[Duplicate publication of articles in the Dutch Journal of Medicine in 1996].

Objective: To determine the number of undisclosed/disclosed duplicate publications of original articles (OA) in the Nederlands Tijdschrift voor Geneeskunde (NTvG).

Design: Retrospective bibliometric study.

Method: All biomedical articles published in January 1994-June 1998 and written by the first or second author of the 148 OA published in 1996, were compared with the articles in the NTvG at the editorial office of the NTvG.

[Physical diagnosis--paradoxical pulse].

Pulsus paradoxus is generally defined as a decline in the systemic systolic blood pressure by more than 10 mmHg during inspiration. The main clinical situations in which a paradoxical pulse may be observed are inflow obstruction into the heart (as in exsudative pericarditis or cardiac tamponade) or extreme respiratory variations in intrathoracal pressure (as during an asthma attack). However, clinical studies indicate that in both situations the predictive value of a present or absent pulsus paradoxus is rather limited.

[Physical examination--the significance of Homan's sign].

Homans's sign is often used in the diagnosis of deep venous thrombosis of the leg. A positive Homans's sign (calf pain at dorsiflexion of the foot) is thought to be associated with the presence of thrombosis. However, Homans's sign has a very poor predictive value for the presence or absence of deep vein thrombosis, like any other symptom or clinical sign of this disease.

[Selective estrogen-receptor modulators (SERM's) in postmenopausal women].

Selective oestrogen receptor modulators (SERMs) constitute a group of new drugs which mimic oestrogen in some organs and tissues but have an oestrogen antagonistic mode of action in other tissues. In postmenopausal women these compounds have a favourable effect on lipoprotein cholesterol levels in the blood and bone mineral density, thereby reducing fracture risk, especially in the vertebral column. In contrast to oestrogen therapy SERMs reduce the risk of mammary carcinoma.

Environment and behavior of 2.5-million-year-old Bouri hominids.

The Hata Member of the Bouri Formation is defined for Pliocene sedimentary outcrops in the Middle Awash Valley, Ethiopia. The Hata Member is dated to 2.5 million years ago and has produced a new species of Australopithecus and hominid postcranial remains not currently assigned to species.

Measurement and classification of retinal vascular tortuosity.

Automatic measurement of blood vessel tortuosity is a useful capability for automatic ophthalmological diagnostic tools. We describe a suite of automated tortuosity measures for blood vessel segments extracted from RGB retinal images. The tortuosity measures were evaluated in two classification tasks: (1) classifying the tortuosity of blood vessel segments and (2) classifying the tortuosity of blood vessel networks.

Learning foraging thresholds for lizards: an analysis of a simple learning algorithm.

This paper gives proof of convergence for a learning algorithm that describes how anoles (lizards found in the Caribbean) learn foraging threshold distance. An anole will pursue a prey if and only if it is within this threshold of the anole's perch. The learning algorithm was proposed by Roughgarden and his colleagues.

[The percentage of articles which were accepted or rejected for publication in the Dutch Journal of Medicine in 1997].

Objective: To determine the acceptance and rejection percentages of articles submitted to the editors of the Nederlands Tijdschrift voor Geneeskunde (NTvG) in 1997.

Design: Retrospective.

Method: The data on all articles reviewed by the editors of the NTvG in 1997 were extracted from the registration system in April 1998.

Immune determinants of organism and outcome in febrile hospitalized Thai patients with bloodstream infections.

Opportunistic infections (OI) and the human immunodeficiency virus (HIV) cause significant morbidity and mortality in developing countries. Immune cell and cytokine profiles may be related to the type and course of OI and to the OI-HIV interaction. Examining cell-specific cytokine production ex vivo has only recently become feasible.

Primary ovarian mucinous cystadenocarcinomas: a clinicopathologic study of 49 cases with long-term follow-up.

Prognostic data for ovarian mucinous carcinoma are limited and difficult to interpret because of differing diagnostic criteria and inclusion of secondary tumors. To better characterize these neoplasms, 49 primary ovarian mucinous tumors diagnosed as carcinoma by the Hart and Norris criteria and staged by the FIGO system were studied. Forty-four tumors (90%) were stage I, four were stage III and one was unstaged.

[Fifty years of the column 'Question and Answer'].

The section 'Question and answer' in the Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine) has existed for over 50 years. Medical questions of readers are published anonymously and answered by an anonymous expert consulted by the editorial staff. At first the column grew rather large but in the last few decades it shrank to only few publications a year.

Adenoid basal epitheliomas of the uterine cervix: a reevaluation of distinctive cervical basaloid lesions currently classified as adenoid basal carcinoma and adenoid basal hyperplasia.

A series of 12 adenoid basal carcinomas and three adenoid basal hyperplasias of the cervix were analyzed. The ages of the patients with adenoid basal carcinoma ranged from 30 to 91 years with a mean of 71 years. Pap smear results for 11 of 12 (92%) were abnormal.

Cost analysis of palliative care for terminally ill cancer patients in the UK after switching from weak to strong opioids. Palliative Care Advisory Committee.

Objective: We constructed a UK-based decision model of palliative care for terminally ill cancer patients who were switched from a weak to a strong opioid so that the expected direct healthcare costs in the UK could be estimated from the time a patient commenced a strong opioid until death.

