Nederlands tijdschrift voor geneeskunde

Publisher: Kluwer

Journal 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

Publisher details


  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Authors own final version can be archived
    • Publisher's protected PDF can be used for a fee
    • Published source must be acknowledged
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    • Articles in some journals can be made Open Access on payment of additional charge
    • 'Kluwer' is an imprint of 'Springer Verlag (Germany)'
  • Classification

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: The latest dietary guidelines recommend increased consumption of vegetables, fruits and nuts; weekly consumption of beans and fish; zero intake of alcohol; reduced meat and salt consumption; water, milk or yoghurt, filtered coffee, and 3-5 daily cups of tea rather than soft drinks and fruit juice; and replacing butter with vegetable oils and soft margarine. The glycemic index is considered not useful. The totality of the guidelines can lower blood pressure substantially. Effects on LDL cholesterol may be limited because the guidelines ignore the saturated fat content of foods, and treat all dairy products as equal. Interpretation of the effects of foods in terms of their constituent parts is mostly dismissed; this is a worrisome development in an otherwise valuable report.
    Nederlands tijdschrift voor geneeskunde 11/2015; 159:A9802.
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    ABSTRACT: Background: To date, there is a lack of consensus concerning the application of local anaesthetics with epinephrine in fingers, due to the alleged risk of ischaemic complications. Case description: We present the case of a 70-year old woman, with a medical history of diabetes mellitus and an ischemic cerebral infarct, who underwent operative trigger finger release under local anaesthetics with 1% lidocaine-epinephrine (1:100,000) solution. A few hours later, she developed persisting numbness and ischemic symptoms of the digits. Initial antithrombotic treatment with nadroparin did not resolve the issue, but vasodilatory treatment with nifedipine improved symptoms. Nevertheless, digital necrosis developed in the affected fingers several weeks later. Post-operatively, severe atherosclerosis was diagnosed in the affected hand. Conclusion: The use of local anaesthesia in conjunction with epinephrine for surgery on digits does offer advantages, but caution is warranted for patients with risk factors predisposing for local circulatory insufficiency. Timely vasodilatory treatment with phentolamine is the preferred option for patients who develop acute ischaemia following local anaesthesia with epinephrine.
    Nederlands tijdschrift voor geneeskunde 11/2015; 159:A9477.
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    ABSTRACT: A 72-year old patient presented himself at the outpatient clinic with a painful swelling on the dorsum of the left foot and a foot drop. The diagnosis was a complete rupture of the tibialis anterior tendon.
    Nederlands tijdschrift voor geneeskunde 11/2015; 159:A9594.
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    ABSTRACT: Background: A "thrombus in transit" is a relatively rare diagnosis involving a thrombus in a patent foramen ovale. Patent foramen ovale occurs in about 25% of the population. A thrombus in transit may lead to paradoxical arterial emboli in the cerebral circulatory system and the extremities, as well as other locations. Case description: A 60-year-old male patient with severe pneumonia sepsis appeared to have a thrombus in the right atrium, extending into the left atrium through a patent foramen ovale. The patient was treated with therapeutic anticoagulants. Cerebral embolization occurred despite this, with extensive cerebral ischaemia. The patient ultimately died from multiple organ failure. Conclusion: A thrombus in transit may be treated with heparins, thrombolysis or by surgical removal of the thrombus. The optimum treatment must be decided for each individual patient. The mortality rate of this condition is high (16-36%).
    Nederlands tijdschrift voor geneeskunde 11/2015; 159:A9491.
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    ABSTRACT: - Infectious diseases and cancer change a patient's metabolism and hence the metabolic compounds produced. The composition of volatile organic compounds (VOCs) in exhaled breath or urine or stool samples can therefore be characteristic of a particular disease. - In recent years many studies have been conducted into the training of animals, including dogs, to recognise diseases by smell. Besides trained animals, electronic noses (e-noses) are also being developed. These devices can identify disease-specific odour profiles in VOCs.- Although the results of research in the field of scent diagnosis are promising, the medical community remains largely sceptical. We discuss applications of scent detection as a diagnostic tool in modern medicine.- Conflict of interest and financial support: none declared.
    Nederlands tijdschrift voor geneeskunde 11/2015; 159:A9434.
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    ABSTRACT: Patients with severe mental illness have an accumulation of risk factors for physical diseases like cardiovascular diseases, metabolic syndrome, diabetes mellitus and COPD. These patients receive suboptimal care in the Netherlands. A major barrier to optimal care is the lack of collaboration between mental health professionals and general practitioners. An improvement could be made if all medical professionals actively supported these high-risk patients in taking adequate care of their health needs. This improvement can only be made if general practitioners and mental health professionals collaborate in a timely and structured manner.
    Nederlands tijdschrift voor geneeskunde 11/2015; 159:A9160.
