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Gorinchem, Netherlands

Schrijver A.M.,St. Antonius Hospital Nieuwegein | Vos J.A.,St. Antonius Hospital | Hoksbergen A.W.J.,University of Amsterdam | Fioole B.,Maasstad Hospital | And 5 more authors.
Journal of Cardiovascular Surgery | Year: 2011

Aim. This study evaluates the short-term outcome of ultrasound-accelerated thrombolysis in patients with lower extremity ischemia caused by thromboembolic occlusions. Methods. A retrospective cohort study was conducted from December 2008 to May 2011 of 57 patients (42 men; median age, 66±11 years) undergoing 62 episodes of ultrasound-accelerated thrombolysis for thromboembolic arterial occlusions of the lower extremities. The EKOS EndoWave System (EKOS Corporation, Bothell, WA, USA) was combined with urokinase (100000 IU/hour). Thirty-day and 6-month follow-up consisted of clinical evaluation, and Duplex scan or magnetic resonance angiography of the treated extremity. Results. Initial technical success was 97%, radiologic success was 82%, and overall clinical success was 77%. Median thrombolysis time was 21 hours (IQR, 15-24). In 38 of 51 procedures with successful lysis (75%) complete lysis was achieved within 24 hours. Major hemorrhage occurred in 2 procedures (3%), and distal embolization in 2 procedures (3%). During the initial hospitalization, the major amputation rate was 8% (N.=5) and the mortality rate was 2% (N.=1). The 30-day patency rate was 81%, without additional mortality. During a median 6-month (range, 2-14) followup, 9 reinterventions were performed. Two patients underwent major amputation and 3 patients died; because of malignancy (N.=2) and stroke (N.=1). Conclusion. Initial success rates of ultrasound-accelerated thrombolysis are high and complication rate is low. However, reintervention rate during short-term follow-up for recurrent ischemia is substantial. Results from a randomized controlled trial comparing ultrasound-accelerated thrombolysis with standard thrombolysis for lower extremity ischemia (DUET, Current Controlled Trials, ISRCTN72676102) are eagerly awaited. Source


Buisman W.J.,St. Antonius Hospital | Unlu C.,St. Antonius Hospital | de Boer S.W.,St. Antonius Hospital | Bos W.J.,St. Antonius Hospital | And 2 more authors.
Surgical and Radiologic Anatomy | Year: 2016

We present a patient with a recurrent precaval left renal artery, stemming from a right-sided common trunk renal artery. The patient was a 44-year male who presented with a post-traumatic grade IV renal injury. After 3 months without renal function improvement and repeated urinary tract infection, a laparoscopic nephrectomy of the affected right kidney was performed, without upfront identification of the vascular variation, resulting in ischemia of the remaining left kidney. An anastomosis of the common renal trunk and the distal left renal artery was created in between the abdominal aorta and the inferior vena cava. This case describes the importance of upfront detection of renal vascular variations using the appropriate imaging techniques. © 2016 Springer-Verlag France Source


Krijnen J.L.M.,Laboratory of Pathology | Fleischeur R.E.M.,Elisabeth Hospital | Van Berkel M.,Beatrix Hospital | Westenend P.J.,Laboratory of Pathology
Clinical Neuropathology | Year: 2010

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 1000 for metastasis of oligodendroglioma outside the central nervous system. ©2010 Dustri-Verlag Dr. K. Feistle. Source


De Jonge V.,Erasmus Medical Center | Nicolaas J.S.,Erasmus Medical Center | Van Baalen O.,Beatrix Hospital | Brouwer J.T.,Reinier de Graaf Hospital | And 5 more authors.
American Journal of Gastroenterology | Year: 2012

OBJECTIVES: Colonoscopy is the gold standard for visualization of the colon. It is generally accepted as a safe procedure and major adverse events occur at a low rate. However, few data are available on structured assessment of (minor) post-procedural adverse events. METHODS: Consecutive outpatients undergoing colonoscopy were asked for permission to be called 30 days after their procedure. A standard telephone interview was developed to assess the occurrence of (i) major adverse events (hospital visit required), (ii) minor adverse events, and (iii) days missed from work. Adverse events were further categorized in definite-, possible-, and unrelated adverse events. Patients were contacted between January 2010 and September 2010. RESULTS: Out of a total of 1,528 patients who underwent colonoscopy and gave permission for a telephone call, 1,144 patients were contacted (response: 75%), 49% were male, the mean age was 59 years (s.d.: 14). Thirty-four patients (3%) reported major adverse events. These were definite-related in nine (1%) patients, possible-related in 6 (1%), and unrelated in 19 patients (2%). Minor adverse events were reported by 466 patients (41%). These were definite-related in 336 patients (29%), possible-related in 36 (3%), and unrelated in the remaining 94 patients (8%). Female gender (odds ratio (OR): 1.5), age <50 years (OR: 1.5), colonoscopy for colorectal cancer screening/surveillance (OR: 1.6), and fellow-endoscopy (OR: 1.7) were risk factors for the occurrence of any definite-related adverse event. Patients who reported definite-related adverse events were significantly less often willing to return for colonoscopy (81 vs. 88%, P<0.01) and were less often positive about the entire colonoscopy experience (84 vs. 89%, P=0.04). CONCLUSIONS: Structured assessment of post-colonoscopy adverse events shows that these are more common than generally reported. Close to one-third of patients report definite-related adverse events, which are major in close to 1 in 100 patients. The occurrence of adverse events does have an impact on the willingness to return for colonoscopy. © 2012 by the American College of Gastroenterology. Source


Stouten K.,Albert Schweitzer Hospital | van de Werken M.,Albert Schweitzer Hospital | Tchetverikov I.,Albert Schweitzer Hospital | Saboerali M.,Beatrix Hospital | And 3 more authors.
Annals of Clinical Biochemistry | Year: 2014

Measurement of serum angiotensin-converting enzyme (ACE) activity can be helpful in the diagnosis and disease monitoring of sarcoidosis. Elevated serum ACE activity is found in 60-70% of sarcoidosis patients. Usually, the ACE activity is mildly increased (<3-fold the upper limit of the reference range) in sarcoidosis patients. Extremely elevated ACE activity is suggestive of the benign condition known as 'familial hyperactivity of ACE'. Familial hyperactivity of ACE is a relatively rare condition and can be confirmed by genetic testing. Considering a genetic cause of strongly elevated serum ACE activity is important to prevent possible overdiagnostics. Here, we highlight the factors that may complicate the interpretation of serum ACE activity measurements, and we present two cases that illustrate the importance of interdisciplinary consultation when extremely elevated serum ACE activity is measured. © The Author(s) 2013 Reprints and permissions:.sagepub.co.uk/journalsPermissions.nav. Source

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