Planning health care for patients with Graves' orbitopathy.

BACKGROUND: To describe disease parameters of patients with Graves' orbitopathy in a tertiary referral center in order to plan health care resource allocations. To investigate whether the clinical activity and/or the severity of the disease can be used as a predictor of the duration of treatment. METHODS: Retrospective, observational, non-comparative case series. One hundred and seventeen charts of GO-patients, randomly chosen out of a pool of 1600, referred to the Orbital Unit of the University Medical Centre Utrecht between 1 January 1992 and 1 January 2002, were analysed. Relevant parameters, such as age, gender, race, disease duration, smoking habits, concomitant diseases, previous treatment, symptoms and signs, number and sort of investigations, severity and activity scores, number and sort of treatments, treatment duration and outcome of treatment were retrieved and analysed. Disease activity and severity at entry were tested as possible predictors of disease duration and extent of treatment. RESULTS: Clinical profile at presentation; duration of the disease; extent of treatment; predictors of disease duration and of number of treatment interventions were the main outcome measures. Three percent of patients had Only Signs, but No Symptoms (OSNS), 61% had mild, 27% had moderately severe and 9% had severe GO. Fifteen percent had inactive disease at presentation, 65% had borderline activity and only 20% had active orbitopathy. Sixty percent complained about eyelid swelling and/or proptosis. The average period of eye treatment was 2.5 years (range: 0-110 months), during which patients were seen at an average of 8 times. Twenty percent needed no treatment at all. Fifteen percent were treated with nothing but lubricants and/or prisms. Twenty-five percent were treated with immunosuppressive modalities. Fifty-six percent underwent one or more surgical corrections. The Clinical Activity Score (CAS) was found to be significantly related to the duration of the treatment (p < 0.001), to the number of visits (p < 0.001), and to the number of surgical interventions (p < 0.001). CONCLUSIONS: The majority of GO patients referred to a tertiary referral centre has no or borderline disease activity and 'mild' orbitopathy, disfiguring eyelids and proptosis being the most frequent complaints. The disease activity as assessed with the CAS can be used to predict the duration and extent of the treatment.

Coronal or swinging eyelid decompression for patients with disfiguring proptosis in Graves' orbitopathy? Comparison of results in one center.

PURPOSE: To compare 2 different approaches for 3-wall orbital decompression in patients with disfiguring proptosis due to Graves' orbitopathy, and to determine which technique is preferable. DESIGN: Retrospective nonrandomized study with a concurrent comparison group. PARTICIPANTS: Charts of 74 consecutive patients with disfiguring proptosis due to Graves' orbitopathy who underwent coronal (46) or swinging eyelid (28) decompression between January 1, 2000 and January 1, 2004 were studied retrospectively. Patients with dysthyroid optic neuropathy were excluded. METHODS: We analyzed the following parameters: proptosis reduction, ocular motility, number of additional operations, number and kind of complications, patients' satisfaction, patients' estimation of numbness or abnormal sensations in the field of operation and surgical scars, and duration of hospitalization time. MAIN OUTCOME MEASURES: Reduction of proptosis, changes in eye motility, and duration of hospitalization. RESULTS: Mean proptosis reductions were 4.8 mm (range, 1-11) after coronal decompression and 5.6 mm (range, 0-8) after swinging eyelid decompression (P = 0.025). Patients who were operated by the swinging eyelid approach had no more deteriorated motility and a shorter hospitalization time. Complications were seen rarely. Both groups of patients showed high satisfaction scores. CONCLUSION: Relative to the coronal approach, swinging eyelid decompression results in at least the same proptosis reduction, no greater motility disturbance, and a shorter hospitalization time.

Measles incidence estimations based on the notification by general practitioners were suboptimal.

OBJECTIVE: The aim of this study was to determine the notification by general practitioners (GPs) to the Municipal Health Service (MHS) and the presentation of measles complaints by patients to the GP during a measles epidemic in a 78% vaccinated population. STUDY DESIGN AND SETTING: Measles cases in children under 13 years were identified via questionnaires, GPs' records, and MHS's records. Consultation rate, notification rate, and completeness of notification were determined. Determinants of consultation were identified by multivariable logistic regression analysis. RESULTS: Among 1654 responders, 164 measles cases were identified. Consultation rate: 30%; notification rate: 30% (range among GPs: 0-62%); completeness of notification: 9%. Determinants of GP consultation: perceived seriousness of illness (adjusted OR 45; 95% CI: 6-347), self-reported complications (adjusted OR 9; 95% CI: 1-70), and need to consult for respiratory tract infections (adjusted OR 8; 95% CI: 1-51). CONCLUSION: Incidence estimations based on the notification by GPs to the MHS are suboptimal for measles in The Netherlands. Perceived seriousness of illness seemed to be the most important factor to consult.