Nederlands tijdschrift voor geneeskunde
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A 55-year-old female experienced palpitations and thoracic pain. Coronary angiography showed a right sided aorta. The patient was diagnosed with a Kommerell's diverticulum that compressed the esophagus and trachea. During follow-up she developed dysphagia and she underwent a transposition of the left subclavian artery to the left common carotid artery followed by endovascular treatment of the distal aortic arch and thereby excluding the diverticulum.
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We present a 41-year-old man with severe traumatic brain injury. Cranial imaging studies revealed cerebral contusion and a longitudinal fracture of the temporal bone. Several days later brain herniated into the left external auditory canal. Imaging studies showed the known skull fracture with a direct connection between the external acoustic meatus and the intracranial structures.
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Ned Tijdschr Geneeskd · Jan 2013
[Five years of European regulation on medication use in children: what has been achieved?].
It is not known if many existing medications can safely be used in children. For this reason the EU Paediatric Regulation came into force in 2007. When new medications are developed, pharmaceutical companies are obliged to produce a plan to research their use in children which must be approved by the regulatory authorities. ⋯ The use of 10 of the 113 new, previously unregistered medications in children was approved, as was the case with 30 registered medications. Examination of existing data shows that results are often limited to changes in the 'Summary of Product Characteristics'. Many planned studies still have to be wound up, but in time the amount of information on safety and efficacy of new medications in children will increase greatly.
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Ned Tijdschr Geneeskd · Jan 2013
[Revised NHG practice guideline 'Acute coronary syndrome': a strong link in the chain of treatment].
This Dutch College of General Practitioners' (NHG) practice guidelines an important component in the care for patients with an acute coronary syndrome. In this commentary, the role of acute pre-hospital triage and percutaneous coronary intervention, high-sensitivity troponins, pharmacological therapy and automatic external defibrillators is reflected upon.
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Screening for lung cancer with computed tomography (CT) appears to be highly effective. A large randomized trial in the United States reported a 7% reduction in all-cause mortality in patients screened by CT in comparison with those screened by chest radiography. ⋯ As CT is superior to radiography in lung cancer detection, CT seems the preferred imaging modality for case finding. As more trial results have to be awaited and cost-effectiveness and optimal screening strategy remain uncertain, CT lung cancer screening is not yet ready for implementation.