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Nederlands Tijdschrift Voor Geneeskunde

E Ten Velde, B C Gonera-de Jong
In this case report we discuss two children with dysphagia. Both presented with difficulties in swallowing and oesophageal impaction of solid food. The first case involves a 16-year-old boy who suffered from dysphagia for many years. After a long diagnostic journey, during which a psychogenic cause was suspected, he was diagnosed with oesophageal achalasia. After a balloon dilatation of the lower oesophageal sphincter his complaints persisted and the treatment procedure was repeated. The second case involves a 15-year-old girl, who presented with a food impaction in the distal oesophagus...
2016: Nederlands Tijdschrift Voor Geneeskunde
T A M Teunissen, S H Lo Fong Wong, A L M Lagro-Janssen
Sexual abuse is very common. In the Netherlands 42% of women and 13% of men aged over 25 years have experienced unacceptable sexual behaviour. Most victims do not seek professional help nor do they report the abuse to the police, and most of the victims who do seek medical help do not mention the abuse. Doctors often do not recognize the signs of sexual abuse. Most victims of rape have symptoms that may develop into posttraumatic stress disorder (PTSD) if they persist for more than 4 weeks, such as sleep problems or panic attacks...
2016: Nederlands Tijdschrift Voor Geneeskunde
H A Marsman, M G Besselink
- The incidence of pancreatic cancer is increasing due to the ageing population among other things, while 5-year survival has improved in the past two decades from 3 to 7%.- In case of biliary obstruction due to pancreatic cancer, biliary drainage before surgery or ablative therapy using a covered metal stent instead of plastic reduces the rate of complications.- In patients with metastasized pancreatic cancer a combination of folinic acid, fluorouracil, irinotecan and oxaliplatin (FOLFIRINOX) results in improved survival...
2016: Nederlands Tijdschrift Voor Geneeskunde
C Savelkoul, A F Klijnsma, E Balk, A Janse, D H T Tjan
Acute intensive care (IC) triage involves a challenging decision-making process. Physicians are required to make life or death decisions about an unfamiliar patient within a short time frame. An 84-year-old female was admitted to the stroke unit following an extensive cerebral infarction. The intensive care unit (ICU) physician was consulted because of a suspected severe abdominal sepsis even though ICU treatment had never previously been discussed. A 77-year-old female with a previous history of myocardial infarction and severe COPD developed acute respiratory failure on the ward, and was admitted to the ICU for support by a mechanical ventilator...
2016: Nederlands Tijdschrift Voor Geneeskunde
B J Laan, S M van den Heiligenberg, M Hemelaar
BACKGROUND: Classical Meigs' syndrome consists of the triad of an ovarian fibroma, ascites and pleural effusion. A characteristic of the syndrome is that the excess fluid is resorbed after surgical resection of the tumour. CASE DESCRIPTION: A 49-year-old woman was admitted to accident and emergency department in a neglected, cachectic and hypothermic condition. A CT scan revealed an ovarian tumour, ascites and a right-sided pleural effusion. The level of the tumour marker CA-125 was also greatly elevated...
2016: Nederlands Tijdschrift Voor Geneeskunde
A A H Bressers, N A Goto, S Piepers, J C Regelink
BACKGROUND: Autoimmune encephalitis is a rare condition characterized by subacute development of cognitive and psychiatric symptoms. A paraneoplastic syndrome involves autoimmune encephalitis caused by classic antibodies. Although this condition is often associated with cancer, no malignancy has yet been found in 70-90% of patients at the time of diagnosis. CASE DESCRIPTION: We saw a 58-year-old male patient with fatigue, diarrhoea and weight loss. He was also experiencing hyperekplexia, personality changes and an instable gait...
2016: Nederlands Tijdschrift Voor Geneeskunde
J M Prins, T van der Poll
Better use of current antibiotics is warranted to curb increasing antimicrobial resistance rates. Procalcitonin guidance can safely reduce antibiotic usage when used to initiate or discontinue antibiotics in adult patients with a respiratory tract infection. However, the claimed reductions in antibiotic usage are mainly achieved in patients with acute bronchitis and exacerbations of COPD, conditions for which guidelines already discourage antibiotic treatment. Sequential procalcitonin measurements can also reduce the treatment duration of community-acquired pneumonia from 10-12 to 5-7 days, which is, however, already the recommended treatment duration for in- and outpatients under the current Dutch guidelines...
