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Nederlands Tijdschrift Voor Geneeskunde

Cora F Jonkers, Maarten R Soeters
Patients with a positive undernutrition screening score stay in hospital 1.4 days longer, with more associated complications and costs. A paper elsewhere in this journal describes the implementation of a novel in-hospital meal service resulting in improved protein and energy intake. Patient satisfaction was maintained and to some extent improved. However, the paper shows the difficulty of improving food intake in hospitalized patients. This may be due to factors such as illness-induced anorexia, poor nurse and physician nutritional awareness, and lack of a clear financial incentive...
July 13, 2018: Nederlands Tijdschrift Voor Geneeskunde
Inez M Verpalen, Jolien de Boer, Rolf D van den Hoed, Joke M Schutte, Gijs Teklenburg, Richard Vossenkaul
Isolated fallopian tubal torsion (IFTT) is a rare cause of lower abdominal pain. It's difficult to diagnose preoperatively due to non-specific clinical symptoms. Furthermore, IFTT is often not considered in the differential diagnosis. Prompt diagnosis is critical, to prevent progression of symptoms and to maintain fertility; therefore, this article discusses diagnostic pitfalls and reports on key imaging features of IFTT that may facilitate preoperative diagnosis. IFTT should be suspected in a female patient with acute lower abdominal pain and a unilateral pelvic mass close to a normal ipsilateral ovary; there may be a history of prior tubal ligation...
July 13, 2018: Nederlands Tijdschrift Voor Geneeskunde
Dorian N Dijxhoorn, Manon G A van den Berg, Joost P H Drenth, Geert J A Wanten
OBJECTIVE: To investigate whether a novel meal service, FoodforCare, improves dietary intake and patient satisfaction, compared to the traditional 3-meals a day service (TMS). DESIGN: We performed a prospective cohort study at medical (Gastroenterology) and surgical (Gynecology, Urology, Orthopedics) wards. Patients were offered TMS (July 2015 - May 2016; n = 326) or FfC meal service (after stepwise introduction per ward from January 2016 - December 2016; n = 311)...
July 13, 2018: Nederlands Tijdschrift Voor Geneeskunde
Eveline L van Velthuijsen, Sandra M G Zwakhalen, G I J M Kempen, Frans R J Verhey
Hypoactive delirium is common among older hospitalised patients: between 29 and 64% of all older patients in hospital develop a delirium, of which the majority is of the hypoactive subtype. Hypoactive delirium often remains undiagnosed or is only diagnosed late and prognosis is worse than for a hyperactive delirium. Psychotic symptoms, fear, and distress are as frequent in hypoactive as in hyperactive delirium. The guideline of the Dutch College of General Practitioners and the multidisciplinary guideline of the Dutch Geriatrics Society differ in their advice on the pharmacological treatment of hypoactive delirium...
July 13, 2018: Nederlands Tijdschrift Voor Geneeskunde
Ashley M Bakker, Nico G Hartwig, Alike Kamerbeek
Newborn twins both had a blue, smooth tumour in the inner angle of the orbit; one of them had two such tumours. They were diagnosed with congenital dacryocystoceles. If decompression into the nose is not effective, patients should undergo probing early in life to reduce the incidence of dacryocystitis and orbital cellulitis.
July 13, 2018: Nederlands Tijdschrift Voor Geneeskunde
Kim E M van Kan, Bianca Panis
BACKGROUND: Glucose transporter type 1 (GLUT1) enables glucose to pass through the blood-brain barrier. A hereditary deficiency of this protein may lead to clinical symptoms when blood glucose levels are decreasing. CASE DESCRIPTION: A 7-year-old girl with therapy-resistant childhood absence epilepsy presented with an exercise and fasting induced dystonic and atactic movement pattern. The movement pattern disappears postprandial. Based on a reduced glucose in the liquor, and also a reduced liquor glucose/serum glucose ratio, the diagnosis of GLUT1 deficiency syndrome was considered...
