Type and severity of septal deviation are not related with the degree of subjective nasal obstruction.

BACKGROUND: Septoplasty is a frequently performed operation by otolaryngologists to relieve nasal obstruction complaints. When objective measurements tools are not available, preoperative decision-making is based on careful clinical examination. Our aim was to evaluate the relationship between type and severity of septal deviation and patient-reported nasal obstruction. METHODOLOGY: 196 Patients of a general otolaryngology population were included. Patients indicated subjective nasal obstruction experienced during the past 1 month on a Visual Analog Scale (VAS). Patients underwent clinical examination to evaluate type and severity of septal deviation. We compared clinical examination findings with patients VAS. RESULTS: We did not find a statistical difference of VAS score between the different types and severities of septal deviation. In 33.9% of the cases without septal deviation, there was a corresponding VAS score of 0. In 26,8% of the cases with septal deviation, there was no complaint of nasal obstruction (VAS = 0). In 7,4% of the cases, there was moderate to severe nasal obstruction complaint (VAS over 4) though no septal deviation was found. CONCLUSIONS: These results demonstrate that patient-reported nasal obstruction varies greatly among patients with similar type of deviation and similar degree of deviation. Classification of septal deviation into type and severity cannot predict the degree of subjective nasal obstruction. Therefore, the decision to proceed to septoplasty has to be thoughtful, with as much as information, based on the combination of patients history, clinical examination, surgeons experience and cautious interpretation of objective measurement tools.

CT cisternography for presurgical evaluation of arachnoid cyst: case report.

A 62-year-old man complaining of vertigo and progressive hearing loss was diagnosed with an arachnoid cyst at the right cerebellopontine angle based on magnetic resonance imaging (MRI). In this case-report, we used computed tomography (CT) cisternography to determine whether the arachnoid cyst communicated with the cerebrospinal fluid (CSF) space. Differentiating between a noncommunicating and communicating arachnoid cyst is required for presurgical evaluation. CT cisternography is a less used but reliable radiological technique for determining the presence of communication, and could therefore be included in the diagnostic work-up of arachnoid cysts. The patient underwent surgery with fenestration of the arachnoid cyst; his vertigo improved and his hearing was preserved.

[Cinnamon: not suitable for the treatment of diabetes mellitus]. / Kaneel: niet geschikt als behandeling voor diabetes mellitus.

OBJECTIVE: To identify published studies evaluating the effects of cinnamon on glycaemic control. DESIGN: Literature search. METHOD: The Medline database was searched using all possible combinations of the words and medical subject headings (MeSH) 'cinnamon', 'diabetes mellitus', 'HbA1C' and 'glucose'. All human or animal studies in which cinnamon was administered as intervention were included. RESULTS: Several animal studies and 5 randomized placebo-controlled trials in humans were found. Most of the animal studies described beneficial effects of cinnamon on glycaemic control. One placebo-controlled trial in patients with type 2 diabetes found that cinnamon intake was associated with favourable effects on fasting plasma glucose. None of the studies reported an improvement in HbA1C. A study in patients with type 1 diabetes found that cinnamon had no effect. CONCLUSION: Based on the currently available evidence, cinnamon should not be recommended for the improvement ofglycaemic control.

[Summary of the practice guideline 'TIA' (first revision) from the Dutch College of General Practitioners]. / Samenvatting van de standaard 'TIA' (eerste herziening) van het Nederlands Huisartsen Genootschap.

The new practice guideline of the Dutch College of General Practitioners on the management of patients with a TIA resembles the first version, but there are some important changes: The concept TIA has been narrowed to a neurological deficit that has resolved spontaneously by the time the patient consults the doctor. The indications for referral of patients with a TIA in the area supplied by the carotid artery for investigation of a possible carotid stenosis and carotid surgery have been broadened. Auscultation of the internal carotid artery is no longer necessary. The daily amount of acetylsalicylic acid to be taken by a patient with a TIA has been increased from 30 mg to 80 mg. The prescription of dipyridamol following a TIA remains controversial.

