Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Dec 1999
Review Case Reports[What should be done if a patient refuses treatment after self- poisoning?].
Three women aged 28, 30 and 39 years, attending an emergency room because of attempted suicide by means of an overdose of drugs, refused somatic treatment considered necessary: one refused gastric lavage and two refused to remain in the hospital. After explanation of the procedure, one patient left the clinic without treatment and one agreed to admission--both were subsequently treated in the outpatient department. ⋯ Obligatory gastric lavage after (auto)intoxication is possible under the Medical Treatment Agreement Act (WGBO) and should follow its rules. However, this may be avoided by using a laboratory test or ECG for the diagnosis and administration of activated charcoal and a laxative for the treatment.
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Ned Tijdschr Geneeskd · Dec 1999
Comment Review['Urinary tract infections'--revised CBO guideline. Dutch Institute for Quality Assurance].
Recently the 'Kwaliteitsinstituut voor de gezondheidszorg CBO' (Dutch Institute++ for Health Care Improvement) published revised guidelines on urinary tract infections. In children less than one year old clinical signs of urinary tract infection are non-specific and the diagnosis should be ruled out by laboratory investigations: a nitrite test, followed by inspection of the urinary sediment for leucocytes and bacteria if the test is negative. If one of the investigations is positive an urinary culture is made and antimicrobial therapy is started as for pyelonephritis. ⋯ Urinary catheters are a risk for infection and their use should be restricted in number and duration. Catheter care should follow the guidelines of the Workgroup Infection Prevention. Urinary cultures should only be made in the presence of signs of infection if there is an indication for antimicrobial therapy.
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Ned Tijdschr Geneeskd · Dec 1999
Case Reports[Intracerebral tuberculomas in a pregnant Somalian woman].
A pregnant Somalian woman aged 28 years, in the Netherlands for the last five years, suffered from a progressive hemiparesis, epilepsia, behavioural problems and low fever. Brain MRI showed multiple lesions with contrast enhancement. Extensive serologic and parasitologic tests on serum and cerebrospinal fluid did not disclose any cause. ⋯ In the meantime the chest X-ray showed miliary tuberculosis and a spine MRI thoracic spondylodiscitis and a large paravertebral abscess. Subsequently the patient was treated successfully with tuberculostatic agents. Her healthy child which was born by caesarean section was treated with the tuberculostatic agents as well.
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Dyspnoea is a frequent symptom in advanced cancer patients. The control of breathing can be impaired by different mental and physical factors that may coincide and change over time. ⋯ Only few controlled trials evaluating the efficacy of symptomatic treatment of dyspnoea in advanced cancer patients are available. There is evidence that systemically administered opioids are effective in alleviating breathlessness in patients with cancer.