Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2016
Review Case Reports[Treatment in the Intensive Care Unit: continue or withdraw?].
End-of-life decision-making in the Intensive Care Unit is a common and complex process. The step-by-step process of decision-making leading to withdrawal of life-sustaining treatment is illustrated in this paper by a clinical case. A variety of factors influences the decision to adjust the initial curative treatment policy towards withdrawal of life-sustaining therapy and the pursuit of comfort care. ⋯ Timely involvement of a legal representative of the patient is essential for an uncomplicated decision-making process. Advance care planning and advance directives provide opportunities for patients to express their preferences beforehand. It is important to realise that end-of-life decisions are significantly influenced by personal and cultural values.
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A 2-month-old infant presented with papules and pustules. Since the patient's mother and brother also had an unexplained--itchy--skin rash, it was thought that the skin rash was due to scabies. This diagnosis was confirmed by dermatoscopy and direct microscopic examination.
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Ned Tijdschr Geneeskd · Jan 2016
[Influence of tumour stage at breast cancer detection on survival in modern times: population based study in 173,797 patients].
To assess influence of stage at breast cancer diagnosis, tumour biology, and therapy on survival in contemporary times of better (neo-)adjuvant systemic therapy. ⋯ Tumour stage at breast cancer diagnosis influences overall survival significantly also in the current era of effective systemic therapy. Early tumour stage at breast cancer diagnosis remains vital.
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Ned Tijdschr Geneeskd · Jan 2016
[The Teratology Information Service: medicines during pregnancy and lactation].
Many women use medication during pregnancy. Both the healthcare professional and the pregnant woman often have many questions about the possible adverse effects of the medication that are not always answered in the product information. ⋯ Healthcare professionals can contact the TIS for information and individual risk assessments. In this article we discuss the background and positioning of the TIS, the characteristics of telephone consultations, the collection of data and the considerations that are important for the use of medication during pregnancy and lactation.
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Ned Tijdschr Geneeskd · Jan 2016
Case Reports[A smoker with hoarseness and a swelling of his neck].
A 68-year-old man was referred to the Department of Otolaryngology because of a swelling of his neck and hoarseness. CT imaging of his neck revealed a cystic mass in the larynx as well as in the neck, with an air-fluid level. The diagnosis 'laryngopyocele' was made.