Internal exposure of Flemish teenagers to environmental pollutants: Results of the Flemish Environment and Health Study 2016-2020 (FLEHS IV).

The Flemish Environment and Health Study (FLEHS) collects information on internal exposure to a broad range of environmental chemicals in the general population in Flanders, the Northern region of Belgium. The aim is to establish biomonitoring exposure distributions for the general population in support of public health and environmental policy, environmental risk assessment and risk management decisions. In 2017-2018, urine and blood samples were collected from 428 teenagers by a stratified clustered two stage randomized design. Samples were analyzed for a broad range of biomarkers related to exposure to chlorinated and newer pesticides, brominated and organophosphate flame retardants (BFR/OPFR), polychlorinated biphenyls (PCBs), bisphenols, phthalates and alternative plasticizers, per-and polyfluoroalkyl substances (PFAS), polycyclic aromatic hydrocarbons (PAHs), benzene, metals and trace elements. The geometric mean levels and percentiles of the distribution were estimated for each biomarker, for the whole study population and following stratification for sex, the household educational attainment and the residence area's urbanicity. Geometric means of biomarkers of lead, dichlorodiphenyltrichloroethane (DDT), PCBs, PAHs, regulated phthalates and bisphenol A (BPA) were lower than in the previous FLEHS cycles. Most biomarker levels were below health-based guidance values (HB-GVs). However, HB-GVs of urinary arsenic, blood lead, blood cadmium, sum of serum perfluorooctane sulfonate (PFOS) and perfluoro-1-hexanesulfonate (PFHxS) and the urinary pyrethroid metabolite (3-PBA) were exceeded in respectively 25%, 12%, 39.5%, 10% and 22% of the teenagers. These results suggest that the levels of exposure in the Flemish population to some environmental chemicals might be of concern. At the same time, we noticed that biomarkers for BPA substitutes, metabolites of OPFRs, an expanded list of PFAS, glyphosate and its metabolite could be measured in substantial proportions of participants. Interpretation of these levels in a health-risk context remains uncertain as HB-GVs are lacking. Household educational attainment and residential urbanicity were significant exposure determinants for many biomarkers and could influence specific biomarker levels up to 70% as shown by multiple regression analysis. The research consortium also took care of the broader external communication of results with participants, policy makers, professional groups and civil society organizations. Our study demonstrated that teenagers are exposed to a wide range of chemicals, it demonstrates the success of public policies to reduce exposure but also points to concern and further priorities and needs for follow up.

A semi-probabilistic modelling approach for the estimation of dietary exposure to phthalates in the Belgian adult population.

In this study, a semi-probabilistic modelling approach was applied for the estimation of the long-term human dietary exposure to phthalates--one of world's most used families of plasticisers. Four phthalate compounds were considered: diethyl phthalate (DEP), di-n-butyl phthalate (DnBP), benzylbutyl phthalate (BBP) and di(2-ethylhexyl) phthalate (DEHP). Intake estimates were calculated for the Belgian adult population and several subgroups of this population for two considered scenarios using an extended version of the EN-forc model. The highest intake rates were found for DEHP, followed by DnBP, BBP and DEP. In the Belgian adult population, men and young adults generally had the highest dietary phthalate intake estimates. Nevertheless, predicted dietary intake rates for all four investigated phthalates were far below the corresponding tolerable daily intake (TDI) values (i.e. P99 intake values were 6.4% of the TDI at most), which is reassuring because adults are also exposed to phthalates via other contamination pathways (e.g. dust ingestion and inhalation). The food groups contributing most to the dietary exposure were grains and grain-based products for DEP, milk and dairy products for DnBP, meat and meat products or grains and grain-based products (depending on the scenario) for BBP and meat and meat products for DEHP. Comparison of the predicted intake results based on modelled phthalate concentrations in food products with intake estimates from other surveys (mostly based on measured concentrations) showed that the extended version of the EN-forc model is a suitable semi-probabilistic tool for the estimation and evaluation of the long-term dietary intake of phthalates in humans.

