Multidisciplinary Diagnostics Research Articles

NGS-based molecular genetics of leukemia-a powerful and decentralized approach

The diagnosis of acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS), originally based on morphological assessment alone, has to bring together more and more disciplines. Today, modern AML/MDS diagnostics rely on cytomorphology, cytochemistry, immunophenotyping, cytogenetics, and molecular genetics. Only the integration of all these methods allows acomprehensive and complementary characterization of each case, which is aprerequisite for optimal AML/MDS diagnosis and treatment. In the following, we present why multidisciplinary and local diagnosis is essential today and will become even more important in the future, especially in the context of precision medicine. We present our idea and strategy implemented at Augsburg University Hospital, which has realized multidisciplinary diagnostics in AML/MDS in an interdisciplinary and decentralized approach. In particular, this includes the recent technical advances that molecular genetics provides with modern methods. The enormous amount of data generated by these techniques represents amajor challenge, but also aunique opportunity. We will reflect on how this increase in knowledge can be integrated into routine practice to lead the way for personalized medicine in AML/MDS to improve patient care.

The cancer epidemic : Global significance of cancer and the situation in oncological imaging

Asignificant increase in the incidence of cancer is expected worldwide. In Europe, cancer will soon be the leading cause of death, ahead of cardiovascular disease. Concerted efforts at the scientific, medical, societal, and political levels are required to address this problem on aglobal scale. High-quality oncological imaging is of particular importance in this regard. Access to it has been shown to have asignificant impact on quality of care and survival. Imaging is an essential component of screening and early detection. In clinical oncology, imaging is essential for multidisciplinary diagnostics and personalized therapy. Likewise, imaging is necessary in translational and clinical research. Imaging techniques are also themselves the subject of research and development and, associated with this, are also of great importance as an economic factor. This article aims to provide insights into the global problem of oncology and the contribution that oncological imaging can make to its management.

Wernicke-Korsakoff syndrome diagnostics and rehabilitation in the post-acute phase

Severe addiction to alcohol can lead to malnutrition. Wernicke's Encephalopathy is an acute and preventable neuropsychiatric syndrome resulting from thiamine deficiency. The disorder is under-diagnosed and under-treated leading to chronic cognitive and motoric issues (Korsakoff syndrome). The acute and chronic phase combined are called Wernicke-Korsakoff syndrome. In this narrative review, we present an outline of Wernicke's Encephalopathy, and how Korsakoff's syndrome can be prevented in the acute and post-acute phase. We highlight novel insights into the post-acute medical care for motoric, psychiatric and cognitive sequalae and present a rehabilitation program aiming for optimal recovery based on both clinical and experimental evidence. We discuss proper diagnostics of Korsakoff's syndrome, and describe how to facilitate the transfer into the community and durable forms of long-term care. Prophylaxis of Wernicke's Encephalopathy is relevant, but the cure requires more than giving high doses of parenteral thiamine in the acute phase. Multidisciplinary diagnostics and care for handling delirium, ataxia, social limitations and reduced autonomy are required after WKS diagnosis. We emphasize the need for advanced diagnosis and treatment of overdue medical conditions in Wernicke's Encephalopathy, and for tailoring treatment programs with both compensatory and rehabilitation strategies for patients diagnosed with Wernicke's Encephalopathy.

Diagnostic Workup of Acute Myeloid Leukemia: What Is Really Necessary? An Italian Survey.

Acute myeloid leukemia (AML) is a heterogeneous disease with a wide variety of clinical presentations, morphological features, and immunophenotypes. The diagnostic approaches to AML that are adopted in Italy have been explored using an online Delphi-based process to expand the global discussion on mandatory tests for the correct diagnosis and, consequently, for optimal management of AML in clinical practice. The final results of the panel of Italian hematologists involved in this work highlight the importance of genetic evaluation for classification and risk stratification and firmly establish that karyotyping, fluorescence in situ hybridization in cases with non-evaluable karyotype, and molecular tests must be performed in every case of AML, regardless of age. Obtaining clinically relevant genetic data at diagnosis is the basis for the success of patient-tailored therapy. The Italian specialists also confirm the role of multidisciplinary diagnostics for AML, now mandatory and expected to become more important in the future context of “precision” medicine.

