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Rood U.M.,Interne Geneeskunde | Seijger C.G.W.,Longziekten | Van Waarde J.A.,Psychiater | De Maat M.,Ziekenhuisapotheker | And 2 more authors.
Tijdschrift voor Psychiatrie | Year: 2017

In the last few years, gamma hydroxybutyricacid (ghb) has been used increasingly as a party drug; this has led to a marked increase in the number of requests for professional help with the treatment of ghb addiction. Pharmaceutical ghb (sodium oxybate.the sodium-salt of ghb), registered for cataplexia in narcolepsy patients, is used off-label to treat the withdrawal symptoms associated with ghb addiction. Pharmaceutical ghb has a high sodium load. In this report we present the cases of two patients who developed symptomatic hypernatremia following treatment with pharmaceutical ghb and who thereafter needed intensive care for the severe withdrawal symptoms that they experienced.


Van Exsel J.A.J.M.,Interne Geneeskunde | Simons S.O.,Interne Geneeskunde | Kramers C.,Interne Geneeskunde | Heijdra Y.F.,Interne Geneeskunde
Nederlands Tijdschrift voor Geneeskunde | Year: 2017

Blood gas analysis plays an important role in the initial assessment of a patient in the emergency ward. We present three different patient cases to illustrate when to opt for a venous or an arterial blood gas analysis. Arterial punctures are more painful and carry a higher risk of complications compared to venous punctures. It is possible to use a venous blood gas to screen for acute acid/base disturbances. Ventilatory compensation or anion gap cannot be calculated reliably with a venous blood gas. On the other hand, the diagnosis diabetic keto-Acidosis can be made with a venous blood gas; this mode of sampling can also be used for lactate measurement at the emergency department as an independent prognostic marker for mortality. Venous blood gas analyses are not able to assess oxygenation. Pulse oximetry is a non-invasive alternative for arterial blood gas sampling. The use of a venous blood gas to assess a patient's ventilation is limited, whereas it can be used to diagnose carbomonoxide intoxication or methaemoglobinaemia.


Costa L.J.,Medical University of South Carolina | Zhang M.-J.,Medical College of Wisconsin | Zhong X.,Medical College of Wisconsin | Lonial S.,Emory University | And 18 more authors.
Biology of Blood and Marrow Transplantation | Year: 2013

The impact of novel drugs for treating multiple myeloma (MM) on the utilization and outcomes of autologous hematopoietic progenitor cell transplantation (AHPCT) is unknown. We reviewed characteristics and outcomes of 20,278 patients who underwent AHPCT within 12months of diagnosis of MM in the United States and Canada and registered at the Center for International Blood and Marrow Transplant Research (CIBMTR) in 3 time cohorts reflecting the increasing availability of novel drugs: 1995 to 1999 (n=2226), 2000 to 2004 (n=6408), and 2005 to 2010 (n=11,644). In the United States, the number of AHPCTs performed increased at a greater rate than new MM cases. Patients in recent cohorts were older, less likely to have stage 3MM, and more likely to have received previous thalidomide, lenalidomide, or bortezomib. On multivariate analysis, AHPCT in the 2000 to 2004 cohort (HR=0.77) or in the 2005 to 2010 cohort (HR=0.68) were associated with lower risk of death. Survival at 60months post-AHPCT improved from 47% in 1995 to 1999 to 55% in 2000 to 2004 and to 57% in 2005 to 2010, owing less to improvement in progression-free survival (50% versus 55% versus 57% at 24months) than to postrelapse/progression survival (58% versus 65% versus 72% at 24months). AHPCT and new biological agents are complementary, nonredundant therapies and should be combined in the management of MM in suitable patients. © 2013 American Society for Blood and Marrow Transplantation.


Van Dooren A.,Sportmax | Beelen M.,Sportmax | Haak H.R.,Interne Geneeskunde | Schep G.,Sportmax
Sport en Geneeskunde | Year: 2014

A well known problem in patients with diabetes mellitus type 1 (DM-I), is the occurrence of hypoglycaemia during or after exercise. Less known in this population is the development of hyperglycaemia due to physical exercise, and the possible preventive effect of carbohydrate ingestion. Hyperglycaemia in exercise can be caused by a large rise in catecholamine levels which stimulates glycogenosis. In addition, catecholamine inhibits the release of insulin. In healthy athletes, the catecholamine levels drop after exercise, resulting in a compensatory increase of insulin. On the contrary, this does not occur in DM-I patients, which could lead to continuation of hyperglycaemia. Ingesting carbohydrates has the potential to protect against this, due to an inhibiting effect on catecholamine release, as proven in healthy subjects. Whether this applies for DM-I patients as well needs further investigation. We describe a case in which substantial hyperglycaemia occurred during exercise and in which ingestion of carbohydrates led to improvement of glycemic control.


