Mortality of people with intellectual disabilities during the 2017/2018 influenza epidemic in the Netherlands: potential implications for the COVID-19 pandemic.

BACKGROUND: Data on the development of Covid-19 among people with intellectual disabilities (IDs) are scarce and it is uncertain to what extent general population data applies to people with ID. To give an indication of possible implications, this study investigated excess mortality patterns during a previous influenza epidemic. METHODS: Using Dutch population and mortality registers, a historical cohort study was designed to compare mortality during the 2017-2018 influenza epidemic with mortality in the same period in the three previous years. People with ID were identified by entitlements to residential ID-care services as retrieved from a national database. RESULTS: Data covered the entire adult Dutch population (12.6 million; GenPop), of which 91 064 individuals were identified with an ID. During the influenza epidemic, mortality among people with ID increased almost three times as much than in the GenPop (15.2% vs. 5.4%), and more among male individuals with ID (+19.5%) than among female individuals with ID (+10.6%), as compared with baseline. In both cohorts, comparable increases in mortality within older age groups and due to respiratory causes were seen. Particularly in the ID-cohort, excess deaths also occurred in younger age groups, due to endocrine diseases and ID-specific causes. CONCLUSIONS: During the 2017-2018 influenza epidemic, excess mortality among people with ID was three times higher than in the general Dutch population, appeared more often at young age and with a broader range of underlying causes. These findings suggest that a pandemic may disproportionally affect people with ID while population data may not immediately raise warnings. Early detection of diverging patterns and faster implementation of tailored strategies therefore require collection of good quality data.

[Disseminated tuberculosis during induction chemotherapy in acute myeloid leukemia]. / Disseminierte Tuberkulose unter Induktionschemotherapie bei akuter myeloischer Leukämie.

A patient with acute myeloid leukemia developed disseminated tuberculosis with cerebral involvement in the early phase of induction chemotherapy before allogenic stem cell transplantation. He presented with persisting fever of unknown origin, and initially misinterpreted organ lesions in CT scans.

Laser-irradiating infrared attenuated total reflection spectroscopy of articular cartilage: Potential and challenges for diagnosing osteoarthritis.

Objective: A prototype infrared attenuated total reflection (IR-ATR) laser spectroscopic system designed for in vivo classification of human cartilage tissue according to its histological health status during arthroscopic surgery is presented. Prior to real-world in vivo applications, this so-called osteoarthritis (OA) scanner has been tested at in vitro conditions revealing the challenges associated with complex sample matrices and the accordingly obtained sparse spectral datasets. Methods: In vitro studies on human knee cartilage samples at different contact pressures (i.e., 0.2-0.5 â€‹MPa) allowed recording cartilage degeneration characteristic IR signatures comparable to in vivo conditions with high temporal resolution. Afterwards, the cartilage samples were assessed based on the clinically acknowledged osteoarthritis cartilage histopathology assessment (OARSI) system and correlated with the obtained sparse IR data. Results: Amide and carbohydrate signal behavior was observed to be almost identical between the obtained sparse IR data and previously measured FTIR data used for sparse partial least squares discriminant analysis (SPLSDA) to identify the spectral regions relevant to cartilage condition. Contact pressures between 0.3 and 0.4 â€‹MPa seem to provide the best sparse IR spectra for cylindrical (d â€‹= â€‹3 â€‹mm) probe tips. Conclusion: Laser-irradiating IR-ATR spectroscopy is a promising analytical technique for future arthroscopic applications to differentiate healthy and osteoarthritic cartilage tissue. However, this study also revealed that the flexible connection between the laser-based analyzer and the arthroscopic ATR-probe via IR-transparent fiberoptic cables may affect the robustness of the obtained IR data and requires further improvements.

Magnetic resonance imaging of skeletal muscles in idiopathic inflammatory myopathies of adults.

The purpose of the study was to describe typical MRI findings in various types of idiopathic inflammatory myopathies in adulthood and to correlate the MRI with histopathological and electromyographic findings, and the serum creatine kinase (CK) activity. A third goal was to assess the diagnostic value of the use of gadolinium-DTPA (Gd-DTPA). Fifty-eight patients (35 women, 23 men), aged 21-83 years (median age 59 years), suffering from idiopathic myositides (13 with acute and 45 chronic diseases; 25 with polymyositis, 14 with dermatomyositis, 8 with granulomatous and 11 with inclusion body myositides) were examined with MRI. Seventeen of them received an intravenous infusion of Gd-DTPA. Histopathological and MRI findings of 21 muscles of 18 patients were compared. MRI of skeletal muscles showed abnormal signal intensities in 56 (96.6%) of the 58 patients. MRI abnormalities were found more often than elevated CK activity (P < 0.001). The hyperintensity of T2-weighted images was more conspicuous than on T1-weighted images in 26 (44.8%) patients, indicating oedema-like abnormalities. MRI of 50 (86.2%) patients showed fat replacement. In acute myositides, oedema-like abnormalities were more often visible and in muscle lipomatosis less often visible than in chronic diseases (P < 0.05 each). In dermatomyositis oedema-like abnormalities were more and lipomatosis less frequent than in the other types of myositis (P < 0.005) and correlated with the acuteness of the disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Imaging techniques in myotonic dystrophy. A comparative study of ultrasound, computed tomography and magnetic resonance imaging of skeletal muscles.

