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Neef C.K.,Universitair Medisch Centrum Maastricht
Nederlands tijdschrift voor geneeskunde | Year: 2010

Picking the wrong container with raw material in making compounded pharmaceutical preparation is one of the threats to patient safety. The question is whether there still is a place for this type of medication in pharmacotherapy. This case raises three questions: is there a therapeutic rationale for this therapeutic agent, how far should we go in individualizing pharmacotherapy and what are the pharmaceutical prerequisites for this kind of compounding? Once there is an agreement about the need for this product, the focus is on the need for implementation of Good Manufacturing Practice (GMP) rules in community pharmacies. Alternatively, this type of individualized therapy should be stopped.

Triest F.,Universitair Medisch Centrum Maastricht
Tijdschrift voor Geneeskunde | Year: 2014

Hyponatremia in small cell lung cancer (SCLC) is often due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). This is primarily caused by an excess of body water. The treatment is based on fluid restriction, to which an increased salt and protein intake can be added. Ectopic production of atrial natriuretic peptide (ANP) causes hyponatremia due to salt and fluid depletion. Thus, the treatment is based on suppleting salt and water. Other possible causes of hyponatremia include medication and comorbidity, such as a decreased intake of solutes (low osmolar load), salt-losing nephropathy due to cisplatinum and adrenal insufficiency because of bilateral adrenal metastasis or a sudden deprivation of corticosteroids. The diagnosis of SIADH should be questioned when the hyponatremia does not improve or when clinical signs of hypovolemia emerge after 72-96 hours of adequate fluid restriction. Understanding the pathophysiology of hyponatremia and the biochemical parameters remains crucial to establish a correct diagnosis.

van den Bergh J.,Universitair Medisch Centrum Maastricht
Nederlands tijdschrift voor geneeskunde | Year: 2010

Vitamin D deficiency is endemic worldwide. The Health Council of the Netherlands advises a colecalciferol intake of 800 IU/day and an intended serum level of calcidiol of at least 50 nmol/l for people aged 50 years and older and for osteoporosis patients. In 64% of 626 fracture patients, we found a reduced serum calcidiol level according to this definition. According to calculations based on meta-analyses, a substantial proportion of fracture patients would not achieve the target calcidiol level of 50 nmol/l with a vitamin D supplement of 800 IU/day. For example, this would be the case in 37% of elderly patients with osteoporosis. Until the results of a prospective study on this are published, we propose that fracture patients are either systematically given doses of vitamin D supplements higher than 800 IU/day, or that their serum calcidiol is measured and the dose of vitamin D supplements is adjusted according to this initial value and the desired serum concentrations, and that the measurement is repeated after 3 months so that the dosage can be adjusted if necessary.

Schieven L.W.,Universitair Medisch Centrum Groningen | Hopman A.H.N.,Universitair Medisch Centrum Maastricht | Van Der Wijk J.,Refaja Ziekenhuis | De Jong I.J.,Universitair Medisch Centrum Groningen | Nijman J.M.,Universitair Medisch Centrum Groningen
Nederlands Tijdschrift voor Urologie | Year: 2010

In this study we tested the reliability of the new Agar Micro-biopsy technique through FNA, which were taken from 40 ex vivo kidneytumors. In 98% the new AM-biopsy technique was concordant with the classifying histological diagnosis of the kidneytumors. Copyright © 2009 by American Urological Association.

de Leeuw P.W.,Universitair Medisch Centrum Maastricht
Nederlands tijdschrift voor geneeskunde | Year: 2011

Many people are inclined to believe that popular music artists are prone to die prematurely. Scientific research into this matter is scarce. There is only one epidemiological study on this subject, showing that mortality among pop stars during the first 25 years after they became famous is increased. This mortality is higher in Northern America than it is in Europe, but European pop stars die on average at an earlier age. A fairly common belief states that many pop stars die at the age of 27 years. This age has even been proclaimed as the most critical for modern musicians. However, data of several hundred deceased pop stars shows no evidence for increased mortality at the age of 27. Moreover, the data suggests that the age of death has increased over the past forty years. As far as the cause of death is concerned, overdose of drugs or alcohol rank highly next to cardiovascular disease and malignancy.

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