Nederlands tijdschrift voor geneeskunde
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In a reasonably large proportion of patients who take antihypertensive drugs (10-30%), hypertension appears to be therapy resistant; even the use of three antihypertensives does not lower the blood pressure sufficiently. The average nocturnal blood pressure is a better predictor of cardiovascular events than blood pressure measured during the day. ⋯ The exact mechanism of this has not yet been unravelled, but randomised, non-blinded studies suggest that this so-called chronotherapy does indeed lower cardiovascular risk in certain groups. The authors regard this as a promising strategy for patients with therapy-resistant hypertension in whom a nocturnal blood pressure dip does not occur.
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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.
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Many experimental studies in mammals, and increasingly also in primates, have shown that almost all anaesthetic agents when administered during a young animal's brain-development phase cause increased neuroapoptosis and changes in dendritic morphology at short term, and later, learning disorders. These findings are being confirmed in increasing numbers of retrospective cohort studies in humans. ⋯ These study results will only provide information on relatively short procedures and will not be available until the first reliable neuropsychological evaluation at age 5 in 2018. Pending this additional data, we should discuss with our surgical colleagues the indications, timing and duration of surgery and - if possible - postpone elective surgery until the child is more mature.
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Ned Tijdschr Geneeskd · Jan 2013
[Revised NHG practice guideline 'Acute coronary syndrome': a strong link in the chain of treatment].
This Dutch College of General Practitioners' (NHG) practice guidelines an important component in the care for patients with an acute coronary syndrome. In this commentary, the role of acute pre-hospital triage and percutaneous coronary intervention, high-sensitivity troponins, pharmacological therapy and automatic external defibrillators is reflected upon.
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A 43-year-old woman came to the Emergency Room with acute abdominal pain during the night. CT examination of the abdomen showed ventral herniation of the stomach and parts of the small intestine and colon in the right hemithorax. We made the diagnosis 'symptomatic Morgagni hernia', a rare congenital defect that is usually diagnosed soon after birth.