Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2003
Practice Guideline Guideline[Admission and discharge criteria for intensive care departments].
Admission and discharge criteria for intensive care departments have been drawn up in order to optimise the use of scarce and costly intensive care facilities. Every patient who could benefit from admission must be assessed by the intensive care specialist beforehand. ⋯ Frequent assessment (several times per day) of the 'indication to stay' is indicated in the case of many patients in order to maximise the admission capacity. Discharge from the intensive care department is indicated if the vital functions are stable without life support and no longer require monitoring or treatment, if nursing the patient in the ward is possible, if continuation of the medical treatment is no longer worthwhile, if the patient no longer consents to the treatment and if the benefit of a treatment no longer outweights its negative effects.
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Ned Tijdschr Geneeskd · Jan 2003
Case Reports[Dementia with Lewy bodies; 2 patients with exacerbation due to an atypical antipsychotic, but with a favorable response to the cholinesterase inhibitor rivastigmine].
In two patients, men aged 80 and 75 years with cognitive deterioration, hallucinations and parkinsonism, the clinical diagnosis 'dementia with Lewy bodies' was established. Treatment with an atypical antipsychotic, risperidone and olanzapine respectively, resulted in an exacerbation of the parkinsonism. Rivastigmine evidently improved the psychosis, the anxiety and the cognitive, mood and behaviour disorders. ⋯ Levodopa can lead to an increase in visual hallucinations. Antipsychotics often cause serious side effects, such as increasing parkinsonism, sedation and cognitive deterioration. Cholinesterase inhibitors such as rivastigmine could possibly provide an alternative treatment for the neuropsychiatric symptoms.
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Ned Tijdschr Geneeskd · Dec 2002
Case Reports[Three patients with African sleeping sickness following a visit to Tanzania].
Three Dutch tourists, a man aged 57 and two women aged 55 en 52 years, acquired African trypanosomiasis in the national parks of Tanzania. Two, without central nervous system involvement, were cured after treatment in the Netherlands, albeit one after having suffered a relapse. In the third patient, involvement of the central nervous system was diagnosed in Africa and she was treated with melarsoprol. ⋯ She died following repatriation. An epidemic of trypanosomiasis is currently raging through Central Africa. In several western countries, trypanosomiasis has been diagnosed recently in tourists who visited Tanzania.
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Ned Tijdschr Geneeskd · Dec 2002
Case Reports[Parenteral administration of low dose ketamine for the treatment of neuropathic pain in cancer patients].
In three patients, a 52-year-old woman with skeletal metastases from bladder carcinoma, a 54-year-old man with metastasised thyroid carcinoma and a 40-year-old man with a non-Hodgkin lymphoma, neuropathic pain developed that could not be alleviated adequately by patient-controlled opioid administration. It is known that ketamine, a N-methyl-D-aspartate (NMDA) receptor antagonist, can improve opioid-induced analgesia. ⋯ The pain in the first two patients responded so well to ketamine that they decided to waive the invasive pain treatment and to continue the ketamine infusion at home until death. In the third patient, the addition of ketamine resulted in an adequate level of analgesia during the waiting period for invasive treatment with an intrathecal catheter.