Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2008
[Multi-detector CT screening for lung cancer is still to be discouraged for the time being].
Lung cancer is an important public health problem with almost no improvement in survival over the past decades. Although observational studies demonstrate that low-dose multi-detector spiral-CT screening is able to detect lung cancer in an early stage in 55-85% of all cancer cases detected, and that 5- and even 10-year survival rates close to 90% can be achieved, these studies do not answer the question whether CT screening is advisable. Excellent survival rates in a few individuals do not necessarily indicate that there is a lung cancer-specific reduction in mortality, since observational studies are subject to several biases: lead time bias, over-diagnosis bias, and length time bias. Therefore, there is a strong worldwide recommendation from various professional organisations not to adopt CT screening for lung cancer on a wide scale, but to await the results from large randomised studies such as the US 'National lung screening trial' and the Dutch-Belgian-Danish 'Netherlands-Louvain lung cancer screening study' (NELSON), which will provide more clarity as to the effectiveness and cost-effectiveness and possible negative effects of CT screening for lung cancer.
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Ned Tijdschr Geneeskd · Jan 2008
Review[Trigeminal autonomic cephalalgias: three forms of unilateral, short-lasting headache with facial autonomic symptoms].
--Trigeminal autonomic cephalalgias (TACs) include cluster headache, paroxysmal hemicranias and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCTs). --Because they are rare, it is often difficult to recognise TACs in practice. Hallmarks of TACs include the strictly unilateral pain near the eye or temple, the accompanying autonomic symptoms, and the specific pattern in the timing of the attacks. --The TAC subtypes differ in the duration and frequency of attacks. Differentiating TAC subtypes is important because it affects the treatment approach. --In rare cases, TAC results from an underlying structural disorder. Neuroimaging (cerebral MRI) is advised in all patients with TAC.
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Ned Tijdschr Geneeskd · Jan 2008
Case Reports[Lidocaine: local anaesthetic with systemic toxicity].
In 4 patients, 3 women aged 63, 17 and 43 years, and a man aged 67 years, lidocain was used as a local anaesthetic for a transthoracic esophageal fundoplication (first patient), severe painful gonarthrosis (fourth patient) and legal abortion (second and third patients). All patients suffered from systemic toxicity as a result, a rare complication. ⋯ The presenting symptoms of systemic toxicity include numbness of the tongue, dizziness, tinnitus, visual disturbances, muscle spasms, convulsions, reduced consciousness, coma, and respiratory arrest. Physicians who use lidocain as a local anaesthetic should be aware of its systemic toxicity.