Hair cortisol concentrations in different breeds of cows: Comparison of hair from unshorn and previously shorn areas and from various regions of the body.

INTRODUCTION: The goals of this study were to investigate hair cortisol concentration (HCC) in seven different breeds of cows, to establish reference intervals for HCC in Brown Swiss cows and to compare cortisol concentrations of hair collected from four different areas of the body. Three groups of cows were used. Group 1 comprised 70 healthy cows representing four dairy breeds (Brown Swiss, Swiss Fleckvieh, Holstein Friesian, Water Buffalo) and three beef breeds (Raetian Grey, Limousin, Highland). Group 2 consisted of 60 healthy Brown Swiss cows in which two different hair samples were collected from the thoracic region to establish reference intervals; A samples consisted of hair that had grown for one month in a pre-clipped area, and B samples consisted of hair from a previously unshorn area. Group 3 comprised 21 healthy Brown Swiss cows, in which HCCs were measured in A and B samples from four different body regions (neck, shoulder, thorax, rump). Liquid chromatography tandem mass-spectrometry was used for cortisol measurement. In group 1, the highest HCCs were measured in Holstein Friesian cows at 1,75 pg/mg, which was significantly higher than those of the Brown Swiss, the Swiss Fleckvieh and the Water Buffalo cows. Hair cortisol concentration and daily milk yield of the 40 dairy cows were highly correlated (r = 0,57, P < 0,01). In group 2, the HCCs of 77 % of the A samples and 85 % of the B samp-les were below the laboratory's limit of quantification (LOQ) of 0,50 pg/mg and the results were expressed semiquantitatively as.

INTRODUCTION: Les objectifs de cette étude étaient d'étudier la concentration de cortisol dans les poils (hair cortisol concentration (HCC)) chez sept races de vaches différentes, d'établir des intervalles de référence pour le HCC chez les vaches de race Suisse Brune et de comparer les concentrations de cortisol dans les poils prélevés sur quatre zones différentes du corps. Trois groupes de vaches ont été utilisés. Le groupe 1 comprenait 70 vaches saines représentant quatre races laitières (Brown Swiss, Swiss Fleckvieh, Holstein Friesian, Buffle d'eau) et trois races à viande (Grise rhétique, Limousin, Highland). Le groupe 2 était composé de 60 vaches Brown Swiss en bonne santé, pour lesquelles deux échantillons de poils différents ont été prélevés dans la région thoracique afin d'établir des intervalles de référence ; les échantillons A étaient constitués de poils ayant poussé pendant un mois sur une zone précédemment tondue et les échantillons B étaient constitués de poils provenant d'une zone non tondue auparavant. Le groupe 3 comprenait 21 vaches suisses brunes en bonne santé, chez lesquelles les HCC ont été mesurés dans des échantillons A et B provenant de quatre régions corporelles différentes (cou, épaule, thorax, croupe). La chromatographie liquide en tandem avec spectrométrie de masse a été utilisée pour la mesure du cortisol. Dans le groupe 1, les HCC les plus élevés ont été mesurés chez les vaches Holstein Friesian à 1,75 pg/mg, ce qui était significativement plus élevé que ceux des vaches Brown Swiss, Swiss Fleckvieh et Buffle d'eau. La concentration de cortisol dans les poils et le rendement laitier quotidien des 40 vaches laitières étaient fortement corrélés (r = 0,57, P < 0,01). Dans le groupe 2, les HCC étaient inférieures à la limite de quantification (LOQ) de 0,50 pg/mg dans 77 % des échantillons A et 85 % des échantillons B et ils ont été indiquées de manière semi-quantitative comme < LOQ. Dans les échantillons restants, les HCC se situaient entre 0,50 et 1,20 pg/mg. Les valeurs des échantillons A et B n'étaient pas significativement différentes. Dans le groupe 3, les valeurs médianes des HCC des échantillons mesurables pour les 4 localisations se situaient entre 0,50 et 1,00 pg/mg de poils. Les HCC ne différaient pas significativement entre les différentes localisations corporelles ni entre les échantillons A et B. Les analyses permettent de supposer que les vaches Holstein-Friesian présentent des HCC significativement plus élevées que les vaches Brown Swiss, Swiss Fleckvieh et les bufflonnes d'eau et que cela est dû au moins en partie à leur production laitière élevée.

