Nederlands tijdschrift voor geneeskunde
-
The Dutch Association for Addiction Medicine and the umbrella organisation GGZ Nederland (sector organisation for mental health and addiction care) have compiled a report entitled 'Strengthening medical care in the addiction care sector'. The report argues why medical care needs to be strengthened and provides guidance as to how the present shortcomings in quality and quantity can be dealt with. Addiction is now considered to be a medical condition with patients instead of clients. ⋯ Furthermore, the training in addiction medicine needs to be given a clearer status in the form of departments, professorships, training institutes and certification. Within the context of this report the responsibility of addiction centres needs to be emphasised. Vacancies in the many forms of social work could be exchanged for well-trained nurses and physicians, without the need for extra financial assistance.
-
Ned Tijdschr Geneeskd · Aug 2003
Case Reports[Shoshin beriberi provoked by the inhalation of salbutamol].
A 45-year-old male alcoholic with a deficient diet was given salbutamol for exertion-related dyspnoea. After inhalation, he presented with a severe dyspnoea, acrocyanosis, anuria and low blood pressure as well as a respiratory compensated lactate acidosis. ⋯ Shoshin beriberi is an acute, cardiac form of beriberi, which can rapidly result in death due to cardiogenic shock and lactate acidosis. Adrenergic agents can cause a hyperdynamic circulation and thus aggravate the effects of a thiamine deficiency.
-
Ned Tijdschr Geneeskd · Aug 2003
Comment[Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: first short term results].
To describe the technique of percutaneous vertebroplasty and the short-term results in patients with symptomatic, osteoporotic vertebral compression fractures. ⋯ Percutaneous vertebroplasty was a technically feasible treatment in these patients with symptomatic, therapy-resistant, osteoporotic vertebral fractures. The first short-term results were comparable with results in the literature. A prospective randomised intervention study will be needed to compare percutaneous vertebroplasty with optimal conservative treatment.
-
Ned Tijdschr Geneeskd · Aug 2003
[Cardiovascular disease in those aged 55 years and over controlled with a combined pill against 4 risk factors: some brief comments].
It was recently proposed that people with a high absolute cardiovascular risk, for example those aged 55 years and over, might considerably benefit from a combined pill that includes proven treatments such as a statins, antihypertensives, antiplatelet therapy and folic acid. Although conceptually attractive, certain negative effects need to be considered. A strategy to treat the population aged 55 years and over might yield large benefits in high-risk patients with fairly normal values for risk factors that are currently often left untreated. ⋯ In these low-risk patients, the side effects of aspirin and blood-pressure lowering treatment might outweigh the benefits. Due to the high costs and also the availability of generic drugs, it is difficult to envision trials that will address these issues. Therefore, the acceptance and implementation of this intriguing concept by health authorities and insurance companies remains doubtful.
-
Ned Tijdschr Geneeskd · Aug 2003
Case Reports[Ulcers on the legs and feet: a seldom recognised side effect of hydroxyurea].
Three male patients aged 52, 49 and 74 years who were treated with hydroxyurea for chronic myeloid leukaemia (CML) or essential thrombocytosis developed severely painful ulcers on the lower legs and feet after an interval varying from 4 months to 2.5 years. These ulcers only healed after discontinuation of the drug. This is an adverse effect of hydroxyurea that is not infrequently seen but is difficult to recognise. ⋯ Often, the drug has already been used for several years before the ulcers develop. They are resistant to treatment unless the hydroxyurea is stopped. Alternatives to hydroxyurea are imatinib for the treatment of CML and interferon alpha-2a or anagrelide for essential thrombocytosis.