No association between MRI changes in the lumbar spine and intensity of pain, quality of life, depressive and anxiety symptoms in patients with low back pain

Introduction. The association between changes in magnetic resonance imaging (MRI) and clinical symptoms in patients with low back pain (LBP) is unclear. Aim. To evaluate correlations between combined MRI findings of the lumbar spine (LS) and pain intensity, depressive and anxiety symptoms and quality of life in patients with LBP. Material and methods. 200 subjects (93 men and 107 women; mean age 51.42 ± 13.21 years) with LBP referred for MRI were enrolled in the study. All patients completed the Hospital Anxiety and Depression Scale (HADS), Quality of Life Scales (EQ-5D, EQ-VAS) and the Visual Analogue Scale (VAS). MRI scans were assessed according to a scoring system prepared by the authors, and the total MRI score was calculated. Results. The mean total MRI score was 11.59 ± 6.73 points (range 0–50 points) and was higher in men than in women (p = 0.015). A correlation was observed between total MRI score and age (p < 0.001) and between total MRI score and BMI (p = 0.005). An association was found between total MRI score and EQ-5D (p = 0.012) and HADS-D results (p = 0.003). VAS and HADS-A results did not correlate with MRI score. When multivariate analysis was done, the total MRI score was only significantly related to age and BMI, and association between the total MRI score and EQ-5D or HADS-D results was not confirmed. Decreased quality of life was associated with increased intensity of pain and depressive and anxiety symptoms. Conclusions. Combined MRI changes in LS do not correlate with pain intensity, depressive and anxiety syndromes or quality of life in patients with LBP

Femoroacetabular impingement as a cause of hip pain in young adult patients. Diagnosis and treatment methods using arthroscopy

Konflikt udowo-panewkowy jest nie do końca poznanym problemem klinicznym, który jest jedną z przyczyn dolegliwości bólowych stawu biodrowego u pacjentów w 3. i 4. dekadzie życia. Zjawisko opisali i zdefiniowali po raz pierwszy Reinhold Ganz i wsp. w 2003 roku. Od tego czasu powstało wiele ciekawych i oryginalnych prac, a problemem tym zajęli się zarówno ortopedzi, radiolodzy, jak i fizjoterapeuci. W niniejszej pracy dokonano przeglądu dostępnego piśmiennictwa. Przedstawiono dane epidemiologiczne, sposoby rozpoznawania, leczenia ze szczególnym uwzględnieniem techniki artroskopowej.Femoroacetabular impingement (FAI) is not well recognized clinical problem and one of the possible cause of hip pain in young adult patients in 3rd and 4th decade of life. This phenomenon was described by Reinhold Ganz et al. in 2003. Since than many interesting oryginal papers about FAI were published by orthopedic surgeons, radiologists and physiotherapists. In this paper we do reasearch of the avaible literature, we presented information about epidemiology, diagnosis, treatment in particular taking into account hip arthroscopy

What factors empower general practitioners for early cancer diagnosis? A 20-country European Delphi Study

Funding Information: The publication of the article in OA mode was financially supported by HEAL-Link. Publisher Copyright: © The Author(s), 2022.Background: Some symptoms are recognised as red flags for cancer, causing the General Practitioner (GP) to refer the patient for investigation without delay. However, many early symptoms of cancer are vague and unspecific, and in these cases, a delay in referral risks a diagnosis of cancer that is too late. Empowering GPs in their management of patients that may have cancer is likely to lead to more timely cancer diagnoses. Aim: To identify the factors that affect European GPs' empowerment in making an early diagnosis of cancer. Methods: This was a Delphi study involving GPs in 20 European countries. We presented GPs with 52 statements representing factors that could empower GPs to increase the number of early cancer diagnoses. Over three Delphi rounds, we asked GPs to indicate the clinical relevance of each statement on a Likert scale. The final list of statements indicated those that were considered by consensus to be the most relevant. Results: In total, 53 GPs from 20 European countries completed the Delphi process, out of the 68 GPs who completed round one. Twelve statements satisfied the pre-defined criteria for relevance. Five of the statements related to screening and four to the primary/secondary care interface. The other selected statements concerned information technology (IT) and GPs' working conditions. Statements relating to training, skills and working efficiency were not considered priority areas. Conclusion: GPs consider that system factors relating to screening, the primary-secondary care interface, IT and their working conditions are key to enhancing their empowerment in patients that could have cancer. These findings provide the basis for seeking actions and policies that will support GPs in their efforts to achieve timely cancer diagnosis.publishersversionPeer reviewe

What factors empower general practitioners for early cancer diagnosis? A 20-country European Delphi Study.

