Utrecht, Netherlands


Utrecht, Netherlands
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Schiphorst A.H.W.,Diakonessenhuis | Langenhoff B.S.,TweeSteden and St Elisabeth Hospital | Maring J.,TweeSteden and St Elisabeth Hospital | Pronk A.,Diakonessenhuis | Zimmerman D.D.E.,TweeSteden and St Elisabeth Hospital
Diseases of the Colon and Rectum | Year: 2014

Background: Currently, the preferred method for local excision of rectal polyps is transanal endoscopic microsurgery, avoiding rectal resection. Transanal minimally invasive surgery is a relatively new technique using a disposable port in combination with conventional laparoscopic instruments. This method is less expensive as compared with transanal endoscopic microsurgery, relatively easy to learn, and available. Despite wide adoption of transanal minimally invasive surgery, to date only a few series on the implementation and use of this technique are reported, and detailed information on the effect of transanal minimally invasive surgery on fecal continence is not available. Objective: The purpose of this work was to prospectively assess the functional outcome after transanal minimally invasive surgery using the Fecal Incontinence Severity Index preoperatively and postoperatively. Design: This was a prospective cohort study. Settings: The study was conducted at a large teaching hospital. Patients: Patients included those who underwent transanal minimally invasive surgery between October 2011 and September 2013. Interventions: Transanal minimally invasive surgery was studied. Main Outcome Measures: We measured postoperative surgical and functional results. Results: A total of 37 patients underwent transanal minimally invasive surgery during our study period. Shortterm morbidity rate was 14%, and positive resection margins were reported in 6 cases (16%); in 1 of these patients, a local recurrence was observed. Overall, there was a significant decline in preoperative and postoperative Fecal Incontinence Severity Index scores (p = 0.02), indicating an improvement in anorectal function after transanal minimally invasive surgery for patients with impaired preoperative continence. Seventeen patients (49%) had impaired continence before transanal minimally invasive surgery (mean Fecal Incontinence Severity Index score = 21). Continence improved in 15 (88%) of these patients after surgery; no change was observed in 1 patient (6%), and continence further decreased in another. In addition, 18 patients (51%) had normal preoperative continence (Fecal Incontinence Severity Index score = 0), of which 83% had no change in functionality, and continence decreased in 3. Limitations: No quality of life was measured. Conclusions: Short-term functional results of transanal minimally invasive surgery for rectal polyps are excellent and comparable to functional results using the dedicated transanal endoscopic microsurgery equipment. More research on outcome after transanal minimally invasive surgery is needed to assess morbidity rates and oncologic clearance. © The ASCRS 2014.

van Broekhoven D.L.M.,Netherlands Cancer Institute | Grunhagen D.J.,Netherlands Cancer Institute | den Bakker M.A.,Maasstad ziekenhuis and Erasmus MC | van Dalen T.,Diakonessenhuis | Verhoef C.,Netherlands Cancer Institute
Annals of Surgical Oncology | Year: 2015

Background: Aggressive fibromatosis (AF) is a locally infiltrating soft-tissue tumor. In a population-based study in the Netherlands, we evaluated time trends for the incidence and treatment of AF. Methods: In PALGA: Dutch Pathology Registry, all patients diagnosed between 1993 and 2013 as having extra-abdominal or abdominal wall aggressive fibromatosis were identified and available pathology data of the patients were evaluated. Epidemiological and treatment-related factors were analyzed with χ2and regression analysis. Results: During the study period, 1134 patients were identified. The incidence increased from 2.10 to 5.36 per million people per year. Median age at the time of diagnosis increased annually by B 0.285 (P = 0.001). Female gender prevailed and increased over time [annual odds ratio (OR) 1.022; P = 0.058]. All anatomic localizations, but in particular truncal tumors, became more frequent. During the study period diagnostic histological biopsies were performed more often (annual OR 1.096; P < 0.001). The proportion of patients who underwent surgical treatment decreased (annual OR 0.928; P < 0.001). When resection was preceded by biopsy, 49.8 % of the patients had R0-resection versus 30.7 % in patients without biopsy (P < 0.001). Conclusions: In this population-based study, an increasing incidence of extra-abdominal and abdominal-wall aggressive fibromatosis was observed. The workup of patients improved and a trend towards a nonsurgical treatment policy was observed. © 2015, The Author(s).

