Nederlands tijdschrift voor geneeskunde
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Endoscopic transpapillary gallbladder drainage is a new, relatively non-invasive treatment for patients with symptomatic gallbladder disease and a high surgery risk. Placement of an internal pigtail stent is an alternative treatment for percutaneous gallbladder drainage. This procedure can be performed in patients with a temporary contra-indication - in preparatory process to a cholecystectomy - as well as in patients with a prolonged contra-indication where the pigtail stent can remain in situ for a longer period of time. This technique appears to be an effective and safe procedure for patients with acute cholecystitis or symptomatic gallbladder disease and a high surgery risk.
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Telemedicine is a way to provide care over a distance. In teleconsultations the intensivist gives advice to his or her colleagues in a remote centre. In tele-intensive care (tele-IC) the intensivist makes medical decisions for the remote patients and is fully responsible for the treatment of the intensive care patients in a remote centre. ⋯ In a pilot setting, the OLVG hospital has implemented a tele-ICU for the 3-bed ICU in the MC Zuiderzee hospital. The tele-ICU was set up on 3 December 2010. Although the tele-ICU performed sufficiently, several aspects, such as cost analysis, need clarification before the system can be widely implemented in the Netherlands.
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Ned Tijdschr Geneeskd · Jan 2014
[Irreversible electroporation: a new form of image-guided tumour ablation].
Irreversible electroporation (IRE) is a new, non-thermal image-guided tumour ablation technique. The repeated application of high-voltage electrical pulses causes pores to form in the cell membrane, so that cells lose their homeostatic properties, and die. The advantage of IRE over other local ablation techniques is that IRE selectively destroys cells, whilst the surrounding extracellular matrix structures remain intact. ⋯ Both in the Netherlands and worldwide, various clinical studies are being run on the safety and efficacy of IRE for centrally located hepatic and pancreatic tumours, which are unsuitable for the current local therapies (surgical resection, irradiation or thermal ablation) due to their anatomic location. Although the long-term results are as yet unknown, the future of IRE appears promising. IRE may prove a valuable tool to add in the multidisciplinary treatment of cancer.
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Ned Tijdschr Geneeskd · Jan 2014
[Thrombosis and embolism during Diane-35 use: analysis of reports made to the Netherlands Pharmacovigilance Centre Lareb].
After media attention on the possible risks of thromboembolic complications associated with the use of cyproterone/ethinylestradiol (Diane-35 and generics), the Netherlands Pharmacovigilance Centre Lareb received a large number of reports over a short period of time. We describe in detail the reports of serious undesirable effects, also taking into account the indication, time to onset and risk factors, identification of the complication, treatment and course. ⋯ It was mentioned that cyproterone/ethinylestradiol was often used as a contraceptive drug. Some reports mentioned the fact that thrombosis and embolism were not always recognised at an early stage by users.
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Ned Tijdschr Geneeskd · Jan 2014
Case Reports[Infestation with Enterobius vermicularis mimicking appendicitis].
Gastrointestinal infestation with the parasite Enterobius vermicularis is common in humans and is usually harmless. Anal pruritus is the most characteristic symptom, but the parasites can cause severe abdominal pain mimicking appendicitis. Early recognition can prevent an unnecessary appendectomy. ⋯ Gastro-intestinal infestation with E. vermicularis is very common, especially in young children. This infestation is usually harmless, but can mimic appendicitis. This infestation is easily treatable with mebendazol.