Nederlands tijdschrift voor geneeskunde
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A 60-year-old man presented with chest pain and weight loss, starting after a period of vomiting. Contrast radiography of the esophagus revealed an esophageal-pleural fistula. The patient was successfully treated by stent placement.
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Ned Tijdschr Geneeskd · Jan 2010
Case Reports[Resuscitation of a pregnant patient--don't hesitate to perform a perimortem caesarean section].
Cardiac arrest is a rare and life-threatening complication during pregnancy. We present the case of a 26-year-old patient in her first pregnancy who during induction of labour at 41 weeks had a cardiac arrest caused by an amniotic fluid embolism. As part of the resuscitation procedure, a perimortem caesarean section was performed in the delivery room within five minutes. ⋯ Pregnancy-induced changes in anatomy and physiology warrant a different approach during resuscitation. All medical personnel involved in the care of pregnant women should be trained to act promptly in acute situations. Training should increase knowledge of the aforementioned changes and stress the importance of performing a perimortem caesarean section, when necessary, on site and without hesitation.
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Ned Tijdschr Geneeskd · Jan 2010
[Vertebroplasty: a treatment option for osteoporotic compression fractures].
Percutaneous vertebral augmentation, with percutaneous vertebroplasty (PVP) as its most widely used variant, is currently the only intervention for painful osteoporotic compression fractures. This procedure offers immediate and substantial pain relief in over 80% of treated patients with a low reported complication rate (< 1.6%). A large number of studies have shown promising results and the superiority of this treatment over conservative treatment has been established. ⋯ Limitations in the design of both trials prevented widespread implementation of the results. We believe that PVP cannot be regarded as an obsolete treatment as long as patients are carefully selected. Patients with persistent (over 2 months) and painful osteoporotic vertebral fractures have been shown to benefit from vertebroplasty and are therefore suitable candidates for this procedure, which, in these cases, can prevent complications due to long-term disabling pain.
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Traditionally, midshaft clavicular fractures have been treated conservatively. However a review of the literature reveals that certain fractures can benefit from operative repair. Conservative treatment, preferably in the form of a sling, of an undisplaced midshaft clavicular fracture leads to excellent results. ⋯ Intramedullary fixation can give good results in simple dislocated fractures, but does not provide optimal preservation of length and rotation in comminuted fractures. Plate osteosynthesis can be used for all clavicular fractures and causes a reduction of the relative risk of non-union of 86%. Due to the increased risk of non-union or malunion and of a worse functional result, osteosynthesis should be considered for patients with dislocated or comminuted midshaft clavicular fractures, with due consideration for the patient's expectations and lifestyle.