Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Mar 2008
Review[Practical questions related to self-measurement of blood pressure].
The results of self-measurements of blood pressure predict the risk of developing cardiovascular disease better than those of blood pressure measurements taken at the GP surgery or hospital. In spite of the increasing availability of devices for home measurement, exactly how, by whom, with what and when, blood pressure should be measured at home remains unclear. Self-measurement is to be recommended as a supplement to conventional blood pressure measurement, as, in this way, the white-coat effect and masked hypertension can be recognized. ⋯ A limit for home measurement of 135/85 mmHg should be adhered to. When blood pressure measurements taken at home lead to a different conclusion than those taken at hospital or GP surgery (and if there is no white-coat or masked hypertension), it is recommended that the procedure be repeated. If after this, there is still a discrepancy between the results of these two methods of blood pressure measurement, ambulatory 24-hour blood pressure measurement will perhaps provide the definitive answer to the 'real' level of the patient's blood pressure.
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Ned Tijdschr Geneeskd · Feb 2008
Review[Prognosis for patients in a coma following cardiopulmonary resuscitation].
Most patients with post-anoxic coma after resuscitation have a poor prognosis. Reliable prediction of poor outcomes (death or vegetative state after 1 month; death, vegetative state or severe disability after at least 6 months) at an early stage is important for both family members and treating physicians. ⋯ The predictive value of a status epilepticus or serum levels of neuron-specific enolase is uncertain at this time. In contrast to poor outcomes, good neurological recovery cannot be predicted reliably at this time.
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Ned Tijdschr Geneeskd · Feb 2008
Review[Induced mild hypothermia to limit neurological damage after resuscitation].
Despite improvements in resuscitation techniques, the prognosis for patients who experience cardiac arrest outside of a hospital remains relatively poor. This is mainly due to brain damage that occurs as a result of global cerebral ischaemia. In 2002, two prospective randomised multicentre studies demonstrated that induced mild hypothermia can increase the chance of good neurologic recovery after out-of-hospital cardiac arrest by at least 40%. ⋯ A safe and effective method to induce mild hypothermia is the infusion of cold fluids during sedation and mechanical ventilation. Cardiac function, renal function and electrolytes must be monitored closely during induced mild hypothermia. Given the potentially deleterious effects of rapid rewarming, a maximal rewarming rate of 0.5 degrees C per hour is recommended.
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--The incidence of type 2 diabetes mellitus is increasing, as is the rate of related long-term complications. --Increased body weight and lack of exercise are the major non-genetic factors that are responsible for the increased incidence of type 2 diabetes mellitus. --People predisposed to developing type 2 diabetes mellitus can be identified easily by taking a patient history (e.g. genetic predisposition, gestational diabetes, medication), performing a physical examination (e.g. body-mass index, fat distribution) and laboratory tests (e.g. impaired fasting and post-load blood glucose levels). --Intensive lifestyle modifications reduce the risk of type 2 diabetes mellitus by 42-58%. --Drug therapy is less effective than lifestyle modifications in the prevention of type 2 diabetes mellitus. Moreover, the disease course after treatment is discontinued is unknown. --Successful intervention resulting in a sustained effect is expected to have a preventive effect on the long-term complications of type 2 diabetes mellitus.
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Ned Tijdschr Geneeskd · Jan 2008
Review[Trigeminal autonomic cephalalgias: three forms of unilateral, short-lasting headache with facial autonomic symptoms].
--Trigeminal autonomic cephalalgias (TACs) include cluster headache, paroxysmal hemicranias and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCTs). --Because they are rare, it is often difficult to recognise TACs in practice. Hallmarks of TACs include the strictly unilateral pain near the eye or temple, the accompanying autonomic symptoms, and the specific pattern in the timing of the attacks. --The TAC subtypes differ in the duration and frequency of attacks. Differentiating TAC subtypes is important because it affects the treatment approach. --In rare cases, TAC results from an underlying structural disorder. Neuroimaging (cerebral MRI) is advised in all patients with TAC.