Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2012
Case Reports[A heart attack: was the patient lucky or unlucky? Circumstances were favourable but outcome ill-fated].
The assessment of signs and symptoms in primary care is an important but difficult task for general practitioners (GPs) who have to decide whether symptoms require immediate action or rather a watchful waiting approach. However, the GP may sometimes just need a bit of luck. This case report describes how the doctor's luck (in taking the initiative to phone the patient shortly after discharge from a hospital where he had undergone surgery on two coronary vessels) and the luck of the patient (a subsequent cardiac arrest at the GP's office) results in an unsuccessful out-of-hospital resuscitation. Based on our analysis of the literature on the prevalence of cardiac arrests and the outcome of out-of-hospital resuscitation, we will leave it up to the readers to decide whether our patient had been lucky or unlucky.
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Ned Tijdschr Geneeskd · Jan 2012
Case Reports[Pregnancy-associated breast cancer: current opinions on diagnosis and treatment].
Because of the trend to postpone childbirth until later in life we will be increasingly confronted with pregnancy-associated breast cancer. We report on two patients with pregnancy-associated breast cancer. ⋯ Pregnancy does not seem to influence the prognosis of breast cancer. All patients with pregnancy-associated breast cancer should be registered in a registration study.
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Lemierre's syndrome is a rare condition mostly secondary caused by an oropharyngeal infection with Fusobacterium necrophorum. We report a 62-year-old man with a classic case of Lemierre's syndrome, most likely caused by a diminished immunity as a result of an underlying chronic lymphatic leukemia.
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Ned Tijdschr Geneeskd · Jan 2012
Case Reports[Torticollis and seizures due to neuroborreliosis in a child].
In children, neuroborreliosis often manifests itself as cranial neuritis (particularly facial palsy) or aseptic meningitis. Presentation with torticollis and simple partial seizures resulting from diffuse leptomeningeal inflammation is rare. ⋯ As illustrated by this case neuroborreliosis can manifest itself atypically with torticollis, seizures and diffuse leptomeningeal enhancement due to inflammation. If there is leptomeningeal enhancement on MRI then neuroborreliosis should be included in the differential diagnosis. In childhood neuroborreliosis can be successfully treated and the prognosis is good.
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Ned Tijdschr Geneeskd · Jan 2012
Case Reports[A woman with fever and a painful hip and lower back].
A 66-year-old woman presented with fever and acute pain in her lower back and left hip. She used prednison for arteritis temporalis. Abdominal radiography revealed no signs of free intraperitoneal gas, but instead a radiolucent area below the spleen suggesting free retroperitoneal gas. This was confirmed by CT-scan of the abdomen and surgery, when a diverticulitis of the colon descendens with retroperitoneal perforation was diagnosed.