Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Sep 1998
[Good results from treatment of patients with abdominal pain at the emergency department of the Amsterdam OLVG Hospital].
Evaluation of the treatment of patients with abdominal complaints at the first aid department of a city hospital, where patients were treated by emergency doctors (EMD) in combination with specialists. ⋯ The organisation of a first aid department like that in the OLVG, with EMDs and specialists, appeared efficient; the rates of morbidity, mortality and missed diagnoses are acceptable. With relatively few additional tests, the EMD appeared to be able to differentiate between GP care and hospital care.
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In the Netherlands, the prevalence of overweight and obesity defined by Body Mass Indexes (BMI, weight in kg, divided by squared height in m) of 25-30 kg/m2 and > or = 30 kg/m2, respectively, is 30-40%. As to obesity, the prevalence of 7% in males and 11% in females is intermediate between the high prevalences in the USA and modernizing and industrializing developing countries and the low prevalences in China and Japan. However, the trend over the last decade is alarming. The Netherlands is amongst the highest together with the USA, UK and Germany; mainly males have an increased risk of obesity and youngsters and subjects with low education an increased risk of overweight.
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Ned Tijdschr Geneeskd · Aug 1998
[Excess mortality in critically ill patients after treatment with human albumin].
According to the results of a systematic review of randomized clinical studies administration of human albumin to critically ill patients is associated with excess mortality, compared with withholding albumin or administration of crystalloid fluids. The study appears to be well done. ⋯ Alternatives to albumin are available in most clinical situations, but unfortunately, they are not completely without drawbacks. The use of albumin has to be limited; it might only be abolished when a better effect of other fluids, such as synthetic solutions, is demonstrated.
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Ned Tijdschr Geneeskd · Aug 1998
Case Reports[Pellagra (deficiency of vitamin B3 or of the amino acid tryptophan): a disease still extant in the Netherlands].
Pellagra was diagnosed in a 48-year-old female patient with a bullous skin disease. The skin disease with purple/red sharply demarcated spots on hands and feet had worsened after sun exposure. She was a chronic alcoholic and for the last few months she had had diarrhoea. ⋯ Pellagra leads to the triad: dermatitis, diarrhoea and dementia, eventually followed by death. The skin changes are characteristic and pathognomonic. Recognition of pellagra is important; the prognosis is good after treatment.
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Ned Tijdschr Geneeskd · Aug 1998
Review Case Reports[Perplexing acute or chronic somatic or psychiatric symptoms: possibly due to porphyria].
A woman aged 35 years had a classical picture of acute intermittent porphyria. However, the diagnosis was only made after repeated clinical investigations by internists, gastroenterologists, gynaecologists and surgeons working at a university hospital, and after an unnecessary laparotomy. ⋯ It may run a serious invalidating and life-threatening course. Its manifestations vary and may lead to very different clinical pictures.