Eindhoven, Netherlands
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Van Gijn W.,Leiden University | Marijnen C.A.M.,Leiden University | Nagtegaal I.D.,Radboud University Nijmegen | Kranenbarg E.M.K.,Leiden University | And 6 more authors.
The Lancet Oncology | Year: 2011

Background: The TME trial investigated the value of preoperative short-term radiotherapy in combination with total mesorectal excision (TME). Long-term results are reported after a median follow-up of 12 years. Methods: Between Jan 12, 1996, and Dec 31, 1999, 1861 patients with resectable rectal cancer without evidence of distant disease were randomly assigned to TME preceded by 5 × 5 Gy radiotherapy or TME alone (ratio 1:1). Randomisation was based on permuted blocks of six with stratification according to centre and expected type of surgery. The primary endpoint was local recurrence, analysed for all eligible patients who underwent a macroscopically complete local resection. Findings: 10-year cumulative incidence of local recurrence was 5% in the group assigned to radiotherapy and surgery and 11% in the surgery-alone group (p<0·0001). The effect of radiotherapy became stronger as the distance from the anal verge increased. However, when patients with a positive circumferential resection margin were excluded, the relation between distance from the anal verge and the effect of radiotherapy disappeared. Patients assigned to radiotherapy had a lower overall recurrence and when operated with a negative circumferential resection margin, cancer-specific survival was higher. Overall survival did not differ between groups. For patients with TNM stage III cancer with a negative circumferential resection margin, 10-year survival was 50% in the preoperative radiotherapy group versus 40% in the surgery-alone group (p=0·032). Interpretation: For all eligible patients, preoperative short-term radiotherapy reduced 10-year local recurrence by more than 50% relative to surgery alone without an overall survival benefit. For patients with a negative resection margin, the effect of radiotherapy was irrespective of the distance from the anal verge and led to an improved cancer-specific survival, which was nullified by an increase in other causes of death, resulting in an equal overall survival. Nevertheless, preoperative short-term radiotherapy significantly improved 10-year survival in patients with a negative circumferential margin and TNM stage III. Future staging techniques should offer possibilities to select patient groups for which the balance between benefits and side-effects will result in sufficiently large gains. Funding: The Dutch Cancer Society, the Dutch National Health Council, and the Swedish Cancer Society. © 2011 Elsevier Ltd.


Willemze R.A.,Tytgat Institute for Liver and Intestinal Research | Luyer M.D.,Catharina Hospital Eindhoven | Buurman W.A.,Maastricht University | De Jonge W.J.,Tytgat Institute for Liver and Intestinal Research
Nature Reviews Gastroenterology and Hepatology | Year: 2015

Studies in neuroscience and immunology have clarified much of the anatomical and cellular basis for bidirectional interactions between the nervous and immune systems. As with other organs, intestinal immune responses and the development of immunity seems to be modulated by neural reflexes. Sympathetic immune modulation and reflexes are well described, and in the past decade the parasympathetic efferent vagus nerve has been added to this immune-regulation network. This system, designated 'the inflammatory reflex', comprises an afferent arm that senses inflammation and an efferent arm that inhibits innate immune responses. Intervention in this system as an innovative principle is currently being tested in pioneering trials of vagus nerve stimulation using implantable devices to treat IBD. Patients benefit from this treatment, but some of the working mechanisms remain to be established, for instance, treatment is effective despite the vagus nerve not always directly innervating the inflamed tissue. In this Review, we will focus on the direct neuronal regulatory mechanisms of immunity in the intestine, taking into account current advances regarding the innervation of the spleen and lymphoid organs, with a focus on the potential for treatment in IBD and other gastrointestinal pathologies. © 2015 Macmillan Publishers Limited. All rights reserved.