Furnee E.,Diakonessenhuis | Hazebroek E.,St Antonius Hospital
Surgical Endoscopy and Other Interventional Techniques | Year: 2013

Background The use of mesh is becoming more popular for large hiatal hernia (type II-IV) repair to reduce the recurrence rate. The aim of this study was to outline the currently available literature on the use of mesh in laparoscopic large hiatal hernia repair, emphasizing objective outcome. Methods A structured search of the literature was performed in the Medline, Embase, and Cochrane Central Register of Controlled Trials databases. Results A total of 26 studies met the inclusion criteria. There were three randomized controlled trials, seven prospective and five retrospective cohort studies, and five prospective and one retrospective case-control study. The study design was not reported in the remaining studies. In the included studies, laparoscopic hiatal hernia repair was performed with mesh in 924 patients (mesh group) and without mesh in 340 patients (nonmesh group). The type of mesh used was very different: polypropylene in six, biomesh in nine, polytetrafluoroethylene (PTFE) in two, expanded PTFE (ePTFE) in two, and composite polypropylene- PTFE in another two. At least two different kinds of mesh were used in five studies. Radiological and/or endoscopic follow-up was performed after a mean (±SEM) period of 25.2 ± 4.0 months. There was no or only a small recurrence (recurrent hiatal hernia≤2 cm) in 385 of the 451 available patients (85.4 %) in the mesh group and in 182 of 247 (73.7 %) in the nonmesh group. Conclusions The use of mesh in the repair of large hiatal hernias is promising with respect to the reduction of anatomical recurrences. However, many different kinds and configurations of mesh are available. This systematic review of the literature is a basis for high-quality randomized controlled trials to obtain the most effective and safe mesh in the long term. © Springer Science+Business Media New York 2013.

Hamaker M.E.,Diakonessenhuis | Mitrovic M.,Innsbruck Medical University | Stauder R.,Innsbruck Medical University
Annals of Hematology | Year: 2014

The G8 screening tool was developed to separate fit older cancer patients who were able to receive standard treatment from those that should undergo a geriatric assessment to guide tailoring of therapy. We set out to determine the discriminative power and prognostic value of the G8 in older patients with a haematological malignancy. Between September 2009 and May 2013, a multi-dimensional geriatric assessment was performed in consecutive patients aged ≥67 years diagnosed with blood cancer at the Innsbruck University Hospital. The assessment included (instrumental) activities of daily living, cognition, mood, nutritional status, mobility, polypharmacy and social support. In parallel, the G8 was also administered (cut-off ≤ 14). Using a cut-off of ≥2 impaired domains, 70 % of the 108 included patients were considered as having an impaired geriatric assessment while 61 % had an impaired G8. The G8 lacked discriminative power for impairments on full geriatric assessment: sensitivity 69, specificity 79, positive predictive value 89 and negative predictive value 50 %. However, G8 was an independent predictor of mortality within the first year after inclusion (hazard ratio 3.93; 95 % confidence interval 1.67-9.22, p<0.001). Remarkably, patients with impaired G8 fared poorly, irrespective of treatment choices (p<0.001). This is the first report on the clinical and prognostic relevance of G8 in elderly patients with haematological malignancies. Although the G8 lacked discriminative power for outcome of multi-dimensional geriatric assessment, this score appears to be a powerful prognosticator and could potentially represent a useful tool in treatment decisions. This novel finding certainly deserves further exploration. © 2014 Springer-Verlag.

van Lieshout A.,Diakonessenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2010

Anal cancer is a rare malignancy with a rapidly rising incidence. The most important risk factor for anal cancer is persistent infection with Human papillomavirus (HPV). In the Netherlands, the incidence of anal cancer increased from 71 to 149 new patients each year over the period 1989-2006. There has been a corresponding overall increase in mortality, although the exact level differs per year. Not enough research has been done to date to clarify why the incidence of anal cancer is increasing.

To compare the clinical competencies of second-year anaesthesiology residents and physician assistants (PA) in the preoperative anaesthesiology outpatient clinic. Comparative qualitative observational study. The two study groups were compared using 5 test stations representing 5 different cases of varying degrees of complexity with standardized patients. For each case, the patients and two anaesthesiologists assessed the results of the PAs and the residents using a quantitative scoring system for 4 clinical skills relevant to the preoperative anaesthesiology outpatient clinic. These skills were history-taking, physical examination, communication, and reporting. At each station, a score was calculated for each skill. The groups' scores were subsequently compared. 9 PAs and 11 residents carried out the station tests. There were no significant differences between the two groups of participants. In this study in a preoperative anaesthesiology outpatient clinic no difference in clinical competencies was found between PAs and second-year anaesthesiology residents.

