Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2013
Review[Peripheral circulation in critically ill patients: non-invasive methods for the assessment of the peripheral perfusion].
Peripheral tissues, such as skin and muscles, are sensitive to alterations in perfusion. During circulatory shock, these tissues are the first to receive less blood and the last to recover after treatment. By monitoring peripheral circulation, disturbance of the systemic circulation can be detected at an early stage. ⋯ Persistent abnormal peripheral perfusion is related to a poorer clinical course. With current non-invasive methods, peripheral circulation in critically ill patients can easily be assessed at the bedside. Interventions that improve peripheral circulation may speed up recovery in critically ill patients.
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Willem Kolff (1911-2009), son of a physician, studied medicine in Leiden and specialised in internal medicine in Groningen. It was there that he started attempts to apply the phenomenon of dialysis in patients suffering from renal failure. He built the first prototypes of dialysis machines after his appointment as an internist in the municipal hospital in Kampen, during the Second World War. ⋯ Haemodialysis also became feasible for patients with chronic renal failure after the 'Scribner shunt' (1960) provided easy access to the circulation. Peritoneal dialysis is another option. Excess mortality, mainly from cardiovascular disease, is still a largely unsolved problem.
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Ned Tijdschr Geneeskd · Jan 2013
[A deceased child as organ donor: a major sacrifice asked of the parents].
A shortage of organs is the key factor limiting transplantation in children. In the Netherlands, the Dutch Organ Donation Act allows voluntary registration. Citizens aged 12 years and older may register as organ donors of their own free will. ⋯ Alternatives such as living-related donor programs have been established as well as recruitment of child donors. A recent study evaluates the procurement of organs and tissues in pediatric intensive care units. This commentary questions this practice in light of voluntary registration and the resulting shortage of donor organs in general.
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Ned Tijdschr Geneeskd · Jan 2013
Review['Postoperative pain treatment' practice guideline revised].
On the initiative of the Dutch Association of Anaesthesiologists, a multidisciplinary workgroup has revised the 2003 practice guideline on 'Postoperative pain treatment' for adults and children. The main reason for revision was the availability of new drugs and new methods of administration. The most important deviations from the previous edition are the following. ⋯ In patients with relative contraindications for epidural analgesia, peripheral and locoregional blocks or multimodal pain treatment are advised. In the case of postoperative nausea and vomiting, administration of dexamethasone, droperidol and 5-HT3-antagonists is recommended, preferably in combination. Non-medicinal treatment options are not recommended.
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Ned Tijdschr Geneeskd · Jan 2013
Review Case Reports[Addison's disease, primary adrenal insufficiency in adults].
Adrenal insufficiency is a rare but fatal disease if left unrecognized. Symptoms often mimic more prevalent diseases. We discuss three patients with primary adrenal insufficiency. ⋯ Treatment consists of glucocorticoid and mineralocorticoid replacement. Primary adrenal insufficiency is a 'master of disguise'. Unexplained syncope, vomiting, weight loss or hypoglycemia should prompt suspicion of this disease.