Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Dec 2006
Review[Optimal adjuvant hormone therapy in postmenopausal women with hormone-sensitive mammary carcinoma: tamoxifen and the aromatase inhibitors anastrozole, exemestane and letrozole].
Postmenopausal patients with hormone-sensitive breast cancer may be eligible for adjuvant hormone therapy. - For years, tamoxifen was the treatment of choice. - However, the side effects associated with tamoxifen, such as endometrial cancer and thromboembolic disorders, and the search for more effective agents have led to the introduction of new hormonal therapies. - The results of randomised trials with the third-generation aromatase inhibitors anastrozole, exemestane and letrozole demonstrate improved efficacy compared to tamoxifen. - Using aromatase inhibitors, the disease-free survival is prolonged and recent data from some studies also show a benefit in overall survival. - Aromatase inhibitors are associated with specific side effects consisting of osteoporosis/increased incidence of fractures and myalgia/arthralgia.
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Ned Tijdschr Geneeskd · Dec 2006
Biography Historical Article[The significance of Bernard Brouwer's contribution to Dutch neurology and neurosurgery. On the 125th anniversary of the year of his birth].
Following his training under Winkler and carrying out research at the Central Institute for Brain Research in Amsterdam, in 1923 Bernard Brouwer (1881-1949) became the firstprofessor ofneurologyindependent from psychiatry, in the Netherlands. His most important scientific work included comparative anatomical studies of the cerebellum and the projection of retinal fibres on the geniculate body and occipital cortex. He gained international fame and in 1926, during one of his American lecture tours, he was invited to fill the new chair of experimental neurology at Johns Hopkins University. ⋯ The Amsterdam neurology clinic became an international exchange centre for students of neuroscience. The difficult decisions he had to make during his rectorate in the Second World War, were criticised in 1945. During the last years of his life, he was director of the Central Institute for Brain Research.
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Illness is associated with involuntary weight loss, which is often the result of malnutrition. The undernourished surgical patient runs a higher risk of postoperative morbidity and mortality. For this reason, perioperative nutrition is an important part of a patient's therapy. ⋯ The Dutch tradition of fasting patients before surgery is difficult to defend any longer because this policy impairs patients' state of health as a result of which they are not optimally prepared for the surgical induced stress response. The postoperative recovery of all surgical patients can be improved by an early postoperative start of enteric nutrition. When the enteric administration of food turns out to be impossible, total parenteral nutrition can be given to bridge a long period without food.
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Ned Tijdschr Geneeskd · Dec 2006
Case Reports[Two patients with lactic acidosis and hypoglycaemia as initial presentation of a lymphoma].
A 32-year-old man who had undergone kidney transplantation presented with malaise, severe diarrhoea, nausea and vomiting, productive cough and shortness of breath. A 42-year-old woman with no relevant medical history presented with fever, weight loss and abdominal pain. Both patients had lactic acidosis and hypoglycaemia. ⋯ Lymphoreticular malignancies should be considered for cases of lactic acidosis with sufficient oxygen supply, particularly when hypoglycaemia is also present. The lactic acidosis and hypoglycaemia result from increased anaerobic glycolysis in tumour cells. Tumour reduction with chemotherapy can reduce the lactic acidosis.