Geheilte Netzhautablösung bei Hydrophthalmus

Zusammenfassung In einem kompensierten Hydrophthalmus, dem einzigen Auge eines 38jährigen Mannes, treten scheinbar spontan innerhalb von 7 Jahren 7mal rezidivierende Netzhautablösungen auf, als deren Ursache schließlich ein kleines Foramen soleaforme festgestellt wurde, nach dessen Verschluß mittels Oberflächendiathermie Rezidive nicht mehr auftraten. Nach berechtigter Annahme wird das Loch 17 Jahre latent geblieben sein. Im Gegensatz zu den bisherigen Erfahrungen hat das Auge die Ablösungen fast ohne Residuen überstanden. Es wurden im Anschluß an diesen Fall verschiedene Fragen diskutiert, von denen die nach der Heilungsmöglichkeit eines Hydrophthalmus als wichtigste bezeichnet wird. Nach Berücksichtigung der ProversiotheorieVogts wurde kurz die Frage angeschnitten, ob die Eigentümlichkeiten des beschriebenen Netzhautloches nicht aus Elastizitätsverlust der Membr. lim. int. et ext. retinae erklärbar seien, welche Eigenschaft vielleicht dem Hydrophthalmus zukommt.Herrn ProfessorVogt zum 60. Geburtstage gewidmet.     

A health comparison of Alabama nurses versus US, UK, and Canadian normative populations

This article is one of a two part series examining the people and environment associated with patient handling. The approach used was that of an occupational injury investigation of a job class, which incorporates defining in the task, environment, tools, and worker health status. Hence, the objective of this portion of the research was to develop a method and use it to compare the physical and mental health of Alabama nurses with known normative populations to determine a baseline of overall health. For this purpose, the validated SF-36© survey was used to collect data on Alabama nurses who had been registered in the state for at least one year. The potential participant pool included 1000 nurses randomly selected from more than 49,000 registered. Physical mailers with a pre-paid return envelope and a follow-up reminder post-card were used. A return rate of 10% was expected based on nursing literature. One hundred and one surveys were returned with 87 being complete. Results confirmed that nursing in the US is a female dominated profession with the survey matching both the Alabama and US national average of 92%. Comparisons of the sample data to general populations yielded significant differences in 3 of the 8 outcome measures: social functioning; physical functioning; bodily pain. In each of these measures, Alabama nurses had a reduced health status compared to at least one comparative population. Additionally, data related to body mass index (BMI) for Alabama nurses were stratified by gender and age. Results indicated 28% had a “healthy” BMI with 37% and 35% of the nurses being “overweight” or “obese”, respectively. Consequently, results suggest Alabama nurses have a reduced health status compared to normative populations and show similar but not identical BMI trends to the general populations for the state of Alabama and the US, which warrants concerns about potential declines in health status among caregivers.

Significance to healthcare

Nurses constitute the largest proportion of the healthcare industry’s workforce. Understanding the perceptions of health status of this employee group is essential to gain further information about possible influences of health on nurses’ ability to continue to perform their jobs.     

Chest radiography in general practice: indications, diagnostic yield and consequences for patient management

BACKGROUND: Chest radiography (CXR) is frequently performed in Western societies. There is insufficient knowledge of its diagnostic value in terms of changes in patient management decisions in primary care. AIM: To assess the influence of CXR on patient management in general practice. DESIGN OF STUDY: Prospective cohort study. SETTING: Seventy-eight GPs and three general hospitals in the Netherlands. METHOD: Patients (n = 792) aged > or =18 years referred by their GPs for CXR were included. The main outcome was change in patient management assessed by means of questionnaires filled in by GPs before and after CXR. RESULTS: Mean age of the patients was 57.3+/-16.2 years and 53% were male. Clinically relevant abnormalities were found in 24% of the CXRs. Patient management changed in 60% of the patients following CXR. Main changes included: fewer referrals to a medical specialist (from 26 to 12%); reduction in initiation or change in therapy (from 24 to 15%); and more frequent reassurance (from 25 to 46%). However, this reassurance was not perceived as such in a quarter of these patients. A change in patient management occurred significantly more frequently in patients with complaints of cough (67%), those who exhibited abnormalities during physical examination (69%), or those with a suspected diagnosis of pneumonia (68%). CONCLUSION: Patient management by the GP changed in 60% of patients following CXR. CXR substantially reduced the number of referrals and initiation or change in therapy, and more patients were reassured by their GP. Thus, CXR is an important diagnostic tool for GPs and seems a cost-effective diagnostic test.     

