Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2009
Practice Guideline[Practice guideline 'Pharmaceutical pain treatment during labour'; the woman's request is sufficient indication].
The basic principle of the practice guideline 'Pharmaceutical pain treatment during labour' is that during labour every woman can have adequate pain treatment at her request. Most women experience severe pain during labour, but retrospective satisfaction also depends on the support of care-givers and on the extent to which the woman was involved in decisions relating to her situation. A number of medical indications require good pain management. ⋯ Pethidine is far less effective. Recommended organisational changes include structured provision of information on pharmaceutical pain management in the 30th week of pregnancy, to be developed by midwives, obstetricians and anaesthetists. Other recommended changes include referral to another hospital for the treatment of choice, development of local protocols across primary and secondary care with agreements about out-patient referral to the anaesthetist, structured daily contact between obstetricians and anaesthetists, the time lapse between the request for pain treatment and the administration of the treatment, and the site of administration and monitoring.
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Two men presented at the Accident & Emergency Department with lower urinary tract symptoms. The first patient was a 76-year-old male with reddish urine and lower abdominal pain. A CT-scan revealed a tumorous mass related to the bladder. ⋯ Voiding problems can arise when the haematoma extends into the prevesical (Retzius) space that is anatomically related to the rectus sheath. A haematoma of the rectus sheath is difficult to diagnose. Current insights show that conservative treatment is generally sufficient.
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A 12-year-old boy fell off his bicycle, hitting his neck on the handle-bars. He sustained a tracheal rupture, which required surgical treatment. ⋯ Both were treated conservatively, the 2-year-old boy needed endotracheal intubation and mechanical ventilation. Blunt neck trauma can cause life-threatening complications, which are difficult to diagnose.
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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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Ned Tijdschr Geneeskd · Jan 2009
Case Reports[Headache following laparotomy; chronic subdural haematoma following epidural anaesthesia].
A 63-year-old man underwent an exploratory laparotomy because of rectal carcinoma. The operation was performed under general anaesthesia in combination with epidural anaesthesia. Since the operation the patient complained of a headache. ⋯ A CT scan showed a subdural haematoma, which was relieved with surgery. We suspected that accidental puncture of the dura caused the haematoma. The incidence, causes, symptoms, diagnosis and treatment of this rare complication are discussed.