Nederlands tijdschrift voor geneeskunde
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A 30 year old man with a history of migraine presented at the neurology outpatient clinic with hypesthesia of the left side of his body during a migraine attack, which was unusual for him. His family history was positive for Rendu-Osler-Weber syndrome. MRI and magnetic resonance angiography (MRA) of the brain showed multiple small infarcts, without vascular malformations. ⋯ Neurological complications include cerebral infarction and brain abscess. Also, there is a higher prevalence of migraine in patients with HHT, although the role that HHT plays in the pathogenesis of migraine is unclear. The treatment of choice of pulmonary AVM is endovascular treatment, with a success rate of 75% in the long term.
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Sarcoidosis is a granulomatous disease of unknown etiology. Standard treatment with immune suppressants such as glucocorticoids is started when vital organ function is threatened. ⋯ In patients with sarcoidosis, only the use of monoclonal antibodies that block tumour necrosis factor (TNF) has been studied scientifically, other biologicals hardly at all. TNF-blockers are used at present in patients with therapy refractory sarcoidosis.
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Constipation is a common problem with a considerable negative impact on quality of life in patients who receive palliative care. Over 35% of patients with heart failure, chronic obstructive pulmonary disease or cancer have constipation. In the palliative phase constipation often has multiple causes. ⋯ Prophylactic use of laxatives is indicated to prevent constipation when initiating constipation inducing medication such as opioids. In treatment-resistant constipation prucalopride, colchicine or misoprostol may be effective. Opioid-antagonists such as naloxone and methylnaltrexone are effective in patients with persistent opioid-induced constipation despite the use of laxatives.
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Ned Tijdschr Geneeskd · Jan 2010
Comparative Study[Cold ischaemia time and outcome of renal transplantation].
To determine the effect of cold ischaemia time (CIT) on the outcome of cadaveric renal transplantation in the Netherlands. ⋯ Prolonged cold ischaemia times are related to a more frequent occurrence of DGF, PNF and decreased graft survival after kidney transplantation. These results underline the need to reduce cold ischaemia times in the Netherlands.
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An 82-year-old woman presented with dyspnoea and palpitations. The patient was admitted to the cardiology ward on suspicion of atrial fibrillation and reduced cardiac output. Examination revealed position-dependent deoxygenation. ⋯ Curative treatment consisted of percutaneous closure of the foramen ovale. A persistent asymptomatic foramen ovale is common and can be revealed in later life. Platypnea-orthodeoxia syndrome is a relatively unfamiliar disorder.