Nederlands tijdschrift voor geneeskunde
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Two men presented at the Accident & Emergency Department with lower urinary tract symptoms. The first patient was a 76-year-old male with reddish urine and lower abdominal pain. A CT-scan revealed a tumorous mass related to the bladder. ⋯ Voiding problems can arise when the haematoma extends into the prevesical (Retzius) space that is anatomically related to the rectus sheath. A haematoma of the rectus sheath is difficult to diagnose. Current insights show that conservative treatment is generally sufficient.
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Two patients were involved in a high-energy trauma that resulted in an unstable pelvic fracture. The first patient, a 51-year-old woman, was trapped between two boats. At our hospital she received a traumatic pelvic orthotic device (T-POD), followed by angiography with embolisation. ⋯ These cases illustrate the variety of possible treatments for patients with unstable pelvic fractures. Choice of treatment depends on the character of the attending injuries and the haemodynamic situation. Fast consultation should take place with a hospital experienced in the initial care and treatment of unstable pelvic fractures.
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Ned Tijdschr Geneeskd · Jan 2009
[When peripheral drips fail: favourable experience with peripherally-inserted central venous catheters].
Evaluation of the technical success rate, insertion complications and patient survival when peripherally-inserted central venous catheters (PICCs) are used in oncologic patients and patients with severe infections in whom it was not possible to place a peripheral drip. ⋯ PICCs appear to be a good alternative in oncologic patients and patients with infections in whom peripheral drip insertion is not possible. The technical success rate of PICCs was high and was associated with a low periprocedural complication rate. The percentage of prematurely removed catheters seems acceptable, in part because these catheters were removed after a mean period of 2 months.
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Since August 7th, treatment with neuraminidase inhibitors (oseltamivir) in the Netherlands has been limited to those patient groups who are considered at high risk of influenza-related complications. This policy is based on one study which shows only limited evidence of the effectiveness of neuraminidase inhibitors in lowering the number of such complications.
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In the Netherlands approximately 14,000 patients are referred to hospital for diverticular disease each year. Overall controversy persists about four aspects of treatment of the different stages of diverticulitis, i.e. the role of antibiotics in the treatment of mild diverticulitis, the question of whether elective surgical resection is justified in recurrent diverticulitis or in persisting abdominal symptoms after an episode of diverticulitis, the question of whether patients with purulent peritonitis due to perforation may be treated with laparoscopic peritoneal lavage instead of Hartmann's procedure, and finally, whether resection with a primary anastomosis is a feasible and safe alternative to Hartmann's procedure in the surgical treatment of Hinchey III or IV diverticulitis. These questions will be addressed in four upcoming Dutch randomised trials.