Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2010
Case Reports[Severe, subacute axonal polyneuropathy due to hypophosphatemia].
A 46-year-old man receiving tube feeding because of anorexia and weight loss developed progressive neurological symptoms initially resembling Guillain-Barré syndrome. Eventually axonal neuropathy due to severe hypophosphatemia was diagnosed. ⋯ The neurological manifestations of hypophosphatemia are reversible if oral or intravenous suppletion of phosphate is started in time. Recognizing the refeeding syndrome is crucial in making a timely diagnosis.
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A 30 year old man with a history of migraine presented at the neurology outpatient clinic with hypesthesia of the left side of his body during a migraine attack, which was unusual for him. His family history was positive for Rendu-Osler-Weber syndrome. MRI and magnetic resonance angiography (MRA) of the brain showed multiple small infarcts, without vascular malformations. ⋯ Neurological complications include cerebral infarction and brain abscess. Also, there is a higher prevalence of migraine in patients with HHT, although the role that HHT plays in the pathogenesis of migraine is unclear. The treatment of choice of pulmonary AVM is endovascular treatment, with a success rate of 75% in the long term.
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Ned Tijdschr Geneeskd · Jan 2010
[Fewer breech deliveries after implementation of a modified cephalic version protocol].
To investigate the effect of implementation of a number of process policy guidelines (protocol), on the success rate of external cephalic version (ECV) for breech presentation. ⋯ After implementation of the process policy guidelines, the success rate of ECV increased considerably. The rate of elective caesarean section for breech presentation declined. These findings are in favour of establishing specialized ECV centres in the Netherlands.
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Ned Tijdschr Geneeskd · Jan 2010
[Endoscopic vein-graft harvesting for coronary bypass grafting: good results in patients at risk for surgical site infection].
To determine the clinical impact of endoscopic vein-graft harvesting in patients undergoing coronary artery bypass grafting (CABG) who are at risk for surgical site infection. ⋯ Endoscopic vein-graft harvesting resulted in a - statistically non-significant - lower incidence of surgical site infection than open harvesting, although the patients had a higher risk for infections. Infections in the endoscopic harvesting group were less severe. The hospital stay was shorter and the patient satisfaction was higher than in the open harvesting group.
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Ned Tijdschr Geneeskd · Jan 2010
[Acute upper-airway obstructions in primary care. Cricothyrotomy performed by the general practitioner].
Acute upper-airway obstructions, especially epiglottitis, are being observed with increasing frequency in adults, both in the hospital situation and in general practice. Acute upper-airway obstructions are life-threatening and therefore need to be treated with the highest priority. When interventions such as manual removal of a foreign body, thoracic compression or the Heimlich manoeuvre fail, the only remaining interventions are intubation and cricothyrotomy. ⋯ Should all GPs be trained in performing life-saving interventions such as cricothyrotomy? This is a difficult question; the intervention is invasive and has a high risk of complications, but securing the airway is a critical life-saving measure. Above all, there is very limited time available to wait for more experienced help. Therefore, we believe that GPs should be trained in performing life-saving interventions such as cricothyrotomy.