Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2003
Case Reports[Primary meningococcal-monoarthritis (Neisseria meningitidis serotype C) in a child].
A 26-month-old girl had a painful, swollen right knee, accompanied by fever and vomiting. She had had an upper respiratory tract infection for a number of days. ⋯ She recovered completely after one joint aspiration and intravenous and oral antibiotic therapy. N. meningitidis serotype C infections without meningitis or septicaemia are rare, but should form part of the differential diagnosis of septic monoarthritis.
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Ned Tijdschr Geneeskd · Jan 2003
Practice Guideline Guideline[Admission and discharge criteria for intensive care departments].
Admission and discharge criteria for intensive care departments have been drawn up in order to optimise the use of scarce and costly intensive care facilities. Every patient who could benefit from admission must be assessed by the intensive care specialist beforehand. ⋯ Frequent assessment (several times per day) of the 'indication to stay' is indicated in the case of many patients in order to maximise the admission capacity. Discharge from the intensive care department is indicated if the vital functions are stable without life support and no longer require monitoring or treatment, if nursing the patient in the ward is possible, if continuation of the medical treatment is no longer worthwhile, if the patient no longer consents to the treatment and if the benefit of a treatment no longer outweights its negative effects.
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Ned Tijdschr Geneeskd · Jan 2003
Case Reports[Dementia with Lewy bodies; 2 patients with exacerbation due to an atypical antipsychotic, but with a favorable response to the cholinesterase inhibitor rivastigmine].
In two patients, men aged 80 and 75 years with cognitive deterioration, hallucinations and parkinsonism, the clinical diagnosis 'dementia with Lewy bodies' was established. Treatment with an atypical antipsychotic, risperidone and olanzapine respectively, resulted in an exacerbation of the parkinsonism. Rivastigmine evidently improved the psychosis, the anxiety and the cognitive, mood and behaviour disorders. ⋯ Levodopa can lead to an increase in visual hallucinations. Antipsychotics often cause serious side effects, such as increasing parkinsonism, sedation and cognitive deterioration. Cholinesterase inhibitors such as rivastigmine could possibly provide an alternative treatment for the neuropsychiatric symptoms.