Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Nov 2003
Review[Percutaneous dilatating tracheostomy in intensive-care patients: technique, indications and complications].
Since tracheal cannulas are increasingly used to wean intensive-care patients from respiratory machines, more doctors and nurses will find themselves having to take care of patients with tracheostomas. Indications for tracheal cannula use include the likelihood of prolonged mechanical ventilation and/or difficult weaning. Percutaneous dilatational tracheotomy is a relatively simple procedure for inserting a tracheal cannula. ⋯ When it is difficult to pinpoint the source of problems arising in patients fitted with a tracheal cannula, it must always be considered that the cannula might be the cause. Although rare, complications may arise several weeks or months after decanulation, such as stenosis of the trachea, changes in voice and fistula formation between the trachea and skin. A strict surveillance protocol is needed to recognize and treat late complication.
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Ned Tijdschr Geneeskd · Nov 2003
Review[Calprotectin: a fecal marker for diagnosis and follow-up in patients with chronic inflammatory bowel disease].
Chronic inflammatory bowel disease (IBD) is characterised clinically by periods of well being interspersed by exacerbations of disease activity. Differentiation between IBD and less severe disorders such as irritable bowel syndrome requires invasive and expensive diagnostic procedures. Diagnostic differentiation between active disease, symptoms due to residual constriction of the fibrotic lumen and functional symptoms is a well-known problem. ⋯ Disease activity was monitored by clinical symptoms, blood tests and endoscopy. Our results confirm previous literature findings that faecal calprotectin is a promising and useful non-invasive tool in the screening of patients presenting with abdominal pain and diarrhoea. Moreover, calprotectin seems helpful in differentiating between active and non-active IBD and possibly also in the monitoring of disease activity.
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A 22-year-old man with a known bipolar disorder was admitted to a psychiatric department for depression and suicidal ideation. He was being given isotretinoin to treat acne conglobata. During admission, he committed suicide. ⋯ Methodologically well-performed research is lacking. However, positive dechallenge and rechallenge cases have been reported. Consequently, physicians must look out for the onset or worsening of psychiatric symptoms in patients treated with isotretinoin.
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Ned Tijdschr Geneeskd · Nov 2003
[Evaluation and validation of a perinatal death audit by means of feedback to the caregivers].
To evaluate a perinatal audit procedure by communicating the results to the caregivers (midwives and obstetricians) involved, in order to determine whether the audit led to specific suggestions for improving practice and whether evaluation of the panel assessments by caregivers leads to a different evaluation of the audit process. ⋯ The feedback of perinatal audit results to the caregivers involved as well as discussion of these results led to specific starting points in the areas of collaboration, documentation and policymaking at both individual and institutional level.
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Ned Tijdschr Geneeskd · Nov 2003
Review[Cyclooxygenase(COX)-2-inhibition in the prevention and treatment of colorectal carcinoma].
Epidemiological studies have found that long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with a lower risk of colorectal cancer (CRC). Cyclooxygenase (COX)-2 expression is present in colorectal cancer and overexpression is associated with metastases and poorer prognosis in multivariate analysis. NSAID treatment results in a reduction of the incidence of colorectal adenoma in patients with familial adenomatous polyposis, in patients with a history of colorectal adenomas and in patients with a history of CRC. ⋯ An anticarcinogenic effect has been shown specifically in selective COX-2 inhibitors in animal models. Selective COX-2 inhibitors have fewer adverse effects than the non-selective NSAIDs and are promising chemopreventative and chemotherapeutical agents. The effects of selective COX-2 inhibition in the prevention of and treatment for colorectal carcinoma will be investigated in clinical randomized multicentre trials.