Nederlands tijdschrift voor geneeskunde

Description

De lange historie en de grote degelijkheid en leesbaarheid van het tijdschrift maken het tot een bolwerk van medische wetenschap in druk, voortdurende dialoog over het medisch ambt. Het tijdschrift wordt gelezen door artsen en aankomend artsen van velerlei signatuur. Het NTVG staat bekend als een wetenschappelijk algemeen medisch tijdschrift.

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  • Website
    Nederlands Tijdschrift voor Geneeskunde website
  • Other titles
    Nederlands tijdschrift voor geneeskunde
  • ISSN
    1876-8784
  • OCLC
    1642618
  • Material type
    Periodical
  • Document type
    Journal / Magazine / Newspaper

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: A 46-year-old woman suffered from pain attacks in her fourth finger over the course of 15 years. Pain was aggravated by low temperatures and touching. A blue spot was visible under the nail. After surgical resection, histologic analysis confirmed the diagnosis 'glomus tumor'. The patient was pain-free at 6 weeks after surgery.
    Nederlands tijdschrift voor geneeskunde 01/2014; 158:A6954.
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    ABSTRACT: Pulmonary oedema in pregnancy may have various causes. A systematic approach to a pregnant woman with pulmonary oedema is important. Acute myocardial infarction should be considered during the differential diagnosis. A 30-year-old primigravida, who had been admitted with pre-eclampsia, complained of increasing shortness of breath at 28 weeks and 5 days gestation. She had pulmonary oedema, which was considered to be consistent with pre-eclampsia. A caesarean section was performed at 28 weeks and 6 days gestation because of increasing oxygen dependency. Following the caesarean section the patient was transferred to the ICU because of imminent respiratory failure, and a semi-acute anterior infarction was diagnosed by means of an ECG (estimated ejection fraction: 30%). The patient was discharged in a reasonable condition 8 days after the caesarean section. Differential diagnosis of pulmonary oedema during pregnancy is wide. Consultation with a cardiologist is recommended if a possible cardiac cause is suspected. Determination of troponin levels, ECG and an electrocardiogram should be the first diagnostic tools of choice in a pregnant patient.
    Nederlands tijdschrift voor geneeskunde 01/2014; 158:A6925.
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    ABSTRACT: In stage III breast carcinoma, metastasized disease needs to be determined. In the past, conventional imaging by liver ultrasound, chest X-ray and bone scintigraphy was the work-up of choice. Recently, FDG-PET/CT was found to have additional value, but clinicians are hesitant to introduce this technique. We present three patients in whom FDG-PET/CT was applied. A 61-year-old woman with stage III breast carcinoma after conventional work-up was upstaged to stage IV breast carcinoma by FDG-PET/CT, upon which her treatment was changed. A 55-year-old woman suspected of stage IV breast carcinoma after conventional imaging was downstaged to stage III after FDG-PET/CT. Her treatment was changed as well. In a 78-year-old woman with recurrent breast carcinoma, the diagnostic certainty of stage III breast carcinoma was increased by FDG-PET/CT. We conclude that FDG-PET/CT is valuable for adequately diagnosing metastases in patients with stage III breast carcinoma and can replace conventional imaging.
    Nederlands tijdschrift voor geneeskunde 01/2014; 158:A7035.
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    ABSTRACT: - The case-control study is an efficient study design for evaluating the effect of cancer screening.- This study method enables calculation of the percentage by which the risk of mortality from cancer decreases in participants in a screening programme if the carcinoma is detected early.- Reductions in mortality of 15-65% have been published for participants in a population screening programme for breast, cervical and colorectal cancer.- The case-control study is an observational study, in other words it does not have an experimental design. There is, therefore, a risk that confounding and self-selection bias may cause over- or underestimation of the mortality reduction.- It is, therefore, important that at publication investigators indicate the extent to which they have succeeded in minimalising the occurrence of these forms of bias in their study design and data analysis.
    Nederlands tijdschrift voor geneeskunde 01/2014; 158:A7047.
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    ABSTRACT: Systemic therapy for malignancy may be accompanied by an acute coronary syndrome (ACS), regardless of cardiovascular risk factors. We present three patients with few cardiovascular risk factors and no history of cardiovascular disease, who suffered an ACS within a week of starting systemic treatment of colorectal cancer, non-Hodgkin's lymphoma and breast cancer, respectively. In all three patients, systemic anti-cancer therapy was continued after making individualised adjustments to the treatment regimen. It is important to recognize the possible relationship between chemotherapy - including the oral compound capecitabine - and ACS, and to withhold systemic anti-cancer treatment until the ACS is adequately treated. Subsequently, a decision has to be made regarding the continuation of the systemic anti-cancer treatment. Factors to be included in decision making are the intent of the treatment (curative or palliative), the availability of a regimen with less cardiovascular toxicity but comparable efficacy, the outcome of the ACS and the patient's wishes.
