Capelle aan den IJssel, Netherlands
Capelle aan den IJssel, Netherlands

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Sint Nicolaas J.,Erasmus Medical Center | de Jonge V.,Erasmus Medical Center | Cahen D.L.,Amstelland Hospital | Ouwendijk R.J.T.,Ikazia Hospital | And 3 more authors.
Clinical Gastroenterology and Hepatology | Year: 2012

Background & Aims: The efficacy of colorectal cancer screening programs depends on the rate of attendance at surveillance colonoscopy examinations. Increasing patients' awareness about the importance of surveillance might improve attendance, but it is not clear how much they know about their follow-up recommendations. We assessed the awareness of patients with adenomas about their surveillance recommendations. Methods: Ten endoscopy departments provided access to their colonoscopy database for quality assurance; 2 datasets were obtained. We analyzed data from 4000 colonoscopies (400 per department) performed on patients with adenomas. All the patients were mailed a survey to determine how much information they had about their colonoscopy results and their follow-up recommendations. Data from 549 patients were included in the analysis. We also assessed surveillance attendance among 500 patients (50 per department) who had adenomas removed. Results: Of the patients analyzed, 85% recalled retrieval of polyps during their colonoscopy, and 85% recalled whether they needed surveillance or not. The indication for surveillance was recalled by 69% of patients (range between departments, 55%-83%; P < .01). Factors that were associated with awareness of recommendations were younger age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.06-1.09), treatment by a gastroenterologist (OR, 5.53; 95% CI, 3.28-9.32), and presence of 3 or more adenomas (OR, 2.97; 95% CI, 1.29-6.85). Attendance among patients with adenomas varied among departments, from 60% to 89% (P < .01), and was not associated with awareness of patients about their recommendations per department (P = .59). Conclusions: Not enough patients (only 85%) who receive colonoscopies are aware of their results or surveillance recommendations. Although awareness of findings and recommendations did not correlate with follow-up attendance, patients should be better informed about findings and their need for surveillance. © 2012 AGA Institute.


PubMed | Erasmus Medical Center, Leiden University, University of Groningen and IJsselland ziekenhuis
Type: Journal Article | Journal: European journal of human genetics : EJHG | Year: 2016

Biotinidase deficiency is a rare inherited metabolic disorder that can cause severe neurological symptoms. To prevent severe clinical presentations, it was included in the Dutch neonatal screening programme in 2007. Since then the number of cases detected has been high. This study set out to describe the incidence of the disease, the clinical and demographic characteristics of the neonates identified and the type of mutations found. In the south-western Netherlands, 304982 neonates were screened between 2007 and 2012; and 92 were identified for further testing. Confirmatory testing revealed 6 (7%) with a profound biotinidase deficiency (<10% enzyme activity), 44 (48%) with a partial deficiency (10-30%) and 42 (46%) with normal activity (>30%). All six patients whose profound deficiency was confirmed had enzyme activities below 15% on neonatal screening. Mutation analysis was performed in 61 neonates: 5 profound, 35 partial and 21 normal. All five profound cases had two severe mutations. Comparison with the northern Netherlands showed that the frequency and types of mutation were representative for the Netherlands as a whole. The most common mutation detected was c.[1330G>C] (p.(Asp444His); 34%), which is considered to be mild, followed by three severe mutations c.[1368A>C], c.[1595C>T] and c.[1330G>C;511G>A]. Seven new mutations were identified. We conclude that neonatal screening for profound biotinidase produces a high number of false positives. Biotinidase deficiency was profound in less than 10% of cases identified. As biotinidase activity lay below 15% on neonatal screening in all such cases, the screening threshold might be reduced to 15%.


van Rijn J.,Amphia Hospital | Dorleijn D.M.J.,IJsselland Ziekenhuis | Boetes B.,IJsselland Ziekenhuis | Wiersma-Tuinstra S.,IJsselland Ziekenhuis | Moonen S.,Amphia Hospital
Journal of Foot and Ankle Surgery | Year: 2012

