An episode of non-cardiogenic lung edema in a young, healthy athlete This article describes a case of a healthy, active 17-year-old man who underwent an elective endoscopic repair of an inguinal hernia under general anesthesia. After being extubated, he experienced a sudden episode of severe hypoxemic respiratory failure in the recovery room. Eventually, the diagnosis of negative pressure pulmonary edema (NPPE) or post-obstructive pulmonary edema (POPE) was made. This condition involves a non-cardiogenic pulmonary edema which occurs due to the generation of highly negative intrathoracic pressures. The most common cause in the adult population is post-extubation laryngospasm, where significant inspiratory forces are exerted against a closed glottis. Young athletes are at a heightened risk of experiencing this complication because they can develop intensely negative intrathoracic pressures. Given the limited treatment options available, it is crucial to prevent this phenomenon and to promptly identify it if present. Given its rarity and relative obscurity, the authors hope to raise the awareness for this phenomenon. It is a condition that any medical professional (internists, surgeons, anesthesiologists, intensivists) may encounter in his or her practice.
{"title":"Een episode van niet-cardiogeen longoedeem bij een jonge, gezonde atleet","authors":"D. Bivort, P. Van Bleyenbergh","doi":"10.47671/tvg.80.24.035","DOIUrl":"https://doi.org/10.47671/tvg.80.24.035","url":null,"abstract":"An episode of non-cardiogenic lung edema in a young, healthy athlete\u0000\u0000 \u0000\u0000This article describes a case of a healthy, active 17-year-old man who underwent an elective endoscopic repair of an inguinal hernia under general anesthesia. After being extubated, he experienced a sudden episode of severe hypoxemic respiratory failure in the recovery room. Eventually, the diagnosis of negative pressure pulmonary edema (NPPE) or post-obstructive pulmonary edema (POPE) was made. This condition involves a non-cardiogenic pulmonary edema which occurs due to the generation of highly negative intrathoracic pressures. The most common cause in the adult population is post-extubation laryngospasm, where significant inspiratory forces are exerted against a closed glottis. Young athletes are at a heightened risk of experiencing this complication because they can develop intensely negative intrathoracic pressures. Given the limited treatment options available, it is crucial to prevent this phenomenon and to promptly identify it if present. Given its rarity and relative obscurity, the authors hope to raise the awareness for this phenomenon. It is a condition that any medical professional (internists, surgeons, anesthesiologists, intensivists) may encounter in his or her practice.","PeriodicalId":23124,"journal":{"name":"Tijdschrift Voor Geneeskunde","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141104123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Finoulst, P. Vankrunkelsven, J. Steyaert, J. Verschraegen, S. Engelborghs
{"title":"Hormoontherapie in de menopauze vermindert het risico op dementie waarschijnlijk niet, mogelijk eerder omgekeerd","authors":"M. Finoulst, P. Vankrunkelsven, J. Steyaert, J. Verschraegen, S. Engelborghs","doi":"10.47671/tvg.80.24.056","DOIUrl":"https://doi.org/10.47671/tvg.80.24.056","url":null,"abstract":"","PeriodicalId":23124,"journal":{"name":"Tijdschrift Voor Geneeskunde","volume":"51 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141118676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Diagnostiek: een olifant in de kamer of een speld in een hooiberg?","authors":"A. Buelens-Terryn","doi":"10.47671/tvg.80.24.033","DOIUrl":"https://doi.org/10.47671/tvg.80.24.033","url":null,"abstract":"","PeriodicalId":23124,"journal":{"name":"Tijdschrift Voor Geneeskunde","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140356318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Folia Pharmacotherapeutica april 2024","authors":"","doi":"10.47671/tvg.80.24.034","DOIUrl":"https://doi.org/10.47671/tvg.80.24.034","url":null,"abstract":"","PeriodicalId":23124,"journal":{"name":"Tijdschrift Voor Geneeskunde","volume":"81 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140366244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alcohol-associated hepatitis: fit for transplant? Alcohol-associated hepatitis is one of the most severe stages of end-stage liver failure. In patients not responding to corticosteroids or when this medication is contraindicated, an early liver transplantation is the last treatment option. This article discusses the transplant process and various topics of controversy, such as relapse, outcome, ethics and organ scarcity, with the aim of determining whether these patients are good transplant candidates. This narrative review is based on 30 sources from various databases. Patients with alcohol-associated hepatitis not responding to corticosteroids have a high short-term mortality, which often makes a rapid intervention with an early liver transplantation the only option. An abstinence period of 6 months is therefore not possible in this population. The outcome of alcohol-associated hepatitis after the transplantation is similar to that of end-stage alcohol-associated liver disease. Only a small proportion of the patients with severe alcohol-associated hepatitis relapses after the transplantation, figures corresponding to those of alcoholic liver disease. The literature shows that, according to the principles of medical ethics, severe alcohol-associated hepatitis is a good indication for a liver transplantation, even in the context of the current organ shortage. The good outcome, low recurrence rates and high urgency and utility are the main reasons.
