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Nederlands Tijdschrift Voor Geneeskunde

Daan T van Yperen, Cornelis H van der Vlies, J T H N de Faber, Charlotte J M Penders, Xander Smit, Esther M M van Lieshout, Michiel H J Verhofstad, - De Rocket-Studiegroep
OBJECTIVE: To report the number of patients with firework-related injuries treated in December 2017 and January 2018 in a hospital in the south-west Netherlands trauma region, and to provide details about the types of firework used and the specific injuries. DESIGN: A prospective multicentre cohort study (NTR6793). METHODS: Patients of all ages with firework-related injuries were eligible for inclusion. The injury had to have been sustained between 1 December 2017 and 31 January 2018, and treated at a hospital in the south-west Netherlands trauma region (approximately 2...
November 29, 2018: Nederlands Tijdschrift Voor Geneeskunde
Lieke L C Hondebrink, Wim Opstelten
A 78-year-old woman visited her general practitioner with a sharply bounded white lesion of her toe. We diagnosed it as gouty tophus, which was confirmed by a high serum urate level. Gout is a chronic disease, characterised by deposition of monosodium urate crystals in joints and tissues. The preferable sites of gouty tophi are fingers, toes, knees, elbows, conchae and heels. Treatment of acute gout consists of NSAIDs, steroids or colchicine. Gouty tophi require lifelong urate-lowering treatment.
November 27, 2018: Nederlands Tijdschrift Voor Geneeskunde
Rolf H H Groenwold, Linda Nab, Maarten van Smeden
Big data is characterised not only by the size of data files, but also by the diversity of data sources and continuity in data collection. Technological developments make it possible to store and analyse ever larger and more complex data files. Unlike more conventional research data, big data are often collected without explicit research questions in mind, and analytical techniques are used to find patterns in the data or to generate hypotheses. Examples of big data in medical research are the large data files of routinely collected data on care, sometimes enhanced by information from other sources such as mobile telephones...
November 27, 2018: Nederlands Tijdschrift Voor Geneeskunde
René E Jonkers
Distinguishing between infectious pneumonia and other causes of abnormal X-rays can be challenging. This commentary describes how this distinction can be made by means of sound clinical reasoning, making judicious use of laboratory tests and especially by using HRCT scanning to confirm certain diagnoses on the basis of well-known radiology patterns.
November 27, 2018: Nederlands Tijdschrift Voor Geneeskunde
Nadine Melman, Stefanie E Damhuis, Hans G I van Weering
A 23-year-old pregnant woman presented with acute right-sided abdominal pain and vomiting in the 21st week of gestation. An MRI scan showed an ovarian torsion and a dermoid cyst. On the same day, laproscopy was performed. After removal of the cyst, the pregnancy and the childbirth progressed without complications.
November 27, 2018: Nederlands Tijdschrift Voor Geneeskunde
Marjan Meekma-van der Horst
In 1953, the South-Western parts of The Netherlands (particularly the province of Zeeland) were flooded. At the time, posttraumatic stress disorder (PTSD) did not yet exist as a formal diagnosis. Research following more recent natural disasters has identified risk factors for the development of PTSD. These risk factors are applied as guidance for research into the circumstances around the 1953 floods. Risk factors such as lower socioeconomic status, pre-existence of psychiatric symptoms and limited support from the government were certainly present...
November 27, 2018: Nederlands Tijdschrift Voor Geneeskunde
Anne W Liesker, Anna A Kroon, Kees J Ponsen
Posterior sternoclavicular luxations are uncommon and potentially life threatening. When clinically suspected, a computed tomography angiography is the gold standard to investigate whether important structures located in the mediastinum are at risk. A fast reduction should be performed to reduce pain and prevent acute and late complications.
