Sexual, addiction and mental health care needs among men who have sex with men practicing chemsex - a cross-sectional study in the Netherlands.

Drug use during sex ('chemsex') has been associated with sexually transmitted infections (STIs) and mental health harms. Little quantitative evidence exists on the health care needs of MSM practicing chemsex from a patient perspective. This study assessed self-perceived benefits and harms and the needs for professional counselling among MSM practicing chemsex. In 2018, 785 MSM were recruited at nine Dutch STI clinics and 511 (65%) completed the online questionnaire. Chemsex was defined as using cocaine, crystal meth, designer drugs, GHB/GBL, ketamine, speed and/or XTC/MDMA during sex <6 months. Chemsex was reported by 41% (209/511), of whom 23% (48/209) reported a need for professional counselling. The most reported topic to discuss was increasing self-control (52%, 25/48). Most MSM preferred to be counselled by sexual health experts (56%, 27/48). The need for professional counselling was higher among MSM who engaged in chemsex ≥2 times per month (30% vs. 17%, p = 0.03), did not have sex without drugs (sober sex) in the past three months (41% vs. 20%, p = 0.04), experienced disadvantages of chemsex (28% vs. 15%, p = 0.03), had a negative change in their lives due to chemsex (53% vs. 21%, p = 0.002), and/or had an intention to change chemsex behaviours (45% vs. 18%, p < 0.001). Our study shows that almost one in four MSM practicing chemsex expressed a need for professional counselling on chemsex-related issues. STI healthcare providers should assess the need for professional counselling in MSM practicing chemsex, especially in MSM with above mentioned characteristics, such as frequent users.

Ultrasound-guided percutaneous ethanol ablation of parathyroid hyperplasia: preliminary experience in patients on chronic dialysis.

OBJECTIVE: We report on a 3-year experience using single-shot, ultrasonography-guided, percutaneous ethanol ablation (PEA) of hyperplastic parathyroid glands in chronic dialysis patients suffering from secondary or tertiary hyperparathyroidism. MATERIALS AND METHODS: Seventeen uraemic patients (mean age 52 +/- 14 years) with hypercalcaemia and elevated serum levels of parathyroid hormone were assessed for ethanol ablation. Ten patients did not fulfil the inclusion criteria and underwent surgical parathyroidectomy. Seven patients were treated using PEA. RESULTS: All patients treated with PEA tolerated the procedure well, and no major complications were observed. Three out of seven patients underwent further ethanol ablation due to recurrent symptomatic hyperparathyroidism. Following the procedures, serum values of total calcium and parathyroid hormone remained within target range with concomitant medical therapy in all patients. CONCLUSION: PEA performed as a single-shot therapy can be used as a minimally invasive and safe supplement to medical therapy in the treatment of secondary or tertiary hyperparathyroidism in selected patients. In case of recurrence, treatment can be repeated without any problems.

[Evaluation of a computer-assisted diagnosis system in breast carcinoma]. / Evaluierung eines computerassistierten Diagnosesystems in der Erkennung des Mammakarzinoms.

PURPOSE: Evaluation of a computerassisted diagnosis (CAD) system (R2 linage Checker 1.2). Comparison of the results of three readers with and without knowledge of the computer results. MATERIALS AND METHODS: The mammograms of 52 patients, bilaterally in two planes each, with histologically proven carcinoma of the breast were included in the study. They were first scanned by the CAD machine and subsequently read by three readers with different degrees of experience in two sessions with and without knowledge of the computer results. RESULTS: Of the 91 views of carcinomas, the readers detected 96%, 89%, and 85%, respectively. With CAD, the values rose to 97%, 93%, and 96%. The increase of the first observer was not significant. As for the 49 areas of malignant microcalcifications, the first reader showed a significant decrease of sensitivity, the other two readers showed no significant change. The sensitivity of CAD was 74% for masses and 86% for microcalcifications at a rate of 1.8 false positive markers per image. All but two tumors were correctly marked in at least one plane. CONCLUSIONS: Use of the CAD machine led to a significant increase of sensitivity in the detection of malignant masses by two of three observers. In the case of malignant microcalcifications, and for the most experienced observer, CAD did not improve the results. The most important problem is the high rate of false positive markers.

[MRI-assisted brachytherapy of nonresectable liver metastases. Preliminary technical and clinical experiences]. / MR-gestützte Brachytherapie nichtresektabler Lebermetastasen. Vorläufige technische und klinische Erfahrungen.

