Perceived neuropsychological impairment inversely related to self-reported health and employment in multiple sclerosis.

BACKGROUND AND PURPOSE: Multiple sclerosis (MS) patients frequently report cognitive difficulties which impact daily functioning. The objective was to investigate the relationship between patient-reported cognitive impairment and depression, demographic and MS-related variables, and to clarify its impact on self-reported health measures and employment. METHOD: A large two-centre survey included the MS Neuropsychological Screening Questionnaire (MSNQ), the two-question screening tool for depression, vitality, health-related quality of life, the Health-Promoting Lifestyle Profile II and questions assessing social network satisfaction and employment status. RESULTS: Of the 751 respondents (median age 54 years, median Expanded Disability Status Scale 5, 66.2% female), two-thirds reported perceived neuropsychological impairment or depressive symptoms. Whilst depressive symptoms were related to higher MSNQ scores, the MSNQ poorly predicted depression. After correcting for confounders, higher MSNQ scores and depressive symptoms decreased vitality, health-related quality of life and health-promoting behaviours and increased the probability of being socially dissatisfied. In participants below retirement age, higher MSNQ and Expanded Disability Status Scale scores increased the probability of unemployment, whilst depression did not. CONCLUSION: The contribution of the MSNQ to self-reported health measures and its unique explanatory power regarding unemployment suggest that subjective cognitive complaints are connected to subtle, yet meaningful, neuropsychological dysfunction.

Health-related costs in a sample of premenopausal non-diabetic overweight or obese females in Antwerp region: a cost-of-illness analysis.

BACKGROUND: People with overweight or obesity are at increased risk for disease later in life which cause important health costs.The aim of this study was to estimate the health status and the corresponding costs in a sample of females with overweight or obesity which were participating in a Randomized Controlled Trial (RCT) exploring the effect of lifestyle habits changes on ectopic adipose tissue. METHODS: Sixty-two non-diabetic premenopausal females without major comorbidities of overweight and obesity were recruited among patients visiting endocrinologists at the obesity clinic of the University Hospital of Antwerp and the University of Antwerp.A RCT-embedded cost-of-illness approach with societal perspective, based on self-reported questionnaires and cost diaries (3 months recall) was applied to estimate the prevalence of different comorbidities and the related direct and indirect costs in this sample of overweight or obese females. The European Quality-of-Life-5D questionnaire was used to define the health state and the corresponding utility index of the participants. RESULTS: The average direct health costs and health utilities observed in this sample were comparable with the general Flemish female population. This may partially be explained by the strict inclusion criteria of the RCT (i.e. overweight or obesity without diabetes type 2 or cardiovascular diseases). However, 15% of the participants had five or more comorbidities resulting in higher average costs and lower average health utility as compared to the general population, only 3 participants were diagnozed with the metabolic syndrome. In this subsample productivity was low due to high average absenteeism, yielding important total costs for the society. CONCLUSION: Secondary prevention to avoid health deterioration in overweight or obese females without major comorbidies is needed to contain health care costs. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02831621, approval of the ethics committee of the University Hospital of Antwerp (number: 14/17/205 -ref: 7543075363).

The effect of diet or exercise on ectopic adiposity in children and adolescents with obesity: a systematic review and meta-analysis.

OBJECTIVE: Ectopic fat depostion in youth with obesity is associated with an increased cardiovascular disease risk. The aim of this meta-analysis was to summarize the evidence for the use of diet and/or exercise on ectopic adiposity in this population. METHODS: A systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Clinical trials that assessed ectopic fat deposition and included study arms with diet and/or exercise were searched in PubMed, PEDro and the Cochrane database. RESULTS: Hepatic fat content and intramyocellular lipid content were described in nine studies and three studies, respectively. Most studies included teenagers, and study duration ranged between 3 and 12 months without follow-up. Using random-effects weights, the standardized mean difference of the change in hepatic adiposity (totalling 320 subjects) was -0.54 Hedges' g (95% confidence interval: -0.69 to -0.38 with p < 0.0001). By re-expressing this effect size, it is seen that diet and/or exercise results in an absolute reduction of intrahepatic lipid with 2%, which accords with a relative reduction up to 70%. Although there were significant ameliorations of insulin sensitivity, no significant changes in intramyocellular lipid were observed. CONCLUSIONS: This meta-analysis showed that diet and/or exercise is effective to reduce hepatic adiposity in youth with obesity.

