Influence of physical fitness and activity behavior on retinal vessel diameters in primary schoolchildren.

Retinal vessel alterations have been shown to be associated with cardiovascular risk factors and physical inactivity as early as childhood. In this context, the analysis of physical activity in children has solely been based on questionnaire assessments. The study aimed to examine the association of physical fitness performance and self-reported physical activity with retinal vessel diameters in young children. Three hundred ninety-one primary schoolchildren [7.3 years (SD 0.4)] were examined in this cross-sectional study. The primary outcome was endurance performance measured with the 20-m shuttle run. The additional tests consisted of a 20-m sprint, jumping sidewards and balancing backwards. Retinal microcirculation was assessed using a static retinal vessel analyzer. Parents completed questionnaires about physical and sedentary activities. Endurance performance was associated with narrower retinal venular diameters [-0.9 (95%CI: -1.8; -0.1) measuring units (mu)/ unit shuttle run, P = 0.04] and a higher arteriolar to venular ratio [0.003 (-0.001; 0.006)/unit shuttle run, P = 0.06]. The sprint performance was associated with narrower retinal arterioles [4.7 (0.8; 8.6) mu/unit sprint, P = 0.02]. Indoor playing activity correlated with narrower retinal venules [-0.04 (-0.07; -0.01) mu/per unit, P = 0.02]. Our data suggest that objectively measured endurance performance relates with better retinal vessel health in early childhood.

[Life-threatening opioid overdose. Decoding the physician pin code of a patient-controlled anesthesia pump by patients]. / Lebensbedrohliche Opioidüberdosierung. Entschlüsselung des Arztboluscodes einer Schmerzpumpe durch Patienten.

Patient-controlled analgesia (PCA) is an established standard therapy for providing postoperative analgesia. To avoid possible abuse by patients each PCA pump is secured by a pin code that should be neither known nor accessible to patients. The two case reports described illustrate how manipulation of a PCA pump led to massive opioid abuse by the patients who decoded the pin code for unlimited additional doses. One patient developed withdrawal symptoms after switching the therapy and, as a consequence even had to be admitted to the intensive care unit (ICU). Easy access to the PCA pump codes on the internet for the patients and the impossibility of changing the pin codes by the medical staff played an important role in these two cases.

Asthma outpatient education by multiple implementation strategy. Outcome of a programme using a personal notebook.

More than 10 years after publication, international guidelines remain poorly implemented. To better implement them, we need to develop new strategies adapted to the expectations of patients and health professionals outside hospital settings and to ensure better outpatient follow up in the community. We developed a bilingual education programme including a brochure designed to support an interdisciplinary health care network and measured hospitalisations (H), work absenteeism (WA), emergency visits (EV), asthma medication (AM) and quality of life (QL Juniper) before and 12 months after the intervention. All QL scores improved significantly in comparison with pre-intervention values. Health service use decreased dramatically when comparing the 12 months prior to and after the intervention(H: 35-8%, WA: 39-14%, EV: 88-53%). The final cost/benefit ratio of the programme was 1.96. Interdisciplinary implementation strategy of patient education is cost-effective, improves quality of life for asthmatics, and reduces strain on health services. Such a health care network does not require an expensive infrastructure and is better adapted to the reality and competences of clinical practice.

Bronchial asthma and self-management education: implementation of Guidelines by an interdisciplinary programme in health network.

UNLABELLED: Asthma is a chronic disease generating very high costs even for Switzerland. Self-management education (SME) is effective and recommended as an integral part of management in the most recent guidelines on asthma treatment. Its aim is to reduce morbidity [hospitalisations (H), lost workdays (LW), emergency consultations (EC)] and improve quality of life (QOL) in these patients. METHOD: Integrated programme with educational platforms (two-language booklet), SME in 66 patients (30 m, 36 f) with interdisciplinary quality team (pneumologists, primary care physicians, pharmacists, specialised nursing staff), QOL questionnaire. Measurement of morbidity parameters 12 months before and after SME. Measurement of QOL before and 12 months after SME. RESULTS: Hospitalisations fell from 35 to 8%*, EC from 88 to 53%*. and LW from 39 to 14%* (*p <0.001). Overall, SME resulted in a health cost saving of CHF 202,510 in terms of LW and CHF 131,200 in terms of days in hospital, i.e. a total of CHF 333,710. Costs saved per patient were CHF 5,056 per year. QOL improved with the following scores: overall QOL 4.5 +/- 0.9 to 5.2 +/- 0.9*; activities 4.5 +/- 0.9 to 5.2 +/- 0.9*; symptoms 4.2 +/- 1.1 to 5.2 +/- 1.1*; emotions 4.9 +/- 1.1 to 5.6 +/- 1*; environment 4.5 +/- 1.4 to 4.9 +/- 1.3* (*p <0.001). CONCLUSION: SME by interdisciplinary health network is effective. It brings a steep fall in costs for asthma treatment by cutting back hospitalisations and lost workdays and by improving the asthmatics' quality of life. It should be recognised and better supported by the health system.

