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Dordrecht, Netherlands

van der Meijden W.A.,Albert Schweitzer ziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2013

Renal function is currently estimated using the Modification of Diet in Renal Disease (MDRD) formula, which is partly based on the serum creatinine level. Patients with impaired renal function are referred to nephrologists in accordance with the Dutch national transmural agreement for 'Chronic renal impairment'. A 54-year-old woman without significant history was referred to analyse a coincidentally found decline in the estimated glomerular filtration rate (eGFR). The patient had no complaints and used no medication except creatine supplements. Additional diagnostic testing showed no abnormalities. After cessation of creatine supplementation, the calculated renal function normalized. Serum creatinine is a reflection of muscle mass. The use of creatine-containing dietary supplements, such as creatine ethyl ester, can influence serum creatinine levels and therefore the eGFR as calculated with the MDRD formula. The use of supplements deserves attention when taking the history.

Kouloubis N.,Albert Schweitzer ziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2013

A 22-year-old women visited the dermatologist with hypertrophic finger- and toenails, palmoplantar keratoderma and oral leukokeratosis since her childhood. The diagnosis 'pachyonychia congenita type 1' was made. This is a rare dermatosis with an autosomal dominant inheritance pattern. The treatment is symptomatic.

Hooker I.D.,Albert Schweitzer ziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2011

A 54-year-old woman was referred to the radiology department for an X-ray of her shoulder because of shoulder ache. Coincidentally, the X-ray showed an abnormality in the right lung. The abnormality was confirmed on chest X-ray, and a CT-scan showed a branching tubular structure with distal air trapping. This finding is pathognomonic for congenital bronchial atresia, a rare congenital abnormality. Usually this is a coincidental finding, because it is not associated with any clinical symptoms or signs. Treatment or follow-up is not necessary.

van Geuns R.-J.,Erasmus Medical Center | Awad K.,STENTYS S.A. | Ijsselmuiden A.,Albert Schweitzer ziekenhuis
Interventional Cardiology Review | Year: 2014

Despite advances with new generation stents, there remains some atypical coronary anatomy where optimal stenting continues to be a challenge; such as stent sizing in large, ectatic or aneurysmal vessels; tapered vessels; and in vasoconstricted arteries such as in ST-segment elevation myocardial infarction or chronic total occlusions. Balloon-expandable stents are tubular and cannot easily accommodate vessel diameter variations; thrombotic vessels increase the risk of distal embolisation and no-reflow; positive remodelling and vasodilation often result in subsequent malapposition; and patients with bifurcation lesions have a higher risk of adverse events. The STENTYS BMS and DES(P) stents have a self-expanding design, which enables a better anatomical fit to the vessel, even with diameter variations (up to 6.0 millimetres [mm]), and can adapt to changes in vessel size over time. The stents deploy atraumatically from distal to proximal, which could reduce distal embolisation and contain disconnectable bridges, which can be opened up at a side branch. Self-apposing technology could therefore provide a potential solution to current challenges with balloon-expandable stent technology. © Radcliffe cardiology 2014.

Timmermans L.,Erasmus Medical Center | Deerenberg E.B.,Erasmus Medical Center | Lamme B.,Albert Schweitzer ziekenhuis | Jeekel J.,Erasmus Medical Center | Lange J.F.,Erasmus Medical Center
Surgery (United States) | Year: 2014

Background. Incisional hernia (IH) is the most frequent complication after abdominal operation, with an incidence of 11-20% and up to 35% in risk groups. Known risk groups for IH are abdominal aortic aneurysm and obesity. Our hypothesis is that parastomal hernia (PH) might also represent a risk factor for developing IH. Identifying risk factors can help determine the need for preventive measures such as primary mesh augmentation. Methods. In a multicenter cross-sectional study, all patients who were operated between 2002 and 2010 by means of a Hartmann procedure or abdominoperineal resection were invited for a follow-up visit to our outpatient clinic. Primary outcome measures were the prevalence of IH and PH. All possible risk factors for IH were scored. A physical examination was performed and, when available, computed tomography was scored for IH and PH. Results. A total of 150 patients were seen in the outpatient clinic. The median follow-up was 49 months (range, 30-75). IH had a prevalence of 37.1%, and PH had a prevalence of 52.3% during physical examination. On CT the prevalence was even greater, ie, 48.3% and 52.9%. IH and PH were both present in the same patient in 30% of all examined and in 35.6% after CT examination. PH was found to be a risk factor for IH on univariate and multivariate logistic regression analyses of variance, with an odds ratio of 7.2 (95% confidence interval 3.3-15.7). In addition, an emergency operation was found to be a risk factor for IH with an odds ratio of 5.8 in the multivariate analyses. Conclusion. Patients with a PH have a 7 times greater chance of developing an IH compared to patients without PH. © 2014 Mosby, Inc. All rights reserved.

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