[The library of the Society of the Dutch Journal of Medicine]. / De bibliotheek van de Vereniging Nederlands Tijdschrift voor Geneeskunde.

This year the library of the Vereniging Nederlands Tijdschrift voor Geneeskunde (Society of the Dutch Journal of Medicine) has reached the age of go. The idea was born in 1900 when the editor-in-chief M.Straub proposed starting a library for the Journal. This was rejected by the members of the Society, but fourteen years later, in 1914, when the new editor-in-chief G.A. van Rijnberk made a similar proposal, it was accepted. His long-term as editor (1913-1946) would prove to be a guarantee for the acquisition of a large collection of books, both antique and contemporary. The collection reflects the history of medicine, notably in The Netherlands, but also in a wider sense. Over the years, several catalogues of the collection have been published, and this year has seen the completion of an electronic catalogue which is available on the Internet (www.ntvg.nl). The acquisition and restoration of books have been re-started in the past five years and a fellowship for the study of the existing collection of books has been instituted.

Short term and long term health related quality of life after congenital anorectal malformations and congenital diaphragmatic hernia.

AIMS: To examine short term and long term health related quality of life (HRQoL) of survivors of congenital anorectal malformations (ARM) and congenital diaphragmatic hernia (CDH), and to compare these patients' HRQoL with that of the general population. METHODS: HRQoL was measured in 286 ARM patients and 111 CDH patients. All patients were administered a symptom checklist and a generic HRQoL measure. For the youngest children (aged 1-4) the TAIQOL (a preliminary version of the TAPQOL) was used, for the other children (aged 5-15) the TACQOL questionnaire, and for adults (aged >16) the SF-36. RESULTS: As appeared from the symptom checklists, many patients remained symptomatic into adulthood. In the youngest ARM patients (aged 1-4 years), generic HRQoL was severely affected, but the older ARM patients showed better HRQoL. In the CDH patients, the influence of symptoms on HRQoL seemed less profound. The instruments we used revealed little difference between adults treated for ARM or CDH and the general population. CONCLUSIONS: These results show that for two neonatal surgical procedures, improved survival does not come at the expense of poor HRQoL in adults. Even though there is considerable suffering in terms of both morbidity and mortality in the youngest group, the ultimate prognosis of survivors of the two studied congenital malformations is favourable. This finding can be used to reassure parents of patients in need of neonatal surgery for one of these conditions about the prospects for their child.

[Anatomy as theatre. From the library of the Society of the Dutch Journal of Medicine. Govard Bidloo: Ontleding des Menschelijken Lichaams (Dissection of the Human Body); 1689; and William Cowper: The Anatomy of Humane Bodies; 1698]. / Anatomie als schouwspel. Uit de bibliotheek van de Vereniging Nederlands Tijdschrift voor Geneeskunde. Govard Bidloo: Ontleding des Menschelijken Lichaams; 1689; en William Cowper: The Anatomy of Humane Bodies; 1698.

Opinions differ regarding the scientific quality of the atlas by Govard Bidloo, Ontleding des Menschelijken Lichaams (Dissection of the Human Body) (1689) and the plagiarism made thereof by William Cowper, The Anatomy of Humane Bodies (1698). Both books were also published in Latin; the Society of the Dutch Journal of Medicine has acquired a copy of all 4 atlases. The anatomical plates were made by the artist Gerard de Lairesse (Liège 1640-Amsterdam 1711) and their great artistic value is beyond all doubt. De Lairesse settled in Amsterdam in 1665, a few months after the reopening of the city theatre, and subsequently achieved fame as an innovative creator of theatre sets. He also became one of the favourite artists of prince William III and many other well-to-do citizens of Amsterdam. The great artistic value of his anatomical plates justifies more attention for his importance as a medical illustrator in medical history.

[From the library of the Netherlands Journal of Medicine. Rudolf Virchow: Die Cellularpathologie in ihrer Begründung auf physiologische und pathologische Gewebelehre; 1858]. / Uit de bibliotheek van het Nederlands Tijdschrift voor Geneeskunde. Rudolf Virchow: die Cellularpathologie in ihrer Begründung auf physiologische und pathologische Gewebelehre; 1858.

