L. Boets, A. van den Bruel, C. Van haecht, K. Cornelis, B. Debbaut, R.-M. Ntahonganyira, J. Flamaing, J. Stokx, B. Decallonne
Increasing use of levothyroxine in Belgium In the past decades, increased prescription of levothyroxine (LT4) has been observed in Belgium, different countries in Western Europe and North America. The increased screening for thyroid dysfunction, longer life expectancy and lower threshold for the initiation of LT4 therapy are believed to play a role. The goal of this article is to present a data overview on the prevalence of hypothyroidism, LT4 use and screening for hypothyroidism in Belgium and other countries. The Belgian data are in line with those from other countries, where an increase in LT4 prescriptions has been observed. The threshold for the initiation of LT4 seems to have lowered. Not only the indication to start LT4, but also follow-up of the serum thyroid-stimulating hormone (TSH) are important to avoid complications. The elderly deserve special attention because of an age-related increase of the serum TSH level. This may increase the risk of overdiagnosis of hypothyroidism and overtreatment with LT4, which is associated with iatrogenic thyrotoxicosis, atrial fibrillation and osteoporosis. In the elderly, the decision whether or not to start LT4 needs to be individualized, particularly in cases with mild TSH elevation. If LT4 is initiated, the principle ‘start low, go slow’ should be followed. There is a need for a better knowledge and implementation of guidelines, adopting age-specific reference ranges for TSH in order to optimize the use of LT4.
{"title":"Stijgend gebruik van levothyroxine in België","authors":"L. Boets, A. van den Bruel, C. Van haecht, K. Cornelis, B. Debbaut, R.-M. Ntahonganyira, J. Flamaing, J. Stokx, B. Decallonne","doi":"10.47671/tvg.79.23.122","DOIUrl":"https://doi.org/10.47671/tvg.79.23.122","url":null,"abstract":"Increasing use of levothyroxine in Belgium\u0000\u0000 \u0000\u0000In the past decades, increased prescription of levothyroxine (LT4) has been observed in Belgium, different countries in Western Europe and North America. The increased screening for thyroid dysfunction, longer life expectancy and lower threshold for the initiation of LT4 therapy are believed to play a role. The goal of this article is to present a data overview on the prevalence of hypothyroidism, LT4 use and screening for hypothyroidism in Belgium and other countries. The Belgian data are in line with those from other countries, where an increase in LT4 prescriptions has been observed. The threshold for the initiation of LT4 seems to have lowered. Not only the indication to start LT4, but also follow-up of the serum thyroid-stimulating hormone (TSH) are important to avoid complications. The elderly deserve special attention because of an age-related increase of the serum TSH level. This may increase the risk of overdiagnosis of hypothyroidism and overtreatment with LT4, which is associated with iatrogenic thyrotoxicosis, atrial fibrillation and osteoporosis. In the elderly, the decision whether or not to start LT4 needs to be individualized, particularly in cases with mild TSH elevation. If LT4 is initiated, the principle ‘start low, go slow’ should be followed. There is a need for a better knowledge and implementation of guidelines, adopting age-specific reference ranges for TSH in order to optimize the use of LT4.","PeriodicalId":507632,"journal":{"name":"Tijdschrift voor Geneeskunde","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139800158","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}
L. Boets, A. van den Bruel, C. Van haecht, K. Cornelis, B. Debbaut, R.-M. Ntahonganyira, J. Flamaing, J. Stokx, B. Decallonne
Increasing use of levothyroxine in Belgium In the past decades, increased prescription of levothyroxine (LT4) has been observed in Belgium, different countries in Western Europe and North America. The increased screening for thyroid dysfunction, longer life expectancy and lower threshold for the initiation of LT4 therapy are believed to play a role. The goal of this article is to present a data overview on the prevalence of hypothyroidism, LT4 use and screening for hypothyroidism in Belgium and other countries. The Belgian data are in line with those from other countries, where an increase in LT4 prescriptions has been observed. The threshold for the initiation of LT4 seems to have lowered. Not only the indication to start LT4, but also follow-up of the serum thyroid-stimulating hormone (TSH) are important to avoid complications. The elderly deserve special attention because of an age-related increase of the serum TSH level. This may increase the risk of overdiagnosis of hypothyroidism and overtreatment with LT4, which is associated with iatrogenic thyrotoxicosis, atrial fibrillation and osteoporosis. In the elderly, the decision whether or not to start LT4 needs to be individualized, particularly in cases with mild TSH elevation. If LT4 is initiated, the principle ‘start low, go slow’ should be followed. There is a need for a better knowledge and implementation of guidelines, adopting age-specific reference ranges for TSH in order to optimize the use of LT4.
