Nederlands Tijdschrift Voor Geneeskunde

A 55-year old woman was seen at the outpatient Dermatology department with orange-red, soft-elastic, asymptomatic papules on her abdomen since five years. A biopsy was positive for Congo-red staining and showed apple-green under bipolarized light. Laboratory work-up showed no systematic amyloidosis. We diagnosed it as primary nodular cutaneous amyloidosis.

Frenotomy of the lingual and maxillary labial frenula in neonates is considered a safe procedure and is increasingly performed globally. However, there is no consistent evidence for the indication and effectiveness of this intervention. In this clinical lesson, we show that frenotomy of the lingual and maxillary labial frenula in neonates is controversial and can have serious complications. We describe a patient that, in addition to pain and the risk of infection, was in a life-threatening haemorrhagic shock after frenotomy of the lingual and maxillary labial frenula...

BACKGROUND: Milk-alkali syndrome is a rare cause of hypercalcemia in the Netherlands, due to ingestion of large amounts of calcium and absorbable alkali. CASE DESCRIPTION: A 38-year-old female patient was admitted with severe stomach pain, vomiting and weight loss. Laboratory results showed hypercalcemia and acute kidney injury. We initially suspected that the hypercalcemia was related to primary hyperparathyroidism, a malignancy with bone metastasis or a granulomatous disease...

The shoulder prosthesis is increasingly used as a solution for various shoulder problems. On the basis of a few cases, an overview is given of the various situations in which a shoulder prosthesis can be used, with a small risk of complications, a high risk of pain reduction and a long survival. In addition, a shoulder prosthesis improves the quality of life and is cost-effective. It is important, however, to set the correct indication with an eye for various psychosocial factors. The individual end result depends on patient-related factors such as pathology, general condition, activity and expectations...

Considering age to be the primary risk factor for developing Parkinson's disease and the observation that the Dutch population is rapidly aging, the parkinson prevalence is expected to increase over the coming years, as there is still no cure available for the disease. This has been confirmed by epidemiological data, which show a steady increase of the disease prevalence in the Netherlands for the period 2010-2021. Genetic risk factors only partially explain the disease pathogenesis. Environmental factors, such as exposure to pesticides and trichloroethylene are associated with a higher risk for developing Parkinson's disease...

Chronic inflammatory bowel diseases (IBD) such as Crohn's disease and ulcerative colitis are increasing prevalent conditions with a high burden on both somatic and mental levels. The pharmacological treatment has significantly improved in recent decades with the introduction of multiple immune modulators and in the coming years, we expect to see the introduction of many new agents. The management of these diseases requires a multidisciplinary approach involving the involvement of surgeons, with timely discussion of surgery as a potential option in the treatment trajectory...

BACKGROUND: Oral nicotine pouches are pouches that contain varying amounts of nicotine. The use of nicotine pouches by adolescents has increased since 2020. Subsequently, there has been an increase in the amount of reports of nicotine intoxications. Acute nicotine intoxications have a biphasic clinical course, during which the initial symptoms may include agitation, tachycardia and vomiting. When large enough doses are used more serious symptoms may emerge. As well as the acute side effects, studies have shown that the use of oral nicotine pouches with tobacco is associated with a younger age at which cigarette smoking is initiated...

A 75-year-old woman was seen at the dermatology department with a large asymptomatic swelling near the left shoulder blade. Based on MRI and the typical localization the diagnosis 'elastofibroma dorsi' was made, which is a slowly progressing benign soft tissue tumor located between the scapula and the posterior chest wall.

The Minister of Health, Welfare and Sport of the Netherlands has asked the Dutch Health Council an advice on lung cancer screening. But even the target group will gain little: yearly approximately 90 fewer lung cancer deaths of over 8,000 due to smoking, and most if not all of them will die as quickly from other consequences of smoking. Moreover, lung cancer screening harms the population screened, as well as our society and health care providers. So how to stop this public health problem? Ban smoking. The health effects are much wider than lung cancer and start immediately...

Bariatric surgery is a popular surgical method for weight loss. Due to the operation, changes are made in the gastrointestinal tract, which can potentially cause malabsorption of orally administrated drugs. Therefore it is important to evaluate each prescription of orally administrated drugs, taking the available evidence in consideration but also the wishes of the individual patient. During the first year after surgery, monitoring patients extensively for efficacy but also for safety is important. When monitoring is not possible a risk assessment on a case-by-case basis should be made taking the risk of therapy failure but also the risk of overdosing in consideration...

