Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2012
Case Reports[Decompression illness: minor symptoms, major consequences].
Nowadays, diving is being performed ever more frequently; it is thus important to take diving injuries into consideration in patients presenting with even minor complaints after diving. Every dive is risky and could result in decompression illness, barotrauma and/or death. We report on two cases of decompression illness: a 30-year old man, an occupational diver, and a 46-year old man, an experienced diver, who were both clinically suspected of having decompression illness and were treated with hyperbaric oxygen in a recompression chamber. ⋯ Symptoms vary and are dependent on the site affected: from minor pain to neurological symptoms and death. If patients are suspected of having diving injuries, we recommend contacting a centre specialised in diving and hyperbaric medicine. Recompression in a hyperbaric chamber is the definitive treatment for decompression illness and should be performed as soon as possible.
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Ned Tijdschr Geneeskd · Jan 2012
[Ultrasonically guided breast-conserving surgery for palpable mammary tumours].
Breast-conserving surgery for palpable mammary tumours is usually guided by palpation. It appears, however, that identifying tumour margins only by palpation can be problematic, resulting in less than optimal effectiveness of this type of operation. The use of ultrasonography is a simple and non-invasive way of facilitating real-time localisation of breast carcinoma during surgery so that a tumour can be excised with controlled precision. ⋯ During tissue dissection, ultrasound can be used to inspect the location and depth of the tumour as well as determining whether the tumour's surrounding margins are sufficient, thereby preventing the unnecessary removal of healthy tissue. Ultrasound can be used again after the excision to verify that the tumour was indeed radically removed. The efficacy of ultrasonically guided surgery for palpable mammary tumours is currently being studied in a prospective, randomised, multicentre trial.
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Ned Tijdschr Geneeskd · Jan 2012
[Determining burn depth: clinical assessment and laser Doppler imaging].
Early accurate determination of burn depth is important to determine the optimal treatment of burns. The method most used to determine burn depth is clinical assessment. ⋯ It is hypothesised that the introduction of LDI will lead to quicker decisions as to whether or not to operate, possibly leading to a shorter length of hospital stay and lower medical costs. To test this hypothesis, a multicentre randomized controlled trial is presently being conducted in the Dutch burn centres.
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Ned Tijdschr Geneeskd · Jan 2012
Comment[Role of secondary care too small in Dutch College of General Practitioners' (NHG) practice guideline 'Dementia'].
The third revision of the Dutch College of General Practitioners' practice guideline 'Dementia' is a major improvement and stimulates the general practitioner by providing concrete advice on stepped care in dementia diagnostics and organizing care management in order to obtain improvement in the quality and realization of dementia care in the primary care setting. However, this practice guideline does not address more effective and efficient dementia care by collaboration between primary and secondary care as it discourages the prescription of cholinesterase inhibitors and recommends limiting further diagnostic procedures to patients in whom a treatable condition is likely. Although, this new practice guideline strengthens the central role of the general practitioner in Dutch dementia care, this role would be further reinforced if general practitioners were to adopt integrated diagnostics of dementia and relevant additional diseases burden as the starting point.
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Ned Tijdschr Geneeskd · Jan 2012
[The 'paper-based' preoperative evaluation: sometimes, a suitable alternative].
In the Netherlands, the majority of elective-surgery patients are evaluated by the anaesthesiologist at the preoperative assessment clinic. We believe that this visit can be omitted in selected patients as it has only minimal benefit, whereas its disadvantages can be substantial. Alternatively, the initial screening could be performed by the completion of a questionnaire via the telephone, via internet, by a nurse or by the surgeon. ⋯ This method does require the conscientious cooperation between anaesthesiologists and surgeons; it should be clear which patients are eligible, what type of anaesthetic technique should be used, how the patient should be informed and how the informed consent is obtained. In our opinion, this paper-based evaluation combines safety and efficiency with patient-friendliness. It should be anchored in current guidelines to ensure quality.