Nederlands tijdschrift voor geneeskunde
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Despite well-known differences in drug response between children and adults, dosing guidelines for children are usually developed by extrapolating the results from studies in adults. Instead of body weight, insight into the pharmacokinetics and pharmacodynamics of drugs should serve as the basis for dosing in children. ⋯ With a population approach, the covariates that affect the pharmacokinetics and pharmacodynamics of drugs can be identified in a covariate analysis; examples of covariates include body weight, age, degree of illness and genetic factors. Drugs that serve as a model for a specific elimination route provide the basis for individualized dosing guidelines for children.
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Quantitative sensory testing (QST) consists of several non-invasive, standardised tests aimed at examining different aspects of the entire somatosensory nervous system. Important advantages of QST over existing supplementary tests such as electromyography are the ability to test the function of thin and unmyelinated nerve fibres as well as the subjective sensation of a somatosensory stimulus. ⋯ In scientific research, QST is useful in the study into pathophysiological mechanisms of diseases and syndromes with sensory symptoms and in the evaluation of the effect of analgesic treatment on the function of the somatosensory nervous system. In the future, QST could be a useful diagnostic and prognostic test in more forms of neuropathy and in other clinical conditions such as chronic unexplained pain syndromes (e.g. fibromyalgia and whiplash-associated disorder.
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Ned Tijdschr Geneeskd · Jan 2013
Review[Measuring cerebral vasoregulation--the possible clinical implications].
Cerebral vessels can keep cerebral perfusion more or less constant. This process is called cerebral vasoregulation and can be measured using different neuromonitoring techniques, which will be discussed in this overview. Cerebral perfusion deficits after brain damage caused by a cerebrovascular accident (CVA), subarachnoid haemorrhage (SAH) or severe traumatic skull and brain injury (TSBI) can be detected early and better understood by using these techniques. ⋯ Other techniques are suitable for the global long-term monitoring of vasoregulation ('monitoring' assessment) where the results could serve as feedback for treatment interventions. Appropriate use of the techniques in daily clinical practice requires standardisation of the methods available for the monitoring of cerebral vasoregulation. Presently, use is mostly restricted to the research setting.
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Sudden unexpected death in epilepsy (SUDEP) is the most important direct epilepsy-related cause of death. Patients with refractory epilepsy are at especially high risk of SUDEP. ⋯ Achieving seizure freedom is the best way to prevent SUDEP. Nocturnal supervision may be another alternative preventive strategy, but this requires further research.
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Ned Tijdschr Geneeskd · Jan 2013
Review[Treatment of cartilaginous defects in the knee: recommendations from the Dutch Orthopaedic Association].
Cartilaginous defects in the knee occur frequently and can cause the patient considerable limitations. They are diagnosed and classified by means of MRI and arthroscopy. The surgical options available to treat deep chondral lesions include bone marrow stimulation techniques (microfracture treatment), chondrocyte therapies (autologous chondrocyte implantation) and tissue replacement therapies (osteochondral autologous transplantation). ⋯ Autologous chondrocyte implantation is a suitable method for treating single symptomatic chondral lesions larger than 2 cm2 in adults up to 50 years of age. There are no significant differences regarding the effectiveness of microfracture treatment, autologous chondrocyte implantation and osteochondral autologous transplantation for small defects: all show good clinical and functional short- and medium-term results. New second- and third-generation autologous chondrocyte implantation techniques seem to yield more sustainable tissue repair and better clinical long-term results for lesions larger than 4 cm2 in comparison to microfracture treatment.