Rademakers L.M.,Catharina ziekenhuis |
Laarman G.J.,TweeSteden Ziekenhuis
Netherlands Heart Journal | Year: 2012
We describe a case of critical hand ischaemia after transradial cardiac catheterisation. The patient presented with hand ischaemia 5 days after transradial coronary angiography. Urgent angiography demonstrated radial artery occlusion with embolisation to the palmar arch and digital arteries. The ischaemia was refractory to an extensive thrombolytic regimen, and subsequently, the patient was referred to the vascular surgeon for urgent thrombectomy and patch angioplasty. The patient recovered slowly and no amputation was necessary, but complaints of right hand numbness and paresthesia of all digits remained. © Springer Media / Bohn Stafleu van Loghum 2012.
VERIFY (VERification of instantaneous wave-free ratio and fractional flow reserve for the assessment of coronary artery stenosis severity in everyday practice): A multicenter study in consecutive patients
Berry C.,University of Glasgow |
Berry C.,Golden Jubilee National Hospital |
Van 'T Veer M.,Catharina Ziekenhuis |
Witt N.,Karolinska Institutet |
And 10 more authors.
Journal of the American College of Cardiology | Year: 2013
Objectives: This study sought to compare fractional flow reserve (FFR) with the instantaneous wave-free ratio (iFR) in patients with coronary artery disease and also to determine whether the iFR is independent of hyperemia. Background: FFR is a validated index of coronary stenosis severity. FFR-guided percutaneous coronary intervention (PCI) improves clinical outcomes compared to angiographic guidance alone. iFR has been proposed as a new index of stenosis severity that can be measured without adenosine. Methods: We conducted a prospective, multicenter, international study of 206 consecutive patients referred for PCI and a retrospective analysis of 500 archived pressure recordings. Aortic and distal coronary pressures were measured in duplicate in patients under resting conditions and during intravenous adenosine infusion at 140 μg/kg/min. Results: Compared to the FFR cut-off value of ≤0.80, the diagnostic accuracy of the iFR value of ≤0.80 was 60% (95% confidence interval [CI]: 53% to 67%) for all vessels studied and 51% (95% CI: 43% to 59%) for those patients with FFR in the range of 0.60 to 0.90. iFR was significantly influenced by the induction of hyperemia: mean ± SD iFR at rest was 0.82 ± 0.16 versus 0.64 ± 0.18 with hyperemia (p < 0.001). Receiver operating characteristics confirmed that the diagnostic accuracy of iFR was similar to resting Pd/Pa and trans-stenotic pressure gradient and significantly inferior to hyperemic iFR. Analysis of our retrospectively acquired dataset showed similar results. Conclusions: iFR correlates weakly with FFR and is not independent of hyperemia. iFR cannot be recommended for clinical decision making in patients with coronary artery disease. (Comparison of Fractional Flow Reserve Versus Instant Wave-Free Ratio for Assessment of Coronary Artery Stenosis Severity in Routine Practice; NCT01559493) © 2013 American College of Cardiology Foundation.
Russo G.,TU Eindhoven |
Russo G.,University of Amsterdam |
Mischi M.,TU Eindhoven |
Scheepens W.,Catharina Ziekenhuis |
And 3 more authors.
BJU International | Year: 2012
As confirmed by all available statistics, cancer represents a major clinical and societal problem in the developed world. The form of cancer with the highest incidence in men is prostate cancer. For prostate cancer, as well as for most forms of cancer, detection of the disease at an early stage is critical to reduce mortality and morbidity. • Today, it is well known that pathological angiogenesis represents a crucial step in cancer development and progression. Comparable with most forms of cancer, angiogenesis also plays a fundamental role for prostate cancer growth. • As a consequence, angiogenesis is an ideal target not only for novel anti-angiogenic therapies, but also for modern imaging techniques that aim at cancer localisation by detection of angiogenic microvascular changes. • These techniques are mainly based on magnetic resonance, ultrasound, and nuclear imaging. • This paper provides a comprehensive review of the available studies on angiogenesis in prostate cancer and its use by modern and emerging imaging techniques for prostate cancer localisation. Accepted for publication 31 May 2012© 2012 THE AUTHORS.
Balak D.M.,Erasmus Medical Center |
Hengstman G.J.,Catharina Ziekenhuis |
Cakmak A.,Erasmus Medical Center |
Thio H.B.,Erasmus Medical Center
Multiple Sclerosis Journal | Year: 2012
Glatiramer acetate and interferon-beta are approved first-line disease-modifying treatments (DMTs) for multiple sclerosis (MS). DMTs can be associated with cutaneous adverse events, which may influence treatment adherence and patient quality of life. In this systematic review, we aimed to provide an overview of the clinical spectrum and the incidence of skin reactions associated with DMTs. A systematic literature search was performed up to May 2011 in Medline, Embase, and Cochrane databases without applying restrictions in study design, language, or publishing date. Eligible for inclusion were articles describing any skin reaction related to DMTs in MS patients. Selection of articles and data extraction were performed by two authors independently. One hundred and six articles were included, of which 41 (39%) were randomized controlled trials or cohort studies reporting incidences of mainly local injection-site reactions. A large number of patients had experienced some form of localized injection-site reaction: up to 90% for those using subcutaneous formulations and up to 33% for those using an intramuscular formulation. Sixty-five case-reports involving 106 MS patients described a wide spectrum of cutaneous adverse events, the most frequently reported being lipoatrophy, cutaneous necrosis and ulcers, and various immune-mediated inflammatory skin diseases. DMTs for MS are frequently associated with local injection-site reactions and a wide spectrum of generalized cutaneous adverse events, in particular, the subcutaneous formulations. Although some of the skin reactions may be severe and persistent, most of them are mild and do not require cessation of DMT. © The Author(s) 2012.
