Isala Klinieken Zwolle

Zwolle, Netherlands

Isala Klinieken Zwolle

Zwolle, Netherlands
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Bosker B.H.,Isala Klinieken | Ettema H.B.,Isala Klinieken | Boomsma M.F.,Isala Klinieken | Kollen B.J.,Isala Klinieken Zwolle | And 3 more authors.
Journal of Bone and Joint Surgery - Series B | Year: 2012

Peri-articular soft-tissue masses or 'pseudotumours' can occur after large-diameter metal-on-metal (MoM) resurfacing of the hip and conventional total hip replacement (THR). Our aim was to assess the incidence of pseudotumour formation and to identify risk factors for their formation in a prospective cohort study. A total of 119 patients who underwent 120 MoM THRs with large-diameter femoral heads between January 2005 and November 2007 were included in the study. Outcome scores, serum metal ion levels, radiographs and CT scans were obtained. Patients with symptoms or an identified pseudotumour were offered MRI and an ultrasound-guided biopsy. There were 108 patients (109 hips) eligible for evaluation by CT scan at a mean follow-up of 3.6 years (2.5 to 4.5); 42 patients (39%) were diagnosed with a pseudotumour. The hips of 13 patients (12%) were revised to a polyethylene acetabular component with small-diameter metal head. Patients with elevated serum metal ion levels had a four times increased risk of developing a pseudotumour. This study shows a substantially higher incidence of pseudotumour formation and subsequent revisions in patients with MoM THRs than previously reported. Because most revision cases were identified only after an intensive screening protocol, we recommend close monitoring of patients with MoM THR. ©2012 British Editorial Society of Bone and Joint Surgery.

Schutte J.M.,Isala Klinieken Zwolle | Steegers E.A.P.,Erasmus University Rotterdam | Schuitemaker N.W.E.,Diakonessenhuis Utrecht | Santema J.G.,Medical Center Leeuwarden | And 5 more authors.
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2010

Objective To assess causes, trends and substandard care factors in maternal mortality in the Netherlands. Design Confidential enquiry into the causes of maternal mortality. Setting Nationwide in the Netherlands. Population 2,557,208 live births. Methods Data analysis of all maternal deaths in the period 1993-2005. Main outcome measures Maternal mortality. Results The overall maternal mortality ratio was 12.1 per 100 000 live births, which was a statistically significant rise compared with the maternal mortality ratio of 9.7 in the period 1983-1992 (OR 1.2, 95% CI 1.0-1.5). The most frequent direct causes were (pre-)eclampsia, thromboembolism, sudden death in pregnancy, sepsis, obstetric haemorrhage and amniotic fluid embolism. The number of indirect deaths also increased, mainly caused by an increase in cardiovascular disorders (OR 2.5, 95% CI 1.4-4.6). Women younger than 20 years and older than 45 years, those with high parity or from nonwestern immigrant populations were at higher risk. Most substandard care was found in women with pre-eclampsia (91%) and in immigrant populations (62%). Conclusions Maternal mortality in the Netherlands has increased since 1983-1992. Pre-eclampsia remains the number one cause. Groups at higher risk for complications during pregnancy should be better identified early in pregnancy or before conception, in order to receive preconception advice and more frequent antenatal visits. There is an urgent need for the better education of women and professionals concerning the danger signs, and for the training of professionals in order to improve maternal health care. © RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology.

Dekker R.R.,Isala Klinieken Zwolle | Dekker R.R.,University of Groningen | Schutte J.M.,Isala Klinieken Zwolle | Stekelenburg J.,Medical Center Leeuwarden | And 3 more authors.
European Journal of Obstetrics Gynecology and Reproductive Biology | Year: 2011

Objective: To assess maternal death and severe maternal morbidity from acute fatty liver of pregnancy (AFLP) in the Netherlands. Study design: A retrospective study of all cases of maternal mortality in the Netherlands between 1983 and 2006 and all cases of severe maternal morbidity in the Netherlands between 2004 and 2006, in which all 98 maternity units in the Netherlands participated. Maternal mortality ratio (MMR) and incidence of severe maternal morbidity were the main outcome measures. Results: The MMR from direct maternal mortality from AFLP was 0.13 per 100,000 live births (95% CI 0.05-0.29). The incidence of severe maternal morbidity from AFLP was 3.2 per 100,000 deliveries (95% CI 1.8-5.7). Conclusions: AFLP is a rare condition which still causes severe maternal morbidity and in some cases mortality. Referral to a tertiary care hospital for treatment of this uncommon disease should be considered. © 2011 Elsevier Ireland Ltd.

