Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Nov 2000
Comparative Study[Multidisplinary approach to chronic back pain: postrehabilitation resumption of work the same 3-4 years later as after 6 months].
To determine the results of a multidisciplinary programme for people with chronic back pain 3 to 4 years post-programme. ⋯ The percentage of people who permanently returned to work following the multidisciplinary approach to chronic back pain, remained stable over a period of 3 to 4 years. The results were comparable to those obtained at 6 months post-programme.
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Ned Tijdschr Geneeskd · Nov 2000
Biography Historical Article[Nobel prize in physiology of medicine for year 2000 for research of signal transduction in the nervous system].
The three Nobel laureates Arvid Carlsson, Paul Greengard and Eric Kandel have made pioneering discoveries concerning slow synaptic transmission between neurons. As common theme, for which the Nobel Prize in Physiology or Medicine for 2000 is given, the Nobel Assembly chose 'signal transduction in the nervous system'. The work of Carlsson led to the discovery of dopamine as transmitter in the brain and opened the way for the development of the levodopa therapy of patients suffering from Parkinson's disease. ⋯ Most of his work was carried out in the sea slug Aplysia in which he was able to relate three psychologically defined forms of learning--habituation, sensitisation, and classical conditioning--to subcellular processes and intercellular signalling. Kandel is known all over the world for his eminent textbook Principles of Neural Science which inspired generations of young neuroscientists. It seems that it is not so much the signal transduction that joins these laureates but their outstanding conceptual approach to, in fact, three different themes of the neurosciences during the second part of the last century.
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Ned Tijdschr Geneeskd · Nov 2000
[An outbreak of scarlet fever, impetigo and pharyngitis caused by the same Streptococcus pyogenes type T4M4 in a primary school].
EPIDEMIC: Following the notification of an unusual number of scarlet fever cases within the same primary school, the epidemiological and clinical features of the outbreak were investigated. Questionnaire information about the cases was collected from parents and general practitioners per telephone. Throat specimens were taken, before and after treatment, for culturing and specific typing of streptococci was performed to determine transmission. Within a period of one month, 21 schoolchildren in a class of 29 pupils, with a mean age of 5 years, presented with symptoms caused by streptococcal infection (attack rate: 72%). Eight had scarlet fever, 5 suffered from impetigo and 8 had pharyngitis. A further 6 children, outside of this class, had complaints of scarlet fever, impetigo or pharyngitis. For 90% (26/29) of the schoolchildren a throat culture was established. Twelve positive cultures of the same strain of beta-haemolytic group A streptococcus, T4M4 exotoxin C gene positive, were found. The advice given was to treat all positive children for 3 days with azithromycin to prevent complications and further spreading of the disease. After two weeks only one child, that had not taken the antibiotics, still had a positive throat culture. No further cases or complications were reported. ⋯ The pattern of the outbreak was typical of a person-to-person transmission. This was confirmed by typing of the isolates. The results of this study demonstrate the importance of mandatory notification of infectious clusters by institutions, such as schools, as introduced in the new Dutch Infectious Disease Act. On the one hand, the notification gives the municipal health authority the opportunity to analyse source and transmission dynamics and on the other to prevent disease and complications.
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The majority of influenza cases are not associated with complications. Secondary bacterial pneumonia, commonly caused by Streptococcus pneumoniae or Staphylococcus aureus, is well known to most clinicians. Primary influenza viral pneumonia, characterized by rapidly progressive hypoxia and respiratory insufficiency together with non-consolidating pulmonary infiltrates, has a high mortality rate. ⋯ In the latter two patients the virus was cultivated from sputum. Despite intensive supporting and drug treatment, the first and the last patients died. In view of evolving therapeutic possibilities, notably regarding neuraminidase inhibitors, it is important that clinicians recognize this complication of influenza at an early stage.