Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2002
Review Case Reports[Complex visual hallucinations in partially sighted elderly: Charles Bonnet syndrome].
In two patients, women aged 85 and 80 years, who suffered from visual hallucinations involving living creatures, cars and buildings, Charles Bonnet syndrome was diagnosed. Both were worried that these signs were an indication of a severe psychiatric condition. ⋯ Patient education and reassurance are the cornerstones of treatment. Other possible treatments are: improving visual acuity and the general physical condition, stopping medication with hallucinogenic side effects, activating the patient, coaching the patient in avoiding hallucination-triggering situations and using stopping strategies, and (still experimental) pharmacological treatment with carbamazepine, valproate, ondansetron or cisapride.
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Ned Tijdschr Geneeskd · Dec 2001
Review[Acute renal replacement therapy in the intensive care unit].
On the intensive care department the most frequently used acute renal replacement techniques are intermittent haemodialysis and continuous haemofiltration. Although continuous techniques appear to have distinct advantages in the treatment of critically ill patients, no consistent differences in mortality have been found between continuous and intermittent treatment modalities. Due to uncertainty in this area, the use of unmodified cellulose membranes is probably best avoided. ⋯ With continuous techniques, the filtration volume should not be below 35 ml/kg/h. Although continuous (high-volume) filtration techniques may contribute to an improvement in the haemodynamics, the mechanisms behind this phenomenon remain unclear. At present, no randomised studies are available which have shown a beneficial effect of continuous techniques on the survival of critically ill patients without manifest renal insufficiency being demonstrated.
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Ned Tijdschr Geneeskd · Dec 2001
Review Case Reports[Spondylodiscitis in 3 children; differential diagnosis and treatment].
Three children, a 4.5-year-old boy and two girls aged 21 months and 10 years respectively, had for several weeks to months experienced lower back pain or walking problems, two of them had an elevated sedimentation and leucocytosis. The MRI scan revealed a narrowing of the lumbal disk. Furthermore, in the case of the 10-year-old girl, Staphylococcus lugdunensis was cultured from the puncture material of the disk. ⋯ In the case of (spondylo)discitis, immobilising the spine with a corset is the mainstay of treatment. Antibiotics are only indicated when osteomyelitis cannot be excluded. Generally, the prognosis is good.
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For large-scale accidents, and for specific categories of wounds there is, in addition to the extramural assistance provided by helicopter teams and mobile medical teams, a need for secondary triage so that patients can be transferred as quickly as possible and the use of limited treatment capacity for specific injuries (such as serious burns) is optimised. After the cafe fire in Volendam, 203 patients were admitted to 27 hospitals. ⋯ The mortality under 75 patients with burns and an inhalation trauma who underwent a planned curative treatment was just 5.3%. Trauma triage teams should be officially recognised within the chain of the project 'Medical assistance in accidents and disasters' (Dutch acronym: GHOR) so that together with the uniform guidelines for the treatment of specific injuries that are present in casualty departments (for example the 'emergency management of severe burns (ESMB) protocol', a protocol for the care of patients with serious burns) the quality of care can be improved.
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Two infants, a girl, aged four weeks, and a boy, aged three weeks, came to our attention with poor feeding and weight loss. Later the typical cough of pertussis appeared. Serological testing confirmed that both patients' mothers had recently had pertussis. ⋯ They then become contagious for unvaccinated infants. Pertussis during the neonatal period is an insidious disease with sometimes severe complications. If pertussis is suspected in mothers with new-born infants or pregnant women towards the end of the pregnancy, they should be treated with antibiotics to prevent pertussis in the new-born infant.