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[Two patients with CC9 intoxication: unexpected symptoms of a novel synthetic cannabinoid]. [两例CC9中毒患者：一种新型合成大麻素的意外症状]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-03-31
Denne A Scharink, Hugo C Hoogeveen, Daan Vlot, Elles Zock, Ankie Lebon, Suzanne Schol-Gelok
{"title":"[Two patients with CC9 intoxication: unexpected symptoms of a novel synthetic cannabinoid].","authors":"Denne A Scharink, Hugo C Hoogeveen, Daan Vlot, Elles Zock, Ankie Lebon, Suzanne Schol-Gelok","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Hexahydrocannabinol-C9 (CC9) is a novel synthetic cannabinoid with largely unknown toxicity and clinical effects.</p><p><strong>Case description: </strong>We report two patients with CC9 intoxication presenting with atypical and prolonged symptoms, including profound somnolence, bradycardia, neuropsychiatric disturbances, and impaired mobility. Both patients experienced a protracted course lasting up to 90 hours.</p><p><strong>Management: </strong>Treatment was primarily focused on symptom control in a low-stimulus environment. Close monitoring of respiratory function was essential in cases of profound sedation, while benzodiazepines were administered when severe agitation occurred. Activated charcoal combined with a laxative was used in one case and may have contributed to recovery by reducing intestinal reabsorption.</p><p><strong>Conclusion: </strong>Clinicians should be alert to the atypical and prolonged course of intoxications caused by new synthetic cannabinoids such as CC9. Early recognition, multidisciplinary consultation, and supportive treatment in a low-stimulus environment are essential.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574776","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}
引用次数: 0
[ADHD in adults: more questions for the general practitioner]. 成人多动症：全科医生的更多问题。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-03-26
Karin M Burgerhout, Nienke Hoekstra, Leontien M van Ravesteyn, Peter Lucassen, Pieter-Jan B Carpentier
{"title":"[ADHD in adults: more questions for the general practitioner].","authors":"Karin M Burgerhout, Nienke Hoekstra, Leontien M van Ravesteyn, Peter Lucassen, Pieter-Jan B Carpentier","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The diagnosis of ADHD remains shrouded in controversy, resulting in alarming reports in (social) media. Danger of underdiagnosis, risk of overdiagnosis, and medicalization of social problems are all mentioned. The diagnostic uncertainty is largely due to the non-specific nature of ADHD symptoms. Yet, an ADHD diagnosis is more than an excuse: its chronic nature makes it a disabling condition when appropriate treatment is not provided. In most cases the general practitioner decides who is referred for further diagnosis; the controversial reporting can contribute to doubt and reluctance. The task in referring, however, is not to make a diagnosis, but to recognize the likelihood of psychiatric problems. This is done by inquiring about the presence and severity of symptoms and the existence of resulting distress. Knowledge of the context (such as work and living situation, family composition) and the patient's life history helps in distinguishing between temporary overload and chronic dysfunction.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147504417","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}
引用次数: 0
[A case of auricular pseudocyst]. [耳假性囊肿1例]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-03-25
Elise J Leeman, V Bauco van der Wal, Laura Loman
{"title":"[A case of auricular pseudocyst].","authors":"Elise J Leeman, V Bauco van der Wal, Laura Loman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A 32-year-old man presented with a fluctuant, mildly tender swelling of the right auricle. Aspiration yielded yellow fluid, confirming an auricular pseudocyst. Treatment with intralesional corticosteroids led to complete resolution. A mild recurrence resolved after re-treatment. Timely recognition and appropriate management may reduce the risk of auricular deformity associated with untreated pseudocysts.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147504386","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}
引用次数: 0
[Periprosthetic femoral fractures: the orthopaedic disease of affluence?] 股骨假体周围骨折：富裕的骨科疾病？］
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-03-24
Laura van Marle, Liesbeth Hempenius, Rinne M Peters, Bas de Hartog, Jetze Visser, Wierd P Zijlstra
{"title":"[Periprosthetic femoral fractures: the orthopaedic disease of affluence?]","authors":"Laura van Marle, Liesbeth Hempenius, Rinne M Peters, Bas de Hartog, Jetze Visser, Wierd P Zijlstra","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A total hip prosthesis (THP) is an effective treatment for hip osteoarthritis. Complications like periprosthetic fractures (PPF) are increasing due to an aging population. PPF accounts for 15% of THP revisions in the Netherlands, with rising incidence driven by risk factors such as prior revisions, older age, osteoporosis, falls, and cementless stems. Cemented stems offer a protective factor, particularly in octogenerians. PPF treatment is complex and costly, often requiring surgical intervention through prosthesis revision and/or open reduction and internal fixation (ORIF), both associated with prolonged preoperative workup and higher complication risks. ORIF often remains unregistered, leading to an underestimation of PPF cases. The Vancouver classification aids as treatment guide, though distinguishing stable from unstable fractures remains challenging. Given the high vulnerability of PPF patients, multidisciplinary care including geriatric co-management, significantly improves outcomes. Increasingly, non-operative management is considered, emphasizing shared decision-making to optimize care for this growing patient population.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147504353","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}
