Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Aug 1998
Review Case Reports[Perplexing acute or chronic somatic or psychiatric symptoms: possibly due to porphyria].
A woman aged 35 years had a classical picture of acute intermittent porphyria. However, the diagnosis was only made after repeated clinical investigations by internists, gastroenterologists, gynaecologists and surgeons working at a university hospital, and after an unnecessary laparotomy. ⋯ It may run a serious invalidating and life-threatening course. Its manifestations vary and may lead to very different clinical pictures.
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Acute urinary retention in women is not a common problem. The incidence is 0.07 per 1000 inhabitants per year. The causes of acute urinary retention can be divided into four groups: obstructive, neurological, pharmacological and psychogenic. ⋯ The most common obstructive cause is a gynaecologic tumor. A psychogenic cause is a diagnosis per exclusionem. The treatment of the acute urinary retention has to be catheterisation before further investigation is done.
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Ned Tijdschr Geneeskd · May 1998
Review['Public health status and perspectives' 1997. I. Introduction].
The 'Public health status and forecasts' 1997 presents a comprehensive and integrated overview of health, disease and health care in the Netherlands, to which more than 250 experts contributed. On the basis of the findings, policy recommendations are formulated regarding target groups, planning, prevention, health care, monitoring and research.
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Current dietary advice with a view to avoiding cardiovascular pathology is to replace fatty foodstuffs and those rich in saturated fat and cholesterol by food rich in complex carbohydrates. Although substitution of carbohydrates for fat lowers the blood level of low-density lipoprotein (LDL) cholesterol, it also lowers the level of high-density lipoprotein (HDL) cholesterol, thereby adversely influencing the risk profile for cardiovascular disease. ⋯ Carbohydrates should be provided by fruits, vegetables, leguminous plants and whole-wheat products. Persons of about the ideal weight should replace saturated and trans-fatty acids in their diet by unsaturated plant oils, and products with refined carbohydrates by fruits, vegetables and whole-wheat products.
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Ned Tijdschr Geneeskd · Apr 1998
Review[The cochlea: modern physiologic insights into sensorineural hearing loss].
The cochlea is organized tonotopically: each frequency between 20 Hz and 20 kHz has its own location on the basilar membrane. In addition the cochlea has a large dynamic range (sound intensity). Active movements of the outer hair cells of the sensory organ of Corti play a crucial part in determining hearing acuity and frequency selectivity. ⋯ Damage of outer hair cells impairs the cochlear amplifier, leading to loss of sensitivity to soft sounds and loss of frequency selectivity. Damage to the inner hair cells has much the same effect as conductive hearing loss. Tinnitus is not caused by otoacoustic emissions, but probably by denervation hypersensitivity following loss of cochlear input.