Injuries to the tarsometatarsal joint are infrequent and the presentation varies. The radiologic evaluation can be difficult, and injuries are missed initially in up to one third of cases. A 60-year-old female sports instructor presented to the emergency department with a Lisfranc fracture dislocation of the foot as result of an indirect trauma. The patient attended to a hospital the day she sustained the injury, where the Lisfranc fracture was missed. At our hospital, the patient underwent immediate restoration of the dislocation. Because of swelling, internal fixation was applied 2 weeks later. Postoperatively, the patient was mobilized in a non-weight-bearing plaster cast for 6 weeks, continued by progressive weight-bearing in a walker. The fixation screws were removed 3 months after surgery. Lisfranc fractures are rare injuries and can be missed at first sight. Careful clinical examination and radiographs in 3 different planes are required to identify the injury. Computed tomography might be helpful when the findings from the above-mentioned examinations are inconclusive. Operative treatment, including anatomic reduction and fixation, is required in almost all cases to achieve the best satisfactory result. Long-term complications include secondary arthritis and foot deformities, which can be treated by foot ortheses or arthrodesis. © 2012 American College of Foot and Ankle Surgeons.


Ramlal S.K.,IJsselland Ziekenhuis | Visser F.J.,Canisius Wilhelmina Ziekenhuis | Hop W.C.J.,Erasmus Medical Center | Dekhuijzen P.N.R.,Radboud University Nijmegen | Heijdra Y.F.,Radboud University Nijmegen
Respiratory Medicine | Year: 2013

Background In chronic obstructive pulmonary disease (COPD) the clinical efficacy of bronchodilator therapy delivered via a nebulizer versus an aerochamber on FEV1 is controversial. No studies comparing changes in inspiratory pulmonary function parameters (ILPs) using these inhaler devices are currently available. This information might be of interest because due to dynamic bronchial compression, the relationship between the ILPs and dyspnea is more reliable than that between FEV1 and dyspnea. Therefore, our study aimed to investigate whether changes in ILPs after use of these inhaler devices were similar to the changes in FEV1 and correlate with VAS (Visual Analogue Scale). Methods Forty-one stable COPD patients participated in a crossover trial. Spirometry was performed before and after two puffs Combivent (200 mcg salbutamol and 20 mcg ipratropium per puff) using an aerochamber or 2 mL of Combivent (2.5 mg salbutamol and 250 mcg ipratropium per mL) using a nebulizer. Differences in lung function parameters and changes in VAS were measured. Results ILP values improved significantly from baseline after Combivent administration using both devices (p ≤ 0.004). With both devices, the mean percent changes were significantly greater for FEV1 than the ILPs (p ≤ 0.003), except for IC (p = 0.19). The mean VAS score did not differ significantly between the devices (p = 0.33), but significant correlations were found between the VAS and forced inspiratory flow at 50% of the vital capacity (FIF50) and peak inspiratory flow (PIF) when a nebulizer was used. With an aerochamber, no significant correlations between lung function parameters and VAS were found. Conclusions The present study demonstrates that ILPs improved significantly after using either device. Although significant correlations were found between the VAS and FIF 50 and PIF for the nebulizer, in stable COPD patients, the pMDI plus spacer is a better route of administration than a nebulizer. © 2013 Elsevier Ltd. All rights reserved.


Takacs I.M.,IJsselland Ziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2010

A 77-year-old woman presented with a large swelling of the knee caused by prepatellar bursitis.


Burgers P.T.P.W.,IJsselland Ziekenhuis | Burgers P.T.P.W.,Rotterdam University | Van Lieshout E.M.M.,Rotterdam University | Verhelst J.,IJsselland Ziekenhuis | And 2 more authors.
International Orthopaedics | Year: 2014

Purpose: Modern management of the elderly with a hip fracture is complex and costly. The aim of this study was to compare the treatment-related hospital length of stay (HLOS) before and after implementing a clinical pathway for patients undergoing hip fracture surgery. Methods: This was a retrospective, before-and-after study. The first period ranged from June 21, 2008 to November 1, 2009 (N=212), and the second was from January 7, 2010 to July 7, 2011 (N=314). The electronic hospital system and patients records were reviewed for demographics, HLOS, mortality, complications and readmissions. Results: In the first period 53 % had a femoral neck fracture, of which 57 % were treated with hemiarthroplasty. In the second period this was 46 % and 71 %. Pertrochanteric fractures were treated with a Gamma nail in 85 % in the first period, and in 92 % in the second period. The median HLOS decreased from nine to six days (p<0.001). For the hemiarthroplasty group HLOS decreased from nine to seven days (p<0.001); for internal fixation there was no significant difference (five versus six days, p=0.557) and after Gamma nailing it decreased from ten to six days (p<0.001). For mortality no statistically significant difference was found (6 % versus 5 %, p=0.698). Complications decreased for the Gamma nail group (44 % versus 31 %, p=0.049). Readmissions for the total group were not different (16 % versus 17 %, p=0.720). Conclusions: Implementing a clinical pathway for hip fractures is a safe way to reduce the HLOS and it improves the quality of care. © 2013 Springer-Verlag.


