Nederlands tijdschrift voor geneeskunde
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A 10-year-old boy consulted a dermatologist with a painful, subungual tumour on one of his toes. X-ray showed an outgrowth of the distal phalanx and histopathological investigation showed osteochondromatous proliferation. ⋯ Subungual exostoses are benign osteocartilaginous tumours that occur beneath the nail bed. Excision was performed, the patient recovered well.
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Aspiration of gastric contents during or after induction of anaesthesia can be prevented by adhering to preoperative fasting guidelines of 6 hours for solid foods and 2 hours for clear liquids. There are frequent cases in which the patient cannot be regarded as having fasted; this applies in particular to non-planned acute or semi-acute patients. Instead of postponing surgery to later the same day or even the next day, there are alternatives, such as bedside ultrasound assessment of the stomach volume or accelerating gastric emptying by administering a low dose of erytromycin. These options can contribute to a more efficient planning of surgery and a higher level of comfort for the patient.
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Ned Tijdschr Geneeskd · Jan 2014
Comment[A limited role for telemedicine on the Dutch intensive care].
The use of telecommunication and information technology has evolved rapidly in many areas. However, it has not kept pace for the organisation of medicine. It can be expected that e-Health will revolutionise the landscape of medicine in the coming years. ⋯ This cannot be compared with the Dutch situation where there are short distances between hospitals, ubiquitous, excellent infrastructure for patient transport and a sufficient number of intensivists. Furthermore, an ICU is not only characterised by its own means in terms of human resources and equipment, but also by the 24/7 availability of other (critical) medical specialities in the hospital. The contribution of tele-ICU is therefore limited in the Netherlands but might play a role for second opinions and consultation for highly specialized expertise.
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Propofol is a widely used and safe hypnotic agent. Complications include pain on injection, dose-dependent hypotension, allergic reactions and hypertriglyceridemia; after long-term administration, propofol infusion syndrome can occur. A less common but serious complication is acute pancreatitis. ⋯ Pancreatitis after propofol administration is a rare complication. This rare complication, however, is likely to become more frequent with increasing demand for propofol use and its administration by different care professionals. In patients who experience abdominal symptoms after propofol administration, pancreatitis should be considered as a possible cause and appropriate diagnostic testing performed.
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Antimicrobial resistance is an increasing health care problem, both abroad and in the Netherlands, and its main driving force is antibiotic use. In patients with pneumonia or sepsis, appropriate antibiotic use has been associated with improved clinical outcome, shorter length of hospital stay, decreased bacterial resistance and reduced costs. ⋯ A social and behavioural scientific approach with different intervention strategies - restrictive and persuasive - is required if antibiotic prescription in hospitals is to be improved. As a part of this antimicrobial stewardship programme, antibiotic teams (A-teams) must be introduced in all hospitals in 2014.