Nederlands tijdschrift voor geneeskunde
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Two male patients, aged 75 and 47 years, suffered from dyspnoea in the terminal phase of their disease, COPD and lung cancer, respectively. Both were given palliative sedation. The palliative consultation team was consulted when problems occurred. ⋯ A symptom is refractory when it causes unbearable suffering and conventional modes of treatment are not effective or timely. Knowledge of this guideline, early anticipation of possible scenarios and communication with the patient and his family contribute to good care. The palliative consultation team can help physicians with these decisions, preferably by starting at an early stage.
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Ketamine is used as an anaesthetic and in third-line pain management. Furthermore, recreational use of the drug is becoming increasingly popular due to its dissociative and hallucinogenic effects. Ketamine can affect the urothelium, possibly with long-term damage to the bladder and kidneys. ⋯ The precise mechanism of ketamine-associated urological symptoms is currently unknown. Treatment, therefore, is symptom-targeted and cessation of ketamine is imperative. We recommend that ketamine use is considered in patients with otherwise unexplained urological symptoms.
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Virginia Apgar (1909-1974), born in New Jersey, managed to continue medical school despite the financial crisis of 1929, continued for a brief time in surgery and subsequently became one of the first specialists in anaesthesiology. In 1949 she was appointed to a professorship, the first woman to reach this rank at Columbia University in New York. ⋯ From 1959 she worked for the National Foundation for Infantile Paralysis (now March of Dimes), to expand its activities from prevention of poliomyelitis to other aspects of preventive child care, such as rubella vaccination and testing for rhesus antagonism. She remained single; in her private life she enjoyed fly fishing, took lessons in aviation and was an accomplished violinist.
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The first case report describes an extremely prolonged activated partial thromboplastin time (APTT) in a patient with no history of increased bleeding tendency. Heparin use was excluded. The APTT mixing study combined with the medical history suggests a deficiency in one of the non-essential coagulation factors. ⋯ Aberrations in the process of haemostasis can be efficiently screened using a platelet count, an APTT, a PT and a thorough physical examination combined with a thorough medical history taking. Common causes of prolonged PT and/or APTT are the use of oral anticoagulants or heparin, vitamin K deficiency and liver disease. Other causes include coagulation factor deficiencies, coagulation factor inhibitors and diffuse intravascular coagulation.
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Ned Tijdschr Geneeskd · Jan 2012
[Mortality following elective surgery for abdominal aorta aneurysm].
Assessment of postoperative mortality in patients undergoing elective surgery for asymptomatic abdominal aorta aneurysm (AAA) in the Academic Medical Center (AMC), Amsterdam, the Netherlands. This is compared with national statistical information and data in the literature. ⋯ The figures presented for elective aneurysm surgery in the AMC are favourable in comparison with the published national mortality statistics of over 10% morality in patients ≥ 75 years of age. Because of the lack of randomized trials for treatment of aneurysms ≥ 5.5 cm there are many uncertainties concerning survival benefit obtained by operation. It is important for each clinic to arrange the care for elective aneurysm surgery in such a way that mortality is minimal. Important factors to achieve this are a well-attuned treatment team and careful patient selection.