Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2015
Case Reports[Two travellers returning from the tropics with persistent wounds on their feet].
Two young tropical medicine residents returned from Zanzibar with multiple aching wounds on their toes that did not heal within 6 weeks. The clinical picture fit 'tungiasis', which is caused by Tunga penetrans, also known as jigger or sandflea. The ectoparasites were surgically removed and the status of tetanus vaccination was checked.
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Ned Tijdschr Geneeskd · Jan 2014
Review Case Reports[Acute arthritis in sarcoidosis: Löfgren's syndrome].
Sarcoidosis is a systemic inflammatory disease usually presenting with pulmonary symptoms. However, acute arthritis could be the presenting sign of sarcoidosis. We present a 47-year-old man with bilateral arthritis of the ankles, erythema nodosum and bilateral hilar adenopathy on the chest X-ray. ⋯ Acute arthritis in patients with sarcoidosis with or without the complete Löfgren's syndrome has a good prognosis. Usually the signs and symptoms will disappear within a few months. Unlike other forms of sarcoidosis, Löfgren's syndrome does not require histological proof of non-caseating granulomas.
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In 2008, approximately 1,559,000 Dutch patients consulted their GP because of back pain. One out of 20 back pain patients is ultimately referred to a specialist, most often to a neurologist. ⋯ Scientific evidence in systematic reviews is scarce for the treatments we investigated because of small patient groups and a lack of randomised research. We made an infographic to show the numbers of patients with back pain who visit their GP or a specialist.
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Ned Tijdschr Geneeskd · Jan 2014
Review Case Reports[Diagnostic evaluation of β-lactam antibiotic allergy].
Many patients report a β-lactam allergy or hypersensitivity without actually having this allergy. Targeted questioning, in combination with an accurate description of the nature of the symptoms, leads to rejection of a large number of these presumed allergies. In a suspected allergic reaction one has to distinguish between the potentially life-threatening, acute type I mediated allergy and delayed type IV skin reaction. ⋯ Patient B was a 58-year-old man with anaphylaxis triggered by amoxicillin/clavulanate as a result of a selective allergy to amoxicillin. Patient C was a 50-year-old man who had had a possible reaction to a penicillin in his childhood. Analysis in an allergology department can be useful for further treatment.
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In the past 10 years there have been major advances in the treatment of cardiac arrest by the application of therapeutic hypothermia (TH). TH is a safe treatment option, providing the physiological effects are taken into consideration and providing the potential pitfalls of application of hypothermia are avoided. TH (32-34°C) is just as safe and effective as cooling to 36°C ('near-normal temperature'). ⋯ The broad spectrum of pathophysiological mechanisms by which therapeutic hypothermia exerts its effect on organism in a hypoxic situation suggests a potential wider role for this therapy than in current daily clinical practice. Cardiogenic shock is no longer regarded as a contraindication for TH; in the past few years the safety and effectiveness of this treatment have been proven in patients with cardiogenic shock. In fact, the anti-ischaemic and positive inotropic effects of TH suggest that this treatment could be a potential treatment specifically for patients with cardiogenic shock.