Inv(X)(p21.1;q22.1) in a man with mental retardation,short stature,general muscle wasting,and facial dysmorphism: clinical study and mutation analysis of the NXF5 gene

We describe a 59-year-old male (patient A059) with moderate to severe mental retardation (MR) and a pericentric inversion of the X-chromosome: inv(X)(p21.1;q22.1). He had short stature, pectus excavatum, general muscle wasting, and facial dysmorphism. Until now, no other patients with similar clinical features have been described in the literature. Molecular analysis of both breakpoints led to the identification of a novel "Nuclear RNA export factor" (NXF) gene cluster on Xq22.1. Within this cluster, the NXF5 gene was interrupted with subsequent loss of gene expression. Hence, mutation analysis of the NXF5 and its neighboring homologue, the NXF2 gene was performed in 45 men with various forms of syndromic X-linked MR (XLMR) and in 70 patients with nonspecific XLMR. In the NXF5 gene four nucleotide changes: one intronic, two silent, and one missense (K23E), were identified. In the NXF2 gene two changes (one intronic and one silent) were found. Although none of these changes were causative mutations, we propose that NXF5 is a good candidate gene for this syndromic form of XLMR, given the suspected role of NXF proteins is within mRNA export/transport in neurons. Therefore, mutation screening of the NXF gene family in phenotypically identical patients is recommended.     

Iridoids from Pentas lanceolata

From the aerial parts of Pentas lanceolata, belonging to the family Rubiaceae, a series of iridoid glucosides was isolated by preparative HPLC. Seven iridoid glucosides were identified. Besides asperuloside and asperulosidic acid, characteristic iridoids for Rubiaceae, five new iridoids were isolated, namely, tudoside (1), 13R-epi-gaertneroside (2), 13R-epi-epoxygaertneroside (3), and a mixture of E-uenfoside (4) and Z-uenfoside (5). Further, it was shown that the compound reported as citrifolinin B (6) is in fact the same as tudoside and should be revised. Also, the configuration of the previously reported iridoids gaertneroside and epoxygaertneroside has been elucidated.     

Herpes simplex induced necrotizing tonsillitis in an immunocompromised patient with ulcerative colitis

We here present the case of a 22-year-old female of Suriname ethnicity with ulcerative colitis who received treatment with mercaptopurine and infliximab. She presented herself with a severe necrotizing tonsillitis due to herpes simplex virus type-1 (HSV-1). Combination therapy consisting of immunomodulators and anti-tumor necrosis factor (TNF) agents is increasingly being used. Anti-TNF therapy is associated with an increased risk of developing serious infections, and especially patients receiving combination treatment with thiopurines are at an increased risk. We here show that HSV infections can cause a severe tonsillitis in immunocompromised patients. Early recognition is essential when there is no improvement with initial antibiotic therapy within the first 24 to 72 h. HSV infections should be in the differential diagnosis of immunocompromised patients presenting with a necrotizing tonsillitis and can be confirmed by polymerase chain reaction. Early treatment with antiviral agents should be considered especially if antibiotic treatment fails in such patients.     

Progression of a solitary plasmacytoma to multiple myeloma. A population‐based registry of the northern Netherlands

Plasmacytoma is characterized by a local accumulation of monoclonal plasma cells without criteria for multiple myeloma (MM). The current treatment regimen is local radiotherapy. However, more than 50% of patients develop MM within 2 years after treatment. A population‐based registry was consulted for the diagnosis of solitary plasmacytoma between 1988 and 2011. Progression to MM and prognostic features for progression to MM were scored, including hypoxia inducible factors (HIF), vascular endothelial growth factor (VEGF, also termed VEGFA) and micro‐vessel density (MVD) expression in biopsy material. A total of 76 patients were included, 34% having extramedullary plasmacytoma (EMP) while 66% had a solitary plasmacytoma of the bone (SBP). Median follow‐up was 89 months, (7–293 months). In Seventy per cent of SBP patients developed MM with a median time to progression of 19 months (5–293). Three patients (12%) with EMP developed MM. High expression of VEGF and HIF‐2α (also termed EPAS1) was demonstrated in conjunction with an increased MVD in 66% of the patients. No association could be shown between angiogenesis parameters and progression to MM. In conclusion, this population‐based study demonstrates that SBP patients have a higher risk of developing MM following local radiotherapy, indicating that this group might benefit from added systemic chemotherapy.