Gelre Hospital

Apeldoorn, Netherlands

Gelre Hospital

Apeldoorn, Netherlands
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Hofhuis J.G.M.,Gelre Hospital | van Stel H.F.,University Utrecht | Schrijvers A.J.P.,University Utrecht | Rommes J.H.,Gelre Hospital | Spronk P.E.,Gelre Hospital
Critical Care | Year: 2013

Introduction: Acute kidney injury (AKI) is a serious complication in critically ill patients admitted to the Intensive Care Unit (ICU). We hypothesized that ICU survivors with AKI would have a worse health-related quality of life (HRQOL) outcome than ICU survivors without AKI. Methods: We performed a long-term prospective observational study. Patients admitted for > 48 hours in a medical-surgical ICU were included and divided in two groups: patients who fulfilled RIFLE criteria for AKI and patients without AKI. We used the Short-Form 36 to evaluate HRQOL before admission (by proxy within 48 hours after admission of the patient), at ICU discharge, hospital discharge, 3 and 6 months following ICU discharge (all by patients). Recovery in HRQOL from ICU-admission onwards was assessed using linear mixed modelling. Results: Between September 2000 and January 2007 all admissions were screened for study participation. We included a total of 749 patients. At six months after ICU discharge 73 patients with AKI and 325 patients without AKI could be evaluated. In survivors with and without AKI, the pre-admission HRQOL (by proxy) and at six months after ICU discharge was significantly lower compared with an age matched general population. Most SF-36 dimensions changed significantly over time from ICU discharge. Change over time of HRQOL between the different AKI Rifle classes (Risk, Injury, Failure) showed no significant differences. At ICU discharge, scores were lowest in the group with AKI compared with the group without AKI for the physical functioning, role-physical and general health dimensions. However, there were almost no differences in HRQOL between both groups at six months.Conclusions: The pre-admission HRQOL (by proxy) of AKI survivors was significantly lower in two dimensions compared with the age matched general population. Six months after ICU discharge survivors with and without AKI showed an almost similar HRQOL. However, compared with the general population with a similar age, HRQOL was poorer in both groups. © 2013 Hofhuis et al.; licensee BioMed Central Ltd.


Cense H.A.,Red Cross | Engel A.F.,Zaans Medical Center | Gerhards M.F.,Onze Lieve Vrouwe Gasthuis | Van Wagensveld B.A.,Sint Lucas Andreas Hospital | And 2 more authors.
Annals of Surgery | Year: 2011

OBJECTIVE:: To investigate which perioperative treatment, ie, laparoscopic or open surgery combined with fast track (FT) or standard care, is the optimal approach for patients undergoing segmental resection for colon cancer. SUMMARY BACKGROUND DATA:: Important developments in elective colorectal surgery are the introduction of laparoscopy and implementation of FT care, both focusing on faster recovery. METHODS:: In a 9-center trial, patients eligible for segmental colectomy were randomized to laparoscopic or open colectomy, and to FT or standard care, resulting in 4 treatment groups. Primary outcome was total postoperative hospital stay (THS). Secondary outcomes were postoperative hospital stay (PHS), morbidity, reoperation rate, readmission rate, in-hospital mortality, quality of life at 2 and 4 weeks, patient satisfaction and in-hospital costs. Four hundred patients were required to find a minimum difference of 1 day in hospital stay. RESULTS:: Median THS in the laparoscopic/FT group was 5 (interquar-tile range: 4-8) days; open/FT 7 (5-11) days; laparoscopic/standard 6 (4.5-9.5) days, and open/standard 7 (6-13) days (P < 0.001). Median PHS in the laparoscopic/FT group was 5 (4-7) days; open/FT 6 (4.5-10) days; laparoscopic/standard 6 (4-8.5) days and open/standard 7 (6-10.5) days (P < 0.001). Secondary outcomes did not differ significantly among the groups. Regression analysis showed that laparoscopy was the only independent predictive factor to reduce hospital stay and morbidity. CONCLUSIONS:: Optimal perioperative treatment for patients requiring segmental colectomy for colon cancer is laparoscopic resection embedded in a FT program. If open surgery is applied, it is preferentially done in FT care. This study was registered under NTR222 (www.trialregister.nl). Copyright C © 2011 by Lippincott Williams & Wilkins.


