Nederlands tijdschrift voor geneeskunde
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Hip resurfacing arthroplasty was introduced as an alternative to the conventional total hip arthroplasty which had shown suboptimal results in younger patients. Application of the resurfacing technique in younger patients has increased over the last few years. To date, no randomized controlled trials with a minimum follow-up span of 10 years comparing hip resurfacing to conventional hip replacement have been conducted in patients under 55 years of age. ⋯ In addition to these disappointing revision rates, the complication of aseptic lymphocytic vasculitis caused by metal particles evoking a local tissue reaction has been increasingly reported. The resurfacing procedure recently received some negative media attention in the Netherlands, leading to confusion among patients. In order to ease patient doubts, it is important to correctly inform them as to the type of implant used, for example, by means of the website or an information card.
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Ned Tijdschr Geneeskd · Jan 2011
Review[Uterus preserving surgery versus vaginal hysterectomy in treatment of uterine descent: a systematic review].
To compare the outcomes of uterus preserving procedures and vaginal hysterectomy in treatment of uterine prolapse. ⋯ Although some uterus preserving procedures are associated with shorter operation time, shorter duration of hospital stay and less blood loss than vaginal hysterectomy, based on the current literature there is no clear preference for either uterus preserving surgery or hysterectomy in surgical treatment of uterine descent, since randomised trials of sufficient quality are lacking. Prospective clinical randomised trials with long term follow-up are needed to investigate the value of uterine preserving procedures.
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3-5% of patients with traumatic or iatrogenic peripheral nerve injury develop a painful neuroma, especially following trauma of small cutaneous sensory nerve branches. Neuroma pain is difficult to treat and often leads to loss of function and reduction of quality of life. Patients with a painful neuroma present with spontaneous electric, shooting or burning pain, allodynia, hyperalgesia and cold intolerance. ⋯ Lasting pain relief is possible by means of surgical neuroma treatment performed by a plastic surgeon. Surgical treatment consists of repair or denervation of the nerve with relocation of the nerve stump in bone or muscle tissue or a vein. Referral of neuroma patients without delay to a plastic surgeon or multidisciplinary consultation is important, because the symptoms become increasingly difficult to treat over time.
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Alopecia is a very common side effect of cytostatic therapy and is considered one of the most emotionally distressing effects. To prevent alopecia scalp cooling is currently used in some indications in medical oncology in 59 hospitals in the Netherlands. The success of scalp cooling depends on various factors such as type of chemotherapy, dose, infusion time, number of treatment cycles and combinations of drugs. ⋯ The reported side-effects are headache, coldness, dizziness and sometimes claustrophobia. An increase in the risk of scalp metastases has not been demonstrated. Proceeding from the South Netherlands Comprehensive Cancer Centre a national working group is put together in order to draw up a national guideline for chemotherapy-induced alopecia.
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In recent years tomographic hybrid scanners have been quickly introduced in nuclear medicine: single-photon emission computed tomography (SPECT)-CT and positron emission tomography (PET)-CT.- Both SPECT-CT and PET-CT techniques provide a higher diagnostic accuracy than conventional (non-tomographic, non-hybrid) bone scintigraphy (bone scan).- Differences between 99mTc hydroxymethylene diphosphonate (HDP) SPECT-CT or 99mTc methylene diphosphonate (MDP) SPECT-CT and 18F-fluoride PET-CT bone scanning relate to image quality, technique, availability, quantification possibilities, radiation dosimetry and financial cost.- Indications for these techniques will especially lie in the field of more accurate detection of skeletal metastases than with bone scans, patients with unexplained musculoskeletal pain, the diagnostic stage after conventional X-ray and/or MRI, and quantification of bone metabolism.