Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Feb 2004
Case Reports[Diagnostic image (177). A lifeless infant. Shaken baby syndrome].
In a 4-months-old male infant who had been discovered in his bed pale, apnoeic and cold, fundoscopy revealed multiple retinal haemorrhages due to shaken baby syndrome.
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Three patients, 2 men aged 21 and 39 years, respectively, and 1 woman aged 29 years, presented with a unilateral swelling of the neck, with no accompanying symptoms. In the youngest man the diagnosis of a 'plunging ranula' was made after repeated fine needle aspiration yielded viscous yellowish mucus with a high amylase content. In the oldest man the diagnosis was made during the operation and in the woman the diagnosis was finally made after two surgical explorations in the neck. ⋯ Important clues for the diagnosis of a 'plunging ranula' are: the simultaneous presence of a ranula in the floor of the mouth (or a history of one), a characteristic cystic mass in the submandibular space with an extension into the sublingual space on CT and/or MRI, and the aspiration of amylase-containing mucus. Excision of the sublingual gland as the source of salivary leakage is the therapy of choice in a case of 'plunging ranula', with drainage of mucus from the ranula into the oral cavity. As the 'plunging ranula' represents a pseudocyst without an epithelial lining, excision is not indicated.
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Ned Tijdschr Geneeskd · Feb 2004
[Part-time medical specialist training; experiences with job-sharing for trainee internists].
Due to various factors such as social changes, an increasing number of couples with two incomes, and a growing proportion of female doctors, there has been a growing demand for part-time work in recent years. This is also true for resident physicians. ⋯ This approach works well in practice, as long as a number of conditions, including the proper transfer of medical information and good communication, are satisfied. Job-sharing is one means of satisfying the growing demand for part-time work among resident physicians and specialists.
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Ned Tijdschr Geneeskd · Feb 2004
Comment[Job-sharing in postgraduate medical training: not automatically a nice duet].
Part-time work is an increasingly common phenomenon amongst medical professionals. Therefore many postgraduate training programmes for resident physicians also offer the opportunity of part-time work, which is usually in the form of an 80% full-time equivalent post. ⋯ Although the experience of the participants is mainly positive, it is unclear how this development will impact the quality of patient care and how it will affect the fulfillment of the training objectives. A more systematic evaluation of job-sharing in postgraduate medical training programmes is required to clarify these points.
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Ned Tijdschr Geneeskd · Feb 2004
Review[Prophylactic perioperative beta-blockade reduces cardiac morbidity and mortality following non-cardiac surgery in patients at risk].
Approximately 5% of all patients undergoing non-cardiac surgery suffer some form of perioperative cardiac morbidity, usually preceded by myocardial ischaemia. In the Netherlands, the cardiac mortality following non-cardiac surgery is 0.68%. ⋯ Prophylactic beta-blockade significantly reduces perioperative cardiac morbidity and mortality: the odds ratio for myocardial ischaemia is 0.34 (95% CI: 0.23-0.52), for non-fatal myocardial infarction 0.15 (95% CI: 0.06-0.40) and for cardiac mortality 0.25 (95% CI: 0.09-0.73). Long-term continuation of the beta-blockade also reduces cardiac morbidity and mortality in the first two years following the operation.