Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2011
Review[Facial transplantation: an overview of 8 of the 13 operations].
Composite tissue allotransplantation (CTA) is a new development in reconstructive surgery that makes it possible to use identical tissue to repair large mutilating deformities, to the face for example. Until now, 13 face transplants have been performed worldwide. The functional and aesthetic results are encouraging. However, the lifelong immunosuppressive therapy necessary to prevent rejection has considerable side effects.
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As paracetamol is widely used and easily available acetaminophen auto-intoxication is frequently seen. In the majority of patients no complications will occur, but in a small group it may lead to liver damage and death. Children are less susceptible to complications than adults. ⋯ This nomogram has only been validated in adults, but nevertheless is also used in children. Gastric lavage should not be implemented, active charcoal can be given to a conscious cooperative patient within 1 hour of ingestion of acetaminophen. A multidisciplinary approach to treatment is needed with the collaboration of an emergency physician, paediatrician or internist, pharmacist and also a child psychiatrist.
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Ned Tijdschr Geneeskd · Jan 2011
Review[Physical examination of patients with acute abdominal pain].
Reliable physical examination of patients presenting with acute abdominal pain and tenderness is necessary for identifying serious causes on the one hand, and for preventing further unnecessary imaging on the other. If acute appendicitis or peritonitis is suspected, positive palpatory findings like rigidity and guarding are helpful diagnostic indicators, whereas negative palpatory findings have little value in excluding these conditions. ⋯ Visible peristalsis strongly argues for small bowel obstruction, but this sign is rarely present. Digital rectal examination appears to have no added diagnostic value for appendicitis, peritonitis, or small bowel obstruction.
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Ned Tijdschr Geneeskd · Jan 2011
Comparative Study[Hospital standardised mortality ratio (HSMR): adjustment for severity of primary diagnosis can be improved].
To study the impact of casemix variations within primary diagnostic groups on hospital standardised mortality ratios and to improve the current HSMR model. ⋯ The HSMR model currently used in the Netherlands does not adequately adjust for casemix differences at the level of ICD-9 primary diagnoses. A model using a severity classification of ICD-9 codes based on actual Dutch hospital mortality allows for a better, albeit not perfect, adjustment. We recommend implementation of the 'Dutch' severity classification in order to improve the HSMR model.
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Effective intra-operative anaesthesia and peri-operative analgesia are important aspects of patient care in orthopaedic surgery. The interscalene regional anaesthetic block technique, performed with the patient lying in a lateral decubitus position, is new for arthroscopic shoulder surgery conducted in the Netherlands. The combination of the interscalene block (without general anaesthesia) and the lateral decubitus position results in better peri-operative conditions for the patient. Better analgesia, increased patient satisfaction and fewer complications in comparison to general anaesthesia have been reported for these types of surgery.