Ramlal S.K.,IJsselland Ziekenhuis | Visser F.J.,Canisius Wilhelmina Ziekenhuis | Hop W.C.,Erasmus Medical Center | Dekhuijzen P.N.R.,Radboud University Nijmegen | Heijdra Y.F.,Radboud University Nijmegen
Respiratory Physiology and Neurobiology | Year: 2010

Background: The responsiveness of short-term bronchodilator use on inspiratory lung function parameters (ILPs), including Forced Inspiratory Volume in one second (FIV1), Inspiratory Capacity (IC), Forced Inspiratory Flow at 50% of the vital capacity (FIF50), Peak Inspiratory Flow (PIF) and on the relationship between these values and dyspnea in COPD subjects has been examined only sparsely in past studies. The aim of this study was to assess the effects of inhaled salbutamol 400mcg, ipratropium 80mcg and a placebo on ILP and FEV1 and their relationship to dyspnea, as measured with a Visual Analogue Scale (VAS). Methods: A total of 85 subjects with stable COPD participated in a crossover, randomized, double-blind, placebo-controlled study. Spirometry was performed before and after inhalation of salbutamol, ipratropium or a placebo. The primary analysis was performed using 63 participants with absent reversibility. Results: All ILP and FEV1 values improved significantly after bronchodilator administration except for FIF50 after ipratropium administration. After administration of both bronchodilators, the mean percent changes from initial values did not significantly differ between the various ILPs and FEV1. The mean VAS score showed significant improvements after bronchodilator and placebo inhalation but did not significantly correlate with changes in lung function parameters. For each lung function parameter, patients were further classified as responders if the amount of change was greater than the coefficient of repeatability of the test. Response rates did not differ significantly between the various ILPs. Moreover, no significant differences were found between responders and non-responders with respect to dyspnea after bronchodilator inhalation. This finding applied to all ILP and FEV1 values. Conclusions: In subjects with COPD, all ILP, FEV1 values and VAS scores showed significant improvements after bronchodilator use as well as with placebo. However, ILPs were not more sensitive than FEV1 for detecting responders after bronchodilator use or changes in the VAS score. © 2010 Elsevier B.V.


Schol-Gelok S.,IJsselland Ziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2012

A 47-year-old woman with a history of ulcerative colitis and rheumatoid arthritis presented with a large ulcer with an erythematous halo of the right lower leg. The clinical course and the histopathological results were indicative of pyoderma gangrenosum.


de Witte D.,IJsselland ziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2010

A young man visited the Emergency Department with a painful right hand after punching his fist against a wall. He suffered a luxation in the fifth carpometacarpal joint and a fracture at the base of the fourth metacarpal bone which were successfully treated by reposition and plaster bandage for 4 weeks.


PubMed | IJsselland Ziekenhuis
Type: | Journal: Nederlands tijdschrift voor geneeskunde | Year: 2016

The porphyrias are a clinically and genetically heterogeneous group of relatively rare metabolic diseases that result from disorders in the biosynthesis of haeme. Porphyria cutanea tarda (PCT) is the most common type, accounting for 80-90% of all porphyrias, and is essentially an acquired disease, although PCT can also occur on a familial basis. We describe a 71-year-old female and a 62-year-old male patient, both of whom had several risk factors for developing PCT, ranging from iron overload due to a mutation in the hereditary haemochromatosis protein (HFE) gene, alcohol use, smoking, and exogenous oestrogen, to persistent hepatitis C infection. The clinical relevance of the several diagnostic modalities is important in PCT. Diagnostic evaluation is important in order to confirm the diagnosis, but also to evaluate the treatment response in the context of long-term follow-up in the prevention of late complications of PCT, i.e. hepatocellular carcinoma.

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