Brain mapping of bilateral visual interactions in children.

Interhemispheric interactions were studied with functional brain mapping of visual processing. Children performed a reaction time task with uni- and bilateral targets and nontargets. The visual evoked potential (VEP) was segmented into P1a, P1b, and N1 microstates using map rather than channel features. Map latencies, amplitudes and sources were tested for bilateral interactions. Bilateral targets yielded shorter VEP map latencies but later response onsets than unilateral ones. Source analyses of the unilateral VEPs indicated a transition from contra- (P1a) to ipsilateral (P1b) visual cortex activation (interhemispheric transfer). Bilateral VEPs were smaller than the summed unilateral VEPs in all microstates. indicating that interhemispheric interactions both precede and follow interhemispheric transfer. Brain mapping of uni- and bilateral VEPs in children thus revealed several distinct forms of interhemispheric interactions in the same, early time range.

Attentional and neuromotor deficits in ADHD.

In order to classify attention-deficit-hyperactivity disorder (ADHD) in 11-year-old children, the role of specific attentional and motor deficits was examined. Participants comprised 22 children with ADHD (19 male, 3 female; median age 11 years, range 8.8 to 13.5 years) and 20 control children (17 male, 3 female; median age 10.6 years, range 8.2 to 12.6 years). Neuromotor assessment indicated that while both groups needed more time to complete finger compared to hand movements, this increase was more pronounced in children with ADHD. Reaction-time testing with continuous-force recording identified both motor and attentional deficits in children with ADHD. Longer intervals between force onset and force peak, and higher rate of responses with multiple force peaks (particularly in the bilateral condition) revealed specific deficits in the speed and quality of their motor output. Increase in errors and variability of force onsets indicated attentional deficits. Prediction analysis indicated that force-onset variability contributed significantly to group classification which was 85.7% correct. Neither neuromotor assessment nor specific motor deficits contributed significantly to classification, indicating that pure motor-speed measures play a minor role in characterizing ADHD in this age range.

Brain mapping of bilateral interactions in attention deficit hyperactivity disorder and control boys.

OBJECTIVES: Children with attention deficit hyperactivity disorder (ADHD) are thought to have deficits in attentional control, whereas the status of deficits at visual and pre-motor processing stages is unclear. METHODS: The timing of such deficits was examined with event-related potential (ERP) microstates (stimulus- and response-related) and continuous force recordings in 15 ADHD and 16 control boys in a choice reaction time task. Unilateral and bilateral stimulus and response conditions were used to assess bilateral interactions at visual, central, and pre-motor stages. RESULTS: ADHD boys showed poorer performance, particularly in the bilateral conditions. In the visual P1 microstates, they exhibited less suppression of visual evoked potential (VEP) amplitudes but similar speeding of VEP latencies in the bilateral compared to the summed unilateral condition. The central P3 and pre-/post-response microstates were attenuated and topographically altered in ADHD boys. The attenuation was most pronounced in the bilateral condition and was similar for stimulus- and response-related averages. The lateralized readiness potential was also reduced in ADHD boys; this was most pronounced for the left hand responses. CONCLUSIONS: Brain mapping during uni- and bilateral stimulus and response conditions thus indicates multilevel deficits in ADHD boys affecting visuo-attentional, central, and pre-motor processes.

[Reducing radiation exposure in angiography]. / Reduzierung der Strahlenexposition in der Angiographie.

Interventional procedures in angiography result in an increased radiation exposure for the physician, medical personnel, and the patient longer fluoroscopic times and of images as compared with pure diagnostic examinations. Damages like epilation and erythema are potential effects. Measures are proposed in this paper to reduce the radiation exposure. There are technical means and possibilities in the application technique. Quality checks and remote diagnosis support these measures in addition by assuring a continuous image quality.

Frequency of bullous pemphigoid-like antibodies as detected by western immunoblot analysis in pruritic dermatoses.