November 27, 2018: Nederlands Tijdschrift Voor Geneeskunde
Albrecht Betrains, Ellen De Langhe, Laurens De Saedeleer, Steven Vanderschueren
The antisynthetase syndrome (AS) is a rare auto-immune disease characterised by inflammatory myopathies, interstitial lung disease, inflammatory arthritis, Mechanic's Hands and Raynaud phenomenon. AS infrequently presents with life-threatening lung disease as its primary or sole manifestation. By means of two clinical case reports, an overview is given of recent advances in diagnosis and treatment of AS-related interstitial lung disease. We emphasise the importance of considering AS as a differential diagnosis if lung disease does not respond to standard treatment in a relatively young patient, certainly if there is even a mild suggestion of myopathy, arthritis or cutaneous involvement...
November 27, 2018: Nederlands Tijdschrift Voor Geneeskunde
Arjan Bouman, Alice S Brooks, Marjon A van Slegtenhorst
Whole Exome Sequencing (WES) is becoming a standard diagnostic tool for patients who potentially suffer from an underlying monogenic condition. This is illustrated by the use of WES panels for specific medical conditions; in such instances, analysis is focused on a subset of genes that can be implicated in the pathogenesis of a condition such as epilepsy, intellectual disability, cardiomyopathy, etc. Physicians requesting WES diagnostics should be informed about the possibilities, limitations and pitfalls of this test...
November 26, 2018: Nederlands Tijdschrift Voor Geneeskunde
Maaike P Smit, Najma S Abdullahi, Boudewijn Bakker, Annette P M van den Elzen
BACKGROUND: Haemolytic group A streptococci (GAS) are the most common bacterial cause of infection in the Netherlands. These bacteria can cause many different non-invasive infections, including scarlet fever. CASE DESCRIPTION: A two-year-old girl presented with fever, tachycardia, exanthema and swelling in the neck. On suspicion of scarlet fever with neck phlegmon we treated her with antibiotics and supportive therapy. Blood and throat cultures revealed growth of haemolytic GAS...
November 26, 2018: Nederlands Tijdschrift Voor Geneeskunde
Michel E van Genderen, J H Vlake
Innovative technologies, such as virtual reality (VR), augmented reality (AR) and mixed reality (MR) are no longer only interesting for a niche of gamers but are increasingly being applied within healthcare. Possible applications for VR in care vary from exposure therapy for PTSD and anxiety disorders to aiding in cognitive and physical rehabilitation. VR has also acquired an important role in medical education. AR/MR are used predominantly within surgery, for instance for perioperative projection of patient information, holographic images and scans...
November 26, 2018: Nederlands Tijdschrift Voor Geneeskunde
Paula M C Mommersteeg, Angela H E M Maas
Psychological symptoms, such as anxiety, depression, and stress, are a risk factor for the development as well as aggravation of ischaemic heart diseases (IHD). Although women report more psychological symptoms than men, research into gender differences regarding cardiac risk of psychological symptoms is limited. Cardiology studies focus predominantly on the classic pattern of obstructive coronary artery disease, which is three times more prevalent in men than in women. Women more often have variant types of IHD, such as myocardial infarction with non-obstructive coronary arteries, spontaneous coronary artery dissection, ischaemia with non-obstructive coronary arteries, coronary spasm, and microvascular angina...
November 22, 2018: Nederlands Tijdschrift Voor Geneeskunde
Sander A J Damen, Marc A Brouwer, C Kramers
A recent meta-analysis by Rothwell and colleagues, presented in The Lancet, of studies using aspirin as primary prevention showed that the effectiveness of the medication was weight-dependent. We discuss the results from both a pharmacological and cardiological perspective to assess the conclusions of this study. The observed result in the meta-analysis could possibly be explained by applying pharmacological principles; however, from a cardiological point of view the extent to which it has an influence on clinical practice is questionable...
November 21, 2018: Nederlands Tijdschrift Voor Geneeskunde
Lieke J M Kursten, Anniek Visser, Marloes Emous, Heleen Lameijer
A 66-year-old patient was seen at the emergency department with a skin infection of the left leg, probably erysipelas, which worsened despite the use of antibiotics. The symptoms had started 5 days earlier. The patient was respiratory and haemodynamically stable, he was not clinically ill and had relatively little pain. Lab tests revealed leucocytosis, significantly elevated CRP values and signs of renal and hepatic impairment. The patient was admitted because of suspected necrotising soft tissue infection (NSTI)...
