Nederlands tijdschrift voor geneeskunde
-
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.
-
Constipation is a common problem with a considerable negative impact on quality of life in patients who receive palliative care. Over 35% of patients with heart failure, chronic obstructive pulmonary disease or cancer have constipation. In the palliative phase constipation often has multiple causes. ⋯ Prophylactic use of laxatives is indicated to prevent constipation when initiating constipation inducing medication such as opioids. In treatment-resistant constipation prucalopride, colchicine or misoprostol may be effective. Opioid-antagonists such as naloxone and methylnaltrexone are effective in patients with persistent opioid-induced constipation despite the use of laxatives.
-
AN EXAMPLE FOR THE PRESENT DAY: The current requirement for explicit quality standards and examination of surgeons is an opportunity to contemplate surgical training from a historical perspective by looking at the regulations of the Amsterdam Surgeons' Guild (1461-1736). At that time Amsterdam surgeons usually trained for five years in a master-apprentice relationship under the guidance of a master surgeon in a surgeon's shop. ⋯ However, over the course of time the final master's exam as the ultimate test of capability at the end of surgical training has disappeared. From the perspective of renewed interest in explicit quality standards and examination of surgeons, the reintroduction of a modern master's exam should perhaps be considered.
-
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.
-
Ned Tijdschr Geneeskd · Jan 2010
Comparative Study[Cold ischaemia time and outcome of renal transplantation].
To determine the effect of cold ischaemia time (CIT) on the outcome of cadaveric renal transplantation in the Netherlands. ⋯ Prolonged cold ischaemia times are related to a more frequent occurrence of DGF, PNF and decreased graft survival after kidney transplantation. These results underline the need to reduce cold ischaemia times in the Netherlands.