The standardized computerized 24-h dietary recall method EPIC-Soft adapted for pan-European dietary monitoring.

BACKGROUND/OBJECTIVES: The EPIC-Soft program (the software initially developed to conduct 24-h dietary recalls (24-HDRs) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) was recommended as the best way to standardize 24-HDRs for future pan-European dietary monitoring. Within European Food Consumption Validation (EFCOVAL), EPIC-Soft was adapted and further developed on various aspects that were required to optimize its use. In this paper, we present the structure and main interview steps of the EPIC-Soft program, after implementation of a series of new specifications deemed to satisfy specific requirements of pan-European monitoring surveys and other international studies. SUBJECTS/METHODS: Updates to optimize the EPIC-Soft program were ascertained according to the following stepwise approach: (1) identification of requested specifications to be potentially implemented through an ad hoc 'EPIC-Soft specifications questionnaire' sent to past, current and possible future users of the software; (2) evaluation of the specifications in collaboration with two ad hoc task force groups and through a workshop; (3) development of a technical solution for each retained specification; (4) implementation of the specifications by software developers; (5) testing and amendment of bugs. RESULTS: A number of new specifications and facilities were implemented to EPIC-Soft program. In addition, the software underwent a full reprogramming and migration to a modern Windows environment, including changes in its internal architecture and user interface. Although the overall concept and structure of the initial software were not changed substantially, these improvements ease the current and future use of EPIC-Soft and increase further its adaptation to other countries and study contexts. CONCLUSIONS: EPIC-Soft is enriched with further functions and facilities expected to fulfil specific needs of pan-European dietary monitoring and risk assessment purposes. The validity, feasibility and relevance of this software for different national and international study designs, and the logistical aspects related to its implementation are reported elsewhere.

Breakfast habits affect overall nutrient profiles in adolescents.

OBJECTIVE: To describe breakfast consumption patterns, on a nutrient and food item level, in Belgian adolescents. DESIGN: A 7-day estimated food record was administered in a cross-sectional survey. SETTING: Secondary schools in Ghent, Belgium. SUBJECTS: A total of 341 adolescents (13-18 years old), multistage clustered sampling. RESULTS: The energy contribution of breakfast to daily energy intake was on average 15.7% in boys and 14.9% in girls. Significantly more overweight girls and significantly more girls following vocational training were categorised as eating a low-quality breakfast. In boys, the energy contribution of polysaccharides was significantly higher in consumers of good-quality breakfasts. The intake of all selected micronutrients was significantly higher in consumers of good-quality breakfasts. In girls, the total energy intake and the proportional intake of proteins and polysaccharides were significantly higher in consumers of good-quality breakfasts, while the proportional contribution of total fat, monounsaturated and polyunsaturated fatty acids was significantly lower in these girls. The intake of all micronutrients was significantly higher in girls consuming a good-quality breakfast. In all adolescents, consumers of a good-quality breakfast had significantly higher intakes of bread, fruit, vegetables, milk and milk products, and fruit juice, while intake of soft drinks was significantly lower than in consumers of low-quality breakfasts. CONCLUSIONS: Consumers of a good-quality breakfast had a better overall dietary pattern - on a nutrient and food group level - than consumers of a low-quality breakfast. A daily breakfast, including whole-grain products, fruit and (semi-) skimmed milk products or an alternative source of calcium, is recommended.

Sources of saturated fatty acids in Belgian adolescents' diet: implications for the development of food-based dietary guidelines.

