Nederlands tijdschrift voor geneeskunde
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An adequate management of scaphoid fractures requires fast and reliable diagnosis. In this, proper history taking and physical examination are essential. Routine scaphoid x-rays miss over 20% of all scaphoid fractures. ⋯ A below-the-elbow cast without immobilisation of the thumb is an adequate treatment for stable fractures. Unstable fractures and all proximal pole fractures are candidates for open or percutaneous treatment. In addition to the type of fracture, patient-specific requirements are important in deciding which type of management is the most suitable.
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Ned Tijdschr Geneeskd · Mar 2007
Case Reports[Amatoxin poisoning due to soup from personally picked deathcap mushrooms (Amanita phalloides)].
Two patients, a 54-year-old man and a 51-year-old woman, presented with abdominal pain, vomiting and diarrhoea; these symptoms developed 9 and 15 hours, respectively, after consumption of soup from mushrooms that they had picked themselves. As a result of these events, a third patient, a 55-year-old woman with diarrhoea who had also eaten the soup, also presented herself. ⋯ The poisoning was later confirmed by the results of urinalysis. The patients were discharged in good condition 8 days later.
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Ned Tijdschr Geneeskd · Mar 2007
Case Reports[Diagnostic image (317). A man with cervical injury after an accident ].
A 20-year-old man suffered a larynx rupture and mucosal laceration, and had local subcutaneous emphysema, due to a motor vehicle accident.
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An 80-year-old man was admitted because of head trauma following a fall down a staircase. Initial CT-imaging of the brain showed only global atrophy, but repeated CT-imaging 4 days later revealed a subdural hygroma. Because of the discrepancy between the radiological deterioration and the unchanged neurological condition, we refrained from neurosurgical evacuation. ⋯ The pathophysiology is not well known. Differentiating subdural hygroma (cerebrospinal fluid (CSF) accumulation in the subdural space) from external hydrocephalus (excessive CSF accumulation in the subarachnoid space) is important in view of the therapeutic consequences. Because CT-imaging usually cannot differentiate between these 2 conditions, we recommend the use of MRI.
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Ned Tijdschr Geneeskd · Mar 2007
Comment[Palliative care is more than palliative antitumour treatment and symptom management].
Nowadays, many palliative treatments are available for advanced cancer. These treatments provide relief of symptoms and add months to life, but their price is high, both literally and figuratively. ⋯ This 'conspiracy of silence' makes it hard to say 'we don't have any further treatment'. Instead of saying 'we have no further treatment', patients should be offered palliative care as a positive choice to achieve the best quality of life, not only with physical but also with psychological, social and spiritual support.