Nederlands tijdschrift voor geneeskunde
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In two boys aged 4 months and one girl aged 2 months one or two toes were red and oedematous, while in one boy aged 3 weeks one toe had become necrotic. In the first-mentioned three children the affected toes were encircled by a hair, the hair was removed under anaesthesia, after which the children recovered. In the last-mentioned child, amputation through the proximal phalanx was necessary. ⋯ Strangulation of the toes by circular foreign material. such as hair or fibre, causes oedema and increasing constriction. Timely treatment is followed by good recovery. Delayed or incomplete treatment can lead to necrosis which may necessitate amputation.
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Ned Tijdschr Geneeskd · Dec 1997
Case Reports[Cerebral hyperperfusion syndrome following carotid endarterectomy].
Three patients with a severe symptomatic carotid stenosis developed headache, epileptic seizures and focal neurologic deficits several days after carotid endarterectomy. CT of the brain revealed hypodensities, indicative of cerebral oedema with haemorrhagic components. ⋯ Dysfunction of the cerebral autoregulation believed to be the cause of this hyperperfusion. Sometimes these complications are incorrectly attributed to one of the better known types of stroke.
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Substantial evidence indicates that outcome of critically ill children, treated in tertiary paediatric intensive care units (PICUs) is superior to that of those treated in other settings. However, a significant number of children who require this level of care are not admitted to such a unit e.g. due to capacity constraints, reluctance of physicians of general hospitals to refer children to a tertiary centre, and transportation problems. Centralization of care, as recently proposed in the UK, is necessary in the Netherlands, as well, to improve the quality of care. This will require a controlled number of PICU beds in a restricted number of centres, adequate transport facilities and step-down or high dependency units in large general hospitals.
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Ned Tijdschr Geneeskd · Nov 1997
Review[Salt sensitive blood pressure and the renin-angiotensin system in hypertension].
The relationship between (excessive) use of sodium chloride and the blood pressure is still equivocal. Blood pressure responses to alterations in dietary salt consumption vary greatly between individuals, which has led to the concept of salt sensitivity. ⋯ A relative inability of this system to respond promptly to alterations in salt intake may underlie the development of salt sensitivity. By administering drugs which block the renin-angiotensin system to patients with essential hypertension, blood pressure is rendered more sensitive to the effects of salt restriction and (or) diuretic treatment.
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Ned Tijdschr Geneeskd · Nov 1997
Clinical Trial[Favorable results with intravenous antimicrobial therapy outside the hospital].
To determine whether intravenous home treatment with antimicrobial drugs of patients with an infection is feasible. ⋯ Home treatment with antimicrobial drugs intravenously is quite feasible. If this were fully implemented, about 1400 patients in the Netherlands could be treated in this manner.