[Surprising diagnosis after suspected appendicitis]. / Verrassende diagnose na verdenking appendicitis.

A 12-year-old boy presented at the emergency department because of right-sided abdominal pain. Laboratory findings and ultrasound examination were suggestive of acute appendicitis. During laparoscopy, an indurated omental mass was seen. The appendix was normal. Histopathological examination confirmed a diagnosis of omental infarction, which is rare in pediatric patients.

[Austrian syndrome: a patient with meningitis, pneumonia and endocarditis]. / Het syndroom van Austrian: een patiënt met meningitis, pneumonie en endocarditis.

A 62-year-old man with a history of significant alcohol consumption presented with atypical neurological symptoms. Bacterial meningitis, caused by Streptococcus pneumoniae, was diagnosed with a 24-hour delay. Despite antibiotic treatment, the patient developed heart failure and multiple organ failure. He also had endocarditis with insufficient mitral and aortic valves. Subsequently, we found signs of a pulmonary infection. Because of an unsustainable haemodynamic situation, double heart valve replacement was considered necessary, despite the extremely high surgical risk and the extracardial infection foci showed by leukocyte scintigraphy. The patient died shortly after surgery. The triad of meningitis, pneumonia and endocarditis caused by Streptococcus pneumoniae is called the Austrian syndrome. This syndrome is rare and often has a serious course. It is strongly associated with asplenia, functional asplenia or hyposplenism, as occurs with alcohol abuse. Early recognition and a combination of antibiotic and surgical treatment is essential.

Second primary tumors involving non-small cell lung cancer: prevalence and its influence on survival.

OBJECTIVES: Patients with lung cancer have a relative high risk for second primary cancers. We studied the prevalence of second primary tumors in patients with a diagnosis of non-small cell lung cancer (NSCLC) in their history or at follow-up. Furthermore, we studied survival in subgroups of those patients. METHODS AND PATIENTS: Retrospectively, 860 patients with NSCLC that had been diagnosed in the period from January 1, 1990, to December 31, 1999, were evaluated for second primary cancers either in their history or in the follow-up period. The patients were divided into the following four groups: group I, patients with another primary tumor detected in the follow-up period (n = 44); group II, patients with another primary tumor in their history (n = 148); group III, patients with no other primary tumor found in their history or at follow-up (n = 634); and group IV, patients with more than one other primary tumor in found in their history or at follow-up (n = 34). RESULTS: The most frequently diagnosed double tumors were located in the lungs, the head and neck region, and the urinary tract. The interval between another malignancy as the first tumor (group II, 83 months) and NSCLC as the second malignancy was significantly longer than vice versa (group I, 14.5 months; p < 0.05). In > 80% of patients, the second primary tumors were diagnosed within 1 year after NSCLC was diagnosed. The 5-year survival rate is significantly better for patients with more than two primary malignancies compared to patients without two primary malignancies and patients with one other tumor in their history (p = 0.004 and 0.012, respectively). The 5-year survival rate in patients with a second tumor in the follow-up period was better than in patients without any other second tumor (p = 0.029). As the TNM stage and therapy were comparable in all subgroups, it could not be used as explanation for the difference in survival rates. CONCLUSION: In 25% of patients, additional tumors that were NSCLC were diagnosed either in their history or in the follow-up period. The majority of second tumors following NSCLC are diagnosed within 1 year. Nevertheless, patients with a second tumor tend to have an overall better survival rate than patients without second primaries, suggesting different growth habits.