Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2013
Practice Guideline[Guideline 'Non-specific symptoms of arm, neck and/or shoulders'].
Complaints of arm, neck and/or shoulder (CANS) constitute an important health problem. Over one third of Dutch adults reported CANS in the past year, and over a quarter were suffering from CANS at the time of interview. Over 10% of sick leave days are also attributed to CANS. ⋯ A care pathway has also been developed, aimed at optimal timing of diagnosis and treatment and multidisciplinary cooperation. Through better diagnosis, patients with specific CANS get targeted treatments sooner. Better insight into treatment results will lead to the choice for effective treatments in cases of non-specific CANS, resulting in more patients receiving the most promising therapies.
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A 11-year-old female gymnast presented with long-standing bilateral wrist pain. Radiographs showed physeal widening and irregularity of the left distal radial and ulnar metaphyses, and irregularity of the right distal radial and ulnar metaphyses without physeal widening. 'Gymnast wrist' was diagnosed and cessation of strenuous activities was advised.
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A re-analysis of the Sydney Diet Heart Study (Ramsden et al., BMJ 2013) suggested that a diet high in linoleic acid increased the risk of coronary heart disease. The authors ascribe this to a lack of the omega-3 fatty acid, alpha-linolenic acid, in the oils and fats consumed. This argument has some weaknesses. ⋯ Additionally, the fats consumed by subjects in the intervention group were high in trans fats, which may have increased risk. Finally, a large recent clinical trial failed to show any benefit of linolenic acid. The conclusion is, therefore, that this re-analysis provides insufficient evidence to justify changes in current dietary recommendations.
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A 43-year-old woman came to the Emergency Room with acute abdominal pain during the night. CT examination of the abdomen showed ventral herniation of the stomach and parts of the small intestine and colon in the right hemithorax. We made the diagnosis 'symptomatic Morgagni hernia', a rare congenital defect that is usually diagnosed soon after birth.
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Screening for lung cancer with computed tomography (CT) appears to be highly effective. A large randomized trial in the United States reported a 7% reduction in all-cause mortality in patients screened by CT in comparison with those screened by chest radiography. ⋯ As CT is superior to radiography in lung cancer detection, CT seems the preferred imaging modality for case finding. As more trial results have to be awaited and cost-effectiveness and optimal screening strategy remain uncertain, CT lung cancer screening is not yet ready for implementation.