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
[When peripheral drips fail: favourable experience with peripherally-inserted central venous catheters].
Evaluation of the technical success rate, insertion complications and patient survival when peripherally-inserted central venous catheters (PICCs) are used in oncologic patients and patients with severe infections in whom it was not possible to place a peripheral drip. ⋯ PICCs appear to be a good alternative in oncologic patients and patients with infections in whom peripheral drip insertion is not possible. The technical success rate of PICCs was high and was associated with a low periprocedural complication rate. The percentage of prematurely removed catheters seems acceptable, in part because these catheters were removed after a mean period of 2 months.
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Ned Tijdschr Geneeskd · Jan 2009
Case Reports['Acute respiratory distress syndrome' (ARDS) as a serious complication of influenza].
'Acute respiratory distress syndrome' (ARDS) developed as a serious complication of an infection with the influenza virus A (H1N1) ('swine flu') in 3 children: a 15-year-old girl, a 6-year-old boy and a 14-year-old girl. The latter two patients also suffered from septic shock. ⋯ The first two patients eventually recovered following treatment with extracorporeal membrane oxygenation (ECMO), but the third patient's condition was too unstable for transfer to an ECMO centre. This patient died.
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Two patients were involved in a high-energy trauma that resulted in an unstable pelvic fracture. The first patient, a 51-year-old woman, was trapped between two boats. At our hospital she received a traumatic pelvic orthotic device (T-POD), followed by angiography with embolisation. ⋯ These cases illustrate the variety of possible treatments for patients with unstable pelvic fractures. Choice of treatment depends on the character of the attending injuries and the haemodynamic situation. Fast consultation should take place with a hospital experienced in the initial care and treatment of unstable pelvic fractures.