Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Mar 2000
Review[Hyponatremia in acute intracranial disorders: cerebral salt wasting].
Hyponatraemia is a frequent finding in the course of an acute intracranial disease, especially after a subarachnoid haemorrhage. The fall in plasma sodium concentration is usually mild and not below 124 mmol/l but may reach dangerously low levels with serious neurological complications. In the early 1950s the cause of the hyponatraemia was believed to be primarily excessive natriuresis and therefore named 'cerebral salt wasting'. ⋯ The increased plasma concentrations of natriuretic peptides are likely to mediate the increased natriuresis. Cerebral salt wasting can be treated with a simple regimen of water and salt suppletion. If needed a mineralocorticoid like fludrocortisone can be given to increase renal tubular sodium reabsorption.
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Disseminated intravascular coagulation is characterised by systemic activation of blood coagulation, resulting in formation of intravascular thrombi and impaired organ perfusion. Simultaneously, the ongoing consumption of platelets and coagulation factors may lead to bleeding. ⋯ The increased insight into the pathogenesis of disseminated intravascular coagulation provides a solid basis for development of improved management strategies for patients with this complication. Therapy may include anticoagulants, platelet and plasma transfusion, concentrates of coagulation inhibitors and antifibrinolytic agents.
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Ned Tijdschr Geneeskd · Mar 2000
Review[Postoperative wound infections: a useful indicator of quality of care?].
An indicator can be defined as a measurable element of care that gives an impression of the quality of care. It can be used for screening on potential quality problems, for monitoring of well-defined processes and for a check after the introduction of quality improvement activities. ⋯ Postoperative wound infections appears to be a valid outcome indicator because of the relationship between process of care (infection prevention policy) and outcome of care (the number of infections). The weak point lies in the reliability of the registration of wound infections.