Nederlands tijdschrift voor geneeskunde
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Syncope can be caused by a pulmonary embolism. This applies in particular to elderly patients admitted with syncope; in the general population, however, syncope is far more frequently caused by a vasovagal response or orthostatic hypotension. Syncope can be the symptom of a pulmonary embolism, even in the absence of any clinical manifestations of this diagnosis; it is, therefore, important to exclude pulmonary embolism in any syncope patient in the accident and emergency department by applying the Wells clinical decision rule. GPs should also be alert to syncope as a possible symptom of pulmonary embolism, and be alert to breathing rate and signs of venous thrombosis.
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Nitrous oxide, laughing gas, is used as a party drug to achieve a euphoric effect. It has been gaining popularity in recent years and is considered a relatively innocent substance. Nitrous oxide is known to cause subacute degeneration of the spinal cord by inactivation of active vitamin B12. ⋯ We present a 17-year-old woman and a 19-year-old man with subacute axonal polyneuropathy caused by laughing gas abuse. Abstinence of laughing gas and treatment with intramuscular and oral vitamin B12 suppletion respectively have led to improvement of their symptoms. Our cases demonstrate a less-known but treatable complication of laughing gas.
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Ned Tijdschr Geneeskd · Jan 2017
[70-Gene signature as an aid to treatment decisions in early-stage breast cancer].
The 70-gene signature test (MammaPrint) has been shown to improve prediction of clinical outcome in women with early-stage breast cancer. We sought to provide prospective evidence of the clinical utility of the addition of the 70-gene signature to standard clinical-pathological criteria in selecting patients for adjuvant chemotherapy. ⋯ Among women with early-stage breast cancer who were at high clinical risk and low genomic risk for recurrence, the receipt of no chemotherapy on the basis of the 70-gene signature led to a 5-year rate of survival without distant metastasis that was 1.5 percentage points lower than the rate with chemotherapy. Given these findings, approximately 46% of women with breast cancer who are at high clinical risk might not require chemotherapy.
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Ned Tijdschr Geneeskd · Jan 2017
[Pulmonary embolism response teams: what is the added value for patients with acute pulmonary embolism?]
Adequate triaging of patients presenting with acute pulmonary embolism (PE) is essential for appropriate treatment, especially for patients with severe PE. Optimal treatment for this latter group of patients includes pharmaco-mechanical reperfusion treatment for the minority of patients who present with haemodynamic instability, and standard anticoagulation and close monitoring on the ward for the intermediate-high risk patient. ⋯ We discuss the potential role of PERT teams in Dutch hospitals. The main advantage of PERT could be a uniform management strategy that is supported by a multidisciplinary team including all key specialists in the treatment of severe PE.
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Ned Tijdschr Geneeskd · Jan 2017
Review[Injuries resulting from accidents and violence in the Netherlands; results of an Emergency Department register].
- Injuries from accidents and violence are amongst the most important public health issues in the world, including in Europe and the Netherlands.- Using the Dutch Injury Surveillance System and the Dutch Burden of Injury Model, we describe the incidence and costs associated with injuries in the Netherlands that are registered via Emergency Departments (ED). We also map the main causes of injury by age category.- Annually, 700,000 patients attend the ED of a hospital with an injury; 1 in 6 attendees is admitted.- The societal costs of these injuries totals 3.2 billion euro per year. ⋯ Injuries occur relatively more often in children and the elderly.- The key underlying causes differ per age category. Common causes in all ages are cycling accidents, falls from heights, and other fall-related incidents.- The government should continue to deliver the public health interventions for prevention of fall injuries and cycling accidents.