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
    • Must link to publisher version
    • Articles in some journals can be made Open Access on payment of additional charge
    • 'Kluwer' is an imprint of 'Springer Verlag (Germany)'
  • Classification
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: A 39-year-old man presented with knee pain and limited knee flexion. MRI showed a mucoid degeneration of the anterior cruciate ligament (celery stalk sign). This rare condition can be treated with arthroscopic debridement with volume reduction of the anterior cruciate ligament. In severe cases, anterior cruciate ligament resection could be considered.
    Nederlands tijdschrift voor geneeskunde 09/2015; 159:A9272.
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    ABSTRACT: Objective: To determine the trends in prevalence of moderate and severe thinness, overweight and obesity in children living in Amsterdam between 2009 and 2013 and estimate prevalences for 2020. Design: Historical cohort study. Method: 158,730 measurements of height and weight of 112,405 children from Amsterdam were analysed. Moderate thinness, severe thinness, overweight and obesity were determined using international BMI cut-off values. Trends were analysed using Generalized Estimating Equations (GEE) for two age groups: pre-schoolers (2 and 3 years) and school-aged children (5, 10 and 14 years). The 'self-projecting method,' which allowed us to extend former trends into the future, was used to estimate prevalences for 2020. Results: The prevalence of moderate thinness increased significantly in both age groups. The prevalence of severe thinness did not change. The prevalences of overweight and obesity declined significantly in both age groups. These trends were most evident in children of Dutch origin. Other ethnic groups also showed declining prevalences but not in both age groups or both categories of overweight. The prognosis for 2020 shows a further decline in the prevalence of overweight and obesity and an increase in the prevalence of thinness. Conclusion: A decline in the prevalences of overweight and obesity was observed in Amsterdam children, including children of Turkish and Moroccan origin. The prevalence rates are still high, so investing in prevention remains necessary. The prevalence of moderate thinness also seems to be increasing. Continued monitoring of children in all BMI classes is therefore important.
    Nederlands tijdschrift voor geneeskunde 09/2015; 159:A8967.
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    ABSTRACT: Point-of-care testing (POCT) is being used increasingly in general practice and other healthcare contexts outside the hospital.
    Nederlands tijdschrift voor geneeskunde 09/2015; 159:A9475.
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    ABSTRACT: The incidence of crural ulcers is high. They reduce quality of life considerably and create a burden on the healthcare budget. The key treatment is ambulant compression therapy (ACT). We describe two patients with crural ulcers whose ambulant compression treatment was suboptimal and did not result in healing. When the bandages were applied correctly healing was achieved. If correctly applied ACT should provide sufficient pressure to eliminate oedema, whilst taking local circumstances such as bony structures and arterial qualities into consideration. To provide pressure-to-measure regular practical training, skills and regular quality checks are needed. Knowledge of the properties of bandages and the proper use of materials for padding under the bandage enables good personalised ACT. In trained hands adequate compression and making use of simple bandages and dressings provides good care for patients suffering from crural ulcers in contrast to inadequate ACT using the same materials.
    Nederlands tijdschrift voor geneeskunde 09/2015; 159:A9157.
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    ABSTRACT: We present a case of a 81-year-old man with blunt chest trauma after a car accident. Trauma screening at the emergency department showed multiple rib fractures and a fractured sternum. We made the diagnosis floating sternum. Cardiac contusion may occur after chest-wall trauma, but was not present in this case.
    Nederlands tijdschrift voor geneeskunde 09/2015; 159:A9039.
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    ABSTRACT: Background: Partial lipodystrophy is a rare acquired disorder characterised by gradual loss of subcutaneous adipose tissue in the upper half of the body. Case description: We saw a 9-year-old girl who had been referred on account of recurrent urinary tract infections. On physical examination, she was noticed to be very thin in the face. Her upper extremities were also skinny. Strikingly, the lower half of her body was normally proportioned, which immediately suggested a diagnosis of partial lipodystrophy. Additional examinations showed a low level of complement factor C3 and the presence of C3 nephritic factor. Conclusion: Partial lipodystrophy is rare but it is important to include it in the differential diagnosis of unwanted disproportional subcutaneous fat loss because of the somatic and psychological consequences.
    Nederlands tijdschrift voor geneeskunde 09/2015; 159:A8872.
