Occupational health care and work incapacity: recent developments in the Netherlands

Due to political priorities and benefit arrangements, preventionof work incapacity has played a minor role in employers' policiesin the Netherlands. However, the comparatively high sicknessabsence rates and large numbers of disability benefit recipientsin the Netherlands have fostered preventive policies and measuresregarding unfavourable working conditions. Corresponding torecent changes in legislation, the role of occupational healthand safety services will substantially increase in the comingyears. Part of the new orientation will be a multi-disciplinarystaff structure and more attention to tailor-made services andeffectiveness. There is much debate about the precise role foroccupational physicians in the control of sickness absenteeismin companies. This paper presents several instruments whichare now being applied or which are still in a developmentalstage. The issues of prevention of sickness absence and monitoringof long-term sick employees will remain a substantial part ofthe responsibilities of occupational health and safety services.     

Endoscopic intubation and intracavitary irradiation in the palliative treatment of inoperable esophageal tumors]

The authors have applied at first in Hungary the intracavital after loading radiotherapy in patients suffering from esophageal tumor. A new method was elaborated for the combined use of endoscopic tube insertion and intracavital irradiation. Out of the 155 patients admitted on the 1st Surgical Department of Semmelweis University, Budapest, 63 had been treated only by tube insertion, 44 were intubated and irradiated, whereas 48 patients had intracavital radiotherapy without intubation. Radiotherapy was performed at the Radiological Unit of Semmelweis University. The irradiation dose ranged from 26,9 to 32,2 Gray in average. The mean survival of group I. was 4,0 months, that of group II. 6,3 months, and in group III. 7,0 months respectively. The expected survival is proportional to the radiation dose. No correlation exists between tumor localisation and survival. Respiratory fistula, the most common complication, occurred in different groups as follows: 3,4%, 6,2%, and 9,0%; but could have been treated by tube insertion, or adequate positioning of the tube. The combined use of intubation and intracavital after loading radiotherapy has been proven to be suitable for palliative treatment of inoperable esophageal tumors.     

Providing regular relief; considerations for palliative care in the Netherlands]

Over the last few decades the attention devoted to the palliative aspects of medicine, particularly those in hospital care, has declined due to the emphasis on medical technology. In Anglo-Saxon countries a review of this development resulted in structured palliative care that benefited terminally ill patients with a progressive fatal disease, especially cancer patients. Due to increasing national and international criticism of both the practice of euthanasia (assumed to be too liberal) and the lack of attention devoted to structured palliative care in the Netherlands, the Dutch government decided to improve the structure of palliative care. The government's viewpoint is based on the assumption that good palliative care that includes adequate pain control benefits patient care and might eventually lead to fewer requests for euthanasia. The improvements to palliative care should be realised by means of improvements in the structure, training and knowledge. Six academic medical clusters have been designated as Centres for the Development of Palliative Care (Dutch acronym: COPZ) for a 5-year period. Each COPZ must develop the various aspects needed to improve palliative care within the region it serves and ensure that its activities are carefully coordinated with those in the other centres. Research will focus on measuring the efficacy of palliative care as well as ethical and epidemiological aspects. A government committee will assess the appropriateness of the activities undertaken by each of the centres.     

Euthanasia, assistance to suicide and the law: developments in The Netherlands.

In this article the developments in euthanasia in The Netherlands are discussed. To a large extent unanimity has been reached about the definition of euthanasia. Since 1973 the courts have become involved in euthanasia cases. The lower courts and the Supreme Court allowed for euthanasia on request under certain conditions. In 1982 a State Committee on Euthanasia was established. This Committee made a proposal of a law on euthanasia and assistance to suicide on request. The Committee delineated requirements to be followed for euthanasia not to be punishable. Although a majority of the Dutch population is in favour of a liberalizing legislation, the political situation delays its adoption.     

