Wetenschap naar de top. Publicaties Jeroen Bosch Ziekenhuis 2007

Publicaties (kaft) 2:Patiëntenfolder basis A5

19-12-2008

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’ S-HERTOGENBOSCH locatie

Carolus Bezoekadres: Hervensebaan 4 5232 JL ’s-Hertogenbosch Postadres: Postbus 1101 5200 BD ’s-Hertogenbosch Telefoon (073) 699 60 00

locatie

Groot Ziekengasthuis Bezoekadressen: Tolbrugstraat 11 5211 RW ’s-Hertogenbosch Nieuwstraat 34 5211 NL ’s-Hertogenbosch Postadres: Postbus 90153 5200 ME ’s-Hertogenbosch Telefoon (073) 699 20 00

locatie

Willem-Alexander Bezoekadres: Deutersestraat 2 5223 GV ’s-Hertogenbosch Postadres: Postbus 90153 5200 ME ’s-Hertogenbosch Telefoon (073) 699 20 00

BOXTEL locatie

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www.jeroenboschziekenhuis.nl

Wetenschap naar de top Publicaties Jeroen Bosch Ziekenhuis 2007

Publicaties Jeroen Bosch Ziekenhuis 2007

Samengesteld door: Wetenschapsbureau en Wetenschapscommissie

’s-Hertogenbosch, 2007

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Inhoudsopgave Voorwoord......................................................................................................... 4 ANESTHESIOLOGIE ....................................................................................... 5 CARDIOLOGIE ................................................................................................ 6 CHIRURGIE...................................................................................................... 8 DERMATOLOGIE .......................................................................................... 21 GERIATRIE .................................................................................................... 23 GYNAECOLOGIE .......................................................................................... 25 INTENSIVE CARE GENEESKUNDE............................................................ 32 INTERNE GENEESKUNDE........................................................................... 36 KINDERGENEESKUNDE.............................................................................. 45 KLINISCHE CHEMIE & HEMATOLOGIE ................................................... 50 KNO ................................................................................................................ 53 LONGZIEKTEN.............................................................................................. 54 MEDISCHE MICROBIOLOGIE..................................................................... 60 MEDISCHE TECHNOLOGIE......................................................................... 64 MOLECULAIRE DIAGNOSTIEK.................................................................. 65 NEUROLOGIE................................................................................................ 70 NUCLEAIRE GENEESKUNDE ..................................................................... 72 ORTHOPEDIE ................................................................................................ 74 PATHOLOGIE ................................................................................................ 75 PSYCHOLOGIE.............................................................................................. 78 RADIOLOGIE................................................................................................. 79 REUMATOLOGIE .......................................................................................... 85 REVALIDATIEGENEESKUNDE .................................................................. 88 UROLOGIE ..................................................................................................... 97 ZIEKENHUISFARMACIE.............................................................................. 99 OVERIG: STAFDIENSTEN.......................................................................... 101 PMA Fysiotherapie..................................................................................... 102 Hygiene & Infectiepreventie ...................................................................... 103 Kwaliteit & Organisatie .............................................................................. 104 Promoties ....................................................................................................... 105 Wetenschapsmiddag 2007.............................................................................. 106 OVERZICHT 2007 ........................................................................................ 114 Index Auteur .................................................................................................. 117 Index Tijdschriften ......................................................................................... 119

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Voorwoord Voor u ligt de tweede uitgave van het publicatieboekje waarin alle wetenschappelijke publicaties van medewerkers van het Jeroen Bosch Ziekenhuis in 2007 zijn opgenomen. Dit boekje is tot stand gekomen op initiatief van het Wetenschapsbureau van het Cluster Leerhuis en de Wetenschapscommissie. De titel: Wetenschap naar de top staat symbool voor ons streven naar de top van het wetenschappelijk onderzoek binnen de STZ ziekenhuizen. Opnieuw wordt met dit overzicht duidelijk dat het JBZ wetenschap hoog in het vaandel heeft. Opgenomen zijn 146 artikelen, waarvan er 108 in PubMed verschenen zijn. Er is meegewerkt aan 3 boeken en er is in dit jaar 1 proefschift geschreven. Uiteraard willen we iedereen die aan de totstandkoming van dit overzicht heeft meegewerkt hartelijk bedanken. Voor opmerkingen en suggesties kunt u zich tot het secretariaat richten: [email protected] of 073-6993114. We hopen dat deze uitgave u uitdaagt om ook de komende jaren onderzoek in het JBZ te blijven uitvoeren, en waar mogelijk een nieuwe impuls te geven. Het Wetenschapsbureau en de Wetenschapscommissie zullen u daarbij van harte ondersteunen. Namens de Wetenschapscommissie en het Wetenschapsbureau,

Judie van den Elshout, MSc. Staffunctionaris Wetenschapsbureau/ Cluster Leerhuis

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ANESTHESIOLOGIE VOORDRACHTEN & POSTERS

Lechner T. Acoustic and visible monitoring of the epidural puncture. Invited speaker VI international congress on orthopaedics and anaestesia Istanbul. April 2007.

Lechner T. The acoustic guided epidural puncture. Workshop European conference on paediatric anaesthesia Amsterdam. Sept. 2007.

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CARDIOLOGIE ARTIKELEN

Daniëls MCG, Naya T, Rundell VLM, de Tombe PP. Development of contractile dysfunction in rat heart failure: hierarchy of cellular events. Am. J. Physiol. 2007;293:R284-R292. Trefwoord: hartfalen, dierexperimenteel. Department of Physiology and Biophysics MC901, Center for Cardiovascular Research, University of Illinois at Chicago, 835 S. Wolcott Ave., Chicago, IL 60612, USA. The cellular mechanisms underlying the development of congestive heart failure (HF) are not well understood. Accordingly, we studied myocardial function in isolated right ventricular trabeculae from rats in which HF was induced by left ventricular myocardial infarction (MI). Both early-stage (12 wk post-MI; E-pMI) and late, end-stage HF (28 wk post-Mi; L-pMI) were studied. HF was associated with decreased sarcoplasmic reticulum Ca(2+) ATPase protein levels (28% E-pMI; 52% L-pMI). HF affected neither sodium/calcium exchange, ryanodine receptor, nor phospholamban protein levels. Twitch force at saturating extracellular [Ca(2+)] was depressed in HF (30% E-pMI; 38% L-pMI), concomitant with a marked increase in sensitivity of twitch force toward extracellular [Ca(2+)] (26% E-pMI; 68% L-pMI). Ca(2+)-saturated myofilament force development in skinned trabeculae was unchanged in E-pMI but significantly depressed in L-pMI (45%). Tension-dependent ATP hydrolysis rate was depressed in L-pMI (49%), but not in E-pMI. Our results suggest a hierarchy of cellular events during the development of HF, starting with altered calcium homeostasis during the early phase followed by myofilament dysfunction at end-stage HF.

PMID: 17363676 [PubMed - indexed for MEDLINE] VOORDRACHTEN & POSTERS

Daniëls MCG, Rundell VLM, de Tombe PP. Development of contractile dysfunction in rat heart failure: hierarchy of cellular events. Neth. Heart J. 2007:15, Suppl. 1: 8. Trefwoord: hartfalen, dierexperimenteel.

Van den Brink M, Comuth W, Daniëls MCG. Open-access bicycle stress testing; patient and physician perspectives. Neth. Heart J. 2007:15, Suppl. 1: 5. Trefwoord: fietstest, hart

Daniëls MCG, Blans W, Krivka E, Gevers RMM, vd Kraaij AMM, Haerkens HE, Elsman P, Meijburg HWJ. Mortality rate according to admission diagnosis; a seven–year single center experience. Neth. Heart J.2007:15, Suppl. 2: 3. Trefwoord: epidemiologie, hart

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Van den Brink M, Comuth W, Daniëls MCG. Eerstelijns ergometrisch onderzoek. CURA 2007;1: 15. Trefwoord: fietstest, hart.

Van den Brink M, Daniëls MCG. Wanneer vraag ik een fietstest aan bij patiënten met thoracale pijnklachten? Labcontact Diagnostisch Centrum 2007, 23. Trefwoord: fietstest, hart.

Daniëls MCG. Biologisch mechanisme van hartfalen verder ontrafelt. CURA 2007;3:15. Trefwoord: hartfalen, hart.

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CHIRURGIE ARTIKELEN

Van Schaik PM, Kouwenhoven EA, Bolhuis RJ, Biesma B, Bosscha K. Pulmonary Resection for Metastases from Colorectal Cancer. J Thorac Oncol. 2007 Jul;2: 652-656. Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands. [email protected] INTRODUCTION: The lung is the most common extraabdominal site for metastases from colorectal cancer. Patients with untreated metastatic disease have a median survival of less than 10 months and a 5-year survival of less than 5%. The purpose of this study was to evaluate long-term survival in patients who underwent pulmonary resection for metastases from colorectal cancer. METHODS: Between January 1990 and January 2005, 23 patients underwent 29 operations for resection of lung metastases. RESULTS: Median age was 68 years (range: 46-80 years). Median follow-up was 30 months (range: 12-149 months). The 2- and 5-year overall survival rates were 64 and 26%, respectively. Of the 23 patients, 16 patients had a solitary lesion, and seven patients had multiple lesions. The 5-year survival rates were 23 and 33%, respectively (not significant). The median diseasefree interval (DFI)--the interval between colon resection and the appearance of lung metastases--was 43 months (1-168). Ten patients had DFIs <36 months, and 13 patients had DFIs >36 months. The 3year survival rates were 20 and 38%, respectively (not significant). Recurrence of lung metastases was diagnosed in seven patients; three patients underwent second resections. They are alive today, with a median follow-up of 18 months. Patients who did not undergo second resections had a median survival of 12 months. CONCLUSIONS: Pulmonary resection for metastases from colorectal cancer does produce longer survival, even in patients with multiple lesions and recurrent metastases.

PMID: 17607122 [PubMed - indexed for MEDLINE]

Ritchie ED, Haverkamp D, Schiphorst TJM, Bosscha K. False aneurysm of the profunda artery, a rare complication of a proximal femoral fracture. Acta Belgica Orthopaedica 2007 Aug; 73: 530-2. Department of Surgery, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands. The authors describe a false aneurysm of the profunda femoris artery caused by a bony fragment from the lesser trochanter after a proximal femoral fracture. False aneurysm as a complication of a hip fracture is rare; however it is essential to consider the possibility, more even so if there is inexplicable persisting pain after internal fixation. Symptoms are sometimes diffi-cult to judge, as they can be almost identical to usual symptoms after an operated hip fracture. In this case we present a female patient with persistent pain after a surgically fixed proximal femoral fracture. CT scan showed a false aneurysm caused by a bony fragment of the lesser trochanter. Because of the persisting mechanical stress from the bony fragment we decided to explore the false aneurysm and to remove the bony fragment. It is essential to be aware of adjacent vascular and neurological structures when a fracture is seen and operated on.


Van la Parra RFD, Ernst MF, Barneveld PC, Broekman J, Rutten MJCM, Bosscha K. The value of sentinal node biopsy in ductal carcinoma in situ (DCIS) and DCIS with micoinvasion of the breast. Eur J Surg Onc 2008 Jun ; 34(6) :631-635. Epub 2007 Sep 11.

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Department of Surgery, Jeroen Bosch Ziekenhuis, P.O. Box 90153, 5200 ME 'sHertogenbosch, The Netherlands. AIM: Ductal carcinoma in situ (DCIS) refers to the preinvasive stage of breast carcinoma and should not give axillary metastases. Its diagnosis, however, is subject to sampling errors. The role of sentinel lymph node biopsy (SLNB) in management of DCIS or DCISM (with microinvasion) remains unclear. The purpose of this study was to review our experience with SLNB in DCIS and DCISM. METHODS: A review of 51 patients with a diagnosis of DCIS (n=45) or DCISM (n=6), who underwent SLNB and a definitive breast operation between January 1999 and December 2006, was performed. RESULTS: In 10 patients (19.6%) definitive histology revealed an invasive carcinoma. SLN (micro)metastases were detected in 5 out of 51 patients, of whom 2 had a preoperative diagnosis of grade III DCIS and 3 of DCISM. Three patients (75%) had micrometastases (< 2 mm) only. In 2 patients, histopathology demonstrated a macrometastasis (> 2 mm). All 5 patients underwent axillary dissection. No additional positive axillary lymph nodes were found. CONCLUSIONS: In case of a preoperative diagnosis of grade III DCIS or a grade II DCIS with comedo necrosis and DCIS with microinvasion, an SLNB procedure has to be considered because in almost 20% of the patients an invasive carcinoma is found after surgery. In this case the SLNB procedure becomes less reliable after a lumpectomy or ablation has been performed. SLN (micro)metastases were detected in nearly 10% of the patients. The prognostic significance of individual tumour cells remains unclear.


Van Wensen RJA, Dautzenberg PLJ, Koek HL, Olsman JG, Bosscha K. Delier na een heupfractuur bij ruim een derde van de patiënten. Ned Tijdschr Geneeskd 2007 Jul; 151(30): 1681-1685. Jeroen Bosch Ziekenhuis, Nieuwstraat 34, 5211 NL's-Hertogenbosch. OBJECTIVE: Inventarisation and evaluation of the incidence, risk factors, and prognosis of postoperative delirium in patients with a fractured hip admitted to a surgical ward. DESIGN: Descriptive study of patient records. METHOD: All patients with a fractured hip admitted to the surgical ward of the Jeroen Bosch Hospital, Den Bosch, the Netherlands, in 2004 were included and evaluated. Active multidisciplinary interventions for the recognition and treatment of delirium by nonpharmacological and pharmacological means take place in this surgical ward. The records of all patients from the surgical and geriatric wards were evaluated and the data were analysed statistically by means of univariate and multivariate logistic 'step-forward' regression analysis. RESULTS: 114 patients were included. The incidence of postoperative delirium was 37%. Older age was a significant risk factor for the development of delirium in both the univariate and the multivariate analysis after correcting for overestimation (p < 0.01). Several other factors, including sex, type of surgery, and medical history, had no effect on the risk of delirium. CONCLUSION: Delirium after a hip fracture is not rare; the most important risk factor is older age.


Ruurda JP, Looij BG, Rutten M, Zwemmer A, Bosscha K. Succesvolle behandeling van miltbloedingen met behoud van de milt door selectieve katheterisatie en embolisatie van de A. lienalis. Ned Tijdschr Geneeskd 2007 Jun 23;151(25): 1418-1423. Jeroen Bosch Ziekenhuis, locatie Groot Ziekengasthuis, Nieuwstraat 34, 5211 NL'sHertogenbosch. [email protected] Two patients with splenic bleeding were treated with transcatheter embolisation and selective coiling of the splenic artery. These were first of all a 78-year-old woman who was on anticoagulants for atrial fibrillation and suffered a laceration of the spleen with extravasation of contrast medium and a falling haemoglobin level. The second patient was a 23-year-old woman who suffered laceration of the spleen as the result of a traffic accident. Embolisation made it possible to avoid surgical treatment and preserve the spleen in both patients. Selective embolisation of the splenic artery is a useful adjunct to

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the non-operative management of patients with traumatic splenic injury. However, the proper patient selection still needs to be established.


Van Schaik PM, Van der Linden JC, Ernst MF, Gelderman WA, Bosscha K. Ex vivo sentinel node “mapping”in colorectal cancer. Eur J Surg Oncol 2007 Dec ;33(10): 1177-1182. Epub 2007 Apr 20. Department of Surgery, Jeroen Bosch Hospital, Tolbrugstraat 11, 5211 RW 'sHertogenbosch, The Netherlands. [email protected] BACKGROUND: The purpose of this study was to evaluate the feasibility and reliability of ex vivo sentinel lymph node mapping in patients with colorectal cancer. METHODS: In the period JanuaryJune 2006, 44 consecutive patients underwent curative surgery for colorectal cancer. In patients with colon and rectal cancer, 0.5-2 ml of Patent Blue Dye was injected submucosally. The injection sites where then gently massaged for 5 min. RESULTS: In 96% of the patients with colon cancer and 94% of the patients with rectal cancer, at least one sentinel lymph node was found. There were no patients with a false negative sentinel node. The sensitivity was 100% with a negative predictive value of 100%. In 19% of the patients with colon cancer and 18% of the patients with rectal cancer the sentinel node was the exclusive site of lymph node metastases. After additional sectioning and staining, 7 of the 23 patients (30%) with a Dukes B colorectal cancer were upstaged. CONCLUSION: The technique of ex vivo sentinel lymph node mapping is technically feasible with high sensitivity, high negative predictive value and a high rate of upstaging. The next step is to investigate, if detection of micro-metastases is associated with decreased survival and/or increased local recurrence rates.


Van der Gaag, De Castro SM, Rauws EA, Bruno MJ, Van Eijck CH, Kuipers EJ, Gerritsen JJ, Rutten JP, Greve JW, Hesselink EJ, Klinkenbijl JH, Rinkes IH, Boerma D, Bonsing BA, Van Laarhoven CJ, Kubben FJ, Van der Harst E, Sosef MN, Bosscha K, De Hingh IH, De Wit ThL, Van Delden OM, Busch OR, Van Gulik TM, Bossuyt PM, Gouma DJ. Preoperative biliary drainage for periampullary tumors causing obstructive jaundice; Drainage vs. (direct) Operation (DROP-trial). BMC Surg 2007 Mar;12: 7: 3. Department of Surgery, Academic Medical Center Amsterdam, The Netherlands. [email protected] BACKGROUND: Surgery in patients with obstructive jaundice caused by a periampullary (pancreas, papilla, distal bile duct) tumor is associated with a higher risk of postoperative complications than in non-jaundiced patients. Preoperative biliary drainage was introduced in an attempt to improve the general condition and thus reduce postoperative morbidity and mortality. Early studies showed a reduction in morbidity. However, more recently the focus has shifted towards the negative effects of drainage, such as an increase of infectious complications. Whether biliary drainage should always be performed in jaundiced patients remains controversial. The randomized controlled multicenter DROPtrial (DRainage vs. Operation) was conceived to compare the outcome of a 'preoperative biliary drainage strategy' (standard strategy) with that of an 'early-surgery' strategy, with respect to the incidence of severe complications (primary-outcome measure), hospital stay, number of invasive diagnostic tests, costs, and quality of life. METHODS/DESIGN: Patients with obstructive jaundice due to a periampullary tumor, eligible for exploration after staging with CT scan, and scheduled to undergo a "curative" resection, will be randomized to either "early surgical treatment" (within one week) or "preoperative biliary drainage" (for 4 weeks) and subsequent surgical treatment (standard treatment). Primary outcome measure is the percentage of severe complications up to 90 days after surgery. The sample size calculation is based on the equivalence design for the primary outcome measure. If equivalence is found, the comparison of the secondary outcomes will be essential in selecting the preferred strategy. Based on a 40% complication rate for early surgical treatment and

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48% for preoperative drainage, equivalence is taken to be demonstrated if the percentage of severe complications with early surgical treatment is not more than 10% higher compared to standard treatment: preoperative biliary drainage. Accounting for a 10% dropout, 105 patients are needed in each arm resulting in a study population of 210 (alpha = 0.95, beta = 0.8). DISCUSSION: The DROPtrial is a randomized controlled multicenter trial that will provide evidence whether or not preoperative biliary drainage is to be performed in patients with obstructive jaundice due to a periampullary tumor.

PMID: 17352805 [PubMed - indexed for MEDLINE] PMCID: PMC1828149 Brokelman WJ, Holmdahl L, Bergström M, Falk P, Klinkenbijl JH, Reijnen MM. Peritoneal transforming growth factor beta-1 expression during laparoscopic surgery. Surgical Endoscopy 2007 Sep; 21(9):1537-41. Epub 2007 Mar 1. Department of Surgery, Alysis Zorggroep, Locatie Rijnstate Wagnerlaan, 55 6815 AD, Arnhem, The Netherlands. [email protected] BACKGROUND: Transforming growth factor-beta 1 (TGF-beta1) is a growth factor involved in various biologic processes, including peritoneal wound healing and dissemination of malignancies. Laparoscopic surgery is evolving rapidly, and indications are increasing. The peritoneal TGF-beta1 expression during laparoscopic surgery is unknown. METHODS: For this study, 50 patients scheduled for laparoscopic cholecystectomy were randomized into five groups, then surgically treated with various pressures, light intensities, and dissection devices. Peritoneal biopsies were taken at the beginning and end of surgery. Tissue concentrations of total and active TGF-beta1 were measured using enzyme-linked immunosorbent assay (ELISA) techniques. RESULTS: There was no significant difference in either total or active TGF-beta1 concentration between peritoneal biopsies taken at the start of surgery and samples taken at the end of the procedure. Patients who underwent surgery with the ultrasonic scalpel had significant lower levels of both active (p < 0.005) and total (p < 0.01) TGFbeta1 at the end of surgery than patients treated with electrocautery. Patients who had surgery with a high light intensity had significantly lower levels of total TGF-beta1 levels (p < 0.005) with an unchanged active part than patients who had surgery with low light intensity. CONCLUSION: The choice of dissection device and the light intensity used in laparoscopic surgery affect peritoneal TGFbeta1 concentrations, indicating that peritoneal biology can be affected by laparoscopic surgery. Because TGF-beta1 is involved in various biologic processes in the peritoneal cavity, this observation may have important clinical consequences.


Brokelman WJ, Holmdahl L, Bergström M, Falk P, Klinkenbijl JH, Reijnen MM. Heating of carbon dioxide during insufflation alters the peritoneal fibrinolytic response to laparoscopic surgery, a clinical trial. Surgical Endoscopy 2007 Oct 18; Epub ahaed of print. Department of Surgery, Alysis Zorggroep, Locatie Rijnstate, Wagnerlaan 55, 6815, AD, Arnhem, The Netherlands, [email protected]. BACKGROUND: Laparoscopic surgery is evolving rapidly. It involves the creation of a pneumoperitoneum, mostly using carbon dioxide. Cooling of the peritoneum, due to insufflation, might traumatize the peritoneum and disturb peritoneal fibrinolysis, important in peritoneal healing processes. The current study was performed to elucidate the effects of the temperature of insufflation gas on the peritoneal fibrinolytic response to laparoscopic surgery. METHODS: Thirty patients scheduled for laparoscopic cholecystectomy were randomized in two groups: one group in which the pneumoperitoneum was created with carbon dioxide at room temperature, and one wherein carbon dioxide at body temperature was used. Peritoneal biopsies were taken at the start and at the end of surgery. Tissue concentrations of tPA antigen, tPA activity, uPA antigen, and PAI-1 antigen were measured using ELISA techniques. RESULTS: Peritoneal PAI-1 antigen levels were significantly higher at the end of the procedure in patients operated with carbon dioxide at room temperature (p <

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.05). A slight, but not significant, decrease in tPA antigen and activity was observed in both groups during the procedure. Peritoneal concentrations of uPa antigen did not change during the procedure. CONCLUSIONS: The temperature of carbon dioxide used for insufflation of the abdominal cavity affects peritoneal biology. Cooling of the peritoneum by unheated carbon dioxide causes increased peritoneal PAI-1 levels, important in peritoneal healing processes.

PMID: 17943363 [PubMed - as supplied by publisher]

Ernst MF, van de Poll-Franse LV, Roukema JA, Coebergh JWW, Gestel van CMJ, Vreugdenhil G, Louwman WJ, Voogd AC. Trends in the prognosis of patients with primary metastatic breast cancer between 1975 and 2002. Breast. 2007 Aug;16(4):344-351. Epub 2007 Feb 15. Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands. We performed a population-based study, including 1089 patients with primary metastatic breast cancer, diagnosed in South-East Netherlands between 1975 and 2002, and tried to give an answer to the question if prognosis of this patient group has improved or not. Follow-up was completed until 1 January 2005. The median survival times for patients with primary metastatic disease were 18, 17 and 20.5 months for patients diagnosed in the periods 1975-1984, 1985-1994 and 1995-2002, respectively. A multivariate analysis, including age, tumour size and information on the localization of metastatic disease and the number of metastatic sites, showed that patients diagnosed in the period 1995-2002 had a 18% lower death risk (95% confidence interval 5-30) compared to those diagnosed in the period 1985-1994. These data show that the prognosis of patients with primary metastatic breast cancer remained unchanged between 1975 and 1994 and that some progress has been made after 1994.


Van la Parra RFD, Ernst MF, Bosscha K. Schildwachtklierbiopsie bij het ductaal carcinoma in situ. Cura maart 2007.

Van Keimpema L, Ruurda JP, Ernst MF, van Geffen HJ, Drenth JP. Laparoscopic fenestration of liver cysts in polycystic liver disease results in a median volume reduction of 12.5%. J Gastrointest Surg. 2008 Mar;12(3):477-82. Epub 2007 Oct 24. Department of Medicine, Division of Gastroenterology and Hepatology, University Medical Center St. Radboud, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. [email protected] INTRODUCTION: Patients with polycystic liver disease (PCLD) may develop symptoms due to increased liver volume. Laparoscopic fenestration is one of the options to reduce liver volume and to relieve symptoms. This study was performed to evaluate the safety and efficacy of laparoscopic liver cyst fenestration. PATIENTS AND METHODS: Twelve patients (all female, median age 45 years, range 35-58) with symptomatic PCLD were included between August 2005 and April 2007. Surgical data were recorded, liver volumes were measured on pre- and postoperative computed tomography (CT) scans, and patients completed a validated symptom-based questionnaire pre- and postoperatively. RESULTS: Median preoperative liver volume was 4,854 ml (range 1,606-8,201) and decreased to 4,153 ml postoperatively (range 1,556-8,232) resulting in median liver volume reduction of 12.5% (range +9.5 to -24.7%). Median procedural time was 123.5 min (range 50-318), and median hospitalization period was 3.5 days (range 1-8). Postoperative complications occurred in three patients including biliary leakage, obstruction of inferior vena cava and sepsis, all recovering with conservative management. Patients reported decreased symptoms of postprandial fullness and abdominal

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distension. CONCLUSION: Laparoscopic fenestration in PCLD patients results in volume reduction of 12.5% and decrease of symptoms.


Berende CA, Ruurda JP, Hazenberg CE, Olsman JG, van Geffen HJ. Inguinal hernia treatment with the Prolene Hernia System in a Dutch regional training hospital. Hernia. 2007 Aug;11(4):303-6. Epub 2007 Apr 4. Department of Surgery, Jeroen Bosch Hospital, Nieuwstraat 34, 5211 's-Hertogenbosch, The Netherlands. [email protected]. INTRODUCTION: In this retrospective study results from inguinal hernia repair with the Prolene Hernia System (PHS) in a regional training hospital were analysed. PATIENTS AND METHODS: One-hundred and seventy-eight primary inguinal hernias and thirty-nine recurrent hernias (initial nonmesh repair) were treated with the PHS. The primary endpoint was the recurrence rate. Secondary endpoints were short-term and long-term complications. Pain was evaluated by use of a visual analog scale (VAS, 0-100), and a short-form 36-item questionnaire was used to assess postoperation quality of life. All patients visited the outpatient clinic for a physical examination (100% follow-up). RESULTS: After a median follow-up of 32 months four patients were diagnosed with recurrent herniation (1.8%), three after primary hernia repair (1.6%) and one after recurrent hernia repair (2.6%). Three superficial wound infections (1.3%), three haematomas needing surgical evacuation (1.3%), and two lesions of the spermatic cord (0.9%) were diagnosed. Seven patients (3.2%) suffered from persistent pain (VAS > 40). Average VAS score was 13 (0-80) >24 months after surgery. CONCLUSION: In a regional training hospital, primary and recurrent inguinal hernias were treated with low recurrence and few complications by use of the PHS.


Gilbert AI, Berende CA, Ruurda JP, Hazenberg CE, Olsman JG, van Geffen HJ. Inguinal hernia treatment with Prolene hernia system in a Dutch regional training hospital. Hernia. 2007 Aug;11(4):297. Epub 2007 May 4. PMID: 17624494

Hinnen JW, Rixen DJ, Koning OH, van Bockel JH, Hamming JF. Development of fibrinous thrombus analogue for in-vitro abdominal aortic aneurysm studies. J Biomech. 2007;40(2):289-95. Epub 2006 Mar 6. Department of Surgery, Section of Vascular Surgery, Leiden University Medical Center, Postbox 9600, K6-R, 2300 RC Leiden, The Netherlands. [email protected] PURPOSE: To develop different thrombus analogues, with mechanical properties similar to those of human fibrinous thrombus, for in-vitro aneurysm sac pressure studies. METHODS: Using dynamic mechanical analysis we determined the E-modulus (/E(*)/) at 0.8, 1.0, 1.5 and 3.9 Hz of ten different human fibrinous thrombus samples. We also determined loss and storage modulus to quantify the visco-elastic properties. For comparison, we measured the E-modulus (|E(*)|), loss and storage modulus of gelatin, Novalyse ST8, ST14 and ST20 with and without contrast agent. RESULTS: Mean E-modulus of the thrombus samples (SD) at 0.8, 1.0, 1.5 and 3.9 Hz was 39 (16), 37 (15), 37 (15) and 38 (14)kPa, respectively. Median (SD) storage and loss modulus were 35 (12) and 8 (4)kPa, respectively. Median (SD) tandelta was 0.25 (0.06). The E-modulus of gelatin, Novalyse ST8, ST14 and ST20 was 4, 27, 48 and 60 kPa, respectively. The E-modulus of Novalyse ST8, ST14 and ST20 mixed with contrast agent was 18, 23 and 33 kPa, respectively. Median (SD) storage, loss modulus and tan delta of the six Novalyse samples were 30 (15), 3 (1) and 0.087 (0.04), respectively. CONCLUSION: All the thrombus analogues, except gelatin, had an E-modulus in the range of human

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fibrinous thrombi. Novalyse samples are validated thrombus analogues for in-vitro aneurysm sac pressure studies. Gelatin is not appropriate to simulate fibrinous thrombus.


Hinnen JW, Rixen DJ, Koning OHJ, van Bockel JH, Hamming JF. Aneurysm sac pressure monitoring: Does the direction of pressure measurement matter in fibrinous thrombus? J Vasc Surg. 2007 Apr;45(4):812-6. Epub 2007 feb 15. Department of Surgery, Division of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands. [email protected] <[email protected]> PURPOSE: This study was conducted to clarify the effect of the direction of pressure measurement on the pressure readout in fibrinous thrombus of the abdominal aortic aneurysm. METHODS: Three weights of 468 g (weight 1), 578 g (weight 2), and 675 g (weight 3) were molded. A specimen of human fibrinous thrombus was positioned under the weights. Because the surface area of the weights and the thrombus was 400 mm(2), weights 1, 2, and 3 caused pressures of 88, 108, and 127 mm Hg, respectively. Pressure measurements were performed at different angles between the sensor and the applied force (0 degrees , 22.5 degrees , 30 degrees , 45 degrees , 60 degrees , 67.5 degrees , 90 degrees ) Thrombi of 10 different patients were analyzed. Pressure measurements in the thrombi at different angles were statistically compared by a linear mixed model analysis. RESULTS: The measurements at 90 degrees differed statistically from the measurements at 0 degrees , 22.5 degrees , 30 degrees , 45 degrees , 60 degrees , and 67.5 degrees (P < .001). The pressure readout was only similar to the applied pressure when the pressure sensor was positioned at 90 degrees to the applied force. Pressure measurements in other sensor positions resulted in lower pressure measurements. Pressure changes were detected in all sensor positions. There appeared to be no significant difference between the pressure measurements taken at same angles in the 10 thrombi (P > .05). CONCLUSION: In fibrinous thrombus of abdominal aortic aneurysm, the direction of pressure measurement

influenced the pressure readout. PMID: 17303368 [PubMed - indexed for MEDLINE]

Hinnen JW, Koning OHJ, Van Bockel HJ, Hamming JF. Regarding "Initial results of wireless pressure sensing for endovascular aneurysm repair: The APEX trial--Acute Pressure Measurement to Confirm Aneurysm Sac EXclusion". J Vasc Surg. 2007 Aug;46(2):403. Author reply 403-4. PMID: 17664128 [PubMed - indexed for MEDLINE]

Hinnen JW, Koning OHJ, van Bockel JH, Hamming JF. Aneurysm Sac Pressure after EVAR: The Role of Endoleak. Eur J Vasc Endovasc Surg. 2007 Oct;34(4):432-41; discussion 442-3. Epub 2007 Aug 1. Section of Vascular Surgery, Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. [email protected] OBJECTIVE: The relation between endoleak and aneurysm sac pressure is not completely clear. This review evaluates the effect of endoleaks on aneurysm sac pressure and summarizes the present knowledge regarding aneurysm sac pressure after EVAR. METHODS: A systematic search of literature was carried out using MEDLINE, EMBASE and Web of Science. Studies were included if aneurysm sac pressure measurements as well as systemic pressure measurements were performed during or after EVAR. Mean pressure indices (MPI), ratio mean aneurysm sac pressure to mean systemic pressure), in the absence of endoleaks and in the presence of different type of endoleaks were compared. RESULTS: Stent-graft deployment does not seem to result in immediate reduction of aneurysm sac in the absence of an endoleak. Aneurysm sac pressure is elevated in the presence of an

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endoleak. However, the MPIs differ widely between studies both in the absence and presence of an endoleak. CONCLUSION: MPI is not specific to the type of endoleak. This implies that the same type of endoleak does not necessarily pose the same MPI and by this the same hazard of aneurysm rupture, because the aneurysm sac pressure is directly related to the aneurysm wall stress.


