Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Sep 2007
Comment[Prognosis of total hip replacement: the importance of an implant register].
The survival of total hip arthroplasty is mainly determined by the loosening of implants. Wear particles generated at the articular contact of head and cup are engulfed by macrophages. These activated macrophages induce the production of RANKL, leading to proliferation and activation of osteoclasts resulting in osteolysis around the hip implant. ⋯ Implant fixation with bone cement still is an excellent technique, but uncemented techniques also give good results. Randomised controlled studies are necessary to give the final answer but are expensive. National hip registers are a good alternative and are an essential element for quality control.
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A 40-year-old man was referred to the cardiology outpatient clinic with dizziness, palpitations and shortness of breath. He remembered being bitten by a tick two to three years previously, but had not noticed a characteristic skin rash. The ECG showed a prominent first degree atrioventricular (AV) block and ambulatory electrocardiographic monitoring showed an intermittent complete AV block. ⋯ The patient was treated with ceftriaxone. In the weeks and months following implantation, the AV block disappeared completely. The reversibility of the AV block secured the diagnosis 'Lyme carditis with secondary AV block', and the pacemaker was explanted.
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Ned Tijdschr Geneeskd · Aug 2007
Case Reports[Respiratory insufficiency in patients with progressive neuromuscular disease can sometimes be treated effectively with ventilatory support].
Three patients with myotonic dystrophy (MD) developed respiratory failure. The first was a 55-year-old man with MD who had been admitted elsewhere with pneumonia and respiratory failure. After discharge he was re-admitted with respiratory failure due to respiratory pump failure. ⋯ All three experienced a remarkable recovery of performance after the institution of mechanical ventilatory support. Respiratory failure that develops over a number of years can be easily missed in aging patients with slowly progressing neuromuscular disease. Timely recognition may lead to improved survival and quality of life by the application of non-invasive ventilatory support.
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Ned Tijdschr Geneeskd · Aug 2007
Review[Again new resuscitation guidelines (2006): justification, costs and potential confusion].
The last revision of the Dutch resuscitation guidelines, a translation of the European Resuscitation Council Guidelines 2005, is based on the recommendations of the International Liaison Committee on Resuscitation (ILCOR). The previous Dutch guidelines were issued in 2002. Most changes are based on laboratory studies and retrospective analyses. ⋯ It would be good to prospectively evaluate the effectiveness and costs of this revision. In the future, these data might help to decide when altered international recommendations should be translated into new Dutch resuscitation guidelines. Alternative strategies should be considered, for example only changing the guidelines for advanced life support.
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Ned Tijdschr Geneeskd · Aug 2007
Comment[Arguments in support of the implementation of the new guidelines for cardio-pulmonary resuscitation in the Netherlands].
The implementation of the new guidelines for cardiopulmonary resuscitation in the Netherlands has been questioned with reference to the expected low cost-effectiveness. The implementation is based on the best available evidence, derived from studies that addressed the specific activities of lay rescuers as well as professionals, but not on studies that integrate all changes in the process, from initial actions of lay rescuers to the last elements of in-hospital management. Therefore, the efficacy of new guidelines cannot be evaluated prior to wide-scale implementation. ⋯ Cost-effectiveness is not a relevant issue, as the cost of implementation of guideline changes to lay rescuers has no impact on the budget for healthcare. In addition, the revision concerns items such as the recognition of circulatory arrest, the balance of thoracic compression versus ventilation and the use of the automatic external defibrillator, which are expected to be very effective. Hence, the implementation of the new guidelines for cardio-pulmonary resuscitation in the Netherlands is justified.