Notes

Enantioselective PCCP Brønsted acid-catalyzed aminalization involving aldehydes.
The introduction of penicillin to medical practice in the Netherlands is closely related to the liberation of the Netherlands from Nazi occupation. The allied forces brought penicillin - of which they had vast quantities - to the Netherlands and introduced it to Dutch doctors. In many of the oldest documented cases involving the use of penicillin in the Netherlands, allied army doctors gave the ampoules of penicillin to Dutch doctors, who used the until then unknown medicine as a last-resort drug to treat patients with severe infections that had failed to respond to other treatments. The archives of the Dutch Journal of Medicine (NTvG) contain numerous interesting examples of case reports. A public call on the website of the Dutch public news broadcaster NOS resulted in several other apt examples. It is, however, not known exactly who the first Dutch patient to receive penicillin was.Endovenous treatment has become the treatment of choice for patients with saphenous varicose veins (great saphenous vein and small saphenous vein). Current thermal treatment modalities are endovenous laser ablation, radiofrequency ablation and steam ablation. These treatments work by heating the vein, causing the vessel to become occluded. These thermal treatment methods require tumescent anaesthesia. The outstanding effectiveness of laser and radiofrequency ablation has now been demonstrated in countless randomised trials and meta-analyses. Steam ablation seems to be just as effective as the other thermal treatment methods, but there is less pain afterwards. Since the treatment is not reimbursed, steam ablation is currently not used in the Netherlands.A recently published randomised controlled trial (the Kompas trial) compared prehydration with sodium bicarbonate solution with no prehydration in patients with chronic kidney disease (eGFR 30-60 ml/min per 1.73 m2) undergoing elective CT scanning with intravenous contrast agent. Although patients were considered to be at risk for postcontrast acute kidney injury (PC-AKI), average serum creatinine concentration increased by 2% after 5-7 days with no serious persistent decline in renal function. No significant differences were found between treatment and no treatment arms of the study. Results are in agreement with previous trials and confirm that risk of clinically relevant PC-AKI is very low and that prehydration is not warranted in this group of patients. Patients with an eGFR of less than 30 ml/min per 1.73 m2 and multiple AKI risk factors have a higher risk of PCI-AKI and may benefit from prehydration, although the risk-benefit balance remains unclear.Dutch medical disciplinary boards consider physicians' gut feelings an element of the professional standards. Some indications can be found in the international literature suggesting intuitive feelings of unease of patients or their relatives can also contribute to adequate diagnostics. What is the view of disciplinary boards on this? A search in the disciplinary boards' database (2010-2017) found 55 rulings where the search term 'ongerust' (worried) was related to a patient, family member or partner and 51 rulings where the term 'bezorgd' (concerned) was related to a patient, family member or partner. The disciplinary boards expect that doctors are prepared to discuss worry and concern with their patients. Additionally, they consider patients' worry and concern to be a useful part of the doctors' diagnostics, which may possibly result in reviewing the diagnosis. This is consistent with the international literature.An 80-year-old woman was seen at the department of dermatology with a dark, stone-like nodule in the umbilicus. Extraction revealed an omphalolith; a benign naval stone consisting of keratin and sebum. It is often related to poor hygiene, and occurs more often in a deeply retracted umbilicus.While chickenpox is usually a mild and self-limiting disease, life-threatening complications can occur, particularly in risk groups such as pregnant women. In the case reported here, a 34-year-old woman, pregnant with her second child, was exposed to the varicella zoster virus (VZV) during the sixth week of pregnancy. Blood results showed seronegative status for VZV. Despite properly and well-timed administration of immunoglobulins, the patient developed chickenpox two weeks after exposure. Two days after developing symptoms she was admitted to the emergency room with fever and sudden shortness of breath. Radiological examination confirmed bilateral pneumonia, most probably due to VZV. Developing chickenpox during pregnancy is not only potentially dangerous for the unborn baby, but also for the mother. All medical specialists involved should be aware of the risks and consequences of this rare, yet dangerous, timing of chickenpox.
Non-arteritic anterior ischaemic optic neuropathy (NAION) is the most common acute optic neuropathy in people older than 50 years.

A 66-year-old man with hypertension consulted the ophthalmologist because of increasing visual-field loss in his right eye; 3 weeks previously he had noticed visual decline in the same eye when he woke up. The eye was not painful. Further questioning revealed that the patient also suffered from sleep apnoea. Following additional investigations we diagnosed NAION.

There is no effective treatment for NAION. learn more Risk factors such as high blood pressure and obstructive sleep apnoea syndrome can be addressed to reduce the risk of reoccurrence of NAION in the other eye.
There is no effective treatment for NAION. Risk factors such as high blood pressure and obstructive sleep apnoea syndrome can be addressed to reduce the risk of reoccurrence of NAION in the other eye.Observational comparative research on the effect of pharmaceuticals or other medical interventions is sometimes conducted, even after the results of large randomised trials have been made available. Does that make any sense? This contribution lists a few of the reasons why observational research should be conducted, even after an RCT has already been carried out. Developments in methods of observational research make it possible to evaluate the effects of different treatments. However, such research is also prone to errors, because statistical corrections in data analysis are often based on researchers' choices, and not always established beforehand.
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