July 13, 2018: Nederlands Tijdschrift Voor Geneeskunde
Twan van der Wel, Louisa J D van Dijk, Annemarie C de Vries
A 73-year-old man with an aneurysm of the abdominal aorta (AAA) presented with abdominal bloating. CT-angiography showed compression of the duodenum between the AAA and the pancreas and superior mesenteric artery with dilatation of the descending duodenum, leading to the diagnosis of mechanical duodenal obstruction due to compression by an AAA.
July 13, 2018: Nederlands Tijdschrift Voor Geneeskunde
Karlijn Groen, Suzanne E Geerlings
The population of people living with HIV is ageing. As a result, an increasing proportion of people on combination antiretroviral therapy will experience comorbidities and polypharmacy, with the risk of drug-drug interactions. These comorbidities will also be treated by physicians who are not specialised in HIV. Moreover, early diagnosis and treatment improve the prognosis of HIV infection, but 11% of the people living with HIV are currently undiagnosed. Therefore, physicians should be alert to the possibility of HIV also with regard to older adults...
July 6, 2018: Nederlands Tijdschrift Voor Geneeskunde
M Matthijs Fockens, Dennis Kox
A 59-year-old woman was referred because of nasal discharge with stones and sand. Some months earlier, a rip current had thrown her over while bathing in the sea. CT showed bilateral stones in the maxillary sinus. A right maxillary sinus rinse was performed, which revealed six small stones.
July 6, 2018: Nederlands Tijdschrift Voor Geneeskunde
Frans W A van Poppel, Govert E Bijwaard, Mart J van Lieburg, Fred A van Lieburg, Rik Hoekstra, Frans Verkade
OBJECTIVE: To examine if, over a period of centuries, the Dutch medical establishment enjoyed a survival advantage over a population group with a comparable social background and level of education. DESIGN: Retrospective database research. METHOD: We used documents which provided data on the births and deaths of 15,649 male and 659 female medical professionals and of 15,304 male clergy. We calculated the remaining life expectancy at the age of 25 of those generations born between the middle of the 16th century and the beginning of the 20th century...
July 6, 2018: Nederlands Tijdschrift Voor Geneeskunde
Cindy Nguyen, Arnold H Schuurman, Tom A P Roeling
Anaesthesia of an entire finger is a routinely performed procedure at the General Practice and the emergency room, and by many surgical disciplines. The method according to Oberst is the most-performed procedure to do this. The transthecal digital block is a new method that can be easily learned. This technique results in less discomfort for patients and doctors and leads to few complications.
July 6, 2018: Nederlands Tijdschrift Voor Geneeskunde
Sabine C Linn
A recent study by Keikes et al. (Clin Colorectal Cancer. 2018;17:58-64) focused on adherence to the Dutch colorectal cancer guideline and concluded that adherence was suboptimal. This commentary puts their results in context. Guidelines are useful for those oncologists who lack time to study the original literature. Medical oncologists nowadays have become more and more specialised in a few tumour types, engage in continuous medical education, and discuss controversial issues at (inter)national meetings. Hence, skilled oncologists will not always follow guidelines where alternative choices are in the best interest of the patient...
July 5, 2018: Nederlands Tijdschrift Voor Geneeskunde
Eveline Verheij, Rosan A van Zoest, Marc van der Valk, Ferdinand W Wit, Peter Reiss
The HIV-infected population in the Netherlands is aging, both as a result of effective combination antiretroviral therapy, and the relative increase in the number of newly diagnosed HIV infections among older people. As the mean age of HIV-positive patients increases, so does the prevalence of non-HIV-associated comorbidities, possibly at higher rates than observed in the general population. As people with HIV continue to age, they will be more likely to experience multimorbidity, polypharmacy, and to receive care from diverse healthcare professionals...
