Cardiac tamponade following post-pericardiotomy syndrome.

SUMMARY: Subxyphoid pericardial window (SPW) is performed as both a diagnostic and therapeutic intervention in patients presenting with a penetrating cardiac injury (PCI). Post-pericardiotomy syndrome (PPS) with cardiac tamponade has been reported after penetrating cardiac trauma and after transdiaphragmatic pericardial window. We describe the first PPS with acute tamponade, weeks after diagnostic SPW for a PCI.

Incidence of bactobilia increases over time after endoscopic sphincterotomy.

Patients with choledochocystolithiasis are usually treated by endoscopic retrograde cholangiography with endoscopic sphincterotomy (ES) followed by laparoscopic cholecystectomy (LC). LC after ES is more difficult than in uncomplicated gallstone disease, possibly due to bacterial colonization of the common bile duct. The goal of this study was to evaluate if bactobilia influences the peri- and postoperative outcomes. Data were obtained from a randomized trial on the timing of LC after ES. Ninety-six patients were randomized after ES to LC either within 72 h (early LC [ELC]) or in 6-8 weeks (delayed LC [DLC]). In 64 of 96 patients bile samples were obtained peroperatively. The overall prevalence of bactobilia was 62.5% [40/64; 50% of ELC patients (n = 13) vs. 71.1% in the DLC group (n = 27); p = 0.088]. Age and group (i.e. ELC/DLC) were independent and significant predictors for the presence of bactobilia. The presence of bactobilia did not influence operating time and difficulty or conversion rate. Patients with bactobilia developed more biliary events in the period between ES and LC (44 vs. 28%). After ES for choledochocystolithiasis, 62.5% of patients have bactobilia at the time of surgery. The prevalence of bactobilia increases with age and time. Patients with bactobilia tend to develop more biliary-related complications awaiting surgery.

Parenting by persons with intellectual disability: an explorative study in the Netherlands.

BACKGROUND: As a sequel to a report by the Health Council of the Netherlands on contraception in persons with intellectual disabilities (IDs), a fierce debate about parenthood by such persons occurred, in which a lack of knowledge about parenting competences became clear. Therefore, the Ministry of Health commissioned a study investigating examples of 'successful parenthood' by persons with IDs. METHODS: In conformity with the literature and with legal categories, we defined 'successful parenthood' as 'good enough parenthood', meaning no indications for child abuse and/or neglect, no dealings with child protection agencies and no legal custody. We combined a nationwide quantitative questionnaire study with a qualitative interview study. Questionnaires were sent to all institutions involved in caring for persons with ID, interviews were held with 'good enough' parents and their professional caregivers, selected on the basis of returned questionnaires. RESULTS: Parenthood occurs in around 1.5% of persons with ID in the Netherlands and is mostly restricted to those with mild handicaps. In total, 51% of the cases were regarded, by caregivers, as not-good-enough parenthood, 33% were clearly good enough and 16% were doubtful. Predicting factors included the ability and the willingness to follow advice, the quality of the social network and the acceptance of parenting in the community. However, there is not one decisive predicting factor; particularly, the predictive value of the IQ alone is small. CONCLUSIONS: A general policy of discouragement of parenthood, as advocated by the Dutch Ministry, is not supported by our results; moreover, it would probably be impossible and have negative effects on social acceptance of parents with ID. The overall conclusion from the study therefore is that some kind of balancing model, in which positive and negative factors are weighed, may be useful to predict success and need for support.

[The control of paratuberculosis]. / Paratuberculosebestrijding.

Satisfactory results were obtained in the control of paratuberculosis in the province of Friesland during the period from 1954 to 1963. 465 Post-mortem findings positive for Johne's disease were observed on a number of farms prior to the start of control, in contrast with thirty-eight (8 per cent) positive findings in comparable conditions following this period. Unsatisfactory results in the Netherlands were reported in recent papers. This was attributed to modern stock farming in loose housings, the problems in carrying out free calf rearing and the fact that the johnin and complement fixation tests were not sufficiently reliable. It should also have been pointed out that incorrect regulations were adopted in controlling the disease, that the number of veterinarians engaged in studies under field conditions was not sufficient and, particularly, that investigators were not interested in working in the field. Vaccination may support control by reducing the pressure resulting from infection, though rapid elimination of shedders of M. Johnei as well as free calf rearing will continue to be essential in the effective control of 'clinical para-tuberculosis.