Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2011
Review[Transfusion policy in trauma involving massive blood loss].
Severe haemorrhage is a significant cause of death in trauma patients. In the case of massive blood loss a combination of coagulation defects, acidosis and hypothermia arise, which are accompanied by high morbidity and mortality rates unless properly corrected. ⋯ Unnecessary FFP transfusions in trauma patients without imminent severe haemorrhage increase the risk of complications such as multi-organ failure and acute respiratory distress syndrome. Additional research is required into the accuracy of diagnosis of acute coagulation disorders.
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Examination of the active and passive range of motion of the shoulder joint is of major importance when diagnosing shoulder disorders. Abduction and external exorotation movements of the shoulder joint can be judged reliably. ⋯ Palpation of the shoulder serves no useful purpose if inspection of the joint and examination of the active range of motion reveal no abnormal signs. The value of physical examination tests that identify impingement or stability of the shoulder joint has not been reliably demonstrated.
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Hidradenitis suppurativa is a chronic skin disease, characterized by painful, deep-seated inflamed lesions, mainly in areas bearing apocrine sweat glands, most commonly the axillary and inguinal regions. Pain leads to mechanical problems, and bacterial growth in the lesions produces a foul-smelling discharge, which reduces the quality of life. In this type of hidradenitis the infection occurs around hair follicles and sebaceous glands, in contrast to what the name would suggest (hidradenitis = sweat-gland inflammation); hidradenitis suppurativa can, therefore be regarded more as a form of acne. ⋯ Tumour necrosis factor-alpha inhibitors are now employed in the treatment of severe and treatment-resistant forms of hidradenitis suppurativa; under certain conditions this treatment will be reimbursed by the health insurance company. This development means that there are more treatment possibilities in hidradenitis than there were 5 years ago. The best results are achieved with a combination of antibiotic, anti-inflammatory and surgical treatment, tailored to the patient's individual situation.
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A 62-year-old man fell from a ladder, after which he could not lower his right arm. X-ray and CT-scan showed inferior luxation of his shoulder (luxatio erecta). A reduction procedure was performed.
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Ned Tijdschr Geneeskd · Jan 2011
Case Reports[Obesity hypoventilation syndrome--serious but reversible providing weight is lost].
Obesity hypoventilation syndrome (OHS) is a condition in which obesity and chronic hypoventilation during waking hours are combined. Patients with OHS are more likely to be hospitalized and to require intensive-care monitoring compared with patients with similar degrees of obesity without hypoventilation. ⋯ In the second case, a 31-year-old man, we show that if a patient with OHS and chronic NPPV looses a significant amount of weight NPPV can be discontinued. Patients with OHS should be treated in a multidisciplinary team in order to achieve significant weight loss, so NPPV could be a temporary treatment or even be avoided.