[Taste and smell changes resulting from cancer therapies]. / Smaak- en reukverandering na oncologische behandeling.

Cancer therapies often cause changes in taste and smell. In this article, three patients treated with immunotherapy, chemotherapy and targeted therapy who experience changes in taste or smell are presented. These patients report lower quality of life and altered eating habits due to these changes. The prevalence and type of taste and smell changes is diverse among different cancer treatments and individual patients. In clinical practice, diagnosis is supported by questionnaires, taste strips or smell sticks. It is important to acknowledge the changes in taste and smell and inform the patient about these changes. More tools become available to provide patients with personalized advise to adjust their meals to their new sense of taste and smell at home. Furthermore, hospital cooks are implementing new strategies to adjust meals to taste and smell alterations and individual preferences. Smell training is an option for patients with severe smell disorders.

[The last specialist secretary of state in the Netherlands: Els Borst-Eilers]. / De laatste vakminister: Els Borst-Eilers.

The announcement of the appointment of Hugo de Jonge as the Netherlands Secretary of State for Health means that there is little chance of having a 'specialist' in this post in the near future. Els Borst-Eilers is generally considered to have been the last specialist Secretary of State for Health in the Netherlands. Whether or not she can rightly be considered to be a specialist, this was certainly the image that she cultivated and also used for political ends, for instance, to depoliticise sensitive issues. In this article, we highlight a particularly good example: the medical experiment involving providing approximately 700 long-term addicts with heroin under medical supervision, which Borst implemented with the consent of the Netherlands parliament in 1998.

[Henry Beecher and medical science: the 50th anniversary of a famous article]. / Henry Beecher en de medische wetenschap.

In 2016, it had been exactly half a century ago that Henry Beecher published his article 'Ethics and clinical research' in The New England Journal of Medicine. Today, this article is considered a turning point in the history of medical research ethics. On the occasion of the fiftieth anniversary of this famous article, we are looking back on this turbulent period in the history of medicine.

Effect of obeticholic acid on liver regeneration following portal vein embolization in an experimental model.

BACKGROUND: The bile salt-activated transcription factor farnesoid X receptor (FXR) is a key mediator of proliferative bile salt signalling, which is assumed to play a role in the early phase of compensatory liver growth. The aim of this study was to evaluate the effect of a potent FXR agonist (obeticholic acid, OCA) on liver growth following portal vein embolization (PVE). METHODS: Rabbits were allocated to receive daily oral gavage with OCA (10 mg/kg) or vehicle (control group) starting 7 days before PVE (n = 18 per group), and continued until 7 days after PVE. PVE of the cranial liver lobes was performed using polyvinyl alcohol particles and coils on day 0. Caudal liver volume (CLV) was analysed by CT volumetry on days -7, -1, +3 and +7. Liver function was determined by measuring mebrofenin uptake using hepatobiliary scintigraphy. Additional parameters analysed were plasma aminotransferase levels, and histological scoring of haematoxylin and eosin- and Ki-67-stained liver sections. RESULTS: Three days after PVE of the cranial lobes, the increase in CLV was 2·2-fold greater in the OCA group than in controls (mean(s.d.) 56·1(20·3) versus 26·1(15·4) per cent respectively; P < 0·001). This increase remained greater 7 days after PVE (+1·5-fold; P = 0·020). The increase in caudal liver function at day +3 was greater in OCA-treated animals (+1·2-fold; P = 0·017). The number of Ki-67-positive hepatocytes was 1·6-fold higher in OCA-treated animals 3 days after PVE (P = 0·045). Plasma aminotransferase levels and histology did not differ significantly between groups. CONCLUSION: OCA accelerated liver regeneration after PVE in a rabbit model. OCA treatment might increase the efficacy of PVE and, thereby, resectability. Surgical relevance Liver failure is the most feared complication after liver surgery, with no effective treatment options. Liver regeneration is essential to avoid liver failure, and recently bile acid signalling was implicated in the initiation of liver regeneration through the nuclear bile acid receptor farnesoid X receptor (FXR). In this study, the potent FXR agonist obeticholic acid accelerated liver regeneration following portal vein embolization in a rabbit model, in terms of liver volume, liver function and proliferation. Obeticholic acid treatment could enhance the efficacy of portal vein embolization, thereby increasing resectability, and could reduce the interval to surgery. In addition, obeticholic acid might have a place in the prevention of liver failure after liver surgery.

