Nederlands tijdschrift voor geneeskunde
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Awareness with recall is defined as 'both conscious experience and memory of events during surgery'. Perceptions of sound, pain or paralysis and assimilation of these in the memory can lead to post-traumatic stress disorder. Prospective studies report an incidence of 0.1-1%. ⋯ No additional benefit has been shown for the use of bispectral index (BIS) monitoring compared with measuring the expired concentration of an inhaled anaesthetic agent. High-risk patients undergoing total intravenous anaesthesia may benefit from BIS for monitoring depth of anaesthesia. Further scientific investigation of the neurological processes involved in awareness with recall is required in order to develop novel monitoring techniques.
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Ned Tijdschr Geneeskd · Jan 2015
Review[Bronchoscopic interventions in severe COPD: improvement of pulmonary function, exercise capacity and quality of life].
The current drug treatment of patients with severe and very severe COPD is often insufficient to achieve an acceptable quality of life. Surgical treatment of patients with COPD, by means of lung volume reduction surgery or lung transplantation is invasive and only available to a limited number of patients. ⋯ In selected patients with severe emphysema, bronchoscopic lung volume reduction brings about a clinically relevant improvement in pulmonary function, exercise capacity and quality of life. In view of the innovative and specialist nature of bronchoscopic lung volume reduction, it is prudent to perform this treatment in a centre of expertise for COPD.
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The clinical condition "winged scapula" (scapula alata) is frequently not recognized as such. The accompanying symptoms are often attributed to more frequently occurring shoulder disorders, which can lead to unnecessary surgical procedures. ⋯ Shoulder symptoms due to scapula alata can be caused be a penetrating wound leading to nerve injury. The treatment of patients with a scapula alata calls for a multidisciplinary approach.
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Ned Tijdschr Geneeskd · Jan 2015
Comment[New potassium binders effective: treatment of hyperkalaemia secondary to RAAS inhibitors].
This commentary discusses two recent publications by Weir et al. and Packham et al. in The New England Journal of Medicine on the efficacy of two novel potassium binders, sodium zirconium cyclosilicate and patiromer. In a similar manner to existing potassium binders, these drugs exchange dietary potassium for either sodium or calcium in the gut, thereby preventing absorption of potassium. Both drugs were tested against placebo in patients with chronic kidney disease who developed hyperkalaemia because they were also using renin-angiotensin-aldosterone system (RAAS) inhibitors. ⋯ A strong point in the trials is that the new potassium binders allow patients to continue using RAAS inhibitors. By doing so, these patients with high cardiovascular risk may continue to benefit from the protective effects of RAAS inhibitors. Limitations include the relatively short treatment period, the lack of a control group using existing potassium binders, and the exclusion of patients with severe or symptomatic hyperkalaemia.
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Ned Tijdschr Geneeskd · Jan 2015
Review[Neurosarcoidosis and paraneurosarcoidosis: new online registration of patients].
The clinical spectrum of neurosarcoidosis is highly diverse; virtually any neurological syndrome can present, depending upon granuloma localization. There are indications that neurosarcoidosis is insufficiently recognized as a separate clinical entity. In the absence of major prospective clinical trials, we launched a large national online registry of neurosarcoidosis patients in the Netherlands in June 2014 at www.neurosarcoidose.nl. ⋯ Neurological symptoms causing disability are an indication for immunosuppressive therapy. There is increasing evidence for the effective treatment of refractory neurosarcoidosis using biologicals. Whether the intravenous administration of immunoglobulins or ARA290, an erythropoietin derivative with TNF-α-antagonistic and tissue-protective characteristics, is effective for small nerve fibre neuropathy in sarcoidosis is subject for study.