Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Dec 1998
Comparative Study Clinical Trial Controlled Clinical Trial[The Dutch 'Rand General Health Rating Index for Children': a questionnaire measuring the general health status of children].
Clinimetric evaluation of the Dutch version of the RAND general health rating index for children (child RAND), measuring the general health of children. ⋯ The Dutch child RAND is recommended as a generic measure of perceived health of children for medical research and may serve as a valuable addition to the measurement of functional health status by the FS II.
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Ned Tijdschr Geneeskd · Oct 1998
Case Reports[A patient with tetanus without an obvious point of entry].
A 59-years-old man with oesophageal cancer (T3NXMo) presented with trismus, dysarthria and diaphoresis. Later, he developed opisthotonus and generalized spasms. ⋯ Tetanus is caused by Clostridium tetani, a Gram-positive rod capable of remaining present latently in the body for years. Absence of a visible external wound suggests that the oesophageal mucosal cancer lesion could have served as portal of entry or that endogenous reactivation of latent tetanus bacteria had taken place.
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Drowning and near-drowning are major causes of death and neurological damage, respectively, in children. The pathophysiological substrate consists of hypoxia, ischaemia, respiratory and metabolic acidosis and sometimes, hypothermia. Most cases involve aspiration of liquid; this leads to a persistent impairment of the gas exchange. ⋯ The prognosis depends in the first place on the duration of the submersion, which, however, is often difficult to establish. Submersion for over 5 minutes is prognostically unfavourable. In hypothermia due to submersion in ice cold water the prognostic factors are less clear--in these cases the treatment should always be continued until the core temperature is > or = 32 degrees C.
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Ned Tijdschr Geneeskd · Oct 1998
[Roaming through methodology. IX. The interpretation of subgroup analyses].
The results of subgroup analyses can be very informative, in particular for clinicians interested in evidence pertaining most directly to a particular patient. However, subgroup analyses may also be potentially misleading. The strength of evidence for subgroup effects depends on the question whether hypotheses have been defined prior to analysis, whether potential problems regarding multiple comparisons have been considered and whether there is biological plausibility of the effects. Using these guidelines the reader of a trial report should be able to decide if presented subgroup effects are of clinical importance or if the overall result is a better estimate of treatment effect.
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In three patients with abdominal pain, two men aged 63 and 18 years and a woman aged 46 years, the use of NSAIDs reduced the symptoms. They were in fact suffering from peritonitis due to gastrointestinal perforation, but the decision to operate was delayed because of the relatively mild presentation. The strong analgesic, antipyretic and anti-inflammatory properties of NSAIDs can reduce the symptoms, signs and laboratory findings of peritonitis.