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Nederlands Tijdschrift Voor Geneeskunde

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https://www.readbyqxmd.com/read/28198345/-a-woman-with-mohawks-on-the-vaginal-wall
#1
T C M de Sutter, A Logmans, I Dierickx
A 27-year-old female was seen with exophytic protrusions on the vaginal wall. Biopsy showed a squamous papilloma. This benign tumour is an expression of a non-oncogenic human papillomavirus infection. Although treatment is not necessary, screening for sexual transmitted diseases is advised.
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28198344/-a-woman-with-reversible-encephalopathy
#2
E M Boot, K H Hanny, F J A Meijer, J J J van Eijk
A 72-year-old woman who recently had been treated with metronidazole presented with subacute dysarthria, gait ataxia and encephalopathy with severe anxiety. Head MRI showed symmetrical T2-hyperintensities. Under suspicion of a metronidazole-induced encephalopathy, metronidazole was stopped immediately. The patient recovered completely and follow-up MRI showed complete resolution of T2-hyperintensities.
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28198343/-skin-to-skin-caesarean-section-a-hype-or-better-patient-care
#3
F J Korteweg, H D de Boer, J M van der Ploeg, H D Buiter, D P van der Ham
A caesarean section (CS) is one of the most common surgical procedures performed in the world, for which there are minimal variations in the surgical approach. During the last few years the "skin-to-skin" CS, also coined "natural" or "gentle" CS, is on the rise; parental participation, slow delivery and direct skin-to-skin contact are important aspects. Most Dutch hospitals offer some form of "skin-to-skin" CS but there are local differences in availability and performance of the procedure. Since 2011, the standard procedure in the Martini Hospital in Groningen is the "skin-to-skin" CS (for both elective and emergency CS, 24/7)...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28198342/-career-development-of-medical-school-graduates-comparison-of-medical-students-from-utrecht-leiden-and-groningen
#4
V van Dee, B M van der Klis, M R van Dijk
OBJECTIVE: To gain insight in the career development of Utrecht medical school graduates. DESIGN: Retrospective cohort study. METHOD: In November 2015, we investigated the achieved academic title, occupation and position for 281 graduates who had started their medical education at University Medical Centre Utrecht (UMCU) in the academic year 2003-2004. Information was gathered from the BIG-register for medical professionals, through social media and Google, and if necessary through private messaging...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28181899/-guideline-on-the-treatment-of-recurrent-varicose-veins-supplement-to-the-dutch-guideline-on-venous-disease
#5
K P de Roos, J A Lawson, M T W Gaastra, C H A Wittens
The Dutch Guideline on Venous disease was lacking a section on recurrent varicose veins. The newly issued supplement on recurrent varicose veins fills this gap and provides clinicians with solutions concerning the management of patients with recurrent varicose veins following earlier treatment. Because venous disease is nowadays considered to be an ongoing disease, patients with this disorder will often require life-long care and different treatment than patients who have never been treated before.
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28181898/-placement-of-nasoenteral-feeding-tubes-by-nurses
#6
T H Mungroop, A Gerritsen, A Duflou, O R Busch, E M Mathus-Vliegen, M G Besselink
Electromagnetic-guided placement of nasoenteral feeding tubes by nurses is an alternative to endoscopic placement by gastroenterologists. During placement, the electromagnetic signal that is emitted by the tip of the guidewire enables visualisation of the position of the tube on a portable monitor. The procedure can be performed by a trained endoscopy nurse at the bedside of the patient. This could have logistic advantages, as the patient transport is not necessary and confirmation of the position of the tube by an abdominal X-ray is not required...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28181897/-discontinuation-of-potentially-inappropriate-medications-at-the-end-of-life-perspectives-from-patients-their-relatives-and-physicians
#7
E C T Geijteman, M M A Tempelman, M K Dees, B A A Huisman, R S G M Perez, L van Zuylen, A van der Heide
OBJECTIVE: To obtain insight into the perspectives of patients, relatives and physicians towards potentially inappropriate medications (PIMs) at the end of life. DESIGN: Qualitative interview study. METHOD: An analysis of in-depth interviews with 17 patients who were diagnosed as having a life expectancy of less than three months, 12 patient relatives, and 20 medical specialists and 12 general practitioners who cared for them. For analysis we applied the constant comparative method, which forms part of the grounded theory approach...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28181896/-a-woman-with-abdominal-pain-and-absence-of-defaecation
#8
E B Deerenberg, H El Addouli, J J B van Lanschot
A 62-years-old female presented to the Emergency Department with abdominal pain and absence of defaecation for two days. CT revealed an ileus with a change in the diameter of the small intestine and a segment without contrast in the intestinal wall. Laparotomy confirmed that a segment of the ileum was ischaemic.
