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Deventer, Netherlands

Hartmans E.,Deventer Ziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2012

A 36-week-old girl presented with an itching papulous skin eruption symmetrically on her cheeks, buttocks and limbs. Based on the specific clinical presentation she was diagnosed with Gianotti-Crosti-syndrome. This is a self-limiting cutaneous response to a viral infection. Source

With 16,000 operations every year, acute appendicitis is one of the most common surgical diagnoses in Dutch emergency rooms. Diagnosis is based on clinical features: history, physical examination and laboratory testing. When the diagnosis is made, surgeons tend to operate quickly to prevent complications. In some cases this means that a healthy appendix is removed. The Dutch College of Surgeons wanted to reduce the number of removed healthy appendixes. This topic is discussed worldwide and the introduction of imaging is widely suggested. Ultrasonography and CT are said to be highly reliable in diagnosing appendicitis. While this may be the case in a research setting, it has been shown that in general hospitals they are not so reliable. Furthermore, the rise in the use of preoperative imaging has not brought down the negative appendectomy rate. We believe that imaging should be reserved for certain groups of patients. In the clear-cut cases it only increases the cost, patient burden and risk of complications; preoperative imaging should not be performed routinely. Source

Tak L.M.,Deventer Ziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2013

The prescribing of low doses of quetiapine for the treatment of sleeping disorders appears to be widespread. Recently, in a systematic literature review on low-dose quetiapine use for the treatment of sleeping disorders, it was concluded that evidence for its efficacy is currently lacking. Furthermore, quetiapine is probably associated with potentially severe adverse effects, also at low doses. In conclusion, sufficient scientific evidence that justifies the current practice of off-label prescribing of low-dose quetiapine for the treatment of sleeping disorders is insufficient; further research into its efficacy and safety is needed. Source

Bouma G.,Deventer Ziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2011

Over a period of 1 year in our hospital, 3 patients were diagnosed with 'ileitis following capecitabine use'. The case of 1 of these patients is presented in this article. A 73-year-old man known to be suffering from liver metastases from rectal cancer was treated with oxaliplatin, bevacizumab and capecitabine. He was admitted to our hospital with abdominal pain, diarrhoea, nausea and a subfebrile temperature. A CT scan of the abdomen showed marked bowel wall thickening, particularly of the ileum, consistent with terminal ileitis. The diagnosis was 'ileitis following capecitabine use' since other disorders were excluded or seemed less likely, and the Naranjo score was compatible with 'possible adverse reaction'. Capecitabine treatment was discontinued. Following recovery, treatment was resumed without complications. Small intestine toxicity during capecitabine use has, to our knowledge, not been described previously. It is important to recognise this side-effect in order to avoid obstruction and perforation. Conservative treatment including an adapted diet and intravenous hydration is the therapy of choice. Surgery does not seem to be indicated. Source

Eichelberg C.,University of Regensburg | Vervenne W.L.,Deventer Ziekenhuis | De Santis M.,Ludwig Boltzmann Research Institute | Fischer Von Weikersthal L.,Gesundheitszentrum Klinikum Amberg | And 14 more authors.
European Urology | Year: 2015

Background Understanding how to sequence targeted therapies for metastatic renal cell carcinoma (mRCC) is important for maximisation of clinical benefit. Objectives To prospectively evaluate sequential use of the multikinase inhibitors sorafenib followed by sunitinib (So-Su) versus sunitinib followed by sorafenib (Su-So) in patients with mRCC. Design, setting, and participants The multicentre, randomised, open-label, phase 3 SWITCH study assessed So-Su versus Su-So in patients with mRCC without prior systemic therapy, and stratified by Memorial Sloan Kettering Cancer Center risk score (favourable or intermediate). Intervention Patients were randomised to sorafenib 400 mg twice daily followed, on progression or intolerable toxicity, by sunitinib 50 mg once daily (4 wk on, 2 wk off) (So-Su), or vice versa (Su-So). Outcome measurements and statistical analysis The primary endpoint was improvement in progression-free survival (PFS) with So-Su versus Su-So, assessed from randomisation to progression or death during second-line therapy. Secondary endpoints included overall survival (OS) and safety. Results and limitations In total, 365 patients were randomised (So-Su, n = 182; Su-So, n = 183). There was no significant difference in total PFS between So-Su and Su-So (median 12.5 vs 14.9 mo; hazard ratio [HR] 1.01; 90% confidence interval [CI] 0.81-1.27; p = 0.5 for superiority). OS was similar for So-Su and Su-So (median 31.5 and 30.2 mo; HR 1.00, 90% CI 0.77-1.30; p = 0.5 for superiority). More So-Su patients than Su-So patients reached protocol-defined second-line therapy (57% vs 42%). Overall, adverse event rates were generally similar between the treatment arms. The most frequent any-grade treatment-emergent first-line adverse events were diarrhoea (54%) and hand-foot skin reaction (39%) for sorafenib; and diarrhoea (40%) and fatigue (40%) for sunitinib. Conclusions Total PFS was not superior with So-Su versus Su-So. These results demonstrate that sorafenib followed by sunitinib and vice versa provide similar clinical benefit in mRCC. Patient summary We investigated if total progression-free survival (PFS) is improved in patients with advanced/metastatic kidney cancer who are treated with sorafenib and then with sunitinib (So-Su), compared with sunitinib and then sorafenib (Su-So). We found that total PFS was not improved with So-Su compared with Su-So, but both treatment options were similarly effective in patients with advanced/metastatic kidney cancer. Trial registration ClinicalTrials.gov identifier NCT00732914, www.clinicaltrials.gov © 2015 European Association of Urology. Source

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