Visual impairment in children with a brain tumor: a prospective nationwide multicenter study using standard visual testing and optical coherence tomography (CCISS study).

BACKGROUND: Children with a brain tumor have a high risk of impaired vision. Up to now, visual acuity measurement, visual field testing and orthoptic testing are the most informative diagnostic investigations for the assessment of visual function. Evaluating vision in children can be challenging given the challenges in cooperation, concentration and age-dependent shifts in visual tests. Since visual loss due to a brain tumor can be progressive and irreversible, we must aim to detect visual impairment as early as possible. Several studies have shown that optical coherence tomography facilitates discovery of nerve fiber damage caused by optic nerve glioma. Consequently, early detection of potential ocular damage will effect treatment decisions and will provide timely referral to visual rehabilitation centers. METHODS/DESIGN: The CCISS study is a prospective, observational, multicenter cohort study in The Netherlands. Patients aged 0-18 years with a newly diagnosed brain tumor are invited for inclusion in this study. Follow-up visits are planned at 6, 12, 18 and 24 months. Primary endpoints are visual acuity, visual field and optical coherence tomography parameters (retinal nerve fiber layer thickness and ganglion cell layer - inner plexiform layer thickness). Secondary endpoints include the course of visual function (measured by visual acuity, visual field and optical coherence tomography at different follow-up visits), course of the disease and types of treatment. DISCUSSION: The CCISS study will heighten the awareness of visual impairment in different types of brain tumors in children. This study will show whether optical coherence tomography leads to earlier detection of visual impairment compared to standard ophthalmological testing (i.e. visual acuity, visual field testing) in children with a brain tumor. Furthermore, the systematic approach of ophthalmological follow-up in this study will give us insight in the longitudinal relation between the course of visual function, course of the disease and types of treatment in children with a brain tumor. TRIAL REGISTRATION: The CCISS study is prospectively registered in the Netherlands Trial Register (NTR) since April 2019. Identifier: NL7697.

Morpho-anatomical and molecular characterization of the mycorrhizas of European Polygala species.

The mycorrhizas of 12 species of Polygala (Polygalaceae), including herbs, subshrubs and one shrub, collected from Germany, Mallorca (Spain) and Malta, were investigated by morpho-anatomical and molecular methods. Aseptate hyphae, arbuscules and vesicles indicate an arbuscular mycorrhiza in all species examined. Hyphal spread in Polygala is predominantly, but not exclusively, intracellular and comprises three characteristic stages of colonization: (i) intracellular, linear hyphal growth in a cascading manner after penetration towards the penultimate parenchyma layer (layer 2), (ii) initially linear hyphal growth in the cells of layer 2 from where hyphal branches repeatedly penetrate the anatomically distinct innermost parenchyma layer (layer 1), forming arbuscule-like structures therein which are subject to degeneration, (iii) more branches from the linear hyphae in layer 2 develop, but coil and make contact to the layer outside layer 2 (layer 3) in which arbuscule-like structures similar to those in layer 1 form and degenerate. This general colonization pattern differs in details between the species, and critical comparisons, in particular between the woody P. myrtifolia, the herbaceous Polygala spp. and the mycoheterotrophic Epirixanthes spp. (Polygalaceae) suggest an evolutionary shift of mycorrhizal features within the family towards an optimization of plant benefit through the fungus. Based on the molecular marker 18S rDNA mycorrhizal fungi detected in roots of Polygala spp. are largely restricted to five clades of Glomeraceae 1 (Glomus Group A). This result rejects the hypothesis of a strict symbiotic specificity in Polygalaceae but may stimulate a discussion on functionally compatible groups of fungi.

Reproductive behavior of individuals with increased risk of having a child with retinoblastoma.

