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Nederlands Tijdschrift Voor Geneeskunde

Z Damen-van Beek, W Opstelten
- The Dutch College of General Practitioners practice guideline 'Suspicious skin lesions' provides recommendations for diagnosis, treatment and referral for the most common premalignant and malignant skin disorders.- The practice guideline includes a flowchart which starts by looking at the colour and surface of the skin lesion to direct the general practitioner to the most likely diagnosis.- In case of strong suspicion of squamous cell carcinoma, keratoacanthoma or melanoma and in case of basal cell carcinoma or Bowen's disease with high-risk characteristics, the general practitioner will refer the patient to a dermatologist...
2017: Nederlands Tijdschrift Voor Geneeskunde
M E van Leerdam
Acute upper gastrointestinal bleeding is still an important emergency situation with an incidence of 48-62 per 100,000 adults per year in the Netherlands. An international multicentre prospective study evaluated different risk scoring systems for patients presenting with upper gastrointestinal bleeding. The authors showed that patients with a Glasgow Blatchford score of 0 or 1 could be safely discharged without endoscopy. Thirty-day all-cause mortality in this group was 0.4%. In the current Dutch guideline, there is no clear advice on management of low-risk patients...
2017: Nederlands Tijdschrift Voor Geneeskunde
A A E Verhagen
Recent follow-up data on babies born at > 24 weeks' gestation in the Netherlands has shown encouraging results; these outcomes reflect policy in national guidelines to limit treatment in babies born at < 24 weeks' gestation. The use of gestational age as a cut-off point for active treatment in extremely premature infants is, however, scientifically and ethically questionable. As an alternative we should consider a tailor-made approach by well-informed, ethically trained doctors who feel comfortable with complex decision-making, irrespective of the gestational age label...
2017: Nederlands Tijdschrift Voor Geneeskunde
E E Bolt, H R W Pasman, D L Willems, B D Onwuteaka-Philipsen
OBJECTIVE: To identify the types of care that patients and relatives perceive as appropriate or inappropriate in the last phase of life. DESIGN: Questionnaire survey. METHOD: By means of an internet questionnaire with open questions, we asked patients and relatives about their experiences of care in the last phase of life and if they found it appropriate or inappropriate, and why. We recruited via e-mails, Twitter, Facebook, newsletters and links on homepages of patient organisations...
2017: Nederlands Tijdschrift Voor Geneeskunde
A M C Dooper, A A Hettinga-Roest, B J H Boden
A 88-year old woman presented with severe pain in the lower back which radiated to her left leg. She was diagnosed with a sacral insufficiency fracture. Sacral insufficiency fractures are a cause of lower back pain in the elderly population that is frequently overlooked because the symptoms and signs are not specific.
2017: Nederlands Tijdschrift Voor Geneeskunde
R C van Houwelingen, C J M Frijns, S T Toering, P J van Laar, J F Meilof
- A diagnosis of cerebral vasculitis is frequently considered in patients with new or progressive neurological symptoms for which there is no other explanation.- A clinician considering a diagnosis of cerebral vasculitis should be well aware of alternative diagnoses, since these are generally more common.- Several consecutive examinations are required for diagnosing cerebral vasculitis, because there is no diagnostic procedure that is highly sensitive as well as highly specific.- The added value of the different procedures may depend on the type of blood vessels involved...
2017: Nederlands Tijdschrift Voor Geneeskunde
P M M Bossuyt
A recently released report by the Dutch Council for Public Health and Society ('Raad voor Volksgezondheid en Samenleving') is subtitled "About the illusion of evidence-based practice in healthcare". The author argues that this report is a sign of the times, a period of "post-truth medicine" and "alternative facts", in which "science offers nothing but a reduction". Although the report rightly - but superfluously - argues that having an evidence base is insufficient for delivering quality care (no decisions without considering context), its depiction of the illusory nature of evidence-based practice represents a brutal slap in the face of all those who turn to sound clinical and biomedical research to back up or refute claims about the effectiveness of healthcare interventions...
2017: Nederlands Tijdschrift Voor Geneeskunde
P van Eijsden
Acute subdural haematoma is a life-threatening condition that can sometimes be mitigated by decompressive craniotomy. However, it can also increase misery when patients survive but are left with severe disabilities. A recent publication shows that neurosurgeons in Belgium and the Netherlands vary considerably in their opinion regarding if, and when, to perform this surgery. This may be due to the fact that this type of intervention asks the question whether the life saved is more favourable than the death averted...
2017: Nederlands Tijdschrift Voor Geneeskunde
M P Schijven, D A Legemate, J Legemaate
The Academic Medical Center, Amsterdam, has started a trial to evaluate the usefulness to team debriefings of performance reports generated by a medical data recorder (MDR) in the operating room (OR). Outcome performance reports in structured debriefings in a secure, non-punitive environment are likely to heighten the level of situational awareness of OR teams. This may prevent future error. In addition, the use of video and - even more likely - use of an MDR may contribute to establishing a 'just culture' in the OR...
2017: Nederlands Tijdschrift Voor Geneeskunde
J W Duijster, D A H Brandwagt, A Timen, A A van der Eijk, H Vennema, M J M Te Wierik
- More evidence has become available concerning the sexual transmission of Zika virus and viral shedding in semen, which has led to the expansion of international guidelines for prevention of sexual transmission; Dutch guidelines have not been altered.- Internationally, the use of condoms during sex or sexual abstinence is advised for the duration of the pregnancy. Furthermore, when actively trying to conceive one should use a condom for six months.- In the Dutch guidelines, men who have visited a Zika virus epidemic area are advised to use a condom for 2 months upon return, irrespective of their partner possibly being pregnant or their wish to conceive...
