Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2010
Case Reports[Juxta facet cyst of the lumbar spine: an uncommon cause of lumbar radiculopathy].
Lumbar juxta facet cysts (JFC) are an uncommon cause of radiculopathy. Spontaneous regression of symptomatic JFC has not often been reported. We describe 2 patients, a 59-year-old man and a 55-year-old man, with radiculopathy of the 5th lumbar nerve root due to a JFC at L4-5. ⋯ In the literature it is suggested that surgical removal of the JFC should be the treatment of choice. However, of the 5 patients who were diagnosed with a JFC in our department, 3 recovered spontaneously and 2 after surgery. In our opinion further studies on the course and management of symptomatic lumbar JFC are warranted.
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Ned Tijdschr Geneeskd · Jan 2010
Case Reports[Antidote against local anaesthetic intoxication: new use of lipid emulsion for intravenous administration].
Local anaesthetics are routinely used for several indications, but despite local administration their use may lead to systemic toxicity. The symptoms include numbness of the tongue, dizziness, tinnitus, visual disturbances, muscle spasms, convulsions, coma, and respiratory and cardiac arrest. ⋯ We describe the application of this lipid emulsion in a 27-year-old patient with generalized seizures and coma due to local anaesthetic toxicity. She recovered quickly and was responsive again 10 minutes after the intravenous administration of the lipid emulsion.
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Ned Tijdschr Geneeskd · Jan 2010
[Crisis in human resources for health: millennium development goals for maternal and child health threatened].
International migration of health care workers from low-income countries to the West has increased considerably in recent years, thereby jeopardizing the achievements of The Millennium Development Goals, especially number 4 (reduction of child mortality) and 5 (improvement of maternal health). This migration, as well as the HIV/AIDS epidemic, lack of training of health care personnel and poverty, are mainly responsible for this health care personnel deficit. It is essential that awareness be raised amongst donors and local governments so that staffing increases, and that infection prevention measures be in place for their health care personnel. Western countries should conduct a more ethical recruitment of health care workers, otherwise a new millennium development goal will have to be created: to reduce the human resources for health crisis.
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Ned Tijdschr Geneeskd · Jan 2010
[Variations in Dutch National Medical Registration hardly affect the hospital standardised mortality rate (HSMR)].
To analyse the variation in the registration of hospital admissions across Dutch hospitals and determine how this variation affects the Hospital Standardised Mortality Rate (HSMR). ⋯ This analysis does not support the view that the HSMR is strongly affected by variation in the registration of hospital admissions and is therefore not reliable. Therefore, there is no need for restraint with regard to publication of the Dutch HSMR.
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A 35-year-old man had been using high doses of gamma-hydroxybutyrate (GHB) for many years. He had been trying to cut down on use of this drug for 2 months. ⋯ Along with serious intoxication and dependency, the possibility of withdrawal symptoms should also be taken into consideration. Administration of high doses of benzodiazepines is an effective treatment for these withdrawal symptoms.