Nederlands tijdschrift voor geneeskunde
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Charles Bonnet syndrome is characterised by complex visual hallucinations in patients who have visual disturbances but no cognitive disorders. The diagnosis is often missed. ⋯ This patient had Charles Bonnet syndrome. If visual hallucinations occur for the first time after the 40th year of life, a somatic cause should first be ruled-out. Refraining from treating Charles Bonnet syndrome with pharmacological agents is advised in light of their many side effects and little evidence of being beneficial for this condition.
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Awake flexible intubation is the gold standard for difficult airway management but failures have been reported in up to 13% of cases. A novel technique called 'awake fibrecapnic intubation', developed in the Netherlands, is described here for the intubation of patients with head and neck cancer who have a difficult airway. After topical anaesthesia is administered, a flexible fibrescope is introduced into the pharynx. ⋯ Spontaneous respiration is maintained in all patients. When four capnograms have been obtained, the flexible scope is railroaded over the catheter and after identification of tracheal rings or carina, the tracheal tube is placed. This new intubation technique is easier to learn than awake flexible intubation.
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According to the practice guideline of the Dutch Workingparty on Infection Prevention (WIP) sterile gloves have to be worn during minor surgery by the general practitioner. This is based on the microbiological principles of Spaulding and is not supported by other evidence. ⋯ Also, in daily practice, only 24% of general practitioners actually wear sterile gloves. We therefore propose to modify the guideline: using clean, nonsterile gloves during minor surgery is sufficient.
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Ned Tijdschr Geneeskd · Jan 2010
Review Meta Analysis[Treatment of tension type headache: paracetamol and NSAIDs work: a systematic review].
Tension-type headache (TTH), also known as tension headache or muscle contraction headache is the most commonly experienced type of headache. Our aim was to evaluate the effectiveness of interventions in patients with TTH. ⋯ The evidence in this review suggests that NSAIDs and acetaminophen are both effective for short-term pain relief in patients with TTH. No specific type of NSAID was clearly more effective than others, but ibuprofen showed fewer side effects. There is insufficient evidence to either support or refute the effectiveness of preventive medication, physiotherapy, (spinal) manipulation, EMG biofeedback or cognitive behavioural treatment in patients with TTH.
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Sarcoidosis is a granulomatous disease of unknown etiology. Standard treatment with immune suppressants such as glucocorticoids is started when vital organ function is threatened. ⋯ In patients with sarcoidosis, only the use of monoclonal antibodies that block tumour necrosis factor (TNF) has been studied scientifically, other biologicals hardly at all. TNF-blockers are used at present in patients with therapy refractory sarcoidosis.