Nederlands tijdschrift voor geneeskunde
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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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Ned Tijdschr Geneeskd · Jan 2013
[Adverse reactions to herbal remedies: analysis of reported adverse reactions in the Netherlands].
To analyse reports of suspected adverse reactions in the use of herbal remedies in the Netherlands. ⋯ Herbs can cause adverse reactions or interactions with medicinal products, but herbal remedies can also be adulterated with regular medicines or illegal - even toxic - ingredients. Reporting adverse reactions significantly contributes to our knowledge about this subject. Physicians and pharmacists should ask patients about the use of alternative medications, particularly those based on herbs.
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Ned Tijdschr Geneeskd · Jan 2013
Case Reports[A man with acute pain of the left side of the chest].
A 42-year-old man came to the emergency department because of acute pain on the left side of the chest. Physical examination, ECG and blood tests revealed no abnormalities. With a CT scan of the thorax we made the diagnosis: 'pericardial fat necrosis'. This is a very rare, self-limiting disease.
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Ned Tijdschr Geneeskd · Jan 2013
[Does CT scan for blunt abdominal trauma in children amount to a lot of radiation for little yield?].
Blunt abdominal trauma in children occurs fairly frequently. Although computed tomography scanning is considered by many to be the gold standard, in children who are hemodynamically stable, CT images do not usually result in new perspectives that lead to changes in treatment management. ⋯ CT scanning for blunt abdominal trauma should therefore be avoided in children who are hemodynamically stable. Novel algorithms, using parameters from the patient's history, physical examination, and possibly ultrasound and laboratory tests, seem to be sufficient for ruling out intra-abdominal injury in more than 95% of cases.