Sonkyker. Afrikaner in die verkeerde eeu

No Abstract

Primary cerebral alveolar rhabdomyosarcoma in adult

Primary cerebral rhabdomyosarcomas are very rare and malignant tumors that occur predominantly in the posterior fossa of pediatric patients. We report a rare case of primary cerebral rhabdomyosarcoma located in the supratentorial compartment of a 51 year-old woman together with a review of the pertinent Literature especially regarding the histological diagnosis and pitfalls

Factors associated with shunt dynamic in patients with cryptogenic stroke and patent foramen ovale: an observational cohort study

<p>Abstract</p> <p>Background</p> <p>As previously reported there is evidence for a reduction in right to left shunt (RLS) in stroke patients with patent foramen ovale (PFO). This occurs predominantly in patients with cryptogenic stroke (CS). We therefore analysed factors associated with a shunt reduction on follow-up in stroke patients suffering of CS.</p> <p>Methods</p> <p>On index event PFO and RLS were proven by transesophageal echocardiography and contrast-enhanced transcranial Doppler-sonography (ce-TCD). Silent PE was proved by ventilation perfusion scintigraphy (V/Q) within the stroke work-up on index event; all scans were re-evaluated in a blinded manner by two experts. The RLS was re-assessed on follow-up by ce-TCD. A reduction in shunt volume was defined as a difference of ≥20 microembolic signals (MES) or the lack of evidence of RLS on follow-up. For subsequent analyses patients with CS were considered; parameters such as deep vein thrombosis (DVT) and silent pulmonary embolism (PE) were analysed.</p> <p>Results</p> <p>In 39 PFO patients suffering of a CS the RLS was re-assessed on follow-up. In all patients (n = 39) with CS a V/Q was performed; the median age was 40 years, 24 (61.5%) patients were female. In 27 patients a reduction in RLS was evident. Silent PE was evident in 18/39 patients (46.2%). Factors such as atrial septum aneurysm, DVT or even silent PE were not associated with RLS dynamics. A greater time delay from index event to follow-up assessment was associated with a decrease in shunt volume (median 12 vs. 6 months, <it>p </it>= 0.013).</p> <p>Conclusions</p> <p>In patients with CS a reduction in RLS is not associated with the presence of a venous embolic event such as DVT or silent PE. A greater time delay between the initial and the follow-up investigation increases the likelihood for the detection of a reduction in RLS.</p

Decrease in shunt volume in patients with cryptogenic stroke and patent foramen ovale

<p>Abstract</p> <p>Background</p> <p>In patients with patent foramen ovale (PFO) there is evidence supporting the hypothesis of a change in right-to-left shunt (RLS) over time. Proven, this could have implications for the care of patients with PFO and a history of stroke. The following study addressed this hypothesis in a cohort of patients with stroke and PFO.</p> <p>Methods</p> <p>The RLS volume assessed during hospitalisation for stroke (index event/T0) was compared with the RLS volume on follow-up (T1) (median time between T0 and T1 was 10 months). In 102 patients with a history of stroke and PFO the RLS volume was re-assessed on follow-up using contrast-enhanced transcranial Doppler/duplex (ce-TCD) ultrasound. A change in RLS volume was defined as a difference of ≥20 microembolic signals (MES) or no evidence of RLS during ce-TCD ultrasound on follow-up.</p> <p>Results</p> <p>There was evidence of a marked reduction in RLS volume in 31/102 patients; in 14/31 patients a PFO was no longer detectable. An index event classified as cryptogenic stroke (P < 0.001; OD = 39.2, 95% confidence interval 6.0 to 258.2) and the time interval to the follow-up visit (P = 0.03) were independently associated with a change in RLS volume over time.</p> <p>Conclusions</p> <p>RLS volume across a PFO decreases over time, especially in patients with cryptogenic stroke. These may determine the development of new strategies for the management in the secondary stroke prevention.</p