{"title":"Stijgend gebruik van levothyroxine in België","authors":"L. Boets, A. van den Bruel, C. Van haecht, K. Cornelis, B. Debbaut, R.-M. Ntahonganyira, J. Flamaing, J. Stokx, B. Decallonne","doi":"10.47671/tvg.79.23.122","DOIUrl":"https://doi.org/10.47671/tvg.79.23.122","url":null,"abstract":"Increasing use of levothyroxine in Belgium\u0000\u0000 \u0000\u0000In the past decades, increased prescription of levothyroxine (LT4) has been observed in Belgium, different countries in Western Europe and North America. The increased screening for thyroid dysfunction, longer life expectancy and lower threshold for the initiation of LT4 therapy are believed to play a role. The goal of this article is to present a data overview on the prevalence of hypothyroidism, LT4 use and screening for hypothyroidism in Belgium and other countries. The Belgian data are in line with those from other countries, where an increase in LT4 prescriptions has been observed. The threshold for the initiation of LT4 seems to have lowered. Not only the indication to start LT4, but also follow-up of the serum thyroid-stimulating hormone (TSH) are important to avoid complications. The elderly deserve special attention because of an age-related increase of the serum TSH level. This may increase the risk of overdiagnosis of hypothyroidism and overtreatment with LT4, which is associated with iatrogenic thyrotoxicosis, atrial fibrillation and osteoporosis. In the elderly, the decision whether or not to start LT4 needs to be individualized, particularly in cases with mild TSH elevation. If LT4 is initiated, the principle ‘start low, go slow’ should be followed. There is a need for a better knowledge and implementation of guidelines, adopting age-specific reference ranges for TSH in order to optimize the use of LT4.","PeriodicalId":507632,"journal":{"name":"Tijdschrift voor Geneeskunde","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139859830","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}
R. Ulenaers, F. Ghafelzadeh, A. Smeets, P. Geens, K. Peers
Posttraumatic bone edema three months after anterior cruciate ligament injury and correlation with pain, a comparison between operatively and conservatively treated patients: an exploratory analysis of the IODA pilot trial Background/Purpose: Recent years have seen a surge of research comparing conservative treatment with immediate surgery for anterior cruciate ligament (ACL) injuries, with some studies reporting comparable clinical outcomes between both approaches. In this study, we aim to compare magnetic resonance imaging (MRI) findings in both treatment groups, in particular bone edema. Methods: This randomized controlled trial involved 25 patients with an acute ACL injury who were assigned to 1) immediate ACL reconstruction or 2) conservative treatment with optional delayed surgery. (1) Two MRI scans were conducted, at the time of injury and after three months, and scored using the Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS). Pain was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). A multivariate linear regression analysis was performed to evaluate the impact of both treatments on bone edema evolution; while a bivariate correlation analysis was conducted to examine the possible relationship between bone edema and pain. Results: Type of treatment had a significant influence on the amount of bone edema after three months, after correcting for bone edema at diagnosis, with higher scores in the operative group. No significant correlation was observed between bone edema and pain at the time of injury (r=0,183, p=0,403) or after three months (r=0,161, p=0,499). Conclusion: Our findings suggest that ACL reconstruction may have an adverse effect on the amount of bone edema at three months, although no significant correlation was seen between bone edema and pain. Further analysis with larger sample size are planned (IODA trial).