The objectives of the present study are to describe the dietary sources of total fat and of saturated fatty acids (SFA) and to formulate food-based dietary guidelines for SFA in Belgian adolescents. A random sample of 13-18-year-old adolescents was drawn from secondary schools in the region of Ghent. A 7 d estimated food record method was used to quantify nutrient and food intake. The average daily SFA intake is 4 % above the recommended 10 % of the total energy contribution. The most important contributors of SFA on food group level were 'fats, oils and savoury sauces', 'meat and meat products', 'sugar, confectionery, sweet fillings and sauces', 'cheese', 'milk and milk products' and 'bread, rusk and breakfast rolls'. On food subgroup level 'fresh meat', 'high-fat margarine' and 'high-fat cheese' had the highest contribution to SFA intake in all adolescents. Adolescents with a low SFA intake (lowest tertile) were compared with adolescents with a high intake (highest tertile). In the lowest tertile the intake of total fat and MUFA was significantly lower than in the highest tertile, while the intake of total carbohydrates, mono- and disaccharides and complex carbohydrates was significantly higher. Overall, the high-fat cheese intake is significantly lower in the lowest tertile, while the fruit intake is higher. The present analysis shows that the nutritional profile of Belgian adolescents could be potentially improved by decreasing the portion sizes of fresh meat (in boys), high-fat margarine, high-fat cheese and reducing intake of commercially prepared baked goods and processed foods, including fast foods.

Iron intake and dietary sources of iron in Flemish adolescents.

OBJECTIVE: To investigate the dietary iron intake and food sources of iron in Flemish adolescents. DESIGN: Cross-sectional survey; dietary assessment method: a 7-day estimated food record. SETTING: Private and public secondary schools in Ghent, a city in the Dutch-speaking part of Belgium. SUBJECTS: A total of 341 adolescents (129 boys and 212 girls), 13-18 y, randomly selected by a multistage clustered sampling technique. RESULTS: The mean total iron intake (s.d.) for boys was 13.4 (+/- 2.91) mg/day and for girls 10.1 (+/- 2.79) mg/day. A proportion of 38.8% of the boys and 99.5% of the girls had a mean total iron intake below the Belgian Recommended Dietary Allowance and 3.1% of the boys and 71.2% of the girls below the British Estimated Average Requirement. When bioavailable iron intake is considered, 84.5% of the boys and only 16.5% of the girls met the age-specific requirement. The food groups with the highest mean proportional contribution to total iron intake in both males and females were bread, meat and meat products, cereals and potatoes. A comparison of adolescents from the highest tertile of iron intake (mg/day) with adolescents from the lowest tertile showed a significantly higher energy-adjusted intake of brown bread and a significantly lower intake of soft drinks in the former group in both boys and girls. A significantly higher energy-adjusted intake of breakfast cereals in adolescents of the highest tertile than those of the lowest tertile was seen in girls only. Analyses in consumers only did not change this overall picture. CONCLUSIONS: One can conclude that the mean iron intake of Flemish girls is considerably lower than the current recommendations. An increased iron intake in this subgroup of the population is therefore advisable.

Results of surgical treatment of Sprengel deformity by a modified Green's procedure.

The results of treatment of seven children with Sprengel deformity are reviewed. The patients were subjected to a modified Green procedure without dissection of the serratus anterior muscle and immediate postoperative mobilization. The results seem to indicate that the postoperative abduction gain (77 degrees) compares favorably in regard to the current literature and that this modification of the classic technique offers a substantial advantage concerning functional outcome in these patients.

Radiologic investigation of renal colic: unenhanced helical CT compared with excretory urography.

