Nederlands tijdschrift voor geneeskunde
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To gain insight into the outcomes of postoperative pain treatment using patient-controlled intravenous analgesia (PCIA) with morphine and oral analgesics after total hip or knee arthroplasty (THA or TKA). ⋯ In view of the somewhat disappointing effectiveness and the side effects of a PCIA pump with morphine and oral analgesics, adjustments in the treatment of pain following THA and TKA are required. The greatest improvement can be realised on the day of surgery and the first postoperative day.
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Ned Tijdschr Geneeskd · Jan 2009
[Mild therapeutic hypothermia following resuscitation; experience and results in the first two years after introduction].
To describe the results of mild therapeutic hypothermia (MTH) following resuscitation in the 'Gelderse Vallei' hospital, Ede, the Netherlands. ⋯ The introduction of MTH in the intensive care department of the "Gelderse Vallei" has taken place without major problems. Although the mortality rate following cardiopulmonary resuscitation was relatively high, the neurological outcome in those patients who were discharged from hospital alive was good.
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Ned Tijdschr Geneeskd · Jan 2009
Case Reports[Recognition of a tarsal coalition; clinical and radiological pointers].
A 34-year-old female had been suffering from pain in her left ankle for more than 6 years. Physical examination revealed no abnormalities other than a rigid subtalar joint. ⋯ However, it is easily missed by treating physicians. In this article the clinical and radiological pointers for establishing the diagnosis are described, and information about the treatment of tarsal coalitions is provided.
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Ned Tijdschr Geneeskd · Jan 2009
Case Reports[Unexplained iron-deficiency due to Helicobacter pylori].
Iron-deficiency is one of the most prevalent worldwide deficiencies. In the western world, chronic, mostly occult, blood loss is a frequent cause. However, in up to 30% of patients an underlying cause is never found during routine investigations. ⋯ In these patients, infection with H. pylori was regarded as the major cause of iron deficiency, and there was lasting normalization of iron status and haemoglobin after successful eradication therapy. Although the underlying mechanism still remains to be established, we recommend investigation for H. pylori infection and appropriate treatment in case of unexplained iron-deficiency. In a number of patients, eradication results in a clinically significant improvement of both iron-balance and status.
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A 67-year-old male and a 43-year-old female were referred to hospital with headaches after intracranial pressure increasing activities, such as coughing. Both patients were diagnosed with primary cough headache. In the case of the first patient, this diagnosis was considered shortly after presentation. ⋯ Primary cough headache should be differentiated from secondary cough headache, in which the symptoms are caused by structural abnormalities of the brain. Additional investigation is required to differentiate between the two. The diagnosis of primary cough headache is supported by a positive reaction to trial treatment with indomethacin.