The WHO Rabies Bulletin Europe: a key source of information on rabies and a pivotal tool for surveillance and epidemiology.

Rabies is one of the most, if not the most, prominent and feared zoonotic diseases in the world and the World Health Organization (WHO) estimates that 55,000 people die of the disease every year. Most of these deaths occur in Asia and Africa and are usually the result of dog-mediated rabies. In Europe, the red fox is considered the main reservoir species for wildlife rabies caused by the rabies virus. Besides foxes, bats have also been identified as a reservoir for European bat lyssaviruses in many European countries. Here, the authors present the rabies surveillance data for Europe in recent years, as reported to the WHO Rabies Bulletin Europe. This journal has evolved into a web-based platform for rabies information (including an online accessible database) that on average receives more than 60,000 visitors each year.

[Aging and the appearance of the hand]. / Alterung und ideale Asthetik der Hand.

The appearance of the hand is clearly secondary to its function. Nonetheless, aging changes on the hands are of considerable importance to many patients. Although rejuvenation of the hand has attracted increased interest in plastic surgery recently, the dermatologists have dealt with this problem for a longer time. Successful rejuvenation requires thorough analysis of the underlying pathophysiology. Hand aging is characterized by dermal and subcutaneous volume loss resulting wrinkle formation. Aging is also associated with increased visibility of tendons and veins as well as age spots and precancerous lesions. Hand rejuvenation aims at successfully reversing this three-dimensional process. The majority of treatment options address only partial aspects of the aging process. Topical treatments are the mainstay of therapy as these changes are most obvious. As patients will mainly seek advice from dermatologist, this field requires increased attention.

A randomised clinical study comparing palmar and dorsal fixed-angle plates for the internal fixation of AO C-type fractures of the distal radius in the elderly.

Current surgical treatments for distal radial fractures include dorsal and palmar plate fixation. We report results of a randomised study comparing these methods for AO C1-3 fractures. The emphasis was placed on the early postoperative functional recovery within the first 6 months as this interval is of decisive importance for elderly patients. Thirty patients with unilateral AO C1-3 fractures were enroled, 15 were treated with a palmar plate and 15 received a dorsal Pi-plate. Results were assessed 6 weeks, 3 months and 6 months postoperatively focusing on functional recovery. The palmar plate group demonstrated significantly better results in range of motion, grip strength and pain.

[Soft tissue coverage of the distal third of the tibia with fasciocutaneous propeller flaps]. / Die Defektdeckung des distalen Unterschenkeldrittels mit perforatorbasierten 180 degrees -Propellerlappen.

BACKGROUND: The distal third of the tibia is often only amenable to free tissue transfer to cover exposed bone, tendons and neurovascular structures. Using relatively constant perforators of the tibial and peroneal vessels, soft tissue coverage can be achieved with so-called propeller flaps. METHODS: 8 patients presenting with post-traumatic defects over the lateral malleolus and the Achilles tendon were included in this study. A propeller flap based on perforators from the peroneal or tibial artery was used to cover the defect. RESULTS: One case of partial flap necrosis was encountered in a diabetic patient. Transient venous congestion of the flap tip was witnessed in two instances, which resolved without further intervention. No other complications occurred. All patients were fully ambulatory within 8 weeks, except for 1 patient, who required a below-knee amputation. CONCLUSION: The propeller flap has proven to be a versatile and elegant method to obtain soft tissue coverage with local tissue. Contrary to conventional rotation flaps, direct closure of the donor site is possible. Patients are not impaired by bulky flaps and may wear normal shoes. Even in the elderly, this flap was successful.

Rabies in Europe--trends and developments.

Rabies continues to be a major public health concern both in Europe and worldwide. In the greater part of the European continent the disease has been eradicated, or its incidence drastically reduced, by oral vaccination of wildlife reservoirs. Yet, 'hot spots' still remain in north-eastern and south-eastern Europe with a high temporal variation of disease distribution in the previous decade. Rabies is predominantly transmitted by the red fox; but in recent years, especially in Eastern European countries, an independent infection cycle in raccoon dogs seems to have developed. Although countries such as the Czech Republic, Slovenia and Poland achieved very impressive rabies control results and trend analyses of rabies occurrence showed a long- and short-term decrease, there is still need for improved rabies surveillance and control in Europe. The Rabies Bulletin Europe (RBE), a quarterly, printed and on-line publication, aims to improve this situation. Besides the need to improve the quality of data in some countries, it will provide a public domain rabies database in the near future. Further strategic cooperation is necessary to control the disease in areas of European public health concern.

Potential risk factors for bovine Neospora caninum infection in Germany are not under the control of the farmers.

