Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jun 2008
Comment Review[Delayed cord clamping in the interest of the newborn child].
The importance of delayed cord clamping, both for the preterm and for the term newborn, for the prevention ofneonatal anaemia (during the neonatal period and/or at the age of3 months) and furthermore to reduce the need of blood transfusions, has recently been demonstrated in controlled clinical studies and meta-analyses. Physiological and pathophysiological factors also provide a rationale for delayed cord clamping: neonatal blood volume may increase by 32% if cord clamping is delayed until the umbilical cord has completely stopped pulsating. A slow transition, involving closure of the ductus arteriosus and the foramen ovale cordis and gradual filling of the neonatal systemic circulation, contributes to the opening of the alveoli due to perfusion of the alveolar capillaries. ⋯ As a standard procedure, the baby's umbilical cord should not be clamped until at least 3 minutes have passed. One should wait at least 30 seconds during the birth of children for whom a more active approach is necessary. Of all people, these children will benefit from a good Hb level.
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Ned Tijdschr Geneeskd · Jun 2008
[Progressive, ascending neurological impairment: a spinal epidural abscess that presents as Guillain-Barré syndrome].
Over the course of 4 days, a 65-year-old man developed fever and thoracic back pain, followed by weakness and sensory changes in both legs. Physical examination revealed dyspnoea, subfebrile temperature, neck pain withoutnuchal rigidity, sensory impairment, areflexia and weakness in both legs (and arms to a lesser extent). Guillain-Barré syndrome was considered, and treatment with intravenous immunoglobulins was started. ⋯ A spinal epidural abscess can be difficult to recognise and is potentially lethal. The diagnosis should be considered in patients with fever and back pain, especially when these coincide with symptoms of neurological impairment. The efficacy of therapy depends on timely recognition; to this end, neuroimaging with MRI is essential.
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Ned Tijdschr Geneeskd · Jun 2008
[Fewer caesarean sections for breech presentation following external cephalic version according to a protocol in a special office visit].
Identification of determinants affecting the outcome of external cephalic version (ECV) in breech presentation, and investigation of the impact of ECV--performed according to a standardized protocol in an outpatient clinic--on the mode of delivery. ⋯ A regular team consisting of a hospital midwife and a gynaecologist working according to a standardized protocol for ECV in a case of breech presentation proved successful: the number of term breech presentations substantially diminished and therefore the percentage of caesarean sections was lower in the group in which ECV had been successful. This could have considerable impact on health care in the Netherlands in terms of reduced maternal morbidity and cost savings.
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In both 2006 and 2007 a large operating room fire occurred in the Netherlands. One patient died as a result of a sudden intense flash fire caused by a leaking oxygen connection. Smaller operating room fires can cause severe burn injuries and inhalation trauma in patients. ⋯ Inflammable substances and ignition sources, such as a diathermic knife or laser, may be present in the operating theatre and environs. The combination of these 3 components (fuel, oxygen and ignition) increases the risk of operation room fires. Prevention and control of this hazard depends on removal of one or more of the 3 components.