Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Mar 2001
Case Reports[Hemicraniectomy for treatment of malignant medial cerebral artery infarction in 3 patients].
In three patients, a 52-year old man, a 54-year old man and a 17-year old woman, sudden neurological signs such as hemiparalysis and hemihypaesthesia developed, with diminished consciousness occurring at a later stage. Imaging revealed total infarction of the area supplied by the right middle cerebral artery with the threat of intracranial hypertension. Once informed consent had been obtained from the patient's representatives, hemicraniectomy with dural augmentation was performed. ⋯ Hemicraniectomy with dural augmentation prevents secondary brain damage caused by the space-occupying effect of the infarct. This operation reduces mortality considerably. The findings in these patients along with the results in the literature warrant a randomised study of the results of hemicraniectomy in patients with malignant middle cerebral artery infarction.
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Homozygous mutations of the ob gene, encoding leptin, are associated with severe obesity, hyperphagia and insulin resistance in humans. Leptin conveys a signal from adipose tissue to hypothalamic nuclei that integrate whole body fuel metabolism, informing those nuclei about the magnitude of fuel reserves. In the absence of leptin, the brain perceives energy availability as insufficient and therefore activates powerful mechanisms to restore fuel depots. If leptin synthesis or signal transduction is perturbed in the presence of food, a severely obese phenotype ensues.
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Ned Tijdschr Geneeskd · Mar 2001
Review[Screening for lung cancer in the Netherlands: the role of spiral CT scan].
The very poor prognosis of lung cancer has barely changed in the last two decades despite all efforts. However, prognosis is better when the disease is detected earlier, so that curative surgery or radiotherapy can be applied. Lung cancer screening in the past by chest X-ray did not lead to a decrease in lung cancer mortality, because the chest X-ray has low sensitivity for early invasive stages. ⋯ These questions can only be resolved in a randomised controlled trial with lung cancer mortality as unbiased end-point. Such a study should be initiated in the Netherlands, a country with large experience in screening trials and a good health care system. Only after lung cancer screening has proven to be cost-effective can appropriate implementation be recommended to prevent uncontrolled and opportunistic diffusion of this new screening technique into clinical practice in the near future.
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Ned Tijdschr Geneeskd · Mar 2001
[Significance of letters published in the Dutch Journal of Medicine, 1997/98].
To determine whether in the correspondence section of the Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine, NTvG) serious criticism is formulated or important mistakes in the original articles are pointed out. ⋯ Of the correspondence letters of the NTvG 4.1% contained scientific criticism which could have led to changes in the article if it had been known before publication.
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To assess the level of suboptimal care prior to cases of perinatal death and the extent to which perinatal mortality can be reduced by further improvements in care. ⋯ This regional audit revealed that further quality improvement of obstetric care is possible if clinical practice guidelines for effective and safe care are better implemented. It is expected that these improvements could reduce the perinatal mortality rate by between 6% and 25%.