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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5-year impact 0.00
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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

Kluwer

  • 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
    green

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: We describe a female neonate with non-grouped pustules directly postpartum without clinical signs of illness. There were no red maculae. At follow-up some pustules had turned to pigmented maculae, which confirmed the diagnosis of neonatal pustular melanosis. This benign transient condition occurs in 4-8% of dark-coloured neonates and in <1% of white neonates.
    No preview · Article · Feb 2016 · Nederlands tijdschrift voor geneeskunde
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    ABSTRACT: A 18-year-old woman experienced abnormal and painful vaginal tissue loss while using an oral contraceptive. A pregnancy test was negative. Histopathological examination of the tissue showed a decidualised endometrium. We made the diagnosis of progesterone-induced membranous dysmenorrhoea.
    No preview · Article · Feb 2016 · Nederlands tijdschrift voor geneeskunde
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    ABSTRACT: The porphyrias are a clinically and genetically heterogeneous group of relatively rare metabolic diseases that result from disorders in the biosynthesis of haeme. Porphyria cutanea tarda (PCT) is the most common type, accounting for 80-90% of all porphyrias, and is essentially an acquired disease, although PCT can also occur on a familial basis. We describe a 71-year-old female and a 62-year-old male patient, both of whom had several risk factors for developing PCT, ranging from iron overload due to a mutation in the hereditary haemochromatosis protein (HFE) gene, alcohol use, smoking, and exogenous oestrogen, to persistent hepatitis C infection. The clinical relevance of the several diagnostic modalities is important in PCT. Diagnostic evaluation is important in order to confirm the diagnosis, but also to evaluate the treatment response in the context of long-term follow-up in the prevention of late complications of PCT, i.e. hepatocellular carcinoma.
    No preview · Article · Feb 2016 · Nederlands tijdschrift voor geneeskunde
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    ABSTRACT: Background: Acute generalised exanthematous pustulosis (AGEP) is a rare and self-limiting pustular cutaneous reaction to a drug or infection. Case description: A 62-year-old male presented to the Emergency Department with fever, erythema and pustules on both thighs. The initial blood analysis showed increased inflammatory parameters. The patient was admitted to the Dermatology Department with suspected AGEP. All medication was stopped. The diagnosis was confirmed histologically. During hospitalisation, the cutaneous reaction spread over 30% of the skin surface. Seven days after onset, the skin disorder regressed and the patient was discharged after 16 days. Use of amoxicillin/clavulanic acid was very likely the triggering factor for the development of AGEP. Conclusion: AGEP, although self-limiting, can have a fulminant course, requiring admission to a burns centre. It is imperative that rechallenge with the triggering drug is avoided.
    No preview · Article · Feb 2016 · Nederlands tijdschrift voor geneeskunde
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    ABSTRACT: A new, dynamic concept of health, which aims to convince critics of the static WHO definition of 1948, was based on an invitational conference in 2009. The concept highlights function, resilience and self-direction. This general concept of health was further elaborated in a follow-up study aiming towards operationalization, and involving Dutch healthcare stakeholder groups. The study revealed a number of differences between the opinions of stakeholder groups about the concept of health and, following the perception of patients, resulted in the broad concept of 'positive health' with six dimensions.
    No preview · Article · Feb 2016 · Nederlands tijdschrift voor geneeskunde
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    ABSTRACT: Background: Metamizole is an analgesic, the orally administered form of which was withdrawn in the Netherlands in 1989 due to an unacceptably high incidence of agranulocytosis. However, later studies showed a much lower incidence and since 2013 the use of metamizole has been recommended by the national guideline on postoperative pain. Case description: A 58-year-old woman was referred by her general practitioner to our hospital with suspected diverticulitis. Three days previously the patient had returned from a four-week period of rehabilitation at a German spa following hip replacement surgery. She had been using metamizole since the operation. Within hours of admission, the patient developed septic shock and was transferred to the intensive care unit. Laboratory tests revealed severe neutropenia of 0.2 × 109/l. Treatment consisted of filgrastim, piperacillin/tazobactam and haemodynamic support. After five days the patient was sufficiently recovered to return to the ward. Conclusion: Metamizole-related agranulocytosis is rare but potentially life-threatening. This condition is expected to occur more frequently as the use of metamizole in the Netherlands increases.
    No preview · Article · Feb 2016 · Nederlands tijdschrift voor geneeskunde
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    ABSTRACT: The diagnosis acute coronary syndrome includes myocardial infarction together with unstable angina. The definition of the latter diagnosis continues to evolve. Due to widespread clinical application of sensitive markers of myocardial necrosis, including high sensitive cardiac troponin (hs-cTn) assays, the diagnosis for many newly presenting patients will now be myocardial infarction rather than unstable angina. However, patients presenting with chest pain and very low (< 0.05 ng/L) or undetectable levels of hs-cTn have been found to be at extremely low risk of development of myocardial infarction and/or death. Consequently, such patients cannot be classified as having unstable angina. A detailed clinical assessment and reasoning will be necessary to establish the true cause of their - often non-cardiac - symptoms.
    No preview · Article · Feb 2016 · Nederlands tijdschrift voor geneeskunde
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    ABSTRACT: In 2012 the Dutch Dying with Dignity Society (NVVE) founded the End-of-life Clinic, which provides euthanasia or help with assisted suicide at the request of people whose own doctor will not carry out euthanasia if the legal requirements of due care can been fulfilled. As part of an independent evaluation, we looked at the applications received by the End-of-life Clinic during its first year and at the outcomes of these applications. We wrote an extensive article on this subject which was published in JAMA Internal Medicine. One of the most important outcomes is that the End-of-life Clinic rejected a large percentage of the requests for its services, mainly as these came from people with psychiatric conditions. This means that the fears that some people have concerning the alleged End-of-life Clinic policy 'you ask, we comply', appear to be unfounded. On the other hand, the End-of-life Clinic is certainly not the solution for all those people whose requests to their own doctor fall on deaf ears.