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    ABSTRACT: Epilepsy is a neurological disorder with an annual incidence in the Netherlands of 30 per 100,000 people. We present two cases of a patient admitted to the emergency department upon experiencing a generalized seizure. In each case, severe metabolic lactic acidosis was identified through routine laboratory diagnostics. Based on their clinical presentation, we had no reasons to suspect another cause of this severe acidosis apart from the seizure. We repeated arterial blood sample one to two hours later and found that both pH and lactate were normalized. Severe lactic acidosis may occur in patients who experience seizures but otherwise do not require treatment. Taking an arterial blood sample from these patients in the emergency setting will be of limited value, because in most patients hyperlactatemia in the postictal state is self-limiting. In some patients, however, a persistent hyperlactatemia may indicate a serious underlying pathology. It is therefore advisable to repeat an arterial blood sample a few hours later.
    Nederlands tijdschrift voor geneeskunde 11/2015; 159:A9068.
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    ABSTRACT: Patients with dementia almost all have one or more symptoms of problem behaviour. This problem behaviour includes a wide range of symptoms including depression, anxiety and apathy, and behavioural problems such as aggression, general restlessness, compulsion to walk, disinhibition and calling, and psychotic disorders such as delusions and hallucinations. Due to the persistence and complexity of problem behaviour in patients with dementia, doctors often prescribe psychotropic drugs for long periods of time. In nursing homes there is a great need for non-pharmacological treatments for patients with psychological or psychiatric problems. The canopy-enclosed bed seems to meet this need and has positive effects. We observed that within a few weeks of patients getting a canopy-enclosed bed, psychotropic drugs could be reduced or even stopped. Using a canopy-enclosed bed is a measure of restraint. Therefore it remains important to carefully trade off its deployment with the intended goal.
    Nederlands tijdschrift voor geneeskunde 11/2015; 159:A9617.
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    ABSTRACT: The Dutch BETER consortium has established a national care infrastructure for Hodgkin lymphoma survivors. 'BETER' [the Dutch word for 'better'] stands for Better care after Hodgkin lymphoma (HL): Evaluation of long-term Treatment Effects and screening Recommendations. The survivorship care focuses on long-term effects of HL treatment. Over 10,000 HL survivors who were treated in the period spanning 1965-2008 have been identified. As part of the survivorship care initiative, specific BETER out-patient clinics have been set up. A dedicated website,, provides HL survivors with relevant information. The stakeholders of the BETER survivorship care programme aim to achieve an improved healthy life expectancy for patients treated for HL.
    Nederlands tijdschrift voor geneeskunde 11/2015; 159:A9269.
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    ABSTRACT: - Thyroid cancer is comparatively rare. Thyroid nodules, on the other hand, are frequently diagnosed as a result of increasing use of diagnostic imaging.- Cytological investigation of small nodules that have been found by chance often reveals micropapillary carcinoma that is probably not clinically relevant.- The new guideline 'Thyroid cancer' advises that cytological investigation of these non-palpable, incidentally discovered thyroid nodules should only be performed on indication.- The standard treatment for patients with papillary or follicular thyroid cancer consists of thyroidectomy followed by, if indicated, lymph-node dissection, ablation therapy with radioactive iodine and TSH-suppression. The extent of this treatment is determined on the basis of known prognostic factors and the results of initial treatment.- Targeted systemic therapy is available for patients with metastatic progressive disease.- There is more focus on the effects of short- and long-term treatment, in order to optimise quality of life.
    Nederlands tijdschrift voor geneeskunde 11/2015; 159:A9413.
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    ABSTRACT: The incidence of thyroid cancer is increasing, especially the papillary subtype. This increase can be mainly attributed to the detection of small - mostly indolent - papillary thyroid cancers as a consequence of the higher sensitivity of diagnostic techniques and the more frequent use of diagnostic applications. Two patients are described with (non-)palpable thyroid nodules to illustrate the risk of overdiagnostics and overtreatment. A thyroid incidentaloma detected on ultrasound, CT or MRI does not require further diagnostic procedures as standard. The pros and cons of diagnostic procedures must be discussed in a multidisciplinary team.
    Nederlands tijdschrift voor geneeskunde 11/2015; 159:A9414.
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    ABSTRACT: - Peritonitis carcinomatosa occurs in 10% of patients with colorectal carcinoma.- Compared with patients with lung and liver metastases, survival in patients with peritonitis carcinomatosa is worse if treated with systemic chemotherapy. However, treatment with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) offers longer survival than systemic chemotherapy.- A Dutch registration study shows that the 3- and 5-year survival of patients treated with cytoreductive surgery and HIPEC had a 3-year survival of 46% and a 5-year survival of 31%.- Mortality and morbidity have dropped greatly due to standardisation of the intervention in accordance with the Dutch protocol.
    Nederlands tijdschrift voor geneeskunde 11/2015; 159:A9319.
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    ABSTRACT: De bridge-studie ter discussie: The management of anticoagulation in patients undergoing invasive procedures is a complex clinical problem. Interrupting anticoagulation for a procedure increases the risk of thromboembolism. On the other hand, bridging anticoagulation with an alternative, short-acting anticoagulans increases the risk for peri-operative bleeding. A recent randomized controlled trial (the BRIDGE trial) shows that in patients with atrial fibrillation who had anticoagulant treatment interrupted for an elective invasive procedure, a strategy of forgoing bridging anticoagulation decreased the risk of major bleeding and was non-inferior to peri-operative bridging with low-molecular-weight heparin for the prevention of arterial thromboembolism.
    Nederlands tijdschrift voor geneeskunde 11/2015; 159:A9652.

