Nederlands tijdschrift voor geneeskunde
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Gait disorders are seen frequently and often have a neurological cause. The clinical management of patients presenting with a gait disorder is often complicated due to the large number of diseases that can cause a gait disorder and to the difficulties in interpreting a specific gait disorder properly. ⋯ Gait disorders can be classified into the following categories: antalgic, paretic-hypotonic, spastic, vestibular, ataxic, hypokinetic-rigid, cautious, or functional. A correct interpretation of the gait disorder is important as this determines the diseases to be considered, the auxilliary investigations that have to be carried out, and the selection of rational therapeutic options.
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Ned Tijdschr Geneeskd · Feb 2007
Review[Angiography and embolisation to control bleeding after blunt injury to the abdomen or pelvis].
Angiography and embolisation are being increasingly used to control bleeding following abdominal and pelvic trauma. CT is a useful tool to select patients for such intervention-radiological angiography. ⋯ Angiography and embolisation are successful in about 90% of the patients; complications occur in < 10% of the patients. An accurate estimate of the patient's physical condition, a correct assessment of the severity of the injury, and a multidisciplinary approach are important factors in the success of embolisation therapy.
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Ned Tijdschr Geneeskd · Feb 2007
[Transcutaneous bilirubinometry useful in the determination of hyperbilirubinaemia in icteric neonates].
To evaluate the usefulness of transcutaneous bilirubinometry in determining the need for phototherapy in neonates with hyperbilirubinaemia and to assess whether this technique may be used as an alternative to blood tests. ⋯ Transcutaneous bilirubin measurement was useful in determining the need for phototherapy in neonates with hyperbilirubinaemia. Use of this non-invasive screening method may help to avoid unnecessary blood sampling in neonates.
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Ned Tijdschr Geneeskd · Feb 2007
Comment[Perioperative use of psychotropic drugs; advice based on casuistic and 'expert-based medicine'].
Little scientific evidence is available on the continuation of psychotropic drugs in the perioperative period. Clinicians often have to rely on case reports and small case series. ⋯ This proposal could be used for the development of an official, evidence-based guideline on the perioperative use of psychotropic drugs. The quality of such a guideline would be improved by prospective cohort studies that compare events in patients who discontinue psychotropic medication with those in patients who continue medication for fear of severe withdrawal symptoms.
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Ned Tijdschr Geneeskd · Jan 2007
Comment[Placement of central venous catheters and patient safety].
Placement of a central venous catheter is one of the most common invasive procedures and is associated with septic and mechanical complications, such as bleeding and pneumothorax. Up to 30% of attempts to cannulate the central vein fail. Correct positioning of the patient can help to maximise the success rate. ⋯ The use of ultrasound has been shown to increase the success rate and avoid mechanical complications when placing a catheter in the internal jugular vein. It may also increase the success rate in subclavian vein catheterisation. To increase patient safety, the use of ultrasound when placing a central venous catheter should be embraced and become the standard of care.