Wetenschappelijk jaaroverzicht 2010 Een uitgave van het Albert Schweitzer ziekenhuis
Albert Schweitzer series, Dordrecht, 2011
Wetenschappelijk jaaroverzicht 2010 Een uitgave van het Albert Schweitzer ziekenhuis
Onder redactie van: Hoofdredactie M.C.J.M. Kock C.N. van Waardhuizen Redactie E.Y. de Kruyf-Haksteen Wetenschapscommissieleden Met dank aan alle medewerkers die de totstandkoming van deze uitgave mogelijk hebben gemaakt.
Oplage: 500 Cover and lay-out: Dekkers Printed by: Dekkers
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Inhoud
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Voorwoord . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
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Samenstelling Wetenschapscommissie 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
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Activiteiten Wetenschapscommissie 2011. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Wetenschappelijk jaaroverzicht 2010 per vakgroep I Anesthesiologie . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 II Apotheek. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 III Cardiologie . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 IV Chirurgie. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 V Gynaecologie. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 VI Interne Geneeskunde . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 VII Kindergeneeskunde. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 VIII Klinische Chemie. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 IX Klinische Fysica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 X Klinische Psychiatrie. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 XI Klinische Psychologie. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 XII Kwaliteit, Veiligheid en Innovatie. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 XIII Longgeneeskunde. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 XIV Maag, Darm en Lever. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 XV Medische Microbiologie. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 XVI Neurologie. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 XVII Nucleaire Geneeskunde . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 XVIII Ouderengeneeskunde. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 XIX Pathologie. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 XX Radiologie. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 XXI Spoedeisende Hulp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 XXII Urologie. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
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Promoties ASz 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Impactfactors Asz publicaties per wetenschappelijk tijdschrift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Verantwoording wetenschappelijk jaaroverzicht 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
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Woord vooraf
Woord vooraf
Voor u ligt het jaarverslag met een weergave van de wetenschappelijke activiteiten die in 2010 hebben plaatsgevonden in het Albert Schweitzer ziekenhuis. De activiteiten variëren van promoties en wetenschappelijke artikelen tot voordachten en posters met betrekking tot de directe patiëntenzorg. Met trots kunnen we zeggen dat het aantal publicaties in vergelijking met het voorgaand jaar duidelijk is toegenomen. Hét bewijs dat het ASz wetenschap hoog in het vaandel heeft staan en daarin investeert. Het (mee) doen aan onderzoek is voor ons ziekenhuis van belang. Belangrijk in het kader van de opleiding tot medisch specialisten en voor andere opleidingen, waarbij kennis van onderzoek en het verrichten ervan een nadrukkelijk onderdeel zijn van de opleiding. Maar ook belangrijk om bij te blijven met de ‘state-of-the-art’. Het dwingt ons om de ontwikkelingen in de medische zorg en de opleidingen te blijven volgen en mee te helpen om de kwaliteit van de zorg nog beter te maken. Het wetenschappelijk jaarverslag benadrukt de deskundigheid van onze medewerkers. Langs deze weg willen we de in huis aanwezige kennis en kunde graag delen met collega’s. Het gaat er uiteindelijk om dat onderzoeksresultaten in de dagelijkse zorgpraktijk worden toegepast. De Wetenschapscommissie biedt u dit jaarverslag dan ook graag aan ter overzicht en inspiratie. We hopen dat dit overzicht weer aanspoort tot nieuwe wetenschappelijke activiteiten. Zodat we met elkaar onze patiëntenzorg op een nóg hoger niveau kunnen brengen. Dr. M.C.J.M. Kock Voorzitter Wetenschapscommissie
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Dagelijks bestuur dr. M.C.J.M. Kock, voorzitter, radioloog dr. M-D Levin, vice-voorzitter, internist-hematoloog C.N. van Waardhuizen MSc, beleidsadviseur mw. E.Y. de Kruyf, secretariaat.
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Samenstelling Wetenschapscommissie 2011
Samenstelling Wetenschapscommissie 2011
Overige leden 2011 dr. ir. B. van den Berg, klinisch fysicus dr. A. Bisschoff, KNO-arts dr. E.F.H. van Bommel, internist-nefroloog drs. R.P.M. Ceulen, dermatoloog prof. dr. A.J.M. Cleophas, internist drs. L.P.L.H. Cuijpers, klinisch psycholoog dr. M.A. Fouraux, klinisch chemicus dr. H.M.E. Frenay, arts-microbioloog mw. R. van Hof, medisch informatiespecialist dr. C.M. Houser, SEG-arts drs. A.D. Klaren, manager Leerhuis drs. S. Hendriks, intensivist-anesthesioloog dr. P.W. Plaisier, chirurg drs. J.M.M. van de Ridder, adviseur Medische Vervolgopleidingen Leerhuis dr. T.C.J. Sas, kinderarts dr. A.C. de Mol, kinderarts-neonatoloog drs. E.M. de Vogel, ziekenhuisapotheker dr. P.J. Westenend, patholoog drs. L.J.P.M. van Woerkens, cardioloog dr. D. Zemel, neuroloog dr. D. Cheung, longarts drs. S. Rombout-de Weerd, gynaecoloog dr. N.B. Swarte, gynaecoloog.
Hoofdredactie Wetenschappelijk tijdschrift ‘WASz’ dr. N.B. Swarte, gynaecoloog drs. A. van der Velden, arts-assistent spoedeisende geneeskunde.
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Activiteiten Wetenschapscommissie 2010
Activiteiten Wetenschapscommissie 2010 Organisatie
In 2010 werd het voorzitterschap van de Wetenschapscommissie overgedragen van Prof. dr. T. Cleophas naar dr. M. Kock. Het regelement is aangepast en er is een dagelijks bestuur geïnstalleerd met een voorzitter, een secretaris en een wetenschapscoördinator welke sinds mei 2010 ondersteund wordt door een beleidsadviseur. Vijftien vakgroepen met onderzoeksactiviteiten hebben een lid in de Wetenschapscommissie. Overige leden zijn; manager en onderwijskundig adviseur van het Leerhuis, medisch informatiespecialist van de bibliotheek, vertegenwoordiger van AIOS, De Wetenschapscommissie vergadert 4 maal per jaar en heeft als hoogtepunt de jaarlijkse Wetenschapsdag van het ASz.
Stipendium In de tweede helft van 2010 heeft de Wetenschapscommissie voor het eerst door gelden van het Leerhuis inschrijving voor een stipendium geopend. Met de gelden uit dit onderzoeksfonds kan de Wetenschapscommissie haar onderzoekers financieel ondersteunen. Het stipendium is bedoeld om financiële ondersteuning te bieden aan onderzoekers om voor een periode van maximaal vier maanden zich fulltime bezig te houden met research activiteiten. Gedurende deze periode beoordeelt de Wetenschapscommissie de voortgang van het onderzoek. Het stipendium is in 2010 toegekend aan de volgende studies en onderzoekers: Intracutaneously versus transcutaneously sutured ileostomy: A randomized multicenter trial (ISI trial), Drs. M.F. Sier, arts-assistent chirurgie, Hoofdonderzoeker dr. R.P.J. Oostenbroek HERBAS trial, Drs. C. Liesting, arts-assistent Interne Geneeskunde/Cardiologie, Hoofdonderzoekers dr. M-D Levin en dr. M.J.M. Kofflard
WASz In 2010 verscheen onder hoofdredactie van Annemarie van der Velden en Nikkie Swarte tweemaal het WASz (Wetenschappelijk tijdschrift Albert Schweitzer ziekenhuis) met een oplage van 500 exemplaren. Hiermee worden medewerkers en verwijzers van het ASz periodiek op de hoogte gehouden van allerlei wetenschappelijk nieuws en activiteiten van het ASz.
Cursussen De volgende cursussen werden in het Albert Schweitzer ziekenhuis gedoceerd. Het totaal aantal deelnemers zijn hierachter genoemd: Wetenschappelijk onderzoek opzetten. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (19) Steekproefgrootte berekenen Statistische software (SPSS) gebruiken . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (47) SPSS Workshop Valideren diagnostische tests PubMed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (24) Poster maken. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (5) Medical Writing in English . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (13) De laatste 3 cursussen werden in 2010 voor het eerst gegeven. Daarnaast zijn extramuraal de volgende cursussen gegeven: • Twee Workshops statistiek, in Academisch Ziekenhuis Nijmegen • SPSS, bijeenkomst wetenschapscoördinatoren STZ
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Wetenschapsdag 2010 Op donderdag 7 oktober werd het ‘6e jaarlijkse Wetenschapsdag Asz’ gehouden. Dit maal in het Da Vinci college op het Leerpark. Er werden negen orale presentaties gegeven over resultaten van lokaal Asz-onderzoek, en 2 gepromoveerden presenteerden hun wetenschappelijke resultaten van hun proefschrift. Daarnaast werden 25 studies gepresenteerd middels een poster. De gastspreker was dr. N.H.M. Renders, arts-microbioloog uit het Jeroen Bosch Ziekenhuis, die een actuele presentatie over Q-koorts verzorgde. De wetenschapsdag werd bezocht door zo’n 100 belangstellenden. Op de wetenschapsdag werden de volgende prijzen uitgereikt: Publicatieprijs: ‘Beste publicatie 2009’ Eunice Korten, Distensibility of Forearm Veins in Haemodialysis Patients on Duplex Ultrasound Testing Using Three Provocation Methods. Prijs ‘Beste mondelinge presentatie 2010’ Jurgen Riedl, Digital Morphology: a proven concept in the modern laboratory. Prijs ‘Beste posterpresentatie 2010’ Elles Zock, Prehospital barriers in acute stroke care in the region of Dordrecht, The Netherlands. Tevens verscheen op de wetenschapsdag het wetenschappelijk jaarverslag van het Albert Schweitzer ziekenhuis.
Wetenschappelijk spreekuur Ook in 2010 werd door de wetenschapscoördinator het Wetenschappelijk spreekuur gehouden. In totaal hebben daar 99 mensen vanuit verschillende disciplines gebruik van gemaakt.
Multidisciplinair onderwijs De Wetenschapscommissie heeft in september het multidisciplinair onderwijs verzorgd. Hierbij werd uitvoerig ingegaan op wat noodzakelijk is om wetenschappelijk onderzoek uit te voeren; van idee naar publicatie, de nieuwe wetenswaardigheden omtrent PubMed; over regelgeving; over de METC, over tips bij presenteren; en allerminst over de ervaringen in het veld over wetenschap bedrijven in het ASz.
Medisch Specialistische OpleidingsCommissie (MSOC) De voorzitter is lid van het MSOC geworden in 2010, om contact met de MSOC aan te halen. Het opleidingsklimaat is belangrijk voor het stimuleren van wetenschappelijk onderzoek. Het streven hierbij is om een toenemende betrokkenheid van opleidingsspecialisten uit het ASz bij wetenschappelijk onderzoek te bewerkstelligen.
Toetsingscommissie In 2010 zijn ook contacten met de toetsingscommissie gemaakt. Het streven is naar onderlinge afstemming bij het faciliteren en stimuleren van lokaal Asz onderzoek.
Website In 2010 is er een begin gemaakt met de doorontwikkeling van de website van de Wetenschapscommissie. Naast algemene informatie over de Wetenschapscommissie is er op deze site diverse informatie te vinden zoals; vergaderdata, ledenlijst, lopende longitudinale onderzoekslijnen, verschillende leermiddelen, wetenschappelijke spreekuren die vanuit de Wetenschapscommissie georganiseerd worden, lijst met wetenschappelijke studies, de wetenschapsdag en overige nieuwsberichten.
Beleid Voor wat betreft de ontwikkeling van het wetenschappelijk beleid in het ASz is er in 2010 een start gemaakt met de verdere professionalisering van de Wetenschapscommissie. Onder meer is nu bijna elke vakgroep met een lid vertegenwoordigd in de Wetenschapscommissie. De bedoeling is dat ieder lid als een contactpersoon fungeert voor de betreffende vakgroep ten aanzien van wetenschappelijke activiteiten. Dit lid heeft het overzicht van lopend onderzoek binnen de vakgroep. De Wetenschapscom-
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Activiteiten Wetenschapscommissie 2010
missie wil uiteindelijk een vorm aanbieden aan de leden hoe onderzoek verder binnen de afdelingen georganiseerd kan worden, Verder is er meer structuur aangebracht in de vergadering van het dagelijks bestuur van de Wetenschapscommissie. Het DB vergadert minstens één keer per maand. Tevens is er een start gemaakt met het opstellen van een meerjaren beleidsplan ten aanzien van het wetenschappelijk onderzoek in het ASz.
STZ De wetenschapscoördinator participeert actief binnen de vergaderingen van de STZ-wetenschapscoördinatoren. De Wetenschapscommissie wil deze continuïteit waarborgen. Momenteel zijn de contacten met andere STZ-ziekenhuizen op wetenschappelijk gebied goed te noemen. Tijdens de STZ vergaderingen zijn er door de wetenschapscoördinator meerdere lezingen gehouden over verschillende onderwerpen.
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Anesthesiologie
Anesthesiologie PubMed publicaties
Prediction of propofol clearance in children from an allometric model developed in rats, children and adults versus a 0.75 fixed-exponent allometric model. Peeters MY, Allegaert K, Blussé van Oud-Alblas HJ, Cella M, Tibboel D, Danhof M, Knibbe CA. Clin Pharmacokinet. 2010 Apr 1,49(4):269-75. For propofol clearance, allometric scaling has been applied successfully for extrapolations between species (rats and humans) and within the human bodyweight range (children and adults). In this analysis, the human bodyweight range is explored to determine for which range an allometric model with a fixed or estimated exponent can be used to predict propofol clearance, without correction for maturation. The predictive value of the allometric equation, clearance (CL) is equal to 0.071 x bodyweight in kg0.78, which was developed from rats, children and adults, and the predictive value of a fixed exponent allometric model derived from the basal metabolic rate, CL is equal to CL standardized to a 70 kg adult x (bodyweight in kg standardized to a 70 kg adult)0.75, were evaluated across five independent patient groups including (i) 25 (pre)term neonates with a postmenstrual age of 27-43 weeks; (ii) 22 postoperative infants aged 4-18 months; (iii) 12 toddlers aged 1-3 years; (iv) 14 adolescents aged 10-20 years; and (v) 26 critically ill adults sedated long term. The median percentage error of the predictions was calculated using the equation %error = (CL(allometric) CL(i))/CL(i) x 100, where CL(allometric) is the predicted propofol clearance from the allometric equations for each individual and CL(i) is the individual-predicted (post hoc) propofol clearance value derived from published population pharmacokinetic models. In neonates, the allometric model developed from rats, children and adults, and the fixed-exponent allometric model, systematically overpredicted individual propofol clearance, with median percentage errors of 288% and 216%, respectively, whereas in infants, both models systematically underpredicted individual propofol clearance, with median percentage errors of -43% and -55%, respectively. In toddlers, adolescents and adults, both models performed reasonably well, with median percentage errors of -12% and -32%, respectively, in toddlers, 16% and -14%, respectively, in adolescents, and 12% and -18%, respectively, in adults. Both allometric models based on bodyweight alone may be of use to predict propofol clearance in individuals older than 2 years. Approaches that also incorporate maturation are required to predict clearance under the age of 2 years. PMID: 20214410 [PubMed - indexed for MEDLINE]
The effects of mivacurium-induced neuromuscular block on Bispectral Index and Cerebral State Index in children under propofol anesthesia - a prospective randomized clinical trial. Weber F, Kriek N, Blussé van Oud-Alblas HJ. Paediatr Anaesth. 2010 Aug, 20(8):697-703. BACKGROUND: In adults anesthetized with propofol, muscle relaxants may decrease the Bispectral Index (BIS). The aim of this prospective randomized trial was to detect the influence of a muscle relaxant bolus on the BIS and the Cerebral State Index (CSI) in children under propofol anesthesia. METHODS: Forty pediatric patients, age 6.6 +/- 3.3 years, weight 24 +/- 9 kg, scheduled for surgical procedures requiring general anesthesia were enrolled. Two minutes after i.v. injection of 0.3 mcg.kg(-1) of sufentanil, general anesthesia was induced by an initial bolus of 3 mg.kg(-1) of propofol, followed by a continuous infusion titrated to achieve a stable BIS value of 50 +/- 5. Patients received either mivacurium 0.25 mg.kg(-1) (Group Miva) or NaCl 0.9% 0.12 ml.kg(-1) (Group Control). Mean BIS and CSI values per minute were compared between (Miva vs. Control) and within groups (Baseline vs 5 min. after study drug administration). RESULTS: The observed changes in BIS and CSI values before and after administration of study drugs revealed no differences between the study groups. Mean baseline BIS and CSI values were lower than 5 min after study drug administration. There were no intergroup differences with respect to BIS and CSI values at any time point. CONCLUSIONS: These data suggest that in pediatric patients anesthetized with propofol, administration of mivacurium has no impact on BIS and CSI values. PMID: 20670234 [PubMed - indexed for MEDLINE]
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Pharmacological treatment of neuropathic facial pain in the dutch general population. Koopman JS, Huygen FJ, Dieleman JP, de Mos M, Sturkenboom MC. J Pain. 2010 Mar, 11(3):264-72. PMID: 20018566 [PubMed - indexed for MEDLINE]
Overige publicaties Richtlijnen massaal bloedverlies. Koopman-van Gemert AWMM en Zwaginga JJ. NTVA 2010; 22: 4-11. Peri-operatieve overbruggingsstrategie bij patienten die orale anticoaglulantia gebruiken. Koopman-van Gemert AWMM. De Anesthesioloog. 2010; 3: 11-13. VMS veiligheidsprogramma: Verwisseling van en bij patienten: “gevolgen voor de anesthesioloog” Koopman-van Gemert AWMM. De Anesthesioloog 2010; 3: 14-15. Anemie en hartfalen: therapeutische opties Koopman-van Gemert AWMM. NTVB 2010; 4: 110-114. SURPASS-checklijst opgenomen in landelijke richtlijnen perioperatief traject. De relatie tussen de landelijke richtlijn preoperatief traject en de SURPASS. Wolff AP, Go P, Koopman-van Gemert AWMM, Damen J, Boermeester MA. De Anesthesioloog 2010; 4: 6-9. Niet het goede moment: reactie op artikel “Relivopan verdient een tweede kans” van Stouwe v.d. R.A. Marcus MAE en Schyns-van den Berg AMJV. Contact, 2010, nr. 11:484-489. 24 uurs zorgenkind: epiduraal. de Neef T, Franx A, van Dijk D, Schyns-van den Berg AMJV. NTOG 2010 Nr. 6. Pijnbestrijding gedurende de partus. Schyns-van den Berg AMJV en Coppens M. A&I, 2010; 2: 10-16. Partus en pijn hoeven nergens hand in hand Schyns-van den Berg AMJV, Engel NMAA, Marcus MAE, Beenakkers ICM. MC 16 december 2010, 65 nr. 50. Wat ons opvalt in de LVR2 - 24 uurs zorgenkind: epiduraal T. de Neef, Franx A, van Dijk D, Schyns-van den Berg AMJV. NTOG 2010 vol 123, oktober 2010, nr. 08. Continuously improving patient safety by a rapid response system. van Bruggen V, Barendrecht P, Geense A, van Dijk E, Achilleos M, Saris I, Meijer M, Deijkers A, Verwoerd G,Taks M, Oskam E, So RKL. Critical Care 2010, 14(Suppl 1): P261.
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Boek of hoofdstuk boek
Anesthesiologie
Bloed en bloedstolling. Koopman-van Gemert AWMM. Hoofdstuk 9 In Klinische Anesthesiologie. PG Noordzij, Klimek M, Stamer AJ. Uitgeverij de Tijdstroom; publicatie augustus 2010. ISBN 978-90-5898-60-8.
Voordrachten Kanker, meer dan een diagnose. van Beuzekom C, Aukes JA. Workshop Pijn ASz, Dordrecht, 6-3-2010. Accreditatie V & VN. Oncologische pijn. Aukes JA. Symposium: Oncologische pijn, herniabehandeling en neuromodulatie. De Vrienden van het Albert Schweitzer ziekenhuis. Onderwerp: “pijnbestrijding” 23 maart 2010. Invasieve technieken bij oncologische pijn. Aukes JA. Lustrumsymposium 5 jaar palliatieve unit ASZ, Dordrecht 22 juni 2010. Accreditatie NIV. Pijnmanagement bij oncologische pijn Aukes JA. Nascholing huisartsen regio Rotterdam 29 juni 2010. Accreditatie NVH. De benadering van de patient met lumbago met of zonder uitstraling vanuit anesthesiologisch Oogpunt. Aukes JA. Regionale refereeravond Neurologie Rotterdam 17 september 2010. Accreditatie NVA en NVN. Klinische toepassing van oncologische pijn. Aukes JA. Symposium “Pijn en Pijnbestrijding, verschillende behandelopties voor chronische en oncologische pijn”. ARA hotel Zwijndrecht 14 oktober 2010. Geaccrediteerd door NVA,NVvH, NVN, NIV, V&VN. Hernia behandeling. van Gorp EJJAA. Symposium Oncologische pijn, herniabehandeling en neuromodulatie. De Vrienden van het Albert Schweitzer ziekenhuis. Onderwerp: “pijnbestrijding” 23 maart 2010. Geschiedenis van de pijngeneeskunde. van Gorp EJJAA. ASz Dordrecht., Studiedag Pijn 15 april. Accreditatie V&VN.
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Klinische toepassing bij neuropathische pijn. van Gorp EJJAA. Symposium“Pijn en Pijnbestrijding, verschillende behandelopties voor chronische en oncologische pijn”. ARA hotel Zwijndrecht, 14 oktober 2010. Geaccrediteerd door NVA,NVvH, NVN, NIV, V&VN. Herniabehandeling. van Gorp EJJAA. Bijscholing voor verpleegkundigen en operatie assistenten. Dordrecht, 18 oktober 2010. Accreditatie V & VN. Bedside teaching voor huisartsen. van Gorp EJJAA. Bijscholing Neuropathische pijn ASz Sliedrecht, 26 oktober 2010. Accreditatie NVH. Behandeling met een zenuwblokkade. Gültuna I. Symposium Oncologische pijn, herniabehandeling en neuromodulatie. De Vrienden van het Albert Schweitzer ziekenhuis. Onderwerp: “pijnbestrijding” 23 maart 2010. Bedside teaching voor huisartsen. Gültuna I, Aukes JA. Bijscholing Neuropatische pijn ASz Sliedrecht, 30 september 2010. Accreditatie NVH. Klinische toepassing van radiculaire pijn. Gültuna I. Symposium “Pijn en Pijnbestrijding, verschillende behandelopties voor chronische en oncologische pijn”. ARA hotel Zwijndrecht 14 oktober 2010. Geaccrediteerd door NVA,NVvH, NVN, NIV, V&VN. Bedside teaching voor huisartsen. Gültuna I, Aukes JA. Bijscholing Neuropatische pijn ASz Sliedrecht, 25 oktober 2010. Accreditatie NVH. Advanced training in Neuromodulation: ECMT (Education Continuing Medical Training) voor “Advanced Nurses in neuromodulation” met live OK verbinding. Gültuna I, Aukes JA, van Gorp EJJAA, Hamm-Faber TE. ECMT symposium 5 en 6 november 2010. Accreditatie V&VN. Neuromodulatie. Hamm-Faber TE. Symposium: Oncologische pijn, herniabehandeling en neuromodulatie. De Vrienden van het Albert Schweitzer ziekenhuis. Onderwerp: “pijnbestrijding” 23 maart 2010. Accreditatie NVA. Toekomst van de pijngeneeskunde, Verpleegkundig Specialist op het Pijnbehandelcentrum. Hamm-Faber TE. Congres sectie Pijn. 27 november 2010 Veldhoven. Accreditatie NVA, NVN, V&VN, VRA, VAVP.
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Anesthesiologie
Verwisseling van en bij patienten. Tevens voorzitter van een worksshop Verwisseling. Koopman-van gemert AWMM. Programma landelijke themaconferentie VMS. 12 maart 2010. Carlton President te Utrecht. Geaccrediteerd door alle verenigingen. Majeure obstetrische bloedingen en stollingsproblemen. Koopman-van Gemert AWMM. Refresher Course Obstetrie 19 maart 2010. Gertrudiskapel Utrecht. Accreditatie NVA. Bloedtransfusie besparen. Wat gaan wij doen? Koopman-van Gemert AWMM. Symposium Anemie, bloedtransfusie en de rol van intraveneus ijzer. 26 mei 2010 NAC Breda. Geaccrediteerd NVA. Beleid rondom antistolling peri-operatief. Koopman-van Gemert AWMM. Nascholing multidisciplinair ASz, Dordrecht 8 juni 2010. Geaccrediteerd NVA. Stories from the workfloor. Koopman-van Gemert AWMM. 4th International Workshop Behavioural Science Applied to surgery. Amsterdam, 13-14 september 2010. Geaccrediteerd NVA en andere WV. Preoperatief proces en opname... Best practice. Tevens voorzitter van een workshop. Koopman-van Gemert AWMM. Programma landelijke themaconferentie VMS Domus medica te Utrecht. 12 oktober 2010. Geaccrediteerd door alle verenigingen. Debriefing. Koopman-van gemert AWMM. Symposium Time Out en Debriefing. 2 november 2010 ASz, Dordrecht. Geaccrediteerd alle verenigingen. Communicatie in onveilige situaties: lessen uit de luchtvaart. van de Ridder M, de Kleijnen W, Koopman-van Gemert AWMM. NVMO-congres 10-12 november 2010 Egmond a Zee. Geaccrediteerd door alle verenigingen. Pulmonaal belaste zwangere vrouw. Schyns-van den Berg AMJV. Refresher course OA op 19 maart 2010 in Utrecht. Accreditatie NVA. Continue kwaliteit verbeteren: van plan... naar werkvloer. So RKL. STZ-3 Leiderschapsbijeenkomst. STZ-3 Netwerk, 13 januari 2010, Heerlen. Geaccrediteerd alle verenigingen. Mortaliteit als motor voor kwaliteitsverbetering. So RKL. Themabijeenkomst “Hoe gaan we om met sterftecijfers? Stichting Samenwerkende Rijnmond Ziekenhuizen/ VMS Netwerk Rijnmond. 8 februari 2010, Rotterdam. Geaccrediteerd door alle verenigingen.
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Continue verbeteren patientveiligheid via een spoed interventie systeem. So RKL. Symposium Venticare 28 mei 2010, Utrecht. Geaccrediteerd door alle verenigingen. Vroegtijdige identificatie van de vitaal bedreigde patient: de Dutch approach. So RKL. NIVAZ Intervisie Congres VMS Zorg thema’s “Lijnsepsis, POWI en SIT”. NVIC 29 september 2010, Ede. Geaccrediteerd door NVA, NVIC. Continue verbeteren door middel van uitkomstindicatoren. So RKL. Executive Course iBMG “Veiligheid in de Zorg” , 2 november 2010, Rotterdam. Accreditatie door alle verenigingen. Sturen op gezondheid: zorgverleners en patienten. So RKL. Consultatieve bijeenkomst Raad voor de Volksgezondheid & Zorg. 8 november 2010, Den Haag. Bevordering van levenslang leren en ontwikkelen door individuele appraisal & assessment van medische professionals. So RKL. NVMO 10-12 november 2010, Egmond aan Zee. Geaccrediteerd door alle verenigingen. Vroegtijdige identificatie van de vitaal bedreigde patient: de Dutch approach. So RKL. Congres Expeditie Patientveiligheid … een nieuwe kijk op leiderschap VMS Zorg. 25 november 2010, Den Haag. Geaccrediteerd door alle verenigingen. Chirurgische checklists, over de TOP en verder....... Vrolijk-de Mos M. Refereeravond Time Out en Debriefing 14 december 2010. Geaccrediteerd NVA. Kan de oudere patient veilig anesthesie krijgen voor grote chirurgie? Vrolijk- de Mos M , Breimer LTM, Koopman-van Gemert AWMM. Multidisciplinaire Thema bijeenkomst 14 december 2010 Da Vinci College Dordrecht. Geaccrediteerd NVA.