Koning OHJ, Kaptein BL, Garling EH, Hinnen JW, Hamming JF, Valstar ER, Bockel JH. Assessment of three-dimensional stent-graft dynamics by using fluoroscopic röntgenographic stereophotogrammetric analysis. J Vasc Surg. 2007 Oct;46(4):773-779. Epub 2007 Aug 30. Department of Surgery, Division of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands. [email protected] OBJECTIVE: To validate the use of fluoroscopic roentgenographic stereophotogrammetric analysis (FRSA) for its feasibility and accuracy for measuring the three-dimensional dynamic motion of stent grafts. METHODS: A digital biplane fluoroscopy setup was calibrated (Siemens Axiom Artis dBc). Stereo images were acquired of a static aortic model with a stent graft in different axial positions, imposed by a micromanipulator. The three-dimensional measurement error of FRSA was determined by comparing FRSA measurements with the micromanipulator. An aortic model with a stent graft was constructed and connected to an artificial circulation with a physiological flow and pressure profile. Markers were added to the spine (tantalum spherical markers; diameter 1 mm) and stent (welding tin; diameter 1 mm). The three-dimensional measurement precision was determined by measuring the position of a single (stable) spine marker during two pulsatile cycles. Finally, three-dimensional stent marker motion was analyzed with a frame rate of 30 images per second, including three-dimensional marker position (change), diameter change, and center of circle position change. RESULTS: The mean error of FRSA measurement of displacement was 0.003 mm (SD, 0.019 mm; maximum error, 0.058 mm). A very high precision of position measurement was found (SD, 0.009-0.015 mm). During pulsatile motion, the position (changes) of the markers could be assessed in the x, y, and z directions, as well as the stent diameter change and center of circle position change. CONCLUSIONS: FRSA has proven to be a method with very high accuracy and temporal resolution to measure three-dimensional stent-graft motion in a pulsatile environment. This technique has the potential to contribute significantly to the knowledge of stent-graft behavior after endovascular aneurysm repair and improvements in stent-graft design. The technique is ready for clinical testing.


Koning OHJ, Garling EH, Hinnen JW, Kroft LJM, Van der Linden E, Hamming JF, Valstar ER, Van Bockel JH. Accurate detection of stent-graft migration in a pulsatile aortic model using Röntgen stereophotogrammetric analysis. J Endovasc Ther. 2007 Feb;14(1):30-8. Departments of Surgery (Division of Vascular Surgery), Leiden University Medical Center, Leiden, The Netherlands. [email protected] PURPOSE: To evaluate the feasibility and accuracy of Roentgen stereophotogrammetric analysis (RSA) versus computed tomography (CT) for detecting stent-graft migration in an in vitro pulsatile circulation model and to study the feasibility of a nitinol endovascular clip (NEC) as an aortic wall reference marker for RSA. METHODS: An aortic model with stent-graft was constructed and connected to an artificial circulation with a physiological flow and pressure profile. Tantalum markers and NECs were used as aortic reference markers for RSA analysis. Stent-graft migrations were measured during pulsatile circulation with RSA and CT. CT images acquired with 64 x 0.5-mm beam collimation were analyzed with Vitrea postprocessing software using a standard clinical protocol and central lumen line reconstruction. RSA in the model with the circulation switched off was used as the reference standard to determine stent-graft migration. The measurement errors of RSA and CT were

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determined during pulsatile circulation. RESULTS: The mean measurement error +/- standard deviation (maximum) of RSA during pulsatile circulation using the tantalum markers was -0.5+/-0.16 (0.7) mm. Using the NEC, the mean (maximum) measurement error was -0.4+/-0.25 (1.1) mm. The mean (maximum) measurement error of CT was -1.1+/-1.17 (2.8) mm. CONCLUSION: RSA is an accurate and feasible tool to measure stent-graft migration in a pulsatile environment. Migration measurement with RSA was more accurate than CT in this experimental setup. The nitinol clip tested in this study is potentially feasible as an aortic reference marker in patients after endovascular repair.


Kortekaas K, van Niekerk J, Olsman JG. “Betere pijnbestrijding op de Spoedeisende Hulp” Kwaliteit in beeld 2007, nr.6: 4-6

van la Parra RFD, Mirck PG, Lohuis PJFM An arachnoid cyst of the Fallopian canal. Otol Neurotol. 2007 May 25. [Epub ahead of print] Department of Otorhinolaryngology/Head and Neck Surgery, Academic Medical Center, Amsterdam, The Netherlands. PMID: 17534197 [PubMed - as supplied by publisher]

van la Parra RFD, Mirck PG, Lohuis PJFM An arachnoid cyst of the Fallopian canal. Department of Otorhinolaryngology/Head and Neck Surgery, Academic Medical Center, Amsterdam, The Netherlands. Otol Neurotol. 2007 Dec;28(8):1153-4 PMID: 18043439 [PubMed - indexed for MEDLINE]

Van Schaik PM, Kouwenhoven EA, Bolhuis RJ, Biesma B, Bosscha K. Pulmonary resection for metastases from colorectal cancer. Lung Cancer. 2007;55(1):S10. Abstract.

BOEKEN

Van Geffen HJ, Kreb D, Simmermacher RKJ, Olsman J, Van der Werken Chr. Long term results of reconstructing large abdominal wall defects with the Components Separation Method. In: Recurrent Hernia; Prevention and Treatment. 2007 Editors: Prof. Dr. V. Schumpelick and Prof. Dr. Robert J. Fitzgibbons. Springer-Verlag. ISBN: 978-3-540-37545-6

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PROEFSCHRIFTEN

Van Geffen HJ Evaluation of the Components Separation Method for treatment of patients with large abdominal wall defects. Doctoral thesis, University of Utrecht 2007. ISBN: 978-90-9021708-6

VOORDRACHTEN & POSTERS Veen EJ, Ritchie ED, Biesma B, Bolhuis RJ. Pneumonectomie als behandeling voor het niet kleincellig longcarcinoom; morbiditeit, mortaliteit en lange termijn resultaten. Jeroen Bosch Ziekenhuis Poster tijdens Hoytemacursus "Thoraxchirurgie X" 14 december 2007.

Hermans E, Van Schaik PM, Van der Linden JC, Ernst MF, Bosscha K. Are micro-metastases in colonic cancer a predictor for the development of distant metastases? Najaarsvergadering NVvH, Ede, 30 november 2007.

Van Wensen R, Bosscha K, Dautzenberg PLJ, Koek HL, Van Loenhout RMM, Koning OHJ. Delirium na centrale vaatreconstructies. Poster: Najaarsvergadering NVvH, Ede, 30 november 2007.

Hermans E, Van Schaik PM, Van der Linden JC, Ernst MF, Bosscha K. Are micro-metastases in colon cancer a predictor for the development of distant metastases? Najaarsvergadering NVGE / NVGIC, 4-5 oktober 2007, Veldhoven, p. 46.

Kreb DL, Rutten MCJM, Van der Linden JC, Pruijt JFM, Bosscha K. Ultrasound-guided radiofrequency ablation of early breast cancer in a resection specimen: first results of a feasibility study. ECCO 14, Barcelona september 2007, p. 204 Kokke M, Kyriazopoulas A, Rutten MCJM, Ernst MF, Bosscha K. MR imaging in the preoperative asessment of patients with lobular carcinoma of the breast. ECCO 14, Barcelona, september 2007, p. 200.

Kokke M, Ernst MF, Eijkeler F, Van der Linden JC, Barneveld PC, Bosscha K. Axillary recurrence after negative sentinel node procedure in breast cancer patients. ECCO 14, Barcelona, september 2007, p. 220.

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Van Schaik PM, Kouwenhoven EA, Bolhuis RJ, Biesma B, Bosscha K. Pulmonary resection for metastases from colorectal cancer. ECCO 14, Barcelona, september 2007, p. 258.

Van la Parra RFD, Ernst MF, Barneveld PC, Broekman J, Bosscha K. The value of sentinel node biopsy in DCIS(M) of the breast. ECCO 14, Barcelona, september 2007, p. 206.

Van la Parra RFD, Ernst MF, Barneveld PC, Broekman J, Bosscha K. Validation of a nomogram to predict the risk of non-sentinel lymph node metastasis in breast cancer patients with a positive sentinel node biopsy. ECCO 14, Barcelona, september 2007, p. 226.

Hermans E, Van Schaik PM, van der Linden JC, Ernst MF, Gelderman WAH, Bosscha K. Ex-vivo sentinel lymph node mapping in patients with colorectal cancer. ESSR (European Society for Surgical Research) Mei 2007, Rotterdam.

Van Wensen RJA, Rutten MCJM, Olsman JG, Bosscha K. Echografie en CT bij verdenking appendicitis acuta in daily practice. Chirurgendagen, Veldhoven, 2007.

Van la Parra RFD, Ernst MF, Barneveld PC, Broekman J, Bosscha K. Schildwachtklierbiopsie bij DCIS. Pathologendagen, Ede, april 2007.

Van Schaik PM, Kouwenhoven EA, Bolhuis RJ, Biesma B, Bosscha K. Pulmonary resection for metastases from colorectal cancer. 5th Int Congres Lung Cancer, Patras, Griekenland, 24-27 January 2007; 55(1):S10.

Van Geffen HJ Inguinal hernia treatment with the Prolene Hernia System in a Dutch regional training hospital. Plenairy Round Table Discussion of the European Hernia Society. Athene, Mei 2007.

Elferink MAG, Janssen-Heijnen MLG, Schouwink JH, Groen HJ, van Geffen HJAA, Siesling S. Treatment and survival of NSCLC stage I and II in the Netherlands. International Association of Cancer Registries November 2007.

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Kaptein BL, Koning OHJ, Garling EH, Hinnen JW, Hamming JF, Valstar ER, van Bockel JH. Assessment of 3-D stentgraft dynamics using fluoroscopic Roentgen stereophotogrammetric analysis (FRSA). Voordracht, First Dutch Conference on Bio-Medical Engineering, Egmond aan Zee, Jan 2007.

Koning OHJ, Garling EH, Hinnen JW, Kroft LJM, Van der Linden E, Hamming JF, Valstar ER, Van Bockel JH. Accurate Detection of Stent-Graft Migration Using Roentgen Stereophotogrammetric Analysis: A Validation Study. Voordracht, International congress XX endovascular interventions, Scottsdale, AZ, USA, Feb 2007.

Koning OHJ, Garling EH, Hinnen JW, Kroft LJM, Van der Linden E, Hamming JF, Valstar ER, Van Bockel JH. Accurate Detection of Stent-Graft Migration Using Roentgen Stereophotogrammetric Analysis: A Validation Study. Association of International Vascular Surgeons (AIVS), Gresonney, Italie, Mrt 2007.

Koning OHJ, Hinnen JW, van Baalen JM. Technique for safe removal of an aortic endograft with suprarenal fixation. Association of International Vascular Surgeons (AIVS), Gresonney, Italie, Mrt 2007.

Koning OHJ, Garling EH, Hinnen JW, Kroft LJM, Van der Linden E, Hamming JF, Valstar ER, Van Bockel JH. Nauwkeurige Detectie van Endoprothese Migratie met behulp van Röntgen Stereofotogrammetrische Analyse (RSA) in een pulsatiel model. Voordracht, Vaatdagen, Noordwijkerhout, Apr 2007.

Koning OHJ, Garling EH, Hinnen JW, Hamming JF, Valstar ER, Van Bockel JH. Roentgen stereophotogrammetric analysis: practical use in follow-up? Voordracht, 11th International symposium on critical issues in endovascular grafting, Groningen, Juni 2007.

Koning OHJ, van Loenhout RM, Korst M. EVAR, oplossing bij een hardnekkig probleem? Voordracht, EVAR in de lage landen, Florence, Italie, Okt 2007.

Van Schaik PM, van der Linden JC, Ernst MF, Gelderman WAH, Bosscha K. De ex-vivo schildwachtklier procedure bij patiënten met een colorectaal carcinoom. Voorjaarsvergadering Nederlandse Vereniging voor Heelkunde, Veldhoven, 10 mei 2007.

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Van Schaik PM, Gelderman WAH, Kouwenhoven EA, Bosscha K. Laag lokaal recidief percentage met multimodale behandeling voor het distale rectumcarcinoom. Voorjaarsvergadering Nederlandse Vereniging voor Heelkunde, Veldhoven, 10 mei 2007.

Van Schaik PM, van der Linden JC, Ernst MF, Gelderman WAH, Bosscha K. Ex-vivo sentinel lymph node mapping in patients with colorectal cancer. Poster, Nederlandse Pathologendagen, Ede, 10 april 2007.

Van Schaik PM, van der Linden JC, Ernst MF, Gelderman WAH, Bosscha K. De ex-vivo schildwachtklier procedure bij patiënten met een colorectaal carcinoom. Vereniging Analisten Pathologen, UMCU, Utrecht, 24 maart 2007.

DIVERSEN Ernst MF, Interview Vooruitgang. Maart 2007.

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DERMATOLOGIE ARTIKELEN

Blokx WA, Lesterhuis WJ, Andriessen MP, Verdijk MA, Punt CJ, Ligtenberg MJ. CDKN2A (INK4A-ARF) mutation analysis to distinguish cutaneous melanoma metastasis from a second primary melanoma. Am J Surg Pathol. 2007 Apr;31(4):637-41. Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. [email protected] The histologic differential diagnosis between a second primary cutaneous melanoma and cutaneous melanoma metastasis in a patient with a previous history of melanoma can be very difficult. This case report describes the first application of CDKN2A mutation analysis for discriminating a cutaneous melanoma metastasis from a new primary melanoma. In 2005, we received a skin excision of the right arm of a 38-year-old female patient for second opinion. Histologically, we considered the lesion to be a melanoma. The patient had a history of superficial spreading melanoma in the right subclavicular region, with a Breslow thickness of 1.1 mm, in 1998. The morphology showed resemblance to the present melanoma on the right arm, but the differential diagnosis between metastasis or second primary melanoma could not be made with certainty based on histology alone. We decided to perform TP53 and CDKN2A mutation analysis on both tumors. Molecular analysis revealed that both the melanoma of 1998 and of 2005 contained an identical CDKN2A mutation (a deletion in exon 1alpha, c.95_112del (p.Leu32_Leu37del)), which was absent in normal control tissue of the patient, thereby excluding a germline mutation. TP53 mutations were absent in both tumors and in normal skin. Based on these molecular findings the present melanoma on the right arm was diagnosed as a metastasis. Seven months later the patient died of widespread metastatic disease confirming the metastatic nature of the lesion. This case illustrates that molecular analysis can contribute to the sometimes-difficult differentiation between a second primary melanoma and a melanoma metastasis. PMID: 17414113 [PubMed - indexed for MEDLINE]

Koetsier MIA, Blokx WAM, van Dooren-Greebe RJ, Janssens RWA. Atypisch fibroxanthoom. Ned Tijdschr Dermatol Venereol 2007;17:298-301

Lucker GP, Speel EJ, Creytens DH, van Geest AJ, Peeters JH, Claessen SM, Vermeulen AH, Pauwels P, Meulemans EV. Differences in Imiquimod treatment outcome in two patients with bowenois papulosis containing either episomal or integrated human papillomavirus 16. J Invest Dermatol. 2007 Mar;127(3):727-9. Epub 2006 Sep 28. PMID: 17008876 [PubMed - indexed for MEDLINE]

Mul VE, van Geest AJ, Pijls-Johannesma MC, Theys J, Verschueren TA, Jager JJ, Lambin P, Baumert BG. Radiation-induced bullous pemphigoid: a systematic review of an unusual radiation side effect. Radiother Oncol. 2007 Jan;82(1):5-9. Epub 2006 Dec 11.

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Department of Radiation Oncology (MAASTRO), GROW, University Hospital Maastricht, Maastricht, The Netherlands. BACKGROUND: Percutaneous radiotherapy (RT) may cause a range of acute and late side effects of the skin within the irradiated area. In rare cases radiotherapy can cause bullous pemphigoid (BP). BP is reported to occur mainly within irradiated fields following radiation treatment. Exceptionally, BP may arise during RT. It is unclear which mechanism exactly triggers BP following megavoltage irradiation and whether there is a potential association with hormonal anticancer treatment. METHODS: A systematic literature based review was performed. Publications reporting histologically confirmed BP and a treatment with RT were retrieved based on a standardized query using electronic databases. A standardized quality assessment was applied. RESULTS: Out of 306 potentially relevant publications 21 were identified to be relevant and included in this review. An association between RT and BP was reported in 27 patients. The majority developed BP after RT and a median dose of 50 Gy. Four patients developed BP during RT after a minimal dose of 20 Gy. CONCLUSIONS: BP induced by RT was observed predominantly in patients with breast cancer. In all reported cases, there is a clear relationship with RT. Therefore, BP may be considered as RT-induced side effect. RT can induce a BP following a minimal dose of 20 Gy. New biological agents may play a role in the future treatment of BP.


Mul VE, Verschueren TA, van Geest AJ, Baumert BG. Bullous pemphigoid (BP) induced by radiotherapy. Radiother Oncol. 2007 Jan;82(1):105. Epub 2006 Dec 11. PMID: 17161480 [PubMed - indexed for MEDLINE]

Sibelt LA, Lokhorst HM, van de Kerkhof PC, van Dooren-Greebe RJ. A "muscle" man without exercise: muscle pseudohypertrophy in myeloma associated generalized amyloidosis. J Eur Acad Dermatol Venereol. 2007 Aug;21(7):986-8. PMID: 17659017 [PubMed - indexed for MEDLINE]

Van der Linden SG, van Dooren-Greebe RJ, Pop VJ. Leerzame ziektegeschiedenissen: alopecia areata en schildklierfunctie onderzoek: bepaal ook de thyroid peroxidase antistoffen (TPO-Ab)! Ned Tijdschr Derm Venereol 2007;17:270-272.

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GERIATRIE ARTIKELEN

Vd. Meer AC, Dautzenberg PLJ. Allochtonen in de geriatrische gezondheidszorg. Enkele valkuilen. Tijdschrift voor VerpleeghuisGeneeskunde 2007;32:58-61.



Heemskerk MC, Kempenaar MC, Eijkeren van FJM, Oomen WJM, Bakker M, Dautzenberg PLJ. Fysiotherapie voor valpreventie. Nederlands Tijdschrift voor fysiotherapie 2007;117:166-75.

VOORDRACHTEN & POSTERS

Dautzenberg PLJ. Samenwerking geheugenpolikliniek en verpleeghuisarts. Workshop: Nieuwjaars congres Geheugenpoliklinieken, Zeist, 17 januari 2007.

Dautzenberg PLJ, Wouters CJ. Depressie bij ouderen Nascholing huisartsen, Amsterdam, 27 juni 2007.

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Dautzenberg PLJ, Wouters CJ. Depressie bij ouderen Nascholing huisartsen, Zwolle 19 september 2007.

Dautzenberg PLJ, Wouters CJ. Depressie bij ouderen Nascholing huisartsen, Den Haag 27 september 2007.

Dautzenberg PLJ. Jong dementerenden op geheugenpolikliniek. Voordracht jaarlijkse geheugenpolidag, Ede 12 oktober 2007.

Van Wensen R, Bosscha K, Dautzenberg PLJ, Koek HL, Van Loenhout RMM, Koning OHJ. Delirium na centrale vaatreconstructies. Poster, Najaarsvergadering NVvH, Ede, 30 november 2007.

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GYNAECOLOGIE ARTIKELEN Keulers MJ, Hamilton CJCM, Franx A, Evers JLM, Bots RSG. The length of the fertile window is associated with the chance of spontaneous conceiving an omgoing pregnancy in subfertile couples. Hum Reprod. 2007 Jun; 22(6):1652-6, 2007. Epub 2007 Apr 20. Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands. [email protected] BACKGROUND: The period in each menstrual cycle during which sexual intercourse can result in conception is called the "fertile window". Although the fertile window closes on the day of ovulation, little is known about the moment it opens. We defined the first day of normal sperm-mucus interaction as the opening of the fertile window. We hypothesized that length of the fertile window varies between couples and that the number of days the fertile window is "open" is related to the time to spontaneous conception. METHODS Serial post-coital tests and sperm-mucus penetration tests were performed to detect the first normal sperm-mucus interaction day. Ovulation was confirmed by serial ultrasound. Using Cox' regression analysis, we determined whether the fertile window length was associated with time to ongoing pregnancy. This association was expressed in fecundability ratios (FR). RESULTS The fertile window length was determined in 410 subfertile couples. The fertile window length varied among couples from <1 to >5 days. The FR increased with increasing fertile window length and varied between 0.11 (95% CI: 0.03-0.45) for a fertile window of 1 day, to 2.4 (95% CI: 1.1-5.2) for a fertile window of 5 days or more. CONCLUSIONS The longer the fertile window in subfertile couples, the higher is the probability of spontaneously conceiving an ongoing pregnancy.


Dankert T, Kremer JAM, Cohlen BJ, Hamilton CJCM, Pasker-de Jong PCM, Straatman H, van Dop PA. Dutch IUI-study group. A randomised clinical trial of clomiphene citrate versus low dose recombinant FSH for ovarian hyperstimulation in intrauterine insemination cycles for unexplained and male subfertility. Hum Reprod. 2007 Mar;22(3):792-7, 2007. Epub 2006 Nov 16. Department of Obstetrics and Gynecology, Radbound University Nijmegen Medical Center, The Netherlands. [email protected] BACKGROUND: Controlled ovarian hyperstimulation with intrauterine insemination (IUI) is a widely accepted treatment for unexplained and male subfertility. No consensus exists about the drug of first choice to be used as hyperstimulation. This randomized multicentre trial using a parallel design compares the efficacy of clomiphene citrate (CC) with that of recombinant FSH (rFSH). METHODS: Couples with primary unexplained or male subfertility were randomized to receive CC or rFSH for ovarian hyperstimulation. The treatment was continued for up to four cycles unless pregnancy occurred. Cycles with more than three follicles were cancelled. Cumulative pregnancy rates and live birth rates were primary outcomes. Cancellation during treatment and multiple birth rates are secondary outcomes. Results were analysed following the intention-to-treat principle. RESULTS: Seventy couples with male subfertility and 68 couples with unexplained subfertility were included. Seventy-one women received CC, and 67 received rFSH. Twenty-seven pregnancies were observed in the CC group (38%) and 23 in the rFSH group (34.3%) relative risk (RR) 1.11 [95% confidence interval (95% CI) 0.71-1.73]. The live birth rate was 28.2% (20/71) and 26.9% (18/67) for CC and rFSH, respectively, RR 1.05 (95% CI 0.61-1.80). Overall, the live birth rates per cycle were 10% for

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CC-stimulated and 8.7% for rFSH stimulated cycles. The total multiple pregnancy rate was 6.0%. Thirty-five cycles (8.6%) were cancelled because of four or more follicles (CC, n = 17; rFSH, n = 18). CONCLUSIONS: In couples with primary unexplained or male subfertility participating in an IUI program, ovarian hyperstimulation can be achieved by CC or rFSH. No significant difference in live birth rates between CC and rFSH was observed. Being less expensive, CC seems the more costeffective drug and therefore, can be offered as drug of first choice.


Oei AL, Boerman OC, Geurts-Moespot A, van Eerd JE, van Tienoven D, Courtenay-Luck N, Thomas CM, Massuger LF, Sweep FC. Development of ELISAs for quantification of HMFG1-specific human anti-mouse IgG and IgM antibodies. Int J Biol Markers. 2007 Jul-Sep;22(3):167-71. Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Center, 6500 HB Nijmegen, The Netherlands. [email protected] The aim of this study was to develop and validate ELISAs for quantification of HAMA-IgM and HAMA-IgG in serum of patients with ovarian cancer who enrolled in a large international randomized phase III trial of intraperitoneal Yttrium-90-labeled HMFG1 murine monoclonal antibody therapy. The capture antibody of these 2 assays was the murine antibody HMFG1, while mouse anti-human IgM-HRP or mouse anti-human IgG(Fc)-HRP served as tracer antibodies. A pool of HAMA-positive serum samples was used to prepare a series of assay standards and another pool served as reference preparation. The analytical sensitivity of the HAMA-IgM assay was 2.5 arbitrary units per mL (AU/mL) and 4.7 AU/mL for the HAMA-IgG ELISA. Diluted serum samples showed good parallelism with the HAMA-IgM and HAMA-IgG standard dose-response curves. Within-assay coefficient of variation was 7.5% for HAMA-IgM and 6.5% for HAMA-IgG. Between-assay variation was 14.2% for HAMA-IgM and 15.3% for HAMA-IgG. The developed HAMA-IgM and HAMA-IgG ELISAs show satisfactory reliability criteria (sensitivity, parallelism and precision) and are suitable for monitoring of HAMA-IgM and HAMA-IgG responses in ovarian cancer patients. These ELISAs will be used to monitor the development of HAMAs in patients who received radioimmunotherapy with murine HMFG1.


Oei AL, Massuger LF, Oyen WJ. Extraperitoneal leakage as a possible explanation for failure of one-time intraperitoneal treatment in ovarian cancer. Cancer Biother Radiopharm. 2007 Aug;22(4):508-14. Department of Obstetrics and Gynecology, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands. [email protected] We conducted a single-arm study to determine the biodistribution of intraperitoneally (i.p.) administered 90yttrium-labeled murine monoclonal antibody HMFG1 (90Y-muHMFG1) in patients with advanced stage ovarian cancer. Seventeen (17) patients in complete clinical remission for epithelial ovarian cancer were included. After completion of chemotherapy, a mixture of 111indiumlabeled muHMFG1 (imaging) and 90Y-muHMFG1 (therapy) was i.p. administered by a surgically placed, indwelling i.p. catheter. Planar and single-photon emission computed tomography images were recorded to determine the distribution of the study medication during the first 6 days postinjection. Of the first 3 patients, 2 patients had extraperitoneal leakage of up to 50% of the injected dose within 24 hours after injection of the study medication. Extraperitoneal leakage was mainly seen in the retroperitoneal spaces covering the upper and lower quadrant of the abdomen. After adjustments in the procedure, leakage was observed in 2 of the remaining 14 patients. Extraperitoneal leakage of i.p. administered therapy does occur. Such leakage would reduce the locally delivered dose of a drug and could potentially have a negative impact on therapeutic efficacy. Given the potential attraction of

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developing i.p. treatments for intra-abdominal cancer, the observations in this study need to be taken into consideration.


Oei AL, de Hullu JA, Grefte JM, Havenith BP. An enlarged groin node as first manifestation of a malignancy: Don't forget the ovaries. Eur J Obstet Gynecol Reprod Biol. 2008 Jun;138(2):240-2. Epub 2007 Apr 26. PMID: 17466436 [PubMed - indexed for MEDLINE]

Oei AL, Verheijen RH, Seiden MV, Benigno BB, Lopes A, Soper JT, Epenetos AA, Massuger LF. Decreased intraperitoneal disease recurrence in epithelial ovarian cancer patients receiving intraperitoneal consolidation treatment with yttrium-90-labeled murine HMFG1 without improvement in overall survival. Int J Cancer. 2007 Jun 15;120(12):2710-4. Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. This study analyzes the site of disease recurrence in ovarian cancer patients to assess the influence of a single intraperitoneal (IP) administration of yttrium-90-labeled murine monoclonal antibody HMFG1 ((90)Y-muHMFG1) on the pattern of disease recurrence. In a large phase III trial ovarian cancer patients in complete clinical remission with FIGO stage Ic-IV were randomized between standard treatment plus a single IP (90)Y-labeled muHMFG1 versus standard treatment alone after negative second-look laparoscopy. Case report forms of all patients with disease recurrence were reviewed to determine site and date of recurrent disease. In total 447 patients were included in the study with a median follow-up of 3.5 years. Relapse was seen in 104/224 in the active and 98/223 in the control arm. Significantly fewer IP (p < 0.05) and more extraperitoneal (p < 0.05) relapses occurred in the active treatment arm. Time to IP recurrence was significantly longer (p = 0.0019) and time to extraperitoneal recurrence was significantly shorter for the active treatment arm (p < 0.001). The impact of IP radioimmunotherapy on IP relapse-free survival could only be seen in the subgroup of patients with residual disease after primary surgery (HR, 0.31; 95% CI, 0.18 to 0.53; p = 0.002). Although, there is no survival benefit for IP radioimmunotherapy as consolidation treatment for epithelial ovarian cancer, we found an improved control of IP disease, that was offset by increased extraperitoneal recurrences.


Oei AL, Salet-van de Pol MR, Borst SM, van den Berg AP, Grefte JM. "Owl's eye" cells in a cervical smear of a transplant recipient: don't forget to inform the referring physician. Diagn Cytopathol. 2007 Apr;35(4):227-9. Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands. [email protected] Cytomegalovirus (CMV) infected cells in cervical smears are a rare finding but may have severe consequences. We describe the presence of characteristic "owl eye" cells in a conventional cervical smear. Medical history revealed a liver transplantation from a CMV seropositive donor 1 yr earlier. The patient experienced a delayed primary CMV infection 6 mo after transplantation. The current CMV infection was considered to be either a persisting manifestation of that primary infection or a reactivation. Since the patient experienced no clinical symptoms, it was decided to "wait and see". Infections with cytomegalovirus in immunocompromised patients may present with aspecific symptoms, but may lead to severe organ-threatening disease such as acute or chronic transplantation

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loss in transplant recipients. Although in the present case no serious consequences occurred, we stress that it is important to recognize these cells and report this finding promptly to the referring physician to prevent possible severe morbidity. (c) 2007 Wiley-Liss, Inc.


De Reu PAOM, Smits LJM, Oosterbaan HP, Snijders RJM, de Reu- Cuppens MJHA, Nijhuis JG. Gender and parity specific reference charts for fetal size in low risk singleton pregnancies at the start of the third trimester. J Perinat Med. 2007; 35(1); 51-61. Verloskundig Centrum Midden Brabant, Boxtel, Noord Brabant, The Netherlands. OBJECTIVES: To determine fetal growth in low risk pregnancies at the beginning of the third trimester and to assess the relative importance of fetal gender and maternal parity. SETTING: Dutch primary care midwifery practice. STUDY DESIGN: Retrospective cohort study on 3641 singleton pregnancies seen at a primary care midwifery center in the Netherlands. Parameters used for analysis were fetal abdominal circumference (AC), fetal head circumference (HC), gestational age, fetal gender and maternal parity. Regression analysis was applied to describe variation in AC and HC with gestational age. Means and standard deviations in the present population were compared with commonly used reference charts. Multiple regression analysis was applied to examine whether gender and parity should be taken into account. RESULTS: The fetal AC and HC increased significantly between the 27th and the 33rd week of pregnancy (AC r2=0.3652, P<0.0001; HC r2=0.3301, P<0.0001). Compared to some curves, our means and standard deviations were significantly smaller (at 30+0 weeks AC mean=258+/-13 mm; HC mean=281+/-14 mm), but corresponded well with other curves. Fetal gender was a significant determinant for both AC (P<0.0001) and HC (P<0.0001). Parity contributed significantly to AC only but the difference was small (beta=0.00464). CONCLUSION: At the beginning of the third trimester, fetal size is associated with fetal gender and, to a lesser extent, with parity. Some fetal growth charts (e.g., Chitty et al.) are more suitable for the low-risk population in the Netherlands than others.


De Reu PAOM, Snijders RJM, Oosterbaan HP, Smits LJM, de Reu-Cuppens, MJHA, Nijhuis JG. Zijn de in Nederland gebruikte echografische groeicurven vergelijkbaar en correct? Tijdschr v Verlosk. 2007; 32 vol 4: 17-18.

Van de Nieuwenhof HP, Juergens-Borst A, Kemperman FAW, Rijnders RJP. Symptomatische hyponatriëmie na een fluxux postpartum en hysterectomie: differentiaal diagnostische overwegingen. Nederlands Tijdschrift voor Obstetrie en Gynaecologie 2007; 120: 7-10.

Westerhuis ME, Moons KG, van Beek E, Bijvoet SM, Drogtrop AP, van Geijn HP, van Lith JM, Mol BW, Nijhuis JG, Oei SG, Porath MM, Rijnders RJ, Schuitemaker NW, van der Tweel I, Visser GH, Willekes C, Kwee A. A randomised clinical trial on cardiotocography plus fetal blood sampling versus cardiotocography plus ST-analysis of the fetal electrocardiogram (STAN) for intrapartum monitoring. BMC Pregnancy Childbirth. 2007 Jul 26;7:13.