News Article | November 28, 2016
Site: www.eurekalert.org

Leesburg, VA, Nov. 23, 2016 -- CT has good sensitivity for the detection of colon cancers with tumors that have spread beyond the bowel wall, however, it remains a challenge in detecting nodal involvement, which could have considerable consequences given the increasing interest in neoadjuvant treatment for colon cancer. This finding was published in the November 2016 issue of the American Journal of Roentgenology (AJR) in an article titled, "Diagnostic Accuracy of CT for Local Staging of Colon Cancer: A Systematic Review and Meta-Analysis." The article, which is available on AJR's website through open access, indicates that thin-slice CT may be an effective tool in identifying nodal involvement. "Detecting nodal involvement with CT is unreliable," Elias Nerad, radiologist at Catharina Hospital Eindhoven and researcher at Netherlands Cancer Institute in Amsterdam, The Netherlands, said. "The use of thin slices improved the detection of tumor invasion beyond the bowel wall, as well as the detection of malignant lymph nodes, and is therefore advocated. Also, evidence suggests that CT colonography improves the accuracy of CT in the local staging of colon tumors, which could have a major clinical effect if neoadjuvant chemotherapy is adopted in the treatment of colon cancer." CT colonography is a technique that uses optimal bowel wall distention and 3D reconstruction of the colon (creating a virtual colonoscopy), which distinguishes it from regular CT of the abdomen. The meta-analysis provided by study coauthor Nerad, et al. was limited to two CT colonography studies because the majority of them identified in the literature search included rectal tumors that were inseparable from the colon tumors and thus were excluded. "CT Colonography is highly sensitive and cost effective in detection of colorectal carcinoma," Nerad said. "Furthermore, it can also be used as a (local) staging tool, making it a very interesting potential subgroup in our meta-analysis." Overall, the research was based on the meta-analysis of 13 studies describing the accuracy of CT in the staging of colon carcinomas. In the literature, colon and rectal cancers are combined despite the fact that they differ in terms of anatomy, diagnostic workup, and treatment. This study does make a clear distinction between the two and aims to exclusively determine the diagnostic accuracy of CT for staging colon cancer only and to evaluate whether CT can help in differentiating high- from low-risk colon cancer tumors. Therapy for rectal cancer is based on staging with MRI or endorectal ultrasound, the study said. For the treatment of MRI-staged high-risk rectal tumors, defined as tumors with involvement of the mesorectal fascia, guidelines recommend neoadjuvant chemoradiotherapy. In contrast, colon cancer is mainly staged with CT and there are no guidelines for the use of neoadjuvant treatment for colon cancer. However, this will most likely change in the near future, if ongoing studies confirm earlier reports that patients with aggressive colon tumors benefit from a neoadjuvant treatment. The meta-analysis provided by Nerad et al. specifically focuses on the diagnostic accuracy of CT for staging colon cancer and to evaluate whether CT can select patients for neoadjuvant treatment (i.e., aggressive colon tumors). Founded in 1900, ARRS is the first and oldest radiology society in the United States, and is an international forum for progress in radiology. The Society's mission is to improve health through a community committed to advancing knowledge and skills in radiology. ARRS achieves its mission through an annual scientific and educational meeting, publication of the American Journal of Roentgenology (AJR) and InPractice magazine, topical symposia and webinars, and print and online educational materials. ARRS is located in Leesburg, VA.


Smit J.M.,Catharina Hospital Eindhoven
Plastic and Reconstructive Surgery | Year: 2010

BACKGROUND:: Mallet finger is a common injury. The aim of this review is to give an overview of the different treatment options of mallet injuries and their indications, outcomes, and potential complications. METHODS:: A literature-based study was conducted using the PubMed database comprising world literature from January of 1980 until January of 2010. The following search terms were used: "mallet" and "finger." RESULTS:: There are many variations in the design of splints; there are, however, only a few studies that compare the type of splints with one another. Splinting appears to be effective in uncomplicated and complicated cases. Equal results have been reported for early and delayed splinting therapy. To internally fixate a mallet finger, many different techniques have been reported; however, none of these studies examined their comparisons in a controlled setting. In chronic mallet injuries, a tenodermodesis followed by splinting or a tenotomy of the central slip is usually performed. If pain and impairment persist despite previous surgical corrective attempts, an arthrodesis of the distal interphalangeal joint should be performed. CONCLUSIONS:: Uncomplicated cases of mallet injuries are best treated by splinting therapy; cases that do not react to splinting therapy are best treated by surgical interventions. Controversy remains about whether mallet injuries with a larger dislocated bone fragment are best treated by surgery or by external splinting. © 2010 by the American Society of Plastic Surgeons.


