Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Aug 1998
[Excess mortality in critically ill patients after treatment with human albumin].
According to the results of a systematic review of randomized clinical studies administration of human albumin to critically ill patients is associated with excess mortality, compared with withholding albumin or administration of crystalloid fluids. The study appears to be well done. ⋯ Alternatives to albumin are available in most clinical situations, but unfortunately, they are not completely without drawbacks. The use of albumin has to be limited; it might only be abolished when a better effect of other fluids, such as synthetic solutions, is demonstrated.
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Ned Tijdschr Geneeskd · Aug 1998
Case Reports[Pellagra (deficiency of vitamin B3 or of the amino acid tryptophan): a disease still extant in the Netherlands].
Pellagra was diagnosed in a 48-year-old female patient with a bullous skin disease. The skin disease with purple/red sharply demarcated spots on hands and feet had worsened after sun exposure. She was a chronic alcoholic and for the last few months she had had diarrhoea. ⋯ Pellagra leads to the triad: dermatitis, diarrhoea and dementia, eventually followed by death. The skin changes are characteristic and pathognomonic. Recognition of pellagra is important; the prognosis is good after treatment.
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Ned Tijdschr Geneeskd · Aug 1998
Review Case Reports[Perplexing acute or chronic somatic or psychiatric symptoms: possibly due to porphyria].
A woman aged 35 years had a classical picture of acute intermittent porphyria. However, the diagnosis was only made after repeated clinical investigations by internists, gastroenterologists, gynaecologists and surgeons working at a university hospital, and after an unnecessary laparotomy. ⋯ It may run a serious invalidating and life-threatening course. Its manifestations vary and may lead to very different clinical pictures.
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Ned Tijdschr Geneeskd · Aug 1998
Multicenter Study[The importance of steroid receptors for the prognosis and hormone treatment of breast cancer patients: a retrospective study in Southeastern Netherlands].
To assess the effect of oestrogen (ER) and progesterone (PgR) receptors on the prognosis of patients with operable breast cancer and the decision to treat these patients with adjuvant tamoxifen. ⋯ This study shows that ER and PgR receptors are significant prognostic factors for survival in breast cancer patients with involved axillary lymph nodes. The prognostic effect appeared to be restricted to the first four years after primary treatment. Selection of patients for endocrine treatment should be based on the steroid receptor status, considering the importance of the steroid receptors for predicting the response to endocrine treatment.
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South Sudan has five million inhabitants and has been fighting a war of independence with North Sudan since 1959. The hostilities have totally disrupted society and the country is the most inaccessible of Africa. ⋯ Semi-nomadic pastoral tribes populate South Sudan. Doctors Without Borders assisted in fighting a major epidemic of kala azar in the late eighties which cost some 200,000 lives; the organization still provides medical aid in the country.