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Department of Obstetrics and Gynaecology, University Medical Center Utrecht, The Netherlands. [email protected] BACKGROUND: Cardiotocography (CTG) is worldwide the method for fetal surveillance during labour. However, CTG alone shows many false positive test results and without fetal blood sampling (FBS), it results in an increase in operative deliveries without improvement of fetal outcome. FBS requires additional expertise, is invasive and has often to be repeated during labour. Two clinical trials have shown that a combination of CTG and ST-analysis of the fetal electrocardiogram (ECG) reduces the rates of metabolic acidosis and instrumental delivery. However, in both trials FBS was still performed in the ST-analysis arm, and it is therefore still unknown if the observed results were indeed due to the ST-analysis or to the use of FBS in combination with ST-analysis. METHODS/DESIGN: We aim to evaluate the effectiveness of non-invasive monitoring (CTG + ST-analysis) as compared to normal care (CTG + FBS), in a multicentre randomised clinical trial setting. Secondary aims are: 1) to judge whether ST-analysis of fetal electrocardiogram can significantly decrease frequency of performance of FBS or even replace it; 2) perform a cost analysis to establish the economic impact of the two treatment options.Women in labour with a gestational age > or = 36 weeks and an indication for CTG-monitoring can be included in the trial.Eligible women will be randomised for fetal surveillance with CTG and, if necessary, FBS or CTG combined with ST-analysis of the fetal ECG.The primary outcome of the study is the incidence of serious metabolic acidosis (defined as pH < 7.05 and Bdecf > 12 mmol/L in the umbilical cord artery). Secondary outcome measures are: instrumental delivery, neonatal outcome (Apgar score, admission to a neonatal ward), incidence of performance of FBS in both arms and cost-effectiveness of both monitoring strategies across hospitals.The analysis will follow the intention to treat principle. The incidence of metabolic acidosis will be compared across both groups. Assuming a reduction of metabolic acidosis from 3.5% to 2.1 %, using a two-sided test with an alpha of 0.05 and a power of 0.80, in favour of CTG plus ST-analysis, about 5100 women have to be randomised. Furthermore, the cost-effectiveness of CTG and STanalysis as compared to CTG and FBS will be studied. DISCUSSION: This study will provide data about the use of intrapartum ST-analysis with a strict protocol for performance of FBS to limit its incidence. We aim to clarify to what extent intrapartum ST-analysis can be used without the performance of FBS and in which cases FBS is still needed. TRIAL REGISTRATION NUMBER: ISRCTN95732366.

PMID: 17655764 [PubMed - indexed for MEDLINE] PMCID: PMC1976105


Hamilton CJCM Van agonist naar antagonist? Gynaecongres Papendal, 8 November 2007.

Kerkhof M. “Dat gaat naar den Bosch toe.” Voortplantingsgeneeskunde, Gynaecologencongres Arnhem, 16 November 2007.

Oei AL ‘Gynaecological surveillance in female members of Lynch syndrome (HNPCC) families is useful with addition of routine microcurettage.’ Poster: ESGO 15th international meeting, Berlijn, Duitsland, 28 Oktober- 1 November 2007.

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Oei AL ”Induction of IgG antibodies to MUC1 improves survival in patients with epithelial ovarian cancer.” Poster: ESGO 15th international meeting, Berlijn, Duitsland, 28 Oktober- 1 November 2007.

Oei AL Clinical and pathological features of metastasis to the ovaries’. Poster: ESGO 15th international meeting, Berlijn, Duitsland, 28 Oktober- 1 November 2007.

Oei AL Surival benefit of human anti-mouse antibodies (HAMA) in patients with epithelial ovarian cancer treated with 90Y-muHMFG1. Poster: ESGO 15th international meeting, Berlijn, Duitsland, 28 Oktober- 1 November 2007.

Oei AL Human anti-mouse antibodies (HAMA) cause transient false CA 125 elevations during monitoring of ovarian cancer patients following intraperitoneal therapy with murine 90YHMFG1. Poster: ESGO 15th international meeting, Berlijn, Duitsland, 28 Oktober- 1 November 2007.

Oei AL Induction of IgG antibodies to MUC1 improves survival in patients with epithelial ovarian cancer. Voordracht: Society of Gynecologic Oncologists (SGO), 38th Annual meeting on women cancer, San Diego, California, USA, 4-7 Maart 2007.

Oei AL Transient false CA-125 elevations caused by human anti-mouse antibodies (HAMA) during monitoring of ovarian cancer patients following a single intraperitoneal administration of monoclonal antibody 90Y-muHMFG1. Poster: Society of Gynecologic Oncologists (SGO), 38th Annual meeting on women cancer, San Diego, California, USA, 4-7 Maart 2007.

Oei AL Induced human anti-mouse antibodies influence survival in patients with epithelial ovarian cancer. Poster: Society of Gynecologic Oncologists (SGO), 38th Annual meeting on women cancer, San Diego, California, USA, 4-7 Maart 2007.

De Reu PAOM, Smits LJM, Oosterbaan HP, de Reu-Cuppens MJHA, Nijhuis JG. Gender and parity specific reference charts for fetal size in low-risk singleton pregnancies at the start of the third trimester.

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Abstractenboek voordrachten en posters 31e Gynaecongres MECC, Maastricht, 7-8 Juni 2007. Tevens Kennispoort Conferentie Amersfoort, 11 December 2007.

De Reu PAOM, Smits LJM, Oosterbaan HP, de Reu-Cuppens MJHA, Nijhuis JG. Predictive value of a single ultrasound early biometry at the onset of the third trimester for the detection of growth deviations at birth. Kennispoort Conferentie Amersfoort, 11 December 2007.

Oosterbaan HP. Eclampsia & HELLP. Voordracht: Managing Obstetric Emergencies & Trauma Course – MOET, Riel, 25 Apr. 2007.

Rijnders RJP. Preconceptiezorg, prenatale screening en prenatale diagnostiek. Bijscholing huisartsen regio Oss/Veghel, Oss, Januari 2007.

Rijnders RJP. Prenatale diagnostiek in het Jeroen Bosch Ziekenhuis. Symposium voor de eerste lijn ter introductie van de prenatale diagnostiek in ’sHertogenbosch. Verkadefabriek ’s Hertogenbosch, Maart 2007.

DIVERSEN

Hamilton CJCM Agonisten-debat: Inleiding (mede-organisator); Slot Zeist, 7 September 2007.

Hamilton CJCM Zwanger worden met hindernissen. Afscheidssymposium Q.Nagtzaam, Klin. Chem. Laboratorium, 28 november 2007.

Oosterbaan HP. [email protected]. NTOG 120:33 (2007)

Oosterbaan HP, Nijhuis JG. Standpunt NVOG: De klinisch verloskundige (www.nvog.nl, 2007).

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INTENSIVE CARE GENEESKUNDE ARTIKELEN

Rovers JM, Louwerse ES, de Jager CPC. Complete recovery from an unusual cause of coma. Intensive Care Med. 2007 Mar;33(3):542-4. Epub 2007 Feb 14. Department of Neurology, St. Elisabeth Hospital, Hilvarenbeekseweg 60, Postbus 90151, 5000 LC, Tilburg, The Netherlands. [email protected] PMID: 17325838 [PubMed - indexed for MEDLINE] PMCID: PMC1915615 Trefwoorden: acute gedisemineerde encephalomyelitis (ADEM), coma

Zuidema X, Duenser MW, Wenzel V, Rozendaal FW, de Jager CPC. Terlipressin as an adjunct vasopressor in refractory hypotension after tricyclic antidepressant intoxication. Resuscitation. 2007 Feb;72(2):319-23. Epub 2006 Nov 22. The Department of Intensive Care Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands. AIM OF STUDY: To report the management of cardiovascular failure refractory to standard catecholamine therapy with terlipressin in a patient with tricyclic antidepressant (TCA) intoxication. CASE REPORT: A 41-year-old woman, with suicidal ingestion of 11.25 g amitriptyline and 1500 mg diclofenac, was admitted to the emergency department. After 30 min in ventricular fibrillation, with ongoing CPR, she regained a potentially perfusing rhythm, but with hypotension refractory to standard catecholamine therapy with adrenaline, 2 microg/kg/min (norepinephrine); adrenaline, 1 microg/kg/min (epinephrine) until 55 min after admission. An injection of 1 mg terlipressin restored mean arterial blood pressure >65 mmHg within 10 min. Ten hours after admission to the intensive care unit, catecholamine support could be withdrawn because of a stable haemodynamic state. Within 7 days, all organ function recovered, and the patient regained full neurological function. CONCLUSIONS: Successful management of cardiovascular failure with terlipressin after TCA intoxication refractory to catecholamines suggests a potential role for terlipressin as an adjunct vasopressor in severely hypotensive patients. PMID: 17123689 [PubMed - indexed for MEDLINE] Trefwoorden: Terlipressine, hypotensie

Schellekens SCM, de Jager CPC, Beutler JJ, Beaumont F, Cohen Tervaert JW. Diffuse alveolar haemorrhage and respiratory insufficiency in a 31-yearr-old-woman. Netherlands Journal Of Critical Care. 2007 Jun; Volume 11, No.3:147-148. Trefwoorden: longbloeding, non-invasieve beademing

Bruns AHW, de Jager CPC. Insuline resistance in critically ill medical patients. Insuline Resistentie. 2007; No.2:19. Trefwoorden: insuline resistentie, intensive care 32

Strobbe L, de Jager CPC, Louwerse ES, Rozendaal FW. Ecstacy-intoxicatie met fatale afloop bij een 22-jarige man. Ned Tijdschr Geneeskd. 2007 Jul 28;151(30):1690-4. Jeroen Bosch Ziekenhuis, locatie Groot Ziekengasthuis, 's-Hertogenbosch. [email protected] A 22-year-old man was admitted to the hospital with an ecstasy (MDMA) intoxication which was accompanied by hyperthermia. The patient developed rhabdomyolysis with hyperkalaemia, hypoglycaemia and acidosis, followed by multiple organ failure with disseminated intravascular coagulation and cerebral oedema. Despite maximal symptomatic treatment, the patient died after 4 days. MDMA is a serotonin agonist but also has noradrenergic and dopaminergic effects. It is a popular drug in the Netherlands among young people and is often wrongly considered to be safe. The occurrence of serious side effects is unpredictable and can have fatal consequences. Especially hyperthermia as a side effect of MDMA is a potentially life-threatening complication. The treatment is mainly symptomatic and consists of cooling, fluids, treatment of electrolyte disturbances, and support for respiration and circulation. The usefulness of dantrolene in the treatment of MDMA-induced hyperthermia is controversial, but for now it is still recommended. PMID: 17725259 [PubMed - indexed for MEDLINE] Trefwoorden: ecstasy, orgaanfalen

Hassink RJ, Baten A, de Jager CPC. Education and imaging. Gastrointestinal: Intrapulmonary feeding tube. J Gastroenterol Hepatol. 2007 Dec;22(12):2360. Intensive Care Unit, Jeroen Bosch Hospital, Tolbrugstraat, RW's-Hertogenbosch, The Netherlands. PMID: 18031402 [PubMed - indexed for MEDLINE] Trefwoorden: sondevoeding, complicatie

Mathoera RB, Wever PC, van den Aker E, de Jager CPC. Necrotising fasciitis caused by invasive group A Streptococcus after trans-obturator placement. Neth J Crit Care 2007 Oct;11(5):267-269. Trefwoorden: fasciitis necroticans, TOT

Duijnhouwer AL, Leuken M, de Jager CPC. A patient with a large periumbilical bruise and acute abdominal pain. Neth J Med. 2007 Nov;65(10):405-6. PMID: 18057468 [PubMed - indexed for MEDLINE] Trefwoorden: Cullen sign, pancreatitis

Zuidema X, de Jager CPC. Terlipressin and tricyclic antidepressant intoxication. Neth J Med. 2007 Sep;65(8):313-4. PMID: 17890795 [PubMed - indexed for MEDLINE] Trefwoorden: terlipressine, werkingsmechanisme

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De Jager CPC, Gemen EFA, Weers-Pothoff G, Mathoera RB, Beaumont F, Walsh IBB, Wever PC. Dynamics of peripheral blood lymphocyte subpopulations in the acute and subacute phase of Legionnaires’ disease, abstract EWGLI 2007, 37. Trefwoorden: lymfocyten subsets, Legionella pneumonie

De Jager CPC, Wever PC. Dynamics of peripheral blood lymphocyte subpopulations in the acute and subacute phase of Legionnaires’ disease. Voordracht: European Working Group on Legionella Infections, Stockholm, 22-th meeting, Stockholm, Zweden, 2-7 June 2007.

De Jager CPC, Haerkens M. Ego’s in de zorg, over crew resource management en de parallellen in de luchtvaart. Lunchbespreking IC 2007.

De Jager CPC. Ik ga naar de markt en koop een koe; het hepato-pulmonale syndroom als verklaring voor langdurig onbegrepen dyspnoe. Lunchbespreking IC 2007.

De Jager CPC. Procalcitonine, een nieuw CRP?; ontsteking markers op de IC in perspectief. Lunchbespreking IC 2007.

Hassink R, de Jager CPC. Een patiënte waar muziek in zit, de complicaties van een sinus vasalva aneurysma met fisteling tussen het rechter atrium en de aorta. Lunchbespreking IC 2007.

Veeken S, de Jager CPC. Een nieuw volkslied; ritmestoornissen en pericardvocht als eerste uitingen van een primair cardiaal non-hodgkin lymfoom. Lunchbespreking IC 2007.

Baten A, Rozendaal FW, de Jager CPC. The X-factor; pulmonale actinomycose bij een immuungecompromiteerde patiënte. Lunchbespreking IC 2007.

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Van Gulik J, van Dorsten F, de Jager CPC. Yellow Submarine; over fulminant leverfalen. Lunchbespreking IC 2007.

Evers J, Rozendaal FW, de Jager CPC. Centrale pontine myelinolyse door een te snelle natriumcorrectie. Lunchbespreking IC 2007.

Rozendaal FW. Maligne Hyperthermie door drugsmisbruik. Symposium: Van Agressieve behandeling tot veilige Zorg. Talent Factory ’s-Hertogenbosch, 12 Okt 2007.

DIVERSEN

De Jager CPC, Wever PC. Infecties rondom de IC. Voorzitter avondsymposium IC, Verkadefabriek, ’s-Hertogenbosch, September 2007.

De Jager CPC Voorzitter necrologiecommissie: Veiligheid in de zorg, symposium JBZ, ervaringen vanuit de Necrologie Commissie, Verkadefabriek, ’s-Hertogenbosch, 2007.

De Jager CPC Dagvoorzitter regionaal IC symposium: Van agressieve behandeling tot veilige zorg. Talent Factory ’s-Hertogenbosch, 12 Okt 2007.

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INTERNE GENEESKUNDE ARTIKELEN

Berends M, Bodewes HW, Netten PM. Rare localisation of air. Neth J Med 2007 May; 65(5):191-5. Department of Internal Medicine, Jeroen Bosch Hospital, location Groot Ziekengasthuis, 'sHertogenbosch, the Netherlands. PMID: 17519516 [PubMed - indexed for MEDLINE]

Camaro C. Different impact of the metabolic syndrome on left ventricular structure and function. Insuline Resistentie Maart 2007; 20.

Duijnhouwer AL, Leuken M, de Jager CPC. A patient with a large periumbilical bruise and acute abdominal pain. Neth J Med. 2007 Nov;65(10):405-6. PMID: 18057468 [PubMed - indexed for MEDLINE]

Erol-Yilmaz A, Atasever B, Mathura K, Lindeboom J, Wilde A, Ince C, Tukkie R. Cardiac resynchronization improves microcirculation. J Card Fail. 2007 Mar;13(2):95-9. Department of Clinical and Experimental Cardiology, University of Amsterdam, Amsterdam, The Netherlands. BACKGROUND: Although it is known that cardiac resynchronization therapy (CRT) in heart failure (HF) patients improves systemic circulation, its acute effects on microcirculation are as yet unknown. Therefore we investigated the sublingual microcirculatory changes in HF patients from CRT and right ventricular (RV) pacing by use of orthogonal polarization spectral (OPS) imaging. METHODS AND RESULTS: Twelve consecutive HF patients with a CRT device and 20 healthy individuals (HI) were included. Acute microcirculatory changes were assessed by functional capillary density (FCD) and capillary velocity (CV) measurement 6 months after CRT. FCD and CV were measured in HF patients sublingually after 15 minutes of programming 1 of 3 pacing modalities in random order (no pacing, RV pacing, and CRT). FCD was significantly higher in HI (11.2 +/- 2.1 cm/cm(2)) compared with HF patients with RV pacing (8.9 +/- 1.9 cm/cm(2); P = .03) and no pacing (8.3 +/- 2.4 cm/cm(2); P = .02). CRT (12.1 +/- 2.2 cm/cm(2)) significantly increased FCD in HF patients compared with RV pacing (8.9 +/- 1.9 cm/cm(2); P = .006) and no pacing (8.3 +/- 2.4 cm/cm(2); P = .008). CV was normal in all patients with or without pacing. CONCLUSIONS: CRT improves microcirculatory function as assessed by OPS imaging.


Curvers WL, Festen HP, Hameeteman W, Meijer GA, Peters FTM, Siersema PD, Tilanus HW, Bergman JJGHM. Huidig beleid bij de surveillance van de barrettslokdarm in Nederland. Ned Tijdschr Geneeskd. 2007 Aug 25;151:1879-84. 36

Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Maag-, Darm- en Leverziekten, Meibergdreef9, 1105 AZ Amsterdam. OBJECTIVE: To gain more insight into current surveillance and treatment of patients with Barrett's oesophagus with the aim of developing new guidelines. DESIGN: Questionnaire. METHOD: In 2004, a questionnaire was sent to 337 physician-endoscopists who were all registered with the Netherlands Society of Gastroenterology. The questionnaire inventoried various aspects of surveillance and treatment of patients with Barrett's oesophagus. RESULTS: Of the 289 respondents (86%), 96% carried out surveillance or had it carried out, on at least a proportion of their patients with Barrett's oesophagus. A total of 258 respondents (89%) carried out the surveillance themselves. An endoscopic indication of the presence of Barrett's oesophagus was, for 31% of the respondents, enough reason to carry out surveillance of this condition irrespective of the results of pathological investigations. 75% applied an age limit for surveillance for Barrett's. The median age limit is 75 years (interquartile distance: 70-75) and 46% of the treating professionals limited themselves to patients who, on the basis of age and co-morbidity, may undergo oesophageal resection. The choice of treatment in early neoplasia, surgical or endoscopic, depends not only on the histological diagnosis, but also on the age and the co-morbidities of the patient. CONCLUSION: Surveillance of Barrett's oesophagus is widespread in the Netherlands, and in general is carried out in accordance with international guidelines. The possibilities of treating patients with high-grade dysplasia or intramucosal carcinoma of the oesophagus endoscopically, and of consulting external advisory bodies are still insufficiently utilized.


Freriks K, Schultze Kool LJ, Timmers HJLM, Deinum J, Lenders JWM, Hermus ARMM. Aldosteronbepaling in bijniervenen voor het vaststellen van enkel- of dubbelzijdige aldosteronoverproductie bij patiënten met primair hyperaldosteronisme. Ned Tijdschr Geneeskd. 2007 May 5;151:1029-34. Universitair Medisch Centrum St. Radboud, Postbus 9101, 6500 HB Nijmegen. In 3 patients, men aged 60, 55 and 60, respectively, with hypertension due to primary hyperaldosteronism, the aldosterone level in the adrenal veins was determined for the purpose of further diagnosis. In two patients, unilateral adrenal enlargement on the CT-scan was accompanied by overproduction ofaldosterone, in one case in a non-enlarged adrenal gland and in the other case in both adrenals. The first patient underwent adrenalectomy of the non-enlarged adrenal gland, while in the second patient surgery was decided against. The third patient had bilateral adrenal gland enlargement on the CT-scan with a surgically treatable, unilateral overproduction ofaldosterone. Now that determination ofthe aldosterone:renin ratio in plasma as a screening method in selected patients with hypertension is being used more often, primary hyperaldosteronism turns out to be more common than was previously thought. For differentiation between unilateral and bilateral overproduction of aldosterone, imaging of the adrenals, for example with CT, is insufficiently accurate. Aldosterone determination in the adrenal veins can distinguish between unilateral and bilateral overproduction of aldosterone with great accuracy, which has important therapeutic consequences.


Freriks K, Beerendonk CCM, Timmermans J, Braat DDM, Hermus ARMM, Timmers HJLM. Het syndroom van Turner op volwassen leeftijd: het belang van multidisciplinaire zorg. Ned Tijdschr Geneeskd. 2007 Jul 21;151(29):1616-22. Afd. Endocriene Ziekten (471), Universitair Medisch Centrum St Radboud, Postbus 910I, 6500 HB Nijmegen. Turner syndrome is the result of the complete or partial absence of one X-chromosome. As well as short stature and gonadal dysgenesis, a wide range of abnormalities which may not present themselves until adulthood, are seen in nearly every organ system. Adult women with this syndrome have a reduced estimated life expectancy due to the greatly increased risk of structural abnormalities of the

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heart and aorta, and of other cardiovascular disease. The latter is due to the higher prevalence of hypertension, type-2 diabetes mellitus and dyslipidaemia. Furthermore, Turner syndrome in adulthood is characterized by infertility and oestrogen substitution is often necessary. Due to the diverse and interconnected nature of these problems, women with Turner syndrome benefit from coordinated medical care provided by a multidisciplinary outpatient team including an internist-endocrinologist, a gynaecologist and a cardiologist. We advise a periodic medical screening of women with this syndrome.

PMID: 17727182 [PubMed - indexed for MEDLINE

Hassink RJ, Franke LJA. Hoogste tijd voor een rookvrije horeca: de argumenten stapelen zich op. Ned Tijdschr Geneeskd. 2007 Feb 24;151(8):488-91. Universitair Medisch Centrum Utrecht, afd. Cardiologie, Utrecht. [email protected] Active and passive smoking are well-known causes of disease, including respiratory and cardiovascular disease and cancer. In 2004 the Dutch government introduced new legislation to regulate smoking in the workplace. However, smoking is still allowed in hotels, bars and restaurants, despite the fact that two-thirds of the Dutch population support a total ban on smoking in public places. Several other European countries and American states have banned smoking in public places. Studies performed in these regions show that the new smoking regulations have had no negative economic effects. Moreover, various studies have shown that smoking bans have a positive impact on public health, even in the short-term, including a significant decrease in respiratory and cardiovascular disease. There is therefore no reason to continue to exclude hotels, bars and restaurants from the smoking ban in all public places in The Netherlands.


Hassink RJ, Baten A, de Jager CPC. Education and imaging. Gastrointestinal: Intrapulmonary feeding tube. J Gastroenterol Hepatol. 2007 Dec;22(12):2360. Intensive Care Unit, Jeroen Bosch Hospital, Tolbrugstraat, RW's-Hertogenbosch, The Netherlands. PMID: 18031402 [PubMed - indexed for MEDLINE] Trefwoorden: sondevoeding, complicatie

Vd Hoeven AM, Scholing M, Wever PC, Fijnheer R, Hermans M, Schneeberger PM. Lack of discriminating signs and symptoms in clinical diagnosis of influenza of patients admitted to the hospital. Infection 2007 Apr;35(2):65-8. Dept. Medical Microbioloy and Infection Control, Jeroen Bosch Ziekenhuis, 90153, 5200, ME's-Hertogenbosch, the Netherlands. [email protected] OBJECTIVES: Rapid diagnosis of influenza in hospitalised patients is important to prevent the transmission of the infection in the hospital. This prospective observational cohort study was designed to determine the relationship between the clinical diagnosis of influenza made by the physician at admission and the presence of influenza virus in patients with respiratory tract infections. METHODS: This prospective observational cohort study was conducted in a large Dutch teaching hospital in a period of four weeks during the influenza season 2004/2005. All patients of 18 years and older, admitted with respiratory tract infections were included in the study. Clinical and laboratory parameters, chest radiograph (CR), blood and sputum cultures and nasopharyngeal swab for polymerase chain reaction (PCR) were obtained for each patient. In addition, the physicians opinion at admission whether this patient had influenza was recorded. RESULTS: A total of 78 patients were hospitalized with respiratory tract infections. In 41 (53%) of them influenza virus was detected by

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PCR. Among the patients that were positive for influenza virus by PCR, a clinical diagnosis of influenza was made in 18 cases (44%). Conversely, clinical diagnosis of influenza was made in 16 out of 37 patients in whom influenza virus was not detected by PCR. Neither C-reactive protein, leucocytes count nor an infiltrate on CR were helpful in determining the cause of the respiratory tract infection. CONCLUSIONS: The present findings failed to demonstrate a significant relationship between the clinical diagnosis of influenza and PCR detection of the virus. Also, the virus was present at least twice more often than influenza was clinically diagnosed. As a consequence, the decision to take protective measures to control spread of the virus should not rely on the clinical diagnosis.


Kemperman FA. Ingezonden brief: Renal function assessment. Ned Tijdschr Geneeskd. 2007 Aug 4; 151(31):1759-60; author reply 1760-1. PMID: 17784706 [PubMed - indexed for MEDLINE]

Van de Nieuwenhof HP, Jeurgens-Borst A, Kemperman FAW, Rijnders RJP. Symptomatische hyponatriëmie na een fluxus postpartum en hysterectomie differentiaaldiagnostische overwegingen. Nederlands tijdschrift voor Obstetrie &Gynaecologie. 2007 Aug;120:7-10.



Strobbe L, Lestrade P, Hermans MHA, Fijnheer R. Detection of the JAK2V617F mutation in patients with slightly elevated platelets or haemoglobin without a secondary cause. Ann Hematol 2007 Nov;86(11): 801-3. Epub 2007 Aug 17. Department of Internal Medicine, Jeroen Bosch Hospital, 5200 ME, 's-Hertogenbosch, The Netherlands. [email protected] Recently, an activating somatic mutation of Janus kinase 2 (JAK2V617F) was identified in the myeloproliferative disorders (MPDs). In this study, we investigated the occurrence of JAK2V617F in patients with slightly elevated platelets or hemoglobin without a secondary cause, who did not meet

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the criteria of polycythemia vera or essential thrombocythemia. Six out of 18 patients (33%) were positive for the JAK2 mutation, and five of these six patients had a history of thrombosis. These findings suggest that apart from thrombocytosis/erythrocytosis, other mechanisms exist that cause thrombosis, and more patients with a latent form of MPD are likely to exist. Future studies will have to elucidate how to treat these patients.


Koopman M, Antonini NF, Douma J, Wals J, Honkoop AH, Erdkamp FL, de Jong RS, Rodenburg CJ, Vreugdenhil G, Loosveld OJ, van Bochove A, Sinnige HA, Creemers GJ, Tesselaar ME, Slee PH, Werter MJ, Mol L, Dalesio O, Punt CJ. Sequential versus combination chemotherapy with capecitabine, irinotecan, and oxaliplatin in advanced colorectal cancer (CAIRO): a phase III randomised controlled trial. Lancet. 2007 Jul 14;370(9582):135-42. Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands. BACKGROUND: The optimum use of cytotoxic drugs for advanced colorectal cancer has not been defined. Our aim was to investigate whether combination treatment is better than sequential administration of the same drugs in patients with advanced colorectal cancer. METHODS: We randomly assigned 820 patients with advanced colorectal cancer to receive either first-line treatment with capecitabine, second-line irinotecan, and third-line capecitabine plus oxaliplatin (sequential treatment; n=410) or first-line treatment capecitabine plus irinotecan and second-line capecitabine plus oxaliplatin (combination treatment; n=410). The primary endpoint was overall survival. Analyses were done by intention to treat. This trial is registered with ClinicalTrials.gov with the number NCT00312000. FINDINGS: 17 patients (nine in the sequential treatment group, eight in the combination group) were found to be ineligible and were excluded from the analysis. 675 (84%) patients died during the study: 336 in the sequential group and 339 in the combination group. Median overall survival was 16.3 (95% CI 14.3-18.1) months for sequential treatment and 17.4 (15.2-19.2) months for combination treatment (p=0.3281). The hazard ratio for combination versus sequential treatment was 0.92 (95% CI 0.79-1.08; p=0.3281). The frequency of grade 3-4 toxicity over all lines of treatment did not differ significantly between the two groups, except for grade 3 hand-foot syndrome, which occurred more often with sequential treatment than with combination treatment (13%vs 7%; p=0.004). INTERPRETATION: Combination treatment does not significantly improve overall survival compared with the sequential use of cytotoxic drugs in advanced colorectal cancer. Thus sequential treatment remains a valid option for patients with advanced colorectal cancer.

PMID: 17630036 [PubMed - indexed for MEDLINE

Van der Spek E, Bloem AC, Sinnige HA, Lokhorst HM. High dose Simvastatin does not reverse resistance to Vincristine, Adriamycin, and Dexamethasone (VAD) in myeloma. Haematologica 2007; Dec;92(12):e130-1. Department of Hematology, University Medical Center Utrecht, the Netherlands. In a prospective phase II study, we evaluated the combination of high dose simvastatin and VAD chemotherapy in patients with refractory or relapsed multiple myeloma. Although treatment was feasible with mild side effects, only 1 of 12 patients achieved a partial response. According to our predefined criteria this was insufficient to continue the study.


Bleeker-Rovers CP, Vos VJ, de Kleijn EM, Mudde AH, Dofferhoff TS, Richter C, Smilde TJ, Krabbe PF, Oyen WJ, van der Meer JW. A Prospective multicenter study onfever of unknown origin: the yield of a structured diagnostic protocol. 40

Medicine (Baltimore). 2007 Jan;86(1):26-38. Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. [email protected] We conducted a prospective study to update our knowledge of fever of unknown origin (FUO) and to explore the utility of a structured diagnostic protocol. From December 2003 to July 2005, 73 patients with FUO were recruited from 1 university hospital (n = 40) and 5 community hospitals (n = 33) in the same region in The Netherlands. FUO was defined as a febrile illness of >3 weeks' duration, a temperature of >38.3 degrees C on several occasions, without a diagnosis after standardized historytaking, physical examination, and certain obligatory investigations. Immunocompromised patients were excluded. A structured diagnostic protocol was used. Patients from the university hospital were characterized by more secondary referrals and a higher percentage of periodic fever than those referred to community hospitals. Infection was the cause in 16%, a neoplasm in 7%, noninfectious inflammatory diseases in 22%, miscellaneous causes in 4%, and in 51%, the cause of fever was not found (no differences between university and community hospitals). There were no differences regarding the number and type of investigations between university and community hospitals. Significant predictors for reaching a diagnosis included continuous fever; fever present for <180 days; elevated erythrocyte sedimentation rate, C-reactive protein, or lactate dehydrogenase; leukopenia; thrombocytosis; abnormal chest computed tomography (CT); and abnormal F-fluorodeoxyglucose positron emission tomography (FDG-PET). For future FUO studies, inclusion of outpatients and the use of a set of obligated investigations instead of a time-related criterion are recommended. Except for tests from the obligatory part of our protocol and cryoglobulins in an early stage, followed by FDGPET, and in a later stage by abdominal and chest CT, temporal artery biopsy in patients aged 55 years or older, and possibly bone marrow biopsy, other tests should not be used as screening investigations.


Strobbe L, de Jager CPC, Louwerse ES, Rozendaal FW. Ecstacy-intoxicatie met fatale afloop bij een 22-jarige man. Ned Tijdschr Geneeskd. 2007 Jul 28;151(30):1690-4. Jeroen Bosch Ziekenhuis, locatie Groot Ziekengasthuis, 's-Hertogenbosch. [email protected] A 22-year-old man was admitted to the hospital with an ecstasy (MDMA) intoxication which was accompanied by hyperthermia. The patient developed rhabdomyolysis with hyperkalaemia, hypoglycaemia and acidosis, followed by multiple organ failure with disseminated intravascular coagulation and cerebral oedema. Despite maximal symptomatic treatment, the patient died after 4 days. MDMA is a serotonin agonist but also has noradrenergic and dopaminergic effects. It is a popular drug in the Netherlands among young people and is often wrongly considered to be safe. The occurrence of serious side effects is unpredictable and can have fatal consequences. Especially hyperthermia as a side effect of MDMA is a potentially life-threatening complication. The treatment is mainly symptomatic and consists of cooling, fluids, treatment of electrolyte disturbances, and support for respiration and circulation. The usefulness of dantrolene in the treatment of MDMA-induced hyperthermia is controversial, but for now it is still recommended. PMID: 17725259 [PubMed - indexed for MEDLINE] Trefwoorden: ecstasy, orgaanfalen

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Beutler J. Renovasculaire Hypertensie, Diagnostiek en behandeling. Internistisch Vasculair Genootschap, Utrecht, 5 februari 2007.

Beutler J. To stent or not to stent in atherosclerotic renovascular disease. Norwegian Soc of Nephrology, Trondheim, Noorwegen, 9 februari 2007.

Beutler J. Nefrologie voor klinisch chemici. Den Bosch, 15 maart 2007.

Beutler J. Waarom en wanneer zoeken naar een atherosclerotische nierarteriestenose. UMC St Radboud, Multidisciplinaire Regionale Vasculaire Refereeravond, 20 maart 2007.

Beutler J. Functional Consequences of Revascularization in Azotemic Renovascular Disease. International Scientific Committee of Radionuclides in Nephrourology (ISCORN). Antalya, Turkije, 11 mei 2007.

Beutler J. Stentplaatsing versus medicamenteuze therapie bij atherosclerotische renovasculaire nierinsufficiëntie. Resultaten van de STAR-studie. Workshop Nefrologie, Papendal 13 December 2007.

Bax L, Mali WPThM, Beutler JJ. STAR trial: medical therapy vs medical therapy and stent for renal artery stenosis to preserve renal function. Cardiovascular and Interventional Radiological Society of Europe, Athens, 9 September 2007.

Thijs AMJ, Beutler JJ, Sinnige HAM. Acute intermittent porphyria and renal insufficiency. Internistendagen, Maastricht, April 2007.

Dekker D, Rozendaal FW, Beaumont F. A breathtakingly tough job. Internistendagen, Maastricht, April 2007.

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Lips J, Hollander AAMJ. Cushing’s syndrome without the cortisol. Internistendagen, Maastricht, April 2007. Ramakers BPC, Conemans JMH, Hollander AAMJ. (Val)acyclovir induced neurotoxicity: two case reports. Internistendagen, Maastricht, April 2007.

