The Hague, Netherlands


The Hague, Netherlands
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Coebergh J.A.,HagaZiekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2010

Two patients presented to Accidents and Emergency with severe neck pain: a 70-year-old woman with acute, severe neck pain, which had developed a few days after outpatient resection of her left lingual tonsil. The patient was suspected to have spondylodiscitis. The other patient, a 54-year-old woman, was referred with severe neck pain and suspected meningitis. In both women, the pain was diagnosed as acute calcifying tendonitis of the longus colli muscle. This benign condition can present to many different specialities. Both patients responded well to treatment with NSAIDs. Acute calcifying tendonitis of the longus colli muscle can be diagnosed using various imaging techniques, such as X-ray, CT or MRI imaging. Calcification on cervical CT or a high signal on T2-weighted MRI images of the longus colli muscle are pathognomonic of tendonitis. A correct diagnosis can prevent further invasive diagnostics and/or unnecessary treatment.

Wolfram's syndrome is a rare neurodegenerative disorder, which usually first manifests itself around the age of 6 years. The diagnosis can be made based on the characteristics incorporated in the 'DIDMOAD' acronym: diabetes insipidus, diabetes mellitus, optic atrophy and deafness. We present 2 boys, diagnosed with diabetes mellitus at the age of 5 and 4 years respectively. Both children developed optic atrophy over the years. These 2 cases illustrate that alongside diabetic retinopathy, possible syndromes, such as Wolfram's syndrome, should also be considered in children with diabetes mellitus and visual impairment.

Schipperus M.,HagaZiekenhuis | Fijnheer R.,Meander Medisch Centrum
Netherlands Journal of Medicine | Year: 2011

Understanding of the mechanisms and aetiology of immune thrombocytopenia (IT P) has progressed significantly in recent years. It is now recognised to be an autoimmune condition, involving not only platelet destruction, but also deficits in platelet production. This has led to widespread research exploring potential mechanisms for therapy, the result of which has been the development of romiplostim and eltrombopag. These new treatments target the thrombopoietin receptor (TPO-R), promoting formation of megakaryocytes and survival of platelets. Furthermore, the advances in the understanding of IT P have led to the production of guidelines to assist healthcare professionals in the diagnosis and treatment of IT P. This review examines the recommendations made in these guidelines, particularly the American Society of Haematology (AS H) 2011 evidence-based practice guidelines. In addition, searches were carried out to retrieve information on clinical trials of new molecules and off-label treatments for IT P. Corticosteroids, anti-Rho(D) immunoglobulins (anti-D), intravenous immunoglobulins (IVIg) and splenectomy are well-established treatments and continue to be recommended in the guidelines. The recently available romiplostim and eltrombopag, which are specific for treatment of IT P, are also included in the recommendations. The only off-label therapy to be recommended in the guidelines is the chimeric monoclonal antibody rituximab. However, investigations are ongoing into products approved for other indications, which may be beneficial to patients suffering from refractory IT P. © Van Zuiden Communications B.V. All rights reserved.

Van Der Rhee H.,Hagaziekenhuis | Coebergh J.W.,Erasmus University Rotterdam | Coebergh J.W.,Comprehensive Cancer Center South | De Vries E.,Erasmus University Rotterdam
European Journal of Cancer | Year: 2013

The number of studies reporting on the association between sunlight exposure, vitamin D and cancer risk is steadily increasing. We reviewed all published case-control and cohort studies concerning colorectal-, prostate-, breast cancer, non-Hodgkin's lymphoma (NHL) and both sunlight and vitamin D to update our previous review and to verify if the epidemiological evidence is in line with the hypothesis that the possible preventive effect of sunlight on cancer might be mediated not only by vitamin D but also by other pathways. We found that almost all epidemiological studies suggest that chronic (not intermittent) sun exposure is associated with a reduced risk of colorectal-, breast-, prostate cancer and NHL. In colorectal- and to a lesser degree in breast cancer vitamin D levels were found to be inversely associated with cancer risk. In prostate cancer and NHL, however, no associations were found. These findings are discussed and it is concluded that the evidence that sunlight is a protective factor for colorectal-, prostate-, breast cancer and non-Hodgkin's lymphoma is still accumulating. The same conclusion can be drawn concerning high vitamin D levels and the risk of colorectal cancer and possibly breast cancer. Particularly in prostate cancer and NHL other sunlight potentiated and vitamin D independent pathways, such as modulation of the immune system and the circadian rhythm, and the degradation of folic acid might play a role in reduced cancer risk as well. © 2012 Elsevier Ltd. All rights reserved.

