Patients' representations of their end-stage renal disease: relation with mortality.

BACKGROUND: Self-regulation theory explains how patients' illness perceptions influence self-management behaviour (e.g. via adherence to treatment). Following these assumptions, we explored whether illness perceptions of ESRD-patients are related to mortality rates. METHODS: Illness perceptions of 182 patients participating in the NECOSAD-2 study in the period between December 2004 and June 2005 were assessed. Cox proportional hazard models were used to estimate whether subsequent all-cause mortality could be attributed to illness perception dimensions. RESULTS: One-third of the participants had died at the end of the follow-up. Mortality rates were higher among patients who believed that their treatment was less effective in controlling their disease (perceived treatment control; RR = 0.71, P = 0.028). This effect remained stable after adjusting for sociodemographic and clinical variables (RR = 0.65, P = 0.015). CONCLUSIONS: If we consider risk factors for mortality, we tend to rely on clinical parameters rather than on patients' representations of their illness. Nevertheless, results from the current exploration may suggest that addressing patients' personal beliefs regarding the effectiveness of treatment can provide a powerful tool for predicting and perhaps even enhancing survival.

[Renal crisis in scleroderma]. / Renale crisis bij sclerodermie.

A case is described of a 30-year-old woman with scleroderma renal crisis. She presented with classical symptoms: malignant hypertension of sudden onset and rapidly progressive renal failure. End-stage renal failure developed in spite of treatment with angiotensin converting enzyme inhibitors and the patient became dialysis-dependent. Five years later her condition was still stable. She lived in a nursing home, severely disabled but mentally healthy. A renal crisis is one of the most life threatening complications of scleroderma. By immediate treatment with ACE inhibitors, dependence on haemodialysis can be prevented in half the patients.

Transient intrasellar collection of air during bromocriptine treatment of a prolactinoma.

A patient is described with a large prolactinoma with expansion into the sphenoid sinus. During bromocriptine treatment an intrasellar area of gas developed, continuous with the air in the sinus. No operation was performed, bromocriptine was continued. During the regression of the tumor, the area of air disappeared.