Long term results after bipolar radial head arthroplasty.

Radial head fractures are common injuries, occurring mostly in active young people 85%. Treatment of the more complex radial head fractures (Mason type III and IV), appear to be challenging and remain a subject of controversy. Replacement of the radial head with a metal prosthesis imitates the stabilizing role of the radial head and has been considered as the treatment of choice. However, long-term results are scarce. We report our mid to long-term (mean 9.4 year) clinical and radiographic results after insertion of a Judet Bipolar Radial Head prosthesis. 34 patients were treated with the Judet Bipolar Head prosthesis between 2000 and 2008. In this study, 21 patients were re-examined after a mean period of 113 months (range, 174-84), ie, 9.4 years (range, 14.5-7). Follow-up examinations included both the Mayo Elbow Performance Index (MEPI) and Dis- abilities of the arm, shoulder and hand (DASH) score. Range of motion was measured with a hand goniometer. X-rays were evaluated for peri-articular ossifications, radiolucent lines and signs of proximal erosion, capitellar erosion. Mean Mayo Elbow Performance Index was 88.6 (Range 100-50). According to the MEPI score we had 14 excellent, 1 good, 5 fair results and one poor result. One patient reported severe pain, 3 patients reported moderate pain, one patient reported mild pain and 16 patients reported no pain at all. Difference between pronation-suppination range was noted between primary or secondary indication of the radial head, no other significant differences were found. Mean DASH score was 23.1° (Range 0-63) without difference between primary and secondary indication. Mean flexion was 121.8° (Range : 110-140), mean extension deficit was 24.8° (Range 15-40), mean pronation was 62.4° (Range : 50-80) and suppination 58.8° (Range : 45-80). Ten patients showed signs of ulnohumeral joint degenerative arthritis. One patient developed symptomatic ulna plus. One patient showed radiolucent lines surrounding the prosthesis with proximal bone erosion. There were no reports of dislocations of the prosthesis. One case of radiological signs of overlenghtening was noted. Mainly good clinical results are achieved with the -Judet bipolar radial head implant. Functional results after long term follow-up are, however less optimistic then the excellent results achieved after short- to mid-term follow-up. No clear link between radiological signs and functional results can be found.

A tropical diabetic foot.

Foot infections are a common problem and an important cause of morbidity in patients with diabetes. We report a patient with type 2 diabetes, presenting with a chronic foot wound resistant to standard care, in whom the diagnosis of eumycetoma was made through histopathological examination of a bone biopsy specimen and confirmed by polymerase chain reaction (PCR). Diagnosis and treatment of eumycetoma are reviewed. Eumycetoma caused by Madurella mycetomatis is an uncommon cause of osteomyelitis in patients with diabetes in Europe, but should be considered in patients from endemic regions when (antibacterial) therapy fails.

Liver involvement in HIV-infected patients diagnosed with syphilis.

PURPOSE: Liver involvement in syphilis has been studied in cohorts of human immunodeficiency virus (HIV)-negative individuals despite the scarcity of data on such HIV-infected patients. Th aim of this study was to assess hepatic involvement of HIV-infected patients diagnosed with syphilis. METHODS: Patients with syphilis and liver involvement, including all stages of syphilis, were systematically identified in our HIV cohort between 2004 and 2008. RESULTS: Of the 1,599 HIV-infected patients identified during the study period, 100 were diagnosed with acute syphilis, all of whom were male. Of these 100 patients, 84% were men who have sex with men. Laboratory parameters of liver involvement were present in 19 of the 100 HIV-infected patients with syphilis; these resolved after successful antibiotic treatment. Among these 19 patients, six were diagnosed to be in the latent stage, with elevated liver enzymes and parameters of inflammation representing the only distinctive feature. CONCLUSIONS: Based on our results, syphilis should be included in the differential diagnosis of increased liver enzymes in HIV-infected patients.

