Nederlands tijdschrift voor geneeskunde
-
Classic idiopathic trigeminal neuralgia is characterized by sharp unilateral shooting pain in the distribution of one or more branches of the trigeminal nerve. It involves a diagnosis of exclusion. Initially, therapy consists of medical therapy, preferably with carbamazepine or oxcarbazepine. ⋯ In case of surgical contraindications, there are other options: radiosurgery or a neurodestructive procedure of the trigeminal ganglion. Short-term outcomes after neurodestructive therapy are good, however effects diminish over time. Every patient with idiopathic trigeminal neuralgia in whom medical therapy has failed, should be counselled at an experienced centre in which neurosurgical treatment is available.
-
Ned Tijdschr Geneeskd · Jan 2014
[People with dementia have more contact with their general practitioners: contact with GPs peaks around the time of diagnosis].
To investigate how often and why people with dementia and their partners have contact with the general practitioner (GP) before and after the diagnosis of dementia. ⋯ People with dementia have more contact with their GP than people without dementia. From 1.5 years before diagnosis they visit the GP with specific complaints more often. Their partners also have regular contact with their GP, especially in the year after diagnosis.
-
The prevalence of ticks seems to have increased with time, and the number of patients with Lyme disease in the Netherlands is also increasing. Lyme disease and other tick-transmitted diseases now attract a lot of attention. Several national initiatives at different levels are now in progress, with the aim of suppressing Lyme disease and providing better care for patients with indications of having these diseases. A more uniform approach between different treatment centres, joint research and further expansion of education and continuing education for physicians and the public could lead to further improvement.
-
Ned Tijdschr Geneeskd · Jan 2014
[Pain registration: for the benefit of the inspectorate or the patient?].
Increasing attention is currently being directed to the measurement and treatment of pain. A recent study concluded that the implementation of a patient safety programme was successful because 99% of the hospitals indicated that they measure postoperative pain. However, another recent study, evaluating this safety programme, concluded that hospitals could improve the implementation of pain measurements, as only 56% of the postoperative patients were subject to standardized pain measurements during the first 3 days following surgery. ⋯ The attitude towards pain needs to change; too often it is still considered as an uninteresting side effect of treatment. Insight in the internal utility and effects of pain registration might help to further improve the quality of postoperative pain management. Acute Pain Service teams should have a facilitating role.
-
Sentinel lymph node biopsy provides melanoma patients with important prognostic information and improves staging and regional tumour control, while the morbidity is limited and the subsequent quality of life is good. The most important result of the only randomised study is the improved ten-year melanoma-specific survival in node-positive patients with an intermediate thickness melanoma. We recommend sentinel lymph node biopsy as a standard diagnostic procedure for these patients. Sentinel lymph node biopsy can be considered in patients with a thinner or thicker melanoma.