Posters Subcutaneous stimulation as add-on therapy to spinal cord stimulation for treatment of limb pain and/or lower back pain” 6 months follow up results. Hamm-Faber TTE, Aukes JA, de Loos F, Gültuna I. Wetenschapsdag ASz 7 oktober 2010. Subcutaneous stimulation as add-on therapy to spinal cord stimulation for treatment of limb pain and/or lower back pain” 1 year follow up results Hamm-Faber TE, Aukes JA, de Loos F, Gültuna I. Congres sectie Pijn 27 november 2010 te Veldhoven.
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Anesthesiologie
Optimal blood management in elective orthopaedic surgery: the “Transfusion Op Maat “study: the first results. So-Osman C, Nelissen R, Koopman-van Gemert AWMM, Kluyver E, Poll R, Onstenk O, van Hilten J, Jansen-Werkhoven T, Brand R and Brand A. Poster ISBT Berlin, 26 June – 1 July 2010. Optimaal Bloed Management bij Electieve Orthopedisch Chirurgie: de eerste resultaten van deTransfusie Op Maat studie. Koopman-van Gemert AWMM, Kuijpers G. Poster Wetenschapsdag 7 oktober 2010. Een alternative methode voor herstel van een defecte pacemaker lead. Schmidt JTh, Schütte PR, Vrolijk-de Mos M, Koopman-van Gemert AWMM, de Vries AG. Poster wetenschapsdag ASz, 7 oktober 2010. Continuous improvement of patient safety by implementing a rapid response system hospital-wide So RKL, van Bruggen V, Barendrecht P, Geense A, van Dijk E, Achilleos M, Saris I, Meijer M, Deykers A, Verwoerd G, Oskam E, Taks M. NVIC dagen 10-12 februari, Ede. Continuous improvement of patient safety by implementing a rapid response system hospital-wide van Bruggen V, Barendrecht P, Geense A, van Dijk E, Achilleos M, Saris I, Meijer M, Deijkers A, Verwoerd G,Taks M, Oskam E, So RKL. International Symposium on Intensive Care & Emergency Medicine Erasme Hospital Brussel & SIZ 22-25 march, Brussel. Continuous improvement of patient safety by implementing a rapid response system hospital-wide So RKL, van Bruggen V, Barendrecht P, Geense A, van Dijk E, Achilleos M, Saris I, Meijer M, Deykers A, Verwoerd G, Oskam E, Taks M. International Forum Quality & Safety in Health Care BMJ-IHI. 20-23 april 2010, Nice.
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Apotheek
Apotheek PubMed publicaties Paracetamol for intravenous use in medium--and intensive care patients: pharmacokinetics and tolerance. de Maat MM, Tijssen TA, Brüggemann RJ, Ponssen HH. Eur J Clin Pharmacol. 2010 Jul;66(7):713-9.
PURPOSE: We studied the pharmacokinetics of paracetamol and determine the incidence of hypotension after intravenous administration in medium- (MCU) and intensive care (ICU) patients. METHODS: All patients on the ICU/MCU starting with paracetamol i.v. were included, yielding 38 patients. Blood samples were collected at predetermined time points to determine paracetamol serum concentration. The number of patients with a clinically relevant reduction in systolic blood pressure (SBP) and the number of patients that needed intervention to regain an acceptable blood pressure level were assessed. RESULTS: Overall, pharmacokinetic data were roughly comparable with earlier publications, but differences were noted in the subgroup ICU patients. Also, there was a trend to a larger peak serum concentration (p = 0.052) and a significantly smaller volume of distribution (p = 0.033) in MCU patients compared with ICU patients. Twenty-two percent (22%) and 33% of patients had a clinically relevant reduction in systolic blood pressure (SBP) 15 and 30 min after start of paracetamol infusion, respectively. In six patients (16%), an intervention was needed to correct blood pressure. Overall, SBP was significantly reduced at T = 15 min and 30 min postinfusion (p < 0.003 at both time points) when compared with SBP at the start of paracetamol infusion. CONCLUSIONS: Further research on differences in paracetamol pharmacokinetics between ICU and MCU patients is warranted, as these differences might result in differences in efficacy. Furthermore, administration of paracetamol i.v. as potential cause of hypotension in the critically ill patient must not be overlooked. PMID: 20300741 [PubMed - indexed for MEDLINE]
Overige publicaties Contra-indicatie helpt medicatiebewaking, minder overbodige signalen. Hiel DCW, Vogel EM, et al. PW 2010, 23: 20-23.
Voordracht Faalkostenbesparing in ontslagmedicatie. Spapens MED. 6e TOC Forum, georganiseerd door Innoquare, 18 november 2010.
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III
Cardiologie
Cardiologie PubMed publicaties Systemic embolisation as presentation and recurrence of cardiac myxoma two years after surgery. Liesting C, Ramjankhan FZ, van Herwerden LA, Kofflard MJ. Neth Heart J. 2010 Oct, 18(10):499-502.
Primary cardiac tumours are rare when compared with metastatic involvement. The majority of primary cardiac tumours are benign and in adults the majority of these masses are myxomas. The treatment is surgical removal because of the risk of embolisation and/or cardiovascular complications. We describe a female presenting with systemic embolisation and recurrence of cardiac myxoma after surgery. Recurrence of myxoma is rare after surgery in case of solitary tumours but more frequent in patients with familial myxomas in association with the Carney complex. Genetic analysis revealed a mutation in the PRKAR1A gene that has never been described before. (Neth Heart J 2010;18:499502.). PMID: 20978595 [PubMed - in process]
Primary percutaneous coronary intervention by magnetic navigation compared with conventional wire technique. Patterson MS, Dirksen MT, IJsselmuiden AJ, Amoroso G, Slagboom T, Laarman GJ, Schultz C, van Domburg RT, Serruys PW, Kiemeneij F. Eur Heart J. 2010 Jan 4. Aims Comparison of magnetic guidewire navigation in percutaneous coronary intervention (MPCI) vs. conventional percutaneous coronary intervention (CPCI)for the treatment of acute myocardial infarction. Methods and results We compared 65 sequential patients (mean age 61 +/- 15 years) undergoing primary MPCI with those of 405 patients undergoing CPCI (mean age 61 +/- 13 years). The major endpoint was contrast media use. Technical success and procedural outcomes were evaluated. Clinical demographics and angiographic characteristics of the two groups were similar, except for fewer patients with previous coronary artery bypass grafting (CABG) and hypertension in the CPCI group and fewer patients with diabetes in the MPCI group. The technical success rate was high in both the MPCI and CPCI groups (95.4 vs. 98%). There was significantly less contrast media usage in the MPCI compared with the CPCI group, median reduction of contrast media of 30 mL with an OR = 0.41 (0.21-0.81). Fluoroscopy times were significantly reduced for MPCI compared with CPCI, median reduction of 7.2 min with an OR = 0.42 0.20-0.79). Conclusion This comparison indicates the feasibility and non-inferiority of magnetic navigation in performing primary PCI and suggests the possibility of reductions in contrast media use and fluoroscopy time compared with CPCI. PMID: 20051425 [PubMed - as supplied by publisher]
Overige publicaties Left atrial stimulation (LAS) compared with right atrial atimulation (RAS) in the treatment of sick sinus syndrome (SSS) and paroxysmal atrial fibrillation (PAF). Does it matter ? Breuls N, Zock E, Van de Bos E, Van Woerkens L, Res J, De Cock C. Europace Even minor elevations in Troponin I predict clinical outcome in patients with atrial fibrillation. Loonstra EEG, van den Bos EJ, Constantinescu AA, van Domburg RT, Kofflard MJM. Neth Heart J 2010. Treatment of patients with Her2Neu positive breast cancer with chemotherapy and Her2Neu-receptor blocking therapy early detection of cardiotoxicity by the use of serum biomarkers, (3D)-echocardiography and cardiac MRI. Liesting C, Bakker J, Kofflard MJM, Levin MD. Neth Heart J 2010, 18 (Suppl):3.
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An unusual cause of angina; treatment of the coronary-subclavian steal syndrome. IJsselmuiden AJ, P. Vermeersch P, Van den Branden F. Netherlands Heart Journal, Accepted 2010.
Voordrachten Treatment of patients with HER2Neu positive breast cancer with chemotherapy and HER2Neu-receptor blocking therapy: Early detection of cardiotoxicity by the use of serum biomarkers, (3D)-echocardiography and cardiac MRI. Liesting C, Bakker J, Kofflard MJM, Levin M-D. NVVC Najaarscongres november 2010. Complete Revascularisation Or Culprit PCI: Outcome on Intermediate and Long term in the Elderly (Crocodile). IJsselmuiden AJ. Staff meeting, Jan 2010, Antwerp, Belgium. A catheter knot: What to do? IJsselmuiden AJ. Oral presentation, Theatre Bleu, EuroPCR May 2010, Paris, France. First report on the use of a novel self-expandable stent for treatment of ST elevation myocardial infarction. IJsselmuiden AJ. Oral presentation, EuroPCR, May 2010, Paris, France. Structural Heart disease: Percutaneous closure of left atrial appendage. IJsselmuiden AJ. BWGIC July 2010, Antwerp, Belgium.
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IV
Chirurgie
Chirurgie PubMed publicaties
A multicenter randomized clinical trial investigating the cost-effectiveness of treatment strategies with or without antibiotics for uncomplicated acute diverticulitis (DIABOLO trial). Unlü C, de Korte N, Daniels L, Consten EC, Cuesta MA, Gerhards MF, van Geloven AA, van der Zaag ES, van der Hoeven JA, Klicks R, Cense HA, Roumen RM, Eijsbouts QA, Lange JF, Fockens P, de Borgie CA, Bemelman WA, Reitsma JB, Stockmann HB, Vrouenraets BC, Boermeester MA. BMC Surg. 2010 Jul 20, 10:23. BACKGROUND: Conservative treatment of uncomplicated or mild diverticulitis usually includes antibiotic therapy. It is, however, uncertain whether patients with acute diverticulitis indeed benefit from antibiotics. In most guidelines issued by professional organizations antibiotics are considered mandatory in the treatment of mild diverticulitis. This advice lacks evidence and is merely based on experts’ opinion. Adverse effects of the use of antibiotics are well known, including allergic reactions, development of bacterial resistance to antibiotics and other side-effects. METHODS: A randomized multicenter pragmatic clinical trial comparing two treatment strategies for uncomplicated acute diverticulitis. I) A conservative strategy with antibiotics: hospital admission, supportive measures and at least 48 hours of intravenous antibiotics which subsequently are switched to oral, if tolerated (for a total duration of antibiotic treatment of 10 days). II) A liberal strategy without antibiotics: admission only if needed on clinical grounds, supportive measures only. Patients are eligible for inclusion if they have a diagnosis of acute uncomplicated diverticulitis as demonstrated by radiological imaging. Only patients with stages 1a and 1b according to Hinchey’s classification or “mild” diverticulitis according to the Ambrosetti criteria are included. The primary endpoint is time-to-full recovery within a 6-month follow-up period. Full recovery is defined as being discharged from the hospital, with a return to pre-illness activities, and VAS score below 4 without the use of daily pain medication. Secondary endpoints are proportion of patients who develop complicated diverticulitis requiring surgery or non-surgical intervention, morbidity, costs, health-related quality of life, readmission rate and acute diverticulitis recurrence rate. In a non-inferiority design 264 patients are needed in each study arm to detect a difference in time-to-full recovery of 5 days or more with a power of 85% and a confidence level of 95%. With an estimated one percent of patients lost to follow up, a total of 533 patients will be included. CONCLUSION: A clinically relevant difference of more than 5 days in time-to-full recovery between the two treatment strategies is not expected. The liberal strategy without antibiotics and without the strict requirement for hospital admission is anticipated to be more a more cost-effective approach. TRIAL REGISTRATION: Trial registration number: NCT01111253. PMID: 20646266 [PubMed - indexed for MEDLINE]
The ladies trial: laparoscopic peritoneal lavage or resection for purulent peritonitisA and Hartmann’s procedure or resection with primary anastomosis for purulent or faecal peritonitisB in perforated diverticulitis (NTR2037). Swank HA, Vermeulen J, Lange JF, Mulder IM, van der Hoeven JA, Stassen LP, Crolla RM, Sosef MN, Nienhuijs SW, Bosker RJ, Boom MJ, Kruyt PM, Swank DJ, Steup WH, de Graaf EJ, Weidema WF, Pierik RE, Prins HA, Stockmann HB, Tollenaar RA, van Wagensveld BA, Coene PP, Slooter GD, Consten EC, van Duijn EB, Gerhards MF, Hoofwijk AG, Karsten TM, Neijenhuis PA, BlankenPeeters CF, Cense HA, Mannaerts GH, Bruin SC, Eijsbouts QA, Wiezer MJ, Hazebroek EJ, van Geloven AA, Maring JK, D’Hoore AJ, Kartheuser A, Remue C, van Grevenstein HM, Konsten JL, van der Peet DL, Govaert MJ, Engel AF, Reitsma JB, Bemelman WA. BMC Surg. 2010 Oct 18, 10:29. BACKGROUND: Recently, excellent results are reported on laparoscopic lavage in patients with purulent perforated diverticulitis as an alternative for sigmoidectomy and ostomy.The objective of this study is to determine whether LaparOscopic LAvage and drainage is a safe and effective treatment for patients with purulent peritonitis (LOLA-arm) and to determine the optimal resectional strategy in patients with a purulent or faecal peritonitis (DIVA-arm: perforated DIVerticulitis: sigmoidresection with or without Anastomosis). METHODS/DESIGN: In this multicentre randomised trial all patients with perforated diverticulitis are included. Upon laparoscopy, patients with purulent peritonitis are treated with laparoscopic lavage and drainage, Hartmann’s procedure or sigmoidectomy with primary anastomosis in a ratio of 2:1:1 (LOLA-arm). Patients with faecal peritonitis will be randomised 1:1 between Hartmann’s procedure and
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resection with primary anastomosis (DIVA-arm). The primary combined endpoint of the LOLA-arm is major morbidity and mortality. A sample size of 132:66:66 patients will be able to detect a difference in the primary endpoint from 25% in resectional groups compared to 10% in the laparoscopic lavage group (two sided alpha = 5%, power = 90%). Endpoint of the DIVA-arm is stoma free survival one year after initial surgery. In this arm 212 patients are needed to significantly demonstrate a difference of 30% (log rank test two sided alpha = 5% and power = 90%) in favour of the patients with resection with primary anastomosis. Secondary endpoints for both arms are the number of days alive and outside the hospital, health related quality of life, health care utilisation and associated costs. DISCUSSION: The Ladies trial is a nationwide multicentre randomised trial on perforated diverticulitis that will provide evidence on the merits of laparoscopic lavage and drainage for purulent generalised peritonitis and on the optimal resectional strategy for both purulent and faecal generalised peritonitis. TRIAL REGISTRATION: Nederlands Trial Register NTR2037. PMID: 20955571 [PubMed - in process]
The Pirogoff amputation for necrosis of the forefoot: a case report. Langeveld AR, Oostenbroek RJ, Wijffels MP, Hoedt MT. J Bone Joint Surg Am. 2010 Apr, 92(4):968-72. PMID: 20360523 [PubMed - indexed for MEDLINE]
Preoperative MRI and surgical management in patients with nonpalpable breast cancer: the MONET – Randomised controlled trial. Peters NH, van Esser S, van den Bosch MA, Storm RK, Plaisier PW, van Dalen T, Diepstraten SC, Weits T, Westenend PJ, Stapper G, Fernandez-Gallardo MA, Borel Rinkes IH, van Hillegersberg R, Mali WP, Peeters PH. Eur J Cancer 2010 Dec 30 [Epub ahead of print]. BACKGROUND: We evaluated whether performing contrast-enhanced breast MRI in addition to mammography and/or ultrasound in patients with nonpalpable suspicious breast lesions improves breast cancer management. METHODS: The MONET - study (MR mammography of nonpalpable breast tumours) is a randomised controlled trial in patients with a nonpalpable BIRADS 3-5 lesion. Patients were randomly assigned to receive routine medical care, including mammography, ultrasound and lesion sampling by large core needle biopsy or additional MRI preceding biopsy. Patients with cancer were referred for surgery. Primary end-point was the rate of additional surgical procedures (reexcisions and conversion to mastectomy) in patients with a nonpalpable breast cancer. FINDINGS: Four hundred and eighteen patients were randomised, 207 patients were allocated to MRI, and 211 patients to the control group. In the MRI group 74 patients had 83 malignant lesions, compared to 75 patients with 80 malignant lesions in the control group. The primary breast conserving surgery (BCS) rate was similar in both groups; 68% in the MRI group versus 66% in the control group. The number of re-excisions performed because of positive resection margins after primary BCS was increased in the MRI group; 18/53 (34%) patients in the MRI group versus 6/50 (12%) in the control group (p=0.008). The number of conversions to mastectomy did not differ significantly between groups. Overall, the rate of an additional surgical intervention (BCS and mastectomy combined) after initial breast conserving surgery was 24/53 (45%) in the MRI group versus 14/50 (28%) in the control group (p=0.069). INTERPRETATION: Addition of MRI to routine clinical care in patients with nonpalpable breast cancer was paradoxically associated with an increased re-excision rate. Breast MRI should not be used routinely for preoperative work-up of patients with nonpalpable breast cancer. PMID: 21195605 [PubMed - as supplied by publisher]
Outcome of 232 morbidly obese patients treated with laparoscopic adjustable gastric banding between 1995-2003. Polat F, Poyck PP, Dickhoff C, Gouma DJ, Hesp WL. Dig Surg. 2010, 27(5):397-402. BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) is widely used for the treatment of morbidly obese patients. We prospectively evaluated the effect of LAGB since 1995. METHODS: Between March 1995 and August 2003, 232 morbidly obese patients underwent LAGB. The pars flaccida technique was used in the majority of the patients. Data were prospectively collected. RESULTS: The median age was 35 years and 93% were female. Initial median body weight was 129 kg with a median BMI of 46. After
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Chirurgie
5 years of follow-up, median BMI decreased to 36 and the median body weight decreased to 98 kg. Median excess weight loss was 37% after 1 year, 42% after 3 years and 42% after 5 years of follow-up. Late postoperative complications were pouch dilatation (n = 33), port revision (n = 19), erosion (n = 4) and necrosis (n = 1). CONCLUSION: LAGB is a safe and successful treatment for patients with morbid obesity. Maximal weight reduction is achieved within 12 months and remains stable up to at least 5 years. These results suggest that LAGB could have a positive outcome on morbid obesity-associated morbidity and overall life expectancy. PMID: 20938184 [PubMed - indexed for MEDLINE]
Stimulation of osteogenic differentiation in human osteoprogenitor cells by pulsed electromagnetic fields: an in vitro study. Jansen JH, van der Jagt OP, Punt BJ, Verhaar JA, van Leeuwen JP, Weinans H, Jahr H. BMC Musculoskelet Disord. 2010 Aug 23, 11:188. BACKGROUND: Although pulsed electromagnetic field (PEMF) stimulation may be clinically beneficial during fracture healing and for a wide range of bone disorders, there is still debate on its working mechanism. Mesenchymal stem cells are likely mediators facilitating the observed clinical effects of PEMF. Here, we performed in vitro experiments to investigate the effect of PEMF stimulation on human bone marrow-derived stromal cell (BMSC) metabolism and, specifically, whether PEMF can stimulate their osteogenic differentiation. METHODS: BMSCs derived from four different donors were cultured in osteogenic medium, with the PEMF treated group being continuously exposed to a 15 Hz, 1 Gauss EM field, consisting of 5-millisecond bursts with 5-microsecond pulses. On culture day 1, 5, 9, and 14, cells were collected for biochemical analysis (DNA amount, alkaline phosphatase activity, calcium deposition), expression of various osteoblast-relevant genes and activation of extracellular signal-regulated kinase (ERK) signaling. Differences between treated and control groups were analyzed using the Wilcoxon signed rank test, and considered significant when p < 0.05. RESULTS: Biochemical analysis revealed significant, differentiation stage-dependent, PEMF-induced differences: PEMF increased mineralization at day 9 and 14, without altering alkaline phosphatase activity. Cell proliferation, as measured by DNA amounts, was not affected by PEMF until day 14. Here, DNA content stagnated in PEMF treated group, resulting in less DNA compared to control.Quantitative RT-PCR revealed that during early culture, up to day 9, PEMF treatment increased mRNA levels of bone morphogenetic protein 2, transforming growth factor-beta 1, osteoprotegerin, matrix metalloproteinase-1 and -3, osteocalcin, and bone sialoprotein. In contrast, receptor activator of NF-kB ligand expression was primarily stimulated on day 14. ERK1/2 phosphorylation was not affected by PEMF stimulation. CONCLUSIONS: PEMF exposure of differentiating human BMSCs enhanced mineralization and seemed to induce differentiation at the expense of proliferation. The osteogenic stimulus of PEMF was confirmed by the up-regulation of several osteogenic marker genes in the PEMF treated group, which preceded the deposition of mineral itself. These findings indicate that PEMF can directly stimulate osteoprogenitor cells towards osteogenic differentiation. This supports the theory that PEMF treatment may recruit these cells to facilitate an osteogenic response in vivo. PMID: 20731873 [PubMed - in process]
A comparison of hemiarthroplasty with total hip replacement for displaced intracapsular fracture of the femoral neck. van den Bekerom MP, Hilverdink EF, Sierevelt IN, Reuling EM, Schnater JM, Bonke H, Goslings JC, van Dijk CN, Raaymakers EL. J Bone Surg Br. 2010 Oct, 92(10):1422-8. The aim of this study was to analyse the functional outcome after a displaced intracapsular fracture of the femoral neck in active patients aged over 70 years without osteoarthritis or rheumatoid arthritis of the hip, randomised to receive either a hemiarthroplasty or a total hip replacement (THR). We studied 252 patients of whom 47 (19%) were men, with a mean age of 81.1 years (70.2 to 95.6). They were randomly allocated to be treated with either a cemented hemiarthroplasty (137 patients) or cemented THR (115 patients). At one- and fiveyear follow-up no differences were observed in the modified Harris hip score, revision rate of the prosthesis, local and general complications, or mortality. The intra-operative blood loss was lower in the hemiarthroplasty group (7% > 500 ml), THR group (26% > 500 ml) and the duration of surgery was longer in the THR group (28% > 1.5 hours versus 12% > 1.5 hours). There were no dislocations of any bipolar hemiarthroplasty than in the eight dislocations of a THR during follow-up. Because of a higher intra-operative blood loss (p < 0.001), an increased duration of the operation (p < 0.001) and a higher number of early and late dislocations (p = 0.002), we do not recommend THR as the treatment of choice in patients aged ≥ 70 years with a fracture of the femoral neck in the absence of advanced radiological osteoarthritis or rheumatoid arthritis of the hip. PMID: 20884982 [PubMed - indexed for MEDLINE]
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Iatrogenic Subtotal Stenosis of the Right Subclavian Artery Treated With Percutaneous Transluminal Angioplasty. Smeenk RM, Kock MC, Elgersma OE, Schnater MJ. Cardiovasc Intervent Radiol. 2010 Sep 16 (epub ahead of print). This report describes a rare vascular complication of surgical placement of a marking clip and a possible approach to problem solving. A 55-year-old patient presented with loss of sensation in the fingers and loss of peripheral pulsations in the right arm 4 days after right upper lobectomy for a pT2N1 moderately differentiated adenocarcinoma of the lung. Duplex examination and computed tomography were performed the same day and showed a subtotal stenosis of the right subclavian artery, which was caused by the surgical placement of a metal clip to mark the surgical boundary. Selective angiography was subsequently performed. Percutaneous transluminal angioplasty (PTA) successfully dilated the stenosis and pushed the clip off. Flow in the right subclavian artery (RSA) was completely restored as were neurology and peripheral pulses. In conclusion, arterial stenosis by a surgical (marking) clip may be feasibly treated with PTA. PMID: 20842362 [PUBMED - IN PROCESS]
Remote endarteriectomy versus supragenicular bypass surgery for long occlusions of the superficial femoral artery: mediumterm results of a randomized controlled trial (the REVA trial). Gisbertz SS, Tutein Nolthenius RP, de Borst GJ, van der Laan L, Overtoom TT, Moll FL, de Vries JP. Ann Vasc Surg 2010, 24:1015-23. BACKGROUND: To investigate the optimal surgical treatment, remote superficial femoral artery endarterectomy (RSFAE) or supragenicular bypass, for Transatlantic Inter-Society Consensus (TASC) C and D lesions of the superficial femoral artery. Medium-term results will be presented. METHODS: The study randomized 116 patients, 61 to RSFAE and 55 to supragenicular bypass surgery. Indications for surgery were claudication in 77, rest pain in 21, or tissue loss in 18. RESULTS: Primary patency after 3 years of follow-up was 47% for RSFAE and 60% for bypass (p = 0.107), assisted primary patency was 63 and 69% (p = 0.406), and secondary patency was 69 and 73% (p = 0.541), respectively. For venous (n = 25) and prosthetic grafts (n = 30) at 3-year follow-up, primary patency was 65% and 56 versus 47% for RSFAE (p = 0.143), assisted primary patency was 84% and 56 versus 63% for RSFAE (p = 0.052), and secondary patency was 89% and 59 versus 69% for RSFAE (p = 0.046), respectively. Limb salvage was 97% after RSFAE and 95% after bypass surgery (p = 0.564). CONCLUSION: RSFAE is a minimally invasive option for surgical repair of TASC C and D superficial femoral artery obstructions, with assisted primary and secondary patency rates comparable with bypass surgery. Venous bypass grafting is superior to both RSFAE and polytetrafluoroethylene grafting, but only 45% of patients had a sufficient saphenous vein available. If the saphenous vein is not applicable, RSFAE should be considered because it is less invasive and prosthetic graft material can be avoided. PMID: 21035693 [PubMed - indexed for MEDLINE]
Second generation locked plating of proximal humerus fractures – a prospective multicentre observational study. Röderer G, Erhardt J, Kuster M, Vegt P, Bahrs C, Kinzl L, Gebhard F. Int Orthop. 2011 Mar, 35(3):425-32. Surgical treatment of most displaced proximal humerus fractures is challenging due to osteoporosis. Locking plates are intended to provide superior mechanical stability. In a prospective multicentre study 131 patients were treated with second generation locked plating (NCB-PH, Zimmer, Inc.). The open procedure (n = 78) was performed using a deltopectoral approach; the minimally invasive technique (n = 53) involved percutaneous reduction and an anterolateral deltoid split approach. Clinical and radiological follow-up was obtained. Improvement in function (ROM) was statistically significant. Fracture type (AO) had the most significant impact on the incidence of complications. The most frequent complications detected were intra-articular screw perforation (15%) and secondary displacement (8%). Complication rate and functional outcome of the NCB-PH are comparable to reports in the literature. Not all problems are likely to be solved by this new generation of implants, i.e. secondary dislocation still occurred in 8% of our patients. PMID: 20419453 [PubMed - in process]
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Collaborating publicaties
Chirurgie