Bokhorst L.P.,Diakonessenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2011

Cataracts are the most important cause of acquired blindness worldwide. The oldest known surgical treatment for cataracts dates back to around 1,000 years before Christ. The Indian surgeon Sushruta described the technique of 'couching', in which the opaque lens is pushed from the line of vision using a needle. At the time of Alexander the Great this technique spread across Europe and then to the rest of the world. Couching was the only available treatment for cataracts for a long time, until the discovery of lens extraction by Jacques Daviel in 1748. Since then lens extraction has replaced couching in the western world, because of poor results and high complication rates. This procedure is, however, still practiced in areas of Africa and Asia.

van Roeden S.E.,Diakonessenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2013

Domperidone is an antiemetic drug with relatively few side-effects. In the Netherlands, domperidone is available over the counter. Recently, discussion on the safety of domperidone has arisen because an association with sudden cardiac death has been suggested. We performed a systematic literature search to investigate whether these concerns can be justified. Three out of four case-control studies found statistically significant increased odds ratios for sudden cardiac death when using domperidone. A dose-response relationship was described in one study. Results may be influenced by several confounders. We conclude that there is a relationship between domperidone use and sudden cardiac death at doses of more than 30 mg per day. We recommend that the indication be weighed up properly, that domperidone be provided only on prescription, and dose advice be given. At a dose of 30 mg per day, domperidone can be prescribed safely.

Pouw C.A.,Diakonessenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2013

Nowadays, cataract surgery is the most commonly performed surgical procedure in the Netherlands. This is due to the increasing incidence of cataracts, the changing indication for surgery in our society where good vision is becoming increasingly important, and the quality of the operation. How was this modern procedure developed? Cataracts were treated by couching until the middle of the 18th century. Since then, many discoveries by a number of doctors changed the procedure gradually from couching to lens extraction and through extracapsular to intracapsular extraction with the simultaneous implantation of an intraocular lens. This article outlines the development and also discusses some of the many inventions in the field of instrumentation and materials that have brought this intervention to its current high level; these include the cryo-probe, implantation of artificial lenses, the use of hyaluronic acid, phaco-emulsification, smaller incisions without sutures and the development of foldable intraocular lenses.

Kolman S.A.M.,Diakonessenhuis
Journal of Human Hypertension | Year: 2016

Longstanding and therapy-resistant hypertension may cause cerebral, renal, cardiac and retinal end-organ damage (EOD). Retinal hypertensive abnormalities are correlated with an increased risk of cardiovascular (CV) disease in general but are not included in CV risk assessment tools. Research into prevalence and determinants of retinal organ damage, such as hypertensive retinopathy (HR), is scarce. We evaluated the prevalence of HR and the association with other signs of EOD in patients with hypertension. A retrospective observational study was performed in all hypertensive patients referred by a general practitioner to the hypertension clinic at the Diakonessenhuis, Utrecht and Zeist, the Netherlands between 2011 and 2013. A screening of risk factors, albuminuria, left-ventricular hypertrophy (LVH) and retinal fundoscopy was performed. In all, 44% (123/280) of patients referred to the clinic were diagnosed with HR, while 15 and 11% were diagnosed with LVH and microalbuminuria, respectively. Patients with isolated HR consisted of 31% of all patients. When HR was added as a form of EOD, the percentage of patients with a treatment indication increased from 3 to 14%. Patients who were already on treatment goal exhibited a high prevalence of HR (28%), warranting treatment intensification. HR is prevalent in a third of hypertensive patients referred to our clinic, and isolated HR accounts for the majority of (end-) organ damages. Fundoscopy in the evaluation of hypertension might improve the indication for therapy. Furthermore, diagnosing HR could be helpful in selecting patients with hypertension on treatment goal in need of more aggressive treatment.Journal of Human Hypertension advance online publication, 28 July 2016; doi:10.1038/jhh.2016.49. © 2016 Macmillan Publishers Limited

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