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Apeldoorn, Netherlands

Schipperus M.,HagaZiekenhuis
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. Source


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. Source


Van Der Rhee H.,HagaZiekenhuis | Coebergh J.W.,Erasmus MC | Coebergh J.W.,Comprehensive Cancer Center South | De Vries E.,Erasmus MC
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. Source


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. Source


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. Source

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