Dossier: Updates on Disability and Dentistry

Universitas Odontologica’s volume 40 of 2021 includes 17 articles in the Health Care Management and Professional Issues, Clinical Practice, and Public Health and Oral Epidemiology sections, as well as the thematic dossier Updates in Disability and Dentistry. Topics cover sterilization, operative and multidisciplinary management, oral anatomy, diagnostics, oral pathology, oral medicine, oral epidemiology, oral health and quality of life, dental anthropology, and disability. Countries of origin are Argentina, Brazil, Chile, Ecuador, Mexico, Venezuela, and Colombia. With the consolidation of the publication entirely in English language and a rolling-volume frequency the journal aspires to increase its international visibility and impact. In 2022, volume 41 of Universitas Odontologica will be devoted to celebrating its 40th anniversary of foundation.

Difficulties of multidisciplinary diagnostics of indeterminate colitis

Aim of the study: Using the example of a clinical case, to show the importance of dynamic observation by means of various diagnostic methods of intestinal imaging, in combination with a pathomorphological confirmation method for setting the correct clinical diagnosis. Materials and methods: The studies were performed on multislice computed tomographs Brilliance CT and ICT (Philips Medical Systems) and magnetic resonance imaging machines (GE), with intravenous contrast enhancement. We used special methods of contrasting the lumen of the intestine with gradual and retrograde filling it with water. The surgical material fixed in 10% neutral formuline for 10-24 hours. Tissue fragments were processed in a Leica TP1020 histoprocessor (Leica BioSystems, Germany) according to a standard protocol, after which it was embedded in paraffin blocks. Histological sections with a thickness of 3-5 μm were made by a Leica RM2245 microtome (Leica BioSystems, Germany). The prepared histological preparations were stained with hematoxylin and eosin in a Leica Autosteiner XL histostiner (Leica BioSystems, Germany). Results: From 2013 to 2020 patient K. underwent 4 colonoscopies, 5 esophagogastroduodenoscopies, 1 Х-ray examination with small bowel series, 3 MRI studies and 5 CT studies, including those with intravenous contrast enhancement, with a total radiation exposure of 187 mSv. The diagnosis was revised from ulcerative colitis, Crohn’s disease to NC. The final diagnosis was made by the pathologist’s analysis of materials. Conclusion: The clinical case presented by us clearly demonstrates the importance of dynamic observation by computed and magnetic resonance imaging, in combination with a pathomorphological confirmation method.

Accessible diagnostics along the care trajectory of children with a developmental disorder

Abstract Background 20% of all children suffer a neurodevelopmental disorder (NDD) worldwide. Each child with a (suspected) NDD should have access to a specialised multidisciplinary diagnostic setting to pass a qualitative and adequate diagnostic trajectory. In Flanders, Belgium, 6 types of public organisations offer multidisciplinary diagnostics of NDD for children. However the objective of timely diagnostics for the population is not realized. Methods Literature review, document- and website analysis, surveys and focus groups were done. Results of the surveys have been analysed by SPSS, focus groups have been thematically analysed by a process of data- and researchers triangulation. Results were discussed and validated by experts in focus groups. Results The response on the survey was 155. 67 surveys were included for analysis. 71 professionals participated in a focus group. As a result of an historical dispersed development, the field of organisations offering diagnostics of NDD in Flanders is heterogeneous. Diagnostics are provided in each region, but not in every region the same competences, knowledge, expertise and capacity are available. Overall it lacks sufficient capacity. The accessibility, nature of the diagnostics, target groups, composition of the diagnostic teams and working processes differ between organisations and are not coordinated. There is no shared interorganisational opinion on the concept and content of diagnostics. An important hampering factor for interorganisational collaboration is the lack of trust in the quality of diagnostics by other organisations. Many ruptures in the overall trajectory hamper continuity of care for NDD. Conclusions Besides creating more diagnostic capacity according to a geographical planning, interorganisational collaboration will tackle the accessibility problem. A coordinated common framework grounded in the logics of cooperation and collaboration of a heterogeneous mix of organisations providing diagnostics, is needed. Key messages Development of collaborative networks of different types of services offering diagnostics will improve the accessibility of early and timely multidisciplinary diagnostics for children with NDD. A shared interorganisational opinion on the concept and content of diagnostics aiming to improve interorganisational trust in the quality of diagnostics, must be developed.

Health problems and care needs in patients with Korsakoff's syndrome: A systematic review.