BACKGROUND Some symptoms are recognised as red flags for cancer, causing the General Practitioner (GP) to refer the patient for investigation without delay. However, many early symptoms of cancer are vague and unspecific, and in these cases, a delay in referral risks a diagnosis of cancer that is too late. Empowering GPs in their management of patients that may have cancer is likely to lead to more timely cancer diagnoses. AIM To identify the factors that affect European GPs' empowerment in making an early diagnosis of cancer. METHODS This was a Delphi study involving GPs in 20 European countries. We presented GPs with 52 statements representing factors that could empower GPs to increase the number of early cancer diagnoses. Over three Delphi rounds, we asked GPs to indicate the clinical relevance of each statement on a Likert scale.The final list of statements indicated those that were considered by consensus to be the most relevant. RESULTS In total, 53 GPs from 20 European countries completed the Delphi process, out of the 68 GPs who completed round one. Twelve statements satisfied the pre-defined criteria for relevance. Five of the statements related to screening and four to the primary/secondary care interface. The other selected statements concerned information technology (IT) and GPs' working conditions. Statements relating to training, skills and working efficiency were not considered priority areas. CONCLUSION GPs consider that system factors relating to screening, the primary-secondary care interface, IT and their working conditions are key to enhancing their empowerment in patients that could have cancer. These findings provide the basis for seeking actions and policies that will support GPs in their efforts to achieve timely cancer diagnosis

Thermal ablation of unresectable liver tumors: Factors associated with partial ablation and the impact on long-term survival

Background: Thermal ablation procedures, including radiofrequency ablation (RFA) or laser-induced interstitial thermotherapy (LITT), are now well established in the treatment of malignant unresectable hepatic tumors. But the impact of partial ablation (PA) on long-term survival following computed tomography (CT)-guided radiofrequency ablation and laser- induced interstitial thermotherapy of unresectable malignant liver lesions and the associated risk factors of PA remain partially unknown. Material/Methods: This study included 254 liver tumors in 91 consecutive patients (66 men and 25 women; age 60.9±10.4 years; mean tumor size 25±14 mm [range 5–70 mm]) who underwent thermal ablation (RFA or LITT) between January 2000 and December 2007. Mean follow-up period was 21.1 month (range 1–69 months). Survival rate and local progression-free survival (PFS) were calculated for patients with complete ablation (CA) vs. patients with partial ablation (PA) to assess the impact on long-term survival. Results: Median survival after CA was 47 months compared to 25 months after PA (P=0.04). The corresponding 5-year survival rates were 44% vs. 20%. Median PFS for CA was 11 months compared to 7 months for PA (P=0.118). The sole statistically significant risk factor for PA was tumor size (>30 mm; P=0.0003). Sustained complete ablation was achieved in 71% of lesions ≤30 mm vs. 47% of lesions >30 mm. Conclusions: We conclude that achievement of complete ablation is a highly important predictor of long-term survival and that tumor size is by far the most important predictor of the likelihood of achieving complete ablation

Wrodzona synostoza promieniowo-łokciowa : opis przypadku

Background: Congenital radioulnar synostosis is a rare malformation of the upper limb, with functional limitations of the limb. Case Report: A 10-year-old child with pain and restricted mobility of the elbow joint was admitted to the hospital. Plain film radiography and CT examination was performed. Radiological examinations showed a congenital radioulnar synostosis. The child underwent surgical treatment - derotational osteotomy. Conclusions: Diagnostic imaging including computed tomography with three-dimentional (3D) reconstructions, preceding surgery enables planning of the surgical treatment

Right aortic arch with aplasia of the left brachiocephalic trunk presented as systolic blood pressure difference between upper extremities

BACKGROUND: The right aortic arch with mirror-image of branching arteries without coexisting congenital heart disease is a very rare anomaly. CASE REPORT: We report a case of the right-sided aortic arch with aplasia of the left brachiocephalic trunk in a 64-year-old women, presenting difference in systolic blood pressure between upper extremities. The history of the patient and angio-CT findings were described and visualized with images. CONCLUSIONS: The knowledge of vascular variations is important for the clinical and therapeutic aspects