OBJECTIVE: Our aim was to compare unenhanced helical CT and excretory urography in the assessment of patients with renal colic. SUBJECTS AND METHODS: Fifty-three of 70 consecutive patients with acute signs of renal colic were prospectively examined with unenhanced helical CT, which was followed immediately by excretory urography. Two radiologists who were unaware of the findings independently interpreted these examinations to determine the presence or absence of ureteral obstruction. On all CT scans that had positive findings for ureteral stones or obstruction, we looked for secondary signs of obstruction (perinephric or periureteral fat stranding, ureteral wall edema, ureteral dilatation, and blurring of renal sinus fat). RESULTS: A stone was recovered in 45 of the 53 patients, nine before and 36 after imaging. The latter 36 patients had their stones identified on CT, whereas only 24 patients had their stones identified on excretory urography. Eight patients without stone disease had normal ureters on both CT and excretory urography. Of the 45 patients who had stone disease, 26 had ureteral dilatation on both CT and excretory urography, and 36 patients who recovered a stone after CT had secondary signs of obstruction. Of the nine patients who recovered a stone before CT, three had secondary signs of obstruction. Two patients had periureteral fat stranding, ureteral wall edema, and renal sinus fat blurring. One patient had only ureteral wall edema. CONCLUSION: Compared with excretory urography, unenhanced helical CT is better for identifying ureteral stones in patients with acute ureterolithiasis. Secondary CT signs of obstruction, including renal sinus fat blurring, were frequently present even when the stone was eliminated before imaging.

[Comparison of spiral computed tomography without contrast media and intravenous urography in the diagnosis of renal colic]. / Comparaison du scanner spiralé sans contraste et de l'urographie intraveineuse dans le diagnostic de la colique néphrétique.

OBJECTIVES: This prospective study was designed to determine the reliability of noncontrast spiral CT scan, compared to that of intravenous urography (IVU), in the diagnostic assessment of acute renal colic. MATERIAL AND METHODS: 53 patients, admitted with an empirical diagnosis of renal colic after initial assessment, were included and underwent spiral CT scan without contrast agent injection, immediately followed by IVU. These examinations were performed according to a blind protocol by two different radiologists. We initially looked for the presence of stones and/or urinary tract obstruction. Patients with a stone and/or obstruction (urinary tract dilatation) visible on CT scan were then examined for the presence of CT signs associated with stone disease (infiltration of the perirenal and periureteric fat, oedema of the ureteric wall and loss of sinus fat). We calculated the statistical correlation between the presence or absence of obstruction and these accessory signs. RESULTS: 45 stones were recovered (in 36 cases before the two examinations). 36 stones were identified on CT versus only 24 on urography. Urinary tract dilatation was demonstrated in 26 out of 53 cases by both urography and CT. The frequency of accessory signs visible on CT in the presence of stones (n = 36) was 66% for infiltration of periureteric fat, 36% for infiltration of perirenal fat and 75% for oedema of the ureteric wall. In the presence of urinary tract dilatation, these frequencies were 92%, 84% and 60% respectively. CONCLUSION: Noncontrast spiral CT is a reliable and rapid diagnostic modality for the detection of urinary stones, providing a morphological study equivalent to that of IVU and able to guide appropriate treatment. It should replace IVU in the diagnostic assessment of renal colic.

Stress fracture of the acetabular roof. Case report and value of MRI.

The authors report the case of an 11-year-old boy with pain in the left leg without history of recent trauma. The diagnosis of a stress fracture of the acetabulum was made based on MRI and bone marrow biopsy. They discuss the role of MRI in the diagnosis of a stress fracture.

[Pneumatosis cystoides intestinalis revisited]. / La pneumatose kystique intestinale reconsidérée.

Two cases of pneumatosis cystoides coli are reported. The authors present an anatomic and physiopathologic review of the entity and give the list of etiologies with the worse prognosis. The radiologic signs are described and their contribution to an accurate diagnosis is stressed, as it may avoid useless surgical interventions.

Adipose tumors of soft tissues.

Thirteen patients with lipoma were examined at least with MRI, which revealed homogeneous and high signal lesions in both T1 and T2 WI sequences. On CT, these lesions were characterized by very negative density values. Sonography was useful to differentiate a lipoma from an old hematoma that share the same signal on MRI. Eighteen cases of biopsy proven liposarcomas were evaluated with at least two techniques. Tumor heterogeneity was the most important clue to malignancy. With CT, contrast injection was necessary because two cases out of eight appeared homogeneous on native examinations. Lobular pattern and large size are constant signs associated with liposarcoma. The correlation of imaging and histology classification was only successful with differentiated tumors. Angiography unspecifically reveals the malignancy of liposarcoma. MRI is better than CT to evaluate tumor expansion and to differentiate the mass from the surrounding tissue.