{"title":"Posttraumatisch botoedeem drie maanden na operatieve en conservatieve behandeling van een voorste kruisbandletsel en de correlatie met pijn: een exploratieve analyse van de IODA piloot studi","authors":"R. Ulenaers, F. Ghafelzadeh, A. Smeets, P. Geens, K. Peers","doi":"10.47671/tvg.79.23.119","DOIUrl":"https://doi.org/10.47671/tvg.79.23.119","url":null,"abstract":"Posttraumatic bone edema three months after anterior cruciate ligament injury and correlation with pain, a comparison between operatively and conservatively treated patients: an exploratory analysis of the IODA pilot trial\u0000\u0000 \u0000\u0000Background/Purpose: Recent years have seen a surge of research comparing conservative treatment with immediate surgery for anterior cruciate ligament (ACL) injuries, with some studies reporting comparable clinical outcomes between both approaches. In this study, we aim to compare magnetic resonance imaging (MRI) findings in both treatment groups, in particular bone edema.\u0000\u0000 \u0000\u0000Methods: This randomized controlled trial involved 25 patients with an acute ACL injury who were assigned to 1) immediate ACL reconstruction or 2) conservative treatment with optional delayed surgery. (1) Two MRI scans were conducted, at the time of injury and after three months, and scored using the Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS). Pain was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). A multivariate linear regression analysis was performed to evaluate the impact of both treatments on bone edema evolution; while a bivariate correlation analysis was conducted to examine the possible relationship between bone edema and pain.\u0000\u0000 \u0000\u0000Results: Type of treatment had a significant influence on the amount of bone edema after three months, after correcting for bone edema at diagnosis, with higher scores in the operative group. No significant correlation was observed between bone edema and pain at the time of injury (r=0,183, p=0,403) or after three months (r=0,161, p=0,499).\u0000\u0000 \u0000\u0000Conclusion: Our findings suggest that ACL reconstruction may have an adverse effect on the amount of bone edema at three months, although no significant correlation was seen between bone edema and pain. Further analysis with larger sample size are planned (IODA trial).","PeriodicalId":507632,"journal":{"name":"Tijdschrift voor Geneeskunde","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139870093","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}
R. Ulenaers, F. Ghafelzadeh, A. Smeets, P. Geens, K. Peers
Posttraumatic bone edema three months after anterior cruciate ligament injury and correlation with pain, a comparison between operatively and conservatively treated patients: an exploratory analysis of the IODA pilot trial Background/Purpose: Recent years have seen a surge of research comparing conservative treatment with immediate surgery for anterior cruciate ligament (ACL) injuries, with some studies reporting comparable clinical outcomes between both approaches. In this study, we aim to compare magnetic resonance imaging (MRI) findings in both treatment groups, in particular bone edema. Methods: This randomized controlled trial involved 25 patients with an acute ACL injury who were assigned to 1) immediate ACL reconstruction or 2) conservative treatment with optional delayed surgery. (1) Two MRI scans were conducted, at the time of injury and after three months, and scored using the Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS). Pain was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). A multivariate linear regression analysis was performed to evaluate the impact of both treatments on bone edema evolution; while a bivariate correlation analysis was conducted to examine the possible relationship between bone edema and pain. Results: Type of treatment had a significant influence on the amount of bone edema after three months, after correcting for bone edema at diagnosis, with higher scores in the operative group. No significant correlation was observed between bone edema and pain at the time of injury (r=0,183, p=0,403) or after three months (r=0,161, p=0,499). Conclusion: Our findings suggest that ACL reconstruction may have an adverse effect on the amount of bone edema at three months, although no significant correlation was seen between bone edema and pain. Further analysis with larger sample size are planned (IODA trial).