Raven E.E.J.,Gelre Hospital | Ottink K.D.,Gelre Hospital | Doets K.C.,Slotervaart Hospital
Journal of Hand Surgery | Year: 2012

We evaluated long-term results for radiolunate and radioscapholunate arthrodeses for patients with rheumatoid or psoriatic arthritis to determine the durability and efficacy of the procedures. The results are described and compared with those in the literature. We carried out arthrodesis of the radiolunate joint (33 wrists) and the radioscapholunate joint (13 wrists) to achieve pain reduction and ulnar translation of the carpus in patients with rheumatoid (42 wrists) or psoriatic arthritis (4 wrists). At follow-up, 11 patients (13 wrists) had died, 2 patients (4 wrists) were lost to follow-up, and in 6 wrists an additional midcarpal arthrodesis had been performed. We evaluated the remaining 23 wrists (19 radiolunate and 4 radioscapholunate, and 1 psoriatic arthritic wrist) after a mean of 11 years. Clinical outcome was good, with a mean visual analog score of 2 out of 10 for pain, mean grip strength of 13 kg, and mean range of flexion-extension of 60°. Outcomes as measured by questionnaires were good. Radiographs demonstrated deterioration of all intracarpal joints as noted by an increased Larsen score and evidence of carpal translation. We noted no significant change in carpal height. Despite radiographic progression, radiolunate and radioscapholunate arthrodeses yield good clinical results at long-term follow-up. Therapeutic IV.


Willemink M.J.,University Utrecht | Leiner T.,University Utrecht | De Jong P.A.,University Utrecht | De Heer L.M.,Cardiothoracic Surgery | And 4 more authors.
European Radiology | Year: 2013

Objectives: To present the results of a systematic literature search aimed at determining to what extent the radiation dose can be reduced with iterative reconstruction (IR) for cardiopulmonary and body imaging with computed tomography (CT) in the clinical setting and what the effects on image quality are with IR versus filtered back-projection (FBP) and to provide recommendations for future research on IR. Methods: We searched Medline and Embase from January 2006 to January 2012 and included original research papers concerning IR for CT. Results: The systematic search yielded 380 articles. Forty-nine relevant studies were included. These studies concerned: the chest(n = 26), abdomen(n = 16), both chest and abdomen(n = 1), head(n = 4), spine(n = 1), and no specific area (n = 1). IR reduced noise and artefacts, and it improved subjective and objective image quality compared to FBP at the same dose. Conversely, low-dose IR and normal-dose FBP showed similar noise, artefacts, and subjective and objective image quality. Reported dose reductions ranged from 23 to 76 % compared to locally used default FBP settings. However, IR has not yet been investigated for ultra-low-dose acquisitions with clinical diagnosis and accuracy as endpoints. Conclusion: Benefits of IR include improved subjective and objective image quality as well as radiation dose reduction while preserving image quality. Future studies need to address the value of IR in ultra-low-dose CT with clinically relevant endpoints. Key Points: • Iterative reconstruction improves image quality of CT images at equal acquisition parameters. • IR preserves image quality compared to normal-dose filtered back-projection. • The reduced radiation dose made possible by IR is advantageous for patients. • IR has not yet been investigated with clinical diagnosis and accuracy as endpoints. © 2013 European Society of Radiology.


Bruintjes T.D.,Gelre Hospital | Companjen J.,Amphia Hospital | van der Zaag-Loonen H.J.,Gelre Hospital | van Benthem P.P.G.,Gelre Hospital
Clinical Otolaryngology | Year: 2014

