Staging for Breast Cancer: A Nationwide Survey about Adherence to Guidelines in German Breast Centers

Introduction: The risk for metastasis at primary diagnosis of breast cancer is about 4%. The German guidelines give clear indications for when, whom and how to stage breast cancer patients. Ideally, this should be done via CAT scan of the thorax and abdomen and an additional bone scan. But daily practice shows that the way health care providers handle staging recommendations can vary. To objectify adherence to guidelines we started a nation-wide survey. Methods: Between July and September 2020 we sent out a survey via email to all certified and non certified breast centers and in addition to all Departments of Obstetrics and Gynecology in Germany. We asked for timing of staging, conditions that cause staging and the applied method. In case we did not get back any reply we sent out a reminder. Results: A total of 220 certified breast centers/28 non-certified breast center/48 Departments of Gynecology and Obstetrics who care for breast cancer patients took part in our survey. A general pre-therapeutic staging was performed in 16,4%/39,3%/66,7% of all institutions and a general post-operative staging was performed in 4,1%/0%/6,3% of each institutional type, respectively. In terms of the applied method, 75% of all certified breast centers used a CAT scan and bone scan, while 23,3% primarily use chest x-ray, ultrasound of the abdomen (27,7%) or MRI. As a potential reason for using x-ray and ultrasound the presence of a „low-risk“ breast cancer was mentioned. Summary: Although certified breast centers show the highest adherence to current guidelines, some still perform a general staging or do not use the recommended staging method. The low probability for primary metastatic breast cancer and the use of a reasonable exposure to radiation warrant a critical discussion.

Isolated traumatic acute subdural haematoma: outcome in relation to age, Glasgow Coma Scale, and haematoma thickness

Background Traumatic acute subdural haematoma occurs in about 10–20% of patients with severe head injuries. This study aims to investigate the relation between outcome and the age, Glasgow Coma Scale on admission as well as haematoma thickness upon admission CAT scan. This is a prospective observational clinical trial study of 39 patients with isolated traumatic acute subdural haematomas treated with conservative or surgical procedures during a one-year study period. Results There was a statistically significant relation between Glasgow Outcome Score and both age of the patients and Glasgow Coma Scale upon admission. However, there was a non-statistically significant relationship between Glasgow Outcome Score and haematoma thickness upon admission CAT scan. Conclusions Age of the patients with traumatic acute subdural haematoma as well as Glasgow Coma Scale upon admission are essential predictors of the outcome. Clinical trial registration details: Name of the registry: Traumatic Acute Subdural Haematoma: Management and Outcome. Trial registration number: NCT03971240. Date of registration: June 3, 2019. URL of trial registry record: https://clinicaltrials.gov/ct2/show/record/NCT03971240?term=Mohamed+Ahmed+Alghriany&draw=2&rank=1.

Analisa Perbandingan Citra Hasil Segmentasi Menggunakan Metode K-Means dan Fuzzy C Means pada Citra Input Terkompresi

