Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2015
Comment[New potassium binders effective: treatment of hyperkalaemia secondary to RAAS inhibitors].
This commentary discusses two recent publications by Weir et al. and Packham et al. in The New England Journal of Medicine on the efficacy of two novel potassium binders, sodium zirconium cyclosilicate and patiromer. In a similar manner to existing potassium binders, these drugs exchange dietary potassium for either sodium or calcium in the gut, thereby preventing absorption of potassium. Both drugs were tested against placebo in patients with chronic kidney disease who developed hyperkalaemia because they were also using renin-angiotensin-aldosterone system (RAAS) inhibitors. ⋯ A strong point in the trials is that the new potassium binders allow patients to continue using RAAS inhibitors. By doing so, these patients with high cardiovascular risk may continue to benefit from the protective effects of RAAS inhibitors. Limitations include the relatively short treatment period, the lack of a control group using existing potassium binders, and the exclusion of patients with severe or symptomatic hyperkalaemia.
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Ned Tijdschr Geneeskd · Jan 2015
[The automated external defibrillator in the resuscitation chain. The importance of the AED examined].
The survival rate for those suffering an out-of-hospital cardiac arrest (OHCA) is improving slowly, with > 90% of the survivors being discharged from hospital with cognitive function intact. A recent analysis of the ARREST (AmsteRdam Resuscitation Study) group documented an increase in survival rates with favourable neurological outcome from 16.2% in 2006 to 19.7% in 2012. ⋯ A recent analysis of the ARREST database points to the increasing use of AEDs (by laypersons, but particularly by police officers and fire-fighters with a training in basic life support) as one of the main drivers of this improved prognosis. An AED is now used in 59% of OHCA in the greater Amsterdam area, and has become an essential link in the resuscitation chain.
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In recent decades, enormous progress has been made in the development of intraocular lenses (IOLs) and cataract surgery. Before the development of the IOL, a cataract would cause impairment or loss of vision. ⋯ The current cataract procedure is associated with a very low incidence of intra- and postoperative complications and satisfactory postoperative visual outcomes. Due to the increasing number of cataract surgeries performed annually, and an ageing population, development of IOLs and surgical techniques continues apace.
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Ned Tijdschr Geneeskd · Jan 2015
Review Case Reports[Acute kidney injury caused by hantavirus in the Netherlands].
Although unusual in the Netherlands, acute kidney injury is sometimes caused by infection with Hantavirus, a zoonosis transmitted by rodents. Hantavirus infections can cause a syndrome known as 'haemorrhagic fever with renal syndrome', characterized by fever, acute kidney injury and thrombocytopenia. Recovery is spontaneous and treatment is mostly supportive. ⋯ Dialysis could be avoided, with spontaneous recovery of renal function in both cases. Serological testing revealed acute Hantavirus infection. Acute kidney injury caused by Hantavirus infections is rare in the Netherlands, but should be suspected in any patient presenting with renal failure and a history of viral infection.
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Ned Tijdschr Geneeskd · Jan 2015
Review Case Reports[The elderly patient with multiple rib fractures].
Rib fractures resulting from blunt thoracic trauma occur frequently in the elderly. Even though these are usually due to a low impact trauma mechanism (e.g. a fall from standing height), rib fractures are associated with significant morbidity and mortality in the elderly patient. ⋯ More specifically, age-specific indications and contra-indications for intravenous or epidural analgesia and operative rib fixation are discussed. In addition, we show that a multidisciplinary approach, involving a trauma surgeon, anaesthetist, intensive care physician and physiotherapist, is paramount for the prevention of potentially lethal complications.