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Schuling J.,Universitair Medisch Centrum Groningen
Nederlands tijdschrift voor geneeskunde | Year: 2013

Elderly patients with multimorbidity treated in accordance with disease-specific guidelines use a large number of drugs. As this approach may harm the patient's wellbeing, our care should evolve from disease-oriented to patient-oriented. A simple tool has been introduced to facilitate this type of consultation. On a visual analogue scale (VAS; 0-100) four generic treatment goals are presented to the patient: extending life, maintaining independence, pain relief and relief of other symptoms. The patient is invited to weigh the importance of these outcomes using the 'trade-off' principle, and asked to rank these goals in such a way that the score reflects the patient's preference profile. With the help of this decision aid, the medication of two female patients aged 85 and 94 was reviewed. Embedding this tool in the first step of the medication review process may help to shift the focus from the disease to the patient. Source

A 58-year-old man, who spoke very little Dutch, had various symptoms and used several drugs including simvastatin. He was prescribed itraconazole for onychomycosis. Simvastatin was concurrently replaced with pravastatin to prevent drug interactions. However, the interaction still occurred when the pravastatin ran out, and the patient resumed taking simvastatin on his own initiative. Myalgia and muscle weakness developed after one week. The general practitioner found a strongly elevated creatine kinase level in the blood. The patient required hospitalisation for severe rhabdomyolysis. He was treated with an infusion of an ample quantity of physiological saline solution and made a full recovery. Due to the elevated risk of toxic interactions, doctors should beware of communication problems in complex patients and avoid new prescriptions not strictly required. Source

D'haeseleer M.,Vrije Universiteit Brussel | Cambron M.,Vrije Universiteit Brussel | Vanopdenbosch L.,AZ Sint Jan Bruges | De Keyser J.,Vrije Universiteit Brussel | De Keyser J.,Universitair Medisch Centrum Groningen
The Lancet Neurology | Year: 2011

Three types of vascular dysfunction have been described in multiple sclerosis (MS). First, findings from epidemiological studies suggest that patients with MS have a higher risk for ischaemic stroke than people who do not have MS. The underlying mechanism is unknown, but might involve endothelial dysfunction secondary to inflammatory disease activity and increased plasma homocysteine concentrations. Second, patients with MS have global cerebral hypoperfusion, which might predispose them to the development of ischaemic stroke. The widespread decrease in perfusion in normal-appearing white matter and grey matter in MS seems not to be secondary to axonal degeneration, but might be a result of reduced axonal activity, reduced astrocyte energy metabolism, and perhaps increased blood concentrations of endothelin-1. Data suggest that a subtype of focal MS lesions might have an ischaemic origin, and there seems to be a link between reduced white matter perfusion and cognitive dysfunction in MS. Third, the pathology of MS might be the consequence of a chronic state of impaired venous drainage from the CNS, for which the term chronic cerebrospinal venous insufficiency (CCSVI) has been coined. A number of recent vascular studies do not support the CCSVI theory, but some elements of CCSVI might be explained by slower cerebral venous blood flow secondary to the reduced cerebral perfusion in patients with MS compared with healthy individuals. © 2011 Elsevier Ltd. Source

Munster J.M.,Universitair Medisch Centrum Groningen
Nederlands tijdschrift voor geneeskunde | Year: 2011

A 42-year-old woman visited the pulmonologist for follow-up after a pneumonia. In retrospect the pneumonia appeared to be a manifestation of an acute Q fever infection. A few weeks later the patient was found to be unexpectedly pregnant. At the normal serological follow-up six months after the primary infection chronic Q fever infection was diagnosed. Doxycycline and hydroxychloroquine are contraindicated in pregnancy and the patient was found to be allergic to co-trimoxazole. Therefore treatment with erythromycin was chosen on empirical grounds. The patient had many symptoms during pregnancy. After 38 weeks and 2 days amenorrhea labour was induced on maternal indication. Finally a healthy boy of 3850 grams was born by caesarean section. In view of the increased risk of chronic Q fever infection during pregnancy we advise intensified serological monitoring of patients with acute Q fever who subsequently become pregnant. Source

Cohen D.,Universitair Medisch Centrum Groningen
Tijdschrift voor Psychiatrie | Year: 2010

Clozapine is an effective antipsychotic drug for the treatment of therapy-resistant schizophrenia. Mandatory saeening of white blood cells is a safety measure for the early detection of agranulocytosis caused by treatment with clozapine. However, so far, there is no standard screening for two other potentially lethal side-effects, namely diabetic ketoacidosis and gastro-intestinal hypomotility. The current situation is weighed up on the basis of a comparison of the chances that these side-effects can occur and cause death. The conclusion is that weekly or monthly saeening should be carried out for all these side-effects. Source

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