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Papers by p slee
The Netherlands Journal of Medicine, 1995
A 36-year-old male patient is described who presented with gynaecomastia, pulmonary nodules and a... more A 36-year-old male patient is described who presented with gynaecomastia, pulmonary nodules and a retropcritoneal mass in combination with a markedly elevated HCG level. A diagnosis of "choriocarcinoma syndrome" was made. Despite a clear response from the tumour to chemotherapy the patient died, at least partially due to delay in treatment. Prompt treatment even without cytological or histological proof is therefore stressed.
Contributions to Oncology, 1988
Mutation Research Letters, 1983
Information about the extent and persistence of cytostatic activity in blood plasma after adminis... more Information about the extent and persistence of cytostatic activity in blood plasma after administration of a cytostatic drug into the body is needed for a better evaluation of the inter-individual variations in drug metabolism and disposition. As an assay for cytotoxic activity, a test system was chosen in which Chinese hamster ovary cells (CHO) were incubated with plasma containing active metabolites of cyclophosphamide (from human patients or rats), after which the frequencies of induced sister-chromatid exchanges per cell were determined. The treatment with plasma increased the frequencies of SCEs very effectively at concentrations of metabolites that were negative in the Salmonella typhimurium back-mutation test with strain TA100. The results obtained indicate that the SCE test system offers the possibility to follow the cytotoxic activity of plasma at various time intervals after administration of cyclophosphamide.
Nederlands tijdschrift voor geneeskunde, Jan 11, 2002
A 47-year-old man was admitted due to serious weight loss after several months in which he had no... more A 47-year-old man was admitted due to serious weight loss after several months in which he had not eaten and had drunk almost solely beer. Shortly after the start of enteral tube feeding, the patient developed serious heart failure. This was associated with severely disrupted electrolyte levels and in particular hypophosphataemia and hypomagnesaemia. This condition is termed refeeding syndrome. The circulating volume increases due to the hyperinsulinaemia which occurs during the feeding phase. Furthermore a shortage of ATP occurs and the heart may fail. In efforts to establish feeding, a weight increase of not more than 1 kg per week should be attempted; if the weight increases by more than this, then fluid retention is the probable cause.
Nederlandsch tijdschrift voor geneeskunde, May 19, 2007
To analyse the results of the laparoscopic adjustable gastric banding (LAGB) procedure for morbid... more To analyse the results of the laparoscopic adjustable gastric banding (LAGB) procedure for morbid obesity. DESIGN. Retrospective, descriptive. From November 1, 1995 to May 31, 2005, laparoscopic adjustable banding surgery was performed in St. Antonius Hospital, Nieuwegein, the Netherlands, in 411 patients. Inclusion criteria were BMI > or = 40 kg/ m(2) or BMI > 35 kg/m(2) and severe comorbidity with > 3 attempts at weight loss in the past. Selection, inclusion and follow-up were performed in a specialised, multidisciplinary setting. Height, weight, and complications were prospectively recorded. In 1995-2000 the perigastric surgical procedure was used and in 2000-2005 the pars-flaccida method. The study group consisted of 350 (85%) women and 61 (I5%) men with a median age of 38 years (range 17-60). Out of these 411 patients, the median weight was 133.4 kg, the median overweight, 69.6 kg and the median BMI 46.3 kg/m2. Two years after surgery, data was known for 267 patients w...
Netherlands Journal of Medicine, 2002
The mission of the journal is to serve the need of the internist to practice up-to-date medicine ... more The mission of the journal is to serve the need of the internist to practice up-to-date medicine and to keep track with important issues in health care. With this purpose we publish editorials, original articles, reviews, controversies, consensus reports, papers on speciality training and medical education, book reviews and correspondence.
Nederlandsch tijdschrift voor geneeskunde, May 11, 2002
A 47-year-old man was admitted due to serious weight loss after several months in which he had no... more A 47-year-old man was admitted due to serious weight loss after several months in which he had not eaten and had drunk almost solely beer. Shortly after the start of enteral tube feeding, the patient developed serious heart failure. This was associated with severely disrupted electrolyte levels and in particular hypophosphataemia and hypomagnesaemia. This condition is termed refeeding syndrome. The circulating volume increases due to the hyperinsulinaemia which occurs during the feeding phase. Furthermore a shortage of ATP occurs and the heart may fail. In efforts to establish feeding, a weight increase of not more than 1 kg per week should be attempted; if the weight increases by more than this, then fluid retention is the probable cause.