WHAT IS KNOWN ON THE SUBJECT?: Patients with Korsakoff's syndrome suffer from a broad range of comorbid somatic and/or psychiatric conditions. The various health problems in patients with Korsakoff's syndrome limit their ability to perform daily activities and also negatively affect their social functioning. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Patients with Korsakoff's syndrome have complex somatic and psychiatric comorbid conditions co-occurring with behavioural and functional problems. They are compounded by patients' poor self-awareness regarding their health status and functioning. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This review demonstrates that patients with Korsakoff's syndrome should receive integrated care. Integrated care for patients with Korsakoff's syndrome should be based on accurate multidimensional and multidisciplinary diagnostics in which nurses and nurse assistants have a prominent role due to their central position in the care process patients with Korsakoff's syndrome. ABSTRACT: Introduction The literature shows that Korsakoff's syndrome is associated with a wide range of severe comorbid somatic and psychiatric health problems that lead to care needs in several domains of functioning. Aim To provide a comprehensive overview of Korsakoff patients' health conditions and related care needs. Method Following the PRISMA guidelines, we searched MEDLINE, PsycInfo, Cochrane Library and CINAHL up to January 2019. After applying our inclusion criteria, two reviewers independently selected the studies, extracted the data and assessed methodological quality. Results Twelve articles were included. The commonest somatic comorbid conditions were liver disease, cardiovascular disease, COPD and diabetes mellitus. The commonest psychiatric comorbid conditions were mood disorder, personality disorder and psychotic disorder. Anxiety, aggressive/agitated behaviour, depressive symptoms and care needs in social functioning and (instrumental) activities of daily living were also very commonly reported. Discussion In patients with Korsakoff's syndrome, somatic and psychiatric comorbid conditions co-occur with behavioural and functional problems. They are compounded by patients' poor self-awareness regarding their health status and functioning. Adequate responses to their care needs require high-quality integrated care. Implications for practice Patients with Korsakoff's syndrome should receive integrated care based on accurate multidimensional and multidisciplinary diagnostics in which nurses have a prominent role.

The power and potential of integrated diagnostics in acute myeloid leukaemia.

SummaryThe field of acute myeloid leukaemia (AML) diagnostics, initially based solely on morphological assessment, has integrated more and more disciplines. Today, state‐of‐the‐art AML diagnostics relies on cytomorphology, cytochemistry, immunophenotyping, cytogenetics and molecular genetics. Only the integration of all of these methods allows for a comprehensive and complementary characterisation of each case, which is prerequisite for optimal AML diagnosis and management. Here, we will review why multidisciplinary diagnostics is mandatory today and will gain even more importance in the future, especially in the context of precision medicine. We will discuss ideas and strategies that are likely to shape and improve multidisciplinary diagnostics in AML and may even overcome some of today's gold standards. This includes recent technical advances that provide genome‐wide molecular insights. The enormous amount of data obtained by these latter techniques represents a great challenge, but also a unique chance. We will reflect on how this increase in knowledge can be incorporated into the routine to pave the way for personalised medicine in AML.

Accessibility of early diagnostics for children with a developmental disorder in Flanders, Belgium

Abstract Background 20% of all children suffer a neurodevelopmental delay or disorder (NDDD) worldwide. Early multidisciplinary diagnostics, early intervention and timely diagnostics along the rehabilitation trajectory are needed to improve the child’s functioning and participation. In Flanders, Belgium, 6 types of public organizations (164 service points in the region) offer multidisciplinary diagnostics of NDDD for children. However the objective of timely diagnostics for the population is not realized. Methods A qualitative thematic analysis identifies the criteria of Federal and Flanders’ regulations for publicly accredited and funded organizations providing multidisciplinary diagnostics for children with (suspected) NDDD. A survey was sent in different settings on waiting periods and perceived determinants hampering early diagnostics These results were discussed and validated by experts in focus groups. Results Average waiting times for diagnostics run up to 1 year before a diagnostic trajectory can be started. Regional differences occur in the availability of diagnostic services. Formal regulations hamper the development of collaborative networks and an integrated health services model offering accessible diagnostics along NDDD trajectories. The field lacks public health services strategies to provide accessible, efficient and effective diagnostics for a complex range of NDDD target groups Conclusions Coordination of services providing multidisciplinary diagnostics for children with (suspected) NDDD is needed. A health services approach supporting mandated regional networks will improve the accessibility of early and timely diagnostics. Key messages Development of collaborative networks of different types of services offering diagnostics will improve the accessibility of early and timely multidisciplinary diagnostics for children with NDDD. Better accessibility to multidisciplinary diagnostics will improve long term outcome for children with NDDD.