July 5, 2018: Nederlands Tijdschrift Voor Geneeskunde
Anna S M Dobbe, Aleksandra C Zoethout, Wim A Bleeker, Dettie G Oenema
BACKGROUND: Lyme disease is a multisystem disease which can present itself in several ways. When the nervous system is involved, it is called Lyme neuroborreliosis. Both central and peripheral nervous systems can be affected. CASE DESCRIPTION: A 39-year-old man visited the emergency department multiple times with severe abdominal-pain attacks with motoric unrest. Extensive diagnostic work-up was done, which was initially inconclusive. Lyme neuroborreliosis was suspected when he developed a facial-nerve palsy during admission; the abdominal pain was thought to be caused by thoracic radiculoneuropathy...
July 5, 2018: Nederlands Tijdschrift Voor Geneeskunde
Saskia Y M Mérelle, Ina Boerema, M Christien van der Linden, Renske Gilissen
OBJECTIVE: To examine issues in care for patients who come to the emergency department after a suicide attempt. DESIGN: Cross-sectional multicentre questionnaire survey. METHOD: In 2015, 7 emergency departments across the Netherlands participated in a questionnaire survey of the 113 Suicide Prevention (113 Zelfmoordpreventie) service as a part of the 2014-2017 National Suicide Prevention Agenda. Emergency physicians and nurses and managers answered 25 multiple-choice questions about: (a) current treatment of and contact with patients who attempted suicide, (b) available knowledge and skills of emergency physicians and nurses and (c) after-care for patients who attempted suicide...
July 2, 2018: Nederlands Tijdschrift Voor Geneeskunde
Iris E Sommer, Andrea W M Evers
A recent meta-analysis showed that antidepressants are more effective than placebo. In placebo-controlled trials, the placebo effect is subtracted from the verum effect to find the specific effect of each antidepressant. In clinical practice, however, the situation is the other way around: non-specific ('placebo') effects are added to the specific effect of the antidepressant and together these effects determine the outcome. The non-specific aspects comprise strength of the therapeutic relation, conviction of both doctor and patient in the diagnosis and treatment, and hope that treatment will induce remission...
June 29, 2018: Nederlands Tijdschrift Voor Geneeskunde
Christiaan H Vinkers
The discussion regarding antidepressant efficacy is known for being heated and ideology-driven. With every scientific publication, a familiar skirmish follows with both proponents and opponents of antidepressant use giving their opinion and interpretation. In the meantime, patients remain somewhat confused: who should they believe? Unfortunately, the debate is often not governed by balanced facts about both advantages and disadvantages. I believe that there are good reasons not to use antidepressants but equally there are also good reasons to use them...
June 29, 2018: Nederlands Tijdschrift Voor Geneeskunde
Henri J van de Vrugt, Martina C Cornel, Rob M F Wolthuis
CRISPR/Cas gene editing makes it much easier to make targeted changes in the DNA of human cells than other forms of gene therapy. This revolutionary technology offers spectacular opportunities to study gene functions; the clinical consequences of gene variations in patients can be determined much faster. The efficacy and accuracy of CRISPR/Cas is so impressive that a breakthrough to therapeutic applications is approaching fast. CRISPR/Cas is already being used in immunotherapy against cancer, and trials for monogenetic blood disorders, such as beta-thalassemia, have been scheduled...
June 29, 2018: Nederlands Tijdschrift Voor Geneeskunde
Henk A Martens, Arjan C L F Steenbakkers, Marcel J A M Franssen
An 80-year-old man with long-standing rheumatoid arthritis presented with severe neck pain. No preceding trauma had occurred and he had no neurological complaints. A CT scan revealed vertical atlanto-axial subluxation without compression of the medulla oblongata. After conservative treatment the pain diminished. There were no neurological complications at follow-up.
June 22, 2018: Nederlands Tijdschrift Voor Geneeskunde
Hendrik J W Schippers, Boudewijn R Toorenvliet
A 75-year-old man developed a cholecystocutaneous fistula after conservative treatment for cholecystitis. Six months later, clinical and radiological examination revealed an abscess at the site of the fistula. Upon incision there was minimal pus, but a large gallstone was extracted.
June 22, 2018: Nederlands Tijdschrift Voor Geneeskunde
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