2016: Nederlands Tijdschrift Voor Geneeskunde
W Kievit, F A C Berden, J P H Drenth
Pharmaceutical companies are under increasing scrutiny because of their strategy for gaining market access and reimbursement authorisation for novel drugs. The tool most often used is that of a randomised controlled trial (RCT) in a highly selected population that has a high chance of responding on the treatment but a low chance of developing side effects. This population differs to a large extent from real-life patients, who have diverging characteristics that can influence effectiveness and safety; these include co-morbidity, age and disease severity...
2016: Nederlands Tijdschrift Voor Geneeskunde
F R K Sanders, M Tenhagen, F W Bloemers
A 48-year-old male presented with a painful right knee after a motorcycle accident. Peripheral pulsations in the lower right leg were absent. X-ray indicated a dislocation of the knee. Additional CT-scan revealed a dissection of the popliteal artery. Surgical exploration revealed extensive vascular, neurological and ligamentar damage.
2016: Nederlands Tijdschrift Voor Geneeskunde
A A H Schalkwijk, G Nijpels, S D M Bot, M J M Chin A Paw, C M Renders, P J M Elders
OBJECTIVE: To describe the implementation and feasibility of the national healthcare guidelines on childhood obesity in a region with a high prevalence of overweight and obesity in children. DESIGN: Descriptive, implementation study. METHOD: The implementation of the guidelines took place in the borough Amsterdam West. In total, 17 general practitioners (GP) from the Academic General Practice Network (ANH) of the VU University Medical Center, Amsterdam, participated in the study, along with 19 child healthcare practitioners and 3 paediatricians...
2016: Nederlands Tijdschrift Voor Geneeskunde
R Hofman, W J Nusselder, I K Veldhuijzen, J H Richardus
OBJECTIVE: To estimate mortality due to chronic hepatitis B-virus (HBV) and hepatitis C-virus (HCV) infections in the Netherlands from 2002 to 2015. DESIGN: A cross-sectional analysis based on cause-of-death statistics. METHOD: From Statistics Netherlands we obtained detailed data regarding the number of deaths per year in the following ICD-10 categories: chronic viral hepatitis; malignant neoplasm of the liver and intrahepatic bile ducts; fibrosis and cirrhosis of the liver; and alcoholic liver disease...
2016: Nederlands Tijdschrift Voor Geneeskunde
A G Spruijt, K R Wilting, G D Mithoe, W J M Niessen
OBJECTIVE: To investigate the effect of an intervention in which medical-microbiological laboratories alert general practitioners (GPs) in writing about patients with a chronic hepatitis B or C infection in their practice, urging them to bring these patients under medical surveillance again now that treatment options have improved and guidelines have been revised. DESIGN: Descriptive, prospective. METHOD: All patients who had been diagnosed with hepatitis B or C between 2003 and 2013 on the request of the GP, and for whom diagnostics by an internist, infectious diseases specialist or gastrointestinal/liver specialist had never been requested, were included...
2016: Nederlands Tijdschrift Voor Geneeskunde
J C de Jonge, D W de Lange, E A Bij de Vaate, H van Leeuwen, J E Arends
- Inappropriate use of antibiotics in patients without bacterial infection contributes significantly to worldwide antibiotic resistance.- The goal of this review is to summarise evidence from randomised trials investigating the value of the biomarker procalcitonin (PCT) in patients with symptoms of a bacterial infection in the emergency department (ED) and intensive care (IC).- In patients with a lower respiratory infection in the ED, RCTs demonstrate that withholding or shortening of antibiotic treatment in patients with low PCT levels does not lead to a change in clinical outcome...
2016: Nederlands Tijdschrift Voor Geneeskunde
M T Letsch, M Kreulen, H A Rakhorst
Infections of the hand can result in significant limitation of the function of the hand, and may even require partial amputation of a digit. A felon is an abscess of the distal pulp of the fingertip, which can spread rapidly through the flexor tendon sheath when not treated appropriately. Knowledge of the anatomy and the correct method of physical examination are essential when assessing a patient suspected of having a felon or flexor tendon sheath infection. Here we present two patients with a complicated felon resulting in palmar necrosis of the distal phalanx of the thumb, in which a groin flap was used to reconstruct the thumb...
