Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jun 2007
Review[Two pneumococcal vaccines: the 7-valent conjugate vaccine (Prevenar) for children up to the age of 5 years and the 23-valent polysaccharide vaccine (Pneumo 23) for the elderly and specific groups at risk].
Despite the availability of antibiotics and the care offered by intensive-care units, invasive pneumococcal disease still causes serious illness with high morbidity and mortality. Currently, two vaccines are available in the Netherlands that offer protection against invasive pneumococcal disease: a 7-valent conjugated vaccine and a 23-valent polysaccharide vaccine. ⋯ The non-conjugated polysaccharide vaccine is intended especially for the elderly and specific groups at risk. Pharmacists should verify that the pneumococcal vaccines they hand out on prescription are recommended for the age-group of the individuals to whom the vaccine will be administered.
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Ned Tijdschr Geneeskd · Jun 2007
Randomized Controlled Trial[Fracture prevention in postmenopausal women with osteoporosis by an annual infusion of zoledronic acid].
A randomised, placebo-controlled study into the effects of the annual intravenous administration of zoledronic acid for the prevention of fractures in postmenopausal women with osteoporosis was recently published. Zoledronic acid, a bisphosphonate, inhibits osteoclasts. The study included 7765 patients with osteoporosis, between the ages of 65 and 89 years, who were given calcium and cholecalciferol daily by mouth in addition to 5 mg zoledronic acid or placebo once a year. ⋯ Fewer fractures were seen in the study group than in the control group: after 3 years, hip fractures were reduced by 41%, non-vertebral fractures by 25% and vertebral fractures by 70%, already within one year (by 6o%). Side effects included acute phase reactions, atrial fibrillation, ocular complaints, renal-function disorders, and hypocalcaemia. Some examples of candidates for treatment with zoledronic acid would be patients with osteoporosis in whom oral treatment meets objections or who are hospitalised due to a fracture.
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Ned Tijdschr Geneeskd · Jun 2007
[Hopeless and unbearable suffering and deliberate ending of life of newborn infants].
Deliberate ending of life of newborns is an extreme measure that is usually based on hopeless and existing unbearable suffering. There are currently developments that may lead to clarification and refinement of the standards and rules surrounding deliberate ending of life of newborns. ⋯ Furthermore, in the case of deliberate ending of life of newborns, consideration must be given not only to current suffering but also the severe suffering that will develop in the near future. The points ofspecial importance that the medical profession had developed in relation to the assessment of future unbearable suffering may provide assistance here and should be implemented.
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Ned Tijdschr Geneeskd · Jun 2007
Comment Letter Case Reports[Ancillary diagnostic imaging is useful if there is atypical evidence of appendicitis].
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Ned Tijdschr Geneeskd · Jun 2007
Case Reports[Successful treatment of splenic haemorrhages with preservation of the spleen by means of selective catheterisation and embolisation of the splenic artery].
Two patients with splenic bleeding were treated with transcatheter embolisation and selective coiling of the splenic artery. These were first of all a 78-year-old woman who was on anticoagulants for atrial fibrillation and suffered a laceration of the spleen with extravasation of contrast medium and a falling haemoglobin level. ⋯ Selective embolisation of the splenic artery is a useful adjunct to the non-operative management of patients with traumatic splenic injury. However, the proper patient selection still needs to be established.