Nederlands tijdschrift voor geneeskunde
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Postoperative pain management is an essential part of surgical management. In the Netherlands paracetamol, NSAIDs and, if necessary, opioids are the most commonly used drugs for perioperative analgesia. Metamizole is a non-opioid analgesic that is rarely used in the Netherlands, although it is one of the most frequently used analgesics around the world. ⋯ Its mechanism of action is still under discussion, but the main action is likely to be an inhibition of prostaglandin synthesis in both peripheral tissues and the central nervous system. Based on the current literature, metamizole deserves a role in the management of post-operative pain in the Netherlands. It seems to be a safe and effective drug for acute pain management especially when compared with NSAIDs.
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A 2-month-old boy with an congenital herniation of the umbilicus presented with a painful swelling of the umbilicus since 1 day, lower intake of food and vomiting. He had an incarcerated umbilical hernia. Eventually emergency surgery was needed.
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Ned Tijdschr Geneeskd · Jan 2012
Review[Revised practice guideline 'Management of patients with mild traumatic head/brain injury'].
Recently the out-of-date Dutch guideline 'Mild traumatic head/brain injury' dating from 2001 was revised under the supervision of the Dutch Institute for Healthcare Improvement (CBO). The revised guideline gives underpinned decision rules for the referral of patients to hospital, carrying out diagnostic imaging investigations, and formulating indications for admission. Mild head-brain injury is no longer an indication for a conventional skull radiograph. ⋯ The guideline can be used in both primary care and on the Emergency Departments of hospitals and is applicable to both adults and children. The guideline does not address the rehabilitation or long-term care of patients with mild traumatic head/brain injury, but it does give advice on reducing the risk of long-term symptoms. Regional implementation of the guideline in primary and secondary care is recommended.
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Ned Tijdschr Geneeskd · Jan 2012
Multicenter Study[Breast-conserving surgery for breast cancer: still much to be gained].
To conduct qualitative research into breast-conserving surgery for palpable and non-palpable breast tumours and the various methods of excising these, measured by the volume exised and surgical radicality. ⋯ Breast-conserving surgery is associated with an average of a 2 to 4-fold removal of excessive tissue. Nevertheless, 1 out of 5 excisions are not radical. Ultrasound-guided surgery for non-palpable breast cancer is the most effective method for achieving radical excision. A multicentre, prospective, randomised trial has been started to assess whether ultrasound-guided lumpectomy for palpable breast cancer can lead to optimisation of the excision volume and radicality.
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The new global strategy to achieve long-term malaria eradication is based on rapid treatment of individual malaria patients and blocking the spread of Plasmodium parasites in the population. In a number of countries increased funding combined with more effective control measures have resulted in a substantial decline in the incidence of malaria and in the resulting morbidity and mortality. Increasing resistance of Anopheles mosquitoes to insecticides (pyrethroids and DDT), and reduced sensitivity of Plasmodium parasites to various antimalarials increase the need for the development of new vector control strategies and medicines. Vaccine development efforts have been speeding up and a first vaccine is expected within three years.