Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2000
Clinical Trial[Fewer x-rays while maintaining quality of clinical care using clinical protocols for physical diagnosis of ankle injuries].
To determine whether it is possible to decrease the number of X-rays in acute ankle injury while keeping the health care constant, using a scoring system. ⋯ Radiological examination in patients wit acute ankle complaints was reduced while health care remained almost constant. In the AZU, a decision was made for a major reduction in X-rays while accepting that some fractures would be missed.
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Ned Tijdschr Geneeskd · Jan 2000
Review Case Reports[Diabetic ketoacidosis presenting as acute abdomen].
Three patients, two women aged 21 and 67 and a man aged 43 years, presented at the emergency department with diabetic ketoacidosis and abdominal symptoms mimicking an acute abdominal condition. In two of them laparotomy was performed which proved to be negative. ⋯ Symptoms indicating a possible diagnosis of acute abdomen have to be regarded as being compatible with diabetic ketoacidosis per se. However, a potential acute abdominal problem prompting surgical intervention should not be overlooked; it may have been the precipitating factor for diabetic ketoacidosis.
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Ned Tijdschr Geneeskd · Jan 2000
Review Case Reports[Children with stumbling gait due to acute spinal cord compression].
Three previously healthy children, two girls aged 2 and almost 5 years and a boy aged 20 months, developed a progressively stumbling gait within days. In two this occurred after a period of weeks during which they complained of, or seemed to have back pain. In all three cases acute spinal cord compression by a malignant tumour was diagnosed. ⋯ Back pain, weakness and a stumbling gait usually are the first symptoms. Sensory symptoms and sphincter dysfunction may develop later. Early recognition is essential, as prognosis depends on neurological findings and duration of symptoms when treatment is started.
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Ned Tijdschr Geneeskd · Jan 2000
Randomized Controlled Trial Multicenter Study Clinical Trial[Dutch research on the effectiveness of medical prescription of heroin; background, research design and preliminary results].
In the Netherlands the total number of heroin addicts amounts to approximately 25,000. Of these about 70% is in contact with the treatment system. The remaining 30% have not been seeking help, believes that no help is needed or has lost faith in a better future altogether. ⋯ During the treatment no medical complications have been observed and no serious public order or safety problems have occurred. Study participants have been very compliant both with the treatment regimen and the research requirements. The latter is indicated by the fact that 85% of all the two-monthly assessments have been completed.
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Most patients with gallbladder stones are asymptomatic and do not require treatment. Biliary colics are the main indication for laparoscopic cholecystectomy: the treatment of choice for gallbladder stones. Dyspepsia is not an indication for treatment of gallstones. ⋯ Bile duct stones are mainly treated endoscopically during endoscopic retrograde cholangiopancreatography (ERCP): pancreatitis, bleeding and perforation are the main complications. Prior to cholecystectomy, an ERCP is indicated in case of cholangitis, severe pancreatitis, persisting jaundice, bile duct stones on ultrasonography, or the combination of dilated ducts and abnormal liver function tests. After endoscopic stone removal, a cholecystectomy is indicated for patients < 50 years but a 'wait and see' policy is justified in elderly patients.