Is it the right time to promote competency-based European Training Requirements in Ophthalmology? A European Board of Ophthalmology survey.

Purpose: To report national practices and recent progress in competency-based medical education (CBME) implementation in ophthalmology across European countries.

Methods: A 30-question online survey was emailed to European Union of Medical Specialists (UEMS) ophthalmology section delegates, European Board of Ophthalmology Diploma (EBOD) examiners and presidents of ophthalmology societies affiliated with UEMS/EBO.

Results: A total of 230 ophthalmologists with an average age of 54.

Orthopnea and pulmonary hypertension. Treat the underlying disease.

We report the case of a patient with longstanding dyspnea upon reclining, who presented with severe right heart failure due to chronic alveolar hypoventilation. Bilateral diaphragmatic paresis was discovered. She recovered from her right ventricular failure with non-invasive mechanical ventilatory support.

Diagnostic thresholds for free light chains in multiple myeloma depend on the assay used.

Leukemia accepted article preview online, 20 November 2017. doi:10.1038/leu.

International multicentre validation of the arteriovenous malformation-related intracerebral haemorrhage (AVICH) score.

Objective: The recently published arteriovenous malformation-related intracerebral haemorrhage (AVICH) score showed better outcome prediction for patients with arteriovenous malformation (AVM)-related intracerebral haemorrhage (ICH) than other AVM or ICH scores. Here we present the results of a multicentre, external validation of the AVICH score.

Methods: All participating centres (n=11) provided anonymous data on 325 patients to form the Spetzler-Martin (SM) grade, the supplemented SM (sSM) grade, the ICH score and the AVICH score.

A Belgian Serosurveillance/Seroprevalence Study of Diphtheria, Tetanus and Pertussis Using a Luminex xMAP Technology-Based Pentaplex.

Serosurveillance and seroprevalence studies are an essential tool to monitor vaccine-preventable diseases. We have developed a magnetic bead-based pentaplex immunoassay (MIA) for the simultaneous detection of IgG antibodies against diphtheria toxin (DT), tetanus toxin (TT), pertussis toxin (PT), filamentous hemagglutinin (FHA) and pertactin (Prn). The in-house pentaplex MIA showed a good correlation with commercial ELISAs with correlation coefficients between 0.

Serodiagnosis of whooping cough in Belgium: results of the National Reference Centre for Bordetella pertussis anno 2013.

Objective: Report on the pitfalls of serodiagnosis of pertussis in Belgium for 2013 by the NRC Bordetella.

Methods: Determine cases of acute infection using an anti-pertussis toxin (PT) IgG antibody ELISA.

Results: A total of 2471 serum samples were received.

Impact of renal impairment on outcomes with lenalidomide and dexamethasone treatment in the FIRST trial, a randomized, open-label phase 3 trial in transplant-ineligible patients with multiple myeloma.

Renal impairment is associated with poor prognosis in myeloma. This analysis of the pivotal phase 3 FIRST trial examined the impact of renally adapted dosing of lenalidomide and dexamethasone on outcomes of patients with different degrees of renal impairment. Transplant-ineligible patients not requiring dialysis were randomized 1:1:1 to receive continuous lenalidomide and dexamethasone until disease progression (n=535) or for 18 cycles (72 weeks; n=541), or melphalan, prednisone, and thalidomide for 12 cycles (72 weeks; n=547).

Severe right heart failure in a patient with chronic obstructive lung disease: a diagnostic challenge.

A 55-year-old male was admitted for evaluation of severe dyspnoea and hypoxaemia. Physical examination upon admission showed elevated jugular venous pressure and an accentuated second heart sound. Chest radiograph showed cardiomegaly with increased bibasilar markings.

Symptom suppression in subjects with perennial allergic rhinitis treated with mometasone furoate nasal spray.

Background: Allergic rhinitis (AR) carries a high symptom burden and impact on quality of life. The ability of an AR treatment to achieve and sustain symptom suppression would be expected to enhance quality of life and improve long-term outcomes.

Methods: In this ad hoc analysis of data from 4 phase 3 clinical trials of mometasone furoate nasal spray (MFNS), subjects with perennial AR recorded the severity of nasal symptoms twice daily for 12 weeks on a 4-point scale to determine the total nasal symptom score.

Malignant transformation of an abdominal inflammatory myofibroblastic tumor with distant metastases in a child.

Inflammatory myofibroblastic tumors (IMT) are lesions that mostly affect young adults and children. The tumor is made up of myofibroblasts and a mixed inflammatory infiltrate and rarely undergoes malignant transformation. We present a case of a 13-year-old boy with a pelvic mass diagnosed as IMT which underwent malignant transformation and metastasised to the liver.

No nodal cutoff in node-positive breast cancer women treated with mastectomy.

Purpose: To search for a prognostic cutoff in the number of involved axillary lymph-nodes, in T1-T2 node-positive (N+) breast cancer treated with mastectomy without radiotherapy.

