wykrywaniu raka piersi. Czułość mammografii MR w wykrywaniu DCIS o niskim i pośrednim stopniu złośliwości jest niższa niż w wykrywaniu raka inwazyjnego i DCIS o wysokim stopniu złośliwości. Warunkiem wysokiej skuteczności mammografii MR jest bardzo dobra — niestety, nie zawsze łatwa do uzyskania — jakość badania. Główne wskazania do mammografii MR (Rekomendacje EUSOBI 2015) to: skrining kobiet z grup wysokiego ryzyka zachorowania na raka piersi; przedoperacyjna ocena stopnia zaawansowania zmian w piersiach u kobiet z rozpozna­nym rakiem piersi; ocena skuteczności neoadiuwantowej chemioterapii; poszukiwanie raka piersi u kobiet mających przerzuty, negatywny wynik mammografii i USG — ukryty rak piersi (occult primary breast cancer); podejrzenie wznowy miejscowej — jeżeli nie może być wykonana biopsja; ocena implantów; lepsza charakterystyka zmian niejednoznacznych w mammografii i USG, jeżeli nie może być wykonana biopsja. Wprowadzenie w ostatnich latach do codziennej praktyki klinicznej tomosyntezy (DBT — digital breast tomosynthesis) oraz mammografii spektralnej po dożylnym podaniu jodowego środka kontrastującego wymaga ponownego prze­analizowania wskazań do mammografii MR oraz określenia algorytmu diagnostycznego u kobiet z podejrzeniem lub rozpoznaniem raka piersi

Application of intravoxel incoherent motion (IVIM) model for differentiation between metastatic and non-metastatic head and neck lymph nodes

Background: Application of intravoxel incoherent motion (IVIM) model parameters, including: true diffusion (D), pseudodiffusion (D*), and perfusion fraction (Fp), for differentiation between metastatic and non-metastatic head and neck lymph nodes. Material/Methods: Diffusion-weighted images/apparent diffusion coefficient (DWI/ADC) images of 86 lymph nodes from 31 cancer patients were analyzed. DWI images were obtained with a 1.5T MRI scanner (Magnetom Avanto); b=0,50, 150, 300, 500, 750, 1000, 1200 s/mm2. Results: In the study group, there were 32 (37%) and 54 (67%) metastatic and non-metastatic lymph nodes, respectively. The mean values of D, D*, and Fp did not differ significantly between metastatic and non-metastatic lymph nodes. Conclusions: IVIM parameters are not useful for differentiation between metastatic and non-metastatic head and neck lymph nodes

Uncertainty in context-aware systems: A case study for intelligent environments

Data used be context-aware systems is naturally incomplete and not always reflect real situations. The dynamic nature of intelligent environments leads to the need of analysing and handling uncertain information. Users can change their acting patterns within a short space of time. This paper presents a case study for a better understanding of concepts related to context awareness and the problem of dealing with inaccurate data. Through the analysis of identification of elements that results in the construction of unreliable contexts, it is aimed to identify patterns to minimize incompleteness. Thus, it will be possible to deal with flaws caused by undesired execution of applications.Programa Operacional Temático Factores de Competitividade (POCI-01-0145-

Гидрогеологические условия и подсчёт запасов подземных вод на участке "Серебряный ключ" для водоснабжения санатория-профилактория (Беловский район Кемеровской области)

Участок работ располагается на территории санатория-профилактория "Серебряный ключ" Беловского района Кемеровской области. Работа выполнена с целью рабработки программы разведки подземных вод в пределах выделенного в лицензии на право пользования недрами (лицензия КЕМ 01527 ВЭ) горного отвода.The site is located on the territory of the sanatorium-preventorium "Silver key" of the Belovo district of the Kemerovo region. The work was carried out for the purpose of working out a program of groundwater exploration within the mining allotment allocated in the license for the right to use subsoil (license KEM 01527 VE)

Clinical review: Practical recommendations on the management of perioperative heart failure in cardiac surgery

Acute cardiovascular dysfunction occurs perioperatively in more than 20% of cardiosurgical patients, yet current acute heart failure (HF) classification is not applicable to this period. Indicators of major perioperative risk include unstable coronary syndromes, decompensated HF, significant arrhythmias and valvular disease. Clinical risk factors include history of heart disease, compensated HF, cerebrovascular disease, presence of diabetes mellitus, renal insufficiency and high-risk surgery. EuroSCORE reliably predicts perioperative cardiovascular alteration in patients aged less than 80 years. Preoperative B-type natriuretic peptide level is an additional risk stratification factor. Aggressively preserving heart function during cardiosurgery is a major goal. Volatile anaesthetics and levosimendan seem to be promising cardioprotective agents, but large trials are still needed to assess the best cardioprotective agent(s) and optimal protocol(s). The aim of monitoring is early detection and assessment of mechanisms of perioperative cardiovascular dysfunction. Ideally, volume status should be assessed by 'dynamic' measurement of haemodynamic parameters. Assess heart function first by echocardiography, then using a pulmonary artery catheter (especially in right heart dysfunction). If volaemia and heart function are in the normal range, cardiovascular dysfunction is very likely related to vascular dysfunction. In treating myocardial dysfunction, consider the following options, either alone or in combination: low-to-moderate doses of dobutamine and epinephrine, milrinone or levosimendan. In vasoplegia-induced hypotension, use norepinephrine to maintain adequate perfusion pressure. Exclude hypovolaemia in patients under vasopressors, through repeated volume assessments. Optimal perioperative use of inotropes/vasopressors in cardiosurgery remains controversial, and further large multinational studies are needed. Cardiosurgical perioperative classification of cardiac impairment should be based on time of occurrence (precardiotomy, failure to wean, postcardiotomy) and haemodynamic severity of the patient's condition (crash and burn, deteriorating fast, stable but inotrope dependent). In heart dysfunction with suspected coronary hypoperfusion, an intra-aortic balloon pump is highly recommended. A ventricular assist device should be considered before end organ dysfunction becomes evident. Extra-corporeal membrane oxygenation is an elegant solution as a bridge to recovery and/or decision making. This paper offers practical recommendations for management of perioperative HF in cardiosurgery based on European experts' opinion. It also emphasizes the need for large surveys and studies to assess the optimal way to manage perioperative HF in cardiac surgery

A case of carotid body paraganglioma and haemangioblastoma of the spinal cord in a patient with the N131K missense mutation in the VHL gene

The article describes paraganglioma case in woman with von Hippel–Lindau disease. She was found to be a carrier of a rare germline mutation in the VHL gene (393C>A; N131K). The patient developed large, untypical for von Hippel–Lindau disease, carotid body paraganglioma at the common carotid artery bifurcation. The carotid body paraganglioma coexisted with the haemangioblastoma situated intramedullary in region C5/C6. The haemangioblastoma reached the right-sided dorsal part of the spinal cord in section C5/C6. It produced radicular symptoms within C5/C6, followed by the later paresis of the right limbs. The haemangioblastoma was resected completely. Twelve months after the operation, the spinal symptoms receded and the carotid body paraganglioma still was asymptomatic. The current case of carotid body paraganglioma in patient with the 393C>A (N131K) missense mutation in the VHL gene, supports association of this specific mutation and VHL disease type 2, and suggests its correlation with susceptibility to paragangliomas