[Tired of waiting: towards a joint approach of waiting times in Flemish mental health care]. / Genoeg gewacht: naar een gezamenlijke aanpak van wachttijden in de Vlaamse ggz.

BACKGROUND: Waiting times are an important barrier to timely obtaining appropriate mental health care in Flanders, but structural data is limited. AIM: To describe the waiting time problem in Flanders and propose some causal hypotheses and possible interventions. METHOD: An exploration of the available waiting time data, supplemented with literature and insights based on the results of some Flemish Centers for Mental Healthcare. RESULTS: Waiting times are especially problematic for subsidized outpatient care and care for children and youth, although the current data provide an incomplete picture. Besides capacity, important factors are the organization of the intake (e.g. assessment) and flow parameters (e.g. mean treatment duration - and intensity). CONCLUSION: Eliminating waiting lists is one of the greatest challenges for Flemish mental health care. There is a need to expand capacity as well as the smarter use of existing capacity and resources. A joint multi-level approach is required.

Conjunctival metastasis as the initial manifestation of lung cancer.

PURPOSE: To report a case of conjunctival metastasis as the initial manifestation of lung cancer. METHOD: A 55-year-old man without known systemic disease developed a conjunctival mass in his right eye. He underwent excision of the tumor and systemic evaluation. RESULTS: Histopathologically, the mass was a metastatic squamous cell carcinoma. Further evaluation disclosed a primary bronchogenic carcinoma with metastasis to ribs and brain. The primary and secondary tumors were treated with chemotherapy and irradiation. CONCLUSIONS: Conjunctival metastasis may be the initial manifestation of lung cancer. It should be considered in the differential diagnosis of a deep conjunctival mass.

Measurement of globe position in complex orbital fractures. I. A modification of Hertel's exophthalmometer, using the external auditory canal as a reference point.

Where there has been displacement or removal of the lateral orbital rim or zygomaticomaxillary complex secondary to trauma or surgery, the measure of globe position by the Hertel exophthalmometer is problematic and inaccurate. A modification of Hertel's instrument that uses the external auditory canal (EAC) rather than the orbital rim as reference point has been developed. Measurement of globe position of 120 normal volunteers was obtained with the Hertel and the modified EAC-fixated exophthalmometer. Although the mean absolute difference between right and left measurements for both methods (Hertel mean, 0.36 mm; modified mean, 0.51 mm; n = 120) differed statistically from 0 (p = 0.0001), that difference was not clinically significant. A more meaningful comparison was that of the variability of the two methods. The variance of the Hertel method (0.32) did not differ from the variance of the modified method (0.40; p = 0.06). No statistically significant difference was noted for sex (p = 0.33) or for race (p = 0.11). We believe this instrument to be of practical use in the assessment of enophthalmos or exophthalmos in patients whose facial deformity, trauma, surgery, or disease precludes the use of a rim-based exophthalmometry.

Association of high plasma prorenin with diabetic retinopathy.

Plasma prorenin, but not renin, is elevated in long-standing diabetes mellitus. Nephropathy and autonomic neuropathy have been implicated as causes. However, we found no arteriovenous difference in prorenin across the kidney, despite high levels of circulating prorenin and a very low renal plasma flow, in five diabetics with combined end-stage nephropathy and proliferative diabetic retinopathy. Moreover, plasma prorenin was normal in 16 non-diabetics with autonomic neuropathy. The presence of a high level of prorenin was closely associated with the presence of diabetic retinopathy, particularly the proliferative type, in 223 consecutive patients. This association was independent of insulin requirements, metabolic control and of the presence of nephropathy or neuropathy. These data are evidence that part of the elevated plasma prorenin in diabetics is produced by an extrarenal source and that perhaps the eye affected by diabetic retinopathy is that source.