BACKGROUND AND DESIGN: Ninety-seven patients suffering from a pruritic dermatosis were screened for the detection of bullous pemphigoid (BP) antibodies (ab) using the Western immunoblot (WB) analysis technique. RESULTS: Twenty-four patients (25%) reacted at least twice with the BP antigen on WB analysis at a 1/10 dilution: seven had typical BP, four had papular BP, 10 had pruritus and prurigo of unknown origin, two had eczema, and one had lichen planus. This corresponds to 13% of BP-type ab in patients who did not fulfill criteria for BP. Therefore, we did the following: (1) tested a control group of 24 subjects; (2) assessed the reproducibility of the WB method by retesting the same serum samples on different epidermal extracts; and (3) estimated the BP ab titer. None of the 24 control subjects had detectable BP ab, and reproducible results were obtained in all groups when serum samples were retested at the 1/10 dilution. Although 86% (6/7) of patients with BP had BP ab titers of 1/100 or greater, only 60% (6/10) of the group with pruritus and prurigo and 33% (1/3) of the group with eczema reached such titers. CONCLUSION: These results indicate that due to its sensitivity, the WB method can detect low titers of BP ab in patients with pruritic dermatoses who did not fulfill criteria for BP, and therefore we question the specificity of this method.

Bullous pemphigoid autoantibodies, HIV-1 infection and pruritic papular eruption.

Bullous pemphigoid (BP)-type autoantibodies were found by Western blot (WB) analysis of epidermal extracts in the serum of 38% of HIV-seropositive patients compared with 21% of HIV-seronegative patients with chronic pruritus and 76% of patients with BP. They were further identified as BP autoantibodies (BPab) by immunoprecipitation and immunoelectron microscopy. Their incidence increased from 21% in HIV infection stage II to 37% and 43% in stages III and IV, respectively. Of the patients suffering from HIV-related chronic pruritic papulovesicular eruption. 75% showed circulating BPab as compared with 29% in those without skin problems (P = 0.0066) and, among them, 30% met the diagnostic criteria for BP when histology, WB, immunofluorescence and immunoelectron microscopy techniques were used. In conclusion, this study identifies an autoimmune skin reaction that may account for, or be related to, the distressing pruritic eruptions occurring in HIV-infected patients.

[Technic and results of computed tomography of the base of the nose and orbit with multiplanar reconstructions]. / Technik und Ergebnis der Computertomographie der Rhinobasis und der Orbita mit multiplanaren Rekonstruktionen.

The additional use of a 3-D display programme provides valuable information in cases of trauma to the mid-face and tumours of the bony orbits. The computer programme provides important additional information for the radiologist and, in future, will influence treatment significantly.

[Problems of indication and execution of long-term steroid therapy in advanced disabling bronchial asthma]. / Schwierigkeiten der Indikationsstellung und Durchführung der Steroid-Langzeittherapie gegen das fortgeschrittene, invalidisierende Asthma bronchiale.

In the management of severe chronic asthma, extensive avoidance of known precipitating factors and optimum betastimulation supported by theophylline have pride of place. In combination with sodium cromoglycate they sufficiently relieve symptoms and lung function disturbances in most cases of adult extrinsic allergic asthma. The cases with chronic disabling intrinsic asthma need, in our experience, additional long-term use of corticosteroids. The intrinsic type (late onset, severe perennial course, aspirin intolerance, nasal polyps) is in many cases recognised only with difficulty. Detailed history-taking, reversibility of the lung function disturbances and eosinophilia in the sputum may in general differentiate it from chronic obstructive bronchitis and extrinsic asthma. The aim of the long-term use of steroids in asthma is to achieve the best effect with minimal risk. In this respect the following treatment schedule has proved its worth: daily administration of prednisone in a single morning dose, beginning with high doses of 40 to 50 mg with rapid reduction by 5 to 10 mg every 4 days to a dose of 15 mg, then gradual withdrawal in steps of 1 mg at longer and longer intervals with becotide support to achieve a daily maintenance dose of 2 to 6 mg prednisone or complete withdrawal. The response to the treatment under discussion is often excellent and the dangerous side effects are low. However, too rapid reduction of cortisone inhibits the success of this treatment plan. High doses of steroids over a long time (more than 10 mg prednisone daily), prescriptions in daily divided doses, depot administrations, self-medication, and repeated high pushes are the most common causes of the dangerous cortisone side effects and are therefore to be avoided.