分子影像学与肿瘤临床诊治

多年来,肿瘤一直是人类健康的宿敌,在相对发达的国家,肿瘤已经成为危胁生命的主要疾病。随社会现代化进程,生活方式、节奏和环境的改变,肿瘤的发病率还在不断攀升。尽管随解剖、病理、生化和B超、CT、MRI等影像技术的发展,使活体诊断水平达到了前所未有的高度,并推动了外科手术、介入、化疗、内分泌、免疫和基因治疗等的进步,但临床上肿瘤的诊治方面仍存在不少挑战与困惑:如病理表现相同、治疗方案相同的肿瘤,何以部分病例存活     

分子影像学与肿瘤临床诊治

多年来,肿瘤一直是人类健康的宿敌,在相对发达的国家,肿瘤已经成为危胁生命的主要疾病.随社会现代化进程,生活方式、节奏和环境的改变,肿瘤的发病率还在不断攀升.尽管随解剖、病理、生化和B超、CT、MRI等影像技术的发展,使活体诊断水平达到了前所未有的高度,并推动了外科手术、介入、化疗、内分泌、免疫和基因治疗等的进步,但临床上肿瘤的诊治方面仍存在不少挑战与困惑:如病理表现相同、治疗方案相同的肿瘤,何以部分病例存活不到3年,而另一部分却可存活10年以上?人类基因组计划已接近完成,极大促进了对肿瘤的起因、本质、生物特征和易感因素等方面的认识,但迄今为止相当多的肿瘤,确诊时已届晚期;由此造成治疗的滞后和失误,更是严重的问题.美国曾统计,每年错误的开胸探查25 000例、乳腺切除400 000例、卵巢癌手术5000例…,充分说明了肿瘤诊治方面需要研究和发展之处甚多.     

卵巢交界性肿瘤的临床诊治体会

目的探讨卵巢交界性肿瘤的诊断与治疗方式。方法对2009～2011年本院收治的15例卵巢交界性肿瘤进行回顾性分析。结果组织学类型：黏液性10例,浆液性5例。临床分期：Ⅰ期9例,Ⅱ期4例,Ⅲ期2例,无Ⅳ期患者。行单侧附件切除术7例,子宫和单侧附件切除术3例,子宫和双侧附件切除术加（或不加）大网膜、阑尾切除术5例。术后未行化疗4例,余11例术后均进行了化疗,病例随诊1～12年,随诊期内均存活。结论黏液性瘤所占比例明显高于浆液性瘤。手术治疗是交界性肿瘤有效的治疗手段。对Ⅰ期有生育要求的患者应尽量保留生育功能,对年轻患者应至少保留一侧卵巢。卵巢交界性肿瘤患者术后化疗与否不影响预后,尤其是Ⅰ期患者。CA125对交界性肿瘤的监测有一定意义。     

Current concepts in diagnosis and treatment of oral malignant tumors

This article offers a short review of risk factors, oral precancerous conditions, and oral precancerous lesions which may cause oral squamous carcinoma. Current diagnostic methods and multidisciplinary strategies for the early detection and appropriate therapy of oral squamous carcinomas are discussed. Close cooperation of oral and maxillofacial surgeons, head and neck surgeons, radiotherapists, and oncologists is essential for the effective therapy of oral squamous carcinomas.     

十二指肠类癌分类、诊断及治疗

类癌是一种少见的神经内分泌系统肿瘤,其组织分化较好、生长缓慢,呈低度恶性,因其细胞颗粒有亲银特性,又称嗜银细胞瘤.类癌发病率为1/10万～2/10万,超过70%发生在消化道[1],但因诊断率低,实际发病率可能更高.胃肠道类癌起源于肠腺管基部的嗜银细胞,发病率占胃肠道肿瘤的0.4%～1.8%,十二指肠类癌仅占胃肠道类癌的1.3%[2],占十二指肠恶性肿瘤的3.0%[3].其发病缓慢,早期无特异性的临床表现,诊断困难,误诊率高,随着肿瘤进展可出现类癌综合征.现对十二指肠类癌进行阐述,以提高对其认识.