The Netherlands journal of medicine
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Letter Case Reports
Giant atria in a patient with systemic lupus erythematosus.
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Review Case Reports
Clostridium perfringens septicaemia with massive intravascular haemolysis: a case report and review of the literature.
We describe the case of a 74-year-old man with cholangitis, complicated by Clostridium perfringens septicaemia and massive intravascular haemolysis. Clostridium perfringens septicaemia is a rare but well-known cause of massive intravascular haemolysis. Here we review 40 similar cases published since 1990. ⋯ If an attempt was made to remove the focus of infection (i.e. by drainage of liver abscess, cholecystectomy, hysterectomy or ERCP), this proved to be a strong prognostic indicator of survival. However, in many of the cases the patient had already gone into shock or died before a diagnosis could be made. In severely ill patients with fever and haemolysis on the emergency department Clostridium perfringens septicaemia should always be considered, since early antibiotic treatment and if possible removal of the focus of infection can rescue patients from an otherwise fatal outcome.
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Lapatinib, a tyrosine kinase inhibitor of human epidermal growth factor receptor 2 (HER2), has shown activity in combination with capecitabine in patients with HER2-positive advanced breast cancer progressive on standard treatment regimens. We present results on preapproval drug access for this combination in such patients occurring in the general oncology practice in the Netherlands. ⋯ In a patient population with heavily pretreated HER2-positive advanced breast cancer lapatinib plus capecitabine was well tolerated and offered clinical benefit.
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Door-to-needle time (DNT), defined as the time between arrival at the emergency department (ED) and intravenous (iv) antibiotic administration is of crucial importance in the treatment of patients suffering from serious infections. The aim of this project was to reduce the DNT for patients with a serious infection as primary outcome parameter. ⋯ Identification of delaying factors and implementation of tailored interventions reduces the DNT .