Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2012
[Endoscopic versus surgical treatment of infected necrotising pancreatitis: the TENSION study].
In patients with infected necrotising pancreatitis there is a significant risk (40%) of complications and mortality with the surgical step-up approach. This approach consists of percutaneous retroperitoneal drainage, if necessary followed by video-assisted retroperitoneal débridement. ⋯ The Dutch Pancreatitis Study Group has recently started the nationwide randomized TENSION-trial, in which in 98 patients the endoscopic step-up approach is compared with the surgical method. The primary endpoint is a composite of mortality and major morbidity (new onset organ failure, bleeding, perforation of a hollow organ or incisional hernia for which intervention is needed).
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Ned Tijdschr Geneeskd · Jan 2012
[High mortality in patients with idiopathic pulmonary fibrosis on Dutch lung transplant waiting list].
To describe patients diagnosed with idiopathic pulmonary fibrosis (IPF) registered for lung transplantation and to evaluate the current referral guidelines for lung transplantation in the Netherlands. ⋯ One-third of the IPF patients on the waiting list died before donor lungs became available. The mean diffusing capacity of 27% of predicted at the time of screening was considerably lower than advised in the international guidelines for placement on the waiting list. This study, therefore, shows that the timing of screening IPF patients for lung transplantation can be improved in the Netherlands.
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Blunt scrotal trauma, mostly induced by sports injuries, can cause a testis rupture. Patient exhibit extreme pain and swollen tender testicle. ⋯ A rupture or a suspicion thereof requires a surgical exploration. Delay of diagnosis can cause irreversible damage to the testicle.
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Ned Tijdschr Geneeskd · Jan 2012
Case Reports[A man with impaired consciousness after femur fractures].
A 23-year-old man presented with femur fractures after a car accident. He underwent intramedullary nail surgery. Afterwards consciousness deteriorated with concurrent respiratory distress followed by seizures. MRI-scan of the brain displayed multiple punctate lesions of restricted diffusion, a so-called starfield pattern, which confirmed the diagnosis of cerebral fat embolism syndrome.
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Post-traumatic lung herniation due to a pathological defect in the chest wall is rare. ⋯ There is still no consensus on surgical treatment of lung herniation. It may be performed immediately (primary) or after a delay (secondary) and depends on the clinical condition of the patient.