Nederlands tijdschrift voor geneeskunde
-
Ned Tijdschr Geneeskd · Jan 2010
[Variations in patient data coding affect hospital standardized mortality ratio (HSMR)].
To investigate the impact of coding variations on 'hospital standardized mortality ratio' (HSMR) and to define variation reduction measures. ⋯ Coding of main diagnoses, urgency of admission and comorbidities showed strong inter-hospital variation with a potentially large impact on the HSMR outcomes of the hospitals. Coding variations originated from differences in interpretation of coding rules, differences in coding capacity, quality of patient records and discharge documentation and timely delivery of these.
-
A 30 year old man with a history of migraine presented at the neurology outpatient clinic with hypesthesia of the left side of his body during a migraine attack, which was unusual for him. His family history was positive for Rendu-Osler-Weber syndrome. MRI and magnetic resonance angiography (MRA) of the brain showed multiple small infarcts, without vascular malformations. ⋯ Neurological complications include cerebral infarction and brain abscess. Also, there is a higher prevalence of migraine in patients with HHT, although the role that HHT plays in the pathogenesis of migraine is unclear. The treatment of choice of pulmonary AVM is endovascular treatment, with a success rate of 75% in the long term.
-
Ned Tijdschr Geneeskd · Jan 2010
[Endoscopic vein-graft harvesting for coronary bypass grafting: good results in patients at risk for surgical site infection].
To determine the clinical impact of endoscopic vein-graft harvesting in patients undergoing coronary artery bypass grafting (CABG) who are at risk for surgical site infection. ⋯ Endoscopic vein-graft harvesting resulted in a - statistically non-significant - lower incidence of surgical site infection than open harvesting, although the patients had a higher risk for infections. Infections in the endoscopic harvesting group were less severe. The hospital stay was shorter and the patient satisfaction was higher than in the open harvesting group.
-
Ned Tijdschr Geneeskd · Jan 2010
Case Reports[Juxta facet cyst of the lumbar spine: an uncommon cause of lumbar radiculopathy].
Lumbar juxta facet cysts (JFC) are an uncommon cause of radiculopathy. Spontaneous regression of symptomatic JFC has not often been reported. We describe 2 patients, a 59-year-old man and a 55-year-old man, with radiculopathy of the 5th lumbar nerve root due to a JFC at L4-5. ⋯ In the literature it is suggested that surgical removal of the JFC should be the treatment of choice. However, of the 5 patients who were diagnosed with a JFC in our department, 3 recovered spontaneously and 2 after surgery. In our opinion further studies on the course and management of symptomatic lumbar JFC are warranted.
-
A 24-year-old female developed DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) as a result of sulfasalazine use. The DRESS syndrome is a severe and acute hypersensitivity reaction that can be caused by a variety of drugs. The clinical presentation is diverse; the most common symptoms are fever, exanthema and lymphadenopathy. ⋯ In most cases the DRESS syndrome needs no further treatment after discontinuation of the associated drug. However, 20% of patients are severely affected and the DRESS syndrome is potentially life-threatening. The patient was successfully treated with a glucocorticoid and an antihistamine.