Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Nov 2001
Review['Caring always'; physicians' expression of condolences to the relatives of patients].
According to the WHO definition, palliative care does not end with the death of the patient, but also includes supporting the family members in dealing with the loss. A recent article refers to the importance of physicians writing letters of condolences. The letter of condolences marks the end of the treatment relationship. ⋯ The letter can also remove any distrust that may exist towards the medical profession. Reasons for not writing a letter of condolences include an own feeling of failure, administrative difficulties, indifference or incapacity. Nevertheless, writing a letter of condolences is an integral part of the care provided by the physician to the patient and his/her relatives.
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Ned Tijdschr Geneeskd · Nov 2001
Case Reports[Nocturnal back pain; a misdiagnosed symptom of spinal tumor].
Four patients had nocturnal back pain or pain that worsened when lying down. In one of these, a 49-year-old man, the medical history mentioned a malignancy, as a result of which a spinal metastasis was suspected. ⋯ The importance of recognising these early complaints is stressed. Nowadays, MRI is the technique of choice to answer the question whether there is a space occupying process in the spine.
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The revised CBO guideline 'High blood pressure' details the present scientific knowledge about the detection, diagnosis and treatment of elevated blood pressure as well as the implementation of this knowledge in practice. For both systolic and diastolic increased blood pressure the risk of cardiovascular disease and mortality gradually increases. The blood pressure is considered to be elevated if the systolic pressure is > or = 140 mmHg and/or the diastolic pressure is > 90 mmHg. ⋯ The indication area for treatment is laid down in the case of elevated blood pressure and an absolute cardiovascular risk of 20% per 10 years. When the absolute cardiovascular risk is between 10% and 20% per year, treatment may be considered. For treatment the target value is the same as the criterion for elevated blood pressure.
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Ned Tijdschr Geneeskd · Oct 2001
Case Reports[Anaphylactic shock after injection of patent blue for sentinel lymph node biopsy].
After being diagnosed with a melanoma, an 18-year-old woman developed anaphylactic shock following an intracutaneous injection of patent blue during a sentinel lymph node biopsy procedure. Intracutaneous allergy tests revealed positive reactions with patent blue (Bleu patenté V 'Guerbet') as well as with several anaesthetics and morphine. It was concluded that patent blue was the most probable causative agent for the anaphylactic reaction and that the possibility of such a reaction should be taken into consideration during sentinel node procedures. After a few days the operation was completed under epidural anaesthesia with technetium Tc 99m sulphur colloid being used to detect the sentinel node.
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Ned Tijdschr Geneeskd · Oct 2001
Review[Acute pancreatitis--a protocol for diagnosis and treatment].
Acute pancreatitis remains a disease with high morbidity and mortality. Acute pancreatitis can be subdivided in acute interstitial pancreatitis and necrotising pancreatitis, largely compatible with clinically mild and severe pancreatitis. This diagnosis is made on the basis of patient history, physical examination, laboratory parameters, contrast CT scan and, occasionally, endoscopic retrograde cholangiopancreatography. ⋯ Indications for surgical intervention are: progressive sepsis despite maximum conservative management, an established infection of (peri)pancreatic necrosis, peripancreatic abscess and perforation of stomach, small intestine or colon. The purpose of an operation is to remove necrotic tissue, achieve adequate drainage of the necrotic area or to treat a perforation. The Groningen and Utrecht University Hospitals have collaborated to develop a protocol to standardise the diagnostic approach, management, timing and choice of surgical intervention, as well as to prospectively investigate the effect of such a strategy in patients with acute pancreatitis.