[Renal and spleen infarction after massive consumption of cannabis and cocaine in a young man]. / Infarctus rénal et splénique après consommation massive de cannabis et cocaïne chez un homme jeune.

Cannabis is the most widely consumed drug in the world, particularly among young subjects. Cocaine is the third leading illicit drug. Cases of renal infarction associated with combined consumption of cannabis and cocaine have been reported in the literature. We describe the case of a 24-year-old man who presented renal and spleen infarction after massive consumption of cannabis and cocaine. Both vascular events arose on healthy arteries. Etiological tests were negative leading to the conclusion that the events resulted from a toxic cause related to cannabis and cocaine consumption. Different mechanisms, potentially including thrombosis, might explain the association of cannabis and cocaine with vascular events. We suggest that a systematic search for cannabis and cocaine consumption among young victims of vascular disease might be useful.

[Postgraduate training for general practitioners in the Netherlands--a model for Germany? Description of postgraduate training and critical comparison]. / Facharztweiterbildung Allgemeinmedizin in den Niederlanden--ein Modell für Deutschland? Beschreibung der Weiterbildung und kritischer Vergleich.

Unlike in other countries, postgraduate training in Germany is not attached to academic centres. Content and duration of postgraduate training are stipulated by the federal medical boards, with the process being unstructured and solely at the responsibility of the trainee. As a model for a structured postgraduate training programme, the Dutch training system for general practitioners is described in detail. The most important difference is the funding of trainees and training facilities within the frame of structured training programmes by the Dutch Ministry of Health. Acquisition of qualifications thus becomes more important than the work performance of the trainee. After reforming graduate medical training, it is now time to rethink postgraduate training in Germany.

Motor cortex activation in Parkinson's disease: dissociation of electrocortical and peripheral measures of response generation.

This study investigated characteristics of motor cortex activation and response generation in Parkinson's disease with measures of electrocortical activity (lateralized readiness potential [LRP]), electromyographic activity (EMG), and isometric force in a noise-compatibility task. When presented with stimuli consisting of incompatible target and distractor elements asking for responses of opposite hands, patients were less able than control subjects to suppress activation of the motor cortex controlling the wrong response hand. This was manifested in the pattern of reaction times and in an incorrect lateralization of the LRP. Onset latency and rise time of the LRP did not differ between patients and control subjects, but EMG and response force developed more slowly in patients. Moreover, in patients but not in control subjects, the rate of development of EMG and response force decreased as reaction time increased. We hypothesize that this dissociation between electrocortical activity and peripheral measures in Parkinson's disease is the result of changes in motor cortex function that alter the relation between signal-related and movement-related neural activity in the motor cortex. In the LRP, this altered balance may obscure an abnormal development of movement-related neural activity.