Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2010
Review[Progesterone for prevention of preterm delivery: only in trial setting].
Since the discovery of progesterone researchers have studied whether administration of exogenous progesterone can prevent preterm birth. Two trials were published in 2003 that showed a positive effect of progesterone with regard to the prevention of recurrent preterm birth. ⋯ In multiple pregnancies the use of progesterone does not seem to reduce the number of preterm births. The results in pregnant women with asymptomatic shortening of the cervix are promising, although more research is needed in this group.
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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.
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Ned Tijdschr Geneeskd · Jan 2010
[Variations in patient data coding affect hospital standardized mortality ratio (HSMR)].
To investigate the impact of coding variations on 'hospital standardized mortality ratio' (HSMR) and to define variation reduction measures. ⋯ Coding of main diagnoses, urgency of admission and comorbidities showed strong inter-hospital variation with a potentially large impact on the HSMR outcomes of the hospitals. Coding variations originated from differences in interpretation of coding rules, differences in coding capacity, quality of patient records and discharge documentation and timely delivery of these.
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Ned Tijdschr Geneeskd · Jan 2010
Case Reports[Antidote against local anaesthetic intoxication: new use of lipid emulsion for intravenous administration].
Local anaesthetics are routinely used for several indications, but despite local administration their use may lead to systemic toxicity. The symptoms include numbness of the tongue, dizziness, tinnitus, visual disturbances, muscle spasms, convulsions, coma, and respiratory and cardiac arrest. ⋯ We describe the application of this lipid emulsion in a 27-year-old patient with generalized seizures and coma due to local anaesthetic toxicity. She recovered quickly and was responsive again 10 minutes after the intravenous administration of the lipid emulsion.
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The use of medicinal oxygen can be dangerous. The spontaneous combustion of an oxygen cylinder was the cause of a fire in an operating theatre and an emergency medical service. ⋯ Not opening the pressure reduction valve while the oxygen flow supply valve is open can prevent this type of fire. Information from the contractor shows that the probability of such an incident is 1 in a million.