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Nederlands Tijdschrift Voor Geneeskunde

A M Vollaard, I Schreuder, L Slok-Raijmakers, W Opstelten, G F Rimmelzwaan, A J Gelderblom
- Adult patients with solid tumours receiving chemotherapy have reduced immunity against infections and are at increased risk of influenza infection and its complications. However, many of said patients are not vaccinated for influenza.- Limited observational research in this patient group has given some indication of the protective effects of the influenza vaccine on clinical outcome measures.- Serological studies have shown that the antibody response following influenza vaccination is often less pronounced in patients with solid tumours compared to healthy individuals...
2017: Nederlands Tijdschrift Voor Geneeskunde
P M Smit, A C Abrahams, R G E Schutgens, N C Notermans, M C Minnema
Monoclonal gammopathy of undetermined significance (MGUS) is a common haematological disorder characterized by the presence of a monoclonal protein (M-protein). MGUS is considered an asymptomatic 'innocent' pre-malignant precursor condition of - mostly - multiple myeloma, without indication for treatment. We present three cases illustrating that MGUS can lead to serious problems. The first patient, a 51-year-old female, presented with polyneuropathy due to anti-MAG antibodies related to IgM MGUS. The second patient, a 37-year-old female, presented with proteinuria due to immunotactoid glomerulopathy caused by renal monoclonal IgG deposition associated with MGUS...
2017: Nederlands Tijdschrift Voor Geneeskunde
D Ruigrok, P Symersky, P W G Elbers, S Kamminga, L J Meijboom, H J Bogaard
- Chronic thromboembolic pulmonary hypertension (CTEPH), characterised by pulmonary hypertension and persistent perfusion defects despite adequate anticoagulation, causes significant morbidity and mortality.- Persistent dyspnoea after acute pulmonary embolism is frequent and an indication for additional diagnostics. Only a minority of these patients develop CTEPH.- Echocardiography and perfusion scintigraphy are the cornerstone of diagnostics when suspecting CTEPH. Right-heart catheterisation and pulmonary angiography should confirm the diagnosis...
2017: Nederlands Tijdschrift Voor Geneeskunde
M G Mentink, R J P Weber, F H Jansen
A 10-year-old boy presented at the radiology department with pain in the right knee. Radiographs of the knee revealed dens metaphyseal bands and subchondral epiphyseal sclerosis as a result of periodic bisphosphonate administration for the treatment of Legg-Calvé-Perthes disease three years ago.
2017: Nederlands Tijdschrift Voor Geneeskunde
F G M Smeets, F P J Peters
A 38-year-old male with a history of laparoscopic cholecystectomy and successfully treated Hodgkin lymphoma had a follow-up CT-scan which showed four nodular densities behind the bladder. Additional investigations demonstrated spilled gallstones instead of a relapse of Hodgkin lymphoma. Spillage of gallstones is relatively common and may mimic malignant diseases.
2017: Nederlands Tijdschrift Voor Geneeskunde
V E T Dörenberg
The beginning of 2015 saw the transition of responsibility for social care, youth care and participation of vulnerable groups in the Netherlands from the government to local authorities. A large majority of municipalities chose to work with neighbourhood social support teams. Their main purpose is to offer integrated care to citizens. Integrated care requires information-sharing between organisations and (healthcare) professionals. Are medical practitioners authorized to share patient information with neighbourhood social support teams? Legal analysis shows that a medical practitioner may play one of the following three roles when sharing information with such teams: the role of referrer, the role of expert or the role of informant...
2017: Nederlands Tijdschrift Voor Geneeskunde
L M de Brauw
The World Health Organization has published a new guideline for the prevention of surgical site infection (SSI), according to which laminar airflow systems should not be used to reduce the risk of SSI in the OR. The Dutch Health Care Inspectorate has, on the other hand, published a directive demanding laminar airflow in most operation rooms in Dutch hospitals. This directive is based on an evidence-based report from the Dutch Working Group on Infection Prevention (WIP). Since these guidelines are contradictory, the evidence presented in the WHO report as well as in the WIP report is evaluated in this article...