In the German state of Rhineland-Palatinate, herds were identified that were likely to have a Neospora caninum sero-prevalence > or = 10% by using a bulk milk ELISA. Individual herd data were obtained by a questionnaire. Univariate logistic regression showed that bulk milk positive farms had a significantly higher chance to report an increased abortion rate than negative farms (P(Wald)<0.1). The chance to have a bulk milk positive herd increased with the minimum number of years a farm had reported an increased abortion rate (P(Wald)<0.1). Questionnaire data, population and dog density as well as climatic data specific for the farm localization were used to identify potential risk factors for a herd to have acquired N. caninum infections. Within an optimized multiple logistic regression model 'Number of farm dogs', 'Herd size', and factors related to the municipality the farm was localized, i.e. 'Mean temperature in July', and 'Dog density' were significant risk factors (P(Wald)<0.1). The present study underlines the role farm dogs have in the epidemiology of neosporosis. In addition, it suggests that the risk a herd has to acquire N. caninum infections is also associated with factors related to the farm location, i.e. factors that are largely out of the control of farmers.

Regional distribution of bovine Neospora caninum infection in the German state of Rhineland-Palatinate modelled by Logistic regression.

To obtain a rapid overview over the distribution of bovine Neospora caninum-infections in the German state of Rhineland-Palatinate, an ELISA to determine specific bovine antibodies against a p38 surface antigen of N. caninum tachyzoites was modified to examine bulk milk samples from cattle herds. Experimental bulk milk samples were used to demonstrate that the seroprevalence in a group of animals can be estimated with this ELISA. A cut-off was selected for the specific detection of herds having a seroprevalence > or =10%. About 90% of the dairy herds located in Rhineland-Palatinate were examined. An overall prevalence of bulk milk-positive herds of 7.9% (95% confidence interval 7.0-8.9%), respectively, was determined. Major regional differences in the distribution of bulk milk-positive herds were observed. Prevalences were higher in regions with an increased degree of urbanisation. Logistic regression was applied to model the prevalence of bulk milk-positive herds on a district and city level. Variables describing the dog density, mean temperature in July, mean temperature in January and the total yearly precipitation in districts and cities were able to explain most of the observed variability in the regional prevalences. Our results provide evidence that in addition to risk factors related to individual farms also risk factors related to the farm location such as dog density in the surrounding and climate factors are important in the epidemiology of bovine neosporosis.

Mass hearing screening in kindergarten students.

OBJECTIVE: To determine the types of hearing losses identified by mass hearing screenings in the public school system. DESIGN: Prospective observational. PARTICIPANTS: Students enrolled in kindergarten in the public school system. SETTING: Major metropolitan area. MAIN OUTCOME MEASURES: (1) hearing screening tests performed by speech pathologists using an audiometer in a quiet room; (2) formal audiologic testing including pure tone audiometry, tympanograms, speech discrimination, and acoustic impedance testing in a sound proof booth. RESULTS: 140 students failed hearing screening on two separate occasions; 91(65%) underwent formal audiologic testing at Milwaukee Public School, 43% demonstrated conductive hearing losses, 14% demonstrated sensorineural losses and 43% demonstrated normal hearing. CONCLUSION: Mass hearing screening in the school system (1) is useful for detecting transient conductive hearing losses, (2) detects a significant number of sensorineural hearing losses and (3) has a very poor follow-through by the families of those students identified with hearing loss through the screening program.

Laparoscopic cholecystectomy: 111 consecutive cases.

Laparoscopic cholecystectomy removes the gallbladder through three or four puncture wounds in the abdominal wall. The technique reduces the recuperative time to full activity, from as long as 4 wk to as little as 3 days, compared with conventional cholecystectomy. We herein present our initial experience with this procedure. In this series of 111 laparoscopic cholecystectomies, there were no mortalities and only one morbidity. Thirty-nine patients (35%) had a history of prior abdominal surgery. Fourteen underwent laparoscopic lysis of adhesions. Intraoperative cholangiograms were performed in 24 patients (21%), demonstrating choledocholithiasis in three. Two of the three patients underwent postoperative endoscopic retrograde cholangiopancreatography (ERCP); in the other, laparoscopic common bile duct exploration was performed. In each case, the common bile duct (CBD) was completely cleared of stones. Incidental laparoscopic appendectomy was also performed in three patients. The average time for completion of laparoscopic cholecystectomy in cases of chronic cholecystitis was 40 min. If the gallbladder was acutely inflamed, the procedure took a mean of 126 min. This series had a higher percentage of patients (19%) with acute cholecystitis then previously reported; therefore, the 2% conversion rate in this series emphasizes the broad applicability of the technique. The average length of stay in the hospital was 1.4 days, and patients returned to work in about 7 days.

Small-bowel obstruction caused by a long-term indwelling urinary catheter.

The first known case report of a small-bowel obstruction caused by a long-term indwelling Foley catheter is presented. The balloon of the catheter passed into and obstructed the lumen of the distal ileum through a vesicoenteric fistula created by chronic irritation. With the exception of recurrent urinary-tract infections, complications of urinary catheters are rare. The patient presented a diagnostic dilemma that was solved with a preoperative computed tomographic scan.

The duty of care: medical negligence.

KIE: This tenth article in a series on National Health Service administration and management reviews the current status of malpractice/negligence law in Great Britain. Among the topics discussed are the liability concerns of administrative units within the NHS; recent decisions in English negligence cases involving questions of established practice, informed consent, legal responsibility of employers, supervisors, and subordinates, and potential liability for lack of medical resources; and the best way of managing civil actions for compensation following medical accidents.^ieng