Nederlandsch tijdschrift voor geneeskunde, Jan 12, 2002
In a 69-year-old obese woman on prednisone treatment for temporal arteritis a widened mediastinum... more In a 69-year-old obese woman on prednisone treatment for temporal arteritis a widened mediastinum on chest X-ray proved to be mediastinal lipomatosis on CT-scan.
The Netherlands journal of medicine, 2004
BACKGROUND Since the need for nonanthracycline-containing chemotherapy regimens increases with th... more BACKGROUND Since the need for nonanthracycline-containing chemotherapy regimens increases with the increased use of anthracyclines in earlier stages of breast cancer, we investigated the feasibility of the combination of docetaxel and 5-fluorouracil (5-FU) with folinic acid (FA). PATIENTS AND METHODS Anthracycline-pretreated patients with metastatic breast cancer were eligible. Docetaxel was administered as a one-hour infusion every three weeks on day 1, FA 500 mg/m2 (fixed dose) as a two-hour infusion on days 1 and 15 and 5-FU as a 24-hour infusion on days 1 and 15. The dose levels tested were (docetaxel/5FU in mg/m2): 60/1800, 75/1800, 85/1800, 100/1800, and 100/2100. RESULTS Altogether 28 patients were accrued and treated in this multicentre open-label study. Dose-limiting toxicities (DLTs) were not observed at dose level I, and in two patients in each of the higher dose levels. DLTs observed were grade III/IV infection (n=4), febrile neutropenia (n=2), diarrhoea (n=1) and erythe...
A 28-year-old patient had suffered from fever, headache, abdominal pains and vomiting for the pas... more A 28-year-old patient had suffered from fever, headache, abdominal pains and vomiting for the past three weeks. She had visited a region in the Dominican Republic where the risk of malaria is considered to be low. The complaints were initially regarded as a viral infection. Later, however, she was found to have severe falciparum malaria. She recovered completely following antibiotic therapy. Since November 2004, 17 cases of falciparum malaria have been reported world-wide among travellers to non-endemic regions in the Dominican Republic. Physicians should always consider the possibility of malaria in travellers because a timely diagnosis of falciparum malaria can be of vital importance.
Nederlands tijdschrift voor geneeskunde, Jan 30, 2005
A 28-year-old patient had suffered from fever, headache, abdominal pains and vomiting for the pas... more A 28-year-old patient had suffered from fever, headache, abdominal pains and vomiting for the past three weeks. She had visited a region in the Dominican Republic where the risk of malaria is considered to be low. The complaints were initially regarded as a viral infection. Later, however, she was found to have severe falciparum malaria. She recovered completely following antibiotic therapy. Since November 2004, 17 cases of falciparum malaria have been reported world-wide among travellers to non-endemic regions in the Dominican Republic. Physicians should always consider the possibility of malaria in travellers because a timely diagnosis of falciparum malaria can be of vital importance.
Oncology Research and Treatment, 1990
Cyclophosphamide (CY) was administered to 22 breast cancer patients treated routinely according t... more Cyclophosphamide (CY) was administered to 22 breast cancer patients treated routinely according to the CMF regimen: 75 mg/m3/d x 14 d p.o. CY, 30 mg/m2 days 1 and 8 i.v. methotrexate (MTX) and 500 mg/m2 days 1 and 8 i.v. 5-Fluorouracil (5-FU). The sequence of drug administration was always the same: 1) CY, 2) MTX; and 3) 5-FU. Capillary gas chromatography was performed for determination of CY in blood. Bioavailability (F) could be determined in 14 patients since CY was also administered intravenously in the same dose. The data of systemic exposure of oral CY in the other 8 patients were matched to those of the first 14 in whom bioavailability could be determined. Mean F was 0.85 +/- 0.22 (85% +/- 22%); in 1 patient F was 0.43 (43%). Furthermore, 3 patients treated with only p.o. CY had low estimated F values: 0.45, 0.49 and 0.50. In comparing patient characteristics with pharmacokinetic data, it was concluded that age might have a predictive value for elimination half-life t 1/2 z of i.v. CY. The youngest patients showed shortest t1/2 z and were also amongst those with the lowest F. This indication requires an extension of the study as well as monitoring of CY metabolism as a function of age. For the premenopausal patients this might be of particular importance, since this group is known to be prone to benefit from chemotherapeutic treatment according to the CMF regimen.