Objective: To evaluate the long-term efficacy of the Epley manoeuvre as a therapeutic procedure for posterior canal benign paroxysmal positional vertigo. Design: Randomised, double-blind, sham-controlled trial. Setting: A multidisciplinary dizziness unit in a non-academic Hospital. Participants: Forty-four patients with posterior canal benign paroxysmal positional vertigo (BPPV) with a duration of at least 1 month. Participants were randomised in two groups of 22 and treated with either the Epley manoeuvre or a sham manoeuvre and followed up for 1 year after treatment. Main outcome measures: Conversion of a 'positive' Dix-Hallpike test to a 'negative' Dix-Hallpike test, impairments perceived by the dizziness assessed by the Dizziness Handicap Inventory (DHI). Statistical analysis: Absolute and relative risks were computed, and Fisher's exact test was used to compare the treatments. Results: Six patients were lost to follow up (five in the sham group, one in the Epley group). The Epley procedure resulted in a treatment success in 20/22 patients (91%) after 12 months of follow-up, whereas the sham procedure had a positive effect in 10/22 patients (46%; P = 0.001). The DHI was significantly lower in the Epley group at all follow-up assessments (median scores 12 months 0 (0-51) versus 20 (0-76), P = 0.003). Conclusion: The Epley manoeuvre provides long-term resolution of symptoms in patients with posterior canal BPPV. © 2014 John Wiley & Sons Ltd.


Elschot M.,University Utrecht | Nijsen J.F.W.,University Utrecht | Dam A.J.,University Utrecht | Dam A.J.,Gelre Hospital | de Jong H.W.A.M.,University Utrecht
PLoS ONE | Year: 2011

Background: Scintillation camera imaging is used for treatment planning and post-treatment dosimetry in liver radioembolization (RE). In yttrium-90 (90Y) RE, scintigraphic images of technetium-99m (99mTc) are used for treatment planning, while 90Y Bremsstrahlung images are used for post-treatment dosimetry. In holmium-166 (166Ho) RE, scintigraphic images of 166Ho can be used for both treatment planning and post-treatment dosimetry. The aim of this study is to quantitatively evaluate and compare the imaging characteristics of these three isotopes, in order that imaging protocols can be optimized and RE studies with varying isotopes can be compared. Methodology/Principal Findings: Phantom experiments were performed in line with NEMA guidelines to assess the spatial resolution, sensitivity, count rate linearity, and contrast recovery of 99mTc, 90Y and 166Ho. In addition, Monte Carlo simulations were performed to obtain detailed information about the history of detected photons. The results showed that the use of a broad energy window and the high-energy collimator gave optimal combination of sensitivity, spatial resolution, and primary photon fraction for 90Y Bremsstrahlung imaging, although differences with the medium-energy collimator were small. For 166Ho, the high-energy collimator also slightly outperformed the medium-energy collimator. In comparison with 99mTc, the image quality of both 90Y and 166Ho is degraded by a lower spatial resolution, a lower sensitivity, and larger scatter and collimator penetration fractions. Conclusions/Significance: The quantitative evaluation of the scintillation camera characteristics presented in this study helps to optimize acquisition parameters and supports future analysis of clinical comparisons between RE studies. © 2011 Elschot et al.


Kloosterman W.P.,University Utrecht | Guryev V.,University Utrecht | van Roosmalen M.,University Utrecht | Duran K.J.,University Utrecht | And 7 more authors.
Human Molecular Genetics | Year: 2011

A variety of mutational mechanisms shape the dynamic architecture of human genomes and occasionally result in congenital defects and disease. Here, we used genome-wide long mate-pair sequencing to systematically screen for inherited and de novo structural variation in a trio including a child with severe congenital abnormalities. We identified 4321 inherited structural variants and 17 de novo rearrangements. We characterized the de novo structural changes to the base-pair level revealing a complex series of balanced inter- and intra-chromosomal rearrangements consisting of 12 breakpoints involving chromosomes 1, 4 and 10. Detailed inspection of breakpoint regions indicated that a series of simultaneous double-stranded DNA breaks caused local shattering of chromosomes. Fusion of the resulting chromosomal fragments involved non-homologous end joining, since junction points displayed limited or no homology and small insertions and deletions. The pattern of random joining of chromosomal fragments that we observe here strongly resembles the somatic rearrangement patterns-termed chromothripsis-that have recently been described in deranged cancer cells. We conclude that a similar mechanism may also drive the formation of de novo structural variation in the germline. © The Author 2011. Published by Oxford University Press. All rights reserved.


