Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Apr 2008
Case Reports[Recurrent pleurisy as sole manifestation of familial Mediterranean fever].
Recurrent pleurisy as sole manifestation offamilial Mediterranean fever. An 18-year-old woman of Turkish descent visited our outpatient department with a 12-year history of recurrent self-limiting febrile attacks accompanied by chest pain. At first the symptoms were attributed to recurrent lower airway infections. ⋯ He was also successfully treated with colchicine. The often long interval from disease onset to correct diagnosis reflects the unfamiliarity of physicians with this disease and the frequency with which it is confused with other syndromes. In patients with paroxysmal febrile attacks and chest pain, especially if they originate from the eastern Mediterranean area, FMF should be considered and colchicine be prescribed to relieve symptoms and prevent amyloidosis.
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Ned Tijdschr Geneeskd · Mar 2008
Randomized Controlled Trial[Prevention of nosocomial infections after cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine; a prospective, randomised study].
To determine the efficacy ofperioperative decontamination of the nasopharynx and oropharynx in reducing nosocomial infection after cardiac surgery with the use of 0.12% chlorhexidine. ⋯ Decontamination of the nasopharynx and oropharynx with chlorhexidine appeared to be an effective method to reduce nosocomial infection after cardiac surgery.
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Ned Tijdschr Geneeskd · Mar 2008
Randomized Controlled Trial[Less ventilator-associated pneumonia after oral decontamination with chlorhexidine; a randomised trial].
To determine the effect of oral decontamination with either chlorhexidine (CHX, 2%) or the combination chlorhexidine-colistin (CHX-COL, 2%-2%) on the frequency and the time to onset of ventilator-associated pneumonia in Intensive Care patients. ⋯ Oral decontamination of the oropharyngeal cavity with chlorhexidine or the combination chlorhexidine-colistin reduced the incidence and the time to onset ofventilator-associated pneumonia.
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The application of oropharyngeal chlorhexidine is mainly active on Gram-positive microorganisms with only a minimal impact on colonisation by Gram-negative microorganisms. Seven randomized clinical trials have been published that showed a significant reduction in ventilator associated pneumonia (VAP) incidence, but not on survival. Some questions remain unanswered: it is presently unclear whether patients who benefit can be selected from the population at risk, and optimal formulation and dosage of chlorhexidine has not yet been established. International recommendations for using oro-pharyngeal topical chlorhexidine in ventilated patients have now been roborated by two Dutch studies.
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Ned Tijdschr Geneeskd · Mar 2008
[Perinatal mortality in The Netherlands: an audit is now more necessary than ever].
In 1999, The Netherlands was found to have the highest perinatal mortality rate (11.4 per thousand), according to the WHO definition, in comparison with 14 other European countries. Many explanations were given, amounting essentially to a higher percentage of women with one or more risk factors (higher age at delivery, more non-western immigrants, and more multiple pregnancies). Furthermore, screening for congenital anomalies was not yet an issue at that time in The Netherlands. ⋯ In The Netherlands, a nationwide perinatal audit programme will start this year. The Netherlands, with its specific obstetric care system, has the obligation to look for the causes of perinatal mortality and to introduce improvements based on the results of a perinatal audit. Hasty conclusions are a threat to a careful audit.