Nederlands Tijdschrift Voor Geneeskunde

BACKGROUND: In 15-25% of patients with rheumatoid arthritis, the presence of pathognomonic autoantibodies (anti-citrullinated protein (aCCP) or rheumafactor (RF) is lacking. In these cases of seronegative rheumatoid arthritis, diagnosis is based on clinical presentation. However, some of the patients with seronegative rheumatoid arthritis are misdiagnosed. CASE DESCRIPTION: Here we discuss a case of a 64 year old female, with a diagnoses of seronegative rheumatoid arthritis for 18 years...

Besides periprosthetic joint infection, metal hypersensitivity should be considered when complaints persist after total joint arthroplasty. To date, there is no consensus on the diagnosis, and believers and non-believers of metal hypersensitivity exist. The pathogenesis of metal hypersensitivity is complex and involves a type-4 delayed hypersensitivity reaction with both a cutaneous and systemic response. It is unclear if complaints after total joint arthroplasty (after eliminating other causes) are caused by metal hypersensitivity...

Addiction is a disease that occurs often and causes a large burden of disease. Patients are frequently stigmatized, also by health caregivers. As a result, care of patients with addiction is often sub-optimal and sometimes harmful. We present three patients in whom the focus on addiction, the diagnosis, and treatment of other somatic disorders has remained underexposed, with severe consequences for the patient. We discuss what stigmatization is and means for patients with addiction. We must recognize that professionals stigmatize, just as patients do themselves...

A 21-year-old man visited the GP complaining of food getting stuck in the back of his throat. We saw a thin string of tissue connecting the uvula to the palatopharyngeal arch and removed it surgically. No such case has previously been described in the absence of a history of trauma, infection or operation.

Synthetic Cannabinoid Receptor Agonists (SCRAs) are a group of New Psychoactive Substances. They are used recreationally to mimic the effects of THC in cannabis. However, THC is a partial agonist of the CB1-receptor and SCRAs are full agonists. Because of this specificity and potency serious adverse events may occur among which psychological, cardiovascular, and gastro-intestinal symptoms. Because of the low incidence in the Netherlands clinical information on SCRA intoxications is limited, making diagnosis and treatment difficult...

Lutetium-177 coupled with a ligand for Prostate Specific Membrane Antigen ([177Lu]Lu-PSMA) is a new treatment in The Netherlands. Patients with metastasized castration resistant prostate carcinoma and progressive disease after hormonal therapy and chemotherapy, and no other regular therapeutic options, can be referred. A good clinical performance state, adequate bone marrow function and a PSMA PET/CT showing adequate targeting in all metastases are essential. The therapy consists of four to six intravenous administrations of 7...

Peripheral neuromas are a prevalent problem following nerve injury or certain surgical interventions like limb amputation. It is important to consider a peripheral neuroma when a patient experiences pain in the innervation area of a peripheral sensory or mixed nerve (branch), especially following trauma or amputation. Adequate recognition of a painful neuroma is crucial to treat patients satisfactorily for their invalidating and chronic symptoms. We want to emphasize that surgical intervention can be an effective and permanent treatment for symptomatic neuromas...

Excess mortality due to covid-19 is estimatedas actual mortality minus expected mortality in the covid-19 period. Excess mortality in 2020-2021 in the Netherlands is estimated to be 30,000 persons. Excess mortality should be divided in mortality as consequences of covid-19 infections (direct effects) and mortality due indirect effects of the pandemic. As excess mortality assesses mortality under one single scenario (the actual scenario including its specific measures), it cannot directly be used to know what the number of deaths would have been under different scenarios...

Antiphospholipid syndrome (APS) is an auto-immune syndrome defined by thrombosis and/or pregnancy morbidity in the persistent presence of antiphospholipid antibodies. Antiphospholipid antibodies are a group of antibodies predominantly directed at phospholipid-bound plasma proteins. The more antibodies a patient has the higher the risk of thrombosis. The origin of the antibodies and the precise prothrombotic mechanism are incompletely understood. A diagnosis of APS can in certain clinical scenarios implicate a longer treatment with anticoagulants after a venous thromboembolism...

BACKGROUND: Acute pancreatitis is a frequently diagnosed disease. The majority is caused by cholelithiasis or alcohol. There are also two forms of auto-immune pancreatitis (AIP). Type 2 AIP presents on a younger age compared with IgG4 related pancreatitis. Clinical presentation as an acute pancreatitis, a mass in the pancreas or with jaundice. There is an association with inflammatory bowel disease. CASE DESCRIPTION: A young patient with Crohn's disease developed abdominal pain compatible with acute pancreatitis...

