Nederlands tijdschrift voor geneeskunde
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A 67-year-old male and a 43-year-old female were referred to hospital with headaches after intracranial pressure increasing activities, such as coughing. Both patients were diagnosed with primary cough headache. In the case of the first patient, this diagnosis was considered shortly after presentation. ⋯ Primary cough headache should be differentiated from secondary cough headache, in which the symptoms are caused by structural abnormalities of the brain. Additional investigation is required to differentiate between the two. The diagnosis of primary cough headache is supported by a positive reaction to trial treatment with indomethacin.
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Ned Tijdschr Geneeskd · Jan 2009
Case Reports['Acute respiratory distress syndrome' (ARDS) as a serious complication of influenza].
'Acute respiratory distress syndrome' (ARDS) developed as a serious complication of an infection with the influenza virus A (H1N1) ('swine flu') in 3 children: a 15-year-old girl, a 6-year-old boy and a 14-year-old girl. The latter two patients also suffered from septic shock. ⋯ The first two patients eventually recovered following treatment with extracorporeal membrane oxygenation (ECMO), but the third patient's condition was too unstable for transfer to an ECMO centre. This patient died.
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To gain insight into the outcomes of postoperative pain treatment using patient-controlled intravenous analgesia (PCIA) with morphine and oral analgesics after total hip or knee arthroplasty (THA or TKA). ⋯ In view of the somewhat disappointing effectiveness and the side effects of a PCIA pump with morphine and oral analgesics, adjustments in the treatment of pain following THA and TKA are required. The greatest improvement can be realised on the day of surgery and the first postoperative day.
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A 55-year-old man with exertional dyspnoea had a chest X-ray with the Westermark sign and a CT scan showing a Hampton hump. Bilateral pulmonary embolisms were diagnosed.
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Since its introduction in 1984, selective decontamination of the digestive tract has had clear supporters and opponents. De Smet et al. conducted a large national study in 13 Dutch intensive care units, investigating the effects of the following 3 regimens on mortality: standard treatment, selective decontamination of the digestive tract and selective oropharyngeal decontamination. The results showed decontamination to have a clear benefit in terms of reducing mortality. Based on these results, decontamination should be used in all intensive care patients.