Hoogeveen EK, Aalten J, Mallat M, Roodnat J, Borm G, Hoitsma AJ, de Fijter JW. Body mass index pre-renal transplantation is a U-shaped risk factor for Graft failure and death. Internistendagen, Maastricht, April 2007.

Hoogeveen EK Body mass index pre-renal transplantation is a U-shaped risk factor for graft failure and death. Bootcongres Wetenschappelijke Voorjaarsvergadering van de Nederlandse Transplantatie Vereniging, Zeewolde, 30 maart 2007.

Ramakers BPC, Lap C, Toll P, Hoogeveen EK, Pruijt JFM. Azathioprine-allopurinol: a potential fatal combination. Internistendagen, Maastricht, April 2007.

Kemink SAG. Behandeling van hyperthyreoidie in de 1e lijn; NHG standaard Schildklieraandoeningen (M31). Wetenschappelijk programma WDH-DAM nascholingscursus voor huisartsen, Lattrop, 19/1 en 2/2 2007.

Kemink SAG. "Onderweg naar morgen: Diabeteszorg: kwijt of rijk?". WDH-DAM districtsduodagen, Vught, 17 April 2007.

Kemink SAG. Ouderdoms Diabetes. DVN voorlichtingsavond, JBZ, Locatie Carolusziekenhuis, 23 April 2007.

Smilde TJ. Adjuvante en neo adjuvante en palliatieve mogelijkheden bij het mammacarcinoom. Nascholing voor mammacare verpleegkundigen. Vught, 10 Mei 2007.

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Smilde TJ. Solide tumoren, is curatie met chemotherapie mogelijk. Nascholing verpleegkundigen Den Bosch eo. ’s-Hertogenbosch 29 Mei 2007.

Smilde TJ. Als de dood nabij is. Palliatie en begeleiding in de laatste levensfase. Nascholing voor Huisartsen. Vught, Maurick 11 September 2007.

Smilde TJ. Targeted therapy for renal cell cancer. Eindhoven 6 November 2007.

Thijs AMJ, Beaumont F. Extrinsic allergic alveolitis in a young woman induced by a feather pillow. Internistendagen, Maastricht, april 2007.

DIVERSEN

Beutler J. Voorzitter wetenscahppelijke vergaderingen. Workshop Nefrologie, Papendal Papendal 14 December 2007.

Hoogeveen EK, Aalten J, Mallat M, Roodnat JI, Borm G, Hoitsma AJ, de Fijter JW. Body Mass Index pre-Renal Transplantation Is a U-Shaped Risk Factor For Graft Failure And Death. Abstractbook, 19e internistendagen, 2007.

Smilde TJ. Projectgroep implementatie richtlijn palliatieve sedatie. Regio ’s Hertogenbosch-Bommelerwaard, 2007.

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KINDERGENEESKUNDE ARTIKELEN Hoekstra JH. Studies on human rotavirus (HRV) vaccination. J Pediatr Gastroenterol Nutr. 2007 Jan;44(1):157-9. Invited Summary. Department of Paediatrics, Hieronymus Bosch Hospital, 's-Hertogenbosch, The Netherlands. PMID: 17204972 [PubMed] Trefwoorden: rotavirus, vaccinatie.

Van der Ent CK, Hoekstra JH, Rijkers GT. Successful treatment of allergic bronchopulmonary arpergillosis with recombinant anti-IgE antibody. Thorax 2007 Mar;62(3):276-7. Department of Pediatric Respiratory Diseases, University Medical Center Utrecht, KH 01.419.0, PO Box 85090, 3508 AB Utrecht, The Netherlands. [email protected] Allergic bronchopulmonary aspergillosis (ABPA) can cause severe worsening of the respiratory condition in patients with cystic fibrosis. Treatment can result in steroid dependency and serious adverse events. A dramatic and rapid improvement of respiratory symptoms and lung function after a single dose of anti-IgE antibody (omalizumab) in a 12-year-old girl with cystic fibrosis and ABPA is described. This is the first report of this experimental treatment. It suggests an important role for IgE in the pathogenesis of ABPA and offers new therapeutic possibilities.

PMID: 17329558 [PubMed - indexed for MEDLINE] Trefwoorden: cystic fibrosis, anti-IgE therapie.

De Ridder L, Rings EH, Damen GM, Kneepkens CM, Kokke FT, Benninga MA, Hoekstra JH, Gijsbers CF, Escher JC. Infliximab dependency in pediatric Crohn’s disease: long-term follow-up of an unselected cohort. Inflamm Bowel Dis. 2008 Mar;14(3):353-8. Epub 2007 Dec 10. Erasmus Medical Center/Sophia Children's Hospital, Dr. Molewaterplein 60, Rotterdam, Netherlands. [email protected] BACKGROUND: Infliximab is effective for induction and maintenance of remission in Crohn's disease. It is unknown how long patients should be kept on infliximab therapy. The primary aim of this study was to assess duration of effective maintenance therapy and infliximab dependency in pediatric CD patients initially responding to infliximab therapy. METHODS: All pediatric patients treated with infliximab by pediatric gastroenterologists in the Netherlands because of severe luminal or fistulizing CD with initial response to infliximab therapy were reviewed. Duration of therapy, clinical response and adverse events were recorded. RESULTS: Sixty-six CD patients (37 boys) in 10 hospitals were initially responding to infliximab therapy. Mean age at the start of infliximab therapy was 14.5 years (range, 8.1-18.5 years). Mean follow-up since infliximab was started was 41.3 months (range 12-165). In total, 991 infusions were administered. Analysis demonstrates that 15.2% of patients had prolonged response, while 56.1% were infliximab dependent and 28.8% lost response. In total, 10 patients (15.2%) developed an infection during infliximab therapy and 8 (12.1%) had an immediate allergic reaction. CONCLUSIONS: Good clinical response to maintenance infliximab therapy was seen in 70% of patients. Infliximab maintenance therapy seems very effective and safe in

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pediatric CD. However, more than half of the patients in this cohort is dependent on repeated infliximab infusions. The number of infliximab infusions received when patients lost response to infliximab was diverse. There was no statistical difference regarding response to infliximab therapy when started early as compared to later in the course of Crohn's disease.

PMID: 18069674 [PubMed - indexed for MEDLINE] Trefwoorden: ziekte van Crohn, TNF-α blokkerend middel.

Albano F, Ashkenazi A, Gendrel D, Hoekstra JH, Shamir R, Szajewska H, Guarino A. Towards evidence-based ESPGHAN/ESPID guidelines for the management of acute gastroenteritis in children in Europe. J Pediatr Gastroenterol Nutr. 2007;44:O88 Trefwoorden: systematic review, acute gastroenteritis

Hoedemakers RMJ, Hoekstra JH. Cost effective testing of celiac disease with anti-rh tissue transglutaminase antibodies. Clin Chem Lab Med. 2007;45:S336. Trefwoorden: serologische bepalingen, coeliakie.

Hoekstra JH. Rota vaccins: profijt voor velen. Tijdschr Kindergeneesk. 2007: S64. Trefwoorden: rotavirus gastro-enteritis, vaccinatie.

Van de Loo M, Walstra BRJ, Plat AW, de Vries E. Case 2: A five-year-old girl with low-grade fever and pain in the leg. Acta Paediatrica 2007 May;96(5):764-767. Department of Paediatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands. PMID: 17462068 [PubMed - indexed for MEDLINE] Trefwoorden: osteomyelitis, bekken.

Poodt AEJ, de Vries E. Diagnose in beeld (337). Een zuigeling met een bomberende fontanel. (A 5-month-old male neonate presented with a bulging fontanel due to benign external hydrocephalus.) Ned Tijdschr Geneeskd. 2007 Aug 18;51(33):1829. Jeroen Bosch Ziekenhuis, locatie Groot Ziekengasthuis, afd. Kindergeneeskunde, Postbus 90.153, 5200 ME 's-Hertogenbosch. [email protected] PMID: 17874639 [PubMed - indexed for MEDLINE] Trefwoorden: fontanel, hydrocefalus.

Schatorjé EJH, Bruijn M, Op de Coul ME, Busari JOO. Preventie en behandeling van congenitale syfilis. Ned Tijdschr Geneeskd. 2007 Oct 13;151(41):2241-7. Atrium Medisch Centrum, afd. Kindergeneeskunde, Henri Dunantstraat 5, 6401 CX Heerlen, i.s.m. St Lucas Andreas Ziekenhuis in Amsterdam; ANIOS.

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Due to uncertainties about the treatment of their mothers' syphilis infections, in three neonates congenital syphilis was suspected. The mother of the first newborn, a girl, had treated herself for a syphilis infection. The second mother, who gave birth to a son, was treated adequately for her infection, but there was no record of this available at the time of birth. The third mother, who gave birth to a girl, had also been treated for syphilis, but within the month before delivery. None of the neonates had any clinical manifestations of congenital syphilis. These obscurities resulted in serological examination of all three neonates and in treatment in the first and third cases. The reported increase in the incidence of syphilis infections in The Netherlands poses a risk of more cases of congenital syphilis infection in newborns. It is crucial to be aware of the consequences of syphilis infection in the neonate and fetus, and also of the various measures available for its prevention and treatment. In The Netherlands, screening for syphilis is routinely carried out during pregnancy. If a pregnant woman is found to be infected, the therapy of choice is penicillin. The Treponema pallidum agglutination test (TPA) and the venereal disease research laboratory (VDRL) test should be performed on the mother and the newborn after birth. All infants born to seropositive but insufficiently treated mothers require careful physical examinations. Infants with proven infection or with a high index of suspicion should be treated with aqueous crystalline penicillin G for a total of 10 days. After discharge, all infants should be followed up with physical and serological examinations up to the first year of life.


BOEKEN

Hoekstra JH, Kneepkens CMF. Dehydratie door braken en diarree. In: PJE Bindels en CMF Kneepkens. Kindergeneeskunde. Bohn, Stafleu en van Loghum 2007, pp. 241-254. ISBN 978 90 313 47971.


Hoekstra JH. Rotavirus: short and long term complications. ESPGHAN 2007, Barcelona Spanje, 12 mei 2007.

Hoekstra JH. Rota vaccins, profijt voor velen. NVK, Veldhoven, 1 november 2007.

Hoekstra JH. Implementeren van de nieuwe opleidingseisen in de praktijk. STZ O&O bijeenkomst, Amersfoort, 20 november 2007.

Hoekstra JH. EBM richtlijnen voor de behandeling van acute gastro-enteritis in Europa. BeSPGHAN, Antwerpen, België, 1 december 2007.

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Hoekstra JH. Modernisering medische vervolgopleiding. Regionaal overleg revalidatieartsen,’s-Hertogenbosch, 18 december 2007.

De Kort EHM, Hammer SC, van Ditzhuijsen CIM, de Vries E. Uitsluiten koemelkeiwitallergie middels dubbelblinde placebogecontroleerde provocatietest voorkomt onnodige eliminatiediëten ook op de lange termijn. 29e congres Nederlandse Vereniging voor Kindergeneeskunde, Veldhoven, 2007.

Kusters MA, van der Vossen PW, Gemen EF, Wever PC, Peer PG, de Jongh-Leuvenink J, , Porto, Portugal, 2007. de Vries E. Normal CD8+ T-lymphocyte subpopulations after cytomegalovirus infection in children with Down syndrome. Poster: European Society for Paediatric Infectious Diseases Kusters MAA, van der Vossen PW, Gemen EFA, Wever PC, Peer PGM, de Jongh-Leuvenink J, de Vries E. Normale T-celsubpopulaties na CMV-infectie bij kinderen met Down syndroom. Poster: 29e congres Nederlandse Vereniging voor Kindergeneeskunde, Veldhoven, 2007.

Poodt AFout! Bladwijzer niet gedefinieerd., Slabbers G, Driessen G, van der Burg M, de Klein A, van Dongen J, de Vries E. Heterogeneity of TACI mutation in a Dutch family with common variable immunodeficiency. Poster: Nederlandse Vereniging voor Immunologie, Noordwijk, 2007

Poodt AEJ, de Vries E. Stamboomonderzoek bij 2 families met Common Variable Immunodeficiency Disease (CVID). Voordracht: Wetenschapsdag Jeroen Bosch Ziekenhuis, `s-Hertogenbosch, 2007.

Vandewall M, de Vries E, de Boo Th M, Brus F. Kinderen met een hartgeruis op de algemene polikliniek: is een ECG zinvol, ja of nee? Voordracht: 29e congres Nederlandse Vereniging voor Kindergeneeskunde, Veldhoven, 2007.

Eggink A, Milczarek M, Ennen L, Hafmans T, Verstegen R, Dekhuijzen R, Kuppevelt T, Daamen W, Wijnen R. Tissue engineering for diaphragmatic replacement with collagen matrices. Preliminary results. Onderzoek verricht in UMCN. Voordracht: IFMSS congres te Aruba, 1 mei 2007. Trefwoorden: congenitale hernia diafragmatica; tissue engineering.

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Verstegen RHJ, Gemen EFA, van der Vossen PW, de Hingh YCM, Mulder AB, de Vries E. Verlaagde expressie van CD21 op B-lymfocyten bij het syndroom van Down: associatie met verminderde pneumokokkenrespons? Voordracht: NVK congres te Veldhoven, 1 november 2007. Trefwoorden: Syndroom van Down; afweersysteem.

Verstegen RHJ, Gemen EFA, van der Vossen PW, de Hingh YCM, Mulder AB, de Vries E. Verlaagde expressie van CD21 op B-lymfocyten bij het syndroom van Down: associatie met verminderde pneumokokkenrespons? Voordracht: 29e congres Nederlandse Vereniging voor Kindergeneeskunde, Veldhoven, 2007.

De Vries E. The ESID diagnostic protocol. UK-PIN, Leeds, UK, 2007.

De Vries E, Sanders EA. Interactieve Sessie Immunologie. 29e congres Nederlandse Vereniging voor Kindergeneeskunde, Veldhoven, 2007.

Walker JC, Peer P, Hilderink BGM, Liem KD, de Vries E. Neutropenie bij dysmature prematuren: een verhoogde infectiekans of niet? Voordracht: 29e congres Nederlandse Vereniging voor Kindergeneeskunde, Veldhoven, 2007.

DIVERSEN

Hoekstra JH. Reviewer voor Journal of Pediatric Gastroenterology and Nutrition Reviewer voor Nutrition Journal Reviewer voor European Journal of Clinical Nutrition Reviewer voor Tijdschrift voor Medisch Onderwijs

De Vries E. ESID Summer School, Malaga, Spanje.

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KLINISCHE CHEMIE & HEMATOLOGIE ARTIKELEN

Jogems-Kosterman BJM, de Knijff DWW, Kusters GCM, van Hoof JJM. Basal cortisol and DHEA levels in women with borderline personality disorder. J Psychiatr Res. 2007 Dec;41(12):1019-26. Epub 2006 Oct 9. Institute of Mental Health Care, GGZ Oost Brabant, PO Box 632, 5340 AP Oss, The Netherlands. [email protected] Previous research suggests that in borderline personality disorder (BPD) normal stress regulation, with a main role for cortisol, is disturbed. However, most studies were confounded by their lack of attention to co-morbidity. Relevant patient characteristics such as depression, childhood abuse, posttraumatic stress disorder (PTSD) and copying styles were not systematically examined. Moreover, none of the studies incorporated dehydroepiandrosterone (DHEA), a hormone that can antagonize the effects of cortisol. Hence, the present pilot study investigates the basic levels of cortisol and DHEA and the ratio (CDR) between the two hormones in BPD patients. Twenty-two women with BPD and 22 healthy female controls provided two diurnal (8 a.m./8 p.m.) salivary samples. Overall cortisol levels were not significantly increased in the patient group as a whole but only in those patients diagnosed with comorbid PTSD and a history of childhood abuse. The patients' cortisol secretions decreased relatively less steep during the day than it did in the controls. Surprisingly, morning DHEA levels were significantly higher in the patients than in the controls. Moreover, the CDR showed a significantly larger and less favourable increase in the BPD group during the day. In the patients lower levels of DHEA in the evening proved significantly related to a stronger tendency to avoid active problem solving and a lowered inclination to seek social support. The current findings underline the relevance of cortisol and DHEA assessments and the need for further scrutiny of their interplay to foster our understanding of the biological basis of stress regulation in BPD.


Hoedemakers RMJ, Hoekstra JH. Cost effective testing of celiac disease with anti-rh tissue transglutaminase antibodies. Clin Chem Lab Med 2007;45:S336.

Van Geest-Daalderop JH, Hutten BA, Péquériaux NC, de Vries-Goldschmeding HJ, Räkers E, Levi M. Invasive procedures in the outpatient setting: managing the short-acting acenocoumarol and the long-acting phenprocoumon. Thromb Haemost. 2007 Oct;98(4):747-55. Department Thrombosis Service of Laboratory of Clinical Chemistry and Haematology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands. [email protected] Treatment with vitamin K antagonists (VKAs) has to be interrupted when invasive procedures are planned. We compared various methods of interruption in patients on acenocoumarol or phenprocoumon in a prospective study. In patients on acenocoumarol (n = 141), 99 stopped three days before the intervention and 42 stopped two days before. All patients on phenprocoumon (n = 111) received vitamin K two days before the intervention, and 55 of these patients discontinued phenprocoumon, whereas 56 did not stop. In a subset of 30 patients we determined International Normalized Ratios (INRs) and coagulation factors II, VII, X and protein C. The mean INR after stopping acenocoumarol for three days was significantly lower than after two days (1.1 vs. 1.3, p = <0.0001), but its clinical relevance may be trivial. In patients using phenprocoumon, the mean INR on

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the day of the intervention was only slightly lower after stopping the VKAs (1.5 vs. 1.6, p = 0.0407), but a similar proportion of patients had an INR

Van Geest-Daalderop JH, Hutten BA, Péquériaux NC, Haas FJ, Levi M, Sturk A. The influence on INRs and coagulation factors of the time span between blood sample collection and intake of phenprocoumon or acenocoumarol: consequences for the assessment of the dose. Thromb Haemost. 2007 Oct;98(4):738-46. Department Thrombosis Service of Laboratory of Clinical Chemistry and Haematology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands. [email protected] Managing treatment with vitamin K antagonists, the prothrombin time (PT), expressed as international normalized ratio (INR), may not represent the INR during the entire 24 hour (h) period, and this variation may be different between long-acting phenprocoumon and short-acting acenocoumarol. For both drugs we investigated the variation in 24 h of the PT/INR, the consequencesfor the assessment of the doses and which vitamin K-dependent factor causes the daily variation. Patients on selfmanagement took their medication at 6 p.m. and determined their INRs for eight weeks, once a week and three times daily (8.30 a.m., 6 p.m. and 11 p.m., thus 14.5 h, 24 h and 29 h after taking the medication, respectively). Acenocoumarol showed a significant variation in INRs over the 24 h period, with 22 out of 80 INRs >20% lower at 11 p.m. versus 8.30 a.m. Phenprocoumon showed only few variations. Patients managed by the anticoagulation clinic took their medication at 6 p.m. for four weeks and then at 8 a.m. for four weeks, 15 h and 25 h, respectively, before the weekly blood collection. PT/INR and coagulation factors VII, X and II were determined. With acenocoumarol, taken 25 h before blood collection, the INRs were significantly different compared to 15 h, especially attributed to plasma levels of factor VII. Those on phenprocoumon were equal. These variations of INRs during 24 h may have major effects on the prescribed dose of short-acting vitamin K antagonists, such as acenocoumarol, especially for INRs at the limits of the therapeutic ranges.



Kusters MA, van der Vossen PW, Gemen EF, Wever PC, Peer PG, de Jongh-Leuvenink J, de Vries E. Normal CD8+ T-lymphocyte subpopulations after cytomegalovirus infection in children with Down syndrome. Poster: European Society of Pediatric Infectious Diseases, April 2007.

Kusters MA, van der Vossen PW, Gemen EF, Wever PC, Peer PG, Geraarts-Peters K, de Jongh-Leuvenink J, de Vries E. Normale T-cel subpopulaties na CMV- infectie bij kinderen met Down syndroom, ondanks veranderde afweer. Poster: Nederlandse Vereniging voor Kindergeneeskunde, 01 november 2007.

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Meijer RP, Arentsen HC, Gemen EFA, v Onna IEW, vd Linden JC, Beerlage HP, Kusters GCM. De waarde van een Artificieel Neuraal Netwerk bij de besluitvorming rond de prostaatbiopsie Voordracht door Arentsen HC: Nederlandse Vereniging voor Urologie, Oktober 2007.

De Jager CPC, Gemen EFA, Weers-Pothoff G, Mathoera RB, Beaumont F, Walsh IBB, Wever PC Dynamics of peripheral blood lymphocyte subpopulations in the acute and subacute phase of Legionnaires’ disease. Voordracht: European Working Group for Legionella Infections, Stockholm, 3 Juni 2007.

Verstegen RHJ, Gemen EFA, van der Vossen PW, de Hingh YCM, Mulder AB, de Vries E. Verlaagde expressie van CD21 op B-lymfocyten bij het syndroom van Down: associatie met verminderde pneumokokkenrespons? Voordracht: Nederlandse Vereniging voor Kindergeneeskunde, 01 november 2007.

Hoedemakers RMJ, Hoekstra JH. (Cost) effective testing of celiac disease with antihuman recombinant tissue transglutaminase antibodies. Poster: IFCC Euromedlab, Amsterdam, 3-7 juni 2007.

Hoedemakers RMJ. Mogelijke rol van hepcidine in anemie Voordracht: regio klinisch chemici zuid-oost Brabant, 2007.

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KNO ARTIKELEN

De Visscher AVM. De granulaire celtumor van de tong. Ned. Tijdschr. KNO Heelk. 2007 Apr;13(2):75-77.


Balter SGT. “Otologie; otitis externa”. Voordracht: Duodagen Huisartsen te Lattrop. 2 februari 2007.

53

LONGZIEKTEN ARTIKELEN

Janssen-Heijnen MLG, Lemmens VEPP, van den Borne BEEM, Biesma B, Oei SB, Coebergh JWW. Negligible influence of comorbidity on prognosis of patients with small cell lung cancer: a population-based study in the Netherlands. Crit Rev Oncol Hematol; 2007 May;62(2):172-78, 2007. Epub 2007 Jan 2. Eindhoven Cancer Registry, Comprehensive Cancer Centre South, P.O. Box 231, 5600 AE Eindhoven, The Netherlands. [email protected] Management of small cell lung cancer (SCLC) among elderly is complex because of decreased organ functions and interactions with comorbidity. Since elderly patients are often excluded from clinical trials, little is known about the way they are treated and outcome.We evaluated the prognostic effects of rising age and comorbidity in unselected Dutch SCLC patients (Eindhoven Cancer Registry). Elderly patients received chemotherapy less often and the dose was also reduced more often. Cardiovascular diseases, hypertension or diabetes lowered the proportion receiving combined chemotherapy and radiotherapy among patients with limited disease. About 80% of the patients receiving chemotherapy suffered from a side effect, which was not related to age. After adjustment for age, gender, stage and treatment modality, comorbidity had a negligible prognostic effect. Chemotherapy (in combination with radiotherapy) seemed to improve survival, however, toxicity and quality of life in these patients should be evaluated thoroughly in future randomized studies.


Van Meerbeeck JP, Kramer GWPM, Van Schil PEY, Legrand C, Smit EF, Schramel F, TjanHeijnen VC, Biesma B, Debruyne C, van Zandwijk N, Splinter TAW, Giaccone G. European Organisation for Research and Treatment of Cancer-Lung Cancer Group. Randomized controlled trial of resection versus radiotherapy in stage IIIA-N2 non-small cell lung cancer. J Natl Cancer Inst. 2007 Mar 21;99(6):442-50, 2007. Department of Respiratory Medicine, 7K12IE, University Hospital Ghent, De Pintelaan 185, 9000 Gent, Belgium. [email protected] BACKGROUND: Induction chemotherapy before surgical resection increases survival compared with surgical resection alone in patients with stage IIIA-N2 non-small-cell lung cancer (NSCLC). We hypothesized that, following a response to induction chemotherapy, surgical resection would be superior to thoracic radiotherapy as locoregional therapy. METHODS: Selected patients with histologic or cytologic proven stage IIIA-N2 NSCLC were given three cycles of platinum-based induction chemotherapy. Responding patients were subsequently randomly assigned to surgical resection or radiotherapy. Survival curves were estimated using Kaplan-Meier analyses from time of randomization. RESULTS: Induction chemotherapy resulted in a response rate of 61% (95% confidence interval [CI] = 57% to 65%) among the 579 eligible patients. A total of 167 patients were allocated to resection and 165 to radiotherapy. Of the 154 (92%) patients who underwent surgery, 14% had an exploratory thoracotomy, 50% a radical resection, 42% a pathologic downstaging, and 5% a pathologic complete response; 4% died after surgery. Postoperative radiotherapy was administered to 62 (40%) of patients in the surgery arm. Among the 154 (93%) irradiated patients, overall compliance to the radiotherapy prescription was 55%, and grade 3/4 acute and late esophageal and pulmonary toxic effects occurred in 4% and 7%; one patient died of radiation pneumonitis. Median and 5-year overall survival for patients randomly assigned to resection versus radiotherapy were 16.4 versus 17.5 months and 15.7% versus 14%, respectively (hazard ratio = 1.06, 95% CI = 0.84 to 1.35). Rates of

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progression-free survival were also similar in both groups. CONCLUSION: In selected patients with pathologically proven stage IIIA-N2 NSCLC and a response to induction chemotherapy, surgical resection did not improve overall or progression-free survival compared with radiotherapy. In view of its low morbidity and mortality, radiotherapy should be considered the preferred locoregional treatment for these patients.


Van Schaik PM, Kouwenhoven EA, Bolhuis RJ, Biesma B, Bosscha K. Pulmonary Resection for Metastases from Colorectal Cancer. J Thorac Oncol. 2007 Jul;2: 652-656. Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands. [email protected] INTRODUCTION: The lung is the most common extraabdominal site for metastases from colorectal cancer. Patients with untreated metastatic disease have a median survival of less than 10 months and a 5-year survival of less than 5%. The purpose of this study was to evaluate long-term survival in patients who underwent pulmonary resection for metastases from colorectal cancer. METHODS: Between January 1990 and January 2005, 23 patients underwent 29 operations for resection of lung metastases. RESULTS: Median age was 68 years (range: 46-80 years). Median follow-up was 30 months (range: 12-149 months). The 2- and 5-year overall survival rates were 64 and 26%, respectively. Of the 23 patients, 16 patients had a solitary lesion, and seven patients had multiple lesions. The 5-year survival rates were 23 and 33%, respectively (not significant). The median diseasefree interval (DFI)--the interval between colon resection and the appearance of lung metastases--was 43 months (1-168). Ten patients had DFIs <36 months, and 13 patients had DFIs >36 months. The 3year survival rates were 20 and 38%, respectively (not significant). Recurrence of lung metastases was diagnosed in seven patients; three patients underwent second resections. They are alive today, with a median follow-up of 18 months. Patients who did not undergo second resections had a median survival of 12 months. CONCLUSIONS: Pulmonary resection for metastases from colorectal cancer does produce longer survival, even in patients with multiple lesions and recurrent metastases.


Schans vd SAM, Janssen-Heijnen MLG, Biesma B, Smeenk FWJM, Poll vd-Franse LV, Seynave C, Coebergh JWW. COPD in cancer patients: higher prevalence in the elderly, a different treatment strategy in case of primary tumours above the diaphragm, and a worse overall survival in the elderly patient. Eur J Cancer; 2007 Oct ;43(15): 2194-2202, 2007. Epub 2007 Sep 19. Eindhoven Cancer Registry, Comprehensive Cancer Centre South, PO Box 231, 5600 AE Eindhoven, The Netherlands. [email protected] The purpose of this study was to document the influence of chronic obstructive pulmonary diseases (COPD) on stage at diagnosis, treatment strategy, and survival for unselected cancer patients (35 years and older) diagnosed between 1995 and 2004 in the Eindhoven Cancer Registry. Follow-up of all patients was complete up to January 1st, 2006. Twelve percent of all cancer patients had COPD at the time of cancer diagnosis, being about 15% in elderly patients (65+) and up to 30% among lung cancer patients, middle-aged males and all females with oesophageal and laryngeal cancer, and middle-aged women with renal cancer. Stage at diagnoses was not significantly different between cancer patients with or without COPD, except for lung cancer patients who were diagnosed at an earlier stage. Nevertheless, non-small cell lung cancer (NSCLC) patients with COPD less frequently underwent surgery, and chemotherapy, and more often radiotherapy. In the presence of COPD, women with oesophageal cancer underwent surgery less often, and patients with laryngeal cancer received radiotherapy more often. The effect of COPD on the type of oncological treatment was not different for middle-aged (35-64 years) and elderly cancer patients. In a multivariate Cox-regression model,

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COPD was associated with a significantly worse survival, especially for elderly patients with colon, rectum, larynx, prostate or urinary bladder cancer. In conclusion, not surprisingly, COPD is related with age and smoking-associated tumours. Therapy of cancer patients with COPD was different for head and neck tumours and primary tumours in the chest organs (above the diaphragm), for whom radiotherapy, as an alternative treatment option, was available. As COPD, especially at older age, is frequently associated with a worse prognosis, further prospective investigation of interactions seems warranted. Further, closer involvement of pulmonologists and COPD nurses in elderly cancer patients might be warranted.


De Jong WK, Groen HJ, Koolen MG, Biesma B, Willems LN, Kwa HB, van Bochove A, van Tinteren H, Smit EF. Phase III study of cyclophosphamide, doxorubicin, and etoposide compared with carboplatin and paclitaxel in patients with extensive disease small-cell lung cancer. Eur J Cancer. 2007 Nov ; 43(16):2345-50. Epub 2007 sep 10. Department of Pulmonology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands. The progression-free survival (PFS) of cyclophosphamide/doxorubicin/etoposide (CDE) and carboplatin/paclitaxel (CP) was compared in chemonaive patients with extensive disease small-cell lung cancer (ED-SCLC). A total of 203 patients were randomised to three-weekly CDE (n=102) or CP (n=101) for five cycles. Tumour response rates in CDE and CP were 60% and 61%. PFS of CP was 5.2 months, PFS of CDE 4.9 months (p=0.60). The major difference in toxicity between CDE and CP was grade 4 leukocytopaenia in 64% and 9% of the patients (p<0.0001), leading to febrile neutropaenia in 30% and 4% of the patients (p<0.0001), respectively. This was the reason for differences in the total number of hospital admissions (63 for CDE and 40 for CP, p=0.0025). This study failed to demonstrate any benefit in PFS with CP compared with CDE. CP was associated with significantly less haematological toxicity, leading to 37% less hospital admissions for febrile neutropaenia.


Biesma B, van de Werf PR, Melissant CF, Brok RG. Anaemia management with epoetin alfa in lung cancer patients in The Netherlands. Lung Cancer. 2007 Oct;58(1):104-11. Epub 2007 Jun 29. Jeroen Bosch Hospital, Department of Pulmonary Diseases, Tolbrugstraat 11, 5211 RW 'sHertogenbosch, The Netherlands. [email protected] Anaemia seriously threatens the quality of life (QOL) in cancer patients receiving chemotherapy. In this article results are presented on the lung cancer population from a Dutch observational study. This study addressed the real-life situation of recombinant human erythropoietin (r-Hu-EPO or epoetin alfa) treatment in anaemic cancer patients receiving chemotherapy, with a focus on efficacy. In total 781 patients were enrolled in the observational study, including 382 patients with lung cancer. At enrolment patients were receiving epoetin alfa treatment and/or patients had a haemoglobin (Hb) level
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reached, the epoetin alfa treatment could not fully correct the Hb decrease which had taken place during chemotherapy before the start of epoetin alfa, resulting in suboptimal Hb levels. In contrast, early intervention with epoetin alfa (start in first week of chemotherapy at Hb>11.3g/dl) was especially effective for NSCLC patients where it resulted in a stabilization of Hb at baseline level. For SCLC patients this strategy was less effective. Furthermore, early intervention seemed to diminish the need for a blood transfusion, i.e., the higher the Hb at epoetin initiation the more patients did not receive any blood transfusion. Results from this observational study demonstrate that epoetin alfa treatment corrects chemotherapy-related anaemia in both NSCLC as well as SCLC patients. Early epoetin alfa intervention seems advantageous for lung cancer patients both in terms of maintaining adequate Hb levels during chemotherapy as well as reducing transfusions.


Rijswijk v HNAJ, Biesma B. Is postoperatieve chemotherapie bij stadium Ib discutabel?. Longartsen Vademecum, 10: 22, 2007.

Rijswijk v HNAJ, Biesma B. Is postoperatieve chemotherapie bij stadium Ib discutabel?. Oncologie Vademecum, 4: 13, 2007.

Van den Bosch J, van de Werf PR, Sleeboom HP, Biesma B, Kerkhofs LGM, Mol JJ, Ten Velde GPM, Melissant CF. Anemiemanagement met epoëtine alfa bij kankerpatiënten - een weergave van de Nederlandse praktijk. Ned Tijdschr voor Oncol; 4: 351- 60, 2007.


Schaik v P, Kouwenhoven E, Bolhuis RJ, Biesma B, Bosscha K. Pulmonary resection for metastases from colorectal cancer. Lung Cancer; 55 (suppl 1): s10, 2007.

