The diagnostic value of provocative clinical tests in ulnar neuropathy at the elbow is marginal.

Background: Provocative clinical tests are often performed in the diagnosis of ulnar neuropathy at the elbow (UNE) although the evidence for the usefulness of these tests is limited. The aim of this study was to determine the diagnostic value of provocative clinical tests in the diagnosis of UNE in a relevant spectrum of patients and controls.

Methods: A prospective cohort study was performed in consecutive patients clinically suspected of having UNE.

Predictors of walking distance after supervised exercise therapy in patients with intermittent claudication.

Objective: To identify predictor variables for results after supervised exercise therapy (SET), and to develop a clinical prediction model that aims to predict a target walking distance for individual patients.

Design: Retrospective analyses on prospectively collected data.

Materials: Patients with intermittent claudication who participated in a SET programme.

Severe hemolysis and methemoglobinemia following fava beans ingestion in glucose-6-phosphatase dehydrogenase deficiency: case report and literature review.

Introduction: Reduced concentrations of glucose-6-phospate dehydrogenase (G6PD) render erythrocytes susceptible to hemolysis under conditions of oxidative stress. In favism, the ingestion of fava beans induces an oxidative stress to erythrocytes, leading to acute hemolysis.

Discussion: The simultaneous occurrence of methemoglobinemia has been reported only scarcely, despite the fact that both phenomena are the consequence of a common pathophysiologic mechanism.

Functional claudication distance: a reliable and valid measurement to assess functional limitation in patients with intermittent claudication.

Background: Disease severity and functional impairment in patients with intermittent claudication is usually quantified by the measurement of pain-free walking distance (intermittent claudication distance, ICD) and maximal walking distance (absolute claudication distance, ACD). However, the distance at which a patient would prefer to stop because of claudication pain seems a definition that is more correspondent with the actual daily life walking distance. We conducted a study in which the distance a patient prefers to stop was defined as the functional claudication distance (FCD), and estimated the reliability and validity of this measurement.

Supervised exercise versus non-supervised exercise for reducing weight in obese adults.

Aim: The prevalence of obesity is rising. Because obesity is positively associated with many health related risks and negatively associated with life expectancy this is a threat to public health. Physical exercise is a well known method to lose fat mass.

Implementation of a competency-based residency curriculum: experiences from a resource-limited environment in the Caribbean.

Background: The introduction of competency-based curricula in institutions situated in resource-limited environments is likely to pose new challenges for the implementation process. The St. Elisabeth Hospital (SEHOS) in Curacao, Dutch Caribbean, is affiliated to university teaching hospitals in the Netherlands.

Supervised exercise therapy for intermittent claudication in daily practice.

Objective: This study describes the results and functioning of community-based supervised exercise therapy (SET) at one year of follow-up.

Methods: We conducted a prospective cohort study of community-based SET in regional physiotherapeutic practices. Consecutive patients with intermittent claudication referred for community-based SET were included.

Validation of the Dutch version of the Walking Impairment Questionnaire.

Objectives: The Walking Impairment Questionnaire (WIQ) is a frequently used questionnaire to evaluate patients with intermittent claudication (IC). The aim of this study is to validate the Dutch WIQ for the European situation using the metric system.

Design: Validation study.

Review of the combined contraceptive vaginal ring, NuvaRing.

The purpose of this review was to test contraceptive efficacy, cycle control, tolerability, and acceptability as found in the non-comparative studies with NuvaRing((R)) by those found in the randomized trials comparing NuvaRing and combined oral contraceptives (COCs). All large non-comparative studies and all relevant randomized controlled trials (RCTs) between NuvaRing and a COC up to and including December 2006 were analyzed. Two large multi-center registration studies, 1 large daily clinical practice study, and 6 RCTs comparing NuvaRing and a COC were identified.

History of methysergide in migraine.

Harold Wolff's theory of vasodilation in migraine is well-known. Less known is his search for a perivascular factor that would damage local tissues and increase pain sensitivity during migraine attacks. Serotonin was found to be among the candidate agents to be included.

Endovascular aortic occlusion for a secondary aorto-enterocutaneous fistula: 44-month follow-up.

Purpose: To describe the durability of endovascular aortic occlusion as an alternative treatment of an aortoenteric fistula in a severely unstable patient.

Case Report: A 47-year-old patient with a history of numerous previous vascular reconstructions underwent surgical exclusion of a persistent aorto-enterocutaneous fistula originating from a former colostomy site in proximity with the occluded left leg of an aortobifemoral bypass. Nine weeks later, he presented in profound hypovolemic shock from bleeding via the cutaneous remnant of the fistula and gastrointestinal tract.

Supervised exercise therapy for intermittent claudication.

Purpose Of The Review: Although exercise therapy is considered to be of significant benefit to people with intermittent claudication, almost half of those affected do not undertake any exercise therapy. The purpose of this review is to evaluate the effects of supervised exercise therapy (SET) for people with intermittent claudication.

