Nederlands tijdschrift voor geneeskunde
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A 50-year-old woman presented with sudden onset of localised pain in the right and later the left lower abdomen, without other complaints. Only tenderness in the left lower abdomen was noted at physical examination. The ESR (25 mm/1st hr) and C-reactive protein (25 mg/l) were slightly elevated. ⋯ On conservative therapy the pain resolved in four weeks. The follow-up US and CT showed disappearance of the lesion after 35 days. When epiploic appendagitis is suspected, an US followed by CT is helpful to confirm the diagnosis and to avoid unnecessary treatment with antibiotics or operation.
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Ned Tijdschr Geneeskd · Jan 1999
Review[Re-irradiation with hyperthermia in patients with recurrent breast cancer].
In the Daniel den Hoed Cancer Centre in Rotterdam, the Netherlands, patients with recurrent breast cancer within a previously irradiated area, are treated by application of hyperthermia in addition to reirradiation. In this development, the following issues are important: (a) the choice of an effective and tolerable reirradiation schedule; (b) the establishment of the limitations of the hyperthermia techniques available; (c) the finding that additional hyperthermia has to be applied to the total tissue volume at risk for tumour recurrence; (d) the assessment of the value of additional hyperthermia by a randomised study. ⋯ The treatment is tolerated well, with acceptable toxicity. In patients with recurrent breast cancer in a previously irradiated area, combined reirradiation and hyperthermia is very effective, well tolerated and little toxic.
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Ned Tijdschr Geneeskd · Dec 1998
Comment[Kidney donation by a 'non-heart-beating' donor from an ethical perspective].
In asystolic patients, kidney donation is possible by using a non-heart-beating (NHB) donation procedure. This involves in situ perfusion of the kidneys by inserting a catheter into the femoral artery and flushing cold fluid through the kidneys. The introduction of an NHB donation programme leads to ethical questions concerning the guarantees for prudent procedure: How should death of a patient be defined in case of NHB donation? Is there a strict separation of responsibilities of the medical teams in the different phases of the procedure (patient treatment and actual donation procedure)? Are sufficient attention and care given to the relatives? Does the NHB donation procedure not interfere with the care of a patient who is expected to die soon? Extensive discussion with the Medical Ethics Committee of the University Hospital Nijmegen, the Netherlands, has led to a protocol for NHB kidney donation that meets the required guarantees.
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Ned Tijdschr Geneeskd · Dec 1998
Case Reports[Lipodystrophy and 'buffalo hump' during treatment with HIV protease inhibitors].
In three patients, a 36-year-old HIV seropositive homosexual man and two women aged 35 and 59 years who had acquired HIV infection through heterosexual contact, signs of lipodystrophy developed after prolonged anti-HIV triple therapy. The observed syndrome is seen after prolonged use of HIV protease inhibitors: it is characterized by peripheral fat wasting, central fat accumulation, hyperlipidaemia and insulin resistance. ⋯ Lipodystrophy caused by protease inhibitors is a risk factor for cardiovascular disease. Recognition of the syndrome is essential for adequate follow-up and possible treatment.
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Ned Tijdschr Geneeskd · Dec 1998
[The Organ Donation Law: changes in the procurement of organs and tissues for transplantation].
The Organ Donation Act fills an old gap in the legislation, leading to improvement of the legal position of those involved. Much attention is given to the protection of the potential donor. ⋯ Hospitals and nursing homes are obliged to have a protocol for organizing tissue donation. Also, conditions have been created for a just division of the available organs and tissues for transplantation.