[Practice guideline 'Adenoid and tonsil disorders in secondary care']. / Richtlijn 'Ziekten van adenoïd en tonsillen in de tweede lijn'.

At the initiative of the Dutch Association of Otolaryngology and Head & Neck Surgery, in cooperation with the Dutch Institute for Healthcare Improvement (CBO), an evidence-based practice guideline was developed for adenoid and tonsil disorders in secondary care. (Adeno)tonsillectomy ((A)TE) is indicated in children with very frequent recurrent tonsillitis: 7 or more tonsillitises per year or 5 tonsillitises per year in the last 2 years. In children with moderately frequent recurrent tonsillitis, i.e. 4 to 6 tonsillitises per year, an (A)TE can be considered. If an (A)TE is performed under inhalation anaesthesia without intubation this must be done with the patient in the supine position. An (A)TE in children can be safely performed in day surgery. It is advisable to give preoperative information to both parents and children.

[The multidisciplinary guideline 'Diagnosis and treatment of people with whiplash-associated disorder I or II']. / De multidisciplinaire richtlijn 'Diagnostiek en behandeling van mensen met een whiplash associated disorder I of II'.

A multidisciplinary guideline for the intake and treatment of whiplash patients has been developed with regard to the impact of whiplash on public health and social security. This guideline is restricted to uncomplicated whiplash, which is defined as the sudden acceleration and deceleration of the skull with energy transfer to the neck without neurological sequelae or fractures. In whiplash victims who are not alert, have pain of the neck, diminished cervical mobility or pain on palpation of the cervical vertebrae, an X ray of the cervical spine should be carried out to exclude fractures. Following whiplash if complications have been excluded, active neck exercise treatment is the correct approach. The patient should start this as soon as possible. After uncomplicated whiplash, rest and immobilisation are undesirable.

[Clinical practice guideline 'Complex regional pain syndrome type I']. / Richtlijn 'Complex regionaal pijnsyndroom type I'.

The development and treatment ofthe complex regional pain syndrome type I (CRPS-I) are a subject of much discussion. Using the method for the development ofevidence-based guidelines, a multidisciplinary guideline for the diagnosis and treatment of this syndrome has been drawn up. The diagnosis of CRPS-I is based on the clinical observation of signs and symptoms. For pain treatment, the WHO analgesic ladder is advised up to step z. In case of pain ofa neuropathic nature, anticonvulsants and tricyclic antidepressants may be considered. For the treatment ofinflammatory symptoms, free-radical scavengers (dimethylsulphoxide or acetylcysteine) are advised. In order to enhance peripheral blood flow, vasodilatory medication may be considered. Percutaneous sympathetic blockades may be used for a cold extremity ifvasodilatory medication produces insufficient effect. To decrease functional limitations, standardised physiotherapy and occupational therapy are advised. To prevent the occurrence of CRPS-I after wrist fractures, the use of vitamin C is recommended. Adequate perioperative analgesia, limitation of operation time and limited use of bloodlessness are advised for the secondary prevention of CRPS-I. Use of regional anaesthetic techniques can also be considered in this connection.

[Guideline 'Leptomeningeal metastases of solid tumours']. / Richtlijn 'Leptomeningeale metastasen van solide tumoren'.

In view of recent progressive insight in the diagnosis and treatment of leptomeningeal metastases of solid tumours, a new guideline has been designed on the initiative of the Dutch Association of NeuroOncology and the Netherlands Society of Neurology, with methodological support from the Dutch Institute for Healthcare Improvement (CBO). - There are no neurological symptoms or signs, nor MRI characteristics that are unique to leptomeningeal metastasis. However, clinical suspicion of leptomeningeal metastasis in a patient known to have cancer, in combination with specific MRI characteristics is sufficient to make the diagnosis. If MRI or CT results are negative or inconclusive cerebrospinal-fluid assessment should be conducted. - Management of care of patients with leptomeningeal metastasis without brain metastases can be based on a series of categories that have been developed using prognostic factors such as Karnofsky performance status, serious encephalopathy or neurological dysfunction, systemic disease, sensitivity of the tumour for chemotherapy or hormonal treatment - In the context of meaningful palliation, systemic treatment, if necessary in combination with radiotherapy to clinically relevant sites, is preferable to intrathecal chemotherapy. - Intrathecal chemotherapy combined with local radiotherapy is recommended if effective systemic treatment is not available, and if the tumour is potentially sensitive to methotrexate, cytarabine or thiotepa. The combination of intrathecal methotrexate and whole-brain radiotherapy should be avoided.

[Guideline 'Diagnosis and treatment of oesophageal carcinoma']. / Richtlijn 'Diagnostiek en behandeling oesofaguscarcinoom'.

An evidence-based guideline for the diagnosis and treatment of oesophageal carcinoma was developed on the initiative of the Netherlands Society of Gastroenterohepatology in cooperation with the Dutch Institute for Healthcare Improvement (CBO) and the Dutch Association of Comprehensive Cancer Centres. If a patient with oesophageal carcinoma is eligible for treatment with curative intent, they should undergo thoracic and abdominal CT, ultrasound investigation of the supraclavicular region and endoscopic ultrasonography for staging purposes. Endoscopic therapy is the preferred treatment for high-grade dysplasia or early cancer in Barrett's oesophagus confined to the mucosa. Surgical resection is indicated if the tumour invades the submucosa. If resection of the oesophageal carcinoma is performed with curative intent, one should aim for radical resection. The type and extent of the resection depends on the location of the tumour. There is evidence that the mortality rate following surgery can be reduced by performing it in centres with ample experience with oesophageal cancer surgery. Preoperative chemotherapy and radiotherapy may improve survival in patients with oesophageal carcinoma. Palliative treatment for oesophageal carcinoma should be considered in cases of local invasion of surrounding organs, metastases, poor physical condition of the patient or recurrent disease after previous curative treatment. Psychosocial support is an important element in the follow-up of patients with oesophageal carcinoma.