Nederlands tijdschrift voor geneeskunde
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Awake flexible intubation is the gold standard for difficult airway management but failures have been reported in up to 13% of cases. A novel technique called 'awake fibrecapnic intubation', developed in the Netherlands, is described here for the intubation of patients with head and neck cancer who have a difficult airway. After topical anaesthesia is administered, a flexible fibrescope is introduced into the pharynx. ⋯ Spontaneous respiration is maintained in all patients. When four capnograms have been obtained, the flexible scope is railroaded over the catheter and after identification of tracheal rings or carina, the tracheal tube is placed. This new intubation technique is easier to learn than awake flexible intubation.
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A 46-year-old man had pain between the shoulders and at the sternum. Two and a half months earlier he had fallen when cycling. It appeared the pain was caused by fractures of thoracic vertebrae V and VI and a dislocation of the manubrium and body of the sternum.
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Ned Tijdschr Geneeskd · Jan 2011
[Thromboprophylaxis with low-molecular-weight heparin insufficient in high-risk pregnancy].
To evaluate the efficacy and safety of thromboprophylaxis with a low of low-molecular-weight heparin (LMWH) in women with an intermediate to high risk of pregnancy-related venous thromboembolism (VTE). ⋯ There was a considerable risk of pregnancy-related VTE in high-risk women despite a prophylactic dose of LMWH during pregnancy and in the post partum period. For these women thromboprophylaxis with a low, prophylactic dose of LMWH appeared to be insufficient.
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A 72-year-old woman from the inlands of Surinam was admitted to the hospital because of chronic painful swelling of both legs, caused by filariasis.
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A 2-year-old boy had fallen at home with a pencil in his hand. On physical examination we found only some blood in the inner corner of his right eye, but MRI showed a traumatic pencil tract into his frontal lobes.