[PTSD in young children after medical procedure]. / PTSS bij jonge kinderen na een medische handeling.

An eight-year-old boy with spastic type bilateral cerebral palsy and a two-year-old girl with biliary atresia were referred to a psycho-trauma centre. Both children developed post-traumatic stress disorder (PTSD) symptoms as a result of the medical procedure. Because of their symptoms, they were resisting further medical treatment. The children were given trauma-focused treatment (eye movement and desensitisation reprocessing and cognitive behavioural therapy). This article argues that hypnosis and distraction can play a role in preventing PTSD symptoms after undergoing a medical procedure. If PTSD is unavoidable, it is important to recognise the symptoms and to treat these children. Furthermore, their parents might also be traumatised. PTSD symptoms in children and their parents can be successfully treated. Also children with sub-threshold PTSD can benefit from trauma treatment.

Epididymo-orchitis due to brucellosis: not only to be considered in endemic areas. Two cases for the price of three patients.

We report 2 patients with epididymo-orchitis, caused by Brucella melitensis, accompanied by severe delay of diagnosis. In 1 patient the correct diagnosis was only suspected after his wife had been diagnosed with brucellosis. Our cases illustrate that diagnosing brucellosis can be difficult in nonendemic areas, especially when physicians are unfamiliar with it. Important clues pointing to brucellosis as cause of epididymo-orchitis are a travel history to endemic areas, unresponsiveness to empiric antibiotic treatment, and a preceding period of episodic subfebrile temperature, night sweats and fatigue. Serology is the diagnostic test of choice because it is faster and more sensitive than blood cultures. Delay of diagnosis may lead to serious complications. Therefore, alertness for brucellosis is warranted, also, if not especially, in nonendemic areas.

Goitre and hearing impairment in a patient with Pendred syndrome.

A case is described here of a young euthyroid woman with a goitre and hearing impairment. Perchlorate discharge test showed increased washout of iodine. Genetic analysis confirmed the diagnosis of Pendred syndrome as a mutation in the Pds gene was found. The patient was treated with potassium iodine orally. During follow-up there where no symptoms of hyperthyroidism and the size of the goitre decreased.

Impaired glucose metabolism predicts mortality after a myocardial infarction.

Diabetes is a risk factor for increased mortality after a myocardial infarction. Whether this applies for patients with hyperglycemia during the acute phase of a acute myocardial infarction is unclear. Therefore we determined the relation between admission plasma glucose level and mortality in a prospectively collected series of 336 consecutive AMI patients. Patients were divided in four groups based on WHO criteria for glucose levels: I: <5.6 mmol/l, II: 5.6--8.3 mmol/l, III: 8.4--11.0 mmol/l, IV: 11.1 mmol/l. The average age was 68+/-11 years with a peak CK of 1378+/-160 U/l, 34% were anterior wall AMIs and 52% were treated with thrombolysis. All patients had a long-term follow-up control at an average of 14.2 months. One year mortality rate was 19.3% and rose to 44% in patients with glucose levels >11.1 mmol/l. The mortality was higher in diabetic patients than in non-diabetic patients (40 vs. 16%; P<0.05). Multivariate analysis revealed an independent effect of glucose level on mortality. In conclusions, our study in an unselected patient population demonstrates that admission plasma glucose level independently predicts 1 year mortality even in absence of diagnosed diabetes mellitus. Further studies evaluating the effect of acute insulin intervention in reducing mortality are warranted.

Long-term follow-up of two patients with metastatic neuroendocrine tumours treated with octreotide.

Two patients are described with metastatic neuroendocrine tumours of the pancreas head and region of Vater. After surgery, administration of the long-acting somatostatin analogue octreotide was started. In the first patient we found an IgG-lambda paraproteinaemia and a parathyroid hormone-related protein (PTHrP) driven hypercalcaemia. By increasing the dose of octreotide the paraproteinaemia disappeared. In the second patient with a metastasized somatostatin producing neuroendocrine tumour, octreotide showed a long-term stabilizing effect on symptoms and progression of disease. The role of octreotide in the induction of changes in biological behaviour of malignant neuroendocrine cells is discussed.

Immunoglobulin patterns in humans over 95 years of age.

Immunoglobulin patterns were investigated in seventy-three volunteers older than 95 years. An idiopathic paraproteinaemia was found in 19% of the cases. A restriction of heterogeneity and an imbalance in the kappa/lambda ratio of the immunoglobulins was seen in a number of other sera. Determinations of immunoglobulin levels in sera of individuals without paraproteinaemia showed an increase in IgA and IgG. The quantitations of the IgG subclasses demonstrated that an increase in the IgG1 and IgG3 subclasses is responsible for the elevated level of the IgG. The variation in the immunoglobulin levels increased significantly with age of IgM and for the three major IgG subclasses. No abnormalities were found in the urine or in the mixed saliva. These results indicate that selective changes in the extent of the antibody-immunoglobulin repertoire characterize the immunoglobulin pattern of ageing man.