Use of an absorbable embolization material for reversible portal vein embolization in an experimental model.

BACKGROUND: Portal vein embolization (PVE) is used to increase future remnant liver size in patients requiring major hepatic resection. PVE using permanent embolization, however, predisposes to complications and excludes the use of PVE in living donor liver transplantation. In the present study, an absorbable embolization material containing fibrin glue and different concentrations of the fibrinolysis inhibitor aprotinin was used in an experimental animal model. METHODS: PVE of the cranial liver lobes was performed in 30 New Zealand White rabbits, which were divided into five groups, fibrin glue + 1000, 700, 500, 300 or 150 kunits/ml aprotinin, and were compared with a previous series of permanent embolization using the same experimental set-up. Caudal liver lobe hypertrophy was determined by CT volumetry, and portal recanalization was identified on contrast-enhanced CT images. Animals were killed after 7 or 42 days, and the results were compared with those of permanent embolization. RESULTS: PVE using fibrin glue with aprotinin as embolic material was effective, with 500 kunits/ml providing the optimal hypertrophic response. Lower concentrations of aprotinin (150 and 300 kunits/ml) led to reduced hypertrophy owing to early recanalization of the embolized segments. The regeneration rate over the first 3 days was higher in the group with 500 kunits/ml aprotinin than in the groups with 300 or 150 kunits/ml or permanent embolization. In the 500-kunits/ml group, four of five animals showed recanalization 42 days after embolization, with minimal histological changes in the cranial lobes following recanalization. CONCLUSION: Fibrin glue combined with 500 kunits/ml aprotinin resulted in reversible PVE in 80 per cent of animals, with a hypertrophy response comparable to that achieved with permanent embolization material. Surgical relevance Portal vein embolization (PVE) is used to increase future remnant liver volume in patients scheduled for major liver resection who have insufficient future remnant liver size to perform a safe resection. The current standard is PVE with permanent embolization materials, which renders patients found to have unresectable disease prone to complications owing to the permanently deportalized liver segments. Absorbable embolization might prevent the PVE-associated morbidity and lower the threshold for its application. In this study, PVE using fibrin glue and aprotinin resulted in an adequate hypertrophy response with 80 per cent recanalization after 42 days. Considering the minor histological changes following recanalization of embolized segments and potentially preserved function, reversible PVE might also be applied in living donor liver transplantation.

[Free choice of doctor: patient's right or doctor's power?]. / Vrije artsenkeuze: recht of macht?

This article outlines the historical development of the principle of patients' free choice of doctor in the Netherlands. Far from being the result of debates on patients' rights, this principle was used instead as an instrument by the medical profession to gain a foothold in the power relations between doctors and sickness funds back in the early 20th-century. This development created a medical power bloc that lasted for most of that century and forced sickness funds and private insurers to start organizing in this fashion too. Therefore, when the new market ideology of introducing competition in health care was introduced in 1987, the fields of health provision and insurance were already defined by a high degree of cartelization. These relations lingered even after the introduction of regulated competition in 2006. Knowledge of this history therefore leads to a better understanding of current debates and problems in the organization of Dutch health care.

Experimental and numerical investigation of the equilibrium geometry of liquid lenses.

The equilibrium configuration of a nonwetted three fluid system takes the form of a floating liquid lens, where the lens resides between an upper and lower phase. The axisymmetric profiles of the three interfaces can be computed by solving the nonlinear Young-Laplace differential equation for each interface with coupled boundary conditions at the contact line. Here we describe a numerical method applicable to sessile or pendant lenses and provide a free, downloadable Mathematica Player file which uses a graphical interface for analyzing and plotting lens profiles. The results of the calculations were compared to optical photographs of various liquid lens systems which were analyzed using basic ray-tracing and Moiré imaging. The lens profile calculator, together with a measurement of the lens radius for a known volume, provides a simple and convenient method of determining the spreading coefficient (S) of a liquid lens system if all other fluid parameters are known. If surfactants are present, the subphase surface tension must also be self-consistently determined. A procedure is described for extracting characteristic features in the optical images to uniquely determine both parameters. The method gave good agreement with literature values for pure fluids such as alkanes on water and also for systems with a surfactant (hexadecane/DTAB), which show a transition from partial wetting to the pseudopartial wetting regime. Our technique is the analog of axisymmetric drop shape analysis, applied to a three fluid system.

