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Nieuwegein, Netherlands

Mol F.,University of Amsterdam | Van Mello N.M.,University of Amsterdam | Strandell A.,Sahlgrenska University Hospital | Strandell K.,Sahlgrenska University Hospital | And 22 more authors.
The Lancet

Background: Tubal ectopic pregnancy can be surgically treated by salpingectomy, in which the affected Fallopian tube is removed, or salpingotomy, in which the tube is preserved. Despite potentially increased risks of persistent trophoblast and repeat ectopic pregnancy, salpingotomy is often preferred over salpingectomy because the preservation of both tubes is assumed to offer favourable fertility prospects, although little evidence exists to support this assumption. We aimed to assess whether salpingotomy would improve rates of ongoing pregnancy by natural conception compared with salpingectomy. Methods: In this open-label, multicentre, international, randomised controlled trial, women aged 18 years and older with a laparoscopically confirmed tubal pregnancy and a healthy contralateral tube were randomly assigned via a central internet-based randomisation program to receive salpingotomy or salpingectomy. The primary outcome was ongoing pregnancy by natural conception. Differences in cumulative ongoing pregnancy rates were expressed as a fecundity rate ratio with 95% CI, calculated by Cox proportional-hazards analysis with a time horizon of 36 months. Secondary outcomes were persistent trophoblast and repeat ectopic pregnancy (expressed as relative risks [RRs] with 95% CIs) and ongoing pregnancy after ovulation induction, intrauterine insemination, or IVF. The researchers who collected data for fertility outcomes were masked to the assigned intervention, but patients and the investigators who analysed the data were not. All endpoints were analysed by intention to treat. We also did a (non-prespecified) meta-analysis that included the findings from the present trial. This trial is registered, number ISRCTN37002267. Findings: 446 women were randomly assigned between Sept 24, 2004, and Nov 29, 2011, with 215 allocated to salpingotomy and 231 to salpingectomy. Follow-up was discontinued on Feb 1, 2013. The cumulative ongoing pregnancy rate was 60.7% after salpingotomy and 56.2% after salpingectomy (fecundity rate ratio 1.06, 95% CI 0.81-1.38; log-rank p=0.678). Persistent trophoblast occurred more frequently in the salpingotomy group than in the salpingectomy group (14 [7%] vs 1 [<1%]; RR 15.0, 2.0-113.4). Repeat ectopic pregnancy occurred in 18 women (8%) in the salpingotomy group and 12 (5%) women in the salpingectomy group (RR 1.6, 0.8-3.3). The number of ongoing pregnancies after ovulation induction, intrauterine insemination, or IVF did not differ significantly between the groups. 43 (20%) women in the salpingotomy group were converted to salpingectomy during the initial surgery because of persistent tubal bleeding. Our meta-analysis, which included our own results and those of one other study, substantiated the results of the trial. Interpretation: In women with a tubal pregnancy and a healthy contralateral tube, salpingotomy does not significantly improve fertility prospects compared with salpingectomy. Source

Ter Schure J.M.A.,University Utrecht | De Vries M.,Antonius Hospital | Weel J.F.L.,Medical Center Leeuwarden | Van Roon E.N.,Medical Center Leeuwarden | Faber T.E.,Medical Center Leeuwarden
Pediatric Infectious Disease Journal

Introduction: Dientamoeba fragilis infection in children is common, and its incidence has increased since the introduction of more sensitive molecular techniques. There is no consensus on the optimal treatment. Current medical practice in the Netherlands is to treat symptomatic children with clioquinol or metronidazole. This study attempts to obtain more information about the clinical picture of D. fragilis infection in children and to evaluate responses to both antiparasitic drugs. Methods: Children <18 years of age with a positive stool polymerase chain reaction test for D. fragilis infection were retrospectively evaluated. Clinical data and effectiveness of treatment were analyzed by examining patient's hospital records from the Medical Centre Leeuwarden by repeated analysis of stool samples by the Centre for Infectious Diseases in Friesland. Results: We analyzed 238 patients with an average age of 8.5 years (±4.2 years). Most patients were symptomatic (95.8%) and presented with abdominal pain (72.7%), loose stools (32.8%) and hard stools (24.8%). Coinfection with other gastrointestinal pathogens was present in 29 patients (12.2%). A higher incidence of infection was found in the winter. Clioquinol had a higher clinical success rate than metronidazole (74.7% versus 55.2%, P= 0.047). Conclusion: These results suggest that clioquinol could be more effective than metronidazole in alleviating symptoms of D. fragilis infection in children, but double-blind prospective placebo-controlled studies should be performed before final conclusions can be made. Copyright © 2013 by Lippincott Williams & Wilkins. Source