Wymenga ANM, Biesma B, Vincent A, Dalesio O, Stigt JA, Smit HJM, Groen HJM. Can baseline Complete Geriatric Assessment (CGA) predict toxicity in elderly non-small cell lung cancer (NSCLC) patients (pts) receiving combination chemotherapy ?. Results from the first 100 pts in the prospective multicenter NVALT-3 study. Proc Am Soc Clin Oncol, 25 (18s): 7537, p 393s, 2007.

Scagliotti G, Kaiser C, Biesma B, Manegold C, Gatzemeier U, Serwatowski P, Syrigos K, Balint B, Smit HJ, Vansteenkiste J. Correlations of biomarker expression and clinical outcome in a large phase III trial of pemetrexed plus cisplatin or gemcitabine plus cisplatin in chemonaive patients with locally advanced or metastatic non-small cell lung cancer (NSCLC). J Thorac Oncol, 2 (suppl 4): s375, 2007.

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Scagliotti G, Purvish P, von Pawel J, Biesma B, Vansteenkiste J, Manegold C, Simms L, Sugarman K, Obasaju C, Blatter J. Phase III study of pemetrexed plus cisplatin versus gemcitabine plus cisplatin in chemonaive patients with locally advanced or metastatic non-small cell lung cancer (NSCLC). J Thorac Oncol, 2 (suppl 4): s306, 2007.

Goss G, Ferry D, Laurie S, Wierzbicki R, Thompson J, Biesma B, Duffield E, Ghiorghiu S, Zarenda M, Armour A. Randomized, double-blind, multicenter, parallel-group, phase II study of gefitinib (IRESSA) plus best supportive care (BSC) versus placebo plus BSC in chemotherapynaïve patients with advanced non-small-cell lung cancer and poor performance status (INSTEP). J Thorac Oncol, 2 (suppl 4): s340, 2007.

Ramlau R, Bennouna J, Tan EH, Biesma B, Santoro A, Boni C, Klein H, Lesniewski K, Mesia R, Gatzemeier U. Phase III study of vinflunine versus docetaxel in patients (pts) with advanced or metastatic non-small cell lung cancer (NSCLC) previously treated with a platinum containing regimen. J Thorac Oncol, 2 (suppl 4): s317, 2007.

Biesma B, Wymenga MN, Vincent A, Dalesio O, Stigt JA, Smit HJM, Groen HJM. A randomized phase III study of carboplatin-gemcitabine (CG) versus carboplatinpaclitaxel (CP) in elderly patients (pts) with advanced non-small cell lung cancer (NSCLC) with emphasis on geriatric assessment and quality of life (QoL): The NVALT-3 study. J Thorac Oncol, 2 (suppl 4): s667, 2007.

Ferry D, Goss G, Wierzbicki R, Thompson J, Biesma B, Duffield E, Ataman O, Zarenda M, Armour A. Gefitinib (IRESSA) plus best supportive care (BSC) versus placebo plus BSC in chemotherapy-naïve patients with advanced (stage IIIB-IV) non-small-cell lung cancer (NSCLC) and poor performance status (PS): a Phase II, randomised, double-blind, multicentre, parallel-group study (INSTEP). Presented at National Cancer Research meeting Birmingham, UK, 30 September-3 October, 2007.

Biesma B. Chemotherapie voor ouderen: een andere groep, een andere behandeling?. Plenaire vergadering Werkgroep Oncologie Datamanagers. Veldhoven, 24 mei 2007.

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Biesma B. (Neo)-adjuvante chemotherapie bij stadium I-IIIa NSCLC. Curriculum AIO’s Longziekten NVALT, Utrecht, 30 mei 2007.

Biesma B. COPD, wat moet ik er mee?. Bosch Medisch Curriculum, geaccrediteerde nascholing huisartsen. Vught, 19 Juni 2007.

Biesma B. Highlights WCLC Seoul. Noord Brabantse Longartsen Vereniging, Den Bosch, 18 Oktober 2007.

Biesma B. COPD, nieuwe NHG standaard 2007. Bossche huisartsen, Den Bosch, 15 November 2007.

Biesma B. Highlights WCLC Seoul. Gelderse Longartsen Vereniging, Rozendaal, 11 December 2007.

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MEDISCHE MICROBIOLOGIE ARTIKELEN

Renders NHM, Janssen MH, Leenders AC. Clindamycine niet geschikt voor empirische behandeling van infecties veroorzaakt door MRSA afkomstig van varkens. Ned Tijdschr Geneeskd. 2007 Oct 13;151(41):2277-80. Jeroen Bosch Ziekenhuis, afd. Regionaal Laboratorium Medische Microbiologie en Infectiepreventie, Tolbrugstraat 11, 5200 ME's-Hertogenbosch. [email protected] OBJECTIVE: To determine the antibiotic sensitivity of methicillin-resistant Staphylococcus aureus (MRSA) isolated from persons in contact with pigs. DESIGN: Retrospective. METHOD: The pigrelated MRSA collection, built up between January 1st 2003 and November 30th 2006 in the Regional Laboratory for Medical Microbiology and Infection Prevention (RLMMI) of the Jeroen Bosch Hospital, Den Bosch, The Netherlands, was tested for sensitivity to a large number ofantibiotics. RESULTS: A total of 65 isolates were obtained from 53 patients. All (100%) of the pig-related MRSA isolates were sensitive to vancomycin, teicoplanin, nitrofurantoin, rifampicin, linezolid, and quinupristin-dalfopristin. Variable sensitivity was found for erythromycin (40%), clindamycin (48%), cotrimoxazole (48%), aminoglycosides (92%), tetracycline (6%), and quinolones (94%). CONCLUSION: In view of the sensitivities found, clindamycin does not seem suitable for the empirical therapy ofpig-related MRSA-infections. In case of severe infection, therapy should be started either with an intravenous glycopeptide or with oral ciprofloxacin, possibly combined with rifampicin or linezolid.


Leenders ACAP. Niet typeerbare MRSA, varkens MRSA, MRSA door vee, wat moet ik ermee? Labcontact 2007; 8:3-4.

Leenders ACAP, Janssen M, Renders NHM, Pelk M. Varkens-MRSA op pluimveebedrijf? Infectieziektebulletin 2007; 18:43-4.

Morroy G, Renders NHM. Een cluster van PVL-positieve community associated-MRSA rond een schoonheidsspecialiste. Infectiebulletin 2007, jaargang 18 (7):232-233.

Herremans M, Vennema H, Bakker J, van der Veer B, Duizer E, Benne R, Waar K, Hendrixks B, Schneeberger P, Blaauw G, Kooiman M, Koopmans MP. Swine-like hepatitis E viruses are a cause of unexplained hepatitis in the Netherlands. Journal of viral hepatitis. J Viral Hepat. 2007 Feb;14(2):140-6.

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National Institute for Public Health and the Environment, Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, Bilthoven, The Netheralnds. [email protected] Hepatitis E virus (HEV) infections in developed countries are recognized as an imported disease related to travel to endemic regions. However, increasing evidence suggests that HEV infection may also occur in the developed countries and that swine may act as a possible reservoir. To investigate the indigenous transmission of HEV in the Netherlands, sera from 50 blood donors and 1027 sera from patients with acute hepatitis were screened with an ELISA for HEV-specific IgG and IgM. Because the Netherlands is considered a nonendemic region, all positive ELISA results were confirmed by immunoblot to exclude false-positive results. Evidence of recent HEV infection was detected in 0% of the blood donors and 4.4% of the cases, based on combined positive IgM and IgG responses. The serodiagnosis was confirmed by a positive polymerase chain reaction (PCR) in 24 patients with hepatitis (2.3% overall, 51% of confirmed IgM+/IgG+ cases). IgG antibodies alone were detected in 4.2% of patients. We found related sequences to virus strains detected in Dutch pigs (genotype 3, 9197% homology) in 89% of PCR-confirmed HEV patients. The detection of unique swine-like HEV sequences in 16 indigenous hepatitis patients without a recent travel history suggests that HEV is endemic in the Netherlands. We recommend including HEV tests in unexplained acute hepatitis patients, despite their travel history.


Huijsmans CJ, Heilman FG, van der Zanden AG, Schneeberger PM, Hermans MH. Single Nucleotide Polymorphism (SNP) profiling assay to exclude serum sample mix-up. Vox Sang. 2007 Feb;92(2):148-53. Molecular Diagnostics, Jeroen Bosch Hospital, 5200 ME 's-Hertogenbosch, The Netherlands. BACKGROUND AND OBJECTIVES: Sample mix-ups are a threat to the validity of clinical laboratory test results. To detect serum sample mix-ups we developed a single nucleotide polymorphism (SNP) profiling test. SNPs are frequent sequence variations in the human genome. Each individual has a unique combination of these nucleotide variations. MATERIALS AND METHODS: Predeveloped SNP amplification assays are commercially available. We recently discovered that these SNP assays could be applied to serological samples, which is not self-evident because a key step in serum preparation is removal of white blood cells, the major source of DNA, from blood. DNA was extracted from serum samples. Real-time polymerase chain reaction (PCR) analysis of the purified DNA using a selection of 10 SNP assays provided SNP profiles. RESULTS: The applicability of the SNP profiling test was demonstrated by means of a case where hepatitis E virus serological determinations of four serum samples of one patient seemed inconsistent. SNP profiling of the samples demonstrated that this was due to the enzyme-linked immunosorbent assay test instead of sample mix-up. CONCLUSION: We have developed an SNP profiling assay that provides a way to link human serum samples to a source, without post-PCR processing. The chance for two randomly chosen individuals to have an identical profile is 1 in 18 000. Solving potential serum sample mix-ups will secure downstream evaluations and critical decisions concerning the patients involved.


Scholing M, Schneeberger PM, van den Dries P, Drenth JP. Clinical features of liver involvement in adult patients with listeriosis. Review of the literature. Infection. 2007 Jun;35(4):212-8. Epub 2007 Jul 23. Department of Medical Microbiology and Infection Control, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. Clinical features of liver involvement due to Listeria monocytogenes infection in adults are rarely reported in literature. This is surprising, regarding the current opinion that the portal system is

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extensively involved in the first stages of pathogenesis in invasive L. monocytogenes disease. A literature search in the PubMed and Embase database revealed 34 cases with clinical features of hepatic involvement due to listeriosis. We systematically analyzed all case reports with respect to clinical manifestations, treatment and outcome. In addition, we added clinical information on a patient diagnosed with a solitary liver abscess due to L. monocytogenes, who was seen at our institution. This review describes the different presentations of liver-involvement reported in listeriosis; solitary liver abscess, multiple liver abscesses and diffuse or granulomatous hepatitis. Distinction between these different forms of liver involvement is clinically relevant as they have a different outcome. We delve into the different pathogenic events leading to different forms of liver involvement. In addition, diagnostic modalities and possible treatments are reviewed.


Van der Hoeven AM, Scholing M, Wever PC, Fijnheer R, Hermans M, Schneeberger PM. Lack of discriminating signs and symptoms in clinical diagnosis of influenza of patients admitted to the hospital. Infection 2007 Apr;35(2):65-8. Dept. Medical Microbioloy and Infection Control, Jeroen Bosch Ziekenhuis, 90153, 5200, ME's-Hertogenbosch, the Netherlands. [email protected] OBJECTIVES: Rapid diagnosis of influenza in hospitalised patients is important to prevent the transmission of the infection in the hospital. This prospective observational cohort study was designed to determine the relationship between the clinical diagnosis of influenza made by the physician at admission and the presence of influenza virus in patients with respiratory tract infections. METHODS: This prospective observational cohort study was conducted in a large Dutch teaching hospital in a period of four weeks during the influenza season 2004/2005. All patients of 18 years and older, admitted with respiratory tract infections were included in the study. Clinical and laboratory parameters, chest radiograph (CR), blood and sputum cultures and nasopharyngeal swab for polymerase chain reaction (PCR) were obtained for each patient. In addition, the physicians opinion at admission whether this patient had influenza was recorded. RESULTS: A total of 78 patients were hospitalized with respiratory tract infections. In 41 (53%) of them influenza virus was detected by PCR. Among the patients that were positive for influenza virus by PCR, a clinical diagnosis of influenza was made in 18 cases (44%). Conversely, clinical diagnosis of influenza was made in 16 out of 37 patients in whom influenza virus was not detected by PCR. Neither C-reactive protein, leucocytes count nor an infiltrate on CR were helpful in determining the cause of the respiratory tract infection. CONCLUSIONS: The present findings failed to demonstrate a significant relationship between the clinical diagnosis of influenza and PCR detection of the virus. Also, the virus was present at least twice more often than influenza was clinically diagnosed. As a consequence, the decision to take protective measures to control spread of the virus should not rely on the clinical diagnosis.


De Groot AC, Kertzman MGM, Wever PC. Resistentie van Propionibacterium acnes tegen antibiotica bij patiënten met acne: oorzaak, gevolg en preventie. Ned Tijdschr Dermatol Venereol 2007;17:59-64.

Ingham CJ, Wever PC. Snelle kweekmethoden in de microbiologie: de nieuwe petrischaal. Cura 2007;4(2)11.

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Wever PC. Wat zijn betrouwbare diagnostische methoden voor de ziekte van Lyme? Labcontact 2007;8(24):1-2.

Mathoera RB, Wever PC, van den Aker E, de Jager CPC. Necrotising fasciitis caused by invasive group A Streptococcus after trans-obturator tape placement. Neth J Crit Care 2007 Oct;11(5):267-269.


De Jager CPC, Gemen EFA, Weers-Pothoff G, Mathoera RB, Beaumont F, Walsh IBB, Wever PC. Dynamics of peripheral blood lymphocyte subpopulations in the acute and subacute phase of Legionnaires’ disease. Voordracht: European Working Group for Legionella Infections, Stockholm, Zweden, 3 juni 2007.

Wever PC. Selectieve darm contaminatie in het Jeroen Bosch Ziekenhuis. Voordracht: Refereeravond Infecties rondom de IC, Verkadefabriek, ’s-Hertogenbosch, 13 september 2007.

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MEDISCHE TECHNOLOGIE ARTIKELEN

Claessens R, Kuenen J en Renders A. Nucleaire Geneeskunde in het Jeroen Bosch ziekenhuis te ’s-Hertogenbosch. Tijdschrift voor nucleaire geneeskunde 2007: 1, 29-30/


Maas AJ. "... zwijgen is fout!" Voordracht, Jubileumsymposium 'Spreken is zilver', 's-Hertogenbosch 29 Maart 2007.

Maas AJ. "Van activiteit naar schade" NVZ bijeenkomst veiligheidsmanagement, Utrecht 19 Juni 2007.

Maas AJ. "Pacemakers als elektronisch medicijn" Gastcollege Technische Universiteit, Eindhoven 24 September 2007.

Maas AJ. "Medische Technologie: veilige en effectieve medische zorg" Voordracht, Club Fifty One, 's-Hertogenbosch 24 Oktober 2007.

De Vries G, Jonker L, van Kleffens H, Vaartjes S, Maas A, Janssen M, Brands P. "Praktijkgids Risicomanagement en Medische Technologie" Uitgave NVZ , November 2007.

Renders AHJ. 'Kwaliteitsborging in de nucleaire geneeskunde' Gastcollege Technische Universiteit Twente, Enschede 14 Maart 2007.

Renders AHJ. 'Wat beeld je je wel in?' Voordracht, Jubileumsymposium 'Spreken is zilver','s-Hertogenbosch 29 Maart 2007.

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MOLECULAIRE DIAGNOSTIEK ARTIKELEN Bencini MA, van den Brule AJC, Claas ECJ, Hermans MHA, Melchers WJG, Noordhoek GT, et al. A multicenter comparison of molecular methods for the detection of Legionella in sputum samples. J Clin Microbiol. 2007 Oct;45(10):3390-2. Epub 2007 Aug 1. Regional Public Health Laboratory Kennemerland, Boerhaavelaan 26, 2035 RC Haarlem, The Netherlands. Legionellosis can be diagnosed by PCR using sputum samples. In this report, the methods of nine laboratories for 12 sputum samples with Legionella pneumophila and Legionella longbeachae are compared. We conclude that (i) liquefaction prevents PCR inhibition, (ii) the employed mip gene PCRs detected L. pneumophila only, and (iii) the 16S rRNA gene PCR detected both Legionella species and is preferred for the diagnosis of legionellosis.

PMID: 17670926 [PubMed - indexed for MEDLINE] PMCID: PMC2045317 Trefwoorden: Legionella, PCR, multicenter Huijsmans CJ, Heilmann FG, van der Zanden AG, Schneeberger PM, Hermans MH. Single nucleotide polymorphism profiling assay to exclude serum sample mix-up. Vox Sang. 2007 Feb;92(2):148-53. Molecular Diagnostics, Jeroen Bosch Hospital, 5200 ME 's-Hertogenbosch, The Netherlands. BACKGROUND AND OBJECTIVES: Sample mix-ups are a threat to the validity of clinical laboratory test results. To detect serum sample mix-ups we developed a single nucleotide polymorphism (SNP) profiling test. SNPs are frequent sequence variations in the human genome. Each individual has a unique combination of these nucleotide variations. MATERIALS AND METHODS: Predeveloped SNP amplification assays are commercially available. We recently discovered that these SNP assays could be applied to serological samples, which is not self-evident because a key step in serum preparation is removal of white blood cells, the major source of DNA, from blood. DNA was extracted from serum samples. Real-time polymerase chain reaction (PCR) analysis of the purified DNA using a selection of 10 SNP assays provided SNP profiles. RESULTS: The applicability of the SNP profiling test was demonstrated by means of a case where hepatitis E virus serological determinations of four serum samples of one patient seemed inconsistent. SNP profiling of the samples demonstrated that this was due to the enzyme-linked immunosorbent assay test instead of sample mix-up. CONCLUSION: We have developed an SNP profiling assay that provides a way to link human serum samples to a source, without post-PCR processing. The chance for two randomly chosen individuals to have an identical profile is 1 in 18 000. Solving potential serum sample mix-ups will secure downstream evaluations and critical decisions concerning the patients involved.

PMID: 17298578 [PubMed - indexed for MEDLINE] Trefwoorden: serum identificatie, SNP test Huijsmans R, Damen J, van der Linden H, Hermans M. Single nucleotide polymorphism profiling assay to confirm the identity of human tissues. J Mol Diagn. 2007 Apr;9(2):205-13.

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Multidisciplinary Laboratory of Molecular Diagnostics, Jeroen Bosch Hospital, 'sHertogenbosch, The Netherlands. To identify issues of sample mix-ups, various molecular techniques are currently used. These techniques, however, are time consuming and require experience and/or DNA sequencing equipment or have a relatively high risk of errors because of contamination. Therefore, a quick and straightforward single nucleotide polymorphism (SNP) profiling assay was developed to link human tissues to a source. SNPs are common sequence variations in the human genome, and each individual has a unique combination of these nucleotide variations. Using potentially mislabeled paraffinembedded tissues, DNA was extracted and SNP profiles were determined by real-time polymerase chain reaction analysis of the purified DNA using a selection of 10 commercially available SNP amplification assays. These profiles were compared with profiles of the supposed owners. All issues (34 in total) of potential sample mix-ups during the last 3 years were adequately solved, with six cases described here. The SNP profiling assay provides a quick (within 24 hours), easy, and reliable way to link human samples to a source, without polymerase chain reaction postprocessing. The chance for two randomly chosen individuals to have an identical profile is 1 in 18,000. Solving potential sample mix-ups will secure downstream evaluations and critical decisions concerning the patients involved.

PMID: 17384212 [PubMed - indexed for MEDLINE] PMCID: PMC1867440 Trefwoorden: weefsel identificatie, SNP test

Strobbe L, Lestrade P, Hermans MHA, Fijnheer R. Detection of the JAK2V617F mutation in patients with slightly elevated platelets or haemoglobin without a secondary cause. Ann Hematol 2007 Nov;86(11): 801-3. Epub 2007 Aug 17. Department of Internal Medicine, Jeroen Bosch Hospital, 5200 ME, 's-Hertogenbosch, The Netherlands. [email protected] Recently, an activating somatic mutation of Janus kinase 2 (JAK2V617F) was identified in the myeloproliferative disorders (MPDs). In this study, we investigated the occurrence of JAK2V617F in patients with slightly elevated platelets or hemoglobin without a secondary cause, who did not meet the criteria of polycythemia vera or essential thrombocythemia. Six out of 18 patients (33%) were positive for the JAK2 mutation, and five of these six patients had a history of thrombosis. These findings suggest that apart from thrombocytosis/erythrocytosis, other mechanisms exist that cause thrombosis, and more patients with a latent form of MPD are likely to exist. Future studies will have to elucidate how to treat these patients.

PMID: 17703302 [PubMed - indexed for MEDLINE] Trefwoorden: JAK2, mutatie, MPD

Troost PW, Lahuis BE, Hermans MH, Buitelaar JK, van Engeland H, Scahill L, Minderaa RB, Hoekstra PJ. Prolactin release in children treated with risperidone: impact and role of CYP2D6 metabolism. J Clin Psychopharmacol. 2007 Feb;27(1):52-7. Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands. [email protected] OBJECTIVE: Little is known about the role of CYP2D6 polymorphism in risperidone-induced prolactin release in children. METHOD: Twenty-five children (aged 5-15 years) with pervasive developmental disorders were genotyped for CYP2D6 polymorphisms. Serum prolactin, risperidone, and 9-hydroxyrisperidone were assessed at baseline and after 8 weeks of risperidone treatment (mean dosage, 0.06 +/- 0.03 mg/kg/d). After 24 weeks of treatment, prolactin was measured in a subsample of 15 children. Adverse effects were evaluated using a clinician-rated survey. RESULTS: Mean +/SD prolactin levels increased from 7.8 +/- 8.0 ng/mL at baseline to 33.2 +/- 12.8 ng/mL at week 8 (P < 0.001), with a slight decrease to 28.8 +/- 13.6 ng/mL at week 24. At week 8, serum prolactin level was

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positively correlated with dose per kilogram (r = 0.648, P < 0.001), number of functional CYP2D6 genes (J = 2.117, P = 0.034), and serum 9-hydroxyrisperidone concentration (r = 0.664, P = 0.001) and was negatively correlated with the risperidone/9-hydroxyrisperidone ratio (r = -0.571, P = 0.004) but not with risperidone concentration (r = -0.243, P = 0.264) nor age (r = 0.072, P = 0.733). Prolactin elevation was not associated with adverse effects. CONCLUSIONS: Low-to-intermediate doses of risperidone induced a 4-fold prolactin increase in children without a clear development of tolerance up to 6 months. CYP2D6 ultrarapid metabolism may be a risk factor for more pronounced prolactin elevation.

PMID: 17224713 [PubMed - indexed for MEDLINE] Trefwoorden: CYP2D6, risperidon

Vd Hoeven AM, Scholing M, Wever PC, Fijnheer R, Hermans M, Schneeberger PM. Lack of discriminating signs and symptoms in clinical diagnosis of influenza of patients admitted to the hospital. Infection 2007 Apr;35(2):65-8. Dept. Medical Microbioloy and Infection Control, Jeroen Bosch Ziekenhuis, 90153, 5200, ME's-Hertogenbosch, the Netherlands. [email protected] OBJECTIVES: Rapid diagnosis of influenza in hospitalised patients is important to prevent the transmission of the infection in the hospital. This prospective observational cohort study was designed to determine the relationship between the clinical diagnosis of influenza made by the physician at admission and the presence of influenza virus in patients with respiratory tract infections. METHODS: This prospective observational cohort study was conducted in a large Dutch teaching hospital in a period of four weeks during the influenza season 2004/2005. All patients of 18 years and older, admitted with respiratory tract infections were included in the study. Clinical and laboratory parameters, chest radiograph (CR), blood and sputum cultures and nasopharyngeal swab for polymerase chain reaction (PCR) were obtained for each patient. In addition, the physicians opinion at admission whether this patient had influenza was recorded. RESULTS: A total of 78 patients were hospitalized with respiratory tract infections. In 41 (53%) of them influenza virus was detected by PCR. Among the patients that were positive for influenza virus by PCR, a clinical diagnosis of influenza was made in 18 cases (44%). Conversely, clinical diagnosis of influenza was made in 16 out of 37 patients in whom influenza virus was not detected by PCR. Neither C-reactive protein, leucocytes count nor an infiltrate on CR were helpful in determining the cause of the respiratory tract infection. CONCLUSIONS: The present findings failed to demonstrate a significant relationship between the clinical diagnosis of influenza and PCR detection of the virus. Also, the virus was present at least twice more often than influenza was clinically diagnosed. As a consequence, the decision to take protective measures to control spread of the virus should not rely on the clinical diagnosis.

PMID: 17401709 [PubMed - indexed for MEDLINE] Trefwoorden: Influenza, diagnose

De Beer JL, van der Zanden AGM, Schirm J, Oostendorp LAB, Noordhoek GT, Mulder S, Hermans MHA, Wiesenekker P, Savelkoul PHM, Mulder B. Comparison of microscopy, culture and Real-Time PCR results for the detection of Mycobacterium tuberculosis complex in clinical samples. Ned Tijdsch Med Microbiol 2007: 15: Suppl. P074.

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Hermans MHA. “Moleculaire Diagnostiek van hematologische maligniteiten in het JBZ” Voordracht, MD themabijeenkomst JBZ. JBZ, 25 januari 2007.

Hermans MHA. “Moleculaire monitoring van CML patiënten. JBZ”. Voordracht, Refereeravond Novartis Oncologie. JBZ 28 februari 2007.

Hermans MHA. “JAK2 assay: The Den Bosch Way”. Voordracht, MODHEM meeting, Utrecht 24 april 2007.

Hermans MHA. “Moleculaire Diagnostiek als speerpunt van het Medisch Beleidsplan 2004-2009” Voordracht, Vereniging Medische Staf, JBZ. JBZ 21 Mei 2007.

Luderer R, Buisman A, van Hannen EJ, van der Zee A, Kortlandt W, Hermans MHA, van Houte AJ. Real-time HLA-B27 detection: a clinical validation for the Dutch population. Abstract, EuroMedLab, Amsterdam, 17th IFCC-FESCC European Congress of Clinical Chemistry and Laboratory Medicine. 4 Juni 2007.

Poodt J. “Het opzetten van een semi-kwantitatieve methode voor de detectie van JAK2 V617F”. Voordracht, VAP dag, Themacongres Hematologische Maligniteiten, 18 septenber 2007. Poodt J. Het opzetten van semi-kwantitatieve methode voor de detectie van JAK2 V617F. Abstract, VAP visie, Juni 2007.

Van der Lubben M, Schuurman R, van Asten L, Fouchier R, Luijt D, Schirm J, Melchers W, van Loon AM, Claas E, Wolffs P, Peeters M, Rossen J, Hermans M, Leenders S, Meijer A, Schutten M, Koopmans M. Pandemic preparedness and detection of avian influenza in the Netherlands. Abstract, ICAAC, Chicago. 17/20 September 2007.

Hermans MHA. “JAK2 mutation analysis with MGB probes”. Voordracht, JAK2 quantification assay workshop. Bergamo, Italië 20 september 2007.

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Hermans MHA. “Moleculaire Diagnostiek”, Voordracht, Kernstafvergadering VieCuri Medisch Centrum, Venlo 24 september 2007.

69

NEUROLOGIE ARTIKELEN

Garssen MP, van Koningsveld R, van Doorn PA, Merkies IS, Scheltens-de Boer M, van Leusden JA, van Schaik IN, Linssen WH, Visscher F, Boon AM, Faber CG, Meulstee J, Prick MJ, van den Berg LH, Franssen H, Hiel JA, van den Bergh PY, Sindic CJ. Treatment of Guillain-Barré syndrome with mycophenolate mofetil: a pilot study. J Neurol Neurosurg Psychiatry. 2007 Sep;78(9):1012-3. No abstract available. Erratum in: J Neurol Neurosurg Psychiatry. 2007 Dec;78(12):1416. PMID: 17702789 [PubMed - indexed for MEDLINE]

Bussmann JB, Garssen MP, van Doorn PA, Stam HJ. Analysing the favourable effects of physical exercise: relationships between physical fitness, fatigue and functioning in Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy. J Rehabil Med. 2007 Mar;39(2):121-5. Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. [email protected] OBJECTIVE: To elucidate the effects of physical exercise in severely fatigued patients with GuillainBarré syndrome and chronic inflammatory demyelinating polyneuropathy, and to clarify the mutual relationships between 5 domains studied in these patients: physical fitness, fatigue, objectively measured actual mobility, perceived physical functioning, and perceived mental functioning. DESIGN: Case series.Subjects/patients: Twenty patients with Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy. METHODS: The patients undertook a 12-week physical exercise program. Relationships between domains were studied in the change scores, and additionally in the baseline data of patients. The percentage of significant relationships between each pair of domains was determined. RESULTS: In the change scores, a small percentage of significant relationships was found between the physical fitness domain and the other 4 domains (2/30, 7%). A higher percentage of significant relationships was found between the domains perceived mental functioning and actual mobility (44%), perceived mental functioning and perceived physical functioning (44%), and between fatigue and perceived physical functioning (33%). Generally, similar patterns were found in the baseline data. CONCLUSION: Changes in fatigue, actual mobility and perceived functioning seem not to be influenced by changes in physical fitness. This study stresses the presence and importance of additional effects of a physical training program, not directly related to increasing fitness.


Garssen MP, Schillings ML, Van Doorn PA, Van Engelen BG, Zwarts MJ. Contribution of central and peripheral factors to residual fatigue in Guillain-Barré syndrome. Muscle Nerve. 2007 Jul;36(1):93-9. Department of Neurology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands. [email protected] Many patients with Guillain-Barré syndrome (GBS) suffer from severe residual fatigue that has an uncertain basis. We determined the relative contribution of peripheral and central factors during a 2min fatiguing sustained maximal voluntary contraction (MVC) in 10 neurologically well-recovered GBS patients and 12 age- and sex-matched healthy controls. Physiological fatigue was defined as the

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decline of voluntary force during an MVC of the biceps brachii. Relative amounts of peripheral fatigue and central activation failure were determined combining voluntary force and force responses to electrical stimulation. Surface electromyography was used to determine muscle-fiber conduction velocity. During the first minute of sustained MVC, peripheral fatigue developed more slowly in patients than in controls. Central fatigue only occurred in patients. The muscle-fiber conduction velocity was higher in patients. The initial MVC, decrease of MVC, initial force response, and initial central activation failure did not significantly differ between the groups. Although peripheral mechanisms cannot be excluded in the pathogenesis of residual fatigue after GBS, these results suggest that central changes are involved. This study thus provides further insight into the factors contributing to residual fatigue in GBS patients.


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NUCLEAIRE GENEESKUNDE ARTIKELEN

Van la Parra RFD, Ernst MF, Barneveld PC, Broekman J, Rutten MJCM, Bosscha K. The value of sentinal node biopsy in ductal carcinoma in situ (DCIS) and DCIS with micoinvasion of the breast. Eur J Surg Onc Epub 2007 Sep 11. Department of Surgery, Jeroen Bosch Ziekenhuis, P.O. Box 90153, 5200 ME 'sHertogenbosch, The Netherlands. AIM: Ductal carcinoma in situ (DCIS) refers to the preinvasive stage of breast carcinoma and should not give axillary metastases. Its diagnosis, however, is subject to sampling errors. The role of sentinel lymph node biopsy (SLNB) in management of DCIS or DCISM (with microinvasion) remains unclear. The purpose of this study was to review our experience with SLNB in DCIS and DCISM. METHODS: A review of 51 patients with a diagnosis of DCIS (n=45) or DCISM (n=6), who underwent SLNB and a definitive breast operation between January 1999 and December 2006, was performed. RESULTS: In 10 patients (19.6%) definitive histology revealed an invasive carcinoma. SLN (micro)metastases were detected in 5 out of 51 patients, of whom 2 had a preoperative diagnosis of grade III DCIS and 3 of DCISM. Three patients (75%) had micrometastases (< 2 mm) only. In 2 patients, histopathology demonstrated a macrometastasis (> 2 mm). All 5 patients underwent axillary dissection. No additional positive axillary lymph nodes were found. CONCLUSIONS: In case of a preoperative diagnosis of grade III DCIS or a grade II DCIS with comedo necrosis and DCIS with microinvasion, an SLNB procedure has to be considered because in almost 20% of the patients an invasive carcinoma is found after surgery. In this case the SLNB procedure becomes less reliable after a lumpectomy or ablation has been performed. SLN (micro)metastases were detected in nearly 10% of the patients. The prognostic significance of individual tumour cells remains unclear.



Kokke M, Ernst MF, Eijkeler F, Van der Linden JC, Barneveld PC, Bosscha K. Axillary recurrence after negative sentinel node procedure in breast cancer patients. ECCO 14, Barcelona, september 2007, p. 220.

Van la Parra RFD, Ernst MF, Barneveld PC, Broekman J, Bosscha K. The value of sentinel node biopsy in DCIS(M) of the breast. ECCO 14, Barcelona, september 2007, p. 206.

Van la Parra RFD, Ernst MF, Barneveld PC, Broekman J, Bosscha K. Validation of a nomogram to predict the risk of non-sentinel lymph node metastasis in breast cancer patients with a positive sentinel node biopsy. ECCO 14, Barcelona, september 2007, p. 226.

