Nederlands tijdschrift voor geneeskunde
-
Ned Tijdschr Geneeskd · Nov 2006
[Proximal femur fractures in the elderly in The Netherlands during the period 1991-2004: incidence, mortality, length of hospital stay and an estimate of the care capacity needed in the future].
To assess the incidence of operations for neck and pertrochanteric femur fractures during the last 15 years and to estimate the future demand for such operations in The Netherlands. ⋯ In the period 1991-2004 there was an annual increase of 230 operations for proximal femur fractures that was closely related to the ageing of the Dutch population. During the years under investigation, the incidence in the same age range was higher in women, but men had a higher hospital mortality. It is estimated that the decreasing hospital mortality and the decrease in the length of hospital stay will increase the need for nursing-home care for this category of patients.
-
Ned Tijdschr Geneeskd · Nov 2006
[Stenting of symptomatic stenosis of the internal carotid artery is not preferred over endarterectomy at this time].
Carotid endarterectomy reduces the risk of stroke in patients with symptomatic internal carotid-artery stenosis of 50% or greater. Carotid-artery stenting may be an attractive alternative. ⋯ Reasons for termination included an excess in stroke and death after stenting, compared with carotid endarterectomy (the EVA-3S trial) and futility reasons and the absence of funding (the SPACE trial). Given that both trials failed to prove the non-inferiority of stenting compared with carotid endarterectomy in the first 30 days, the use of stenting should be restricted to patients with contraindications to surgery and those participating in randomised clinical trials.
-
Ned Tijdschr Geneeskd · Nov 2006
Review[Coagulation disorders in patients with trauma to the skull and brain: a frequent and potentially fatal combination].
Abnormalities in blood coagulation are relatively common after traumatic brain injury (TBI) and play an important role in the morbidity and mortality after head injuries. Exposure oftissue factor, which is abundantly present in brain tissue, is the initiator of the coagulation cascade and plays an important role in the pathogenesis of coagulopathy after TBI. Coagulopathy after TBI is actually a manifestation of the disseminated intravascular coagulation (DIC) syndrome. ⋯ The DIC score, a combination of frequently used coagulation parameters, is not only a measure of the coagulopathy but can also predict the outcome and prognosis following TBI. Primary and secondary prevention of coagulopathy together with timely and effective intervention are the most important elements in the treatment of coagulation disorders. Nevertheless, the risk of death remains high.
-
Ned Tijdschr Geneeskd · Nov 2006
Case Reports[Takayasu arteritis: a chronic vasculitis that is rare in children].
Takayasu arteritis was diagnosed in two children, a 15-year-old girl and a 10-year-old boy. The girl had suffered from fatigue, malaise, abdominal pain and weight loss for several months, but no clear cause could be found. A few weeks later, when a blood pressure of 222/155 mmHg was measured, the possibility of renal artery stenosis was considered and imaging studies revealed indications for Takayasu's disease. ⋯ Radiological examination may consist ofangiography, magnetic resonance imaging or CT-scans. Treatment consists of corticosteroids and other immunosuppressants, such as cyclophosphamide, methotrexate, azathioprine, and antagonists of tumour-necrosis factor alpha. In addition, balloon dilatation or stenting is often necessary.
-
The prevalence of overweight individuals in The Netherlands is increasing sharply as has also been observed in populations worldwide. In addition to the long-term health risks of being overweight, overweight women of reproductive age are more commonly faced with reproductive disorders. Women who are overweight are less fertile than women of normal weight. ⋯ The chance of a live birth is also decreased due to an increased risk of miscarriage. Furthermore pregnancy outcome is compromised by obesity-related complications of pregnancy. Weight loss of 5-15% in subfertile women who are overweight increases the chance of spontaneous conception and conception after fertility treatment and can be achieved through a low-calorie diet, increased exercise and behaviour modification.