Freytes C.O.,University of Texas Health Science Center at San Antonio | Vesole D.H.,Hackensack University Medical Center | Lerademacher J.,Medical College of Wisconsin | Zhong X.,Medical College of Wisconsin | And 10 more authors.
Bone Marrow Transplantation | Year: 2014

There is no standard therapy for multiple myeloma relapsing after an autotransplant. We compared the outcomes of a second autotransplant (N=137) with those of an allotransplant (N=152) after non-myeloablative or reduced-intensity conditioning (NST/RIC) in 289 subjects reported to the CIBMTR from 1995 to 2008. NST/RIC recipients were younger (median age 53 vs 56 years; P<0.001) and had a shorter time to progression after their first autotransplant. Non-relapse mortality at 1-year post transplant was higher in the NST/RIC cohort, 13% (95% confidence interval (CI), 8-19) vs 2% (95% CI, 1-5, P≤0.001). Three-year PFS and OS for the NST/RIC cohort were 6% (95% CI, 3-10%) and 20% (95% CI, 14-27%). Similar outcomes for the autotransplant cohort were 12% (95% CI, 7-19%, P=0.038) and 46% (95% CI, 37-55%, P=0.001). In multivariate analyses, risk of death was higher in NST/RIC recipients (hazard ratio (HR) 2.38 (95% CI, 1.79-3.16), P<0.001), those with Karnofsky performance score<90 (HR 1.96 (95% CI, 1.47-2.62), P<0.001) and transplant before 2004 (HR 1.77 (95% CI, 1.34-2.35) P≤0.001). In conclusion, NST/RIC was associated with higher TRM and lower survival than an autotransplant. As disease status was not available for most allotransplant recipients, it is not possible to determine which type of transplant is superior after autotransplant failure. © 2014 Macmillan Publishers Limited. All rights reserved.


PubMed | Hackensack University Medical Center, Roswell Park Cancer Institute, Imperial College London, Mayo Medical School and 7 more.
Type: Comparative Study | Journal: Bone marrow transplantation | Year: 2014

There is no standard therapy for multiple myeloma relapsing after an autotransplant. We compared the outcomes of a second autotransplant (N=137) with those of an allotransplant (N=152) after non-myeloablative or reduced-intensity conditioning (NST/RIC) in 289 subjects reported to the CIBMTR from 1995 to 2008. NST/RIC recipients were younger (median age 53 vs 56 years; P<0.001) and had a shorter time to progression after their first autotransplant. Non-relapse mortality at 1-year post transplant was higher in the NST/RIC cohort, 13% (95% confidence interval (CI), 8-19) vs 2% (95% CI, 1-5, P0.001). Three-year PFS and OS for the NST/RIC cohort were 6% (95% CI, 3-10%) and 20% (95% CI, 14-27%). Similar outcomes for the autotransplant cohort were 12% (95% CI, 7-19%, P=0.038) and 46% (95% CI, 37-55%, P=0.001). In multivariate analyses, risk of death was higher in NST/RIC recipients (hazard ratio (HR) 2.38 (95% CI, 1.79-3.16), P<0.001), those with Karnofsky performance score<90 (HR 1.96 (95% CI, 1.47-2.62), P<0.001) and transplant before 2004 (HR 1.77 (95% CI, 1.34-2.35) P0.001). In conclusion, NST/RIC was associated with higher TRM and lower survival than an autotransplant. As disease status was not available for most allotransplant recipients, it is not possible to determine which type of transplant is superior after autotransplant failure.


