Nederlands tijdschrift voor geneeskunde
-
Clozapine is an antipsychotic drug which is used in the treatment of therapy-resistant schizophrenia. The most frequently reported side effects (occurring in more than 10% of patients) are gastro-intestinal complaints, including constipation. Here we describe the case of a 28-year-old man with schizophrenia who developed constipation and abdominal distension for several weeks while taking clozapine. ⋯ Because conservative treatment with enemas, prokinetic drugs and antibiotics did not have sufficient effect, the cholinergic drug neostigmine was added to the treatment regimen. This led to a good clinical response, thereby averting the need for surgery. This case illustrates that decreased intestinal motility can be a severe problem for patients taking clozapine, which may lead to life-threatening complications.
-
Ned Tijdschr Geneeskd · Jan 2009
Case Reports[Patients with a haematological malignancy in intensive care].
In this case report we describe 2 patients with acute leukaemia, a 38-year-old and a 21-year-old woman who were both admitted to the intensive care unit (ICU) twice for different complications of underlying disease and chemotherapy. Although the survival rates for patients with haematological malignancies requiring admission to intensive care have increased in the last two decades, many physicians are still reluctant to admit these patients to intensive care. ⋯ The length of stay in the ICU does not correlate with mortality in the ICU either. Intensive mechanical ventilation and multiple organ failure increase mortality in patients with haematological malignancies undergoing intensive treatment in an ICU.
-
Ned Tijdschr Geneeskd · Jan 2009
Case Reports[Headache following laparotomy; chronic subdural haematoma following epidural anaesthesia].
A 63-year-old man underwent an exploratory laparotomy because of rectal carcinoma. The operation was performed under general anaesthesia in combination with epidural anaesthesia. Since the operation the patient complained of a headache. ⋯ A CT scan showed a subdural haematoma, which was relieved with surgery. We suspected that accidental puncture of the dura caused the haematoma. The incidence, causes, symptoms, diagnosis and treatment of this rare complication are discussed.
-
Ned Tijdschr Geneeskd · Jan 2009
Case Reports[Traumatic atlas fracture in a child following fall on head].
An 8-year-old girl presented at the Accident & Emergency Department with torticollis and neck pain after falling on her head from a climbing frame. A computed tomography scan revealed a Gehweiler type 1 avulsion fracture combined with widening of an anatomically variant single anterior synchondrosis. ⋯ Differential diagnosis between pain-reactive muscular torticollis and atlantoaxial rotatory subluxation is essential. Children presenting with posttraumatic torticollis require a conventional or dynamic computed tomography scan.
-
The first exemption to the comprehensive ban on smoking in public places in the Netherlands was made on 14 May 2009. The exemption was based on a technicality in the wording of the law, and could potentially lead to further exemptions to the smoking ban being made. The authors argue that focusing solely on the wording is a sidetrack in the main discussion. ⋯ That is exactly what smoking in public places does. They also argue that other legislative measures comparable to the smoking ban are already in effect. In conclusion, the ban on smoking in public places does not remove the right to smoke, but serves to create a healthier social environment for everyone.