Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jul 2008
Case Reports[Diagnostic image (380). A woman with papules on the heel].
A 54-year-old woman had piezogenic pedal papules. They became apparent when she was standing, and disappeared when the weight was taken off the foot.
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Ned Tijdschr Geneeskd · Jul 2008
Case Reports[Dissection of the carotid artery following blunt trauma: still a pitfall].
Two young patients, an 18-year-old woman and a 25-year-old man, were admitted to hospital after accidents with a car. They developed very severe complications as a consequence of blunt carotid artery dissection. ⋯ Early diagnosis by means of Doppler ultrasonography and CT-angiography is important in adequate management of this injury and may reduce morbidity and mortality. The treatment of carotid dissection consists of antithrombotic, endovascular or surgical therapy and needs to be individualized.
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Nearly 60% of the Dutch population undergoing surgery is over the age of 65. The elderly are at higher risk of developing perioperative complications (e.g. myocardial infarction, pneumonia or delirium), that lead to a prolonged hospital stay or death. ⋯ The type of anaesthesia, fluid management and pain management strongly influences the outcome of surgery and the way this is experienced by the patient. Recent developments focus on multimodal perioperative care of the older patient to shorten hospital stay, using minimal invasive surgery, postoperative anaesthesiology rounds and early geriatric consultation.
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Ned Tijdschr Geneeskd · Jun 2008
Comment Review[Delayed cord clamping in the interest of the newborn child].
The importance of delayed cord clamping, both for the preterm and for the term newborn, for the prevention ofneonatal anaemia (during the neonatal period and/or at the age of3 months) and furthermore to reduce the need of blood transfusions, has recently been demonstrated in controlled clinical studies and meta-analyses. Physiological and pathophysiological factors also provide a rationale for delayed cord clamping: neonatal blood volume may increase by 32% if cord clamping is delayed until the umbilical cord has completely stopped pulsating. A slow transition, involving closure of the ductus arteriosus and the foramen ovale cordis and gradual filling of the neonatal systemic circulation, contributes to the opening of the alveoli due to perfusion of the alveolar capillaries. ⋯ As a standard procedure, the baby's umbilical cord should not be clamped until at least 3 minutes have passed. One should wait at least 30 seconds during the birth of children for whom a more active approach is necessary. Of all people, these children will benefit from a good Hb level.
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Ned Tijdschr Geneeskd · Jun 2008
[Progressive, ascending neurological impairment: a spinal epidural abscess that presents as Guillain-Barré syndrome].
Over the course of 4 days, a 65-year-old man developed fever and thoracic back pain, followed by weakness and sensory changes in both legs. Physical examination revealed dyspnoea, subfebrile temperature, neck pain withoutnuchal rigidity, sensory impairment, areflexia and weakness in both legs (and arms to a lesser extent). Guillain-Barré syndrome was considered, and treatment with intravenous immunoglobulins was started. ⋯ A spinal epidural abscess can be difficult to recognise and is potentially lethal. The diagnosis should be considered in patients with fever and back pain, especially when these coincide with symptoms of neurological impairment. The efficacy of therapy depends on timely recognition; to this end, neuroimaging with MRI is essential.