Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2013
Review[Secondary prevention with clopidogrel after TIA or stroke].
In patients with TIA or stroke of arterial origin various antiplatelet agents, or combinations of these, have been found to be effective to reduce the risk of new vascular complications. International guidelines currently recommend three treatment strategies with antiplatelet agents after TIA or stroke: acetylsalicylic acid in combination with dipyridamole, clopidogrel monotherapy, or alternatively acetylsalicylic acid monotherapy. In the Netherlands, current standard antiplatelet therapy after a TIA or stroke is a combination of acetylsalicylic acid and dipyridamole. ⋯ Clopidogrel monotherapy is easier to use, has fewer side effects and has recently become cheaper than the combination of acetylsalicylic acid and dipyridamole. For secondary prevention in the Netherlands we advise following the international guidelines on thromboprophylaxis after TIA or stroke. Clopidogrel could be considered as an alternative treatment to the combination of acetylsalicylic acid and dipyridamole.
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Ned Tijdschr Geneeskd · Jan 2013
Review Case Reports[Organ donation after active euthanasia in a patient with a neurodegenerative disease].
In countries where active euthanasia by a physician is allowed under law - Belgium and the Netherlands - physicians are sometimes confronted with patients who want to donate organs after active euthanasia has been performed. This combination of procedures has been reported in Belgium, and this article is the first description of such a case in the Netherlands. ⋯ The combination of two complex and controversial procedures - active euthanasia and organ donation - raises important ethical, legal and practical issues. It is suggested that with a thorough preparation and a strict separation of both procedures, organ donation after active euthanasia can strengthen patient autonomy and increase the number of donated organs.
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A substantial number of patients suffering from aortic dissection will show neurological signs. These can dominate the clinical picture and hinder an accurate diagnosis of this life-threatening disease. We present a case of lower extremity pain and a case of transient global amnesia caused by aortic dissection. ⋯ High-risk clinical features are predisposing factors in medical history, typical acute onset back or chest pain, and pulse deficit, blood pressure asymmetry or a new cardiac murmur on physical examination. These features should be explicitly evaluated in patients with an acute neurological deficit. If neurological symptoms and a high-risk clinical feature are present, immediate aortic imaging should be considered since early detection can be life saving.
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Ned Tijdschr Geneeskd · Jan 2013
Review Case Reports[Hypothenar hammer syndrome; rare arterial disorder of the hand due to blunt trauma].
The hypothenar hammer syndrome is a condition characterised by ischaemia of a finger secondary to thrombosis or an aneurysm or pseudoaneurysm of the ulnar artery in the hand. It typically occurs in the dominant hand of middle-aged men whose occupational or recreational activities require the use of the hand as a hammer. ⋯ Severe symptomatic cases are treated by surgical resection and revascularisation. The pathophysiology of this syndrome, its diagnosis and its management are discussed in this article by means of two representative cases, each having a different clinical presentation, diagnostic method and treatment.
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Despite well-known differences in drug response between children and adults, dosing guidelines for children are usually developed by extrapolating the results from studies in adults. Instead of body weight, insight into the pharmacokinetics and pharmacodynamics of drugs should serve as the basis for dosing in children. ⋯ With a population approach, the covariates that affect the pharmacokinetics and pharmacodynamics of drugs can be identified in a covariate analysis; examples of covariates include body weight, age, degree of illness and genetic factors. Drugs that serve as a model for a specific elimination route provide the basis for individualized dosing guidelines for children.