Nederlands tijdschrift voor geneeskunde
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A 60-year-old man presented with acute chest pain and dyspnoea, which was caused by pericarditis secondary to a neo-oesophago-pericardial fistula after previous oesophagectomy for oesophageal cancer. The fistula presumably originated from a penetrating peptic ulcer.
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A 41-year-old man visited his general practitioner because of upper abdominal pain. Physical examination revealed splenomegaly. Laboratory testing showed pancytopenia with a striking monocytopenia with hairy cells. Immunological and molecular analysis confirmed the diagnosis hairy cell leukemia.
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Ned Tijdschr Geneeskd · Jan 2015
[Primary care patients hastening death by voluntarily stopping eating and drinking].
Little is known about the role family physicians play when a patient deliberately hastens death by voluntarily stopping eating and drinking (VSED). The purpose of this study was to gain more insight for family physicians when confronted with patients who wish to hasten death by VSED. We aimed to describe physicians' involvement in VSED, to describe characteristics and motives of their patients, and to describe the process of VSED in terms of duration, as well as common symptoms in the last 3 days of life. ⋯ Patients who hasten death by VSED are mostly in poor health. It is not unlikely for family physicians to be confronted with VSED. They can play an important role in caring for these patients and their proxies by informing them of VSED and by providing support and symptom management during VSED.
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A "thrombus in transit" is a relatively rare diagnosis involving a thrombus in a patent foramen ovale. Patent foramen ovale occurs in about 25% of the population. A thrombus in transit may lead to paradoxical arterial emboli in the cerebral circulatory system and the extremities, as well as other locations. ⋯ A thrombus in transit may be treated with heparins, thrombolysis or by surgical removal of the thrombus. The optimum treatment must be decided for each individual patient. The mortality rate of this condition is high (16-36%).
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Ned Tijdschr Geneeskd · Jan 2015
[Are we on the verge of lung-cancer screening in the Netherlands?].
Previous studies of low-dose computed tomography (CT) screening for lung cancer have shown a decrease in lung-cancer-related deaths. Data from the NELSON trial, using new thresholds for defining a positive test, resulted in less over-diagnosis without a decrease in test-specific sensitivity. However, in our opinion it is still too early to implement screening in the Netherlands. Further development of the optimal screening algorithm based on defined volumetric thresholds and stratified by personal characteristics such as age, smoking habits, gender and comorbidities, will probably result in a better balance between the harms and benefits of lung-cancer screening to individuals and society.