Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2010
Review[Mucocutaneous abnormalities in Chlamydia trachomatis-induced reactive arthritis].
Reactive arthritis (previously known as Reiters syndrome) is an inflammatory arthritis that is a type of spondyloarthropathy. The disease consists of the classical triad of arthritis, urethritis and conjunctivitis, but mucocutaneous abnormalities also frequently appear: balanitis circinata, keratoderma blennorrhagicum, aphthous ulcers in the mouth and nail disorders. These skin lesions are mainly found in reactive arthritis induced by Chlamydia trachomatis (Ct). ⋯ Although in the Netherlands a Ct induced reactive arthritis is not yet treated with antibiotics, a recent published clinical trial in patients with a chronic Ct induced reactive arthritis showed a significant reduction in complaints in the group treated with a combination of antibiotics for 6 months, compared to the placebo group. Active genitourinary Ct infection should be treated with antibiotics, the first choice being azithromycin 1000 mg as a single dose. It is important that the patient's partner is tested at the same time and if necessary treated simultaneously to prevent reinfection.
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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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Ned Tijdschr Geneeskd · Jan 2010
Comparative Study[Cold ischaemia time and outcome of renal transplantation].
To determine the effect of cold ischaemia time (CIT) on the outcome of cadaveric renal transplantation in the Netherlands. ⋯ Prolonged cold ischaemia times are related to a more frequent occurrence of DGF, PNF and decreased graft survival after kidney transplantation. These results underline the need to reduce cold ischaemia times in the Netherlands.
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AN EXAMPLE FOR THE PRESENT DAY: The current requirement for explicit quality standards and examination of surgeons is an opportunity to contemplate surgical training from a historical perspective by looking at the regulations of the Amsterdam Surgeons' Guild (1461-1736). At that time Amsterdam surgeons usually trained for five years in a master-apprentice relationship under the guidance of a master surgeon in a surgeon's shop. ⋯ However, over the course of time the final master's exam as the ultimate test of capability at the end of surgical training has disappeared. From the perspective of renewed interest in explicit quality standards and examination of surgeons, the reintroduction of a modern master's exam should perhaps be considered.
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Ned Tijdschr Geneeskd · Jan 2010
[Implementation of the curriculum for specialist training in Emergency Medicine: room for improval on details].
To investigate what aspects of the new curriculum for specialist training in Emergency Medicine are actually implemented in daily practice. ⋯ The responses to the questionnaire demonstrated how the curriculum is handled in daily practice and provided information on the progress of the implementation of the curriculum. This will enable focussed feedback to teaching hospitals.