The status of euthanasia in The Netherlands.
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Advance Directives↗
Biomedical subjects
W Hart
Publications and source records attributed to W Hart.
[Diagnostic image (8). Amebic colitis].
A 34-year-old woman suffered from progressive abdominal pain and diarrhoea. Laparotomy revealed colonic perforation due to amebic colitis.
Abdominal Pain↗
[Recommendations for calcium and vitamin D in the report 'Nutritional standards' of the Netherlands Health Council].
The Health Council of the Netherlands has issued a report on the recommended use of calcium, vitamin D and a number of other vitamins. The recommendations for calcium and vitamin D have been adjusted (upward) in view of recent evidence that these nutrients affect the occurrence of osteoporosis and bone fractures in all stages of life.
Adult↗
[Clinical thinking and decision-making in practice. A pregnant Turkish woman with a liver tumor].
A 30-year-old Turkish woman suffered from pain in the right upper abdomen during the 32nd week of her third pregnancy. On ultrasound a liver tumour was diagnosed. The patient was followed without treatment during pregnancy. The outcome of the pregnancy was uncomplicated. The diagnosis of focal nodular hyperplasia was made post partum using MRI with contrast and a liver biopsy. The born son suffered the syndrome of Klippel-Trenaunay-Weber, also a vascular malformation. A liver tumour during pregnancy can influence the outcome of the pregnancy, but the pregnancy may also affect the progression of tumour growth. Considerations regarding the diagnostic evaluation and treatment should be made with caution. Ultrasound and MRI are well established methods to diagnose a liver tumour during pregnancy. The duration of the pregnancy is important in the diagnostic and therapeutic approach to the tumour.
Adult↗
[Diagnostic image (5) (Ileum pathology)].
In a 28-year-old woman Crohn's disease was diagnosed. She had drug treatment but the situation deteriorated and ileocoecal resection was carried out. In the surgical specimen the diagnosis was confirmed.
Adult↗
[Diagnostic image (I). Staphylococcal endocarditis].
A 48-year-old man had high fever and paralysis of the left leg, caused by an infectious endocarditis from which Staphylococcus aureus was cultured.
Aortic Valve↗
[Clinical thinking and decision making in practice. A patient with persistent fever].
A 20-year old man was admitted to hospital with fever and malaise after travel to India. He was soon found to have typhoid fever, caused by a multi-drug resistant Salmonella typhi. According to in-vitro resistance testing he was treated with cefotaxim, but fever and shivering were still present after 7 days of cefotaxim, with liver enzyme disturbances. The physicians caring for him started an extensive search for possible complications of typhoid fever, and they thought of the possibility of an alternative disease to explain the fever. When cefotaxim was stopped all symptoms and signs disappeared. During every medication, drug fever is a possibility. This diagnosis can only be supported by discontinuing the use and if necessary, restarting it (dechallenge and rechallenge).
Adult↗
[Increase of the proportion of women physicians published in the Dutch Journal of Medicine (1948-1998), stable proportion of male physicians].
OBJECTIVE: To determine the number of female authors in six volumes of the Nederlands Tijdschrift voor Geneeskunde (NTvG) and the number of physicians who contributed to at least one article in those volumes. DESIGN: Retrospective. METHOD: We counted the number of articles in the NTvG in 10 different article categories in volumes 1948, 1958, 1968, 1978, 1988 and 1998. The number of authors and the sex and profession of the authors were registered. No author was counted more than once per volume. The results were compared with the number of physicians in the Netherlands in those years. RESULTS: In the first 4 volumes studied 3-5% of the total number of authors were female (n = 19; 22; 21; 16); this increased to 10 and 21% in 1988 (125) and 1998 (326). The percentage of female physicians who contributed to at least one article in one volume was 0.7% in 1948 (5) and 1958 (9), and increased to 1.0 (83) and 1.4% (211) in 1988 and 1998. The percentage of male physicians who contributed to at least one article fluctuated between 2.4 (471) and 3.1% (325) between 1958 and 1998. The mean number of authors per article increased from 1.2 in 1948 (354 articles) to 3.3 in 1998 (472 articles). CONCLUSION: The number of female authors steadily increased in the past fifty years. The percentage of female physicians that contributed to at least one article in the NTvG doubled in the volumes investigated, while the percentage of male physicians remained stable.
