Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2012
Comment[The 'paper-based' preoperative evaluation: non-optimal health care].
A nationwide preoperative assessment guideline was introduced in the Netherlands in 1997 at the advice of the Health Council of the Netherlands. The preoperative assessment should entail an appropriate interview, a physical examination, additional tests, risk assessment and informing the patient. Dutch and several international guidelines recommend a complete assessment under the responsibility of the anaesthesiologist. ⋯ A complete assessment may reduce health care costs by reducing the number of consultations by other specialists, additional tests, cancellations and length of stay. The assessment also reduces patient anxiety and improves patient satisfaction. In conclusion, a complete preoperative assessment is required by guidelines and law and does offer many advantages.
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A 36-week-old girl presented with an itching papulous skin eruption symmetrically on her cheeks, buttocks and limbs. Based on the specific clinical presentation she was diagnosed with Gianotti-Crosti-syndrome. This is a self-limiting cutaneous response to a viral infection.
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A 9-year-old girl complained of a sudden severe headache during skiing, there was no previous trauma. She was nauseous, vomited and had weakness of the left arm and leg. ⋯ MRI showed acute infarction of the right hemisphere caused by a dissection of the internal carotid artery. The patient recovered partially with rehabilitation.
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Ned Tijdschr Geneeskd · Jan 2012
Comment[How can breast-conserving surgery be improved even more?].
Due to population-wide screening and increased awareness of breast cancer by women, more early-stage diagnoses are being made. Breast-conserving surgery, performed according to well-established guidelines, results in the same level of local control and long-term survival as mastectomy for the same indication. ⋯ There are two provisions: the tumour and its gross delineation must be visible by ultrasound, and the breast surgeon needs to learn the technique and apply it sensibly. Generally speaking, ultrasound-guided breast-conserving resection of invasive breast cancer may well lead to more initially complete resections and better cosmetic results.
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Heinrich Irenaeus Quincke (1842-1922), the son of a physician, was born in Frankfurt but was educated in Berlin where he also completed his medical studies in 1864. After a 'grand tour' that took him to Paris, Vienna and London, he was trained in Berlin, first in surgery and later in internal medicine, under Von Frerichs (1819-1885). In 1878, he became a professor of internal medicine in Berne; from 1883 he held the chair of medicine in Kiel, which he would hold for the next 30 years. ⋯ Quincke accurately described the clinical features and distinguished the familial from the sporadic forms. He was correct in attributing the condition to increased vascular permeability, but he surmised the causal factors were neurogenic rather than humoral, according to current insights (excess of bradykinin due to external factors or hereditary deficiency of C1-esterase inhibitor). Quincke not only contributed to several other clinical observations, but also pioneered the lumbar puncture, initially not for diagnostic purposes, but to relieve headache in hydrocephalic children.