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Van la Parra RFD, Ernst MF, Barneveld PC, Broekman J, Bosscha K. Schildwachtklierbiopsie bij DCIS. Pathologendagen, Ede, april 2007.

Van la Parra RFD, Ernst MF, Barneveld PC, Broekman J, Damen J, Rutten MJCM, Bosscha K. The value of sentinel lymph node biopsy in DCIS. Poster, Pathologendagen, Ede, april 2007.

Van Urk P, Barneveld PC (eindreactie). Aanbevelingen Nucleaire Geneeskunde 2007. Kloosterhof uitgeverij april 2007. ISBN 978-90-78876-01-04

Hoekstra CJ. Response monitoring met PET bij NSCLC. Congres Thoraxchirurgie, Enschede, december, 2007.

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ORTHOPEDIE VOORDRACHTEN & POSTERS

Bom LPA. “5 jaar Resurfacing, wat hebben wij geleerd”. 6e Orthopedisch Symposium, Den Bosch, 30 januari 2007.

Bom LPA. “Radiology and Fractures in Resurfacing Arthroplasty”. Faculty Member. Advanced Course on Resurfacing, Gent (B), 23-26 mei 2007.

Bom LPA. “History of Resurfacing”. 2nd Dutch Hip Resurfacing Symposium, Tilburg, 6 september 2007.

Bom LPA. “Voorkomen is goedkoper dan genezen”. OK Symposium, Den Bosch, 27 september 2007.

Bom LPA. “Anterolateral Approach in Resurfacing Hip Arthroplasty”. International Symposium on Hip Resurfacing, Frankfurt am Main (D), 6 oktober 2007.

Bom LPA. “Nieuwe ontwikkelingen in de orthopedie”. Duodagen huisartsen, Vught, 9 oktober 2007.

Bom LPA. “6 jaar ervaring met de Birmingham Hip”. Jaarcongres Nederlandse Orthopaedische Vereniging, Veldhoven, 11 oktober 2007. Veldhoven

Bom LPA. “Alternative Approaches Hip Resurfacing”. Skillslab UMC Rotterdam, 16 november 2007.

Bom LPA. “Van Oud naar Nieuw, OK’s in het JBZ”. Symposium VVCN, Utrecht, 19 november 2007. 74

PATHOLOGIE ARTIKELEN Van la Parra RFD, Ernst MF, Barneveld PC, Broekman J, Rutten MJCM, Bosscha K. The value of sentinal node biopsy in ductal carcinoma in situ (DCIS) and DCIS with micoinvasion of the breast. Eur J Surg Onc 2008 Jun ; 34(6) :631-635. Epub 2007 Sep 11. Department of Surgery, Jeroen Bosch Ziekenhuis, P.O. Box 90153, 5200 ME 'sHertogenbosch, The Netherlands. AIM: Ductal carcinoma in situ (DCIS) refers to the preinvasive stage of breast carcinoma and should not give axillary metastases. Its diagnosis, however, is subject to sampling errors. The role of sentinel lymph node biopsy (SLNB) in management of DCIS or DCISM (with microinvasion) remains unclear. The purpose of this study was to review our experience with SLNB in DCIS and DCISM. METHODS: A review of 51 patients with a diagnosis of DCIS (n=45) or DCISM (n=6), who underwent SLNB and a definitive breast operation between January 1999 and December 2006, was performed. RESULTS: In 10 patients (19.6%) definitive histology revealed an invasive carcinoma. SLN (micro)metastases were detected in 5 out of 51 patients, of whom 2 had a preoperative diagnosis of grade III DCIS and 3 of DCISM. Three patients (75%) had micrometastases (< 2 mm) only. In 2 patients, histopathology demonstrated a macrometastasis (> 2 mm). All 5 patients underwent axillary dissection. No additional positive axillary lymph nodes were found. CONCLUSIONS: In case of a preoperative diagnosis of grade III DCIS or a grade II DCIS with comedo necrosis and DCIS with microinvasion, an SLNB procedure has to be considered because in almost 20% of the patients an invasive carcinoma is found after surgery. In this case the SLNB procedure becomes less reliable after a lumpectomy or ablation has been performed. SLN (micro)metastases were detected in nearly 10% of the patients. The prognostic significance of individual tumour cells remains unclear.


Huijsmans R, Damen J, van der Linden JC, Hermans M. Single nucleotide polymorphism profiling assay to confirm the identity of human tissues. J Mol Diagn. 2007 Apr;9(2):205-13. Multidisciplinary Laboratory of Molecular Diagnostics, Jeroen Bosch Hospital, 'sHertogenbosch, The Netherlands. To identify issues of sample mix-ups, various molecular techniques are currently used. These techniques, however, are time consuming and require experience and/or DNA sequencing equipment or have a relatively high risk of errors because of contamination. Therefore, a quick and straightforward single nucleotide polymorphism (SNP) profiling assay was developed to link human tissues to a source. SNPs are common sequence variations in the human genome, and each individual has a unique combination of these nucleotide variations. Using potentially mislabeled paraffinembedded tissues, DNA was extracted and SNP profiles were determined by real-time polymerase chain reaction analysis of the purified DNA using a selection of 10 commercially available SNP amplification assays. These profiles were compared with profiles of the supposed owners. All issues (34 in total) of potential sample mix-ups during the last 3 years were adequately solved, with six cases described here. The SNP profiling assay provides a quick (within 24 hours), easy, and reliable way to link human samples to a source, without polymerase chain reaction postprocessing. The chance for two randomly chosen individuals to have an identical profile is 1 in 18,000. Solving potential sample mix-ups will secure downstream evaluations and critical decisions concerning the patients involved.

PMID: 17384212 [PubMed - indexed for MEDLINE] PMCID: PMC1867440

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Nooijen P, Damen J, Rigter H. Hoe wordt de Her2 status bepaald bij patiënten met mamacarcinoom? Labcontact 9e jaargang juli 2007 no. 23. Pathologie JBZ ’s-Hertogenbosch. Kreb D, Bosscha K, van der Linden JC, Rutten M. Wat is de rol van RadioFrequente Ablatio (RFA) in de behandeling van mammacarcinoom? Labcontact 8e jaargang februari 2007 no. 22.

Overbeek L, Ligtenberg M, Willems R, Blokx W, Dubois S, van der Linden H, Meijer J, Mlynek-Kersjes M, Hoogerbrugge N, Hebeda K, van Krieken H. Interpretation of immunohistochemistry for mismatch repair proteins is only reliable in a specialized setting. Am J Surgical Pathology. 2007;(4,1).

Meulenbeld HJ, Spiering W, Nooijen P, Peters W en Creemers GJ Hepatosplenic gammadelta T-cell lymphoma: A case report. Eur J Itern Med. 2007; May;18(30):241-3. Department of Internal Medicine, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands. A 53-year-old man complained of weight loss, night sweats, and splenomegaly. The patient was diagnosed with stage IV hepatosplenic gammadelta T-cell non-Hodgkin's lymphoma, a highly aggressive and rare form of peripheral T-cell lymphoma. After completing CHOP chemotherapy, the patient relapsed. He did not respond to subsequent alemtuzumab therapy.

PMID: 17449399 [PubMed - in process]

VOORDRACHTEN & POSTERS Broekman J. Juridische aspecten van de (obductie) pathologie. Dagvoorzitter en Voordracht, NFI Symposium Rijswijk, 27 oktober 2007.

Van la Parra RFD, Ernst MF, Barneveld PC, Broekman J, Damen J, Rutten MJCM, Bosscha K. The value of sentinel lymph node biopsy in DCIS. Poster: Pathologendagen, Ede, april 2007.

Damen J. “Het Pathologisch Laboratorium” Cursus Medische Terminologie, JBZ, ’s Hertogenbosch, 30 Jan 2007.

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Kokke MC, Ernst MF, Eijckeler E, Damen JA, van der Linden JC, Bosscha K. Okselrecidief na een negatieve schildwachtklier procedure bij het mammacarcinoom. Poster: Pathologendagen, Ede, april 2007.

Kokke MC, Ernst MF, Eijckeler F, van der Linden JC, Barneveld PC, Gelderman WA, Wissing J, Bosscha K. Axillary recurrence after negative sentinel node procedure in breast cancer patients. Poster, ECCO, Venetië, 2007.

Rigter H, Damen J, van Weerden P. Kwaliteitssysteem CCKL en Laboratotium voor Pathologie Bijeenkomst kwaliteitsmentoren JBZ, ’s-Hertogenbosch, 25 september 2007.

Van Weerden P, Jansen T, Gebruik UDPS. Voordracht, PCP dag Stichting PALGA, Bunnik, 11 oktober 2007.

Van Schaik P, van der Linden J, Ernst M, Gelderman W, Bosscha K. Ex-vivo Sentinal Lymph node Mapping in Patients with Colorectal cancer. Poster, Pathologendagen, Ede, april 2007.

Meijer RP, Gemen EFA, Onna IEW, vd Linden JC, Beerlage HP, Kusters GCM. The value of an artificial neural network in the dicision-making for prostate biopsies. Voordracht, Congres NVU, Eindhoven, 5 okt 2007.

Van der Linden H. “HPV ziekenhuis breed” Symposium Pathologielaboratorium Brabant, Jeroen Bosch Ziekenhuis, 17 november 2007.

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PSYCHOLOGIE VOORDRACHTEN & POSTERS

Robben, SHM, Olde Rikkert, MGM, van Bergen, FS, Dautzenberg, PLJ. Pilot study of a three-step diagnostic pathway for Parkinson’s disease dementia in elderly patients: screen, test and then diagnose PDD. Abstracts of the 2nd International Congress on Gait & Mental Function, 1-3 February 2008, Amsterdam, The Netherlands. Published as supplement 1 tot Parkinsonism & Related Disorders, Vol 14, 2008.

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RADIOLOGIE ARTIKELEN

Rutten MJ, Jager GJ, de Waal Malefijt MC, Blickman JG. Double line sign: A helpful sonographic sign to detect occult fractures of the proximal humerus. Eur Radiol. 2007 Mar;17(3):762-767. Epub 2006 Jun 7. Department of Radiology, Jeroen Bosch Hospital, Nieuwstraat 34, 5211 NL, 'sHertogenbosch, The Netherlands. [email protected] The aim of this study was to describe a new sonographic sign of bone fracture and to determine if it can be helpful in decreasing the number of missed fractures of the proximal humerus. Ultrasound (US) of the shoulder was performed in 57 consecutive patients with shoulder pain and/or disability following trauma. All cases were prospectively reviewed for the presence of a humeral fracture. Sonographic signs of fractures, with special emphasis on what was termed the 'double line sign' (DLS), were assessed. Plain radiography was considered the standard of reference and in equivocal cases magnetic resonance imaging (MRI). Twenty-eight patients had a tuberosity complex fracture, which were all detected at US examination. Sonographic features of a fracture were periosteal elevation, corticol bone discontinuity, step-off deformity or a combination of these findings. This study showed that in 26 (93%) patients an additional sonographic feature, a DLS, could be demonstrated. The DLS is a helpful and probably reliable sonographic sign to indicate a humeral fracture. High-spatial-resolution US substantially increases the detection of fractures of the proximal humerus and should be considered as an alternative diagnostic tool prior to computed tomography (CT), MRI and arthroscopy in patients with persisting shoulder pain and/or disability following trauma.

PMID: 16758160 [PubMed - indexed for MEDLINE] Trefwoorden: echografie, fractuur

Rutten MJCM, Maresch BJ, Jager GJ, de Waal Malefijt MC. Injection of the subacromial-subdeltoid bursa: blind or ultrasound-guided? Acta Orthop. 2007 Apr;78(2):254-7. Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands. BACKGROUND: Blind injection of the subacromial-sub-deltoid bursa (SSB) for diagnostic purposes (Neer test) or therapeutic purposes (corticosteroid therapy) is frequently used. Poor response to previous blind injection or side effects may be due to a misplaced injection. It is assumed that ultrasound (US)-guided injections are more accurate than blind injections. In a randomized study, we compared the accuracy of blind injection to that of US-guided injection into the SSB. PATIENTS AND METHODS: 20 consecutive patients with impingement syndrome of the shoulder were randomized for blind or US-guided injection in the SSB. Injection was performed either by an experienced orthopedic surgeon or by an experienced musculoskeletal radiologist. A mixture of 1 m'L methylprednisolone acetate, 4 mL prilocaine hydrochloride and 0.02 mL (0.01 mmol) Gadolinium DTPA was injected. Immediately after injection, a 3D-gradient T1-weighted magnetic resonance scan of the shoulder was performed. The location of the injected fluid was independently assessed by 2 radiologists who were blinded as to the injection technique used. RESULTS: The accuracy of blind and US-guided injection was the same. The fluid was injected into the bursa in all cases. INTERPRETATION: Blind injection into the SSB is as reliable as US-guided injection and could therefore be used in daily routine. US-guided injections may offer a useful alternative in difficult cases, such as with changed anatomy postoperatively or when there is no effective clinical outcome.


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Trefwoorden: echografie, schouderpunctie

Rutten MJ, Maresch BJ, Jager GJ, Blickman JG, van Holsbeeck MT. Ultrasound of the rotator cuff with MRI and anatomic correlation. Eur J Radiol. 2007 Jun;62(3):427-36. Epub 2006 Dec 28. Department of Radiology, Jeroen Bosch Hospital, Hertogenbosch, The Netherlands. [email protected] Magnetic resonance imaging and high-resolution ultrasound (US) are frequently used for the detection of rotator cuff tears. The diagnostic yield of US is influenced by several factors as technique, knowledge of the imaging characteristics of anatomic and pathologic findings and of pitfalls. The purpose of this article is to illustrates that the standardized high-resolution US examination of the shoulder covers the entire rotator cuff and correlates with MR imaging and anatomic sections. PMID: 17196354 [PubMed - indexed for MEDLINE] Trefwoorden: echografie, schouder

Van la Parra RFD, Ernst MF, Barneveld PC, Broekman JM, Rutten MJCM, Bosscha K. The value of sentinal node biopsy in ductal carcinoma in situ (DCIS) and DCIS with micoinvasion of the breast. Eur J Surg Onc 2008 Jun ; 34(6) :631-635. Epub 2007 Sep 11. Department of Surgery, Jeroen Bosch Ziekenhuis, P.O. Box 90153, 5200 ME 'sHertogenbosch, The Netherlands. AIM: Ductal carcinoma in situ (DCIS) refers to the preinvasive stage of breast carcinoma and should not give axillary metastases. Its diagnosis, however, is subject to sampling errors. The role of sentinel lymph node biopsy (SLNB) in management of DCIS or DCISM (with microinvasion) remains unclear. The purpose of this study was to review our experience with SLNB in DCIS and DCISM. METHODS: A review of 51 patients with a diagnosis of DCIS (n=45) or DCISM (n=6), who underwent SLNB and a definitive breast operation between January 1999 and December 2006, was performed. RESULTS: In 10 patients (19.6%) definitive histology revealed an invasive carcinoma. SLN (micro)metastases were detected in 5 out of 51 patients, of whom 2 had a preoperative diagnosis of grade III DCIS and 3 of DCISM. Three patients (75%) had micrometastases (< 2 mm) only. In 2 patients, histopathology demonstrated a macrometastasis (> 2 mm). All 5 patients underwent axillary dissection. No additional positive axillary lymph nodes were found. CONCLUSIONS: In case of a preoperative diagnosis of grade III DCIS or a grade II DCIS with comedo necrosis and DCIS with microinvasion, an SLNB procedure has to be considered because in almost 20% of the patients an invasive carcinoma is found after surgery. In this case the SLNB procedure becomes less reliable after a lumpectomy or ablation has been performed. SLN (micro)metastases were detected in nearly 10% of the patients. The prognostic significance of individual tumour cells remains unclear.

PMID: 17851019 [PubMed - indexed for MEDLINE] Trefwoorden: DCIS mammacarcinoom, sentinal node

Rutten MJCM Renal artery stenting using the 0.014 Rx Herculink® Elite. Clinical Observer 2007; 1: 7. Trefwoorden: nier arterie stenose, stentplaatsing

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Ruurda JP, Looij BG, Rutten M, Zwemmer A, Bosscha K. Succesvolle behandeling van miltbloedingen met behoud van de milt door selectieve katheterisatie en embolisatie van de A. lienalis. Ned Tijdschr Geneeskd 2007 Jun 23;151(25): 1418-1423. Jeroen Bosch Ziekenhuis, locatie Groot Ziekengasthuis, Nieuwstraat 34, 5211 NL'sHertogenbosch. [email protected] Two patients with splenic bleeding were treated with transcatheter embolisation and selective coiling of the splenic artery. These were first of all a 78-year-old woman who was on anticoagulants for atrial fibrillation and suffered a laceration of the spleen with extravasation of contrast medium and a falling haemoglobin level. The second patient was a 23-year-old woman who suffered laceration of the spleen as the result of a traffic accident. Embolisation made it possible to avoid surgical treatment and preserve the spleen in both patients. Selective embolisation of the splenic artery is a useful adjunct to the non-operative management of patients with traumatic splenic injury. However, the proper patient selection still needs to be established.

PMID: 17668609 [PubMed - indexed for MEDLINE] Trefwoorden: miltbloeding, embolisatie

Ruurda JP, Looij BG, Rutten M, Zwemmer A, Bosscha K. Succesvolle behandeling van miltbloedingen met behoud van de milt door selectieve katheterisatie en embolisatie van de A. lienalis Cura, nr 3, jaargang 4, oktober 2007.

Fütterer JJ, Engelbrecht MR, Jager GJ, Hartman RP, King BF, Hulsbergen-Van de Kaa CA, Witjes JA, Barentsz JO. Prostate cancer: comparison of local staging accuracy of pelvic phased-array coil alone versus integrated endorectal-pelvic phased-array coils. Local staging accuracy of prostate cancer using endorectal coil MR imaging. Eur Radiol. 2007 Apr;17(4):1055-65. Epub 2006 Oct 6. Department of Radiology, University Medical Center Nijmegen, Nijmegen, The Netherlands. [email protected] To compare the visibility of anatomical details and prostate cancer local staging performance of pelvic phased-array coil and integrated endorectal-pelvic phased-array coil MR imaging, with histologic analysis serving as the reference standard. MR imaging was performed in 81 consecutive patients with biopsy-proved prostate cancer, prior to radical prostatectomy, on a 1.5T scanner. T2-weighted fast spin echo images of the prostate were obtained using phased-array coil and endorectal-pelvic phasedarray coils. Prospectively, one radiologist, retrospectively, two radiologists and two less experienced radiologists working in consensus, evaluated and scored all endorectal-pelvic phased-array imaging, with regard to visibility of anatomical details and local staging. Receiver operator characteristics (ROC) analysis was performed. Anatomical details of the overall prostate were significantly better evaluated using the endorectal-pelvic phased-array coil setup (P<0.05). The overall local staging accuracy, sensitivity and specificity for the pelvic phased-array coil was 59% (48/81), 56% (20/36) and 62% (28/45), and for the endorectal-pelvic phased-array coils 83% (67/81), 64% (23/36) and 98% (44/45) respectively, for the prospective reader. Accuracy and specificity were significantly better with endorectal-pelvic phased-array coils (P<0.05). The overall staging accuracy, sensitivity and specificity for the retrospective readers were 78-79% (P<0.05), 56-58% and 96%, for the endorectal-pelvic phased-array coils. Area under the ROC curve (Az) was significantly higher for endorectal-pelvic phased-array coils (Az=0.74) compared to pelvic phased-array coil (Az=0.57), for the prospective reader. The use of endorectal-pelvic phased array coils resulted in significant improvement of anatomic details, extracapsular extension accuracy and specificity. Overstaging is reduced significantly with equal sensitivity when an endorectal-pelvic phased-array coil is used.

PMID: 17024497 [PubMed - indexed for MEDLINE] 81


Rutten MJCM. Shoulder US: Technique and indications. Voordracht, Nederlandse Orthopaedische Vereniging: Echocursus schouder, Werkgroep schouder-elleboog. Baarn, 22 maart 2007. TOSHIBA User Day, Zoetermeer, 26 September 2007.

Rutten MJCM. Shoulder US: Tips and Tricks. Voordracht, Nederlandse Orthopaedische Vereniging: Echocursus schouder, Werkgroep schouder-elleboog. Baarn, 22 maart 2007. TOSHIBA User Day, Zoetermeer, 26 September 2007.

Rutten MJCM. Shoulder US and MRI: Evidence Based. Voordracht, Nederlandse Orthopaedische Vereniging: Echocursus schouder, Werkgroep schouder-elleboog. Baarn, 22 maart 2007. TOSHIBA User Day, Zoetermeer, 26 September 2007.

Kreb DL, Rutten MJCM, van der Linden JC, Pruijt JFM, Bosscha K. De eerste resultaten van echogeleide radiofrequente ablatie van mammacarcinoom Poster, Pathologendagen, Ede, april 2007.

Kokke MC, Kyriazopoulos A, Rutten MJCM, Ernst MF, Bosscha K Magnetic Resonance Imaging (MRI) in de preoperatieve work-up bij patiënten met een lobulair mammacarcinoom. Chirurgendagen, Veldhoven, 10 mei 2007.

Van Wensen RJA, Rutten MJCM, Olsman JG, Bosscha K. Echografie en CT bij verdenking 'appendicitis acuta' in daily practice. Chirurgendagen, Veldhoven, 10 mei 2007.

Kreb DL, Rutten MJCM, van der Linden JC, Pruijt JFM, Bosscha K. Ultrasound-guided radiofrequency ablation of early breast cancer in a resection specimen: first results of a feasibility study. 42nd Congress of the European Society for Surgical Research, Rotterdam, Mei 2007.

Rutten MJCM. Oncologische interventies, RFA Levertumoren en toekomstige ontwikkelingen. NVvR - Sandwichcursus Interventieradiologie, Utrecht, 19 en 22 juni 2007.

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Van Bokhoven SC, Rutten MJ, vander Plas LG, Sijbrandij PG, Jager GJ. Stent placement in the femoropopliteal segment: preliminary results of the absolute stent evaluated in the triple S study. Scientific exhibit Cirse, Athene, Greece, 2007.

Rutten MJCM. Radiofrequency ablation bij de behandeling van het niercelcarcinoom. Regionale refereeravond Urologie, ’s-Hertogenbosch, 16 oktober 2007.

Rutten MJCM. Belang goede communicatie op de interventie kamer. Dutch Nurse Day - Crossroads Institute for Cardiac and Vascular Education, Brussel, 29 oktober 2007.

Rutten MJ, Bouffard JA, Brandon CJ, Cardinal E, Ceulemans RY, Craig JG, Fessell DP, Habra G, Kislyakova M, Introcaso JH, Jacobson JA, Martinoli C, van Holsbeeck MT, Wortsman XL. Refresher course: Musculoskeletal Ultasound with focus on peripheral nerves. RSNA 93rd Scientific assembly and annual Meeting, Chicago, 27 November, 2007.

Rutten MJ, Cardinal E, van Holsbeeck MT, Wortsman XL, Bouffard JA, Bureau NJ, Ceulemans RY, Craig JG, Fessell PD, Habra G, Introcaso JH, Jacobson JA, Martinoli C, Khoury V. Refresher course: Dynamic Musculoskeletal Ultrasound. RSNA 93rd Scientific assembly and annual Meeting, Chicago, 27 November 2007.

Rutten MJCM. Radio Frequency Ablation Regionale refereeravond Radiologie, OOR regio-avond Noord-Oost, Den Bosch, 12 december 2007.

Rutten MJCM. Interventieradiologie. Bijscholingscursus Nederlandse Vereniging voor Radiologie: Utrecht, 19 en 22 juni 2007. (Voorzitter sessie: “Vertebroplastieken”, “Endovasculaire interventies thoracala en abdominale aorta” en “Embolisatie technieken en toepassingen”.)

DIVERSEN

Rutten MJCM. Oncologische interventies.

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NVvR, EDURAD Syllabus interventieradiologie 2007: 57: 49-53. Trefwoorden: interventie radiologie, oncologie Rutten MJ. Reviewer voor: European Radiology, AJR Moderator; Dutch Nurse day: Interventional Radiology ‘Crossroads Institute for Cardiac and Vascular Education’, Brussel, 29 oktober 2007.

Ranschaert ER. Member Subcommittee for Computer Applications van het ECR-congres, 2007.

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REUMATOLOGIE ARTIKELEN

Van Lieshout AW, Popa C, Meyer-Wentrup F, Lemmers HL, Stalenhoef AF, Adema GJ, van Riel PL, van Tits LJ, Radstake TR. Circulating CXCL16 is not related to circulating oxLDL in patients with rheumatoid arthritis. Biochem Biophys Res Commun. 2007 Apr 6;355(2):392-7. Epub 2007 Feb 6 Department of Rheumatology, Radboud University Nijmegen Medical Centre and Nijmegen Centre of Molecular Life Sciences, The Netherlands. CXCL16 acts as a scavenger receptor for oxLDL in its membrane-bound form and induces migration of activated T cells in its soluble form. Due to these properties, CXCL16 has been suggested to play a role in both atherosclerosis and rheumatoid arthritis (RA). Our aim was to evaluate the contribution of soluble CXCL16 to the scavenging of oxLDL and its potential as a marker for cardiovascular disease (CVD) in patients with RA. We found that circulating CXCL16 was not correlated with plasma oxLDL or ApoB and was not related to the presence of CVD in RA patients. Moreover, CXCL16 did not bind and scavenge oxLDL in an in vitro setting. These data suggest that binding of oxLDL by soluble CXCL16 does not play a role in atherosclerosis and, although confirmation in larger studies is needed, that circulating CXCL16 is not related to the presence of CVD in patients with RA.


Hartkamp A, Geenen R, Godaert GLR, Bootsma H, Kruize AA, Bijlsma JWJ, Derksen RHWM. Het effect van dehydroepiandrosteron op moeheid, welbevinden en functioneren bij het primaire syndroom van Sjögren; een dubbel-blind, placebo-gecontroleerd onderzoek. Nederlands Tijdschrift voor Reumatologie. 2007;10(extra uitgave):19-20.

Hartkamp A, Geenen R, Godaert GL, Bootsma H, Kruize AA, Bijlsma JW, Derksen RH. Effect of dehydroepiandrosterone administration on fatigue, well-being, and functioning in women with primary Sjögren syndrome: a randomised controlled trial. Ann Rheum Dis. 2008 Jan;67(1):91-7. Epub 2007 Jun 1. Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands. OBJECTIVE: Dehydroepiandrosterone (DHEA) administration has been reported to improve fatigue, psychological distress, and physical disability. These are common features of primary Sjögren syndrome (pSS). We investigated the effects of DHEA administration on fatigue, well-being, and functioning in women with pSS. METHODS: In a double-blind, randomised placebo-controlled clinical trial, 60 female patients with pSS received 200 mg oral DHEA or placebo. Primary outcome measures were general fatigue, depressive mood, mental well-being, and physical functioning. In addition, pain, sicca complaints and disease activity parameters were measured. Patients were assessed before treatment, after 3, 6, and 12 months on study medication, and 6 months after cessation of treatment. RESULTS: Patients from both the DHEA- and placebo-treated group improved on general fatigue (p<0.001), mental well-being (p = 0.04), and depressive mood (p = 0.008). Physical functioning did not change (p = 0.44). Of the secondary outcome variables, complaints of a dry mouth diminished during treatment in both groups (p = 0.006), the erythrocyte sedimentation rate showed a decrease for the DHEA group (p = 0.02), and complaints of dry eyes improved in the placebo group (p = 0.01). The belief to have used DHEA was a stronger predictor for improvement of fatigue and wellbeing than the actual use of DHEA. CONCLUSIONS: Our study does not support a superior effect of

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DHEA over placebo in female patients with pSS. Both DHEA and placebo induce improvement of fatigue and well-being. This may suggest possibilities for cognitive behavioural interventions.


Kievit W, Fransen J, Oerlemans AJ, Kuper HH, van der Laar MA, de Rooij DJ, De Gendt CM, Ronday KH, Jansen TL, van Oijen P, Brus HL, Adang EM, van Riel PL. The efficacy of anti-TNF in rheumatoid arthritis, a comparison between randomised controlled trials and clinical practice. Ann Rheum Dis. 2007 Nov;66(11):1473-8. Epub 2007 Apr 10. Department of Rheumatology (470), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. [email protected] BACKGROUND: Randomised controlled trials (RCTs) evaluating the efficacy of antagonists to tumour necrosis factor alpha (TNFalpha) showed high response percentages in the groups treated with active drugs. OBJECTIVE: To compare the efficacy of anti-TNF treatments for rheumatoid arthritis (RA) patients in RCTs and in daily clinical practice, with an emphasis on the efficacy for patients eligible and not eligible for RCTs of anti-TNF treatments. METHODS: First, randomised placebocontrolled trials written in English for etanercept, infliximab and adalimumab for patients with RA were selected by a systematic review. Second, the DREAM (Dutch Rheumatoid Arthritis Monitoring) register with patients starting for the first time on one of the TNF-blocking agents was used. Patient characteristics, doses of medication and co-medication as well as the ACR20 response percentages were compared between RCTs and DREAM data, stratified for trial eligibility. RESULTS: In 10 of 11 comparisons, the ACR20 response percentages were lower in daily clinical practice than in the RCT active drug group, which was significant in five of 11 comparisons. Only 34-79% of DREAM patients fulfilled the selection criteria for disease activity in the several RCTs examined. DREAM patients eligible for RCTs had higher response percentages than ineligible DREAM patients. ACR20 response percentages of eligible DREAM patients were comparable with the ACR20 response percentages of the RCT active drug group in 10 of 11 comparisons. CONCLUSION: The efficacy of TNF-blocking agents in RCTs exceeded the efficacy of these drugs in clinical practice. However, in clinical practice more patients with lower disease activity were treated with TNF-blocking agents compared with those treated in RCTs. For daily practice patients who were eligible for RCTs, responses were more similar to responses reached in RCTs.



Hartkamp A. Dehydroepiandrosterone in women with primary Sjögren’s syndrome: a randomized, placebo controlled, double blind trial. Voordracht Najaarsdagen Nederlandse Vereniging voor Reumatologie. Veldhoven, Nederland, 20 september 2007.

Van Oijen PML. “NSAIDS - COXIBS "state of the art". Symposium “Reumatologie Avond Noord-oost Brabant”, Rosmalen, 11 December 2007.

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Van Oijen P. "Ruggespraak". Gewrichtsdagen voor huisartsen, Papendal, 2007.

Van Oijen P. "Cursus injectietechniek". Cursus voor huisartsen, Uden , 2007.

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REVALIDATIEGENEESKUNDE ARTIKELEN Bos GJ, Meijer JWG. Maatregelen bij extreme temperaturen in het revalidatiecentrum. Revalidata, Aug 2007, nr 138, 26-30.

Van Kuijk AA, Hendricks HT, Pasman JW, Kremer BH, Geurts AC. Are clinical characteristics associated with upper-extremity hypertonia in severe ischemic supratentorial stroke? J Rehabil Med. 2007 Jan;39(1):33-7. Department of Rehabilitation Medicine, Radboud University, Medical Centre, Nijmegen, The Netherlands. [email protected] OBJECTIVE: The primary goal of this study was to identify clinical risk factors, in addition to muscle weakness, for upper-extremity hypertonia in patients with severe ischaemic supratentorial stroke. The secondary goal was to investigate the time course of upper-extremity hypertonia in these patients during the first 26 weeks post-stroke. DESIGN: Inception cohort. PATIENTS: Forty-three consecutive patients with an acute ischaemic supratentorial stroke and an initial upper-extremity paralysis admitted to an academic hospital. MAIN OUTCOME MEASURES: Primary outcome: hypertonia assessed by the Ashworth scale at week 26 post-stroke. Potential risks factors: motor functions assessed by the upper-extremity subscore of the Fugl-Meyer motor assessment, Barthel Index at week 1, consciousness, sensory disturbances, apraxia, neglect, and hyper-reflexia. Secondary outcome: time course of upper-extremity hypertonia by assessing its prevalence at 6 consecutive moments post-stroke during a follow-up period of 26 weeks. RESULTS: Twenty-five patients (63%) developed hypertonia during the follow-up period of 26 weeks. During this period, the prevalence of hypertonia followed a rather dynamic course, with cases of early, transient and late hypertonia. Univariate analyses yielded none of the selected clinical characteristics as significantly associated with hypertonia. CONCLUSION: Despite the high incidence of hypertonia (63%) observed, none of the selected clinical characteristics could be identified as a risk factor for hypertonia.


Van Kuijk AA, Hendricks HT, Pasman JW, Kremer BH, Geurts AC. Are neuroradiological or neurophysiological characteristics associated with upper- extremity hypertonia in severe ischemic supratentorial stroke? J Rehabil Med. 2007 Jan;39(1):38-42. Department of Rehabilitation Medicine, Radboud University, Medical Centre, Nijmegen, The Netherlands. [email protected] OBJECTIVE: The primary goal was to identify the neuroradiological and neurophysiological risk factors for upper-extremity hypertonia in patients with severe ischaemic supratentorial stroke. DESIGN: Inception cohort. PATIENTS: Forty-three consecutive patients with an acute ischaemic supratentorial stroke and an initial upper-extremity paralysis admitted to an academic hospital recruited over a 1.5-year period. MAIN OUTCOME MEASURES: Upper-extremity hypertonia was assessed by the Ashworth scale and clinically relevant hypertonia was defined as Ashworth scale >or=2. Any association of (clinically relevant) hypertonia with neuroradiological (lesion side, extent of lesion, and stroke history), and neurophysiological (motor-evoked potential and silent period) characteristics was investigated. RESULTS: Associations between hypertonia and the selected neuroradiological and neurophysiological risk factors were generally low. Univariate analyses yielded

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none of the selected neuroradiological or neurophysiological characteristics as significantly associated with hypertonia. CONCLUSION: Despite the high incidence of hypertonia in these patients, we could not identify any of the selected neuroradiological or neurophysiological characteristics as a risk factor for hypertonia.


