Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2009
[Neuraminidase inhibitors and high risk of influenza complications: considered and widely-supported recommendations].
It has been suggested that it is unwise to employ neuraminidase inhibitors in order to diminish the risk of influenza-related complications in cases of infection with the new influenza A(H1N1). However, the major argument, i.e. that the beneficial effects shown in the published evidence may be due to age differences between treatment and placebo groups, can easily be refuted. The Netherlands' policy to limit treatment to those patient groups who are considered at high risk of influenza complications is a sound one. In addition, it is endorsed by recent guidelines of the WHO and CDC.
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A 54-year-old man was admitted with fever following a trip to St. Maarten in the Dutch Antilles, from where he had returned 6 days earlier. One year prior to this he had been treated on an Intensive Care Unit for a severe influenza A infection. ⋯ Neither IgG nor IgM antibodies against dengue were found, but PCR on dengue virus RNA was positive. Over past decades there has been a strong increase in the number of dengue virus infections in travellers returning from Southeast Asia, Central and South America, the Caribbean and Africa. Whilst in general a primary dengue virus infection does not result in severe disease, this case illustrates the potentially fatal consequences of dengue in travellers.
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Ned Tijdschr Geneeskd · Jan 2009
Case Reports[Hyperchloraemic metabolic acidosis in a patient with an ureteroileostomy according to Bricker].
A 79-year-old male with a Bricker loop and chronic renal failure was admitted to hospital because progressive dyspnoea. This was due to severe hyperchloraemic metabolic acidosis. Hyperchloraemic acidosis can occur if urinary diversions are constructed from the colon or ileum. ⋯ A loopogram is necessary to investigate the cause. In our patient the loopogram showed that the incorporated bowel segment was too long. After shortening of the Bricker loop, the patient recovered from the hyperchloraemic metabolic acidosis.
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Ned Tijdschr Geneeskd · Jan 2009
Case Reports[Patients with a haematological malignancy in intensive care].
In this case report we describe 2 patients with acute leukaemia, a 38-year-old and a 21-year-old woman who were both admitted to the intensive care unit (ICU) twice for different complications of underlying disease and chemotherapy. Although the survival rates for patients with haematological malignancies requiring admission to intensive care have increased in the last two decades, many physicians are still reluctant to admit these patients to intensive care. ⋯ The length of stay in the ICU does not correlate with mortality in the ICU either. Intensive mechanical ventilation and multiple organ failure increase mortality in patients with haematological malignancies undergoing intensive treatment in an ICU.
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Clozapine is an antipsychotic drug which is used in the treatment of therapy-resistant schizophrenia. The most frequently reported side effects (occurring in more than 10% of patients) are gastro-intestinal complaints, including constipation. Here we describe the case of a 28-year-old man with schizophrenia who developed constipation and abdominal distension for several weeks while taking clozapine. ⋯ Because conservative treatment with enemas, prokinetic drugs and antibiotics did not have sufficient effect, the cholinergic drug neostigmine was added to the treatment regimen. This led to a good clinical response, thereby averting the need for surgery. This case illustrates that decreased intestinal motility can be a severe problem for patients taking clozapine, which may lead to life-threatening complications.