Operation compared with watchful waiting in elderly male inguinal hernia patients: a review and data analysis. INCA Trialist Collaboration (Berendes T, Oostenbroek RJ, Poyck PPC, Plaisier PW). J Am Coll Surg 2010 Dec 22 [Epub ahead of print]. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. De Bruin JL, Baas AF, Buth J, Prinssen M, Verhoeven EL, Cuypers PW, van Sambeek MR, Balm R, Grobbee DE, Blankensteijn JD and the DREAM Study Group. (Tutein Nolthenius RP). N Engl J Med 2010; 362:1881-9. BACKGROUND: For patients with large abdominal aortic aneurysms, randomized trials have shown an initial overall survival benefit for elective endovascular repair over conventional open repair. This survival difference, however, was no longer significant in the second year after the procedure. Information regarding the comparative outcome more than 2 years after surgery is important for clinical decision making. METHODS: We conducted a long-term, multicenter, randomized, controlled trial comparing open repair with endovascular repair in 351 patients with an abdominal aortic aneurysm of at least 5 cm in diameter who were considered suitable candidates for both techniques. The primary outcomes were rates of death from any cause and reintervention. Survival was calculated with the use of Kaplan-Meier methods on an intention-to-treat basis. RESULTS: We randomly assigned 178 patients to undergo open repair and 173 to undergo endovascular repair. Six years after randomization, the cumulative survival rates were 69.9% for open repair and 68.9% for endovascular repair (difference, 1.0 percentage point; 95% confidence interval [CI], -8.8 to 10.8; P=0.97). The cumulative rates of freedom from secondary interventions were 81.9% for open repair and 70.4% for endovascular repair (difference, 11.5 percentage points; 95% CI, 2.0 to 21.0; P=0.03). CONCLUSIONS: Six years after randomization, endovascular and open repair of abdominal aortic aneurysm resulted in similar rates of survival. The rate of secondary interventions was significantly higher for endovascular repair. (ClinicalTrials.gov number, NCT00421330.) PMID: 20484396 [PubMed - indexed for MEDLINE]
Multicenter randomized clinical trial of supervised exercise therapy with or without feedback versuswalking advice for intermittent calaudication. Nicolaï SP, Teijink JA, Prins MH, Exercise Therapy in Peripheral Arterial Disease Study Group. (Tutein Nolthenius RP). J Vasc Surg 2010; 52:348-52. OBJECTIVE: The initial treatment for intermittent claudication is supervised exercise therapy (SET). Owing to limited capacity and patient transports costs of clinic-based SET, a concept of SET provided by local physiotherapists was developed. We hypothesized that provision of daily feedback with an accelerometer in addition to SET would further increase walking distance. METHODS: This multicenter randomized trial was set in vascular surgery outpatient clinics and included 304 patients with intermittent claudication. Patients were randomized to exercise therapy in the form of “go home and walk” advice (WA), SET, or SET with feedback. Local physiotherapists provided SET. The primary outcome measure was the change in absolute claudication distance. Secondary outcomes were the change in functional claudication distance and results on the Walking Impairment Questionnaire (WIQ) and Short-Form 36 (SF-36) Health Survey after 12 months. RESULTS: In 11 centers, 102, 109, and 93 patients were included, respectively, in the WA, SET, and SET with feedback groups, and data for 83, 93, and 76, respectively, could be analyzed. The median (interquartile range) change in walking distance between 12 months and baseline in meters was 110 (0-300) in the WA group, 310 (145-995) in the SET group, and 360 (173-697) in the SET with feedback group (P < .001 WA vs SET). WIQ scores and relevant domains of the SF-36 improved statistically significantly in the SET groups. CONCLUSIONS: SET is more effective than WA in improving walking distance, WIQ scores, and quality of life for patients with intermittent claudication.Additional feedback with an accelerometer did not result in further improvement. SET programs should be made available for all patients with intermittent claudication. PMID: 20478681 [PubMed - indexed for MEDLINE]
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Optimizing supervised exercise therapy for patients with intermittent Claudication. Nicolaï SP, Hendriks EJ, Prins MH, Teijink JA, EXITPAD study Group (Tutein Nolthenius RP). J Vasc Surg 2010; 52: 1226-33. BACKGROUND: The first-line intervention for intermittent claudication is usually supervised exercise therapy (SET). The literature describes a range of exercise programs varying in setting, duration, and content. The purpose of the present study was to examine the exercise protocols offered and to identify the impact of the intensity of the SET programs (in terms of frequency, duration, and type of exercise) on improvements in walking distance (response) in the first 3 months.The present study is part of the Exercise Therapy in Peripheral Arterial Disease (EXITPAD) study, a multicenter randomized clinical trial comparing the effects of SET provided by regional physiotherapists, with or without daily feedback, on the level of activities with the effects of walking advice. METHODS: The analysis included patients randomized to receive SET with or without feedback. The physical therapists administering the SET were asked to fill out therapy evaluation sheets stating frequency, duration, and type of exercises. The relationship between training volume and the impact on walking distance was explored by dividing training volume data into tertiles and relating them to the median change in maximum walking distance at 3 and 12 months. RESULTS: Data of 169 patients were included in the analysis. A SET program consisting of at least two training sessions per week each lasting over 30 minutes, during the first 3 months of a 1-year program tailored to individual patients’ needs led to better results in terms of walking distance after 3 and 12 months than the other variants. The results of our analysis dividing training volume into tertiles suggest that there is a relationship between training volume and improvement in walking distance and that at least 590 minutes of training should be offered in the first 3 months. No differences were found between program involving only walking and a combination of exercises, nor between individual and group training. CONCLUSION: A SET programs consisting of at least two training sessions a week, each lasting over 30 minutes, should be offered during the first 3 months of the SET program to optimize improvement in terms of maximum walking distance. PMID: 20692797 [PubMed - indexed for MEDLINE]
Cost-effectiveness of exercise therapy in patients with intermittent claudication: supervised exercise therapy versus a ‘go home and walk’ advice. van Asselt AD, Nicolaï SP, Joore MA, Prins MH, Teijink JA, Exercise Therapy in Peripheral Arterial Disease Study Group. (Tutein Nolthenius RP). Eur J Vasc Endovasc Surg 2010 Dec 14 [Epub ahead of print]. OBJECTIVES: The Exercise Therapy in Peripheral Arterial Disease (EXITPAD) study has shown supervised exercise therapy (SET) to be more effective regarding walking distance and quality of life than a ‘go home and walk’ advice (WA) for patients with intermittent claudication. The present study aims to assess the cost-effectiveness of SET versus WA. PATIENTS AND METHODS: Data from the EXITPAD study, a 12-month randomised controlled trial in 304 patients with claudication, was used to study the proportion of costs to walking distance and quality of life. Two different incremental cost-effectiveness ratios (ICERs) were calculated for SET versus WA: costs per extra metre on the treadmill test, and costs per quality-adjusted life year (QALY). QALYs were based on utilities derived from the EuroQoL-5 dimensions (EQ-5D). RESULTS: Mean total costs were higher for SET than for WA (3407 versus 2304 Euros), mainly caused by the costs of exercise therapy. The median walking distance was 620 m for SET and 400 m for WA. QALYs were 0.71 for SET and 0.67 for WA. All differences were statistically significant. The ICER for cost per extra metre on the 12-month treadmill test was € 4.08. For cost per QALY, the ICER was € 28,693. CONCLUSION: At a willingness-to-pay threshold of € 40,000 per QALY, SET likely is a cost-effective therapeutic option for patients with claudication. PMID: 21159527 [PubMed - indexed for MEDLINE]
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Overige publicaties
Chirurgie
Acute buikklachten bij patienten met een maagband. Dickhoff C, Polat F, Poyck PP, Oosterbaan AM, Hesp WLEM. Ned Tijdschr Geneeskd 2010, 154:A1504. Performance indicators for lung cancer surgery in the Netherlands. Plaisier PW, Damhuis RAM. Interact Cardiovasc Thorac Surg 2010, 11(suppl 1):S2. Prognostic impact of platelet count on survival after surgery for stage I lung cancer. Plaisier PW, Damhuis RAM. Interact Cardiovasc Thorac Surg 2010, 11(suppl 1):S43. Oncologiebespreking in het Albert Schweitzer Ziekenhuis: van stand-alone systeem naar geintegreerd onderdeel van het ziekenhuisinformatiesysteem. Van Iersel CA, Van Hooren ACG, Klaren AD, Plaisier PW. IKR Bulletin 2010, 34:38-41. Een 73-jarige man met een merkelcel-carcinoom. Post ICJH, van Ingen G, Hendriks TR, Plaisier PW. Ned Tijdschr Geneeskd 2010, 154:1964-8. Het subclavian steal syndroom, 2 patienten en een beknopt overzicht. Mets OM, Idu MM, Nederkoorn PJ, de Mol BAJM, Schnater JM. Ned Tijdschr Heelkunde 2010, 19:58-61. Letter to the Editor: ‘‘Incidence of contralateral occult inguinal hernia found at the time of laparoscopic trans-abdominal preperitoneal (TAPP) repair’’ by Griffin et al. (Hernia 14:345–349, 2010). van Wessem KJP, Plaisier PW, Lange JF. Hernia (2010) 14:669.
Boek of hoofdstuk in boek Complications in abdominoplasty patients after bariatric surgery. Larsen M, Plaisier PW. In: Shiffman MA, Di Giuseppe A (eds.). Body contouring: art, science, and clinical practice. Berlijn: Springer-Verlag; 2010. ISBN: 978-3-642-02638-6 (DOI: 10.1007/978-3-642-02639-3).
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Voordrachten Performance indicators for lung cancer surgery in the Netherlands. Plaisier PW, Damhuis RAM. 18th European Conference on General Thoracic Surgery, Valladolid, Spanje, mei 2010. Geaccrediteerd door: European Society for Thoracic Surgery. Rebanding na pouchdilatatie: heeft het nut en kan het veilig? Polat F, Poyck PP, Gouma DJ, Hesp WLEM. Voorjaarsvergadering NVvH, mei 2010, Veldhoven. Geaccrediteerd door: Nederlandse Vereniging voor Heelkunde. Interne audit bij de medisch specialistische vervolgopleidingen. Oostenbroek RJ, van de Ridder JMM. Jaarcongres Nederlandse Vereniging voor Medisch Onderwijs november 2010, Noordwijkerhout. Geaccrediteerd door: Nederlandse Vereniging voor Medisch Onderwijs. A randomised controlled multicenter trial comparing hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures. Hilverdink E, van den Bekerom MPJ, Sierevelt IN, Reuling EMBP, Schnater JM, Bonke HJ, van Dijk CN, Goslings JC, Raaymakers ELFB. Residents meeting Traumatology, January 2010, Soestduinen. Geaccrediteerd door: Nederlandse Orthopeden Vereniging. A randomised controlled multicenter trial comparing hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures. Van den Bekerom MPJ, Hilverdink E, Sierevelt IN, Reuling EMBP, Schnater JM, Bonke HJ, van Dijk CN, Goslings JC, Raaymakers ELFB. AAOS Annual Meeting, March 2010, New Orleans, U.S. Geaccrediteerd door: American Academy of Orthopedic Surgeons. A randomised controlled multicenter trial comparing hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures. van den Bekerom MPJ, Hilverdink E, Sierevelt IN, Reuling EMBP, Schnater JM, Bonke HJ, van Dijk CN, Goslings JC, Raaymakers ELFB. NOV, spring meeting, May 2010, Utrecht. Geaccrediteerd door: Nederlandse Orthopeden Vereniging. A randomised controlled multicenter trial comparing hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures. Hilverdink E, van den Bekerom MPJ, Sierevelt IN, Reuling EMBP, Schnater JM, Bonke HJ, van Dijk CN, Goslings JC, Raaymakers ELFB EFOST, November 2010, Brussels, Belgie. Geaccrediteerd door: European Federation of National Associations of Orthopaedic Sports Traumatology. A randomised controlled multicenter trial comparing hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures. Hilverdink E, Van den Bekerom MPJ, Sierevelt IN, Reuling EMBP, Schnater JM, Bonke HJ, van Dijk CN, Goslings JC, Raaymakers ELFB. Traumadagen, November 2010, Amsterdam. Geaccrediteerd door: Nederlandse Orthopeden Vereniging en Nederlandse Vereniging voor Traumatologie. Hip to revise? – The results of hip surgery raised as a new performance indicator. Vijfhuize S, Jakma, TSC, Plaisier PW, Oostenbroek RJ, Punt BJ. 11th European Congress of Trauma & Emergency Surgery 3rd ESTS Congress 2010, Mei 2010, Brussel, Belgie. Geaccrediteerd door: European Society for Trauma Surgery. De resultaten van heupchirurgie opgeworpen als nieuwe prestatie-indicator. Vijfhuize S, Jakma, TSC, Plaisier PW, Oostenbroek RJ, Punt BJ. Chirurgendagen, Mei 2010, Veldhoven. Geaccrediteerd door: Nederlandse Vereniging voor Heelkunde.
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Posters
Chirurgie
Prognostic impact of platelet count on survival after surgery for stage I lung cancer. Plaisier PW, Damhuis RAM. 18th European Conference on General Thoracic Surgery, Valladolid, Spanje, mei 2010. Is biliopancreatische diversie met duodenale switch een goede revisiebehandeling na het falen van laparoscopische bandplaatsing? Polat F, Poyck PP, Gouma DJ, Hesp WLEM. Voorjaarsvergadering NVvH, mei 2010, Veldhoven. Colovesicale fistels bij diverticulitis: altijd een beschermend ileostoma aanleggen. Smeenk RM, Plaisier PW, Oostenbroek RJ, Hesp WLEM. Najaarsvergadering Nederlandse Vereniging voor Heelkunde, Ede, november 2010. [posterprijs]
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Gynaecologie
Gynaecologie PubMed publicaties
Implementation of the external cephalic version in breech delivery. Dutch national implementation study of external cephalic version. Vlemmix F, Rosman AN, Fleuren MA, Rijnders ME, Beuckens A, Haak MC, Akerboom BM, Bais JM, Kuppens SM, Papatsonis DN, Opmeer BC, van der Post JA, Mol BW, Kok M. BMC Pregnancy Childbirth. 2010 May 10, 10:20. BACKGROUND: Breech presentation occurs in 3 to 4% of all term pregnancies. External cephalic version (ECV) is proven effective to prevent vaginal breech deliveries and therefore it is recommended by clinical guidelines of the Royal Dutch Organisation for Midwives (KNOV) and the Dutch Society for Obstetrics and Gynaecology (NVOG). Implementation of ECV does not exceed 50 to 60% and probably less.We aim to improve the implementation of ECV to decrease maternal and neonatal morbidity and mortality due to breech presentations. This will be done by defining barriers and facilitators of implementation of ECV in the Netherlands. An innovative implementation strategy will be developed based on improved patient counselling and thorough instructions of health care providers for counselling. METHOD/DESIGN: The ultimate purpose of this implementation study is to improve counselling of pregnant women and information of clinicians to realize a better implementation of ECV.The first phase of the project is to detect the barriers and facilitators of ECV. The next step is to develop an implementation strategy to inform and counsel pregnant women with a breech presentation, and to inform and educate care providers. In the third phase, the effectiveness of the developed implementation strategy will be evaluated in a randomised trial. The study population is a random selection of midwives and gynaecologists from 60 to 100 hospitals and practices. Primary endpoints are number of counselled women. Secondary endpoints are process indicators, the amount of fetes in cephalic presentation at birth, complications due to ECV, the number of caesarean sections and perinatal condition of mother and child. Cost effectiveness of the implementation strategy will be measured. DISCUSSION: This study will provide evidence for the cost effectiveness of a structural implementation of external cephalic versions to reduce the number of breech presentations at term. TRIAL REGISTRATION: Dutch Trial Register (NTR): 1878. PMID: 20459717 [PubMed - indexed for MEDLINE]
Well being of obstetric patients on minimal blood transfusions (WOMB trial). Prick BW, Steegers EA, Jansen AJ, Hop WC, Essink-Bot ML, Peters NC, Uyl-de Groot CA, Papatsonis DN, Akerboom BM, Metz GC, Bremer HA, van Loon AJ, Stigter RH, van der Post JA, van Alphen M, Porath M, Rijnders RJ, Spaanderman ME, Schippers DH, Bloemenkamp KW, Boers KE, Scheepers HC, Roumen FJ, Kwee A, Schuitemaker NW, Mol BW, van Rhenen DJ, Duvekot JJ. BMC Pregnancy Childbirth. 2010 Dec 16, 10:83. BACKGROUND: Primary postpartum haemorrhage is an obstetrical emergency often causing acute anaemia that may require immediate red blood cell (RBC) transfusion. This anaemia results in symptoms such as fatigue, which may have major impact on the health-related quality of life. RBC transfusion is generally thought to alleviate these undesirable effects although it may cause transfusion reactions. Moreover, the postpartum haemoglobin level seems to influence fatigue only for a short period of time. At present, there are no strict transfusion criteria for this specific indication, resulting in a wide variation in postpartum policy of RBC transfusion in the Netherlands. METHODS/DESIGN: The WOMB trial is a multicentre randomised non-inferiority trial. Women with acute anaemia due to postpartum haemorrhage, 12-24 hours after delivery and not initially treated with RBC transfusion, are eligible for randomisation. Patients with severe physical complaints are excluded. Patients are randomised for either RBC transfusion or expectant management. Health related quality of life (HRQoL) will be assessed at inclusion, at three days and one, three and six weeks postpartum with three validated measures (Multi-dimensional Fatigue Inventory, ShortForm-36, EuroQol-5D). Primary outcome of the study is physical fatigue three days postpartum. Secondary outcome measures are general and mental fatigue scores and generic health related quality of life scores, the number of RBC transfusions, length of hospital stay, complications and health-care costs. The primary analysis will be by intention-to-treat. The various longitudinal scores will be evaluated using Repeated Measurements ANOVA. A costs benefit analysis will also be performed. The power calculation is based on the exclusion of a difference in means of 1.3 points or greater in favour of RBC transfusion arm regarding physical fatigue subscale. With missing data not exceeding 20%, 250 patients per arm have to be randomised (one-sided alpha = 0.025, power = 80%).
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DISCUSSION: This study will provide evidence for a guideline regarding RBC transfusion in the postpartum patient suffering from acute anaemia. Equivalence in fatigue score, remaining HRQoL scores and physical complications between both groups is assumed, in which case an expectant management would be preferred to minimise transfusion reactions and costs. PMID: 21162725 [PubMed - in process]
Prediction of 30-day morbidity after primary cytoreductive surgery for advanced stage ovarian cancer. Gerestein CG, Nieuwenhuyzen-de Boer GM, Eijkemans MJ, Kooi GS, Burger CW. Eur J Cancer 2010 Jan, 46(1):102-9. OBJECTIVES: Treatment in advanced stage epithelial ovarian cancer (EOC) is based on primary cytoreductive surgery followed by platinum-based chemotherapy. Successful cytoreduction to minimal residual tumour burden is the most important determinant of prognosis. However, extensive surgical procedures to achieve maximal debulking are inevitably associated with postoperative morbidity and mortality. The objective of this study is to determine predictors of 30-day morbidity after primary cytoreductive surgery for advanced stage EOC. METHODS: All patients in the South Western part of the Netherlands who underwent primary cytoreductive surgery for advanced stage EOC between January 2004 and December 2007 were identified from the Rotterdam Cancer Registry database. All peri- and postoperative complications within 30 days after surgery were registered and classified according to the definitions of the National Surgical Quality Improvement Programme (NSQIP).To investigate independent predictors of 30-day morbidity, a Cox proportional hazards model with backward stepwise elimination was utilised. The identified predictors were entered into a nomogram. RESULTS: Two hundred and ninety-three patients entered the study protocol. Optimal cytoreduction was achieved in 136 (46%) patients. 30-day morbidity was seen in 99 (34%) patients. Postoperative morbidity could be predicted by age (P = 0.007; odds ratio [OR] 1.034), WHO performance status (P = 0.046; OR 1.757), extent of surgery (P = 0.1308; OR = 2.101), and operative time (P = 0.017; OR 1.007) with an optimism corrected c-statistic of 0.68. Conclusion: 30-day morbidity could be predicted by age, WHO performance status, operative time and extent of surgery. The generated nomogram could be valuable for predicting operative risk in the individual patient. PMID: 19900801 [PubMed - indexed for MEDLINE]
A 60-month non-comparative study on bleeding profiles with the levonorgestrel intrauterine system from the late transition period to estrogen supplemented menopause. Depypere HT, Hillard T, Erkkola R, Lukkari-Lax E, Kunz M, Rautiainen P, Schram JH. Eur J Obstet Gynecol Reprod Biol. 2010 Dec;153(2):176-80. OBJECTIVES: The primary aim of this study was to assess the transition from using the levonorgestrel-releasing intrauterine system (LNG IUS, 20 μg LNG/24 h) for reproductive-age contraception to using it as menopausal-age endometrial protection during estrogen replacement therapy (ERT). The transfer process was evaluated by assessment of the vaginal bleeding pattern. Continuation rates were also recorded. STUDY DESIGN: Open, multicentre, non-comparative study was conducted in 11 menopausal centres in Finland (3), The Netherlands (4), Belgium (2) and UK (2). Three hundred and ninety-four healthy women aged 46-51 years at entry with regular menstrual cycles, but without any climacteric symptoms, and who were willing to start oral or transdermal estrogen treatment for climacteric symptoms. If by 48 months a woman was not menopausal, she was not eligible for the ERT phase. Bleeding patterns were recorded in 90-day reference periods. RESULTS: One hundred and sixty-eight women were eligible for the ERT phase. The mean ± SD number of bleeding/spotting days was highest (49 ± 19 days) in the first 90-day reference period in the contraceptive phase. For subjects who switched to ERT this number was 10 ± 13 days in the last contraceptive reference period and decreased to 9 ± 12 days in the first and 6 ± 10 days in the last 90-day reference period of the ERT phase. For both spotting and bleeding days there was no statistically significant difference between the last contraceptive and the first reference period of the ERT phase. CONCLUSIONS: In general, the results indicate that continuing with the LNG IUS from contraception to ERT has no adverse effects on the vaginal bleeding profile, and show a positive effect of the combined estrogen and LNG IUS treatment on the quality of life. PMID: 20888118 [PubMed - in process]
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Overige publicaties
Gynaecologie
Prediction of haemorrhage postpartum in women with gestational hypertension or mild preeclampsia at term. Koopmans CM, van der Tuuk K, Groen H, Doornbos JPR, de Graaf IM, Oudijk MA, Porath MM, Kuppens SMI, Wijnen EJ, Aardenburg R, van Loon AJ, Akerboom BMC, van der Lans PJA, Mol BWJ and van Pampus MG. Abstract ISSHP congress Melbourne 2010. Prediction of neonatal sepsis in women with PPROM between 34 and 37 weeks of gestational age. van der Ham D, Nijhuis J, Mol BW, van Beek H, Opmeer B, Mulder T, Bijlenga D, Vijgen S, Groenewout M, Mantel G, Bloemenkamp K, van Wijngaarden W, Sikkema M, Pernet P, Porath M, Molkenboer J, Kuppens S, Derks J, Kars M, Spaanderman M, Weinans M, Wildschut H, Akerboom BMC, Willekes C. Abstract SMFM congres, Chicago 2010. Does induction of labor in women with a positive GBS vaginal culture decreases the risk for neonatal sepsis in women with PPROM between 34 and 37 weeks? van der Ham D, Nijhuis J, Mol BW, van Beek H, Opmeer B, Mulder T, Bijlenga D, Vijgen S, Groenewout M, Mantel G, Bloemenkamp K, van Wijngaarden W, Sikkema M, Pernet P, Porath M, Molkenboer J, Kuppens S, Derks J, Kars M, Spaanderman M, Weinans M, Wildschut H, Akerboom BMC, Willekes C. Abstract SMFM congres, Chicago 2010. Suburethral slings: erosion, malfunction and a save way to solve them. Hogewoning CRC, Hogewoning CJA. Abstract and Poster ICS/IUGA Toronto 2010. Male circumcision associated with a lower prevalence of colposcopy-detected, human papillomavirus-associated penile lesions among Kenyan men. Backes DM, Bleeker MCG, MD, Meijer CJLM, Hudgens MG, Bailey RC, Agot K, Ndinya-Achola JO, Hayombe J , Hogewoning CJA, Moses S, MD, Snijders PJF, Smith JS. Canada J Infectious Dis 2010 june 1;201(11):1677-85. The MiniArc single incision sling for female stress urinary incontinence: Clinical results of a prospective evaluation with a minimum follow up of one year and a review of literature. Hogewoning CRC, Ruhé I, Bekker MD, Roovers JPWR, Hogewoning CJA, Putter H , De Ruiter MC, Pelger RCM, Elzevier HW. Submitted Eur Journal Urol. Low risk of recurrent CIN2+ after successful treatment; a long term cohort study. Kocken M, Helmerhorst TJM, Berkhof J, Louwers JA, Nobbenhuis M, Bais A, Hogewoning CJA, Zaal A, Verheijen RHM, Snijders PJF, Meijer CJLM. Accepted Lancet Oncology February 2011. Uterine perforation as complication of unsafe abortion. Immerzeel TD, Stekelenburg, S, Hogewoning, CJA. Submitted Int Journal Obst Gynecol. Treatment of female stress urinary incontinence by TVT-O or TOT after multidisciplinary analysis. Bakker C, Schram JHN, Van Oevelen E, Potjer RW, Cornelis J.A. Hogewoning CJA. Abstract ICS/IUGA Toronto 2010.
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Voordrachten Risk factors associated with colposcopy-detected penile lesions in Kenyan men. Hogewoning CJA, Backes DM, Bleeker MCG, Bailey RC, Hudgens MG, Agot K, Ndinya-Achola JO, Pittchar T, Onyango R, Maclean IW, Meijer CJLM, Snijders PJF, Moses S, and Smith JS. Monaco, STD/HIV Collaborative Group Annual Meeting, Eurogin, 20 februari 2010. BRCA=gendragerschap en de gynecoloog, consequenties voor de dagelijkse praktijk. Kooi GS. Rotterdam IKR symposium erfelijke tumoren, 15 maart 2010. Neonatale sterfte in Nederland, lopen we achter? Lokale audit in de regio Dordrecht en omstreken. Rombout-de Weerd S. KNMG districtbijeenkomst, 23 maart 2010. Repair of pelvic organ prolaps using mesh and IVS tunnelers: a prospective, intention to treat study. Noorlander M, Van der Gaast MH, Schram JHN, Steensma AB, Hogewoning CJA. Abstract ICS/IUGA Toronto 2010.
Posters Hip dysplasia and breech presentation: prognostic value of version from breech to cephalic positon on neonatal outcome. Lambeek AF, Hellendoorn I, Akerboom BMC, Lambers MDA, Brouwers EMJ, den Breejen M, Papatsonis DNM, Lunshof SM, Vos DL, Kooi GS. Posterpresentatie SMFM congres, Chicago 2010. Uitwendige versie bij Stuitligging. Hellendoorn I, Engeltjes B, Cabenda-Narain NE, Akerboom-Straberger BMC, Lambers MDA. Posterpresentatie tijdens wetenschapsdag ASZ 2010. Suburethral slings: erosion, malfunction and a save way to solve them. Hogewoning CRC, Hogewoning CJA. Abstract and Poster ICS/IUGA Toronto 2010. Nomogram for suboptimal cytoreduction at primary surgery for advanced stage ovarian cancer. Nieuwenhuyzen-de Boer GM, Gerestein CG, Eijkemans MJ, Burger CW and Kooi GS. 13th Biennial Gynecologic Cancer Society Meeting (October 2010) in Praque, Czech Republic.
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VI
Interne geneeskunde
Interne geneeskunde PubMed publicaties Practitioners and Nondrug Treatment of Hypertension, Effects of Participating in a Survey. Atiqi R, Elhani S, Cleophas TJ. Am J Ther. 2010 Jun 9. [Epub ahead of print].