{"title":"Posttraumatisch botoedeem drie maanden na operatieve en conservatieve behandeling van een voorste kruisbandletsel en de correlatie met pijn: een exploratieve analyse van de IODA piloot studi","authors":"R. Ulenaers, F. Ghafelzadeh, A. Smeets, P. Geens, K. Peers","doi":"10.47671/tvg.79.23.119","DOIUrl":"https://doi.org/10.47671/tvg.79.23.119","url":null,"abstract":"Posttraumatic bone edema three months after anterior cruciate ligament injury and correlation with pain, a comparison between operatively and conservatively treated patients: an exploratory analysis of the IODA pilot trial\u0000\u0000 \u0000\u0000Background/Purpose: Recent years have seen a surge of research comparing conservative treatment with immediate surgery for anterior cruciate ligament (ACL) injuries, with some studies reporting comparable clinical outcomes between both approaches. In this study, we aim to compare magnetic resonance imaging (MRI) findings in both treatment groups, in particular bone edema.\u0000\u0000 \u0000\u0000Methods: This randomized controlled trial involved 25 patients with an acute ACL injury who were assigned to 1) immediate ACL reconstruction or 2) conservative treatment with optional delayed surgery. (1) Two MRI scans were conducted, at the time of injury and after three months, and scored using the Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS). Pain was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). A multivariate linear regression analysis was performed to evaluate the impact of both treatments on bone edema evolution; while a bivariate correlation analysis was conducted to examine the possible relationship between bone edema and pain.\u0000\u0000 \u0000\u0000Results: Type of treatment had a significant influence on the amount of bone edema after three months, after correcting for bone edema at diagnosis, with higher scores in the operative group. No significant correlation was observed between bone edema and pain at the time of injury (r=0,183, p=0,403) or after three months (r=0,161, p=0,499).\u0000\u0000 \u0000\u0000Conclusion: Our findings suggest that ACL reconstruction may have an adverse effect on the amount of bone edema at three months, although no significant correlation was seen between bone edema and pain. Further analysis with larger sample size are planned (IODA trial).","PeriodicalId":507632,"journal":{"name":"Tijdschrift voor Geneeskunde","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139810069","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. Falter, K. Schoonheydt, L. Henckaerts, P. Bruynseels, J. Valk, N. Van Regenmortel
Severe pulmonary Nocardia nova infection in a kidney transplant patient This article describes the disease course of a severe Nocardia nova infection in a patient with an underlying immunodeficiency due to a kidney transplantation, with the visualisation of Nocardia colonies in the pleural cavity through video-assisted thoracoscopic surgery. The patient was hospitalised in the emergency department with acute respiratory symptoms and respiratory failure. A CT scan of the chest revealed a massive unilateral pleural effusion with complete compressive atelectasis of the left lung. Video-assisted thoracoscopic surgery revealed bloody pleural effusion and white, nodular, pleural structures. Cultures of the biopsies grew N. nova. The empiric antibiotic treatment was switched to a combination therapy with trimethoprim-sulfamethoxazole, meropenem and a single dose of amikacin. Sensitivity testing revealed a strain of N. nova resistant to trimethoprim-sulfamethoxazole. The antibiotics were thereupon switched to linezolid and meropenem. Unfortunately, the patient died due to a refractory septic shock with multi-organ failure. Infections due to the Nocardia genus are rare and usually occur in patients with underlying immunodeficiencies. Pulmonary disease is the most frequent presentation and pleural effusion is common. Disseminated disease with central nervous system and skin involvement is also frequent. A correct microbiological diagnosis, species identification and sensitivity testing are of utmost importance because of the high intra- and interspecies differences. The strain isolated in this case had an unexpected resistance to trimethoprim-sulfamethoxazole, which is considered to be the cornerstone treatment of a Nocardia infection.