The Netherlands journal of medicine, 2002
The mission of the journal is to serve the need of the internist to practice up-to-date medicine ... more The mission of the journal is to serve the need of the internist to practice up-to-date medicine and to keep track with important issues in health care. With this purpose we publish editorials, original articles, reviews, controversies, consensus reports, papers on speciality training and medical education, book reviews and correspondence.
Nederlands Tijdschrift voor Geneeskunde, 2006
A 50-year-old woman complained of nausea, diarrhoea, tiredness and dizziness five weeks after a v... more A 50-year-old woman complained of nausea, diarrhoea, tiredness and dizziness five weeks after a visit to Egypt. She was deeply tanned with hyperpigmentation on the metacarpophalangeal joints, palm of hand creases and buccal mucosa, due to Addison's disease.
Annales De Chirurgie Vasculaire, 1996
Les fistules aorto-digestives primitives(FADP), realisant une communication directe entre l'a... more Les fistules aorto-digestives primitives(FADP), realisant une communication directe entre l'aorte et le tube digestif, sont une cause rare d'hemorragie digestive. Nous rapportons les observations de 8 malades traites dans un seul hopital, ainsi qu'une revue de l'ensemble des malades traites chirurgicalement et publies dans la litterature au cours des 10 dernieres annees. La cause habituelle des FADP est l'erosion d'un anevrysme atheromateux dans le duodenum qui lui adhere, mais de nombreuses autres causes et topographies ont ete decrites. Le tableau clinique est habituellement celui d'une hemorragie digestive intermittente aboutissant a une hemorragie massive mortelle en quelques heures ou jours. Des douleurs, une masse abdominale pulsatile ou de la fievre peuvent etre ou non presents. L'endoscopie, l'arteriographie, l'echographie et la tomodensitometrie peuvent etre utiles pour le bilan de ces malades mais l'examen clinique et l'evoca...
Nederlands tijdschrift voor geneeskunde, 2006
A 50-year-old woman complained of nausea, diarrhoea, tiredness and dizziness five weeks after a v... more A 50-year-old woman complained of nausea, diarrhoea, tiredness and dizziness five weeks after a visit to Egypt. She was deeply tanned with hyperpigmentation on the metacarpophalangeal joints, palm of hand creases and buccal mucosa, due to Addison's disease.
Nederlands tijdschrift voor geneeskunde, 2007
OBJECTIVE To analyse the results of the laparoscopic adjustable gastric banding (LAGB) procedure ... more OBJECTIVE To analyse the results of the laparoscopic adjustable gastric banding (LAGB) procedure for morbid obesity. DESIGN. Retrospective, descriptive. METHOD From November 1, 1995 to May 31, 2005, laparoscopic adjustable banding surgery was performed in St. Antonius Hospital, Nieuwegein, the Netherlands, in 411 patients. Inclusion criteria were BMI > or = 40 kg/ m(2) or BMI > 35 kg/m(2) and severe comorbidity with > 3 attempts at weight loss in the past. Selection, inclusion and follow-up were performed in a specialised, multidisciplinary setting. Height, weight, and complications were prospectively recorded. In 1995-2000 the perigastric surgical procedure was used and in 2000-2005 the pars-flaccida method. RESULTS The study group consisted of 350 (85%) women and 61 (I5%) men with a median age of 38 years (range 17-60). Out of these 411 patients, the median weight was 133.4 kg, the median overweight, 69.6 kg and the median BMI 46.3 kg/m2. Two years after surgery, data was...
Nederlands tijdschrift voor geneeskunde, 2002
In a 69-year-old obese woman on prednisone treatment for temporal arteritis a widened mediastinum... more In a 69-year-old obese woman on prednisone treatment for temporal arteritis a widened mediastinum on chest X-ray proved to be mediastinal lipomatosis on CT-scan.
Nederlands tijdschrift voor geneeskunde, 2002
A 47-year-old man was admitted due to serious weight loss after several months in which he had no... more A 47-year-old man was admitted due to serious weight loss after several months in which he had not eaten and had drunk almost solely beer. Shortly after the start of enteral tube feeding, the patient developed serious heart failure. This was associated with severely disrupted electrolyte levels and in particular hypophosphataemia and hypomagnesaemia. This condition is termed refeeding syndrome. The circulating volume increases due to the hyperinsulinaemia which occurs during the feeding phase. Furthermore a shortage of ATP occurs and the heart may fail. In efforts to establish feeding, a weight increase of not more than 1 kg per week should be attempted; if the weight increases by more than this, then fluid retention is the probable cause.
