Nederlands tijdschrift voor geneeskunde
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To gain insight into the outcomes of postoperative pain treatment using patient-controlled intravenous analgesia (PCIA) with morphine and oral analgesics after total hip or knee arthroplasty (THA or TKA). ⋯ In view of the somewhat disappointing effectiveness and the side effects of a PCIA pump with morphine and oral analgesics, adjustments in the treatment of pain following THA and TKA are required. The greatest improvement can be realised on the day of surgery and the first postoperative day.
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Ned Tijdschr Geneeskd · Jan 2009
Case Reports[Unexplained iron-deficiency due to Helicobacter pylori].
Iron-deficiency is one of the most prevalent worldwide deficiencies. In the western world, chronic, mostly occult, blood loss is a frequent cause. However, in up to 30% of patients an underlying cause is never found during routine investigations. ⋯ In these patients, infection with H. pylori was regarded as the major cause of iron deficiency, and there was lasting normalization of iron status and haemoglobin after successful eradication therapy. Although the underlying mechanism still remains to be established, we recommend investigation for H. pylori infection and appropriate treatment in case of unexplained iron-deficiency. In a number of patients, eradication results in a clinically significant improvement of both iron-balance and status.
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A 67-year-old male and a 43-year-old female were referred to hospital with headaches after intracranial pressure increasing activities, such as coughing. Both patients were diagnosed with primary cough headache. In the case of the first patient, this diagnosis was considered shortly after presentation. ⋯ Primary cough headache should be differentiated from secondary cough headache, in which the symptoms are caused by structural abnormalities of the brain. Additional investigation is required to differentiate between the two. The diagnosis of primary cough headache is supported by a positive reaction to trial treatment with indomethacin.
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Three patients presented with an intoxication caused by Aconitum napellus, commonly known as Aconite, Monkshood or Wolfsbane. The first patient, a woman aged 24, was resuscitated after accidental ingestion of plant material 'from nature'. She experienced severe ventricular tachyarrhythmias. ⋯ She had no symptoms during observation in the hospital. Aconite alkaloids are known to cause ventricular arrhythmia by a prolonged activation of sodium channels. Because there is no antidote, treatment is largely supportive but serious arrhythmias and respiratory arrest need to be anticipated.
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Ned Tijdschr Geneeskd · Jan 2009
Biography Historical Article[The cause of death of Theo van Gogh (1857-1891)].
In 1992 Theo van Gogh's medical files from the Willem Arntsz Huis, a psychiatric centre in Utrecht, the Netherlands, were made available. A study based on two copies of these files was published in this journal earlier. While reviewing the archives, the author noticed a third copy which included an extra (last) page that was missing in the other two copies. ⋯ M. Other symptoms mentioned were vomiting, fever and early signs of decubitus. The family did not give permission for a post-mortem.