Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2010
[Outcomes of 16 years of oesophageal surgery: low postoperative mortality and improved long-term survival].
To assess trends in patient characteristics and treatment outcomes in a large cohort of patients who underwent oesophagectomy for oesophageal carcinoma in a tertiary referral centre over a period of 16 years. ⋯ Over the past 16 years in-hospital mortality in patients undergoing oesophagectomy for a potentially curable oesophageal carcinoma at the AMC, has been stably low. The total number of complications increased during these periods. Long-term survival improved during this time to a three-year overall survival of more than 50% in the most recent period.
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Ned Tijdschr Geneeskd · Jan 2010
Practice Guideline[Guideline 'Diagnosis and treatment of inflammatory bowel disease in adults'. II. Special situations and organisation of medical care].
The Dutch national practice guideline 'Diagnosis and treatment of inflammatory bowel diseases (IBD) in adults' describes the multidisciplinary approach for adult patients with (suspected) IBD, recommended following analysis of the literature according to the principles of evidence based guideline development. Ulcerative colitis and Crohn's disease are associated with temporary or permanent extra-intestinal disorders: reactive inflammatory conditions, associated conditions, and those arising as a consequence of long standing, inflammatory, intestinal disease. Treatment is aimed first at the IBD disease process and subsequently at the specific extra-intestinal conditions if complaints persist. ⋯ These positive findings have not yet been incorporated into the practice of life insurance providers. The diversity of IBD patient health care and its delivery by many professionals places stringent requirements on the organisation of care by hospitals and those providing treatment. The transfer process from paediatric specialist to gastroenterologist affects both patients and parents deeply.
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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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Ned Tijdschr Geneeskd · Jan 2010
Case Reports[Severe, subacute axonal polyneuropathy due to hypophosphatemia].
A 46-year-old man receiving tube feeding because of anorexia and weight loss developed progressive neurological symptoms initially resembling Guillain-Barré syndrome. Eventually axonal neuropathy due to severe hypophosphatemia was diagnosed. ⋯ The neurological manifestations of hypophosphatemia are reversible if oral or intravenous suppletion of phosphate is started in time. Recognizing the refeeding syndrome is crucial in making a timely diagnosis.
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Ned Tijdschr Geneeskd · Jan 2010
[Fewer breech deliveries after implementation of a modified cephalic version protocol].
To investigate the effect of implementation of a number of process policy guidelines (protocol), on the success rate of external cephalic version (ECV) for breech presentation. ⋯ After implementation of the process policy guidelines, the success rate of ECV increased considerably. The rate of elective caesarean section for breech presentation declined. These findings are in favour of establishing specialized ECV centres in the Netherlands.