Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2013
Review Case Reports[Therapy resistant diabetes mellitus and lipodystrophy: leptin therapy leads to improvement].
Lipodystrophy is a congenital or acquired disorder characterized by complete or partial absence of subcutaneous fat tissue, often accompanied by insulin resistance, diabetes mellitus (DM), hypertriglyceridemia and hepatic steatosis. A decrease in both number and function of adipocytes leads to ectopic fat depositions and decreased production of adipokines such as leptin. We present 2 patients with inadequately regulated DM, hypertriglyceridemia and hepatic steatosis who were eventually diagnosed with lipodystrophy: 1 with congenital generalized lipodystrophy (Berardinelli-Seip syndrome) and 1 with congenital partial lipodystrophy (Dunnigan syndrome). ⋯ This resulted in improved plasma levels of triglyceride, glucose and HbA1c and a decrease in liver size. In addition, hepatic triglyceride content decreased from 19.3% to 1.3% in the first patient and from 20.6% to 12.4% in the second. Leptin therapy is an effective and safe treatment for therapy-resistant diabetes and hypertriglyceridemia in patients with congenital lipodystrophy.
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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
Case Reports[The diagnostic benefits of lipase values in acute pancreatitis].
Serum lipase is a biochemical marker used for diagnosing acute pancreatitis. Lipase has largely replaced amylase in terms of diagnostic value, although both markers are still commonly used. ⋯ The first patient, who had recently experienced cholecystitis, presented to the emergency room with abdominal pain and high lipase levels. The second patient, who had received a renal transplant a few years earlier, visited the gastroenterological outpatient clinic with abdominal pain and only a slightly elevated lipase level.
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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.