With the publication of Die Cellularpathologie in ihrer Begründung auf physiologische und pathologische Gewebelehre in 1858, the author Rudolf Virchow (1821-1902) originated the idea that each cell in each living organism, both plant and animal, originates from another cell and that the origin of disease can only be located in the cell. The book laid the foundations for cell pathology as a scientific discipline and was the most important publication by Virchow, who as doctor and statesman gathered so much fame that he became almost a mythical figure in his own time. The finding that every cell originates from another cell and does not develop from amorphous interstitium is actually attributable to Robert Remak.

[DNA damage and aging]. / DNA-beschadiging en veroudering.

At present the mouse is the ideal experimental animal for studying molecular biological processes in human diseases. Premature aging occurred in mice with an induced mutation that resulted in a defective DNA repair mechanism. Compared to normal unmanipulated mice they exhibited characteristic symptoms of premature aging, such as premature greying, aging of the skin, osteoporosis, kyphosis, early menopause and a reduced longevity. Although these experiments only cover a small number of the many aging symptoms present in humans, it is nevertheless clear that DNA damaged by free oxygen radicals but which is not repaired, is an important cause of the onset of aging.

[One hundred years of the Association of Surgeons in the Netherlands. IX. Pediatric surgery]. / Honderd jaar Nederlandse Vereniging voor Heelkunde. IX. Kinderchirurgie.

The Working Group 'Surgrey in Children and Newborns', founded in 1974, was the precursor of the first subsection of the Association of Surgeons in the Netherlands, founded in 1981: the Netherlands Association for Paediatric Surgrey. Around 1900, paediatric surgery acquired an identity on the basis of what took place in children's hospitals. All the admissions were then on social indications with a surgeon being called in as a consultant if necessary. Following the Second World War, the development in anaesthesia and analgesia and an increasing understanding of metabolic processes made ever larger operations possible. The required specific expertise and the need to bring it together were decisive arguments for the foundation of the subsection. Since then, the developmental biological and genetic aspects of severe congenital malformations have, inter alia, become new topics for investigation; the consequences for medical ethics continue to be a point for attention.

The cost-effectiveness of neonatal surgery and subsequent treatment for congenital anorectal malformations.

BACKGROUND/PURPOSE: The progress made in all fields of medicine, including neonatal surgery, has contributed to the rise in healthcare costs. Although neonatal surgery may provide survival gains, these could be at the expense of worse quality of life caused by impairment after surgery. For example, congenital anorectal malformations (CAM) are complex anomalies, and the surgical techniques available have their limitations in achieving continence. It therefore seems justifiable to consider what the effects of treatment are in relation to the costs. Evidence of the cost-effectiveness of neonatal surgery, however, is lacking. METHODS: The authors analyzed both direct and indirect, medical and nonmedical costs in patients who had undergone treatment for CAM. Quality-adjusted life years (QALYs) were measured using the EuroQol EQ-5D questionnaire. Descriptive quality-of-life data were collected using a disease-specific questionnaire and a medical consumption questionnaire. RESULTS: Mean costs of treatment are calculated at Euro 31,593. Treated CAM patients suffer stool difficulties and their medical consumption is relatively high. The EQ-5D, however, shows that the quality of life of CAM patients is only slightly lower than that of the general population (0.88 v 0.93). Treatment results in a gain of 12.7 QALYs. Costs per QALY of treatment for CAM amount to Euro 2,482. CONCLUSIONS: Treatment for CAM has a favorable cost-effectiveness ratio compared with other evaluated healthcare programs. Bearing in mind the increasing political interest in evidence-based and cost-effective medicine, the results are encouraging.

[From the library of the Dutch Journal of Medicine. Giovanni Battista Morgagni: De sedibus, et causis morborum per anatomen indagatis, 1761]. / Uit de bibliotheek van het Nederlands Tijdschrift voor Geneeskunde. Giovanni Battista Morgagni: De sedibus, et causis morborum per anatomen indagatis, 1761.

The library of the Vereniging Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine Association) is a treasure-trove of information for those who wish to study the roots of the identity of the modern doctor. Recently, a book published in 1761 was purchased: De sedibus, et causis morborum per anatomen indagatis was written by Giovanni Battista Morgagni (1682-1771) when he was almost eighty years old. This book, in which Morgagni recorded the findings of 700 autopsies and linked them to the complaints of the patients and the symptoms of their diseases, marked the advent of anatomic pathology as a separate medical discipline.

