Nederlands tijdschrift voor geneeskunde
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Three men aged 52, 60, and 38 years, complained of dysuria and recurrent cystitis. One patient mentioned pneumaturia, a feature which later appeared to be present in all three. Ultrasound examination showed air in the bladder, and demonstrated the fistulous tract in two cases. ⋯ The key to the diagnosis of enterovesical fistula is to think of it. Pneumaturia and faecaluria are pathognomonic symptoms. Both ultrasound and computed tomography may be helpful in the diagnosis.
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Ned Tijdschr Geneeskd · Apr 2000
Review[Panic disorder in patients with chest pain and palpitations: an often unrecognized relationship].
The prevalence of panic disorder in patients who present with chest pain or palpitations to a First Heart Aid setting varies in the literature between 0%-59%. In a high percentage of cases, panic disorder is not recognized by the cardiologist in patients who present initially with chest pain or palpitations. ⋯ A selective serotonin reuptake inhibitor and/or cognitive therapy appear to be good treatment of panic disorder in patients who present initially with chest pain or palpitations. A CO2 challenge test elicits the symptoms in patients with panic disorder with high sensitivity and specificity but this test has not been validated in patients who present initially with chest pain or palpitations and in whom the diagnosis 'panic disorder' is not yet established.
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Ned Tijdschr Geneeskd · Apr 2000
Case Reports[Clinical thinking and decision making in practice. A student with sudden headache].
A previously healthy man aged 18 years suddenly developed a severe headache, followed by nausea, vomiting, fever. During the following weeks a left-sided hemiparesis developed. CT of the brain revealed a pansinusitis and a frontal epidural empyema. ⋯ A sudden severe headache can be caused by an intracranial infection and intracranial pus collections can occur in the subdural as well as in the epidural space. Epidural empyema is a limited disease with relatively mild symptoms and a favourable prognosis, whereas subdural empyema may rapidly spread and cause severe disease with a poor prognosis. Quick antibiotic treatment and surgical drainage are required.
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Ned Tijdschr Geneeskd · Apr 2000
Review[Serum lactate level as a indicator of tissue hypoxia in severely ill patients].
Adequate oxygen supply to the tissues is of vital importance to survive critical illness and trauma. Shock can be defined as an imbalance between oxygen demand and oxygen supply. Clinical features of shock, like hypotension, tachycardia, cold clammy skin et cetera, are poorly correlated with presence of tissue hypoxia. ⋯ In severely ill patients tissue hypoxia is the most important cause of increased lactate levels. Increased blood lactate levels are related to increased mortality. Optimizing oxygen supply by fluid resuscitation is the intervention of first choice.
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Ned Tijdschr Geneeskd · Apr 2000
Comment[Panic disorder, chest pain and palpitations: a pilot study of a Dutch First Heart Aid].
To determine how many patients, presenting to a First Heart Aid (FHA) with chest pain or palpitations without a cardiac origin for their complaints, have a panic disorder and/or depression. ⋯ In 83% of the patients who visited the Maastricht FHA with cardiac complaints but without a cardiac origin and who had a HADS score > or = 8, panic disorder and/or depression was diagnosed.