Notes

Iatrogenic caecal perforation 48 hrs from a caesarean part, an incident statement.
In the past 10 years, there has been a decrease in the number of patients who report to the Emergency Department (ED) every year for injuries from accidents or violence, especially in the subgroup of patients who did not require hospital admission. We investigated how the number of injury-related emergency department visits and GP contacts evolved over the period 2013-2017.

Retrospective observational trend study.

To calculate the trend in emergency department visits in the Netherlands, we used data from the injury information system (LIS) for the period 2013-2017. To calculate the trend in GP contacts (GP practices as well as GP centres), we used data from the NivelZorgregistraties (Nivel medical records). In order to compare the trends, we distinguished between minor and major injuries. The numbers from the records were extrapolated to numbers for the whole of the Netherlands.

In the period studied, the number of patients with minor injuries who visited the ED dropped by 38.5%, while the number of patients with major injuries (fractures and brain injuries) increased by 4.1%. In the same period, the number of GP contacts for minor injuries at GP practices increased by 25% and at GP centres by 43%; the number of primary care contacts for major injuries increased by 5.1% (GP practices) and 31% (GP centres) respectively.

The role of general practitioners in the treatment of patients with minor injuries is increasing. The trend in major injuries is a better indicator for monitoring accidents and violence in the Netherlands. Conflict of interest and financial support none declared.
The role of general practitioners in the treatment of patients with minor injuries is increasing. The trend in major injuries is a better indicator for monitoring accidents and violence in the Netherlands. Conflict of interest and financial support none declared.In thisarticle, we present the case of a 14-year-old girl withcyclicalabdominalpainand a palpablemass in thelower abdomen duetoanimperforate hymen.Of all medical procedures euthanasia is surely the most fearful, involving as it does the deliberate ending of a human life. Yet after 1975 there was growing unease about the medical treatment of dying patients, resulting in requests to stop useless treatments and end a patient's life as a way out of unbearable suffering. The actual practice of euthanasia went through many stages. The slippery slope question is very astute over the years new groups of suffering persons emerged who considered themselves eligible. Next to terminal patients came patients with chronic diseases, psychiatric patients, people suffering from dementia in the early stages, and dementia in the later stages. In spite of many misgivings, there is the fact that for the first time in history people have the possibility to leave life when it has become unbearable, in open communication with their loved ones.Euthanasia is legal in the Netherlands. Nevertheless, some individuals decide to plan their self-chosen death without the help of a physician. 'Right-to-die' organisations provide advice about humane deaths, which include voluntary refusal of food and fluids, the helium method and use of a lethal overdose of medication. It is known that suicides are sometimes influenced by the media and internet. Since 2013, 'right-to-die' organisations have informed individuals about the use of a deadly barbiturate overdose and the helium method. A rise in suicides resulting from these methods has subsequently been observed in the Netherlands. Suicides are recorded as deaths resulting from unnatural causes and are therefore investigated by a forensic physician, forensic investigator and tactical investigator. Investigation should determine the cause of death and rule out a staged crime, 'criminal' assisted suicide or an accident.The Artificial Insemination Donor Data Act was first evaluated in 2012, and a second time in 2018. The aim of the most recent evaluation was to gain insight into the effectiveness and side effects of the law. The researchers did not only conduct a judicial analysis of the legislation and parliamentary history; they also visited fertility clinics, they undertook research at SDKB (Foundation for Artificial Insemination Donor Data), and interviewed stakeholders and key people involved in the process. From this, 17 recommendations were made, addressed to the Ministry of Health, Welfare and Sport, SDKB, fertility clinics and the Health and Youth Care Inspectorate. Some of these recommendations also affect the actions of fertility physicians and gynaecologists working in clinics and hospitals that perform donor treatments.Every dead body is examined by a doctor to establish the manner of death. In the Netherlands, however, both the quality of post-mortem examinations and the number of autopsies carried out in a clinical or forensic setting are low. Not all causes of death can be determined by post mortem examination alone; the law should, therefore, be changed to allow a forensic physician to legally request additional investigations, such as a toxicological or radiological report, to ensure the detection of crimes such as murder. Additional investigation could increase the quality of post-mortem examinations, and might bridge the quality gap between full autopsy and a simple post mortem. The information obtained could, for instance, be informative for relatives in the context of hereditary research. Finally, to improve the quality of post-mortem examination and identify all cases of murder, it is of the utmost importance that there is sufficient focus on post mortem examination of the cadaver during medical specialist training.In this case series, we describe four children and adolescents with tall stature or growth acceleration to illustrate the diagnostic evaluation of tall stature according to the new Paediatric Association of the Netherlands (NVK) Guideline on growth disorders. A 14-year-old girl with tall stature and a relatively late onset of puberty was