Nederlands tijdschrift voor geneeskunde
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A 2-month-old boy with an congenital herniation of the umbilicus presented with a painful swelling of the umbilicus since 1 day, lower intake of food and vomiting. He had an incarcerated umbilical hernia. Eventually emergency surgery was needed.
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Ned Tijdschr Geneeskd · Jan 2012
Review[Revised practice guideline 'Management of patients with mild traumatic head/brain injury'].
Recently the out-of-date Dutch guideline 'Mild traumatic head/brain injury' dating from 2001 was revised under the supervision of the Dutch Institute for Healthcare Improvement (CBO). The revised guideline gives underpinned decision rules for the referral of patients to hospital, carrying out diagnostic imaging investigations, and formulating indications for admission. Mild head-brain injury is no longer an indication for a conventional skull radiograph. ⋯ The guideline can be used in both primary care and on the Emergency Departments of hospitals and is applicable to both adults and children. The guideline does not address the rehabilitation or long-term care of patients with mild traumatic head/brain injury, but it does give advice on reducing the risk of long-term symptoms. Regional implementation of the guideline in primary and secondary care is recommended.
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Ned Tijdschr Geneeskd · Jan 2012
Multicenter Study[Breast-conserving surgery for breast cancer: still much to be gained].
To conduct qualitative research into breast-conserving surgery for palpable and non-palpable breast tumours and the various methods of excising these, measured by the volume exised and surgical radicality. ⋯ Breast-conserving surgery is associated with an average of a 2 to 4-fold removal of excessive tissue. Nevertheless, 1 out of 5 excisions are not radical. Ultrasound-guided surgery for non-palpable breast cancer is the most effective method for achieving radical excision. A multicentre, prospective, randomised trial has been started to assess whether ultrasound-guided lumpectomy for palpable breast cancer can lead to optimisation of the excision volume and radicality.
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The new global strategy to achieve long-term malaria eradication is based on rapid treatment of individual malaria patients and blocking the spread of Plasmodium parasites in the population. In a number of countries increased funding combined with more effective control measures have resulted in a substantial decline in the incidence of malaria and in the resulting morbidity and mortality. Increasing resistance of Anopheles mosquitoes to insecticides (pyrethroids and DDT), and reduced sensitivity of Plasmodium parasites to various antimalarials increase the need for the development of new vector control strategies and medicines. Vaccine development efforts have been speeding up and a first vaccine is expected within three years.
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Ned Tijdschr Geneeskd · Jan 2012
Case Reports[A heart attack: was the patient lucky or unlucky? Circumstances were favourable but outcome ill-fated].
The assessment of signs and symptoms in primary care is an important but difficult task for general practitioners (GPs) who have to decide whether symptoms require immediate action or rather a watchful waiting approach. However, the GP may sometimes just need a bit of luck. This case report describes how the doctor's luck (in taking the initiative to phone the patient shortly after discharge from a hospital where he had undergone surgery on two coronary vessels) and the luck of the patient (a subsequent cardiac arrest at the GP's office) results in an unsuccessful out-of-hospital resuscitation. Based on our analysis of the literature on the prevalence of cardiac arrests and the outcome of out-of-hospital resuscitation, we will leave it up to the readers to decide whether our patient had been lucky or unlucky.