Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2015
Case Reports[Fever with a rash caused by chronic meningococcemia].
Fever with a rash is a common clinical presentation, which can be caused by various medical conditions. ⋯ Chronic meningococcemia is a rare manifestation of meningococcal infection and should be considered in patients with prolonged fever, purpuric skin lesions and joint involvement.
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Invasive pulmonary aspergillosis (IPA) is a life-threatening infection that occurs predominantly in severely immunocompromised patients. Recently, IPA is also increasingly seen in less severely immunocompromised patients, such as patients with COPD receiving glucocorticoids and patients on ventilation in an IC unit. ⋯ Since the 2009 influenza pandemic, IPA has been increasingly reported as a superinfection in patients with a severe influenza virus infection. This combined Aspergillus and influenza infection often has a fatal outcome. An Aspergillus sputum culture should be taken seriously in patients with severe influenza pneumonia, and treatment should be considered early in the disease course.
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Ned Tijdschr Geneeskd · Jan 2015
[Strict treatment of hypertension during pregnancy: safe but not obviously better].
The CHIPS (Control of Hypertension In Pregnancy Study) trial showed that tight blood pressure control in women with hypertension during pregnancy was safe with respect to neonatal outcome. However it was not linked to improvement of the predefined maternal composite outcome. The CHIPS trial is without doubt a landmark study in this field; however some questions are still unresolved. ⋯ Moreover the primary neonatal endpoint is defined too broadly because of the inclusion of the rather vague component "higher than usual neonatal care". An endpoint combining major neonatal and maternal comorbidities would have been more clinically relevant. It is unlikely that the results of this trial will influence the Dutch guidelines.
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A 60-year-old man presented with acute chest pain and dyspnoea, which was caused by pericarditis secondary to a neo-oesophago-pericardial fistula after previous oesophagectomy for oesophageal cancer. The fistula presumably originated from a penetrating peptic ulcer.
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Ned Tijdschr Geneeskd · Jan 2015
Review Case Reports[Treatment of breakthrough pain in cancer patients].
Pain is common in patients with cancer (33-64%) and can be divided into background and breakthrough pain (BTP). BTP is a passing, acute pain that occurs despite the use of analgesia to control background pain. BTP may arise spontaneously or be provoked by certain movements or activities. ⋯ Both patients had to wait too long before they received their BTP medication, causing the BTP to have passed its peak. After consultation with their nurses, both patients were allowed to have one dose of breakthrough medication in advance, which resulted in better treatment of their BTP. Every hospitalized patient with BTP should have one dose of breakthrough medication ready for taking in advance.