Brinkman J.W.,Klinisch Chemisch Laboratorium | Ijpelaar D.H.T.,Interne Geneeskunde | Schrander-van Der Meer A.M.,Interne Geneeskunde | Jonkers G.J.P.M.,Interne Geneeskunde | Beijer C.,Klinisch Chemisch Laboratorium
Nederlands Tijdschrift voor Klinische Chemie en Laboratoriumgeneeskunde | Year: 2011

Clinical laboratories play an essential role in the study of monoclonal gammopathies. Because of the complexity, guidelines have been published containing recommendations on implementation and interpretation of this laboratory investigation. In The Netherlands, the CBO (Dutch Institute for Healthcare Improvement) guideline 'Monoclonal Gammopathy' with recommendations on screening and follow-up research for paraproteins in both serum and urine is often used. Although this guideline is practical for most cases it is not for our case. Specifically, the CBO guideline recommends analysis of monoclonal free light chains in urine when the concentration of total protein in urine is above 200 mg/L. However, the currently used total protein assays in urine reportedly appear neither sensitive nor specific enough, missing the diagnosis; in agreement with classical findings of Brigden et al. (1990).


Djelantik M.,Universitair Medisch Centrum Utrecht | Bloemkolk D.,Tergooi Ziekenhuis | Tijdink J.,Interne Geneeskunde
Tijdschrift voor Psychiatrie | Year: 2015

Wernicke encephalopathy is an acute neuropsychiatric disease with heterogeneous symptoms, including changes in mental status, ataxia and ocular abnormalities; if left untreated, these symptoms can lead to morbidity and even to mortality.The treatment is thiamine suppletion. Because of the heterogeneity of the symptoms and the high risk of morbidity and mortality if the symptoms are not treated, it is vitally important that on observing a patient's early symptoms the clinician immediately suspects that the symptoms could point to Wernicke encephalopathy.


Man W.H.,Universitair Medisch Centrum | Hagen C.E.C.,Interne Geneeskunde | Wielders J.P.M.,Klinische Chemie | Malingre M.M.,Universitair Medisch Centrum
Nederlands Tijdschrift voor Klinische Chemie en Laboratoriumgeneeskunde | Year: 2014

Increased catecholamine and metanephrine levels in urine and blood are characteristic features of a pheochromocytoma. These increased levels of catecholamines can result in hypertension, palpitations and an increased heart rate. We describe a 41-year old obese man with severe hypertension. He was treated successfully with antihypertensive drugs. For treatment of ADHD methylphenidate was started. The hypertension deteriorated. Laboratory tests showed increased urinary metanephrine and normetanephrine levels. After withdrawal of methylphenidate metanephrine levels normalized. After restart of methylphenidate, only normetanephrine levels increased again. The blood pressure did not change. Use of methylphenidate and a pheochromocytoma can both result in increased urinary levels of metanephrines. In the diagnostic pathway for pheochromocytoma based on catecholamine and metanephrine-levels, next to effects of dietary components, also effects of medication should be excluded. © 1997-2014 Nederlandse V ereniging voor Klinische Chemie en Laboratoriumgeneeskunde.


Hunfeld N.,Ziekenhuisapotheker in Opleiding | Evers D.,Interne Geneeskunde | Van Hest R.,Ziekenhuisapotheker in Opleiding | Wijermans P.,Hematologie
Pharmaceutisch Weekblad | Year: 2010

Objective: This case report describes renal failure in a 71 year old male with multiple myeloma, stage IIA, after administration of bortezomib and erythromycin. We considered the possibility of an interaction between bortezomib and erythromycin. Design and methods: Description of the case and literature search. Results: During the first cycle of bortezomib, the patient showed a decrease in renal clearance (creatinin increased from 150 to 370 μmol/l). Renal function recovered within a week. Bortezomib was then continued at a reduced dose of 50%. Two days before the fourth administration, the patient developed fever. Erythromycin was started (500 mg p.o. four times daily), creatinin was still 150 μmol/l. One week later, the patient developed renal failure (creatinin 541 μmol/l) and was diagnosed with tubulo-interstitial nephritis caused by bortezomib toxicity likely based on an interaction with erythromycin. There is no information about this interaction in literature, but its occurrence can be explained by effects on CYP3A4 metabolism. Erythromycin is a moderate CYP3A4 inhibitor and substrate and bortezomib is a CYP3A4 substrate. Conclusion: We recommend frequent monitoring (serum creatinin on day 3/4 and day 7/8) of renal function in patients during and after administration of bortezomib in combination with a CYP3A4 inhibitor.

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