[The care standard 'Depressive disorders']. / De zorgstandaard Depressieve stoornissen.

BACKGROUND: The care standard 'Depressive disorders' describes the complete patient journey for patients with depressive symptoms and disorders from the age of 8 years onwards.
AIM: To describe the most important recommendations in this care standard.
METHOD: The care standard is an adaptation of the existing guidelines for depression, supplemented with practical knowledge from professionals and patients' values and preferences.
RESULTS: Core elements in the care for depression are an appropriate use of care and a focus on relapse prevention. A combination of psychotherapy and medication is indicated for persistent depression and more sessions of psychotherapy might be required. There is some evidence for the use of repetitive transcranial magnetic stimulation in treatment-resistant depression.
CONCLUSION: The care standard is an important instrument to improve the quality of care for depression at both the organisational and the regional level.

Molecular Identification of Cutaneous Alternariosis in a Renal Transplant Patient.

Cutaneous alternariosis is a rare condition, caused by an uncommon opportunistic pathogen. The most frequently affected individuals are immunosuppressed patients, e.g., organ transplant patients on immunosuppressive therapy. Clinical manifestations range from local skin lesions to disseminated disease. We present a case report of cutaneous alternariosis in a renal transplant recipient, confirmed by histological examination and molecular means. In addition, a review of the literature was performed.

Late onset of Strongyloides stercoralis meningitis in a retired Belgian miner.

We report a rare case of Strongyloides stercoralis meningitis in an immunocompromised patient treated for a lung carcinoma. Despite his Belgian origin, he was infected with S. stercoralis due to his former work as a miner. Although mostly prevalent in (sub)tropical areas, there are temperate regions where this nematode can occur.

A rare cause of severe recurrent abdominal pain.

Recurrent abdominal pain may be enigmatic to solve. We report three cases, presenting after a protracted history of severe recurrent bouts of epigastric pain, impeding daily activities. In all cases, serology for strongyloidiasis stercoralis proved positive. In one case, stool examination was positive for larvae. Treatment with ivermectin or albendazole resulted in complete resolution of abdominal symptoms without recurrence in all three cases.

[Update of the multidisciplinary guidelines for anxiety and depression]. / Herziening van de multidisciplinaire richtlijnen angst en depressie.

The multidisciplinary guidelines for depression, panic disorder and post-traumatic stress disorder have been revised. They incorporate some important changes: algorithms are now based on the severity of the disorders, a 'stepped-care' approach is promoted, so-called basic interventions are required for each algorithm and so-called first-step interventions are advocated for mild disorders. Antidepressants are no longer indicated for mild disorders.

Case reports: testicular pain as a manifestation of polyarteritis nodosa.

Polyarteritis nodosa (PAN) is a necrotising vasculitis of medium-sized vessels of unknown origin. This type of vasculitis is usually systemic, but restriction to a single organ, for example the testis, the appendix or the gall bladder, can occur. Testicular pain or tenderness are frequent clinical features. In this report, we present three cases of PAN. In every patient, testicular pain was the main symptom or first sign of systemic disease. We state that a thorough history taking, clinical examination and biochemical analyses are obligatory in patients presenting with acute or chronic scrotal pain. Polyarteritis nodosa should always be taken into account, and a search for systemic spread is mandatory. We emphasize that before initiation of systemic therapy with corticosteroids and/or cyclophosphamide, a Five Factor Score should be obtained, which also gives crucial prognostic information.

Satisfaction with reduced dentitions in elderly people.

Natural dentitions of elderly people are often reduced and the remaining teeth are heavily restored. It is unknown whether they are satisfied or dissatisfied with this situation. To get more insight into this phenomenon 320 dentate non-institutionalized elderly subjects were clinically examined and interviewed by means of a questionnaire. Analysis of the data showed that only 13% of the subjects had at least a complete dentition from the right first molar to the left first molar; 50% had less than four occlusal units, 39% of the subjects were wearing a removable partial denture. Ninety per cent of the subjects was satisfied with the dental state and nearly all subjects mentioned they could chew well (97%), despite the fact that 91% of the subjects mentioned they had to deal with one or more dental discomforts. Satisfaction decreased significantly when the number of the occlusal units was reduced or a removable partial denture was present. The conclusion is drawn that although the dentitions of the elderly are often reduced they are, in general, satisfied with their dental state.

The importance of postoperative radiation therapy in the treatment of Merkel cell carcinoma.