2017: Nederlands Tijdschrift Voor Geneeskunde
R H C Zegers
BACKGROUND: Not infrequently, patients mistakenly put glue in their eye. This often induces considerable emotional and physical reaction. CASE DESCRIPTION: A 20-year-old man came to the Emergency Department at night because he had mistaken a tube of superglue for his eye ointment and instilled the glue into his right eye. All the glue was removed, as were most of his eyelashes. The glue-induced corneal abrasion healed completely and the patient did not sustain any permanent injury...
2017: Nederlands Tijdschrift Voor Geneeskunde
D H van der Meer, A D Pranger, I Jansen, E B Wilms, H Kieft, J G Maring
BACKGROUND: Since the introduction of the electronic e-cigarette a few years ago, its use has greatly increased. The liquid formulations used in these e-cigarettes contain nicotine in high concentrations; ingestion of these liquids can be fatal. CASE DESCRIPTION: A 42-year-old male was admitted to the Intensive Care ward due to cardiac arrest. The patient had ingested highly concentrated liquid nicotine, originating from a vial with liquid for e-cigarettes. When the ambulance personnel found the patient he did not have a pulse; following CPR and administration of adrenaline his pulse returned...
2017: Nederlands Tijdschrift Voor Geneeskunde
M A Kempeneers, M G Besselink, Y Issa, J E van Hooft, H van Goor, M J Bruno, H C van Santvoort, M A Boermeester
- Chronic pancreatitis is a progressive inflammatory disease, which leads to a severe decrease in quality of life and reduced life expectancy.- 85-90% of patients with chronic pancreatitis consult the doctor because of pain.- Pain in chronic pancreatitis has a multifactorial aetiology, with nociceptive and neuropathological components.- Current treatment of chronic pancreatitis uses a step-up approach, starting with lifestyle interventions and medication, followed by endoscopic or surgical treatment or a combination of these two...
2017: Nederlands Tijdschrift Voor Geneeskunde
C C Moor, W J Lie
A 54-year-old, Turkish, unvaccinated woman presented with chronic cough. Bronchoscopy revealed an ulcer-like abnormality in the trachea. Surprisingly, the culture showed growth of non-toxigenic Corynebacterium diphtheriae. This is a rare pathogen that usually causes only local respiratory symptoms. At control bronchoscopy after antibiotic treatment the abnormalities were no longer seen.
2017: Nederlands Tijdschrift Voor Geneeskunde
S E van Brummelen, D Melles, M van der Eerden
BACKGROUND: An odontogenic cause of a lung abscess can easily be overlooked. CASE DESCRIPTION: A 61-year-old man presented at the emergency department with a productive cough and dyspnoea. He was admitted to the pulmonary ward with a suspected odontogenic lung abscess. A thorax CT scan confirmed the diagnosis 'lung abscess', following which the dental surgeon confirmed that the lung abscess probably had an odontogenic cause. The patient made a full recovery following a 6-week course of antibiotics, and he received extensive dental treatment...
2017: Nederlands Tijdschrift Voor Geneeskunde
S M Bollen, M J C M Rutten
Dual-energy CT (DECT) provides more information than a conventional CT scan. This new technique does not only provide morphological information, but also provides information about the chemical composition of tissues and substances, e.g. uric acid or calcium, based on material-specific differences in X-ray attenuation, leading to diagnostic improvement. Other benefits include reduced radiation dose, reduced use of contrast fluids due to better iodine detection and improved image quality. DECT fulfils a need in patients with a hypersensitivity to contrast agents, leads to less kidney damage, and avoids the necessity of more invasive diagnostic methods such as lumbar punctures...