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    ABSTRACT: - Iron deficiency and anaemia occur frequently in patients with chronic kidney disease (CKD) or chronic heart failure (CHF) and are associated with lower quality of life and higher mortality. - Treating anaemia with erythropoietic growth factors produces no improvement. In recent years, the focus has therefore shifted to correction of iron deficiency. - Chronic inflammation in CKD increases the production of hepcidin, which blocks iron absorption from the intestine and leads to less efficient re-use of iron from the macrophages. - In absolute iron deficiency the body's iron stores are depleted, whereas in functional iron deficiency the supply of iron is not sufficient to meet demand from the bone marrow.- Normal or high ferritin levels do not exclude iron deficiency at tissue level. The iron saturation fraction is a more useful indicator.- Parenteral iron therapy ameliorates in CHF the symptoms of iron deficiency, irrespective of the effect on haemoglobin levels. - The long-term effects of intravenous iron on mortality and morbidity are still unknown.
    Nederlands tijdschrift voor geneeskunde 09/2015; 159:A8769.
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    ABSTRACT: Maturity-onset diabetes of the young (MODY) is the most common type of monogenic diabetes mellitus, estimated to account for approximately 1-4% of patients with diabetes. The predicted prevalence is, therefore, 20,000 patients in The Netherlands. Unfortunately less than 5% of these patients are confirmed by molecular genetic analysis. MODY is a clinically heterogeneous group of disorders caused by β-cell dysfunction, which is caused by mutations in multiple genes. MODY is characterized by an early onset of diabetes (often before the age of 30 years) and autosomal dominant inheritance. Patients do not usually require insulin at diagnosis. To emphasize the importance of genetic analysis we describe a 7-year-old boy and his siblings with MODY type 2. Molecular genetic testing is essential for individual patient care, as treatment options differ between the various forms of MODY; it also provides an opportunity to screen relatives.
    Nederlands tijdschrift voor geneeskunde 09/2015; 159:A9247.
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    ABSTRACT: When drugs are registered, relatively little is known about their adverse effects as clinical trials generally include only small numbers of patients and are of limited duration. New European legislation and the monitoring of adverse events are intended to enable the timely recognition of adverse effects of newly-registered drugs. However, many adverse effects of commonly-used older drugs are already well-known. Therefore, in order to improve the quality of health care, research should also be focused on the risk factors associated with developing such adverse effects.
    Nederlands tijdschrift voor geneeskunde 09/2015; 159:A9210.
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    ABSTRACT: An 84-year-old woman underwent a diagnostic laparoscopy preceding a planned total gastrectomy. A bilateral pneumothorax was diagnosed postoperatively, following an uneventful procedure. The patient's clinical parameters led to the diagnosis of capnothorax, a rare complication of laparoscopic surgery. It is important to be able to differentiate between a capnothorax and a pneumothorax because the treatment is different: a capnothorax can generally be treated conservatively. The perioperative signs and symptoms, physiology and treatment of a capnothorax are discussed in this article.
    Nederlands tijdschrift voor geneeskunde 09/2015; 159:A8918.
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    ABSTRACT: It is well established that the presence of impaired renal function is associated with an increased risk of end-stage renal disease, cardiovascular events and all-cause mortality. Irrespective of the starting level of renal function, a decline in renal function over two years is a relevant and strong risk factor for end-stage renal disease, cardiovascular death and all-cause mortality. Even a decline of 20 to 30 per cent is associated with to a considerable increased risk and requires further attention.
    Nederlands tijdschrift voor geneeskunde 09/2015; 159:A8106.
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    ABSTRACT: Background: Variant angina, or vasospastic angina, is a form of angina caused by vasospasm of the coronary arteries, probably caused by endothelial dysfunction. This form of angina is provoked by non-classical risk factors such as stress, alcohol use, use of sympathomimetics and low environmental temperatures, but also by smoking. Treatment is based on elimination of risk factors and vasodilator therapy with nitrates and long-acting calcium antagonists. Case description: We present a 68-year-old woman with recurring thoracalgia at rest and during exercise, suggestive of severe variant angina in more than one coronary artery. Despite elimination of risk factors and administration of vasodilatory therapy the treatment was initially insufficient. It eventually emerged that the probable cause was frequent use of a vasoconstrictive nasal spray, although this was not described in literature, and not originally mentioned by the patient. Conclusion: A thorough case history is of vital importance in a patient presenting with a history suggestive of variant angina. Even undescribed and apparently less important risk factors can be responsible for persistence of symptoms, and can lead to an applied treatment not producing the desired result.
