Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Dec 1997
Review[Revision consensus hemophilia: treatment and responsibility. Nederlandse Vereniging van Hemophilia Patients].
Haemophilia is an X-linked clotting disease occurring in 1400 men in the Netherlands. As the result of factor VIII or IX deficiency, haemophilia patients suffer from severe bleedings, spontaneous or caused by trauma. Bleedings mostly occur in major joints and muscles. ⋯ Over the last 20 years haemophilia treatment has improved much. This has resulted in a decrease of the number and of the duration of hospitalization, and a decrease in days lost at school or work. This has led to great improvement of the social life of haemophilia patients.
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Ned Tijdschr Geneeskd · Nov 1997
Review[Salt sensitive blood pressure and the renin-angiotensin system in hypertension].
The relationship between (excessive) use of sodium chloride and the blood pressure is still equivocal. Blood pressure responses to alterations in dietary salt consumption vary greatly between individuals, which has led to the concept of salt sensitivity. ⋯ A relative inability of this system to respond promptly to alterations in salt intake may underlie the development of salt sensitivity. By administering drugs which block the renin-angiotensin system to patients with essential hypertension, blood pressure is rendered more sensitive to the effects of salt restriction and (or) diuretic treatment.
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Ned Tijdschr Geneeskd · Oct 1997
Review[High-dose chemotherapy followed by hematopoietic stem cell transplantation as therapy for systemic rheumatic autoimmune diseases].
Remissions of autoimmune diseases can be accomplished in animals by myeloablative chemotherapy followed by allogeneic or autologous bone marrow transplantation. Remissions of autoimmune diseases have been reported in patients with concomitant malignancies for which they were treated with myeloablative chemotherapy followed by stem cell transplantation. Survival of patients with systemic rheumatic autoimmune disease is reduced. Since transplantation related mortality after autologous stem cell transplantation is less than 5%, this treatment becomes a possibility for patients with severe systemic rheumatic autoimmune disease, such as systemic sclerosis.
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Ned Tijdschr Geneeskd · Sep 1997
Review[Is the pulmonary artery catheter discredited because of ignorance?].
Recently in an observational study the use of a pulmonary artery catheter in critically ill patients was associated with an increase in both mortality and utilization of resources when compared with case-matched control patients. The authors corrected for selection bias by using a propensity score. The publication of this article elicited a flood of commentary in both medical journals and the lay press. Critical assessment of this study and other studies about pulmonary artery catheterization in our opinion supports the view that it is probably not the use of the catheter itself, but physicians' insufficient knowledge of right heart catheterization and the specific treatment resulting from its use that is at fault.
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Ned Tijdschr Geneeskd · Apr 1997
Review[Clinical application of albumin: a closer look at indications].
Albumin infusions are given far from always on the correct indications, and often there are alternatives that are cheaper and equally suitable. In septic or hypovolaemic shock, crystalline fluids are cheaper and equally efficacious for volume therapy. ⋯ In decompensated hepatic cirrhosis with ascites, it appears useful to combine paracentesis with albumin infusion, to prevent renal insufficiency and hyponatraemia, but other colloidal fluids are probably equally suitable. Combating hypoalbuminemia as such is not useful in seriously ill patients; it is the underlying disease that should be treated.