Nederlands tijdschrift voor geneeskunde
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An 82-year-old woman presented with dyspnoea and palpitations. The patient was admitted to the cardiology ward on suspicion of atrial fibrillation and reduced cardiac output. Examination revealed position-dependent deoxygenation. ⋯ Curative treatment consisted of percutaneous closure of the foramen ovale. A persistent asymptomatic foramen ovale is common and can be revealed in later life. Platypnea-orthodeoxia syndrome is a relatively unfamiliar disorder.
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Ned Tijdschr Geneeskd · Jan 2010
Review Meta Analysis[Treatment of tension type headache: paracetamol and NSAIDs work: a systematic review].
Tension-type headache (TTH), also known as tension headache or muscle contraction headache is the most commonly experienced type of headache. Our aim was to evaluate the effectiveness of interventions in patients with TTH. ⋯ The evidence in this review suggests that NSAIDs and acetaminophen are both effective for short-term pain relief in patients with TTH. No specific type of NSAID was clearly more effective than others, but ibuprofen showed fewer side effects. There is insufficient evidence to either support or refute the effectiveness of preventive medication, physiotherapy, (spinal) manipulation, EMG biofeedback or cognitive behavioural treatment in patients with TTH.
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Ned Tijdschr Geneeskd · Jan 2010
Review[Primary management and treatment of paediatric septic shock].
Paediatric shock is common. Hypovolaemic and septic shock are the main forms. Early and rapid results-oriented therapy of paediatric septic shock has a favourable effect on survival. ⋯ In a child in shock, the clinical picture should be recognized within 15 minutes and an attempt should be made to reverse the situation by rapid fluid infusion. If the shock persists after 15 minutes, vasoactive medication should be given and the child should be transferred to a local paediatric intensive care unit. Intubation and mechanical ventilation are then also required.
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Ned Tijdschr Geneeskd · Jan 2010
Review[Exclusion of deep-vein thrombosis and pulmonary embolism using clinical decision rules and D-dimer tests].
Clinical diagnosis of a venous thromboembolism (VTE) is often difficult because the symptoms of this disorder are diverse and unspecified. The combination of a low probability clinical decision rule and an unremarkable D-dimer test is a safe way to exclude the presence of a VTE. ⋯ During pregnancy and puerperium using a clinical decision rule and a D-dimer test is inadequate: additional radiologic investigation is always indicated in this situation. The diagnostic value of the D-dimer test during suspected recurrence of a VTE is yet to be determined.
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A 39-year-old man was admitted to the ICU after having taken 96 tablets of 500 mg acetylsalicylic acid. Although a high plasma concentration (1040 mg/l) was found, underestimation and misinterpretation of clinical signs and symptoms with decreasing salicylate plasma concentrations led to haemodialysis being postponed. One day after admission the patient suddenly died of cardiovascular collapse due to severe salicylate toxicity. ⋯ The hyperlactaemia was artificial and caused by an interaction between glycolic acid and lactate on a point-of-care analyser. Doctors should consider artificial hyperlactaemia in patients with ethylene glycol intoxication. The patient recovered.