To investigate reproductive behavior of individuals at increased risk of having a child with retinoblastoma (Rb), we conducted a cross-sectional questionnaire survey among 118 counselees visiting the Clinical Genetics Department of the National Rb Center in the Netherlands. The recurrence risk for counselees ranged from <1% to 50%. The response rate was 69%. Of 43 respondents considering having children after becoming aware of their increased risk, Rb influenced reproductive behavior for 25 (58%), of whom 14 had a recurrence risk <3%. Twenty of these 25 decided against having more children and 5 used prenatal diagnosis. Eighteen of the 43 respondents did not use any of the alternative reproductive options and had children (or more children), although half indicated having had doubts about their decisions. Multiple logistic regression showed that only perceived risk (p = 0.003) was significantly associated with Rb influencing reproductive behavior. Of 17 respondents planning children (or more children), 11 (65%) considered using one of the alternative reproductive options. We conclude that reproductive behavior is greatly influenced by Rb and that perceived risk, not objective risk, is the most important factor of influence. It is important to offer individuals at increased risk continued access to genetic counseling, even when this risk is small.

Single-shot turbo spin-echo diffusion-weighted imaging for retinoblastoma: initial experience.

BACKGROUND AND PURPOSE: Retinoblastoma may exhibit variable hyperintensities on DWI, resulting in different values in the ADC maps, depending on their histology and cellularity. However, EP-based DWI has susceptibility artifacts and image distortions, which make DWI of the orbit a challenging technique. The aim of this study was to investigate the feasibility of single-shot turbo spin-echo (HASTE) DWI in the evaluation of children with retinoblastoma and to assess the value of ADC maps in differentiating viable and necrotic tumor tissue. MATERIALS AND METHODS: Two radiologists assessed conventional MR images, DWI, and ADC maps of 17 patients with retinoblastoma (n = 17 eyes). Non-EP DWI was performed by using a HASTE sequence with b-values of 0 and 1000 s/mm(2). ADC values were measured for enhancing and nonenhancing tumor tissue. ADC maps were compared with histopathologic findings regarding tumor differentiation and viability. RESULTS: On DWI, vital tumor tissue showed hyperintensity with negligible intensity of surrounding vitreous. The difference in mean (range) ADC values between enhancing (1.03 [0.72-1.22] × 10(-3) mm(2) s(-1)) and nonenhancing (1.47 [0.99-1.80] × 10(-3) mm(2) s(-1)) parts of retinoblastoma was statistically significant (P < .0005). Nonenhancing tumor parts showed a significantly lower ADC compared with vitreous (2.67 [2.24-3.20]×10(-3) mm(2) s(-1)) (P < .0005) and subretinal fluid (2.20 [1.76-2.96] × 10(-3) mm(2) s(-1)) (P < .0005). Histopathologically, low ADC values (enhancing tumor part) correlated to viable tumor tissue, whereas intermediate ADC values (nonenhancing tumor parts) correlated to necrotic tumor tissue. CONCLUSIONS: HASTE DWI allowed adequate characterization of retinoblastoma, and ADC is a helpful tool to differentiate viable and necrotic tumor tissue and might be valuable in monitoring the response to eye-preserving therapies.

Reproductive decision-making: a qualitative study among couples at increased risk of having a child with retinoblastoma.

Little is known about the reproductive decision-making process of couples with an increased risk of having a child with retinoblastoma (Rb). A qualitative study was conducted to explore the impact of prospective risk on reproductive decisions, factors influencing these decisions, and the needs of couples with regard to reproductive counselling. Fourteen couples of childbearing age who received genetic counselling between 2002 and 2006 participated in semi-structured interviews in 2008. The risk of having a child with Rb ranged from less than 1% to 50%. In most cases, the diagnosis of Rb influenced subsequent family planning. Prenatal diagnosis was used by two couples, while others refrained from having more children. Reproductive decisions were influenced by the burden of the disease for the patient and family members, the impact of ophthalmological screening under anaesthesia, and couples' perceived risk, which did not always relate to their actual risk. Reproductive choices with regard to the number of children wanted changed over time. Our findings indicate topics to be discussed during genetic counselling of couples at increased risk for a child with Rb. We suggest continued access to genetic counselling also after the initial diagnosis and treatment.

Risk of third malignancies and death after a second malignancy in retinoblastoma survivors.