{"title":"Alcoholgeassocieerde hepatitis: geschikt voor transplantatie?","authors":"O. Bouzezza, H. Van Vlierberghe","doi":"10.47671/tvg.80.24.015","DOIUrl":"https://doi.org/10.47671/tvg.80.24.015","url":null,"abstract":"Alcohol-associated hepatitis: fit for transplant?\u0000\u0000 \u0000\u0000Alcohol-associated hepatitis is one of the most severe stages of end-stage liver failure. In patients not responding to corticosteroids or when this medication is contraindicated, an early liver transplantation is the last treatment option. This article discusses the transplant process and various topics of controversy, such as relapse, outcome, ethics and organ scarcity, with the aim of determining whether these patients are good transplant candidates.\u0000\u0000 \u0000\u0000This narrative review is based on 30 sources from various databases.\u0000\u0000 \u0000\u0000Patients with alcohol-associated hepatitis not responding to corticosteroids have a high short-term mortality, which often makes a rapid intervention with an early liver transplantation the only option. An abstinence period of 6 months is therefore not possible in this population. The outcome of alcohol-associated hepatitis after the transplantation is similar to that of end-stage alcohol-associated liver disease. Only a small proportion of the patients with severe alcohol-associated hepatitis relapses after the transplantation, figures corresponding to those of alcoholic liver disease. The literature shows that, according to the principles of medical ethics, severe alcohol-associated hepatitis is a good indication for a liver transplantation, even in the context of the current organ shortage. The good outcome, low recurrence rates and high urgency and utility are the main reasons.","PeriodicalId":23124,"journal":{"name":"Tijdschrift Voor Geneeskunde","volume":"77 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140368568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joint reflection on moral doubts with CURA: a low-threshold clinical ethics support instrument Healthcare providers frequently encounter morally challenging situations. Clinical ethics support helps them to navigate in these complex situations by fostering reflection and generating new insights and courses of action. CURA is an instrument developed to provide low-threshold support in situations that evoke moral doubt. This article presents a case study to illustrate how CURA works and to underline the benefits it can bring to healthcare providers. The case involves a woman with Alzheimer’s disease exhibiting restlessness at night, disrupting the sleep of other clients of the residential care center. The night shift nurses want the situation to be resolved, for instance through measures such as fixation. The dementia case manager, however, advocates for an approach that meets her values and the needs of all participants. This case discussion highlights the significance of joint reflection with clinical ethics support: provide good care through generating new courses of action together and reduce moral distress by sharing moral doubts. CURA is one of the methods that can be used to achieve these goals.
{"title":"Gezamenlijke reflectie over ethische twijfel met CURA: een laagdrempelig instrument voor moreel beraad","authors":"M. van Schaik, G. Froyen","doi":"10.47671/tvg.80.24.011","DOIUrl":"https://doi.org/10.47671/tvg.80.24.011","url":null,"abstract":"Joint reflection on moral doubts with CURA: a low-threshold clinical ethics support instrument\u0000\u0000Healthcare providers frequently encounter morally challenging situations. Clinical ethics support helps them to navigate in these complex situations by fostering reflection and generating new insights and courses of action. CURA is an instrument developed to provide low-threshold support in situations that evoke moral doubt.\u0000\u0000 \u0000\u0000This article presents a case study to illustrate how CURA works and to underline the benefits it can bring to healthcare providers. The case involves a woman with Alzheimer’s disease exhibiting restlessness at night, disrupting the sleep of other clients of the residential care center. The night shift nurses want the situation to be resolved, for instance through measures such as fixation. The dementia case manager, however, advocates for an approach that meets her values and the needs of all participants. This case discussion highlights the significance of joint reflection with clinical ethics support: provide good care through generating new courses of action together and reduce moral distress by sharing moral doubts. CURA is one of the methods that can be used to achieve these goals.","PeriodicalId":23124,"journal":{"name":"Tijdschrift Voor Geneeskunde","volume":"121 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140379006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Jeandarme, S. Vandenbosch, B. Claessens, T. Michem, S. Vermeulen
Somatic pathology in high security internees Psychiatric problems of forensic patients have already been identified in Flanders (Belgium), but no research has been done on the occurrence of somatic comorbidity. In order to improve somatic care, the authors aim to map the prevalence and nature of somatic diagnoses and the causes of death. Through a retrospective study, the medical records of all patients admitted and discharged in a high security forensic psychiatric center were analyzed. All somatic diseases were coded dichotomously. In order to obtain the most complete picture possible, various sources of information (file information, measured parameters, laboratory results) were used. The nature of the deaths (natural, unnatural, suicide) and the causes of natural deaths were examined. More than 2/3 of the deaths were caused by suicides. The 3 most prevalent somatic conditions were obesity (38.9%), hypertension (34.4%) and the metabolic syndrome (33.7%). The current study further indicates that certain data were missing in the files, such as registrations of blood pressure measurements, weight and waist circumferences. Therefore, some problems may have remained underdiagnosed and undertreated. As a consequence, there is room for improvement in the detection and monitoring of somatic diseases. This first study demonstrates an important somatic comorbidity in forensic patients with high security needs and may contribute to a better understanding and treatment of physical problems. This aspect of the holistic treatment of forensic-psychiatric patients has been recognized insufficiently, despite its great importance.
