Keep your eyes on the ribs: the spectrum of normal variants and diseases that involve the ribs

A variety of normal variants or pathologic conditions of the ribs may be overlooked at chest radiography if the ribs are not evaluated carefully. Rib lesions may simulate pulmonary disease as well. Normal rib variants include cervical, intrathoracic, and pelvic ribs; forked rib; fusion and bridging; and pseudarthrosis of the first rib. Trauma-related lesions are common and usually occur in isolation but can alert the radiologist to other injuries. Metastases may appear as vague areas of increased opacity overlying the lung if seen en face and typically have a smooth interface with the lung on oblique images. Chondroid lesions nearly always arise at or near the anterior end of the rib. Osteochondroma (exostosis) typically manifests as a deformity or expansion of the rib with calcification of the cartilaginous cap. Acute rib infections are seen as focal areas of bone destruction, whereas chronic infections may manifest as periosteal reaction or a bone sequestrum. Inferior rib notching may be seen in a wide variety of pathologic conditions. Rib abnormalities may also be seen in fibrous dysplasia, Langerhans cell histiocytosis, Paget disease, and various hemoglobinopathies. In most cases, radiography is sufficient for the identification and diagnosis of normal variants and pathologic conditions of the ribs.

CT urograms in pediatric patients with ureteral calculi: do adult criteria work?

BACKGROUND

Secondary signs of urinary obstruction associated with ureteral calculi are useful adjuncts to diagnosis in adults with renal colic evaluated by unenhanced helical CT.

OBJECTIVE

Our purpose was to evaluate the frequency of secondary signs of obstruction in children with renal colic undergoing unenhanced helical CT.

MATERIALS AND METHODS

Ureteral calculi were identified in 20 of 61 children with acute flank pain examined by unenhanced helical CT. Each imaging study was evaluated for the presence of secondary signs of urinary obstruction. The frequencies of individual signs were compared with each other by means of the McNemar test.

RESULTS

Six children had no secondary sign identified. In the remaining 14 children, proximal ureteral dilatation was seen in 10, renal enlargement in 10, hydronephrosis in 9, tissue rim sign in 6, decreased kidney attenuation in 5, and perinephric stranding in 1. Comparison of the frequencies strongly suggested that perinephric stranding occurs less frequently than proximal ureteral dilatation (P = 0.004), hydronephrosis (P = 0.008), or renal enlargement (P = 0.012).

CONCLUSION

Perinephric stranding, a common secondary sign in adults with ureteral calculi, occurs less frequently in children than other reported secondary signs.

A mediational model of obesity related disordered eating: The roles of childhood emotional abuse and self-perception

The extant literature indicates negative self-perceptions are a risk factor for disordered eating (DE) and DE is a risk factor for overweight and obesity. While childhood emotional abuse (EA) is often linked to DE and obesity, it is typically not included in comprehensive models of these health problems. Further investigation of interactions among EA, self-perception, and DE is needed to refine treatments for overweight, obesity, and DE. This study evaluated a model of DE and weight difficulties in which negative self-perception mediate the relationship between EA and DE, and DE predicts body mass index (BMI) in a population of emerging adults. Further, this study investigated the utility of history of EA for prediction of DE and classification of individuals with and without DE. Self-report questionnaires on childhood trauma, psychopathology, and eating behaviors were administered to 598 undergraduate students. Latent variable analysis confirmed the hypothesized model. Recursive partitioning determined that individuals reporting a high level of EA likely meet criteria for night eating syndrome (NES) or binge eating disorder (BED), and history of EA has a moderate to high level of specificity as a predictor of BED and NES. These findings confirm the necessity of evaluating EA and DE in emerging adults with weight difficulties, and the importance of assessing self-perception and DE in individuals with a history of EA. Future studies should investigate the utility of addressing EA and self-perception in interventions for DE and obesity and to determine whether these findings can be generalized to a clinical population.

