Nederlands tijdschrift voor geneeskunde
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An 85-year-old woman with a severe kyphosis presented at the emergency room because of progressive dyspnea and cough, without other complaints. During auscultation, peristaltic sounds were heard over the thorax. A massive diaphragmatic hernia with intrathoracic stomach, small intestine and colon, was seen on CT-scan.
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Many medical doctors have become famous writers or poets. The two professions do have similarities: both have a professional preference for people in a crisis situation, both need to come close to their subject while maintaining a certain distance, the relationship between the individual and the general plays a central role in the practice of medicine and writing, writing and healing are similar in many ways and stories play an important role for both doctors and writers. We discuss these similarities in this article.
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The first case report describes an extremely prolonged activated partial thromboplastin time (APTT) in a patient with no history of increased bleeding tendency. Heparin use was excluded. The APTT mixing study combined with the medical history suggests a deficiency in one of the non-essential coagulation factors. ⋯ Aberrations in the process of haemostasis can be efficiently screened using a platelet count, an APTT, a PT and a thorough physical examination combined with a thorough medical history taking. Common causes of prolonged PT and/or APTT are the use of oral anticoagulants or heparin, vitamin K deficiency and liver disease. Other causes include coagulation factor deficiencies, coagulation factor inhibitors and diffuse intravascular coagulation.
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We report on 3 male patients aged 57, 47, and 53, who each sustained an unstable straddle injury during low-energy pelvic trauma while horseback riding. All 3 patients were haemodynamically stable; radiography revealed diastasis of the pubic symphysis in each case. ⋯ Fractures of the pelvic ring are relatively rare and are typically associated with high-energy trauma. Immediate surgical treatment is necessary for patients with fractures of the pelvic ring for the stabilisation of haemorrhagic shock, identification of soft-tissue injuries and fixation of the pelvis.
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We present a neonate with transient neonatal pustular melanosis, a benign skin rash seen in 0.2-2.2% of white neonates and in 4-5% of black neonates. Vesicopustular lesions are present at birth, the lesions rupture in 24-48 hours leaving hyperpigmented macules. These slowly fade in 3-10 weeks.