Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Apr 2007
[Retrospective application of the performance indicator 'hip fracture: operate within 24 hours' in 217 patients treated at the University Medical Centre Utrecht in 2000-2003: reduction in postoperative pneumonia but not mortality].
To evaluate whether patients with hip fracture who undergo surgery within 24 hours--which has been propagated as an indicator of quality care--is associated with a reduced risk of mortality and complications, compared with later surgery. ⋯ Postoperative pneumonia occurred less frequently in patients with hip fracture who underwent surgery within 24 hours. Postoperative mortality was related to poor patient condition but not the timing of surgery. Early surgery should be avoided in patients with severe comorbidity who are not optimally prepared for surgery.
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Ned Tijdschr Geneeskd · Apr 2007
Case Reports[Risk of acute hepatic insufficiency in children due to chronic accidental overdose of paracetamol (acetaminophen)].
Two girls aged 4 and 3 years, respectively, experienced acute liver failure due to accidental ingestion of supratherapeutic doses of paracetamol (90 mg/kg/day or more). Recognition of chronic paracetamol intoxication as a cause of acute hepatic failure is often delayed. It is important to consider the possibility of paracetamol-induced hepatotoxicity because many patients will recover if treated with N-acetylcysteine, as did both of these children. Patients with acute liver failure due to chronic paracetamol intoxication present with very high transaminase levels (> 4000 U/l), disproportionately low total bilirubin levels (< 200 micromol/l) and often hypoglycaemia.
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Ned Tijdschr Geneeskd · Apr 2007
Case Reports[Diagnostic image (320). A new mother with opisthotonus and extensor spasms].
A 21-year-old woman was admitted to a rural hospital in Tanzania after a home delivery one week before. She had signs of general body rigidity due to maternal tetanus.
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Ned Tijdschr Geneeskd · Apr 2007
Case Reports[Three patients with a paraneoplastic neurological syndrome: the significance of paraneoplastic antibodies].
Establishing the presence of paraneoplastic antibodies is important in identifying an often severe neurological syndrome as paraneoplastic and hence directing the search for an underlying neoplasm. A paraneoplastic neurological syndrome was diagnosed in 3 patients. The first was a 64-year-old woman in whom paraneoplastic encephalomyelitis was diagnosed. ⋯ Biopsy from a paraaortic mass was positive for undifferentiated carcinoma. The patient had a high titre ofanti-Ma2 antibodies and was subsequently tested positive for serum alpha-foetoprotein (AFP) and beta-human-chorionic gonadotrophin (bta-HCG). During chemotherapy for a non seminoma testicular cancer, the limbic encephalitis improved both clinically and radiologically, but the patient died as a result of the toxicity of the treatment.
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Ned Tijdschr Geneeskd · Apr 2007
Case Reports[Abdominal gunshot wounds: possibilities for selective conservative management].
Two men aged 45 and 26 years, respectively, presented with abdominal gunshot wounds and were treated successfully using a nonsurgical approach. Normally, abdominal gunshot wounds are treated surgically in the Netherlands. This policy produces negative laparotomy findings in 22-41% of procedures. ⋯ Physical examination, adequate CT investigation and possibly additional radiological evaluation play a pivotal role in this approach. Therefore, assessment by a multidisciplinary trauma team is crucial at the time of presentation and during further treatment for abdominal gunshot wounds. Ned Tijdschr Geneeskd.