Design: Decision analysis techniques were used to estimate the expected total direct healthcare cost per patient, stratified according to the first choice of strong opioid. The model was based on prescription data on 1975 terminally ill cancer patients who were on the Intercontinental Medical Statistics database, Mediplus (IMS Ltd, Middlesex, England).

Metastatic intestinal carcinomas simulating primary ovarian clear cell carcinoma and secretory endometrioid carcinoma: a clinicopathologic and immunohistochemical study of five cases.

Five cases of ovarian metastases of intestinal adenocarcinomas that suggested the diagnosis of clear cell adenocarcinoma or the secretory variant of endometrioid carcinoma of the ovary are reported. Patient age ranged from 27 to 71 years at the time of diagnosis of the ovarian neoplasms. In four, the ovarian and intestinal tumors were discovered synchronously, and, in the fifth, the ovarian metastasis occurred 1 year after the intestinal primary was diagnosed.

Apoptotic bodies: a consistent morphologic feature of endocervical adenocarcinoma in situ.

To evaluate the occurrence of apoptotic bodies in endocervical adenocarcinoma in situ (AIS) and investigate the relationship of apoptosis to mitotic activity, we performed counts of apoptotic bodies and mitotic figures in 43 patients with AIS and in a comparable control group with nonneoplastic endocervical glandular epithelium. The ages of the patients with AIS ranged from 27 to 74 years (mean = 40). Mitotic figures were present in all AIS cases, and apoptotic bodies were seen in all but two extremely small lesions.

Perianal Paget's disease: a histologic and immunohistochemical study of 11 cases with and without associated rectal adenocarcinoma.

Perianal Paget's disease is rare, and its relationship to an associated internal regional cancer has been ill defined. We analyzed the histologic and immunohistochemical features of perianal Paget's disease in 11 patients to determine the frequency and relationship of associated regional internal carcinoma and to gain insight into its histogenesis. Of five patients with documented rectal adenocarcinoma, it was discovered synchronously with the Paget's disease in four and, subsequently, in one.

Barnidipine, a novel calcium antagonist for once-daily treatment of hypertension: a multicenter, double-blind, placebo-controlled, dose-ranging study. Dutch Barnidipine Multicenter Study Group.

The antihypertensive effects and tolerance of once-daily barnidipine, a novel dihydropyridine calcium antagonist, were evaluated. A total of 190 patients with a sitting diastolic blood pressure (DBP) of 95-114 mmHg were investigated in this multicenter, double-blind, placebo-controlled, dose-ranging study. After a 4-week single-blind placebo run-in period, patients were randomized to placebo or barnidipine (10 mg, 20 mg, or 30 mg modified release capsules) once daily for 6 weeks.

[Costs of known diabetes mellitus in Spain].

Background: Diabetes mellitus is an important cause of mortality and morbidity in western nations with high costs for both patients and health care systems.

Material And Methods: Based on the latest epidemiological studies and in combination with Spanish demographic data the direct health care costs of known diabetes mellitus were estimated for the following areas: hospitalisation directly due to the disease, hospitalisation due to certain chronic complications such as acute myocardial infarction, amputations and renal disease (dialysis and transplant), outpatient visits, consumption of anti-diabetic medication, self-control, analyses, additional explorations and camps for diabetic children.

Results: In 1994, the total direct costs of diabetes mellitus in Spain were estimated to be more than 90,000 millions pesetas in a population of more than 1,400,000 known diabetic persons.

Congenital optic tract syndrome: magnetic resonance imaging and scanning laser ophthalmoscopy findings.

Lesions of the optic tract produce a distinctive pattern of optic atrophy and visual field loss and may be due to either congenital or acquired causes. We report a case of a congenital optic tract syndrome and correlate the magnetic resonance imaging findings with the appearance of nerve fiber layer defects found by confocal scanning laser ophthalmoscopy.

Bizarre leiomyomas of the uterus: a comprehensive pathologic study of 24 cases with long-term follow-up.

A series of 24 bizarre (symplastic, pleomorphic) leiomyomas was analyzed to determine their spectrum of gross and microscopic features and to establish their clinical behavior by obtaining long-term follow-up. Patients' ages ranged from 25 to 51 years (mean 40.7).

Pure embryonal rhabdomyosarcoma of the fallopian tube.

Rhabdomyosarcoma is a neoplasm of childhood which commonly arises in the genitourinary tract. Reported locations include the bladder, prostate, paratestis, vagina, uterus, cervix, and ovary. Rhabdomyosarcomas have been reported to occur in the fallopian tube only as a component of a malignant mixed müllerian tumor.

Vulvar Paget's disease: a clinicopathologic and immunohistochemical study of 19 cases.

Vulvar Paget's disease (VPD) is the most common type of extramammary Paget's disease; however, the frequency of dermal invasion and its clinical significance are unclear, as are the frequency and relationship of an associated regional internal cancer. Thus, we studied the clinicopathologic and immunohistochemical features of 19 patients with VPD. Patients ranged in age from 56 to 86 years (median 65).

Lattice and off-lattice side chain models of protein folding: linear time structure prediction better than 86% of optimal.

This paper considers the protein energy minimization problem for lattice and off-lattice protein folding models that explicitly represent side chains. Lattice models of proteins have proven useful tools for reasoning about protein folding in unrestricted continuous space through analogy. This paper provides the first illustration of how rigorous algorithmic analyses of lattice models can lead to rigorous algorithmic analyses of off-lattice models.