Nederlands tijdschrift voor geneeskunde
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Mallet finger is a very common injury, but there is still much discussion about the best treatment. Mallet finger should be operated on if a fracture is larger than 1/3 of the articular surface or in volar subluxation, because otherwise the fracture may remain unstable or there may be loss of function. ⋯ Although there is no significant difference in complications between splinting and surgery, the complications of an operation may be far more serious. In spite of the current operation indication, we should be more reluctant to operate on mallet finger.
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The prevalence of ticks seems to have increased with time, and the number of patients with Lyme disease in the Netherlands is also increasing. Lyme disease and other tick-transmitted diseases now attract a lot of attention. Several national initiatives at different levels are now in progress, with the aim of suppressing Lyme disease and providing better care for patients with indications of having these diseases. A more uniform approach between different treatment centres, joint research and further expansion of education and continuing education for physicians and the public could lead to further improvement.
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Ned Tijdschr Geneeskd · Jan 2014
[Pain registration: for the benefit of the inspectorate or the patient?].
Increasing attention is currently being directed to the measurement and treatment of pain. A recent study concluded that the implementation of a patient safety programme was successful because 99% of the hospitals indicated that they measure postoperative pain. However, another recent study, evaluating this safety programme, concluded that hospitals could improve the implementation of pain measurements, as only 56% of the postoperative patients were subject to standardized pain measurements during the first 3 days following surgery. ⋯ The attitude towards pain needs to change; too often it is still considered as an uninteresting side effect of treatment. Insight in the internal utility and effects of pain registration might help to further improve the quality of postoperative pain management. Acute Pain Service teams should have a facilitating role.
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Sentinel lymph node biopsy provides melanoma patients with important prognostic information and improves staging and regional tumour control, while the morbidity is limited and the subsequent quality of life is good. The most important result of the only randomised study is the improved ten-year melanoma-specific survival in node-positive patients with an intermediate thickness melanoma. We recommend sentinel lymph node biopsy as a standard diagnostic procedure for these patients. Sentinel lymph node biopsy can be considered in patients with a thinner or thicker melanoma.
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Ned Tijdschr Geneeskd · Jan 2014
Comment[Pill matters: targeted research into side effects necessary].
The paper by Van Hunsel et al. in this issue of the Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine) describes reports of side effects among users of hormonal preparations containing cyproterone acetate (Diane-35 and generics) following reports from France of fatal venous thrombosis and subsequent regulatory action. These preparations are licensed for treatment of acne and hirsutism, but are used as oral contraceptives. ⋯ It is noteworthy that oral contraceptives containing cyproterone acetate have been known to be unsafe since 2001, and still they have been used by more than 100,000 women in the Netherlands. The information from Lareb also shows that a pharmacovigilance system based on voluntary reports by physicians and patients is not sufficient to detect increased frequencies of 'common' side effects.