Mixed lichen planus-lupus erythematosus disease: a distinct entity? Clinical,histopathological and immunopathological studies in six patients

This report describes six patients with Features of both chronic discoid lupus erythematosus (DIE) and lichen planus (LP). All patients showed chronic, livid, partly atrophic LE-like lesions, preferentially located on the head, the face and the upper trunk. Reticular, whitish patches were found in the oral mucosa of five patients. In addition, papulo-nodular, verrucous lesions and lichenoid papules were present in some of these cases. The histopathological and immunopathological findings in these lesions are discussed in detail. It is concluded that some of our patients have a coexistence of both diseases while others suffer from an unusual variant of CDLE. We do not support the suggestion that this ‘mixed LP-LE disease’ should be considered as a distinct entity.     

Health education about occupational allergies and dermatoses for adolescents

Background: Occupational dermatoses and allergies are frequent and often affect individuals with atopic dermatitis. Our aim was to inform adolescents about potentially dangerous occupations, risk groups and preventive measures before they started apprenticeships in order to minimize the risk of occupational allergies or skin diseases. Methods: 1015 high‐school students were instructed by two dermatologists/ allergists (Heidelberg) and a teacher (Potsdam) in a 90‐minute instructional unit.This included the exemplification of occupational skin hazards and allergies, the identification of at‐risk persons, and application of preventive measures. A questionnaire was filled in by the students prior to and at least two weeks after the training. Results: In both regions, the students showed an increase in knowledge after the training, which was statistically significant higher in the Heidelberg region (6.6 points on average vs.4.4 points). 76% of students termed the subject matter as “important”, and 67% rated the teaching unit as “very good” or “good”. Conclusions: We demonstrate that students who have not yet chosen a career are highly interested in this subject, that the developed instructional unit is widely accepted, and that it leads to an increase in knowledge. Therefore we suggest nation‐wide implementation of this primary prevention measure in high‐schools.     

Evaluation of time,attendance of medical staff and resources for radiotherapy in pediatric and adolescent patients

Strahlentherapie und Onkologie - The German Society of Radiation Oncology (DEGRO) initiated a multicenter trial to develop and evaluate adequate modules to assert core procedures in radiotherapy....     

The long-term clinical impact of biochemical recurrence of prostate cancer 5 or more years after radical prostatectomy

PURPOSE: Information regarding the clinical impact of delayed (5 years or greater) biochemical failure (BF) after radical prostatectomy (RP) is lacking. We undertook an investigation to differentiate the innocuous recurrence of serum prostate specific antigen (PSA) from that which heralds an eventual clinical failure (CF), and to determine if there is a period following RP when a patient is cured of clinical disease. MATERIALS AND METHODS: Men with clinically localized prostate cancer (PCA) undergoing RP (1987 to 1995) were identified from our longitudinal PCA registry. Outcome measurements were based on the detection of post-RP serum PSA 0.4 ng/ml or greater, clinical identification of cancer recurrence and disease related death. RESULTS: Following RP in 3,903 eligible men, 33% had a detectable PSA (median followup 8.8 years). Of these BFs 27% occurred after 5 or more disease-free years. Currently, 29% of all men with BF have clinical evidence of PCA, with 8% dying of PCA (median actuarial survival time from CF to death 9.8 years). Progression from BF to CF was not significantly altered by the disease-free interval (p = 0.544). A PSA doubling time less than 12 months significantly increased the risk of CF regardless of the interval from surgery. Risk factors for BF were significant throughout the duration of followup. CONCLUSIONS: Patients are at prolonged risk for BF and CF following RP. Regardless of the timing of the initial PSA recurrence the PSA doubling time is the most powerful predictor of progression, stratifying patients with BF into high and low risk groups for CF.     

Determinants of patient satisfaction after cataract surgery in 3 settings

PURPOSE: To analyze the determinants of satisfaction and postoperative visual function after cataract surgery in 3 settings in The Netherlands. SETTING: University Hospital Maastricht (outpatient care), Atrium Medical Center Heerlen (inpatient care), and Medical Center Maastricht Annadal (outpatient care), Maastricht, The Netherlands. METHODS: This cross-sectional study consisted of 150 patients of 50 years and older who had first-eye phacoemulsification with intraocular lens implantation. Data were collected by a written questionnaire. The following parameters were measured: medical outcome, postoperative function, patient satisfaction with medical outcome and hospital care, and overall patient satisfaction. RESULTS: In general, patients were very satisfied (mean score 8.43 on a 10-point scale ranging from 1 = very bad to 10 = excellent). The 3 centers did not differ regarding the patient satisfaction (P =.092). However, postoperative visual function (P =.012), counseling (P =.010), and waiting time (P <.001) were different among the settings. Patient satisfaction with hospital care had a stronger correlation with overall satisfaction than patient satisfaction with the medical outcome (r = 0.669 versus r = 0.543, respectively). CONCLUSIONS: A causal model of patient satisfaction was tested, indicating that satisfaction was related to the patient's preoperative expectations and the quality of care given during the hospital stay and follow-up at the outpatient clinic. This emphasizes the relevance of patient education (to set realistic expectations) and counseling (need for care) by hospital staff in a cataract surgery setting.     

