Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · May 2000
Case Reports[Luxatio cordis in blunt-trauma thoraco-abdominal injuries].
A 56-year old woman was admitted to the emergency ward after suffering a blunt thoraco-abdominal high-velocity trauma as she hit the wheel when her car drove into a tree. A laparotomy was performed because of haemodynamic instability and radiographic suspicion of a diaphragmatic rupture. ⋯ Haemostasis of liver, splenectomy and suturing of defects in pericardium and diaphragm resulted in a haemodynamically stable situation. A high index of suspicion of rupture of pericardium and diaphragm with luxation of the heart in the trauma patient is important to reduce morbidity and mortality due to delay of surgical intervention.
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Ned Tijdschr Geneeskd · May 2000
[CBO guideline 'Stroke' (revision) Dutch Institute for Healthcare Improvement].
The stroke consensus dating from 1991 had to be revised, because of the introduction of new developments in the treatment of patients with stroke. More than 50 representatives from 25 professions and institutions participated. Under methodological assistance of the Dutch Institute for Healthcare Improvement CBO separate working groups (diagnosis, treatment, organization of care, rehabilitation/education, implementation and cost-effectiveness) studied the literature and translated the results into recommendations with explanatory text. ⋯ Early intensive rehabilitation increases the chance of recovery. Silent cognitive defects may hinder rehabilitation. The extensive guideline summarises the scientific literature about treatment of patients with stroke and should serve as a basis for local protocols and appointments.
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Hunger strikes raise ethical and legal issues, in addition to societal and medical ones. The World Medical Association adopted resolutions in 1975 (Declaration of Tokyo) and 1991 (Declaration of Malta) in which respect for the decision to refuse food was confirmed. A survey of the relevant international and national standards shows that in the Netherlands law and policy are more supportive of respect for food refusal (and against forced feeding) than would seem to be the case at the international level. ⋯ The existence of an unambiguous legal framework will not save the advising physician from difficult dilemmas which will in particular occur in case of a protracted hunger strike. In anticipation of expected loss of judgement capacities in protracted hunger strikers it is advisable that the wishes of the striker and the professional policy that the physician will adopt are written down. In case of hunger strike legal standards cannot fully replace psychological insight, professional ethics and conscience, however.
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Ned Tijdschr Geneeskd · May 2000
Review Case Reports[Delirium? Admission to the general hospital, rather than a psychiatric hospital].
Delirium is often not recognized either by psychiatrists or by other physicians. In two men, aged 78 and 70 years, a diagnosis of delirium was not recognized at admission. ⋯ The first patient died later on because of complications of a pneumonia and the other patient was transferred to a nursing home on a maintenance dose of haloperidol. Since delirium is a symptom of a medical disorder, delirious patients should be referred primarily to a general hospital.
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In many Dutch hospitals gastric lavage leaving charcoal and a laxative is the treatment of choice after autointoxication. Gastric lavage is not without risks. No difference has been demonstrated in efficacy and safety of gastric lavage combined with administration of activated charcoal on the one hand and just administration of activated charcoal on the other. ⋯ In case of a mild intoxication (for example with benzodiazepines), the risks of drug toxicity do not outweigh those of lavage, regardless of the time elapsed after ingestion. If gastric lavage is applied, it should be performed properly, i.e. with warm water (38 degrees C), with a 36-40 Fr. tube, using aliquots of 200-300 ml. In a minority of the intoxications whole bowel lavage should be employed.