Nederlands tijdschrift voor geneeskunde
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Most patients with gallbladder stones are asymptomatic and do not require treatment. Biliary colics are the main indication for laparoscopic cholecystectomy: the treatment of choice for gallbladder stones. Dyspepsia is not an indication for treatment of gallstones. ⋯ Bile duct stones are mainly treated endoscopically during endoscopic retrograde cholangiopancreatography (ERCP): pancreatitis, bleeding and perforation are the main complications. Prior to cholecystectomy, an ERCP is indicated in case of cholangitis, severe pancreatitis, persisting jaundice, bile duct stones on ultrasonography, or the combination of dilated ducts and abnormal liver function tests. After endoscopic stone removal, a cholecystectomy is indicated for patients < 50 years but a 'wait and see' policy is justified in elderly patients.
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Shortly after moving from the Netherlands to Egypt, the author, a physician, started procedures to get his medical certificate recognized. These procedures began at the Egyptian Medical Association, housed in the Dar al-Hikmah ('House of Wisdom'). The Association first required a comparison between the Netherlands and the Egyptian medical education, to be made by the Supreme Council of Universities. ⋯ This Ministry inquired at the Ministry of Foreign Affairs whether an Egyptian education would be recognized in the Netherlands, in order for the 'principle of reciprocity' to be applied. The reply of the Dutch Embassy was positive but progress has stopped since. A registration as a physician in the United Kingdom was obtained without problems and in a short time; this registration might be helpful in efforts to resume the process in Egypt.