Mid-Treatment Sleep Duration Predicts Clinically Significant Knee Osteoarthritis Pain reduction at 6 months: Effects From a Behavioral Sleep Medicine Clinical Trial

Study Objectives

To determine the relative influence of sleep continuity (sleep efficiency, sleep onset latency, total sleep time [TST], and wake after sleep onset) on clinical pain outcomes within a trial of cognitive behavioral therapy for insomnia (CBT-I) for patients with comorbid knee osteoarthritis and insomnia.

Methods

Secondary analyses were performed on data from 74 patients with comorbid insomnia and knee osteoarthritis who completed a randomized clinical trial of 8-session multicomponent CBT-I versus an active behavioral desensitization control condition (BD), including a 6-month follow-up assessment. Data used herein include daily diaries of sleep parameters, actigraphy data, and self-report questionnaires administered at specific time points.

Results

Patients who reported at least 30% improvement in self-reported pain from baseline to 6-month follow-up were considered responders (N = 31). Pain responders and nonresponders did not differ significantly at baseline across any sleep continuity measures. At mid-treatment, only TST predicted pain response via t tests and logistic regression, whereas other measures of sleep continuity were nonsignificant. Recursive partitioning analyses identified a minimum cut-point of 382 min of TST achieved at mid-treatment in order to best predict pain improvements 6-month posttreatment. Actigraphy results followed the same pattern as daily diary-based results.

Conclusions

Clinically significant pain reductions in response to both CBT-I and BD were optimally predicted by achieving approximately 6.5 hr sleep duration by mid-treatment. Thus, tailoring interventions to increase TST early in treatment may be an effective strategy to promote long-term pain reductions. More comprehensive research on components of behavioral sleep medicine treatments that contribute to pain response is warranted.

Childhood abuse, adult interpersonal abuse, and depression in individuals with extreme obesity

This study sought to examine (a) a mediational model of childhood abuse, adult interpersonal abuse, and depressive symptoms and (b) the impact of weight-related teasing on rates and correlates of childhood abuse. Charts of 187 extremely obese individuals seeking psychological clearance for bariatric (weight-loss) surgery were retrospectively examined. Among the participants, 61% reported a history of childhood abuse, 30.5% reported adult interpersonal abuse, and 15% reported clinically significant depressive symptoms. Initially, the relationship between childhood abuse and current depressive symptoms was significant (p<.001). However, the introduction of adult interpersonal abuse as a mediator in the model reduced the magnitude of its significance (Sobel's test p=.01). The associations between childhood abuse and adult interpersonal abuse and between adult interpersonal abuse and depressive symptoms were significant (p<.001 and p=.002, respectively), and the model showed a good fit across multiple indices. Finally, weight-related teasing was a significant moderator in the relationship between childhood and adult interpersonal abuse. Bariatric surgery patients report elevated rates of childhood abuse that are comparable to rates in psychiatric populations (e.g., eating disorders, depression), and higher than those in community samples and other medical populations. The relationship between child abuse and depressive symptomatology may be partially explained by the presence of adult interpersonal abuse; additionally, the relationship between childhood and adult interpersonal abuse was stronger for those who did not endure weight-related teasing than for those who did.

Weight-related abuse: Perceived emotional impact and the effect on disordered eating

The purpose of this article was to evaluate theories that (1) weight-related abuse (WRA) plays a unique role in the development of disordered eating, above and beyond general childhood verbal abuse and weight-related teasing, and (2) the perceived emotional impact of WRA mediates the relationship between WRA and current disordered eating. Self-report questionnaires on childhood trauma, weight-related teasing, WRA, and current eating behaviors were administered to a total of 383 undergraduate students. In initial regressions, WRA significantly predicted binge eating, emotional eating, night eating, and unhealthy weight control. WRA continued to significantly predict all 4 forms of disordered eating following the introduction of measures of weight-related teasing and childhood verbal abuse into the regression. Latent variable analysis confirmed that perceived emotional impact of WRA mediated the relationship between WRA and disordered eating, and tests for indirect effects yielded a significant indirect effect of WRA on disordered eating through perceived emotional impact. In sum, WRA is a unique construct and the content of childhood or adolescent maltreatment is important in determining eventual psychopathology outcomes. These findings support the necessity of incorporating information on developmental history and cognitive factors into assessment and treatment of individuals with disordered eating.