Limb and trunk muscles of 57 patients with the juvenile or adult form of myotonic dystrophy were studied by imaging techniques (ultrasound, computed tomography, magnetic resonance imaging). Typical findings were atrophy of the tibialis anterior and triceps brachii muscles and fatty degeneration of the vastus intermedius, sartorius, tibialis anterior and soleus muscles as well as of medial head of the gastrocnemius muscle. Magnetic resonance imaging was the most sensitive technique in depicting mesenchymal muscle alterations, followed by computed tomography and ultrasound. The data support that imaging is more sensitive in detecting the myopathy than measurement of the creatine kinase activity.

[Value of magnetic resonance tomography in the diagnosis of diseases of the thoracic aorta]. / Wertigkeit der Kernspintomographie in der Diagnostik thorakaler Aortenerkrankungen.

MRI with imaging in the frontal and axial planes can replace, in most cases, CT as well as angiography. By limiting oneself to these planes, the examination can be carried out on patients with acute symptoms. If the findings on MRI are indefinite due to movement or flow artifacts, angiography can be carried out immediately. This may not be possible after CT, due to limitation of contrast volumes. With the exception of patients being ventilated after multiple trauma, MRI should nowadays be the primary form of examination, particularly in high risk patients.

[NMR tomography of lunate malacia]. / Kernspintomographie der Lunatummalazie.

Conventional radiographs are not always able to exclude ischemic necrosis of the lunate in the early stages of the disease. Tomograms on two planes have a higher sensitivity than radiographs in two planes. Sensitivity during middle and late stages of ischemic necrosis of the lunate is approximately the same as that of magnetic resonance imaging. MRI is indicated if conventional techniques are negative or doubtful and where there are clinical signs of malacia (Decoulx stages 0 to 1). For these indications MRI is a justifiable additional method for diagnosing ischemic necrosis of the lunate.

[Gd-DTPA contrast enhancement in the nuclear magnetic resonance tomographic diagnosis of thoracic space-occupying lesions]. / Gd-DTPA-Kontrastverstärkung in der kernspintomographischen Diagnostik thorakaler Raumforderungen.

The optimal technique for examining mediastinal masses is the use of T1 weighted spin-echo sequences (TR 500 msec/TE 17 msec) in transverse and coronal slice orientation pre and post contrast application. This setup provides an excellent morphological depiction of anatomy and pathology as well as T2 comparable information about tumor structure without the disadvantage of a reduction of the signal-to-noise ratio.

[Dynamic functional MRT of the cervical spine]. / Dynamische Funktions-MRT der Halswirbelsäule.

To obtain functional studies of the cervical spine, a device has been developed which allows MRI examinations to be carried out in five different degrees of flexion. T1 and T2* weighted FFE sequences were used. Dynamic functional MRI was performed on 5 normals and 31 patients (5 disc herniation, 4 whiplash injuries, 6 spinal canal stenoses, 14 laminectomies and spinal fusions, 2 rheumatoid arthritis). The relationship of the spinal cord to the bony and ligamentous components in different degrees of flexion was particularly well shown in whiplash injury, spinal stenosis and postoperative situations.

[Magnetic resonance tomography of scaphoid pseudarthrosis: clinical and x-ray aspects]. / Kernspintomographie der Skaphoidpseudarthrose: Klinische und röntgenologische Gesichtspunkte.

37 patients with non-unions of fractures of the carpal scaphoid were examined with MRI and the results compared with conventional radiographs. Advantages of MRI are the documentation of concomitant soft tissue changes in the region of the pseudarthrosis, and the early detection of osteonecrosis of one of the fragments. Advantages of conventional radiographs are the exact documentation of cancellous bone morphology and the position of the fragments.

[Hemophiliac arthropathy of the knee joint. Gd-DTPA-enhanced MRI; clinical and roentgenological correlation]. / Hämophile Arthropathie des Kniegelenkes. Gd-DTPA-verstärkte MRT; klinische und röntgenologische Korrelation.