引用次数: 0
[Perianal surgery in a non-sterile setting: risks, cost-saving ad climate benefits]. [非无菌环境下的肛周手术：风险、成本节约和气候效益]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-03-24
Sytske M Kuipers, Martine E de Greeff, Gabie M de Jong, Jasper B van Praagh
{"title":"[Perianal surgery in a non-sterile setting: risks, cost-saving ad climate benefits].","authors":"Sytske M Kuipers, Martine E de Greeff, Gabie M de Jong, Jasper B van Praagh","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Sustainable healthcare is essential to reduce environmental impact without compromising patient safety. This study investigates whether minor perianal surgery can be safely performed under a non-sterile condition, aiming to reduce material use, costs, and CO2-emissions, and whether these findings can be incorporated into a widely supported surgical protocol.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted among patients who underwent minor perianal surgery under sterile or non-sterile conditions. Primary outcomes were postoperative wound infections (POWIs) within 30 days, cost savings, and CO2-reduction. A literature review and a survey among surgeons regarding the treatment of perianal abscesses were also conducted.</p><p><strong>Results: </strong>263 patients were included. POWI rates did not differ significantly between the groups. A non-sterile approach can save at least €1925 per hospital annually and significantly reduce CO2 -emissions. Nearly all surgeons considered sterile conditions unnecessary for the treatment of perianal abscesses.</p><p><strong>Conclusion: </strong>Non-sterile conditions for perianal surgery are both cost-effective and more sustainable. Moreover, there is strong support for implementations of this change among surgeons.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147504348","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}
引用次数: 0
[Cancer screening: blessing or curse?] 癌症筛查：是福还是祸？］
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-03-19
Willem P Th M Mali, Yolanda van der Graaf
{"title":"[Cancer screening: blessing or curse?]","authors":"Willem P Th M Mali, Yolanda van der Graaf","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Cancer screening seems intuitively logical: early detection to prevent worse outcomes. However, this article reveals the complexity behind this assumption. Cancer's linear growth model- on which early detection was based - proves outdated. Cancers grow at vastly different rates; some even stop or disappear spontaneously. The main problem is overdiagnosis: in Dutch breast cancer screening, approximately 2,000 women are treated annually for cancers that would never cause symptoms. Epidemiological data show a persistent increase in stage I cancers without a decline in stage IV cases - a sign of overdiagnosis. Screening has a Janus face: on one hand life-saving potential, on the other unnecessary treatments with side effects. Effectiveness must be proven through randomized trials that reduce cancer-specific and overall mortality. Citizens deserve honest information about this balance between intuition and scientific evidence. Core message: Screening only works if it reduces mortality, not merely by finding more cancers.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468805","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}
引用次数: 0
[Does a cloth cap on a newborn's head do any harm? Facts and fables]. 在新生儿头上戴一顶布帽有什么害处吗？事实和寓言]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-03-17
Xavier W Werner, Feline Herrmann, Gerbrich N van der Meulen
{"title":"[Does a cloth cap on a newborn's head do any harm? Facts and fables].","authors":"Xavier W Werner, Feline Herrmann, Gerbrich N van der Meulen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>An increasing number of parents opt not to place a cap on their newborn immediately after birth, a trend influenced by information circulating online and on social media. We describe a term neonate who, following a home birth without a cap, was admitted with hypothermia and hypoglycemia. This presentation illustrates the risk of inadequate postnatal thermoregulation in the home setting. In the discussion, we appraise common arguments against neonatal caps, including alleged interference with early bonding or oxytocin release, using current evidence. We found no scientific evidence to support these claims. By contrast, neonatal hypothermia is consistently linked to substantial morbidity and mortality. We conclude that use of a cap, particularly in less controlled environments such as out-of-hospital births, is a simple, low-cost, and effective measure to prevent heat loss. Clinicians should counsel parents proactively about maintaining the warm chain after delivery and about the risks of forgoing a cap.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468781","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}
