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Nederlands Tijdschrift Voor Geneeskunde

Ferhat Beyaz, Bas Inberg
We present a 48-year-old man who had developed a skin lesion on his big toe. In 2 years' time, the lesion had evolved from melanonychia striata to an erratic, erosive, granulomatous plaque of approximately 3,0 x 3,0 cm. Histopathological examination of 2 skin biopsies revealed a nodular melanoma. Diagnostic imaging and histopathological examination of 2 sentinel lymph node biopsies showed no signs of metastases. We performed a hallux amputation.
March 11, 2019: Nederlands Tijdschrift Voor Geneeskunde
Pieta C Wijsman, Wouter de Monyé
We describe a 59-year-old woman, who came to the Emergency Room with fever, dyspnoea and lung abnormalities on chest x-ray. The X-ray abnormalities were not related to the clinical symptoms and could be explained by the patient's medical history, which included rib fractures and spinal compression fractures. The confined spherical structures visible on chest X-ray were indicative of previous rib fractures. The linear hyperdense branching structures represent diffuse pulmonary cement embolisms after percutaneous vertebroplasty...
March 11, 2019: Nederlands Tijdschrift Voor Geneeskunde
Désirée M T V Klemann, Helen J M M Mertens, G G van Merode
OBJECTIVE: To analyse the quantity and size of health care claims per medical specialty in the past 10 years. DESIGN: Descriptive, evaluative and comparative study. METHOD: Anonymised damage claim data from Centramed and MediRisk were used for this study. The numbers and sizes of the claims per specialty have been analysed over a ten-year period and plotted against production numbers of the various specialties, calculated on the basis of DBC data...
March 11, 2019: Nederlands Tijdschrift Voor Geneeskunde
Sanne A Groeneveld, Niels Jongejan, Brenno J S A A F de Winter, Aernoud T L Fiolet
Technological progress in healthcare offers a plethora of opportunities, but they also raise important issues, such as safety. Every year, around 18,000 electronic implants with a therapeutic function, such as pacemakers and implantable cardioverter defibrillators (ICDs), are implanted in patients in the Netherlands. Most of these devices are able to establish a wireless internet connection to share technical and diagnostic information remotely with healthcare providers. If the access to the device is not sufficiently protected, a security risk arises with potential health risks...
March 8, 2019: Nederlands Tijdschrift Voor Geneeskunde
Elke Stenvers, Jos J A M van Raay
Posterior shoulder dislocation after a traumatic event is often underdiagnosed. Consequently, treatment is initiated too late and patients experience pain and loss of motion. Conventional X-ray is the standard to diagnose a posterior shoulder dislocation. If symptoms persist, a CT scan should be performed. We describe two patients with chronic posterior shoulder dislocation. Each patient received different treatment due to the duration of the posterior dislocation and the age of the patient. The purpose of this report is to highlight the importance of early recognition and diagnosis of a posterior shoulder dislocation, and the need for clinicians to consider this condition and treat it correctly...
March 8, 2019: Nederlands Tijdschrift Voor Geneeskunde
M I Koedam, Harmke Verheij
A 9-year-old healthy girl visited the general practitioner with a recurring purple discoloration of the skin around the mouth without any other complaints. She was diagnosed with factitious purpura due to a vacuum that was caused by creating a negative pressure through placement of a plastic cup around the mouth.
March 8, 2019: Nederlands Tijdschrift Voor Geneeskunde
David Engelhard
'The more my patient looks like a real patient, the more I will look like a real doctor.' Certain young medical professionals may think that way, as they widen the gap between themselves as 'trained professionals' and their patients as 'ignorant laymen'. Medical doctors and patients have a relationship with each other. They both play their respective part: the doctor acts like a doctor. But what kind of role does the patient have and how do they influence each other? David Engelhard, both patient (with multiple sclerosis) and trainer in professional performances, describes two situations he experienced in hospital...
March 7, 2019: Nederlands Tijdschrift Voor Geneeskunde
Jessica D Workum, Laurens L A Bisschops, Maarten J W van den Berg
We present two patients who were treated for an intentional overdose of sodium nitrite. When ingested sodium nitrite leads to severe methaemoglobinaemia, resulting in severe hypoxia (as methaemoglobin does not transport oxygen), vasodilation and hypotension. Symptoms include cyanosis, headache, nausea, convulsions, coma and death. When measured by pulse oximetry, patients with a sodium nitrite intoxication and severe methaemoglobinaemia generally have an oxygen saturation of around 85%. This value is unreliable as the oxygen content of the blood is often extremely low - this can be confirmed by arterial blood gas analysis...
March 4, 2019: Nederlands Tijdschrift Voor Geneeskunde
Tim Schutte, Shanti Ramawadhdoebe, Jeroen Schotten
BACKGROUND: Myocardial infarction can be categorized based on ECG-findings (presence or absence of ST-elevations on STEMI/NSTEMI) or on the results from coronary angiography (CAG) (presence or absence of obstructive atherosclerosis). Myocardial infarction without significant obstruction on CAG (Myocardial Infarction with Non-Obstructive Coronary Arteries/Atherosclerosis; MINOCA) occurs in up to a quarter of patients with myocardial infarcts. These patients have a higher risk of future heart diseases; up to a quarter of MINOCA patients suffer from heart diseases during a median follow-up of four years...