Materials And Methods: Women aged 51-64 years presenting with a first primary T1-T2, N+, M0 unilateral carcinoma diagnosed in 1988-97 were selected from the SEER 9-registries. Cutoffs from 1 to 23 nodes were scanned with Cox models that included diagnostic year, age, area, race, marital status, histology, grade, hormone receptors, tumor location, size, and nodes examined.

Osteomyelitis and septic arthritis in children.

Osteomyelitis is an infection in bone most frequently occurring in children. The current incidence is 1 in 5000. Septic arthritis is an infection of a synovial joint which may occur in all age groups in children but has a specific infantile form affecting the infant from birth to the first year of life.

Pulmonary embolism: current treatment options.

The initial treatment of patients with acute pulmonary embolism has traditionally involved unfractionated heparin. Given the more predictable pharmacodynamic and pharmacokinetic properties of low molecular weight heparins, their simpler (fixed) dosing regimens, and few or no laboratory monitoring requirements, low molecular weight heparins are gradually replacing heparin for the initial treatment of most patients diagnosed with acute pulmonary embolism, except in very obese patients or patients with renal failure. Only selected patients with massive, life-threatening pulmonary embolism should be managed with intravenously administered thrombolytic drugs, surgical embolectomy, or catheter-based embolectomy.

Coronary artery bypass grafting in a patient with HIV.

We report a successful case of a conventional coronary artery bypass operation performed in a patient with HIV infection and severe three-vessel coronary artery disease. The signal change in outcome of HIV disease, in addition to the reported evidence for accelerated atherosclerosis caused by the disease itself and by its treatment with protease inhibitors, is likely to produce a larger population of HIV-infected patients developing premature coronary artery disease for whom cardiac surgery will be required. Surgical risk, outcome and operative team risk are discussed.

Down-regulation of HLA-A and HLA-Bw6, but not HLA-Bw4, allospecificities in leukemic cells: an escape mechanism from CTL and NK attack?

Human leukocyte antigen (HLA) class I antigen defects may have a negative impact on the growing application of T-cell-based immunotherapeutic strategies for treatment of leukemia. Therefore in the present study, taking advantage of a large panel of HLA class I allele-specific human monoclonal antibodies, we have compared HLA class I antigen expression on leukemic cells with that on autologous and allogeneic normal cells. Down-regulation of HLA-A and/or -B allospecificities was present in the majority of the patients studied.

Clinical and biological characterization of macroprolactinemia with and without prolactin-IgG complexes.

Objective: Macroprolactinemia, which can be detected by a polyethylene glycol (PEG) precipitation test, is a clinically and biologically heterogeneous condition. In this study, we analyzed whether the clinical presentation, the hormonal findings and the in vitro lactogenic activity differed between macroprolactinemic patients with and without circulating prolactin (PRL)-IgG complexes.

Design: Clinical data were reviewed and additional hormonal studies were performed in 50 hyperprolactinemic patients with macroprolactinemia.

Bowing fractures of the forearm in children: a long-term followup.

Eleven children with forearm bowing fractures were followed up after 80 months. They were evaluated specifically for pain, function, and cosmesis. Remodeling was assessed by comparing radiographs.

Laparoscopic repair of diaphragmatic Morgagni hernia.

A novel case of laparoscopic repair of a diaphragmatic hernia through the foramen of Morgagni in a 5-year-old boy is reported. The patient had a prompt and complete recovery, with no evidence of recurrence noted at 1 year after surgery. Laparoscopic repair is considered to be a suitable and safe procedure for the treatment of Morgagni hernia.

Orbital involvement in sinus pathology: often without ocular pain.

Many and diverse sinus pathologies can present with an orbital involvement. Contrary to popular belief, uncomplicated rhinosinusitis causes rarely orbital pain or headaches. However, especially in children, acute ethmoidal rhinosinusitis can be complicated by an extension of the infection into the orbit.

Soluble HLA-DR levels in serum are associated with therapy and genetic factors in rheumatoid arthritis.

As rheumatoid arthritis (RA) is an HLA-DR associated autoimmune disease and soluble HLA-DR (sHLA-DR) molecules have the capacity to regulate the immune response, we studied the sHLA-DR levels in RA patients in view of therapy modalities and clinical and biologic parameters of disease activity. For this sHLA-DR concentrations from 87 RA patients were determined by a sensitive enzyme-linked immunoabsorbent assay (ELISA) format. There was a weak but significant correlation between sHLA-DR levels and disease activity (r 0.

Circulating anti-prolactin auto-antibodies must be considered in the differential diagnosis of hyperprolactinaemia in adolescents.

Unlabelled: In four adolescents (two girls and two boys), who were investigated for galactorrhoea or short stature, we found moderately elevated serum prolactin (PRL) levels, but without a decreased gonadotropin and sex hormone production. Serum PRL levels were not responding to the intravenous injection of thyrotropin releasing hormone. Magnetic resonance imaging of the hypothalamic-pituitary region revealed no abnormality.