Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Oct 2007
Review[Guideline 'Chronic Achilles tendinopathy, in particular tendinosis, in sportsmen/sportswomen'].
--Chronic Achilles tendinopathy in sports often leads to various therapeutic strategies, medical shopping and frequently to inability to perform at the desired level. --Although it is clear that this chronic tendinopathy is not an inflammatory disease of the tendon, the cause of the degeneration of the tendon fibres is not understood. --The main therapeutic measure--based on scientific evidence--is eccentric calf-muscle training for at least 3 months. --Recent therapies such as sclerotherapy ofneovascularizations in and around the Achilles tendon appear to be promising, but more studies are required. --About 20% of the patients tend to be refractive to conservative measures. --In selected cases surgery can be undertaken, with percutaneous longitudinal tenotomy proving effective in 75-80% of the cases.
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Ned Tijdschr Geneeskd · Sep 2007
Review[Influenza vaccination in health-care workers: an effective method to reduce the consequences of influenza in health care users].
Only few usable studies into the effect of influenza vaccination of health-care workers on sick leave and influenza among their patients are available in the literature. However, together these studies provide consistent evidence that this vaccination is effective and cost effective, reducing the death rate from all causes of residents of nursing homes for the elderly by 27-44%. Therefore, measures to raise the vaccination rate among health-care workers, which is at present under 25%, are highly recommended. However, more studies in this field are needed.
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Ketamine is a new party drug, which is easy to obtain. For this reason, it is possible that physicians will be increasingly confronted with users that have medical problems. Relatively few cases of ketamine intoxication with a fatal outcome have been reported thus far. ⋯ As a result, the chance of untoward effects is increased. Anaesthetists use ketamine for short surgical procedures, sedation and analgesia. It is also used more and more often as an analgesic in patients who do not respond well to opioids.
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Ned Tijdschr Geneeskd · Aug 2007
Review[Again new resuscitation guidelines (2006): justification, costs and potential confusion].
The last revision of the Dutch resuscitation guidelines, a translation of the European Resuscitation Council Guidelines 2005, is based on the recommendations of the International Liaison Committee on Resuscitation (ILCOR). The previous Dutch guidelines were issued in 2002. Most changes are based on laboratory studies and retrospective analyses. ⋯ It would be good to prospectively evaluate the effectiveness and costs of this revision. In the future, these data might help to decide when altered international recommendations should be translated into new Dutch resuscitation guidelines. Alternative strategies should be considered, for example only changing the guidelines for advanced life support.
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Erythrocytosis is a phenomenon with life-threatening complications and a broad differential diagnosis. Erythrocytosis is usually secondary to a cardiopulmonary condition leading to a low arterial oxygen tension. ⋯ The differential diagnosis can be narrowed down by a determination of the erythropoietin concentration and the JAK2 mutation. If the erythrocytosis is found to be non-physiological, then reduction of the haematocrit via bloodletting and, depending on the diagnosis, treatment with acetylsalicylic acid are indicated.