Nederlands tijdschrift voor geneeskunde
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'Acute kidney injury' is modern terminology for a sudden decline in kidney function, and is defined by the RIFLE classification (RIFLE is an acronym for Risk, Injury, Failure, Loss and End-stage kidney disease). Acute kidney injury occurs as a result of the combination of reduced perfusion in the kidney, systemic inflammation, and the administration of nephrotoxic drugs. Patients with chronic renal damage, advanced age, diabetes mellitus or heart failure are at an increased risk of acute kidney injury. ⋯ Treatment of patients with acute kidney injury is currently supportive in nature. The optimisation of a patient's haemodynamics results in a reduction of the occurrence of acute kidney injury during extensive surgical procedures. A promising treatment aimed at preventing acute kidney injury is called 'remote ischaemic pre-conditioning'.
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Ned Tijdschr Geneeskd · Jan 2012
Case Reports[Pulmonary toxicity resulting from the use of nitrofurantoin].
Acute pulmonary syndrome is an uncommon but severe adverse reaction to nitrofurantoin. This syndrome is seldom recognised at the moment of presentation, which potentially subjects patients to unnecessary treatment and delays in the discontinuation of nitrofurantoin. ⋯ The diagnosis of acute pulmonary syndrome should be considered in patients presenting with fever, dyspnoea, dry cough, leukocytosis (typically with eosinophilia) and a bilateral interstitial pattern visible on the chest X-ray after having started nitrofurantoin. The prognosis is excellent if the condition is recognised early and the exposure to nitrofurantoin is discontinued.
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Ned Tijdschr Geneeskd · Jan 2012
Case Reports[Unexplained anaemia in men: be aware of hypogonadism].
Unexplained anaemia is not uncommon. We present two male patients suffering from longstanding mild anaemia, for which no cause could be found. We performed an extensive analysis, but there were no signs of malignant disease, chronic inflammation, renal failure, hypothyroidism, myelodysplastic syndrome, haemolysis or nutritional deficiencies. ⋯ After exclusion of prostate carcinoma, testosterone substitution therapy was started in both patients, which improved their haematocrits and sexual and general well-being substantially. Testosterone exerts anabolic effects in multiple organ systems; in bone marrow it potentiates the stimulatory effect of erythropoietin on erythropoiesis. Primary hypogonadism frequently occurs in elderly patients, while secondary hypogonadism is frequently seen in middle-aged men with type 2 diabetes mellitus and obesity.
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Ned Tijdschr Geneeskd · Jan 2012
Comparative Study[Reliability of the registration of data on complex patients: effects on the hospital standardised mortality ratio (HSMR) in the Netherlands].
To evaluate the reliability of data registration in calculating the hospital standardised mortality ratio (HSMR). ⋯ Comorbidities in patients with pancreatic carcinoma who undergo a resection are being inadequately recorded in the LMR. This results in insufficient correction in the case mix and a low score on the Charlson index, which could result in an incorrect HSMR.
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Ned Tijdschr Geneeskd · Jan 2012
Case Reports[Autoimmune limbic encephalitis: importance of early diagnosis and treatment].
Autoimmune limbic encephalitis is a rare disorder, characterised by the subacute onset of seizures, short-term memory loss, and psychiatric and behavioural symptoms. Initially, it was recognised as a paraneoplastic disorder, but recently a subgroup of patients without systemic cancer was identified. This type of limbic encephalitis is associated with voltage-gated potassium channel (VGKC) or N-methyl-D-aspartate receptor (NMDAR) antibodies. ⋯ These case descriptions emphasise the importance of timely recognition of autoimmune limbic encephalitis in order to rule out malignancy and to quickly initiate treatment. This potentially life-threatening disease responds well to immunomodulatory therapy.