Nederlands tijdschrift voor geneeskunde
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A 35-year-old woman with a history of gastric bypass presented with acute abdominal pain, nausea and an urge to move. She showed normal vital signs. We found abdominal guarding and elevated ASAT, ALAT and LDH. A CT scan showed the whirl sign, caused by a mesenteric herniation through the Roux-en-Y gastric bypass.
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Necrotising soft tissue infection (NSTI) is an infection of the subcutaneous tissues and often follows a fulminant course if not recognised in time. ⋯ NONE DECLARED.
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- Medication-overuse headache is a highly prevalent disorder with a major impact on the quality of life.- Medication-overuse headache is defined as headache on ≥ 15 days per month with overuse of acute headache medication for ≥ 3 months. We talk about overuse in case of intake of simple analgesics on ≥ 15 days per month or triptans or combinations of analgesics on ≥ 10 days per month.- The underlying type of headache is usually migraine or tension-type headache.- One of the possible underlying mechanisms of medication-overuse headache is changed sensitivity as a consequence of central sensitisation.- The initial treatment is detoxification of the headache medication. The preferred detoxification method is outpatient, abrupt withdrawal of all acute-headache medication and caffeine-containing products. Essential for successful detoxification is education about the reasons for detoxification, the expected course and the subsequent treatment.
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Duodenoscopes for Endoscopic Retrograde Cholangiopancreatography (ERCP) are used for diagnostic and, presently predominantly, for minimally invasive therapeutic procedures involving the biliary tree and the pancreatic duct. In 2012, in the Erasmus MC in the Netherlands, a large outbreak of multidrug-resistant bacteria was caused by a contaminated duodenoscope; its design was such that thorough cleaning was not possible. ⋯ In view of the recent outbreaks, it is imperative that all relevant parties (manufacturers, regulatory bodies, government agencies, gastroenterologists and medical microbiologists) actively contribute to the development of standard operating procedures that - in the interim - minimise the risk of contamination. In the long-term, novel duodenoscope designs and innovation in cleaning, disinfection and/or sterilization techniques must prevent interpatient transmission of bacteria during ERCP.
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The aim of these studies was to examine the influence of hospital of diagnosis on the probability of receiving curative treatment and its impact on survival among oesophageal and gastric cancer. ⋯ The variation in probability of undergoing potentially curative treatment for oesophageal and gastric cancer between hospitals of diagnosis and its impact on survival indicates that treatment decision-making for these patients may be improved. Regional expert multidisciplinary team meetings in this field may improve the selection of patients for curative treatment.