Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Dec 1998
Comment[Kidney donation by a 'non-heart-beating' donor from an ethical perspective].
In asystolic patients, kidney donation is possible by using a non-heart-beating (NHB) donation procedure. This involves in situ perfusion of the kidneys by inserting a catheter into the femoral artery and flushing cold fluid through the kidneys. The introduction of an NHB donation programme leads to ethical questions concerning the guarantees for prudent procedure: How should death of a patient be defined in case of NHB donation? Is there a strict separation of responsibilities of the medical teams in the different phases of the procedure (patient treatment and actual donation procedure)? Are sufficient attention and care given to the relatives? Does the NHB donation procedure not interfere with the care of a patient who is expected to die soon? Extensive discussion with the Medical Ethics Committee of the University Hospital Nijmegen, the Netherlands, has led to a protocol for NHB kidney donation that meets the required guarantees.
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Ned Tijdschr Geneeskd · Dec 1998
Case Reports[Lipodystrophy and 'buffalo hump' during treatment with HIV protease inhibitors].
In three patients, a 36-year-old HIV seropositive homosexual man and two women aged 35 and 59 years who had acquired HIV infection through heterosexual contact, signs of lipodystrophy developed after prolonged anti-HIV triple therapy. The observed syndrome is seen after prolonged use of HIV protease inhibitors: it is characterized by peripheral fat wasting, central fat accumulation, hyperlipidaemia and insulin resistance. ⋯ Lipodystrophy caused by protease inhibitors is a risk factor for cardiovascular disease. Recognition of the syndrome is essential for adequate follow-up and possible treatment.
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Ned Tijdschr Geneeskd · Dec 1998
[The Organ Donation Law: changes in the procurement of organs and tissues for transplantation].
The Organ Donation Act fills an old gap in the legislation, leading to improvement of the legal position of those involved. Much attention is given to the protection of the potential donor. ⋯ Hospitals and nursing homes are obliged to have a protocol for organizing tissue donation. Also, conditions have been created for a just division of the available organs and tissues for transplantation.
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What is a good doctor? From the 12th to the 19th century the doctor was mostly an intellectual largely restricted to observing and describing symptoms and diseases. The 19th century saw the beginning of scientific insight into the causes of diseases. ⋯ This involves both knowledge and art. Both arise from talent and education and are best achieved by early practical introduction to the basic subjects and scientific research, and during contacts with prominent teachers.
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Ned Tijdschr Geneeskd · Dec 1998
Editorial Comment[Who is the author and why? Will the scientific authorship be revised?].
There is much ado about medical and scientific authorship. The criteria for authorship as stated by the International Committee of Medical Journal Editors are debated. For readers, reviewers and editors it is of importance to know who is accountable and responsible for the contents of published articles. ⋯ This discussion has not come to a conclusion yet, but some journals (Journal of the American Medical Association (JAMA), British Medical Journal (BMJ), The Lancet) have already begun to publish the contribution(s) of individual authors (as stated by the authors themselves) at the end of their articles. The editors of the Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine) are also going to ask for the authors' contributions from January 1, 1999 and intend to publish them later on in the year in the same way as The Lancet does. The maximum number of 6 authors that is allowed now, may be lapsed since the contributions of all authors will be known.