Nederlands tijdschrift voor geneeskunde
-
Ned Tijdschr Geneeskd · Jan 2017
[Deciding on surgery for acute subdural haematoma; does a neurosurgeon rather fill nursing homes or cemeteries?]
Acute subdural haematoma is a life-threatening condition that can sometimes be mitigated by decompressive craniotomy. However, it can also increase misery when patients survive but are left with severe disabilities. A recent publication shows that neurosurgeons in Belgium and the Netherlands vary considerably in their opinion regarding if, and when, to perform this surgery. ⋯ This requires a value judgement that has to be informed by the flawed and incomplete medical literature and by the perhaps even more flawed and incomplete (relayed) accounts of the wishes and attitudes of the unconscious patient. However, in the end, the surgeon also evaluates his own convictions in the whole issue and this will inevitably introduce subjectivity and practice variation. A structured moral debate may help to improve the extremely difficult decision-making process around the management of acute subdural haematoma.
-
To determine the degree of agreement between delirium experts on the diagnosis of delirium based on exactly the same information, and to assess the sensitivity of delirium screening methods used by clinical nurses. ⋯ There was considerable disagreement between the classifications of individual delirium experts, based on exactly the same information, indicating the difficulty of the diagnosis. Furthermore, the sensitivity of the delirium screening tools used by the clinical nurses was poor. Further research should focus on the development of objective methods for recognising delirium.
-
Ned Tijdschr Geneeskd · Jan 2017
[E-bikers are more often seriously injured in bicycle accidents: results from the Groningen bicycle accident database].
Analysing injury types, injury severity and mortality in victims of accidents with electric bicycles in comparison with conventional bicycles. ⋯ E-bikers who had a bicycle accident had more severe injuries, more frequently had multiple injuries and had more severe head injuries than conventional cyclists. This resulted in a greater need for care. Preventive measures such as riding lessons and helmet use should be encouraged. Care providers should pay extra attention to the possibility of severe injuries when a patient had a bicycle accident with an e-bike.
-
Carotid sinus massage for diagnosis and termination of supraventricular tachycardia (SVT) is still a widely used vagal manoeuvre in the A&E department. However, itsefficacy is limited (termination of the SVT in approximately 20%) and carotid sinus massage may be complicated by (potentially devastating) neurologic complications in 0.2-1% of the patients. ⋯ Carotid sinus massage remains an important diagnostic method in patients with unexplained syncope in whom, based on the clinical history, carotid sinus hypersensitivity is suspected. It should be avoided in patients with previous TIA or stroke within the past 3 months, or those with carotid bruits, except if carotid Doppler studies have excluded significant stenosis (≥ 70%).
-
Ned Tijdschr Geneeskd · Jan 2017
[The alpha-gal syndrome: an allergic reaction to mammalian meat secondary to a tick bite].
Here we present the case of a 68-year-old patient with alpha-gal syndrome. This is a delayed-onset allergic reaction, characteristically occurring 2-6 hours after ingestion of mammalian meat products. ⋯ The alpha-gal syndrome is usually self-limiting as long as there are no new tick bites. Clinicians should be aware of this syndrome, which is often not recognized as such.