    Nederlands tijdschrift voor geneeskunde 01/2014; 158:A6940.
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    ABSTRACT: - All NSAIDs may induce cardiotoxicity. In this respect naproxen is relatively the safest choice.- Selective cyclo-oxygenase-2-inhibitors (coxibs) are at least as effective in preventing clinically relevant gastrointestinal toxicity as non-selective NSAIDs plus a protonpump inhibitor (PPI).- Non-selective NSAIDs plus a PPI are more effective in prevention of dyspepsia than coxibs.- After a serious gastrointestinal complication while using NSAIDs, in principal the patient should no longer use NSAIDs. If needed, a coxib plus a PPI is the first choice.
    Nederlands tijdschrift voor geneeskunde 01/2014; 158:A7311.
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    ABSTRACT: A 41-year-old man had a palpable mass on the volar side of his hand. X-ray, ultrasound and MRI showed an inhomogeneous tumour with calcification. Histologic examination ruled out the suspicion of a liposarcoma. The surgeon successfully excised the ossifying lipoma, which is a rare variant of a common lipoma and can clinically and radiologically mimic malignant neoplasms.
    Nederlands tijdschrift voor geneeskunde 01/2014; 158:A7498.
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    ABSTRACT: - In shoulder pain there is often no direct relationship between the symptoms and the anatomical substrate; for this reason, the term 'subacromial pain syndrome' (SAPS) is better than 'impingement'. - The diagnosis of SAPS can only be made using a combination of tests.- Imaging diagnostics, preferably ultrasound, can be carried out if conservative treatment does not give the required result.- Acute pain is treated by giving advice and if necessary analgesics; a subacromial injection of glucocorticoids is indicated if symptoms recur or are persistent. - Exercise therapy should be specific, of low intensity and high frequency, including eccentric training, scapula stabilization and trigger point massage. - Rehabilitation in a specialized unit may be considered if pain maintaining behaviour is playing a role.- There is no convincing evidence that surgical treatment is more effective than conservative management and there is no indication for the surgical treatment of asymptomatic rotator cuff tears.
    Nederlands tijdschrift voor geneeskunde 01/2014; 158:A6985.
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    ABSTRACT: Mydriasis is a rare phenomenon in non-comatose patients, usually caused by toxic agents or oculomotor neuropathy. We describe two patients who presented with mydriasis at the outpatient clinic. The first patient was a 46-year-old woman with mydriasis, headache, ptosis, ophthalmoplegia and transient ataxia after an influenza vaccination. The second was a 47-year-old woman with mydriasis, ophthalmoplegia, ptosis and ataxia after she had used doxycycline for an upper respiratory tract infection. In both patients, GQ1b-antibodies were detected and both were diagnosed with Miller Fisher syndrome. The second patient was treated with immunoglobulins, the other patient improved spontaneously. Miller Fisher syndrome is characterised by a triad of ophthalmoplegia, ataxia and areflexia. An infection or vaccination may give rise to an auto-immune response with GQ1b-antibodies directed against gangliosides in peripheral nerve tissue. The Miller Fisher syndrome has a good prognosis with spontaneous recovery ensuing in most patients. Treatment with immunoglobulins is required in some patients.
    Nederlands tijdschrift voor geneeskunde 01/2014; 157:A6581.
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    ABSTRACT: In 2012 the Dutch Central Committee on Research Involving Human Subjects (CCMO) introduced a new procedure to obtain medical ethics committee approval for multicentre studies in the Netherlands. A recent cohort study demonstrated that the 2012 procedure is a more efficient one. Our additional prospective evaluation of two multicentre trials confirmed this finding; the implementation of the 2012 procedure in 16 participating centres shortened the local review procedure by a median of 20 days (from 45 to 25 days). However, 6 of the 16 centres (38%) apparently did not follow the new procedure. Strict procedural adherence has the potential to further streamline the process for obtaining ethical approval for multicentre trials in the Netherlands.
    Nederlands tijdschrift voor geneeskunde 01/2014; 158:A7328.
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    ABSTRACT: The transanal total mesorectal excision (TME) for colorectal tumours is a new endoscopic approach in which the rectum is mobilized transanally from down-to-up using a flexible transanal single-access port. The advantage of this technique is that it could result in fewer conversions from laparoscopic to open procedures and consequently fewer complications and more radical resections. Standard endoscopic armamentarium is used for the transanal technique so that costs remain low. The length of the learning curve is expected to be comparable to other laparoscopic techniques, and is even shorter for an experienced laparoscopic surgeon. Additional research is needed to compare long-term oncological and clinical results of transanal TME to laparoscopic and open TME.
    Nederlands tijdschrift voor geneeskunde 01/2014; 158(6):A7054.
