Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · May 2008
[Splenectomy in a large general hospital: often caused by iatrogenic injury, often causing multiple complications; poor adherence to post-operative guidelines for vaccination and prophylaxis].
To assess the indications, complications and mortality associated with splenectomy in a large general hospital, and to evaluate adherence to guidelines for postoperative vaccination and prophylactic antibiotics. ⋯ In this large general hospital, splenectomy was often performed due to iatrogenic injury and was associated with a relatively high complication rate. Adherence to guidelines on vaccination and prophylactic antibiotics could be improved.
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Ned Tijdschr Geneeskd · May 2008
[Helicopter-Mobile Medical Teams in The Netherlands: significant differences in deployment frequencies between different emergency room regions].
To investigate whether Helicopter-Mobile Medical Teams (H-MMTs or HEMS) are optimally deployed in all emergency dispatch centres. ⋯ By relating the deployment of H-MMTs with the number of inhabitants per region, a comparison can be made of the deployment frequencies in different emergency dispatch regions. The deployment of H-MMTs proved to differ significantly between emergency dispatch centres.
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--Cholangiocarcinoma is a rare malignancy originating from the biliary epithelium. The disease can arise anywhere in the biliary tract: intrahepatic, perihilar or distal. The overall prognosis for cholangiocarcinoma is poor. --The treatment necessitates a multidisciplinary approach. --Radical resection of the extrahepatic bile ducts, usually in combination with concomitant partial liver resection, remains the only curative treatment. --Liver transplantation in combination with neoadjuvant chemoradiation therapy seems to be promising in a highly selected group of patients. --Palliative treatment should be targeted at adequate biliary drainage, preferably by stenting. --Radiotherapy and systemic chemotherapy are not standard treatment and should be applied in an experimental setting only. --New options such as photodynamic therapy and tyrosine kinase inhibitors are promising, but still experimental treatments.
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Ned Tijdschr Geneeskd · Apr 2008
Case Reports[The placing of an unborn child under formal supervision where there is doubt about the safety of the home situation].
Requests to place an unborn child under formal supervision was made in the course of two pregnancies. The first woman was 27 years old, she had a history of schizophrenia, forensic psychiatric care, and a personality disorder with impulsive aggressive behaviour. The second patient was 36 years old. ⋯ In the Netherlands it is possible to place a foetus under formal supervision after 24 weeks gestation. This may prevent hospitalization of a healthy newborn in an unhealthy environment which is poor in stimuli. It also prevents the stressful situation that may arise when parents threaten to take their newborn child from the hospital, pending the inquiry into the domestic situation.