Nederlands tijdschrift voor geneeskunde最新文献

Spontaneous intracerebral hemorrhage (ICH) is a devastating condition, with high mortality and morbidity. For decades, neurosurgical treatment has been studied as a potential treatment, yet consensus on its role is still lacking. In a recent Cochrane review, we showed that surgical evacuation may have benefit in terms of functional recovery and survival, but the certainty of the evidence was low. Craniotomy probably reduces mortality but has uncertain effects on functional outcome, while minimally invasive approaches appear more promising. Decompressive craniectomy has only been investigated in a single small trial. Key uncertainties remain regarding overall effectiveness, optimal surgical technique, timing of intervention, and patient selection. Until ongoing trials provide more robust evidence, clinical practice requires careful patient selection, multidisciplinary decision-making, and participation in ongoing trials.

Accidents involving electric vehicles containing lithium-ion batteries are becoming increasingly common in the Netherlands. These incidents can result in exposure to fumes from burning Li-ion batteries, potentially resulting in exposure to higher concentrations of HF and LiOH. The effects of these substances should be considered when treating patients exposed to this type of fume. Both can cause respiratory toxicity if inhaled. Pulmonary oedema due to hydrogen fluoride can develop after a latency period of up to 12 hours and in extreme cases hydrogen fluoride can cause hypocalcaemia. Calcium gluconate nebulization and gel can be used as an antidote for hydrogen fluoride toxicity. In addition to respiratory symptoms, lithium hydroxide can also cause chemical burns. This clinical lesson describes a case of a patient exposed to fumes following an accident with his electric vehicle, followed by recommendations for observation and treatment.

Traditionally, osteoarthritis was considered a wear and tear process, but new insights indicate that it is a biologically and evolutionarily determined process, related to biological rather than chronological age. Articular cartilage contains chondrocytes that are stable under normal conditions. However, in osteoarthritis, some of these cells become hypertrophic, similar to what occurs during endochondral ossification in the growth plate. This leads to cartilage breakdown and consequently a cascade of processes, including inflammation and further destruction, finally leading to the symptoms of osteoarthritis and the burden on the patient. OA should be considered an age related condition with an evolutionary and biological basis rather than a wear and tear process. The concept of wear and tear leads to avoiding and fear of movement, while exercise is actually an effective treatment for osteoarthritis and comorbidities. Using joint wear and tear to communicate about osteoarthritis should be avoided.

A 69-year-old woman presented with progressive gangrene affecting the toes of both feet. Laboratory investigations showed marked thrombocytosis (800 x 109/l). A positive JAK2V617F-mutation confirmed essential thrombocytosis as the underlying cause of the gangrene. With thrombocyte-lowering therapy, platelet counts normalized and the gangrene showed no further progression.

Sacroiliac joint (SIJ) dysfunction is an underrecognized yet frequent cause of low back pain, often misdiagnosed due to symptom overlap with other spinal disorders and the absence of clear anatomical abnormalities. This article outlines the diagnostic challenges, clinical presentation, and treatment options for SIJ dysfunction. Risk groups include postpartum women and patients with connective tissue disorders. Diagnosis relies on clinical history, provocation tests, and diagnostic SIJ infiltration with local anesthetics. Initial treatment is conservative, focusing on physical therapy and rehabilitation. For refractory cases, minimally invasive SIJ fusion may be considered, although evidence remains limited. A multidisciplinary approach involving care providers, general practitioners, medical specialists, and paramedical professionals is essential for timely diagnosis and effective care. Increased awareness and structured protocols can reduce unnecessary diagnostics and improve outcomes for patients with persistent low back pain due to SIJ dysfunction.

Nasal fractures are the most common facial fractures, with a higher incidence in males. They typically result from trauma related to sports, accidents, or physical violence, often involving alcohol. Accurate assessment requires knowledge of nasal anatomy, as fractures may involve both bony and cartilaginous structures. Presentation includes swelling, epistaxis, deformity, and nasal obstruction. The trauma's mechanism and patient's age influence the fracture type. Diagnosis is primarily clinical, as imaging has limited diagnostic value and does not alter management. Closed reduction is ideally performed within 3-10 days post-trauma, once swelling subsides. In children, repositioning often requires general anesthesia, and rhinoplasty is avoided or delayed until adulthood due to iatrogenic growth retardation concerns. Septal hematomas must be urgently drained to prevent necrosis and warrant immediate ENT referral. Timely recognition and appropriate management are essential to avoid long-term consequences such as deformity, obstruction, or septal perforation.

In media and on platforms like LinkedIn, survey results are often presented as undeniable facts: "The numbers don't lie." However, these interpretations can be misleading, as many studies are influenced by methodological limitations. This article explores examples of medical surveys that have shaped public opinion and policy but are based on selective or incomplete data. For instance, claims about doctors considering career changes or the impact of disciplinary complaints are often overstated, leading to misguided policy decisions. Similarly, misinterpretations of ICT risks or burnout rates among medical professionals can drive unnecessary investments or exacerbate issues without addressing the root causes. These misinterpretations can distort the actual needs of the healthcare system, resulting in inefficient use of resources and worsening the work environment for healthcare professionals. It is crucial to always contextualize survey data and carefully consider its limitations to make informed, effective decisions that truly improve healthcare.

Acute mesenteric ischemia (AMI) is a severe condition with nonspecific symptoms, making it difficult to diagnose and easily missed in clinical practice. Early recognition is crucial, as delayed treatment results in high mortality rates. The number of AMI patients is expected to rise due to the aging population and increasing risk factors. There are no specific laboratory tests for the early detection of AMI. Imaging plays a crucial role, with contrast-enhanced CT being the standard diagnostic tool. Over the past decades, significant progress has been made in AMI treatment. Endovascular procedures can restore blood flow to the intestines quickly and non-invasively, improving clinical outcomes. Timely recognition is critical for implementing life-saving treatments.

The recently published Dutch guideline 'Non-obstetric perioperative care during pregnancy' provides recommendations for managing surgical procedures in pregnant patients. Despite limited evidence, key recommendations include favouring minimally invasive techniques, such as laparoscopy, due to reduced recovery time and complications. Laparoscopy is feasible in all trimesters, with considerations for uterine size and trocar placement. Neuraxial or regional anaesthesia is preferred over general anaesthesia when possible, as it improves postoperative pain control and reduces opioid use. Routine foetal monitoring is not recommended unless significant maternal hemodynamic fluctuations are expected. The timing of surgery should be carefully evaluated, with elective procedures preferably postponed unless medically necessary. A multidisciplinary approach involving surgeons, obstetricians, anaesthesiologists, and neonatologists is essential for optimizing maternal and foetal outcomes. Shared decision-making and thorough patient counselling remain crucial.

The Dutch healthcare system is strained due to population aging, workforce shortages, and rising costs. The Integral Care Act introduced the concept of appropriate care, in which value-based choices are central. Frail elderly patients with an abdominal aortic aneurysm (AAA) have worse outcomes after surgery. Clear guidelines for this group are lacking, while appropriate care could provide benefits. A conservative approach by refraining from surgery, despite an indication for intervention, may be a realistic option aligned with the do no further harm principle. Two measures can support this choice: refraining from further increasing volume thresholds, as this may have counterproductive effects, and providing appropriate reimbursement for the complex preoperative assessment, shared decision-making process, and where needed the multidisciplinary involvement. These measures support vascular surgeons, patients, and caregivers to achieve genuine shared decision-making, ensuring a meaningful final stage of life for patients.