PURPOSE: To determine the role of postoperative radiation therapy in the treatment of Merkel cell carcinoma (MCC). METHODS AND MATERIALS: Eighty patients with MCC of the skin were treated with curative intent at the Queensland Radium Institute between 1981 and 1991. Fifty-one patients (63.7%) were referred after initial biopsy for further treatment and 29 patients (36.3%) were referred with locally recurrent disease following primary surgery elsewhere. Thirteen patients (16.3%) presented with nodal disease without a clinically definable primary skin lesion. RESULTS: Of the 80 patients, 38 had undergone surgery (S) alone, 34 surgery plus radiotherapy (S + RT), 7 RT after incomplete S, and 1 patient had chemotherapy (CT) plus RT. Overall survival at 36 months for all patients was 68%. All of the 38 patients treated with S alone relapsed. The median time to recurrence was 5.5 months. Ten of the 34 patients treated with S + RT relapsed. The median time to recurrence was 16.5 months. Of the 80 patients, 55 have relapsed after primary treatment, 25 have developed systemic metastases, and 26 patients have died as a direct result of MCC. CONCLUSION: Our large series confirms earlier reports from this Institute and highlights the importance of S + RT over S alone in preventing local recurrence of this highly malignant skin cancer.

Relationship between wearing a removable partial denture and satisfaction in the elderly.

Natural dentitions of elderly people are often reduced, remaining teeth heavily restored and removable partial dentures (RPD's) frequently used to replace absent teeth. Lack of knowledge exists on how the elderly experience the comfort of these replacements. To get more insight 320 dentate noninstitutionalized subjects between 55 and 75 yr of age were clinically examined and interviewed by means of a questionnaire. Data showed that only 13% of the subjects had a complete dentition from the right to the left first molar; 50% had less than four occlusal units. 39% of the subjects was wearing a RPD. Analysis showed that subjects with a RPD were in general less satisfied with their dental state than subjects without a partial denture. However, when the RPD added occlusal units to the dentition, satisfaction increased significantly. No differences in satisfaction were found between subjects with a metal frame prosthesis and an acrylic denture, nor between tooth-bounded and distal extension prostheses. The conclusion can be drawn that the indication for a RPD should be limited in elderly people, unless the RPD increased the number of the occlusal units.

Oral function in dentate elderly with reduced dentitions.

This study covers the characteristics of reduced dentitions in a population of elderly people. The sample consisted of 329 independently living individuals between 55 and 75 years of age. They all had one or more natural teeth and were all interviewed and investigated clinically. The findings showed that 13% of the subjects had a natural dentition with at least the first molars; 4-7 natural occlusal units (defined as 'pairs of opposing teeth that support the occlusion') occurred in 37% of the subjects; 1-4 natural occlusal units in 41% and 0 units in 9% (only anterior contacts). A removable partial denture was worn by 39% of the subjects; most of them were acrylic based dentures (61%). The percentages of restored teeth per subject were high. The need for further restorations, however, was low. Periodontal problems were uncommon; 25% of the subjects had one pocket above 5 mm; 8% had severe problems. Poor oral hygiene was present in a quarter of the cases. Most of the subjects (70%) had no pain or noises in the temporomandibular joint. Only 10% of subjects had more than one sign of craniomandibular dysfunction. Most of the subjects (85%) visit their dentist regularly and 65% had their last tooth extraction more than three years ago. A majority mentioned that they have never had problems with their dentition in the past; 50% had had no real toothache for the last five years. However, problems with food-packing were often mentioned. It can be concluded that, although the dentitions of the elderly in this population are often reduced, their dentitions are in general in good condition and few give TMJ problems.

A standard protocol for the quality control of microbiological media.

A protocol, comprising standardized analysis and data forms, has been drawn up for the quality control of microbiological media. It was developed in order to standardize the testing procedures in our laboratory and to test media with minimal investment in time and resources. The forms encourage proper recording of the trials, which facilitates internal and external consideration of the results. The protocol was validated in a comparative investigation of the quality of media obtained from different suppliers and were shown to work satisfactorily. Based on the overall results, preferred suppliers for each medium were chosen. The standardized forms can be used in conjunction with the documents drafted by the International Committee for Food Microbiology and Hygiene (ICFMH) Working Party for Culture Media, bringing standardization of testing procedures one step nearer.

Is there a need for gerodontology?

One of the major criteria of successful ageing is maintaining a natural, healthy, functional dentition throughout life, including all the social and biological benefits such as aesthetics and comfort, and the ability to chew, taste and speak. However, the oral health of elderly people is far from optimal. The treatment needs are high due to edentulism, missing teeth, caries, periodontal diseases and tooth wear resulting in impaired oral functions. The demand for treatment is much lower than the need. In the future the elderly will retain their natural dentition and more teeth per individual will be present. Despite this there will be a rise in edentulousness due to the sharp rise in numbers of the elderly population. The 'new elderly' will be more critical and more demanding of oral health care services. The dental profession and governments in all industrialised countries must be aware of these trends which should be reflected in undergraduate and postgraduate education of dentists and in research. The European College of Gerodontology has been founded to contribute to solving all problems related to oral health and oral health care of the elderly.

[Natural dentition of the elderly. An occlusal concept]. / De natuurlijke dentitie van de oudere mens. Een occlusieconcept.

Treatment of the impaired dentition of the elderly has to be focused on maintaining the strategic natural teeth. This means not necessarily the preservation of all teeth. At least a minimal functional level should be preserved.