Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2010
Review[Exclusion of deep-vein thrombosis and pulmonary embolism using clinical decision rules and D-dimer tests].
Clinical diagnosis of a venous thromboembolism (VTE) is often difficult because the symptoms of this disorder are diverse and unspecified. The combination of a low probability clinical decision rule and an unremarkable D-dimer test is a safe way to exclude the presence of a VTE. ⋯ During pregnancy and puerperium using a clinical decision rule and a D-dimer test is inadequate: additional radiologic investigation is always indicated in this situation. The diagnostic value of the D-dimer test during suspected recurrence of a VTE is yet to be determined.
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A 39-year-old man was admitted to the ICU after having taken 96 tablets of 500 mg acetylsalicylic acid. Although a high plasma concentration (1040 mg/l) was found, underestimation and misinterpretation of clinical signs and symptoms with decreasing salicylate plasma concentrations led to haemodialysis being postponed. One day after admission the patient suddenly died of cardiovascular collapse due to severe salicylate toxicity. ⋯ The hyperlactaemia was artificial and caused by an interaction between glycolic acid and lactate on a point-of-care analyser. Doctors should consider artificial hyperlactaemia in patients with ethylene glycol intoxication. The patient recovered.
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A 60-year-old man presented with chest pain and weight loss, starting after a period of vomiting. Contrast radiography of the esophagus revealed an esophageal-pleural fistula. The patient was successfully treated by stent placement.
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Ned Tijdschr Geneeskd · Jan 2010
[Crisis in human resources for health: millennium development goals for maternal and child health threatened].
International migration of health care workers from low-income countries to the West has increased considerably in recent years, thereby jeopardizing the achievements of The Millennium Development Goals, especially number 4 (reduction of child mortality) and 5 (improvement of maternal health). This migration, as well as the HIV/AIDS epidemic, lack of training of health care personnel and poverty, are mainly responsible for this health care personnel deficit. It is essential that awareness be raised amongst donors and local governments so that staffing increases, and that infection prevention measures be in place for their health care personnel. Western countries should conduct a more ethical recruitment of health care workers, otherwise a new millennium development goal will have to be created: to reduce the human resources for health crisis.
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A 34 year old male was admitted to our hospital with a severe pancreatitis. On a CT scan we diagnosed a developing emphysematous pancreatitis. This is a rare form of pancreatitis usually caused by an infection with an Escherichia coli.