ABSTRACT
INTRODUCTION: Dermatophytosis is a common skin infection in children. Although the epidemiology is relatively unknown it is becoming a major health problem in some countries. We determine the incidence and management of dermatophytosis in Dutch general practice in 1987 and 2001. METHODS: We used data of all children aged 0-17 years derived from two national surveys performed in Dutch general practice in 1987 and 2001 respectively. All diagnoses, prescriptions and referrals were registered over a 12 months period by the participating general practitioners (GPs), 161 and 195 respectively. Data were stratified for socio-demographic characteristics. RESULTS: Compared to 1987, in 2001 the total reported incidence rate of dermatophytosis in children in general practice increased from 20.8 [95%CI 18.9-22.8] to 24.6 [95%CI 23.5-25.7] per 1,000 person years. Infants (<1 year), girls, children in rural areas and children of non-western immigrants more often consulted the GP for dermatophytosis in 2001. In both surveys GPs treated the majority of children with dermatophytosis with topical drugs, especially with azoles. CONCLUSIONS: The reported incidence rate of dermatophytosis in children in general practice increased; however it is unclear whether this is a consequence of an increasing prevalence in the population or a changing help seeking behaviour. GPs generally follow the national guideline for the treatment of dermatophytosis in children.
Subject(s)
Antifungal Agents/therapeutic use , Dermatomycoses/epidemiology , Adolescent , Child , Child, Preschool , Data Collection , Dermatomycoses/drug therapy , Family Practice , Female , Humans , Incidence , Infant , Male , Netherlands/epidemiology , Socioeconomic FactorsABSTRACT
BACKGROUND: Impetigo is a common skin infection in children. The epidemiology is relatively unknown, and the choice of treatment is subject to debate. OBJECTIVE: The objective of our study was to determine the incidence and treatment of impetigo in Dutch general practice, and to assess trends between 1987 and 2001. METHODS: We used data from the first (1987) and second (2001) Dutch national surveys of general practice. All diagnoses, prescriptions and referrals were registered by the participating general practitioners (GPs), 161 and 195, respectively. RESULTS: The incidence rate of impetigo increased from 16.5 (1987) to 20.6 (2001) per 1000 person years under 18 years old (P < 0.01). In both years, the incidence was significantly higher in summer, in rural areas and in the southern region of the Netherlands, compared with winter, urban areas and northern region, respectively. Socioeconomic status was not associated with the incidence rate. From 1987 to 2001, there was a trend towards treatment with a topical antibiotic (from 43% to 64%), especially fusidic acid cream and mupirocin cream. Treatment with oral antibiotics (from 31% to 14%) and antiseptics (from 11% to 3%) was prescribed less often. CONCLUSIONS: We have shown an increased incidence of impetigo in the past decade, which may be the result of an increased tendency to seek help, or increased antibiotic resistance and virulence of Staphylococcus aureus. Further microbiological research on the marked regional difference in incidence may contribute to understanding the factors that determine the spread of impetigo. Trends in prescribing for impetigo generally follow evidence-based knowledge on the effectiveness of different therapies, rather than the national practice guideline.
Subject(s)
Family Practice/statistics & numerical data , Impetigo/epidemiology , Adolescent , Age Distribution , Anti-Bacterial Agents/administration & dosage , Child , Child, Preschool , Female , Health Surveys , Humans , Impetigo/drug therapy , Incidence , Infant , Infant, Newborn , Male , Netherlands/epidemiology , Seasons , Urban Health/statistics & numerical dataABSTRACT
Conventional adrenalectomy requires relatively large incisions. To assess the value of retroperitoneal endoscopic adrenalectomy, a case-control study was performed comparing the endoscopic technique to conventional posterior adrenalectomy. All patients had adrenal tumors less than 7 cm in diameter. Endoscopic retroperitoneal adrenalectomy required more operative time (90 vs. 60 minutes, p < 0.0001) than the open approach but was associated with less blood loss (20 vs. 125 ml, p < 0.0001). Endoscopic adrenalectomy caused less pain postoperatively (p = 0.0005) and was associated with fewer complications (p = 0.035). The hospital stay was shorter after endoscopic adrenalectomy than after open adrenalectomy (p < 0.0001). In conclusion, we advocate endoscopic retroperitoneal adrenalectomy in patients with small adrenal tumors.
Subject(s)
Adenoma/surgery , Adrenal Gland Neoplasms/surgery , Adrenalectomy/methods , Endoscopy , Adrenal Gland Neoplasms/pathology , Adult , Case-Control Studies , Humans , Middle Aged , Retroperitoneal Space , Retrospective StudiesABSTRACT
The success of parathyroid surgery is determined by the identification and removal of all parathyroid tumors. Parathyroid tumors accumulate and retain 2-methoxyisobutylisonitrile (MIBI) labeled with technetium-99m. Intravenous injection of this radiopharmacon prior to parathyroid surgery allows identification of parathyroid tumors with a hand-held gamma detector. To assess the value of this technique, a case-control study was performed with 62 patient having nuclear-guided parathyroidectomy and 60 patients having conventional parathyroid explorations. The sensitivity rates of the MIBI probe in single and multiple gland disease were 84.6% and 63.0%, respectively. Rates of success, temporary and permanent hypoparathyroidism, and injury of the recurrent laryngeal nerve were similar in patients who underwent probe-guided surgery and those who had conventional surgery. In conclusion, although the MIBI probe appears to be a valuable tool in parathyroid surgery, its use has not improved the outcome of such surgery at our institution.