    Nederlands tijdschrift voor geneeskunde 09/2015; 159:A8971.
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    ABSTRACT: Background: Vision problems are common and the causes are diverse. This case illustrates the fact that vision problems may also be the first manifestation of a neurodegenerative disorder. Case description: A 46-year-old male developed progressive, incapacitating vision problems. Multiple pairs of glasses with lenses of different strengths did not improve symptoms. No ophthalmological explanation of the problems could be found. Oculomotor apraxia and visual extinction were seen on neurological examination. Visuoperceptual impairment was the main finding on neuropsychological examination. Impairment was also identified in visuoconstruction, memory and praxis. Conclusion: Cognitive problems in several areas, interference with activities of daily living, and young age of onset complete the clinical picture of presenile dementia. Posterior cortical atrophy is a spectrum of neurodegenerative disorders, characterized by progressive, incapacitating visuospatial and visuoperceptual impairment. The most prevalent underlying pathology is Alzheimer's disease. At present there is no curative therapy for posterior cortical atrophy.
    Nederlands tijdschrift voor geneeskunde 09/2015; 159:A8878.
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    ABSTRACT: Epiglottitis is a rare and life-threatening cause of acute sore throat. Usually, epiglottitis is caused by a bacterium, such as Haemophilus influenzae type b. Symptoms of epiglottitis are acute and rapidly progressive sore throat, a hoarse voice, fever, and drooling. We present two adult patients with acute sore throat who were diagnosed with epiglottitis. In adults with symptoms compatible with epiglottitis, it is justified to look down the throat with a light. Only if the view is impeded should a spatula be used but carefully. If there is a discrepancy between the severity of symptoms and few or no abnormal findings on examination of the throat, epiglottitis should be considered. If epiglottitis is suspected, referral to an ENT specialist is always indicated. Symptoms of upper airway obstruction, such as drooling, dyspnoea, inspiratory stridor and fear or anxiety, are an indication for emergency referral by ambulance.
    Nederlands tijdschrift voor geneeskunde 09/2015; 159:A9061.
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    ABSTRACT: - The aim of a diagnostic work-up in patients with acute sore throat is to exclude serious causes of tonsillitis and, in cases of a pharyngotonsillitis, to assess the degree of illness and the risk of complications.- A diagnostic work-up aimed at the distinction between a viral or bacterial cause of pharyngotonsillitis does not determine initial treatment policy.- Pharyngotonsillitis usually has a benign natural course; patient information and analgesia are usually sufficient treatment.- Complications of an infection with group A streptococci are rare; diagnostic work-up for this bacterial cause is, therefore, not recommended.- Antibiotics are only useful in cases of severe pharyngotonsillitis, increased risk of complications or a peritonsillar infiltration.- The antibiotic of choice is a narrow spectrum penicillin; however, amoxicillin/clavulanate is indicated in patients with peritonsillar infiltration.- If there is discrepancy in adults between the severity of symptoms and findings on physical examination, the possibility of epiglottitis should be considered.
    Nederlands tijdschrift voor geneeskunde 09/2015; 159:A9456.
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    ABSTRACT: - In the majority of breast cancer families, DNA testing does not show BRCA1 or BRCA2 mutations and the genetic cause of breast cancer remains unexplained. - Routine testing for the CHEK2*1100delC mutation has recently been introduced in breast cancer families in the Netherlands. - The 1100delC mutation in the CHEK2-gene may explain the occurrence of breast cancer in about 5% of non-BRCA1/2 families in the Netherlands. - In the general population the CHEK2*1100delC mutation confers a slightly increased breast cancer risk, but in a familial breast cancer setting this risk is between 35-55% for first degree female carriers. - Female breast cancer patients with the CHEK2*1100delC mutation are at increased risk of contralateral breast cancer and may have a less favourable prognosis. - Female heterozygous CHEK2*1100delC mutation carriers are offered annual mammography and specialist breast surveillance between the ages of 35-60 years.- Prospective research in CHEK2-positive families is essential in order to develop more specific treatment and screening strategies.
    Nederlands tijdschrift voor geneeskunde 09/2015; 159:A8910.