Assessment of coincidence and defect sizes in Bankart and Hill–Sachs lesions after anterior shoulder dislocation: a radiological study

Objective:

Bankart and Hill–Sachs lesions are often associated with anterior shoulder dislocation. The MRI technique is sensitive in diagnosing both injuries. The aim of this study was to investigate Bankart and Hill–Sachs lesions with MRI to determine the correlation in occurrence and defect sizes of these lesions.

Methods:

Between 2006 and 2013, 446 patients were diagnosed with an anterior shoulder dislocation and 105 of these patients were eligible for inclusion in the study. All patients were examined using MRI. Bankart lesions were classified as cartilaginous or bony lesions. Hill–Sachs lesions were graded I–III using a modified Calandra classification.

Results:

The co-occurrence of injuries was high [odds ratio (OR) = 11.47; 95% confidence interval (CI) = 3.60–36.52; p < 0.001]. Patients older than 29 years more often presented with a bilateral injury (OR = 16.29; 95% CI = 2.71–97.73; p = 0.002). A correlation between a Bankart lesion and the grade of a Hill–Sachs lesion was found (ρ = 0.34; 95% CI = 0.16–0.49; p < 0.001). Bankart lesions co-occurred more often with large Hill–Sachs lesions (OR = 1.24; 95% CI = 1.02–1.52; p = 0.033).

Conclusion:

If either lesion is diagnosed, the patient is 11 times more likely to have suffered the associated injury. The size of a Hill–Sachs lesion determines the co-occurrence of cartilaginous or bony Bankart lesions. Age plays a role in determining the type of Bankart lesion as well as the co-occurrence of Bankart and Hill–Sachs lesions.

Advances in knowledge:

This study is the first to demonstrate the use of high-quality MRI in a reasonably large sample of patients, a positive correlation of Bankart and Hill–Sachs lesions in anterior shoulder dislocations and an association between the defect sizes.A shoulder dislocation is a traumatic event with an incidence of around 24 per 100 000 in North America.^1,2 Anterior shoulder dislocation is the most common direction, and most patients are male.^1–4 The highest incidence (48 per 100 000) was found between the ages of 20 and 29 years.² Anterior dislocation causes a typical impression fracture on the posterior humeral head, known as a Hill–Sachs lesion.^5,6 The labrum or the glenoid itself may also be damaged; these injuries are known as Bankart lesions.⁷Although Hill–Sachs lesions can be found in 47–100% of all patients with first-time or recurrent shoulder dislocation, a distinction must be drawn between cartilaginous and bony Bankart lesions.^8–13 Cartilaginous lesions occur more often than bony ones.¹⁴ However, Bankart and Hill–Sachs lesions do not necessarily occur simultaneously. In 2006, Widjaja et al¹⁵ reported that, if one of the lesions was identified, the other was 2.67 times as likely to be present. Yet, this result failed to reach statistical significance because of the small sample size. Griffith et al¹⁰ evaluated CT scans and found a weak correlation between glenoidal bone loss and the size of the Hill–Sachs lesion (p = 0.030). However, the more frequently occurring cartilaginous Bankart lesion was not considered in this study.The aim of the present study was to evaluate the association between defect sizes in Hill–Sachs and bony as well as cartilaginous Bankart lesions after anterior shoulder dislocation using MRI. We hypothesized that there exists a higher correlation than previously thought between temporal occurrence and defect size of the lesions. The results of this study should help to improve diagnostic and therapeutic procedures.     

Neuropsychological outcome after selective amygdalohippocampectomy: subtemporal versus transsylvian approach

Objective In the context of discussions on the optimal cognitive outcome of temporal lobe epilepsy surgery, and stimulated by recent reports on the beneficial effects of a selective subtemporal approach to memory function, this study evaluated the cognitive consequences of subtemporal versus transsylvian selective amygdalohippocampectomy (SAH) in patients with mesial temporal lobe epilepsy, taking verbal/figural memory and language functions into account. Methods We contrasted cognitive outcomes of 26 subtemporal SAH patients with those observed in a transsylvian SAH control group. The surgical groups were pairwise matched with regard to clinical and demographic characteristics. Preoperative and 1 year postoperative memory and language evaluations served as within group factors, and surgical approach (transsylvian vs subtemporal) and side of surgery (right vs left) as between group factors. Results Both surgical approaches caused decline in verbal memory to a similar degree. Differential effects were seen with regard to decline in verbal recognition memory (more affected by left transsylvian SAH) as well as in figural memory and verbal fluency (more affected by subtemporal SAH). Interpretation Different from previous optimistic reports, this study demonstrates that subtemporal surgery, such as transsylvian surgery, poses similar risks for verbal memory. Differences between the approaches appear to reflect the effect of different collateral temporal lobe lesions due to the approach. Different cognitive outcomes across studies on the subtemporal approach are discussed as being in part due to study design and the chosen dependent functional measures.