<p><em style="text-align: justify; text-indent: 14.2pt;"><span style="font-family: 'Times New Roman',serif; mso-ansi-language: EN;" lang="EN">In pattern recognition, image processing plays a role in automatically separating objects from the background. In addition, the object will be processed by the pattern classifier. In the medical world, image processing plays a very important role. CT Scan (Computed Tomography) or CAT Scan (Computed Axial Tomography) is an example of an image processing application that can be used to view fragments or cross sections of parts of the human body. Tomography is the process of producing two-dimensional images from three-dimensional film through several one-dimensional scans. Magnetic resonance imaging (MRI) is the image most often used in the field of radiology. MRI images can display the anatomical details of objects clearly in multiple sections (multiplanar) without changing the patient's position. In this study, two methods were compared, namely K-Means and Fuzzy C Means, in a segmentation process with the aim of separating between normal areas or areas with disturbances (lesions). The images used are brain and chest MRI images with a total of 10 MRI images. The image quality of the segmentation results is compared with the quality test using the Variation of Information (VOI) parameters, Global Consistency Error (GCE), MSE (Mean Square Error), PSNR (Peak Signal to Noise Ratio) and segmentation time.</span></em></p><pre style="text-align: justify; text-indent: 14.2pt;"><em><span style="font-family: 'Times New Roman',serif; mso-ansi-language: EN;" lang="EN">In pattern recognition, image processing plays a role in automatically separating objects from the background. In addition, the object will be processed by the pattern classifier. In the medical world, image processing plays a very important role. CT Scan (Computed Tomography) or CAT Scan (Computed Axial Tomography) is an example of an image processing application that can be used to view fragments or cross sections of parts of the human body. Tomography is the process of producing two-dimensional images from three-dimensional film through several one-dimensional scans. Magnetic resonance imaging (MRI) is the image most often used in the field of radiology. MRI images can display the anatomical details of objects clearly in multiple sections (multiplanar) without changing the patient's position. In this study, two methods were compared, namely K-Means and Fuzzy C Means, in a segmentation process with the aim of separating between normal areas or areas with disturbances (lesions). The images used are brain and chest MRI images with a total of 10 MRI images. The image quality of the segmentation results is compared with the quality test using the Variation of Information (VOI) parameters, Global Consistency Error (GCE), MSE (Mean Square Error), PSNR (Peak Signal to Noise Ratio) and segmentation time.</span></em></pre>

Localised cervical lymphadenopathy: a rare presenting sign of syphilis

Recognising syphilis can be challenging due to enormous variability in disease presentation. We present a case of 56-year-old female patient, without any medical history, with unilateral cervical lymphadenopathy and night sweats since 3 weeks. Initial differential diagnosis consisted of infectious disease, lymphoproliferative disease and autoimmune disease. Despite considerable diagnostic efforts, including serological tests for common infectious diseases, a CAT scan and histologic examination, no diagnosis was found. After reconsideration, serologic testing for syphilis was performed and was positive. Hereby, the final diagnosis of syphilis was made. Neurosyphilis and HIV coinfection were ruled out before treatment with benzylpenicillin was initiated. After which our patient made a full recovery. Treatment delay could have been considerably diminished if the localised lymphadenopathy was recognised as possible syphilitic disease. In future cases this could not only prevent further dissemination and potential morbidity in the individual patient as well as further emergence within the population.

CAT Scan: A Critical Review of the Critical-Thinking Assessment Test

The CAT is entirely dedicated to assessing the critical-thinking skills involved in scientific reasoning and practical problem solving. While the test is found to have reasonable content validity, various issues with its prompts are discussed, along with significant issues with its scoring. The CAT’s recommended use as a “model” for curricular changes, called CAT Apps, is criticized as “teaching to the test.”

The Effects of Steroids in Severe Hospitalized Patients with COVID-19: A Retrospective Cohort Study

The efficacy of corticosteroids in the treatment of patients with severe COVID-19 remains unknown. We evaluated the impact of corticosteroids on clinical improvement among severe COVID-19 patients. In this retrospective, two-centered, cohort study, we enrolled 101 patients with severe COVID-19: with 39 patients in the steroid group and 63 patients in the non-steroid group. The primary endpoint was Time to Clinical Improvement (TTCI) by up to 28 days after the treatment. Secondary endpoints included the rate of CAT scan improvement, the percentage of negative SARS-Cov-2 RT-PCR tests by Day 28, and the time to discharge. We found that patients in the steroid group did not have significant differences of TTCI from patients in the non-steroid group by 28 days after the treatment (median, 19 days vs. 20 days; hazard ratio, 1.07; p=0.797). The CAT scan improvement rate was not statistically different between the two groups by Day 28 (87.2% vs. 79.0%, p=0.170). The negative test of SARS-CoV2 RT-PCR by Day 28 was 68.4% in the steroid group, 87.1% in the non-steroid group (p= 0.060). Time to discharge was significantly longer in the steroid group than the non-steroid group (35 days vs 21 days, p=0.005). Our findings indicated the short-term corticosteroid at a low to moderate dose did not improve the clinical outcomes for patients with severe COVID-19. Further randomized clinical trials are needed to confirm the findings.