Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Nov 2001
Review Case Reports[Resection of the sciatic nerve with preservation of leg function].
Four patients, three women aged 32, 65 and 77 years and one man aged 51 years, had a soft tissue tumour of the upper dorsal thigh or gluteal region. They were treated by resection of both the sciatic nerve and the tumour. This resulted in a good functional outcome with limited functional disturbances. ⋯ The man was treated on several occasions for local recurrences of the malignancy. Patients with soft tissue sarcomas involving the sciatic nerve are often treated by amputating the affected limb. Nerve resection is a good alternative for complete tumour resection whilst still preserving the limb.
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Ned Tijdschr Geneeskd · Nov 2001
Comment Review[Preoperative examination: anamnesis and physical examination mandatory].
Preoperative assessment has been subject to discussion for many years. What should be done and by whom? Fortunately there is a general consensus that routine laboratory and function tests are not only of no benefit to the patient but are also wasteful of resources. ⋯ Efforts to validate this questionnaire have demonstrated that in practice it was not helpful. Therefore it seems justified to conclude that preoperative screening should not fundamentally differ from that performed during a basic clinical examination.
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Ned Tijdschr Geneeskd · Nov 2001
Review['Caring always'; physicians' expression of condolences to the relatives of patients].
According to the WHO definition, palliative care does not end with the death of the patient, but also includes supporting the family members in dealing with the loss. A recent article refers to the importance of physicians writing letters of condolences. The letter of condolences marks the end of the treatment relationship. ⋯ The letter can also remove any distrust that may exist towards the medical profession. Reasons for not writing a letter of condolences include an own feeling of failure, administrative difficulties, indifference or incapacity. Nevertheless, writing a letter of condolences is an integral part of the care provided by the physician to the patient and his/her relatives.
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The revised CBO guideline 'High blood pressure' details the present scientific knowledge about the detection, diagnosis and treatment of elevated blood pressure as well as the implementation of this knowledge in practice. For both systolic and diastolic increased blood pressure the risk of cardiovascular disease and mortality gradually increases. The blood pressure is considered to be elevated if the systolic pressure is > or = 140 mmHg and/or the diastolic pressure is > 90 mmHg. ⋯ The indication area for treatment is laid down in the case of elevated blood pressure and an absolute cardiovascular risk of 20% per 10 years. When the absolute cardiovascular risk is between 10% and 20% per year, treatment may be considered. For treatment the target value is the same as the criterion for elevated blood pressure.
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Ned Tijdschr Geneeskd · Oct 2001
Review[Acute pancreatitis--a protocol for diagnosis and treatment].
Acute pancreatitis remains a disease with high morbidity and mortality. Acute pancreatitis can be subdivided in acute interstitial pancreatitis and necrotising pancreatitis, largely compatible with clinically mild and severe pancreatitis. This diagnosis is made on the basis of patient history, physical examination, laboratory parameters, contrast CT scan and, occasionally, endoscopic retrograde cholangiopancreatography. ⋯ Indications for surgical intervention are: progressive sepsis despite maximum conservative management, an established infection of (peri)pancreatic necrosis, peripancreatic abscess and perforation of stomach, small intestine or colon. The purpose of an operation is to remove necrotic tissue, achieve adequate drainage of the necrotic area or to treat a perforation. The Groningen and Utrecht University Hospitals have collaborated to develop a protocol to standardise the diagnostic approach, management, timing and choice of surgical intervention, as well as to prospectively investigate the effect of such a strategy in patients with acute pancreatitis.