{"title":"VATS-visualisatie van een ernstige pulmonale infectie met Nocardia nova resistent tegen trimethoprim-sulfamethoxazol","authors":"M. Falter, K. Schoonheydt, L. Henckaerts, P. Bruynseels, J. Valk, N. Van Regenmortel","doi":"10.47671/tvg.79.23.118","DOIUrl":"https://doi.org/10.47671/tvg.79.23.118","url":null,"abstract":"Severe pulmonary Nocardia nova infection in a kidney transplant patient\u0000\u0000 \u0000\u0000This article describes the disease course of a severe Nocardia nova infection in a patient with an underlying immunodeficiency due to a kidney transplantation, with the visualisation of Nocardia colonies in the pleural cavity through video-assisted thoracoscopic surgery.\u0000\u0000\u0000The patient was hospitalised in the emergency department with acute respiratory symptoms and respiratory failure. A CT scan of the chest revealed a massive unilateral pleural effusion with complete compressive atelectasis of the left lung. Video-assisted thoracoscopic surgery revealed bloody pleural effusion and white, nodular, pleural structures. Cultures of the biopsies grew N. nova. The empiric antibiotic treatment was switched to a combination therapy with trimethoprim-sulfamethoxazole, meropenem and a single dose of amikacin. Sensitivity testing revealed a strain of N. nova resistant to trimethoprim-sulfamethoxazole. The antibiotics were thereupon switched to linezolid and meropenem. Unfortunately, the patient died due to a refractory septic shock with multi-organ failure.\u0000\u0000 \u0000\u0000Infections due to the Nocardia genus are rare and usually occur in patients with underlying immunodeficiencies. Pulmonary disease is the most frequent presentation and pleural effusion is common. Disseminated disease with central nervous system and skin involvement is also frequent. A correct microbiological diagnosis, species identification and sensitivity testing are of utmost importance because of the high intra- and interspecies differences. The strain isolated in this case had an unexpected resistance to trimethoprim-sulfamethoxazole, which is considered to be the cornerstone treatment of a Nocardia infection.","PeriodicalId":507632,"journal":{"name":"Tijdschrift voor Geneeskunde","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139870235","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. Falter, K. Schoonheydt, L. Henckaerts, P. Bruynseels, J. Valk, N. Van Regenmortel
Severe pulmonary Nocardia nova infection in a kidney transplant patient This article describes the disease course of a severe Nocardia nova infection in a patient with an underlying immunodeficiency due to a kidney transplantation, with the visualisation of Nocardia colonies in the pleural cavity through video-assisted thoracoscopic surgery. The patient was hospitalised in the emergency department with acute respiratory symptoms and respiratory failure. A CT scan of the chest revealed a massive unilateral pleural effusion with complete compressive atelectasis of the left lung. Video-assisted thoracoscopic surgery revealed bloody pleural effusion and white, nodular, pleural structures. Cultures of the biopsies grew N. nova. The empiric antibiotic treatment was switched to a combination therapy with trimethoprim-sulfamethoxazole, meropenem and a single dose of amikacin. Sensitivity testing revealed a strain of N. nova resistant to trimethoprim-sulfamethoxazole. The antibiotics were thereupon switched to linezolid and meropenem. Unfortunately, the patient died due to a refractory septic shock with multi-organ failure. Infections due to the Nocardia genus are rare and usually occur in patients with underlying immunodeficiencies. Pulmonary disease is the most frequent presentation and pleural effusion is common. Disseminated disease with central nervous system and skin involvement is also frequent. A correct microbiological diagnosis, species identification and sensitivity testing are of utmost importance because of the high intra- and interspecies differences. The strain isolated in this case had an unexpected resistance to trimethoprim-sulfamethoxazole, which is considered to be the cornerstone treatment of a Nocardia infection.