Predictors of suicidality in bariatric surgery candidates

Risk for suicidality (current or past suicidal ideation or attempt) increases after bariatric surgery; however, there is a paucity of research investigating suicidality predictors in this population. This study involved a retrospective chart review of individuals seeking psychological clearance for bariatric surgery. In total, 32 participants (15.8%) were classified as reporting suicidality. These participants endorsed greater depressive symptomatology and hopelessness, and hopelessness and mood disorder diagnosis each uniquely predicted whether or not a patient was classified as reporting suicidality. The findings within suggest that increased attention to the relationship among these variables may improve methods for identification of high-risk patients. Implications for clinical practiced are discussed.

Sexual Coercion and Psychological Aggression Victimization: Unique Constructs and Predictors of Depression

Sexual coercion of women is a common problem in couples that is often conceptualized as a facet of sexual assault or as a form of psychological aggression. Because psychological aggression is consistently linked to depressive symptoms, the researchers evaluated the unique contribution of sexual coercion victimization in the prediction of depressive symptoms beyond the variance explained by psychological aggression victimization. Sample 1 consisted of women living with a partner for at least a year and parenting a young child, whereas Sample 2 consisted of undergraduate students in relationships of at least 6 months. Overall, 27.4% of the women in Sample 1 and 22.8% of the women in Sample 2 reported experiencing sexual coercion victimization. Across both samples, depressive symptoms and psychological aggression victimization were significantly greater in women who experienced sexual coercion victimization. In addition, sexual coercion victimization and psychological aggression victimization each contributed significantly and uniquely to the prediction of depressive symptoms. Thus, although related to psychological aggression victimization, sexual coercion in an intimate relationship is a distinct construct. Implications for assessment, prevention, and couple therapy are discussed.

The Weight-Related Abuse Questionnaire (WRAQ): Reliability, validity, and clinical utility

Weight-related teasing (WRT)/stigmatization may be distinct from teasing and general abuse and may differentially impact adult outcomes. As WRT increases in severity so do depression and disordered eating. Currently, there are no validated measures designed to assess abuse specific to weight. Thus, we developed the Weight-Related Abuse Questionnaire (WRAQ) and validated it in young adult and clinically obese populations. The WRAQ was administered to 3 samples of participants: 292 undergraduate students, 382 undergraduate students, and 59 individuals seeking bariatric surgery. Concurrent validity was assessed via measures of WRT and general childhood abuse. Convergent validity was assessed with measures of depression and disordered eating. Study 1 data were used to further develop the structure of the WRAQ. Study 2 indicated that the WRAQ had excellent psychometric properties (based on factor analyses and reliability/scale consistency analysis) and strong concurrent and convergent validity, supporting the validity of the questionnaire. 6-month test-retest reliability was also good. In Study 3 responses on the WRAQ converged well with interview responses, showed good psychometric properties, and showed moderate correlations with measures of childhood abuse and psychopathology. The WRAQ has strong psychometric properties and is strongly associated with measures of current psychopathology. Additionally, it fills a gap in the assessment literature and may be a beneficial tool for determining which individuals are at increased risk for psychopathology.

Personal assistance, disability, and intimate partner violence: A guide for healthcare providers

PURPOSE/OBJECTIVE

Our objective was to provide evidence-based guidance for health care providers to engage in brief and extensive assessment of intimate partner violence (IPV) and to initiate appropriate safety precautions and referrals, all within the context of disability. Research Method/Design: This article is a review of the literature on prevalence and risk factors for IPV in nondisabled couples and in couples where a partner has a disability, on various assessment tools, and on the impact of personal assistance on relationships.

RESULTS

When an individual has a disability, it is often her or his partner who provides personal assistance. While providing this assistance can produce individual and/or interrelational benefits, it is also associated with a number of mental and physical health problems, including anxiety, depression, anger, drug abuse, and relationship discord and dissatisfaction. In addition, IPV is not uncommon among couples, and risk for partner violence may include depression, drug abuse, and relationship dissatisfaction, among others.

