Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2012
Comment[How can breast-conserving surgery be improved even more?].
Due to population-wide screening and increased awareness of breast cancer by women, more early-stage diagnoses are being made. Breast-conserving surgery, performed according to well-established guidelines, results in the same level of local control and long-term survival as mastectomy for the same indication. ⋯ There are two provisions: the tumour and its gross delineation must be visible by ultrasound, and the breast surgeon needs to learn the technique and apply it sensibly. Generally speaking, ultrasound-guided breast-conserving resection of invasive breast cancer may well lead to more initially complete resections and better cosmetic results.
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A 14-year-old girl had a painful hip after making a splits on a trampoline. On X-ray we discovered an avulsion fracture of the spina iliaca anterior superior, which healed in 6 weeks with conservative treatment.
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A 56-year-old woman presented with retrograde amnesia and confusion at the Emergency Department after falling down the stairs. Physical examination revealed a bilateral periorbital hematoma (raccoon eyes) and bilateral retroauricular ecchymosis, both strongly indicative of a basilar skull fracture.
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Ned Tijdschr Geneeskd · Jan 2012
Comment[Useful guideline for treatment of pain in vulnerable elderly people].
Forty to fifty percent of elderly people (> 70 years of age) appear to have pain that interferes with daily life. The frail elderly, described as elderly people who are vulnerable, mostly chronically ill, with physical, and psychological, as well as social, and communicative disabilities, are often inadequately treated for pain. This interdisciplinary guideline aims to improve recognition and treatment of chronic pain in frail elderly patients and is therefore very useful in clinical practice. Interventional, minimally invasive pain treatment is not described in this guideline, although for a number of pain syndromes this could be an evidence-based potential treatment.
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Improved aquarium techniques are enabling sea aquariums to imitate reality even better. This means that they sometimes contain known and unknown marine toxins. Aquarium keepers and their families may then develop potentially severe poisoning. ⋯ Manipulation of certain soft corals found in sea aquariums can cause emission of palytoxin. This may cause a potentially severe episode of poisoning. When working in a sea aquarium protective measures should be taken. There is no specific therapy for or antidote to palytoxin poisoning and for this reason, treatment is supportive.