Tears of the supraspinatus tendon: assessment with indirect magnetic resonance arthrography in 67 patients with arthroscopic correlation.

BACKGROUND: Magnetic resonance (MR) arthrography is generally regarded as the gold standard for shoulder imaging. As an alternative to direct MR arthrography, the less invasive indirect MR arthrography technique was proposed, offering logistic advantages because fluoroscopic or ultrasonographic guidance for joint injection is not required. PURPOSE: To assess the diagnostic performance of indirect MR arthrography in the diagnosis of full- and partial-thickness supraspinatus tears in a symptomatic population. MATERIAL AND METHODS: Two radiologists with different levels of experience independently and retrospectively interpreted indirect MR (1.5T) arthrograms of the shoulder obtained in 67 symptomatic patients who underwent subsequent arthroscopy. On MR, the supraspinatus tendon was evaluated for full- or partial-thickness tear. With arthroscopy as the standard of reference, sensitivity, specificity, and diagnostic accuracy of indirect MR arthrography in the detection of full- and partial-thickness tears of the supraspinatus tendon was calculated. Kappa (kappa) statistics were used for the assessment of the agreement between arthroscopic and imaging findings and for the assessment of interobserver agreement. RESULTS: For full-thickness tears of the supraspinatus tendon, sensitivities, specificities, and accuracies exceeded 90% for both observers, with excellent interobserver agreement (kappa = 0.910). For partial-thickness tears, sensitivities (38-50%) and accuracies (76-78%) were poor for both reviewers, and interobserver agreement was moderate (kappa = 0.491). Discrepancies between MR diagnosis and arthroscopy were predominantly observed with small partial-thickness tears. CONCLUSION: Indirect MR arthrography is highly accurate in the diagnosis of full-thickness rotator cuff tears. However, the diagnosis of partial-thickness tears with indirect MR arthrography remains faulty, because exact demarcation of degenerative change and partial rupture is difficult. On the basis of the above findings, we do not recommend indirect MR arthrography on patients for whom rotator cuff disease is suspected clinically.

Imaging of femoroacetabular impingement: pictorial review.

Femoroacetabular impingement (FAI) is a cause of progressive osteoarthritis of the hip in younger patients. Three types of FAI have been described: a cam-type, a pincer-type and a mixed type. Early recognition of the morphologic hip features of each type of impingement is important, because arthroscopic treatment is still successful in the initial stage to prevent or delay further hip degeneration. This article reviews the imaging features of the different types of FAI. Magnetic resonance arthrography (MRA) is the preferred modality to detect, localise and characterise the type of FAI and the resulting injuries of the acetabular hyaline cartilage and fibrocartilaginous labrum.

Palliative care physicians' religious / world view and attitude towards euthanasia: a quantitative study among flemish palliative care physicians.

AIMS: To Study the religious and ideological views and practice of Palliative Care physician towards Euthanasia. MATERIALS AND METHODS: An anonymous self administered questionnaire approved by Flemish Palliative Care Federation and its ethics steering group was sent to all physicians(n-147) working in Flemish Palliative Care. Questionnaire consisted of three parts. In first part responded were requested to provide demographic information. In second part the respondents were asked to provide information concerning their religion or world view through several questions enquiring after religious or ideological affiliation, religious or ideological self-definition, view on life after death, image of God, spirituality, importance of rituals in their life, religious practice, and importance of religion in life. The third part consisted of a list of attitudinal statements regarding different treatment decisions in advanced disease on which the respondents had to give their opinion using a five-point Likert scale.99 physician responded. RESULTS: WE WERE ABLE TO DISTINGUISH FOUR CLUSTERS: Church-going physicians, infrequently church-going physicians, atheists and doubters. We found that like the Belgian general public, many Flemish palliative care physicians concoct their own religious or ideological identity and feel free to drift away from traditional religious and ideological authorities. CONCLUSIONS: In our research we noted that physicians who have a strong belief in God and express their faith through participation in prayer and rituals, tend to be more critical toward euthanasia. Physicians who deny the existence of a transcendent power and hardly attend religious services are more likely to approve of euthanasia even in the case of minors or demented patients. In this way this study confirms the influence of religion and world view on attitudes toward euthanasia.