2017: Nederlands Tijdschrift Voor Geneeskunde
A Bosman, A Borghorst, P P A Hedeman Joosten, R Hoencamp
A 71-year-old male presented with periumbilical ecchymosis formed after acute onset of abdominal pain and near collapse. At the time of presentation the haematoma was the only symptom. Following a CT scan, the diagnosis of a contained rupture of an iliac artery aneurysm was made. The patient was successfully treated with an endovascular stent graft.
2017: Nederlands Tijdschrift Voor Geneeskunde
H F Wunderink, I N Vlasveld, M J Knol, A van der Ende, E H R van Essen, E J Kuijper
BACKGROUND: Meningococcal disease usually presents as meningitis and/or septicaemia, but can also present as pneumonia or arthritis. Since 2000, a worldwide increase in meningococcal disease is reported which is caused by a new virulent clone of serogroup W (MenW:cc11). This subtype is more likely to give an atypical clinical presentation and results in high mortality rates. CASE DESCRIPTION: A 68-year-old woman with polymyalgia rheumatica, managed with prednisone, developed an acute gastrointestinal syndrome of nausea, diarrhoea, vomiting, fever and chills...
2017: Nederlands Tijdschrift Voor Geneeskunde
N de Graeff, C Savelkoul, A Köse, M Ghaly, C B M Hoffer, D H T Tjan
Suffering and death are an inevitable part of life. In our increasingly multicultural society, healthcare professionals are frequently confronted with ideas on suffering and death that are different from their own. As Muslims are the largest migrant group in the Netherlands, this article focuses specifically on their perspective, illustrated by a clinical case. The different experience of these phenomena, influenced by culture and religion, can lead to confusion and frustration for patients, their relatives, and healthcare professionals alike...
2017: Nederlands Tijdschrift Voor Geneeskunde
M C A Müller, G A E Ponjee
Thromboelastography is becoming increasingly important for diagnosing coagulation disorders in patients with massive blood loss. This whole-blood measurement provides information about the speed of clot formation, clot strength, and degree of fibrinolysis. The result can be used as a basis for making a faster and better choice of a suitable blood product for the patient with severe blood loss. This technique can be carried out simply and quickly as a rapid test ('point-of-care test') or in a central laboratory...
2017: Nederlands Tijdschrift Voor Geneeskunde
G Reijnen, P J E Vos, C Das, U J L Reijnders
Deceased individuals may be found in a position that raises the question of whether or not the individual died from being in that position. We describe 3 victims of 35, 84 and 54 years of age, respectively. All were found in an unusual position that may have impeded breathing. Breathing may be impaired by compression of the thoracic wall or by extrathoracic airway obstruction caused by the position. Reduced independence, with causes varying from dementia to inebriation, is a risk factor for positional asphyxia...
2017: Nederlands Tijdschrift Voor Geneeskunde
C M M Peeters, J C Sluimer, T Gosens
A 77-year-old male who had had an olecranon fracture 15 years ago presented himself with mild pain of the right elbow. Physical examination revealed painless hardening of the finger and wrist flexors in an area of 10 cm from the origin. Conventional radiographs showed a mature myositis ossificans.
2017: Nederlands Tijdschrift Voor Geneeskunde
N A van der Poel, E G van der Veer, F A Ebbens, M M de Win, R J Kloos, M P Mourits
Orbital cellulitis is a rare disease usually caused by sinusitis. Generally, the prognosis of both preseptal cellulitis and orbital cellulitis is favourable. Radiological distinction should be made between an orbital abscess and subperiosteal empyema. Theoretically, empyema is more accessible to antibiotics and, as it arises in a pre-existing anatomical space, it needs less aggressive treatment than an abscess. In contrast, the wall of an abscess created by the bacteria is scarcely permeable to antibiotics...
2017: Nederlands Tijdschrift Voor Geneeskunde
L van Bergen
Georg Friedrich Nicolai was a German professor and heart specialist who was one of the few who protested against the war at the beginning of World War I. As a result, he lost his job and was convicted. After the war, right-wing nationalist students and lack of support from his university superiors made it impossible for him to teach. He left Germany in 1922, never to return. In his book, Die Biologie des Krieges (The Biology of War), which was published in neutral Switzerland in 1917, he contradicted the social Darwinist idea - supported by many physicians as well - that war strengthened humanity, people and races, physically and mentally...
2017: Nederlands Tijdschrift Voor Geneeskunde
I M Markusse, B Velstra, K van der Putten
An 83-year-old woman presented with painful erythematous nodules on her feet and legs. Recently, she had been admitted several times because of pancreatitis of unknown cause. A biopsy showed fat cell necrosis with ghost cells and the diagnosis of pancreatic panniculitis was made.
2017: Nederlands Tijdschrift Voor Geneeskunde
T C C Boerlage, Y I Z Acherman, S T Houweling, F Holleman, V E A Gerdes
- Bariatric surgery is performed in patients with a body mass index (BMI) > 40kg/m2, or BMI > 35 kg/m2 with obesity-related comorbidities. The Roux-en-Y gastric bypass and sleeve gastrectomy are the most frequently used procedures.- On average, patients have lost 25-27% of their original weight 10 years after surgery.- Obesity-related comorbidities improve dramatically in many patients following surgery. The effect is most noticeable in patients with diabetes mellitus type 2 and obstructive sleep apnoea syndrome...
2017: Nederlands Tijdschrift Voor Geneeskunde
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