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Apeldoorn, Netherlands

De Ru J.A.,Central Military Hospital | Van Benthem P.P.G.,Gelre Ziekenhuizen
Otology and Neurotology

Objective: To critically appraise the topic, questioning whether administering antiviral medication in case of Ramsay Hunt syndrome improves the restoration of facial nerve function. Methods: We reviewed the literature on this subject and calculated the odds ratios for the different treatment modalities. Results: Our study clearly shows that antiviral medication in combination with corticosteroids improves the outcome for patients with Ramsay Hunt syndrome. Conclusion: Contrary to a recent Cochrane Library review, we conclude that patients with Ramsay Hunt syndrome should be treated with combination therapy including antivirals. Copyright © 2011 Otology & Neurotology, Inc. Source

Bouhbouh S.,Gelre Ziekenhuizen
Nederlands tijdschrift voor geneeskunde

A central venous catheter was inserted in a 37-year-old man. During placement the catheter took a route to the left side of the heart. On CT it appeared the catheter was placed in a persisting left V. cava superior. Source

To assess interobserver agreement between pathologists in judging photographs of lymph node preparations of occult tumour cells of patients with colon cancer. Descriptive and comparative study of interobserver variability. All lymph nodes of 82 pN0 patients with colon cancer were analysed using three monoclonal antibodies against epithelial cells. Digital pictures of the 37 lesions detected were placed on a secured website. Forty pathologists selected at random were asked to examine the pictures and to categorize the lesions into 'micro metastases', 'isolated tumour cells' or something else. The degree of agreement was calculated by the Kendall W coefficient (with a range of 0.0-1.0). Thirty-five pathologists (88%) categorized the 37 lesions. Five lesions (14%) were categorized unanimously as micro metastases or isolated tumour cells. In 26 pictures (70%) the degree of agreement was poor to moderate. When the analysis was performed only on those diagnoses of which the pathologists were confident about their judgment, the percentage of lesions with good agreement rose to 49%. Differences in agreement were principally associated with multifocal lesions, clusters of tumour cells < 0.2 mm with proliferation characteristics in the parenchyma of the lymph node and lymphangio invasion. The differentiation between micro metastases and isolated tumour cells in lymph nodes of patients with colon cancer was not uniform. If this classification has clinical relevance to colon cancer then better definitions are needed. Source

Donswijk L.F.,Gelre Ziekenhuizen | Gale E.A.M.,University of Bristol
BMJ (Online)

Objective: To determine whether trial publications of glucose lowering drugs are dominated by a small group of highly prolific authors ("supertrialists") and to identify some of their characteristics. Design: Bibliographic analysis of trial publications. Data sources and review methods We searched PubMed for all randomised controlled trials (RCTs) relating to glucose lowering drugs published between 1 January 1993 and 31 December 2013. From these publications we identified the 110 most prolific authors using PubReMiner. The 991 RCTs they published were examined for various characteristics such as author number, commercial sponsorship, company authorship, conflicts of interest, etc. The track record of the top 11 authors was studied in more detail. Main outco me measure: Proportion of articles published by the top 110 and the top 11 authors. Results: 3782 articles from 13 592 authors were identified. The top 110 authors were named in 1227 (32.4%) of all articles, and the top 11 authors in 397 (10.5%) of all articles. The top 110 authors published 991 RCTs for a median of 20 (range 4-77) RCTs per author; the top 11 published 354 RCTs for a median of 42 (36-77) RCTs per author. Of the 110 top authors, 48 were employed by a pharmaceutical company. Of the 991 RCTs, 906 were commercially sponsored. Of 704 articles that could be assessed for conflicts of interest, only 42 (6%) were considered fully independent. Medical writing assistance was acknowledged in 439 (44.3%) of 991 RCTs. Conclusion: The past two decades have seen an explosive increase in the number of published clinical trials regarding glucose lowering treatment. Some authors have made a disproportionate contribution to the therapeutic evidence base; one third of the RCT evidence base on glucose lowering drug treatment for diabetes was generated by less than 1% of authors. Of these, 44% were company employees and 56% were academics who work closely with the pharmaceutical companies. ©BMJ Publishing Group Ltd 2015. Source

Van Der Zaag E.S.,Gelre Ziekenhuizen
Gastrointestinal Endoscopy

Background: In colorectal cancer (CRC), colonoscopic tattooing is performed to mark the tumor site before laparoscopic surgery. Objective: To determine whether colonoscopic tattooing can be used to refine staging accuracy by increasing the lymph node (LN) yield per specimen and to determine its accuracy as a sentinel LN procedure. Design: Retrospective, case-control study. All LNs were microscopically examined for the presence of carbon particles. Setting: A university hospital and a teaching hospital. Patients: A consecutive series of 95 tattooed patients who had surgery for CRC between 2005 and 2009. A series of 210 non-tattooed patients who had surgery in the same time period served as controls. Main Outcome Measurements: Total number of LNs retrieved, detection rate, and sensitivity of tattooing as a sentinel node procedure. Results: A higher LN yield was observed in patients with preoperative tattooing, median (interquartile range) 15 (10-20) versus 12 (9-16), (P =.014). In multivariable analysis, the presence of carbon-containing LNs was an independent predictive factor for a higher LN yield (P =.002). The detection rate was 71%, with a median of 5 carbon-containing LNs per specimen. If preoperative tattooing was used for sentinel node mapping, the overall accuracy of predicting LN status was 94%. In the 24 N1 cases, there were 4 false-negative procedures (sensitivity 83%). Limitations: Retrospective series. Conclusion: After tattooing of CRC, the LN yield was higher than in a control group, and it could be used as a sentinel node procedure with acceptable accuracy rates. Because LN yield and sentinel node mapping are associated with improved diagnostic accuracy of LN involvement, preoperative tattooing can refine staging. © 2012 American Society for Gastrointestinal Endoscopy. Source

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