A nationwide survey in the Netherlands among 600 randomly sampled practitioners revealed that the advice (1) quit smoking, (2) reduce alcohol, (3) healthy diet, and (4) physical activities was only given by 76%, 26%, 44%, and 61% of the practitioners. To confirm these data, and to study the effects of the personal characteristics of the practitioners, and the effect of their participation in a survey. All general practitioners in the areas of Dordrecht in the Netherlands, with 350,000 inhabitants, were invited to participate. Self-administered questionnaires included questions about non-pharmaceutical treatment recommendations given, about blood pressure increasing factors including blood pressure increasing medicines, and healthy life style. After 1 year, the survey was repeated among the practitioners who completed the first one. The current survey produced a result largely similar to that of the nationwide survey. The combined results were as follows: among 281 practitioners a quit smoking advice was given by 82%, reduce alcohol advice by 47%, healthy diet advice by 51%, and physical activities advice by only 73% of the practitioners with 95% confidence intervals of, respectively, 75%-84%, 38%-49%, 41%-53%, and 64%-75%. Country physicians and older physicians were more active in giving nondrug treatments with P-values of <0.02 to <0.05. Increased blood pressure as a side effect of concomitant medications was virtually never addressed. After the survey, 26 practitioners (24.8%, P < 0.001) had started life style recommendations. PMID: 20535012 [PubMed - as supplied by publisher]
Prevalence of iatrogenic admissions to the Departments of Medicine/Cardiology/ Pulmonology in a 1,250 bed general hospital. Atiqi R, van Bommel EF, Cleophas TJ, Zwinderman AH. Int J Clin Pharmacol Ther. 2010 Aug, 48(8):517-25. A recent meta-analysis in this journal showed incidences between 3.4 and 33.9%. Studies performed by pharmacists and epidemiologists produced lower incidences than internists’ studies. We reassessed the prevalence of iatrogenic admissions in a study of internists. Iatrogenic disease was defined as adverse drug reactions according to the World Health Organization Definition and complications induced by non-drug medical interventions. Subsequent admissions at the Departments of Medicine/Cardiology/Pulmonology in a 1,250 bed general hospital in the Netherlands from May 2007 to August 2007 were studied. 2,000 consecutive admissions were studied: 576 (29%, 26-32%) were classified as possibly iatrogenic; out of these 380 (19%, 17-22%) as definitely iatrogenic, out of whom 229 (12%, 10-14%) had already been classified as iatrogenic by the admitting physicians. Patients with cardiac disease, hypertension, gastrointestinal conditions, anticoagulant treatment and use of NSAIDs were, particularly, at risk of iatrogenic admission with percentages of 22 (16-24), 13 (11-18), 12 (9-15), and 7 (5-11) %. An independent predictor of iatrogenic admissions was age with an odds ratio of 1.27 per 10 years (p = 0.0001). 1. At least 19% of admissions to the Departments of Internal Medicine/Cardiology/Pulmonology, and, maybe, even percentages up to 29% were due to adverse drug effects. 2. A large difference between the numbers of iatrogenic admission according to the physicians in charge of admission and the investigators, 229 versus 380 patients, was observed. 3. Most often iatrogenic admissions were observed with cardiac disease, hypertension, gastrointestinal conditions, anticoagulant treatment, and use of NSAIDs. PMID: 20650043 [PubMed - indexed for MEDLINE]
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A randomized phase 3 study on the effect of thalidomide combined with adriamycin, dexamethasone, and high-dose melphalan, followed by thalidomide maintenance in patients with multiple myeloma. Lokhorst HM, van der Holt B, Zweegman S, Vellenga E, Croockewit S, van Oers MH, von dem Borne P, Wijermans P, Schaafsma R, de Weerdt O, Wittebol S, Delforge M, Berenschot HW, Bos GM, Jie KS, Sinnige H, van Marwijk-Kooy M, Joosten P, Minnema MC, van Ammerlaan R, Sonneveld P; Dutch-Belgian Hemato-Oncology Group (HOVON). Blood. 2010 Feb 11, 115(6):1113-20. The phase 3 trial HOVON-50 was designed to evaluate the effect of thalidomide during induction treatment and as maintenance in patients with multiple myeloma who were transplant candidates. A total of 556 patients was randomly assigned to arm A: 3 cycles of vincristine, adriamycin, and dexamethasone, or to arm B: thalidomide 200 mg orally, days 1 to 28 plus adriamycin and dexamethasone. After induction therapy and stem cell mobilization, patients were to receive high-dose melphalan, 200 mg/m(2), followed by maintenance with alphainterferon (arm A) or thalidomide 50 mg daily (arm B). Thalidomide significantly improved overall response rate as well as quality of the response before and after high dose melphalan. Best overall response rate on protocol was 88% and 79% (P = .005), at least very good partial remission 66% and 54% (P = .005), and complete remission 31% and 23% (P = .04), respectively, in favor of the thalidomide arm. Thalidomide also significantly improved event-free survival from median 22 months to 34 months (P < .001), and prolonged progression free from median 25 months to 34 months (P < .001). Median survival was longer in the thalidomide arm, 73 versus 60 months; however, this difference was not significant (P = .77). Patients randomized to thalidomide had strongly reduced survival after relapse. This trial was registered on www.controlled-trials.com as ISRCTN06413384. PMID: 19880501 [PubMed - indexed for MEDLINE]
Enteroviral encephalitis in a patient with a marginal zone lymphomatreated with rituximab. Schilthuizen C, Berenschot HW, Levin MD. Neth J Med. 2010 May, 68(5):221-3. A 64-year-old woman with a progressive marginal zone lymphoma for which she had received induction therapy with six courses of rituximab and fludarabine presented with fever while receiving maintenance therapy with rituximab. In addition to the fever she complained of nausea, vomiting, weight loss and fatigue. After an extensive diagnostic procedure no cause was found for the fever. Finally, additional testing showed a positive polymerase chain reaction (PCR) for enterovirus in the cerebrospinal fluid and faeces. Because the immunoglobulin G level of our patient was 4.06 g/l (normal values 5.2 to 16 g/l), she was treated with intravenous immunoglobulins (IVI g) weekly with the goal to maintain an IgG level above 10 g/l. This resulted in a significant rise in anti-enteroviral antibodies from 10 IE / ml to 106 IE /ml. One month after treatment with IVI g, while withholding the rituximab, the PCR for enterovirus on faeces was negative and antibodies to the enterovirus in the serum had returned to normal levels. Rituximab can cause a prolonged B-cell deficiency resulting in hypogammaglobulinaemia. We believe that treatment with ritxumab may have played a significant role in the development of this rare central nervous system infection. PMID: 20508271 [PubMed - indexed for MEDLINE]
(18)F-fluorodeoxyglucose position emission tomography (FDG-PET) for monitoring disease activity and treatment response in idiopathic retroperitoneal fibrosis. Jansen I, Hendriksz TR, Han SH, Huiskes AW, van Bommel EF. Eur J Intern Med. 2010 Jun;21(3):216-21. OBJECTIVE: To evaluate the value of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) in monitoring disease activity and predicting treatment response in idiopathic retroperitoneal fibrosis (iRPF). PATIENTS AND METHODS: This prospective study was approved by the institutional review board. Informed consent was obtained from all patients. Twenty-six patients with iRPF receiving tamoxifen monotherapy underwent repeated FDG-PET (baseline and, if positive, at 3 months) and computed tomographic (CT) scanning (baseline, 4 and 8 months). Maximal RPF mass thickness in 3 different view directions was measured on each CT scan; FDG-uptake was semi-quantified using a visual 4-point scale. Initial and follow-up PET scan results were correlated with clinical, laboratory and CT scan follow-up data. Treatment outcome was the aggregate measure of clinical, laboratory and CT-documented response to tamoxifen. RESULTS: FDG-PET was positive in 20 patients. Patients with positive PET scan result had higher C-reactive protein level (P=0.02) and larger mass size (P=0.01) compared with patients with negative PET scan result. Visual PET score correlated with C-reactive protein level (P=0.002) and CT-documented mass thickness (P=0.04). Visual PET score decreased following treatment (P<0.01). This decrease cor-
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Interne geneeskunde
related with decrease in ESR (P<0.001) but not with CT-documented mass regression. Positive predicting value (PPV) of initial positive PET scan result was 0.63; PPV of negative follow-up PET scan result in patients with initial positive PET scan result was 0.66. CONCLUSION: FDG-PET is valuable in detecting (recurrent) disease activity. Short-term follow-up with FDG-PET cannot be routinely recommended for the therapeutic evaluation of RPF disease in tamoxifen-treated patients. PMID: 20493425 [PubMed - indexed for MEDLINE]
Pseudocyst formation in retroperitoneal fibrosis relapse. Jansen I, Hendriksz TR, van Bommel EF. Br J Radiol. 2010 Jun;83(990):e111-3. We describe a 45-year-old male patient with recurrent retroperitoneal fibrosis (RPF), in whom a pseudocyst in the peri-aortic fibrotic mantle was diagnosed. Without any intervention other than oral treatment with tamoxifen, the pseudocyst showed significant regression. Although rare, pseudocyst formation may sometimes appear in RPF and may mimic other benign and malignant conditions. This is the first paper to describe pseudocyst formation in an RPF relapse. PMID: 20505023 [PubMed - indexed for MEDLINE]
Time-dependent predictors in clinical research, performance of a novel method. van de Bosch J, Atiqi R, Cleophas TJ. Am J Ther. 2010 Nov-Dec, 17(6):e202-7. Individual patients’ predictors of survival may change across time, because people may change their lifestyles. Standard statistical methods do not allow adjustments for time-dependent predictors. In the past decade, time-dependent factor analysis has been introduced as a novel approach adequate for the purpose. Using examples from survival studies, we assess the performance of the novel method. SPSS statistical software is used (SPSS Inc., Chicago, IL). Cox regression is a major simplification of real life; it assumes that the ratio of the risks of dying in parallel groups is constant over time. It is, therefore, inadequate to analyze, for example, the effect of elevated low-density lipoprotein cholesterol on survival, because the relative hazard of dying is different in the first, second, and third decades. The time-dependent Cox regression model allowing for nonproportional hazards is applied and provides a better precision than the usual Cox regression (P = 0.117 versus 0.0001). Elevated blood pressure produces the highest risk at the time it is highest. An overall analysis of the effect of blood pressure on survival is not significant, but after adjustment for the periods with highest blood pressures using the segmented time-dependent Cox regression method, blood pressure is a significant predictor of survival (P = 0.04). In a long-term therapeutic study, treatment modality is a significant predictor of survival, but after the inclusion of the time-dependent low-density lipoprotein cholesterol variable, the precision of the estimate improves from a P value of 0.02 to 0.0001. Predictors of survival may change across time, e.g., the effect of smoking, cholesterol, and increased blood pressure in cardiovascular research and patients’ frailty in oncology research. Analytical models for survival analysis adjusting such changes are welcome. The time-dependent and segmented time-dependent predictors are adequate for the purpose. The usual multiple Cox regression model can include both time-dependent and time-independent predictors. PMID: 20393346 [PubMed - in process]
Artificial intelligence for diagnostic purposes: principles, procedures and limitations. Cleophas TJ, Cleophas TF. Clin Chem Lab Med. 2010 Feb, 48(2):159-65. BACKGROUND: Back propagation (BP) artificial neural networks are a distribution-free method for data analysis based on layers of artificial neurons that transduce imputed information. It has been recognized as having a number of advantages compared to traditional methods including the possibility to process imperfect data, and complex non-linear data. The objective of this study was to review the principles, procedures, and limitations of BP artificial neural networks for a non-mathematical readership. METHODS: A real data sample of weight, height and measured body surface area from 90 individuals was used as an example. SPSS 17.0 with neural network add-on was used for the analysis. The predicted body surface from a two hidden layer BP neural network was compared to the body surface calculated by the Haycock equation. RESULTS: Both the predicted values from the neural network and from the Haycock equation were close to the measured values. A linear regression analysis with neural network as predictor produced an r(2)-value of 0.983, while the Haycock equation produced an r(2)-value
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of 0.995 (r(2)>0.95 is a criterion for accurate diagnostic testing). CONCLUSIONS: BP neural networks may, sometimes, predict clinical diagnoses with accuracies similar to those of other methods. However, traditional statistical procedures, such as regression analyses need to be added for testing their accuracies against alternative methods. Nonetheless, BP neural networks have great potential through their ability to learn by example instead of learning by theory. PMID: 20001439 [PubMed - indexed for MEDLINE]
Handling Categories Properly: A Novel Objective of Clinical Research. Cleophas TJ, Atiqi R, Zwinderman AH. Am J Ther. 2010 Jul 10. A major objective of clinical research is to study outcome effects in subgroups. Such effects generally have stepping functions that are not strictly linear. Analyzing stepping functions in linear models thus raises the risk of underestimating the effects. In the past few years, recoding subgroup properties from continuous variables into categorical ones has been recommended as a solution to the problem. The objectives of this study were to demonstrate from examples how recoding works and to show that stepping functions, if used as continuous variables, do not produce significant effects, whereas they produce very significant effects after recoding. In the first example, the effects on physical strength were assessed in 60 subjects of different races. A linear regression in SPSS with race as the independent and physical strength score as the dependent variable showed that race was not a significant predictor of physical strength. Using the process of recoding, the variable race into categorical dummy variables showed that compared with the presence of Hispanic race, the black and white races were significant positive predictors (P = 0.0001 and 0.004 respectively) and Asian race is a significant negative predictor (P = 0.050). In the second example, the effects of numbers of comedications on admissions to a hospital resulting from adverse drug effects were assessed. A logistic regression in SPSS with numbers of comedications as the independent variable showed that comedications was not a significant predictor of iatrogenic admission. Using again the process of recoding for categorical dummy variables showed that comedication was a very significant predictor of iatrogenic admission with P = 0.004. Categorical variables are currently rarely analyzed in a proper way. Mostly they are analyzed in the form of continuous variables. This approach does not always fit the data patterns causing negative results as demonstrated in the examples of this article. We recommend that such variables be recoded into categorical dummy variables. PMID: 20634677 [PubMed - as supplied by publisher]
Clinical Research: A Novel Approach to the Analysis of Repeated Measures. Cleophas TJ, Zwinderman AH, van Ouwerkerk B. Am J Ther. 2010 Oct 22. In current clinical research, repeated measures in a single subject are common. The problem with repeated measures is that they are closer to one another than unrepeated measures. If this is not taken into account, then data analysis will lose power. In the past decade, userfriendly statistical software programs such as SAS and SPSS have enabled the application of mixed models as an alternative to the classical general linear model for repeated measures with, sometimes, better sensitivity. The objective was to assess whether in studies with repeated measures, designed to test between-subject differences, the mixed model performs better than does the general linear model. In a parallel group study of cholesterol-reducing treatments with 5 evaluations per patient, the mixed model performed much better than did the general linear model with P values of 0.0001 and 0.048, respectively. In a crossover study of 3 treatments for sleeplessness, the mixed model and general linear model performed similarly well with P values of 0.005 and 0.010. Mixed models do, indeed, seem to produce better sensitivity of testing, when there are small within-subject differences and large between-subject differences and when the main objective of your research is to demonstrate between- rather than within-subject differences. The novel mixed model may be more complex. Yet, with modern user-friendly statistical software, its use is straightforward, and its software commands are no more complex than they are with standard methods. We hope that this article will encourage clinical researchers to make use of its benefits more often. PMID: 21048432 [PubMed - as supplied by publisher]
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A Novel Approach to Noninferiority Testing: Documented Proof Rather Than Arbitrary Margins. Cleophas TJ, Zwinderman AH. Am J Ther. 2010 Oct 23.
Interne geneeskunde
Noninferiority trials have been criticized for their wide margins of noninferiority, making it virtually impossible to reject noninferiority. Recommendations have been given to replace the practice of arbitrarily set margins.The objective of this study was to review various alternative methods of assessment based on statistical reasoning. Four examples are given. (1) In a 300-patient parallel group study of 2 inhalers for asthma, noninferiority was demonstrated at P = 0.0001. This result was supported by both the lack of a significant difference between the standard and new inhalers and the presence of a significant difference between the new inhaler and a placebo at P = 0.0001. (2) In a 236-patient parallel group sleeping pill study, noninferiority was demonstrated at P = 0.04. The presence of noninferiority was supported by a significant superiority of the new compound against a placebo at P = 0.021. However, the significantly worse performance against the standard treatment undermined these findings. (3) In a 200-patient hypertension study of 2 treatment groups, noninferiority was demonstrated at P = 0.028. The presence of noninferiority was supported by the lack of a significant difference between the new and the standard treatment. However, these findings were undermined by the lacking superiority of the new compound against a placebo. (4) In a 160-patients parallel group cholesterol study, noninferiority was demonstrated at P = 0.01. The presence of noninferiority was undermined by both the significant difference between the new and the standard treatment and the lack of efficacy of the new treatment against a placebo.We conclude that expert investigators traditionally set an arbitrary margin of noninferiority based on clinical arguments and that they benefit from wide margins. As an alternative and more meaningful approach to noninferiority testing, we propose to use (1) margins based on counted rather than on arbitrary criteria, (2) null hypothesis tests between the new and standard treatments, (3) null hypothesis tests between the new treatment and a placebo. PMID: 20975529 [PubMed - as supplied by publisher]
Item response modelling for clinical and laboratory testing. Cleophas TJ, Zwinderman AH. Eur J Clin Invest 2010, 40: 911-7. BACKGROUND: Item response models using exponential modelling are more sensitive than classical linear methods for making predictions from psychological questionnaires. OBJECTIVE: To assess whether they can also be used for making predictions from quality of life questionnaires and clinical and laboratory diagnostic-tests. METHODS: Of 1000 anginal patients assessed for quality of life and 1350 patients assessed for peripheral vascular disease with diagnostic laboratory tests, items response modelling was applied using the Latent Trait Analysis program -2 of Uebersax. RESULTS: The 32 different response patterns obtained from test batteries of five items produced 32 different quality of life scores ranging from 3·4% to 74·5% and 32 different levels of peripheral vascular disease ranging from 9·9% to 83·5% with overall mean scores, by definition, of 50%, whereas the classical method of analysis produced the discrete scores of only 0-5. The item response models produced an adequate fit for the data as demonstrated by chi-square goodness of fit values/degrees of freedom of 0·86 and 0·64. CONCLUSIONS: 1 Quality of life assessments and diagnostic tests can be analysed through item response modelling, and provide more sensitivity than do classical linear models. 2 Item response modelling can change largely qualitative data into fairly accurate quantitative data, and can, even with limited sets of items, produce fairly accurate frequency distribution patterns of quality of life, severity of disease and other latent traits. PMID: 20678119 [PubMed - indexed for MEDLINE]
Acute Effects of Acylated and Unacylated Ghrelin on Total and High Molecular Weight Adiponectin in Morbidly Obese Subjects. Kiewiet RM, Hazell MJ, Van Aken MO, Van der Weerd K, Visser JA, Themmen AP, Van der Lely AJ. J Endocrinol Invest. 2010 Oct 15. [Epub ahead of print]. BACKGROUND: Energy homeostasis and body weight are regulated by a highly complex network involving the brain, the digestive tract and white adipose tissue (WAT). Knowledge about signalling pathways connecting digestive tract and WAT is limited. Gut hormone ghrelin and adipokine adiponectin are both decreased in obesity and they share a potent effect on insulin sensitivity: both adiponectin and the combination of acylated (AG) and unacylated ghrelin (UAG) improve insulin sensitivity. AIM: In the present study, we evaluated whether acute administration of UAG alone or combined with AG affects adiponectin concentrations.
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SUBJECTS AND METHODS: Eight morbidly obese non-diabetic subjects were treated with either UAG 200microg, UAG 100microg + AG 100microg (Comb), or placebo in 3 episodes in a double blind randomized cross-over design. Study medication was administered as single i.v. bolus injections at 09.00h after an overnight fast. High molecular weight (HMW) and total adiponectin, glucose, insulin and total and acylated ghrelin were measured up to one hour after administration. Results HMW and total adiponectin concentrations did not change after administration of either UAG or Comb, nor were they different from placebo. Insulin concentrations decreased significantly after acute administration of Comb, reaching a minimum at 20 min: 58.2 ± 3.9% of baseline. Conclusions Acute intravenous administration of UAG and the combination of UAG and AG in morbidly obese non-diabetic subjects without overt diabetes does not affect total or HMW adiponectin concentrations, neither directly nor indirectly by changing insulin concentrations. PMID: 20959720 [PubMed - as supplied by publisher]
Tamoxifen is associated with lower mortality of encapsulating peritoneal sclerosis: results of the Dutch Multicentre EPS Study. Korte MR, Fieren MW, Sampimon DE, Lingsma HF, Weimar W, Betjes MG. Nephrol Dial Transplant. 2011 Feb;26(2):691-697. Epub 2010 Jun 27. BACKGROUND: Encapsulating peritoneal sclerosis (EPS) is a serious complication of peritoneal dialysis (PD) with an increasing incidence. There is no clear consensus on the treatment of EPS, but anecdotal reports indicate improvement in EPS patients treated with tamoxifen. At present, there is no evidence for the effect of tamoxifen treatment in EPS patients. This study investigates the effect of treatment with tamoxifen on survival in EPS patients. METHODS: This study is a retrospective analysis of survival in EPS patients as part of the Dutch multicentre EPS study in the period January 1996 to July 2007. Sixty-three patients with severe EPS were followed up until August 2008. Demographic, patient and PD-related variables of EPS patients were investigated. Patients treated with tamoxifen were compared to patients not treated with tamoxifen. Survival was analysed with multivariate Cox regression analysis. RESULTS: Twenty-four patients were treated with tamoxifen, and 39 were not treated with tamoxifen. The clinical and demographic characteristics were similar for the tamoxifen-treated and non-treated groups. The mortality rate was significantly lower in tamoxifen-treated patients compared to EPS patients not treated with tamoxifen (45.8% vs 74.4%, P = 0.03). Survival in tamoxifen-treated patients, adjusted for calendar time, age, use of corticosteroids, presence of functioning transplantation, use of parental nutrition and centre influences was longer in comparison to not-treated patients (HR 0.39, P = 0.056). CONCLUSIONS: Tamoxifen treatment in EPS patients is associated with lower mortality and shows a trend to an increased multivariateadjusted survival. This supports additional use of tamoxifen to treat patients with severe EPS. PMID: 20584735 [PubMed - as supplied by publisher]
Early diagnostic markers for encapsulating peritoneal sclerosis: a case-control study. Sampimon DE, Korte MR, Barreto DL, Vlijm A, de Waart R, Struijk DG, Krediet RT. Perit Dial Int. 2010 Mar-Apr;30(2):163-9. OBJECTIVE: Encapsulating peritoneal sclerosis (EPS) is a severe complication of long-term peritoneal dialysis (PD). The aim of this study was to investigate whether dialysate levels of cancer antigen-125 (CA125), K(+), interleukin (IL)-6, and vascular endothelial growth factor (VEGF) are early diagnostic markers of EPS. Therefore, we analyzed the time courses of the above described dialysate markers in EPS patients and controls. METHODS: Dialysate and serum samples of 11 EPS patients and 31 control patients, all treated with PD for at least 57 months, were longitudinally collected during standard peritoneal permeability analyses. CA125 and IL-6 were measured in dialysate only, K(+) and VEGF were measured in both dialysate and serum. CA125 and IL-6 are expressed as appearance rates (AR). The linear mixed model was used to analyze the time courses. Sensitivity and specificity were calculated based on the results of the last 2 time points. RESULTS: No differences in the time courses of the different markers were present between the groups. For K(+) and VEGF attributed to local production, no differences between the groups were found. However, AR-CA125 was lower during the last 3 years prior to EPS (p < 0.05) and AR-IL-6 tended to be higher 2 years prior to EPS (p = 0.09). The combination of AR-CA125 < 33 U/min and AR-IL-6 > 350 pg/ min had a sensitivity of 70% and a specificity of 89% for the development of EPS. CONCLUSIONS: Compared to controls, AR-CA125 showed lower values and AR-IL-6 tended to be higher during the last years prior to the diagnosis of EPS. The sensitivity and specificity of the combination of CA125 and IL-6 indicate their potential use for an early diagnosis of EPS. PMID: 20124195 [PubMed - in process]
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Use of Angiotensin II Inhibitors in Patients That Develop Encapsulating Peritoneal Sclerosis. Sampimon DE, Kolesnyk I, Korte MR, Fieren MW, Struijk DG, Krediet RT. Perit Dial Int. 2010 Nov;30(6):656-9.
Interne geneeskunde
PMID: 21148060 [PubMed - in process]
Paracetamol for intravenous use in medium--and intensive care patients: pharmacokinetics and tolerance. de Maat MM, Tijssen TA, Brüggemann RJ, Ponssen HH. Eur J Clin Pharmacol. 2010 Jul;66(7):713-9. PURPOSE: We studied the pharmacokinetics of paracetamol and determine the incidence of hypotension after intravenous administration in medium- (MCU) and intensive care (ICU) patients. METHODS: All patients on the ICU/MCU starting with paracetamol i.v. were included, yielding 38 patients. Blood samples were collected at predetermined time points to determine paracetamol serum concentration. The number of patients with a clinically relevant reduction in systolic blood pressure (SBP) and the number of patients that needed intervention to regain an acceptable blood pressure level were assessed. RESULTS: Overall, pharmacokinetic data were roughly comparable with earlier publications, but differences were noted in the subgroup ICU patients. Also, there was a trend to a larger peak serum concentration (p = 0.052) and a significantly smaller volume of distribution (p = 0.033) in MCU patients compared with ICU patients. Twenty-two percent (22%) and 33% of patients had a clinically relevant reduction in systolic blood pressure (SBP) 15 and 30 min after start of paracetamol infusion, respectively. In six patients (16%), an intervention was needed to correct blood pressure. Overall, SBP was significantly reduced at T = 15 min and 30 min postinfusion (p < 0.003 at both time points) when compared with SBP at the start of paracetamol infusion. CONCLUSIONS: Further research on differences in paracetamol pharmacokinetics between ICU and MCU patients is warranted, as these differences might result in differences in efficacy. Furthermore, administration of paracetamol i.v. as potential cause of hypotension in the critically ill patient must not be overlooked. PMID: 20300741 [PubMed - indexed for MEDLINE]
Physicians’ and nurses’ opinions on selective decontamination of the digestive tract and selective oropharyngeal decontamination: a survey. Jongerden IP, de Smet AM, Kluytmans JA, te Velde LF, Dennesen PJ, Wesselink RM, Bouw MP, Spanjersberg R, Bogaers-Hofman D, van der Meer NJ, de Vries JW, Kaasjager K, van Iterson M, Kluge GH, van der Werf TS, Harinck HI, Bindels AJ, Pickkers P, Bonten MJ. Crit Care. 2010;14(4):R132. INTRODUCTION: Use of selective decontamination of the digestive tract (SDD) and selective oropharyngeal decontamination (SOD) in intensive care patients has been controversial for years. Through regular questionnaires we determined expectations concerning SDD (effectiveness) and experience with SDD and SOD (workload and patient friendliness), as perceived by nurses and physicians. METHODS: A survey was embedded in a group-randomized, controlled, cross-over multicenter study in the Netherlands in which, during three 6-month periods, SDD, SOD or standard care was used in random order. At the end of each study period, all nurses and physicians from participating intensive care units received study questionnaires. RESULTS: In all, 1024 (71%) of 1450 questionnaires were returned by nurses and 253 (82%) of 307 by physicians. Expectations that SDD improved patient outcome increased from 71% and 77% of respondents after the first two study periods to 82% at the end of the study (P = 0.004), with comparable trends among nurses and physicians. Nurses considered SDD to impose a higher workload (median 5.0, on a scale from 1 (low) to 10 (high)) than SOD (median 4.0) and standard care (median 2.0). Both SDD and SOD were considered less patient friendly than standard care (medians 4.0, 4.0 and 6.0, respectively). According to physicians, SDD had a higher workload (median 5.5) than SOD (median 5.0), which in turn was higher than standard care (median 2.5). Furthermore, physicians graded patient friendliness of standard care (median 8.0) higher than that of SDD and SOD (both median 6.0). CONCLUSIONS: Although perceived effectiveness of SDD increased as the trial proceeded, both among physicians and nurses, SOD and SDD were, as compared to standard care, considered to increase workload and to reduce patient friendliness. Therefore, education about the importance of oral care and on the effects of SDD and SOD on patient outcomes will be important when implementing these strategies. TRIAL REGISTRATION: ISRCTN35176830. PMID: 20626848 [PubMed - indexed for MEDLINE]
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Overige publicaties The many faces of Lymfoma. Berenschot HW. Abstract RSNA 2010. Enteroviral encephalitis in a patient with marginal zone lymphoma treated with rituximab. Schilthuizen C, Berenschot HW, Levin MD. Neth J Med. 2010; 68: 221-223. Cardiovascular research: data dispersion issues. Cleophas TJ, Zwinderman AH, Atiqi R, van den Bosch J. Heart International 2010 (5): 40-4. Biological processes are full of variations and so are responses to therapy as measured in clinical research. Estimators of clinical efficacy are, therefore, usually reported with a measure of uncertainty, otherwise called dispersion. This study aimed to review both the flaws of data reports without measure of dispersion and those with over-dispersion. Examples of estimators commonly reported without a measure of dispersion include: 1) number needed to treat; 2) reproducibility of quantitative diagnostic tests; 3) sensitivity / specificity; 4) Markov predictors; 5) risk profiles predicted from multiple logistic models. Data with large differences between response magnitudes can be assessed for over-dispersion by goodness of fit tests. The c2 goodness of fit test allows adjustment for over-dispersion. For most clinical estimators, the calculation of standard errors or confidence intervals is possible. Sometimes, the choice is deliberately made not to use the data fully, but to skip the standard errors and to use the summary measures only. The problem with this approach is that it may suggest inflated results. We recommend that analytical methods in clinical research should always attempt to include a measure of dispersion in the data. When large differences exist in the data, the presence of over-dispersion should be assessed and appropriate adjustments made. SPSS kookboekje 2010 (editie Albert Schweitzer Ziekenhuis, Dordrecht). Cleophas TJ, Klaren AD, Juliana-Stefess I, et al. Albert Schweitzer ziekenhuis Dordrecht. Cookbook for starters on SPSS. Cleophas TJ, Zwinderman AH. Ed: Springer Dordrecht, Netherlands. Cardiovascular research: Poisson regression more sensitive than linear or logistic regression for the analysis of events. van den Bosch J, Cleophas TJ. Perfusion 2010: 23: 146-50. Statistische data analyse met een hand-rekenmachine. Cleophas TJ. Uitgave Albert Schweitzer Ziekenhuis Dordrecht. Cardiovascular Research: dispersion issues. Cleophas TJ, Zwinderman AH, Atiqi R, van den Bosch J. www.pagepress.org Missing data. Cleophas EP, Cleophas TJ. Am J Ther 2010; doi: 10.1097. Encapsulating peritoneal sclerosis: stand van zaken. Korte MR. Capita Selecta Nefrologie, nummer 1 2010. Het geheim van Dordrecht. Sprangers SM, Levin MD. IKR Bulletin (kwaliteit in beeld: parels uit de IKR regio) 2010; 34: 42.