CONCLUSIONS/IMPLICATIONS

It is likely that health care providers will encounter individuals with disabilities who are both receiving care from their partners and who are also the victims of partner violence. Thus, they will need to be prepared to assess and triage patients who are in or may be at risk for abusive relationships and to ensure patient safety in the context of these relationships. However, it is also critically important that this assessment occurs within a culturally inclusive and disability-affirming context. (PsycINFO Database Record

Adjustment problems and maladaptive relational style: a mediational model of sexual coercion in intimate relationships

Four hundred and fifty-three married or cohabitating couples participated in the current study. A meditational model of men's perpetration of sexual coercion within an intimate relationship was examined based on past theories and known correlates of rape and sexual coercion. The latent constructs of adjustment problems and maladaptive relational style were examined. Adjustment problem variables included perceived stress, perceived low social support, and marital discord. Maladaptive relational style variables included psychological aggression, dominance, and jealousy. Sexual coercion was a combined measure of men's reported perpetration and women's reported victimization. As hypothesized, adjustment problems significantly predicted sexual coercion. Within the meditational model, adjustment problems were significantly correlated with maladaptive relational style, and maladaptive relational style significantly predicted sexual coercion. Once maladaptive relational style was introduced as a mediator, adjustment problems no longer significantly predicted sexual coercion. Implications for treatment, limitations, and future research are discussed.

Key process issues in Cognitive Behavioral Analysis System of Psychotherapy (CBASP): translation of an evidence-based model into clinical practice and training

Our "desired outcome" in writing this article was to present not only key process issues stemming from the Cognitive Behavioral Analysis System of Psychotherapy (CBASP; McCullough, 2000), but to highlight those therapy maneuvers that we, a "seasoned" clinician/supervisor and a clinical trainee, find most useful in delivering treatment and in conducting supervision. We strongly believe that it is only through the translation of evidence-based therapeutic models, such as CBASP, into effective training that a true integration of science and practice can be obtained. Thus, the congruence of trainer's and trainee's views on what constitute top process issues in therapy is important in evaluating the reliability of a therapy model; with this in mind, we focus on three process issues, as follows: (1) problems are anchored to the "here and now" and to specific situational outcomes; (2) patients are encouraged to identify the role they play in affecting their distressing outcomes and to take responsibility for "fixing" them; and (3) the therapist planfully engages in the process of change via disciplined personal involvement. Research and theory supporting these maneuvers are presented, in conjunction with clinical examples.

Ureteroscopic removal of mid and proximal ureteral calculi

PURPOSE

Extracorporeal shock wave lithotripsy (ESWL) is considered standard therapy for most renal calculi as well as more than 80% of all upper urinary tract stones. The development of flexible and small diameter rigid ureteroscopes, and the increased availability of laser lithotriptors have made endoscopic treatment of ureteral calculi more successful and safe. This report represents our contemporary series of 80 single mid and proximal ureteral calculi treated endoscopically.

MATERIALS AND METHODS

A total of 78 patients underwent 80 primary endoscopic procedures with 3 auxiliary ESWL and 2 endoscopic re-treatments for 41 mid and 39 proximal ureteral calculi. Lithotripsy was performed for 55 of the 80 stones.

RESULTS

Of the 80 stones 75 (94%) successfully cleared 1 month after 1 endoscopic procedure. The success rate was 38 of 39 (97%) for proximal calculi and 37 of 41 (90%) for mid ureteral stones. With a single re-treatment overall success increased to 96%. If adjuvant ESWL was added, 100% success was attained. Currently all procedures are performed on an outpatient basis. Morbidity is low and there have been no major complications, such as stricture, renal loss or death.

CONCLUSIONS

Our series demonstrates the high success rate that can be achieved with ureteroscopic removal of mid and proximal ureteral calculi. Thus, ureteroscopic treatment should be considered a treatment of choice for upper ureteral calculi.