Simultaneous Occurrence of Hemangiosarcoma and Grade II Mast Cell Tumor in a Pit Bull Terrier

Background: The incidence of cutaneous neoplasms in dogs is high and quite variable. Hemangiosarcoma (HSA) and mast cell tumor (MCT) are commonly diagnosed neoplasms in isolation; however, reports of concomitant occurrence in a single patient are rare. HSA is a malignant mesenchymal neoplasm of endothelial origin; the spleen is the most commonly affected organ. MCT is a common neoplasm that may affect any region of the body, without predilection for sex, although some breeds have shown higher incidence. This report describes a case of HSA and MCT in a Pit bull terrier.Case: A 5-year-old white male Pit bull was presented to the Small Animal Clinic of the Federal Rural University of Pernambuco with nodules in preputial region measuring 5,4 x 3,7 cm and an ulcerated nodule in the right lateral thoracic region measuring 23,0 x 19,0 x 5,5 cm. The owner reported surgical excision of two previous nodules one year before the consultation, but neither were submitted for cytopathological or post-surgical histopathological examination. Two months after the procedure, the nodules recurred. Cytopathological examinations of preputial and lateral thoracic nodules were performed, with a suggestive diagnosis for HSA and MCT, respectively. Due to the unfavorable prognosis and the weakness of the animal, euthanasia was elected. Necroscopic examination revealed an ideal body condition score (4/9), hypertrophy of right pre-scapular and axillary lymph nodes, red hepatization in the apical lobe of the right lung, with multiple, soft and pigmented nodules in the spleen, liver, pancreas and testis. Several tissue samples were collected, conditioned in 10% buffered formaldehyde solution, routinely processed for histology, and stained with hematoxylin-eosin and toluidine blue. Microscopically, the lateral thoracic nodule consisted of round cells in cordonal arrangement, with sparse basophilic and discretely granular cytoplasm, and a round, central nucleus with a single evident nucleolus. Some cells were positively marked by toluidine blue, and the neoplasm was classified as grade II MCT. The preputial and digital nodules were confirmed as well-differentiated HSA, with fusiform cells forming vascular structures containing large numbers of erythrocytes and irregular fibrovascular stroma. Metastases of HSA were observed in the lung, liver, spleen, pancreas, and testis. Invasion of mast cells was observed in lymph node.Discussion: Although the etiology of HSA has not yet been clarified, its occurrence in dogs with poorly pigmented skin exposed to ultraviolet light is well established, consistent with observations in this case. MCTs often occur on the pelvic and thoracic limbs, abdomen, and chest. Primary site of HSA may be in any tissue, but it is commonly seen in highly vascular organs such as the spleen. When it occurs on the skin, HSA has more frequently been reported in the preputial and scrotal regions in dogs. For both neoplasms, the locations in this Pit bull corresponded to those commonly reported. MCTs with ulceration, edema, pruritus, and flushing are associated with worse prognosis. Metastasis is a major concern when evaluating oncologic patients. While it is difficult to determine the primary site of HSAs, metastasis often occurs in the lungs and liver. In this case, metastatic lesions were identified in the lungs, liver, spleen, pancreas, and testis by necropsy and histopathology. Fine needle aspiration of neoplasm-suggestive lesions should be performed prior to surgical procedures, especially because of its high sensitivity for MCTs. MCT and HSA are tumors of great significance, due to their high occurrence and variable prognosis. Multidisciplinary diagnostics involving clinical and pathological aspects are essential to guide the prognosis and treatment of these tumors.Mariana Lumack do Monte Barretto, Rômulo Freitas Francelino Dias, Saulo Romero Felix Gonçalves, Órion Pedro da Silva, Roseane Oliveira Feitosa, Stephanie Caroline Gueiros Silva, Valdemiro Amaro da Silva Junior & Andrea Alice da Fonseca Oliveira

OROFACIAL PAIN - DIAGNOSTIC AND THERAPEUTIC CHALLENGES.

