[Care for adolescents with an autism spectrum disorder and an intellectual disability]. / Zorg voor adolescenten met autisme en een verstandelijke beperking.

BACKGROUND: Due to an experienced gap in care for adolescents with an autism spectrum disorder (ASD) and an intellectual disability (ID), an interdisciplinary outpatient clinic was initiated by child- and adolescent psychiatry services together with intellectual disability physicians in the Rotterdam region in 2017. AIM: Evaluation of the ASD-ID outpatient clinic. METHOD: A retrospective chart review study of the first year of the ASD-ID outpatient clinic was performed. The care specific traits of the adolescents who visited the ASD-ID outpatient clinic, their health care costs and the effect of the ASD-ID outpatient clinic on both the health care costs and the patient outflow was compared to the traits of the adolescents of the autism outpatient clinic. RESULTS: 32 adolescents who were referred to the ASD-ID outpatient clinic were comparable to 204 adolescents of the autism outpatient clinic in age (mean 16.5 years) and gender (75% male). They had 39% more DSM-IV classifications, were in care 3.7 years longer and had 44% more health care costs. After visiting the ASD-ID outpatient clinic, 50% of the adolescents were transferred within a year and 100% within three years to a intellectual disability physician. CONCLUSION: Adolescents with ASD and ID are a group with a substantial demand for care who deserve specific attention. An integrated ASD-ID outpatient clinic contributes to this demand.

[Subjective and objective success of Burch's method of colpo-suspension concerning continence, satisfaction and micturition pattern]. / Subjectief en objectief succes van colposuspensie volgens Burch ten aanzien van continentie, tevredenheid en mictiepatroon.

OBJECTIVE: A comparison of subjective and objective continence and satisfaction after Burch colposuspension in patients with stress incontinence. SETTING: Department of gynaecology, Ikazia Hospital Rotterdam, the Netherlands. DESIGN: Retrospective. METHODS: 61 patients completed a questionnaire with 9 questions about incontinence and micturition, comparing the pre- and postoperative situations. Satisfaction was scored on a five-point scale. Objective continence and micturition frequency were measured with a pad test during ambulatory urodynamics (n = 29). RESULTS: The response was 100%, satisfaction 90%, subjective incontinence 70%, objective incontinence 59%. Subjective micturition frequency fell from 17.0 to 7.7, objective frequency from 10.4 to 8.1, urine loss from 10.8 to 2.0 g/h. CONCLUSION: In determining postoperative satisfaction the severity and timing of urine loss appear more important than absolute absence of incontinence. The pad test is advised for objective assessment of success because of its easy interpretation and repeatability.

Angiosarcoma of the uterus following radiotherapy for squamous cell carcinoma of the cervix.

A case report of a 61-year-old woman who developed a uterine angiosarcoma 6.5 years after primary radiotherapy for a moderately well differentiated squamous cell carcinoma of the uterine cervix stage IB is presented. The diagnosis was confirmed by immunohistochemical studies showing positive staining for Ulex europaeus agglutinin 1 and supported by ultrastructural studies. Though various post-irradiation angiosarcomas are reported in the literature, this is, to our knowledge, the first report of an angiosarcoma of the uterus after radiotherapy.

De novo detrusor instability after Burch colposuspension.

After successful surgery for stress incontinence, detrusor instability can develop in a previously stable bladder. A review of six studies with a total of 396 patients is presented. Sixty-eight of these patients (17%) developed de novo DI. The prevalence varied from 5 to 27% in the different studies. The highest cure rate was 98%; the lowest 64%. It is concluded that the prevalence of de novo DI may be dependent on the details of the cystometric and surgical technique as well as unknown patient characteristics. Since the exact pathophysiologic mechanism of this phenomenon is unknown, it is difficult to predict it preoperatively in the individual patient.

Trisomy 18 in monozygotic twins.

We report a very rare case of a pair of monozygotic twins with trisomy 18 discordant for major anomalies. Our case contributes to published data on the role of nongenetic factors in the etiology of discordance of congenital malformations in genotypically identical twins. We stress the importance of accurate ultrasonic examination in reducing the number of caesarean sections to deliver trisomy 18 infants.