Nederlands tijdschrift voor geneeskunde
-
Ned Tijdschr Geneeskd · Jan 2010
Practice Guideline[Guideline 'Diagnosis and treatment of inflammatory bowel disease in adults'. II. Special situations and organisation of medical care].
The Dutch national practice guideline 'Diagnosis and treatment of inflammatory bowel diseases (IBD) in adults' describes the multidisciplinary approach for adult patients with (suspected) IBD, recommended following analysis of the literature according to the principles of evidence based guideline development. Ulcerative colitis and Crohn's disease are associated with temporary or permanent extra-intestinal disorders: reactive inflammatory conditions, associated conditions, and those arising as a consequence of long standing, inflammatory, intestinal disease. Treatment is aimed first at the IBD disease process and subsequently at the specific extra-intestinal conditions if complaints persist. ⋯ These positive findings have not yet been incorporated into the practice of life insurance providers. The diversity of IBD patient health care and its delivery by many professionals places stringent requirements on the organisation of care by hospitals and those providing treatment. The transfer process from paediatric specialist to gastroenterologist affects both patients and parents deeply.
-
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.
-
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.
-
Ned Tijdschr Geneeskd · Jan 2010
Case Reports[Resuscitation of a pregnant patient--don't hesitate to perform a perimortem caesarean section].
Cardiac arrest is a rare and life-threatening complication during pregnancy. We present the case of a 26-year-old patient in her first pregnancy who during induction of labour at 41 weeks had a cardiac arrest caused by an amniotic fluid embolism. As part of the resuscitation procedure, a perimortem caesarean section was performed in the delivery room within five minutes. ⋯ Pregnancy-induced changes in anatomy and physiology warrant a different approach during resuscitation. All medical personnel involved in the care of pregnant women should be trained to act promptly in acute situations. Training should increase knowledge of the aforementioned changes and stress the importance of performing a perimortem caesarean section, when necessary, on site and without hesitation.
-
Ned Tijdschr Geneeskd · Jan 2010
[Vertebroplasty: a treatment option for osteoporotic compression fractures].
Percutaneous vertebral augmentation, with percutaneous vertebroplasty (PVP) as its most widely used variant, is currently the only intervention for painful osteoporotic compression fractures. This procedure offers immediate and substantial pain relief in over 80% of treated patients with a low reported complication rate (< 1.6%). A large number of studies have shown promising results and the superiority of this treatment over conservative treatment has been established. ⋯ Limitations in the design of both trials prevented widespread implementation of the results. We believe that PVP cannot be regarded as an obsolete treatment as long as patients are carefully selected. Patients with persistent (over 2 months) and painful osteoporotic vertebral fractures have been shown to benefit from vertebroplasty and are therefore suitable candidates for this procedure, which, in these cases, can prevent complications due to long-term disabling pain.