2016: Nederlands Tijdschrift Voor Geneeskunde
N H Chavannes
In a systematic review in the Dutch Journal of Medicine (NTvG), Dallinga et al. look for an answer to the societally relevant question of whether mobile apps are proven to lead to a more active and healthy lifestyle. Decision makers in healthcare have high expectations of eHealth, a field where scientific evidence sometimes seems overruled merely by the opinions of self-declared 'futurists'. Commonly, eHealth is propelled forward as the solution to the lack of manpower in healthcare, given the expected rise of chronic disease...
2016: Nederlands Tijdschrift Voor Geneeskunde
A Vahl, B Elsman, A van Enst
- Revision of the 2005 guideline 'Diagnostics and treatment of lower extremity peripheral arterial disease' and the development of an audit have instigated a degree of efficiency and transparency for the treatment of patients with peripheral arterial disease (PAD). - The key recommendations are that first-line treatment of patients, who - preferably by means of a consultation in a vascular laboratory - are diagnosed with intermittent claudication, is supervised exercise therapy and secondary prevention. Referral for second-line treatment only needs to occur when invasive therapy is considered, for example when there is insufficient improvement in symptoms or in patients who have or are developing critical ischemia...
2016: Nederlands Tijdschrift Voor Geneeskunde
W J W Bos, G J Navis
A recent meta-analysis published in The Lancet related sodium excretion to mortality in both hypertensive and normotensive subjects. High salt excretion, measured in a spot urine test, was related to increased mortality in hypertensive subjects only, whereas low sodium excretion was related to increased mortality in both hypertensive and normotensive subjects. Here we discuss practical consequences of this analysis. The data underline the importance of salt restriction in hypertension; the analysis also shows that there is a lower limit to salt restriction...
2016: Nederlands Tijdschrift Voor Geneeskunde
J M Dallinga, S E Zwolsman, V T Dekkers, M Baart de la Faille-Deutekom
OBJECTIVE: To present an overview of the literature on the effect of smartphone apps and activity trackers on a healthy lifestyle. DESIGN: Systematic review. METHOD: PubMed, the Cochrane Library, Embase and CINAHL were searched for relevant articles. Inclusion criteria were: (a) the intervention was a mobile app or activity tracker; (b) that stimulated activity and healthy diet; (c) in adults with an unhealthy lifestyle but so far without medical disorders; (d) aimed at preventative healthcare, improvement in health or healthy behaviour; and (e) measured the effect of physical activity, diet and weight...
2016: Nederlands Tijdschrift Voor Geneeskunde
B C J Majoor, N M Appelman-Dijkstra, M A J van de Sande, H M Kroon, N A T Hamdy, P D S Dijkstra
Fibrous dysplasia is a rare genetic bone disorder with a wide variation in clinical expression, ranging from asymptomatic patients to severely affected patients with extensive bone disease, pain, repetitive fractures and deformities and serious endocrinological symptoms (McCune-Albright syndrome). Here, we report on three different cases of fibrous dysplasia. First, a 46-year-old woman with a small solitary lesion in the proximal femur. Second, a 25-year-old man with polyostotic disease of the left leg who received both surgical and medical treatment...
2016: Nederlands Tijdschrift Voor Geneeskunde
D Postema, A J B M Maas
Before the introduction of the Dutch Human Fertilisation (Donor Information) Act (in Dutch: Wet Donorgegevens Kunstmatige Bevruchting) in 2004, approximately 40,000 donor-conceived offspring were born in the Netherlands. The majority is conceived by means of artificial insemination with anonymous donor sperm (in Dutch: kunstmatige inseminatie met anoniem donorzaad - KID). This means that they have little or no access to information about their genetic origins. Through the Fiom KID-DNA Databank, established in 2010 in association with the Canisius Wilhelmina Hospital, it is possible for these donor-conceived offspring and donors to search for one another...
2016: Nederlands Tijdschrift Voor Geneeskunde
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