A new Dutch Law regulating provision of identifying information of donors to offspring: background, content and impact.

In 2004 a law was introduced in The Netherlands, which gives offspring conceived by semen or oocyte donation the right to know the identity of the donor. The law also regulates the provision of other information concerning the donor to the offspring, their parents or their general practitioner. With the introduction of this law, a choice has been made in which the wish of offspring prevails above others involved. Donors can no longer claim absolute anonymity; they are anonymous at the time of donation, but if a child aged > or =16 years requests information the donor may now be traced. During 15 years of debate on the abolition of donor anonymity the number of donors decreased by >70% and the number of semen banks by 50%. We describe the debate which led to the law, the characteristics of the law itself and note some of the probable and possible consequences for donor offspring, parents, donors and semen banks.

[Cryopreservation of semen of adolescents and young adult men with cancer]. / Invriezen van sperma bij pubers en jonge volwassen mannen met kanker.

The importance of cryopreserving semen for young male cancer patients is illustrated in three case descriptions. A 28-year-old man with chronic myeloid leukaemia that resulted in azoospermia, later fathered a child with his semen that had been stored prior to chemotherapy. In an 18-year-old adolescent with non-Hodgkin lymphoma the possibility to store cryopreserved semen was only raised after chemotherapy had been started and had caused azoospermia. This caused the patient serious regret. A 14-year-old boy with acute lymphatic leukaemia had his semen stored despite initial hesitations due to his young age. The cancer hardly ever affects the semen quality to the extent that cryopreservation of the semen becomes impossible. The aim should be to obtain several ejaculates prior to the cancer therapy and to store multiple portions, so that later a number of fertilisation attempts are possible. The primary attending physician is initially responsible for raising the possibility of semen cryopreservation. Ideally, however, all health professionals involved should be aware of this aspect. There is a need for multidisciplinary protocols for oncology centres and sperm banks, so that the timely informing of patients is guaranteed, responsibilities are recorded--with appropriate procedures to prevent unnecessary delay--and procedures that concur with legal requirements and financial constraints are established.

Prognosis of post-neonatal respiratory distress syndrome (RDS) treated with positive end-expiratory pressure ventilation (PEEP).

Thirty-six patients with respiratory distress syndrome (RDS) were treated with mechanical ventilation with positive end-expiratory pressure (PEEP). In 16 patients the RDS was the result of direct pulmonary injury due to chest trauma (group A), and in 20 patients the RDS followed non-direct injury of the lungs (group B). Fifteen patients died. At the moment of death the RDS had disappeared. No difference in mortality existed between groups A and B. Four patients died from causes unrelated to the RDS, one patient died from an avoidable error in the treatment. The ultimate outcome did not seem to be related to age, use of mechanical ventilation or PEEP, or occurrence of complications (e.g. a pneumothorax, which appeared to be related rather to the chest trauma). Of probably prognostic significance was the presence of a combination of massive aspiration and RDS. Of the 12 patients who suffered from this combination, nine died. PEEP ventilation was more unsuccessful in raising PaO2 appreciably in these patients than in others. The combination of massive aspiration and RDS posses a therapeutic dilemma. PEEP ventilation is invaluable in the treatment of RDS. Interruption of the PEEP within the first 1-2 days may sometimes result in massive recurrence of the RDS. Endotracheal suctioning which is a prerequisite for the treatment of massive aspiration, may under these circumstances be virtually impossible within this period. A compromise, including PEEP ventilation for as short a period as possible (usually no longer than 2 to 3 days) without interruption, followed thereafter by intensive physiotherapy with endotracheal suctioning, may succeed in saving some of the patients.