Nederlands tijdschrift voor geneeskunde
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A 11-year-old female gymnast presented with long-standing bilateral wrist pain. Radiographs showed physeal widening and irregularity of the left distal radial and ulnar metaphyses, and irregularity of the right distal radial and ulnar metaphyses without physeal widening. 'Gymnast wrist' was diagnosed and cessation of strenuous activities was advised.
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Ned Tijdschr Geneeskd · Jan 2013
Practice Guideline[Guideline 'Non-specific symptoms of arm, neck and/or shoulders'].
Complaints of arm, neck and/or shoulder (CANS) constitute an important health problem. Over one third of Dutch adults reported CANS in the past year, and over a quarter were suffering from CANS at the time of interview. Over 10% of sick leave days are also attributed to CANS. ⋯ A care pathway has also been developed, aimed at optimal timing of diagnosis and treatment and multidisciplinary cooperation. Through better diagnosis, patients with specific CANS get targeted treatments sooner. Better insight into treatment results will lead to the choice for effective treatments in cases of non-specific CANS, resulting in more patients receiving the most promising therapies.
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Many ICU survivors experience physical, cognitive and mental complications of critical care. This phenomenon has recently been defined as post-intensive care syndrome (PICS). We present 2 patients who survived treatment in an ICU. ⋯ He was treated for 55 days in the ICU. He ultimately survived, but later developed a post-intensive care syndrome that had a long-lasting impact on his quality of life. Early rehabilitation and the limited use of sedatives might mitigate the severity of this syndrome.
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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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The use of creams is considered to be generally safe. However, systemic side effects can occur. ⋯ An overdose of EMLA cream, whether or not in combination with laser-induced skin damage, can produce a high systemic o-toluidine concentration. This can lead to methaemoglobinaemia. In such cases, the pulse oximeter is not reliable for measuring the oxygen saturation; therefore, blood gas analysis is necessary for making a diagnosis.