[How to defend yourself against a complaint?] / Verweer tegen een klacht bij de tuchtrechter.

A complaint to the disciplinary court is usually a major event for a doctor. However, that complaint will not disappear by itself. There will have to be a defence. That has to be done right. This article is about that.

[Parents with cancer and their minor children--a nationwide survey of outpatient psychosocial cancer counselling service regarding needs and its utilisation]. / Krebskranke Eltern und ihre minderjährigen Kinder--eine bundesweite Befragung ambulanter psychosozialer Krebsberatungsstellen zu Bedarf und Inanspruchnahme.

OBJECTIVES: Children of cancer patients have an increased risk for developing emotional problems. While psychosocial cancer counselling services are available all over the country, it is unclear if parents seek for help and if specific approaches for families are offered. METHODS: A survey was made of outpatient cancer counselling services in Germany (n=228). The response rate was 56%. Descriptive and content analyses of the data have been used. RESULTS: Providers estimate that 55% of their patients are between 18 and 55 years with 18% of them having minor children. However, only 53% do regularly ask their patients if they have minor children. Family- or child-settings are not provided regularly. Over 60% of providers would welcome special courses on this subject. CONCLUSION: Although psychosocial care of minor children is mentioned in outpatient psychosocial cancer counselling guidelines, children are not included regularly. A stronger emphasis on this topic in further education has to be made.

Pelvic lymphangioleiomyomatosis. Atypical precursor to pulmonary disease.

A 22-year-old woman presented with left pelvic pain and mass. Ultrasonography confirmed a multilocular left adnexal mass containing cysts of varying sizes. The patient had no pulmonary symptoms at the time of presentation. The mass was surgically excised and pathologic diagnosis of lymphangioleiomyomatosis (LAM) was made. Subsequently, she developed hemoptysis and pleural effusion. High-resolution computed tomography of the chest showed findings consistent with LAM. Early diagnosis and treatment for LAM was possible in this atypical case.

Effect of a physical conditioning program upon left ventricular ejection fractions determined serially by a noninvasive technique.

6 clinically normal subjects underwent a 3-month physical conditioning program with the ejection fractions determined before and after physical conditioning using a scintillation probe. All subjects achieved a conditioning effect as evidenced by increased treadmill test duration after conditioning (mean duration before conditioning: 658 vs. 715 sec after conditioning; p less than 0.02). All 6 subjects increased resting ejection fractions after conditioning (mean ejection fraction before conditioning: 54.5 +/- 5.4%; mean ejection fraction after conditioning: 67.0 +/- 9.0%; p less than 0.01). Thus, an aerobic physical conditioning program appears to increase resting ejection fractions in normal subjects.

Decreased frequency of exercise-induced ventricular ectopic activity in the second of two consecutive treadmill tests.

Two exercise tests were performed with an intervening rest period of 45 minutes in a group of 13 subjects with previously identified exercise-induced ventricular arrhythmias and no resting arrhythmias. Both normal subjects and patients with heart disease were included in the group. The level of stresss was equal in both tests as judged by similar rate-pressure products at peak exercise. There was a significant decrease (P less than 0.05) in the number of VPCs induced by exercise during and after the second test. When the number of VPCs on test I and test II in the same patients were compared, a regression line fitted the data well (r = 0.92). Analysis of the recovery periods revealed significant (P less than 0.01) decreases in systolic blood pressure at one and three minutes post exercise, comparing the second to the first test. The underlying mechanism may be decreased myocardial oxygen demand during the second test as the lowered rate-pressure products during recovery (P less than 0.01) reflect. The results of this study indicate that tests of effectiveness of an antiarrhythmic drug should not be based solely on a decrease in the amount of severity of ventricular irritability between two successive exercise tests, one immediately before and the other following administration of the drug.