Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Sep 2007
[Co-morbidity in acutely hospitalised older patients as a risk factor for death in hospital or within 3 months after discharge].
To study the presence of co-morbidity and delirium and to determine whether these factors are predictors of hospital and shortterm mortality in elderly patients acutely admitted to a department of internal medicine. ⋯ At discharge from the hospital, the risk of death within 3 months after discharge in acutely hospitalised patients of 65 years and older was determined by a combination of delirium at admission, pre-admission ADL limitations, a malignancy, and co-morbidity. These results can be used to identify elderly patients who might benefit from comprehensive geriatric assessment during hospitalisation and from a well-prepared discharge planning that takes their co-morbidity into consideration.
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Ned Tijdschr Geneeskd · Sep 2007
Case Reports[Acute abdominal pain in the third trimester of pregnancy caused by adnexal torsion based on a small cystic adenoma].
A 25-year-old woman presented in the third trimester of pregnancy with severe abdominal pain in the lower right abdominal quadrant. Differential diagnosis included urolithiasis, adnexal torsion and appendicitis. A definitive diagnosis could not be made based on clinical and laboratory examination. ⋯ Adnexal torsion is rarely caused by cysts smaller than 5 cm, especially in the third trimester. Emergency laparoscopyllaparotomy should be performed if adnexal torsion is suspected to confirm the diagnosis and uncoil the twist to prevent ovarian damage. Adnexal torsion should be considered in the differential diagnosis of acute abdominal pain in the third trimester of pregnancy.
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The step from house-man to residency is a large one. The medical curricula at the universities of Leiden and Utrecht have started a project called the 'schakeljaar' (connecting year). Such a connecting year is intended to make the transition smoother and may have the added advantage that one can start the postgraduate training more quickly. ⋯ Secondly, it is questionable whether one can really start the postgraduate training more quickly. The capacity of the postgraduate training programmes is limited. Thirdly, relatively little time can be saved in the basic medical curriculum.
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Ned Tijdschr Geneeskd · Sep 2007
Comment[Prognosis of total hip replacement: the importance of an implant register].
The survival of total hip arthroplasty is mainly determined by the loosening of implants. Wear particles generated at the articular contact of head and cup are engulfed by macrophages. These activated macrophages induce the production of RANKL, leading to proliferation and activation of osteoclasts resulting in osteolysis around the hip implant. ⋯ Implant fixation with bone cement still is an excellent technique, but uncemented techniques also give good results. Randomised controlled studies are necessary to give the final answer but are expensive. National hip registers are a good alternative and are an essential element for quality control.