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Zwolle, Netherlands

Theuns D.A.M.J.,Erasmus MC | Elvan A.,Isala Klinieken | De Voogt W.,St Lucas Andreas Hospital | De Cock C.C.,VU University Amsterdam | And 2 more authors.
Circulation: Arrhythmia and Electrophysiology

Background: The Riata family of implantable cardioverter-defibrillator (ICD) leads is prone to a specific insulation abrasion characterized by externalization of conductor cables. The objective of this study was to determine the prevalence of externalized conductors and electrical abnormalities in Riata ICD leads by fluoroscopic screening and standard ICD interrogation. Methods and Results: All ICD implantation centers were contacted by the Netherlands Heart Rhythm Association Device Advisory Committee to identify all patients with an active Riata ICD lead and to perform fluoroscopic screening of the lead. In addition, the electrical integrity of the lead was assessed. As of March 1, 2012, data for 1029 active Riata leads were available; 47% of these were 8-F Riata and 53% were 7-F Riata ST. Externalized conductors were observed in 147 leads (14.3%). Proportion of externalized conductors was higher in 8-F Riata compared with 7-F Riata ST (21.4% vs 8.0%; P<0.001). Median time from implantation to detection of externalized conductors was 65.3 months. The estimated rates of externalized conductors were 6.9% and 36.6% at 5 and 8 years after implantation, respectively. Of the 147 leads with externalized conductors, 10.9% had abnormal electrical parameters vs 3.5% in nonexternalized leads (P<0.001). Conclusions: The prevalence of externalized conductors in Riata leads is significantly high (14.3%) using fluoroscopic screening. The majority of externalized conductors are not detectable with standard ICD interrogation. Screening with fluoroscopy is reasonable. © 2012 American Heart Association, Inc. Source

Louwerens J.W.K.,Foot and Ankle Reconstruction Unit | Schrier J.C.M.,Isala Klinieken
International Orthopaedics

Despite recent advances in pharmacological management of rheumatoid arthritis, forefoot deformity, with its symptoms, remains a common problem, often requiring operative treatment. Typical deformities in these patients comprise hallux valgus and deformity of the lesser metatarsophalangeal (MTP) joints and toes. With regard to the lesser rays the standard operative procedure, advocated for the disabling forefoot pain in these patients, remains metatarsal head resection. It should be considered that with increasing success of pharmacological treatment the degree of forefoot deformity in these patients is becoming less and that resection of the lesser MTP joints is becoming more and more superfluous. This supports a trend towards metatarsal head-preserving surgery. The optimal treatment of the hallux deformity remains unclear. Fusion of the first MTP joint is, generally, recommended. This article will discuss the current surgical options in rheumatoid forefoot pathology. © 2013 Springer-Verlag Berlin Heidelberg. Source

Franken A.A.,Isala Klinieken
Nederlands tijdschrift voor geneeskunde

Osteonecrosis of the jaw in association with long-term use of bisphosphonates (BRONJ) is a relatively rare but serious side effect that is difficult to treat. The incidence of BRONJ in patients treated for osteoporosis is low at 0.1%. The incidence in cancer patients treated with high doses of intravenous bisphosphonates is higher, ranging between 3% and 10%. Risk factors for BRONJ are invasive treatments such as tooth extractions, root canal procedures and the placement of dental implants, as well as trauma caused by pressure from poorly fitting dental prostheses. High-risk patients should be examined by a dentist or an oral surgeon and, if necessary, undergo dental treatment prior to treatment with bisphosphonates. All patients taking bisphosphonates should maintain good oral hygiene, receive regular dental examinations and see a dentist if any oral symptoms develop. Physicians who prescribe medication as well as the patient's dentist and oral surgeon should be aware of the use of bisphosphonates and BRONJ as a possible adverse reaction. This requires cooperation and the exchange of information between a patient's health care providers. Source

de Jonge H.J.,Isala Klinieken
Nederlands tijdschrift voor geneeskunde

Ischaemic colitis is a relatively rare disease that predominantly affects elderly patients. This disorder has varying underlying causes and diverse clinical symptoms. A 29-year-old primigravida was admitted to our hospital with rectal bleeding and diffuse abdominal pain. The number of leucocytes and the CRP were elevated. Because the patient was pregnant a sigmoidoscopy without sedation was performed. The endoscopic image and histopathology of the biopsies revealed ischaemic colitis. Our patient recovered quickly under conservative treatment. Ischaemic colitis is usually self-limiting and a conservative treatment will suffice. Ischaemic colitis during pregnancy has been reported extremely rarely and the aetiology is unknown. Source

Struijk-Mulder M.C.,Isala Klinieken
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association

To establish the incidence of venous thromboembolic complications as detected by bilateral complete compression ultrasonography (CCUS) after arthroscopic anterior cruciate ligament (ACL) reconstruction without thromboprophylaxis. We performed a prospective cohort study to establish the incidence of venous thromboembolic complications after arthroscopic ACL reconstruction, as detected by bilateral CCUS at 14 days (range, 11 to 17 days) postoperatively. One hundred consecutive patients underwent bilateral extended ultrasonography. One hundred predominantly European patients with a mean age of 30 ± 10 years and mean body mass index of 25 ± 4 underwent ACL reconstruction with a mean operative duration of 68 ± 23 minutes and a tourniquet time of 76 ± 23 minutes. In 84% of patients an autologous hamstring graft was used, in 14% a bone-patellar tendon-bone graft was used, and 2 patients received an allograft. Of 100 patients, 9 (incidence, 9%; 95% confidence interval, 4.2 to 16.4) showed asymptomatic proximal or distal deep vein thrombosis on CCUS, of whom 4 (incidence, 4%; 95% confidence interval, 1.1 to 9.9) were symptomatic. A nonfatal pulmonary embolus developed in 1 patient during the 8-week follow-up period. This study shows that the incidence of venous thromboembolism after arthroscopic ACL reconstruction is relatively high; a 9% incidence of asymptomatic proximal or distal deep vein thrombosis was found, whereas 4% of patients were symptomatic. Further research is recommended to assess the need for thromboprophylaxis in patients undergoing ACL reconstruction, especially when risk factors are present. Level IV, case series. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved. Source

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