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28181895/-inter-practice-variation-in-polypharmacy-prevalence-amongst-older-patients-in-primary-care
#9
J Sinnige, J C Braspenning, F G Schellevis, K Hek, I Stirbu, G P Westert, J C Korevaar
PURPOSE: Complex medication management in older people with multiple chronic conditions can introduce practice variation in polypharmacy prevalence. This study aimed to determine the inter-practice variation in polypharmacy prevalence and examine how this variation was influenced by patient and practice characteristics. METHODS: This cohort study included 45,731 patients aged 55 years and older with at least one prescribed medication from 126 general practices that participated in NIVEL Primary Care Database in the Netherlands...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28181894/-costs-and-benefits-of-smoking
#10
J J Polder, P F van Gils, L Kok, R Talhout, T L Feenstra
- Two recent societal cost-benefit analyses have documented the costs of smoking and the cost-effectiveness of preventing smoking.- Smoking costs the Netherlands society EUR 33 billion per year.- The majority of this is the monetary value of health loss; these are "soft" euros that cannot be re-spent.- There is not a great deal of difference between costs and benefits when expressed in "hard" euros, which means that there is no clear business case for anti-smoking policy.- The greatest benefit of discouraging smoking is improved health for the individual and increased productivity for the business sector; however, the benefits cannot be easily realised, because even in the most favourable scenario the number of smokers will decrease slowly...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28181893/gebruik-van-comedicatie-tijdens-palliatieve-sedatie
#11
H Westdorp, S M C H Langenberg, C Kramers, C A H H V M Verhagen
- Palliative sedation is a treatment option for patients in the terminal stage of their disease who have one or more refractory symptoms.- In giving palliative sedation it is important to take into account the pharmacokinetic and pharmacodynamic properties of medications that contribute to good palliation: this covers both medication used in palliative sedation and continued chronic medication.- This article provides tools for clinical practice to deal with the difficulties concerning stopping or continuing chronic medication and on interaction between medications in palliative sedation...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28181892/-fever-and-hypotension-after-treatment-of-syphilis-the-jarisch-herxheimer-reaction
#12
K D Hendriks, R W van Etten, P van Wijngaarden
A 73-year-old man presented with fever and hypotension, which had developed a few hours after receiving treatment with benzyl-penicillin for secondary syphilis. These symptoms were due to the so-called Jarisch-Herxheimer reaction. The patient was admitted to hospital and treated with prednisone and intravenous fluids. Within 24 hours the patient had fully recovered. The symptoms, pathogenesis and treatment of Jarisch-Herxheimer reaction are discussed.
