Nederlands tijdschrift voor geneeskunde
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An adequate management of scaphoid fractures requires fast and reliable diagnosis. In this, proper history taking and physical examination are essential. Routine scaphoid x-rays miss over 20% of all scaphoid fractures. ⋯ A below-the-elbow cast without immobilisation of the thumb is an adequate treatment for stable fractures. Unstable fractures and all proximal pole fractures are candidates for open or percutaneous treatment. In addition to the type of fracture, patient-specific requirements are important in deciding which type of management is the most suitable.
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Gait disorders are seen frequently and often have a neurological cause. The clinical management of patients presenting with a gait disorder is often complicated due to the large number of diseases that can cause a gait disorder and to the difficulties in interpreting a specific gait disorder properly. ⋯ Gait disorders can be classified into the following categories: antalgic, paretic-hypotonic, spastic, vestibular, ataxic, hypokinetic-rigid, cautious, or functional. A correct interpretation of the gait disorder is important as this determines the diseases to be considered, the auxilliary investigations that have to be carried out, and the selection of rational therapeutic options.
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Ned Tijdschr Geneeskd · Feb 2007
Review[Angiography and embolisation to control bleeding after blunt injury to the abdomen or pelvis].
Angiography and embolisation are being increasingly used to control bleeding following abdominal and pelvic trauma. CT is a useful tool to select patients for such intervention-radiological angiography. ⋯ Angiography and embolisation are successful in about 90% of the patients; complications occur in < 10% of the patients. An accurate estimate of the patient's physical condition, a correct assessment of the severity of the injury, and a multidisciplinary approach are important factors in the success of embolisation therapy.
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Ned Tijdschr Geneeskd · Dec 2006
Review[Optimal adjuvant hormone therapy in postmenopausal women with hormone-sensitive mammary carcinoma: tamoxifen and the aromatase inhibitors anastrozole, exemestane and letrozole].
Postmenopausal patients with hormone-sensitive breast cancer may be eligible for adjuvant hormone therapy. - For years, tamoxifen was the treatment of choice. - However, the side effects associated with tamoxifen, such as endometrial cancer and thromboembolic disorders, and the search for more effective agents have led to the introduction of new hormonal therapies. - The results of randomised trials with the third-generation aromatase inhibitors anastrozole, exemestane and letrozole demonstrate improved efficacy compared to tamoxifen. - Using aromatase inhibitors, the disease-free survival is prolonged and recent data from some studies also show a benefit in overall survival. - Aromatase inhibitors are associated with specific side effects consisting of osteoporosis/increased incidence of fractures and myalgia/arthralgia.
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Illness is associated with involuntary weight loss, which is often the result of malnutrition. The undernourished surgical patient runs a higher risk of postoperative morbidity and mortality. For this reason, perioperative nutrition is an important part of a patient's therapy. ⋯ The Dutch tradition of fasting patients before surgery is difficult to defend any longer because this policy impairs patients' state of health as a result of which they are not optimally prepared for the surgical induced stress response. The postoperative recovery of all surgical patients can be improved by an early postoperative start of enteric nutrition. When the enteric administration of food turns out to be impossible, total parenteral nutrition can be given to bridge a long period without food.