Retinoblastoma patients have a strongly increased risk of second malignancies, and survivors with a third or subsequent malignancy are increasingly observed. However, it has not been examined whether survivors who developed a second malignancy have a greater risk of a subsequent malignancy. On the basis of the Dutch retinoblastoma registry, the risk of a third malignancy was compared with cancer risk in the Dutch population. Cox model analysis with a time-dependent covariate was used to compare the subsequent malignancy risk and survival among patients with and without a second malignancy. Risk of a third malignancy was increased 8-fold compared with the general population. The hazard ratio (HR) of a third malignancy after a second malignancy was more than 7-fold increased compared to the risk of a second malignancy after retinoblastoma. Radiotherapy increased the risk 3-fold. A third malignancy was associated with worse survival compared with survival of patients only diagnosed with a second malignancy (HR=5.0). Survivors of retinoblastoma who already developed a second primary malignancy have an even higher risk of subsequent primary malignancies than retinoblastoma survivors without a second malignancy. Treating physicians and patients should be aware of this higher risk.

Brain abnormalities on MR imaging in patients with retinoblastoma.

BACKGROUND AND PURPOSE: Although pineoblastoma is the main brain abnormality associated with hereditary retinoblastoma, recent studies suggest an association with pineal cysts. This association is important because some pineoblastomas mimic pineal cysts. If there is a relationship, then radiologists should be aware of it because diagnostic confusion is possible. Mental retardation and congenital brain anomalies are also reported in patients with retinoblastoma, mostly in combination with 13q deletion syndrome. In this retrospective study, the presence of brain abnormalities on MR images in a large group of consecutive patients with retinoblastoma is evaluated. MATERIALS AND METHODS: Brain MR images of 168 patients with retinoblastoma from 1989 to 2009 were evaluated by 2 radiologists for tumors, structural anomalies, myelinization, and coincidental findings. Clinical records were reviewed for laterality, heredity, and the presence of the 13q deletion syndrome. RESULTS: The hereditary group (patients with bilateral and unilateral proved RB1-germline mutation) included 90 (54%) of 168 patients. Seven patients had 13q deletion syndrome. Normal findings on brain MR images were seen in 150 (89%) patients. Five pineoblastomas were detected, all in patients with hereditary retinoblastoma (5.5% in the hereditary subgroup). Nine pineal cysts were detected (2.2% in the hereditary subgroup). Corpus callosum agenesis was found in 1 patient and a Dandy-Walker variant in 1 patient, both in combination with 13q deletion syndrome. CONCLUSIONS: Pineoblastoma is associated with hereditary retinoblastoma, and structural brain abnormalities are restricted to patients with the 13q deletion syndrome. The incidence of pineal cysts in patients with retinoblastomas is similar to that in healthy children and is not associated with hereditary retinoblastoma.

Contrast-enhancement of the anterior eye segment in patients with retinoblastoma: correlation between clinical, MR imaging, and histopathologic findings.

BACKGROUND AND PURPOSE: AES contrast-enhancement is recognized in a substantial number of retinoblastoma-affected eyes. We retrospectively investigated the histopathologic basis of AES contrast-enhancement on MR images in retinoblastoma. MATERIALS AND METHODS: Pretreatment contrast-enhanced MR images were obtained from 42 children with retinoblastoma. Forty-two enucleated eyes were included in this study, AES enhancement was evaluated by using a 3-point score, and these data were correlated with clinical, MR imaging, and histopathologic findings. Additionally, 14 specimens were immunohistochemically analyzed for CD31, VEGF, and Flt-1 expression. Statistical correlations with AES enhancement were assessed by using a linear-by-linear association test and univariate and multivariate ordinal regressions. RESULTS: The degree of abnormal AES enhancement was moderate in 15 (36%) eyes and strong in 14 (33%) eyes, whereas 13 (31%) eyes showed normal AES enhancement. In multivariate analysis, the degree of AES enhancement showed statistically significant correlations with iris surface-vessel count (P = .05) and optic nerve invasion (P = .04) in the enucleated eye and with tumor volume (P = .02) as detected on MR imaging. No significant associations between AES enhancement and VEGF expression in the iris were observed. Flt-1 (P = .04) staining in iris stroma and IA as detected with CD31 staining (P = .009) both yielded a statistically significant positive correlation with abnormal AES enhancement. CONCLUSIONS: The degree of abnormal AES enhancement on MR imaging in retinoblastoma reflects angiogenesis in the iris. AES enhancement is also a hallmark of advanced retinoblastoma because its degree correlates with tumor volume and optic nerve invasion.