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28181891/-chronic-traumatic-encephalopathy-an-old-acquaintance-in-athletes
#13
E G B Vijverberg, A C M Pijnenburg, P Scheltens, Y A L Pijnenburg
- Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease caused by repetitive head injuries like those seen in sports such as boxing, American football and soccer.- The clinical features of CTE are a range of cognitive, psychiatric and motor symptoms, and histopathology involves deposits of hyperphosphorylated tau protein and the presence of TAR DNA-binding protein (TDP-43) with relatively little beta-amyloid.- CTE is difficult to differentiate clinically from Alzheimer's disease, frontotemporal dementia and psychiatric disorders because of the major symptom overlap between these conditions...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28145216/-lowering-ldl-cholesterol-the-lower-the-better
#14
M L Bots
There is still a debate about the optimal LDL level to achieve with pharmacological treatment. Some support the 'the lower, the better' approach, others support 'a level less than 2.5 mmol/l suffices'. Two recent JAMA papers lend support to both views. So what to believe? The issue is whether those with an achieved low LDL level (< 1.8 mmol/l) carry a lower vascular risk than those with an LDL between 1.8 and 2.5 mmol/l. To study this, both groups need to be identical with respect to all other factors that determine the risk, and therefore only differ in their respective LDL levels...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28145215/-incidental-findings-on-brain-mriprevalence-clinical-management-and-natural-course
#15
D Bos, A van der Lugt, M A Ikram, M W Vernooij
OBJECTIVE: Diagnostic brain imaging has been performed increasingly since the 1990s. A direct result of this is the rise in the detection of incidental findings. The objective of this study is to provide insight into the prevalence, clinical relevance and natural course of incidental findings on brain magnetic resonance imaging (MRI) scans. DESIGN: Prospective cohort study. METHOD: Within the framework of the Rotterdam study, 5800 participants underwent a brain MRI scan during the period 2005-2014...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28145214/-faecolithiasis-straightforward-to-detect-but-often-missed
#16
B Katerberg, F Ter Borg
Faecal impaction is a problem which is becoming more prevalent now that the number of elderly patients is increasing. When not detected and treated inadequately, it can lead to symptoms such as diarrhoea, faecal incontinence and other serious problems like anorexia, vomiting and rectal ulcers with bleeding or even a bowel perforation. We describe two patients with serious and less common complications of faecolithiasis. Patient A, a 79-year-old woman with signs of dementia, presented with faecal incontinence and unexplained worsening of her cognitive symptoms leading to a situation where she could no longer live in her own home...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28145213/-amyloid-pet-imaging-in-patients-with-alzheimer-s-disease
#17
P Scheltens, M Zwan, R Ossenkoppele, F Bouwman, B N M van Berckel
Until a few years ago, amyloid plaques in the brains of patients with Alzheimer's disease could only be demonstrated by means of neuropathological examination. New PET tracers allow for visualisation of these amyloid plaques in living patients. Biological validity and clinical relevance of this technique have been established. Expertise in interpretation of the images and the diagnostic impact is required. Cost effectiveness and added value over existing methods in terms of diagnosis and prognosis are still being investigated...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28145212/-when-is-a-venous-blood-gas-analysis-sufficient-in-the-emergency-department
#18
J A J M van Exsel, S O Simons, C Kramers, Y F Heijdra
Blood gas analysis plays an important role in the initial assessment of a patient in the emergency ward. We present three different patient cases to illustrate when to opt for a venous or an arterial blood gas analysis. Arterial punctures are more painful and carry a higher risk of complications compared to venous punctures. It is possible to use a venous blood gas to screen for acute acid/base disturbances. Ventilatory compensation or anion gap cannot be calculated reliably with a venous blood gas. On the other hand, the diagnosis diabetic keto-acidosis can be made with a venous blood gas; this mode of sampling can also be used for lactate measurement at the emergency department as an independent prognostic marker for mortality...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28145211/-fatal-cerebral-oedema-during-the-treatment-of-diabetic-ketoacidosis-in-an-adult-male
#19
T J A Dekker, J A Janson, E J Hoorn, Y W J Sijpkens
Diabetic ketoacidosis is relatively common, but the optimal treatment of this condition is still controversial. Cerebral oedema is a rare, but potentially fatal complication. We present the case of an adult patient who presented with de novo diabetic ketoacidosis that was complicated by cerebral oedema during treatment. In this article we discuss factors that may have played a role in the development of this complication. A prolonged hyperosmolar state in diabetic ketoacidosis may increase the risk of cerebral oedema as a result of cerebral compensatory mechanisms...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28120732/-is-histopathology-still-the-gold-standard
#20
M A den Bakker
In the diagnostic process, microscopical analysis is considered to be the gold standard in determining the presence and nature of a disease. In some cases, in particular in rare diseases and in precursor lesions in which pathological changes have not yet fully developed, histological assessment is subject to diagnostic uncertainty. This uncertainty may be further compounded by the increasing tendency to submit small biopsies which may only harbour part of a pathological process. Several strategies may be adopted to increase the precision of histological analysis...
2017: Nederlands Tijdschrift Voor Geneeskunde
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