Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Nov 2006
Review Meta Analysis[From the Cochrane Library: wearing compression stockings during long-distance flights reduces the risk of asymptomatic deep-vein thrombosis].
A recent Cochrane systematic review assessed the effects of wearing compression stockings during long-distance flights on the risk of deep-vein thrombosis (DVT). Ten randomised trials were included, 9 of which compared wearing compression stockings on both legs during the whole flight (at least 7 hours) with not wearing compression stockings. ⋯ Wearing stockings had a significant impact in reducing oedema of the lower legs. No significant adverse effects of wearing stockings were reported.
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Ned Tijdschr Geneeskd · Nov 2006
Comment Review[Deep-vein thrombosis and pulmonary embolism due to air travel].
In recent years, the association between air travel and the incidence of deep-vein thrombosis or pulmonary embolism has become clearer. Epidemiologic studies reveal an increased relative risk of thromboembolism after flights of more than 8 hours and especially in subjects at higher risk for this disease, due, for example, to congenital thrombophilia or the use of oral contraceptives. However, the absolute risk of deep-vein thrombosis or pulmonary embolism after prolonged air travel is very small. ⋯ Acetylsalicylic acid is not effective in the prevention of thrombosis during air travel and may be dangerous. Prophylactic subcutaneous low molecular weight heparin may be effective to prevent air travel-associated thrombosis. However, pending more solid evidence, this strategy should only be used cautiously, e.g. only in patients with a high risk of thrombosis who are planning a long flight.
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Ned Tijdschr Geneeskd · Nov 2006
Case Reports[Sore throat and a swollen neck: Lemierre's syndrome until proven otherwise].
Physicians seldom prescribe antibiotics to patients presenting with a combination of sore throat and feelings of malaise. However, this restrictive regimen may have a downside. Two patients, men aged 23 and 19 years, respectively, with pharyngitis developed a life-threatening syndrome following a Fusobacterium throat infection. ⋯ The main pathogen is Fusobacterium necrophorum. Early recognition is essential, since prompt antibiotic treatment is usually effective. This syndrome should be suspected until proven otherwise in any patient with signs of pharyngitis, a painful swollen neck and pulmonary symptoms.
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Ziconotide is a synthetic analogue of a peptide found in the poison of the marine snail Conus magus. Ziconotide blocks N-type calcium channels, which play an important role in the transmission of pain signals in the dorsal ganglia of the spinal cord. The drug is indicated for 'severe chronic pain' and is administered intrathecally.
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Ned Tijdschr Geneeskd · Nov 2006
Review[The practice guideline 'Volume suppletion in critically-ill neonates and children up to the age of 18 years' of the Dutch Paediatric Association].
Hypovolaemia is the most common cause of circulatory failure in children. Treatment consists of volume suppletion with a crystalloid or colloid solution; which agent is the best in children is not clear. This evidence-based practice guideline formulates recommendations as to which fluid should be used for volume suppletion in critically-ill neonates and children up to the age of 18 years with hypovolaemia. ⋯ On the basis of data from the literature and considerations regarding the applicability of evidence in adults to children and neonates, the side effects of resuscitation fluids, pathophysiology and costs, the first-choice fluid for neonates and children with hypovolaemia is isotonic saline. Albumin should not be used for the treatment of hypovolaemia. The volume to be administered and the infusion rate depend on the severity of the hypovolaemia and should be determined on an individual basis.