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    ABSTRACT: To map the relation between metformin prescription and renal function in an outpatient setting. To investigate whether there is an association between renal function, metformin concentration and lactate concentration. Pilot for a prospective observational cohort study. We included outpatients with diabetes mellitus type 2 who were treated with metformin. At inclusion, we determined the HbA1c, lactate, metformin and creatinine concentrations and the estimated glomerular filtration rate (eGFR). Information on the prescribed dosage of metformin was acquired from patient files. Our primary outcome measure was the number of patients in whom the dose was not adjusted to the renal function. Our secondary outcome measure was the difference in median lactate concentration between patients with a normal (≤ 2.5 mg/l) and an increased (> 2.5 mg/l) metformin concentration. Eighty-eight patients were included, 12 (14%) of whom had an eGFR ≤ 30, 31 (36%) an eGFR of 30-50 and 44 (50%) an eGFR > 51 ml/min/1.73 m2. In 27 (31%) of all patients, the daily dose of metformin exceeded the dose recommended in the practice guidelines. The 28 patients with an increased metformin concentration had a significantly higher median lactate concentration: 2.3 mmol/l compared to 1.5 mmol/l for the 60 patients with a normal metformin concentration (p < 0.0001). Our study shows that in outpatient practice, the metformin dose is not sufficiently adjusted to a reduced renal function in 31% of the patients. The accumulation of metformin appears to be associated with an increased lactate concentration and a reduced renal function. Extra attention to the dose of metformin in reduced renal clearance is therefore recommended.
    Nederlands tijdschrift voor geneeskunde 01/2014; 158(5):A6266.
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    ABSTRACT: In the Netherlands, lithium is the mood stabilizer of choice for patients with bipolar disorder. Long-term treatment with lithium can only be implemented safely with frequent and appropriate monitoring of serum lithium concentrations. Here we use 3 cases to illustrate that severe complications can arise when careful monitoring is not performed: a 47-year-old woman with symptoms of a lithium intoxication with therapeutic plasma levels; a 73-year-old woman with chronic lithium intoxication; and a 56-year-old woman with end-stage renal failure after many years of probable toxic lithium levels.
    Nederlands tijdschrift voor geneeskunde 01/2014; 158:A7207.
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    ABSTRACT: In the Dutch Public Health Status and Forecast report (PHSF), the Dutch National Institute for Public Health and the Environment explores the future of public health and health care in the Netherlands until 2040. The PHSF-2014 will consist of four parts: (a) a description of public health in the Netherlands now and in the past; (b) future trends, based on model calculations and expert opinions; (c) future scenarios based on four normative perspectives on public health; and (d) opportunities and dilemmas in the prevention of future problems. In this first article of a short series on the PHSF-2014, we briefly explain these four parts of the study. In the next article, we will describe the most important future trends until 2030. In the final article, we will summarize the conclusions of the PHSF-2014.
    Nederlands tijdschrift voor geneeskunde 01/2014; 158:A7477.
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    ABSTRACT: - The decision to move to a form of mechanical ventilation in patients with acute respiratory failure due to an acute exacerbation of COPD is influenced by expectations about survival and quality of life after discharge from the ICU.- Physicians tend to be too pessimistic about the survival outcome of an ICU stay with invasive mechanical ventilation.- The forced expiratory volume in 1 second (FEV1) is not an adequate prognostic parameter.- In order to prevent undertreatment of patients with respiratory failure due to an exacerbation of COPD, knowledge of prognostic parameters and quality of life in these patients is very important.- End of life care should be integrated into the standard care of COPD patients.
    Nederlands tijdschrift voor geneeskunde 01/2014; 158:A5276.
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    ABSTRACT: The prevalence of aortic stenosis is increasing due to aging of the general population. Transcatheter aortic valve implantation (TAVI) is an alternative for surgical aortic valve replacement (AVR) for high-risk patients. Cardiac scoring systems have been developed to predict the risk of adverse outcomes following surgery, but currently they do not include frailty parameters, and frail patients have an increased risk of adverse health outcomes. Preoperative frailty correlates with adverse outcomes, mortality and functional decline in patients undergoing TAVI; by identifying these patients it is possible to counteract symptoms of frailty by implementing tailored intervention by the geriatrician. The Comprehensive Geriatric Assessment (CGA) is a tool used to detect frailty. Based on the current literature, we highly recommend performing a CGA and a minimum of a Timed Up and Go test, a mini nutritional assessment and serum albumin measurements in patients aged > 70 years undergoing a TAVI or surgical AVR, in order to aim reducing the accompanying risks of the intervention.
    Nederlands tijdschrift voor geneeskunde 01/2014; 158:A7381.

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