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Contains fulltext : 47905.pdf (Publisher’s version ) (Closed access) OBJECTIVES: To establish the prevalence of vegetative state in Dutch nursing homes, describe the patient characteristics, and highlight the possible influence of medical decisions at the end of life. DESIGN: A cross-sectional survey. The vegetative state was defined according to the Multi Society Task Force on PVS. All Dutch nursing homes were approached to provide data on patients in a vegetative state. In cases of doubt, the researcher discussed the diagnosis with the patient's physician and, if necessary, examined the patient. Information on patients in a vegetative state in care between 2000 and September 2003 and end of life decisions for them were also recorded. RESULTS: All nursing homes and physicians participated. After assessment of 12 doubtful patients, 32 met the criteria of vegetative state lasting longer than one month, a prevalence of 2/1,000,000. Of these, 30 patients' data were analysed: age 9-90 years; 73% female; duration of vegetative state 2 months-20 years (26 surviving >1 year, 13 >5 years). Stroke was the commonest cause. Between 2000 and September 2003, there were 76 patients in a vegetative state in care of whom 34 died of complications and nine after withdrawal of artificial nutrition and hydration. CONCLUSIONS: The prevalence of vegetative state in Dutch nursing homes has been established for the first time. The figures are lower than suggested in the literature. The study included a heterogeneous group of patients, of which a substantial number survived for many years. The results cannot be explained by a policy of systematically withdrawing artificial nutrition and hydration.

The literature concerning patent ductus arteriosus is briefly reviewed. A persistent patent ductus arteriosus may be eliminated by surgical division or ligation. When the duct remains open after the first year of life, spontaneous obliteration is not likely to occur. Unless associated with other cardiovascular anomalies, its surgical treatment in children over the age of four years should be considered in order that life expectancy may be increased. The surgical mortality in skilled hands is sufficiently low to justify this conclusion. Since recanalization has frequently followed ligation of a patent ductus arteriosus, division is considered the procedure of choice. A modified technic for division of a patent ductus arteriosus is presented. This technic is considered to have several advantages, being safer and more widely applicable than the technics now in use. Twelve cases are reported in which the diagnosis of patent ductus arteriosus was made and operation performed. In one case the preoperative diagnosis of patent ductus was in error. There was one surgical (anesthetic?) death. Other cases reported in detail include: one in which massive hemorrhage occurred following division of the duct and in which convalescence was complicated by the occurrence of pulmonary emboli; one in which the aorta was clamped for a total of thirty- five minutes while hemorrhage was being controlled and the duct divided; one case in which attacks resembling narcolepsy were apparently relieved following ligation of the duct; and one in which decortication of the lung was performed at the time of ductus ligation.