[Emergency ambulance call-outs often provide primary care].

Objective: To examine patient and care characteristics of emergency ambulance call-outs and to determine how many of them were, in retrospect, effectively providing primary care.

Design: Retrospective cross-sectional study.

Method: We charted patient and care characteristics of 598 emergency ambulance call-outs in the Zuid-Gelderland region in the east of the Netherlands by applying a retrospective dossier analysis method.

[Merkel cell carcinoma during treatment with TNF-alpha inhibitors: coincidence or warning?].

Background: Increasing numbers of patients are being treated with TNF-alpha inhibitors. Two patients in our outpatient clinic developed Merkel cell carcinoma during treatment with TNF alpha inhibitors. Since this is a very rare malignancy, this is a remarkable observation.

The modified Honig velopharyngoplasty - a new technique to treat hypernasality by palatal lengthening.

Background: Palatal lengthening by pushback with a pharyngeal flap is a commonly used operative technique for the treatment of velopharyngeal insufficiency. The conventional Honig velopharyngoplasty uses full thickness mucoperiosteal flaps for the oral lining of the defect.

Purpose: A modification is described using only mucosal flaps, thus preserving the periosteum and the palatine arteries.