## Radiology image: A woman with dysmenorrhea and hypermenorrhea

Patient data Age: 42 Gender: female Medical history: none Initial presentation: heavy, painful and elongated menstrual period for a few years.

## Interview: prof. dr. U. Beuers

Area of expertise Cholestatic and autoimmune liver and bile duct diseases. When did you decide to become a physician? As a child, I had grown up on a ‘Zauberberg’ (Thomas Mann) next to a hospital for pulmonary diseases - my…

## Clinical Image: A child with kidney stones

A child with kidney stones

[headline_subtitle subtitle=”Can you come up with the proper diagnosis?”]
##### Case

This Syrian boy, the second child of consanguineous parents, presented with kidney stones in his country of origin at the age of 5½ years. In the following years he developed end stage kidney disease. He started hemodialysis treatment at the age of 11 years. In 2012 he underwent a kidney transplant, which failed soon after surgery. Hemodialysis was resumed. The following year he lost his ability to walk. In 2015 the patient moved to the Netherlands. Upon arrival, he was found to be underdialysed, underfed and to suffer from severe bone disease. An abdominal X-ray was performed.

## Solving statistics: Help! How do I get a normal distribution?

Help! How do I get a normal distribution?

## Background

The distribution of a continuous numerical variable tells you something about how likely each possible outcome or groups of outcomes will occur. The distribution of a continuous numerical variable can be described as normal or non-normal. A normal distribution is the name for a specific mathematical concept that follows a symmetric bell shaped curve and is completely defined by its mean and standard deviation. Approximately 68% of the observations fall between one standard deviation below and one standard deviation above the mean. And approximately 95% of the observations fall between two standard deviations below and two standard deviations above the mean. Normal distribution is an important term within the field of statistics. If you have a normal distribution you can perform a certain number of statistical tests that you cannot perform if your distribution is non-normal.1

## Subject 101: Glucosuria – trick or treatment?

Glucosuria – trick or treatment?

The color and odor, quantity, clarity & viscosity, foaminess, saltiness & sweetness of one’s urine was once ample information to determine the flaws in our personal well-being, summarized in the acronym of a modern shoe; ASICS. Anima sana in corpore sano. Both soul and body were represented in our clear-golden liquid.1 A particular disease, diagnosed spot-on through this method, is one of the oldest medical entities ever described.2 Already in 1500 AD, an Egyptian manuscript mentions an epithetical name; too great emptying of the urine. This emptying, defined in 230 AD by the Greek Apollonius of Memphis as διαβήτης (diabetes), “to pass through” (dia – through, betes – to go), was sufficient to characterize the condition for centuries.3 Only in 1675, when Thomas Willis, known for his discovery of the arterial circle in our brain, coined in his Pharmaceutice rationalis the term mellitus, “honey-like”, to differentiate between mellitus and insipidus, “tasteless”, the name diabetes mellitus emerged as a clinical condition.4 The doctor’s trick for diagnosis was simply to taste the urine.

## Changing Perspectives: MRI and arthroscopy of the knee in patients over 50 years of age

MRI and arthroscopy of the knee in patients over 50 years of age

In the Netherlands knee injuries occur approximately 300,000 times a year.1 Meniscal tears are among the most common knee injuries with an incidence of 2 per 1,000 patients a year.2 As a result arthroscopic meniscectomy is performed nearly 30,000 times a year in patients over 50 years of age.3 In over half of these patients magnetic resonance imaging (MRI) was performed prior to surgery. However, multiple randomized controlled trial observed no significant difference between knee function, pain relief and patient satisfaction when comparing arthroscopy to conservative treatment.4,5 In addition, the amount of knee arthroscopies where no therapeutic intervention was conducted during surgery ranges from 27 to 61%.1

Consequently, it is questioned whether these procedures benefit healthcare efficacy. Especially when taking into account that patients over 50 years of age are at risk of having existing osteoarthritis (OA) of the knee.6 This is accompanied by degenerative meniscal tears in up to 80%.7 Therefore, differentiating whether the symptoms are caused by the meniscal tear or developing OA is quite challenging. As a result, there is no indication to perform MRI in patients over 50 years of age according to the Netherlands Orthopedic Association (NOV). On that account, it is advised only to perform knee arthroscopy in case of locking of the knee caused by mechanical obstruction in these patients. This is without performing MRI prior to surgery.1

Therefore a substantial reduction of MRI and knee arthroscopies in patients over 50 years of age is warranted, especially in these times of increasing awareness of cost-effectiveness.6

## Expert Opinion: Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease

Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease

## Background

Low density lipoprotein (LDL) cholesterol is an important modifiable risk factor for cardiovascular disease. The recently developed monoclonal antibody evolocumab, targeting proprotein convertase subtilisin-kexin type 9 (PCSK9), has superior lipid-lowering effects to conventional statin therapy, additionally decreasing LDL cholesterol levels by approximately 60%. The trial we will discuss in this article is the first to assess the potential of evolocumab as secondary prevention for cardiovascular events in a large patient cohort.

## Editorial: The Nobel Prize praises excellent researchers

The Nobel Prize praises excellent researchers

Since 1901 the Nobel Prize praises excellent researchers for their contributions in various disciplines in the (bio)medical field. Until now, three Dutch scientists received the Nobel Prize in Physiology or Medicine. Willem Einthoven, who discovered the mechanism of the electrocardiogram, was the first of them to receive the golden medal and prize money to the value of what would now be about 1 million euros in 1924. Shortly after, Christiaan Eijkman received the award in 1924 (together with Frederick Gowland Hopkins, Great Britain) for his discovery in the role of vitamins in Beriberi. The last Dutch researcher who received the Nobel Prize in Physiology or Medicine was Niko Tinbergen, who received the award together with Karl von Frisch and Konrad Lorenz (both from Austria) in 1973 for their analysis of social behaviour in animals. Over the years researchers worked tremendously hard to understand our world a little better. Sometimes things are discovered by accident, such as the discovery of the world’s first antibiotic, by Alexander Fleming. In either case, multiple steps are required to eventually find the last piece for ground-breaking research.