Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2012
Case Reports[A heart attack: was the patient lucky or unlucky? Circumstances were favourable but outcome ill-fated].
The assessment of signs and symptoms in primary care is an important but difficult task for general practitioners (GPs) who have to decide whether symptoms require immediate action or rather a watchful waiting approach. However, the GP may sometimes just need a bit of luck. This case report describes how the doctor's luck (in taking the initiative to phone the patient shortly after discharge from a hospital where he had undergone surgery on two coronary vessels) and the luck of the patient (a subsequent cardiac arrest at the GP's office) results in an unsuccessful out-of-hospital resuscitation. Based on our analysis of the literature on the prevalence of cardiac arrests and the outcome of out-of-hospital resuscitation, we will leave it up to the readers to decide whether our patient had been lucky or unlucky.
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A 67-year-old man presented in the emergency department after a fall on his outstretched right hand. Physical examination showed tenderness of the anatomical snuffbox and the dorsal side of the wrist. X-rays of the wrist revealed a perilunate luxation combined with a scaphoid fracture.
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An 85-year-old woman with a severe kyphosis presented at the emergency room because of progressive dyspnea and cough, without other complaints. During auscultation, peristaltic sounds were heard over the thorax. A massive diaphragmatic hernia with intrathoracic stomach, small intestine and colon, was seen on CT-scan.
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Lemierre's syndrome is a rare condition mostly secondary caused by an oropharyngeal infection with Fusobacterium necrophorum. We report a 62-year-old man with a classic case of Lemierre's syndrome, most likely caused by a diminished immunity as a result of an underlying chronic lymphatic leukemia.
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Ned Tijdschr Geneeskd · Jan 2012
Case Reports[Torticollis and seizures due to neuroborreliosis in a child].
In children, neuroborreliosis often manifests itself as cranial neuritis (particularly facial palsy) or aseptic meningitis. Presentation with torticollis and simple partial seizures resulting from diffuse leptomeningeal inflammation is rare. ⋯ As illustrated by this case neuroborreliosis can manifest itself atypically with torticollis, seizures and diffuse leptomeningeal enhancement due to inflammation. If there is leptomeningeal enhancement on MRI then neuroborreliosis should be included in the differential diagnosis. In childhood neuroborreliosis can be successfully treated and the prognosis is good.