Direct and delayed admissions to ICU in older medical patients.

The aims of this retrospective cohort study were to retrieve characteristics and outcomes of older (65+) medical patients who are directly admitted to ICU from the ED and to compare these with those admitted to ICU from a ward. Of 1396 patients, 21 (1.5%) were directly admitted to ICU and 54 (3.9%) after a delay. Blood pressure was lower and respiratory rate higher in the direct than in the delayed group. The direct group had lower mortality (28-day: 19.0 vs. 38.9%, p=0.14; 1-year: 42.9 vs. 66.7%; p=0.06), shorter length-of-stay and returned more frequently to independent living than the delayed group. Only a fraction of older patients are admitted to ICU; directly admitted patients tend to have better outcomes.

[A Somali man with a painful thyroid mass: thyroid tuberculosis]. / Een Somalische man met een pijnlijke schildklierzwelling: thyreoiditis tuberculosa.

A 21-year-old man from Somalia presented with a painful mass in the thyroid, 6 months offatigue, weight loss and fever. Two separate courses of antibiotics did not improve his condition. Thyroid function tests were normal. The chest X-ray showed an enlarged hilus with some pulmonary infiltration around it. The diagnosis ofthyroid tuberculosis was established by cytological, microbiological and PCR testing of a fine needle aspirate of a thyroid lymph node. Treatment with antituberculosis agents resulted in a complete clinical response. The differential diagnosis of a painful thyroid mass encompasses subacute granulomatous thyroiditis, infectious thyroiditis, radiation- or trauma-induced thyroiditis and haemorrhage in the thyroid lymph nodes. Although thyroid tuberculosis is mainly a disease of developing countries, increasing immigration can lead to a higher incidence of this rare form of extrapulmonary tuberculosis and should therefore also be considered in patients with a painful thyroid mass.

Blood pressure in rats: a comparison of a multifactorial experimental design to measurements in an outbred stock.

Systolic blood pressure was measured in males of 8 inbred strains and 1 outbred stock of rats 5 times over a period of 20 min on 5 consecutive days. The strain means ranged between 107.9 mmHg and 149.3 mmHg. The estimated variance between strains (V = 248.7 mmHg) was about 5 times higher than the variance within strains (V = 54.3 mmHg). The intraindividual variance within strains was relatively constant (V = 24.0-37.6 mmHg), while the interindividual variance varied to a great extent (V = 4.5-44.5 mmHg) from strain to strain. The outbred stock showed values of blood pressure and components of variance similar to those of a single inbred strain. Thus, by investigation of a battery of 8 inbred strains in a multifactorial experimental design a greater phenotypic variability due to genetic strain differences is achieved than by measurements in a single outbred stock.