Incidence of retinoblastoma in Dutch children conceived by IVF: an expanded study.

BACKGROUND: In 2003, we reported an increased risk of retinoblastoma in children conceived by IVF between 1995 and 2002. However, population-based studies among children conceived by IVF did not find an elevated risk of retinoblastoma. METHODS: From nationwide estimates of numbers of live births conceived by IVF (n = 40 330), we estimated the expected numbers of patients with retinoblastoma conceived by IVF in the period 1995-2007. The observed number of retinoblastoma diagnoses in children conceived by IVF was obtained by questionnaires sent to the parents of children with retinoblastoma diagnosed between 1995 and 2005. For non-responders and patients diagnosed after 2005, information was available through the medical files, in which information on fertility treatment has been routinely recorded since 2000. The relative risk (RR) of retinoblastoma among children conceived by IVF was calculated for the total study period (1995-2007) and for the expanded study period (2002-2007). RESULTS: Of all eligible patients with retinoblastoma (n = 162) diagnosed in the period 1995-2007, seven were conceived by IVF. In the total study period (1995-2007) the risk was significantly elevated [RR = 2.54, 95% confidence interval (CI) = 1.02-5.23]. In the expanded study period (2002-2007), no significantly elevated risk (RR = 1.29, 95% CI = 0.16-4.66) was found. CONCLUSIONS: We found a significantly increased risk of retinoblastoma in children conceived by IVF in the total study period 1995-2007. However, this increased risk was mostly based on the much stronger risk increase observed previously, for 1995-2002. Caution and awareness on the one hand and avoiding unnecessary worries on the other hand are important at this stage of our knowledge.

Cancer mortality in long-term survivors of retinoblastoma.

This study examined long-term cause-specific mortality among 998 Dutch retinoblastoma survivors, diagnosed from 1862 to 2005, according to follow-up time, treatment and heredity. After a median follow-up of 30.8 years, only cause-specific mortality for second malignancies among hereditary retinoblastoma survivors was statistically significantly increased with 12.8-fold. Risk of death from second malignancies among non-hereditary survivors was not increased. Mortality rates of second malignancy among hereditary patients were non-significantly elevated with 1.6-fold for treated with radiotherapy, compared to those treated otherwise. Standardised mortality ratios (SMRs) for second malignancy among hereditary patients increased during the first three decades after retinoblastoma diagnosis. Whereas these risks decreased after three decades, the absolute excess risk (AER) increased significantly, up to 23.2 excess cases per 1000 patients/year after five decades of follow-up. Fifty years after retinoblastoma diagnosis the cumulative mortality from any second malignancy was 17.3% for hereditary patients. Very long-term follow-up of retinoblastoma patients revealed an emerging excess risk of mortality in hereditary retinoblastoma survivors. This implies that lifelong follow-up is needed, whereas at the same time, patients and their physicians must be alerted to the increased second malignancy risks.

Coping strategies of retinoblastoma survivors in relation to behavioural problems.

OBJECTIVE: To assess coping strategies of long-term retinoblastoma (RB) survivors and explore determinants of behavioural functioning, including medical, socio-demographic and coping variables. METHODS: This population-based cross-sectional study included 117 RB survivors (12-35 years), registered in the Dutch national RB register. Survivors were asked to fill in coping, social support and behavioural questionnaires, and situational characteristics were obtained from medical archives and from an interview. Prevalence rates of coping strategies were computed based on self-reports. One-sample t-tests were applied to analyse differences in the use of coping strategies compared with healthy reference samples. Multiple regression analyses were performed to identify various determinants for behavioural problems within the RB sample. RESULTS: RB survivors differed from their healthy reference group in one coping style, i.e. they showed significantly less emotion-oriented coping behaviour. Adolescents who came from a single-parent family and/or experienced lower social support and used more emotion-oriented coping reported more total problem behaviour. More internalizing problems were reported for adolescents who experienced less social support and less acceptance of the disease. For adults, more life events, emotion-oriented coping and lower social support explained more total problem behaviour, especially internalizing problems. CONCLUSION: RB survivors showed less emotion-oriented coping behaviour compared with the reference group. Behavioural problems are best determined by emotion-oriented coping, social support, life events other than RB and acceptance of the disease, and not by medical variables. Therefore, these variables should be taken into consideration during interventions for this group.

