Ichthyosis bullosa of Siemens present. A distinctive characteristic of IBS which is not present in other forms of ichthyosis is called the "Mauserung phenomenon" (Mauserung is German for "moulting" and was first described by H.W.Siemens). These are small patches of bare, apparently normal skin in the middle of areas of hyperkeratosis. As the sufferer ages the flaking and blistering should improve. The hyperkeratosis may grow more severe but more localized and is generally only present on flexural folds of the major joints. IBS is an autosomal dominant genetic condition caused by a mutation in the gene for keratin 2e on chromosome 12. This means
Emergency medical services in the Netherlands The exceptional level of training permits what is, for the most part, independent practice, conducted according to a set of National Emergency Care Protocols, issued by the Dutch Ambulance Institute, and reviewed and revised every four years. Medical oversight for protocol compliance is conducted by each service's Medical Manager, who is a licensed physician. On those occasions when the patient's condition actually exceeds the paramedic protocols, the paramedic has the option of either calling their own Medical Manager for additional instructions, or requesting the response of a mobile medical team. All ambulances are staffed by a crew of two. These