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To determine whether socio-economic differences in hospital admissions of adolescents and young adults are related to differences in intelligence.. Retrospective cohort study.The data were derived from a group of 10,231 young adults and adolescents who were followed for a total of 47,212 person years with regard to their hospital admissions. Intelligence was measured in the first year of secondary school by 2 non-verbal intelligence tests for fluid intelligence. Data from hospital admissions were matched to a large-scale educational and occupational cohort. Data were analysed with Cox proportional hazards analysis.Intelligence was not found to be related to hospital admissions. However, a low occupational and educational level of the young adults or their parents, was strongly related to heightened risk for hospital admissions. In particular, the low socio-economic status of a respondent was associated with heightened risk for hospital admissions due to accidents (relative risk: 3.49; 95% confidence interval: 1.91-6.39).The small extent to which the socio-economic differences in hospital admissions seem to be based upon fluid intelligence, at least in adolescents and young adults, as well as the heightened risks of hospital admissions in lower socio-economic status groups and the associated high costs for health care legitimise further study of the determinants of these differences.

Primary pulmonary hypertension (PPH) is a rare, progressive and life-threatening pulmonary vascular disease of unknown aetiology, which results in elevated pulmonary vascular resistance, pulmonary hypertension and eventually right ventricle failure. PPH occurs in all age groups, but most frequently in women aged 20-30 years old. The mean survival after the onset of symptoms is 2-3 years. Although the disease remains incurable at present, major advances in treatment options have been made during the last 10 years. This had led to a considerable improvement in extended survival and the quality of life in a substantial number of PPH patients. At present the most important treatment options include anticoagulants, calcium channel antagonists, chronic prostacyclin therapy (cost of this only reimbursed by health insurers in the Netherlands since 1999) and if needs be lung or heart-lung transplantation. Chronic continuous intravenous administration of epoprostenol is burdensome for the patient and requires adequate patient selection and a well-developed intramural and extramural infrastructure.

Metabolic acidosis occurs frequently in small children. The most common causes are hypoxia, sepsis, gastroenteritis and hypovolaemia. Calculation of the anion gap is useful in establishing the cause. An increased anion gap represents unmeasured anions, e.g. lactate in lactic acidosis. Metabolic acidosis was diagnosed in two boys aged one year and six weeks respectively. The first patient had a normal, the second an increased anion gap in blood. By determining the pH and the anion gap in urine it is possible to distinguish between a proximal and a distal tubular disease. The first patient had distal renal tubular acidosis; he recovered after correction of the acidosis. The second patient had a defect in the mitochondrial respiratory chain; he died at the age of seven months.

Since 1986 the number of parenteral exposures to potentially infectious blood reported to the Amsterdam Public Health Service increases every year. The number of needlestick accidents increased significantly from 64 in 1986 to 166 in 1996 whereas the number of other exposures decreased from 59 to 44 in these years. The increase was mainly seen in nonhospital based (para)medics. A possible explanation of this increase is greater awareness of the potential infection risk with HIV, hepatitis B or C virus leading to a tendency to report more readily. This assumption is in contradiction with results of studies in hospital-based personnel where a decrease is observed as a result of educational programmes. Other explanations are a higher frequency of use of sharp instruments and (or) an increase in the workload. Out of a total of 1886 needlestick accidents in 1986-1996 one woman became HIV positive; she was deliberately infected by her ex-partner who injected her with blood of an AIDS patient, and one person contracted an hepatitis C virus infection: a policeman wounded by a needle used by a drug addict.

A previously healthy boy aged 14 developed persistent ventricular tachycardia while engaged in sports; ultrasonography revealed arrhythmogenic right ventricular dysplasia (ARVD). He was treated with a class III antiarrhythmic drug but nevertheless died 4 years later during recreational activities. An uncle of the boy was found to have died suddenly on a playing field, 25 years previously at the age of 20. In ARVD, fibrolipomatous areas in the right ventricle lead to dilations of the wall where (sometimes fatal) re-entrant tachycardias may develop. An autosomal dominant heredity with variable expression and penetrance is considered probable, while the genetic defect was located recently. Examination and, if necessary, pharmacotherapy of relatives of an ARVD patient may reduce the risk of a fatal arrhythmia.

In a large commercial goat farm rickets-like symptoms were diagnosed in goat kids. The disease was probably caused by the synthetic milk which was freely available to the kids. The milk feed was for calves and had a calcium-phosphorus ratio of 0.83:1.

The effect of dose interval on gentamicin serum concentrations in preterm babies (less than 35 weeks gestational age) was studied in the first week after birth. When gentamicin (2,5 mg/kg) was given intravenously every 12 hours, 53% of the babies had elevated pre dose serum concentrations (greater than 2,0 microgram/ml). This occurred in 27% of the babies when gentamicin was given every 18 hours (p less than 0.01). We recommend that 2.5 mg/kg/18 hours should be used in preterm babies in the first week after birth, although monitoring of gentamicin serum levels remains essential.