{"title":"VATS-visualisatie van een ernstige pulmonale infectie met Nocardia nova resistent tegen trimethoprim-sulfamethoxazol","authors":"M. Falter, K. Schoonheydt, L. Henckaerts, P. Bruynseels, J. Valk, N. Van Regenmortel","doi":"10.47671/tvg.79.23.118","DOIUrl":"https://doi.org/10.47671/tvg.79.23.118","url":null,"abstract":"Severe pulmonary Nocardia nova infection in a kidney transplant patient\u0000\u0000 \u0000\u0000This article describes the disease course of a severe Nocardia nova infection in a patient with an underlying immunodeficiency due to a kidney transplantation, with the visualisation of Nocardia colonies in the pleural cavity through video-assisted thoracoscopic surgery.\u0000\u0000\u0000The patient was hospitalised in the emergency department with acute respiratory symptoms and respiratory failure. A CT scan of the chest revealed a massive unilateral pleural effusion with complete compressive atelectasis of the left lung. Video-assisted thoracoscopic surgery revealed bloody pleural effusion and white, nodular, pleural structures. Cultures of the biopsies grew N. nova. The empiric antibiotic treatment was switched to a combination therapy with trimethoprim-sulfamethoxazole, meropenem and a single dose of amikacin. Sensitivity testing revealed a strain of N. nova resistant to trimethoprim-sulfamethoxazole. The antibiotics were thereupon switched to linezolid and meropenem. Unfortunately, the patient died due to a refractory septic shock with multi-organ failure.\u0000\u0000 \u0000\u0000Infections due to the Nocardia genus are rare and usually occur in patients with underlying immunodeficiencies. Pulmonary disease is the most frequent presentation and pleural effusion is common. Disseminated disease with central nervous system and skin involvement is also frequent. A correct microbiological diagnosis, species identification and sensitivity testing are of utmost importance because of the high intra- and interspecies differences. The strain isolated in this case had an unexpected resistance to trimethoprim-sulfamethoxazole, which is considered to be the cornerstone treatment of a Nocardia infection.","PeriodicalId":507632,"journal":{"name":"Tijdschrift voor Geneeskunde","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139810227","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":"Psychiatrie: geen ver-van-uw-bedshow","authors":"A. Buelens-Terryn","doi":"10.47671/tvg.80.24.009","DOIUrl":"https://doi.org/10.47671/tvg.80.24.009","url":null,"abstract":"","PeriodicalId":507632,"journal":{"name":"Tijdschrift voor Geneeskunde","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139873262","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":"Psychiatrie: geen ver-van-uw-bedshow","authors":"A. Buelens-Terryn","doi":"10.47671/tvg.80.24.009","DOIUrl":"https://doi.org/10.47671/tvg.80.24.009","url":null,"abstract":"","PeriodicalId":507632,"journal":{"name":"Tijdschrift voor Geneeskunde","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139813336","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}
R. Van Lerberghe, E. Hill, K. Strickaert, P. Alexander, C. Gysbrechts, W. Mattelin
COVID-19 vocal cord paralysis and paresis in a patient with stridor COVID-19 can affect several organs, giving various disease presentations. The authors describe a case of a 42-year-old patient who presented with stridor. A bronchoscopy and flexible endoscopy revealed vocal cord paralysis on the left and vocal cord paresis on the right. With additional imaging, no other aetiology for the vocal cord impairment could be found, upon which the diagnosis of COVID-19-related vocal cord paralysis and paresis was made. The patient was successfully treated with short-term CPAP and a short course of methylprednisolone in tapering schedule. Hereafter, clinically and visually by means of a flexible endoscopy, there was rapid improvement of the vocal cord dysfunction. With this case, the authors suspect that corticosteroids may have a beneficial effect on the recovery of vocal cord deterioration caused by COVID-19.