Juxtapapillary duodenal diverticula and diverticula of the colon: is there a general "gastrointestinal diverticular disease"?

Both juxtapapillary duodenal diverticula and colon diverticula are acquired lesions, the pathogenesis of which is believed to involve the influence of high intraluminal pressure on loci minoris resistentiae in the gastrointestinal wall. We wanted to investigate whether juxtapapillary duodenal diverticula and colon diverticula occur independently, or whether they are part of a hypothetical general "gastrointestinal diverticular disease". 239 patients with juxtapapillary duodenal diverticula were identified in 2231 patients undergoing ERCP. Complete radiology data were available in 119/239 patients. Double contrast barium enema had been performed in 28/119 patients. In these patients, colon diverticula were present in 9/20 women and 1/8 men. The frequency of colon diverticula in these patients was compared with randomly chosen age- and sex-matched controls, for whom barium enema results were available. In these controls, 9/20 women and 1/8 men also had colon diverticula (n.s.). We conclude that after stratification for age and sex, the occurrence of colon diverticula is not higher in patients with juxtapapillary duodenal diverticula than in the general population. Juxtapapillary duodenal diverticula and colon diverticula thus occur independently. These data are not in favor of the existence of a general gastrointestinal diverticular disease.

CT of the heel and midfoot.

The authors stress the importance of CT examination in certain pathologic conditions of the heel and midfoot. In this region the bone structures form complicated articulations which can be affected by a number of disorders. This study (43 cases) includes the normal CT images of the heel and midfoot and an illustration of the various pathologic conditions encountered in this region: heel traumata (18 cases), bone tumors (4 cases), congenital coalitions (5 cases), and some inflammatory and soft tissue disorders (12 cases). Depending on the clinical aspect a coronal and/or axial incidence with fine slice technique and adapted bone or soft tissue algorithm was chosen. Especially traumatic lesions and congenital coalitions can benefit from better therapy if a good visualisation is obtained. In uneasy instances, CT provides additional information.

Klatskin tumors: radiological and imaging findings in eleven patients.

A retrospective study of 11 patients with Klatskin tumor is presented. The series includes 3 men and 8 women with a mean age of 71 years (range: 61-84 years). Histologic examination revealed a well-differentiated cholangiocarcinoma in 7 cases, an undifferentiated type in 3 and a sclerosing type in one. Ultrasound plays an increasing role in setting a directive diagnosis. Preoperative localisation of the tumor and status of the intrahepatic bile ducts are best depicted with cholangiography. CT findings are non specific, but are useful for an adequate pre- and post-treatment staging.

[Appendicitis: advantages of US and CT in aspecific clinical and radiological findings]. / Appendicitis: voordelen van US en CT in aspecifieke klinische en radiologische bevindingen.

We present the case of a 23-year-old woman with atypical clinical and radiological findings of subacute appendicitis. When abdominal plain film and contrast medium enema examination show atypical findings and ultrasound results are uncertain, CT should be considered. CT after peroral and intravenous contrast administration can confirm or exclude the diagnosis of suspected appendicitis showing the possible presence, location and degree of inflammation, phlegmon and abscess masses.

Spinal meningeal cyst.

A case of meningeal cyst of the spine in the thoraco-lumbar region is described. Although water-soluble myelography may disclose a filling defect and possibly reveal communication between the cyst and the subarachnoid space, computerized tomographic myelography more readily reveals communication between the cyst and the subarachnoid space. This finding allows accurate diagnosis of a spinal meningeal cyst and rules out other mass lesions. A classification comprising three categories is made: spinal extradural meningeal cysts without spinal nerve root fibers (Type I), spinal extradural meningeal cysts with spinal nerve root fibers (Type II) and spinal intradural meningeal cysts (Type III). Final characterization is based on operative inspection and histological examination.