Reversible migratory osteoporosis in renal oncocytoma mimicking renal cell carcinoma with bone metastases.

We report a case in which initially the wrong diagnosis of renal cell carcinoma with bone metastases was made. Nephrectomy and bone biopsy led to the right diagnosis of oncocytoma with transient osteoporosis. This report stresses the importance of pathological investigation and points to oncocytoma in the differential diagnosis of solid renal masses. In addition, the possible relationship between this tumour and migratory osteoporosis, which disappeared after surgery, is described.

Experience of severe fatigue long after stroke and its relation to depressive symptoms and disease characteristics.

Although the experience of abnormal fatigue is recognised as a major disabling symptom in many chronic neurological diseases, little is known about the persistence of severe fatigue after an abrupt neurological incident like a stroke. Therefore, the objectives of this study were to test whether the experience of severe fatigue persists long after a stroke has occurred, and to assess the relation between experienced fatigue and levels of physical impairment and depression. Ninety stroke outpatients and 50 controls returned mailed questionnaires. Compared to age-matched controls, a significantly larger proportion (16 vs. 51%) of the stroke respondents experienced severe fatigue, while 20% of the patients and 16% of the controls had elevated depression symptom scores. The time which had elapsed since the stroke occurred could not explain levels of fatigue. In the control group, the number of depressive symptoms explained most of the variance in levels of fatigue, while impairment of locomotion explained most of the variance in the stroke group.

Use of care by home-dwelling stroke patients during three years following hospital discharge.

Of 82 stroke survivors who had been discharged from hospital, 49 were still living at home after a three-year period. Thirty-three of these patients formed the population of the present study of the use of care at home. Sixty-one percent had received professional care and 88% had received family care. Although their overall functional status indicated only mild handicaps, after three years patients still reported a large number of disabilities and problems. The average weekly amount of family care was 37 h, and many family carers experienced a high burden of care and had emotional problems coping with the patients' disabilities. Concerning factors related to the use of care, in spite of the relatively small number of study patients, some interesting hypotheses can be advanced.

Adrenomyeloneuropathy: a rare cause of Addison's disease?

A 31-year-old male patient is reported who presented with neurological symptoms. He developed a urinary tract infection and an Addisonian crisis. This was due to adrenomyeloneuropathy, a form of X-linked adrenoleukodystrophy and characterized by accumulation of very-long-chain fatty acids in the adrenal cortex and nervous tissues.

[Patient characteristics with predictive significance for 'blocked bed' problems in the neurological department of a general hospital]. / Patiëntkenmerken met voorspellende betekenis voor 'verkeerde-bedproblematiek' op de neurologische afdeling van een algemeen ziekenhuis.

OBJECTIVE: To determine the extent and the prognostic patient characteristics of bed-blocking (hospital beds occupied by patients who no longer need specialist medical treatment) in the neurological ward of a general hospital. DESIGN: Prospective cohort study. SETTING: Maasland hospital Sittard-Geleen (location Sittard). METHOD: During one year each patient of the complete patient population of two neurological wards was registered relating to: main diagnosis, age, sex, living situation, lesion localisation (only for cerebrovascular accident (CVA) patients) and bed-blocking. The predictive patient characteristics for bed-blocking were determined by logistic regression analysis. RESULTS: 1088 patients were registered, of whom 21% with a CVA. In 10% of the registered patients bed-blocking occurred, 86% of these had the diagnosis of CVA. Of all CVA patients 40% became bed-blockers. Of all nursing days of CVA patients 20% were bed-blocking days. Among the CVA patients sex (female), age (> or = 70), and the localisation of the lesion were found to be significant risk factors for bed-blocking. The main patient characteristics predictive for bed-blocking were the diagnosis of CVA and age > or = 70 years. CONCLUSION: Neurological patients with an increased risk to end up in a blocked bed are mainly found among CVA patients. Since 20% of the nursing days of CVA patients were bed-blocking days, shortening of hospitalization time and improvement of home care is recommended.

Idiopathic spasmodic torticollis: a survey of the clinical syndromes and patients' experiences.

We evaluated the medical and psychosocial experiences of 59 patients with idiopathic spasmodic torticollis (ST) by means of a structured questionnaire. The results generally corresponded with those of other studies in the literature. Diagnosis is delayed in many patients, and ST negatively influences the patients' social lives. Because drug treatment and physiotherapy are only of sufficient value in a minority, most patients seek benefit from numerous other therapies, none of which has been shown to improve ST.

Ossification of the posterior longitudinal ligament.

Two non-Japanese patients with ossification of the cervical posterior longitudinal ligament were described. This abnormality is very common in Japan, but rare in non-Japanese people. The reason is unknown. Although the disease appears to be generally asymptomatic, it can cause a myelopathy. The clinical picture, the diagnostic important X-ray examinations and the histopathological findings are revealed. The similarity to the vascular pattern in the lumbar spine in cases of intermittent neurogenic claudication is noted.