Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2013
Case Reports[The diagnostic benefits of lipase values in acute pancreatitis].
Serum lipase is a biochemical marker used for diagnosing acute pancreatitis. Lipase has largely replaced amylase in terms of diagnostic value, although both markers are still commonly used. ⋯ The first patient, who had recently experienced cholecystitis, presented to the emergency room with abdominal pain and high lipase levels. The second patient, who had received a renal transplant a few years earlier, visited the gastroenterological outpatient clinic with abdominal pain and only a slightly elevated lipase level.
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Ned Tijdschr Geneeskd · Jan 2013
Multicenter Study Meta Analysis[Improved end-of-life care for patients with dementia: greater family satisfaction and possibly greater end-of-life comfort].
To analyse possible trends in families' evaluations of the quality of end-of-life care and the quality of dying in dementia. ⋯ We found a positive trend of increased satisfaction with end-of-life care. Families also reported a possible increase in residents' end-of-life comfort. Ongoing surveillance of outcomes measuring end-of-life quality is important in view of the increasing healthcare budget constraints.
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Ned Tijdschr Geneeskd · Jan 2013
Review[Guideline 'Wound Care': recommendations for 5 challenging areas].
The interdisciplinary evidence-based guideline 'Wound Care' covers the treatment and management of acute wounds in adults and children and by all wound care disciplines. This guideline answers 5 basic questions with 38 recommendations covering wound cleansing, pain relief, instructing the patient, various dressings and the organisational aspects of wound care. The guideline recommendations include not to cleanse wounds that are primarily closed, to cleanse acute open wounds with clean tap water, to use the WHO pain ladder as the basis for the choice of analgesics for continuous wound pain, to administer lidocaine or prilocaine for localized pain relief during manipulation, not to cover primarily closed wounds with dressings, to use simple dressings for open wounds and to give the patient clear instructions. The guideline also advises about wound registration, documentation and hand-over of wound care, and recommends making clear agreements about referrals and responsibilities.
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Ned Tijdschr Geneeskd · Jan 2013
Case Reports[The Morel-Lavallée-lesion: delayed symptoms after trauma].
The Morel-Lavallée lesion is a post-traumatic collection of fluid arising after a 'closed degloving injury' has caused the separation of the skin and subcutis from the underlying muscular fascia. It usually occurs in the trochanteric region or proximal thigh. ⋯ A Morel-Lavallée lesion, which could manifest even months later, should be considered after any traumatic injury. Ultrasound, CT and MRI are useful tools for proper diagnosis. There is no consensus about treatment in either the acute or the chronic phase to date.
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Bariatric surgery is becoming popular as treatment of morbid obesity. With this popularity there is a danger that it surpasses or even replaces conservative medical therapy. ⋯ There is a new Dutch practice guideline on the treatment of morbid obesity in which conservative treatment is hardly covered. There is little evidence of the highest level to support the recommendations in this guideline.