Nederlands tijdschrift voor geneeskunde
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Nitrous oxide, laughing gas, is used as a party drug to achieve a euphoric effect. It has been gaining popularity in recent years and is considered a relatively innocent substance. Nitrous oxide is known to cause subacute degeneration of the spinal cord by inactivation of active vitamin B12. ⋯ We present a 17-year-old woman and a 19-year-old man with subacute axonal polyneuropathy caused by laughing gas abuse. Abstinence of laughing gas and treatment with intramuscular and oral vitamin B12 suppletion respectively have led to improvement of their symptoms. Our cases demonstrate a less-known but treatable complication of laughing gas.
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Ned Tijdschr Geneeskd · Jan 2017
[Pulmonary embolism response teams: what is the added value for patients with acute pulmonary embolism?]
Adequate triaging of patients presenting with acute pulmonary embolism (PE) is essential for appropriate treatment, especially for patients with severe PE. Optimal treatment for this latter group of patients includes pharmaco-mechanical reperfusion treatment for the minority of patients who present with haemodynamic instability, and standard anticoagulation and close monitoring on the ward for the intermediate-high risk patient. ⋯ We discuss the potential role of PERT teams in Dutch hospitals. The main advantage of PERT could be a uniform management strategy that is supported by a multidisciplinary team including all key specialists in the treatment of severe PE.
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Ned Tijdschr Geneeskd · Jan 2017
[70-Gene signature as an aid to treatment decisions in early-stage breast cancer].
The 70-gene signature test (MammaPrint) has been shown to improve prediction of clinical outcome in women with early-stage breast cancer. We sought to provide prospective evidence of the clinical utility of the addition of the 70-gene signature to standard clinical-pathological criteria in selecting patients for adjuvant chemotherapy. ⋯ Among women with early-stage breast cancer who were at high clinical risk and low genomic risk for recurrence, the receipt of no chemotherapy on the basis of the 70-gene signature led to a 5-year rate of survival without distant metastasis that was 1.5 percentage points lower than the rate with chemotherapy. Given these findings, approximately 46% of women with breast cancer who are at high clinical risk might not require chemotherapy.
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Ned Tijdschr Geneeskd · Jan 2017
[Deciding on surgery for acute subdural haematoma; does a neurosurgeon rather fill nursing homes or cemeteries?]
Acute subdural haematoma is a life-threatening condition that can sometimes be mitigated by decompressive craniotomy. However, it can also increase misery when patients survive but are left with severe disabilities. A recent publication shows that neurosurgeons in Belgium and the Netherlands vary considerably in their opinion regarding if, and when, to perform this surgery. ⋯ This requires a value judgement that has to be informed by the flawed and incomplete medical literature and by the perhaps even more flawed and incomplete (relayed) accounts of the wishes and attitudes of the unconscious patient. However, in the end, the surgeon also evaluates his own convictions in the whole issue and this will inevitably introduce subjectivity and practice variation. A structured moral debate may help to improve the extremely difficult decision-making process around the management of acute subdural haematoma.
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Ned Tijdschr Geneeskd · Jan 2017
[The alpha-gal syndrome: an allergic reaction to mammalian meat secondary to a tick bite].
Here we present the case of a 68-year-old patient with alpha-gal syndrome. This is a delayed-onset allergic reaction, characteristically occurring 2-6 hours after ingestion of mammalian meat products. ⋯ The alpha-gal syndrome is usually self-limiting as long as there are no new tick bites. Clinicians should be aware of this syndrome, which is often not recognized as such.