[The prevalence of late complications of type II diabetes mellitus]. / De prevalentie van late complicaties bij diabetes mellitus type II.

Prevalence of late complications determined in a representative group of 137 patients with type II diabetes mellitus and a control group of 128 persons without diabetes from the same population. Retinopathy was not rare in type II diabetes mellitus (prevalence 35%), but only 50% of diabetic patients had proper ophthalmological care. Microalbuminuria was found in 42% of the patients with diabetes mellitus, although serious renal dysfunction was seldom found. The ratio of serious diabetic foot problems was 5%. Neuropathy and macrovascular problems occurred more frequently in the diabetic group, but above 70 years of age there was a remarkable reduction in difference between diabetics and non-diabetics with regard to these complications. In microalbuminuria the same tendency was observed. The cause of this reduction in difference at an older age is discussed.

[Is fundus photography useful in screening for diabetic retinopathy in patients with type II diabetes mellitus?]. / Is fundusfotografie zinvol bij de screening op diabetische retinopathie bij patiënten met diabetes mellitus type II?

OBJECTIVE: To determine the value of a screening programme with fundus photography for diabetic retinopathy in diabetes mellitus type II patients. DESIGN: Prospective. SETTING: General practices in the region Zwolle, The Netherlands. METHOD: 650 Patients from 50 general practices were photographed after dilating both eyes. Of these 215 were examined by an ophthalmologist. Data of patients who did not join the study were analysed in 13 general practices. Any symptom of retinopathy and/or photographs of poor quality implied referral to an ophthalmologist. RESULTS: Of a total of 1300 photographs 208 (16%) could hardly or not at all be assessed. The agreement in the group of 215 patients between photography and ophthalmoscopy was statistically significant at classification level (Cohen's kappa 0.41). The advice given to patients after photography did not differ from that after ophthalmoscopy (kappa: 0.50); photography did not miss any high-risk characteristics, it yielded more warnings, and underestimated the level of retinopathy in 8 out of 215 cases. With current ophthalmologic rates in the Netherlands fundus photography was not financially advantageous as 71 (33%) out of 215 patients needed to be referred to an ophthalmologist. However, in the other 144 (67%) patients photography sufficed. This may offer a solution where ophthalmic care is in short supply. Of 168/420 patients who did not apply for photography 116 (69%) were either under ophthalmic supervision already or too disabled to be screened. CONCLUSION: The use of a fundus camera is equivalent to funduscopy by an ophthalmologist in screening for retinopathy of type II diabetic patients. There are no financial benefits, but it reduces the work load of ophthalmologists.

[Regulation of diabetes and late complications in the ambulatory treatment of patients with Type II diabetes mellitus]. / Diabetesregulatie en late complicaties bij poliklinisch behandelde patiënten met diabetes mellitus type II.

In order to obtain more information on the quality of metabolic control and presence of secondary complications in type 2 diabetic patients treated in a hospital outpatient-clinic, we studied 124 of our diabetic patients (56 males, 68 females, age 65 (SD 11) years, duration of diabetes 9, range 1-32 years). HbA1c levels were 7.9% in patients on oral hypoglycaemic agents (n = 56), and 8.2% in insulin-treated patients (n = 59). Cholesterol and triglyceride levels tended to be lower in the insulin-treated patients. The prevalence of vascular abnormalities was high: in comparison with a population of general practice patients more patients had hypertension (56% vs 38%), coronary artery disease (48% vs 40%), and cerebrovascular disease (15% vs 6%). In addition, 35% of our diabetics had signs of peripheral artery disease. Retinopathy was present in 35 patients, microalbuminuria was found in 31 patients, proteinuria in 18 patients. The presence of microalbuminuria and proteinuria was a strong indicator for cardiovascular disease, polyneuropathy and retinopathy. The use of cardiovascular medication was high: 57 patients used antihypertensive therapy, 37 used diuretics, and 26 long-acting nitrates. Only 25 patients took no medication apart from to their diabetes therapy.

