Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Nov 2004
Review[Medicinal cannabis for diseases of the nervous system: no convincing evidence of effectiveness].
--In 1996, the Netherlands Health Council issued a negative recommendation regarding the use of medication on the basis of cannabis (marihuana). However, interest in medicinal cannabis has certainly not waned since. --The neurological diseases for which cannabis could presently be used therapeutically are: multiple sclerosis, chronic (neuropathic) pain and the syndrome of Gilles de la Tourette. --Since September 2003, the Dutch Ministry of Health, Welfare and Sport delivers medicinal cannabis to Dutch pharmacies, so that now for the first time, medicinal cannabis can be given to patients on a prescription basis within the framework of the Opium Law. ⋯ There was no significant effect of treatment on the primary outcome measure, i.e. objectively determined spasticity. Nevertheless, it was concluded that the mobility was improved and that the pain was subjectively decreased. --Until now, convincing scientific evidence that cannabinoids are effective in neurological conditions is still lacking. --However, it is also not possible to conclude definitely that cannabinoids are ineffective; still, this is no basis for official stimulation of their use.
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Ned Tijdschr Geneeskd · Nov 2004
Review[The value and limitations of the body mass index (BMI) in the assessment of the health risks of overweight and obesity].
--The Body Mass Index (BMI) is used as a measure of overweight and obesity. In epidemiological studies age, sex and ethnic background all have to be taken into consideration, particularly when determining the health risk caused by the amount of body fat. --Caution should be observed when using the BMI as a measure for interpreting overweight and obesity as body composition can be highly variable yet have the same BMI. ⋯ The BMI does not give any insight into regional body fat distribution. Waist circumference is a valid index of visceral fat accumulation and can therefore be used as an indicator of health risks associated with visceral obesity.
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Ned Tijdschr Geneeskd · Nov 2004
[Ending a patient's life without a request: time for a good assessment procedure].
Empirical studies have shown that in approximately 900 cases per year, Dutch physicians end a patient's life without his or her explicit request. These cases involve mostly incompetent patients with cancer, but also severely handicapped newborns. In 1994, the Dutch government made it mandatory for physicians to report these cases to the public prosecutor. ⋯ One option might be to introduce a separate category in criminal law. The medical profession favours a system in which the reported cases are analysed by a multidisciplinary committee consisting of a lawyer, a physician, and an ethicist. It is expected that such a system would increase the willingness to report cases.
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A 68-year-old man under systemic corticosteroid treatment was diagnosed with widespread pediculosis caused by Phthirus pubis.
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Ned Tijdschr Geneeskd · Nov 2004
Review[Risk factors for skin melanoma: genetic factors probably more important than exposure to sunlight].
Pigmented naevi (moles) are increasingly regarded as risk factors for the development of melanoma. The probability of melanoma developing from congenital naevi is proportional to the volume of the naevi. The risk of melanoma development from large naevi (diameter > 20 cm) is already present in the early years of childhood. ⋯ Recent research has shown that dysplastic naevi synthesise more phaeomelanin. There are also strong indications that dysplastic naevus cells suffer from chronic oxidative stress. This situation can lead to hypermutability and genetical instability.