Short-coupled variant of torsade de pointes.

A 36-year-old man with a history of primary sclerosing cholangitis and epilepsy was admitted to our hospital for cholangitis. During admission he was resuscitated because of ventricular fibrillation. ECGs showed multiple ventricular premature beats (VPBs) with a short coupling interval (240 ms), resulting in frequent torsade de pointes (TdP). In total, the patient had to be defibrillated 12 times. Short-coupled TdP is a rare variant of polymorphic ventricular tachycardia, with unknown aetiology. Verapamil seems to be the only drug able to suppress the arrhythmia. Verapamil, however, does not lower the risk of sudden death; therefore, an ICD implantation is advised. (Neth Heart J 2008;16:246-9.).

Operative and functional treatment of rupture of the lateral ligament of the ankle. A randomised, prospective trial.

Consecutive patients with a confirmed rupture of at least one of the lateral ligaments of the ankle were randomly assigned to receive either operative or functional treatment. They were evaluated at a median of 8 years (6 to 11). In total, 370 patients were included. Follow-up was available for 317 (86%). Fewer patients allocated to operative treatment reported residual pain compared with those who had been allocated to functional treatment (16% versus 25%, RR 0.64, CI 041 to 1.0). Fewer surgically-treated patients reported symptoms of giving way (20% versus 32%, RR 0.62, CI 0.42 to 0.92) and recurrent sprains (22% versus 34%, RR 0.66, CI 0.45 to 0.94). The anterior drawer test was less frequently positive in surgically-treated patients (30% versus 54%, RR 0.54, CI 0.41 to 0.72). The median Povacz score was significantly higher in the operative group (26 versus 22, p < 0.001). Compared with functional treatment, operative treatment gives a better long-term outcome in terms of residual pain, recurrent sprains and stability.

Comparison of intellectually disabled offenders with a combined history of sexual offenses and other offenses versus intellectually disabled offenders without a history of sexual offenses on dynamic client and environmental factors.

Sexually offensive behavior is prevalent among individuals with intellectual disabilities (ID) and many sex offenders also commit other offenses such as vandalism or assault. We examined the differences between sex offenders with ID and a history of combined sex and other types of offenses (mixed sex offenders) versus offenders with no history of sexual offenses (non-sex offenders). Dynamic client and environmental factors were measured using the Adult Behaviour Checklist (ABCL) and the Risk Inventarization Scale on Sexually Offensive Behavior of Clients with intellectual disabilities (RISC-V). Item, subscale, and total scores were then compared for the two groups. Most of the comparisons did not reveal significant differences between the two groups. The findings call for a general theory of offending behavior to explain the absence of differences between the mixed sex offenders and non-sex offenders with ID.

Sexual risk assessment for people with intellectual disabilities.

Given that sexually offensive behavior on the part of people with intellectual disabilities has been identified as a significant problem, we developed a risk assessment questionnaire, that takes not only various static and dynamic factors into account but also environmental risk variables. Psychologists and staff members completed this Risk Inventarization Scale on Sexually Offensive Behavior of Clients with Intellectual Disabilities for 56 intellectually disabled clients with sexually offensive behavior problems. The scale contains static client variables (rated using two- or five-point likert scales and open questions) and both dynamic client and environmental variables (rated using a five-point Likert scale). Factor analyses of the dynamic client and environmental variables revealed three subscales: quality of supervision, offending behavior and emotional and social stability. Reliability analyses showed sufficient to good reliability for both the total scale (r=0.82) and the identified subscales (quality of guidance r=0.94; offending behavior r=0.75, and emotional and social stability r=0.58). Correlational analyses of the quality of guidance subscale showed high positive correlations with such static variables as values and norms, living conditions, and criminal offenses in early youth. Because both dynamic and environmental variables can be altered, the implications for treatment of the sexually offensive behavior of clients with intellectual disabilities are discussed further.