Mols F.,University of Tilburg | Martens E.J.,University of Tilburg | Martens E.J.,Catharina Hospital Eindhoven | Denollet J.,University of Tilburg
Heart | Year: 2010

Objective: In this prospective follow-up study we investigated whether the type D personality construct (the tendency to experience negative emotions and to be socially inhibited) exerts an independent effect on disease-specific health status in post-myocardial infarction (MI) patients, after adjustment for disease severity and depressive symptoms. Methods: Patients (n=503) were assessed on demographic and clinical variables and completed the type D scale (DS14) and Beck Depression Inventory (BDI) within the first week of hospital admission for acute MI. Two months post-MI, all patients completed the WHO Composite International Diagnostic Interview (CIDI) interview. After 18 months, they filled out the Seattle Angina Questionnaire (SAQ) to assess disease-specific health status. Results: At follow-up, type D patients had significantly lower mean scores on all SAQ subscales, indicating worse disease-specific health status, compared to non-type D patients (all p values <0.01). After adjustment for disease severity and depression in multivariate analysis, type D patients still had more physical limitations (mean SAQ score: 49 versus 54; p=0.014), less angina stability (62 versus 71; p=0.002) and a less accurate disease perception (52 versus 61; p≤0.001) compared with nontype D patients. Depressed patients (BDI ≥10) also reported significantly lower SAQ scores compared to nondepressed patients. Conclusions: The type D construct is an independent predictor of impaired disease-specific health status. Type D personality, in addition to depression, may thus be an important psychological factor that deserves attention during the period of rehabilitation in post-MI patients.


Van Berkel M.,Catharina Hospital Eindhoven | Scharnhorst V.,Catharina Hospital Eindhoven
Clinical Chemistry and Laboratory Medicine | Year: 2011

Background: Heparin binds positively charged electrolytes. In blood gas syringes, electrolyte-balanced heparin is used to prevent a negative bias in electrolyte concentrations. The potential pre-analytical errors introduced by blood gas syringes are largely unknown. Here, we evaluate electrolyte concentrations in non-anticoagulated blood compared with concentrations measured in electrolyte-balanced blood gas syringes. Methods: Venous blood was collected into plain tubes. Ioni-zed calcium, potassium, sodium and hydrogen ions were analyzed directly using a blood gas analyzer and the remaining blood was collected into different blood gas syringes in random order: Preset (Becton Dickinson), Monovette (Sar-stedt) and Pico 50-2 (Radiometer). Results: Ionized calcium and sodium concentrations were significantly lower in blood collected in Becton Dickinson and Sarstedt syringes compared to non-heparinized (NH) blood. The mean bias exceeded biological variation-based total allowable error, which in most cases leads to clinically misleading individual results. In contrast, ionized calcium concentrations in blood collected in Pico 50-2 syringes were identical to values obtained from NH blood. Sodium showed a minor, yet statistically significant, bias. Conclusions: Despite the fact that blood gas syringes now contain electrolyte-balanced heparin, one should be aware of the fact that these syringes can introduce pre-analytical bias in electrolyte concentrations. The extent of the bias differs between syringes. © 2011 by Walter de Gruyter.


Vermeer T.A.,Catharina Hospital Eindhoven
Current oncology reports | Year: 2014

The management of rectal cancer has improved considerably in recent decades. Surgery remains the cornerstone of the treatment. However, the role of preoperative imaging has made it possible to optimize the treatment plan in rectal patients. Neoadjuvant treatment may be indicated in efforts to sterilize possible tumor deposits outside the surgical field, or may be used to downsize and downstage the tumor itself. The optimal sequence of treatment modalities can be determined by a multidisciplinary team, who not only use pretreatment imaging, but also review pathologic results after surgery. The pathologist plays a pivotal role in providing feedback about the success of surgery, i.e., the distance between the tumor and the circumferential resection margin, the quality of surgery, and the effect of neoadjuvant treatment. Registry and auditing of all treatment variables can further improve outcomes. In this century, rectal cancer treatment has become a team effort.


Axillary lymph node dissection (ALND) in patients with breast cancer has the potential to induce side-effects, including upper-limb lymphedema. Axillary reverse mapping (ARM) is a technique that enables discrimination of the lymphatic drainage of the breast from that of the upper limb in the axillary lymph node (LN) basin. If lymphedema is caused by removing these lymphatics and nodes in the upper limb, the possibility of identifying these lymphatics would enable surgeons to preserve them. The aim of this study is to determine the clinical relevance of selective axillary LN and lymphatic preservation by means of ARM. To minimize the risk of overlooking tumor-positive ARM nodes and the associated risk of undertreatment, we will only include patients with a tumor-positive sentinel lymph node (SLN). Patients who are candidates for ALND because of a proven positive axillary LN at clinical examination can be included in a registration study. The study will enroll 280 patients diagnosed with SLN biopsy-proven metastasis of invasive breast cancer with an indication for a completion ALND. Patients will be randomized to undergo standard ALND or an ALND in which the ARM nodes and their corresponding lymphatics will be left in situ. Primary outcome is the presence of axillary surgery-related lymphedema at 6, 12, and 24 months post-operatively, measured by the water-displacement method. Secondary outcome measures include pain, paresthesia, numbness, and loss of shoulder mobility, quality of life, and axillary recurrence risk. The benefit of ALND in patients with a positive SLN is a subject of debate. For many patients, an ALND will remain the treatment of choice. This multicenter randomized trial will provide evidence of whether or not axillary LN preservation by means of ARM decreases the side-effects of an ALND. Enrolment of patients will start in April 2013 in five breast-cancer centers in the Netherlands, and is expected to conclude by April 2016. TC3698.


