Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Apr 2000
Case Reports[Clinical thinking and decision making in practice. A student with sudden headache].
A previously healthy man aged 18 years suddenly developed a severe headache, followed by nausea, vomiting, fever. During the following weeks a left-sided hemiparesis developed. CT of the brain revealed a pansinusitis and a frontal epidural empyema. ⋯ A sudden severe headache can be caused by an intracranial infection and intracranial pus collections can occur in the subdural as well as in the epidural space. Epidural empyema is a limited disease with relatively mild symptoms and a favourable prognosis, whereas subdural empyema may rapidly spread and cause severe disease with a poor prognosis. Quick antibiotic treatment and surgical drainage are required.
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Ned Tijdschr Geneeskd · Apr 2000
Review[Serum lactate level as a indicator of tissue hypoxia in severely ill patients].
Adequate oxygen supply to the tissues is of vital importance to survive critical illness and trauma. Shock can be defined as an imbalance between oxygen demand and oxygen supply. Clinical features of shock, like hypotension, tachycardia, cold clammy skin et cetera, are poorly correlated with presence of tissue hypoxia. ⋯ In severely ill patients tissue hypoxia is the most important cause of increased lactate levels. Increased blood lactate levels are related to increased mortality. Optimizing oxygen supply by fluid resuscitation is the intervention of first choice.
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Ned Tijdschr Geneeskd · Apr 2000
Comment[Panic disorder, chest pain and palpitations: a pilot study of a Dutch First Heart Aid].
To determine how many patients, presenting to a First Heart Aid (FHA) with chest pain or palpitations without a cardiac origin for their complaints, have a panic disorder and/or depression. ⋯ In 83% of the patients who visited the Maastricht FHA with cardiac complaints but without a cardiac origin and who had a HADS score > or = 8, panic disorder and/or depression was diagnosed.
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Ned Tijdschr Geneeskd · Apr 2000
[Ethanol for treatment of delirium in alcohol dependent patients on intensive care units in the Netherlands: efficacy not proven].
To determine the use of ethanol in Dutch intensive care departments (ICUs) for the treatment of deliriant symptoms in alcohol-dependent patients, and to study the literature data concerning this use. ⋯ Because only a small percentage of deliriums on ICUs are caused by alcohol withdrawal, and the effectiveness of ethanol in alcohol-dependent patients with a delirium has never been proven, the use of ethanol in such cases is discouraged.
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Ned Tijdschr Geneeskd · Mar 2000
Review[Hyponatremia in acute intracranial disorders: cerebral salt wasting].
Hyponatraemia is a frequent finding in the course of an acute intracranial disease, especially after a subarachnoid haemorrhage. The fall in plasma sodium concentration is usually mild and not below 124 mmol/l but may reach dangerously low levels with serious neurological complications. In the early 1950s the cause of the hyponatraemia was believed to be primarily excessive natriuresis and therefore named 'cerebral salt wasting'. ⋯ The increased plasma concentrations of natriuretic peptides are likely to mediate the increased natriuresis. Cerebral salt wasting can be treated with a simple regimen of water and salt suppletion. If needed a mineralocorticoid like fludrocortisone can be given to increase renal tubular sodium reabsorption.