Standaardafrikaans: daar's 'n vlieg in die salf

Standard Afrikaans: there is a a fly in the ointment. This article discusses the central question as to whether a term such as `Oosgrensafrikaans' (Eastern Cape Afrikaans) interpreted in terms of how it is defined in the relevant literature truly reflects the linguistic reality of the time. Can the hypothesis that Afrikaans was standardised on the basis of Eastern Cape Afrikaans – without taking account of the Afrikaans of the inhabitants elsewhere in the Cape Colony at the time – be empirically underpinned? In order to answer this question it was necessary to investigate the linguistic uniqueness of Eastern Cape Afrikaans. This article reports on a small empirical investigation in this regard. Another possibility other than the claim that Standard Afrikaans stems from Eastern Cape Afrikaans as defined presently, remains open. Standard Afrikaans could quite conceivably have sprouted from a relatively homogenous but variable variety spoken in the regions inhabited by the Trekboers of old – the Overberg and areas immediately north and west of the Boland up to the farthest eastern boundaries of the Colony. The uncertainty surrounding the status of Eastern Cape Afrikaans as a historically unique variety of Afrikaans and especially in relationship to modern Standard Afrikaans once again highlights important issues. Die sentrale vraag wat in hierdie artikel onder die loep kom, is in hoe 'n mate 'n term soos `Oosgrensafrikaans' asook die definisie van hierdie begrip in die literatuur die werklike aard van die destydse taalopset weerspieël. Berus die hipotese dat Oosgrensafrikaans die grondslag vorm van Standaardafrikaans – sonder dat die Afrikaans van die bewoners elders in die destydse Kaapkolonie dus vermeld word – op stewige empiriese gronde? Ten einde antwoorde op hierdie vraag te verskaf, was dit dus noodsaaklik om groter helderheid te verkry oor die linguistiese uniekheid van Oosgrensafrikaans. In hierdie artikel word verslag gedoen van 'n klein empiriese ondersoek in hierdie verband. 'n Ander moontlikheid as dié dat Standaardafrikaans gebaseer is op Oosgrensafrikaans soos wat dit tans in die literatuur gedefinieer word, bestaan egter steeds. Dit is naamlik moontlik dat Standaardafrikaans kon gegroei het uit 'n betreklik homogene, maar veranderlike variëteit wat gepraat is in die destydse Trekboergebiede van die Overberg en die gebiede onmiddellik noord en wes van die Boland tot aan die grense van die Kolonie in die ooste. Die onsekerhede rondom die status van Oosgrensafrikaans as onderskeie historiese variëteit van Afrikaans, en veral ten opsigte van sy posisie in verhouding tot moderne Standaardafrikaans, bring belangrike vraagstukke na vore. (S/ern Af Linguistics & Applied Language Studies: 2002 20(1&2): 37-46

Role of arterial hypertension in comorbidity of chronic headaches

INTRODUCTION: The literature concerning the association between headache and arterial hypertension is very scarce, mostly prior to the actual IHS classification and based on very diverse methods, being therefore difficult to interpret. OBJECTIVES: To analyse the association between arterial hypertension and two types of chronic headache and to determine, if and how arterial hypertension may affect the outcome of prophylactic therapy for chronic headaches. PATIENTS AND METHODS: Sixty four files of our headache outpatient clinic, chosen randomly among patients suffering from migraine or tensional type headache (TTH), were analysed retrospectively. Patients were considered hypertensive, if blood pressure was higher than normal several times without an acute crisis present. Resistance to treatment was defined as lack of benefit concerning number and/or intensity of crisis. RESULTS: Age varied between 18 and 80 years, the mean age being 42,9 (SD 13,86) years. Eighty six percent were females. Twenty nine patients suffered from TTH and 35 from migraine. Prevalence of hypertension was 35,9% among all patients, 28,5% among migraine patients, 44,8% among patients with TTH. The prevalence of resistance to treatment was 39,8%, 34,3% and 41,3%, respectively. Of the patients resistant to treatment 60% were hypertensive and 62,5% of the hypertensive patients showed resistance to therapy. CONCLUSIONS: Arterial hypertension was more prevalent in the study sample than would be expected in an equivalent sample of the general population. Hypertension was significantly more prevalent among patients resistant to therapy, as was resistance to treatment among hypertensive patients. We therefore conclude that there is a relevant comorbidity between chronic headache and hypertension and that arterial hypertension complicates the control of chronic headaches

Psychiatric, additive or organic: a challenge in adolescence

RESUMO Introdução: O alargamento da idade pediátrica até atingir os 18 anos de idade introduziu novos desafios pelo surgimento de quadros clínicos idênticos aos dos adultos no atendimento pediátrico. As alterações agudas do comportamento no adolescente são muitas vezes associadas ao consumo de drogas, álcool ou medicamentos. Estas podem, no entanto, ser a manifestação inaugural de uma psicose ou de uma doença neurológica de origem infeciosa ou autoimune. Caso clínico: Apresenta-se o caso de um adolescente com desajuste súbito do comportamento, de agravamento progressivo, semelhante a surto psicótico. A investigação permitiu o diagnóstico de meningoencefalite por Mycoplasma pneumoniae. Discussão / Conclusão: Este caso clínico vem reforçar a necessidade de uma abordagem alargada do adolescente com alterações agudas do comportamento. É fundamental manter a suspeita de patologia orgânica, investigando sempre a possibilidade de uma causa inflamatória, infeciosas ou imunológica. O Mycoplasma pneumoniae é um agente essencialmente respiratório, com potenciais complicações extrapulmonares, embora raras, sendo destas as neurológicas as mais frequentes. Realça-se com este caso o desafio que a avaliação de adolescentes nas unidades de agudos de Pediatria constitui.ABSTRACT Introduction: The extension of paediatric age to the adolescents introduced new challenges in the paediatric health care. Acute behaviour disturbances are usually associated with drugs or alcohol abuse. Besides that, they can represent the onset of either psychiatric disorders or neurological diseases of both infectious or autoimmune origin. Clinical case: A teenager presented with sudden progressive behavioural disturbances. The investigation performed allowed the diagnosis of Mycoplasma pneumoniae meningoencephalitis. Discussion / Conclusion: This case report underlines the need of a multidisciplinary approach to the adolescent with behaviour disturbances. The suspicion of an organic disease must always be kept in mind, and laboratory and imaging studies conducted to the possibility of a inflammatory neurological disorder, both infectious or immune. Mycoplasma pneumoniae is mainly a cause of respiratory disease but has the potential of extra pulmonary complications, being the neurological the most frequent of these. We highlight the challenging of evaluating teenagers in acute paediatric units