Nederlands tijdschrift voor geneeskunde
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The improved prognosis of cancer patients has led to an increased incidence of both bone metastases and (impending) pathological fractures. A solitary bone lesion seen on radiography should never be assumed to be a metastasis. Preoperative biopsy is necessary in patients with a known malignancy and a solitary lytic bone lesion as well as in patients in whom the primary tumor is unknown, in order to prevent an incorrect operation (also known as 'whoops surgery'). ⋯ Surgical fixation of an impending pathologic fracture is recommended when radiography indicates that a length of more than 3 cm of the cortex of a long bone has been destroyed. If surgical treatment is necessary, it should support the whole long bone in order to enable full weight bearing. When the diagnosis of a bone lesion is uncertain, referral to an experienced treatment centre is recommended.
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Traditionally, midshaft clavicular fractures have been treated conservatively. However a review of the literature reveals that certain fractures can benefit from operative repair. Conservative treatment, preferably in the form of a sling, of an undisplaced midshaft clavicular fracture leads to excellent results. ⋯ Intramedullary fixation can give good results in simple dislocated fractures, but does not provide optimal preservation of length and rotation in comminuted fractures. Plate osteosynthesis can be used for all clavicular fractures and causes a reduction of the relative risk of non-union of 86%. Due to the increased risk of non-union or malunion and of a worse functional result, osteosynthesis should be considered for patients with dislocated or comminuted midshaft clavicular fractures, with due consideration for the patient's expectations and lifestyle.
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Ned Tijdschr Geneeskd · Jan 2010
Review[Mucocutaneous abnormalities in Chlamydia trachomatis-induced reactive arthritis].
Reactive arthritis (previously known as Reiters syndrome) is an inflammatory arthritis that is a type of spondyloarthropathy. The disease consists of the classical triad of arthritis, urethritis and conjunctivitis, but mucocutaneous abnormalities also frequently appear: balanitis circinata, keratoderma blennorrhagicum, aphthous ulcers in the mouth and nail disorders. These skin lesions are mainly found in reactive arthritis induced by Chlamydia trachomatis (Ct). ⋯ Although in the Netherlands a Ct induced reactive arthritis is not yet treated with antibiotics, a recent published clinical trial in patients with a chronic Ct induced reactive arthritis showed a significant reduction in complaints in the group treated with a combination of antibiotics for 6 months, compared to the placebo group. Active genitourinary Ct infection should be treated with antibiotics, the first choice being azithromycin 1000 mg as a single dose. It is important that the patient's partner is tested at the same time and if necessary treated simultaneously to prevent reinfection.
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Ned Tijdschr Geneeskd · Jan 2010
Review[Progesterone for prevention of preterm delivery: only in trial setting].
Since the discovery of progesterone researchers have studied whether administration of exogenous progesterone can prevent preterm birth. Two trials were published in 2003 that showed a positive effect of progesterone with regard to the prevention of recurrent preterm birth. ⋯ In multiple pregnancies the use of progesterone does not seem to reduce the number of preterm births. The results in pregnant women with asymptomatic shortening of the cervix are promising, although more research is needed in this group.
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Ned Tijdschr Geneeskd · Jan 2010
[Fewer breech deliveries after implementation of a modified cephalic version protocol].
To investigate the effect of implementation of a number of process policy guidelines (protocol), on the success rate of external cephalic version (ECV) for breech presentation. ⋯ After implementation of the process policy guidelines, the success rate of ECV increased considerably. The rate of elective caesarean section for breech presentation declined. These findings are in favour of establishing specialized ECV centres in the Netherlands.