Rijnland Ziekenhuis

Leiderdorp, Netherlands

Rijnland Ziekenhuis

Leiderdorp, Netherlands
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The prevalence of Down syndrome (DS) in the Netherlands is 14/10,000 live births; this is almost 1.5 times higher than during the 1980s and 90 s. In the Netherlands the uptake of prenatal screening is lower than in the rest of Europe and the percentage of pregnant women > 36 years has increased. The early diagnosis and treatment of congenital heart abnormalities means that mortality among DS children has fallen. Although their life expectancy has increased greatly, other comorbidities have come to the fore. Wheezing is reported in 1/3 of the children with DS; it seems unrelated to asthma and atopy. The percentage of mothers who start breastfeeding a child with Down syndrome is low (48%), despite the preventive effect on celiac disease and infections and its therapeutic value for speech and language development. Children with DS score lower on quality of life for the domains of lung and stomach problems, motor function and communication. Medical support and screening addressing specific comorbidities (heart, thyroid, lungs, hearing, vision) and special support for cognitive, motor and speech development in children with Down syndrome is worthwhile.

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:.

A 49-year-old woman with a painless mass in the neck was examined by the surgeon. Imaging and cytology prior to surgery suggested the mass to be either a thyroid cyst or a branchial cleft cyst. After surgery, the patient reported a hoarse voice and the pathologist confirmed the removed lesion to be a cystic schwannoma of the left recurrent laryngeal nerve. The inconclusive imaging results, combined with colloid-like material in the punctate should prompt the investigator to include cystic schwannoma in the differential diagnosis. With the probability of a neurogenic origin of the mass in mind, nerve-sparing surgery can be performed. As a future prospect, positron emission tomography scans are mentioned as a modality with possibilities to discriminate a cystic schwannoma from other common cystic lesions.

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.

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.

A 71-year-old man was referred to our outpatient clinic because of arthralgia and swelling of his right hand. He also showed a subcutaneous nodule on his left knee. A second patient, a 57-year-old woman, was referred because of painful skin of her legs. Dermatologic examination revealed erythematous livid discoloration on both feet and legs. There were reticular varices, corona flebectatia paraplantaris medialis and minimal pitting oedema. Serology tested positive in both patients for Borrelia and they both recalled tick bites. A third patient, a 73-year-old woman, was referred because of erythema and maculae located at her lower legs and positive Borrelia serology. Pathologic examination was typical for acrodermatitis chronica atrophicans, a late skin manifestation of Lyme borreliosis. In all patients, symptoms improved after treatment with doxycycline for four weeks. A lack of familiarity with this skin condition may lead to unnecessary vascular investigations and considerable delay in adequate treatment.

To establish whether there was a link between the preventative interventions executed and two groups of patients: those with and those without a postoperative wound infection (POWI). DESIGN : Descriptive and comparative research. At Rijnland Hospital, a Dutch non-academic teaching hospital, 284 indicator operations were carried out between 1 April 2009 and 31 March 2010. We investigated whether preventative interventions were carried out during these operations. The types of surgery included mastectomy with and without axillary node dissection, resection of the colon and central vascular surgery (reconstruction of the aorta via an endovascular or open approach). Four types of intervention were studied: hygienic discipline (measurement of the number of times the operating theatre doors moved), the timely administration of preoperative antibiotic prophylactics, the avoidance of preoperative shaving and the attempts at perioperative normothermia. A 'postoperative wound infection' was registered as such if it had developed within 30 days of surgery. In total, 22 POWIs (7.7%) were registered, arising from 284 operations: 5 POWIs (2.8%) after mammary surgery, 1 POWI (2.8%) after central vascular surgery, and 16 POWIs (21.6%) after colon surgery, respectively (see table 2). Meeting the criteria of all 4 types of intervention had no influence on the development of a POWI. A significant association to the development of a POWI was, however, determined to be the variables related to wound classification, duration of surgery and the average number of door movements per hour during surgery; specifically, 7 or more. Surveillance by way of registration and feedback of interventions and their optimisation, particularly in terms of door movement, can possibly contribute to a reduction in the number of postoperative would infections.

Schell-Feith E.A.,Rijnland Ziekenhuis | Kist-Van Holthe J.E.,Leiden University | Van Der Heijden A.J.,ErasmusMC Sophia Childrens Hospital
Pediatric Nephrology | Year: 2010

The prevalence of nephrocalcinosis (NC) in preterm neonates in recent reports is 7-41%. The wide range in prevalence is a consequence of different study populations and ultrasound equipment and criteria, in addition to a moderate interobserver variation. NC in preterm neonates has a multifactorial aetiology, consisting of low gestational age and birth weight, often in combination with severe respiratory disease, and occurs as a result of an imbalance between stone-promoting and stoneinhibiting factors. A limited number of histological studies suggest that calcium oxalate crystals play an important role in NC in premature neonates. In 85% of children resolution of NC occurs in the first years of life. Prematurity, per se, is associated with high blood pressure, relatively small kidneys, and (distal) tubular dysfunction. In addition, NC in preterm neonates can have long-term sequelae for glomerular and tubular function. Long-term follow-up of blood pressure and renal function of prematurely born children, especially with neonatal NC, is recommended. Prevention of NC with (low) oral doses of citrate has not resulted in a significant decrease in the prevalence of NC; a higher citrate dosage deserves further study. Future research pertaining to prevention of NC in preterm neonates is crucial. © IPNA 2008.

Minderhoud J.,Rijnland Ziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2013

We report a 44-year-old man with a diagnosis of right-sided periorbital cellulitis caused by a group A β-hemolytic streptococcus who developed severe eyelid necrosis. After intravenous antibiotic treatment and necrotomy, reconstructive eyelid surgery was needed.

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.

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