[The ICD in the terminal stage].

ICDs are used to prevent sudden death caused by ventricular fibrillation. The number of patients with an ICD will keep growing. ICD shocks can severely disturb the dying process in terminally ill patients.

[A newborn with a tumour on the tongue and alveolar ridge].

In a newborn boy, a tumour was seen on the tongue and mandibula. A diagnosis of congenital epulis was made. This usually pedunculated tumour is present at birth and located on the maxillary or mandibular alveolar ridge (more commonly on the maxilla), but rarely on the tongue.

[Summary of the Dutch College of General Practitioners' practice guideline on food hypersensitivity].

October 2010 the Dutch College of General Practitioners issued a revised version of their previous practice guideline of 1995 on food hypersensitivity in infants. If patients suspect either themselves or their child of having a food allergy, this is usually not demonstrated in subsequent investigation. Wrongly prescribed elimination diets may have adverse effects.

[Summary of Dutch College of General Practitioners guidelines on "Rectal bleeding"].

Rectal bleeding is often caused by a harmless disorder such as haemorrhoids or an anal fissure, but may be a symptom of colorectal cancer or inflammatory bowel disease. Risk factors for colorectal cancer are: older age (arbitrary > 50 years), a first-degree relative aged < 70 years with colorectal cancer, change in bowel habit, blood mixed with stools and the absence of anal or perianal symptoms. Colonoscopy should be performed when colorectal cancer is suspected.

[Summary of the practice guideline 'Prevention and early diagnosis of cervical cancer' of the Dutch College of General Practitioners].

A persistent infection with human papillomavirus (HPV) underlies all cases of cervical cancer. HPV testing is repeated 6 months after initial Pap smears 2 or 3a1. As vaccination against HPV is now included in the National Immunisation Programme of the Netherlands, yearly cervical cancer morbidity and mortality rates are expected to be cut by half.