The Netherlands Journal of Medicine, 1995
A 36-year-old male patient is described who presented with gynaecomastia, pulmonary nodules and a... more A 36-year-old male patient is described who presented with gynaecomastia, pulmonary nodules and a retropcritoneal mass in combination with a markedly elevated HCG level. A diagnosis of "choriocarcinoma syndrome" was made. Despite a clear response from the tumour to chemotherapy the patient died, at least partially due to delay in treatment. Prompt treatment even without cytological or histological proof is therefore stressed.
Contributions to Oncology, 1988
Mutation Research Letters, 1983
Information about the extent and persistence of cytostatic activity in blood plasma after adminis... more Information about the extent and persistence of cytostatic activity in blood plasma after administration of a cytostatic drug into the body is needed for a better evaluation of the inter-individual variations in drug metabolism and disposition. As an assay for cytotoxic activity, a test system was chosen in which Chinese hamster ovary cells (CHO) were incubated with plasma containing active metabolites of cyclophosphamide (from human patients or rats), after which the frequencies of induced sister-chromatid exchanges per cell were determined. The treatment with plasma increased the frequencies of SCEs very effectively at concentrations of metabolites that were negative in the Salmonella typhimurium back-mutation test with strain TA100. The results obtained indicate that the SCE test system offers the possibility to follow the cytotoxic activity of plasma at various time intervals after administration of cyclophosphamide.
Nederlands tijdschrift voor geneeskunde, Jan 11, 2002
A 47-year-old man was admitted due to serious weight loss after several months in which he had no... more A 47-year-old man was admitted due to serious weight loss after several months in which he had not eaten and had drunk almost solely beer. Shortly after the start of enteral tube feeding, the patient developed serious heart failure. This was associated with severely disrupted electrolyte levels and in particular hypophosphataemia and hypomagnesaemia. This condition is termed refeeding syndrome. The circulating volume increases due to the hyperinsulinaemia which occurs during the feeding phase. Furthermore a shortage of ATP occurs and the heart may fail. In efforts to establish feeding, a weight increase of not more than 1 kg per week should be attempted; if the weight increases by more than this, then fluid retention is the probable cause.
Nederlandsch tijdschrift voor geneeskunde, May 19, 2007
To analyse the results of the laparoscopic adjustable gastric banding (LAGB) procedure for morbid... more To analyse the results of the laparoscopic adjustable gastric banding (LAGB) procedure for morbid obesity. DESIGN. Retrospective, descriptive. From November 1, 1995 to May 31, 2005, laparoscopic adjustable banding surgery was performed in St. Antonius Hospital, Nieuwegein, the Netherlands, in 411 patients. Inclusion criteria were BMI > or = 40 kg/ m(2) or BMI > 35 kg/m(2) and severe comorbidity with > 3 attempts at weight loss in the past. Selection, inclusion and follow-up were performed in a specialised, multidisciplinary setting. Height, weight, and complications were prospectively recorded. In 1995-2000 the perigastric surgical procedure was used and in 2000-2005 the pars-flaccida method. The study group consisted of 350 (85%) women and 61 (I5%) men with a median age of 38 years (range 17-60). Out of these 411 patients, the median weight was 133.4 kg, the median overweight, 69.6 kg and the median BMI 46.3 kg/m2. Two years after surgery, data was known for 267 patients w...
Netherlands Journal of Medicine, 2002
The mission of the journal is to serve the need of the internist to practice up-to-date medicine ... more The mission of the journal is to serve the need of the internist to practice up-to-date medicine and to keep track with important issues in health care. With this purpose we publish editorials, original articles, reviews, controversies, consensus reports, papers on speciality training and medical education, book reviews and correspondence.
Nederlandsch tijdschrift voor geneeskunde, May 11, 2002
A 47-year-old man was admitted due to serious weight loss after several months in which he had no... more A 47-year-old man was admitted due to serious weight loss after several months in which he had not eaten and had drunk almost solely beer. Shortly after the start of enteral tube feeding, the patient developed serious heart failure. This was associated with severely disrupted electrolyte levels and in particular hypophosphataemia and hypomagnesaemia. This condition is termed refeeding syndrome. The circulating volume increases due to the hyperinsulinaemia which occurs during the feeding phase. Furthermore a shortage of ATP occurs and the heart may fail. In efforts to establish feeding, a weight increase of not more than 1 kg per week should be attempted; if the weight increases by more than this, then fluid retention is the probable cause.
