Effectiveness of Nitrate Policy in Flanders (1990-2003): Modular Modelling and Response Analysis

The impact of current nitrate policy measures in Flanders is estimated. A modular modelling system has been developed for comparing response and pressure indicators and for decomposing the response impact of policy measures. Compared to 1990, the internalised manure surplus is reduced to zero, whereas the distance to target of the soil surface balance to the water quality standard dropped only with 58%. Source-linked and sink-related measures each account for about the half of the manure surplus reduction. The impact of abatement technologies is minor. The modular approach helps to unravel the discrepancy between pressure and response and to propose policy alternatives.abatement technology, DPSIR scheme, nitrogen pollution reduction, Agricultural and Food Policy, B41, C51, H21, K32,

A Man with Labile Blood Pressure

Ronald Ma and colleagues discuss the differential diagnosis and management of a patient who presented with recurrent episodes of chest discomfort, palpitations, and labile blood pressure

Torsades de pointes during laparoscopic adrenalectomy of a pheochromocytoma: a case report

<p>Abstract</p> <p>Introduction</p> <p>Torsades de pointes is a rare but potentially lethal arrhythmia. The amount of literature available on Torsades de pointes occurring in patients with pheochromocytoma is limited, and we found no literature describing this dysrhythmia in a patient with pheochromocytoma under anesthesia.</p> <p>Case presentation</p> <p>We describe the case of a 42-year-old Caucasian woman without QT prolongation preoperatively with recurrent Torsades de pointes during laparoscopic removal of a pheochromocytoma. Torsades de pointes mainly occurs in the setting of a prolonged QT interval. This patient neither had a prolonged QT preoperatively nor was her family history suspect for a congenital long QT syndrome. Most likely, our patient had an acquired long QT syndrome, elicited by the combination of flecainide, hypomagnesemia and adrenergic stimulation during manipulation of the tumor.</p> <p>Conclusion</p> <p>We show that in the case of a surgical pheochromocytoma removal, perioperative conditions can elicit an acquired or previously unknown congenital long QT syndrome. Therefore, preoperative α- and β-blockade is advised, QT-prolonging drugs should be avoided and potassium and magnesium plasma levels should be kept at normal to high levels.</p

Central and cerebrovascular effects of leg crossing in humans with sympathetic failure

General rights It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulations If you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: https://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. A B S T R A C T Leg crossing increases arterial pressure and combats symptomatic orthostatic hypotension in patients with sympathetic failure. This study compared the central and cerebrovascular effects of leg crossing in patients with sympathetic failure and healthy controls. We addressed the relationship between MCA V mean (middle cerebral artery blood velocity; using transcranial Doppler ultrasound), frontal lobe oxygenation [O 2 Hb (oxyhaemoglobin)] and MAP (mean arterial pressure), CO (cardiac output) and TPR (total peripheral resistance) in six patients (aged 37-67 years; three women) and age-and gender-matched controls during leg crossing. In the patients, leg crossing increased MAP from 58 (42-79) In the control subjects, CO increased 11 % (P &lt; 0.05) with no change in TPR. By contrast, in the patients, CO increased 9 % (P &lt; 0.05), but also TPR increased by 13 % (P &lt; 0.05). In conclusion, leg crossing improves cerebral perfusion and oxygenation both in patients with sympathetic failure and in healthy subjects. However, in healthy subjects, cerebral perfusion and oxygenation were improved by a rise in CO without significant changes in TPR or MAP, whereas in patients with sympathetic failure, cerebral perfusion and oxygenation were improved through a rise in MAP due to increments in both CO and TPR

Central and cerebrovascular effects of leg crossing in humans with sympathetic failure

A B S T R A C T Leg crossing increases arterial pressure and combats symptomatic orthostatic hypotension in patients with sympathetic failure. This study compared the central and cerebrovascular effects of leg crossing in patients with sympathetic failure and healthy controls. We addressed the relationship between MCA V mean (middle cerebral artery blood velocity; using transcranial Doppler ultrasound), frontal lobe oxygenation [O 2 Hb (oxyhaemoglobin)] and MAP (mean arterial pressure), CO (cardiac output) and TPR (total peripheral resistance) in six patients (aged 37-67 years; three women) and age-and gender-matched controls during leg crossing. In the patients, leg crossing increased MAP from 58 (42-79) to 72 (52-89) compared with 84 (70-95) to 90 (74-94) mmHg in the controls. MCA V mean increased from 55 (38-77) to 63 (45-80) and from 56 (46-77) to 64 (46-80) cm/s respectively (P &lt; 0.05), with a larger rise in O 2 Hb [1.12 (0.52-3.27)] in the patients compared with the controls [0.83 (− 0.11 to 2.04) μmol/l]. In the control subjects, CO increased 11 % (P &lt; 0.05) with no change in TPR. By contrast, in the patients, CO increased 9 % (P &lt; 0.05), but also TPR increased by 13 % (P &lt; 0.05). In conclusion, leg crossing improves cerebral perfusion and oxygenation both in patients with sympathetic failure and in healthy subjects. However, in healthy subjects, cerebral perfusion and oxygenation were improved by a rise in CO without significant changes in TPR or MAP, whereas in patients with sympathetic failure, cerebral perfusion and oxygenation were improved through a rise in MAP due to increments in both CO and TPR