Nederlands tijdschrift voor geneeskunde
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Pneumococcal pneumonia and bacteraemia are an important cause of morbidity and mortality, especially in a number of risk groups. On the basis of data from available literature, there is no convincing evidence that vaccination of such risk groups, including all people over 65, with a polyvalent vaccine of pneumococcal capsular polysaccharides in addition to influenza vaccination offers any additional protection against the risk of acquiring pneumococcal pneumonia. There is adequate evidence that pneumococcal vaccination does protect against invasive infections and that in this respect vaccination of all elderly persons could be cost-effective. ⋯ Therefore a well-considered assessment of the cost-effectiveness of applying such a strategy in the Netherlands is not yet possible. Vaccination of (imminent) immuno-compromised persons is only effective and of value if an adequate antibody response can be expected. There is as yet no proven advantage of vaccination with a conjugate vaccine in adults.
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Ned Tijdschr Geneeskd · Mar 2003
Comment Case Reports[Missing spleen: indication for pneumococcal vaccination].
Two female patients, aged 39 and 52 years, developed severe pneumococcal meningitis. Both patients had undergone splenectomy in the past (one after trauma and one for idiopathic thrombocytopenic purpura) and pneumococcal vaccination was only given immediately after the splenectomy. ⋯ Vaccination after splenectomy in order to prevent a severe sepsis syndrome is very important. Indications for the 7 valent pneumococcal conjugate vaccine and the 23 valent polysaccharide vaccine are given.
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Ned Tijdschr Geneeskd · Mar 2003
Case Reports[Diagnostic image (129). A woman who collapsed upon catheterisation. Air embolism].
A subclavian catheter was introduced in a 72-year-old woman whereupon she collapsed due to air embolism. The emboli were seen in the superior V. cava, the right atrium and the left pulmonary artery.
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Ned Tijdschr Geneeskd · Mar 2003
[The troponin assay in a cardiac emergency unit: especially to exclude severe cardiac risk].
To determine the value in daily practice of a troponin assay for triage of patients with chest pain. ⋯ A troponin assay, performed six hours or more after the onset of cardiac symptoms, appears to be a safe method to exclude patients with severe coronary artery disease resulting in myocardial necrosis and an elevated risk of death. An elevated troponin level was always associated with myocardial damage, but not always with coronary artery disease. Therefore, there must be a clear indication for requesting a troponin assay, and one should always keep in mind that a normal troponin level does not exclude coronary artery disease.