Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jul 2000
Comment Review[Acute and chronic Q fever; epidemiology, symptoms, diagnosis and therapy of infection caused by Coxiella burnetii].
Q fever is a zoonosis caused by Coxiella burnetii, an obligate intracellular bacterium. Domestic ungulates and parturient cats are the primary reservoirs of infection. The animals excrete the bacterium in urine, faeces, milk and amniotic fluid. ⋯ Doxycycline is the antibiotic of choice in the treatment of Q fever. Endocarditis needs therapy for years with the addition of rifampin or hydroxychloroquine. Q fever is poorly recognised due to the variety of clinical presentations.
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Ned Tijdschr Geneeskd · Jun 2000
[Alterations of stage distribution for breast cancer since the implementation of national screening program in the Netherlands during 1989-1995].
To determine the results of the nation-wide breast cancer screening on the basis of the stage distribution of diagnosed breast cancer 1989-1995. ⋯ When the implementation scheme of the national screening programme is taken into account, the results are indicative of a reduction in breast cancer mortality. Whether such a mortality reduction actually will follow, has to be awaited.
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Ned Tijdschr Geneeskd · Jun 2000
Comment[Nationwide breast cancer screening fully accomplished; results from the implementation phase 1990-1997. National Evaluation Team for Breast Cancer Screening].
To present an overview of the main results of the nationwide breast cancer screening programme implemented in the Netherlands from 1990 to 1997 and providing a biennial mammography for all women aged 50-69 years. ⋯ Of almost 4 million women invited, 78.5% attended for screening. The screening resulted in 13.1 referrals, 9.2 biopsies and 6.1 breast cancers detected per 1,000 initially screened women, and in 6.9 referrals, 4.5 biopsies and 3.5 detected breast cancers per 1,000 subsequently screened women. All these parameters showed a clear variation at regional level. In the first 2 years after initial screens 0.96 interval cancers per 1,000 women-years were diagnosed (0.93 per 1,000 women-years after subsequent screens). Of all screen-detected cancers 76% were ductal carcinomas in situ (13%) or invasive cancers < or = 20 mm in size (63%); 26% of the invasive cancers were lymph node positive. This stage distribution was clearly more favourable than that of interval cancers and of the breast cancers diagnosed in unscreened women. The detection of breast cancer at subsequent screening was lower than expected and the staging of the carcinomas was less favourable than expected; the other results were largely in accordance with the expectations.
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Ned Tijdschr Geneeskd · May 2000
Review Historical Article[Fifty years of plastic surgery in the Netherlands. VI. Microsurgery].
Use of the operating microscope created many new possibilities in plastic, reconstructive and hand surgery. Initially most work was done in digital replantation and, somewhat later, in transfers of toes for reconstruction of amputated thumbs. Microvascular surgery, however, appeared to be a technique suitable for more applications. ⋯ With free flap surgery single-stage and complex reconstructions could be achieved leading to earlier mobilization and better restoration of function with a shorter hospital stay. Today, microvascular free tissue transfer is an essential part of plastic and reconstructive surgery. Further advances in microsurgery and free tissue transfers deserve to be mentioned: pre-fabrication of free flaps, reduction of donor site morbidity, development of artificial conduits and instrumentation and finally homologous transplantations.