Nederlands tijdschrift voor geneeskunde
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Traditionally, midshaft clavicular fractures have been treated conservatively. However a review of the literature reveals that certain fractures can benefit from operative repair. Conservative treatment, preferably in the form of a sling, of an undisplaced midshaft clavicular fracture leads to excellent results. ⋯ Intramedullary fixation can give good results in simple dislocated fractures, but does not provide optimal preservation of length and rotation in comminuted fractures. Plate osteosynthesis can be used for all clavicular fractures and causes a reduction of the relative risk of non-union of 86%. Due to the increased risk of non-union or malunion and of a worse functional result, osteosynthesis should be considered for patients with dislocated or comminuted midshaft clavicular fractures, with due consideration for the patient's expectations and lifestyle.
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Ned Tijdschr Geneeskd · Jan 2010
Review[Primary management and treatment of paediatric septic shock].
Paediatric shock is common. Hypovolaemic and septic shock are the main forms. Early and rapid results-oriented therapy of paediatric septic shock has a favourable effect on survival. ⋯ In a child in shock, the clinical picture should be recognized within 15 minutes and an attempt should be made to reverse the situation by rapid fluid infusion. If the shock persists after 15 minutes, vasoactive medication should be given and the child should be transferred to a local paediatric intensive care unit. Intubation and mechanical ventilation are then also required.
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Sarcoidosis is a granulomatous disease of unknown etiology. Standard treatment with immune suppressants such as glucocorticoids is started when vital organ function is threatened. ⋯ In patients with sarcoidosis, only the use of monoclonal antibodies that block tumour necrosis factor (TNF) has been studied scientifically, other biologicals hardly at all. TNF-blockers are used at present in patients with therapy refractory sarcoidosis.
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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.
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Ned Tijdschr Geneeskd · Jan 2010
Review[Progesterone for prevention of preterm delivery: only in trial setting].
Since the discovery of progesterone researchers have studied whether administration of exogenous progesterone can prevent preterm birth. Two trials were published in 2003 that showed a positive effect of progesterone with regard to the prevention of recurrent preterm birth. ⋯ In multiple pregnancies the use of progesterone does not seem to reduce the number of preterm births. The results in pregnant women with asymptomatic shortening of the cervix are promising, although more research is needed in this group.