[Haematoma of the floor of the mouth following implant surgery]. / Hematoom in de mondbodem na een implantaatbehandeling.

A patient experienced severe bleeding in the floor of the mouth as a consequence of the placement of 2 implants in the resorbed anterior segment of the mandible. The resulting swelling of the floor of the mouth caused a life-threatening obstruction of the trachea. The patient was urgently transferred to a hospital. Treatment there consisted of the administration of medication and intensive observation. In the literature an intubation or the carrying out of a tracheotomy with possible surgical interventions is also described. The cause lay in damage to the lingual cortical plate of the mandible and trauma of the underlying vascular structures. Especially the cuspid and bicuspid regions are vulnerable because of the often seen lingual concavity in the processus alveolaris. Serious atrophy of the processus alveolaris is also a predisposition. To reduce the probability of such complications knowledge of the local anatomy, good clinical inspection and various radiographic evaluations are important. In case of obstruction of the trachea it is of vital importance to immediately transport the patient to the nearest hospital for further treatment.

[Oral pathology in a denture practice]. / Orale pathologie in een tandprothetische praktijk.

An 86-year-old edentulous patient visits a denturist for the provision of a new set of dentures. In the region 36/37 of the lower denture base extension is a bony like structure apparent, that does really not bother the patient. The denturist refers the patient for further diagnosis. It appeared to be a benign condition (traumatic periosteal ossification) that did not require surgical intervention. The responsibilities and capabilities of the denturist with regard to the treatment of edentulous patients are discussed in light of the current Dutch legislation.

Treatment of primary Sjögren's syndrome with D-penicillamine: a pilot study.

BACKGROUND: Up to now no satisfying systemic treatment is available for patients with primary Sjögren's syndrome. METHODS: In a prospective, open study we investigated the effect of D-penicillamine (first three months 250 mg/day, next three months 500 mg/day) on clinical and immunological parameters in 19 patients with primary Sjögren's syndrome and a mean disease duration of 3.8 years. RESULTS: Eight patients had to stop treatment mainly due to severe (reversible) loss of taste. Clinically, a statistically significant increase in basal salivary flow was observed after three months (p<0.05). In addition, improvement was noted in the Schirmer test and stimulated parotid salivary flow after six months, but these differences were not statistically significant. Laboratory values showed a decrease in ESR (p<0.05) and levels of IgA and IgM (both p<0.02) after six months, a decrease in levels of IgA-Rf and IgM-Rf after three months (both p<0.05), and an increase in haemoglobin level (p<0.05). CONCLUSION: From this pilot study we conclude that the treatment of primary Sjögren's syndrome with D-penicillamine has only marginal beneficial effects. Together with its clear side effects this means that D-penicillamine is unsuitable for this indication.

[Microhistory or biography? On the meaning of the life of Joannes Groenevelt]. / Microstoria of biografie? Over de betekenis van het leven van Johannes Groenevelt.

The main goal of the microstoria, a genre that was coined by Carlo Ginzburg in his book about the world view of a sixteenth-century Italian heretic, seems to be to criticize the grand narratives of history. By zooming in on the life of atypical persons, microhistory sets out to show that historiography has a tendency to blur the complexities of the past by reducing it to a set of sweeping statements about kings, generals, and geniuses. Recently, Harold Cook has written a book about Joannes Groenevelt, an 'ordinary doctor' who lived at the end of the seventeenth century, who moved in the circles of the Royal Society and who was found guilty of malpractice by the London College of Physicians. Although Cook claims his book to be a microhistory, Groenvelt was far from 'atypical'. Instead, he is being presented as an exponent of that important watershed in the history of science labelled 'Scientific Revolution'. It is argued that Cook's book - which is a traditional biography rather than a microhistory -- is important for at least two reasons. First, because it shows how the life of an ordinary physician can shed light on the nature of medicine and its workings in society; and second, by playing with dormant notions about the period, it shows the heuristic value of period labels like the Scientific Revolution.