[Recommendations concerning the initial regimen and dose adjustments of insulin therapy for type 2 diabetes mellitus]. / Aanbevelingen voor het instellen en aanpassen van insulinetherapie bij diabetes mellitus type 2.

Although physicians are confronted with an increasing number of insulin-treated patients with type 2 diabetes mellitus, guidelines for the initial insulin regimen and dose adjustment are rare. If the fasting blood glucose level is > 10 mmol/l and the postprandial values are not much higher than the fasting ones, then the patient can be started on 8-12 IU of an intermediate-acting insulin before going to sleep. In the case of blood glucose levels which increase during the day or if a single insulin dose has insufficient effect, the patient can be started on a twice-daily administration of a premixed insulin. If more than 40 IU of insulin per injection are needed to regulate the blood glucose levels, it might be necessary to switch to administering insulin 4 times per day. Of this total daily quantity, initially 20% is administered as (ultra)short-acting insulin before the three daily meals and 40% as a bedtime intermediate-acting insulin. Occasionally elevated blood glucose levels do not necessarily have to be a reason for adjusting the insulin dosage.

The use of portable equipment for the activity concentration index determination of building materials: method validation and survey of building materials on the Belgian market.

The Euratom BSS requires that in the near future (2015) the building materials for application in dwellings or buildings such as offices or workshops are screened for NORM nuclides. The screening tool is the activity concentration index (ACI). Therefore it is expected that a large number of building materials will be screened for NORM and thus require ACI determination. Nowadays, the proposed standard for determination of building material ACI is a laboratory analyses technique with high purity germanium spectrometry and 21 days equilibrium delay. In this paper, the B-NORM method for determination of building material ACI is assessed as a faster method that can be performed on-site, alternative to the aforementioned standard method. The B-NORM method utilizes a LaBr3(Ce) scintillation probe to obtain the spectral data. Commercially available software was applied to comprehensively take into account the factors determining the counting efficiency. The ACI was determined by interpreting the gamma spectrum from (226)Ra and its progeny; (232)Th progeny and (40)K. In order to assess the accuracy of the B-NORM method, a large selection of samples was analyzed by a certified laboratory and the results were compared with the B-NORM results. The results obtained with the B-NORM method were in good correlation with the results obtained by the certified laboratory, indicating that the B-NORM method is an appropriate screening method to assess building material ACI. The B-NORM method was applied to analyze more than 120 building materials on the Belgian market. No building materials that exceed the proposed reference level of 1 mSv/year were encountered.

Impact of late complications in type 2 diabetes in a Dutch population.

The prevalence of late complications was determined in four general practices in a representative group of 137 patients with Type 2 diabetes and a control group of 128 non-diabetic individuals. Retinopathy was found in 35% of all diabetic patients, with the same prevalence below and above the age of 70 years. Microalbuminuria was found in 42% of diabetic patients and in 22% of the control group (p less than 0.001). Above 70 years of age microalbuminuria was found with increasing frequency in the control group and was not significantly higher in the diabetes group. Serum creatinine was the same in the diabetic patients and the control group. Peripheral neuropathy was found frequently in the diabetes group, but was not uncommon in the control group (abnormal temperature sensation 63 vs 49% (p less than 0.05), abnormal vibration perception 53 vs 33% (p less than 0.001), absent tendon reflex 62 vs 21% (p less than 0.001]. Above age 70 years there was again a reduction in the difference in prevalence of neuropathy between the diabetes and control groups. Ischaemic heart disease was found more frequently in the diabetes group, but only below 70 years of age (32% of diabetic patients and 14% of the control group with ischaemic changes on ECG (p less than 0.01]. Above that age 46% of the diabetes group and 45% of the control group had ECG signs of ischaemic heart disease.