Nederlands tijdschrift voor geneeskunde
-
Ned Tijdschr Geneeskd · Jun 2018
[The contribution of an asthma diagnostic consultation service in obtaining an accurate asthma diagnosis for primary care patients: results of a real-life study].
Previous studies showed that general practitioners (GPs) have problems in diagnosing asthma accurately, resulting in both under and overdiagnosis. To support GPs in their diagnostic process an asthma diagnostic consultation service (ADCS) was set up. ⋯ In conclusion, the ADCS helped GPs significantly in setting accurate diagnoses for their patients with an asthma hypothesis. This may contribute to diminish the problem of over and underdiagnosis and may result in more appropriate treatment regimens.
-
Emphysematous cholecystitis is a rare presentation of cholecystitis and is caused by gas producing bacteria such as Clostridium perfringens, Klebsiella species or Escherichia coli. We describe a fatal case of a 82-year-old man who presented with abdominal pain, vomiting, fever and acute confusion. An ultrasound and subsequent CT scan showed emphysematous cholecystitis.
-
The term priapism describes erections of >4 hours that arise in the absence of or last well beyond sexual stimulation. Ischaemic priapism is the most common form and treatment success is strongly dependent on the duration of priapism. The aetiology is widely variable as a result of which several specialisms can be confronted with this condition. ⋯ According to current guidelines, early prosthesis implantation is recommended if the priapism lasted >36 hours. Treatment of stuttering priapism should be focused on prevention of subsequent episodes. Non-ischaemic priapism generally follows a mild course and can initially be approached conservatively.
-
Ned Tijdschr Geneeskd · May 2018
[Remifentanil during labour; has its place in pain relief during labour been decided?]
Patient-controlled analgesia using remifentanil (remifentanil PCA) has been used as a new form of pain relief during labour since soon after its release on the market. Reduction in pain scores lasts for 1 to 2 hours, and the analgesia is inferior to that of an epidural. Remifentanil PCA can be an alternative for epidural analgesia in cases where the woman cannot or does not want to receive epidural anaesthesia. ⋯ The Netherlands RAVEL study comparing remifentanil with epidural analgesia showed greater satisfaction with pain relief in the epidural group. There is a high risk of hypoventilation during remifentanil PCA use, leading to desaturation; since desaturation can be a late consequence of hypoventilation, adequate monitoring of the woman is essential. It would be ideal to monitor the frequency and depth of ventilation along with peripheral saturation, and one-on-one care of the woman is advised.
-
Ned Tijdschr Geneeskd · May 2018
[Practice variation in the application of remifentanil during labour; an overview of its application in Dutch hospitals].
To survey (a) the frequency of the use of patient-controlled analgesic remifentanil-PCA during labour in the Netherlands; (b) considerations by obstetricians whether or not to offer remifentanil-PCA; (c) target population for remifentanil-PCA and (d) the application of maternal monitoring. ⋯ A large variation between Dutch hospitals exists in the application of remifentanil-PCA during labour. In the majority of the hospitals, remifentanil-PCA is available for all women. The most common motives mentioned by obstetricians for its use are 'a need for an alternative for epidural analgesia' and 'at the request of pregnant women'.