Nederlandsch tijdschrift voor geneeskunde, Jan 12, 2002
In a 69-year-old obese woman on prednisone treatment for temporal arteritis a widened mediastinum... more In a 69-year-old obese woman on prednisone treatment for temporal arteritis a widened mediastinum on chest X-ray proved to be mediastinal lipomatosis on CT-scan.
The Netherlands journal of medicine, 2004
BACKGROUND Since the need for nonanthracycline-containing chemotherapy regimens increases with th... more BACKGROUND Since the need for nonanthracycline-containing chemotherapy regimens increases with the increased use of anthracyclines in earlier stages of breast cancer, we investigated the feasibility of the combination of docetaxel and 5-fluorouracil (5-FU) with folinic acid (FA). PATIENTS AND METHODS Anthracycline-pretreated patients with metastatic breast cancer were eligible. Docetaxel was administered as a one-hour infusion every three weeks on day 1, FA 500 mg/m2 (fixed dose) as a two-hour infusion on days 1 and 15 and 5-FU as a 24-hour infusion on days 1 and 15. The dose levels tested were (docetaxel/5FU in mg/m2): 60/1800, 75/1800, 85/1800, 100/1800, and 100/2100. RESULTS Altogether 28 patients were accrued and treated in this multicentre open-label study. Dose-limiting toxicities (DLTs) were not observed at dose level I, and in two patients in each of the higher dose levels. DLTs observed were grade III/IV infection (n=4), febrile neutropenia (n=2), diarrhoea (n=1) and erythe...
A 28-year-old patient had suffered from fever, headache, abdominal pains and vomiting for the pas... more A 28-year-old patient had suffered from fever, headache, abdominal pains and vomiting for the past three weeks. She had visited a region in the Dominican Republic where the risk of malaria is considered to be low. The complaints were initially regarded as a viral infection. Later, however, she was found to have severe falciparum malaria. She recovered completely following antibiotic therapy. Since November 2004, 17 cases of falciparum malaria have been reported world-wide among travellers to non-endemic regions in the Dominican Republic. Physicians should always consider the possibility of malaria in travellers because a timely diagnosis of falciparum malaria can be of vital importance.
Nederlands tijdschrift voor geneeskunde, Jan 30, 2005
A 28-year-old patient had suffered from fever, headache, abdominal pains and vomiting for the pas... more A 28-year-old patient had suffered from fever, headache, abdominal pains and vomiting for the past three weeks. She had visited a region in the Dominican Republic where the risk of malaria is considered to be low. The complaints were initially regarded as a viral infection. Later, however, she was found to have severe falciparum malaria. She recovered completely following antibiotic therapy. Since November 2004, 17 cases of falciparum malaria have been reported world-wide among travellers to non-endemic regions in the Dominican Republic. Physicians should always consider the possibility of malaria in travellers because a timely diagnosis of falciparum malaria can be of vital importance.
Oncology Research and Treatment, 1990
Cyclophosphamide (CY) was administered to 22 breast cancer patients treated routinely according t... more Cyclophosphamide (CY) was administered to 22 breast cancer patients treated routinely according to the CMF regimen: 75 mg/m3/d x 14 d p.o. CY, 30 mg/m2 days 1 and 8 i.v. methotrexate (MTX) and 500 mg/m2 days 1 and 8 i.v. 5-Fluorouracil (5-FU). The sequence of drug administration was always the same: 1) CY, 2) MTX; and 3) 5-FU. Capillary gas chromatography was performed for determination of CY in blood. Bioavailability (F) could be determined in 14 patients since CY was also administered intravenously in the same dose. The data of systemic exposure of oral CY in the other 8 patients were matched to those of the first 14 in whom bioavailability could be determined. Mean F was 0.85 +/- 0.22 (85% +/- 22%); in 1 patient F was 0.43 (43%). Furthermore, 3 patients treated with only p.o. CY had low estimated F values: 0.45, 0.49 and 0.50. In comparing patient characteristics with pharmacokinetic data, it was concluded that age might have a predictive value for elimination half-life t 1/2 z of i.v. CY. The youngest patients showed shortest t1/2 z and were also amongst those with the lowest F. This indication requires an extension of the study as well as monitoring of CY metabolism as a function of age. For the premenopausal patients this might be of particular importance, since this group is known to be prone to benefit from chemotherapeutic treatment according to the CMF regimen.
