Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2010
Biography Historical Article[Thomas Schwencke and Wolfgang Amadeus Mozart].
Thomas Schwencke (1694-1767) was Professor of Anatomy and Surgery and Lecturer in Obstetrics at the Surgical School in The Hague, the Netherlands. In 1743 he published the very first textbook on haematology. Furthermore, he described his observations on the variolation of smallpox, and published the design of a new obstetric instrument. ⋯ During his Dutch tour the young Mozart fell seriously ill, probably from typhoid fever. At the request of the court Mozart was seen for a second opinion and thereafter successfully treated by Schwencke. Mozart could continue his concert tour and Schwencke's reputation as Mozart's physician was established.
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A 24-year-old female developed DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) as a result of sulfasalazine use. The DRESS syndrome is a severe and acute hypersensitivity reaction that can be caused by a variety of drugs. The clinical presentation is diverse; the most common symptoms are fever, exanthema and lymphadenopathy. ⋯ In most cases the DRESS syndrome needs no further treatment after discontinuation of the associated drug. However, 20% of patients are severely affected and the DRESS syndrome is potentially life-threatening. The patient was successfully treated with a glucocorticoid and an antihistamine.
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Ned Tijdschr Geneeskd · Jan 2010
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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We describe the clinical course of a 51-year-old woman in a vegetative state and of a 63-year-old woman in a minimally conscious state. The difference between these two states is an important one, as clinical course, prognosis and medical-ethical considerations of both are different. ⋯ The differences between these two states regarding rehabilitation, pain management and medical-ethical decisions are important. The effects of neuro-rehabilitation and the implications of a minimally conscious state for patients and their proxies need further investigation.
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Ned Tijdschr Geneeskd · Jan 2010
Case Reports[Angio-oedema and urticaria as side effects of frequently used drugs].
Angio-oedema and urticaria can be symptoms of both allergic (IgE-mediated) and non-allergic drug hypersensitivity reactions. Non-allergic drug reactions, that may have a similar clinical presentation as allergic drug reactions, are not caused by an IgE-mediated immune mechanism. Because of unfamiliarity with non-allergic drug reactions and the unclear time course between drug use and reactions, the relationship with the responsible drug is often not recognized, leading to unnecessary patient risks. ⋯ Patient A was a 69-year-old man with ACE-inhibitor induced angio-oedema. Patient B was a 40-year-old woman with urticaria and angio-oedema after ingestion of a NSAID caused by a non-allergic drug reaction. Patient C was a 54-year-old woman who developed an anaphylactic shock because of a type I allergy to betalactams.