SUMMARYThe concept of diagnostics and therapy of musculoskeletal and neuropathic diseases of the stomatognathic system, which are the subject of this paper, has been developing for decades. It can be said that in order to avoid misunderstanding, the orofacial pain as a clinical problem, in the narrower sense, involves non-odontogenic and non-malignant causes of orofacial region. In this study, the results of clinical diagnosis of the population of 557 consecutive patients with orofacial pain based on multidisciplinary diagnostics were evaluated. 15.6% of patients have given up on the participation in the study. It has been shown that the patients who dropped out of the study were significantly older (p=0.0411) than those who agreed to participate, but there was no difference in gender ratio (p=0.185) since the proportion of female patients prevailed. In an analysis of 84.4% of patients participating in the study, the elevated anxiety values were established (mean value on STAI 1 was 39.2 and STAI 2 was 41.1) and statistical significance was found in correlation between elevated anxiety and intensity of pain as shown on visual analogue scale on open mouth (p<0.0001). Compared to the age, the statistical significance was for STAI 1 (p=0.0097) but not for STAI 2 (p=0.5599). The most common form of therapy is Michigan stabilization splint: for disc displacement of temporomandibular joint (TMJ) in 38.9% of patients and in combination with physiotherapy in 18.7% of patients; for osteoarthritis of TMJ in 28.4% and in combination with physiotherapy in 26.4% of patients. The treatment with anticonvulsant drugs for trigeminal neuralgia predominates in 54.3% of patients, which is combined with acupuncture in 25.7% of patients and only acupuncture in 17.1% of patients. In this study, a multidisciplinary co-operation in initial diagnostics and differential was designed to develop subspecialist knowledge on orofacial pain.

Integrated care for diagnostics along the disease trajectory of children with a neurobiological developmental delay or disorder. A network approach

Introduction: Children with a (suspected) neurobiological developmental delay or disorder (NDDD) are clinically expected to be diagnosed by a multidisciplinary team as early as possible, given the impact on subsequent development. In different stages of the disorder trajectory and health care use trajectory of the child, diagnostics are needed to clear out development, evolution and recent symptoms. Currently, there is no evidence on the types and organization of diagnostics and follow-up care children with NDDD need, related to the phases of the trajectory. Methods: Systematicliterature review on neurobiological developmental disorders, (multidisciplinary) diagnostics, disease trajectories. Results: Neurobiological developmental delays and disorders (NDDD) are dysfunctions in the development, involving a large variety in etiology, expression and severity. Assessment at all areas of development (verbal and non-verbal cognition, expressive and receptive language, fine and gross motor development, social communication, social-emotional development) is needed. Classifying and action-oriented diagnostics can be distinguished, as well as mono- and multidisciplinary diagnostics. Mostly, diagnostics are followed by interventions (rehabilitation, support), which may prevent academic failure, behavior problems, dropout, delinquency and the development of more severe mental health issues in later life. These interventions are based on the diagnostic outcome and partly determine the health care use and personal functioning trajectory of a child. Discussion: Diagnostics with different goals are needed at different stages of the trajectory of the child, because of the complexity and dynamic characteristics of NDDD. Mono- or multidisciplinary diagnostics and classifying or action-oriented diagnostics need to be organized in an effective and efficient way and should be easy accessible both on population level, and in different stages of NDDD trajectory. This type of services can be provided in an network model of services integrating types of diagnostics and care. Literature on policy or mandated interorganizational networks suggests that network approaches help to tackle complex problems, if autonomous settings offer complementary services and become mutually dependent to reach common goals. Conclusion: Children with NDDD follow a non-linear trajectory of diagnostics, rehabilitation and support. Specialized diagnostics are needed at different stages along the trajectory of the child. An integrated health care approach taking into account the characteristics of trajectories needs to be enhanced through whole (mandated) networks. Lessons learned: Timely accessible multi- and monodisciplinary classifying and action-oriented diagnostics are needed during the trajectory of a child with a NDDD. Integration of diagnostic and other health services can be realized through (mandated) networks taking into account the health system characteristics. Limitations: This review is conceptual in nature and needs further empirical validation. The empirical part would allow to better understand how local context and health system-characteristics affect the development and implementation of effective networks. Suggestions for future research: Further research on disorder trajectories, health care use trajectories and personal functioning trajectories of children with a NDDD is needed, as well as research on the implementation of (mandated) networks in order to provide accessible quality care for children with a NDDD.

