[National guideline 'Cryopreservation of ovarian tissue']. / Richtlijn 'Cryopreservatie van ovariumweefsel'.

The treatment of children and young adults with cancer increasingly results in cure, but for a number of female patients this is at the expense of infertility. For women and girls with cancer and the wish to have children in the future, cryopreservation of ovarian tissue may be a solution in the absence of alternatives for the conservation of fertility. Because of the uncertain effectiveness and safety of cryopreservation of ovarian tissue, the Dutch national guideline 'Cryopreservation of ovarian tissue' advises removing and freezing ovarian tissue only if this is done within the framework of scientific research. Reimbursement of this procedure and financing of the relevant and necessary research have not yet been arranged.

[Female professors in medicine in 2003: appointment, duties and family life]. / Vrouwelijke hoogleraren in de geneeskunde anno 2003: aanstelling, taakvervulling en gezinsleven.

OBJECTIVE: To inventory (a) how and when female professors of medicine were appointed, (b) how they combined their work with family life, (c) which changes in health care female and male professors expected as a consequence of the increasing number of women physicians, and (d) which changes they wished to see for their successors. DESIGN: Descriptive. METHOD: A questionnaire was used to collect data from the female professors of medicine who worked in the Netherlands as of 1 January 2003 (n = 43), and from the same number of male professors of medicine, who were matched for age and speciality. RESULTS: 39 women and 39 men responded (91%). The women were more often appointed after a closed application procedure (69 versus 51%). Two fifths of the women had a part-time appointment as professor, but they worked at least 45 hours per week. Women were more often present in educational committees than in selection committees. At the time of their appointment most women had no children (n = 16) or children who did not live at home (n = 7); the other 16 (41%) had children at home, as did 33 (85%) of the male professors. Over half of the 23 women with children were at home for at least 2 half-days per week when the children were young and in some cases the partners cared for the children full-time; the opposite was found among the 35 men with children. A quarter of both mothers and fathers was present for activities of their children, like soccer training and final swimming tests, during office hours. The most important recommendations regarding the appointment and the functioning of professors concerned the structure and flexibility of medical education, the carefulness when considering appointments, and the possibilities to work part-time and to have a family life.

[Guideline on 'non-small cell lung carcinoma; staging and treatment']. / Richtlijn 'Niet-kleincellig longcarcinoom; stadiëring en behandeling'.

A national, evidence-based guideline on the staging and treatment of patients with non-small cell lung carcinoma (NSCLC) has been compiled by the various disciplines involved. The initial diagnostic measures in patients with suspected lung cancer include history taking, physical examination and chest x-ray. Additional examinations include CT scan of the chest and upper abdomen, bronchoscopy, and 18F-fluorodeoxyglucose-positron-emission-tomography(FDG-PET)-scintigraphy, if curative therapy is planned. Cervical mediastinoscopy or endoscopic echography with fine needle aspiration can be performed for mediastinal tissue staging. The preferred treatment in stage I, II or limited III is radical resection. Postoperative radiotherapy is recommended in cases of incomplete resection and can be considered in patients in whom mediastinal lymph-node metastases are unexpectedly encountered. Chemoradiotherapy is recommended in locally advanced NSCLC. In patients with NSCLC stage I-III and poor performance status, palliative radiotherapy may be the only feasible treatment. Some patients with NSCLC stage III and stage IV can be offered palliative chemotherapy and supportive care. In cases of doubt about operability, resectability, significant pulmonary or cardiac comorbidity or combined treatment, a specialist centre should be consulted. Diagnostics should be completed within 3-5 weeks. Ensuing surgery or radiotherapy should be carried out within 2 weeks. Follow-up of patients with NSCLC includes history taking, physical examination and an optional chest x-ray. In the first year after treatment patient visits are planned quarterly, in the second year half-yearly and then yearly for at least five years.

[Dutch Institute for Health Care Improvement's standard code of practice entitled, "Donation of fetal tissue"]. / CBO-modelreglement 'Terbeschikkingstelling van foetaal weefsel'.

The Dutch Law on Foetal Tissue (Wet Foetaal Weefsel) sets out conditions and regulations concerning the donation, storage and permissibility of use of foetal tissue. Each institution where foetal tissue becomes available has to formulate an in-house code of conduct describing how the law will be applied within that institution. A committee, including abortion physicians and gynaecologists, has formulated a number of rules of conduct within the standard code of conduct under the auspices of the Kwaliteitsinstituut voor de Gezondheidszorg CBO [Dutch Institute for Healthcare Improvement]. Complying with this standard code ensures that the law is upheld. In clinical practice, one may deviate from this standard code in case of solid reasons only. Generally, all women can be asked to donate foetal tissue. A basic prerequisite for the inclusion of non-Dutch women is that oral and written communication is possible. The committee considers the age of 16 as a minimum threshold and mental incompetence as an exclusion criterion. Much attention should be paid to providing the women with information and to requesting permission. The basic principle is that the decision to terminate a pregnancy should be strictly separated from the decision to donate foetal tissue. As a general rule, foetal tissue should be stored anonymously. Adjustment of the abortion method in view of the intended scientific research is not permitted.

[Dutch Institute for Health Care Improvement (CBO) Guideline 'lymphedema']. / CBO-richtlijn 'Lymfoedeem'.

Lymphedema is a symptom of tissue fluid accumulation which arises as a consequence of impaired lymphatic drainage. This reduced drainage can be either congenital or acquired, for example after breast cancer treatment. Early diagnosis of a swollen limb and adequate treatment are important in order to prevent irreversible tissue changes. The medical history and characteristic clinical presentation form the cornerstone of the diagnostic process. Lymphoscintigraphy can be used to obtain additional information about the functioning of the lymphatic system. Information and recommendations on precautions, preventive measurements and self-management instructions are important to all patients with (risk of) lymphedema. Treatment for lymphedema has to be adjusted to the patient and may consist of several therapeutic options, including manual lymphatic drainage. After volume reduction has been accomplished, a well-fitted compressive garment is essential in the maintenance phase. Surgical procedures for lymphedema are strictly indicated and should be performed by protocol in a multidisciplinary setting with long-term follow-up. Lymphedema is seen in many medical disciplines. A treatment plan is drawn up on the basis of a thorough knowledge of the diagnostics and treatment, with targeted referral to paramedical personnel. As it is a chronic condition, lymphedema requires life-long treatment and follow-up. In view of the complex nature of lymphedema it is recommended that local lymphedema protocols be developed.