The Netherlands journal of medicine
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Megestrol acetate (MA) is a progestational agent for the treatment of metastatic breast cancer and endometrial cancer. MA has also been used to promote weight gain in malnourished elderly patients, in patients with immunodeficiency virus and in cancer-induced cachexia. In addition to thromboembolic disease, MA may induce hyperglycaemia, osteoporosis, suppression of the gonadal axis, and Cushing's syndrome. ⋯ The patients were treated with cortisone acetate supplements, had clear evidence of HPA-axis suppression but recovered fully after MA was discontinued. Patients receiving MA might have an inadequate adrenal response during stressful conditions, possibly because 160-320 mg MA daily may not provide adequate protection to prevent the symptoms of adrenal insufficiency. The adverse MA effect on the HPA axis is probably not well recognised in clinical practice, and clinicians need an increased awareness of the endocrine complications secondary to MA treatment.
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The Early Warning Score (EWS) is used for early detection of deteriorating vital parameters and has been correlated with adverse outcomes. Unfortunately, neither its value on general wards nor the optimal cut-off value have been investigated. We aimed to find the optimal cut-off value for EWS on general wards, and investigated the possibility to raise this value from EWS ≥ 3 without compromising sensitivity too much. ⋯ Raising the EWS threshold to 4 on general wards in the hospital would lead to an unacceptable decrease in sensitivity. Therefore, we recommend that the pre-defined cut-off should remain 3, with the possibility to personalise the threshold.
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Review Case Reports
Biologics for rare inflammatory diseases: TNF blockade in the SA PHO syndrome.
SAPHO is an invalidating syndrome characterised by Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis. The low prevalence and heterogeneous presentation often leads to a significant diagnostic delay. Here, we provide an up-to-date overview of current insights into the pathogenesis and different treatment options. In addition, we describe the effects of anti-TNF treatment in three refractory cases. ⋯ These case reports illustrate, consistent with the current literature, that TNF blockers can be considered for treatment of refractory SAPHO syndrome.
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Comparative Study
Identification of modifiable risk factors for acute kidney injury after cardiac surgery.
Acute kidney injury (AKI) is a common problem after cardiac surgery and is associated with an increase in morbidity, mortality and duration of hospital stay. With this study we aimed to identify potential risk factors for cardiac surgery associated AKI (CS-AKI) in a single-centre population with a special focus on modifiable risk factors. ⋯ In our series we could identify intraoperative administration of packed cells and postoperative administration of furosemide or packed cells as potentially modifiable risk factors in the development of AKI.
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Comparative Study
Causes of death in intensive care patients with a low APACHE II score.
Little is known about the actual causes of death of patients with a low APACHE II score, but iatrogenic reasons may play a role. The aim of this study was to evaluate the demographics, course of disease, and causes of death in this specific group of ICU patients. ⋯ Most patients with an APACHE II score lower than 15 who died were admitted to the ICU because of respiratory insufficiency. The main cause of death was haemodynamic insufficiency following limited therapy because of an unfavourable prognosis. In less than one out of 1000 cases of this low-risk group of patients death was related to iatrogenic injury.