引用次数: 0
[School absenteeism as a red flag]. [学校旷课是一个危险信号]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-03-17
Marloes Ekkelkamp, Esther K Pijl, Nathalie Drost, Yvonne Vanneste
{"title":"[School absenteeism as a red flag].","authors":"Marloes Ekkelkamp, Esther K Pijl, Nathalie Drost, Yvonne Vanneste","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>School attendance is essential for children and adolescents and plays a vital role in their cognitive, social, physical, and mental health. Extensive school absenteeism is a risk factor for adverse health outcomes, both in the short and long term. The MASS intervention focuses on the early identification of school absenteeism following reports of illness-related absences by schools. Currently, a structural pathway for signalling school absenteeism from within curative healthcare is missing. As a physician, it is important to address school absenteeism when consulting with children or adolescents and their parents. Consider school attendance as a routine aspect of overall health, and be aware that psychosocial problems often underlie significant absenteeism. If concerns arise, actively collaborate with the youth health professional as part of an integrated care approach.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468802","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}
引用次数: 0
[Beware of hearing loss in children]. [注意儿童听力损失]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-03-12
Stefanie N H Reijers, Jantien L Vroegop, Martijn N Spoelstra, Nathanja Tjeerdema, Roderick P Venekamp, Marc P van der Schroeff
{"title":"[Beware of hearing loss in children].","authors":"Stefanie N H Reijers, Jantien L Vroegop, Martijn N Spoelstra, Nathanja Tjeerdema, Roderick P Venekamp, Marc P van der Schroeff","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Hearing problems in children can significantly impact daily functioning, yet they are often underrecognized. This article explores the primary causes, consequences, and preventive measures related to hearing loss in young individuals. Causes range from genetic factors and congenital infections to noise exposure and recurrent otitis media. Even mild hearing loss can affect speech development, academic performance, and social interactions. Early detection is crucial, but current screening programs focus mainly on newborns and young children. The Dutch Health Council recently reviewed the feasibility of a nationwide hearing screening for children aged 5-18 years. While recognizing the growing issue of noise-induced hearing loss, they found insufficient evidence to justify large-scale screening. Instead, they recommend improving existing health questionnaires and strengthening prevention efforts. Simple interventions, such as volume limits on personal audio devices and awareness campaigns, may help mitigate risks. Further research is needed to refine screening strategies and preventive measures.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147434414","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}
引用次数: 0
[Safety and effectiveness of the early-onset sepsis calculator to reduce antibiotic exposure in at-risk newborns: a cluster-randomised controlled trial]. [早发脓毒症计算器减少高危新生儿抗生素暴露的安全性和有效性：一项集群随机对照试验]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-03-12
Sanne W C M Janssen, Frans B Plötz, Niek B Achten
{"title":"[Safety and effectiveness of the early-onset sepsis calculator to reduce antibiotic exposure in at-risk newborns: a cluster-randomised controlled trial].","authors":"Sanne W C M Janssen, Frans B Plötz, Niek B Achten","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>Assessing the safety and effectiveness of the early-onset sepsis (EOS) calculator compared with the categorical guideline in reducing empiric antibiotic treatment in newborns with suspected EOS.</p><p><strong>Design: </strong>Open-label, cluster-randomised controlled trial in 10 Dutch hospitals, randomised 1:1 to the EOS calculator or the categorical guideline.</p><p><strong>Method: </strong>1830 newborns (gestational age ≥34 weeks, ≥1 EOS risk factor) were included. Non-inferiority was assessed using four predefined harm criteria (respiratory support, circulatory support, culture-proven EOS, referral to tertiary hospital). Superiority was assessed as reduction of empiric antibiotics <24 hours postpartum.</p><p><strong>Results: </strong>At least one harm criterion was present in 7.0% (64/915) of the EOS calculator arm, compared to 14.6% (134/915) in the categorical guideline arm (relative risk 0.48; 95% CI 0.36-0.63). Antibiotics were started in 7.2% (66/915) versus 26.6% (243/915), respectively (absolute risk reduction: 19.0%, 95% CI 11.3-26.7).</p><p><strong>Conclusion: </strong>EOS calculator implementation safely reduces empiric antibiotic use in newborns.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147434343","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}
引用次数: 0
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