{"title":"Covid-19-stembandparalyse en -parese bij een patiënte met stridor","authors":"R. Van Lerberghe, E. Hill, K. Strickaert, P. Alexander, C. Gysbrechts, W. Mattelin","doi":"10.47671/tvg.79.23.116","DOIUrl":"https://doi.org/10.47671/tvg.79.23.116","url":null,"abstract":"COVID-19 vocal cord paralysis and paresis in a patient with stridor\u0000\u0000 \u0000\u0000COVID-19 can affect several organs, giving various disease presentations. The authors describe a case of a 42-year-old patient who presented with stridor. A bronchoscopy and flexible endoscopy revealed vocal cord paralysis on the left and vocal cord paresis on the right. With additional imaging, no other aetiology for the vocal cord impairment could be found, upon which the diagnosis of COVID-19-related vocal cord paralysis and paresis was made. The patient was successfully treated with short-term CPAP and a short course of methylprednisolone in tapering schedule. Hereafter, clinically and visually by means of a flexible endoscopy, there was rapid improvement of the vocal cord dysfunction. With this case, the authors suspect that corticosteroids may have a beneficial effect on the recovery of vocal cord deterioration caused by COVID-19.","PeriodicalId":507632,"journal":{"name":"Tijdschrift voor Geneeskunde","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139597571","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}
Adrenaline in the treatment of anaphylaxis: hard for the heart The cornerstone of the treatment of anaphylaxis is adrenaline. The European Resuscitation Council recommends rapid administration by intramuscular route. In addition to acting as a catecholamine on alpha-1, beta-1 and beta-2 adrenergic receptors, it also reduces mediator release from mast cells, decreases obstructive respiratory symptoms and prevents cardiovascular collapse. Serious adverse effects of adrenaline when used in the treatment of anaphylaxis are rare, but can be life-threatening. This case describes a stress-induced (Takotsubo) cardiomyopathy after the erroneous administration of adrenaline via intravenous route instead of intramuscularly in a patient with anaphylaxis. Takotsubo cardiomyopathy is seen in situations of acute stress or intense emotion, mainly in middle-aged women. Clinically, this disease resembles an acute coronary syndrome with an increase in cardiac markers, changes on the electrocardiography (ECG) and reversible left ventricular dysfunction. On a coronarography, however, the coronary arteries are shown to be patent. The exact aetiology is still uncertain. The patient in this case study underwent cardiac catheterisation to rule out primary coronary artery damage and subsequently received a drug treatment with an angiotensin-converting enzyme (ACE) inhibitor and a low-dose beta blocker, in combination with a cardiac rehabilitation programme. The follow-up via a transthoracic echocardiography 1 month later showed a complete recovery of the left ventricular function.
{"title":"Adrenaline bij de behandeling van anafylaxie: hard voor het hart","authors":"S. Soetaert, C. Smets","doi":"10.47671/tvg.79.23.114","DOIUrl":"https://doi.org/10.47671/tvg.79.23.114","url":null,"abstract":"Adrenaline in the treatment of anaphylaxis: hard for the heart\u0000\u0000 \u0000\u0000The cornerstone of the treatment of anaphylaxis is adrenaline. The European Resuscitation Council recommends rapid administration by intramuscular route. In addition to acting as a catecholamine on alpha-1, beta-1 and beta-2 adrenergic receptors, it also reduces mediator release from mast cells, decreases obstructive respiratory symptoms and prevents cardiovascular collapse.\u0000\u0000 \u0000\u0000Serious adverse effects of adrenaline when used in the treatment of anaphylaxis are rare, but can be life-threatening. This case describes a stress-induced (Takotsubo) cardiomyopathy after the erroneous administration of adrenaline via intravenous route instead of intramuscularly in a patient with anaphylaxis.\u0000\u0000 \u0000\u0000Takotsubo cardiomyopathy is seen in situations of acute stress or intense emotion, mainly in middle-aged women. Clinically, this disease resembles an acute coronary syndrome with an increase in cardiac markers, changes on the electrocardiography (ECG) and reversible left ventricular dysfunction. On a coronarography, however, the coronary arteries are shown to be patent. The exact aetiology is still uncertain.\u0000\u0000 \u0000\u0000The patient in this case study underwent cardiac catheterisation to rule out primary coronary artery damage and subsequently received a drug treatment with an angiotensin-converting enzyme (ACE) inhibitor and a low-dose beta blocker, in combination with a cardiac rehabilitation programme. The follow-up via a transthoracic echocardiography 1 month later showed a complete recovery of the left ventricular function.","PeriodicalId":507632,"journal":{"name":"Tijdschrift voor Geneeskunde","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139608466","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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