{"title":"Somatische pathologie bij ‘high security’-geïnterneerden","authors":"I. Jeandarme, S. Vandenbosch, B. Claessens, T. Michem, S. Vermeulen","doi":"10.47671/tvg.80.24.012","DOIUrl":"https://doi.org/10.47671/tvg.80.24.012","url":null,"abstract":"Somatic pathology in high security internees\u0000\u0000 \u0000\u0000Psychiatric problems of forensic patients have already been identified in Flanders (Belgium), but no research has been done on the occurrence of somatic comorbidity.\u0000\u0000 \u0000\u0000In order to improve somatic care, the authors aim to map the prevalence and nature of somatic diagnoses and the causes of death.\u0000\u0000 \u0000\u0000Through a retrospective study, the medical records of all patients admitted and discharged in a high security forensic psychiatric center were analyzed. All somatic diseases were coded dichotomously. In order to obtain the most complete picture possible, various sources of information (file information, measured parameters, laboratory results) were used. The nature of the deaths (natural, unnatural, suicide) and the causes of natural deaths were examined.\u0000\u0000 \u0000\u0000More than 2/3 of the deaths were caused by suicides. The 3 most prevalent somatic conditions were obesity (38.9%), hypertension (34.4%) and the metabolic syndrome (33.7%). The current study further indicates that certain data were missing in the files, such as registrations of blood pressure measurements, weight and waist circumferences. Therefore, some problems may have remained underdiagnosed and undertreated. As a consequence, there is room for improvement in the detection and monitoring of somatic diseases.\u0000\u0000 \u0000\u0000This first study demonstrates an important somatic comorbidity in forensic patients with high security needs and may contribute to a better understanding and treatment of physical problems. This aspect of the holistic treatment of forensic-psychiatric patients has been recognized insufficiently, despite its great importance.","PeriodicalId":23124,"journal":{"name":"Tijdschrift Voor Geneeskunde","volume":" 35","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140221837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The ‘Clinical Ethics Support Team’ of the Brugmann Hospital Helping people to make decisions and reflect on ethically difficult situations (on a case-by-case basis) is not (any longer) a part of the mission of hospital ethics committees in Belgium. However, there is a real need for such a tool in the field. Driven by a multidisciplinary group of professionals, the Brugmann Hospital (Belgium) has set up a protocolized system to support healthcare teams experiencing ethical tensions in a given care situation. The Clinical Ethics Support Team (CEST) consists of healthcare professionals, non-healthcare professionals and patients, all of whom have been trained in the methodology. CEST can be called upon by any member of the institution, under certain conditions. In this context, CEST helps professionals to identify and disentangle the issues, values and principles at stake in a given situation so that they can see the decision-making process they are involved in more clearly and so that they can make choices in a more enlightened and peaceful manner. By virtue of its existence and the guidance it offers, CEST helps to make a critical and reflective professional culture effective, contributes to the roll-out of high-quality decision-making processes and makes it possible to offer more appropriate care thanks to the consistency and embeddedness of the guidance it aims to promote.
