Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2009
Case Reports[Traumatic atlas fracture in a child following fall on head].
An 8-year-old girl presented at the Accident & Emergency Department with torticollis and neck pain after falling on her head from a climbing frame. A computed tomography scan revealed a Gehweiler type 1 avulsion fracture combined with widening of an anatomically variant single anterior synchondrosis. ⋯ Differential diagnosis between pain-reactive muscular torticollis and atlantoaxial rotatory subluxation is essential. Children presenting with posttraumatic torticollis require a conventional or dynamic computed tomography scan.
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Ned Tijdschr Geneeskd · Jan 2009
Case Reports[Headache following laparotomy; chronic subdural haematoma following epidural anaesthesia].
A 63-year-old man underwent an exploratory laparotomy because of rectal carcinoma. The operation was performed under general anaesthesia in combination with epidural anaesthesia. Since the operation the patient complained of a headache. ⋯ A CT scan showed a subdural haematoma, which was relieved with surgery. We suspected that accidental puncture of the dura caused the haematoma. The incidence, causes, symptoms, diagnosis and treatment of this rare complication are discussed.
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Ned Tijdschr Geneeskd · Jan 2009
[When peripheral drips fail: favourable experience with peripherally-inserted central venous catheters].
Evaluation of the technical success rate, insertion complications and patient survival when peripherally-inserted central venous catheters (PICCs) are used in oncologic patients and patients with severe infections in whom it was not possible to place a peripheral drip. ⋯ PICCs appear to be a good alternative in oncologic patients and patients with infections in whom peripheral drip insertion is not possible. The technical success rate of PICCs was high and was associated with a low periprocedural complication rate. The percentage of prematurely removed catheters seems acceptable, in part because these catheters were removed after a mean period of 2 months.
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Ned Tijdschr Geneeskd · Jan 2009
Case Reports[Unexplained iron-deficiency due to Helicobacter pylori].
Iron-deficiency is one of the most prevalent worldwide deficiencies. In the western world, chronic, mostly occult, blood loss is a frequent cause. However, in up to 30% of patients an underlying cause is never found during routine investigations. ⋯ In these patients, infection with H. pylori was regarded as the major cause of iron deficiency, and there was lasting normalization of iron status and haemoglobin after successful eradication therapy. Although the underlying mechanism still remains to be established, we recommend investigation for H. pylori infection and appropriate treatment in case of unexplained iron-deficiency. In a number of patients, eradication results in a clinically significant improvement of both iron-balance and status.
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Ned Tijdschr Geneeskd · Jan 2009
Case Reports[Recognition of a tarsal coalition; clinical and radiological pointers].
A 34-year-old female had been suffering from pain in her left ankle for more than 6 years. Physical examination revealed no abnormalities other than a rigid subtalar joint. ⋯ However, it is easily missed by treating physicians. In this article the clinical and radiological pointers for establishing the diagnosis are described, and information about the treatment of tarsal coalitions is provided.