Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2009
Review[Vaccination against chickenpox, shingles and rotavirus-infection].
The Dutch National Immunisation Programme (NIP) has been very successful over the past 50 years. In future, this programme shall not include all new vaccines. Such vaccines can, however, be individually administered. ⋯ More than 95% of children experience one or more episodes of rotavirus gastroenteritis before their 5th birthday. In the Netherlands about 3400 children are hospitalised each year for rehydration following rotavirus infection. The vaccine is given orally.
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Ned Tijdschr Geneeskd · Jan 2009
[Neuraminidase inhibitors and high risk of influenza complications: considered and widely-supported recommendations].
It has been suggested that it is unwise to employ neuraminidase inhibitors in order to diminish the risk of influenza-related complications in cases of infection with the new influenza A(H1N1). However, the major argument, i.e. that the beneficial effects shown in the published evidence may be due to age differences between treatment and placebo groups, can easily be refuted. The Netherlands' policy to limit treatment to those patient groups who are considered at high risk of influenza complications is a sound one. In addition, it is endorsed by recent guidelines of the WHO and CDC.
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A 12-year-old boy fell off his bicycle, hitting his neck on the handle-bars. He sustained a tracheal rupture, which required surgical treatment. ⋯ Both were treated conservatively, the 2-year-old boy needed endotracheal intubation and mechanical ventilation. Blunt neck trauma can cause life-threatening complications, which are difficult to diagnose.
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Three patients presented with an intoxication caused by Aconitum napellus, commonly known as Aconite, Monkshood or Wolfsbane. The first patient, a woman aged 24, was resuscitated after accidental ingestion of plant material 'from nature'. She experienced severe ventricular tachyarrhythmias. ⋯ She had no symptoms during observation in the hospital. Aconite alkaloids are known to cause ventricular arrhythmia by a prolonged activation of sodium channels. Because there is no antidote, treatment is largely supportive but serious arrhythmias and respiratory arrest need to be anticipated.
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Ned Tijdschr Geneeskd · Jan 2009
Case Reports[Placement of one-way endobronchial valves to treat severe pulmonary emphysema in an 84-year-old].
An 84-year-old man with end-stage emphysema was hospitalised on two occasions because of an episode of severe COPD exacerbation, each time successfully treated in a classical pharmacological manner. Further analysis of a high-resolution CT chest scan revealed very pronounced destruction of the lung parenchyma in the left lower lobe. ⋯ This intervention had a very satisfactory outcome with positive changes in the lung function parameters, imaging studies and quality of life. The inevitable placement in a nursing home could consequently be postponed and, at follow-up one year later, no exacerbation or pneumonia had developed since the intervention.