[Infection with human parvovirus B19 ('fifth disease') during pregnancy: potential life-threatening implications for the foetus].

Four pregnant women, aged 29, 32, 36 and 36 years, respectively, were diagnosed with Human parvovirus B19 (B19V) infection. Only the first woman had exanthema and fever. In the first three cases, the source of infection appeared to be another child; two of these children were infected during a school outbreak.

[Natural orifice translumenal endoscopic surgery].

Over the past few decades gastrointestinal endoscopy has developed from a purely diagnostic technique to one having numerous therapeutic gastrointestinal applications. Simultaneously, minimal invasive surgery is increasingly replacing traditional open abdominal procedures. These trends have led to a new and innovative way of accessing the peritoneal cavity through the orifices of the body (mouth, anus and vagina) by means ofendoscopic surgery: natural orifice translumenal endoscopic surgery (NOTES).

[Clinical applicability of the term 'transient neurological attack'].

Transient neurological symptoms not fulfilling the criteria for TIA are a problem often encountered in clinical practice. In a large cohort from the Rotterdam study, it was found that these 'transient neurological attacks' (TNA) increase the risk of future cardiovascular events and dementia. However, the group of patients diagnosed with TNA concerns a heterogeneous group with a wide variety of non-focal symptoms.

[Imaging in the diagnosis of colorectal liver metastases and extrahepatic abnormalities].

Imaging using ultrasonography, spiral CT, MRI and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), plays a major role at two situations during the management of patients with colorectal liver metastases: (a) at the time of the diagnosis and treatment of the primary colorectal tumour, and (b) during the follow-up for the detection of liver metastases and assessing the resectability of these metastases. At the time of the diagnosis and the treatment of the primary tumour, imaging comprising spiral CT or MRI to detect and characterize liver lesions is considered to be the modality of choice. Due to their low prevalence, imaging for the evaluation of lung metastases may be limited to conventional chest radiography.

[From gene to disease; X-linked adrenoleukodystrophy].

X-linked adrenoleukodystrophy (X-ALD) is the most common peroxisomal disorder, characterized by impaired peroxisomal beta-oxidation, subsequent accumulation of very long-chain fatty acids (> 22 carbon atoms), and mutations in the ABCD1 gene. Clinical manifestations, diagnostic procedures and treatment options are discussed.

[Interstitial pregnancy: a rare type of ectopic pregnancy].

Three women, aged 21, 28 and 37 years, respectively, were diagnosed with interstitial pregnancies. The first patient presented with lateral abdominal pain, the second patient was asymptomatic and consulted the physician for a routine first trimester scan and the third patient had painless vaginal bleeding in the first trimester. Each was treated with systemic methotrexate in a multiple dose regimen, which was successful in the latter two patients.

[Prevention of nosocomial infections after cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine; a prospective, randomised study].

Objective: To determine the efficacy ofperioperative decontamination of the nasopharynx and oropharynx in reducing nosocomial infection after cardiac surgery with the use of 0.12% chlorhexidine.

Design: Randomized, double-blind, placebo-controlled clinical trial (www.

[From the Cochrane Library: ultrasonographic screening for abdominal aortic aneurysm in men aged 65 years and older: low risk of fatal aneurysm rupture].

Abdominal aortic aneurysm (AAA) is present in 5-10% of men aged 65-79 years and is often asymptomatic. The major complication is rupture, which requires emergency surgery. The mortality rate after rupture is high: about 80% of those who reach the hospital and 50% of those undergoing emergency surgery will die.

[Monitoring the safety of participants in randomised clinical trials: basis and methods].

--Prior to conducting a randomised trial, permission must be obtained from the medical ethics committee (METC). The METC assesses the relevance of the trial and the appropriateness of the chosen study methods. It also weighs the clinical/scientific relevance against the potential benefits, risks and burdens for participants.

[Uterine artery embolisation in the treatment of uterine fibroids: outcomes of randomised trials].

In the past so years, uterine artery embolisation has gained popularity in the treatment of uterine fibroids compared with traditional surgical interventions. This was based on promising results from a few non-randomised studies, which reported success rates of 95 to 98%. Were these rates accurate? Two recent randomised studies (the Dutch EMMY trial and the Scottish REST trial) showed that, in patients with symptomatic uterine fibroids, the time to recovery and return to work was significantly shorter after embolisation than after surgery (hysterectomy or myomectomy).

[Summary of the practice guideline 'Asthma in children' (second revision) from the Dutch College of General Practitioners].

A number of important changes have been made in the second revision of the guideline 'Asthma in children' from the Dutch College of General Practitioners. In children under the age of 6 years, the symptoms stuffiness and recurrent cough are no longer considered part of the symptomatic diagnosis of asthma. Wheezing has become the key symptom of asthma.

[Imperforate hymen; importance of inspection of the external genitalia].

Three women aged 17, 12 and 13 years presented with intermittent abdominal pain. Secondary sexual characteristics, i.e.

[The neurovascular costoclavicular compression syndrome exists].

The neurovascular costoclavicular compression syndrome is rare. Physicians generally have little experience with this syndrome. It is difficult to provide evidence based on sound clinical science that proves the existence of the syndrome in relation to diagnosis and treatment.

[The value of positron emission tomography in the diagnosis and treatment of oesophageal cancer].