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Uw diagnose? Riedl JA, Levin MD, Van Gelder W. Ned. Tijdschr. v. Hematol. 2010; 7: 303.
Interne geneeskunde
Overgangen tussen MPD’s: de ene MPD is de andere niet….of toch wel. Levin MD, Commandeur S. Pur Sang, het MPD-magazine 2010 3: 12. Interim Analysis on a Dutch HOVON multicenter randomised open label phase II trial on 3 Rituximab dosing schemes in chronic ITP patients. Zwagingag JJ, Van der Holt R, Biemond BJ, Te Boekhorst PAW, Levin MD, Vreugdenhil A, Huijgens PC, Brand A, Van der Greind R, Luten M, Pruijt H, De Weerdt O, Van Pampus E, Zweegman S, Hollestein R, Koene HR. Blood 2010; 116:1042 (abstract 2514).
Voordrachten Idiopathic retroperitoneal fibrosis: prospective evaluation of incidence and clinicoradiologic presentation. Aarnoudse ALHJ, van Bommel EFH, Jansen I, Hendriksz TR. Nederlandse Nefrologiedagen 2010, Veldhoven. Idiopathic retroperitoneal fibrosis: prospective evaluation of incidence and clinicoradiologic presentation. Aarnoudse ALHJ, van Bommel EFH, Jansen I, Hendriksz TR. Nederlandse Internistendagen 2010, Maastricht. Atiqi R, Cleophas TJ, Niemeijer MG. Invited speaker KNMG Congres. Diagnose-behandel-combinaties. 10 mei 2010 Utrecht. Cleophas AJM. Module statistics applied to clinical trials, European Socrates Project College of Pharmaceutical Medicine, Lyon. December 5-11. Cleophas AJM. Annecy meeting academic committee European College Pharmaceutical Medicine. 10-15 mei Annecy. Cleophas AJM. Statistische workshop STZ Ziekenhuis Deventer. 24 november 2010. Cleophas AJM. Statistische workshop STZ Ziekenhuis Deventer. 27 november 2010. De chirurgische behandeling van obesitas. Kiewiet RM. Rotterdamse Internistendag 2010. Tamoxifen is associated with lower mortality of encapsulating peritoneal sclerosis: results of the Dutch Multicentre EPS Study. Korte MR Nederlandse Nefrologie Dagen maart 2010. Award beste klinisch wetenschappelijke abstract. Encapsulating Peritoneal Sclerosis contributes significantly to mortality after kidney transplantation. Korte MR, Habib M, Weimar W, Betjes MGH. Rotterdam, Nederlandse Transplantatie Congres februari 2010.
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Risicofactoren voor encapsulating peritoneal sclerosis. Korte MR. Rotterdam, Symposium “ De toekomst van Peritoneale Dialyse”, juli 2010. Enteroviral encephalitis in a patient with a marginal zone lymphoma treated with rituximab. Schilthuizen C, Levin MD. Dutch Hematology congres 27 januari 2010. Veel... heel veel leukocyten...en dan? Riedl JA, Levin MD, van Gelder W. Kasteel van Rhoon, Hematologische casuïstiek, 3 november 2010. Medicamenteuze preventie bij perifeer vaatlijden. Smak Gregoor PJH. Noordwijkerhout Vaatdagen 2010. Huisartsen nascholing Transmuraal. Smak Gregoor PJH. Serfaus, Oostenrijk januari 2010. ABPM Huisartsen nascholing regio Dordrecht. Smak Gregoor PJH. diverse avonden 2010. Huisartsen nascholing Transmuraal. Smak Gregoor PJH. Koudekerke april 2010. Thema avond rondom donatie; rol internist bij donatie/transplantatie. Smak Gregoor PJH. Dordrecht januari 2010. Donatie on tour. Smak Gregoor PJH. Dordrecht juni 2010. Niertransplantatie. Smak Gregoor PJH. Albeda college Rotterdam november 2010.
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Wetenschappelijke workshop/cursus
Interne geneeskunde
Cleophas AJM. Albert Schweitzer Dordrecht statistische workshops. 4 februari/ 18 februari/ 18 maart/ 15 april/ 22 april/ 6 mei/ 20 mei/ 10 juni/ 9 september 2010. Cleophas AJM. Academisch Ziekenhuis Nijmegen, statistische workshops. 26 mei 2010. Cleophas AJM. Academisch Ziekenhuis Nijmegen, statistische workshops. 7 juli 2010. Cleophas AJM. Presentatie wetenschapscoördinatoren STZ ziekenhuizen over SPSS. 27 mei 2010.
Poster The development of a European encapsulating sclerosis registry. Korte MR, Goffin E, Verger C, Davies S. Munchen, Duitsland, European Renal Association Congress 2010. Post-Transplantation Encapsulating Peritoneal Sclerosis Contributes Significantly to Mortality after Kidney Transplantation. Korte MR, Habib SM, Lingsma H, Weimar W, Betjes MGH. Denver, VS, American Society of Nephrology 2010. Interim Analysis on a Dutch HOVON multicenter randomised open label phase II trial on 3 Rituximab dosing schemes in chronic ITP patients. Levin MD. HOVON, Fifty-second annual meeting of the American Society of Hematology.
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VII
Kindergeneeskunde
Kindergeneeskunde PubMed publicaties Omphalocele and alveolar capillary dysplasia: a new association. Gerrits LC, de Mol AC, Bulten J, van der Staak FH, van Heijst AF. Pediatr Crit Care Med. 2010 May,11(3):e36-7.
OBJECTIVE: First report of an infant with coexistent omphalocele and alveolar capillary dysplasia. DESIGN: Descriptive case report. SETTING: Neonatal intensive care unit of a tertiary care children’s hospital. PATIENT: We describe a term infant with omphalocele and respiratory insufficiency attributable to pulmonary hypertension. The patient was placed on extracorporeal membrane oxygenation, but the pulmonary hypertension persisted. After 10 days on extracorporeal membrane oxygenation, a lung biopsy was performed. It showed alveolar capillary dysplasia. Because of the lethal prognosis, extracorporeal membrane oxygenation was withdrawn and the patient expired. CONCLUSIONS: This is the first description of an association between omphalocele and alveolar capillary dysplasia. In newborns with omphalocele who have severe respiratory insufficiency and pulmonary hypertension, alveolar capillary dysplasia should be considered. PMID: 20453609 [PubMed - indexed for MEDLINE]
Adult height in children with growth hormone deficiency: a randomized, controlled, growth hormone dose-response trial. Sas TC, de Ridder MA, Wit JM, Rotteveel J, Oostdijk W, Reeser HM, Otten BJ, de Muinck Keizer-Schrama SM. Horm Res Paediatr. 2010, 74(3):172-81. AIM: To investigate the effect of 2 growth hormone (GH) doses on adult height (AH) in GH deficiency (GHD). METHODS: A multicenter, randomized, controlled dose-response trial comparedattained AH minus target height (TH) between children receiving 0.7 mg/m(2)/day biosynthetic GH (approx. 0.025 mg/kg/day) or 1.4 mg/m(2)/day (approx. 0.050 mg/kg/day). The patients enrolled in the trial were 20 ‘naïve’ GHD children (had not received GH before) and 15 ‘transfer’ GHD children (already on GH for at least 1 year). RESULTS: In the naïve group, the mean +/- SD AH minus TH was -5.3 +/- 6.1 and -2.2 +/- 6.9 cm in patients on 0.7 and 1.4 mg/m(2)/day, respectively (mean +/- SE difference 3.1 +/- 2.9; p = 0.3). In the transfer group, the mean +/- SD AH minus TH was -4.4 +/- 6.4 and +0.6 +/7.0 cm in patients on 0.7 and 1.4 mg/m(2)/day, respectively (mean +/- SE difference 5.0 +/- 3.5; p = 0.17). Spontaneous puberty started 1.1 years earlier in children on 1.4 compared to 0.7 mg/m(2)/day. Induction of puberty was more often delayed in transfer children on 0.7 than on 1.4 mg/m(2)/day. CONCLUSION: In our GHD patients, AH was 4-5 cm less than TH in patients on 0.7 mg/m(2)/day GH, while it was 0-2 cm less in patients on 1.4 mg/m(2)/day GH, but this difference did not reach statistical significance, probably due to limited numbers of patients, considerable variability in the growth response and earlier spontaneous puberty and pubertal induction in the children on 1.4 mg/m(2)/day. PMID: 20424418 [PubMed - indexed for MEDLINE]
The effect of the weak androgen oxandrolone on psychological and behavioral characteristics in growth hormone-treated girls with Turner syndrome. Menke LA, Sas TC, Visser M, Kreukels BP, Stijnen T, Zandwijken GR, de Muinck Keizer-Schrama SM, Otten BJ, Wit JM, CohenKettenis PT.Horm Behav. 2010 Mar, 57(3):297-305. The weak androgen oxandrolone (Ox) increases height gain in growth-hormone (GH) treated girls with Turner syndrome (TS), but may also give rise to virilizing side effects. To assess the effect of Ox, at a conventional and low dosage, on behavior, aggression, romantic and sexual interest, mood, and gender role in GH-treated girls with TS, a randomized, placebo-controlled, double-blind study was conducted. 133 patients were treated with GH (1.33 mg/m(2)/d) from baseline, combined with placebo (Pl), Ox 0.03 mg/kg/d, or Ox 0.06 mg/kg/d from the age of eight, and with estrogens from the age of 12. The child behavior checklist (CBCL), Junior Dutch Personality Questionnaire (DPQ-J), State-subscale of the Spielberger’s State-Trait Anger Scale, Romantic and Sexual Interest Questionnaire, Mood Questionnaire,
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and Gender Role Questionnaire were filled out before, during, and after discontinuing Ox/Pl. The changes during Ox/Pl therapy were not significantly different between the dosage groups. In untreated patients, the mean CBCL total (P=0.002) and internalizing (P=0.003) T scores, as well as the mean DPQ-J social inadequacy SD score (SDS) (P=0.004) were higher than in reference girls, but decreased during GH+Ox/Pl therapy (P<0.001, P=0.05, P<0.001, respectively). Whereas the mean total (P=0.01) and internalizing (P<0.001) T score remained relatively high, the mean social inadequacy SDS became comparable with reference values. We conclude that in GH-treated girls with TS, Ox 0.03 mg/kg/d or 0.06 mg/kg/d does not cause evident psychological virilizing side effects. Problem behavior, frequently present in untreated girls with TS, decreases during therapy, but total and internalizing problem behavior remain increased. PMID: 20053349 [PubMed - indexed for MEDLINE]
Efficacy and safety of oxandrolone in growth hormone-treated girls with turner syndrome. Menke LA, Sas TC, de Muinck Keizer-Schrama SM, Zandwijken GR, de Ridder MA, Odink RJ, Jansen M, Delemarre-van de Waal HA, Stokvis-Brantsma WH, Waelkens JJ, Westerlaken C, Reeser HM, van Trotsenburg AS, Gevers EF, van Buuren S, Dejonckere PH, Hokken-Koelega AC, Otten BJ, Wit JM. J Clin Endocrinol Metab. 2010 Mar, 95(3):1151-60. Context and Objective: GH therapy increases growth and adult height in Turner syndrome (TS). The benefit to risk ratio of adding the weak androgen oxandrolone (Ox) to GH is unclear. Design and Participants: A randomized, placebo-controlled, double-blind, dose-response study was performed in 10 centers in The Netherlands. One hundred thirty-three patients with TS were included in age group 1 (2-7.99 yr), 2 (8-11.99 yr), or 3 (12-15.99 yr). Patients were treated with GH (1.33 mg/m(2) . d) from baseline, combined with placebo (Pl) or Ox in low (0.03 mg/kg .d) or conventional (0.06 mg/kg . d) dose from the age of 8 yr and estrogens from the age of 12 yr. Adult height gain (adult height minus predicted adult height) and safety parameters were systematically assessed. Results: Compared with GH+Pl, GH+Ox 0.03 increased adult height gain in the intention-to-treat analysis (mean +/- sd, 9.5 +/- 4.7 vs. 7.2 +/4.0 cm, P = 0.02) and per-protocol analysis (9.8 +/- 4.9 vs. 6.8 +/- 4.4 cm, P = 0.02). Partly due to accelerated bone maturation (P < 0.001), adult height gain on GH+Ox 0.06 was not significantly different from that on GH+Pl (8.3 +/- 4.7 vs. 7.2 +/- 4.0 cm, P = 0.3). Breast development was slower on GH+Ox (GH+Ox 0.03, P = 0.02; GH+Ox 0.06, P = 0.05), and more girls reported virilization on GH+Ox 0.06 than on GH+Pl (P < 0.001). Conclusions: In GH-treated girls with TS, we discourage the use of the conventional Ox dosage (0.06 mg/kg . d) because of its low benefit to risk ratio. The addition of Ox 0.03 mg/kg . d modestly increases adult height gain and has a fairly good safety profile, except for some deceleration of breast development. PMID: 20061421 [PubMed - indexed for MEDLINE]
The effect of oxandrolone on body proportions and body composition in growth hormone-treated girls with Turner syndrome. Menke LA, Sas TC, Zandwijken GR, de Ridder MA, Stijnen T, de Muinck Keizer-Schrama SM, Otten BJ, Wit JM. Clin Endocrinol (Oxf). 2010 Aug, 73(2):212-9. OBJECTIVE: Untreated girls with Turner syndrome (TS) have short stature, relatively broad shoulders, a broad pelvis, short legs, a high fat mass and low muscle mass. Our objective was to assess the effect of the weak androgen oxandrolone (Ox) on body proportions and composition in growth hormone (GH)-treated girls with TS. DESIGN/PATIENTS: 133 patients were included in a randomized, placebo-controlled, double-blind study. METHODS: Patients were treated with GH (1.33 mg/m(2) per day) from baseline, combined with placebo (Pl) or Ox in a low (0.03 mg/ kg per day) or previously conventional (0.06 mg/kg per day) dose from the age of eight, and oestrogens from the age of twelve. Sitting height, biacromial and biiliacal distances compared with height (i.e. shape values), BMI, waist circumference, sum of 4 skinfolds (sum4skin) and upper arm muscle area (UAMA) SD scores (SDS) were assessed half-yearly. RESULTS: Compared with GH + Pl, adult shape values on GH + Ox tended to be higher for sitting height (Ox 0.03, P = 0.2; Ox 0.06, P = 0.02) and biacromial distance (Ox 0.03, P = 0.2; Ox 0.06, P = 0.07) and lower for biiliacal distance (Ox 0.03, P = 0.004; Ox 0.06, P = 0.08). Sum4skin SDS tended to decrease more (Ox 0.03, P = 0.2; Ox 0.06, P = 0.005) while UAMA SDS increased more (Ox 0.03, P < 0.001; Ox 0.06, P < 0.001) than on GH + Pl. The increase in BMI and waist circumference SDS was comparable between the dosage groups. CONCLUSIONS: In GH-treated girls with TS, Ox 0.06 increases sitting height and tends to increase biacromial distance and decrease biiliacal distance, while Ox 0.03 significantly decreases biiliacal distance compared with height. Furthermore, Ox 0.06 reduces subcutaneous fat mass, and both Ox dosages increase muscle mass. PMID: 20105186 [PubMed - indexed for MEDLINE]
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Effect of Oxandrolone on Glucose Metabolism in Growth Hormone-Treated Girls with Turner Syndrome. Menke LA, Sas TC, Stijnen T, Zandwijken GR, de Muinck Keizer-Schrama SM, Otten BJ, Wit JM. Horm Res Paediatr. 2010 Sep 3.
Kindergeneeskunde
Background: The weak androgen oxandrolone (Ox) may increase height but may also affect glucose metabolism in girls with Turner syndrome (TS). Methods: In a randomized, placebo-controlled, double-blind study, we assessed the effect of Ox at a dosage of either 0.06 or 0.03 mg/ kg/day on glucose metabolism in 133 growth hormone (GH)-treated girls with TS. Patients were treated with GH (1.33 mg/m(2)/day) from baseline, combined with placebo (Pl) or Ox from the age of 8, and estrogens from the age of 12. Oral glucose tolerance tests (OGTT) were performed, and HbA1c levels were measured before, during, and after discontinuing Ox/Pl therapy. Results: Insulin sensitivity, assessed by the whole-body insulin sensitivity index (WBISI) decreased during GH+Ox/Pl (p = 0.003) without significant differences between the dosage groups. Values returned to pre-treatment levels after discontinuing GH+Ox/Pl. On GH+Ox, fasting glucose was less frequently impaired (Ox 0.03, p = 0.001; Ox 0.06, p = 0.02) and HbA1c levels decreased more (p = 0.03 and p = 0.001, respectively) than on GH+Pl. Conclusions: We conclude that in GH-treated girls with TS, Ox at a dosage of 0.03 or 0.06 mg/kg/day does not significantly affect insulin sensitivity. Insulin sensitivity decreases during GH therapy, to return to a pre-treatment level after discontinuing therapy. PMID: 20814189 [PubMed - as supplied by publisher]
The Effect of Oxandrolone on Voice Frequency in Growth Hormone-Treated Girls With Turner Syndrome. Menke LA, Sas TC, van Koningsbrugge SH, de Ridder MA, Zandwijken GR, Boersma B, Dejonckere PH, de Muinck Keizer-Schrama SM, Otten BJ, Wit JM. J Voice. 2010 Oct 23. OBJECTIVES/HYPOTHESIS: Oxandrolone (Ox) increases height gain but may also cause voice deepening in growth hormone (GH)-treated girls with Turner syndrome (TS). We assessed the effect of Ox on objective and subjective speaking voice frequency in GH-treated girls with TS. STUDY DESIGN: A multicenter, randomized, placebo (Pl)-controlled, double-blind study was conducted. METHODS: One hundred thirty-three patients were included and treated with GH (1.33mg/m(2)/d) from baseline, combined with Pl or Ox in a low (0.03mg/kg/d) or conventional (0.06mg/kg/d) dose from the age of 8 years and estrogens from the age of 12 years. Yearly from starting Ox/Pl until 6 months after discontinuing GH+Ox/Pl, voices were recorded and questionnaires were completed. RESULTS: At start, mean (±standard deviation [SD]) voice frequency SD score (SDS) was high for age (1.0±1.2, P<0.001) but normal for height. Compared with GH+Pl, voices tended to lower on GH+Ox 0.03 (P=0.09) and significantly lowered on GH+Ox 0.06 (P=0.007). At the last measurement, voice frequency SDS was still relatively high in GH+Pl group (0.6±0.7, P=0.002) but similar to healthy girls in both GH+Ox groups. Voice frequency became lower than -2 SDS in one patient (3%) on GH+Ox 0.03 and three patients (11%) on GH+Ox 0.06. The percentage of patients reporting subjective voice deepening was similar between the dosage groups. CONCLUSIONS: Untreated girls with TS have relatively high-pitched voices. The addition of Ox to GH decreases voice frequency in a dose-dependent way. Although most voice frequencies remain within the normal range, they may occasionally become lower than -2 SDS, especially on GH+Ox 0.06mg/kg/d. PMID: 20971614 [PubMed - as supplied by publisher]
Boek of hoofdstuk in boek NVK Werkboek Kinderendocrinologie, chapter “bijnierinsufficientie” en de “ziekte van Cushing” Sas TC.
Voordrachten Het effect van bladderbox alarmen tijdens va-ECMO op cerebrale oxygenatie en hemodynamiek. de Mol AC, Gerrits LC, Van Heijst AF, Menssen J , Van der Staak FH, Liem KD. Oral presentation. 11e symposium neonatale neurologie, 29 januari 2010, Nederland. Abstract symposium book.
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The effect of bladderbox alarms during va-ECMO on cerebral oxygenation and hemodynamics in lambs. de Mol AC. Voordracht regionale refereeravond neonatologie, regio Zuid-Holland Zuid, Rotterdam, december 2010. Lipids and Carbohydrate Metabolism in Turner syndrome. Sas TC. 49th Annual meeting of the European Society for Paediatric Endocrinology (ESPE) Prague, september 2010. AC1 (PLAG1) degree of methylation is associated with prenatal and postnatal growth parameters in a general population of children. Sas TC, Koudou Y, Azzi S, Souberbielle JC, Dargent P, Le Bouc Y, Netchine I, Charles MA. 49th Annual meeting of the European Society for Paediatric Endocrinology (ESPE) Prague, september 2010. Russell-Silver Syndrome (RSS) with 11p15 epimutation: Does the degree of ICR1 loss of methylation correlate to clinical severity? Vu-Hong TA, Rossignol S, Azzi S, Sas TC, Cabrol S, Le Bouc Y, Netchine I. 49th Annual meeting of the European Society for Paediatric Endocrinology (ESPE) Prague, september 2010. Long term effects of GH treatment in girls with Turner syndrome. Sas TC. Symposium “Novel findings in Turner syndrome” LUMC Leiden, december 2010.
Posters Changes in cerebral oxygenation and hemodynamics caused by bladderbox alarms during va-ECMO in lambs. de Mol AC, Gerrits LC, Van Heijst AF, Menssen J , Van der Staak FH, Liem KD. Oral posterpresentation, 32e congres Kindergeneeskunde, NVK, november 2010, Veldhoven, Nederland. Abstract: Tijdschrift voor kindergeneeskunde 2010.
Proefschriften Sas TC Copromotor of PhD student Dr. L. Menke, defence of thesis ‘Oxandrolone in Growth Hormone treated girls with Turner syndrome, Leiden, 16 December 2010.
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Klinische chemie
Klinische chemie PubMed publicaties
Automated morphological analysis of cells in body fluids by the digital microscopy system DM96. Riedl JA, Dinkelaar RB, van Gelder W. J Clin Pathol. 2010 Jun, 63(6):538-43. BACKGROUND: Differential counting and morphological analysis of nucleated cells in body fluids (eg, cerebrospinal fluid and pleural fluid) are of great diagnostic importance to the clinician. A recent development in this field was the introduction of an application for an automated microscopy system, the DM96 Body Fluid module, enabling the automated analysis of body fluid samples. This computerised system provides an automated morphological analysis of body fluids, including an automated classification of all nucleated cells. AIMS: To investigate the ability of the digital microscopy system, DM96, to automatically classify cells in different types of body fluids. METHODS: A total of 177 body fluids (including cerebrospinal fluid, abdominal fluid and continuous ambulant peritoneal dialysis fluid) were analysed on the DM96, and results were compared with the manual microscopy method. RESULTS: A study in 177 samples demonstrates an overall preclassification accuracy of 90% in spinal fluid and 83% in other body fluids using the automated system. Correlation coefficients for postclassification as compared with manual review range from 0.92 to 0.99 for spinal fluid sample analyses and from 0.83 to 0.98 for other body fluids. The within-run variation of automated classification is less than 6% for all cell categories (4% excluding macrophages). CONCLUSION: The DM96 has proven to be reliable and efficient, contributing to overall quality improvement in morphological analysis and automated cell classification of peripheral blood and other body-fluid samples. PMID: 20498027 [PubMed - indexed for MEDLINE]
Overige publicaties Troponine T-testen voor en door de SEH: een pilot. Tak J, De Vries-Verbaas I, Dubois EA, Fouraux MA. Ned Tijdschr Klin Chem Labgeneesk. 2010 (35): 112. Onderzoek naar de juistheid van immunochemische bepalingen uit ongecentrifugeerd en 24 uur bij kamertemperatuur bewaard serum en plasma. Castel R, Verdaas M, Fouraux MA, Verheijen FM. Ned Tijdschr Klin Chem Labgeneesk. 2010 (35): 113. Uw Diagnose. Riedl JA, Levin MD, van Gelder W. Nederlands Tijdschrift voor Hematologie. Vol. 7; Nr. 7-2010. Geautomatiseerde morfologische analyse van perifeer bloed, liquor cerebrospinalis en andere lichaamsvloeistoffen met het digitale microscopiesysteem DM96. Riedl JA, van Gelder W. Ned Tijdschr Klin Chem Labgeneesk 2010; 35: 203-205. Digital morphology: towards auto-validation. Riedl JA, Dinkelaar RB, van Gelder W. Ned Tijdschr Klin Chem Labgeneesk 2010, vol. 35, no. 2. [A woman with low hemoglobin values] Riedl JA, Berenschot HW. Ned Tijdschr Geneeskd. 2010, 154:A1035.
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Analyse van een patient met intoxicatie: valkuilen. De Bree GJ, Butterhof-Terlingen MH, Vermeer HJ, Treskes M, Van der Linden PD, Ruys TA. Ned Tijdschr Geneeskd, 2010, 154:A1605.
Posters Onderzoek naar de juistheid van immunochemische bepalingen uit plasma, en ongecentrifugeerd bij kamertemperatuur bewaard serum. Castel R. NVKC conference 22/23 april 2010. Digital morphology: towards auto-validation. Riedl JA, Dinkelaar RB, van Gelder W. NVKC conference 22/23 april 2010.
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Klinische fysica
Klinische fysica Voordracht Men wil wel, maar in de praktijk valt het toch tegen! Niehof S. Voordracht op DRN dag in Leiden 10 december 2010.