Behavioural functioning of retinoblastoma survivors.

OBJECTIVE: To assess behavioural problems in retinoblastoma (RB) survivors. METHODS: This population-based cross-sectional study included 148 RB survivors (8-35 years), registered in the Dutch national RB register. Survivors and parents were asked to fill in behavioural questionnaires. Prevalence rates were computed, based on both self-reports and proxy reports. One-sample T-tests were applied to analyse differences compared with healthy reference samples. Multiple regression analyses were performed to identify predictors for behavioural problems within the RB sample. RESULTS: Between-group differences varied across informants and across age groups. Parents reported significantly elevated total problem behaviour in 30% of their offspring (aged 8-17 years); this against 9% in adolescents (12-17 years) and 12% in adults (18-35 years) based on self-report. Parental reports showed significantly elevated rates of (1) internalising problems in boys and (2) somatic complaints in both girls and boys. Self-reports indicate significantly lowered levels of (1) externalising problems in adolescent and adult women and (2) thought problems in female adolescents and in adult men. Especially survivors who suffered hereditary RB, who had undergone more intensive treatment, and who came from a single-parent family were identified to be at most behavioural risk. CONCLUSION: Perception of severity and the nature of behavioural problems seem to differ between beholder, and to vary between age groups, if not between life stages. Health professionals should be aware that especially those who are confronted with hereditary RB and who subsequently undergo intensive treatment, and who grow up in broken families, run the risk of developing behavioural difficulties.

Rutaceae sampled from Germany, Malta, and Mallorca (Spain) are associated with AMF clustering with Glomus hoi Berch & Trappe.

Six Rutaceae species collected from natural habitats (Malta, Mallorca (Spain), and Tenerife (Spain)) and the Botanical Garden in Marburg were examined with respect to mycorrhizal structures and fungal identity. All species have the same gross colonization pattern of arbuscular mycorrhiza (AM) with distinct intracellular and intercellular phases but show remarkable differences in details, especially in terms of the extent of the intracellular phase. The associated AM fungi, identified using molecular methods, cluster together with Glomus hoi Berch & Trappe, although the plants were collected from very distant locations.

Specialized mycorrhizal colonization pattern in achlorophyllous Epirixanthes spp. (Polygalaceae).

Roots of the achlorophyllous Epirixanthes papunana and E. elongata were sectioned in complete series in order to reconstruct the three-dimensional mycorrhizal colonization pattern within their tissues. Hyphal morphology, vesicles, as well as the exclusively intracellular mode of colonization indicate a PARIS-type of arbuscular mycorrhiza showing a hitherto unknown colonization pattern: (1) the outer cortex is colonized by persistent straight-growing hyphae which branch in a cascading manner, (2) a specific layer (called layer 2) is inhabited by persistent hyphal coils, (3) in the cells of the anatomically distinct inner cortex parenchyma layer (called layer 1) the hyphae immediately degenerate, and (4) the layer outside to layer 2 (called layer 3) is either transitional layer 2 when penetrated from the outer cortex or the fungal material degenerates when colonized from the layer 2. This complex colonization pattern is a reasonable adaptation to the particular demands of Epirixanthes as a myco-heterotrophic plant. It not only allows a sustained benefit from the fungal symbiont but also provides a two-level distribution system of hyphae within the roots. The outer cortex hyphae function as a permanent intraradical resource of living fungi providing connection to the external mycelium as well as a coarse distribution of hyphae within the root. Layer 2 represents the fine scale distribution of hyphae, having access to all potentially digesting cells of the layers 1 and 3. Common structural features of mycorrhizae in myco-heterotrophic plants are pointed out in order to find putative prerequisites for their heterotrophic mode of life.

