Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jul 2000
Review[Preoperative outpatient evaluation of young adults by anesthesiologist: anamnesis and physical examination are satisfactory--short questionnaire of Dutch Public Health Council is not].
The report of the Netherlands Health Council 'Preoperatief onderzoek; een herijking van uitgangspunten' recommends that the health status of patients aged 16-39 years can be investigated preoperatively by the anaesthesiologist using a short questionnaire (6 questions). However, it is not clear whether such an abbreviated preoperative investigation will be informative enough for a safe and balanced anaesthesiologic management. ⋯ Only blood group, rhesus factor and the presence of irregular antibodies may need to be determined if indicated by the kind of surgery. Currently, however, there is not sufficient evidence to demonstrate that the short questionnaire of the Netherlands Health Council is informative enough.
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Ned Tijdschr Geneeskd · Jul 2000
Review Case Reports[Multitrauma patients: principles of 'damage control surgery'].
The principles of damage control surgery were applied in the cases of three severely injured multitrauma patients, men aged 47 and 33 years who had a motorcycle accident and a 66-year-old man who had a car crash. Victims of major trauma suffer from a worsening physiologic derangement manifested by the triad of acidosis, hypothermia and coagulopathy. This often leads to a vicious cycle that heralds imminent death or organ failure. ⋯ The second involves aggressive correction of the lethal triad in the intensive care unit. The third is the planned re-operation for the definitive repair of the injuries. As shown in these three patients, the appropriate use of this strategy can lead to a decrease in the morbidity and mortality in complex trauma patients.
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Ned Tijdschr Geneeskd · Jul 2000
Comment Review[Acute and chronic Q fever; epidemiology, symptoms, diagnosis and therapy of infection caused by Coxiella burnetii].
Q fever is a zoonosis caused by Coxiella burnetii, an obligate intracellular bacterium. Domestic ungulates and parturient cats are the primary reservoirs of infection. The animals excrete the bacterium in urine, faeces, milk and amniotic fluid. ⋯ Doxycycline is the antibiotic of choice in the treatment of Q fever. Endocarditis needs therapy for years with the addition of rifampin or hydroxychloroquine. Q fever is poorly recognised due to the variety of clinical presentations.
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Ned Tijdschr Geneeskd · May 2000
Review Historical Article[Fifty years of plastic surgery in the Netherlands. VI. Microsurgery].
Use of the operating microscope created many new possibilities in plastic, reconstructive and hand surgery. Initially most work was done in digital replantation and, somewhat later, in transfers of toes for reconstruction of amputated thumbs. Microvascular surgery, however, appeared to be a technique suitable for more applications. ⋯ With free flap surgery single-stage and complex reconstructions could be achieved leading to earlier mobilization and better restoration of function with a shorter hospital stay. Today, microvascular free tissue transfer is an essential part of plastic and reconstructive surgery. Further advances in microsurgery and free tissue transfers deserve to be mentioned: pre-fabrication of free flaps, reduction of donor site morbidity, development of artificial conduits and instrumentation and finally homologous transplantations.
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Ned Tijdschr Geneeskd · May 2000
Review Case Reports[Delirium? Admission to the general hospital, rather than a psychiatric hospital].
Delirium is often not recognized either by psychiatrists or by other physicians. In two men, aged 78 and 70 years, a diagnosis of delirium was not recognized at admission. ⋯ The first patient died later on because of complications of a pneumonia and the other patient was transferred to a nursing home on a maintenance dose of haloperidol. Since delirium is a symptom of a medical disorder, delirious patients should be referred primarily to a general hospital.