Search

Differentiated thyroid carcinoma is a rare disease. Appropriate diagnosis, treatment and follow-up are complex but greatly influence treatment outcomes and patient quality of life. - Patients with differentiated thyroid carcinoma present in many hospitals throughout the Netherlands, underscoring the need for uniformity in diagnosis and treatment. - This prompted the Dutch Society of Nuclear Medicine and the Dutch Endocrine Society to develop an evidence-based guideline that emphasises not only new scientific developments but also the organisation of care. - Thyroid-stimulating hormone (TSH) assessment and fine needle aspiration cytology play a central role in the diagnostic assessment of a patient with a thyroid nodule. - Ablation of residual thyroid tissue with radioiodine (I-131) is recommended for all patients who have undergone total thyroidectomy. - Follow-up protocols distinguish between patients with a low risk of thyroid-carcinoma recurrence and those with a non-low risk of recurrence.

Differentiated thyroid carcinoma is a rare disease. Appropriate diagnosis, treatment and follow-up are complex but greatly influence treatment outcomes and patient quality of life. - Patients with differentiated thyroid carcinoma present in many hospitals throughout the Netherlands, underscoring the need for uniformity in diagnosis and treatment. - This prompted the Dutch Society of Nuclear Medicine and the Dutch Endocrine Society to develop an evidence-based guideline that emphasises not only new scientific developments but also the organisation of care. - Thyroid-stimulating hormone (TSH) assessment and fine needle aspiration cytology play a central role in the diagnostic assessment of a patient with a thyroid nodule. - Ablation of residual thyroid tissue with radioiodine (I-131) is recommended for all patients who have undergone total thyroidectomy. - Follow-up protocols distinguish between patients with a low risk of thyroid-carcinoma recurrence and those with a non-low risk of recurrence.

The autopsy of a 16-year-old boy who had died suddenly revealed hypertrophic cardiomyopathy (HCM). Molecular genetic investigation revealed mutations in the MYBPC3gene. His surviving family members could then be examined and reassured that they did not carry the mutation. An 18-year-old boy who died suddenly turned out to have known HCM. No further investigations were done and no tissue was saved. Genetic investigation of his immediate family was impossible due to the lack of a known mutation in the family. Periodic examination in clinically unaffected family members was therefore advised. Sudden cardiac death at young age is not infrequently the first symptom of an inherited cardiac disease. Because these diseases usually inherit as an autosomal dominant trait, first-degree family members have a 50% chance of carrying the same genetic defect. Besides clinical cardiologic examination of the remaining family members, post-mortem molecular genetic investigation can be of value in reaching a diagnosis and in determining the subsequent therapeutic options for immediate relatives.

The autopsy of a 16-year-old boy who had died suddenly revealed hypertrophic cardiomyopathy (HCM). Molecular genetic investigation revealed mutations in the MYBPC3gene. His surviving family members could then be examined and reassured that they did not carry the mutation. An 18-year-old boy who died suddenly turned out to have known HCM. No further investigations were done and no tissue was saved. Genetic investigation of his immediate family was impossible due to the lack of a known mutation in the family. Periodic examination in clinically unaffected family members was therefore advised. Sudden cardiac death at young age is not infrequently the first symptom of an inherited cardiac disease. Because these diseases usually inherit as an autosomal dominant trait, first-degree family members have a 50% chance of carrying the same genetic defect. Besides clinical cardiologic examination of the remaining family members, post-mortem molecular genetic investigation can be of value in reaching a diagnosis and in determining the subsequent therapeutic options for immediate relatives.

Giant congenital naevi have a higher risk of malignant transformation compared to acquired naevi. Benign proliferative nodules in giant congenital naevi can have clinical and histological similarities with malignant melanoma. The diagnosis can be established by subtle histological differences and recognition.

Giant congenital naevi have a higher risk of malignant transformation compared to acquired naevi. Benign proliferative nodules in giant congenital naevi can have clinical and histological similarities with malignant melanoma. The diagnosis can be established by subtle histological differences and recognition.

