Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2015
Case Reports[Fever with a rash caused by chronic meningococcemia].
Fever with a rash is a common clinical presentation, which can be caused by various medical conditions. ⋯ Chronic meningococcemia is a rare manifestation of meningococcal infection and should be considered in patients with prolonged fever, purpuric skin lesions and joint involvement.
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Ned Tijdschr Geneeskd · Jan 2015
[Ethical aspects of clinical drug research in critically ill children].
All critically ill children admitted to a paediatric intensive care unit (PICU) receive drug treatment. However, the majority of these drugs has never been tested in these children, and their safety and efficacy have not been proven. Clinical drug research is therefore required in this patient group. ⋯ The PICU environment and the vulnerable population raise specific ethical challenges and mean that the research should be designed and conducted with care. The ethical challenges are related to 4 areas: a) study design and conduct; b) informed consent from parents and children; c) burden and risk for the child; and d) research or experimental treatment. These challenges and possible solutions will be discussed in this article.
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Ned Tijdschr Geneeskd · Jan 2015
Case Reports[A young woman with skin necrosis after sclerotherapy].
A 23-year-old woman developed painful skin necrosis after injections with lauromacrogol 400 for varicose veins. This complication, called embolia cutis medicamentosa or Nicolau syndrome, is characterised by acute pain and necrosis of the skin, subcutaneous tissue and muscle. Surgical intervention by local excision seems to be the best therapy.
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Malrotation occurs when there is a failure in the intestinal rotation leading to abnormal fixation to the abdominal wall and a mesentery with a short root. Volvulus is a life-threatening complication of malrotation. It can lead to irreversible intestinal necrosis and requires immediate attention. ⋯ Case B, a 1-month-old female, was taken to the general practitioner after acute onset of crying and flexing of the legs. Case C, a 5-year-old-boy with no medical history, had started vomiting hourly. In presenting these 3 cases, we highlight the dangers of untreated malrotation and make recommendations on how to manage a patient suspected of having this congenital abnormality.
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Ned Tijdschr Geneeskd · Jan 2015
Biography Historical Article[David Sackett and 25 years of evidence-based medicine: person and the context].
David Sackett, the father of evidence-based medicine (EBM), died recently - exactly 25 years after the term EBM was coined. This coincidence calls for reflection on the historical significance of EBM and on Sackett's role. ⋯ However, context alone does not explain everything; the course of history - and the history of EBM - is partly determined by special men and women, individual reformers who manage to set things and people in motion. David Sackett is an excellent example of this.