Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2012
Practice Guideline[Prevention of severe infections in patients with hyposplenism or asplenia].
Each year, up to a 1000 splenectomies are performed in the Netherlands. Aside from patients without a spleen, there is also a large group of patients with hyposplenism or functional asplenia due to other primary diseases. ⋯ Healthcare professionals in first and secondary care in the Netherlands are generally not well informed about which preventive measures should be taken to prevent these infections, resulting in often suboptimal management of patients. In this article, recommendations are given on vaccination and administration of antibiotics to prevent severe infections such as PSS in this group of patients.
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Two male patients, aged 75 and 47 years, suffered from dyspnoea in the terminal phase of their disease, COPD and lung cancer, respectively. Both were given palliative sedation. The palliative consultation team was consulted when problems occurred. ⋯ A symptom is refractory when it causes unbearable suffering and conventional modes of treatment are not effective or timely. Knowledge of this guideline, early anticipation of possible scenarios and communication with the patient and his family contribute to good care. The palliative consultation team can help physicians with these decisions, preferably by starting at an early stage.
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A 67-year-old man presented in the emergency department after a fall on his outstretched right hand. Physical examination showed tenderness of the anatomical snuffbox and the dorsal side of the wrist. X-rays of the wrist revealed a perilunate luxation combined with a scaphoid fracture.
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Ned Tijdschr Geneeskd · Jan 2012
Case Reports[Fatal respiratory failure in a morbidly obese patient].
Healthcare professionals are seeing an increasing number of morbidly obese patients. Medical interventions are often difficult to perform in these patients. In acute situations this can lead to major problems. ⋯ Designating centres for care, also in the acute situations, of morbidly obese patients is recommended, to improve the care of these patients and to prevent disasters.
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Ketamine is used as an anaesthetic and in third-line pain management. Furthermore, recreational use of the drug is becoming increasingly popular due to its dissociative and hallucinogenic effects. Ketamine can affect the urothelium, possibly with long-term damage to the bladder and kidneys. ⋯ The precise mechanism of ketamine-associated urological symptoms is currently unknown. Treatment, therefore, is symptom-targeted and cessation of ketamine is imperative. We recommend that ketamine use is considered in patients with otherwise unexplained urological symptoms.