Bondevang6744
During winter, the influenza and Respiratory Syncytial Virus season, children are often seen in the emergency department with fever and respiratory symptoms.
We describe the case of a 2-year-old girl with fever, dyspnea and signs of heart failure during physical examination. Echocardiogram showed a large amount of pericardial effusion with signs of cardiac tamponade. Pericardiocentesis showed 200 ml purulent liquid. Surgical drainage was performed. However pericardial effusion recurred. Because constrictive pericarditis was feared, a pericardiectomy was performed after which the patient recovered. Cultures showed Haemophilus influenzae type b and the patient was treated with amoxicillin for 4 weeks in total.
Fever and dyspnea may also be caused by a problem outside the respiratory system. With physical examination a cardiac cause, such as pericarditis, can be detected. An ECG is easily obtained and can help in the differential diagnosis. An echocardiogram can confirm the diagnosis.
Fever and dyspnea may also be caused by a problem outside the respiratory system. With physical examination a cardiac cause, such as pericarditis, can be detected. An ECG is easily obtained and can help in the differential diagnosis. An echocardiogram can confirm the diagnosis.In the Netherlands a population-based screening program was denied by the government. Based on progressive research in the detection of significant prostate cancer using prostate MRI and identification of risk groups that need treatment because they are at risk for aggressive prostate cancer, we propose a program where men with high-risk tumours are identified and treated at an earlier stage. It has to be determined if this program leads to a lower prostate cancer mortality and a reduction in costs.A chronic subdural hematoma is a common neurological disorder that occurs mainly in the elderly. The inciting event is often a minor head trauma and subsequent inflammation may play a role in the pathogenesis. The clinical spectrum can present heterogeneously, and symptom onset and progression can vary from days to weeks. To date surgical evacuation of the subdural collection remains the main treatment approach for symptomatic patients. Evidence is still scarce for dexamethasone as an effective primary conservative treatment strategy. Future research is necessary to elucidate the effect of various pharmacological therapies compared to primary surgery on functional outcome.Osteoarthritis of the knee is often accompanied by degeneration of the meniscus. Worldwide, the arthroscopic partial meniscectomy has been a standard of care for patients with knee pain in the presence a degenerative meniscal tear. However, in recent years, clinical studies have proven that a meniscectomy is not effective in the osteoarthritic knee. Physiotherapy is often as effective. The updated Dutch guidelines for meniscal tears therefore recommend an arthroscopic partial meniscectomy or fixation in case of a locked knee and for traumatic meniscal tears in younger patients. There also is an indication for a meniscectomy after failure of conservative treatment in case of a symptomatic meniscal tear in the absence of osteoarthritis.In this article we extracted potential safety risks of supervising medical interns based on disciplinary cases filed since 2010 at Dutch Medical Disciplinary Boards. The main risks lie in the remote supervision of medical interns. The history and physical examination of complex patients (for example very ill patients or patients with a physical or mental disability) may require a direct form of supervision. Further, the management of medical records by interns requires a proper supervision. There is also a risk of a complaint in patients who do not want an intern to be present during their anamnesis or physical examination.Cleavage of tongue tie (ankyloglossia) in newborns is controversial and has known varying degrees of popularity over time. The last decade frenotomy is advocated and increasingly performed in infants with breastfeeding problems. However, evidence for an association between ankyloglossia and breastfeeding is dubious. Moreover, evidence for the effect of frenotomy on breastfeeding is lacking. Well-conducted controlled trials are sparse and methodological quality of reported trials is weak and merely hindered by lack of equipoise. Thus, the tongue tie and frenotomy are prone for overdiagnosis and overmedicalization. Until robust, well conducted, randomized controlled trials have been performed frenotomy should not routinely nor easily be recommended.
Orthostatic tremor is a rare disease characterized by difficulty with standing still. Patients often undergo a long diagnostic search and often feel underrecognized, partly due to unfamiliarity of physicians with the disease.
We report a 72-year-old male experiencing difficulty in standing still, accompanied by a tingling, trembling and painful sensation in the legs, over the last ten years. Several orthopedic and neurological causes had been suspected until neurological examination revealed a 'helicopter sign' upon auscultation of the leg muscles. Tremor registration showed a 14 Hz tremor in the legs upon standing, confirming the diagnosis of orthostatic tremor. There was moderate improvement with pharmacological treatment.
Orthostatic tremor should be suspected in patients with instability or atypical symptoms upon standing. A neurological referral including tremor registration is recommended in these cases.
Orthostatic tremor should be suspected in patients with instability or atypical symptoms upon standing. A neurological referral including tremor registration is recommended in these cases.
Ferric carboxymaltose (FCM) is highly effective in supplementing iron-deficiency anemia and frequently used. However, it can severely interfere with the phosphate metabolism.
