Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2013
[Does CT scan for blunt abdominal trauma in children amount to a lot of radiation for little yield?].
Blunt abdominal trauma in children occurs fairly frequently. Although computed tomography scanning is considered by many to be the gold standard, in children who are hemodynamically stable, CT images do not usually result in new perspectives that lead to changes in treatment management. ⋯ CT scanning for blunt abdominal trauma should therefore be avoided in children who are hemodynamically stable. Novel algorithms, using parameters from the patient's history, physical examination, and possibly ultrasound and laboratory tests, seem to be sufficient for ruling out intra-abdominal injury in more than 95% of cases.
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Ned Tijdschr Geneeskd · Jan 2013
Case Reports[A man with acute pain of the left side of the chest].
A 42-year-old man came to the emergency department because of acute pain on the left side of the chest. Physical examination, ECG and blood tests revealed no abnormalities. With a CT scan of the thorax we made the diagnosis: 'pericardial fat necrosis'. This is a very rare, self-limiting disease.
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Screening for lung cancer with computed tomography (CT) appears to be highly effective. A large randomized trial in the United States reported a 7% reduction in all-cause mortality in patients screened by CT in comparison with those screened by chest radiography. ⋯ As CT is superior to radiography in lung cancer detection, CT seems the preferred imaging modality for case finding. As more trial results have to be awaited and cost-effectiveness and optimal screening strategy remain uncertain, CT lung cancer screening is not yet ready for implementation.
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A 47-year-old man presented to the emergency department with a rapidly progressive, generalized rash and pustulosis shortly after he had started amoxicillin/clavulanic acid for the treatment of a pulmonary infection. Based on the patient's history and the clinical symptoms, the diagnosis of 'acute generalized exanthematous pustulosis' (AGEP) was suspected. This was confirmed by histopathological examination. The skin abnormalities slowly disappeared after terminating antibiotic medication.
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Ned Tijdschr Geneeskd · Jan 2013
[Concerns about residents' mental fitness: two possible strategies for a solution].
A good level of physical and mental fitness is essential in order to function optimally as a resident. Concerns about residents' mental fitness have recently been raised, based on high percentages of residents suffering from burnout and depression and data on the experience of stress and anxiety. ⋯ Finding solutions for the lack of, or deterioration in, mental fitness is crucial. We discuss two potential strategies: (1) the removal or reduction of obstacles to residents' mental fitness and (2) the provision of resources to improve mental fitness.