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Leiderdorp, Netherlands

van den Broek M.A.,Rijnland Ziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2013

Randomized controlled trials (RCTs) are the gold standard for establishing the efficacy of surgical interventions. As the trial results are frequently incorporated in clinical guidelines, proper methodology and reporting of RCTs are essential. Trial protocol registration has been introduced, with the aim of improving the latter. A recent study by Hannink and colleagues showed that the quality of registration of surgical RCTs published in surgical journals was inferior to those published in medical journals. In addition, there was a discrepancy between registered and published outcome in approximately 50% of surgical trials. In this comment we critically assess the quality of surgical journals and surgical scientific research. Although there is still room for improvement, we conclude that major quality improvements have been made in these fields, such as the adoption of trial protocol registration by the editorial boards of high-impact surgical journals and the establishment of multidisciplinary study groups, which assure the future of evidence-based surgery. Source

Morssinkhof M.L.,Rijnland Ziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2013

A 81-year-old woman presented at the emergency department with a painful right arm due to a comminuted fracture of the humeral head. Operation was postponed because of a wound and vulnerable skin due to a large hematoma. By the time of the operation, the humeral head had migrated subcutaneously which resulted in a solid swelling of the upper arm. Source

A 42-year-old Dutch woman with no previous relevant medical history presented with hidradenitis suppurativa in the left inguinal region. After surgical excision, pathological investigations confirmed a diagnosis of squamous cell carcinoma. Further investigations showed no signs of metastases and after 6 months of follow-up there were no signs of recurrence. Hidradenitis suppurativa is a common chronic skin condition, localised in the axillary, inguinal and perianal regions. Squamous cell carcinoma of the skin is a rare complication of hidradenitis suppurativa. It occurs in extra-axillary locations of the hidradenitis foci, and has a poor prognosis. Pathological examination of excised skin in patients with hidradenitis foci is recommended, especially in the case of extra-axillary lesions. Source

Krol C.G.,Rijnland Ziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2010

A 20-year-old woman with borderline personality disorder was referred to the emergency department by a psychiatric clinic. After taking 10 g of nutmeg she complained of stomach ache and dizziness. A physical examination showed mild hypothermia and sinus tachycardia. She was admitted for observation and discharged after 24 h to the psychiatric clinic without sequelae. Nutmeg is a spice. Relatively unknown are the hallucinogenic and euphoric effects for which it is used by drug abusers and students. Symptoms appear 6 h after ingestion of at least 10 g of nutmeg and are related to its effects on the central nervous system. Use of the drug can lead to anxiety and feelings of doom and even to psychosis. Dry mouth, nausea and dizziness may also occur. A physical examination may show hypothermia, tachycardia or hypertension or, in rarer cases, hypotension and shock. Symptoms disappear without sequelae after 24-48 h. Treatment consists of supportive measures. In the event of haemodynamic instability, cardiovascular monitoring is indicated. Source

Weijerman M.,Rijnland Ziekenhuis
Huisarts en Wetenschap | Year: 2013

Weijerman ME. Caring for children with Down's syndrome. Huisarts Wet 2013;56(10):534-9. The life expectancy of children with Down's syndrome has improved substantially and the prevalence of the disorder has stabilized in the last 10 years. People with Down's syndrome form a heterogeneous group, with different clinical symptoms, social and cognitive development, life style, and social position. The nature of comorbidity has changed and preventive care during childhood has become more important. Most children with Down's syndrome grow up at home with their families, and for this reason families often approach general practitioners with their questions about care and assistance. The Netherlands Paediatrics Association has recently revised its multidisciplinary guideline on the medical management of children with Down's syndrome, and this article reviews the main points for general practitioners. © 2013 Bohn, Stafleu van Loghum. Literatuur:. Source

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