Authorship↗
[Physical diagnosis--percussion and palpation of liver].
Percussion and palpation of the liver can produce useful information regarding size, consistency and the surface of the lower liver edge. However, the accuracy of the physical examination of the liver is limited, especially concerning the predictive value of the absence at physical examination of hepatomegaly (> or = 15 cm liver width in the right midclavicular line) for the absence of a truly enlarged liver. Also, the inter-observer variability may be considerable. These limitations of the test may be partly due to a number of pitfalls and misconceptions concerning physical examination of the liver.
Hepatomegaly↗
[Clinical thinking and decision making in practice. A severely ill elderly man with icterus].
A 74-year-old man was admitted to hospital because of jaundice and malaise of several weeks' duration. Five years earlier he had sustained a stroke from which he had recovered almost completely. On physical examination he was overweight and had an enlarged liver. Laboratory values were consistent with cholestasis and hepatitis. An abdominal ultrasound showed multiple nodular abnormalities in the liver consistent with a malignancy. Rapidly developing abnormalities in blood coagulation were thought to be a contraindication to hepatic biopsy. The patient deteriorated and sustained a new stroke. The physicians were convinced that he had cancer and could not be cured. They planned further diagnostic studies, but at the same time made an advance directive for non-resuscitation. Three days after admission the patient was found dead; no consent for an autopsy was obtained. If it is suspected that a patient is suffering from a malignant disease, the malignancy should be demonstrated or excluded as quickly as possible in the least uncomfortable way. Also, the patient and his family should be informed of any restriction on the possibilities of treatment.
Aged↗
[Man with cherubism].
Cherubism was diagnosed in a male when he was 6 years old. Cherubism is a benign, bilateral, painless lesion. It is commonly located in the mandible but in a minority of patients also in the maxilla. Cherubism is a familial condition with an autosomal dominant pattern of inheritance. At least one member of the family of the patient described had cherubism. The disease becomes manifest during early childhood and progresses until puberty when it spontaneously regresses. In the majority of patients no treatment is required. However, in the patient presented surgical procedures and odontological corrections were necessary. Due to a flare-up of the disease at the age of 22 years, the patient was treated with calcitonin for 1 year followed by bisphosphonates. During these treatments the disease symptoms diminished.
Adult↗
Priority setting in public health and health services research.
Models for strategic priority setting in public health and health services research typically lack coherence or omit key considerations. We propose a new model, the Seven 'I's, with seven components: innovation, identification, inequalities, incorporation, importance, influences, and interventions. It tests the 'relevance' of research, while 'excellence' will be evaluated using existing criteria for peer review. It should be used to set research priorities primarily on the basis of expected health benefits, with adjustments for other non-health benefits as necessary. We discuss each component and compare our approach to other models. We argue that our model helps ensure resource allocation is transparent and accountable, and encourages the link to population health gains. It is flexible, and is applicable to both commissioned and investigator-driven research. It may be applied to assess existing proposals, or to generate research ideas.
Australia↗
HLA-B27 expression and reactive arthritis susceptibility in two patient cohorts infected with Salmonella Typhimurium.
BACKGROUND: Reactive arthritis (ReA) is an inflammatory arthritis triggered by certain gastrointestinal and genitourinary infections. Single source outbreaks of triggering infections provide an opportunity to elucidate host susceptibility factors in this disease. AIM: To determine the role of Major Histocompatibility Complex (MHC) Class I alleles in ReA susceptibility after two large single source outbreaks of Salmonella Typhimurium gastroenteritis. METHODS: A questionnaire screening for features of ReA and a request for HLA class I typing were sent to all patients affected by two single source outbreaks of S. Typhimurium gastroenteritis. Individuals with arthritis of recent onset were interviewed, examined and diagnostic criteria for ReA applied. RESULTS: Nineteen cases of reactive arthritis, 11 female, were diagnosed in the 424 respondents with S. Typhimurium gastroenteritis from both outbreaks. Clinical features of the arthritis were similar to those described after other large single source outbreaks of Salmonella infection. HLA-B27 was expressed by only two of the 19 ReA patients and therefore did not predict susceptibility to this form of arthritis. Caucasians were, however, more likely to develop reactive arthritis than Asians. CONCLUSIONS: In this study, susceptibility to ReA was not increased in HLA-B27 positive individuals or males but was greater in those of Caucasian descent.
