Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2015
Review[Bronchoscopic interventions in severe COPD: improvement of pulmonary function, exercise capacity and quality of life].
The current drug treatment of patients with severe and very severe COPD is often insufficient to achieve an acceptable quality of life. Surgical treatment of patients with COPD, by means of lung volume reduction surgery or lung transplantation is invasive and only available to a limited number of patients. ⋯ In selected patients with severe emphysema, bronchoscopic lung volume reduction brings about a clinically relevant improvement in pulmonary function, exercise capacity and quality of life. In view of the innovative and specialist nature of bronchoscopic lung volume reduction, it is prudent to perform this treatment in a centre of expertise for COPD.
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Ned Tijdschr Geneeskd · Jan 2015
Review Case Reports[The elderly patient with multiple rib fractures].
Rib fractures resulting from blunt thoracic trauma occur frequently in the elderly. Even though these are usually due to a low impact trauma mechanism (e.g. a fall from standing height), rib fractures are associated with significant morbidity and mortality in the elderly patient. ⋯ More specifically, age-specific indications and contra-indications for intravenous or epidural analgesia and operative rib fixation are discussed. In addition, we show that a multidisciplinary approach, involving a trauma surgeon, anaesthetist, intensive care physician and physiotherapist, is paramount for the prevention of potentially lethal complications.
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Homeless people have substantial health disadvantages as compared to the general population, and excessive losses in life expectancy. High proportions of psychiatric disorders, substance abuse and intellectual disability have been reported. This makes palliative care for this population extremely complex. ⋯ Involvement of a palliative care consultation team and transfer to a homeless shelter, to which homeless people with life-threatening diseases could be admitted, gave both the patient and his family relief. This case illustrates that palliative care in homeless patients may be extremely complex due to the specific physical and psychosocial features involved. Such care should be offered proactively and on a multidisciplinary basis.
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Ned Tijdschr Geneeskd · Jan 2015
Review Case Reports[Dichotomy of psychiatric and somatic emergency care; fundamental flaw should be addressed].
In the Netherlands, acute psychiatric care is characterised by mind-body dualism. For acute psychiatric patients, the first port of call is the general practitioner (GP); after-hour care is provided by the out-of-hours GP service. ⋯ Integration of the out-of-hours GP service, A&E and acute psychiatric care, therefore, would enable elimination of the current partitioning of somatic and psychiatric medicine in acute emergency care. This solution would not only improve acute emergency care, but would also ensure a targeted and efficient implementation of services and might even lead to a decreased stigmatisation of psychiatric patients in general.
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Ned Tijdschr Geneeskd · Jan 2015
Review[Neurosarcoidosis and paraneurosarcoidosis: new online registration of patients].
The clinical spectrum of neurosarcoidosis is highly diverse; virtually any neurological syndrome can present, depending upon granuloma localization. There are indications that neurosarcoidosis is insufficiently recognized as a separate clinical entity. In the absence of major prospective clinical trials, we launched a large national online registry of neurosarcoidosis patients in the Netherlands in June 2014 at www.neurosarcoidose.nl. ⋯ Neurological symptoms causing disability are an indication for immunosuppressive therapy. There is increasing evidence for the effective treatment of refractory neurosarcoidosis using biologicals. Whether the intravenous administration of immunoglobulins or ARA290, an erythropoietin derivative with TNF-α-antagonistic and tissue-protective characteristics, is effective for small nerve fibre neuropathy in sarcoidosis is subject for study.