Nederlands tijdschrift voor geneeskunde
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Persistent abdominal pain in a 15-year-old girl was diagnosed after examination by the GP, the pediatrician, the gynaecologist and finally, the surgeon as rib-tip syndrome. The patient could be treated sufficiently by the injection of local anaesthetics and corticosteroids. In the rib-tip syndrome hypermobility of the lower ribs irritates the intercostal nerves causing pain along the lower edge of the chest. The condition can be established objectively with the aid of fluoroscopy and electrostimulation, electromyography or magnetic stimulation.
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Ned Tijdschr Geneeskd · Mar 1999
Review Case Reports[Acute severe headache: a subarachnoidal hemorrhage?].
Five patients, three women aged 87, 50, and 31 years, and two men aged 31 and 32 years, presented with severe headache of sudden onset. A sudden onset of unusually severe headache is suggestive of an intracranial haemorrhage or other serious disease, even in the absence of focal neurologic deficits. ⋯ There are no characteristics from history or examination that accurately discriminate among all these causes; idiopathic thunderclap headache and subarachnoid haemorrhage are commonest. Consultation of a neurologist and further ancillary investigations are necessary for proper diagnosis and treatment.
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Ned Tijdschr Geneeskd · Mar 1999
Review[Roaming through methodology. XII. Pragmatic and pathophysiologic trials: a question of goal formulation].
The design of clinical trials depends on the research question. In pragmatic trials the research question is: 'How do I treat patients with this disease?' In explanatory trials this question is: 'What is the mechanism of this new treatment?' Pragmatic trials are characterised by liberal patient selection, open treatment modalities corresponding with regular care, outcome measures considered from the patient's perspective and intention-to-treat analysis. In explanatory trials patient selection is strict and treatment is double-blind and pathophysiologically pure. Often proxy outcome measures are used and emphasis is on per protocol ('on treatment') analysis.
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Ned Tijdschr Geneeskd · Mar 1999
Case Reports[Intracranial arteriovenous malformations in pregnant women].
Three women, aged 27, 32 and 30 years, respectively, suffered from headache, nausea and neurological abnormalities and were found to have an intracranial arteriovenous malformation (AVM). One of them after diagnosis had two pregnancies, both ended by caesarean section with good results. Another woman was 32 weeks pregnant when the AVM manifested itself with a haemorrhage; she recovered well and was delivered by caesarean section. ⋯ It appears that pregnancy does not increase the rate of first cerebral haemorrhage from an AVM. The management of AVM rupture during pregnancy should be based primarily on neurosurgical rather than on obstetric considerations. Close collaboration with a team of neurologists, neurosurgeons, obstetricians and anaesthesiologists is mandatory.
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Ned Tijdschr Geneeskd · Feb 1999
Review[Management and choice of antibiotics for patients with an allergy to penicillin].
Allergic reactions to penicillin occur in 0.7-8% of treatments. Management of bacterial infections in patients allergic to penicillin depends on the availability of alternative antibiotics and on the type of allergy. Skin tests can be used to exclude the risk of IgE-mediated reactions (e.g. anaphylaxis) to subsequent penicillin administration. If penicillin is the first choice for treatment and the patient has an IgE-mediated allergy (on the basis of a positive skin test), desensitization therapy to the drug can be performed.