Samson A.D.,Hagaziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2012

Immune thrombocytopenic purpura (ITP) is a multicausal disease. In the majority of cases, autoimmune antibodies against thrombocytes and other autoimmune processes play a role. However, in about 20% of cases an underlying cause can be identified. Recently, Helicobacter pylori infection was recognized as one of these underlying causes. We present two patients with ITP in whom a significant increase of thrombocytes occurred after eradication of H. pylori. In the first patient, a 75-year-old man, experimental therapy was withheld. The second patient, a 47-year-old man, never received immunosuppressive medication. H. pylori screening and eradication should be standard practice in the work up of a patient with thrombocytopenia. Despite the lack of clear pathophysiological understanding, in a minority of ITP cases there is evidence of a correlation between H. pylori infection and ITP. Tests and treatment are non-invasive, cheap and without major side-effects. In the event of a platelet response, expensive immunosuppressive treatment with significant side effects may be avoided.

Russel I.K.,Hagaziekenhuis
Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance | Year: 2011

Increased left ventricular (LV) torsion has been observed in patients with manifest familial hypertrophic cardiomyopathy (HCM), and is thought to be caused by subendocardial dysfunction. We hypothesize that increased LV torsion is already present in healthy mutation carriers with normal wall thickness. Seventeen carriers with an LV wall thickness <10 mm, and seventeen age and gender matched controls had cardiovascular magnetic resonance (CMR) cine imaging and tissue tagging. LV volumes and mass were calculated from the cine images. LV torsion, torsion rate, endocardial circumferential strain and torsion-to-endocardial-circumferential-shortening (TECS) ratio, which reflects the transmural distribution in contractile function, were determined using tissue tagging. LV volumes, mass and circumferential strain were comparable between groups, whereas LV ejection fraction, torsion and TECS-ratio were increased in carriers compared to controls (63 ± 3% vs. 60 ± 3%, p = 0.04, 10.1 ± 2.5° vs. 7.7 ± 1.2°, p = 0.001, and 0.52 ± 0.14°/% vs. 0.42 ± 0.10°/%, p = 0.02, respectively). Carriers with normal wall thickness display increased LV torsion and TECS-ratio with respect to controls, which might be due to subendocardial myocardial dysfunction. As similar abnormalities are observed in patients with manifest HCM, the changes in healthy carriers may be target for clinical intervention to delay or prevent the onset of hypertrophy.

Rampen A.J.J.,HagaZiekenhuis | Wirtz P.W.,HagaZiekenhuis | Tavy D.L.J.,HagaZiekenhuis
Muscle and Nerve | Year: 2011

There exists no 'gold standard' in the treatment of ulnar neuropathy at the elbow (UNE). We treated 7 patients with mild UNE using a local steroid injection with ultrasonographic monitoring. At clinical follow-up after 6 weeks, 4 patients had improved, 2 were stable, and 1 reported an increase in symptoms. Ultrasound-guided steroid injection in mild UNE is safe and could be effective. Further investigation is needed to prove its efficacy. © 2011 Wiley Periodicals, Inc.

Dijksman T.,Hagaziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2011

A 2.5-year-old girl was brought to the ER because of walking difficulties for some time. The girl had bowed legs, frontal bossing and enlargement of the wrists. From X-ray and laboratory findings, it appeared the girl had vitamin D deficient hypocalcaemic rickets.

A 5-year-old boy was seen for a second opinion as he had episodes of severe abdominal pain and a variably distended abdomen. Ultrasonography showed a suspected duplication cyst of the terminal ileum. A laparoscopically assisted resection was performed. Histology confirmed the diagnosis of a duplication cyst. A few months later a 10-year-old boy presented with a history of abdominal pain, diarrhoea and vomiting. Abdominal ultrasonography showed an intussusception halfway up the transverse colon where a cyst was seen with a fluid level. The intussusception was reduced during laparoscopy and resection of the duplication cyst of the ileum was performed. Although intestinal duplication cysts are rare (prevalence 1:4500), it is important to know they exist. Laparoscopically assisted resection is an elegant way of treating duplication cysts in children.

A 3-year-old boy presented at the emergency room with abdominal pain, nausea and non-bilious vomiting. Physical examination revealed moderate symptoms of dehydration, a tender and slightly extended but soft abdomen and active peristalsis. With the working diagnosis of viral gastroenteritis the boy was admitted to the hospital for rehydration therapy by nasogastric tube. After a few days an abdominal X-ray was taken because of bilious vomiting and persistent absence of defecation. Connected foreign bodies were seen in the small intestine. These appeared to be 3 magnetic toy parts. Laparotomy showed that all symptoms were due to a volvulus of the small intestine around a fistula caused by entrapment of the intestinal wall between attracted magnets. Magnetic construction toys can be bought in toy stores in the Netherlands. Vigilance should be exercised with magnetic toys, because ingestion of multiple magnets can cause potentially life-threatening bowel complications.

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