Organen, weefsels en cellen worden gebruikt voor een verscheidenheid aan medische toepassingen. Op Europees niveau bestaat er behalve voor bloed, nog geen wettelijke regeling om de kwaliteit en veiligheid van lichaamsmaterialen te waarborgen. In Nederland ligt er een wetsvoorstel dat zich in meer detail richt op kwaliteits- en veiligheidsaspecten van lichaamsmateriaal (uitgezonderd bloed), de Wet Veiligheid en Kwaliteit Lichaamsmateriaal (WVKL). Een belangrijk veiligheidsaspect voor lichaamsmaterialen is het risico op ziekteoverdracht. Dit risico is een van de elementen van een risicoanalyse en verdient aandacht van elk van binnen de ketenzorg betrokken instellingen. Het risico wordt bepaald door factoren als de prevalentie van de overdraagbare aandoening in de donorpopulatie, de morbiditeit en mortaliteit behorend bij de opgelopen infectie, het orgaan of weefsel dat gedoneerd wordt, donorselectiemethodes en de mate van bewerking. Deze factoren vormen de basis voor het invoeren van specifieke beheersmaatregelen die het risico op ziekteoverdracht reduceren. Voor een inventarisatie van richtsnoeren die deze beheersmaatregelen omvatten is contact gezocht met Nederlandse beroepsverenigingen, orgaanbanken, individuele beroepsbeoefenaars en andere organisaties betrokken bij procedures rond orgaan- weefsel- en celdonaties. Uit de inventarisatie blijkt dat voor de meeste lichaamsmaterialen er richtsnoeren bestaan die zijn opgesteld door (inter-)nationale organisaties of autoriteiten. De niet-weefselspecifieke normen zijn vaak opgesteld volgens Good Manufacturing Practice, oftewel voor de "branche"- lichaamsmaterialen Good Tissue Practice (GTP). Voor de weefselspecifieke normen blijkt dat de risicomomenten omtrent donorkeuring in alle gevallen gedetailleerd aan de orde komen, echter handelingen aan het lichaamsmateriaal zijn in sommige gevallen onderbelicht. Verder is gesignaleerd dat het in kweek brengen van en het bewerken van cellen uit humane bestanddelen met het doel ze te gebruiken bij een geneeskundige behandeling tot op heden nauwelijks in richtsnoeren is vastgelegd. Dit heeft te maken met de nog prille stand van deze tak van wetenschap en met de nog onduidelijke Europese wettelijke status van dit soort producten. De inventarisatie zoals in dit rapport beschreven kan gebruikt worden voor een normstelling in het kader van de WVKL.

Giant congenital naevi have a higher risk of malignant transformation compared to acquired naevi. Benign proliferative nodules in giant congenital naevi can have clinical and histological similarities with malignant melanoma. The diagnosis can be established by subtle histological differences and recognition.

Differentiated thyroid carcinoma is a rare disease. Appropriate diagnosis, treatment and follow-up are complex but greatly influence treatment outcomes and patient quality of life. - Patients with differentiated thyroid carcinoma present in many hospitals throughout the Netherlands, underscoring the need for uniformity in diagnosis and treatment. - This prompted the Dutch Society of Nuclear Medicine and the Dutch Endocrine Society to develop an evidence-based guideline that emphasises not only new scientific developments but also the organisation of care. - Thyroid-stimulating hormone (TSH) assessment and fine needle aspiration cytology play a central role in the diagnostic assessment of a patient with a thyroid nodule. - Ablation of residual thyroid tissue with radioiodine (I-131) is recommended for all patients who have undergone total thyroidectomy. - Follow-up protocols distinguish between patients with a low risk of thyroid-carcinoma recurrence and those with a non-low risk of recurrence.

Organen, weefsels en cellen worden gebruikt voor een verscheidenheid aan medische toepassingen. Op Europees niveau bestaat er behalve voor bloed, nog geen wettelijke regeling om de kwaliteit en veiligheid van lichaamsmaterialen te waarborgen. In Nederland ligt er een wetsvoorstel dat zich in meer detail richt op kwaliteits- en veiligheidsaspecten van lichaamsmateriaal (uitgezonderd bloed), de Wet Veiligheid en Kwaliteit Lichaamsmateriaal (WVKL). Een belangrijk veiligheidsaspect voor lichaamsmaterialen is het risico op ziekteoverdracht. Dit risico is een van de elementen van een risicoanalyse en verdient aandacht van elk van binnen de ketenzorg betrokken instellingen. Het risico wordt bepaald door factoren als de prevalentie van de overdraagbare aandoening in de donorpopulatie, de morbiditeit en mortaliteit behorend bij de opgelopen infectie, het orgaan of weefsel dat gedoneerd wordt, donorselectiemethodes en de mate van bewerking. Deze factoren vormen de basis voor het invoeren van specifieke beheersmaatregelen die het risico op ziekteoverdracht reduceren. Voor een inventarisatie van richtsnoeren die deze beheersmaatregelen omvatten is contact gezocht met Nederlandse beroepsverenigingen, orgaanbanken, individuele beroepsbeoefenaars en andere organisaties betrokken bij procedures rond orgaan- weefsel- en celdonaties. Uit de inventarisatie blijkt dat voor de meeste lichaamsmaterialen er richtsnoeren bestaan die zijn opgesteld door (inter-)nationale organisaties of autoriteiten. De niet-weefselspecifieke normen zijn vaak opgesteld volgens Good Manufacturing Practice, oftewel voor de "branche"- lichaamsmaterialen Good Tissue Practice (GTP). Voor de weefselspecifieke normen blijkt dat de risicomomenten omtrent donorkeuring in alle gevallen gedetailleerd aan de orde komen, echter handelingen aan het lichaamsmateriaal zijn in sommige gevallen onderbelicht. Verder is gesignaleerd dat het in kweek brengen van en het bewerken van cellen uit humane bestanddelen met het doel ze te gebruiken bij een geneeskundige behandeling tot op heden nauwelijks in richtsnoeren is vastgelegd. Dit heeft te maken met de nog prille stand van deze tak van wetenschap en met de nog onduidelijke Europese wettelijke status van dit soort producten. De inventarisatie zoals in dit rapport beschreven kan gebruikt worden voor een normstelling in het kader van de WVKL.

