Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Dec 2001
Biography Historical Article[From the library of the Dutch Journal of Medicine. Giovanni Battista Morgagni: De sedibus, et causis morborum per anatomen indagatis, 1761].
The library of the Vereniging Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine Association) is a treasure-trove of information for those who wish to study the roots of the identity of the modern doctor. Recently, a book published in 1761 was purchased: De sedibus, et causis morborum per anatomen indagatis was written by Giovanni Battista Morgagni (1682-1771) when he was almost eighty years old. This book, in which Morgagni recorded the findings of 700 autopsies and linked them to the complaints of the patients and the symptoms of their diseases, marked the advent of anatomic pathology as a separate medical discipline.
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Ned Tijdschr Geneeskd · Dec 2001
Historical Article[History of pituitary surgery in humans and animals: from experiments with dogs to treatment of patients].
At the end of the 19th century and the start of the 20th century experimental hypophysectomy was carried out on cats and dogs, by means of the lateral temporal approach, to investigate the physiological role of the pituitary gland because there was a debate as to whether the pituitary gland was essential for life. At the same time pioneering neurosurgeons such as Harvey Cushing used animal experiments to explore the different approaches to the neurocranium and the pituitary, thereby taking the first steps towards neurosurgery in humans. ⋯ Veterinary medicine has benefited from these developments in the medical field. For the past few decades, hypophysectomy has been used for the treatment of pituitary adenomas in dogs and cats that are kept as pets.
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Ned Tijdschr Geneeskd · Dec 2001
Review[Acute renal replacement therapy in the intensive care unit].
On the intensive care department the most frequently used acute renal replacement techniques are intermittent haemodialysis and continuous haemofiltration. Although continuous techniques appear to have distinct advantages in the treatment of critically ill patients, no consistent differences in mortality have been found between continuous and intermittent treatment modalities. Due to uncertainty in this area, the use of unmodified cellulose membranes is probably best avoided. ⋯ With continuous techniques, the filtration volume should not be below 35 ml/kg/h. Although continuous (high-volume) filtration techniques may contribute to an improvement in the haemodynamics, the mechanisms behind this phenomenon remain unclear. At present, no randomised studies are available which have shown a beneficial effect of continuous techniques on the survival of critically ill patients without manifest renal insufficiency being demonstrated.
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Ned Tijdschr Geneeskd · Dec 2001
Review Case Reports[Spondylodiscitis in 3 children; differential diagnosis and treatment].
Three children, a 4.5-year-old boy and two girls aged 21 months and 10 years respectively, had for several weeks to months experienced lower back pain or walking problems, two of them had an elevated sedimentation and leucocytosis. The MRI scan revealed a narrowing of the lumbal disk. Furthermore, in the case of the 10-year-old girl, Staphylococcus lugdunensis was cultured from the puncture material of the disk. ⋯ In the case of (spondylo)discitis, immobilising the spine with a corset is the mainstay of treatment. Antibiotics are only indicated when osteomyelitis cannot be excluded. Generally, the prognosis is good.
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For large-scale accidents, and for specific categories of wounds there is, in addition to the extramural assistance provided by helicopter teams and mobile medical teams, a need for secondary triage so that patients can be transferred as quickly as possible and the use of limited treatment capacity for specific injuries (such as serious burns) is optimised. After the cafe fire in Volendam, 203 patients were admitted to 27 hospitals. ⋯ The mortality under 75 patients with burns and an inhalation trauma who underwent a planned curative treatment was just 5.3%. Trauma triage teams should be officially recognised within the chain of the project 'Medical assistance in accidents and disasters' (Dutch acronym: GHOR) so that together with the uniform guidelines for the treatment of specific injuries that are present in casualty departments (for example the 'emergency management of severe burns (ESMB) protocol', a protocol for the care of patients with serious burns) the quality of care can be improved.