Fludeoxyglucose positron emission tomography (FDG-PET) is a noninvasive imaging technique that applies the glucose metabolism to visualise the metabolic activity ofa tumour. FDG-PET might improve the selection of potentially curable patients with oesophageal cancer in addition to state-of-the-art conventional work-up (e.g.

[Early invasive strategy no better than a selective invasive strategy for patients with non-ST-segment elevation acute coronary syndromes and elevated cardiac troponin T levels: long-term follow-up results of the ICTUS trial].

Objective: To determine whether routine coronary angiography followed by revascularisation where appropriate is better than initial drug treatment in patients with non-ST-segment elevation acute coronary syndromes (nSTE-ACS) and elevated troponin T concentrations.

Design: Multicentre randomised clinical trial (www.controlled-trials.

[Thromboprophylaxis for cerebrovascular disorders: acetylsalicylic acid remains the cornerstone].

Antithrombotic medication plays a key role in the treatmentand secondary prophylaxis of atherothrombotic conditions. Numerous studies have found that acetylsalicylic acid is effective in reducing the incidence of (recurrent) acute vascular events, such as myocardial infarction or ischaemic stroke. For coronary atherothrombosis, anticoagulation with vitamin K antagonists was shown to be slightly superior to acetylsalicylic acid in high-risk patients.

[Induced mild hypothermia to limit neurological damage after resuscitation].

Despite improvements in resuscitation techniques, the prognosis for patients who experience cardiac arrest outside of a hospital remains relatively poor. This is mainly due to brain damage that occurs as a result of global cerebral ischaemia. In 2002, two prospective randomised multicentre studies demonstrated that induced mild hypothermia can increase the chance of good neurologic recovery after out-of-hospital cardiac arrest by at least 40%.

[Prognosis for patients in a coma following cardiopulmonary resuscitation].

Most patients with post-anoxic coma after resuscitation have a poor prognosis. Reliable prediction of poor outcomes (death or vegetative state after 1 month; death, vegetative state or severe disability after at least 6 months) at an early stage is important for both family members and treating physicians. Poor outcome can be predicted with 100% reliability in the first 3 days after resuscitation in about 80% of patients using pupillary and corneal reflexes and motor response from the neurological examination, cortical responses from somatosensory evoked potentials and EEG.

[Severe anaemia caused by Human Parvovirus B19 infection in a patient with autoimmune haemolytic anaemia and a B-cell non-Hodgkin lymphoma].

A 65-year-old man with a 15-year history of 'leukemicised' low-grade lymphocytic B-cell non-Hodgkin lymphoma with a low-titre of IgM kappa paraprotein was admitted with severe anaemia and reticulocytopenia. Treatment with prednisone and chlorambucil had been started two weeks earlier because of a recently diagnosed Coombs-positive haemolytic anaemia. He also received a blood transfusion at that time.

[Hypertension due to liquorice and liquorice tea consumption].

--Compared to other countries, liquorice consumption in the Netherlands is very high; on average it is 2 kg per person annually. Also liquorice tea is growing in popularity. Both products contain glycyrrhizin.

[The practice guideline 'Thyroid disorders' (first revision) from the Dutch College of General Practitioners; a response from the perspective of internal medicine].

The revised practice guideline from the Dutch College of General Practitioners offers straightforward instruction on the diagnosis and treatment of thyroid dysfunction. Most cases of hypothyroidism can indeed be managed by general practitioners, and indications for referral to specialists are made clear. For substitution therapy with levothyroxine in otherwise healthy subjects the guidelines advocate the 'start low, go slow'-principle under the adage 'better safe than sorry'.

[Determining the thyroid hormones T3 and T4 in the urine: an unreliable test for hypothyroidism].

A 24-year-old woman complained of tiredness, sensitivity to cold, and feelings of depression. A diagnosis of hypothyroidism based on decreased 24 h urinary T3 and T4 excretion was made, and she was treated with levothyroxin. No blood tests were done.

[Health care insurance for Africa].

Long-term substantial development aid has not prevented many African countries from being caught in a vicious circle in health care: the demand for care is high, but the overburdened public supply of low quality care is not aligned with this demand. The majority of Africans therefore pay for health care in cash, an expensive and least solidarity-based option. This article describes an innovative approach whereby supply and demand of health care can be better aligned, health care can be seen as a value chain and health insurance serves as the overarching mechanism.

[AIDS treatment in Africa: the risk of antiretroviral resistance].

--In recent years, implementation of antiretroviral therapy in developing countries with a high prevalence of HIV-1 has been recognised as a public health priority. Consequently, the availability ofantiretroviral combination therapy for people with HIV is increasing rapidly in sub-Saharan Africa. --HIV treatment programmes are implemented according to the standardised, simplified public health guidelines developed by the World Health Organization (WHO).

[Surgical drainage of the pancreatic duct in patients with chronic pancreatitis is more effective than endoscopic drainage: randomized trial].

Objective: To compare endoscopic and surgical drainage of the pancreatic duct for ductal decompression in patients with severe pain due to chronic pancreatitis and a dilated pancreatic duct.

Design: Randomized clinical trial.

Method: All symptomatic patients with chronic pancreatitis and a distal obstruction of the pancreatic duct, but without an inflammatory mass, were eligible for this study.