Nederlands tijdschrift voor geneeskunde最新文献

A 72-year-old man with no relevant medical history underwent coronary angiography for angina complaints. One day post-procedure, he developed a progressive, painless right-sided neck swelling. Ultrasound revealed a well-defined 30.1 mm cyst in the right thyroid lobe without connection to the carotid artery or signs of aneurysm. Diagnosis: thyroid cyst haemorrhage.

Decent work contributes to health, security of existence and social prosperity. This also applies to the majority of people with (chronic) diseases. Attention for work is an important task for every healthcare provider. By identifying problems in the area of work and health in a timely manner, a healthcare provider can promote work capacity and recovery and possibly prevent absenteeism or disability. Moreover, work-focused health care also reaches the group of patients without supervision from a company or insurance doctor. This educational article offers healthcare providers tools to shape work-focused health care in their daily practice.

Oncological pain in palliative care is common. This article presents a 61-year-old man with a Pancoast tumor which caused severe pain and impaired his quality of life. Multimodal analgesia was not effective due to a limited analgesic effect and side effects. After one year the patient underwent a percutaneous cordotomy which resulted in a complete and long-term pain relief and an improvement of social and physical functioning. Reflecting on this case, the patient might have benefited from an earlier referral to a pain clinic that performs the cordotomy. Timely referral is recommended to discuss the possibility of a cordotomy with the patient in the early palliative phase. During this phase, the patient can make a well-considered decision whether the advantages and disadvantages of analgesics still outweigh those of a cordotomy. Early treatment might lead to a longer and improved quality of life with less or without pain.

Agitated patients present a challenge in clinical practice. Management strategies vary depending on severity, ranging from (non-)verbal de-escalation to pharmacological sedation. This article outlines a stepwise approach to treating agitation, distinguishing between mild, moderate, and extreme agitation. Mild agitation can often be managed with verbal and non-verbal techniques, while moderate agitation may require anxiolytics or antipsychotics. Extreme agitation necessitates rapid and effective sedation, administered by trained healthcare professionals, to ensure the safety of both patients and caregivers. Midazolam is commonly used for extreme agitation; however, research suggests that droperidol may be more effective and safer. When this initial approach is ineffective, ketamine can be considered. This article provides practical guidelines for selecting the appropriate interventions to optimize both patient and caregiver safety and well-being.

This case report describes the presence of an acquirednaevus of Ito on a 78-year-old Dutch male. Naevus of Ito is a blue-grey discolouration that most commonly presents on Asian individuals during childhood. It is exceedingly rare for this naevus to occur later in life in a non-Asian individual.

Vitiligo is a chronic skin disease characterized by white patches caused by the destruction of melanocytes. The most well-known variant is non-segmental vitiligo, where patches are symmetrically distributed across the entire body, with alternating periods of stability and progression. The white patches arise due to an autoimmune reaction in which cytotoxic T-cells attack the melanocytes. Treatment aims to halt the progression and to achieve repigmentation of existing lesions. The treatment often consists of a combination of topical therapy and phototherapy, sometimes supplemented by systemic corticosteroids or surgical techniques. However, recently new treatments have entered the market, notably treatment with JAK inhibitors (both topical and systemic), with promising results.

Objective: To investigate sex differences in the pharmacological treatment of hypertension in primary care.

Design: Cross-sectional study among 14,384 patients with hypertension from the Julius General Practitioners' Network, without cardiovascular disease or diabetes, treated with antihypertensive medications.

Methods: We compared men and women in the number and type of prescribed antihypertensives and their blood pressure.

Results: Women (n=8596) and men (n=5788) were prescribed the same number of antihypertensive agents on average (1.8). Women received lower dosages, more often beta-blockers (35% vs. 26%, p<0.001) and diuretics (54% vs. 51%, p<0.001), but less often ACE inhibitors (35% vs. 46%, p<0.001) and calcium channel blockers (29% vs. 36%, p<0.001). Blood pressure control was more often achieved in women than in men (50% vs. 46%, p<0.001).

Conclusion: Although current guidelines do not distinguish between sexes, differences exist in the type and dosage of antihypertensives prescribed, and in the rate of blood pressure control.

BRASH syndrome is an acronym for Bradycardia, Renal failure, AV blockade, Shock, and Hyperkalemia. It arises from the synergy between AV nodal blocking medications (such as beta-blockers or calcium antagonists), renal failure, and hyperkalemia, leading to bradycardia and renal hypoperfusion. This exacerbates the decline in renal function and hyperkalemia, increasing the effect of AV-node blocking medication and creating a vicious cycle with the risk of multi-organ failure. Patients often improve with basic supportive therapy, such as discontinuing AV nodal blockers, correcting hyperkalemia, and rehydration. We present a case that highlights the importance of early recognition of this often-overlooked syndrome in patients with combined cardiovascular and renal comorbidities.

In the face of increasing patient demands and the urgent threat of climate change, this article critically examines the current challenges within oncology. The authorsadvocate for a sustainable healthcare system that balances patient care with environmental responsibilities. Highlighting the significant carbon footprint of oncology, driven by costly treatments and pharmaceuticals, the authors argue that the pursuit of aggressive, life-extending therapies often conflicts with goals of accessibility and sustainability. To mitigate these issues, the article proposes a four-tier roadmap for reducing the environmental impact of oncological care: (1) assessing societal impacts; (2) engaging patients in discussions on personal values; (3) incorporating sustainability in professional standards; and (4) implementing dosage reduction strategies. This approach aims to align oncology practices with sustainable healthcare objectives, ensuring responsible care for future generations.

A 33-year old woman presented with a slowly progressive but asymptomatic nail disorder of the left index finger. MRI and histological examination revealed a subungual neurofibroma as the cause of this single digit clubbing. Surgical removal resulted in good recovery with preservation of the nail.