布鲁格曼医院的 "临床伦理支持小组 帮助人们做出决定并对伦理难题进行反思（以个案为基础），这不再是比利时医院伦理委员会的任务。然而，该领域确实需要这样一种工具。在一个由多学科专业人员组成的小组的推动下，比利时布鲁曼医院（Brugmann Hospital）建立了一个协议化系统，为在特定医疗情况下遇到伦理紧张局势的医疗团队提供支持。临床伦理支持小组（CEST）由医护专业人员、非医护专业人员和患者组成，他们都接受过相关方法的培训。在特定条件下，医疗机构的任何成员都可以向 CEST 求助。在这种情况下，CEST 可帮助专业人员识别和厘清特定情况下的关键问题、价值观和原则，使他们能够更清楚地了解自己所参与的决策过程，从而以更开明、更平和的方式做出选择。通过其存在及其提供的指导，CEST 有助于使批判性和反思性的专业文化行之有效，有 助于推广高质量的决策过程，并由于其旨在促进的指导的一致性和嵌入性，使提供更适当的 护理成为可能。
{"title":"Het ‘Clinical Ethics Support Team’ van het Brugmann-ziekenhuis","authors":"V. Hélin, T. Locoge, C. Meuris","doi":"10.47671/tvg.80.24.007","DOIUrl":"https://doi.org/10.47671/tvg.80.24.007","url":null,"abstract":"The ‘Clinical Ethics Support Team’ of the Brugmann Hospital\u0000\u0000 \u0000\u0000Helping people to make decisions and reflect on ethically difficult situations (on a case-by-case basis) is not (any longer) a part of the mission of hospital ethics committees in Belgium.\u0000\u0000 \u0000\u0000However, there is a real need for such a tool in the field.\u0000\u0000 \u0000\u0000Driven by a multidisciplinary group of professionals, the Brugmann Hospital (Belgium) has set up a protocolized system to support healthcare teams experiencing ethical tensions in a given care situation. The Clinical Ethics Support Team (CEST) consists of healthcare professionals, non-healthcare professionals and patients, all of whom have been trained in the methodology. CEST can be called upon by any member of the institution, under certain conditions. In this context, CEST helps professionals to identify and disentangle the issues, values and principles at stake in a given situation so that they can see the decision-making process they are involved in more clearly and so that they can make choices in a more enlightened and peaceful manner. By virtue of its existence and the guidance it offers, CEST helps to make a critical and reflective professional culture effective, contributes to the roll-out of high-quality decision-making processes and makes it possible to offer more appropriate care thanks to the consistency and embeddedness of the guidance it aims to promote.","PeriodicalId":23124,"journal":{"name":"Tijdschrift Voor Geneeskunde","volume":"154 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140233874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adrenocortical carcinoma: an extremely rare cause of psychosis, hypokalemia and metabolic alkalosis Adrenocortical carcinoma (ACC) is an utmost rare malignancy with a generally poor prognosis due to the fact that most ACCs are diagnosed in a late stage. The case of a 40-year-old female patient diagnosed with liver-metastasized ACC after an acute psychotic episode in the presence of severe hypokalemia and metabolic alkalosis is presented. Despite the treatment with ketoconazole followed by an adrenalectomy and adjuvant therapy with mitotane, the patient showed rapid clinical deterioration. Palliative care was initiated about a month after her admission. She died a few weeks later. This article summarizes the current literature on the epidemiology, clinical presentation, diagnosis, treatment and prognosis of ACC.
{"title":"Adrenocorticaal carcinoom als uiterst zeldzame oorzaak van psychose, hypokaliëmie en metabole alkalose","authors":"N. Mutebi, D. Unuane, N. De Leu","doi":"10.47671/tvg.80.24.006","DOIUrl":"https://doi.org/10.47671/tvg.80.24.006","url":null,"abstract":"Adrenocortical carcinoma: an extremely rare cause of psychosis, hypokalemia and metabolic alkalosis\u0000\u0000 \u0000\u0000Adrenocortical carcinoma (ACC) is an utmost rare malignancy with a generally poor prognosis due to the fact that most ACCs are diagnosed in a late stage.\u0000\u0000 \u0000\u0000The case of a 40-year-old female patient diagnosed with liver-metastasized ACC after an acute psychotic episode in the presence of severe hypokalemia and metabolic alkalosis is presented. Despite the treatment with ketoconazole followed by an adrenalectomy and adjuvant therapy with mitotane, the patient showed rapid clinical deterioration. Palliative care was initiated about a month after her admission. She died a few weeks later.\u0000\u0000 \u0000\u0000This article summarizes the current literature on the epidemiology, clinical presentation, diagnosis, treatment and prognosis of ACC.","PeriodicalId":23124,"journal":{"name":"Tijdschrift Voor Geneeskunde","volume":"9 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140241114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Brief aan de redactie: Verwevenheid van psychische en somatische comorbiditeit in de dagelijkse geneeskundige zorg","authors":"F. Van Den Eede","doi":"10.47671/tvg.80.24.029","DOIUrl":"https://doi.org/10.47671/tvg.80.24.029","url":null,"abstract":"","PeriodicalId":23124,"journal":{"name":"Tijdschrift Voor Geneeskunde","volume":"46 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140259095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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