  • Nederlands tijdschrift voor geneeskunde 10/2015;
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    ABSTRACT: Objective: To investigate whether axillary radiotherapy (ART) in patients with primary breast cancer and a tumour-positive sentinel node results in a similar axillary tumour recurrence rate compared with axillary lymph node dissection (ALND), and whether ART results in lower morbidity. Design: Randomised, multicentre non-inferiority trial. Method: Patients with breast cancer ≤ 5 cm without clinical signs of lymph node metastases but with a tumour-positive sentinel node were randomised between ALND or ART. The primary endpoint was the 5-year axillary recurrence rate. Secondary endpoints were disease-free survival, overall survival, morbidity (lymphoedema and shoulder function) and quality of life. (, study number NCT00014612.) RESULTS: Between 2001 and 2010, 1425 patients with a tumour-positive sentinel node were included, 744 of whom had been randomised to ALND and 681 to ART. After a median follow-up period of 6.1 years, the 5-year axillary recurrence rate was 0.43% after ALND and 1.19% after ART; the difference was not statistically significant. The primary analysis was underpowered due to the low number of axillary recurrences. At 5 years the disease-free survival rate was 86.9% after ALND and 82.7% after ART. Overall survival was 93.3% and 92.5% respectively. Lymphoedema was noted significantly more often after ALND than after ART at 1 year, 3 years and 5 years. There were no significant differences in shoulder function or quality of life. Conclusion: Both ART and ALND produce very low axillary recurrence rates in patients with breast cancer ≤ 5 cm and a tumour-positive sentinel node. ART results in significantly less lymphoedema than ALND.
    Nederlands tijdschrift voor geneeskunde 10/2015; 159:A9302.
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    ABSTRACT: The AMAROS trial showed that substituting axillary lymph node dissection by radiotherapy of the axillary and periclavicular nodes (ART) in patients with sentinel node (SN) metastases results in less lymphoedema, without a significant difference in the 5-year axillary recurrence rate (ARR). Three surgical studies showed no increase in ARR after omitting axillary treatment in cases of limited SN metastases, provided that adjuvant systemic therapy and tangential breast radiotherapy were applied. On the other hand, several recent radiotherapy trials, including a meta-analysis by the Early Breast Cancer Trialists' Collaborative Group, showed that regional radiotherapy improves disease-free survival where there are positive axillary nodes. In view of the low ARR and good overall survival with contemporary breast cancer treatments, limiting axillary treatment and its associated morbidity is a logical development. However, it is too early to omit axillary treatment in all SN-positive patients. ART is a safe next step in reducing axillary treatment.
    Nederlands tijdschrift voor geneeskunde 10/2015; 159(44):A9510.
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    ABSTRACT: Recently, the evidence-based guideline 'Spinal metastasis' produced by the Dutch National Working Group on Neuro-Oncology appeared. This guideline applies to patients with spinal metastases and spinal localizations of haematological malignancies, with or without epidural extension. Timely diagnosis and treatment of spinal metastases is essential in order to reduce pain and neurological deficit in particular. An important aim of this guideline is to reduce both patient and doctor delay by providing information to high-risk patients and their general practitioners and to give clear advice on the organization of care. In this case report we describe two patients with spinal metastases in order to illustrate the difficulties in providing a timely diagnosis and optimal treatment for symptomatic spinal metastases. Furthermore, we provide advice to all health care professionals involved to secure the highest possible quality of life for patients with spinal metastases.
    Nederlands tijdschrift voor geneeskunde 10/2015; 159:A9256.
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    ABSTRACT: - In 2015, the Dutch Neuro-Oncology Working Group produced the multidisciplinary evidence-based guideline 'Spinal metastasis'.- The guideline applies to patients with spinal metastases of solid tumours and patients with spinal localisations of haematological malignancies. - This article gives a short overview of some key recommendations in the areas of diagnostics, treatment and follow-up.
    Nederlands tijdschrift voor geneeskunde 10/2015; 159:A9101.