Nederlands tijdschrift voor geneeskunde
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Catatonia is a neuropsychiatric syndrome characterized by dysregulation of the motor system. It is associated with affective disorders, psychosis, and a number of somatic conditions. The condition tends to be undertreated due to under-recognition. ⋯ We recommend being alert for catatonia in patients with or without a psychiatric disorder. Early recognition and treatment is vital for the quality of life of these patients, and may in some cases be life-saving. In addition, we recommend a thorough analysis of possible underlying somatic disorders.
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Appendicitis was first recognised by the American surgeon Fitts in 1886. Three years later, the New York surgeon Charles McBurney (1845-1913) described the location of greatest pain in this condition: '... between an inch and a half and two inches from the anterior spinous process of the ilium on a straight line drawn from that process to the umbilicus'. He also advocated early surgical treatment and described a variety of surgical techniques.
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Ned Tijdschr Geneeskd · Jan 2010
[Guideline on responsible teamwork: don't let it become a manacle].
The recently published guideline entitled 'Division of responsibility in teamwork within the care sector' was developed on the request of the Dutch Health Care Inspectorate. Its aim is to ensure that in a teamwork situation in the care sector proper agreements are made concerning the responsibilities of the care providers who work together. ⋯ The document does not reflect everyday practice, but an abstracted theoretical situation, in which the patient, nurse and doctor are indicated using terms such as 'subject expert', 'client', 'care professional' and 'contact'. The document emphasizes responsibilities strongly, but the quality of health care could perhaps be better served by the motivation of caregivers to provide the best possible care.
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A 20-year-old woman with borderline personality disorder was referred to the emergency department by a psychiatric clinic. After taking 10 g of nutmeg she complained of stomach ache and dizziness. A physical examination showed mild hypothermia and sinus tachycardia. ⋯ Symptoms disappear without sequelae after 24-48 h. Treatment consists of supportive measures. In the event of haemodynamic instability, cardiovascular monitoring is indicated.
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Ned Tijdschr Geneeskd · Jan 2010
Case Reports[Unexplained fever after exposure to rats: rat bite fever or Haverhill fever].
A 24-year old man presented himself to the emergency ward with complaints of fever, nausea, headache, muscle ache and chest pain. Two weeks before presentation he had been bitten by a pet rat. We determined that he had bacteraemia caused by a Streptobacillus moniliformis infection, which led to the development of an illness called rat bite fever. ⋯ It is the cause of two similar illnesses: rat bite fever and Haverhill fever. Clinicians should consider these infections in the work-up of unexplained fever or sepsis, certainly in the presence of known exposure to rats. Treatment consists of antibiotics.