Van Kuijk AA, Pasman JW, Hendricks HT, Schelhaas JH, Zwarts MJ, Geurts AC. Supratentorial ischemic stroke: more than an upper motor neuron disorder. J Clin Neurophysiol. 2007 Dec;24(6):450-5. Department of Rehabilitation Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands. [email protected] The primary goal of this study was to identify secondary functional changes in the peripheral motor units of the paretic upper extremity (UE) in patients with severe ischemic stroke and to determine how these changes develop during the first weeks after stroke. An inception cohort of 27 consecutive patients with an acute ischemic supratentorial stroke and an initial UE paralysis was compared with 10 healthy control subjects. The ulnar nerve was electrically stimulated proximal to the wrist and electromyographic recordings were obtained from the abductor digiti minimi muscle. Hemiparetic side mean values of the compound muscle action potential (CMAP) 1 and 3 weeks after stroke were compared with the nonparetic side and with CMAP values obtained from healthy control subjects. The mean CMAP amplitude in patients was significantly lower on the paretic side compared with the nonparetic side and with control subjects. Decrease in CMAP amplitude was observed in more than half of the stroke patients, sometimes as early as 4 days after stroke, and persisted in most cases. Whenever present, it was accompanied by absence of motor recovery at that specific time after stroke. Decreased CMAP amplitude in the abductor digiti minimi muscle can be seen already in the very acute phases after stroke unrelated to peripheral neuropathy, radiculopathy, or plexopathy, and it is accompanied by absence of UMN recovery. This knowledge is important for interpreting electrophysiological data in stroke patients.


Rommers GM, Ryall NH, Kap A, de Laat F, van der Linde H. The mobility scale for lower limb amputees: The SIGAM/WAP mobility scale. Disabil Rehabil. 2007 Sep 7:1-10. [Epub ahead of print] Center for Rehabilitation, University Medical Center, University of Groningen, The Netherlands. Purpose. To translate the SIGAM mobility scale into the Dutch language and to test and validate its properties in everyday practice. Method. The SIGAM mobility scale as published by Ryall et al. was translated into the Dutch language with the local used verbs for prosthetic use. The translated Dutch text was reviewed by several authors and a panel of professionals. The retranslation by a native speaker was reviewed by the original author who suggested modifications. The Dutch trial version of the mobility scale was presented to a panel of prosthetic users and therapists who advised slight modifications for better understanding of the questionnaire. IN training sessions prosthetic teams across The Netherlands were trained in the use of the translated SIGAM/WAP mobility scale. Results. During the translation there were problems with slang words and the use of specific words in the care of amputee patients. The instruction of team members and the test scoring of the questionnaire and the algorithm showed no difficulties. There was good to perfect agreement between scores in case training sessions with perfect inter observer reliability. Conclusions. With this instrument we have a specific measurement tool in the English and Dutch language to measure mobility in lower limb amputees.

PMID: 17852268 [PubMed - as supplied by publisher]

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Heijnen IC, Franken RJ, Bevaart BJ, Meijer JW. Long-term outcome of Superficialis-to-Profundus tendon transfer in patients with clenched fist due to spastic hemiplegia. Disabil Rehabil. 2008;30(9):675-8. Abstract pre-published online 2007. Rehabilitation Centre Tolbrug, 's-Hertogenbosch, The Netherlands. BACKGROUND: Spastic hemiplegia is a common feature after stroke, which can result in a clenched fist deformity with secondary hygienic problems and pain. Operative treatment can improve these problems, although literature about its long-term effects is lacking. PURPOSE: To determine whether Superficialis-to-Profundus tendon (StP-) transfer procedure leads to permanent improvement of hygiene and reduction of pain in patients with clenched fist due to spastic hemiplegia following stroke. METHOD: Patients who underwent a StP-transfer in 2003-2005 were evaluated on skin condition, upper extremity joint mobility, resting position and muscle tone and with VAS scores on hygiene maintenance and pain in the hand. RESULTS: Six patients (mean age 54 years; duration after stroke 10 years) were included. Indications to operate were hygienic problems only (3) or combined with pain (3). The average follow-up period was 19 months. After 6 weeks of post-operative splinting, no standard follow-up was applied. Serious post-operative complications were not reported. At follow-up no hygienic problems were present and pain was decreased in all except one patient. All hands could passively be fully opened. In resting position, flexion was seen in the MCP-joints (60-90 degrees). Muscle tone was raised in flexors of the wrist and fingers and m. adductor pollicis (Ashworth 1-2). Given the same pre- and post-operative circumstances, all patients would agree to have the surgery over again. CONCLUSION: Even 19 months after the StP-transfer for clenched fist, all operated hands could still be fully opened and there was a permanent improvement of hygiene and pain reduction.



Heijnen ICM, Bevaart BJW, Franken RJP, Meijer JWG. Long term outcome of Superficialis to Profundus tendon transfer in patients with clenched fist due to spastic hemiplegia. Abstract in: Moving beyond disability; proceedings of the 12th World Congress of ISPO. Bach TM, Lemaire ED, Hubbard S, Kyberd PJ, editors. Vancouver Canada, ISBN 978-09783908-0-8.

Bos GJ. Cursus Neurorevalidatie in het kader van CVA Ketenzorg. Module 1: Een beroerte, oorzaken en gevolgen. Revalidatie van CVA-patiënten. Regio ’s-Hertogenbosch, 4 okt 2007.

Van Haelst A. “Revalidatiedagbehandeling nu ook in ziekenhuis Bernhoven”. Symposium huisarts/medisch specialist in ziekenhuis Bernhoven, 5 april 2007.

Van Haelst A. “Neuromusculaire aandoeningen en ademhalingsinsufficientie”. Regionaal refereeravond te ’s-Hertogenbosch, 3 dec 2007.

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Van Kuijk AA, Pasman JW, Hendricks HT, Kremer BH, Geurts ACH. Can clinical, neuroradiological, or neurophysiological characteristics predict upper- extremity spasticity in severe ischemic supratentorial stroke? Consensus bijeenkomst “interpreting spasticity from muscle activity”. Roessingh Enschede, 8-9 februari 2007.

Van Erp P, van Stuivenberg-Vrielinck C, van Kuijk AA, Meijer JWG. Preventive measures evaluated in unilateral diabetic lower limb amputees. 5th International Symposium on the Diabetic Foot, Noordwijkerhout, 9 – 12 Mei 2007.

Van Erp P, van Stuivenberg-Vrielinck C, van Kuijk AA, Meijer JWG. Comorbidity in diabetic amputees: a confounder or reality in clinical research. 5th International Symposium on the Diabetic Foot, Noordwijkerhout, 9 – 12 Mei 2007.

Van Kuijk AA, Vugts M, Troe E. Patients and parents perception of (night) splints; conventional versus dynamic splints. European Academy of Childhood Disability (EACD), Groningen, 14-16 Mei 2007.

Van Kuijk AA, Vugts M, Troe E. Patient en ouders beleving van (nacht)spalken; conventionele versus dynamische spalk. Dutch ACD, Utrecht 22 september 2007.

Van Erp P, van Stuivenberg-Vrielinck C, van Kuijk AA, Meijer JWG. Preventive measures evaluated in unilateral diabetic lower limb amputees. Leren in de Revalidatie. Jaarcongres VRA, Ermelo, 31 oktober – 1 november 2007.

Van Kuijk AA. Can clinical, neuroradiological, or neurophysiological characteristics predict upperextremity spasticity in severe ischemic supratentorial stroke? Consensus bijeenkomst “interpreting spasticity from muscle activity”. Roessingh Enschede, 9 Februari 2007.

Van Kuijk AA. Spasticiteit en orthesiologie. Lezing orthopedisch instrument en schoenmakers firma Livit regio Noord-Oost Brabant, 20 april 2007.

Van Kuijk AA. Geneeskunde les 1. IMC weekend school Tilburg, 13 mei 2007.

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Van Kuijk AA. Spasticiteit bij verstandelijk gehandicapten: Onderwijs/ nascholing AVG-artsen. Cello, ’s-Hertogenbosch e.o, 24 mei 2007.

Van Kuijk AA. Voorspellen van herstel van handmotoriek en spasticiteit na CVA. WCN voordracht, Kastanjehof, Apeldoorn, 20 September 2007.

Van Kuijk AA. VRA Basiscursus: dwarslaesie. Lezing NHO. Enschede, 23 november 2007.

Van Kuijk AA. “Voorspellen van herstel van handmotoriek na CVA”. Refereeravond Brabantse revalidatieartsen, 3 december 2007.

Van Stuivenberg-Vrielink CH., de Laat FAJ., van Kuijk AA. Intra- and Interobserver variability of volume measurements in transtibial amputees. Leren in de Revalidatie. Jaarcongres VRA, Ermelo, 31 oktober – 1 november 2007.

De Laat F. “Dynamische knie-enkel-voetortheses, een technische vergelijking.”. Refereeravond Brabantse revalidatieartsen Bergen op Zoom, 2 april 2007.

De Laat F. “Ketenzorg bij het behandelprogramma beenamputatie van RC Tolbrug.” Bijeenkomst Landelijke Vereniging van Geamputeerden, ’s Hertogenbosch, 24 Mei 2007.

De Laat F. “Kosten prothesetraining bij beengeamputeerden. Benchmarking van revalidatiecentra Zuid Nederland.” Landelijke WAP-dag. RC Hoogstraat, Utrecht, 14 december 2007.

De Laat FAJ, Rosbergen W. ”Comorbidity in a cohort lower limb amputees with a prosthesis.” Leren in de Revalidatie. Jaarcongres VRA, Ermelo, 31 oktober - 1 november 2007.

Meijer JWG. Application of recommendations to indicate a new NMES device in clinical practice.

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Abstract in: Moving beyond disability; proceedings of the 12th World Congress of ISPO. Bach TM, Lemaire ED, Hubbard S, Kyberd PJ, editors. Vancouver Canada, ISBN 978-09783908-0-8.

Meijer JWG, Dun van E, Santegoets KMLW. Effects of neuromuscular electrostimulation of the upper limb in stroke. Abstract in: Moving beyond disability; proceedings of the 12th World Congress of ISPO. Bach TM, Lemaire ED, Hubbard S, Kyberd PJ, editors. Vancouver Canada, ISBN 978-09783908-0-8.

Santegoets KMLW, Geurts ACH, Meijer JWG. Long term use of a hybrid orthosis for neuromuscular electrical stimulation of the upper limb in severe stroke patients in the Netherlands. Abstract in: Moving beyond disability; proceedings of the 12th World Congress of ISPO. Bach TM, Lemaire ED, Hubbard S, Kyberd PJ, editors. Vancouver Canada, ISBN 978-09783908-0-8.

Meijer JWG, Hem van der MT, Erp van P, Smit AJ, Links TP. Quality of life in diabetic foot disease. Abstract in: Moving beyond disability; proceedings of the 12th World Congress of ISPO. Bach TM, Lemaire ED, Hubbard S, Kyberd PJ, editors. Vancouver Canada, ISBN 978-09783908-0-8.

Meijer JWG, Hem van der MT, Sluijter WT, Smit AJ, Links TP. Presence of diabetic neuropathy: predictor for overall mortality in diabetes. Abstract in: Moving beyond disability; proceedings of the 12th World Congress of ISPO. Bach TM, Lemaire ED, Hubbard S, Kyberd PJ, editors. Vancouver Canada, ISBN 978-09783908-0-8.

Meijer JWG, Hem van der MT, Smit AJ, Links TP. The relation between signs and symptoms and functional status in diabetic polyneuropathy. Abstract in: Moving beyond disability; proceedings of the 12th World Congress of ISPO. Bach TM, Lemaire ED, Hubbard S, Kyberd PJ, editors. Vancouver Canada, ISBN 978-09783908-0-8.

Meijer JWG. De diabetische voet. Abstract in: Revalidatie: onderweg naar huis. Nascholingscursus voor de (verpleeg)huisarts. Boerhaave Leiden, ISBN 978-90-6767-298.

Meijer JWG. “Een integrale kijk op spasticiteitsbehandeling van de arm na CVA.” Symposium Kennisnetwerk CVA Nederland, Huizen, 25 april 2007.

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Meijer JWG, van der Hem, MT, van Erp P, Smit AJ, Links TP. Quality of Life in diabetic foot disease. 5th International Symposium on the Diabetic Foot. Noordwijkerhout, 9 – 12 mei 2007.

Meijer JWG, van der Hem, MT, Smit AJ, Links TP. The relation between signs and symptoms and functional status in diabetic polyneuropathy. 5th International Symposium on the Diabetic Foot. Noordwijkerhout, 9 – 12 mei 2007.

Meijer JWG, van der Hem, MT, Sluijter WJ, Smit AJ, Links TP. Presence of diabetic neuropathy: predictor for overall mortality in diabetes. 5th International Symposium on the Diabetic Foot. Noordwijkerhout, 9 – 12 mei 2007.

Meijer JWG. “Een integrale kijk op spasticiteitsbehandeling van de arm na CVA.” Symposium Kennisnetwerk CVA Nederland, Kampen, 12 Juni 2007.

Meijer JWG, van der Hem, MT, van Erp P, Smit AJ, Links TP. “Quality of Life in diabetic foot disease.” Leren in de Revalidatie. Jaarcongres VRA. Ermelo, 31 oktober – 1 november 2007.

Meijer JWG, van der Hem, MT, Smit AJ, Links TP. The relation between signs and symptoms and functional status in diabetic polyneuropathy. Leren in de Revalidatie. Jaarcongres VRA. Ermelo, 31 oktober – 1 november 2007.

Meijer JWG, van der Hem, MT, Sluijter WJ, Smit AJ, Links TP. Presence of diabetic neuropathy: predictor for overall mortality in diabetes. Leren in de Revalidatie. Jaarcongres VRA. Ermelo, 31 oktober – 1 november 2007. Meijer JWG. "Comorbidity in diabetic amputees: a confounder or reality in clinical research” Leren in de Revalidatie. Jaarcongres VRA. Ermelo, 31 oktober - 1 november 2007.

Meijer JWG. “Diagnostiek en risicoclassificatie van de diabetische voet.” Leiden Boerhaave Cursus, Utrecht, 8 november 2007.

Meijer JWG. “Identifying the neuropathies: introduction and overview.”

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25th Anniversary of TATCOT, Kilimanjaro Medical Centre, Moshi, Tanzania, 12 november 2007.

Meijer JWG. “Rehabilitation of Neuropathies.” 25th Anniversary of TATCOT, Kilimanjaro Medical Centre, Moshi, Tanzania, 12 november 2007.

Meijer JWG. “Pathogenesis and Risk classification of the Diabetic Foot.” 25th Anniversary of TATCOT, Kilimanjaro Medical Centre, Moshi, Tanzania, 13 november 2007.

Meijer JWG. “Diagnosis of the diabetic foot.” 25th Anniversary of TATCOT, Kilimanjaro Medical Centre, Moshi, Tanzania, 13 november 2007.

Meijer JWG. “De Diabetische Voet.” Revalidatie: op weg naar huis. Boerhaave Cursus Huisartsen en verpleeghuisgeneeskunde. Leiden, 22 november 2007.

Santegoets K. Handmasteronderzoek. Wetenschapsmiddag JBZ, Feb 2007.

Santegoets K. Plagiocephalie. Refereeravond, Breda, 4 September 2007.

Santegoets K. ISPO handmasteronderzoek. Symposium van de ISPO (International Society for Prosthetics and Orthotics), Amsterdam, 6 Oktober 2007. Schreibers M. Workshop traumarevalidatie. VRA-najaarsvergadering, Oktober 2007.

Schreibers M. “Opioïdgebruik bij chronische pijn” Refereeravond Brabant, December 2007.

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Vugts M. Scoliose bij kinderen met cerebrale parese. Brabantse refereeravond, RC Breda, 5 Februari 2007.

Vugts M. Patients and parents perception of (night)splints; conventional versus dynamic splints. Poster: Development and Differentation in Childhood Disability, 19th annual meeting EACD, Groningen 14,15,16 juni 2007.

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UROLOGIE ARTIKELEN

Meijer RP, Groeneveld AE. Intersex: four cases in one family J Pediatr Urol. 2007 Apr;3(2):137-41. Epub 2006 May 19. Department of Urology, Jeroen Bosch Ziekenhuis, Nieuwstraat 34, 5211 NL 'sHertogenbosch, The Netherlands. Intersex presents a unique challenge to modern medicine. Generally, patients with ambiguous genitalia present in the neonatal period. Due to functional failure of the assigned gender role, some patients may be discovered later in life, as in the presented cases. The four patients, all members of the same family and aged 23, 15, 13 and 4 years, presented with ambiguous genitalia. The family history revealed parental consanguinity and one additional case of genital ambiguity. The eldest two patients had developed gynaecomastia during puberty. Examination of the genitalia revealed penoscrotal hypospadias and bifid scrotum in all the four. Gonads were palpable bilaterally in three of the patients, but in the fourth only one gonad was palpable. Buccal smear was negative for sex chromatin in all the cases. On abdominal ultrasound Müllerian structures were found in the two eldest patients. The karyotype in all four cases was determined as 46XY. Gonadal biopsies revealed immature testicular tissue and azoospermia, as sometimes seen in cryptorchidism. We conclude that these cases should be classified as dysgenetic male pseudohermaphrodites, a rare variety of ambiguous genitalia. In agreement with the patients and their parents, they were assigned the male gender and surgery was performed accordingly. We stress the need for active involvement of patient and parents in the process of gender assignment and awareness of hasty decision making.

PMID: 18947719 [PubMed - in process] Bolla M, Van Tienhoven G, De Reijke Th.M, Van den Bergh ACM, Oddens J, Poortmans PMP, Gez E, Kil P, Musat E, Collette L. Six months versus three years concomitant and adjuvant hormonal treatment with external beam irradiation for locally advanced prostate cancer: Results of the EORTC randomized Phase III trial 22961. Eur J Cancer Suppl 5(4): 279, 2007. (abs. 4002)

De Vries RR, van der Poel HG, Nieuwenhuijzen JA, Oddens J, Meinhardt W, Bex A, Horenblas S. Sexuality preserving cystectomy and neobladder (SPCN) and classsic neobladder; a functional and oncological comparison. J Urol 177 (4) supplement pg 64: no192.

Mattelaer JJ, Schipper RA, Das S. The circumcision of Jesus Christ. History Office, European Association of Urology, Kortrijk, Belgium. J Urol. 2007 Jul;178(1):31-4. Epub 2007 May 11. PURPOSE: We study the controversies manifested in religious writings, art, sculpture and music as well as the theological disputes surrounding the circumcision of Jesus Christ. MATERIALS AND METHODS: Data are derived from relevant historical and theological articles. RESULTS: Jesus

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Christ was circumcised as a Jew on the 8th day after his birth. Until 1960 the Catholic church celebrated the day as Circumcision Day. In medieval times the holy foreskin was worshipped in many European churches. CONCLUSIONS: Christianity never condoned the ritual of circumcision and established the sacrament of baptism in its place.

Personal Name as Subject: Jesus Christ PMID: 17574055 [PubMed - indexed]

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ZIEKENHUISFARMACIE ARTIKELEN

De Groot A., Stoof T, De Beer H, Conemans J, Mulder C. Dermatitis herpetiformis. IV medicamenteuze behandeling. Ned Tijdschr DermVenereol 2007;17:240-4. Trefwoorden: gastroenterologie, dermatologie

Conemans J, Bekkers C, Hermans M. Farmacogenetica: farmacotherapie op maat van de genenkaart. Wat heeft de huisarts aan farmacogenetica, en wat kan de huisarts aanvragen? Labcontact 2007;8(24):2-3. Trefwoorden: farmacogenetica, bijwerkingen

Handoko KB, Zwart-van Rijkom JEF, Hermens WAJJ, Souverein PC, Egberts ACG. Changes in medication associated with epilepsy-related hospitalisation: a case-crossover study. Pharmacoepidemiol Drug Saf 2007;16:189-96 Trefwoorden: epilepsie, anti-epileptica

Handoko K, Hermans M, Majoie M. Genetica van therapieresistente epilepsie: Waarom anti-epileptica soms niet werken. Epilepsie 2007; 3: 10-13. Trefwoorden: epilepsie, genetica

BOEKEN

Uges DRA, Conemans JMH. Antidepressants and antipsychotics. In: Bogusz M, Smith R, eds. Forensic science. Handbook of analytical separations 6. Second ed.. Elsevier, Amsterdam, 2007, Chapter 7: 287-317. Trefwoorden: psychiatrie, analytische chemie


Conemans JMH, Pijnenburg CC, Hesselink W, Ivanovic I. Systematic Toxicological Identification Procedure (STIP) system for screening of Drugs and Toxic Substances in Serum and Drug of Abuse (STIP-DOA) in urine after Solid Phase Extraction (SPE). Poster, HPLC, Ghent, 17-21 June 2007. Abstract Book p. 637.

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Trefwoorden: toxicologie, analytische chemie

Handoko KB, Zwart-van Rijkom JEF, Visee HF, Hermens WAJJ, Hekster JA, Egberts TCG. Drug treatment-related determinants of inadequate seizure control. 2nd Netherlands Association for Hospital Pharmacists Day, Leiden, 11 okt 2007. Trefwoorden: epilepsie, anti-epileptica

Handoko KB, van Puijenbroek EP, Bijl AMH, Hermens WAJJ, Zwart-van Rijkom JEF, Hekster YAH, Egberts ACG. Hypersensitivity Reactions due to Antiepileptic Drugs: A Chemical Structure Based Association? ISoP International Society of Pharmacovigilance, Bournemouth, UK,21-24 okt 2007. Trefwoorden: anti-epileptica, hypersensitiviteit

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OVERIG: STAFDIENSTEN

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PMA Fysiotherapie ARTIKELEN

Heemskerk MC, Kempenaar MC, van Eijkeren FJM, Oomen WJM, Bakker M, Dautzenberg PLJ. Fysiotherapie voor valpreventie. Nederlands Tijdschrift voor fysiotherapie 2007;117:166-75.


Van Eijkeren FJM, Reijmers RSJ, Kleinveld HJ, Minten A, ter Bruggen JP. Nordic Walking improves mobility in Parkinson’s disease. Internationaal congres M. Parkinson, Istanbul, Turkije, juni 2007.

DIVERSEN

Van Eijkeren FJM Scholingsprogramma voor fysiotherapeuten van het Geriatrie Fysiotherapie. Netwek ’s-Hertogenbosch e.o. 2007.

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Hygiene & Infectiepreventie ARTIKELEN

Renders NHM, Janssen MWH, Leenders ACA. Clindamycine niet geschikt voor empyrische behandeling van infecties veroorzaakt door methicillinerestente Staphylococcus aureus (MRSA) afkomstig door varkens. Ned tijdschr Geneeskunde, 13 oktober 2007.

Van Wijk PTL, Pelk-Jongen M, Wijkmans C, Voss A, Schneeberger P. Meldpunt prikaccidenten; een 3-jarige prospectieve studie. Infectieziektenbulletin; april 2007.

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Kwaliteit & Organisatie ARTIKELEN

Verhoeven M. “Sneller Beter in het Jeroen Bosch Ziekenhuis” Kwaliteit en Beeld, 2007.


Casarotto M. “Patiëntenlogistiek” Congres Zorglogistieke Bedrijfsvoering, 2007.

Verhoeven M. “Over kwaliteit gesproken”. Symposium Landelijke Studiedag Kwaliteitszorg, 2007.

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Promoties Van Geffen HJ. Evaluation of the Components Separation Method for treatment of patients with large abdominal wall defects. Doctoral thesis, University of Utrecht 2007. ISBN: 978-90-9021708-6

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Wetenschapsmiddag 2007 Jeroen Bosch Ziekenhuis, Locatie: Groot Ziekengasthuis, donderdag 1 februari 2007. In volgorde van bespreking:

Brandes M. Resultaten van vier jaar Fertibase. Fertiliteitsarts/arts-onderzoeker, afdeling Gynaecologie, Jeroen Bosch Ziekenhuis. Sinds 2002 worden alle nieuwe patiënten die zich melden op de polikliniek Fertiliteit opgenomen in een elektronisch patiënten dossier: Fertibase. Hierdoor hebben we een grote database aangelegd aan fertiliteitspatiënten. ENDOMETRIUMDIKTE EN ZWANGERSCHAP: De relatie tussen de pre-ovulatoire endometriumdikte (TET) en zwangerschapskans is reeds onderzocht. Deze relatie was vooralsnog alleen onderzocht in gestimuleerde cycli. Keulers et al hebben aan de had van onze database onderzocht wat de relatie is in natuurlijke cycli. Als exclusie criteria gelden uterine en tuba afwijkingen, endometriose, ernstige mannelijke subfertiliteit. Resultaat: De totale enodmetrium dikte is een voorspeller voor zwangerschap. Waarbij het optimum voor zwangerschap ligt tussen de 7 en 8 mm. Bij een TET boven de 8 vindt een daling in het zwangerschapscijfer plaats. De leeftijd van de vrouw en de concentratie spermatozoa zijn eveneens een sterke voorspeller voor zwangerschap. HET FERTILITEITSVENSTER: Dit is het venster (het aantal dagen voor de eisprong) in de cyclus van de vrouw dat ze vruchtbaar is en zwanger kan raken. Dus het aantal dagen voor de eisprong dat het cervicale slijm doorlaatbaar is voor spermatozoën. In het standaard vruchtbaarheidsonderzoek verrichten wij de Post Coïtus Test (PCT), wat wil zeggen dat er in het cervix slijm onder de microscoop bewegende spermatozoën worden opgespoord. Met behulp van de PCT kan per patiënt gemeten worden wat de lengte is van het vruchtbaarheidsvenster. Resultaat: De kans op zwangerschap heeft een significant positieve relatie met de duur van het fertiliteitsvenster. Daarmee is het fertiliteitsvenster een bruikbare prognostische factor als aanvulling op het standaard vruchtbaarheidsonderzoek. POPULATIE STUDIE: Hull et al publiceerden reeds in 1985 een populatiestudie waarbij van 708 koppels in kaart werd gebracht wat de oorzaken waren van subfertiliteit met de zwangerschapskansen per subgroep. Onderstaande grafiek heeft jaren gediend als leidraad om patiënten te informeren over hun zwangerschapskansen en therapie mogelijkheden. Op twee gebieden is dit onderzoek verouderd. Patiënten die met IVF of KID behandeld werden zijn geëxcludeerd evenals patiënten paren met een meervoudige diagnose. Wij willen het onderzoek van Hull et al opnieuw verrichten maar dan in een moderne setting met als onderzoeksvragen: Wat is de incidentie van enkel en meervoudige diagnoses met per subgroep de uitkomst m.b.t. een spontane zwangerschap? Welk behandeltraject doorlopen de verschillende subgroepen en wat is de uitkomst? Zijn er subgroepen die een stap in een behandeltraject over kunnen slaan? Welke behandeling is met name verantwoordelijk voor het onstaan van meerlingzwangerschappen? Wat zijn de kosten per subgroep en wat is de kosteneffectiviteit? Nieuw innovatief onderzoek: PULSE TRIAL: In de pulse trial wordt de conventionele IVF behandeling (met dagelijkse subcutane gonadotrofinen injecties) vergeleken met een IVF behandeling waarbij de gonadotrofinen pulsatiel intraveneus worden afgegeven. De hypothese is dat wanneer de ovaria op een meer natuurlijke manier, namelijk pulsatiel, worden gestimuleerd er oöcyten onstaan met een betere kwaliteit dan oöcyten die ontstaan na conventionele behandeling. Betere oöcyten betekenen wellicht betere embryo’s. Hieruit volgt dat er minder oöcyten nodig zijn tijdens een behandeling. Een en ander impliceert dat ovariële hyperstimulatie met een lagere dosering gonadotrofinen zou kunnen gebeuren. De kosteneffectiviteit van IVF zou hierdoor groter worden en de kans op Ovarieel HyperStimulatie Syndroom (OHSS) zou

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verminderen. Een prospectieve gerandomiseerde studie is van start gegaan. Er zijn nog geen voorlopige resultaten.

Van den Brink M.1, Comuth W.1, Daniëls M.2. Eerste lijns toegankelijkheid tot ergometrie in het JBZ: Resultaten, arts- én patiëntenperspectief. 1 AIOS cardiologie, en 2cardioloog, vakgroep Cardiologie, locatie Groot Ziekengasthuis, Jeroen Bosch Ziekenhuis. Sinds begin 2006 bestaat voor huisartsen uit de regio de mogelijkheid rechtstreeks ergometrisch onderzoek aan te vragen. Dit is in het kader van cardiologische evaluatie bij patiënten die (nog) niet bekend zijn bij de cardioloog. Voor de test wordt de patiënt kort gezien door een cardioloog (voor een beperkte anamnese en lichamelijk onderzoek), die vervolgens de test interpreteert en retourneert aan de huisarts voorzien van een eventueel advies. Tussen januari en september 2006 werden 120 patiënten ingepland voor ergometrie; slechts 2 patiënten zijn niet verschenen. De helft van de patiënten was man. De patiënten waren verwezen door 43 verschillende huisartsen, waarvan de meerderheid 1 of 2 testen hadden aangevraagd. Negen huisartsen hadden 4 of meer testen aangevraagd. De meest voorkomende indicatie voor de test was een thoracale pijnklacht (69%); bij meer dan de helft hiervan was dit door de huisarts reeds gekwalificeerd als atypisch voor een cardiale origine. Vermoeidheid en dyspnoe vormden ieder 6% van de vraagstellingen. Voorafgaande aan de test hadden 15 patiënten (13%) reeds een afwijkend ECG; van deze patiënten werd in 2 gevallen op basis van het ECG én het klachtenpatroon besloten tot opname, nog voor ergometrie werd verricht. Van de resterende 116 patiënten waren er 4 (3%) onvoldoende belastbaar om de test adequaat te kunnen interpreteren. Eén patiënt werd na afloop van de test opgenomen. In totaal werden dus 3 patiënten direct voor of na de test opgenomen, dwz 2,5% van de patiënten. Los van de 3 opgenomen patiënten werd in nog 9 patiënten geadviseerd tot verwijzing naar een cardioloog. Bij 10 patiënten kreeg de huisarts een behandeladvies (met name bloeddrukcontrole). Uiteindelijk werden uit de gehele groep van 118 uitgevoerde testen 16 patiënten verwezen naar de cardioloog (13,5%). Voor 102 patiënten kon derhalve mogelijk een regulier polikliniekbezoek bespaard worden. Met iedere ergometrie werd aan de verwijzend huisarts een enquête formulier gestuurd; 55 enquêtes (47%) werden teruggezonden. Vrijwel alle huisartsen gaven aan dat het voor hen een toegevoegde waarde heeft zelf ergometrieen te kunnen aanvragen. Met name bij de patiënten waarbij de test geen bijzonderheden aan het licht bracht bleek de tevredenheid groot. Ten slotte werd ook onder patiënten geïnventariseerd hoe zij de huisartsen-ergometrie hadden ervaren. Tot op dit moment kon met 33 patiënten telefonisch contact worden opgenomen. Alle patiënten bleken tevreden over de wachttijd tussen de aanvraag en het onderzoek (1-3 weken) en de verdere logistiek; 2 patiënten noemden de wachttijd in de wachtkamer direct voor ergometrie als een probleem. De meeste patiënten bleken het prettig te vinden “alles” in één bezoek te kunnen afronden; niemand gaf er de voorkeur aan eerst de cardioloog te bezoeken, mogelijk omdat door de korte anamnese en lichamelijk onderzoek kort voor de ergometrie veel patiënten toch het gevoel hadden een afspraak bij de cardioloog te hebben gehad. Opvallend is dat ongeveer een kwart van de patiënten achteraf niet geïnformeerd werd over de uitslag van de test. Van de geïnterviewden voelde 75% (25 patiënten) zich geholpen met het onderzoek; zij voelden zich gerustgesteld of meenden dat er meer duidelijkheid was gekomen in de oorzaak van hun klacht. Aan de andere kant gaven 8 patiënten (25%) aan niets te zijn opgeschoten met het onderzoek; dit bleek in alle gevallen te worden veroorzaakt door het persisteren van de klachten waarvoor de ergometrie in eerste instantie was aangevraagd. Concluderend lijkt de 1ste lijns toegankelijkheid tot ergometrie zowel voor arts als patient een toegevoegde waarde te hebben.