diagnosed with idiopathic familial tall stature, and the patient decided not to opt for epiphysiodesis. A 14-year-old boy with prepubertal growth acceleration and a history of behavioural problems was diagnosed with Klinefelter syndrome. A 7-year-old boy with tall stature, arachnodactyly, pectus excavatum and lumbar scoliosis was diagnosed with Marfan syndrome. Finally, a 16-year-old girl with isolated progressive tall stature was diagnosed with growth hormone excess caused by a pituitary somatotroph adenoma. The most clinically relevant conditions associated with tall stature are Klinefelter and Marfan syndrome, and secondary growth disorders such as precocious puberty and growth hormone excess.Pectus excavatum is the most common deformity of the anterior chest wall. Nevertheless, awareness amongst physicians is lacking and consequences of the diagnosis are often underestimated. Symptoms include cardiopulmonary symptoms such as palpitations, fatigue and exercise intolerance. Moreover, patients often have psychosocial problems and suffer from poor body image and lower quality of life. A multidisciplinary approach is recommended for diagnostic work-up and treatment, involving dedicated paediatricians, cardiologists and surgeons. Treatment can be non-surgical or surgical. Conservative options include physiotherapy and vacuum bell therapy. In symptomatic patients, surgical treatment is warranted from the age of 12-14 years. Minimally invasive repair with the Nuss bar technique is considered the gold standard for adolescents. Patients who are unsuitable for minimally invasive repair can be treated with open surgical correction, for example, via a modified Ravitch procedure. Early referral to a specialised centre is recommended.Depression is one of the most common psychiatric disorders and is a heavy burden, not only for the patient and his or her environment but also in economic and social terms. 35% of depressed patients do not recover after standard treatment with medication or psychotherapy. There is a need for more effective treatment options for depression. In recent decades, new forms of brain stimulation have been developed for the treatment of depression, the most important of which is transcranial magnetic stimulation (TMS). TMS uses magnetic pulses to influence brain activity. BlasticidinS Meta-analyses show approximately 30-40% of patients respond to treatment with repetitive TMS. The depression goes into remission in about 20-30% of cases. Research has led to new treatment protocols and variations on the conventional TMS method. More research into the effectiveness of these developments is needed. We recommend using TMS as an add-on treatment more often when the patient has completed two steps of the treatment guideline.Thanks to new developments in the field of 3D printing, surgeons have been able to use 3D-printed templates for correction osteotomy of the distal radius; recently, 3D-printed titanium implants, tailor-made for patients, have been introduced. This technique makes it possible to fix the bone elements in an anatomical position when performing a correction osteotomy in patients with complex malunions of the distal radius. In this article we discuss this new technique and illustrate it through presentation of a case.Glaucoma is a widespread sight-threatening condition often only recognized when very pronounced. It is initially characterized by peripheral visual field losses, while advanced stages also affect the central vision. Some of these patients may experience visual hallucinations, the Charles Bonnet syndrome (CBS). In this systematic review and meta-analysis, we provide an overview of the literature dealing with the prevalence of CBS in patients with glaucoma. We searched the databases PubMed/MEDLINE, Embase, Web of Science, the Cochrane Central and PsycInfo on 22 March 2020. Eight studies (n = 827 patients) were identified and included for a qualitative and quantitative analysis. No studies included a representative sample of patients with only glaucoma. In patients with glaucoma in different stages and with ocular comorbidities, prevalence of CBS was 2.8% (CI95% 0.7-6.1%). Among patients with glaucoma where all had bilateral low visual acuity, prevalence of CBS was 13.5% (CI95% 8.4-19.6%). In patients with glaucoma who visited vision rehabilitation clinics, presumably due to an extensive vision impairment, prevalence of CBS was 20.1% (CI95% 16.8-23.6%). Risk factors of CBS besides low vision were high age, female gender, reduced contrast sensitivity and not living alone. Taken together, we find that CBS may not be rare in patients with advanced glaucoma with and without ocular comorbidities. However, limitations of the current literature should be highlighted and careful approach towards conclusions is important. More studies are needed to better understand the prevalence and risk factors among different populations of patients with glaucoma.
To evaluate changes in the tear film lipid layer thickness (LLT) in cataract patients with diabetes mellitus (DM) after cataract surgery.

We recruited consecutive cataract patients and recorded data regarding DM condition. Lipid layer thickness (LLT) and partial blinks rates measured with the LipiView interferometer, tear break-up time (TBUT) and Schirmer's tests, and dry eye symptoms evaluated with the Ocular Surface Disease Index (OSDI) questionnaire were conducted before and one month after cataract surgery.

Finally, 38 age-related cataract (ARC) and 31 diabetic cataract (DC) patients were available for analysis. No significant difference in preoperative LLT and partial blink rates was found between ARC and DC group. However, preoperative TBUT and Schirmer's test results were significantly lower in DC group compared to ARC group (both p<0.001). DC group showed higher preoperative OSDI score with no significant difference than ARC group (p=0.279). In DC group, LLT was significantly thinner in cases with longer duration of DM (over 10years) than in those with shorter duration (p<0.
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