Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Sep 2002
Case Reports[Conservative treatment of a spontaneous splenic rupture in a patient with infectious mononucleosis].
A 30-year-old man with flu-like symptoms for several weeks presented at the emergency room with pain in the left upper abdomen. There was no history of trauma. The patient had a spontaneous rupture of the spleen due to mononucleosis infectiosa. ⋯ Although splenectomy is the accepted treatment for haemodynamically unstable patients, some patients, may be adequately treated with conservative management. They should be observed during the critical phase and must comply to a period of restricted physical activity after they are discharged from the hospital. There is no consensus about the length or content of this restriction period.
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Ned Tijdschr Geneeskd · Aug 2002
Review[Medical maintenance treatment of chronic obstructive pulmonary disease (COPD)].
Chronic obstructive pulmonary disease (COPD) is a chronic disorder of the lungs and airways that imposes a huge socioeconomic burden on both the patients and society. COPD is the only major chronic disease for which both the incidence and mortality are still rising worldwide. From the literature evidence-based insights can be obtained about maintenance medication for reducing symptoms and disease progression. ⋯ A reduction in exacerbation frequency seems to exist in some studies, yet this has not yet been conclusively demonstrated. Acetylcysteine has been proven to reduce exacerbation frequency. There is no place for maintenance therapy with antibiotics.
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Ned Tijdschr Geneeskd · Aug 2002
Comment Case Reports[Acute appendicitis in children: serious complications when treatment is delayed].
Three children, two boys aged 9 and 6 and a 12-year-old girl, had diffuse abdominal complaints, diarrhoea and a (sub)febrile temperature for several days. On admission, they were found to have a perforated inflamed appendix and peritonitis. Following asystole, intra-abdominal abscesses and an enterocutaneous fistula, the oldest boy showed good recovery after a hospital stay of two months; the girl recovered after one month in hospital following a psoas muscle abscess and two episodes of constrictive pericarditis with threatened tamponade. ⋯ Appendicitis is not always easy to diagnose. An atypical presentation, very often with diarrhoea, can result in diagnostic delay. Early surgical consultation is mandatory in a child with progressive abdominal pain.
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Ned Tijdschr Geneeskd · Aug 2002
[Acute respiratory distress syndrome more frequently diagnosed in intensive care patients in the Netherlands than would occur according to internationally established criteria].
To determine the agreement of the diagnosis 'acute respiratory distress syndrome' (ARDS) established by intensive care (IC) specialists, with that according to internationally accepted objective criteria. ⋯ In this investigation, the diagnosis of ARDS was more frequently established than would occur according to the NAECC criteria.
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Ned Tijdschr Geneeskd · Aug 2002
Comment Case Reports[The pregnant patient with acute liver disease].
Acute liver disease was diagnosed in three pregnant patients: two 30-year-old women had a 'haemolysis, elevated liver enzymes, low platelets' (HELLP) syndrome and acute fatty liver of pregnancy, respectively, and a 20-year-old woman had acute liver failure due to acute hepatitis B. The first two patients had a caesarean section, the third one delivered her child, which died spontaneously shortly after birth at a gestational age of 23 weeks. She was then treated by liver transplantation. ⋯ Acute fatty liver disease and acute liver failure due to hepatitis present with liver insufficiency characterised by anorexia, nausea, coagulopathy, hypoglycaemia and elevated serum ammonia levels. Management depends on the diagnosis and the gestational age; pregnancy complicated by acute fatty liver disease should be terminated while pregnancy complicated by the HELLP syndrome early in pregnancy may be maintained to improve the outcome of the foetus. In acute liver failure due to viral hepatitis, termination of pregnancy alone does not affect the disease.