Nederlands tijdschrift voor geneeskunde
-
We report on 3 male patients aged 57, 47, and 53, who each sustained an unstable straddle injury during low-energy pelvic trauma while horseback riding. All 3 patients were haemodynamically stable; radiography revealed diastasis of the pubic symphysis in each case. ⋯ Fractures of the pelvic ring are relatively rare and are typically associated with high-energy trauma. Immediate surgical treatment is necessary for patients with fractures of the pelvic ring for the stabilisation of haemorrhagic shock, identification of soft-tissue injuries and fixation of the pelvis.
-
Post-traumatic lung herniation due to a pathological defect in the chest wall is rare. ⋯ There is still no consensus on surgical treatment of lung herniation. It may be performed immediately (primary) or after a delay (secondary) and depends on the clinical condition of the patient.
-
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.
-
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.
-
Ned Tijdschr Geneeskd · Jan 2012
[Dutch national safety programme will not lead to a fifty per cent reduction in avoidable mortality in hospitals].
Progress in improving patient safety in hospitals has been frustratingly slow, for several reasons. There are, for example, few proven effective improvement interventions available. Evaluation of the effectiveness of safety interventions is complicated by the complexity and variability of these interventions due to local differences and preferences of care providers. ⋯ Also, problems experienced by care providers when implementing safety interventions are not being systematically addressed. For these reasons, the aim of the Dutch national safety programme in hospitals - to reduce the incidence of avoidable harm by 50% in 5 years - will not be feasible or measurable. It is necessary to identify effective safety interventions and to exchange experiences in successful implementation of these in order to support care providers in improving patient safety.