Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Oct 1997
Review[High-dose chemotherapy followed by hematopoietic stem cell transplantation as therapy for systemic rheumatic autoimmune diseases].
Remissions of autoimmune diseases can be accomplished in animals by myeloablative chemotherapy followed by allogeneic or autologous bone marrow transplantation. Remissions of autoimmune diseases have been reported in patients with concomitant malignancies for which they were treated with myeloablative chemotherapy followed by stem cell transplantation. Survival of patients with systemic rheumatic autoimmune disease is reduced. Since transplantation related mortality after autologous stem cell transplantation is less than 5%, this treatment becomes a possibility for patients with severe systemic rheumatic autoimmune disease, such as systemic sclerosis.
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Ned Tijdschr Geneeskd · Oct 1997
Case Reports[Acute perceptive hearing loss and metabolic acidosis as complications of the topical treatment of psoriasis with salicylic acid-containing ointment].
A 36-year-old woman, hospitalized because of an exacerbation of psoriasis, developed fever, sudden deafness and severe metabolic acidosis after treatment with a 10% salicylic acid containing ointment for four days. The use of salicylic acid on large areas of inflamed skin enhances the risk of transcutaneous resorption and intoxication. High serum concentrations (> 300 mg/l) of salicylic acid deregulate the blood glucose metabolism and cause damage to the inner ear. After timely intervention such symptoms are largely reversible.
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Ned Tijdschr Geneeskd · Oct 1997
Comparative Study[The white coat in pediatrics: link between medical history and preference for informally dressed physicians].
To find out if children show a preference for a doctor in a white coat or an informally dressed doctor, and what factors influence this preference. Further to determine if children show a preference for a physician of their own or of the other sex. ⋯ The preference of children for a doctor in a white coat or for an informally dressed doctor depended on their medical history. The more extensive the medical history, the more the preference shifted to an informally dressed doctor. Also, the children preferred a doctor of their own sex.
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Ned Tijdschr Geneeskd · Sep 1997
Review[Is the pulmonary artery catheter discredited because of ignorance?].
Recently in an observational study the use of a pulmonary artery catheter in critically ill patients was associated with an increase in both mortality and utilization of resources when compared with case-matched control patients. The authors corrected for selection bias by using a propensity score. The publication of this article elicited a flood of commentary in both medical journals and the lay press. Critical assessment of this study and other studies about pulmonary artery catheterization in our opinion supports the view that it is probably not the use of the catheter itself, but physicians' insufficient knowledge of right heart catheterization and the specific treatment resulting from its use that is at fault.
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Ned Tijdschr Geneeskd · Jul 1997
Case Reports[Three patients with accidental hypothermia: customized rewarming].
Three patients, two men aged 47 and 33 years and a woman aged 33 years, became hypothermic after an accident with body temperatures of 34.5, 26.2 and 23.1 degrees C, respectively. Two of them developed circulatory disorders, for which reanimation was performed. All three patients recovered after active external heating using among other things warmed infusion fluids, a warmed waterbed, continuous arteriovenous rewarming and rewarming with the heart-lung machine. For the treatment to be successful, the type of rewarming selected should be guided by the degree of hypothermia, the circulatory situation and the severity of the accessory injuries.