17 patients with hemophilic arthropathy of the knee joint were studied with static and dynamic MRT before and after i.v. bolus injection of Gadolinium-DTPA (0.1 mmol/kg body weight). After contrast enhancement, synovial proliferations exhibited an increase of signal intensity (SI) on FFE and SE images of 47.7% and 37.4% respectively, whereas muscle and fatty tissue, tendons, bone marrow and joint effusion revealed only minor increase in SI. The gradient of signal intensity (ratio SI/time) of pannus was 39.6%/min. Gd-DTPA enhanced MRI studies delineate and quantify the synovial proliferations in hemophilic arthropathy. Dynamic studies in hemophilic arthropathy do not provide qualitative assessment of the inflammatory process.

[Rheumatoid arthritis of the wrist. Dynamic Gd-DTPA enhanced MRT]. / Rheumatoide Arthritis des Handgelenkes. Dynamische Gd-DTPA-verstärkte MRT.

21 patients with rheumatoid arthritis of the wrist diagnosed according to the criteria of the American Rheumatism Association were examined by dynamic MRT before and after the i.v. injection of Gd-DTPA (0.1 mmol/kg). The results were correlated with the clinical and radiological findings. The increased signal intensity of the pannus was 1.17 +/- 0.45%/sec and this differed significantly (p < 0.001) from bone marrow (0.16 +/- 0.11%/sec) and from muscle (0.25 +/- 0.16%/sec). Blood sedimentation rate correlated with the gradient of synovial proliferation (p < 0.05). There were no further statistically significant correlations between the clinical, radiological and MRT findings and the change in signal intensity from synovial proliferation as shown by dynamic MRT.

[DIL vena cava filter. Initial experiences in 15 patients]. / DIL Vena-Cava-Filter. Erste Erfahrungen bei 15 Patienten.

DIL filters were permanently inserted through the cubital vein, using a 7-F catheter, in 15 patients and were followed up for six months in 12 patients. One filter could not be opened and 4 others were only partly open. Clinically there were no recurrences of pulmonary emboli. There were no complications from the correctly placed filters. Amongst the 4 incompletely expanded filters, two caused perforation of the cava, in one the cava thrombosed and in another the filter migrated to the bifurcation of the pulmonary artery. It follows that unexpanded filters should not be placed in the cava. Measurements in 10 patients showed the cava reduced to less than 10 mm lumen. In two cases the reduction of lumen was only slight, measuring more than 15 mm. The effect of the reduction in the lumen remains to be compared with that achieved by other filters.

[The nitinol stent as a palliative measure in inoperable carcinoma of the esophagus and cardia. Possibilities and limitations of the procedure]. / Der Nitinolstent als Palliativmassnahme bei inoperablem Osophagus- und Kardiakarzinom. Möglichkeiten und Grenzen des Verfahrens.

Nitinol stents were used in ten patients as palliative treatment for carcinoma of the esophagus and the cardia. Following insertion of the stent the severity of dysphagia decreased on average from 3.2 to 1.5 (on a scale from 0-4). Difficulties with stent opening and passage through the gut were found particularly in the region of metal sutures at esophago-jejunal anastomoses. One stent, which had been obstructed by mucosal folds, had to be removed and replaced. One stent which had been incorrectly placed was extended by introducing a second stent by a coaxial technique. During the period of observation, six patients died after an average of 4.6 months. The palliative effect of the stent lasted on average for eleven weeks. In two patients the tumour grew beyond the stent and in three there was tumour growth into the stent.

Outbreak of mucosal disease among apparently immunotolerant heifers.

An outbreak of mucosal disease that occurred among Friesian heifers aged 15 to 18 months is described as it occurred. Investigation suggested that many heifers were immunotolerant to bovine virus diarrhoea-mucosal disease virus. Serious losses were incurred. The present policy of surveillance is described.

Omasal and abomasal impaction in beef suckler cows.

A group of late gestation suckler cows were housed in straw yards and had been fed solely on pea haulm for the previous three weeks. Four cows became ill, with a variety of clinical signs, two died, one was euthanased and one recovered spontaneously. Postmortem examination revealed severe omasal and abomasal impaction. No further cases occurred after changes were made to the diet of the cows.

[Kienboeck's disease: comparative study of magnetic resonance tomography and roentgenologic imaging]. / Kienböck'sche Erkrankung: Kernspintomographische und röntgenologische Vergleichsstudie.

Magnetic resonance imagine of the carpus is helpful in diagnosing or ruling out even early stages of lunatomalacia. MRI is capable of providing information on the vitality of the lunate and is thus helpful in developing a proper therapy plan.