Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2009
Case Reports[Traumatic atlas fracture in a child following fall on head].
An 8-year-old girl presented at the Accident & Emergency Department with torticollis and neck pain after falling on her head from a climbing frame. A computed tomography scan revealed a Gehweiler type 1 avulsion fracture combined with widening of an anatomically variant single anterior synchondrosis. ⋯ Differential diagnosis between pain-reactive muscular torticollis and atlantoaxial rotatory subluxation is essential. Children presenting with posttraumatic torticollis require a conventional or dynamic computed tomography scan.
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The first exemption to the comprehensive ban on smoking in public places in the Netherlands was made on 14 May 2009. The exemption was based on a technicality in the wording of the law, and could potentially lead to further exemptions to the smoking ban being made. The authors argue that focusing solely on the wording is a sidetrack in the main discussion. ⋯ That is exactly what smoking in public places does. They also argue that other legislative measures comparable to the smoking ban are already in effect. In conclusion, the ban on smoking in public places does not remove the right to smoke, but serves to create a healthier social environment for everyone.
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Ned Tijdschr Geneeskd · Jan 2009
Case Reports[Placement of one-way endobronchial valves to treat severe pulmonary emphysema in an 84-year-old].
An 84-year-old man with end-stage emphysema was hospitalised on two occasions because of an episode of severe COPD exacerbation, each time successfully treated in a classical pharmacological manner. Further analysis of a high-resolution CT chest scan revealed very pronounced destruction of the lung parenchyma in the left lower lobe. ⋯ This intervention had a very satisfactory outcome with positive changes in the lung function parameters, imaging studies and quality of life. The inevitable placement in a nursing home could consequently be postponed and, at follow-up one year later, no exacerbation or pneumonia had developed since the intervention.
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Three patients, men aged 30, 33 and 32 years respectively, died in police custody in Amsterdam, the Netherlands. According to autopsy reports, all patients died from excited delirium syndrome induced by cocaine use. Excited delirium is a state of mental and physiological hyperarousal commonly associated with the use of cocaine. ⋯ Medical and police staff should aim to reduce confrontation. When patients are too agitated to cooperate, benzodiazepines should be used for sedation of the patient. Beta blockers and antipsychotic medication should not be administered, as these medications can exacerbate the fatal cardiac effects seen in excited delirium.
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Ned Tijdschr Geneeskd · Jan 2009
Case Reports[Takotsubo cardiomyopathy; reversible cardiomyopathy induced by stress].
Takotsubo cardiomyopathy was diagnosed in a 79-year-old woman. She visited her husband who had been admitted for primary percutaneous coronary intervention, and during her visit she developed acute chest pain. Further investigation revealed transient left ventricular apical ballooning, diagnosed as takotsubo cardiomyopathy. ⋯ Especially in elderly women presenting with the clinical features of an ST-elevation myocardial infarction, takotsubo cardiomyopathy should be considered as an alternative diagnosis. Regarding the exact aetiology and pathophysiology many questions remain unanswered. With supportive treatment the prognosis is favourable.