Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2009
Biography Historical Article[The cause of death of Theo van Gogh (1857-1891)].
In 1992 Theo van Gogh's medical files from the Willem Arntsz Huis, a psychiatric centre in Utrecht, the Netherlands, were made available. A study based on two copies of these files was published in this journal earlier. While reviewing the archives, the author noticed a third copy which included an extra (last) page that was missing in the other two copies. ⋯ M. Other symptoms mentioned were vomiting, fever and early signs of decubitus. The family did not give permission for a post-mortem.
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In the Netherlands approximately 14,000 patients are referred to hospital for diverticular disease each year. Overall controversy persists about four aspects of treatment of the different stages of diverticulitis, i.e. the role of antibiotics in the treatment of mild diverticulitis, the question of whether elective surgical resection is justified in recurrent diverticulitis or in persisting abdominal symptoms after an episode of diverticulitis, the question of whether patients with purulent peritonitis due to perforation may be treated with laparoscopic peritoneal lavage instead of Hartmann's procedure, and finally, whether resection with a primary anastomosis is a feasible and safe alternative to Hartmann's procedure in the surgical treatment of Hinchey III or IV diverticulitis. These questions will be addressed in four upcoming Dutch randomised trials.
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Ned Tijdschr Geneeskd · Jan 2009
Review[Perioperative suspension of anticoagulants: practical recommendations].
If patients being treated with anticoagulants need to undergo an operation then physicians need to consider whether to suspend the use of this medication or to allow its use to be continued. Suspending the use of anticoagulants increases the risk of thrombosis, whereas continued use may cause bleeding complications. ⋯ For daily practice, appropriate bridging strategies can be used for perioperative anticoagulant policy for various risk groups, such as patients with venous thromboembolism, atrial fibrillations, mechanical heart valves and coronary heart diseases (including coronary stents) and patients who have experienced a cerebrovascular accident. In the vast majority of cases the treating physician must carefully consider each individual case in order to realise the best policy.
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Ned Tijdschr Geneeskd · Jan 2009
Review[Acetylsalicylic acid in patients with diabetes mellitus: can be used for secondary but not primary prevention of cardiovascular events].
There is no consensus in international guidelines about the role of acetylsalicylic acid in primary prevention of cardiovascular events in patients with diabetes mellitus. Primary prevention trials suggest that in diabetic patients, acetylsalicylic acid has either no or less favourable effects in preventing cardiovascular events compared to patients with other cardiovascular risk factors. ⋯ Also increasing the dose of acetylsalicylic acid is probably not worthwhile. We do not recommend acetylsalicylic acid as primary prevention of cardiovascular events in patients with diabetes mellitus, but we do recommend it as a means of secondary prevention.
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Adequate training for the insertion of chest drains in a trauma setting reduces the occurrence of procedure-related complications. Prophylactic antibiotics reduce the risk of infectious complications and empyema. For drainage of a traumatic pneumo- or haemothorax a large drain (28-36 French) is advised. ⋯ Occult air leaks before removal of the drain can be detected by a temporary water seal or by clamping the drain followed by a chest X-ray. Removal of a chest drain at end-inspiration is as secure as end-expiration. Attention must be paid to potential complications of chest drains.