Nederlands tijdschrift voor geneeskunde
-
Ned Tijdschr Geneeskd · Jul 2008
Case Reports[Percutaneous vertebroplasty for vertebral fractures caused by multiple myeloma, an aggressive vertebral haemangioma and in a traumatic burst fracture].
Percutaneous vertebroplasty (PVP) using polymethylmethacrylate bone cement is frequently used in the treatment of painful osteoporotic vertebral compression fractures in the Netherlands. In three patients there was another indication. A 44-year-old woman suffering from vertebral pain due to an osteolytic lesion caused by multiple myeloma was treated with vertebroplasty of 4 vertebral levels. ⋯ Vertebroplasty is a minimal invasive procedure resulting in most patients in rapid diminishment of the pain caused by pathological vertebral fractures, which may be present for a longer period and may have different causes. The indication triad for vertebroplasty consists of localised back pain, pain when pressure is applied to the processus spinosus of the fractured level and MRI bone oedema, findings suggestive of microfractures in a pathologically changed vertebral body. The procedure is also suitable in patients with extensive comorbidity or a short life expectancy.
-
Ned Tijdschr Geneeskd · Jul 2008
Case Reports[Diagnostic image (382). A man with a painful knee and black cartilage].
A 56-year-old man presented with a painful knee with black pigmentation of synovium and cartilage due to ochronosis caused by alkaptonuria.
-
Ned Tijdschr Geneeskd · Jul 2008
Case Reports[Diagnostic image (380). A woman with papules on the heel].
A 54-year-old woman had piezogenic pedal papules. They became apparent when she was standing, and disappeared when the weight was taken off the foot.
-
Ned Tijdschr Geneeskd · Jul 2008
Case Reports[Dissection of the carotid artery following blunt trauma: still a pitfall].
Two young patients, an 18-year-old woman and a 25-year-old man, were admitted to hospital after accidents with a car. They developed very severe complications as a consequence of blunt carotid artery dissection. ⋯ Early diagnosis by means of Doppler ultrasonography and CT-angiography is important in adequate management of this injury and may reduce morbidity and mortality. The treatment of carotid dissection consists of antithrombotic, endovascular or surgical therapy and needs to be individualized.
-
Nearly 60% of the Dutch population undergoing surgery is over the age of 65. The elderly are at higher risk of developing perioperative complications (e.g. myocardial infarction, pneumonia or delirium), that lead to a prolonged hospital stay or death. ⋯ The type of anaesthesia, fluid management and pain management strongly influences the outcome of surgery and the way this is experienced by the patient. Recent developments focus on multimodal perioperative care of the older patient to shorten hospital stay, using minimal invasive surgery, postoperative anaesthesiology rounds and early geriatric consultation.