Nederlands tijdschrift voor geneeskunde
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Current dietary advice with a view to avoiding cardiovascular pathology is to replace fatty foodstuffs and those rich in saturated fat and cholesterol by food rich in complex carbohydrates. Although substitution of carbohydrates for fat lowers the blood level of low-density lipoprotein (LDL) cholesterol, it also lowers the level of high-density lipoprotein (HDL) cholesterol, thereby adversely influencing the risk profile for cardiovascular disease. ⋯ Carbohydrates should be provided by fruits, vegetables, leguminous plants and whole-wheat products. Persons of about the ideal weight should replace saturated and trans-fatty acids in their diet by unsaturated plant oils, and products with refined carbohydrates by fruits, vegetables and whole-wheat products.
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Ned Tijdschr Geneeskd · Apr 1998
Case Reports[Right-sided diverticulitis mimicking acute appendicitis].
The probability diagnosis in two patients, women aged 43 and 41 years, who for the last few days had had pain in the right lower abdomen, without nausea or vomiting, was acute appendicitis; a third patient, a woman aged 49 with the same symptoms, had undergone appendectomy in the past. Peroperative findings and, in two patients, microscopy of the resected specimen showed diverticulitis in the caecum or ascending colon. ⋯ In the absence of perforation or abscess, conservative treatment suffices. Otherwise, resection of the colon is necessary.
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Ned Tijdschr Geneeskd · Apr 1998
Review[The cochlea: modern physiologic insights into sensorineural hearing loss].
The cochlea is organized tonotopically: each frequency between 20 Hz and 20 kHz has its own location on the basilar membrane. In addition the cochlea has a large dynamic range (sound intensity). Active movements of the outer hair cells of the sensory organ of Corti play a crucial part in determining hearing acuity and frequency selectivity. ⋯ Damage of outer hair cells impairs the cochlear amplifier, leading to loss of sensitivity to soft sounds and loss of frequency selectivity. Damage to the inner hair cells has much the same effect as conductive hearing loss. Tinnitus is not caused by otoacoustic emissions, but probably by denervation hypersensitivity following loss of cochlear input.
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Ned Tijdschr Geneeskd · Apr 1998
[The contribution of general practice medicine to undergraduate medical education].
The Blueprint 1994. Objectives of undergraduate medical education, was issued in 1994 and has since been used as a guideline by the eight medical faculties in the Netherlands. This prompted a team of representatives of all eight Institutes for General Practice Medicine of the country to describe the contribution of general practice medicine to undergraduate medical education. ⋯ Out of the approximately 250 problems from the general problem list of the Blueprint, 134 were assigned to general practice medicine: 89 in view of their high incidence in general practice, 15 because of the emergency nature, since GPs are easily accessible, 12 in which a major disease has to be excluded and 18 regarding chronic conditions. In this way, insight is provided into the matters regarding which medical faculties can address departments of general practice medicine about the curriculum to be drawn up. It appears advisable that other specialisms as well should define their potential contributions to undergraduate medical education and the relevant priorities.
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Ned Tijdschr Geneeskd · Mar 1998
[Perioperative mortality and the role of anesthesiologic activity at the Vrije University Hospital in Amsterdam].
To determine the perioperative mortality and the share of anaesthesiological activity in it. ⋯ The mortality rate within 7 days after a clinical surgical intervention was 0.5%. A connection with anaesthesiological activity was present in 2.5 per 10,000 operations.