Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · May 2002
Case Reports[Diagnostic image (89). A woman with dysphagia. Dysphagia lusoria].
In a 49-year-old woman with dysphagia diagnostic endoscopy revealed a mass directly dorsal to the esophagus. CT showed an aberrant right subclavian artery being the cause of her swallowing problem: dysphagia lusoria.
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Ned Tijdschr Geneeskd · May 2002
Case Reports[Ketoacidosis after cessation of chronic alcohol consumption].
A 52-year-old man was admitted with diarrhea, near dehydration and dyspnoea. After many years of alcohol consumption, he had stopped drinking alcohol over a very short space of time and had eaten very little or nothing. ⋯ The syndrome is explained by metabolic changes induced by chronic alcohol consumption and ketogenesis as the result of fasting and dehydration. Treatment consisted of correction of the fluid deficit and administration of glucose, after which the patient made a rapid recovery.
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Ned Tijdschr Geneeskd · May 2002
Case Reports[Vulvovaginal complaints, dyspareunia and oral mucosa abnormalities: erosive lichen planus].
Three women, aged 46, 48 and 73 years respectively, suffered from erosive genital lichen planus. Vulvar irritation, dyspareunia and vaginal discharge are the prominent signs of this disease. Lichen planus is an inflammatory dermatosis, which can involve skin and oral and genital mucosa. ⋯ Narrowing of the vagina and painful mucosal lesions often prevent sexual intercourse. The combination of oral and genital complaints can help in the diagnosis of lichen planus. Strict follow-up is necessary because of the possible malignant degeneration of the disease.
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Two women, aged 31 and 36 years, under treatment for schizophrenia and psychotic episodes, respectively, became pregnant and decided to discontinue their medication. Thereupon the psychiatric disorder recurred and they refused--i.e. they were unable--to consent to a proposed treatment or investigation regarding their pregnancies. ⋯ In the second case approval from the judge was obtained for the patient to be admitted against her will to protect her life and that of the foetus. In the Netherlands obstetric intervention to protect the life of the mother or her unborn child is legally regulated by the Wet Bijzondere Opnemingen in Psychiatrische Ziekenhuizen (Act on Compulsory Admissions to Psychiatric Hospitals) and the Wet op de Geneeskundige Behandelingsovereenkomst (Act on Agreement Concerning Medical Treatment).
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Ned Tijdschr Geneeskd · Apr 2002
Case Reports[Tetanus in a young unvaccinated girl after a fall in the street].
A 4-year-old girl developed tetanus after she had fallen on the street a week before. She had never been vaccinated and despite pressure from the family practitioner, the parents refused to allow her to be given human anti-tetanus immunoglobulin as a matter of principle after the wound had been stitched. Seven days later she was admitted to hospital with trismus and risus sardonicus. ⋯ Finally she made a complete clinical recovery. Thanks to the extensive national vaccination program, tetanus has become a rare disease in the Netherlands. However, the very serious course and possible fatal outcome warrant a keen attitude and adequate treatment.