Cost-effectiveness of neonatal surgery: a review.

BACKGROUND/PURPOSE: Technological developments have revolutionized both diagnosis and treatment in neonatal surgery. However, it has been increasingly recognized that financial resources might become insufficient to provide all the medical care that is technically feasible or that patients and families might desire. The purpose of this study is to apply the theory of health economics to neonatal surgery and to explore the extent and the kind of economic evaluation done in neonatal surgery. METHODS: To explore the work done so far, the authors undertook a literature search aimed at costs and effects of surgical interventions in newborns with Ravitch' surgical index diagnoses of congenital anomalies. Common keywords in cost-effectiveness analysis were used to search Medline. RESULTS: Evidence about the cost effectiveness of neonatal surgery is largely lacking. This is probably because of difficulties in long-term tracking of the patients and to the problem that most generic quality-of-life measures are not applicable in children yet. CONCLUSIONS: Further cost-effectiveness research in neonatal surgery is warranted to settle priority discussions in health care when neonatal surgery is part of such discussions. Methodology for generic quality-of-life measurement in children is badly needed.

Intussusception in a tropical country: comparison among patient populations in Jakarta, Jogyakarta, and Amsterdam.

BACKGROUND: Intussusception is the most common cause of intestinal obstruction in young children, and high mortality rates remain a problem in developing countries. The purpose of this study was to describe and elucidate the differences in outcome between groups of children with intussusception in Indonesia, a developing country, and The Netherlands, a developed country. METHODS: In this retrospective review, 176 patients were studied in three types of hospitals. A comparison was made among children treated at a primary care rural hospital in Indonesia, at a secondary care urban hospital in Indonesia, and at a tertiary care urban hospital in The Netherlands. RESULTS: Children in the rural community hospital in Indonesia were more severely ill at arrival and had a significantly longer duration of symptoms, an increased incidence of nonviable bowel, and a mortality rate of 20%, in contrast to a mortality rate of 3% in the urban hospital in Indonesia and no deaths in the Dutch hospital. CONCLUSIONS: The mortality of children with intussusception in rural Indonesia is much higher than in urban Indonesia or in The Netherlands, probably because of delayed treatment, which results in more patients undergoing surgery in worse physical condition.

Directing portal flow is essential for graft survival in auxiliary partial heterotopic liver transplantation in the dog.

BACKGROUND/PURPOSE: Auxiliary liver transplantation is an attractive alternative for orthotopic liver transplantation in patients with certain inborn errors of metabolism of the liver in which complete resection of the liver is unnecessary or even contraindicated. Because in these diseases portal hypertension is mostly absent, finding a balance in portal blood distribution between native liver and graft is complicated. The objective of this study was to investigate requirements for long-term (180 days) graft survival in auxiliary partial heterotopic liver transplantation (APHLT) in a dog model. METHODS: A metabolic defect was corrected in 26 dalmation dogs with a 60% beagle heterotopic auxiliary liver graft. Four groups of different portal inflow were studied. In the ligation group the portal vein to the host liver was ligated. In the split-flow group graft and host liver received separate portal inflow. In the banding group the distribution of the portal flow was regulated with an adjustable strapband and in the free-flow group the portal blood was allowed to flow randomly to host or graft liver. RESULTS: Metabolic correction increased in all groups after transplantation from 0.19 +/- 0.02 to 0.70 +/- 0.05 (P< .0001) but remained significantly better in the ligation and split-flow groups (graft survival, 135 +/- 27 and 144 +/- 31 days). In the banding group metabolic correction decreased significantly after 70 days, and although the grafts kept some function for 155 +/- 14 days, in 4 of 6 dogs portal thrombosis was found. In the free-flow group, competition for the portal blood led to reduced correction within 12 days and total loss of function in 96 +/- 14 days. Graft function also was assessed with technetium (Tc) 99m dimethyl-iminodiacetic acid uptake. A good linear association between HIDA uptake and metabolic correction was observed (r = 0.74; P < .0005). Grafts that contributed more than 15% to the total uptake of HIDA showed biochemical correction. This indicates a critical graft mass of about 15% to 20% of the hepatocyte volume to correct this metabolic defect. CONCLUSION: Auxiliary partial heterotopic liver transplantation can be a valuable alternative treatment for inborn errors of hepatic metabolism if the native liver and the graft receive separate portal blood inflow.