Nederlands tijdschrift voor geneeskunde最新文献

Group A-streptococcal (GAS) infection can lead to various clinical presentations and is fulminant when it reaches the deep tissues, leading to a high morbidity and mortality. The severity of postpartum GAS infections is widely known. In this case report we describe the course of disease in a pregnant patient with GAS toxic shock syndrome with initial complaints of abdominal pain, diarrhea and fetal demise at first presentation. Within 10 hours this patient died. It is important to stay vigilant for a fulminant GAS infection in pregnant patients, to recognize it quickly and treat it adequately.

Dutch physicians are increasingly encountering patients with a migration background. Research indicates that this group is more likely to receive suboptimal quality of care than those without a migration background. Despite the intention to treat all their patients equally, the behaviour and professional decisions of physicians can sometimes contribute to this inequality. Various factors play a role in this. This paper addresses some factors that have been insufficiently highlighted in the Netherlands to date: implicit biases and cultural misinterpretation. These factors can contribute to discrimination, misunderstanding, medication non-adherence, and negatively impact healthcare outcomes. We conclude with practical tips and the prerequisites for a multidimensional, long-term approach to addressing these issues.

A 36-year-old woman with a history of spondylolisthesis underwent respondylodesis 13 years after spondylodesis of vertebrae L3-L4. The respondylodesis was performed by screw fixation augmented with cement. One year after respondylodesis, the patient developed pulmonary complaints. Chest radiology revealed pulmonary cement embolism.

Over the last 75 years, the field of Human Genetics has developed enormously. One of the recent developments involves health-related direct-to-consumer genetic tests (DTC-GTs), through which consumers gain insight in their genetic information and personal health risks without involvement of a health care professional. The DTC-GT market is diverse and dynamic, testing for continuously changing combinations of traits and DNA-variants that can affect personal health and disease. DTC-GTs can have positive and negative consequences for individuals, health care, society, and science. Notably, consumers are presently not optimally empowered for informed decision making regarding health-related DTC-GT usage. It is important to protect them from negative impact, given the present lack of actionable legislation. Insight in which citizens buy these tests, and why they do so, will help to properly inform and empower consumers to make informed decisions both before and after purchasing health-related DTC-GTs. Projects answering these questions are ongoing.

The prognosis for locked-in syndrome after acquired brainstem injury is unfavourable. However, partial recovery of motor function occurs in many patients and benefits from intensive rehabilitation. Here we evaluate two patient cases and results of a questionnaire among medical doctors specialised in rehabilitation. We define bottlenecks in the treatment of acute locked-in syndrome in the ICU. Locked-in patients have a years-long life expectancy once they have survived the acute phase. There is no validated prognostic instrument to predict recovery, but even small neurological recovery can have large functional benefits. Recovery may take place over an extended period of time, up to years after onset. To unlock the potential to recover we recommend to start with early rehabilitation while the patient is still in the ICU on life sustaining treatment This may set the patient off along the road from locked-in to unlocked.

Background: In this article we describe an underexposed cause of subgaleal hematoma in the older child. Subgaleal hematomas are well-known in the context of trauma or blood clotting disorders. International literature acknowledges excessive force during hair styling as a possible cause. Here, we present two cases to illustrate the importance of a complete patient work-up.

Case description: Recently, two patients presented themselves at Juliana Children's Hospital, the Hague, the Netherlands, with a swelling on the head and headache with no obvious cause. Radiological imaging showed subgaleal hematomas. Upon questioning, both patients mentioned using extensive traction while styling their hair.

Conclusion: In conclusion, when analysing an older child with a swelling on the head with no obvious cause, consider the diagnoses subgaleal hematoma due to hair traction. It might be helpful to observe them styling their hair. A proper clinical review can therefore prevent over-testing and overtreatment.

In case of suspicion of a T1 colorectal tumor, the tumor should not be biopsied but removed completely (so-called en-bloc resection). With more recent endoscopic techniques, T1 colorectal tumors can be more often radical resected. If at least one of the following four characteristics is present, there is a high-risk T1 colorectal tumor and it is recommended to consider surgical resection with adequate lymphadenectomy; poor differentiation, presence of (lymphatic) angioinvasion, high-grade tumor budding (grade 2-3) and a positive resection margin (where the malignant cells approach the cut edge to 0.1mm). The risk of recurrent disease after endoscopic resection of a high-risk T1 colorectal tumor without additional surgery is not well known. Scheduled surgery for bowel cancer at an early stage is associated with the same risk of a serious complication and/or death as scheduled surgery at a more advanced stage.

This study researches the quality of care of the newly redesigned Department of Acute Care (AAZ), at the Noordwest Hospital in Den Helder. It is a multi-methodological study. Quality indicators were descriptively compared with a conventional Emergency Department (ED) at the location in Alkmaar. Moreover, focus groups were held among nurses employed in the AAZ and patient experiences were recorded by the Picker Institute with a validated questionnaire. The study shows that the quality of acute care in the harmonica model of the AAZ achieves comparable results compared to the conventional ED design at Alkmaar. These results imply that it is feasible to provide acute care near the patient, with efficient staffing through a redesign of the acute care chain.

Trichophyton indotineae is a recently identified dermatophyte that frequently causes extensive and persistent dermatomycosis, particularly tinea corporis, tinea cruris, and tinea faciei. The infection is frequently encountered in countries of the Indian subcontinent and surrounding areas. In Europe, T. indotineae has mainly been detected in patients with an epidemiological link to the aforementioned regions. Unlike dermatomycoses caused by other dermatophyte species, infections caused by T. indotineae often exhibit treatment failure with commonly prescribed antifungal drugs. Reduced susceptibility to terbinafine is often observed in T. indotineae. In addition, reduced susceptibility to itraconazole has also been reported. Due to the extensive and persistent nature of the infection, as well as the reduced susceptibility to antifungal drugs, international experts recommend aggressive treatment of T. indotineae using a combination of oral and topical antifungals. Susceptibility testing may be warranted to guide treatment decisions. Early recognition of T. indotineae infections is crucial to prevent prolonged recurrences.

The prevalence of obesity in the Netherlands has been on the rise for decades and recent preventive efforts of government and other societal actors appear insufficient to reverse this trend. The development of food technologies neutralizing the impact of fat and sugar, and medicines that might help individuals losing weight could be seen as part of a solution. We argue however that these also reinforce three fundamental societal problems underlying the obesity crisis: a vicious market cycle, the framing of overweight as a problem of individuals, and an epistemological dilemma in science. Together these problems constitute a vicious circle that is especially harmful for socioeconomically disadvantaged groups. Many societal actors are involved in these problems and share moral responsibility for taking away the causes of injustice, including food industry, retailers, health care, and government. Effective prevention of obesity may require developing avenues to legally enforce these responsibilities.