The Dutch diabetes guideline advises GPs to screen for diabetes every year in the first five years after the birth of the youngest child, by simply measuring fasting glucose. Based on the increased risk for cardiovascular disease in women with a history of gestational diabetes, it seems appropriate to not only screen for diabetes, but to combine that with monitoring all the other features of the insulin resistance syndrome. Even without a disturbance in glucose tolerance, that could stimulate helpful lifestyle interventions at an earlier stage...

BACKGROUND: Toxic inhalations form a rare cause of poisoning in the Netherlands. The initial symptoms of toxic inhalations may appear similar to acute viral infections. In the maritime sector aluminum or zinc phosphide is used to overcome rodent infestations during transportation. CASE DESCRIPTION: Here we discuss two patients intoxicated with gaseous phosphide used as fumigant in the transport of grains. The exposure to phosphide gas resulted in respiratory and gastrointestinal tract symptoms...

In current practice, radiological diagnostics are often assessed by both the referring clinician as well as the radiologist. Specific medical specialists like pulmonologists and orthopaedic surgeons make treatment decisions mostly on their own expertise and interpretation of radiological images, before the radiological report is available. For health care as a whole, a single assessment gives efficiency gains, and the radiologist is not disturbed by getting rid of 'bulk' and can focus on the more complex matter in which he or she is indispensable...

In the case of persistent complaints of instability due to a rupture of the anterior cruciate ligament (ACL), surgical treatment can be opted for, in which reconstruction with a body's own tendon graft (autograft) is the gold standard. New information has created renewed interest in the primary repair of an ACL rupture. Potential advantages of repair of the ACL rupture compared with a reconstruction are the restoration of the complex natural anatomy including the proprioception of the native ACL, and no donor site morbidity...

In addition to progress, medical-technological innovations often involve transformations, for example in the conceptualization and experience of disease(s). A historical example is the rise of self-regulation by diabetes patients in the 1970s and 1980s. Textual analysis of Diabc, the monthly magazine of the Diabetes Vereniging Nederland (DVN), shows that the introduction of self-testing and self-regulation was not only very welcome for many DVN members, but also brought about a qualitative change in their views of diabetes and themselves...

Besides periprosthetic joint infection, metal hypersensitivity should be considered when complaints persist after total joint arthroplasty. To date, there is no consensus on the diagnosis, and believers and non-believers of metal hypersensitivity exist. The pathogenesis of metal hypersensitivity is complex and involves a type-4 delayed hypersensitivity reaction with both a cutaneous and systemic response. It is unclear if complaints after total joint arthroplasty (after eliminating other causes) are caused by metal hypersensitivity...

BACKGROUND: In 15-25% of patients with rheumatoid arthritis, the presence of pathognomonic autoantibodies (anti-citrullinated protein (aCCP) or rheumafactor (RF) is lacking. In these cases of seronegative rheumatoid arthritis, diagnosis is based on clinical presentation. However, some of the patients with seronegative rheumatoid arthritis are misdiagnosed. CASE DESCRIPTION: Here we discuss a case of a 64 year old female, with a diagnoses of seronegative rheumatoid arthritis for 18 years...

Hypoxia can be an early sign of infection, respiratory or circulatory pathology in infants. Since it is difficult to properly judge oxygen saturation solely by skin discoloration, it is preferable to objectify this parameter via pulse oximetry (PO). PO in young infants has shown to be feasible in the primary care setting. Even though PO is broadly used by general practitioners (GPs) in older children and adults, it is rarely performed in young infants. We present three patients, aged 0 to 6 months, who were seen in primary care, where PO was an important factor in determining the level of illness...

OBJECTIVE: To determine the effectiveness of treatment for an adjustment disorder in accordance with the Dutch guideline for an adjustment disorder in cancer survivor (i.e. people living with or after cancer) on distress, psychological symptoms and quality of life. DESIGN: Prospective cohort in which cancer survivors completed questionnaires prior to and after they received treatment for an adjustment disorder in accordance with the Dutch guideline 'adjustment disorder in patients with cancer'...

Female physicians, especially those in surgical subspecialties, have an increased risk on subfertility and pregnancy complications, amongst preterm birth, compared to the general population. Long hours and unpredictable work weeks in a working climate that seems to discourage to start a family are contributing to these increased risks. Many physicians were unaware of the negative impact of delayed family planning and often regretted their decision to postpone pregnancy. Although differences between countries exist, also in the Netherlands, despite paid pregnancy and maternity leave, we also may not create the right working climate and truthful pregnancy-protective circumstances for female doctors to be able to work as safely as possible on something that could conceivably be viewed upon as their most important life's work...