How regulations of multidisciplinary diagnostic settings for children with a neurobiological developmental delay or disorder impact on integration of care: the case of Flanders, Belgium

Introduction: An early and fluent diagnostic trajectory, accessible for every child, is currently not guaranteed in Flanders despite the availability of different types of settings offering multidisciplinary diagnostics for neurobiological developmental delays or disorders NDDD. Regulative, organizational and work practice differences potentially impact on the development of collaborative networks guaranteeing accessible and integrated diagnostics, along the trajectories of children. Methods: Mapping the regulative frameworks at the federal and community levels for specialized multidisciplinary diagnostic teams for children with suspected NDDD in Flanders. Analysis of policy documents and legal frameworks of the centers for ambulatory rehabilitation CAR, centers for developmental disorders CDD, student guidance centers SGC, ambulatory mental health care centers MHC, autism reference centers ARC, ambulatory hospital services for pediatric neuropsychiatry APP. Results: Organizations are currently regulated by Federal or Community regulations. The different organizations providing multidisciplinary diagnostics for NDDD fall under different policy domains mental health, rehabilitation, hospitals, education. Federal regulations are more detailed and regulate more aspect than community regulations. For diagnostics at a CAR or MHC, children have to be referred. The regulations on target group facility for the CAR, ARC and MHC, is pathology-based; on CDD, SGC and APP more generally described. In a CAR, MHC and APP diagnostics aim at support and rehabilitation. Diagnostics at SGC aims at support, referral and coordination. ARC and CDD do clinical classifying diagnostics, referral and further coordination. The ARC uses a standardized protocol for diagnostics. The regulations on team composition numbers and disciplines are set for the CDD and MHC; more detailed rules are set for ARC, CAR, SGC and APP. Discussion: Literature on policy or mandated networks suggests that network approaches help to tackle complex problems, if settings offer complementary services and are mutually dependent to reach societal goals. The current confusion and ineffectiveness in the field is partly affected by regulations that do not promote collaboration and complementarity. Services were historically regulated specifically in different fields sectors. Those regulations do not refer to collaboration or cooperation. For the population, it is not clear what types of service are offered, how they differ from or overlap with each other, or for what purpose different organizations can be consulted. Conclusion: Regulations in public services impact on the organization of services and clinical practice. Current regulations in Flanders are not adapted to support network practice and an integrated way of providing accessible diagnostics along NDDD trajectories. Lessons learned: Current regulative frameworks for multidisciplinary diagnostics of NDDD are not adequately adapted to implement accessible and integrated care. The literature on mandated or policy networks urges to develop supportive regulative frameworks identifying complementarities of the different types of facilities. Limitations: Private, non-subsidized multidisciplinary settings are not included. Suggestions for future research: Additional health service research is needed on differences in organizational practice in the field of multidisciplinary diagnostics of NDDD, affecting network development, and on governance mechanisms supporting the development of integrated care. This should include research on factors affecting the accessibility of services.

Scoring of the radiological picture of idiopathic interstitial pneumonia: a study to verify the reliability of the method.

BackgroundIdiopathic pulmonary fibrosis (IPF) is a clinical form of usual interstitial pneumonia (UIP). Computed chest tomography (CT) has a fundamental role in the multidisciplinary diagnostics. However, it has not been verified if and how a subjective opinion of a radiologists or pneumologists can influence the assessment and overall diagnostic summary.PurposeTo verify the reliability of the scoring system.Material and MethodsAssessment of conformity of the radiological score of high-resolution CT (HRCT) of lungs in patients with IPF was performed by a group of radiologists and pneumologists. Personal data were blinded and the assessment was performed independently using the Dutka/Vasakova scoring system (modification of the Gay system). The final score of the single assessors was then evaluated by means of the paired Spearman’s correlation and analysis of the principal components.ResultsTwo principal components explaining cumulatively a 62% or 73% variability of the assessment of the single assessors were extracted during the analysis. The groups did not differ both in terms of specialty and experience with the assessment of the HRCT findings.ConclusionAccording to our study, scoring of a radiological image using the Dutka/Vasakova system is a reliable method in the hands of experienced radiologists. Significant differences occur during the assessment performed by pneumologists especially during the evaluation of the alveolar changes.

