Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2013
[A deceased child as organ donor: a major sacrifice asked of the parents].
A shortage of organs is the key factor limiting transplantation in children. In the Netherlands, the Dutch Organ Donation Act allows voluntary registration. Citizens aged 12 years and older may register as organ donors of their own free will. ⋯ Alternatives such as living-related donor programs have been established as well as recruitment of child donors. A recent study evaluates the procurement of organs and tissues in pediatric intensive care units. This commentary questions this practice in light of voluntary registration and the resulting shortage of donor organs in general.
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Ned Tijdschr Geneeskd · Jan 2013
Review['Postoperative pain treatment' practice guideline revised].
On the initiative of the Dutch Association of Anaesthesiologists, a multidisciplinary workgroup has revised the 2003 practice guideline on 'Postoperative pain treatment' for adults and children. The main reason for revision was the availability of new drugs and new methods of administration. The most important deviations from the previous edition are the following. ⋯ In patients with relative contraindications for epidural analgesia, peripheral and locoregional blocks or multimodal pain treatment are advised. In the case of postoperative nausea and vomiting, administration of dexamethasone, droperidol and 5-HT3-antagonists is recommended, preferably in combination. Non-medicinal treatment options are not recommended.
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Ned Tijdschr Geneeskd · Jan 2013
Review Case Reports[Addison's disease, primary adrenal insufficiency in adults].
Adrenal insufficiency is a rare but fatal disease if left unrecognized. Symptoms often mimic more prevalent diseases. We discuss three patients with primary adrenal insufficiency. ⋯ Treatment consists of glucocorticoid and mineralocorticoid replacement. Primary adrenal insufficiency is a 'master of disguise'. Unexplained syncope, vomiting, weight loss or hypoglycemia should prompt suspicion of this disease.
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Ned Tijdschr Geneeskd · Jan 2013
Case Reports[Splenic rupture not always painful: diagnostics after blunt abdominal trauma].
In blunt abdominal traumata the spleen is the most frequently and often the only injured organ. Splenic rupture can result in severe abdominal pain and haemodynamic instability, but may only have mild symptoms. A normal physical exam following abdominal trauma does not exclude splenic rupture. ⋯ Intra-abdominal injuries after blunt abdominal trauma can present late and with only mild symptoms. New or progressive symptoms indicate the need for further imaging investigations. Non-operative treatment is indicated for most haemodynamically stable patients with splenic rupture; exercise restrictions and outpatient check-ups are necessary.
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Ned Tijdschr Geneeskd · Jan 2013
Review[Secondary prevention with clopidogrel after TIA or stroke].
In patients with TIA or stroke of arterial origin various antiplatelet agents, or combinations of these, have been found to be effective to reduce the risk of new vascular complications. International guidelines currently recommend three treatment strategies with antiplatelet agents after TIA or stroke: acetylsalicylic acid in combination with dipyridamole, clopidogrel monotherapy, or alternatively acetylsalicylic acid monotherapy. In the Netherlands, current standard antiplatelet therapy after a TIA or stroke is a combination of acetylsalicylic acid and dipyridamole. ⋯ Clopidogrel monotherapy is easier to use, has fewer side effects and has recently become cheaper than the combination of acetylsalicylic acid and dipyridamole. For secondary prevention in the Netherlands we advise following the international guidelines on thromboprophylaxis after TIA or stroke. Clopidogrel could be considered as an alternative treatment to the combination of acetylsalicylic acid and dipyridamole.