Nederlands tijdschrift voor geneeskunde
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Memory loss and lack of concentration are symptoms that frequently occur in patients who have undergone a surgical procedure. Although cognitive function can be assessed using neuropsychological tests, diagnosing postoperative cognitive decline (POCD) reliably appears to be difficult. Therefore, the true incidence of POCD is unknown. ⋯ In these cases, POCD probably reflects micro embolic brain injury. Apart from the nature of the surgical procedure, advanced age is the most important risk factor for POCD. The anaesthetic technique used is not a determinant: the risks of POCD occurring appear to be similar following both general and local anaesthesia.
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Ned Tijdschr Geneeskd · May 2007
Comment[Anejaculation caused by haemosiderosis: male infertility in hereditary haemochromatosis].
A couple was investigated for subfertility. Haemochromatosis was suspected when the 36-year-old man had failure of ejaculation, fatigue and limited facial hair growth. Haemochromatosis was confirmed by an iron saturation of 102% (normal range: 20-45), a highly elevated serum ferritin concentration of 5468 mg/1l (normal range: 18-280) and highly elevated liver enzymes. ⋯ The age at diagnosis and the start of venesections is critical for reversal of organ damage. Aggressive venesection can restore hypothalamic-pituitary-gonadal function, preventing further organ damage. But with increasing disease progression venesection will not restore azoospermia or the failure to ejaculate.
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Anaphylaxis due to the ingestion of peanuts is a serious, common condition, known to both the general public and physicians. Recently, an increasing number ofpatients with an anaphylactic reaction after eating small amounts of cashew nuts have been reported. In three children, a boy aged 7 and two girls aged 9 and 10 years, respectively, with heterogeneous case histories involving allergic upper airway and conjunctival symptoms and constitutional eczema, allergy for cashew nuts was diagnosed in the first two and allergy for peanuts in the third. ⋯ If the clinical relevance of a sensitisation to cashew nuts is unknown, a food provocation test may be necessary. The treatment consists of dietary intervention, and an adrenaline auto-injector is prescribed for a serious anaphylactic reaction. So far, three major allergens from the cashew nut (Anacardium occidentale) have been identified and purified.