Bariatric surgery is widely used as an effective treatment for obesity. Changes in the anatomy of the digestive tract as a result of these operations may lead to changes in drug availability. This is illustrated by three cases in which problems arose with calcium metabolism, thyroid hormone substitution or weight. Effects on medication after bariatric surgery are not always predictable and there are no uniform guidelines how to handle. We advocate therefore a proactive attitude of physicians by monitoring direct effects (such as blood pressure, glucose, or mood) or determining drug concentrations, to prevent treatment failure or toxicity...

Recent work revealed that ethnic minority gp-trainees are more at risk of underperformance than their majority peers. We argue that causes for underperformance can be identified from two perspectives, namely that of the trainees ('them') and that of the assessors and the institution ('us'). Potential impeding factors from the student perspective include lack of practical clinical skills and differences in communication styles. At the level of the assessors, it is important to consider in-group bias and individual assessors' perceptions and preferences...

A 58-years old man was seen at the dermatology outpatient clinic because of a spot near his ear. However, during physical examination soft-elastic papules on his left shoulder were visible. As the patient had not undergone additional examination for this, a biopsy was taken. Histopathological examination confirmed the diagnosis of cutaneous segmental neurofibromatosis type 1.

The operating room nowadays is a data-rich environment to which Artificial Intelligence (AI) can respond. Current AI applications mainly focus on supporting perioperative decision-making and on improving surgical skills and safety. Specific steps need to be taken to advance the implementation of AI. Further studies are needed that focus on external validation and standardization of data and monitoring of the implementation process, as well as consensus on ethical and legal issues. In conclusion, much is expected from AI in making surgical care more efficient and safer...

BACKGROUND: Sodium glucose transporter 2 (SGLT-2) inhibitors are a relatively new group of antidiabetic drugs. The renal glucose reabsorption is blocked resulting in higher glucose levels in the urine (glucosuria). Recently studies are being conducted into the medications nephrological and cardiovascular potential. As a result, we may expect that SGLT-2 inhibitors will be more and more frequently prescribed. Thus, physicians of any specialty may come into contact with patients that are using this drug...

Lifestyle interventions potentially contribute to the prevention and treatment of a number of common chronic diseases, such as type 2 diabetes and obesity. Nobody questions the importance of a healthy lifestyle, but at the same time it is clear that the effectiveness of lifestyle interventions has often not been investigated in a randomized controlled study, whereas the randomized clinical trial (RCT) is the golden standard in clinical drug research. In this article we discuss the methodological (im)possibilities of using RCTs in evaluating the effects of lifestyle interventions...

Feeding problems in children are usually harmless and common, but can rarely exist as a result of pathology. Heart failure is one of them and has to be recognized early because of its many consequences. We present a 15-week-old female infant who was seen at the outpatient clinic. She had already been evaluated several times by a youth doctor and general practitioner because of feeding problems and transpiration, for which several nutritional interventions had already been carried out. With no effect of nutritional interventions she was referred to a pediatrician...

BACKGROUND: Symptoms of acute alcohol withdrawal like tremors, seizures and delirium are commonly treated with benzodiazepines and vitamins. When complaints are not reacting to this treatment, an alternative diagnosis must be considered. Although hypomagnesemia is present in at least 30 percent of the patients with alcohol dependence, it can provoke and maintain these complaints. CASE DESCRIPTION: We present a 43-year-old man with alcohol dependence, who shows neurological, muscular, and cardiac consequences of an undiagnosed hypomagnesemia...

An 89-year-old female came to the Emergency Department in acute respiratory distress and septic shock caused by a right-sided intra-thoracic incarcerated necrotic ileum. An idiopathic right-sided diaphragmatic herniation is rare. The herniation presumably occurred due to an old defect or weakness of the right-sided diaphragm post-traumatically.

If an out-of-hospital cardiac arrest (OHCA) takes longer than 15 minutes, the chances of survival are greatly reduced. With a shockable rhythm (VF/VT), there is often a treatable underlying cause, which most often can only be treated in a hospital. The patient can be transported, and circulation can be restored in the hospital, using extracorporeal cardiopulmonary resuscitation (ECPR) to gain time to treat the underlying problem. There are observational studies and one single-centre study that support the use of ECPR in refractory OHCA...