Zespół trzaskającego biodra w dynamicznym badaniu ultrasonograficznym

Snapping hip syndrome is an audible or palpable snap in a hip joint during movement which may be accompanied by pain or locking. It is typically seen in young athletes performing activities requiring repeated extreme movements of the hip. It may also follow a physical trauma, intramuscular injections or surgeries. There are two main forms of snapping hip: extra- or intra-articular. Extra-articular snapping hip is elicited by an abnormal movement of specific tendons and is divided into two forms: internal and external. The internal form of snapping hip syndrome is attributed to an abrupt movement of an iliopsoas tendon against an iliopectineal eminence. Radiograph results in patients with this form of snapping tend to be normal. Dynamic ultrasound is the gold standard diagnostic technique in both forms of extra-articular snapping hip syndrome. The objective of the following text is to describe a step-by-step dynamic ultrasonography examination in internal extra-articular snapping hip syndrome in accordance to the proposed checklist protocol. To evaluate abrupt movement of an involved tendon, the patient needs to perform specific provocation tests during the examination. With its real-time imaging capabilities, dynamic ultrasonography detects the exact mechanism of the abnormal tendon friction during hip movement in a noninvasive way. It also allows for a diagnosis of additional hip tissue changes which may be causing the pain.Zespół trzaskającego biodra klinicznie manifestuje się słyszalnym lub odczuwalnym przez pacjenta przeskakiwaniem w stawie biodrowym podczas ruchu, któremu może towarzyszyć ból oraz blokowanie w stawie. Problem ten najczęściej dotyczy młodych sportowców wykonujących powtarzalne ćwiczenia z wykorzystaniem pełnego zakresu ruchu w stawie biodrowym. Przyczyną zespołu trzaskającego biodra mogą być również: przebyty uraz, ostrzykiwanie okolicy biodra lub zabieg chirurgiczny. Ze względu na etiologię zespołu trzaskającego biodra wyróżnia się jego dwie podstawowe formy: wewnątrz i zewnątrzstawową. Zespół zewnątrzstawowy jest związany z nieprawidłowym ruchem ścięgien i w zależności od nieprawidłowego ruchu danej struktury anatomicznej może występować jako forma wewnętrzna lub zewnętrzna. Złotym standardem w obrazowaniu zewnątrzstawowego zespołu trzaskającego biodra jest dynamiczne badanie ultrasonograficzne. W pracy zaprezentowano schemat dynamicznego badania ultrasonograficznego u pacjentów z podejrzeniem zewnątrzstawowego zespołu trzaskającego biodra o podtypie wewnętrznym. Aby prawidłowo ocenić ruchomość ścięgien biorących udział w zespole trzaskającego biodra, konieczne jest przeprowadzenie testów prowokacyjnych. Ultrasonografia ze względu na możliwość obrazowania poruszających się ścięgien w czasie rzeczywistym pozwala na nieinwazyjne zobrazowanie dokładnego mechanizmu konfliktowania ścięgna. Dodatkowo badanie to pozwala na rozpoznanie innych często towarzyszących patologii w stawie biodrowym, takich jak zapalenie kaletki czy ścięgna

Internal snapping hip syndrome in dynamic ultrasonography

Snapping hip syndrome is an audible or palpable snap in a hip joint during movement which may be accompanied by pain or locking. It is typically seen in young athletes performing activities requiring repeated extreme movements of the hip. It may also follow a physical trauma, intramuscular injections or surgeries. There are two main forms of snapping hip: extra- or intra-articular. Extra-articular snapping hip is elicited by an abnormal movement of specific tendons and is divided into two forms: internal and external. The internal form of snapping hip syndrome is attributed to an abrupt movement of an iliopsoas tendon against an iliopectineal eminence. Radiograph results in patients with this form of snapping tend to be normal. Dynamic ultrasound is the gold standard diagnostic technique in both forms of extra-articular snapping hip syndrome. The objective of the following text is to describe a step-by-step dynamic ultrasonography examination in internal extra-articular snapping hip syndrome in accordance to the proposed checklist protocol. To evaluate abrupt movement of an involved tendon, the patient needs to perform specific provocation tests during the examination. With its real-time imaging capabilities, dynamic ultrasonography detects the exact mechanism of the abnormal tendon friction during hip movement in a noninvasive way. It also allows for a diagnosis of additional hip tissue changes which may be causing the pain

TNFα gene G-308A polymorphism and the risk of ischemic stroke

TNFα, a significant immune mediator, may contribute to the initiation and progression of the ischemic stroke. Genetics of TNFα molecule may have an important role in the risk of ischemic stroke. The most interesting aspects of the G-308A polymorphism remain unexplained; there are many discrepancies between the results. Differences in the ethnicity of the studied cohorts may be taken as one of the possibility. Our study material consisted of 101 patients with ischemic stroke, including 30% classified as lacunar stroke. The diagnosis was based on the presence of rapidly developing neurological signs lasting longer then 24h and confirmed by neuroimaging matter. All patients were of Polish Caucasian origin. Randomly selected 100 individuals without any sign of the vascular disease of central nervous system were taken as the control material. The frequency of polymorphism G-308A in TNFα gene was determined as described by Rubattu et al. [11]. The genotype distribution in our material was similar and statistically insignificant between patients and controls. The heterozygotic G/A genotype was detected in 9% of patients and in 15% of control materials, homozygotic A/A was found in 5% of patients and only in one of control and G/G in 87% of patients and in 84% of control individuals. Our results are negative with respect to the impact of 308 TNFα polymorphism on the risk of ischemic stroke in Caucasians living in Poland