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Klinische psychiatrie
Klinische psychiatrie Overige publicaties Steroidpsychose bij behandeling van dreigende vroeggeboorte. Koster MIME, de Jong MK, Derksen MTh, Gool AR. Nederlands Tijdschrift voor geneeskunde. Geaccepteerd in 2010.
Voordrachten Cognitief gedragstherapeutische groepstherapie voor volwassenen met ADHD. Derksen MTh. Utrecht, Landelijk Congres Netwerk ADHD, “Dubbelfocus op ADHD”, 21 januari 2010. Geaccrediteerd door: Nederlandse Vereniging voor Psychiatrie, Nederlands Instituut voor Psychologen, Nederlandse vereniging voor Kindergeneeskunde, Nederlandse Vereniging verzekeringsgeneeskundigen, Nederlandse Vereniging arbeids- en bedrijfsgeneeskunde. ADHD: Een toenemend probleem. Derksen MTh. Oostenrijk, Serfaus, Nascholing Stichting Transmuraal Albert Schweitzer ziekenhuis, voor specialisten en huisartsen, 28 januari 2010. Geaccrediteerd door de commissie accreditering huisartsen van de KNMG. ADHD bij volwassenen: een zorgprogramma plus. Derksen MTh. Dordrecht, Avondsymposium “ADHD van kind tot in de volwassenheid. Het brein, de symptomen en de behandeling”, 4 maart 2010. Geaccrediteerd door: Nederlandse Vereniging voor Psychiatrie, Nederlands Instituut voor Psychologen, Nederlandse vereniging voor Kindergeneeskunde, Nederlandse Vereniging voor Neurologen. Effectmeting groepstherapie bij volwassenen met ADHD. Derksen MTh. Dordrecht, Avondsymposium “ADHD van kind tot in de volwassenheid. Het brein, de symptomen en de behandeling”. Avondsymposium voor de regio van het Consortium Psychiatrie en aanverwante algemeen ziekenhuizen, 4 maart 2010. Geaccrediteerd door: Nederlandse Vereniging voor Psychiatrie, Nederlands Instituut voor Psychologen, Nederlandse vereniging voor Kindergeneeskunde, Nederlandse Vereniging voor Neurologen. Kijken met een diagnostische traumabril in de ziekenhuis psychiatrie. Derksen.MTh, Baeten BM. Maasstricht, Voorjaarscongres van de Nederlandse Vereniging voor Psychiatrie,14 april 2010. Geaccrediteerd door: Nederlandse Vereniging voor Psychiatrie. Trauma collegiale opvang en EMDR. Derksen MTh. Rotterdam , Aios huisartsengeneeskunde jaar dag, 25 november 2010. Kijken naar trauma’s in de ziekenhuispsychiatrie en behandelen met EMDR. Derksen MTh. Rotterdam, Regionale Werkgroep Consultatieve Psychiatrie Rijnmond ,14 september 2010. Geaccrediteerd door: Nederlandse Vereniging voor Psychiatrie.
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Poster Steroidpsychose bij behandeling van dreigende vroeggeboorte. Koster MIME, de Jong MK, Derksen MTh, van Gool AR. Poster voorjaarscongres van de Nederlandse Vereniging voor Psychiatrie, april 2010.
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Klinische psychologie
Klinische psychologie Boek of hoofdstuk in boek
Educatie bij mensen met pas ontdekte diabetes. Thoolen B. In “Diabetes, van wetenschap naar praktijk, -Tips en tools voor de professional- “, redactie: G.E.H.M. Rutten.Van Gorcum en ZonMw. ISBN: 978 90 232 4618 3.
Voordrachten De psychische begeleiding bij perifere aangezichtsverlamming. Driessen E. Symposium: De perifere aangezichtsverlamming, diagnostiek en behandeling UMC St. Radboud 16 juni 2010. Geaccrediteerd voor KNO-artsen, neurologen. plastisch chirurgen, fysiotherapeuten en huisartsen.
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Kwaliteit, Veiligheid en Innovatie
Kwaliteit, Veiligheid en Innovatie PubMed publicaties
Limited contamination in the Dutch-Belgian randomized lung cancer screening trial (NELSON). Baecke E, de Koning HJ, Otto SJ, van Iersel CA, Van Klaveren RJ. Lung Cancer. 2010 Jul;69(1):66-70. Purpose of this study was to determine the rate of contamination, defined as lung cancer screening in the control arm, of the DutchBelgian randomized lung cancer screening trial (NELSON) as contamination adversely affects the power of a trial. The NELSON cohort includes 15,822 high-risk current and former smokers, aged 50-75 years, equally randomized to the screen and control arm. Questionnaires were sent to a sample of 1460 male subjects of the control arm, stratified on smoking determinants. The response rate was 73.0%. The participants were asked whether they received a chest X-ray or CT scan in the last 4 years and, if so, when and for what reason it had been performed. Examinations performed after randomization because of “Precaution” or “No examination was offered by NELSON” were regarded as contamination. In the first 24 months after randomization 3.1% (2.3-3.8%) of the respondents received a lung cancer screening examination. Contamination reached a non-significant peak within the first 3 months after randomization, with a lower limit of 2.5 and an upper limit of 3.1 per 1000 person-months. This screening rate did not differ from the background rates in the last 18 months before randomization. No significant differences were observed between current and former smokers. In conclusion, the rate of contamination among male subjects of the control arm of the NELSON trial is low and is not likely to jeopardize the power of the trial. PMID: 19801174 [PubMed - indexed for MEDLINE]
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Longgeneeskunde
Longgeneeskunde PubMed publicaties
Safety and tolerability of NVA237, a once-daily long-acting muscarinic antagonist, in COPD patients. Vogelmeier C, Verkindre C, Cheung D, Galdiz JB, Güçlü SZ, Spangenthal S, Overend T, Henley M, Mizutani G, Zeldin RK. Pulm Pharmacol Ther. 2010 Oct;23(5):438-44. NVA237 is a novel once-daily inhaled long-acting muscarinic antagonist administered via a dry powder inhaler. This randomized, doubleblind, placebo-controlled study evaluated the safety, tolerability and bronchodilator efficacy of two doses of NVA237 (100 and 200 microg), versus placebo, in patients with moderate-to-severe COPD (forced expiratory volume in 1s [FEV(1)]>or=30% and <80% predicted and FEV(1)/forced vital capacity [FVC]<0.7, 30 min after inhalation of 80 microg ipratropium bromide). After appropriate washout periods, patients were randomized to treatment with NVA237 100 microg (n=92), NVA237 200 microg (n=98) or placebo (n=91) for 28 days. The primary objective was evaluation of safety, with efficacy measures included as secondary objectives. NVA237 was generally well tolerated and associated with a frequency and distribution of adverse events similar to placebo. Serious adverse events were uncommon and there was no evidence of adverse cardiovascular effects or unexpected events. Trough FEV(1) was significantly higher in those receiving NVA237 compared with placebo. For NVA237 100 microg the differences were 131 and 161 mL on Days 1 and 28, respectively (p<0.05), and for NVA237 200 microg the differences were 146 and 151 mL on Days 1 and 28, respectively (p<0.05). Peak FEV(1), FEV(1) at all timepoints up to 24h after dosing, and FEV(1) area under the curve during 5 min-5 h post-dosing were also significantly higher in both NVA237 groups, compared with placebo. Patients receiving NVA237 required fewer daily puffs of rescue medication and had a higher percentage of days on which rescue medication was not required. Overall, the present study provides further evidence of the safety, tolerability and bronchodilator efficacy of once-daily treatment with NVA237 100 and 200 microg in patients with moderate-to-severe COPD. PMID: 20416390 [PubMed - indexed for MEDLINE]
Circulating DNA is a non-invasive prognostic factor for survival in non-small cell lung cancer. Van der Drift MA, Hol BE, Klaassen CH, Prinsen CF, van Aarssen YA, Donders R, van der Stappen JW, Dekhuijzen PN, van der Heijden HF, Thunnissen FB. Lung Cancer. 2010 May;68(2):283-7. INTRODUCTION: Circulating plasma DNA is present in a considerably higher concentration in lung cancer patients than in controls. Conflicting data are reported about circulating DNA as a prognostic factor. The aim of this study was to prospectively analyse the relationship of circulating plasma DNA with overall survival (OS) of previously untreated non-small cell lung cancer (NSCLC) patients. METHODS: 46 untreated NSCLC patients and 21 controls with a follow-up time of 6.5 years were analyzed. Quantification of baseline circulating plasma DNA was performed by a real-time quantitative polymerase chain reaction (qPCR) targeting the human beta-globin gene. Survival analysis was performed using the Kaplan-Meier method and compared with a Cox-regression analysis. RESULTS: The median DNA concentration of the patients who died (87%) was significantly higher compared to the patients that survived at the end of follow-up (55ng/ml versus 23ng/ml, p=0.02). In patients with higher DNA concentration overall survival was significantly worse. In this study no relation of DNA concentration with tumour characteristics, age, gender or pulmonary inflammatory conditions was found. CONCLUSION: In this study a high circulating plasma DNA concentration at time of diagnosis in NSCLC patients was a prognostic factor for poorer survival. Circulating DNA may be used as a non-invasive biomarker to refine the prognostic profile in NSCLC patients. PMID: 19632736 [PubMed - indexed for MEDLINE]
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Maag, Darm en Lever
Maag, Darm en Lever PubMed publicaties Predictors for outcome of failure of balloon dilatation in patients with achalasia. Alderliesten J, Conchillo JM, Leeuwenburgh I, Steyerberg EW, Kuipers EJ. Gut. 2011 Jan;60(1):10-6. Epub 2010 Nov 10.
BACKGROUND: Pneumatic balloon dilatation (PD) is a regular treatment modality for achalasia. The reported success rates of PD vary. Recurrent symptoms often require repeated PD or surgery. OBJECTIVE: To identify predicting factors for symptom recurrence requiring repeated treatment. METHODS: Between 1974 and 2006, 336 patients were treated with PD and included in this longitudinal cohort study. The median follow-up was 129 months (range 1-378). Recurrence of achalasia was defined as symptom recurrence in combination with increased lower oesophageal sphincter (LOS) pressure on manometry, requiring repeated treatment. Patient characteristics, results of timed barium oesophagram and manometry as well as baseline PD characteristics were evaluated as predictors of disease recurrence with Kaplan-Meier curves and Cox regression analysis. RESULTS: 111 patients had symptom recurrence requiring repeated treatment.Symptoms recurred after a mean follow-up of 51 months (range 1-348). High recurrence percentages were found in patients younger than 21 years in whom the 5 and 10-year risks of recurrence were 64% and 72%, respectively. These risks were respectively 28% and 36% in patients with classic achalasia, respectively 48% and 60% in patients without complete obliteration of the balloon’s waist during PD and respectively 25% and 33% in patients with a LOS pressure greater than 10 mm Hg at 3 months post-dilatation. These four predictors remained statistically significant in a multivariable Cox analysis. CONCLUSION: Although PD is an effective primary treatment in patients with primary achalasia, patients are at risk of recurrent disease, with this risk increasing during long-term follow-up. Young age at presentation, classic achalasia, high LOS pressure 3 months after PD and incomplete obliteration of the balloon’s waist during PD are the most important predicting factors for the need for repeated treatment during follow-up. Patients who meet one or more of these characteristics may be considered earlier for alternative treatment, such as surgery. PMID: 21068135 [PubMed - indexed for MEDLINE]
The risk of inflammatory bowel disease-related colorectal carcinoma is limited: results from a nationwide nested case-control study. Baars JE, Looman CW, Steyerberg EW, Beukers R, Tan AC, Weusten BL, Kuipers EJ, van der Woude CJ. Am J Gastroenterol. 2011 Feb;106(2):319-28. Epub 2010 Nov 2. OBJECTIVES: The risk for inflammatory bowel disease (IBD)-related colorectal cancer (CRC) remains a matter of debate. Initial reports mainly originate from tertiary referral centers, and conflict with more recent studies. Overall, epidemiology of IBD-related CRC is relevant to strengthen the basis of surveillance guidelines. We performed a nationwide nested case-control study to assess the risk for IBD-related CRC and associated prognostic factors in general hospitals. METHODS: IBD patients diagnosed with CRC between January 1990 and July 2006 in 78 Dutch general hospitals were identified as cases, using a nationwide automated pathology database. Control IBD patients without CRC were randomly selected. Clinical data were collected from detailed chart review. Poisson regression analysis was used for univariable and multivariable analyses. RESULTS: A total of 173 cases were identified through pathology and chart review and compared with 393 controls. The incidence rate of IBD-related CRC was 0.04%. Risk factors for IBD-related CRC were older age, concomitant primary sclerosing cholangitis (PSC, relative ratio (RR) per year duration 1.05; 95% confidence interval (CI) 1.01-1.10), pseudopolyps (RR 1.92; 95% CI 1.28-2.88), and duration of IBD (RR per year 1.04; 95% CI 1.02-1.05). Using immunosuppressive therapy (odds ratio (OR) 0.3; 95% CI 0.16-0.56, P<0.001) or anti-tumor necrosis factor (TNF) (OR 0.09; 95% CI 0.01-0.68, P<0.02) was protective. CONCLUSIONS: We found a limited risk for developing IBD-related CRC in The Netherlands. Age, duration of PSC and IBD, concomitant pseudopolyps, and use immunosuppressives or anti-TNF were strong prognostic factors in general hospitals. PMID: 21045815 [PubMed - in process]
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The long-term effect of ursodeoxycholic acid on laboratory liver parameters in biochemically non-advanced primary biliary cirrhosis. Kuiper EM, Hansen BE, Lesterhuis W, Robijn RJ, Thijs JC, Engels LG, Koek GH, Aparicio MN, Kerbert-Dreteler MJ, van Buuren HR. Gastroenterol Clin Biol. 2010 Aug 30. BACKGROUND AND AIMS: Ursodeoxycholic acid (UDCA) has an established effect on liver biochemistries in primary biliary cirrhosis (PBC). Few studies have evaluated long-term laboratory treatment effects and data beyond 6 years are not available. The aim of this study was to assess the long-term evolution of liver biochemistries during prolonged treatment with UDCA in biochemically non-advanced PBC. PATIENTS AND METHODS: Prospective multicenter cohort study of patients with PBC with pretreatment normal bilirubin and albumin, treated with UDCA 13-15mg/kg/day. At yearly intervals, follow-up data including serum bilirubin, alkaline phosphatase (ALP), transaminases, albumin and IgM were collected. Data were analyzed with a repeated measurement model. RESULTS: Two hundred and twenty-five patients were included and followed during a median period of 10.3 years. Following 1-year treatment with UDCA 36-100% of the total biochemical improvement was achieved, the maximum response was observed after 3 years. After initial improvements, bilirubin and AST levels increased and albumin levels significantly decreased after 6-10 years. However, these changes were of limited magnitude. The beneficial effects on ALT and ALP were maintained while IgM continued to decrease. CONCLUSION: In non-advanced PBC the biochemical response to UDCA is maintained up to 15 years. The long-term evolution of bilirubin, albumin and ALT differs from that of ALP and AST. The mean IgM level normalised and levels continued to decrease during the period of follow-up. PMID: 20810227 [PubMed - as supplied by publisher]
Collaborating publicaties Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study. Plessier A, Darwish-Murad S, Hernandez-Guerra M, Consigny Y, Fabris F, Trebicka J, Heller J, Morard I, Lasser L, Langlet P, Denninger MH, Vidaud D, Condat B, Hadengue A, Primignani M, Garcia-Pagan JC, Janssen HL, Valla D; European Network for Vascular Disorders of the Liver (EN-Vie). Collaborators: … Beukers R, van de Vrie W... Hepatology. 2010 Jan;51(1):210-8. Current recommendations for early anticoagulation in acute portal vein thrombosis unrelated to cirrhosis or malignancy are based on limited evidence. The aim of this study was to prospectively assess the risk factors, outcome, and prognosis in patients managed according to these recommendations. We enrolled 102 patients with acute thrombosis of the portal vein, or its left or right branch. Laboratory investigations for prothrombotic factors were centralized. Thrombus extension and recanalization were assessed by expert radiologists. A local risk factor was identified in 21% of patients, and one or several general prothrombotic conditions in 52%. Anticoagulation was given to 95 patients. After a median of 234 days, the portal vein and its left or right branch were patent in 39% of anticoagulated patients (versus 13% initially), the splenic vein in 80% (versus 57% initially), and the superior mesenteric vein in 73% (versus 42% initially). Failure to recanalize the portal vein was independently related to the presence of ascites (hazard ratio 3.8, 95% confidence interval 1.3-11.1) and an occluded splenic vein (hazard ratio 3.5, 95% confidence interval 1.4-8.9). Gastrointestinal bleeding and intestinal infarction occurred in nine and two patients, respectively. Two patients died from causes unrelated to thrombosis or anticoagulation therapy. CONCLUSION: Recanalization occurs in one-third of patients receiving early anticoagulation for acute portal vein thrombosis, whereas thrombus extension, intestinal infarction, severe bleeding, and death are rare. Alternative therapy should be considered when ascites and splenic vein obstruction are present. PMID: 19821530 [PubMed - indexed for MEDLINE]
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Overige publicaties A colorectalcancer-risk prediction model for inflammatory bowel disease patients in general hospitals:a first step towards individualized surveillance strategies. Baars JE, Looman CW, Steyerberg EW, Beukers R, Tan ACITL, Weusten BAML, Kuipers EJ, van der Woude CJ. Am J Gastroenterol. 2011 Feb;106(2):319-28. Epub 2010 Nov 2. Yield of routine molecular analyses in colorectal cancer patients ≤ 70 years to detect underlying Lynch syndrome. Van Lier MGF, Leenen CHM, Dinjens, Wagner A, Ramsoekh D, Dubbink HJ, Westenend PJ , de Graaf EJR, Wolters LMM, Vrijland W, Kuipers EJ, Van Leerdam ME, Steyerberg EW. Submitted.
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Voordrachten Voorlichtingsavond Coloncarcinoom. Beukers R. Dordrecht, mei 2010. Coloncarcinoom en screening. Honkoop P. Serfaus, Oostenrijk, Huisartsennascholing Transmuraal, januari 2010. Help I found a liverlesion. Honkoop P. Rotterdam, 19e Erasmus Gastroenterology day, maart 2010. Coloncarcinoom en screening. Honkoop P. Koudekerke, Huisartsennascholing Transmuraal, april 2010. Rectaal bloedverlies, buikpijn en diarree. Honkoop P. Zwijndrecht, KOEL-nascholing, november 2010. Een patient met amyloidose van de lever. Vendelo M, Lesterhuis W. Diner pensant Rotterdam: De omgekeerde wereld, maart 2010. Acute diarree, rectaal bloedverlies, dikke darmkankerscreening, prikkelbaar darm syndroom. Lesterhuis W. Rockanje, KOEL-nascholing huisartsen, april 2010. Prikkelbaar Darm Syndroom. Lesterhuis W. PDS patientenvereniging, Dordrecht, juni 2010 Video Capsule Endoscopy in the Albert Schweitzer hospital. Bharos A, Konings I, Elderson Y, Van Dieren J, Lesterhuis W. Wetenschapsdag Albert Schweitzer ziekenhuis, Dordrecht, oktober 2010. Een subfulminant verlopen acute infectie met HEV. Lesterhuis W. Diner pensant Rotterdam: De brugwachter, november 2010. Patient met icterus eci. Wolters LWW. Diner pensant Rotterdam, maart 2010. Patient met onbegrepen darmontsteking. Wolters LWW. Regionale GE bijeenkomst Rotterdam, april 2010.
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Medische microbiologie
Medische microbiologie PubMed publicaties
Ecological effects of selective decontamination on resistant gram-negative bacterial colonization. Oostdijk EA, de Smet AM, Blok HE, Thieme Groen ES, van Asselt GJ, Benus RF, Bernards SA, Frénay IH, Jansz AR, de Jongh BM, Kaan JA, Leverstein-van Hall MA, Mascini EM, Pauw W, Sturm PD, Thijsen SF, Kluytmans JA, Bonten MJ. Am J Respir Crit Care Med. 2010 Mar 1, 181(5):452-7. RATIONALE: Selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) eradicate gram-negative bacteria (GNB) from the intestinal and respiratory tract in intensive care unit (ICU) patients, but their effect on antibiotic resistance remains controversial. OBJECTIVES: We quantified the effects of SDD and SOD on bacterial ecology in 13 ICUs that participated in a study, in which SDD, SOD, or standard care was used during consecutive periods of 6 months (de Smet AM, Kluytmans JA, Cooper BS, Mascini EM, Benus RF, van der Werf TS, van der Hoeven JG, Pickkers P, Bogaers-Hofman D, van der Meer NJ, et al. N Engl J Med 2009;360:20-31). METHODS: Point prevalence surveys of rectal and respiratory samples were performed once monthly in all ICU patients (receiving or not receiving SOD/SDD). Effects of SDD on rectal, and of SDD/SOD on respiratory tract, carriage of GNB were determined by comparing results from consecutive point prevalence surveys during intervention (6 mo for SDD and 12 mo for SDD/SOD) with consecutive point prevalence data in the pre- and postintervention periods. MEASUREMENTS AND MAIN RESULTS: During SDD, average proportions of patients with intestinal colonization with GNB resistant to either ceftazidime, tobramycin, or ciprofloxacin were 5, 7, and 7%, and increased to 15, 13, and 13% postintervention (P < 0.05). During SDD/SOD resistance levels in the respiratory tract were not more than 6% for all three antibiotics but increased gradually (for ceftazidime; P < 0.05 for trend) during intervention and to levels of 10% or more for all three antibiotics postintervention (P < 0.05). CONCLUSIONS: SOD and SDD have marked effects on the bacterial ecology in an ICU, with rising ceftazidime resistance prevalence rates in the respiratory tract during intervention and a considerable rebound effect of ceftazidime resistance in the intestinal tract after discontinuation of SDD. PMID: 19965807 [PubMed - indexed for MEDLINE]
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Neurologie
Neurologie PubMed publicaties Thermal hypesthesia in patients with complex regional pain syndrome related dystonia. Munts AG, van Rijn MA, Geraedts EJ, van Hilten JJ, van Dijk JG, Marinus J. J Neural Transm. 2010 Dec 29.
The quantitative thermal test showed cold and warmth hypesthesia without increased heat pain sensitivity in the affected limbs of complex regional pain syndrome (CRPS) patients with tonic dystonia (n = 44) in comparison with healthy controls with a similar age and sex distribution (n = 35). The degrees of cold and warmth hypesthesia were strongly correlated. We conclude that dysfunction in small nerve fiber (i.e., C and Aδ) processing is present in patients with CRPS-related dystonia. PMID: 21190049 [PubMed - as supplied by publisher]
Poster PreHospital barriers in Acute STroke care in the region of Dordrecht, the Netherlands: PHAST study. Zock E, Kerkhoff H, Kleyweg RP. poster wetenschapsdag ASZ.
Voordrachten Vermoeidheid en MS. Zemel D. Workshop Jaarlijkse Nationale MS-Symposium Karel V, 5 -6 november 2010.
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Nucleaire geneeskunde
Nucleaire geneeskunde PubMed publicaties
(18)F-fluorodeoxyglucose position emission tomography (FDG-PET) for monitoring disease activity and treatment response in idiopathic retroperitoneal fibrosis. Jansen I, Hendriksz TR, Han SH, Huiskes AW, van Bommel EF. Eur J Intern Med. 2010 Jun;21(3):216-21. OBJECTIVE: To evaluate the value of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) in monitoring disease activity and predicting treatment response in idiopathic retroperitoneal fibrosis (iRPF). PATIENTS AND METHODS: This prospective study was approved by the institutional review board. Informed consent was obtained from all patients. Twenty-six patients with iRPF receiving tamoxifen monotherapy underwent repeated FDG-PET (baseline and, if positive, at 3 months) and computed tomographic (CT) scanning (baseline, 4 and 8 months). Maximal RPF mass thickness in 3 different view directions was measured on each CT scan; FDG-uptake was semi-quantified using a visual 4-point scale. Initial and follow-up PET scan results were correlated with clinical, laboratory and CT scan follow-up data. Treatment outcome was the aggregate measure of clinical, laboratory and CT-documented response to tamoxifen. RESULTS: FDG-PET was positive in 20 patients. Patients with positive PET scan result had higher C-reactive protein level (P=0.02) and larger mass size (P=0.01) compared with patients with negative PET scan result. Visual PET score correlated with C-reactive protein level (P=0.002) and CT-documented mass thickness (P=0.04). Visual PET score decreased following treatment (P<0.01). This decrease correlated with decrease in ESR (P<0.001) but not with CT-documented mass regression. Positive predicting value (PPV) of initial positive PET scan result was 0.63; PPV of negative follow-up PET scan result in patients with initial positive PET scan result was 0.66. CONCLUSION: FDG-PET is valuable in detecting (recurrent) disease activity. Short-term follow-up with FDG-PET cannot be routinely recommended for the therapeutic evaluation of RPF disease in tamoxifen-treated patients. Copyright 2010 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. PMID: 20493425 [PubMed - indexed for MEDLINE]
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Ouderengeneeskunde
Ouderengeneeskunde PubMed publicaties
Diagnostic impact of CSF biomarkers in a local hospital memory clinic. Kester MI, Boelaarts L, Bouwman FH, Vogels RL, Groot ER, van Elk EJ, Blankenstein MA, van der Flier WM, Scheltens P. Dement Geriatr Cogn Disord. 2010 Jul;29(6):491-7. BACKGROUND: CSF biomarkers amyloid-beta 1-42 (Abeta42), total tau (tau) and tau phosphorylated at threonine 181 (ptau-181) are useful diagnostic markers for Alzheimer’s disease (AD). We examined the impact of these biomarkers in the diagnostic process in a nonacademic memory clinic. METHODS: One hundred and nine patients with available CSF were included from the local hospital memory clinic. Initially, patients were clinically diagnosed, and the clinician indicated their confidence in the diagnosis. Next the CSF results were presented, and the clinician re-valuated his initial diagnosis. The main outcomes were changes in initial diagnosis and diagnostic confidence. RESULTS: Forty-seven patients were initially diagnosed with AD, 26 were diagnosed with another type of dementia, 18 were diagnosed with mild cognitive impairment, and 18 received a non-dementia diagnosis. All biomarkers distinguished between AD and non-dementia (p < 0.01); tau and ptau-181 also distinguished AD from other types of dementia (p < 0.001). After CSF biomarker levels were revealed, 11 diagnoses changed. In 31% of the diagnoses, the clinician gained confidence, while in 10% confidence decreased. CONCLUSION: We found that knowledge of CSF biomarker profiles changed the diagnosis in 10% of the cases, and confidence in the diagnosis increased for one third of the patients. PMID: 20523047 [PubMed - indexed for MEDLINE]
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Pathologie PubMed publicaties Metastatic oligodendroglioma: a case report and incidence in The Netherlands. Krijnen JL, Fleischeur RE, van Berkel M, Westenend PJ. Clin Neuropathol. 2010 May-Jun, 29(3):141-6.