Magnetic resonance imaging of variants of the knee.

Magnetic resonance imaging has become the imaging modality of choice for evaluation of internal derangements of the knee. Anatomical variants are often an incidental finding on these examinations. Knowledge and recognition of variants is important, not only to avoid misdiagnosis but also to avoid additional imaging and over-treatment. This pictorial essay provides an overview of variants encountered during a review of 1,873 magnetic resonance imaging examinations of the knee. Emphasis is laid on these variants that are clinically important.

The effectiveness of diagnostic imaging methods for the assessment of soft tissue and articular disorders of the shoulder and elbow.

There are no clear guidelines for diagnostic imaging of articular and soft tissue pathologies of the shoulder and elbow. Several methods are used, including magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA) and ultrasound (US). Their cost-effectiveness is still unclear. We performed a meta-analysis of the relevant literature and discussed the role of MR imaging of the shoulder and elbow compared with other diagnostic imaging modalities. For the shoulder impingement syndrome and rotator cuff tears, MRI and US have a comparable accuracy for detection of full-thickness rotator cuff tears. MRA and US might be more accurate for the detection of partial-thickness tears than MRI. Given the large difference in cost of MR and US, ultrasound may be the most cost-effective diagnostic method for identification of full-thickness tears in a specialist hospital setting (Evidence level 3). Both MRA and CT arthrography (CTA) are effective methods for the detection of labrum tears. More recently, multidetector CTA has offered the advantages of thinner slices than with MRA in a shorter examination time. Still, MRA has the advantage towards CTA to directly visualize the affected structures with a better evaluation of extent and location and to detect associated capsuloligamentous injuries. For the elbow pathologies, plain MRI or MRA have the advantage towards CTA to detect occult bone injuries. CTA is better for the assessment of the thin cartilage of the elbow. Both US and MRI are reliable methods to detect chronic epicondylitis; US is more available and far more cost-effective (Evidence level 2). MRA can differentiate complete from partial tears of the medial collateral ligament. US or MRI can detect partial and complete biceps tendon tears and/or bursitis. MRI can provide important diagnostic information in lesions of the ulnar, radial, or median nerve.

Proceedings of the European Society of Musculoskeletal Radiology (ESSR) training module, Antwerp, 20-21.01.05. Part two: bone tumors. Benign bone lesions: characteristic imaging features.

Benign bone lesions are a fairly common finding in radiology practice. Often, the combination of patient's age and plain radiographic findings are sufficient for diagnosis and obviates the need for further imaging. Generally the following parameters should be assessed in the evaluation of a bone lesion: clinical features, age of the patient, location, size, pattern of bone destruction, cortical involvement, zone of transition, sclerotic margination and matrix calcification. Cross sectional imaging, such as CT or MRI complements radiography, especially in complex anatomical sites. This article reviews the spectrum of clinical and imaging appearances of the most common benign bone tumors.

Imaging of malignant bonetumors.

Diagnostic imaging plays a pivotal role in the initial detection, characterization, pre-operative assessment and long term follow-up of malignant bone tumors. The purpose of this brief review is to discuss the specific role of the different imaging modalities in the diagnostic work-up of malignant bone tumors. The imaging features, with emphasis on standard radiography, allowing differentiation, of malignant bone tumors, will be highlighted.

Imaging of soft tissue tumors: general imaging strategy and technical considerations.

This paper reviews the imaging strategy and protocol for detection, grading and staging, and posttherapeutic follow-up of soft tissue tumors (STT), used in our institution. The role of each imaging technique, with emphasis on magnetic resonance imaging, is highlighted.