Both autologous and allogeneic human organs, tissues and cells are used for a wide variety of medical applications. At the moment national legislation for safety and quality aspects of human tissue is under development in the Netherlands. One important safety aspect is the risk of infectious disease transmission. This can occur through infectious donors and by contamination of the human material during the whole transplantation process. The latter includes besides, transport, processing and storage, also the actual retrieval and implantation. Measures to control these risks should at least be based on scientific rationales, such as the prevalence of infectious disease agents among the donor population, and the mortality and morbidity associated with the diseases. The measures should preferably be based on international agreements, since international exchange is taking place for most human tissues. It is the responsibility of all those involved in the transplantation process to reduce the risk of disease transmission and to implement the relevant control measures. The latter could be achieved by the formulation of guidelines with recommendations, instructions and minimal requirements to support daily practice. Our inventory of guidelines has revealed that for most human tissues such guidelines are developed by (inter) national organisations. Non-tissue-specific guidelines focus mainly on the implementation of a quality system for tissue establishments, sometimes referred to as Good Tissue Practice (GTP). The GTP approach provides basic requirements for factors such as personnel, buildings, materials and documentation. In several guidelines these basic requirements are combined with detailed information on donor selection, storage and transport. In addition, tissue-specific guidelines in existence for several categories also focus in detail on donor selection and, in most cases, on detailed procedures during the whole transplantation process. This inventory could be used for standardisation activities in the framework of the new Dutch act on human tissues.

The autopsy of a 16-year-old boy who had died suddenly revealed hypertrophic cardiomyopathy (HCM). Molecular genetic investigation revealed mutations in the MYBPC3gene. His surviving family members could then be examined and reassured that they did not carry the mutation. An 18-year-old boy who died suddenly turned out to have known HCM. No further investigations were done and no tissue was saved. Genetic investigation of his immediate family was impossible due to the lack of a known mutation in the family. Periodic examination in clinically unaffected family members was therefore advised. Sudden cardiac death at young age is not infrequently the first symptom of an inherited cardiac disease. Because these diseases usually inherit as an autosomal dominant trait, first-degree family members have a 50% chance of carrying the same genetic defect. Besides clinical cardiologic examination of the remaining family members, post-mortem molecular genetic investigation can be of value in reaching a diagnosis and in determining the subsequent therapeutic options for immediate relatives.

Consumers increasingly use vitamin supplements. Also, since June 1996, foodstuffs enriched with vitamins are available on the Dutch market. -These sources of extra vitamins may be useful for groups at risk for marginal vitamin deficiencies. -These risk groups include the chronically ill (e.g. diabetics), people using medicaments, older people and pregnant women. - Extra vitamins from low-dose supplements or enriched foodstuffs may also constitute a valuable and safe supplement to the diet of children, smokers, people eating unbalanced, people on slimming diets, vegetarians and people engaged in intensive sports. -According to the advisory group Nutrition of the Health Council, addition of vitamins to foodstuffs causes no risks of any importance for public health, apart from vitamins A and D and of the trace elements selenium, copper and zinc. Consequently, these should only be added to reconstituted foodstuffs or in a substitution product, not in enriched foodstuffs.

Consumers increasingly use vitamin supplements. Also, since June 1996, foodstuffs enriched with vitamins are available on the Dutch market. -These sources of extra vitamins may be useful for groups at risk for marginal vitamin deficiencies. -These risk groups include the chronically ill (e.g. diabetics), people using medicaments, older people and pregnant women. - Extra vitamins from low-dose supplements or enriched foodstuffs may also constitute a valuable and safe supplement to the diet of children, smokers, people eating unbalanced, people on slimming diets, vegetarians and people engaged in intensive sports. -According to the advisory group Nutrition of the Health Council, addition of vitamins to foodstuffs causes no risks of any importance for public health, apart from vitamins A and D and of the trace elements selenium, copper and zinc. Consequently, these should only be added to reconstituted foodstuffs or in a substitution product, not in enriched foodstuffs.