Oligodendroglioma is a tumor of the central nervous system which rarely metastasizes. The diagnosis of oligodendroglioma is based on histomorphology with limited use of immunohistochemistry. However, recently a specific 1p/19q codeletion has been found which can be demonstrated by in situ hybridization. We report a case of a 58-years-old man with a 31-months history of oligodendroglioma presenting with fatigue and anemia. A bone marrow biopsy demonstrated massive localization of oligodendroglioma which was confirmed by in situ hybridization for the 1p/19q deletion. In addition we studied data from PALGA, the nationwide network and registry of histo- and cytopathology in the Netherlands and found an incidence of approximately 2 in 1,000 for metastasis of oligodendroglioma outside the central nervous system. PMID: 20423687 [PubMed - in process]
[Waldenstrom’s macroglobulinaemia of the lacrimal gland in a patient with sarcoidosis]. Hafezi F, Moesen I, Carels G, Mooy C, Paridaens D. Ophthalmologe. 2010 Jan, 107(1):60-3. We report a case of bilateral lacrimal gland involvement as the first sign of Waldenstrom’s macroglobulinaemia in a patient with sarcoidosis. Histological analysis of an incisional biopsy revealed a lymphoplasmocytic lymphoma consistent with Waldenstrom’s macroglobulinaemia. No noncaseating granulomas were encountered. Systemic treatment was initiated and resulted in complete resolution of the lesions. In a patient with a systemic disease, such as sarcoidosis, and lacrimal gland involvement, a biopsy of the lacrimal gland mass should be taken to make a correct diagnosis and start appropriate treatment. PMID: 19669149 [PubMed - indexed for MEDLINE]
Zipper cell endotheliopathy: a new subset of idiopathic corneal edema. Hillenaar T, Mooy CM, Verjans GM, Remeijer L. Ophthalmology. 2010 Dec, 117(12):2255-62. PURPOSE: To report the clinical and histologic findings of a new subset of idiopathic corneal edema: zipper cell endotheliopathy. DESIGN: Observational case report. PARTICIPANT: A 55-year-old woman with unilateral bullous keratopathy. METHODS: Clinical observation consisted of slit-lamp examination and in vivo confocal microscopy (IVCM). Aqueous humor samples and the excised corneal button were analyzed for the presence of herpes viruses. The excised cornea was subjected to detailed immunohistochemistry (IHC) and scanning and transmission electron microscopy. MAIN OUTCOME MEASURES: Clinical and pathologic characteristics of zipper cell endotheliopathy. RESULTS: In vivo confocal microscopy revealed unique morphologic alterations of the corneal endothelial layer. Focal areas of denudation were surrounded by endothelial cells with zipper-like cell borders and intercellular structures. Besides central corneal edema, no other signs of corneal inflammation were detected. A herpes virus origin for the bullous keratopathy was excluded. The IHC analysis disclosed positive staining for cytokeratin (CK) 7, CK8/18, and CK19, suggesting epithelial metaplasia of the endothelial cells. Ultrastructural examination confirmed the IVCM findings by showing large areas of endothelial denudation and vacuolated endothelial cells with large, broad-based extensions that partially overlapped neighboring cells. Despite extensive complementary research and review of the literature, the endothelial alterations could not be attributed to any known corneal disorder. CONCLUSIONS: To the authors’ knowledge, zipper cell endotheliopathy is a new subset of idiopathic corneal edema. The case report presented illustrates the potential use of IVCM to differentiate the spectrum of corneal disorders and to discover new corneal diseases. PMID: 20705342 [PubMed - indexed for MEDLINE]
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Chromosomal aberrations in iris melanomas. Mensink HW, Vaarwater J, de Keizer RJ, de Wolff-Rouendaal D, Mooy CM, de Klein A, Paridaens D. Br J Ophthalmol. 2011 Mar, 95(3):424-8. Epub 2010 Sep 29. Background Uveal melanomas can develop in the choroid, ciliary body and iris. In choroidal and ciliary body melanomas, specific chromosomal changes correlate with metastatic disease. Iris melanomas have a better prognosis than choroidal melanomas, and it would be interesting to know if they share chromosomal changes.In addition, iris melanomas might harbour UV-induced mutations of tumour suppressor genes, such as PTEN and CDKN2A. Methods Twenty iris melanomas were analysed for chromosome 1p, 3, 6, 8, 9p and 10q abnormalities using fluorescence in situ hybridisation. These results were correlated to clinical follow-up data using statistical analyses. Results (Partial) loss of chromosome 3 was observed in nine iris melanomas, and gain of 8q was present in seven tumours. Loss of chromosome 9p was demonstrated in seven tumours, but no deletions of the PTEN region on chromosome 10 were found. Three patients died of metastatic disease, and one patient developed liver metastases, but is still alive. Univariate analysis indicated a lower disease-free survival for patients with diffuse growing melanomas (p=0.01), melanomas that lost a copy of chromosome 3 (p=0.03), or invading the ciliary body (p=0.01). In a multivariate analysis, none of the correlations were significant. Conclusion Loss of chromosome 3 as well as loss of chromosomal region 9p21 (that entails tumour suppressor gene CDKN2A) plays a role in iris melanoma. A firm correlation with diseasefree survival could not be established, possibly due to the small sample size. PMID: 20881029 [PubMed - in process]
Small cell carcinoma of the lung and large cell neuroendocrine carcinoma interobserver variability. Den Bakker MA, Willemsen S, Grünberg K, Noorduijn LA, van Oosterhout MF, van Suylen RJ, Timens W, Vrugt B, Wiersma-van Tilburg A, Thunnissen FB. Histopathology. 2010 Feb, 56(3):356-63. AIMS: To test the hypothesis that the published morphological criteria permit reliable segregation of small cell carcinoma of the lung (SCLC) and large cell neuroendocrine carcinoma (LCNEC) cases by determining the interobserver variation. METHODS AND RESULTS: One hundred and seventy cases of SCLC, LCNEC and cases diagnosed as neuroendocrine lung carcinoma before LCNEC had been established as a diagnostic category were retrieved from the archives of the assessor’s institutes. A representative haematoxylin and eosin section from each case was selected for review. Batches of cases were circulated among nine pathologists with a special interest in pulmonary pathology. Participants were asked to classify the cases histologically according to the 2004 World Health Organization (WHO) criteria. The diagnoses were collected and kappa values calculated. Unanimity of diagnosis was achieved for only 20 cases; a majority diagnosis was reached for 115 cases. In 35 cases no consensus diagnosis could be reached. There was striking variability amongst assessors in diagnosing SCLC and LCNEC. The overall level of agreement for all cases included in this study was fair (kappa=0.40). CONCLUSIONS: Using non-preselected cases, the morphological WHO criteria for diagnosing SCLC and LCNEC leave room for subjective pathological interpretation, which results in imprecise categorization of SCLC and LCNEC cases. PMID: 20459535 [PubMed - indexed for MEDLINE]
Protein profiling in pathology: analysis and evaluation of 239 frozen tissue biopsies for diagnosis of B-cell lymphomas. Jansen C, Feuth T, Raemaekers JM, Rijntjes J, Meijer JW, Westenend PJ, van Baarlen J, van Krieken JH, Hebeda KM, Groenen PJ. Proteomics Clin Appl. 2010 May, 4(5):519-27. PURPOSE: We determined the potential value of protein profiling of tissue samples by assessing how precise this approach enables discrimination of B-cell lymphoma from reactive lymph nodes, and how well the profiles can be used for lymphoma classification. EXPERIMENTAL DESIGN: Protein lysates from lymph nodes (n=239) from patients with the diagnosis of reactive hyperplasia (n=44), follicular lymphoma (n=63), diffuse large B-cell lymphoma (n=43), mantle cell lymphoma (n=47), and chronic lymphocytic leukemia/small lymphocytic B-cell lymphoma (n=42) were analysed by SELDI-TOF MS. Data analysis was performed by (i) classification and regression tree-based analysis and (ii) binary and polytomous logistic regression analysis. RESULTS: After internal validation by the leave-one-out principle, both the classification and regression tree and logistic regression classification correctly identified the majority of the malignant (87 and 96%, respectively) and benign cases (73 and 75%, respectively). Classification was less successful since approximately one-third of the cases of each group were misclassified according to the histological classification. However, an additional mantle cell lymphoma case that was misclassified as chronic lymphocytic leukemia/small lymphocytic B-cell lymphoma initially was identified based on the protein profile.
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CONCLUSIONS AND CLINICAL RELEVANCE: SELDI-TOF MS protein profiling allows for reliable identification of the majority of malignant lymphoma cases; however, further validation and testing robustness in a diagnostic setting is needed.
Pathologie
PMID: 21137069 [PubMed - in process]
Receptor conversion in distant breast cancer metastases. Hoefnagel LD, van de Vijver MJ, van Slooten HJ, Wesseling P, Wesseling J, Westenend PJ, Bart J, Seldenrijk CA, Nagtegaal ID, Oudejans J, van der Valk P, van der Groep P, de Vries EG, van der Wall E, van Diest PJ. Breast Cancer Res. 2010 Sep 23, 12(5):R75. INTRODUCTION: When breast cancer patients develop distant metastases, the choice of systemic treatment is usually based on tissue characteristics of the primary tumor as determined by immunohistochemistry (IHC) and/or molecular analysis. Several previous studies have shown that the immunophenotype of distant breast cancer metastases may be different from that of the primary tumor (receptor conversion), leading to inappropriate choice of systemic treatment. The studies published so far are however small and/or methodologically suboptimal. Therefore, definite conclusions that may change clinical practice could not yet be drawn. We therefore aimed to study receptor conversion for estrogen receptor alpha (ERα), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) in a large group of distant (non-bone) breast cancer metastases by re-staining all primary tumors and metastases with current optimal immunohistochemical and in situ hybridization methods on full sections. METHODS: A total of 233 distant breast cancer metastases from different sites (76 skin, 63 liver, 43 lung, 44 brain and 7 gastro-intestinal) were IHC stained for ERα, PR and HER2, and expression was compared to that of the primary tumor. HER2 in situ hybridization (ISH) was done in cases of IHC conversion or when primary tumors or metastases showed an IHC 2+ result. RESULTS: Using a 10% threshold, receptor conversion by IHC for ERα, PR occurred in 10.3%, 30.0% of patients, respectively. In 10.7% of patients, conversion from ER+ or PR+ to ER-/PR- and in 3.4% from ER-/PR- to ER+ or PR+ was found. Using a 1% threshold, ERα and PR conversion rates were 15.1% and 32.6%. In 12.4% of patients conversion from ER+ or PR+ to ER-/PR-, and 8.2% from ER-/PR- to ER+ or PR+ occurred. HER2 conversion occurred in 5.2%. Of the 12 cases that showed HER2 conversion by IHC, 5 showed also conversion by ISH. One further case showed conversion by ISH, but not by IHC. Conversion was mainly from positive in the primary tumor to negative in the metastases for ERα and PR, while HER2 conversion occurred equally both ways. PR conversion occurred significantly more often in liver, brain and gastro-intestinal metastases. CONCLUSIONS: Receptor conversion by immunohistochemistry in (non-bone) distant breast cancer metastases does occur, is relatively uncommon for ERα and HER2, and is more frequent for PR, especially in brain, liver and gastro-intestinal metastases. PMID: 20863372 [PubMed - as supplied by publisher]
Preoperative MRI and surgical management in patients with nonpalpable breast cancer: The MONET - Randomised controlled trial. Peters NH, van Esser S, van den Bosch MA, Storm RK, Plaisier PW, van Dalen T, Diepstraten SC, Weits T, Westenend PJ, Stapper G, Fernandez-Gallardo MA, Borel Rinkes IH, van Hillegersberg R, Mali WP, Peeters PH. Eur J Cancer. 2010 Dec 30. BACKGROUND: We evaluated whether performing contrast-enhanced breast MRI in addition to mammography and/or ultrasound in patients with nonpalpable suspicious breast lesions improves breast cancer management. METHODS: The MONET - study (MR mammography of nonpalpable breast tumours) is a randomised controlled trial in patients with a nonpalpable BIRADS 3-5 lesion. Patients were randomly assigned to receive routine medical care, including mammography, ultrasound and lesion sampling by large core needle biopsy or additional MRI preceding biopsy. Patients with cancer were referred for surgery. Primary end-point was the rate of additional surgical procedures (reexcisions and conversion to mastectomy) in patients with a nonpalpable breast cancer. FINDINGS: Four hundred and eighteen patients were randomised, 207 patients were allocated to MRI, and 211 patients to the control group. In the MRI group 74 patients had 83 malignant lesions, compared to 75 patients with 80 malignant lesions in the control group. The primary breast conserving surgery (BCS) rate was similar in both groups; 68% in the MRI group versus 66% in the control group. The number of re-excisions performed because of positive resection margins after primary BCS was increased in the MRI group; 18/53 (34%) patients in the MRI group versus 6/50 (12%) in the control group (p=0.008). The number of conversions to mastectomy did not differ significantly between groups. Overall, the rate of an additional surgical intervention (BCS and mastectomy combined) after initial breast conserving surgery was 24/53 (45%) in the MRI group versus 14/50 (28%) in the control group (p=0.069).
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INTERPRETATION: Addition of MRI to routine clinical care in patients with nonpalpable breast cancer was paradoxically associated with an increased re-excision rate. Breast MRI should not be used routinely for preoperative work-up of patients with nonpalpable breast cancer. PMID: 21195605 [PubMed - as supplied by publisher]
Overige publicaties Een 73-jarige man met een merkelcel-carcinoom. Post ICJH, van Ingen G, Hendriks TR, Plaisier PW. Ned Tijdschr Geneeskd 2010, 154:A1974. Receptor conversion in distant breast cancer metastasis Hoefnagel LCD, van de Vijver MJ, van Slooten HJ, Wesseling P, Westenend PJ, Bart J et al. Abstractboek NVVP, 78. 2010. Variable Life-Adjusted Display (VLAD) grafiek en Tissue Micro Array (TMA) als instrument voor de kwaliteitsborging van Her2neu. Een haalbaarheidsstudie. Westenend PJ, Riemens M, Damhuis RAM. Abstractboek NVVP, 137. 2010. Evaluation of an internally controlled semi-quantitative real-time PCR for detection of Pneumocystis jiroveci in paraffin-embedded clinical samples. Westenend PJ, Hermans M, Kroonen R, Breugelmans A-J, Mooij CM, van der Zee A. Abstractboek NVVP, 148. 2010.
Voordrachten Zipper cell endotheliopathy, a subset of unilateral corneal oedema. Mooy CM. Dublin: European Ophthalmic Pathology Society (EOPS), 12-06-2010. Leber’s hereditary optic neuropathy. Mooy CM. Berlijn: World Ophthalmology Congress (WOC), 05-06-2010. Immunologie voor pathologen. Noorduyn LA. Groningen: Cursus Basisonderwijs Pathologie, 03-12-2010. De snijranden staan ter discussie. Westenend PJ. Rotterdam: Symposium Borstkanker behandeling beter, 14-10-2010. De nieuwe TNM classificatie. Westenend PJ. Rotterdam: regiobijeenkomst netwerk pathologen IKR, 09-11-2010.
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Radiologie PubMed publicaties
Percutaneous vertebroplasty is not a risk factor for new osteoporotic compression fractures: results from VERTOS II. Klazen CA, Venmans A, de Vries J, van Rooij WJ, Jansen FH, Blonk MC, Lohle PN, Juttmann JR, Buskens E, van Everdingen KJ, Muller A, Fransen H, Elgersma OE, Mali WP, Verhaar HJ. AJNR Am J Neuroradiol. 2010 Sep, 31(8):1447-50. BACKGROUND AND PURPOSE: PV is increasingly used as treatment for osteoporotic VCFs. However, controversy exists as to whether PV increases the risk for new VCFs during follow-up. The purpose of our research was to assess the incidence of new VCFs in patients with acute VCFs randomized to PV and conservative therapy. MATERIALS AND METHODS: VERTOS II is a prospective multicenter randomized controlled trial comparing PV with conservative therapy in 202 patients. Incidence, distribution, and timing of new VCFs during follow-up were assessed from spine radiographs. In addition, further height loss during follow-up of treated VCFs was measured. RESULTS: After a mean follow-up of 11.4 months (median, 12.0; range, 1-24 months), 18 new VCFs occurred in 15 of 91 patients after PV and 30 new VCFs in 21 of 85 patients after conservative therapy. This difference was not significant (P = .44). There was no higher fracture risk for adjacent-versus-distant vertebrae. Mean time to new VCF was 16.2 months after PV and 17.8 months after conservative treatment (logrank, P = .45). The baseline number of VCFs was the only risk factor for occurrence (OR, 1.43; 95% CI, 1.05-1.95) and number (P = .01) of new VCFs. After conservative therapy, further height loss of treated vertebrae occurred more frequently (35 of 85 versus 11 of 91 patients, P < .001) and was more severe (P < .001) than after PV. CONCLUSIONS: Incidence of new VCFs was not different after PV compared with conservative therapy after a mean of 11.4 months’ followup. The only risk factor for new VCFs was the number of VCFs at baseline. PV contributed to preservation of stature by decreasing both the incidence and severity of further height loss in treated vertebrae. PMID: 20651016 [PubMed - indexed for MEDLINE]
Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Klazen CA, Lohle PN, de Vries J, Jansen FH, Tielbeek AV, Blonk MC, Venmans A, van Rooij WJ, Schoemaker MC, Juttmann JR, Lo TH, Verhaar HJ, van der Graaf Y, vanEverdingen KJ, Muller AF, Elgersma OE, Halkema DR, Fransen H, Janssens X, Buskens E, Mali WP. Lancet. 2010 Sep 25, 376(9746):1085-92. BACKGROUND: Percutaneous vertebroplasty is increasingly used for treatment of pain in patients with osteoporotic vertebral compression fractures, but the efficacy, cost-effectiveness, and safety of the procedure remain uncertain. We aimed to clarify whether vertebroplasty has additional value compared with optimum pain treatment in patients with acute vertebral fractures. METHODS: Patients were recruited to this open-label prospective randomised trial from the radiology departments of six hospitals in the Netherlands and Belgium. Patients were aged 50 years or older, had vertebral compression fractures on spine radiograph (minimum 15% height loss; level of fracture at Th5 or lower; bone oedema on MRI), with back pain for 6 weeks or less, and a visual analogue scale (VAS) score of 5 or more. Patients were randomly allocated to percutaneous vertebroplasty or conservative treatment by computer-generated randomisation codes with a block size of six. Masking was not possible for participants, physicians, and outcome assessors. The primary outcome was pain relief at 1 month and 1 year as measured by VAS score. Analysis was by intention to treat. This study is registered at ClinicalTrials.gov, number NCT00232466. FINDINGS: Between Oct 1, 2005, and June 30, 2008, we identified 431 patients who were eligible for randomisation. 229 (53%) patients had spontaneous pain relief during assessment, and 202 patients with persistent pain were randomly allocated to treatment (101 vertebroplasty, 101 conservative treatment). Vertebroplasty resulted in greater pain relief than did conservative treatment; difference in mean VAS score between baseline and 1 month was -5·2 (95% CI -5·88 to -4·72) after vertebroplasty and -2·7 (-3·22 to -1·98) after conservative treatment, and between baseline and 1 year was -5·7 (-6·22 to -4·98) after vertebroplasty and -3·7 (-4·35 to -3·05) after conservative treatment. The difference between groups in reduction of mean VAS score from baseline was 2·6 (95% CI 1·74-3·37, p<0·0001) at 1 month and 2·0 (1·13-2·80, p<0·0001) at 1 year. No serious complications or adverse events were reported. INTERPRETATION: In a subgroup of patients with acute osteoporotic vertebral compression fractures and persistent pain, percutaneous
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vertebroplasty is effective and safe. Pain relief after vertebroplasty is immediate, is sustained for at least a year, and is significantly greater than that achieved with conservative treatment, at an acceptable cost. FUNDING: ZonMw; COOK Medical. PMID: 20701962 [PubMed - indexed for MEDLINE]
(18)F-fluorodeoxyglucose position emission tomography (FDG-PET) for monitoring disease activity and treatment response in idiopathic retroperitoneal fibrosis. Jansen I, Hendriksz TR, Han SH, Huiskes AW, van Bommel EF. Eur J Intern Med. 2010 Jun, 21(3):216-21. OBJECTIVE: To evaluate the value of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) in monitoring disease activity and predicting treatment response in idiopathic retroperitoneal fibrosis (iRPF). PATIENTS AND METHODS: This prospective study was approved by the institutional review board. Informed consent was obtained from all patients. Twenty-six patients with iRPF receiving tamoxifen monotherapy underwent repeated FDG-PET (baseline and, if positive, at 3 months) and computed tomographic (CT) scanning (baseline, 4 and 8 months). Maximal RPF mass thickness in 3 different view directions was measured on each CT scan; FDG-uptake was semi-quantified using a visual 4-point scale. Initial and follow-up PET scan results were correlated with clinical, laboratory and CT scan follow-up data. Treatment outcome was the aggregate measure of clinical, laboratory and CT-documented response to tamoxifen. RESULTS: FDG-PET was positive in 20 patients. Patients with positive PET scan result had higher C-reactive protein level (P=0.02) and larger mass size (P=0.01) compared with patients with negative PET scan result. Visual PET score correlated with C-reactive protein level (P=0.002) and CT-documented mass thickness (P=0.04). Visual PET score decreased following treatment (P<0.01). This decrease correlated with decrease in ESR (P<0.001) but not with CT-documented mass regression. Positive predicting value (PPV) of initial positive PET scan result was 0.63; PPV of negative follow-up PET scan result in patients with initial positive PET scan result was 0.66. CONCLUSION: FDG-PET is valuable in detecting (recurrent) disease activity. Short-term follow-up with FDG-PET cannot be routinely recommended for the therapeutic evaluation of RPF disease in tamoxifen-treated patients. PMID: 20493425 [PubMed - indexed for MEDLINE]
Pseudocyst formation in retroperitoneal fibrosis relapse. Jansen I, Hendriksz TR, van Bommel EF. Br J Radiol. 2010 Jun, 83(990):e111-3. We describe a 45-year-old male patient with recurrent retroperitoneal fibrosis (RPF), in whom a pseudocyst in the peri-aortic fibrotic mantle was diagnosed. Without any intervention other than oral treatment with tamoxifen, the pseudocyst showed significant regression. Although rare, pseudocyst formation may sometimes appear in RPF and may mimic other benign and malignant conditions. This is the first paper to describe pseudocyst formation in an RPF relapse. PMID: 20505023 [PubMed - indexed for MEDLINE]
Iatrogenic subtotal stenosis of the right subclavian artery treated with percutaneous transluminal angioplasty. Smeenk RM, Kock MC, Elgersma OE, Schnater MJ. Cardiovasc Intervent Radiol. 2011 Feb, 34 Suppl 2:S57-9. This report describes a rare vascular complication of surgical placement of a marking clip and a possible approach to problem solving. A 55-year-old patient presented with loss of sensation in the fingers and loss of peripheral pulsations in the right arm 4 days after right upper lobectomy for a pT2N1 moderately differentiated adenocarcinoma of the lung. Duplex examination and computed tomography were performed the same day and showed a subtotal stenosis of the right subclavian artery, which was caused by the surgical placement of a metal clip to mark the surgical boundary. Selective angiography was subsequently performed. Percutaneous transluminal angioplasty (PTA) successfully dilated the stenosis and pushed the clip off. Flow in the right subclavian artery (RSA) wascompletely restored as were neurology and peripheral pulses. In conclusion, arterial stenosis by a surgical (marking) clip may be feasibly treated with PTA. PMID: 20842362 [PubMed - in process]
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Preoperative MRI and surgical management in patients with nonpalpable breast cancer: T he MONET - Randomised controlled trial. Peters NH, van Esser S, van den Bosch MA, Storm RK, Plaisier PW, van Dalen T, Diepstraten SC, Weits T, Westenend PJ, Stapper G, Fernandez-Gallardo MA, Borel Rinkes IH, van Hillegersberg R, Mali WP, Peeters PH. Eur J Cancer. 2010 Dec 30. BACKGROUND: We evaluated whether performing contrast-enhanced breast MRI in addition to mammography and/or ultrasound in patients with nonpalpable suspicious breast lesions improves breast cancer management. METHODS: The MONET - study (MR mammography of nonpalpable breast tumours) is a randomised controlled trial in patients with a nonpalpable BIRADS 3-5 lesion. Patients were randomly assigned to receive routine medical care, including mammography, ultrasound and lesion sampling by large core needle biopsy or additional MRI preceding biopsy. Patients with cancer were referred for surgery. Primary end-point was the rate of additional surgical procedures (re-excisions and conversion to mastectomy) in patients with a nonpalpable breast cancer. FINDINGS: Four hundred and eighteen patients were randomised, 207 patients were allocated to MRI, and 211 patients to the control group. In the MRI group 74 patients had 83 malignant lesions, compared to 75 patients with 80 malignant lesions in the control group. The primary breast conserving surgery (BCS) rate was similar in both groups; 68% in the MRI group versus 66% in the control group. The number of re-excisions performed because of positive resection margins after primary BCS was increased in the MRI group; 18/53 (34%) patients in the MRI group versus 6/50 (12%) in the control group (p=0.008). The number of conversions to mastectomy did not differ significantly between groups. Overall, the rate of an additional surgical intervention (BCS and mastectomy combined) after initial breast conserving surgery was 24/53 (45%) in the MRI group versus 14/50 (28%) in the control group (p=0.069). INTERPRETATION: Addition of MRI to routine clinical care in patients with nonpalpable breast cancer was paradoxically associated with an increased re-excision rate. Breast MRI should not be used routinely for preoperative work-up of patients with nonpalpable breast cancer. PMID: 21195605 [PubMed - as supplied by publisher]
Dutch randomized trial comparing standard catheter-directed thrombolysis versus ultrasound-accelerated thrombolysis for thromboembolic infrainguinal disease (DUET): design and rationale. Schrijver AM, Reijnen MM, van Oostayen JA, Nolthenius RP, van der Valk PH, Hoksbergen AW, Lely RJ, Fioole B, Vroegindeweij D, van Leersum M, de Vries JP. Trials. 2011 Jan 23, 12:20. BACKGROUND: The use of thrombolytic therapy in the treatment of thrombosed infrainguinal native arteries and bypass grafts has increased over the years. Main limitation of this treatment modality, however, is the occurrence of bleeding complications. Low intensity ultrasound (US) has been shown to accelerate enzymatic thrombolysis, thereby reducing therapy time. So far, no randomized trials have investigated the application of US-accelerated thrombolysis in the treatment of thrombosed infra-inguinal native arteries or bypass grafts. The DUET study (Dutch randomized trial comparing standard catheter-directed thrombolysis versus Ultrasound-accElerated Thrombolysis for thrombo-embolic infrainguinal disease) is designed to assess whether US-accelerated thrombolysis will reduce therapy time significantly compared with standard catheter-directed thrombolysis. METHODS/DESIGN: Sixty adult patients with recently (between 1 and 7 weeks) thrombosed infrainguinal native arteries or bypass grafts with acute limb ischemia class I or IIa, according to the Rutherford classification for acute ischemia, will be randomly allocated to either standard thrombolysis (group A) or US-accelerated thrombolysis (group B). Patients will be recruited from 5 teaching hospitals in the Netherlands during a 2-year period. The primary endpoint is the duration of catheter-directed thrombolysis needed for uninterrupted flow in the thrombosed infrainguinal native artery or bypass graft, with outflow through at least 1 crural artery. DISCUSSION: The DUET study is a randomized controlled trial that will provide evidence of whether US-accelerated thrombolysis will significantly reduce therapy time in patients with recently thrombosed infrainguinal native arteries or bypass grafts, without an increase in complications. TRIAL REGISTRATION: Current Controlled Trials ISRCTN72676102. PMID: 21255459 [PubMed - in process]
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Receptor conversion in distant breast cancer metastases. Hoefnagel LD, van de Vijver MJ, van Slooten HJ, Wesseling P, Wesseling J, Westenend PJ, Bart J, Seldenrijk CA, Nagtegaal ID, Oudejans J, van der Valk P, van der Groep P, de Vries EG, van der Wall E, van Diest PJ. Breast Cancer Res. 2010 Sep 23, 12(5):R75. INTRODUCTION: When breast cancer patients develop distant metastases, the choice of systemic treatment is usually based on tissue characteristics of the primary tumor as determined by immunohistochemistry (IHC) and/or molecular analysis. Several previous studies have shown that the immunophenotype of distant breast cancer metastases may be different from that of the primary tumor (receptor conversion), leading to inappropriate choice of systemic treatment. The studies published so far are however small and/or methodologically suboptimal. Therefore, definite conclusions that may change clinical practice could not yet be drawn. We therefore aimed to study receptor conversion for estrogen receptor alpha (ERα), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) in a large group of distant (non-bone) breast cancer metastases by re-staining all primary tumors and metastases with current optimal immunohistochemical and in situ hybridization methods on full sections. METHODS: A total of 233 distant breast cancer metastases from different sites (76 skin, 63 liver, 43 lung, 44 brain and 7 gastro-intestinal) were IHC stained for ERα, PR and HER2, and expression was compared to that of the primary tumor. HER2 in situ hybridization (ISH) was done in cases of IHC conversion or when primary tumors or metastases showed an IHC 2+ result. RESULTS: Using a 10% threshold, receptor conversion by IHC for ERα, PR occurred in 10.3%, 30.0% of patients, respectively. In 10.7% of patients, conversion from ER+ or PR+ to ER-/PR- and in 3.4% from ER-/PR- to ER+ or PR+ was found. Using a 1% threshold, ERαand PR conversion rates were 15.1% and 32.6%. In 12.4% of patients conversion from ER+ or PR+ to ER-/PR-, and 8.2% from ER-/PR- to ER+ or PR+ occurred. HER2 conversion occurred in 5.2%. Of the 12 cases that showed HER2 conversion by IHC, 5 showed also conversion by ISH. One further case showed conversion by ISH, but not by IHC. Conversion was mainly from positive in the primary tumor to negative in the metastases for ERα and PR, while HER2 conversion occurred equally both ways. PR conversion occurred significantly more often in liver, brain and gastro-intestinal metastases. CONCLUSIONS: Receptor conversion by immunohistochemistry in (non-bone) distant breast cancer metastases does occur, is relatively uncommon for ERα and HER2, and is more frequent for PR, especially in brain, liver and gastro-intestinal metastases. PMID: 20863372 [PubMed - as supplied by publisher]
Collaborating publicaties Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. de Bruin JL, Baas AF, Buth J, Prinssen M, Verhoeven EL, Cuypers PW, van Sambeek MR, Balm R, Grobbee DE, Blankensteijn JD and the DREAM Study Group (Hendriksz TR). N Engl J Med 2010, 362:1881-9. BACKGROUND: For patients with large abdominal aortic aneurysms, randomized trials have shown an initial overall survival benefit for elective endovascular repair over conventional open repair. This survival difference, however, was no longer significant in the second year after the procedure. Information regarding the comparative outcome more than 2 years after surgery is important for clinical decision making. METHODS: We conducted a long-term, multicenter, randomized, controlled trial comparing open repair with endovascular repair in 351 patients with an abdominal aortic aneurysm of at least 5 cm in diameter who were considered suitable candidates for both techniques. The primary outcomes were rates of death from any cause and reintervention. Survival was calculated with the use of Kaplan-Meier methods on an intention-to-treat basis. RESULTS: We randomly assigned 178 patients to undergo open repair and 173 to undergo endovascular repair. Six years after randomization, the cumulative survival rates were 69.9% for open repair and 68.9% for endovascular repair (difference, 1.0 percentage point; 95% confidence interval [CI], -8.8 to 10.8; P=0.97). The cumulative rates of freedom from secondary interventions were 81.9% for open repair and 70.4% for endovascular repair (difference, 11.5 percentage points; 95% CI, 2.0 to 21.0; P=0.03). CONCLUSIONS: Six years after randomization, endovascular and open repair of abdominal aortic aneurysm resulted in similar rates of survival. The rate of secondary interventions was significantly higher for endovascular repair. (ClinicalTrials.gov number, NCT00421330.) PMID: 20484396 [PubMed - indexed for MEDLINE]
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Overige publicaties
Radiologie
Heart failure.Chest X-ray. Cremers SEH, Bradshaw, Herfkens HF. The Radiology assistant. September 2010. Een 73-jarige man met een merkelcel-carcinoom. Post ICJH, van Ingen G, Hendriksz TR, Plaisier PW. Ned Tijdschr Geneeskund. 2010, 154:A1974.
