Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Mar 2003
Comment Case Reports[Missing spleen: indication for pneumococcal vaccination].
Two female patients, aged 39 and 52 years, developed severe pneumococcal meningitis. Both patients had undergone splenectomy in the past (one after trauma and one for idiopathic thrombocytopenic purpura) and pneumococcal vaccination was only given immediately after the splenectomy. ⋯ Vaccination after splenectomy in order to prevent a severe sepsis syndrome is very important. Indications for the 7 valent pneumococcal conjugate vaccine and the 23 valent polysaccharide vaccine are given.
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Ned Tijdschr Geneeskd · Mar 2003
[The troponin assay in a cardiac emergency unit: especially to exclude severe cardiac risk].
To determine the value in daily practice of a troponin assay for triage of patients with chest pain. ⋯ A troponin assay, performed six hours or more after the onset of cardiac symptoms, appears to be a safe method to exclude patients with severe coronary artery disease resulting in myocardial necrosis and an elevated risk of death. An elevated troponin level was always associated with myocardial damage, but not always with coronary artery disease. Therefore, there must be a clear indication for requesting a troponin assay, and one should always keep in mind that a normal troponin level does not exclude coronary artery disease.
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Ned Tijdschr Geneeskd · Feb 2003
Review[Mechanical ventilation in acute respiratory distress syndrome (ARDS): lung protecting strategies for improved alveolar recruitment].
For patients with acute respiratory distress syndrome (ARDS) the most important objective of mechanical ventilation is opening and keeping open the alveoli to achieve adequate oxygenation, without further damaging the lungs or negatively affecting the circulation. Alveolar recruitment is achieved by making use of positive end-expiratory pressure (PEEP). The best PEEP level is that with which the largest improvement in oxygen transport and lung compliance is achieved, without a decrease in the stroke volume of the left ventricle. ⋯ Ventilation in a prone position increases the end-expiratory lung volume and reduces the intrapulmonary shunt and the regional differences in the degree of ventilation. These factors possibly contribute to preventing ventilation-induced lung damage. Administration of natural surfactant during the ventilation of patients with ARDS seems to be a highly promising strategy; the clinical effectiveness still needs to be demonstrated.
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Ned Tijdschr Geneeskd · Feb 2003
Case Reports[Diagnostic image (127). A man with respiratory insufficiency. Pneumothorax with giant bullae].
A 38-year-old man presented with respiratory insufficiency due to a pneumothorax on the left side and giant bullae on the right side.