Organic syndromes diagnosed as conversion disorder: identification and frequency in a study of 85 patients.

BACKGROUND: The percentage of patients initially diagnosed with a conversion disorder and later identified as having an organic disorder has been decreasing in recent studies. METHOD: Consecutive patients with a diagnosis of conversion disorder were referred for psychiatric diagnosis and treatment. Research questions were: (1) What incidence of neurological disorder is revealed by neurological reassessment and by which diagnostic technique is the final diagnosis established? (2) What differences can be observed between true-positive and the false-positive results? RESULTS: Ten (11.8%) of the 85 patients examined appeared to suffer from a neurological disorder. In this sample, variables discriminating between the true positives and false positives were: (1) prior suspicion of neurological disorder; (2) older age at referral; (3) older age at onset of symptoms; (4) longer duration of symptoms; and (5) use of medication. Three variables contributed significantly to the prediction of organic disorder: prior suspicion of neurological disorder; age at onset of symptoms; and duration of symptoms. CONCLUSIONS: Although our results are in line with those of other recent studies, the percentage of false positives was still high. The data further emphasize the dangers of making a diagnosis of conversion disorder in the absence of positive evidence. It is important to continue to provide follow up for patients with a diagnosis of conversion disorder. Unfortunately, unreliable psychiatric indications, like certain behavioral characteristics, are still used in the diagnostic process. The results show that a general neurological examination is still a valuable diagnostic instrument in addition to modern diagnostic techniques.

[The global eradication of polio by the year 2000]. / Polio de wereld uit, rond het jaar 2000.

The World Health Organization wants to attain global eradication of poliomyelitis in the year 2000. In all countries commissions are installed to document polio-free certification. Four activities are considered vital by the WHO to achieve this goal: (a) strict surveillance of all suspected cases of poliomyelitis, (b) close clinical and virological examination of all children younger than 15 years with acute flaccid paralysis (AFP), (c) laboratory surveillance of poliovirus isolates and (d) surveillance of sewage. The Netherlands has been selected as example country for the certification process. However, the AFP surveillance is not yet optimal, therefore all physicians are asked to join in the effort.

Significant reduction in post-lumbar puncture headache using an atraumatic needle. A double-blind, controlled clinical trial.

A characteristic headache occurs in about 36-55% of patients after lumbar puncture, and many of these patients need bed rest for one or more days to get relief. In a double-blind randomized trial we compared a new 22-gauge atraumatic puncture needle with the most widely used 20-gauge "conventional" needle. In 49 patients randomized to the atraumatic needle, post-lumbar puncture headache occurred in 6%, whereas in the 50 patients randomized to the conventional needle this occurred in 32% (p = 0.001). On the basis of these results we recommend use of the atraumatic needle in order to diminish the frequency of post-lumbar puncture headache.

[Less headache following lumbar puncture with the use of an atraumatic needle; double-blind randomized study]. / Minder hoofdpijn na lumbale punctie bij gebruik van een atraumatische naald; dubbelblind gerandomiseerd onderzoek.

OBJECTIVE: To investigate the difference in frequency of headache after lumbar puncture with a standard needle or an atraumatic needle. DESIGN: Prospective, randomised double blind study. SETTING: Department of Neurology, Merwedeziekenhuis, Dordrecht. METHOD: One hundred sequential patients were randomised to lumbar puncture with a 'standard needle' (20 gauge) or an 'atraumatic needle' (pencil point, 22 gauge). The patients were interviewed one week later. Patient and interviewer were unaware of the needle used. RESULTS: After puncture with the standard needle 32% of the patients suffered from postlumbar puncture headache, after use of the atraumatic needle 6% (p < 0.001; 95% confidence interval of the difference: 0.11-0.40). Postpuncture complaints appeared to be less severe after puncture with the atraumatic needle. CONCLUSION: In comparison with a standard needle, there is significantly less postpuncture headache after lumbar puncture with an atraumatic needle.