Willemink M.J.,University Utrecht | De Jong P.A.,University Utrecht | Leiner T.,University Utrecht | De Heer L.M.,University Utrecht | And 4 more authors.
European Radiology | Year: 2013

Objectives: To explain the technical principles of and differences between commercially available iterative reconstruction (IR) algorithms for computed tomography (CT) in non-mathematical terms for radiologists and clinicians. Methods: Technical details of the different proprietary IR techniques were distilled from available scientific articles and manufacturers' white papers and were verified by the manufacturers. Clinical results were obtained from a literature search spanning January 2006 to January 2012, including only original research papers concerning IR for CT. Results: IR for CT iteratively reduces noise and artefacts in either image space or raw data, or both. Reported dose reductions ranged from 23 % to 76 % compared to locally used default filtered back-projection (FBP) settings, with similar noise, artefacts, subjective, and objective image quality. Conclusion: IR has the potential to allow reducing the radiation dose while preserving image quality. Disadvantages of IR include blotchy image appearance and longer computational time. Future studies need to address differences between IR algorithms for clinical low-dose CT. Key Points: • Iterative reconstruction technology for CT is presented in non-mathematical terms. • IR reduces noise and artefacts compared to filtered back-projection. • IR can improve image quality in routine-dose CT and lower the radiation dose. • IR's disadvantages include longer computation and blotchy appearance of some images. © 2013 European Society of Radiology.


Van Den Broek E.M.J.M.,Gelre Hospital | Van Der Zaag-Loonen H.J.,Gelre Hospital | Bruintjes T.D.,Gelre Hospital
Otolaryngology - Head and Neck Surgery (United States) | Year: 2014

Objective. In this rapid systematic review, we studied the efficacy of the Gufoni maneuver for the treatment of lateral canal benign paroxysmal positional vertigo (BPPV) with geotropic nystagmus. Methods. A comprehensive search, including PubMed, Embase, Web of Science, and Cochrane as data sources, resulted in 44 original papers for randomized trials that compared the Gufoni maneuver with other maneuvers (date of search: April 23, 2013). Three studies (389 patients) remained after screening of title, abstract, and full text. Results. After method assessment, 2 of these 3 studies were considered to have a low risk of bias and a high level of validity. The third study did not properly report the treatment allocation and blinding; moreover, outcome data were incomplete. The first 2 studies compared the Gufoni maneuver with a sham maneuver (and the barbecue roll in one study). The third study compared the Gufoni maneuver with a treatment with vestibular suppressants and with the barbecue roll (plus forced prolonged positioning). All 3 studies reported short-term results. Midterm results (1 month) were reported in 2 studies. Conclusion and Recommendation. Given the variety in the comparative treatments and follow-up duration, all 3 studies showed that the Gufoni maneuver was more effective than the sham maneuver or treatment with vestibular suppressants. All agreed that the maneuver was easy to perform, which made it suitable for older, immobile, and obese patients. However, there were insufficient data to establish the relative efficacy of the Gufoni maneuver compared with other maneuvers. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2014.


Habets J.,University Utrecht | Habets J.,Gelre Hospital | Mali W.P.T.M.,University Utrecht | Budde R.P.J.,University Utrecht | Budde R.P.J.,Gelre Hospital
Radiographics | Year: 2012

Prosthetic heart valves (PHVs) are commonly implanted to replace diseased native heart valves. PHV dysfunction is an infrequent but potentially life-threatening condition. In daily clinical practice, transthoracic and transesophageal echocardiography and fluoroscopy are the imaging modalities used for diagnostic evaluation of suspected PHV dysfunction. These modalities may not allow determination of the cause of PHV dysfunction, mostly because of acoustic shadowing. Multidetector computed tomographic (CT) angiography is a promising complementary technique for evaluation of PHVs, especially in patients with PHV obstruction and endocarditis. The CT image quality of PHVs mainly depends on their composition, with most causing only limited artifacts. Retrospectively electrocardiographically gated acquisition is advisable for PHV imaging because it enables dynamic leaflet evaluation and anatomic assessment in both systole and diastole. For accurate image interpretation, dedicated reconstruction in plane with and perpendicular to the PHV leaflets is mandatory. Besides PHV assessment, CT also provides information on the coronary arteries, the location and patency of bypass grafts, the dimensions of the aorta, and the distance between the sternum and right ventricle, information valuable for planning repeat surgery. To achieve the optimal diagnostic yield in PHV imaging, multidisciplinary cooperation between the departments of cardiology, cardiothoracic surgery, and radiology is crucial. © RSNA, 2012.

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