A 63 year old man with iron-deficiency anemia due to hereditary hemorrhagic telangiectasia was treated with intravenous FCM. After initiation of the FCM he developed generalized bone and muscle pain as well as insufficiency fractures. Treatment with colecalciferol was started. However, the bone pain increased and further investigation showed a hypophosphatemicosteomalacia with high urine phosphate loss suggesting renal phosphate wasting. Serum FGF23 level was increased confirming the diagnosis of FGF23 mediated hypophosphatemicosteomalacia induced by intravenous iron suppletion.
FCM injections may cause FGF23 mediated hypophosphatemia already 4 weeks after suppletion. Therefore it is recommended that serum phosphate levels should be checked frequently. In patients developing hypophosphatemia, a non-maltose form of iron suppletion must be started as well as active vitamin D.
FCM injections may cause FGF23 mediated hypophosphatemia already 4 weeks after suppletion. Therefore it is recommended that serum phosphate levels should be checked frequently. In patients developing hypophosphatemia, a non-maltose form of iron suppletion must be started as well as active vitamin D.
Hoarseness caused by Ortner's syndrome is a rare diagnosis, first described in 1897 in a patient with an enlarged left atrium due to mitral valve stenosis. Due to mechanical compression on the left recurrent laryngeal nerve patients present with hoarseness.
A 70 year old male presents with hoarseness and an inability to swallow. Examination reveals a paresis of the left vocal cord. A Computed Tomography scan shows a saccular aneurysm of the proximal descending thoracic aorta, consistent with Ortner's syndrome. Patient was successfully treated with a thoracic endovascular aortic repair procedure.
Hoarseness is rarely caused by cardiovascular conditions, a more common condition is a lung neoplasm. Thoracic aneurysms as a cause of Ortner's syndrome are often described in combination with a dissection of the aneurysm. Diagnostic work-up of persisting hoarseness without laryngeal pathology should include a contrast enhanced computed tomography (CT) scan to rule our life-threatening conditions.
Hoarseness is rarely caused by cardiovascular conditions, a more common condition is a lung neoplasm. Thoracic aneurysms as a cause of Ortner's syndrome are often described in combination with a dissection of the aneurysm. Diagnostic work-up of persisting hoarseness without laryngeal pathology should include a contrast enhanced computed tomography (CT) scan to rule our life-threatening conditions.Antidepressants are the subject of lively public debate. Over one million Dutch people are prescribed an antidepressant each year for a variety of reasons. The number of long-term antidepressant users is smaller, estimated to be around 150,000 patients for over a year for depression. Clinicians and patients together must carefully weigh the pros and cons of antidepressants. In this article, we discuss the latest scientific insights how antidepressants can be used rationally.Breast-conserving therapy (BCT), consisting of local excision of the tumor followed by whole breast radiotherapy, is nowadays considered standard of care for early stage breast cancer. For patients at low risk of local recurrence, partial breast irradiation (PBI) is an alternative treatment. The rationale for PBI is that irradiation of only the tumour bed and surrounding area will result in less toxicity, while maintaining an acceptable low local recurrence rate as most of the local recurrences occur at or near the original tumor site. Because the target volume is smaller than with WBI, reduced toxicity is expected and a higher dose per fraction can be applied. As a result, overall treatment time can be reduced. There are various methods to deliver PBI, including brachytherapy, intraoperative radiation therapy, and external beam radiation therapy (EBRT). Multiple studies showed less toxicity and similar or improved cosmetic outcome after PBI using EBRT.Tapering medication is difficult for many patients using chronic medication. Physicians must be aware of why patients experience difficulties in discontinuation. Important are the cognitions of patients about why the medication is necessary, for example because of the deficit of a certain substance that is supplemented by the medication. Or a too favourable expectation of the effect while time-to-benefit has passed. The experience of withdrawal effects during earlier attempts or the experience of dependency hamper new attempts to stop. This is important in medication that induces physical dependency antipsychotics, antidepressants, benzodiazepines, or proton pump inhibitors. Fear for relapse is also hampering discontinuation; this is at stake in patients with psychosis, depression and epilepsy. Protein Tyrosine Kinase inhibitor Finally, poor communication and not having a trusted professional are impediments for discontinuation. To be successful in helping patients discontinue their medication professionals must communicate well about the patient's personal attitude, experience, emotions, and life circumstances as well as to possess expertise about the technical aspects of the procedure of stopping medication.A visible mass around the sternoclavicular (SC) joint may be explained by a wide variety of diagnoses, each with its own diagnostic pathway and treatment options. Here we report three cases a 56-year-old male with an anterior luxation of the right SC joint, a 59-year-old male with osteomyelitis of the left SC joint and a 78-year-old male with a painless swelling to the right medial clavicle, interpreted as sterno-costo-clavicular hyperostosis (SCCH) as part of his SAPHO syndrome. An atraumatic swelling of the SC joint is most often caused by osteoarthritis, characterized by a slowly progressing solid swelling. Acute swelling with concurrent redness and fever justifies an intra-articular- or bone aspiration, possibly CT guided, in combination with laboratory blood tests to differentiate between an infectious or rheumatologic cause. Since there are also multiple rare diseases that present specifically around the SC joint, a multidisciplinary review often proves helpful.
