Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2013
Review Case Reports[Addison's disease, primary adrenal insufficiency in adults].
Adrenal insufficiency is a rare but fatal disease if left unrecognized. Symptoms often mimic more prevalent diseases. We discuss three patients with primary adrenal insufficiency. ⋯ Treatment consists of glucocorticoid and mineralocorticoid replacement. Primary adrenal insufficiency is a 'master of disguise'. Unexplained syncope, vomiting, weight loss or hypoglycemia should prompt suspicion of this disease.
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In a reasonably large proportion of patients who take antihypertensive drugs (10-30%), hypertension appears to be therapy resistant; even the use of three antihypertensives does not lower the blood pressure sufficiently. The average nocturnal blood pressure is a better predictor of cardiovascular events than blood pressure measured during the day. ⋯ The exact mechanism of this has not yet been unravelled, but randomised, non-blinded studies suggest that this so-called chronotherapy does indeed lower cardiovascular risk in certain groups. The authors regard this as a promising strategy for patients with therapy-resistant hypertension in whom a nocturnal blood pressure dip does not occur.
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Ned Tijdschr Geneeskd · Jan 2013
Case Reports[Palliative sedation in a man with oral cancer; the Royal Dutch Medical Association guidelines not always sufficient].
Palliative sedation is an effective treatment option in patients with refractory symptoms in the last phase of life. In 2009 the Royal Dutch Medical Association (KNMG) published revised guidelines. The dosage of propofol recommended in these guidelines is, however, based on one single study. ⋯ In our opinion the advised starting dose of propofol is too low, especially in comparison with sedation in regional anaesthesia described in the literature. Furthermore, we advocate that administration of drugs from step 2, midazolam and levomepromazine, is not discontinued when propofol sedation is commenced in step 3.
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Ned Tijdschr Geneeskd · Jan 2013
Comment[New practice guideline for spine related low back pain; anesthesiologists use a different classification system than general practitioners].
The practice guideline 'Invasive treatment of spine related low back pain' was recently released by the Netherlands Society of Anesthesiologists. This guideline evaluates the state of the art regarding the diagnosis and value of invasive treatment for facet joint pain, pain in the sacroiliac joint, coccygodynia, discogenic pain and the 'failed back surgery syndrome'. ⋯ The guideline was created in a methodologically sound manner, but the results are disappointing: the evaluated diagnoses remain disputable and the recommendations for the evaluated treatments are mostly based on expert opinion. The guideline lacks information on the scientific basis of the proposed new classification system, which makes its clinical usefulness questionable.
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A 1.5-year-old boy was referred to the Dutch Retinoblastoma Center with leukocoria, a white pupillary reflex. Fundoscopy revealed a white retinal tumor and ultrasonography showed a calcified mass. ⋯ Histopathological examination of the retinal tumor confirmed the diagnosis 'retinoblastoma'. Leukocoria is a cardinal sign of retinoblastoma.