Nederlands tijdschrift voor geneeskunde
-
Ned Tijdschr Geneeskd · Jul 2000
Review[Preoperative outpatient evaluation of young adults by anesthesiologist: anamnesis and physical examination are satisfactory--short questionnaire of Dutch Public Health Council is not].
The report of the Netherlands Health Council 'Preoperatief onderzoek; een herijking van uitgangspunten' recommends that the health status of patients aged 16-39 years can be investigated preoperatively by the anaesthesiologist using a short questionnaire (6 questions). However, it is not clear whether such an abbreviated preoperative investigation will be informative enough for a safe and balanced anaesthesiologic management. ⋯ Only blood group, rhesus factor and the presence of irregular antibodies may need to be determined if indicated by the kind of surgery. Currently, however, there is not sufficient evidence to demonstrate that the short questionnaire of the Netherlands Health Council is informative enough.
-
Ned Tijdschr Geneeskd · Jul 2000
Review Case Reports[Multitrauma patients: principles of 'damage control surgery'].
The principles of damage control surgery were applied in the cases of three severely injured multitrauma patients, men aged 47 and 33 years who had a motorcycle accident and a 66-year-old man who had a car crash. Victims of major trauma suffer from a worsening physiologic derangement manifested by the triad of acidosis, hypothermia and coagulopathy. This often leads to a vicious cycle that heralds imminent death or organ failure. ⋯ The second involves aggressive correction of the lethal triad in the intensive care unit. The third is the planned re-operation for the definitive repair of the injuries. As shown in these three patients, the appropriate use of this strategy can lead to a decrease in the morbidity and mortality in complex trauma patients.
-
Ned Tijdschr Geneeskd · Jul 2000
[Diagnosis and treatment of 39 patients with cervical lymph node metastases of squamous cell carcinoma of unknown primary origin, referred to Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, 1979-98].
Evaluation of diagnostic procedures and treatment results in patients with lymph node metastases of squamous cell carcinoma in the head and neck region with an unknown primary. ⋯ Early treatment of patients with cervical lymph node metastases from an unknown primary tumour improves survival rates. Radiation therapy of the laryngo-pharyngeal axis seems effective in preventing outgrowth of an occult primary.
-
Ned Tijdschr Geneeskd · Jul 2000
Comment Review[Acute and chronic Q fever; epidemiology, symptoms, diagnosis and therapy of infection caused by Coxiella burnetii].
Q fever is a zoonosis caused by Coxiella burnetii, an obligate intracellular bacterium. Domestic ungulates and parturient cats are the primary reservoirs of infection. The animals excrete the bacterium in urine, faeces, milk and amniotic fluid. ⋯ Doxycycline is the antibiotic of choice in the treatment of Q fever. Endocarditis needs therapy for years with the addition of rifampin or hydroxychloroquine. Q fever is poorly recognised due to the variety of clinical presentations.