The Netherlands journal of medicine, 2002
The mission of the journal is to serve the need of the internist to practice up-to-date medicine ... more The mission of the journal is to serve the need of the internist to practice up-to-date medicine and to keep track with important issues in health care. With this purpose we publish editorials, original articles, reviews, controversies, consensus reports, papers on speciality training and medical education, book reviews and correspondence.
Nederlands Tijdschrift voor Geneeskunde, 2006
A 50-year-old woman complained of nausea, diarrhoea, tiredness and dizziness five weeks after a v... more A 50-year-old woman complained of nausea, diarrhoea, tiredness and dizziness five weeks after a visit to Egypt. She was deeply tanned with hyperpigmentation on the metacarpophalangeal joints, palm of hand creases and buccal mucosa, due to Addison's disease.
Annales De Chirurgie Vasculaire, 1996
Les fistules aorto-digestives primitives(FADP), realisant une communication directe entre l'a... more Les fistules aorto-digestives primitives(FADP), realisant une communication directe entre l'aorte et le tube digestif, sont une cause rare d'hemorragie digestive. Nous rapportons les observations de 8 malades traites dans un seul hopital, ainsi qu'une revue de l'ensemble des malades traites chirurgicalement et publies dans la litterature au cours des 10 dernieres annees. La cause habituelle des FADP est l'erosion d'un anevrysme atheromateux dans le duodenum qui lui adhere, mais de nombreuses autres causes et topographies ont ete decrites. Le tableau clinique est habituellement celui d'une hemorragie digestive intermittente aboutissant a une hemorragie massive mortelle en quelques heures ou jours. Des douleurs, une masse abdominale pulsatile ou de la fievre peuvent etre ou non presents. L'endoscopie, l'arteriographie, l'echographie et la tomodensitometrie peuvent etre utiles pour le bilan de ces malades mais l'examen clinique et l'evoca...
Nederlands tijdschrift voor geneeskunde, 2006
A 50-year-old woman complained of nausea, diarrhoea, tiredness and dizziness five weeks after a v... more A 50-year-old woman complained of nausea, diarrhoea, tiredness and dizziness five weeks after a visit to Egypt. She was deeply tanned with hyperpigmentation on the metacarpophalangeal joints, palm of hand creases and buccal mucosa, due to Addison's disease.
Nederlands tijdschrift voor geneeskunde, 2007
OBJECTIVE To analyse the results of the laparoscopic adjustable gastric banding (LAGB) procedure ... more OBJECTIVE To analyse the results of the laparoscopic adjustable gastric banding (LAGB) procedure for morbid obesity. DESIGN. Retrospective, descriptive. METHOD From November 1, 1995 to May 31, 2005, laparoscopic adjustable banding surgery was performed in St. Antonius Hospital, Nieuwegein, the Netherlands, in 411 patients. Inclusion criteria were BMI > or = 40 kg/ m(2) or BMI > 35 kg/m(2) and severe comorbidity with > 3 attempts at weight loss in the past. Selection, inclusion and follow-up were performed in a specialised, multidisciplinary setting. Height, weight, and complications were prospectively recorded. In 1995-2000 the perigastric surgical procedure was used and in 2000-2005 the pars-flaccida method. RESULTS The study group consisted of 350 (85%) women and 61 (I5%) men with a median age of 38 years (range 17-60). Out of these 411 patients, the median weight was 133.4 kg, the median overweight, 69.6 kg and the median BMI 46.3 kg/m2. Two years after surgery, data was...
Nederlands tijdschrift voor geneeskunde, 2002
In a 69-year-old obese woman on prednisone treatment for temporal arteritis a widened mediastinum... more In a 69-year-old obese woman on prednisone treatment for temporal arteritis a widened mediastinum on chest X-ray proved to be mediastinal lipomatosis on CT-scan.
Nederlands tijdschrift voor geneeskunde, 2002
A 47-year-old man was admitted due to serious weight loss after several months in which he had no... more A 47-year-old man was admitted due to serious weight loss after several months in which he had not eaten and had drunk almost solely beer. Shortly after the start of enteral tube feeding, the patient developed serious heart failure. This was associated with severely disrupted electrolyte levels and in particular hypophosphataemia and hypomagnesaemia. This condition is termed refeeding syndrome. The circulating volume increases due to the hyperinsulinaemia which occurs during the feeding phase. Furthermore a shortage of ATP occurs and the heart may fail. In efforts to establish feeding, a weight increase of not more than 1 kg per week should be attempted; if the weight increases by more than this, then fluid retention is the probable cause.