Nederlands tijdschrift voor geneeskunde
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We report on 3 male patients aged 57, 47, and 53, who each sustained an unstable straddle injury during low-energy pelvic trauma while horseback riding. All 3 patients were haemodynamically stable; radiography revealed diastasis of the pubic symphysis in each case. ⋯ Fractures of the pelvic ring are relatively rare and are typically associated with high-energy trauma. Immediate surgical treatment is necessary for patients with fractures of the pelvic ring for the stabilisation of haemorrhagic shock, identification of soft-tissue injuries and fixation of the pelvis.
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We present a neonate with transient neonatal pustular melanosis, a benign skin rash seen in 0.2-2.2% of white neonates and in 4-5% of black neonates. Vesicopustular lesions are present at birth, the lesions rupture in 24-48 hours leaving hyperpigmented macules. These slowly fade in 3-10 weeks.
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A 47-year-old woman with a history of ulcerative colitis and rheumatoid arthritis presented with a large ulcer with an erythematous halo of the right lower leg. The clinical course and the histopathological results were indicative of pyoderma gangrenosum.
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Ned Tijdschr Geneeskd · Jan 2012
[Dutch national safety programme will not lead to a fifty per cent reduction in avoidable mortality in hospitals].
Progress in improving patient safety in hospitals has been frustratingly slow, for several reasons. There are, for example, few proven effective improvement interventions available. Evaluation of the effectiveness of safety interventions is complicated by the complexity and variability of these interventions due to local differences and preferences of care providers. ⋯ Also, problems experienced by care providers when implementing safety interventions are not being systematically addressed. For these reasons, the aim of the Dutch national safety programme in hospitals - to reduce the incidence of avoidable harm by 50% in 5 years - will not be feasible or measurable. It is necessary to identify effective safety interventions and to exchange experiences in successful implementation of these in order to support care providers in improving patient safety.
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Ned Tijdschr Geneeskd · Jan 2012
Randomized Controlled Trial Multicenter Study[Direct total body CT scan in multi-trauma patients].
Immediate total body computed tomography (CT) scanning has become important in the early diagnostic phase of trauma care because of its high diagnostic accuracy. However, literature provides limited evidence whether immediate total body CT leads to better clinical outcome then conventional radiographic imaging supplemented with selective CT scanning in trauma patients. The aim of the REACT-2 trial is to determine the value of immediate total body CT scanning in trauma patients. ⋯ The REACT-2 trial is the first multicenter randomized clinical trial that will provide evidence on the value of immediate total body CT scanning during the primary survey of severely injured trauma patients.