Retinal dysplasia mimicking intraocular tumor: MR imaging findings with histopathologic correlation.

We report a 6-month-old boy who presented with unilateral leukocoria, retinal detachment, and a retrolental mass in a microphthalmic eye based on retinal dysplasia with concurrent optic nerve aplasia. Dysplastic retinal tissue, a rare congenital defect, may create a clinical and radiologic picture of an intraocular mass closely resembling tumor tissue. MR imaging findings with histopathologic correlation are presented to facilitate discrimination of the more common causes of leukocoria.

[Which factors influence job satisfaction and motivation in an institute of radiology?]. / Welche Faktoren beeinflussen die Arbeitszufriedenheit und -motivation an einem Institut für Radiologie?

PURPOSE: As empirically shown, increasing job satisfaction and motivations correlates with reduced job fluctuation and costs of absenteeism in an organisation. To provide a motivating environment for employees becomes more important in the health-care system and thus also in radiology. The purpose of our study was therefore to evaluate job satisfaction of our team and to define important influencing factors. METHODS: For data collection, as standardized questionnaire was designed. As a result of a discussion in a focus group, 9 indicators characterizing job satisfaction and motivation were determined (four-point ordinal scale), in addition there were open questions as well as space for comments. The questionnaires were distributed to all employees at the institute during the study period 11/2005. It was assured in the study design that data analysis was anonymous. For statistical analysis, all replies were coded (scale 1-4) and transferred to an excel sheet. RESULTS: Rate of return was 92% (46/50). In general, employees enjoyed work (mean 3.37 +/- 0.5); no significant difference between physicians, technicians and other staff members were observed. Factors most important for personal motivation were good working climate (3.85 +/- 0.4), good reputation of the institute (3.56 +/- 0.8) and personal recognition (3.54 +/- 0.6). Wage raise (3.01 +/- 0.9) and bonus payments (3.11 +/- 0.9) were rated less important. Communication between groups of employees could be improved (2.78 +/- 0.7). When asked, which factors would improve motivation, common answer included teamwork and communication (n = 9), more participation in planning processes (n = 8), more appreciation (n = 7) and continuing education (n = 5). CONCLUSIONS: Profound knowledge of factors influencing job satisfaction and motivation of employees allows for the implementation of targeted strategies for continuous improvement.

Stage of presentation and visual outcome of patients screened for familial retinoblastoma: nationwide registration in the Netherlands.

BACKGROUND: In the Netherlands a comprehensive programme for screening just after birth for familial retinoblastoma is taking place. In this report the stage of the disease at the time of detection, by way of screening, and the long term visual outcome in these patients was evaluated. METHODS: A nationwide, retrospective study. From January 1992-July 2004, patients at risk for familial retinoblastoma were screened 1-2 weeks after birth, and investigated for laterality, Reese-Ellsworth classification/International Classification of Retinoblastoma, macular involvement, age of primary retinoblastoma, initial therapy, and visual outcome. RESULTS: 17 patients were diagnosed with familial retinoblastoma. 88.3% developed bilateral, 11.7% unilateral retinoblastoma. Of the 34 eyes, 56% were R-E group I, 16% were group II A-B, 16% were group III A-B, 9% were group IV, 3% were group V. Using the International Classification of Retinoblastoma, 72% were group A, 19% were group B, 6% were group C, 3% were group E. The visual outcome revealed 73.5% of eyes with 20/20-20/40, 26.5% eyes with < or = 20/100-no light perception; 5.9% of eyes were enucleated, all other eyes were treated with local or conservative treatment methods. Of all eyes, 59% had extramacular retinoblastoma, 98% of patients had at least one eye with extramacular retinoblastoma. CONCLUSION: Most familial retinoblastoma patients present as a R-E group I or group A when screened within 2 weeks after birth. Nearly 90% of patients had a long term visual acuity of 20/20-20/40. Despite the common occurrence of macula involvement, bilateral macula involvement was infrequent, and since most eyes were salvaged, good vision was obtained in the majority of patients.