Symersky P.,Isala Klinieken Zwolle | Budde R.P.J.,University Utrecht | Prokop M.,University Utrecht | De Mol B.A.J.M.,TU Eindhoven
Journal of Heart Valve Disease | Year: 2011

Background and aim of the study: Electrocardiogram-gated multidetector-row computed tomography (MDCT) imaging may aid in the evaluation of prosthetic valve dysfunction. A pulsatile in vitro model was developed to study the MDCT imaging characteristics of mechanical heart valves (MHVs). Methods: Björk-Shiley (BS), St. Jude Medical (SJM), Medtronic-Hall (MH), CarboMedics (CM) and ON-X valves were inserted into an in vitro pulsatile model and scanned using a 64-detector row scanner. The image quality regarding visualization of the leaflets, prosthetic detail and periprosthetic detail, as well as the presence of image artifacts, was scored on a fourpoint scale. Results: The image quality for the BS valve was scored poor to moderate for all criteria, and was inferior to that seen with the other valves. Leaflet visualization was excellent for all the other valves. The prosthetic detail was good for MH and SJM valves, and excellent for the CM and ON-X valves. Periprosthetic detail was good for MH, SJM and CM valves, and excellent for ON-X valves. Artifacts were moderate for MH and SJM valves, minor for CM, and minimal for ON-X. All differences were shown to be statistically significant (p <0.001). Conclusion: The pulsatile in vitro model is an effective tool to detect differences in the MDCT imaging characteristics of MHVs. The image quality is determined by the prosthesis components and, to a lesser degree, by prosthesis design. Modern carbon-titanium MHVs yield good to excellent image quality on MDCT. © Copyright by ICR Publishers 2011.

PubMed | LivaNova Cardiac Rhythm Management, LivaNova, University of Barcelona, Herz und Diabeteszentrum and 9 more.
Type: | Journal: European heart journal | Year: 2016

Although cardiac resynchronization therapy (CRT) is effective in patients with systolic heart failure (HF) and a wide QRS interval, a substantial proportion of patients remain non-responsive. The SonR contractility sensor embedded in the right atrial lead enables individualized automatic optimization of the atrioventricular (AV) and interventricular (VV) timings. The RESPOND-CRT study investigated the safety and efficacy of the contractility sensor system in HF patients undergoing CRT.RESPOND-CRT was a prospective, randomized, double-blinded, multicentre, non-inferiority trial. Patients were randomized (2:1, respectively) to receive weekly, automatic CRT optimization with SonR vs. an Echo-guided optimization of AV and VV timings. The primary efficacy endpoint was the rate of clinical responders (patients alive, without adjudicated HF-related events, with improvement in New York Heart Association class or quality of life), at 12 months. The study randomized 998 patients. The rate of responders was 75.0% in the SonR group vs. 70.4% within the Echo group (mean difference, 4.6%; 95% CI, 1.4% to 10.6%; P<0.001 for non-inferiority margin 10.0%). At an overall mean follow-up of 548190 days SonR was associated with a 35% risk reduction in HF hospitalization (hazard ratio, 0.65; 95% CI, 0.46-0.92; log-rank P=0.01).Automatic AV and VV optimization using the contractility sensor was safe and as effective as Echo-guided AV and VV optimization in increasing response to CRT.NCT01534234.

Schutte J.M.,Isala Klinieken Zwolle | De Jonge L.,Leiden University | Schuitemaker N.W.E.,Diakonessen Hospital | Steegers E.A.P.,Erasmus Medical Center | And 2 more authors.
Acta Obstetricia et Gynecologica Scandinavica | Year: 2010

Objective. To assess causes, trends, and substandard care in indirect maternal mortality in the Netherlands. Design. Confidential enquiry into causes of maternal death. Setting. Nationwide in the Netherlands. Population. A total of 2,557,208 live births. Methods. Data analysis of indirect maternal deaths in the period 1993-2005. Main outcome measures. Indirect maternal mortality. Results. Of the study subjects, 97 were classified as indirect deaths, representing a maternal mortality ratio of 3.3/100,000 live births, a significant increase compared to the preceding enquiry in the period 1983-1992 (MMR 2.4, OR 1.5, 95%CI 1.0-2.1). The percentage of cases not directly reported to the Maternal Mortality Committee decreased from 15 to 5%. Cardiovascular disorders were the leading cause of indirect maternal mortality, followed by cerebrovascular disorders. Vascular dissection (n=19) was the most frequent specified cause of death. Risk factors were advanced maternal age, non-indigenous origin (Surinam and Dutch Antilles), and medical health risks before pregnancy. Substandard care was present in 35%, mainly being misjudgment of the severity of the condition and delay in initiating therapy. Conclusion. The rise of mortality due to indirect causes is considered a reflection of the change in risk profile of women of childbearing age and the result of demographic alterations concerning ethnicity and maternal age. The identification of high risk groups, preferably by programs of preconception care, should lead to improved care for these women, with a multidisciplinary approach when needed. © 2010 Informa UK Ltd.

Kraaij-Dirkzwager M.,National Institute for Public Health and the Environment RIVM | Timen A.,National Institute for Public Health and the Environment RIVM | Dirksen K.,Public Health Service The Hague | Gelinck L.,Medical Center Haaglanden | And 10 more authors.
Eurosurveillance | Year: 2014

Two patients, returning to the Netherlands from pilgrimage in Medina and Mecca, Kingdom of Saudi Arabia, were diagnosed with Middle East respiratory syndrome coronavirus (MERS-CoV) infection in May 2014. The source and mode of transmission have not yet been determined. Hospital-acquired infection and community-acquired infection are both possible.

