Nederlands tijdschrift voor geneeskunde
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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
Comment[Insight into end-of-life decisions in newborns in Flanders, Belgium].
In the Netherlands, as in many other European countries, the majority of deaths in newborns are preceded by end-of-life decisions. In most cases, these decisions concern the withholding or withdrawing of treatment. Drugs with a potential life-shortening effect are often prescribed in the terminal phase of treatment of newborns to alleviate their suffering. ⋯ The Dutch government has recently announced the instalment of a multidisciplinary committee of experts to whom all cases must be reported. The advice of the committee to the prosecuting authorities will be crucial. It is expected that this change will increase the willingness to report cases.
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Ned Tijdschr Geneeskd · Feb 2006
[The practice guideline 'Headache' from the Dutch College of General Practitioners; a response from the perspective of neurology].
In comparison with the previous version, the Dutch College of General Practitioners' practice guideline 'Headache' has been improved in several respects. The addition of information on cluster headache, tension headache and substance-induced headache may benefit the daily practice of the general practitioner. ⋯ There is a need for studies into the non-medicinal treatment of tension headache. In these practice guidelines, the medicinal treatment of migraine is largely consistent with the guidelines of The Netherlands Society of Neurology.
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Ned Tijdschr Geneeskd · Feb 2006
[Granted, undecided, withdrawn and refused requests for euthanasia and physician-assisted suicide in the Netherlands; 2000-2002].
To determine the characteristics of patients who request euthanasia or physician-assisted suicide and whether these characteristics differ among those whose request is granted, those who die before the procedure, those who die before completion of the approval process, those who withdraw their request, and lastly, those whose request is refused by the physician. ⋯ The complexity of euthanasia or physician-assisted suicide decision-making is reflected in the fact that, besides granting and refusing a request, 3 other situations could be distinguished. The decisions physicians made, the reasons for their decisions and the way they arrived at their decisions appeared to be based on patient evaluations and on the official requirements for accepted practice.
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Ned Tijdschr Geneeskd · Feb 2006
Case Reports[Re-expansion pulmonary oedema in a patient after treatment of pneumothorax].
In a 32-year-old man with left-sided pneumothorax, dyspnoea and tachypnoea with a drop in blood pressure and severe hypoxaemia recurred during drainage. The chest X-ray revealed an alveolar infiltrate in the middle and lower segments of the left lung that was interpreted as re-expansion pulmonary oedema. The patient was respirated and given extra fluids. ⋯ The pathophysiology of re-expansion pulmonary oedema is not completely understood and is probably multifactorial. The treatment is merely supportive: oxygen, intravenous fluid substitution and if necessary artificial ventilation. The use of diuretics should be avoided in patients with hypotension.