Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Apr 2005
Case Reports[Three infants with constipation and muscular weakness: infantile botulism].
Two previously healthy infants, a boy of 10 weeks and a girl of 4 months presented with apathy and muscle weakness. A third previously healthy child, a girl of 6 weeks old was admitted with respiratory insufficiency. None of the three had had a bowel movement for a number of days. ⋯ The diagnosis can quickly be confirmed by electromyography with repetitive 50-Hz-stimulation. Honey is a well-known source of the C. botulinum spore and should not be given to children under the age of 12 months. These three children are the first cases to be described in the Netherlands.
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Ned Tijdschr Geneeskd · Apr 2005
Case Reports[Rocky Mountain spotted fever in an American tourist].
In a 28-year-old male American tourist who presented in the hospital with fever, cold shivers, headache, nausea, myalgia and arthralgia, Rocky Mountain spotted fever was suspected, partly because he came from an endemic region (the state of Georgia). The patient was treated with doxycycline, 100 mg b.i.d.; 9 days after the first appearance of the symptoms, the diagnosis was confirmed by the report of a positive antibody titre against Rickettsia rickettsii. The patient did not have exanthema. ⋯ The travel history is still not a standard component of the anamnesis and is therefore often forgotten. This can lead to under-diagnosis and delayed treatment of diseases that were formerly limited to the continent. The early recognition and treatment of Rocky Mountain spotted fever is important since delayed treatment is associated with a clear increase in both morbidity and mortality.
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Ned Tijdschr Geneeskd · Apr 2005
Review[Decisions around the end of life on Intensive Care: making the transition from curative to palliative treatment].
The decision to move from curative treatment to palliative care in the intensive-care situation is less related to morals and ethics than it is to the assessment of medical issues, professionalism, communication and orchestration. Treatment should be considered medically pointless if, in the view of the treating physicians, it does not offer realistic chance to return to a meaningful life. Continuing futile care can be seen as disrespectful, both to the patient, his partner and the family, as well as to the members of the ICU team. ⋯ This is based on the trust that is built up through their skill, attitude and behaviour and that is perpetuated in a continuing process of intensive communication. Conflicts should be prevented, or at least recognised early and discussed. Ifa conflict is ongoing then it should be tackled by planning a number of consecutive consultations.
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Ned Tijdschr Geneeskd · Apr 2005
[Sexual harassment of medical students during their period of work placement].
To investigate the incidence, type and consequences of sexual harassment of medical students at the Radboud University in Nijmegen, the Netherlands, during their period of work placement, as well as the students' need for care thereafter. ⋯ The problem of sexual harassment of medical students during their period of work placement should not be underestimated. It has a negative impact on the personal and professional conduct of future doctors. This subject should be part of the training of both medical students and their supervisors.