Diabetisches Fußsyndrom

Diabetic foot syndrome is a major complication for patients with diabetes mellitus. About 25% of the 6 million patients with diabetes in Germany will suffer from diabetic foot syndrome at some point during the course of disease. Diabetic neuropathy and peripheral vascular disease are the main causative factors in the pathogenesis of diabetic foot ulcers. The mortality rate of these patients is more than twice as high as that of the average population. 25% of costs incurred by patients with diabetes are spent on diabetic foot ulcers, and 50% of hospital days are attributed to the treatment of the diabetic foot syndrome. This syndrome is also the most common cause of non-traumatic amputations. Both the risk of amputation and mortality are much increased in case of peripheral vascular disease. Hence, the aim is to lower the still high number of amputations in Germany by appropriate preventive measures as well as by multidisciplinary diagnostics and therapy.

Intérêts d’un centre de référence pour IMOC adultes

The Centre interuniversitaire de référence pour l’infirmité motrice cérébrale (CIRICU) was created in December 2005. It gathers together three belgian universities (ULG, ULB, and VUB). This reference center makes possible to realize multidisciplinary diagnostics and functional check-up. The center brings together doctors with different specializations (paediatrician, orthopedic and abdominal surgeon, neurologist, physiotherapist) who collaborate with paramedical team composed with physical therapist, occupational therapist, speech therapist, dietitian, nurse and social worker. The check up can be realized the same day, in the same hospital, which is very easy for the cerebral palsy patient. Each medical file is discussed with all the team members at the end of the day. The conclusions and treatment suggestions are communicated to the patient or his family a few days after. In Liège, in September 2009, 346 patients are registered; 101 of them are between 17 and 69 years old. The reasons for the consultations have been analysed. What are the main requests of the patients? What is our assessment after 4 years?

Long-term sick leavers with difficulty in resuming work: comparisons between psychiatric–somatic comorbidity and monodiagnosis

The number of patients with difficulty in resuming work after long-term sick leave has increased in several European countries including Sweden. The general aim of this study was a comprehensive description--based on multidisciplinary diagnostics and assessments--of patients with the common feature of marked difficulty in resuming working life after a long absence. A particular aim was to elucidate the possible effect of comorbidity on pain descriptors, disability, quality of life, assessed working ability and rehabilitation needs. Six hundred and thirty-five long-term sick leavers were referred from National Insurance Offices and consecutively accepted for investigation. Several self-report questionnaires were used. All patients were examined by three board-certified specialist physicians in psychiatry, orthopaedic surgery and rehabilitation medicine, respectively. Fifty-five percent of the patients had psychiatric-somatic comorbidity. The three most frequent combinations of diagnoses in the comorbidity group were fibromyalgia/myalgia and depressive episode, fibromyalgia/myalgia and recurrent depression, spinal pain and depressive episode, whereas the three most frequent in those with psychiatric diagnosis only were depressive episode, recurrent depression, phobias/anxiety. Differences in pain descriptors and in difficulties with activities were found among the three groups. All had lower health-related quality of life than references. Only one-sixth had no assessed working capacity and only 3% were assessed as able to resume work without rehabilitation; 80% were multidisciplinarily assessed as needing rehabilitation. Patients with psychiatric diagnoses, with or without concomitant somatic diagnoses, need medical rehabilitation or medical/vocational rehabilitation in combination to a greater extent than patients with somatic diagnoses only. This implies that medical rehabilitation programmes ought to adapt increasingly to the needs of patients with psychiatric-somatic comorbidity.

Effects of intracavernosal pharmacotherapy on self-esteem, performance anxiety and partnership in patients with chronic erectile dysfunction.

156 patients undergoing intracavernosal autoinjection pharmacotherapy for periods of 2-36 months were studied for the effect of treatment on self-esteem, performance anxiety, partnership and acceptance using a semi-structured questionnaire. Replies were received from 86.3% of the patients. 93% gave a very good, good or satisfactory rating of intracavernosal pharmacotherapy. 78.2% indicated that their self-esteem had grown. 79.4% said that performance anxiety diminished in the course of therapy (25.6%) or disappeared entirely (53.8%). 71.8% of the replies confirm the positive effect of treatment on marital relations or partnership. 61.9% of the patients used intracavernosal pharmacotherapy permanently. 28.3% needed therapy intermittently or at large intervals only, and 4.5% (7 patients) were cured of their chronic sexual dysfunction. When preceded by thorough multidisciplinary diagnostics and careful patient selection, intracavernosal pharmacotherapy constitutes an efficient mode of treatment for chronic erectile dysfunction.