Nederlands tijdschrift voor geneeskunde
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One of the undoubted major breakthroughs in the recent treatment of cancer is imatinib, a tyrosine-kinase inhibitor of the bcr-abl fusion protein, the stem-cell factor receptor c-kit (KIT) and the platelet-derived growth-factor receptor. The successes obtained with imatinib in the treatment of chronic myeloid leukaemia (CML), gastrointestinal stroma-cell tumours (GIST), and dermatofibrosarcoma protuberans, demonstrate that targeted therapy with a rationally designed, small, synthetic molecule can be highly successful. However, experience so far with imatinib in KIT-positive tumours indicates that imatinib seems only to be effective in those tumours with a gain-of-function mutation in c-kit. There are arguments in favour of investigating a combined therapy of imatinib and classical chemotherapy.
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Ned Tijdschr Geneeskd · Oct 2003
Review[Imatinib, a specific tyrosine-kinase inhibitor, for the treatment of patients with a gastrointestinal stroma cell tumor].
The c-kit oncogene, encoding for a transmembrane growth-factor receptor with tyrosine-kinase activity (KIT), plays an important role in the tumourigenesis of gastrointestinal stroma-cell tumours (GISTs). GISTs are a heterogeneous group of mesenchymal tumours, mainly localised in the abdomen. Immunohistochemical staining using antibodies directed towards the c-kit protein on the cell surface, is a useful tool in the often difficult differential diagnosis of GISTs from other mesenchymal tumours. ⋯ As a result of the short period of time between the drug's experimental introduction and actual registration, many unanswered questions about its use for the treatment of GISTs remain. These can only be answered in well-designed clinical trials. It is therefore recommended that patients with these rare tumours are referred to a centre with experience in the diagnosis and treatment of these soft-tissue sarcomas.
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Ned Tijdschr Geneeskd · Oct 2003
[Advantages and disadvantages of a "no-fault" compensation system].
Should the present legal regulation of medical negligence be replaced by a no-fault compensation system (NFCS)? The Dutch government is preparing a viewpoint on this issue on the basis of a research report that describes the pros and cons of a NFCS. Recently, the British chief medical officer (CMO) rejected the introduction of a comprehensive NFCS. ⋯ A NFCS has certain advantages but is supposedly very expensive. Other policy measures can be considered as well.
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Ned Tijdschr Geneeskd · Oct 2003
Case Reports[Chickenpox in pregnancy with serious consequences for both mother and child].
A 41-year-old woman with chickenpox in the third trimester of her pregnancy was admitted to the Intensive Care Unit of our hospital for ventilatory support. She was treated with aciclovir, amoxicillin-clavulanic acid and erythromycin. Her baby was delivered by forceps following placental abruption. ⋯ This reduces the risk of maternal complications and may prevent a fetal varicella syndrome. If the mother has already developed chickenpox and there are serious complications, she should be treated with intravenous aciclovir. If possible, delivery should be delayed until 5 days after the onset of maternal chickenpox.