Thijssen W.,Catharina Ziekenhuis
Huisarts en Wetenschap | Year: 2016
Thijssen WA. Emergency services in A&E departments: does it work? Huisarts Wet 2016;59(2):54-6. In the past 10 years, many out-of-hours services have become integrated with accident & emergency (A&E) departments in hospitals to provide emergency general practice services. However, little is known about the effect of this development on the flow and characteristics of patients coming to an A&E department. There has been a clear decrease in the number of non-urgent self-referrals to A&E departments, most of which are referred back to a general practitioner. Unexpectedly, there has been an increase in referrals to A&E departments, which leads to more diagnostic investigations, more A&E admissions, and more outpatient follow-ups. The collaboration between GPs and A&E departments needs to be more intensive in order to shorten A&E waiting times and to decrease unnecessary referrals, investigations, and hospital admissions. GPs working in such an emergency service should have full access to the diagnostic facilities of the hospital and be able to consult an A&E specialist. © 2016, Bohn Stafleu van Loghum.
Jansen L.,Catharina Ziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2013
Ataxia due to a vitamin B12 deficiency can be a cause of falls in elderly patients. An 86-year-old woman presented with functional decline and gait problems. She had been falling regularly. The patient's gait was ataxic and she was unable to stand without support. Additional laboratory tests showed a volume macrocytic blood picture and a severe vitamin B12 deficiency, as well as antibodies directed against intrinsic factor and parietal cells. We diagnosed her as having falls and ataxia caused by vitamin B12 deficiency. Vitamin B12 supplementation resulted in improvement of gait. Ataxia due to vitamin B12 deficiency is a rare problem which in 20-25% of cases is not accompanied by anaemia. Prompt treatment reduces the chance of neurological sequelae.
Daams F.,Catharina Ziekenhuis |
Luyer M.,Catharina Ziekenhuis |
Lange J.F.,Erasmus Medical Center
World Journal of Gastroenterology | Year: 2013
All colorectal surgeons are faced from time to time with anastomotic leakage after colorectal surgery. This complication has been studied extensively without a significant reduction of incidence over the last 30 years. New techniques of prevention, by innovative anastomotic techniques should improve results in the future, but standardization and "teachability" should be guaranteed. Risk scoring enables intra-operative decision-making whether to restore continuity or deviate. Early detection can lead to reduction in delay of diagnosis as long as a standard system is used. For treatment options, no firm evidence is available, but future studies could focus on repair and saving of the anastomosis on the one hand or anastomotical breakdown and definitive colostomy on the other hand. © 2013 Baishideng. All rights reserved.
Kortenhorst M.S.,Catharina Ziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2012
Iron deficiency is a frequent cause of anaemia in pregnancy and often results in fatigue and malaise. To prevent complications during labour, timely iron suppletion is important. A 30-year-old multiparous female presented at the outpatient clinic in her 38th week of this pregnancy because of fatigue and lightheadedness. She had been prescribed oral iron suppletion a month earlier but had not taken the tablets. Because her haemoglobin level had decreased to 6.3 mmol/l, it was decided to start her on intravenous iron dextran treatment. During administration of the test dose, the patient experienced acute dyspnoea and severe abdominal and back pain. Foetal bradycardia was observed and the patient underwent an emergency caesarean section. She delivered a healthy boy whose arterial pH was 7.05 (base excess: -7.6 mmol/l) and venous pH was 7.18 (base excess: -6.8 mmol/l). This case demonstrates that dextran anaphylaxis can occur, with potentially lethal consequences, even when no known underlying risk factors are present.
Yo L.S.,Catharina ziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2010
Three patients, 2 women aged 42 and 20 years and a 21-year-old man, presented with painful swelling of the upper extremity. The symptoms developed after activities involving repetitive, excessive use of the upper extremity. Duplex examination and venography showed thrombosis of the subclavian vein. This specific type of thrombosis is known as effort thrombosis or Paget-von Schroetter syndrome. It results from a narrowed thoracic outlet combined with repetitive strenuous use of the upper extremity. All three patients were first treated with thrombolytic therapy using urokinase delivered locally in the thrombus with a catheter. After the thrombus had resolved, a first rib resection was performed to decompress the thoracic outlet. Due to the remaining substantial stenosis and vessel wall irregularity, additional percutaneous transluminal angioplasty was performed. It is important to treat effort thrombosis immediately and adequately. Otherwise, it may lead to a postthrombotic syndrome, which can be severely disabling.
Wlazlo N.,Catharina Ziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2011
A 64-year-old man was admitted to hospital with increasing low back pain, radiating to his upper legs. MRI of the lumbar spine showed inflammatory lesions of vertebrae L3-L5, after which the patient was treated with flucloxacilline for 6 weeks. However, he did not improve and the pain became more extensive. Finally, PET-CT study showed abnormalities in shoulders, back and hips, indicating a probable diagnosis of polymyalgia rheumatica. Upon treatment with prednisone, the pain quickly decreased and 3 months later the inflammatory changes visible on MRI were clearly reduced. Polymyalgia rheumatica (PMR) is often recognized by its typical clinical presentation, but in atypical cases, investigation using imaging may be helpful. Abnormalities in shoulder and hip joints are most common, but signs of cervical and lumbar interspinous bursitis might also be found in patients with PMR.