2017: Nederlands Tijdschrift Voor Geneeskunde
M M Ros, C E Delsing
A 55-year-old woman with fever, a rash and elevated liver enzymes was diagnosed with drug reaction with eosinophilia and systemic symptoms (DRESS). After treatment with high-dose prednisolone and withholding carbamazepine, all symptoms resolved completely. This case emphasises the importance of recognizing a drug-related cause of fever and rash other than infectious causes.
2017: Nederlands Tijdschrift Voor Geneeskunde
L van Dalen
In case of severe illnesses such as dementia it is important to keep inquiring how the person concerned and his or her social network view and experience the illness. For conditions that cannot be cured, family and social ties have proven to be the most important factors in experiencing quality of life. In case of dementia, people can be distressed when they feel excluded from such conversations. Family members are often only approached in their roles as informal caregivers or representatives. However, by also discussing other roles in relationships, families and friendships and by alternating in these conversations between the positions of so-called expert and advisor, doctors can contribute to preventing connections from breaking off prematurely...
2017: Nederlands Tijdschrift Voor Geneeskunde
E Richard, E P Moll van Charante
With the advancement of diagnostic tests, the call for an ever-earlier diagnosis of people with memory problems is becoming louder. Diagnostic tests for people with mild cognitive impairment are in fact prognostic tests, complicating the application and interpretation of test results. There is currently insufficient evidence on the incremental diagnostic (or prognostic) value of specific diagnostic tests including MRI, CSF and PET scanning in representative memory clinic populations. Labelling large groups of people who may never develop dementia as having prodromal Alzheimer's disease may be more harmful than a postponed nosological diagnosis in those with mild cognitive impairment...
2017: Nederlands Tijdschrift Voor Geneeskunde
P Scheltens, F Gillissen, F H Bouwman, W M van der Flier
- The Netherlands health service features a stepwise diagnostic course in primary, secondary and tertiary care. In the diagnostic process for dementia the patient can go to the general practitioner, then to one of the 100 memory clinics and finally to one of the 4 academic Alzheimer centres.- The diagnostic process for dementia is described in the care practice guideline 'Dementia', the NHG (Dutch College of General Practitioners) practice guideline 'Dementia' and the multidisciplinary guideline 'Dementia diagnostics'...
2017: Nederlands Tijdschrift Voor Geneeskunde
M L Haaksma, J A H R Claassen, M G M Olde Rikkert, R J F Melis
- There is currently a lot of uncertainty about the future prevalence of dementia. Not only increasing age, but also educational level and lifestyle of the population appear to play a role.- There is little scientific and societal attention for the great uncertainty around average incidence and prevalence estimates for dementia.- When estimating the prognosis of people with dementia, the average disease course is often used as a basis, while this is not at all representative of the individual course of most patients...
2017: Nederlands Tijdschrift Voor Geneeskunde
H V U Kaptein
Here we present the case of a nursing home physician observing a patient representative - although legally appointed by a judge to fulfil said role - overextending her role on behalf of a patient with early stage vascular dementia. One example of this involves the representative wanting to represent the patient in circumstances in which the patient herself is mentally competent in the opinion of the doctor. This case scenario serves as an introduction of the nuance around the Dutch legal system and the topic of representation: the representative has to promote that the patient will personally exert his/her rights of autonomy and self-determination...
2017: Nederlands Tijdschrift Voor Geneeskunde
M Vernooij-Dassen, A de Boer, M E de Vugt, F J M Meiland, R M Dröes
- In this article, we describe the current state of affairs with respect to informal care for people with dementia. We focus on the impact of informal care on the caregiver, caregiving strategies and effective ways to support informal caregivers, including e-health and technological support.- Informal care for people with dementia is intense and has consequences, both positive and negative: 78% of informal caregivers has good feelings about the care they give, but 15% feels heavily burdened.- A stimulating and supportive approach creates a positive and safe environment...
2017: Nederlands Tijdschrift Voor Geneeskunde
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