March 1, 2019: Nederlands Tijdschrift Voor Geneeskunde
Nienke Fleuren, W F Scholte
Nigerian victims of human trafficking often fear revenge of voodoo spirits after escaping from their offenders. Human traffickers usually tell them that voodoo spirits will disturb their sleep and their peace of mind and eventually drive them crazy in case the victim would break the contract. In the Nigerian context, this fear is real and threatening. Western health care professionals should not consider this fear of voodoo as an anxiety disorder, especially because treatment would improperly challenge the validity of deeply rooted religious beliefs...
March 1, 2019: Nederlands Tijdschrift Voor Geneeskunde
Louis Achterbergh, Jeanine Suurmond, Gabor E Linthorst
Physicians sometimes use ethnicity as part of their clinical reasoning. Using ethnicity can sometimes, however, lead to bias and may lead to discrimination or racial discrimination. In this article we discuss some examples of wrongful medical profiling based on ethnicity, but also show how ethnic profiling can be performed respectfully.
March 1, 2019: Nederlands Tijdschrift Voor Geneeskunde
Lizzy M Brewster
From experiments by the Nazis in Germany, to the infamous American Tuskegee study, controversies surround racialized medical science and clinical practice. However, although 'race' is a social construct, disease patterns may cluster in groups with a common ethno-cultural ancestry. In this journal, Buckle and Achterbergh et al. discuss the use of race and ethnicity in a medical context in the Netherlands. Buckle puts forward the concept that 'race' is a social reality, and both authors discuss the use of 'ethnicity'...
March 1, 2019: Nederlands Tijdschrift Voor Geneeskunde
Fred H Menko, Efraim H Rosenberg, Lizet E van der Kolk
Three BRCA1/BRCA2 mutations occur more frequently in the Jewish population than in the general population. In Jewish patients with breast cancer about 10% of cases are caused by one of these mutations; consequently, all patients with breast cancer and who are of Jewish ancestry, or their healthy family members, are eligible for genetic testing.
March 1, 2019: Nederlands Tijdschrift Voor Geneeskunde
Wouter W van Solinge, Maarten J Ten Berg, Saskia Haitjema
In the near future, making a correct medical diagnosis will be increasingly supported by artificial intelligence. The development of algorithms that integrate all data from an individual into the diagnostic process calls for a multidisciplinary approach that includes not only healthcare professionals and patients, but also data scientists. Because of the position of the clinical chemist in the current health care process, this medical specialist is naturally suited to initiate the development of self-learning diagnostic algorithms and to take the lead in the process to take big data to the next level and create value for health care...
February 28, 2019: Nederlands Tijdschrift Voor Geneeskunde
A C Hendriks
Doctors can decide to subject individuals who wish to become parents to a test to analyse their parental competence. From a legal perspective there is no justification to subject only those individuals with a mental impairment to such a test. In fact, it could be argued that all potential parents should undergo such a test, but due to the impact this would have on the healthcare system that is simply not feasible.
February 28, 2019: Nederlands Tijdschrift Voor Geneeskunde
Gretchen N de Graav, Willem Maat, Yorick Sandberg
A 67-year-old man, experiencing nasal bleedings and shortness of breath for months, had a blurry vision for a few days. Bone marrow biopsy and laboratory findings led to the diagnosis of Waldenström's macroglobulinaemia. Fundoscopy showed cotton wool spots and retinal haemorrhages, associated with Waldenström's retinopathy. Plasmapheresis improved both vision and retinal abnormalities.
February 28, 2019: Nederlands Tijdschrift Voor Geneeskunde
Astrid A M Heijthuijsen, Karlijn Sijstermans, Michiel Appelman
On a sunny day, a 2-year-old boy came to the paediatric department with skin abnormalities. These had started as redness and blisters and later also included hyperpigmentation. He had played near a phototoxic plant known as 'common rue' (Ruta graveolens). Our diagnosis was phytophotodermatitis caused by the common rue.
February 27, 2019: Nederlands Tijdschrift Voor Geneeskunde
Duco D Deenstra, A J Verheul
A 94-year-old man with a history of colon cancer presented to the emergency department with a painful, suppurating, parasternal swelling. The swelling had been present for more than a year and its size had increased over time. However, previous diagnostic tests (CT, MRI and cytological punctures) had not led to a diagnosis. Upon inquiry, the patient told that in 1945, he was admitted to a sanatorium because of pulmonary tuberculosis. A positive culture for Mycobacterium tuberculosis confirmed the diagnosis of reactivation of tuberculosis, after which the patient was effectively treated with tuberculostatics...
February 27, 2019: Nederlands Tijdschrift Voor Geneeskunde
Anne D van der Made, Mario Maas
A 27-year-old woman presented to the Emergency Department with a painful right elbow after falling off a road bike. X-ray examination ruled out an elbow fracture, but showed a radiolucency in the radial tuberosity. MRI demonstrated normal bone marrow, which indicated that the radiolucency was in fact a radial tuberosity pseudolesion.
February 27, 2019: Nederlands Tijdschrift Voor Geneeskunde
Henriëtte E van der Horst, Tim C Olde Hartman
The relationship between doctors and patients often becomes tense when the patient has medically unexplained symptoms: doctors may experience frustration because they feel ill-equipped to provide their patients with a plausible explanation of the symptoms. Patients often feel that their doctor does not take them seriously and would like to understand why they are having symptoms. Research into the effect of the quality of the doctor-patient relationship and doctor-patient communication where medically unexplained symptoms are concerned has led to some recommendations for communication...
February 27, 2019: Nederlands Tijdschrift Voor Geneeskunde
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