Nederlands tijdschrift voor geneeskunde最新文献

A 65-year-old woman presented with progressively increasing swelling on the right lateral side of her tongue. Further investigation confirmed it to be a schwannoma. Surgical excision of the tumour was performed, resulting in an uncomplicated postoperative recovery with complete preservation of the tongue function.

Eosinophilia is a common laboratory finding with a broad differential diagnosis. Eosinophilia can be classified as primary, secondary, or idiopathic hypereosinophilic syndrome (HES). Primary eosinophilia results from a clonal disorder of eosinophils, while secondary eosinophilia is reactive to a variety of underlying conditions, such as allergic diseases, infections, and drug reactions. Idiopathic HES is a diagnosis of exclusion in patients with persistent hypereosinophilia and end-organ damage without an identifiable cause. The diagnostic workup should focus on identifying the cause and assessing for end-organ damage. The initial evaluation should include a detailed history and physical examination, and laboratory tests to assess for organ involvement. Further testing may be necessary based on the clinical presentation and laboratory findings. The treatment depends on the cause. In cases of secondary eosinophilia, treatment should be directed at the underlying condition.

Treatment options for patients with severe pulmonary embolism (PE) have increased substantially over the past decade. Although systemic thrombolysis is still the reperfusion therapy of choice for hemodynamically unstable PE patients, several new catheter guided reperfusion therapies have emerged as possibly safer alternatives. These therapies are increasingly implemented in clinical practice even though their efficacy and safety are yet to be proven by clinical outcome studies. Along with the rise of new interventional therapies has come the introduction of multidisciplinary Pulmonary Embolism Response Teams (EXPERT-PE, referred to as PERT in the United States), composed of multidisciplinary experts involved in treating acute PE. The EXPERT-PE concept provides a multidisciplinary and rapid platform for deciding on an individualized treatment strategy in an era of rapidly developing advanced treatment options, combining expert opinion from all involved specialties and forming the base for future research in PE care.

Inconsistent use of the Dutch terms 'zorg op maat' (customised care) and 'passende zorg' (appropriate care) in healthcare-, policy- and political discourse in the Netherlands makes them unclear umbrella terms and causes confusion and annoyance among many involved. 'Zorg op maat' and 'passende zorg', originally meant 'providing care according to the wishes and care-related possibilities of the individual patient', but now mainly concern the approaching financial limits of the healthcare-system. 'Passende zorg' has also become a key concept in the marketing strategy of healthcare organizations as a management instrument. Many (bedside)healthcare providers now see 'passende zorg' as a euphemism for financial cutbacks. The authorsaim to create awareness about the use of these terms to prevent incorrect expectations and irritation. Fresh names for new policies or financially feasible care ensure a transparent process and less complicated implementation.

Introduction: Health professionals do not routinely ask patients about alcohol use, although it is associated with a range of somatic and psychological problems. Therefore, alcohol use may not be recognized as the cause of a health problem, which may result in worsening of the situation, incorrect diagnosis or incorrect treatment. This is illustrated by three cases from different clinical practices: the emergency department, the hospital ward and the general practice.

Barriers: Several factors, such as time limitations and provider beliefs, can hinder asking about and discussing alcohol use.

Importance of early detection: By discussing alcohol use, patients with alcohol-related problems can receive information and guidance to prevent further harm. Motivational interventions can be effective, but shorter interventions, such as a short feedback conversation, can also contribute to awareness and change in alcohol consumption. Adequate registration and hand-over, and referral and follow up agreements between institutions can improve continuity of care.

In the Netherlands, an average of 92,000 patients with burn injuries are seen annually by a general practitioners. A burn injury is defined as skin damage caused by heat, radiation, electricity, and/or chemical agents. It is crucial to make an accurate assessment of the severity of the burn. The severity is primarily determined by the size (also referred to as the total burned body surface area, or TBSA), the depth of the burn, as well as the location, any associated injuries (such as inhalation trauma) and patient factors such as age and comorbidities. What initial measures do you take, what should you pay attention to, what treatment do you administer and when is it necessary to contact one of the three burn centers? This article will provide more clarity on these questions.

Introduction: Alcohol consumption increases the risk of approximately 200 health conditions. Nature, severity, and prevalence of alcohol-related issues in the Netherlands warrant more structured attention in medical consultations. Over 20 GP-guidelines recommend addressing alcohol consumption and providing advice. However, only severe alcohol-related issues are commonly addressed in the consultation room.

Method: Based on scientific literature challenges and opportunities are outlined.

Results: Physicians are key figures in the (early) detection of problematic alcohol use, but addressing this often proves difficult and is mostly limited to cases of (suspected) severe alcohol problems. Discomfort with the topic, underestimation of the issue, and unfamiliarity with referral options play a significant role.

Discussion: By briefly addressing alcohol use, inquiring about amount and frequency of consumption, implementing evidence-based short interventions, and referring to on- and offline prevention services from addiction care, physicians can contribute to the prevention and reduction of risky drinking.

A 33-year-old pregnant, Indian woman presented with acute confusion initially interpreted as symptomatic hyponatraemia from SIADH. She was later diagnosed with disseminated tuberculosis and meningoencephalitis. X-ray showed signs of TB after chronic cough was revealed. This case underscores the need for thorough evaluation, including radiology, especially in patients with risk factors, regardless of pregnancy.

Retinal artery and vein occlusions can both lead to significant vision loss. Vein occlusions are much more common, while visual acuity is usually more severely affected in artery occlusions. In addition to ophthalmological treatment, both types of occlusions require a multidisciplinary approach, in which cardiovascular risk management is important. In the event of an artery occlusion, an urgent search for the source of the embolism must be carried out. We discuss two cases. First, a 71-year-old man with a central retinal artery occlusion who presented three hours after the event and was treated successfully. Second, a 37-year-old obese man with a central retinal vein occlusion for which he has undergone long-term treatment with intravitreal anti-VEGF injections for persistent macular edema.

Hyperglycemia at admission is associated with complications and mortality. There is only little evidence, however, for beneficial effects of strict glycemic control during hospitalization. Strict glycemic control may prevent postoperative infections. Strict control can increase the risk of hypoglycemia, which is independently associated with mortality. The ideal glucose target values for patients admitted to a general ward range from 5.6 to 10 mmol/L, with consideration for higher targets in certain populations. The sliding scale insulin regimen stands as a hallmark prescription for medical interns in hospital settings, yet the evidence shows this regimen is ineffective. Guidelines have been advising against the sliding scale regimen for almost 20 years. We advocate a basal-bolus insulin regimen for the management of elevated glucose levels, while tolerating mild hyperglycemia.A transition away from sliding insulin towards basal-bolus insulin, has shown promising outcomes. Embracing a paradigm shift towards basal-bolus insulin regimens offers a more nuanced approach to glucose management, leading to better patient outcomes and a lower workload for healthcare providers.