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Daniels M.1, 2 , Naya T.1, Rundell V.1,de Tombe P.1. Development of contractile dysfunction in rat heartfailure: Hierarchy of cellular events. 1 Center for Cardiovascular Research, Department of Physiology and Biophysics, University of Illinois at Chicago, Chicago IL, and 2Department of Cardiology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands. The cellular mechanisms underlying the development of congestive heart failure (HF) are not well understood. Accordingly, we studied myocardial function in isolated right ventricular trabeculae from rats in which HF was induced by left ventricular myocardial infarction (MI). Both early stage (12 weeks post MI; E-pMI) and late, end-stage HF (28 weeks post-Mi; L-pMI) were studied. HF was associated with decreased sarcoplasmic reticulum Ca2+ ATPase protein levels (28% E-pMI; 52% L-pMI). Sodium/calcium exchange, ryanodine receptor, nor phospholamban protein levels were affected by HF. Twitch force at saturating extracellular [Ca2+] was depressed in HF (30% EpMI; 38% L-pMI), concomitant with a marked increase in sensitivity of twitch force toward extracellular [Ca2+] (26% E-pMI; 68% L-pMI). Ca2+ saturated myofilament force development in skinned trabeculae was unchanged in E-pMI, but significantly depressed in L-pMI (45%). Tension dependent ATP hydrolysis rate was depressed in L-pMI (49%), but not in E-pMI. Our results suggest a hierarchy of cellular events during the development of HF, starting with altered calcium homeostasis during the early phase followed by myofilament dysfunction at end-stage HF.

Hulstein J. Acute activatie van endotheelcellen in HELLP syndroom leidt tot verhoogde hoeveelheid actief Von Willebrand Factor. Klinisch chemicus in opleiding, Laboratorium Klinische Chemie en Hematologie, locatie Groot Ziekengasthuis, Jeroen Bosch Ziekenhuis. Von Willebrand factor (VWF) is een multimeer plasmaeiwit. Onder normale omstandigheden circuleert VWF samen met bloedplaatjes zonder dat er een interactie optreedt. Pas wanneer het VWF ontvouwen is, wat gebeurt bij wondheling, zullen de bloedplaatsjes aan VWF hechten. Het syndroom van hemolyse, verhoogde leverenzymen en lage bloedplaatjesaantallen (HELLP syndroom) is een ernstige vorm van zwangerschapsvergiftiging waarbij een trombocytopenie optreedt. Zowel bij zwangerschapsvergiftiging als bij HELLP syndroom is er sprake van beschadiging of activatie van de endotheelcellen. Het is nog onduidelijk hoe deze beschadiging bij patiënten met HELLP syndroom trombocytopenie induceert. Endotheelschade leidt tot verhoogde uitscheiding van VWF. Het VWF dat hierbij vrij komt is ultralarge (UL) VWF dat zeer reactief is met bloedplaatjes. Normaal gesproken wordt dit UL-VWF geknipt in kleinere minder actieve multimeren door ADAMTS13, het VWF-klievend protease. Met behulp van een nieuwe assay hebben wij gevonden dat in HELLP syndroom een 2-maal verhoogde hoeveelheid actief VWF aanwezig is in de circulatie vergeleken met patiënten met een zwangerschapsvergiftiging (p=0.001). De activiteit van ADATMS13 was licht verlaagd in HELLP patiënten vergeleken met gezonde zwangeren, maar niet vergeleken met patiënten met zwangerschapsvergiftiging. Door de verhouding VWF-propeptide / VWF te bepalen hebben we gevonden dat een extra acute activatie van de endotheelcellen optreedt in HELLP syndroom vergeleken met zwangerschapsvergiftiging. Bovendien vonden we een positieve correlatie tussen deze ratio en de hoeveelheid actief VWF. CONCLUSIE: Acute activatie van het endotheel en een verlaagde ADAMTS13 activiteit leiden tot verhoogde hoeveelheden actief VWF in de circulatie. Dit zou de hoge bloedplaatjes consumptie en de trombotische microangiopatie kunnen verklaren, die bij HELLP syndroom aanwezig is. Remming van het actieve VWF zou een nieuwe behandelmethode kunnen zijn voor deze symptomen van het HELLP syndroom.

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De Jager CPC.1, Rozendaal W.2. Research on the ICU, case-reporting as a first step. 1 Internist-intensivist, 2anesthesioloog-intensivist, Intensive Care and Emergency Department, locatie Groot Ziekengasthuis, Jeroen Bosch Ziekenhuis. Initiating research on an ICU will not only depend on the local “culture” but may also be troubled by diverse case-mix. Case-reports remain one of the cornerstones of medical progress and can be easily initiated from the ICU (1). Initially this format was used as medical education and audit in the form of a clinical conference. Interesting cases on our ICU (12 bed mixed ICU, 700 admissions/year) were studied and if possible clinical conferences were held. Residents were stimulated to publish. From januari 2005 until december 2006, 20 conferences were held. 15 articles were prepared and so far 7 accepted for publication (Table 1). The use of terlipressin in severe amitriptiline intoxication was an illustrating example of detecting novelty (therapeutic use of the vasopressine receptor) (2). We conclude that case-reporting may be a valuable first tool in initiating research on an ICU. 1: JP Vandebroucke, Ann Int Med 2001, Feb 20; 134(4): 330-4 In Defense of Case Reports and Case Series. 2: Zuidema X, Duenser MW, Wenzel V, Rozendaal FW, de Jager CP, Terlipressin as an adjunct vasopressor in refractory hypotension after tricyclic antidepressant intoxication, Resuscitation, 2006 Nov 21.

Table 1 Subject Mesenterial trombosis and morbus Crohn Right Sided Endocarditis MTX pneumonitis How to cope with a young suicidal patient Cullens sign in acute pancreatitis Glucose control on the ICU Streptococcal infections on the ICU Terlipressin in refractory hypotension due to amitryptilline intoxication Pulmonary tumor embolism Cathether fragmentation in recurrent pulmonary embolism Cardiac angiosarcoma Vasodilation in aortic stenosis Pumonary haemorrhage in Wegener Inadvert subclavion cannulation Transfusion associated lung injury Acute dissiminated encephalomyelitis Hemofagocytosis in a 21 year old female Abdominal Compartiment Syndrome Pre-operative managment Therapeutic hypothermia in the ICU Angioedema of the tonque Fatale Ecstasy intoxication

Article

Publication

no no yes yes yes yes yes (2) yes

no no internet internet Netherlands Journal of Internal Medicine Netherlands Journal of Critical Care submitted (2) Resuscitation

yes yes

no submitted

yes no yes yes no yes yes no no no yes yes

no no No Netherlands Journal of Internal Medicine no submitted no no no no New England Journal of Medicine submitted

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Mathoera R.*,1, Wever P.2, Rozendaal W.1, Broekman J.3, de Jager P.1. Intravascular changes during activated protein C/immunoglobuline combination therapy for necrotising fasciitis caused by invasive Group A Streptococcus: a case-report. *arts-assistent intensive care, 1Departments of Intensive Care Medicine, 2Medical Microbiology and Infection Control and 3Pathology, locatie Groot Ziekengasthuis, Jeroen Bosch Ziekenhuis. BACKGROUND: Recombinant human activated protein C (rhAPC), designed to treat diffuse intravascular coagulation and inflammation, has been used in the treatment of sepsis with varying results. The characteristic of necrotising fasciitis and its current management based on aggressive surgery has been a limitation to the use of rhAPC in these patients. DESIGN: case-report. SETTING: Tertiary care surgical Intensive Care Unit. PATIENT: A 42-year-old male patient with a history of psoriatic lesions was diagnosed with necrotising fasciitis in the left lower leg. The patient was in shock with multi-organ failure requiring fluids, vasopressors and mechanical ventilation. INTERVENTION: The patient was treated with rhAPC and polyclonal intravenous immunoglobulines (IVIg) within respectively 48 and 24 hours of admission combined with clindamycin and penicillin and surgical necrotectomy. Immunohistochemical analysis of biopsies before and after combination treatment was performed. MEASUREMENT AND MAIN RESULT: Immunohistological sections showed diffuse intravascular coagulation (DIC), as reflected in the presence of microthrombi and platelet-neutrophil aggregation, which were reduced after rhAPC/IVIg combination therapy. The number of microthrombi and platelet-neutrophil aggregates was different from the centre to periphery of the lesion. The patient survived after rhAPC/IVIg combination therapy. CONCLUSION: Necrotising fasciitis caused by invasive group A Streptococcus, often associated with Streptococcal Toxic Shock Syndrome is expected to respond well to rhAPC. Treatment with IVIg could postpone surgical intervention to allow treatment with rhAPC. This case report shows that combination treatment with IVIg and rhAPC is possible in necrotising fasciitis and may show beneficial effect.

Van la Parra R.*,1, Ernst M.1, Barneveld P.2, Broekman J.3, Rutten M.4, Bosscha K.1. SNB bij DCIS. * arts-assistent chirurgie 1Afdelingen Chirurgie, 2Nucleaire Geneeskunde, 3Pathologie en 4 Radiologie, Jeroen Bosch Ziekenhuis. INLEIDING: Het ductaal carcinoma in situ (DCIS) verwijst naar een pre-invasief stadium (stadium 0) van het mamma carcinoom en gaat niet gepaard met okselkliermetastasen. Echter, de diagnose kan onderhevig zijn aan ‘sampling errors’. Ook over de rol van de schildwachtklierbiopsie bij DCIS of DCISM (met micro-invasie) wordt in de literatuur veelvuldig gediscussieerd. STUDIEDOEL: Het doel van de studie was om onze ervaring met de schildwachtklierprocedure bij patiënten met DCIS en DCISM te bepalen. METHODE: Vierenveertig patiënten met de diagnose van DCIS (n= 38) of DCISM (n= 6), die een schildwachtklierprocedure en een borstoperatie ondergingen in de periode januari 1999 - december 2005, werden in kaart gebracht. Van deze 44 patiënten ondergingen 26 patiënten een lumpectomie en 18 een ablatio. RESULTATEN: Bij 7 van de 44 patiënten (16%), die een preoperatieve diagnose van DCIS(M) hadden, toonde de definitieve histologie een invasief carcinoom. Schildwachtklier metastasen werden bij vier van de 44 (9,1%) patiënten gevonden. Eén van de vier patiënten had een preoperatieve diagnose van DCIS en 3 patiënten hadden een DCISM. Drie van de vier schildwachtklieren waren alleen positief voor micrometastasen (< 2 mm). Bij 1 patiënt was er sprake van een metastase (> 2 mm). Alle vier patiënten ondergingen een okselklierdissectie. Bij geen van hen werden er andere positieve okselklieren gevonden.

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CONCLUSIE: In geval van een preoperatieve diagnose van DCIS graad 3, graad 2 DCIS met comedo necrose of extensive disease en bij DCISM moet het doen van een schildwachtklierprocedure zeker overwogen worden, omdat er bij ongeveer 20% van de patiënten postoperatief sprake is van een invasief carcinoom. Het doen van een schildwachtklierprocedure is minder betrouwbaar na een lumpectomie en, in geval van een ablatio, niet meer mogelijk. SNB (micro)metastasen werden bij bijna 10% van de patiënten aangetroffen. De prognostische betekenis van deze cellen is onduidelijk.

Poodt A.1, de Vries E.2. Stamboomonderzoek bij 2 families met Common Variable Immuundeficiency Disease. 1 Arts-assistent, 2kinderarts-immunologe, Afdeling Kindergeneeskunde, locatie Groot Ziekengasthuis, Jeroen Bosch Ziekenhuis. Inleiding: Common Variable Immunodeficiency Disease (CVID) is een late-onset hypogammaglobulinemie. Er zijn tot nu toe 4 genen geïdentificeerd die kunnen leiden tot het CVID fenotype. Deze bekende gendefecten komen in 10% van de CVID patiënten voor. Voor de overgebleven 90% van de CVID patiënten is de etiologie nog onduidelijk. Op de polikliniek zien wij 2 families met kinderen en volwassenen die CVID hebben. Deze 2 families komen uit een klein Brabants dorp en daarom denken wij dat deze 2 families mogelijk verweven zijn met elkaar. Onderzoek: Het in kaart brengen van de 2 familiestambomen en de eventuele verwevenheid ertussen. Bepalen van de immuunstatus van de CVID patiënten en hun ouders en eventueel andere eerstegraads familieleden. Eventueel DNA-onderzoek naar onderliggend gendefect. Resultaten tot nu toe: nog geen verwevenheid tussen de 2 families gevonden. Lage geheugen Blymfocyten bij de jongste kinderen van onze onderzoeksgroep, echter in de literatuur worden nog geen referentiewaarden beschreven. Plannen voor de toekomst: verder onderzoek naar normaalwaarden van geheugen B-lymfocyten bij kinderen is nodig.

Santegoets KMLW., Meijer J. Toepassing van de NESS Handmaster in Nederland: lange termijn gebruik en voorspellende factoren. Revalidatieartsen, Revalidatiecentrum Tolbrug ACHTERGROND: De Handmaster is een verstevigde onderarm orthese gecombineerd met electrostimulatie die wordt gebruikt voor de behandeling van complicaties na CVA. De Werkgroep CVA Nederland (WCN) heeft een aanbeveling opgesteld mbt de indicering van de Handmaster (HM) waarin een proefbehandeling centraal staat met 3 meetmomenten. DOEL: 1 bepalen van het lange termijn gebruik van de HM voorgeschreven cf de WCN aanbeveling. 2 selecteren van factoren die het lange termijn gebruik voorspellen. PATIENTEN EN METHODE: Alle patiënten die de HM definitief kregen voorgeschreven volgens de WCN aanbeveling tussen 01.07.01 en 01.01.03 in 17 WCN-instellingen werden geïncludeerd. Bij deze patiënten werd het gebruik nagevraagd. Tevens werden de meetgegevens van de proefbehandeling opgevraagd: Ashwort elleboog en polsflexoren, oedeem score, VAS pijn en passieve mobiliteit pols en elleboog (basisvariabelen). RESULTATEN: 148 patiënten, uit 17 instellingen, zijn benaderd.127 patiënten hebben toestemming gegeven voor deelname. Na gemiddeld 2.7 jaar (SD 0.6) gebruikt 76.4% de HM nog, 23.6% is gestopt. De gebruikersgroep en stopgroep zijn volledig vergelijkbaar qua geslacht, leeftijd en locatie van het CVA. Er zijn geen significante verschillen gedurende de verschillende meetmomenten van de proefbehandeling voor de basis variabelen, muv de delta-Ashwort polsflexor. In de HM gebruikers groep treden significante veranderingen op in t0-t1-t2. Het bleek onmogelijk om een kleine voorspellende set variabelen te selecteren die het lange termijn gebruik op individueel niveau voorspellen.

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CONCLUSIE: Na gemiddeld 2.7 jaar wordt de Handmaster nog gebruikt door 74,6% van de patiënten. Met de in deze studie gebruikte variabelen is het niet mogelijk op individueel niveau wel/niet chronisch gebruik te voorspellen.

Strobbe L. JAK2 mutatie bij myeloproliferatieve syndromen. Arts-assistent interne geneeskunde, Afdeling Interne Geneeskunde, locatie Groot Ziekengasthuis, Jeroen Bosch Ziekenhuis. Recently, an activating somatic mutation (V617F) of Janus kinase 2 (JAK2) was identified in the myeloproliferative disorders (MPDs). This finding can lead to earlier identification of MPDs than with the current recognized diagnostic criteria. In this study we investigated the occurrence of JAK2V617F in patients with slightly elevated platelets or hemoglobin without a secondary cause, who did not meet the criteria of polycythemia vera (PV) or essential thrombocythemia (ET). 6 out of 18 patients (33%) were positive for the JAK2V617F mutation and 5 of these 6 patients had a history of thrombosis. These findings suggest that apart form thrombocytosis/erythrocytosis other [JAK2V617 related?] mechanisms exist that cause thrombosis and some authors did find a higher incidence of thrombosis in mutation positive ET/PV patients Thus, more patients with a latent form of MPD are likely to exist. Future studies will have to elucidate what to do with them: just follow-up or early treatment with aspirin or even cytoreduction to prevent future thrombosis?

Van Stuivenberg C1, de Laat F.2, van Kuijk A.2. Validiteit en intra- en interbeoordelaarbetrouwbaarheid van een indirecte volumemeting bij transtibiale amputaties. 1 Arts-assistent revalidatie, 2revalidatiearts, Revalidatiecentrum Tolbrug INLEIDING:In Nederland vinden jaarlijks per 100.000 inwoners 18-20 amputaties van de onderste extremiteit plaats. 47 % heeft een onderbeenamputatie en 48% krijgt uiteindelijk een prothese. Volumewisselingen spelen in de eerste periode na amputatie een belangrijke rol en bepalen het moment waarop een definitieve prothese kan worden aangemeten. Dan moet het stompvolume constant zijn. Ook bij patiënten die al langere tijd een prothese dragen kan het volume wisselen waardoor de prothese niet goed past. Wanneer een nieuwe prothese moet worden aangevraagd wil de verzekering objectieve gegevens weten, volumemetingen. ONDERZOEK: In de dagelijkse praktijk in Nederland wordt de stompomvang (dus niet het volume) in het algemeen bepaald middels omtrekmetingen met behulp van een standaard meetlint. Naar deze meetmethode is nauwelijks onderzoek verricht en er is geen standaard meetprotocol dat overal in Nederland gebruikt wordt. In de literatuur wordt als gouden standaard voor onderzoek de waterverplaatsmethode gebruikt. Hierbij wordt het stompvolume bepaald aan de hand van de hoeveelheid water die, door de beenstomp in een bak met water te plaatsen, verplaatst wordt. Deze methode is erg betrouwbaar, maar niet zo gebruiksvriendelijk en niet gemakkelijk overal te gebruiken. Ook met behulp van moderne technieken, zoals MRI, CT en laser, kan het stompvolume bepaald worden. Naar deze meetmethoden wordt de laatste tijd meer onderzoek gedaan. In de praktijk in Nederland worden deze meetmethoden echter weinig gebruikt vanwege de hoge kosten en beperkte beschikbaarheid. Bij patiënten met oedeem van de bovenste extremiteit na borstkanker is onderzoek gedaan naar volumemetingen met behulp van omtrekmetingen. De waarden van deze omtrekmetingen worden ingevoerd in een formule afgeleid van het volume van een afgeknotte kegel. Er wordt hierbij gebruik gemaakt van een meetlint waar een veertje aan is bevestigd zodat het meetlint bij elke meting onder dezelfde rek gehouden wordt. In dit onderzoek bleek deze meetmethode even betrouwbaar te zijn als de gouden standaard, de waterverplaatsmethode. Wanneer deze meetmethode bij volumemetingen van onderbeenstompen even betrouwbaar blijkt te zijn als de gouden standaard, dan hebben we de beschikking over een meetmethode die goedkoop en eenvoudig overal toe te passen is. REVALIDATIECENTRUM TOLBRUG: In revalidatiecentrum Tolbrug is per 1 maart 2006 een onderzoek gestart naar deze volumemetingen met de titel: “Validiteit en intra- en interbeoordelaarbetrouwbaarheid van een indirecte volumemeting bij transtibiale amputaties.” Hierbij zullen de metingen met behulp van deze nieuwe meetmethode vergeleken worden met de waterverplaatsmethode (gouden standaard) en met het meten met een standaard meetlint zoals dat

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momenteel in het revalidatiecentrum Tolbrug en elders in Nederland plaatsvindt. Aan patiënten met een onderbeenamputatie zal gevraagd worden om deel te nemen aan het onderzoek. Op 2 verschillende dagen zullen deze metingen verricht worden door 3 onderzoekers. Het onderzoek wordt uitgevoerd door C. van Stuivenberg-Vrielink, AIOS revalidatie onder supervisie van F. de Laat, revalidatiearts en A. van Kuijk, revalidatiearts. De overige onderzoekers zijn: F. van Teklenburg, instrumentmaker LIVIT en H. Morelissen, fysiotherapeut RCT. RESULTATEN: Inmiddels zijn 22 patienten gemeten voor het onderzoek.

Van Wensen R.1, Dautzenberg P.2, Bosscha K.1. Delier binnen het JBZ. 1 Afdeling chirurgie, 2afdeling geriatrie, Jeroen Bosch Ziekenhuis. Een delier wordt gedefinieerd als een acute verwardheid met afname van aandacht en gestoorde cognitieve functies met dikwijls stoornissen in psychomotorische activiteit, slaap-waakritme en emoties. Het optreden van een delier na een heupfractuur is een frequente complicatie en gaat gepaard met een verhoogde morbiditeit en mortaliteit. Uit eigen onderzoek blijkt dat de incidentie van het delier 37% te zijn. Inventarisatie en evaluatie van de risicofactoren en prognose van het postoperatieve delier bij patiënten met een heupfractuur op een afdeling chirurgie liet zien dat een toenemende leeftijd de belangrijkste risicofactor is voor het ontwikkelen van een delier. De pathogenese van het delier wordt niet goed begrepen. Waarschijnlijk spelen bij het ontstaan van het delier vele neurotransmitters een rol. Tot op heden is er niet veel methodologisch goed onderzoek verricht naar de medicamenteuze behandeling van het delier. Wel is het aannemelijk dat het antipsychoticum haloperidol effectief is voor de behandeling van een delier bij somatisch zieke patiënten, met echter een niet te onderschatten kans op bijwerkingen. Case-reports melden dat cholinesterase-remmers, zoals rivastigmine, een delirium kunnen verbeteren, opheffen en voorkomen. In het Jeroen Bosch Ziekenhuis, locatie Groot Ziekengasthuis, is er in samenwerking met chirurgie, orthopedie en geriatrie een dubbelblind gerandomiseerd, placebogecontroleerde studie DELTa-S ontwikkeld. In DELTa-S willen we bij patiënten opgenomen met een heupfractuur die gedurende de opname een delier ontwikkelen nagaan wat de veiligheid en effectiviteit is van rivastigmine of haloperidol in de primaire behandeling van het delier t.o.v. een placebo. Om voldoende analyse-power te krijgen worden de resultaten van DELTa-S toegevoegd aan die van DELTa-G, een zuster-studie, die uitgevoerd wordt op de afdeling geriatrie. Het delier wordt op korte termijn een kwaliteits- en prestatieindicator. Om deze reden willen we het onderzoek m.b.t. het delier binnen het JBZ op de kaart zetten en het op diverse fronten en afdelingen uitbreiden.

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OVERZICHT 2007 Tabel 1: Overzicht van het aantal artikelen (ook ingezonden brieven), boeken en promoties. Posters en voordrachten zijn niet in de tabel opgenomen.

Anesthesiologie Cardiologie Chirurgie Dermatologie Geriatrie Gynaecologie Intensive Care Gnk. Interne Gnk. Kinder Gnk. KC&H laboratorium KNO Longziekten Med. Microbiol. Med. Technologie Mol. Diagnostiek Neurologie Nucleaire Gnk. Oogheelkunde Orthopeadie Pathologie Psychiatrie Psychologie Radiologie Reumatologie Revalidatie Gnk. Urologie Ziekenhuisapotheek Overige stafdiensten1

Totalen:

Totaal aantal artikelen 2006 2007 0 0 3 1 19 24 6 7 6 3 3 11 5 9 50 18 7 9 3 4 0 1 8 9 2 12 0 1 3 7 9 3 1 1 1 0 1 02 0 6 3 0 1 02 7 8 3 4 16 6 4 4 6 4 1 4 179 156

PubMed geciteerd 2006 2007 0 0 3 1 9 21 1 5 2 1 2 9 0 6 28 16 5 6 3 3 0 0 5 6 8 5 0 0 2 6 6 3 0 1 1 0 1 02 0 3 2 0 0 02 7 6 3 3 1 5 3 2 2 0 0 0 94 108

Boeken 2006 1 1 2 1 2 1 1 9

2007 1 1 1 3

Promoties 2006 1 1 2

2007 1 1

Letters 2006 1 1 2 1 1 1 7

2007 0

1

PMA Fysiotherapie, Hygiëne & Infectiepreventie en Kwaliteit & Organisatie. 2 Hebben in 2007 geen artikelen, boeken of ingezonden brieven gepubliceerd (wel posters en voordrachten).

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es th es io l C ar ogie di ol o C gi D h ir u e er m rg i e at ol og ie G In Gy eri te na atr ns i iv eco e e C lo g ar ie In e G te rn nk. KC K e G i &H nd nk . e la r G bo nk ra to . r iu m Lo K N n gz O M e i M d. M ekt e ed i . T cro n b e M i c ol hn ol. . D ol o ia g n g ie o N sti N eur ek uc o le log O a ir e i e og he G n k. e O lku rth nd op e e Pa ad t h ie o P s lo g y c ie Ps hia yc trie ho R lo g ad ie R e iol R u m o g ie ev at al olo id at gie ie Zi G ek nk en U . O r h o ve ui l o gi r ig s a e p e st oth e af di ek en st en

An

aantal publicaties

Publicaties per vakgroep

60

50

Totaal 2006 Totaal 2007 PubMed 2006 PubMed 2007

40

30

20

10

0

vakgroep

Grafiek 1: Overzicht van publicaties per vakgroep in 2006 en 2007 (met specificatie voor PubMed geciteerde artikelen).

115

th es C iolo ar g di ie ol o C D hi gie er ru m rg at ie ol o In G Ge gie te yn ri ns a at iv ec rie e C olog a In re ie te G rn nk KC e . &H Kin G de nk la r . bo G ra nk to . riu Lo K m M ng N M ed. zie O ed M kt . ic en M Tec rob ol h io . D no l. ia log gn ie N os N eu tie uc ro k l l O eair ogi og e e he G n O elku k. rth n op de Pa ea th die Ps olo y g Ps chi ie yc atr h ie R olo R ad gie R eum iolo ev a g al to ie id lo at gi Zi ie e ek O enh U Gnk ve u ro . rig isa lo e po gie st af the di e en k st en

An es

aantal publicaties

Publicaties per FTE per vakgroep

8,00

Totaal aantal artikelen per FTE PubMed geciteerd per FTE

7,00

6,00

5,00

4,00

3,00

2,00

1,00

0,00

vakgroep

Grafiek 2: Overzicht van publicaties per FTE per vakgroep in 2007 (met specificatie voor PubMed geciteerde artikelen).

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Index Auteur Andriessen MP, 21 Balter SGT, 53 Barneveld PC, 72; 73 Bekkers C, 99 Berends M, 36 Bergen van FS, 78 Beutler J, 42; 44 Bevaart BJW, 90 Biesma B, 54; 55; 56; 57; 58; 59 Bolhuis RJ, 8; 17 Bom LPA, 74 Bos GJ, 88; 90 Bosscha K, 8; 9; 10; 17; 18 Brandes M, 106 Brink van den M, 107 Broekman J, 75; 76 Brokelman WJ, 11 Camaro C, 36 Casarotto M, 104 Conemans J, 99 Damen J, 75; 76; 77 Daniëls MC, 6; 7; 108 Dautzenberg PLJ, 23; 24 Dekker D, 42 Dooren van-Greebe RJ, 21; 22 Duijnhouwer AL, 36 Dun van E, 93 Eijckeler E, 77 Eijkeren van FJM, 102 Ernst MF, 8; 10; 12; 17; 18; 20 Erol-Yilmaz, 36 Festen HP, 36 Freriks K, 37 Garssen MP, 70 Geest van AJ, 21; 22 Geffen van HJ, 12; 13; 16; 17; 18; 105 Gemen EF, 51; 52 Haelst van A, 90 Hamilton CJCM, 25; 29; 31 Handoko KB, 99; 100 Hartkamp A, 85; 86 Hassink RJ, 38 Hermans M, 99 Hermans MHA, 65; 66; 67; 68; 69 Hermens WAJJ, 99; 100 Hoedemakers RMJ, 50; 52 Hoekstra CJ, 73 Hoekstra JH, 45; 46; 47; 48; 49

Hoeven vd AM, 38 Hollander AAMJ, 43 Hoogeveen EK, 43; 44 Huijsmans CJ, 65 Hulstein J., 108 Jager de CPC, 32; 33; 34; 35; 109 Jager GJ, 79; 81 Jansen T, 77 Janssen MWH, 103 Janssens RWA, 21 Jongh de-Leuvenink J, 51 Kemink SAG., 43 Kemperman FA, 39 Kerkhof M, 29 Koek HL, 39 Koning OHJ, 13; 14; 15; 17; 19 Kort de EHM, 48 Kuijk van AA, 88; 89; 91; 92 Kusters GCM, 50; 52 Kusters MA, 48 Laat de F, 89; 92 Lechner T., 5 Leenders AC, 60; 103 Lestrade P, 39 Lieshout van AW, 85 Linden van der JC, 75; 76; 77 Lips J, 43 Loo van de M, 46 Maas AJ, 64 Mathoera R, 110 Meijer JWG, 88; 90; 91; 92; 93; 94; 95 Meijer RP, 97 Netten PM, 36 Nooijen P, 76 Oddens J, 97 Oei AL, 26; 27; 29; 30 Oijen van P, 86; 87 Olsman JG, 9; 13; 16 Oosterbaan HP, 28; 30; 31 Parra van la R, 16; 110 Pelk-Jongen M, 103 Péquériaux NC, 50; 51 Pijnenburg CC, 99 Poodt AEJ, 46; 48; 111 Poodt J, 68 Pruijt JFM, 43 Ramakers BPC, 43 Ranschaert ER, 84 117

Renders A, 64 Renders NHM, 60; 103 Rigter H, 76; 77 Rijnders RJP, 28; 31 Rozendaal FW, 32; 33; 35 Rutten MJ, 79; 80; 81; 82; 83; 84 Ruurda JP, 9 Santegoets KMLW, 93; 95; 111 Schaik van PM, 8; 10; 16; 18; 19; 20 Schatorjé EJH, 46 Schipper RA, 97 Schneeberger P, 60; 61; 62; 103 Schreibers M, 95 Sinnige HA, 40; 42 Smilde TJ, 40; 43; 44 Strobbe L, 39; 41; 112

Stuivenberg van C, 112 Thijs AMJ, 42; 44 Vandewall M, 48 Verhoeven M., 104 Verstegen R, 48; 49 Visee HF, 100 Visscher de AVM, 53 Vries de E, 46; 48; 49 Vugts M, 96 Walker JC, 49 Weerden van P, 77 Wensen van R, 113 Wever PC, 62; 63 Wijk van PTL, 103 Wouters CJ, 23; 24

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Index Tijdschriften Acta Belgica Orthopaedica, 8 Acta Orthop, 79 Acta Paediatrica, 46 Am J Surg Pathol, 21; 76 Am. J. Physiol, 6 Ann Hematol, 39; 66 Ann Rheum Dis, 85; 86 Biochem Biophys Res Commun, 85 BMC Pregnancy Childbirth, 28 BMC Surg, 10 Breast., 12 Cancer Biother Radiopharm, 26 Clin Chem Lab Med, 46; 50 Clinical Observer, 80 Crit Rev Oncol Hematol, 54 Cura, 7; 12; 62; 81 Diagn Cytopathol, 27 Disabil Rehabil, 89; 90 Epilepsie, 99 Eur J Cancer, 55; 56; 97 Eur J Itern Med., 76 Eur J Obstet Gynecol Reprod Biol, 27 Eur J Radiol, 80 Eur J Surg Onc, 8; 10; 72; 75; 80 Eur J Vasc Endovasc, 14 Eur Radiol, 79; 81 Haematologica, 40 Hernia, 13 Hum Reprod, 25 Infectieziektebulletin, 60; 103 Infection, 38; 61; 62 Inflamm Bowel Dis, 45 Insuline Resistentie, 36 Int J Biol Markers, 26 Int J Cancer, 27 Intensive Care Med, 32 J Biomech, 13 J Card Fail, 36 J Clin Microbiol, 65 J Clin Neurophysiol, 89 J Clin Psychopharmacol, 66 J Endovasc Ther, 15 J Gastroenterol Hepatol, 33 J Gastrointest Surg, 12 J Invest Dermatol, 21 J Mol Diagn, 65 J Natl Cancer Inst, 54

J Neurol Neurosurg Psychiatry, 70 J Pediatr Gastroenterol Nutr, 45; 46 J Pediatr Urol, 97 J Perinat Med, 28 J Psychiatr Res, 50 J Rehabil Med, 70; 88 J Thorac Oncol, 8; 55; 57; 58 J Urol, 97 J Vasc Surg, 14; 15 J Viral Hepat, 60 Kwaliteit in beeld, 16 Labcontact, 60; 63; 76; 99 Labcontact Diagnostisch Centrum, 7 Lancet, 40 Lung Cancer, 56 Medicine (Baltimore), 41 Muscle Nerve., 70 Ned Tijdsch Med Microbiol, 67 Ned Tijdschr Derm Venereol, 21; 22; 62; 99 Ned Tijdschr Geneeskd, 9; 23; 33; 36; 37; 38; 39; 41; 46; 60; 81; 103 Ned Tijdschr voor Oncol, 57 Ned. Tijdschr. KNO Heelk, 53 Nederlands Tijdschrift voor fysiotherapie, 23; 102 Nederlands Tijdschrift voor Obstetrie en Gynaecologie, 28; 39 Nederlands Tijdschrift voor Reumatologie, 85 Neth J Crit Care, 32; 33; 63 Neth J Med, 33; 36 Neth. Heart J, 6 Otol Neurotol, 16 Pharmacoepidemiol Drug Saf, 99 Radiother Oncol, 21 Resuscitation., 32 Revalidata, 88 Surgical Endoscopy, 11 Thorax, 45 Thromb Haemost, 50; 51 Tijdschr Kindergeneesk, 46 Tijdschr v Verlosk, 28 Tijdschrift voor nucleaire geneeskunde, 64 Tijdschrift voor VerpleeghuisGeneeskunde, 23 Vox Sang, 61; 65

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Wetenschap naar de top. Publicaties Jeroen Bosch Ziekenhuis 2007

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