Neuroleptic malignant syndrome: a diagnosis easily missed

A woman admitted with psychotic depression developed a number of physical problems. Urinary incontinence, headache, neck stiffness and breathing difficulties were all treated separately but were later found to be part of the neuroleptic malignant syndrome. Treatment of the disorder led to complete recovery. We review the criteria for diagnosis of this serious disorder and some differential diagnoses.     

Wound measurement: the comparative reliability of direct versus photographic tracings analyzed by planimetry versus digitizing techniques

OBJECTIVE: To investigate two methods of wound measurement (planimetry and digitizing) performed on two routinely used techniques of clinical wound assessment, tracings taken directly from a patient's wound (raw tracing) and from photographs of the wound (photographic tracing). DESIGN: We examined the level of repeatability and thus reliability of these methods, and determined if absolute measured wound size differed between the combinations of method and assessment procedures. PATIENTS: Seven patients (4 women, 3 men; mean age +/- standard error of the mean = 63.1+/-5.0yrs) with a total of 11 wounds. SETTING: Patients attended a podiatry outpatient department on two separate days for raw and photographic tracing of their wounds. For both of these trace types, a series of repeated recordings were conducted by a single investigator using planimetry and digitizing measurement methods. MAIN OUTCOME MEASURE: Independent statistical analyses (analysis of variance, p < .05) were conducted on logged coefficients of variation and logged means data to investigate for repeatability and for size differences, respectively. RESULTS: Planimetry produced a significantly larger degree of variability (thus less repeatability) than digitizing (p = .02) and also produced smaller readings (p = .00001). Averaging over methods also indicated that photographic tracings produced smaller readings than raw tracings (p = .019). CONCLUSION: For the wound sizes and shapes examined, tracings taken directly from the patients were found to be an inexpensive clinical and research assessment tool on which digitizing was conducted with a higher level of repeatability than planimetry. Further research is needed to determine if the current findings apply to a wider population within wound management clinics.     

"Deep" figurate erythema

Deep figurate erythema is a rare dermatologic disease of unknown etiology. Early onset is exceptional. We report a clinical observation of neonatal onset, which serves to confirm the characteristic presentation of this disease, its benign nature and lack of response to different therapeutic attempts.     

Improving return-to-work after childbirth: design of the Mom@Work study,a randomised controlled trial and cohort study

Background  

Many women suffer from health problems after giving birth, which can lead to sick leave. About 30% of Dutch workers are on sick leave after maternity leave. Structural contact of supervisors with employees on maternity leave, supported by early medical advice of occupational physicians, may increase the chances of return-to-work after maternity leave. In addition, to understand the process of sick leave and return-to-work after childbirth it is important to gain insight into which factors hinder return-to-work after childbirth, as well, as which prognostic factors lead to the development of postpartum health complaints. In this paper, the design of the Mom@Work study is described.