Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jun 2005
Case Reports[Drug rash with eosinophilia and systemic symptoms (DRESS) attributed to the oral skin-care supplement Imedeen].
In a 56-year-old woman, 'drug rash with eosinophilia and systemic symptoms' (DRESS) was diagnosed. She had been admitted to hospital twice in two months because of fever and skin rash. Further studies revealed that in addition to the skin rash, the woman also suffered from eosinophilia, lymphadenopathy and a temporary liver-function disorder. ⋯ The DRESS syndrome is characterised by skin rash, fever, lymphadenopathy and haematological abnormalities, especially eosinophilia and/or atypical lymphocytosis. Single or multiple organ involvement, especially of the liver, kidney, lungs and/or heart, is also common. The syndrome is associated with a number of different drugs.
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Ned Tijdschr Geneeskd · Jun 2005
Comment[Indicators as the basis for quality-control in the midwifery practice].
A study on the quality of primary obstetric care in uncomplicated pregnancies carried out by means of a checklist revealed substandard factors in perinatal care in 71 out of 72 pregnancies. However there are many objections to the quality-control procedure. ⋯ In other items definitions and circumstances had not been properly considered and in some cases the patient's own wishes were responsible for a change in policy. The quality of the care delivered cannot be judged only by counting items on a checklist, but requires careful consideration of the situation and of the circumstances that led to the choices in perinatal care.
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Investigating the frequency and nature of sub-standard care factors in non-complicated pregnancies in primary obstetric care. ⋯ Sub-standard care factors were demonstrated in many of the pregnancies investigated. A limited number of these factors gave reason to question whether guidelines for good quality perinatal care are being properly applied.
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Ned Tijdschr Geneeskd · Jun 2005
Case Reports[Pulmonary arterial hypertension due to the use of amphetamines as drugs or doping].
Pulmonary arterial hypertension (PAH) was diagnosed in three patients. All three had a history ofamphetamine consumption. The patients were a 48-year-old male drug addictwho had used intravenous amphetamine for more than 20 years, a 43-year-old man who had been administered intravenous amphetamines during a period of intensive cycling and a 34-year-old woman who regularly consumed amphetamine at dance festivals. ⋯ Amphetamines may lead to PAH due to the release of serotonin, which causes pulmonary vasoconstriction and the proliferation of smooth muscle cells. Due to the pathophysiology of amphetamine-induced PAH, other amphetamine derivatives such as methylenedioxymethamphetamine (ecstasy) and methylphenidate can be risk factors for PAH. These three cases show that PAH should be considered in patients who present with dyspnoea and a reduced exertion tolerance, and who are known to have a history of amphetamine use.