Biomedical subjects

J C Taal

Publications and source records attributed to J C Taal.

3 recordsLinked to original sources

PubMed2001

Hyponatremia in intracranial disorders.

Hyponatremia is a common electrolyte disturbance following intracranial disorders. Hyponatremia is of clinical significance as a rapidly decreasing serum sodium concentration as well as rapid correction of chronic hyponatremia may lead to neurological symptoms. Especially two syndromes leading to hyponatremia in intracranial disorders need to be distinguished, as they resemble each other in many, but not all ways. These are the syndrome of inappropriate ADH secretion (SIADH) and the cerebral salt wasting syndrome (CSW). The syndrome of inappropriate ADH secretion is characterized by water retention, caused by inappropriate release of ADH, leading to dilutional hyponatremia. The cerebral salt wasting syndrome on the other hand, represents primary natriuresis, leading to hypovolemia and sodium deficit. SIADH should be treated by fluid restriction, whereas the treatment of CSW consists of sodium and water administration. However, in the literature there is abundant evidence that hyponatremia in intracranial diseases is mostly caused by CSW. Therefore, treatment with fluid and salt supplementation seems indicated in patients with intracranial disorders who develop hyponatremia and natriuresis.

Brain Diseases↗

PubMed1997

[Beyond maternal death?].

Three women, aged 33, 27, and 31 years, had serious gestational problems (pre-eclampsia with cerebral haemorrhage, toxic shock syndrome with multiple organ failure, and hypertension complicated by prolonged circulatory arrest, respectively), but eventually survived, albeit with serious handicap (cognitive and motor disturbances, blindness, and persistent vegetative state, respectively). When the maternal mortality ratio is as low as it currently is in the Netherlands (10 women in 100,000 live births), it is worthwhile to assess cases of severe maternal morbidity. The cases presented lead to the pertinent question whether obstetric interventions to prevent death may not sometimes be worse than accepting death itself.

Adult↗

PubMed1994

Aneurysmal bleeding. A plea for early surgery in good-risk patients.

From 1985 onwards we have aimed at operating on good-risk patients, i.e., those graded I-III on the WFNS SAH Scale, within 3 days after the aneurysmal bleed. We report on a series of 100 consecutive operations for saccular aneurysm, covering a period of 5 1/2 years. Early operations (in the above sense) were done in 57 good-risk but otherwise unselected patients. After a one year follow-up, 47 of them (82%) were found to have made a good recovery (Glasgow Outcome Score I). The outcome of (mostly early) surgery in 15 selected poor-risk patients (WFNS SAH Scale IV and V) was much less favourable. Late surgery (4 or more days after SAH) was performed in 28 good-risk patients, most of whom had been admitted several days or weeks after the bleeding. Almost all of these patients had a good outcome. It is argued that the known management results of delayed surgery, which during the deliberately chosen interval exposes the patient to the risk of rebleeding and vasospasm, have by now been surpassed by those of early surgery. However excellent the surgical results of delayed operations may be, early operation should become the treatment of choice in good-risk patients.

Aged↗