Van De Langenberg R.,Maastricht University | De Bondt B.-J.,Isala Klinieken Zwolle | Nelemans P.J.,Maastricht University | Dohmen A.J.C.,Maastricht University | And 2 more authors.
Otology and Neurotology | Year: 2011

Objective: The purpose of this study was to identify factors predicting growth and audiologic deterioration during follow-up (FU) in a wait and scan (W&S) policy of vestibular schwannomas (VSs) using a novel volumetric measuring tool. So far, only consecutive magnetic resonance imaging (MRI) is able to show growth objectively, and growth, combined with hearing function, generally dictates further intervention. Other factors predicting growth or hearing deterioration would be invaluable and might ease clinical decision making. Study Design: Retrospective case study. Setting: Tertiary referral center. Patients: Sixty-three patients diagnosed with VS at Maastricht University Medical Center between 2003 and 2008, with FU data available from 36 patients. Intervention(s): A W&S policy for unilateral VS with sequential contrast-enhanced T1- and T2-weighted MRI and audiograms during FU. Main Outcome Measure(s): 1. Patient and radiologic VS features potentially related to growth and auditory function during a W&S policy. 2. The correlation between increase in VS volume and audiologic deterioration during FU. Results: Labyrinthine hypointensity on T2-weighted magnetic resonance images and complaints of hearing loss at presentation are predictive of a faster deterioration of hearing (p < 0.05). Growth during the first FU year predicts further growth. Vestibular schwannoma volume does not correlate with audiologic deterioration significantly. Conclusion: Hypointensity on T2-weighted image of the affected labyrinth will result in a significant faster deterioration of hearing. Hearing loss was more profound, and hearing will deteriorate significantly faster in patients presenting with complaints of hearing loss. Significant growth during the first year of FU predicts further growth during FU. Sequential MRI cannot be substituted by audiologic examinations solely because increase in VS volume does not correlate with audiologic deterioration significantly. © 2011, Otology & Neurotology, Inc.

Yarde F.,University Utrecht | Maas A.H.E.M.,Radboud University Nijmegen | Franx A.,University Utrecht | Eijkemans M.J.C.,University Utrecht | And 6 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2014

Context: The association between early menopause and vascular disease as a possible causative factor has recently received attention. Preeclampsia (PE) is associated with future cardiovascular risk factors, and this premature vascular aging potentially modifies the ovarian aging process. Objective: The purpose of this study was to assess whether women with a history of PE have lower anti-Müllerian hormone (AMH) levels than women with normotensive pregnancies. Design: This was a retrospective cohort study. Setting: The study was conducted in a tertiary referral center. Patients: Clinical data and blood samples of participants in the Preeclampsia Risk EValuation in FEMales study were used (336 women with a history of PE and 329 women after a normotensive pregnancy). Interventions: There were no interventions. Main Outcome Measures: The relative decrease in AMH levels was assessed after a median follow- up of 10.5 years. Results: The meanAMHlevel was 2.00 ± 1.87μg/L in the PE group compared with 2.26 ± 2.56μg/L in the reference group. Linear regression analysis with censoring for undetectable AMH levels, adjusted for age, smoking, and hormonal contraceptive use, showed a relative reduction in AMH levels of 20.9% at any age (fold change 0.79, 95% confidence interval, 0.67-0.94). Conclusions:Wedemonstrate that women with a history of PE have significantly lowerAMHlevels than women with normotensive pregnancies. Calculations based on a reference population indicate advancement of reproductive age of approximately 1.5 years. Because PE is considered a manifestation of impaired vascular health, these results support the hypothesis that compromised vascular health could act as a causative mechanism in early ovarian aging. Copyright © 2014 by the Endocrine Society.

PubMed | Isala Klinieken Zwolle
Type: | Journal: Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation | Year: 2016

This study sought to assess whether radial artery access improves clinical outcomes in patients presenting with acute myocardial infarction compared with femoral artery access.This is asingle-centre, prospective observational registry of all STEMI and NSTEMI patients who underwent coronary angiography and/or primary PCI in the period January 2010 to December 2013. Primary endpoint was 30-day all-cause mortality. Choice of access was left to the discretion of the cardiologist. Differences in the risk of death at 30days between patients undergoing transradial intervention versus transfemoral intervention was assessed on an intention-to-treat comparison.Retrospective analysis of prospectively collected data was performed in 3580patients with an acute coronary syndrome who underwent coronary angiography, of which 1310 had radial artery access. PCI was performed in 77% of the patients. Before propensity score matching, patients who underwent transradial intervention and those intended to undergo transfemoral approach differed significantly in intra-aortic balloon pump use (1.7% vs. 6.7%, p< 0.001), and Killip class (Killip 1: 10.8% vs. 17.3%, p< 0.001). 30-day mortality rates were 1.7% in the transradial group and 4.6% in the transfemoral group (p< 0.001). After matching on the propensity score, the hazard ratio for 30-day mortality in the transradial group was 0.56 (95% CI: 0.29-1.07, p= 0.08).This registry-based study showed that radial access is associated with improved outcome in patients with an acute coronary syndrome. However, this difference was no longer significant after multivariate and propensity score adjustment for differences in baseline characteristics.

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