Novel Strategies for the Detection of Systolic and Diastolic Heart Failure

The incidence and prevalence of dyspnea increases with age. Frequently, for the general practitioner with his limited diagnostic facilities, it is impossible to separate dyspnea from cardiac causes and non-cardiac causes. Without cardiac imaging it is also impossible to separate systolic dysfunction from diastolic dysfunction. After a thorough physical examination, initial screening of systolic and diastolic heart failure can be done by measurement of plasma NT-pro BNP or plasma BNP. Additionally a Chest X-Ray or ECG can be performed. To improve diagnostic performance an open access echocardiographic service can be initiated. Recent studies showed, that open access echocardiography can easily detect systolic and diastolic dysfunction in the community and can separate cardiac from non-cardiac dyspnea

Early diagnosis of temporomandibular joint involvement in juvenile idiopathic arthritis: a pilot study comparing clinical examination and ultrasound to magnetic resonance imaging

Objectives. To study the validity of both rheumatological and orthodontic examinations and ultrasound (US) as screening methods for early diagnosis of TMJ arthritis against the gold standard MRI. Methods. Thirty consecutive juvenile idiopathic arthritis (JIA) patients were included in this pilot study. Rheumatological and orthodontic examinations as well as US were performed within 1 month of the MRI in a blinded fashion. Joint effusion and/or increased contrast enhancement of synovium or bone were considered signs of active arthritis on MRI. Results. A total of 19/30 (63%) patients and 33/60 (55%) joints had signs of TMJ involvement on MRI. This was associated with condylar deformity in 9/19 (47%) patients and 15/33 (45%) joints. Rheumatological, orthodontic and US examinations correctly diagnosed 11 (58%), 9 (47%) and 6 (33%) patients, respectively, with active TMJ arthritis, but misdiagnosed 8 (42%), 10 (53%) and 12 (67%) patients, respectively, as having no signs of inflammation. The best predictor for active arthritis on MRI was a reduced maximum mouth opening. Conclusion. None of the methods tested was able to reliably predict the presence or absence of MRI-proven inflammation in the TMJ in our cohort of JIA patients. US was the least useful of all methods tested to exclude active TMJ arthriti

Survey of Period Variations of Superhumps in SU UMa-Type Dwarf Novae

We systematically surveyed period variations of superhumps in SU UMa-type dwarf novae based on newly obtained data and past publications. In many systems, the evolution of superhump period are found to be composed of three distinct stages: early evolutionary stage with a longer superhump period, middle stage with systematically varying periods, final stage with a shorter, stable superhump period. During the middle stage, many systems with superhump periods less than 0.08 d show positive period derivatives. Contrary to the earlier claim, we found no clear evidence for variation of period derivatives between superoutburst of the same object. We present an interpretation that the lengthening of the superhump period is a result of outward propagation of the eccentricity wave and is limited by the radius near the tidal truncation. We interpret that late stage superhumps are rejuvenized excitation of 3:1 resonance when the superhumps in the outer disk is effectively quenched. Many of WZ Sge-type dwarf novae showed long-enduring superhumps during the post-superoutburst stage having periods longer than those during the main superoutburst. The period derivatives in WZ Sge-type dwarf novae are found to be strongly correlated with the fractional superhump excess, or consequently, mass ratio. WZ Sge-type dwarf novae with a long-lasting rebrightening or with multiple rebrightenings tend to have smaller period derivatives and are excellent candidate for the systems around or after the period minimum of evolution of cataclysmic variables (abridged).Comment: 239 pages, 225 figures, PASJ accepte

Marco Gietema en Cecile aan de Stegge, Vergeten slachtoffers. Psychiatrische inrichting de Willem Arntsz Hoeve in de Tweede Wereldoorlog

Marco Gietema en Cecile aan de Stegge, Vergeten slachtoffers. Psychiatrische inrichting de Willem Arntsz Hoeve in de Tweede Wereldoorlog (Amsterdam: Boom, 2017, 269 pp., isbn 978 90 8953 946 5).

De pendel, de kloof en de kliniek.Leendert Bouman (1869-1936) en de ‘psychologische wending’ in de Nederlandse psychiatrie

The pendulum, the gap, and the clinic. Leendert Bouman (1869-1936) and the ‘psychological turn’ in Dutch psychiatry In recent historical literature, the Dutch psychiatrist Leendert Bouman (1869-1936) is named ‘the godfather of psychological psychiatry’. He is regarded as one of the exponents of a shift or ‘pendulum’ movement from a biological-materialistic to a psychological, phenomenological orientation in the Dutch psychiatry of the Interbellum. As a professor of the orthodox calvinist Vrije Universiteit of Amsterdam, he explicitly opposed a ‘soul-less’, biological-reductionist psychiatry. In addition, he played an important part in the introduction and spread of new ‘psychological’ theories and especially Karl Jaspers’ phenomenology in the Netherlands. It is one-sided and misleading, however, to refer to Bouman as a ‘psychological’ psychiatrist. Most of his scientific work was of a neurological and biological nature. He did not see biological (or nomothetic) and psychological (or idiographic) approaches as mutually exclusive, but as necessarily complementary. In this he followed Jaspers’ distinction between and complementary use of the causal connections of psychic life (explanatory psychology) and meaningful psychic connections (psychology of meaning). Boumans pluralist orientation was rooted in his fundamentally clinical attitude toward psychiatry. In his view, a psychiatrist was in the first place a clinician. In the clinic, he stressed, a psychiatrist has to view and examine each individual patient in his bio-psycho-social totality. The case of Bouman illustrates that the history of psychiatry is by far richer and more complicated than is suggested by the standard account of that history being characterized by a pendulum movement and a one-dimensional struggle between ‘somatic’ and ‘psychological’ schools. It also suggests that the interaction between theory and clinical practice should be emphasized as an important dynamic factor in the history of psychiatry – next to or even above the dichotomy between ‘biology’ and ‘psychology’