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A Hogewoning,1,* AJAE Van de Loo,1,* M Mackus,1 SJ Raasveld,1 R De Zeeuw,1 ER Bosma,1 NH Bouwmeester,1 KA Brookhuis,2 J Garssen,1,3 JC Verster1,4 1Division of Pharmacology, Utrecht University, Utrecht, 2Faculty of Behavioral and Social Sciences, Groningen University, Groningen, 3Nutricia Research, Utrecht, the Netherlands; 4Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC, Australia *These authors contributed equally to this work Background: A number of social drinkers claim that they do not experience next-day hangovers despite consuming large quantities of alcohol. The aim of this study was to investigate the characteristics of drinkers who claim to be hangover immune and compare them with drinkers who do report having hangovers. Methods: A total of 36 social drinkers participated in a naturalistic study consisting of a hangover day (alcohol consumed) and a control day (no alcohol consumed). Data were collected on alcohol consumption, demographics, sleep, next-day adverse effects, and mood. Data from drinkers with a hangover (N=18) were compared with data from drinkers who claim to be hangover immune (N=18). Results: Drinkers with a hangover reported drowsiness-related symptoms, symptoms related to reduced cognitive functioning, and classic hangover symptoms such as headache, nausea, dizziness, weakness, and stomach pain. Corresponding mood changes comprised increased feelings of depression, anger–hostility, fatigue, and reduced vigor–activity. In contrast, hangover-immune drinkers reported relatively few hangover symptoms, with only mild corresponding severity scores. The reported symptoms were limited to drowsiness-related symptoms such as sleepiness and being tired. The classic hangover symptoms were usually not reported by these drinkers. Conclusion: In contrast to drinkers with a hangover, for those who claim to be hangover immune, next-day adverse effects of alcohol consumption are limited to a mild increase in drowsiness-related symptoms. Keywords: alcohol, hangover, symptoms, mood, immunity

Objective: Ultrasound-guided foam sclerotherapy has become an accepted technique in the treatment of varicose veins. Compared with liquid sclerotherapy, foam is a much more powerful tool in the hands of an experienced practitioner. The introduction of consensus statements on foam sclerotherapy enhances its efficacy. This report will provide clinical tips and tricks during ultrasound-guided foam sclerotherapy. Methods: In general, consensus statements do not include practical tips and tricks to facilitate ultrasound-guided foam sclerotherapy itself. Experiences acquired during ultrasound-guided foam sclerotherapy sessions in our clinical practice can enhance the power of this treatment, which may be useful for colleagues in their everyday clinical practice. Conclusion: This report presents useful tips and tricks, which may contribute to effective ultrasound-guided foam sclerotherapy.

SummaryBackground Only a few international studies have assessed the economic burden of atopic dermatitis (AD), and no costs-of-illness study for AD has been done for the Netherlands. Objectives To estimate the incidence, prevalence and health-care costs of AD in the Netherlands and to put these in an international perspective. Methods We conducted a retrospective cohort study by using the data of an information system of general practitioners (GPs). To calculate the health-care costs at the primary care level we assessed medical resources utilization. We assessed the costs of patients with more severe AD from a retrospective study of patient files at the department of dermatology of a general hospital. We compared our results with costs-of-illness studies for other countries. Results The overall general population incidence and prevalence of AD were 0·8% and 2·3%, respectively. The incidence and prevalence were high among children until the age of 6 years, respectively, 3·1% and 11·3%, but decreased rapidly thereafter. The total mean health-care costs per patient were US$71. The most significant costs were due to visits to the GP (US$32) and medication, mostly corticosteroids (US$21). Young children were treated more often with emollients alone. Only 7·8% of patients were referred to a specialist. The mean costs for these patients were US$186. Costs-of-illness studies for Australia, Germany, the U.K., the U.S.A. and the Netherlands suggested that the costs associated with AD vary considerably across countries. Estimates of the costs-of-illness for AD ranged from US$71 in the Netherlands to US$2559 in Germany per patient due to variation in the study population (GP vs. hospital) and the number of cost components included. Studies that included costs due to the time spent on treatment had relatively high estimates. Conclusions The prevalence and incidence of AD are high among young children. In general, the health-care costs for AD were low. Patients' out-of-pocket costs were relatively high.

The increase in the abuse of illicit drugs in recent years is a matter of growing concern within society. The most widely used technique for detecting the consumption of illicit drugs is that of urine analysis, usually referred to as drug testing, and the results generated can be used to establish if an individual has consumed drugs within a time period prior to the collection of the sample. Drug testing has been progressively extended from its original clinical setting, where results were utilised to improve the therapeutic care of the addict, to other sectors of society such as workplace safety, forensic science, prisons, insurance medicals, driving under the influence of drugs and anti-doping programmes in sports. In certain situations, when medico-legal implications have to be considered, a positive identification can have a serious impact on the individual's freedom and livelihood. The European countries have different approaches to the drugs of abuse problem. Consequently, each country has a different approach to drug testing and to the implementation of measures for ensuring the quality of

Introduction: Non-invasive methods for imaging varicose veins allow quantification and evaluation of venous diseases. This paper will describe a technique to visualize superficial (subdermal) varicose veins using digital infrared imaging and analysis with special software. Method: After image acquisition, the pictures were analysed with special software that segmented the varicose veins and calculated the surface area (per gridblock) occupied by varicose veins. By comparing the surfaces occupied by varices before and after a specific treatment, one can establish which treatment method performs the best. Aim for the future: Validation of this technique and quantification of the effects of treatment modalities for superficial (subdermal) varicose veins. We also investigate the use of this technique for the other clinical CEAP stages and the potential resemblance with duplex scanning.