Adolescent↗
[Importance of supplementary testing for diagnostic proficiency at the bedside].
Two patients are described who were originally published in Reports of medical cases (1827; 1831) by Richard Bright. The first patient suffered from haematuria and oedema (dropsy) and died after acute epiglottitis. At autopsy the kidneys were swollen and haemorrhagic (acute glomerulonephritis in present terms). The second patient died after two episodes of acute headache and decreased consciousness. At autopsy an aneurysmatic dilatation of a brain artery was found. Today the diagnosis of acute glomerulonephritis or subarachnoid haemorrhage would have been made from the history and physical examination, and newly developed laboratory and histological techniques would have been helpful in securing it. But even nowadays, clinical skills are still continually expanding by feedback from new diagnostic techniques.
Acute Disease↗
[From the library of the Dutch Journal of Medicine: Richard Bright (1789-1858) and his 'Reports of Medical cases'].
At the beginning of the 19th century, medicine underwent an important metamorphosis. The emphasis shifted from function to structure, and from organism to organ. This went hand in hand with the development of the physical examination. The founders of the new movement were Italian and French. In Great Britain, Richard Bright (1789-1858) was an important pioneer. In his books Reports of medical cases, published in 1827 and 1831, with many colour plates, Bright correlated clinical features with morphological changes found at autopsy. He became most famous for showing the relationship of dropsy, coagulable urine and kidney changes. Acute glomerulonephritis is named after him. With Addison and Hodgkin he contributed to the fame of Guy's Hospital in London.
Eponyms↗
[Duplicate publication of articles in the Dutch Journal of Medicine in 1996].
OBJECTIVE: To determine the number of undisclosed/disclosed duplicate publications of original articles (OA) in the Nederlands Tijdschrift voor Geneeskunde (NTvG). DESIGN: Retrospective bibliometric study. METHOD: All biomedical articles published in January 1994-June 1998 and written by the first or second author of the 148 OA published in 1996, were compared with the articles in the NTvG at the editorial office of the NTvG. Resemblances in the objective, study design, study population between the different articles were observed. The researchers assessed whether the same article had been published twice or more and whether this was acceptable or redundant (according to the criteria of the International Committee of Medical Journal Editors). RESULTS: In 1996 the NTvG published 30 (20%) OA which were also published elsewhere. In 23 cases (77%) the article was first published in another scientific journal and in 7 cases (23%) the article was published once again after its appearance in the NTvG. In 20 duplicate articles in the NTvG a footnote with a reference to the first publication was present. In 10 duplicate articles no such footnote could be found. In comparison with a similar study of the years 1990-1992 the number of duplicate publications was the same but the fraction of correctly disclosed duplicate publications had risen from 5/23 (22%) to 16/22 (73%) (p < 0.001).
Bibliometrics↗
[Physical diagnosis--paradoxical pulse].
Pulsus paradoxus is generally defined as a decline in the systemic systolic blood pressure by more than 10 mmHg during inspiration. The main clinical situations in which a paradoxical pulse may be observed are inflow obstruction into the heart (as in exsudative pericarditis or cardiac tamponade) or extreme respiratory variations in intrathoracal pressure (as during an asthma attack). However, clinical studies indicate that in both situations the predictive value of a present or absent pulsus paradoxus is rather limited.
Airway Obstruction↗
[Physical examination--the significance of Homan's sign].
Homans's sign is often used in the diagnosis of deep venous thrombosis of the leg. A positive Homans's sign (calf pain at dorsiflexion of the foot) is thought to be associated with the presence of thrombosis. However, Homans's sign has a very poor predictive value for the presence or absence of deep vein thrombosis, like any other symptom or clinical sign of this disease.
Humans↗