Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2009
Case Reports[Placement of one-way endobronchial valves to treat severe pulmonary emphysema in an 84-year-old].
An 84-year-old man with end-stage emphysema was hospitalised on two occasions because of an episode of severe COPD exacerbation, each time successfully treated in a classical pharmacological manner. Further analysis of a high-resolution CT chest scan revealed very pronounced destruction of the lung parenchyma in the left lower lobe. ⋯ This intervention had a very satisfactory outcome with positive changes in the lung function parameters, imaging studies and quality of life. The inevitable placement in a nursing home could consequently be postponed and, at follow-up one year later, no exacerbation or pneumonia had developed since the intervention.
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Three patients, men aged 30, 33 and 32 years respectively, died in police custody in Amsterdam, the Netherlands. According to autopsy reports, all patients died from excited delirium syndrome induced by cocaine use. Excited delirium is a state of mental and physiological hyperarousal commonly associated with the use of cocaine. ⋯ Medical and police staff should aim to reduce confrontation. When patients are too agitated to cooperate, benzodiazepines should be used for sedation of the patient. Beta blockers and antipsychotic medication should not be administered, as these medications can exacerbate the fatal cardiac effects seen in excited delirium.
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Ned Tijdschr Geneeskd · Jan 2009
Case Reports[Takotsubo cardiomyopathy; reversible cardiomyopathy induced by stress].
Takotsubo cardiomyopathy was diagnosed in a 79-year-old woman. She visited her husband who had been admitted for primary percutaneous coronary intervention, and during her visit she developed acute chest pain. Further investigation revealed transient left ventricular apical ballooning, diagnosed as takotsubo cardiomyopathy. ⋯ Especially in elderly women presenting with the clinical features of an ST-elevation myocardial infarction, takotsubo cardiomyopathy should be considered as an alternative diagnosis. Regarding the exact aetiology and pathophysiology many questions remain unanswered. With supportive treatment the prognosis is favourable.
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Ned Tijdschr Geneeskd · Jan 2009
Case Reports[Recognition of a tarsal coalition; clinical and radiological pointers].
A 34-year-old female had been suffering from pain in her left ankle for more than 6 years. Physical examination revealed no abnormalities other than a rigid subtalar joint. ⋯ However, it is easily missed by treating physicians. In this article the clinical and radiological pointers for establishing the diagnosis are described, and information about the treatment of tarsal coalitions is provided.
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Ned Tijdschr Geneeskd · Jan 2009
Case Reports['Acute respiratory distress syndrome' (ARDS) as a serious complication of influenza].
'Acute respiratory distress syndrome' (ARDS) developed as a serious complication of an infection with the influenza virus A (H1N1) ('swine flu') in 3 children: a 15-year-old girl, a 6-year-old boy and a 14-year-old girl. The latter two patients also suffered from septic shock. ⋯ The first two patients eventually recovered following treatment with extracorporeal membrane oxygenation (ECMO), but the third patient's condition was too unstable for transfer to an ECMO centre. This patient died.