November 19, 2018: Nederlands Tijdschrift Voor Geneeskunde
Liselotte C de Kloet, Sebastian E E Schagen, Anemone van den Berg, Agnes Clement-de Boers, Mieke E C A M Houdijk, Daniëlle C M van der Kaay
BACKGROUND: Growth failure can be a unique manifestation of untreated intestinal inflammation in children with inflammatory bowel disease (IBD). It can, however, be difficult to diagnose IBD in the absence of symptoms or in the presence of aspecific gastrointestinal symptoms. A delay in diagnosis is a risk factor for lower adult height. CASE DESCRIPTION: A 15--year-old boy was referred to a paediatric endocrinologist for growth failure and delayed puberty. Additional investigations were performed and he was diagnosed with Crohn's disease...
November 19, 2018: Nederlands Tijdschrift Voor Geneeskunde
J S Burgers
When formulating recommendations, guideline developers have opportunities to use systematic reviews (SRs), which are widely considered to be the best available evidence. However, in practice the use of SRs by guideline developers is limited. Recent research has shown that only 22% (60/279) of the recommendations on screening of newborns for rare diseases were based on SRs. Moreover, the non-use of SRs was correlated with positive recommendations. This commentary discusses the reasons for limited SR use and the influence of wishful thinking on decision making...
October 26, 2018: Nederlands Tijdschrift Voor Geneeskunde
Mark C van der Wel
The introduction in the USA of the new AHA Guideline on management of Hypertension has fuelled controversy on the optimal definition and treatment of hypertension. A more strict definition (130/80 mmHg) and the advice to treat the major part of the hypertensive population well below 140/90 mmHg is a recipe for medicalisation of society. Advocates of the guideline emphasise the growing body of evidence to support more aggressive treatment. This evidence however seems to focus merely on the reduction of risk on cardiovascular disease or death...
October 18, 2018: Nederlands Tijdschrift Voor Geneeskunde
Jodai Stehouwer, Jacoba van der Kooy, Johanna P de Graaf, Alex J Eggink, Loes C M Bertens, Jasper V Been
OBJECTIVE: To compare maternal and neonatal outcomes of planned primary-care birth-centre deliveries with those of planned home deliveries and planned outpatient deliveries. DESIGN: Retrospective cohort study. METHOD: We used data collected in the period February 2009 to November 2013 from 4 community midwife practices attached to the Sophia birth centre (GCS), which is attached to the Erasmus MC academic hospital in Rotterdam, The Netherlands...
October 18, 2018: Nederlands Tijdschrift Voor Geneeskunde
Marleen van der Burg, Martin N Gerding
Thiopurine drugs, such as thioguanine, mercaptopurine and azathioprine, are used for treating inflammatory bowel disease, such as ulcerative colitis. One must be aware of the serious side effects these drugs can have (e.g. bone marrow depression). A 56-year-old man with ulcerative colitis was treated with mercaptopurine. He developed leukopenia as a result. Thioguanine was started ten months later, resulting in life-threatening pancytopenia. Thiopurine methyltransferase (TPMT) genotyping proved that the patient was a poor metaboliser of thioguanine (TPMT3A*/3A*)...
October 18, 2018: Nederlands Tijdschrift Voor Geneeskunde
Deborah N Kalkman, Tom F Brouwer, Wilko Spiering, Ron J G Peters, B J H van den Born
According to the 2011 Dutch guideline on Cardiovascular risk management 1 in 5 hypertensive patients are eligible for blood pressure lowering treatment. The Dutch guideline recommends striving for a systolic blood pressure (SBP) of < 140 mmHg in adult patients who have no cardiovascular disease or diabetes mellitus, while the recent American guideline now recommends an SBP target value of < 130 mmHg for all adult patients. An important reason for using a stricter SBP target value are the results of randomised studies and meta-analyses that looked at the effect of intensive antihypertensive therapy on the risk of mortality and cardiovascular disease...
October 18, 2018: Nederlands Tijdschrift Voor Geneeskunde
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