Purpose: After an evening of heavy alcohol consumption, next day alcohol hangovers are commonly experienced. However, about 20 to 25% of the people claim not to have a hangover, despite heavy alcohol consumption [1]. It has been suggested that not experiencing alcohol hangovers may increase the risk of continuing harmful drinking behavior. Therefore, further research on this topic is warranted. Although the causes of alcohol hangovers are unknown, it has been suggested that the immune system might play a role [2]. Previous research has found significant increases in IL-10, IL-12, and IFN-γ concentrations in during the hangover state [3]. Whereas these findings were observed in blood, the aim of the current study was to investigate cytokines levels in saliva and urine, determined after an evening of alcohol consumption in people who report a hangover compared to people who do not report a hangover (hangover resistant). Methods: N= 36 healthy subjects (22 female, 14 male), aged 18 to 35 years old, participated in this naturalistic study. N= 17 reported being hangover resistant and N= 19 reported having hangovers after heavy alcohol consumption. Of both groups, saliva and urine samples were collected on a control day (no alcohol consumed) and approximately 9 hours after stopping alcohol consumption on a hangover day (the day after an evening consuming alcohol). Cytokine concentrations (IL-1b, IL-2, IL-4, IL-5, IL-6, IL-10, GM-CSF, IFN-γ and TNF-α) on the hangover and control day were determined using Multiplex Bead Immuno-essays (Invitrogen by Life Technologies, California, USA) according to manufacturer's instructions. Difference scores (hangover - placebo) of cytokine concentrations were compared between subjects with a hangover and the hangover resistant group. Results: On average, participants consumed 11.6 (4.6) alcoholic drinks in the alcohol condition (hangover resistant group: 11.0 (4.6) drinks, hangover group: 12.1 (7.2) drinks. The difference in total alcohol consumed was not significant (p = 0.61). In saliva, significant increases in IL-2, IL-4, IL-5, IL-6, IL-10, IFN-γ and TNF-α concentrations were found in the hangover condition. In urine, significant increases were found for Il-4 and IL-6 in the hangover condition, whereas a significant decrease was found for IL-8. No significant differences were found between subjects with a hangover and hangover resistant subjects. Cytokine levels in urine were less pronounced when compared to those determined in saliva samples. Conclusions: Our results are consistent with previous research, showing significant increases in cytokine concentrations during alcohol hangover. The results were consistent in both saliva and urine samples, although the observed effects in saliva were more clear. No significant differences were found between subjects with a hangover and hangover resistant subjects. Further research should investigate the role of the immune system in the pathogenesis of alcohol hangover, and why some drinkers claim to be hangover resistant despite heavy alcohol consumption.

Background. about 25% of drinkers claim to be hangover resistant, despite occasional heavy alcohol consumption. The aim of this study was to compare the presence and severity of hangover-related symptoms and mood of hangover resistant drinkers versus people reporting a hangover. Methods. N = 17 hangover resistant and N = 19 …

Background: A randomized clinical trial was performed to compare open appendectomy (OA) and laparoscopic appendectomy (LA). Methods: 201 patients with similar characteristics of appendicitis were randomized to either OA or LA. Operative time and technique, reintroduction of diet, postoperative pain, use of analgesia, hospital stay, and complications were documented. Results: 104 patients were allocated to the OA group and 97 to the LA group. Postoperative pain was significantly less in the LA group on the 1st (p < 0.001) and 2nd (p < 0.001) postoperative day, resulting in less use of analgesics on both days (p < 0.001). Restoration of diet was similar in both groups. Mean operative time was longer in the LA group: 61 vs 41 min (p < 0.001). Postoperative complications did not differ in either group, except for wound infections (six OA group vs zero LA group, p < 0.05). Mean hospital stay was similar in both groups. Conclusions: LA results in less postoperative pain and fewer wound infections. The laparoscopic procedure is technically more demanding to perform, resulting in longer operative time.

Polymorphic differences in dextromethorphan metabolism were observed in three studies conducted in a total of 44 subjects (of Dutch origin) administered 60 mg dextromethorphan hydrobromide as an OROS tablet. Mean plasma dextromethorphan (DM) concentrations after a single dose and at steady state were 4-75 times higher in the poor metabolizers (PM) relative to the extensive metabolizers (EM). Following a single dose, the mean areas under the plasma concentration-time curve (AUC, 0-24 hr) of DM, total dextrorphan (DR), and total 3-hydroxymorphinan (HM) were 6.9-fold higher, 17.4-fold lower, and 11-fold lower, respectively, for the PM than for the EM. Correspondingly, steady-state AUC values were 52.8 times higher, 6.7 times lower, and 3.3 times lower for DM, total DR, and total HM, respectively, for the PM relative to the EM. Drug/metabolite ratios (DMR) for amounts excreted in the urine of DR and HM indicated polymorphism in O-demethylation of DM since DMR for PM was 352 and 338 times higher than that for EM for DR and HM, respectively. However, polymorphism in N-demethylation was not observed. Ratios of conjugated/free dextrorphan and 3-hydroxymorphinan excreted in the urine suggest also a lack of conjugative capacity in the PM, relative to the EM. The overall incidence of PM was 9.1% in this population.