Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2015
Historical Article[The first Dutch debate on anaesthesia in obstetrics].
After the publication of the Dutch medical guideline on pharmacological analgesia during childbirth in 2008, the question of whether pharmacological pain relief should be permissible during labour was hotly debated. This discussion has been going on since the second half of the 19th century when the introduction of ether and chloroform was extensively studied and described in Great Britain. ⋯ Study of historical journals and textbooks, originating in the Netherlands and elsewhere, and of historical medical literature on anaesthesia and obstetrics shows that the Dutch protagonists adopted more nuanced ideas on this issue than many of their foreign colleagues. This description of the first Dutch debate on anaesthesia in obstetrics shows that in fact the issues and arguments are timeless.
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Ned Tijdschr Geneeskd · Jan 2015
Review Case Reports[Dichotomy of psychiatric and somatic emergency care; fundamental flaw should be addressed].
In the Netherlands, acute psychiatric care is characterised by mind-body dualism. For acute psychiatric patients, the first port of call is the general practitioner (GP); after-hour care is provided by the out-of-hours GP service. ⋯ Integration of the out-of-hours GP service, A&E and acute psychiatric care, therefore, would enable elimination of the current partitioning of somatic and psychiatric medicine in acute emergency care. This solution would not only improve acute emergency care, but would also ensure a targeted and efficient implementation of services and might even lead to a decreased stigmatisation of psychiatric patients in general.
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Invasive pulmonary aspergillosis (IPA) is a life-threatening infection that occurs predominantly in severely immunocompromised patients. Recently, IPA is also increasingly seen in less severely immunocompromised patients, such as patients with COPD receiving glucocorticoids and patients on ventilation in an IC unit. ⋯ Since the 2009 influenza pandemic, IPA has been increasingly reported as a superinfection in patients with a severe influenza virus infection. This combined Aspergillus and influenza infection often has a fatal outcome. An Aspergillus sputum culture should be taken seriously in patients with severe influenza pneumonia, and treatment should be considered early in the disease course.
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Ned Tijdschr Geneeskd · Jan 2015
[Strict treatment of hypertension during pregnancy: safe but not obviously better].
The CHIPS (Control of Hypertension In Pregnancy Study) trial showed that tight blood pressure control in women with hypertension during pregnancy was safe with respect to neonatal outcome. However it was not linked to improvement of the predefined maternal composite outcome. The CHIPS trial is without doubt a landmark study in this field; however some questions are still unresolved. ⋯ Moreover the primary neonatal endpoint is defined too broadly because of the inclusion of the rather vague component "higher than usual neonatal care". An endpoint combining major neonatal and maternal comorbidities would have been more clinically relevant. It is unlikely that the results of this trial will influence the Dutch guidelines.
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Chikungunya is a rapidly spreading infectious disease throughout the Caribbean, reaching epidemic proportions in Suriname, with more than 1200 registered cases in 2014. Similar to dengue, classic symptoms are high fever, rash and arthralgia. However, the presentation differs in adults and children. ⋯ A 2.5-month-old baby with fever, vomiting, diarrhoea and a rash was brought to the ER. She was agitated and had signs of meningism. The symptoms resolved quickly in all patients after rehydration and pain medication.