Blok J.L.,University of Groningen | Boersma M.,University of Groningen | Terra J.B.,University of Groningen | Spoo J.R.,University of Groningen | And 5 more authors.
Journal of the European Academy of Dermatology and Venereology

Background Treatment of hidradenitis suppurativa (HS) is a difficult undertaking, especially as there is no consensus on what surgical technique is preferred. At our centre severe HS (Hurley II/III) is operated under general anaesthesia, mostly with the STEEP procedure. Objectives To investigate characteristics, surgical outcomes and patient satisfaction of HS patients who underwent deroofing or STEEP under general anaesthesia. Methods A clinical records-based retrospective analysis was conducted of all patients who had surgery under general anaesthesia between 1999 and 2013. Patient satisfaction was retrospectively investigated with questionnaires. Results A total of 482 operations (363 primary operations and 119 re-operations) were performed during the study period. The proportion of women in the included population was 68%. The median diagnostic delay (patient's and doctor's delay) was 6.5 years. Relapses occurred after 29.2% of primary operations. Women had higher relapse rates than men [odds ratio 2.85 (1.07;7.61)]. Hypergranulation of the wound was the most common complication and occurred in 7% of all operations. The median score patients attributed to the medical effect of surgery was eight of 10 (zero corresponding to very dissatisfied and 10 to very satisfied). Conclusion The diagnostic delay in HS is long due to a lack of knowledge in both patients and health care professionals, indicating that there is a need for education. Deroofing and the STEEP are effective surgical procedures in severe cases of HS and lead to a relatively high patient satisfaction. The postoperative relapse risk is higher in women. Prospective studies are required for the development of clear guidelines on the appropriate choice of surgery. © 2015 European Academy of Dermatology and Venereology. Source

Elzinga M.,VU University Amsterdam | Segers M.,Antonius Hospital | Siebenga J.,Atrium Medical | Heilbron E.,VU University Amsterdam | And 2 more authors.

The Load Sharing Classification (LSC) allocates one to three points to each of three different radiological characteristics of traumatic thoracolumbar fractures: the vertebral body involved in the fracture, the displacement of the fracture parts and the kyphotic deformity. Added up, a minimal score of three and a maximal score of nine can be obtained. When the LSC score is three to six, a short segment pedicle screw fixation suffices. When the LSC score is seven to nine, a high rate of failure in patients with a short segment pedicle screw fixation exists. In these cases an anterior stabilising procedure of the spine is advised. The LSC has been examined by Dai and Jin, who claim an almost perfect inter- and intraobserver agreement, according to the Landis and Koch criteria. Dai and Jin only present results for the separate three items of the LSC and for the total LSC scores. Observer agreement for the two LSC score categories (three to six and seven to nine) have not been studied. The aim of this study is to study the inter- and intraobserver agreement of the LSC for the total score, the three separate items and also for the two LSC score categories. Three observers determine twice the LSC scores of forty traumatic thoracolumbar fractures. The average standard Cohen's kappa values for the separate LSC items range between 0.06 and 0.48. For the total LSC score the average standard Cohen's kappa and weighted kappa values are 0.22 and 0.67 respectively. For the two LSC score categories, there is unanimous agreement in 55% of the cases and a majority agreement in 40%. In the remaining 5% of the fractures there is a split decision. Standard Cohen's kappa value for the two LSC score categories is 0.53. The standard Cohen's kappa values can be rated as fair to moderate. From these data it can be concluded that the inter- and intraobserver reliability of the Load Sharing Classification of Spinal fractures can be rated as fair. © 2011 Elsevier Ltd. Source

Vasak B.,University Utrecht | Graatsma E.M.,University Utrecht | Hekman-Drost E.,Gelre Hospital | Eijkemans M.J.,University Utrecht | And 3 more authors.
American Journal of Obstetrics and Gynecology

Objective We sought to study whether uterine electromyography (EMG) can identify inefficient contractions leading to first-stage labor arrest followed by cesarean delivery in term nulliparous women with spontaneous onset of labor. Study Design EMG was recorded during spontaneous labor in 119 nulliparous women with singleton term pregnancies in cephalic position. Electrical activity of the myometrium during contractions was characterized by its power density spectrum (PDS). Results Mean PDS peak frequency in women undergoing cesarean delivery for first-stage labor arrest was significantly higher (0.55 Hz), than in women delivering vaginally without (0.49 Hz) or with (0.51 Hz) augmentation of labor (P =.001 and P =.01, respectively). Augmentation of labor increased the mean PDS frequency when comparing contractions before and after start of augmentation. This increase was only significant in women eventually delivering vaginally. Conclusion Contraction characteristics measured by uterine EMG correlate with progression of labor and are influenced by labor augmentation. © 2013 Mosby, Inc. All rights reserved. Source

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