Nederlands tijdschrift voor geneeskunde
-
Ned Tijdschr Geneeskd · Nov 2006
Review[Coagulation disorders in patients with trauma to the skull and brain: a frequent and potentially fatal combination].
Abnormalities in blood coagulation are relatively common after traumatic brain injury (TBI) and play an important role in the morbidity and mortality after head injuries. Exposure oftissue factor, which is abundantly present in brain tissue, is the initiator of the coagulation cascade and plays an important role in the pathogenesis of coagulopathy after TBI. Coagulopathy after TBI is actually a manifestation of the disseminated intravascular coagulation (DIC) syndrome. ⋯ The DIC score, a combination of frequently used coagulation parameters, is not only a measure of the coagulopathy but can also predict the outcome and prognosis following TBI. Primary and secondary prevention of coagulopathy together with timely and effective intervention are the most important elements in the treatment of coagulation disorders. Nevertheless, the risk of death remains high.
-
The prevalence of overweight individuals in The Netherlands is increasing sharply as has also been observed in populations worldwide. In addition to the long-term health risks of being overweight, overweight women of reproductive age are more commonly faced with reproductive disorders. Women who are overweight are less fertile than women of normal weight. ⋯ The chance of a live birth is also decreased due to an increased risk of miscarriage. Furthermore pregnancy outcome is compromised by obesity-related complications of pregnancy. Weight loss of 5-15% in subfertile women who are overweight increases the chance of spontaneous conception and conception after fertility treatment and can be achieved through a low-calorie diet, increased exercise and behaviour modification.
-
Ned Tijdschr Geneeskd · Nov 2006
Comment Review[Deep-vein thrombosis and pulmonary embolism due to air travel].
In recent years, the association between air travel and the incidence of deep-vein thrombosis or pulmonary embolism has become clearer. Epidemiologic studies reveal an increased relative risk of thromboembolism after flights of more than 8 hours and especially in subjects at higher risk for this disease, due, for example, to congenital thrombophilia or the use of oral contraceptives. However, the absolute risk of deep-vein thrombosis or pulmonary embolism after prolonged air travel is very small. ⋯ Acetylsalicylic acid is not effective in the prevention of thrombosis during air travel and may be dangerous. Prophylactic subcutaneous low molecular weight heparin may be effective to prevent air travel-associated thrombosis. However, pending more solid evidence, this strategy should only be used cautiously, e.g. only in patients with a high risk of thrombosis who are planning a long flight.
-
Ned Tijdschr Geneeskd · Nov 2006
Review Meta Analysis[From the Cochrane Library: wearing compression stockings during long-distance flights reduces the risk of asymptomatic deep-vein thrombosis].
A recent Cochrane systematic review assessed the effects of wearing compression stockings during long-distance flights on the risk of deep-vein thrombosis (DVT). Ten randomised trials were included, 9 of which compared wearing compression stockings on both legs during the whole flight (at least 7 hours) with not wearing compression stockings. ⋯ Wearing stockings had a significant impact in reducing oedema of the lower legs. No significant adverse effects of wearing stockings were reported.
-
Ned Tijdschr Geneeskd · Nov 2006
Review Meta Analysis[From the Cochrane Library: wearing compression stockings during long-distance flights reduces the risk of asymptomatic deep-vein thrombosis].
A recent Cochrane systematic review assessed the effects of wearing compression stockings during long-distance flights on the risk of deep-vein thrombosis (DVT). Ten randomised trials were included, 9 of which compared wearing compression stockings on both legs during the whole flight (at least 7 hours) with not wearing compression stockings. ⋯ Wearing stockings had a significant impact in reducing oedema of the lower legs. No significant adverse effects of wearing stockings were reported.