PURPOSE: To evaluate the feasibility and efficacy of MR-guided interstitial brachytherapy of non-resectable liver metastasis. METHODS: Liver metastases (0.8-5.2 cm in diameter) were treated during a prospective phase I/II study using an open 0.2 Tesla MR system (Magnetom Open Viva, Siemens, Erlangen). MR-compatible brachytherapy applicators were placed percutaneously under MR-guidance in an open 0.2 Tesla MR system (Magnetom Open Viva, Siemens, Erlangen) using fast T1-weighted sequences. Pretreatment and follow-up studies were performed using a 1.5 Tesla MR system. RESULTS: Preliminary results of an unpublished prospective study are discussed exemplary on 2 selected patients. The median procedure time was 4.9 h. No major complications were observed and late effects were acceptable. In large symptomatic metastases only a temporary relief of pain was achieved. In smaller metastases (DM 3 cm) a tumor control was observed. CONCLUSION: MR-guided brachytherapy is feasible and has the potential to ablate liver metastases with diameter of less than 3 cm. Further developments are necessary.

Intraluminal 192Ir brachytherapy following transjugular intrahepatic portosystemic shunt revision: long-term results and radiotherapy parameters.

PURPOSE: The stenosis or occlusion of transjugular intrahepatic portosystemic shunt (TIPS) occurs in up to 75% of patients within 12 months after treatment. The aim of our investigation was to evaluate the feasibility, safety and efficacy of intraluminal high-dose rate brachytherapy (HDRBT) with Iridium-192 following TIPS revision to prevent restenosis due to pseudointimal hyperplasia. MATERIALS AND METHODS: Between September and November 1996, intraluminal BT was performed in five patients after TIPS revision. The indications for initial TIPS were a Budd-Chiari syndrome in two female patients and recurrent variceal bleeding by alcoholic liver cirrhosis in three male patients. TIPS was created with Wallstents (10 mm diameter in four patients) and Palmaz stent (10 mm diameter in one patient). The re-dilatation was done in all five patients 6 months after first stenting because of restenosis (>50% stent lumen reduction) or occlusion of the stent. A 5-French closed-tip, noncentered BT delivery catheter was used for subsequent radiotherapy. The whole length of the stent and performed dilatation (interventional length - IL) was taken as clinical target length (CTL). A 10-mm safety margin was added proximal and distal to the CTL due to uncertainties of BT source positioning, so forming the planning target length (PTL). To ensure that prescribed dose covers the whole PTL, the active source length (ASL) was 5 mm longer proximal and distal than PTL, so forming the reference isodose length (RIL). A dose of 12 Gy was prescribed in 3 mm distance from the source axis in the mid-plane of the applicator for three patients and in 5 mm distance for two patients. RESULTS: A normal patency (<50% lumen reduction) of the stent was achieved at 44 months follow-up (duplex sonography+portography) in all three patients with liver cirrhosis, whereas further revisions were necessary in two patients with Budd-Chiari syndrome (after 5.5 and 18 months). No acute, subacute or late brachytherapy (BT)-related side effects were seen until now. CONCLUSIONS: HDRBT following TIPS revision was safe and feasible in all patients. The exact impact of BT on the TIPS patency should be evaluated in larger clinical trials. Moderate dose escalation and use of today's commercially available centering radiation catheters seem to be necessary.

Radiological findings in acute adult epiglottitis.

Acute epiglottitis is a rare but life-threatening disease that commonly occurs in children, and also rarely in adults. The symptoms may be mild and non-specific before a rapid onset of airway obstruction occurs. Early diagnosis is essential, as delayed treatment is associated with a high rate of complications including death. We present the clinical and radiological findings of this unusual condition in an adult.

[Computer-assisted diagnosis in mammography: the R2 ImageChecker System in detection of spiculated lesions]. / Computerassistierte Diagnose in der Mammographie: Das R2 Image Checker-System in der Detektion spikulierter Läsionen.

Because of the rapid development of computer systems for digitalization and image analysis, they play an increasing important role in computer-assisted diagnosis (CAD). Especially in the field of mammography, the early signs of malignancy are relatively uniform and therefore more easily detected by a computer algorithm. In this study, we tested one of the few commercially available systems for the detection of both microcalcifications and suspicious, spiculated solid lesions on 40 cases of proven breast carcinomas. These mammograms were analyzed by three independent observers with and without knowledge of the computer results, respectively. Depending on the time of their radiologic experience, the sensitivity of the observers alone was 92.4%, 86.1% and 82%. With knowledge of the computer interpretation, sensitivity of all three observers rose significantly to 100%, 92.7%, and 95%, respectively. However, due to a high number of false positive results of the computer algorithm (0.4 markers per image), the positive predictive value of the interpretations worsened from 100%, 92.7%, and 95.5% to 86.4%, 97.3%, and 91.1%, respectively. It can be expected that future developments will soon overcome this problem and CAD will become an effective tool in screening mammography.