Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Feb 2006
Comment[Mechanical circulatory support after paediatric cardiac surgery].
When circulatory failure occurs after paediatric cardiac surgery despite conventional therapy (inotropic medication, optimising pre- and afterload) mechanical assist devices can be used. Assist devices can be categorised in different ways: according to the type of pump used (centrifugal, axial flow, or pneumatic), according to univentricular or biventricular support and in relation to the presence of an oxygenator. Paediatric devices are non-implantable. ⋯ The main disadvantage of ECMO is that it can be used for a maximum of several weeks while modern pneumatic assist devices (MEDOS, Berlin Heart) can be used for several months. Thromboembolic events, bleeding and sepsis are the main complications of all assist devices. The use of circulatory assist devices can increase the chances of survival when severe cardio(pulmonary) failure occurs following surgical correction of congenital heart defects.
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Ned Tijdschr Geneeskd · Feb 2006
Historical Article[From the poliomyelitis epidemic to the founding of artificial respiration centres, intensive care units and centres for home mechanical ventilation].
In 1952, Copenhagen was confronted with a poliomyelitis epidemic that involved the respiratory musculature in large numbers of patients. The anaesthetist B. Ibsen, who established carbon dioxide intoxication due to severe hypoventilation as the cause of death, proposed that the patients be treated by tracheostomy and positive pressure respiration in order to achieve better ventilation than with an iron lung. ⋯ The mechanical ventilation centres developed into the intensive care units as we know them today. Most of the forms of treatment now in use are based on the techniques thought up and elaborated by the pioneers working in the mechanical ventilation centres. The latest development in this series is the development of centres for home mechanical ventilation.
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Ned Tijdschr Geneeskd · Feb 2006
[Questionable efficacy and safety of activated drotrecogin alpha (activated protein C) in the treatment of severe sepsis].
Activated protein C (APC) has both anticoagulant and anti-inflammatory properties. In a clinical trial, recombinant APC reduced the mortality rate in patients with severe sepsis by 6.1%. However, the results were felt to be questionable. ⋯ This trial was terminated prematurely because no benefit from APC could be observed. In a post-hoc analysis, increased mortality was found in patients who had undergone recent surgery. Additional information is required to establish definitively the efficacy and safety of recombinant APC in patients with severe sepsis and a high risk of death.
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Ned Tijdschr Geneeskd · Feb 2006
Case Reports[Recurrent abdominal pain caused by left mesocolic hernia].
A 37-year-old man presented with symptoms of intestinal obstruction. Laparotomy revealed a congenital left mesocolic hernia. ⋯ Congenital mesocolic hernias are an infrequent cause of intestinal obstruction. In order to conduct the operation properly, surgeons must have a good understanding of the origin of the hernia and its anatomic relationships.