Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Sep 2003
Case Reports[Diagnostic image (157). A man with fever and a 'tache noire' after a holiday in South Africa. Rickettsiosis, probably African tick-bite fever].
A 54-year-old man presented with fever and an eschar, probably caused by African tick-bite fever, contracted during a holiday in South Africa. He recovered rapidly after treatment with doxycyclin.
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Ned Tijdschr Geneeskd · Sep 2003
Comment Review[Thrombosis prophylaxis in orthopaedic surgery: considerations and uncertainties].
As it is not always possible to identify patients at extra risk of deep-venous thrombosis after major orthopaedic surgery, it is considered advisable to prescribe prophylactic treatment. Prophylaxis with a low dose of unfractionated heparin is more effective than no prophylaxis at all but less effective than low molecular-weight heparin or cumarine derivatives. Acetylsalicylic acid does not appear to have a place in the prevention of venous thromboemboli in elective total-hip and total-knee surgery. ⋯ Intermittent pneumatic compression appears to be effective after total-knee arthroplasty but in practice is difficult to deliver. Support stockings, a foot pump and rapid mobilization have little effect on the incidence of proximal deep-venous thrombosis. There are insufficient data regarding the use of thrombosis prophylaxis in day surgery.
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Ned Tijdschr Geneeskd · Sep 2003
Review[Monitoring and treatment of patients with shock in the intensive care unit].
The controversy surrounding the use of the pulmonary artery catheter, has stimulated research into alternative methods of haemodynamic monitoring. As yet, however, no new gold standard has emerged. In the future, interest in haemodynamic monitoring is likely to focus more on tissue perfusion and metabolism instead of central circulation. ⋯ Early initiation of aggressive fluid resuscitation, if necessary accompanied by vasoactive and inotropic agents, improves survival. In addition, low dose corticosteroids have a positive impact on mortality. In the treatment of patients with acute heart failure, phosphodiesterase III-inhibitors are becoming part of standard therapy in addition to beta-adrenoceptor agonists, especially in patients who take beta-blockers.
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The Dutch Association for Addiction Medicine and the umbrella organisation GGZ Nederland (sector organisation for mental health and addiction care) have compiled a report entitled 'Strengthening medical care in the addiction care sector'. The report argues why medical care needs to be strengthened and provides guidance as to how the present shortcomings in quality and quantity can be dealt with. Addiction is now considered to be a medical condition with patients instead of clients. ⋯ Furthermore, the training in addiction medicine needs to be given a clearer status in the form of departments, professorships, training institutes and certification. Within the context of this report the responsibility of addiction centres needs to be emphasised. Vacancies in the many forms of social work could be exchanged for well-trained nurses and physicians, without the need for extra financial assistance.
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Ned Tijdschr Geneeskd · Aug 2003
Case Reports[Shoshin beriberi provoked by the inhalation of salbutamol].
A 45-year-old male alcoholic with a deficient diet was given salbutamol for exertion-related dyspnoea. After inhalation, he presented with a severe dyspnoea, acrocyanosis, anuria and low blood pressure as well as a respiratory compensated lactate acidosis. ⋯ Shoshin beriberi is an acute, cardiac form of beriberi, which can rapidly result in death due to cardiogenic shock and lactate acidosis. Adrenergic agents can cause a hyperdynamic circulation and thus aggravate the effects of a thiamine deficiency.