    No preview · Article · Feb 2016 · Nederlands tijdschrift voor geneeskunde
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    ABSTRACT: In our professional lives as a hospital pharmacist/clinical pharmacologist and an internist/vascular medicine specialist, "time" plays an important role. Dosage recommendations are made based on elimination half-life and determination of drug levels is generally only useful after the patient has achieved the steady-state phase. Time effects also play a pharmacodynamic role. Some drugs work better when taken at bedtime than in the morning, certain cardiovascular drugs for example. We present an anthology of our activities over an average working day at Radboud University Medical Center, the Netherlands, whereby time plays an essential role.
    No preview · Article · Dec 2015 · Nederlands tijdschrift voor geneeskunde
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    ABSTRACT: - One of the challenges in medicine is to give patients good advice and guidance that will enable them to live for as long as possible in as good a state of health as possible.- Prevention of disease is the best treatment. This is why it is so important to accurately predict the risk of various diseases such as cancer, vascular disease or diabetes mellitus.- In high-risk patients it is useful to take preventative measures. To do this it is necessary to have information about the expected absolute treatment effect for each individual patient.- All this information can then be used in a discussion between the patient and their treating professional so that together they can make an informed decision about whether or not to take preventative measures that are aimed at a longer disease-free life. This may or may not mean living longer, but it does mean a life in as good a state of health as possible.
    No preview · Article · Dec 2015 · Nederlands tijdschrift voor geneeskunde
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    ABSTRACT: Is it true that haste is sneaking into medicine? In this article, it is argued that it mainly concerns the perception of being rushed, which is caused by a loss of autonomy of the modern physician. In the fifties, physicians were busy as well, but because they enjoyed a greater degree of autonomy compared to their contemporary colleagues, they did not experience this in a negative way. Due to increased bureaucracy and the introduction of market dynamics, the medical profession has lost autonomy, which in turn led to a loss of job satisfaction.
    No preview · Article · Dec 2015 · Nederlands tijdschrift voor geneeskunde
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    ABSTRACT: The end of the year is always a perfect moment to look back. However, looking back over the past year alone is not enough if you want a complete picture of developments in medical science, which is why the Dutch Journal of Medicine (NTvG) has posted a timeline on its website charting medical milestones over the past 45 years. Some of these milestones are illustrated in the infographic in this number, and some interesting patterns can be observed. In this article we discuss various trends, from the increasing tendency to quantify to the rise of evidence-based medicine.
    No preview · Article · Dec 2015 · Nederlands tijdschrift voor geneeskunde
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    ABSTRACT: Calf vein thrombosis is a much-debated entity. The literature shows that progression to deep venous thrombosis or pulmonary embolism occurs infrequently and is usually detected using serial two-point ultrasonography. Additionally, undetected and untreated calf vein thrombosis is not associated with serious adverse events in large management trials studying diagnostic strategies for suspected deep venous thrombosis. Recurrent venous thromboembolism can occur after calf vein thrombosis, but anticoagulant treatment does not reduce the incidence. In this article, three case histories describe the anatomical considerations for proper diagnosis of calf vein thrombosis, some aspects of the natural course, and the treatment that these patients received. A case is made for restrictive use of prolonged anticoagulation therapy as a means to reduce thromboembolic complications. Because symptomatic treatment has not been studied, expert opinion suggests a short (3-week) course of therapeutically-dosed low-molecular-weight heparin.
    No preview · Article · Dec 2015 · Nederlands tijdschrift voor geneeskunde
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    ABSTRACT: Prior to the industrial revolution in the mid-1800s, the modal lifespan for humans was somewhat less than 75 years. Natural life expectancy was approximately 35 years, with a high child mortality rate strongly contributing to this low figure. At that time, natural life expectancy of someone aged 75 was 6 years, whereas the current life expectancy of, for example, a 75-year-old French woman is 14.5 years. The sharp increase in longevity means an added eight years of life in old age. Nevertheless, the rate of ageing, i.e. the degree of mortality-risk increase related to age, remains astonishingly constant. Preventive strategies that use the absolute risk of age-related diseases for setting treatment goals, in fact treat increasing age. For each population, the risk reaches its peak at a certain age; over a lifetime, the risk of death is always 100%. Under pressure from modern society and medicine, old age is now treated as a disease and medicalised to a great degree. To improve medical management of elderly patients, we will have to accustom ourselves to consider the goals of these actions, to ask ourselves: what is called wisdom?
    No preview · Article · Dec 2015 · Nederlands tijdschrift voor geneeskunde

  • No preview · Article · Dec 2015 · Nederlands tijdschrift voor geneeskunde
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    ABSTRACT: - According to current Dutch and European guidelines, morphine has a place in the treatment of patients with cardiac asthma.- There are no studies showing an improvement in objective parameters with the use of morphine in patients with cardiac asthma.- Recent large retrospective cohort studies indicate an increased mortality risk among patients given morphine in the treatment of cardiac asthma, even after correction for confounders. In addition, morphine may be linked to an increased risk of intensive care unit admission.- Morphine should be used with caution in patients with cardiac asthma.
    No preview · Article · Dec 2015 · Nederlands tijdschrift voor geneeskunde