Hansson B.M.E.,Canisius Wilhelmina Hospital | Slater N.J.,Radboud University Nijmegen | Van Der Velden A.S.,Canisius Wilhelmina Hospital | Groenewoud H.M.M.,Radboud University Nijmegen | And 3 more authors.
Annals of Surgery | Year: 2012

Background: Parastomal hernias are a frequent complication of enterostomies that require surgical treatment in approximately half of patients. This systematic review aimed to evaluate and compare the safety and effectiveness of the surgical techniques available for parastomal hernia repair. Methods: Systematic review was performed in accordance with PRISMA. Assessment of methodological quality and selection of studies of parastomal hernia repair was done with a modified MINORS. Subgroups were formed for each surgical technique. Primary outcome was recurrence after at least 1-year follow-up. Secondary outcomes were mortality and postoperative morbidity. Outcomes were analyzed using weighted pooled proportions and logistic regression. Results: Thirty studies were included with the majority retrospective. Suture repair resulted in a significantly increased recurrence rate when compared with mesh repair (odds ratio [OR] 8.9, 95% confidence interval [CI] 5.2-15.1; P < 0.0001). Recurrence rates for mesh repair ranged from 6.9% to 17% and did not differ significantly. In the laparoscopic repair group, the Sugarbaker technique had less recurrences than the keyhole technique (OR 2.3, 95% CI 1.2-4.6; P = 0.016). Morbidity did not differ between techniques. The overall rate of mesh infections was low (3%, 95% CI 2) and comparable for each type of mesh repair. Conclusions: Suture repair of parastomal hernia should be abandoned because of increased recurrence rates. The use of mesh in parastomal hernia repair significantly reduces recurrence rates and is safe with a low overall rate of mesh infection. In laparoscopic repair, the Sugarbaker technique is superior over the keyhole technique showing fewer recurrences. © 2012 Lippincott Williams & Wilkins.


Van Rutte P.W.J.,Catharina Hospital Eindhoven | Smulders J.F.,Catharina Hospital Eindhoven | De Zoete J.P.,Catharina Hospital Eindhoven | Nienhuijs S.W.,Catharina Hospital Eindhoven
Obesity Surgery | Year: 2012

Background: Sleeve gastrectomy (SG) is an upcoming primary treatment modality for morbid obesity. The aim of this study was to report the indications for and the outcomes of revisional surgery after SG. Methods: Four hundred sixteen individuals underwent a SG between August 2006 and July 2010 with a minimum follow-up of 12 months. The patients that needed revision were identified from our prospective registry. Patients were subdivided in a first group undergoing revision as part of a two-step procedure, a second group with failure of a secondary SG, and a third group with failure of a primary SG. Results: Twenty-three patients (5.5 %) had an unplanned revision. Fourteen (3.4 %) had a two-step procedure because of super obesity. A significant additional weight loss was achieved after revision; no complications occurred in this group. Five patients with failure of a secondary SG had no significant additional weight loss after revision. Reflux disease was cured. Eighteen patients in the third group showed significant additional weight loss and remission of diabetes and hypertension. Both reflux disease and dysphagia did not heal in all affected patients after revision. The early complication rate in the whole cohort was 23.4 %; staple line leakage was 5.4 %, and bleeding was 8.1 %. Revision-related mortality was 0 %. Conclusion: In a large series of sleeve gastrectomies, the unplanned revision rate was 5.5 %. Revision of a sleeve gastrectomy is feasible in patients that do not achieve sufficient weight loss and in those patients developing complications after the initial sleeve gastrectomy. © 2012 Springer Science + Business Media, LLC.

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