The Netherlands journal of medicine
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Faecal incontinence is a disabling condition caused by: (1) sphincter damage caused by childbirth, anorectal surgery, trauma, fistulae and abscesses; (2) pudendal neuropathy ("idiopathic faecal incontinence") caused by stretch injury by long-standing constipation or prolonged labor; (3) diminished rectal compliance in proctitis, low anterior resection or small pouches; (4) faecal impaction causing paradoxal diarrhoea; (5) neurological disease involving the pelvic floor and or the central nervous system; (6) diarrhoea. Often several factors play a role in a patient. A medical history and physical examination will generally provide a reasonable diagnosis. ⋯ A suggested work-up of the incontinent patient is given in a table. Besides the classic surgical treatments such as sphincter repair, rectopexy and post-anal repair new (surgical) options have been tried. The most promising new therapy seems the dynamic gracilis repair.
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The purpose of this study was to examine the effect of patient- and non-patient-related factors (co-morbidity, demographics, and method of surveillance) on the frequency of "do-not-resuscitate" (DNR) orders in aged inpatients. ⋯ The DNR decision is related to the PAM index score and age. The variance in DNR decisions is partly related to the method of data collection, a non-patient-related factor in DNR decision-making. Without attention to the DNR/CPR decision, the DNR frequency decreased markedly.
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To assess the effect of combined therapy (CT) of ursodeoxycholic acid (UDCA) with prednisone on symptoms and biochemistry in patients with non-advanced primary biliary cirrhosis (PBC), who had responded insufficiently to either drug alone. ⋯ In PBC, combined treatment with UDCA and prednisone appears to improve symptoms and biochemical parameters to a larger extent than either treatment alone; randomized controlled trials should be performed to establish the benefit/risk ratio of this combination therapy.
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Comparative Study
Comparison of clinical examination, current and vibratory perception threshold in diabetic polyneuropathy.
The study of diabetic polyneuropathy is complicated by a lack of clear definitions and the absence of a simple reliable test procedure. Recently, a new sensory perception testing device has been introduced for detection of thresholds for electrical stimuli (current perception: CPT) at different frequencies (Neurometer). We compared standardized clinical examination scores with measurements of vibratory perception threshold (VPT) and CPT (foot) and obtained reproducibility figures. ⋯ Correlations between CPT and VPT were only moderate and maximal at 2000 Hz (r = 0.61). Reproducibility of CPT was good at 2000 Hz (coefficient of variation 13.3-20.2%), but moderate to poor at lower frequencies (ranging to 62%). We conclude that CPT and VPT quantitative sensory testing is only of limited value, mainly because of high variability and poor reproducibility.
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To determine the incidence and course of multiple myeloma (MM) in the Afro-Caribbean population of Curaçao, we studied all MM patients discharged from the only hospital on the island during an 11-year period starting in 1980. As 50 patients fulfilled the diagnostic criteria for MM proposed by Durie, the average annual incidence (AI) of MM was estimated at 3.1/100,000 person years; AI was similar in males and females, but showed a steep increase with age in both sexes; 10% of all MM patients were < 40 years of age. ⋯ Infections were the immediate cause of death in 54% of the non-survivors. We conclude that the incidence rate of MM in the Afro-Caribbean population of Curaçao is one of the lowest reported in black populations; however, the presentation and course of MM follow the pattern seen in most other countries.