Materials And Methods: SET will be compared with non-supervised exercise therapy programs and the superiority of SET will be demonstrated.

Concentration-dependency of beta-lactam-induced filament formation in Gram-negative bacteria.

Ceftazidime and cefotaxime are beta-lactam antibiotics with dose-related affinities for penicillin-binding protein (PBP)-3 and PBP-1. At low concentrations, these antibiotics inhibit PBP-3, leading to filament formation. Filaments are long strands of non-dividing bacteria that contain enhanced quantities of endotoxin molecules.

Historical study of coma: looking back through medical and neurological texts.

In the 1960s, two major works on coma by Fisher, Plum and Poser were published and ushered in the beginning of a comprehensive clinical examination in coma. How these ideas matured has been rarely investigated. In this article, we describe observations and experiments that led to a better understanding of consciousness and coma in medical texts prior to that episode.

Carcinoid tumours of the testis.

Objective: To review previous reports of carcinoid (an endocrine tumour mostly of the gastrointestinal tract) tumours of the testis.

Methods: Carcinoid tumours of the testis are rare and can be divided into primary carcinoid (group 1), testicular metastasis from another location (group 2) and carcinoid within a testicular teratoma (group 3). A case of testicular carcinoid within our clinic prompted us to review previous reports; all the cases found were assessed for patient and tumour characteristics, diagnostic tools used, treatment and prognosis.

The Dutch experience of open access echocardiography.

Cardiac disease is not easy to recognise in general practice. An echocardiogram is an excellent way to provide information about left ventricular mass and diastolic (dys)function and the presence of valvular heart disease. To improve diagnostic care of cardiac patients, an open access echocardiography service was established in the referral area of our hospital, where general practitioners were able to ask for an echocardiogram without referring the patient to the cardiologist.

[The South-American eel. Two early letters on animal electricity from the Dutch colonies].

Speculations about the nature of nerve action, including animal spirits, date back to antiquity. Only during the 18th century, when it became possible to store electricity in Leyden jars, did natural philosophers begin to realise that the sensations caused by electric fish are like those produced by these primitive capacitors. The important roles played by amateur observers in the Dutch colonies of South-America, and how they communicated with more established Dutch scientists in The Netherlands, are often relatively overlooked in histories of how the nerves became electrical.

Thrombotic and infectious complications of central venous catheters in patients with hematological malignancies.

Central venous catheters (CVCs) have considerably improved the management of patients with hematological malignancies, by facilitating chemotherapy, supportive therapy and blood sampling. Complications of insertion of CVCs include mechanical (arterial puncture, pneumothorax), thrombotic and infectious complications. CVC-related thrombosis and infections are frequently occurring complications and may cause significant morbidity in patients with hematological malignancies.

Quality of clinical supervision as perceived by attending doctors in university and district teaching hospitals.

Context: Attending doctors (ADs) play important roles in the supervision of specialist registrars. Little is known, however, about how they perceive the quality of their supervision in different teaching settings. We decided to investigate whether there is any difference in how ADs perceive the quality of their supervision in university teaching hospital (UTH) and district teaching hospital (DTH) settings.

Breast-conserving therapy for palpable and nonpalpable breast cancer: can surgical residents do the job irrespective of experience?

Background: The aim of this study was to evaluate the influence of operative experience in obtaining tumor-free margins in breast-conserving therapy. In the case of palpable breast cancers, lumpectomies can safely be performed by any surgical resident. For nonpalpable breast cancers, lumpectomies should be treated only by senior residents or attending surgeons, even if supervision during the operation is given by an attending surgeon for junior residents.

Sequential versus combination chemotherapy with capecitabine, irinotecan, and oxaliplatin in advanced colorectal cancer (CAIRO): a phase III randomised controlled trial.

Background: The optimum use of cytotoxic drugs for advanced colorectal cancer has not been defined. Our aim was to investigate whether combination treatment is better than sequential administration of the same drugs in patients with advanced colorectal cancer.

Methods: We randomly assigned 820 patients with advanced colorectal cancer to receive either first-line treatment with capecitabine, second-line irinotecan, and third-line capecitabine plus oxaliplatin (sequential treatment; n=410) or first-line treatment capecitabine plus irinotecan and second-line capecitabine plus oxaliplatin (combination treatment; n=410).

Nifedipine Gastrointestinal Therapeutic System (GITS) in the treatment of coronary heart disease and hypertension.

Since the 1960s, calcium antagonists have been available for the treatment of angina pectoris and hypertension. The first of this class, nifedipine, was introduced and readily accepted as the third treatment option for angina, alongside beta-blockers and nitrates. However, the short-acting formulations of nifedipine had pharmacokinetic properties that were far from ideal and in 1995, several studies involving various dosing regimens reported possible dangerous effects in secondary prevention.