Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2011
Review[Perioperative 3D fluoroscopy of intra-articular fractures of the extremities].
During operative treatment of intra-articular fractures of the extremities, 2D fluoroscopy is often used for assessing the quality of fracture reduction and fixation and for making any necessary corrections. Post-operative radiographs or CT scans, however, frequently reveal suboptimal reduction or fixation of the fracture. To help prevent this, a 3D-fluoroscopy technique that can be used during surgery has been developed. ⋯ The diagnostic value of 3D fluoroscopy is comparable to that of CT scanning. Extra corrections were performed during a considerably high percentage of operations (11-39%) using 3D fluoroscopy; it is unknown, however, whether corrections are required of all the defects detected. In a randomised clinical trial, we are currently investigating the added value of 3D fluoroscopy in terms of the quality of procedures involving the reduction and fixation, as well as patient-relevant outcomes such as pain and joint function in the long term.
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The Hajj, the pilgrimage to Mecca, is the largest mass migration in the world. Each year, 2.5 million Muslims from over 160 countries travel to the same place, 5000-6000 of these being from the Netherlands. ⋯ The chance of transmission of infective disease is also high and rapid contagion of Hajj pilgrims could cause a pandemic. It is therefore important that the responsible doctor is aware of the health risks to the Hajj pilgrim and his environment.
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3-5% of patients with traumatic or iatrogenic peripheral nerve injury develop a painful neuroma, especially following trauma of small cutaneous sensory nerve branches. Neuroma pain is difficult to treat and often leads to loss of function and reduction of quality of life. Patients with a painful neuroma present with spontaneous electric, shooting or burning pain, allodynia, hyperalgesia and cold intolerance. ⋯ Lasting pain relief is possible by means of surgical neuroma treatment performed by a plastic surgeon. Surgical treatment consists of repair or denervation of the nerve with relocation of the nerve stump in bone or muscle tissue or a vein. Referral of neuroma patients without delay to a plastic surgeon or multidisciplinary consultation is important, because the symptoms become increasingly difficult to treat over time.
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Ned Tijdschr Geneeskd · Jan 2011
Review[Physical examination of patients with acute abdominal pain].
Reliable physical examination of patients presenting with acute abdominal pain and tenderness is necessary for identifying serious causes on the one hand, and for preventing further unnecessary imaging on the other. If acute appendicitis or peritonitis is suspected, positive palpatory findings like rigidity and guarding are helpful diagnostic indicators, whereas negative palpatory findings have little value in excluding these conditions. ⋯ Visible peristalsis strongly argues for small bowel obstruction, but this sign is rarely present. Digital rectal examination appears to have no added diagnostic value for appendicitis, peritonitis, or small bowel obstruction.
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Ned Tijdschr Geneeskd · Jan 2011
Case Reports[Pitfalls in the treatment of neuropathic pain in patients with cancer].
Three patients with cancer experienced severe side-effects after starting anti-neuropathic pain therapy. All patients, 1 woman and 2 men aged between 69 and 71, fell or had problems with balance. ⋯ There is little research into the treatment of neuropathic pain in patients with cancer. In this patient group it is advisable to monitor the patient at least once a week for an optimal treatment and to prevent severe side-effects, especially in the first weeks after starting the treatment.