Boek of hoofdstuk in boek Vascular diseases of the upper extremity. Ho and Reddy: Cardiovascular Imaging. Expert Radiology Series. Leiner T, Kock MC. Chapter 117. Eds. Ho V, Reddy G. Elsevier. 2010. p. 1832.
Voordrachten Treatment of patients with HER2Neu positive breast cancer with chemotherapy and HER2Neu-receptor blocking therapy: Early detection of cardiotoxicity by the use of serum biomarkers, (3D)-echocardiography and cardiac MRI. Liesting C, Bakker J, Kofflard MJM, Levin MD. NVVC Najaarscongres 4 en 5 november 2010. Is routine screening for hip dysplasia with ultrasound indicated in infants born after successful external cephalic version of a breech position? Cremers SEH. Presentatie ECR. Wenen, 4-8 maart 2010. Is routinematige screening op heupdysplasie met behulp van echografie geindiceerd bij kinderen geboren in hoofdligging na versie van een stuitligging? Cremers SEH. Presentatie Nederlandse Radiologendagen Oktober 2010. Bevordering van levenslang leren en ontwikkelen door individuele ‘Appraisal and Assessment’ van medische professionals. So RKL, Drexhage V, Hendriksz TR, Ridder JMM. Workshop congres Nederlandse vereniging voor Medisch onderwijs 2010.
Posters Analysis of abdominal aortaic diameter and aortic expansion pattern in patients with idiopathic retroperitoneal fibrosis. van Damme HJC, Aarnoudse ALJH, Hendriksz TR, van Bommel EFH. Poster Wetenschapsdag Asz 2010. The many faces of lymphoma: A pictorial essay. Ghandi A, Bakker J, Levin MD, Berenschot H. Posterpresentatie Nederlandse Radiologendagen Oktober 2010. Assessment of image quality of the right ventricle in three different post-gadolinium IR sequences in patients suspected of ARVC. Plaisier AS. Poster presentatie ECR. Wenen, 4-8 maart 2010.
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Visceral fat volume and its association with mesenteric panniculitis. van Putte-Katier N, Elgersma OE, Hendriksz TR. European congres of Radiology, ECR book of abstracts, march 2010 en poster Wetenschapsdag ASz 2010. 2-year follow-up of 94 patients with mesenteric panniculitis. van Putte-Katier N, Elgersma OE, Hendriksz TR. European congres of Radiology, ECR book of abstracts, march 2010.
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Spoedeisende hulp
Spoedeisende hulp PubMed publicaties
Pain management in emergency departments: a review of present protocols in The Netherlands. Gaakeer MI, van Lieshout JM, Bierens JJ. Eur J Emerg Med. 2010 Oct, 17(5):286-9. This descriptive study presents availability and content of acute pain protocols in emergency departments (EDs) in The Netherlands. Current acute pain protocols were collected and an a priori list of questions was used for analysis. Findings were compared with current international standards. Sixty-six of the 108 EDs responded. Fifty-six percent of the protocols did not address adults and 35% did not address children. Protocols were rather conservative and showed poor multidisciplinary approach. Seventy-three percent required a diagnosis before pain relief. Six percent did not include opioids, 36% did not allow intravenous opioids and only 49% allowed direct administration of opioids in severe pain. Pain measurement was included in 55% and in only 5% a target score was defined. Nonpharmacological approaches were mentioned in 6%. Acute pain protocols are lacking in many EDs. Most protocols did not apply current standards. We exposed an area with space for leadership. PMID: 19820399 [PubMed - in process]
Medical Student Disaster Medical Education: The Development of an Educational Resource. Pfenninger EG, Domres BD, Stahl W, Bauer A, Houser CM, Himmelseher S. International Journal of Emergency Medicine 2010 3(1), 9-20. BACKGROUND: Disaster medicine education is an enormous challenge, but indispensable for disaster preparedness. AIMS: We aimed to develop and implement a disaster medicine curriculum for medical student education that can serve as a peer-reviewed, structured educational guide and resource. Additionally, the process of designing, approving and implementing such a curriculum is presented. METHODS: The six-step approach to curriculum development for medical education was used as a formal process instrument. Recognized experts from professional and governmental bodies involved in disaster health care provided input using disaster-related physician training programs, scientific evidence if available, proposals for education by international disaster medicine organizations and their expertise as the basis for content development. RESULTS: The final course consisted of 14 modules composed of 2-h units. The concepts of disaster medicine, including response, medical assistance, law, command, coordination, communication, and mass casualty management, are introduced. Hospital preparedness plans and experiences from worldwide disaster assistance are reviewed. Life-saving emergency and limited individual treatment under disaster conditions are discussed. Specifics of initial management of explosive, war-related, radiological/nuclear, chemical, and biological incidents emphasizing infectious diseases and terrorist attacks are presented. An evacuation exercise is completed, and a mass casualty triage is simulated in collaboration with local disaster response agencies. Decontamination procedures are demonstrated at a nuclear power plant or the local fire department, and personal decontamination practices are exercised. Mannequin resuscitation is practiced while personal protective equipment is utilized. An interactive review of professional ethics, stress disorders, psychosocial interventions, and quality improvement efforts complete the training. CONCLUSIONS: The curriculum offers medical disaster education in a reasonable time frame, interdisciplinary format, and multi-experiential course. It can serve as a template for basic medical student disaster education. Because of its comprehensive but flexible structure, it should also be helpful for other health-care professional student disaster education programs. PMID: 20414376 [PubMed]
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Second generation locked plating of proximal humerus fractures-A prospective multicentre observational study. Roderer G, Erhardt J, Kuster M, Vegt P, Bahrs C, Kinzl L, Gebhard F. International Orthopaedics (SICOT) 2010 10. 10 07 /s00264-010-1015-7. Surgical treatment of most displaced proximal humerus fractures is challenging due to osteoporosis. Locking plates are intended to provide superior mechanical stability. In a prospective multicentre study 131 patients were treated with second generation locked plating (NCBPH, Zimmer, Inc.). The open procedure (n=78) was performed using a deltopectoral approach; the minimally invasive technique (n=53) involved percutaneous reduction and an anterolateral deltoid split approach. Clinical and radiological follow-up was obtained. Improvement in function (ROM) was statistically significant. Fracture type (AO) had the most significant impact on the incidence of complications. The most frequent complications detected were intra-articular screw perforation (15%) and secondary displacement (8%). Complication rate and functional outcome of the NCB-PH are comparable to reports in the literature. Not all problems are likely to be solved by this new generation of implants, i.e. secondary dislocation still occurred in 8% of our patients. PMID: 20419453 [PubMed - in process]
Energy intake does not correlate with nutritional state in children with severe generalized cerebral palsy and intellectual disability. Calis EA, Veugelers R, Rieken R, Tibboel D, Evenhuis HM, Penning C. Clin Nutr. 2010 Mar 24. BACKGROUND & AIMS: The majority of children with cerebral palsy and intellectual disability has a poor nutritional state compared with their healthy peers.Several studies have found reduced daily energy intake in this population. The hypothesis is tested that low daily energy intake correlates with poor nutritional state. METHODS: In a population-based sample of 176 children with severe generalized cerebral palsy and intellectual disability (mean age 10 years, SD 2 months; 16% GMFCS score 4; 84% GMFCS score 5) anthropometric parameters (weight, upper arm and tibia length, biceps, triceps, subscapular and suprailiacal skinfold thickness, mid upper arm circumference) were measured and dietary intake was registered. RESULTS: No correlation was found between energy intake(%EAR) and anthropometric Z-scores. Higher age, female gender, mobility, and to a lesser extent the absence of tube feeding predicted lower anthropometric Z-scores. CONCLUSIONS: In children with severe generalized cerebral palsy and intellectual disability nutritional state is not primarily determined by energy intake. Differences in energy expenditure presumably play an important role, although more research is needed to clarify the complex association between energy intake and nutritional state. Individualized nutritional care is suggested, preferably based on energy expenditure, in order to avoid malnutrition, but also overweight. PMID: 20346547 [PubMed - indexed for MEDLINE]
Prevalence and clinical presentation of constipation in children with severe generalized cerebral palsy. Veugelers R, Benninga MA, Calis EA, Willemsen SP, Evenhuis H, Tibboel D, Penning C. Dev Med Child Neurol. 2010 May 24. AIM: Our aim was to study the prevalence and characteristics of constipation in children with profound multiple disabilities, as data in this area are scarce. METHOD: A cross-sectional observational study was performed in specialized day-care centres and schools in the Netherlands. The study included 152 children (81 males, 71 females; mean age 9 y 6 mo, SD 4 y 6 mo). Intellectual disability ranged from moderate (7%) to profound (52%) in all participants who also had severe motor disabilities (83% classified at Gross Motor Function Classification System level V). We collected data on defaecation characteristics, food and fluid intake, and laxative consumption using standardized bowel diaries and interviews.Constipation was defined as (1) scybalous, pebble-like, hard stools in over a quarter of defaecations in combination with a defaecation frequency of less than three times per week during a 2-week study period; (2) large stools palpable on abdominal examination; or (3) laxative use or manual disimpaction of faeces. RESULTS: Of the studied population, 57% were constipated and 55% used laxatives, 27% of whom showed symptoms of constipation. Daily intakes of water and fibre were below the required standards in 87% and 53% of participants respectively, without a proven relation to constipation. INTERPRETATION: Constipation is a common problem in children with severe disabilities. Laxative use is high but dosing is frequently inadequate to prevent symptoms. PMID: 20497454 [PubMed - indexed for MEDLINE]
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Overige publicaties
Spoedeisende hulp
Acute pijn op de Spoedeisende Hulp beter behandelen. Gaakeer MI, Veugelers R, Houser CM, Berben SA & Bierens JJ. Ned Tijdschr Geneeskd 2010, 154:A2241.
Voordrachten Emergency Medicine Career Development & Decision in The Netherlands: First Cross-sectional Study Among Dutch Emergency Physicians. Houser CM, Sandel MH, Westra AF. 2010, 4th Dutch North Sea EM Conference, NVSHA (Nederlandse Vereniging van Spoedeisende Hulp Artsen), Egmond aan Zee. Emergency Medicine Career Development & Decision in The Netherlands: First Cross-sectional Study Among Dutch Emergency Physicians. Houser CM, Sandel MH, Westra AF. EuSEM 2010, 6th European Congres on Emergency Medicine, Stockholm. Reviewing for the EM Literature (also co-chair for session). Houser CM. EuSEM 2010, 6th European Congres on Emergency Medicine, Stockholm. Reviewing for the EM Literature (also co-chair for session). Houser CM. European Congress on Emergency Medicine (EuSEM), Stockholm, Sweden. Alcohol = GIF! Stuart P. Insula College, Dordrecht, Nederland. NCB Trauma Course. Vegt P. Wenen (tweemaal), Parijs, en Graz. Fellowship project: kritisch lezen voor SEH-artsen. Veugelers R. 2010, 4th Dutch North Sea EM Conference, NVSHA (Nederlandse Vereniging van Spoedeisende Hulp Artsen), Egmond aan Zee.
Posters Bicycle related head injuries in children. Bink MHC, Gaakeer MI, van Lieshout JM. 2010, 4th Dutch North Sea EM Conference, NVSHA (Nederlandse Vereniging van Spoedeisende Hulp Artsen), Egmond aan Zee. Bicycle related head injuries in children. Bink MHC, Gaakeer MI, van Lieshout JM. EuSEM 2010, 6th European Congres on Emergency Medicine, Stockholm. Bilateral swelling of the submandibular salivary glands after i.v. non-ionic contrast administration: a case report. Dierckx I. 2010, 4th Dutch North Sea EM Conference, NVSHA (Nederlandse Vereniging van Spoedeisende Hulp Artsen), Egmond aan Zee.
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Barbed fish hook removal: needle cover technique in pictures. Gaakeer MI, van Lieshout JM. 2010, 4th Dutch North Sea EM Conference, NVSHA (Nederlandse Vereniging van Spoedeisende Hulp Artsen), Egmond aan Zee. Emergency Medicine Career Development & Decision in The Netherlands: First Cross-sectional Study Among Dutch Emergency Physicians. Houser CM, Sandel MH, Westra AF. 2010, 4th Dutch North Sea EM Conference, NVSHA (Nederlandse Vereniging van Spoedeisende Hulp Artsen), Egmond aan Zee. Emergency Medicine Career Development & Decision in The Netherlands: First Cross-sectional Study Among Dutch Emergency Physicians. Houser CM, Sandel MH, Westra AF. EuSEM 2010, 6th European Congres on Emergency Medicine, Stockholm. Case report: a clear case of pericarditis... or is it? Zwets ED, Oskam E. 2010, 4th Dutch North Sea EM Conference, NVSHA (Nederlandse Vereniging van Spoedeisende Hulp Artsen), Egmond aan Zee. Case report: a clear case of pericarditis... or is it? Zwets ED, Oskam E. EuSEM 2010, 6th European Congres on Emergency Medicine, Stockholm. Conscious Sedation & Hip Dislocation. Stegeman E, Tjon Kon Sang P. 2010, 4th Dutch North Sea EM Conference, NVSHA (Nederlandse Vereniging van Spoedeisende Hulp Artsen), Egmond aan Zee. Relief of dyspnea: no convincing evidence for opiates or benzodiazepines. van der Velden AM, Zwets ED. 2010, 4th Dutch North Sea EM Conference, NVSHA (Nederlandse Vereniging van Spoedeisende Hulp Artsen), Egmond aan Zee. Relief of dyspnea: no convincing evidence for opiates or benzodiazepines. van der Velden AM, Zwets ED. EuSEM 2010, 6th European Congres on Emergency Medicine, Stockholm.
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Urologie
Urologie PubMed publicaties
Short-term outcomes of the prospective multicentre ‘Prostate Cancer Research International: Active Surveillance’ study. van den Bergh RC, Vasarainen H, van der Poel HG, Vis-Maters JJ, Rietbergen JB, Pickles T, Cornel EB, Valdagni R, Jaspars JJ, van der Hoeven J, Staerman F, Oomens EH, Rannikko A, Roemeling S, Steyerberg EW, Roobol MJ, Schröder FH, Bangma CH. BJU Int. 2010 Apr;105(7):956-62. OBJECTIVE: To evaluate the short-term outcomes of the prospective international Prostate Cancer Research International: Active Surveillance (‘PRIAS’) study (Dutch Trial Register NTR1718), as active surveillance (AS) for early prostate cancer might provide a partial solution to the current overtreatment dilemma in this disease. PATIENTS AND METHODS: The first 500 (of >950) participants with asymptomatic T1c/T2 prostate cancer, with a prostate-specific antigen (PSA) level of < or =10.0 ng/mL, a PSA density of <0.2 ng/mL/mL, a Gleason score of < or =3 + 3 = 6, and one or two positive biopsy cores, were analysed. The follow-up protocol consisted of frequent PSA measurements, digital rectal examinations, and standard repeat biopsies (the first after 1 year). The primary outcome is survival free of active therapy; the secondary endpoints are reasons for stopping AS, findings in 1-year repeat biopsies, and outcomes after radical prostatectomy (RP). RESULTS: Patients were included between December 2006 and July 2008. The median (25-75th percentile) follow-up after diagnosis was 1.02 (0.6-1.5) years. The 2-year survival rate free from active therapy was 73%. Of the 82 men who changed to active therapy during the follow-up, 68 (83%) did so based on the protocol. Of the 261 repeat biopsies available for analysis, 90 (34%) showed no cancer, while 57 (22%) showed a Gleason score of >6 or more than two positive biopsy cores. There was a relatively unfavourable PSA doubling time of 0-10 years in 53% (102/194) and 62% (33/53) of men with favourable and unfavourable re-biopsy results, respectively. After RP, four of 24 (17%) men had T3 disease and 12 (50%) had a Gleason score of >6. CONCLUSION: AS seems feasible, but mortality outcomes are unknown. A strict follow-up protocol including standard 1-year repeat biopsies resulted in a quarter of men stopping AS after 2 years. PMID: 19817747 [PubMed - indexed for MEDLINE]
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Promoties ASz 2010
Promoties ASz 2010 Interne geneeskunde Kiewiet-Kemper RM. Proefschrift Medical and surgical use of the gut in the treatment of obesity. Medisch en chirurgisch gebruik van de darm voor de behandeling van obesitas.
ter verkrijging van de graad van doctor aan de Erasmus Universiteit Rotterdam op gezag van de rector magnifi cus Prof. dr. H.G. Schmidt en volgens besluit van het College voor Promoties. De openbare verdediging zal plaatsvinden op woensdag 5 januari 2011 om 15.30 uur door: Rosalia Marije Kiewiet-Kemper, geboren te Dordrecht Promotor: Prof.dr. A.J. van der Lelij Overige leden: Prof.dr. J.F. Lange Prof.dr. J.A. Romijn Prof.dr.ir. A.P.N. Themmen Co-promotor: Dr.ir. J.A. Visser
Gynaecologie Gerestein CG. Proefschrift Value of prediction models in determining treatment strategies in patients with advanced stage epithelial ovarian cancer. Waarde van predictiemodellen bij het bepalen van behandelstrategieen bij patienten met een gevorderd stadium epitheliaal ovarium carcinoom. Ter verkrijging van de graad van doctor aan de Erasmus Universiteit Rotterdam op gezag van de rector magnificus Prof.dr. H.G. Schmidt en volgens besluit van het College voor Promoties. De openbare verdediging zal plaatsvinden op vrijdag 5 maart 2010 om 13.30 uur. door: Cornelis Gijsbertus Gerestein, geboren te Zeist. Promotor: Prof.dr. C.W. Burger Overige leden: Prof.dr. R. de Wit Prof.dr. J.W.W. Coebergh Prof.dr. A.G.J. van der Zee Co-promotor: Dr. G.S. Kooi
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Impactfactors Asz publicaties per wetenschappelijk tijdschrift Titel tijdschrift N Engl J Med Lancet Hepatology Am J Respr Crit Care Med Blood Eur Heart J Gut J Clin Endocrinol Metab Am J Gastroenterol Ophthalmology Breast Cancer Res Crit Care Clin Pharmacokinet Eur J Cancer Histopathology J Pain Horm Behav J Am Coll Surg J Vasc Surg J Bone Joint Surg Am Nephrol Dial Transplant Am J Neuroradiol Clin Nutr Clin Endocrinol Lung Cancer Dev Med Child Neurol Eur J Vasc Endocvasc Surg Br J Ophthalmol BJU Int Eur J Clin Pharmacol J Bone Joint Surg Br Eur J Clin Invest Dement Geriatr Cogn Disord Pediatr Crit Care Med J Clin Path J Neural Transm Br J Radiol Pulm Pharmacol Ther Trials Cardiovasc Intervent Radiol Clin Chem Lab Med Bmc Musculoskelet Disord Proteomics Clin Appl Int Orthop Perit Dial Int J Voice Eur J Obstet Gynecol Reprod Biol Neth J Med Neth Heart J Eur J Intern Med Int J Clin Pharmaecol Ther Digest Surg J Endocrinol Invest
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issn 0028-4793 0140-6736 0270-9139 1073-449X 0006-4971 0195-668X 0017-5749 0021-972X 0002-9270 0161-6420 1465-5411 1466-609X 0312-5963 0959-8049 0309-0167 1526-5900 0018-506X 1072-7515 0741-5214 0021-9355 0931-0509 0195-6108 0261-5614 0300-0664 0169-5002 0012-1622 1078-5884 0007-1161 1464-4096 0031-6970 0301-620X 0014-2972 1420-8008 1529-7535 0021-9746 0300-9564 0007-1285 1094-5539 1745-6215 0174-1551 1434-6621 1471-2474 1862-8346 0341-2695 0896-8608 0892-1997 0301-2115 0300-2977 0929-7456 0953-6205 0946-1965 0253-4886 0391-4097
Impact factor over 2009 47,05 30,758 10,84 10,689 10,555 9,8 9,357 6,202 6,012 5,491 5,326 4,931 4,56 4,121 3,855 3,778 3,77 3,651 3,517 3,427 3,306 3,296 3,274 3,201 3,14 3,019 2,919 2,917 2,865 2,743 2,655 2,643 2,578 2,376 2,333 2,259 2,105 2,024 2,02 1,949 1,886 1,88 1,875 1,825 1,636 1,587 1,582 1,503 1,392 1,385 1,381 1,372 1,347
issn 0890-5096 0722-5091 0941-293X 0399-8320 0969-9546 1075-2765 1471-2393 1471-2482 1663-2818 1865-1380 1155-5645
Impact factor over 2009 1,169 1,037 1 0,928 0,733
Promoties ASz 2010
Titel tijdschrift Ann Vasc Surg Clin Neuropathol Ophthalmologe Gastroenterol Clin Biol Eur J Emerg Med Am J Ther Bmc Pregnancy Childbirth Bmc Surg Horm Res Paediatr Int J Emerg Med Paediatric anaesth
Impact factor van 2009 van de tijdschriften gepubliceerd in PubMed
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Verantwoording
Verantwoording
De data ten behoeve van het wetenschappelijk jaaroverzicht1 zijn verzameld via de leden van de Wetenschapscommissie en via de vakgroepen. Daarnaast is er door het DB Wetenschapscommissie actief gezocht in Google Scholar en PubMed. In het wetenschappelijk jaaroverzicht zijn de publicaties opgenomen die zijn terug te vinden op PubMed. ‘Collaborators publicaties’ staan apart onder PubMed publicaties vermeld. Onder ‘overige publicaties’ zijn internationale/nationale publicaties opgenomen die niet in PubMed zijn terug te vinden en verschenen zijn in tijdschriften die geen impactfactor hebben2. Naast PubMed publicaties zijn wetenschappelijke bijdrages in de vorm van een ‘boek of hoofdstuk van een boek’ opgenomen. Voor de genoemde publicaties geldt dat de (co) auteur en tijde van dataverzameling, dataverwerking of opschrijven van de resultaten een aanzienlijk deel van de werkzaamheden moet hebben verricht in het Albert Schweitzer ziekenhuis en daar werkzaam moet zijn (geweest). Indien het artikel van de (co)auteur gepubliceerd wordt tijdens de aanstellingsperiode in het Albert Schweitzer ziekenhuis, maar de feitelijke werkzaamheden reeds onder een andere aanstelling zijn verricht, kunnen de artikelen niet in het Wetenschappelijk jaaroverzicht van het Albert Schweitzer ziekenhuis worden opgenomen. De digitale publicaties voorafgaand aan de geprinte versie (Epub ahead of print) van 2010 zijn zoveel als mogelijk meegenomen in het jaaroverzicht 2010. Voor ‘voordrachten’ en ‘posters’ geldt dat deze in het wetenschappelijk jaaroverzicht opgenomen worden indien het geaccrediteerde wetenschappelijke symposia, congressen nationaal of internationaal betreft waar een abstract is gepubliceerd. Hierbij geldt dat de (co) auteur ten tijde van de voordracht werkzaam moet zijn (geweest) in het Albert Schweitzer ziekenhuis. Het wetenschappelijk jaaroverzicht is opgesteld volgens de regels voor biomedische tijdschriften, de Vancouverregels. De auteursnamen zijn alfabetisch gerangschikt op naam van de eerste betrokken auteur werkzaam in het Albert Schweitzer ziekenhuis en zijn vet gedrukt. Bij meerdere ASz auteurs is de referentie bij de betreffende vakgroepen opgenomen. De gehele lijst wordt zoveel mogelijk met links naar full text te zijner tijd geplaatst op de intranet – en internetsite van het Leerhuis/ Wetenschapscommissie.
1 In het kader van het (geassocieerd) STZ-lidmaatschap wordt gestreefd naar een situatie waarin er consensus bestaat tussen de STZ-ziekenhuizen ten aanzien van de criteria voor plaatsing van wetenschappelijke output in jaaroverzichten. Op deze manier zijn ziekenhuizen met betrekking tot wetenschappelijke output daadwerkelijk te vergelijken. De kans bestaat dus dat de huidige criteria zoals beschreven in het wetenschappelijke jaaroverzicht 2010 van het Albert Schweitzer ziekenhuis in de toekomst geherformuleerd worden. Dit kan betekenen dat de omschreven criteria veranderen en/of (deels) komen te vervallen. 2 Een aantal tijdschriften is nog te nieuw om al een impact te hebben verworven.
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