The Netherlands journal of medicine
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The introduction and development of continuous renal replacement therapy (CRRT) represents one of the most substantial changes in patient management on the intensive care unit (ICU). Several issues, however, are still unresolved. Adequacy of dialysis in critically ill patients involves more than simple control of urea (although considered reflective of toxic uraemic compounds). ⋯ Continuing effort should be made to develop 'evidence-based' guidelines for the appropriate prescription and delivery of renal replacement therapy to treat ARF in the ICU. This should include efforts to determine a validated dialysis dose methodology in ARF patients to address further the dose/outcome relationship. Based on existing data, some guidelines for the prescription and delivery of adequate (C)RRT are provided.
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In patients with inflammatory bowel disease, assessment of disease activity is important in order to monitor and adjust therapy. In individual patients, disease evaluation is largely based on subjective symptoms. ⋯ These indices may be distinguished in more subjective clinical indices, more objective endoscopic and histological indices, and in indices with combinations of both subjective and objective parameters. In the design of a new clinical trial, an appropriate disease activity index should be selected which is based on the patient selection criteria and the aims of the study.
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Shared-care constructions between general practitioners and pulmonary physicians are seemingly attractive for asthma and COPD patients. Thus they have to be implemented in further guidelines. However, anticipation that rapid changes will occur in treatment options towards optimal disease management justifies rapid adjustments in these strategies and requires investigations as to their ultimate benefit in disease outcome.
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Case Reports
Tension pneumopericardium caused by positive pressure ventilation complicating anaerobic pneumonia.
A 22-year-old man was admitted with pneumonia. He was immediately intubated and positive pressure ventilation was initiated. Blood and sputum cultures showed Bacteroides fragilis and Corynebacterium sp., which were treated with metronidazole and clindamycin. ⋯ Two weeks later he was discharged. A pneumopericardium without previous thorax trauma is very rare and early recognition is imperative because a tension pneumopericardium with cardiac tamponade may develop, as happened in this case. A tension pneumopericardium has to be treated with immediate pericardiocentesis followed by partial pericardiectomy to avoid recurrence.