Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Sep 2001
Case Reports[Relative adrenocortical insufficiency with sepsis, diagnosed and treated with hydrocortisone supplementation].
An 82-year-old woman was admitted to the ICU with septic shock and multiple organ failure. Despite the lack of a persistent septic focus she continued to be dependent on large doses of norepinephrine whilst receiving adequate antimicrobial therapy. After a trial treatment with hydrocortisone the norepinephrine infusion could be withdrawn within a few days and she made a full recovery. ⋯ The remarkable clinical response to the administration of hydrocortisone (400 mg in the first 24 h) confirmed the diagnosis. The dosage of vasopressors can be reduced remarkably quickly. The stimulatory test for adrenocorticotropin hormone (ACTH) has no added value as reference values for critically ill patients are not available and because the results do not predict the response to the treatment.
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Ned Tijdschr Geneeskd · Sep 2001
Review Case Reports[Sodium bicarbonate infusion for intoxication with tricyclic antidepressives: recommended inspite of lack of scientific evidence].
Sodium bicarbonate infusion is widely recommended in textbooks for patients who present with self-poisoning from tricyclic antidepressives. Cardiac conduction disorders could also be treated or prevented by means of such an infusion. The scientific basis for these recommendations was investigated by using Medline to search for publications about clinical studies that supported the use of sodium carbonate; 111 articles were scrutinized. ⋯ Randomized studies in patients have not been carried out. As the toxicity of sodium bicarbonate is low, and its potential benefit appears to be high, we recommend its use, despite the lack of scientific evidence. No recommendations concerning dosing, concentration and the length of the therapy can be provided on the basis of the literature.
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Ned Tijdschr Geneeskd · Sep 2001
Review[Disease burden of diabetes mellitus type II in the Netherlands: incidence, prevalence and mortality ].
A consistent estimate of the prevalence, mortality and incidence of diabetes mellitus type II in the Netherlands was obtained by combining data from several sources using statistical and modelling techniques. In the Netherlands, the prevalence of diabetes in the age-group 30-74 years is 2.7-3.2%. The prevalence increases with age: for men by 7% per year of age and for women by almost 8% per year of age. ⋯ Diabetic patients account for 12% of the total mortality in men and 18% in women; in 2.5% and 5% of the cases respectively, diabetes is the cause of mortality. If this excess mortality could be eliminated then the life expectancy for men with diabetes would increase by 4.7 years at the age of 45 and for women the corresponding increase would be 6.3 years. The estimated incidence per year increases from 8 per 10,000 men (7 for women) in the age group 40-44 years to 80 per 10,000 men (86 for women) in the age group 75-79 years.
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Ned Tijdschr Geneeskd · Aug 2001
Case Reports[Abdominal pain and vomiting: a 4-year old boy with relaxation of diaphragm].
A 4-year-old boy presented with vomiting, abdominal pain and a visible swelling on the left side of the upper abdomen. He had been generally unwell for a week, and had been suffering from constipation for a longer period of time. Radiological examination revealed a large space containing air and fluid in the left side of the upper abdomen and the chest region. ⋯ Patient recovered well and remained without complaints. Diaphragm relaxation is rare, and can be either congenital or acquired. Unlike congenital diaphragmatic hernia, diaphragm relaxation is characterised by an elevated diaphragm which, although intact, is hypoplastic.