Kennemer Gasthuis

Haarlem, Netherlands

Kennemer Gasthuis

Haarlem, Netherlands
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Heckenberg S.G.B.,Kennemer Gasthuis
Handbook of Clinical Neurology | Year: 2014

Bacterial meningitis is a neurologic emergency. Vaccination against common pathogens has decreased the burden of disease. Early diagnosis and rapid initiation of empiric antimicrobial and adjunctive therapy are vital. Therapy should be initiated as soon as blood cultures have been obtained, preceding any imaging studies. Clinical signs suggestive of bacterial meningitis include fever, headache, meningismus, and an altered level of consciousness but signs may be scarce in children, in the elderly, and in meningococcal disease. Host genetic factors are major determinants of susceptibility to meningococcal and pneumococcal disease. Dexamethasone therapy has been implemented as adjunctive treatment of adults with pneumococcal meningitis. Adequate and prompt treatment of bacterial meningitis is critical to outcome. In this chapter we review the epidemiology, pathophysiology, and management of bacterial meningitis. © 2014 Elsevier B.V.


Witlox J.,Medical Center Alkmaar | De Jonghe J.F.M.,Medical Center Alkmaar | Kalisvaart K.J.,Kennemer Gasthuis
JAMA - Journal of the American Medical Association | Year: 2010

Context: Delirium is a common and serious complication in elderly patients. Evidence suggests that delirium is associated with long-term poor outcome but delirium often occurs in individuals with more severe underlying disease. Objective: To assess the association between delirium in elderly patients and long-term poor outcome, defined as mortality, institutionalization, or dementia, while controlling for important confounders. Data Sources: Asystematic search of studies published between January 1981 and April 2010 was conducted using the databases of MEDLINE, EMBASE, PsycINFO, and CINAHL. Study Selection: Observational studies of elderly patients with delirium as a study variable and data on mortality, institutionalization, or dementia after a minimum follow-up of 3 months, and published in the English or Dutch language. Titles, abstracts, and articles were reviewed independently by 2 of the authors. Of 2939 references in the original search, 51 relevant articles were identified. Data Extraction: Information on study design, characteristics of the study population, and outcome were extracted. Quality of studies was assessed based on elements of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cohort studies. Data Synthesis: The primary analyses included only high-quality studies with statistical control for age, sex, comorbid illness or illness severity, and baseline dementia. Pooled-effect estimates were calculated with random-effects models. The primary analysis with adjusted hazard ratios (HRs) showed that delirium is associated with an increased risk of death compared with controls after an average follow-up of 22.7 months (7 studies; 271/714 patients [38.0%] with delirium, 616/2243 controls [27.5%]; HR, 1.95 [95% confidence interval {CI}, 1.51-2.52]; I2, 44.0%). Moreover, patients who had experienced delirium were also at increased risk of institutionalization (7 studies; average follow-up, 14.6 months; 176/527 patients [33.4%] with delirium and 219/2052 controls [10.7%]; odds ratio [OR], 2.41 [95% CI, 1.77-3.29]; I2, 0%) and dementia (2 studies; average follow-up, 4.1 years; 35/56 patients [62.5%] with delirium and 15/185 controls [8.1%]; OR, 12.52 [95% CI, 1.86-84.21]; I2, 52.4%). The sensitivity, trim-and-fill, and secondary analyses with unadjusted high-quality risk estimates stratified according to the study characteristics confirmed the robustness of these results. Conclusion: This meta-analysis provides evidence that delirium in elderly patients is associated with poor outcome independent of important confounders, such as age, sex, comorbid illness or illness severity, and baseline dementia. ©2010 American Medical Association. All rights reserved.


Horeweg N.,Erasmus Medical Center | Scholten E.T.,Kennemer Gasthuis | de Jong P.A.,University Utrecht | van der Aalst C.M.,Erasmus Medical Center | And 10 more authors.
The Lancet Oncology | Year: 2014

Background: Low-dose CT screening is recommended for individuals at high risk of developing lung cancer. However, CT screening does not detect all lung cancers: some might be missed at screening, and others can develop in the interval between screens. The NELSON trial is a randomised trial to assess the effect of screening with increasing screening intervals on lung cancer mortality. In this prespecified analysis, we aimed to assess screening test performance, and the epidemiological, radiological, and clinical characteristics of interval cancers in NELSON trial participants assigned to the screening group. Methods: Eligible participants in the NELSON trial were those aged 50-75 years, who had smoked 15 or more cigarettes per day for more than 25 years or ten or more cigarettes for more than 30 years, and were still smoking or had quit less than 10 years ago. We included all participants assigned to the screening group who had attended at least one round of screening. Screening test results were based on volumetry using a two-step approach. Initially, screening test results were classified as negative, indeterminate, or positive based on nodule presence and volume. Subsequently, participants with an initial indeterminate result underwent follow-up screening to classify their final screening test result as negative or positive, based on nodule volume doubling time. We obtained information about all lung cancer diagnoses made during the first three rounds of screening, plus an additional 2 years of follow-up from the national cancer registry. We determined epidemiological, radiological, participant, and tumour characteristics by reassessing medical files, screening CTs, and clinical CTs. The NELSON trial is registered at www.trialregister.nl, number ISRCTN63545820. Findings: 15 822 participants were enrolled in the NELSON trial, of whom 7915 were assigned to low-dose CT screening with increasing interval between screens, and 7907 to no screening. We included 7155 participants in our study, with median follow-up of 8.16 years (IQR 7.56-8.56). 187 (3%) of 7155 screened participants were diagnosed with 196 screen-detected lung cancers, and another 34 (<1%; 19 [56%] in the first year after screening, and 15 [44%] in the second year after screening) were diagnosed with 35 interval cancers. For the three screening rounds combined, with a 2-year follow-up, sensitivity was 84.6% (95% CI 79.6-89.2), specificity was 98.6% (95% CI 98.5-98.8), positive predictive value was 40.4% (95% CI 35.9-44.7), and negative predictive value was 99.8% (95% CI 99.8-99.9). Retrospective assessment of the last screening CT and clinical CT in 34 patients with interval cancer showed that interval cancers were not visible in 12 (35%) cases. In the remaining cases, cancers were visible when retrospectively assessed, but were not diagnosed because of radiological detection and interpretation errors (17 [50%]), misclassification by the protocol (two [6%]), participant non-compliance (two [6%]), and non-adherence to protocol (one [3%]). Compared with screen-detected cancers, interval cancers were diagnosed at more advanced stages (29 [83%] of 35 interval cancers vs 44 [22%] of 196 screen-detected cancers diagnosed in stage III or IV; p<0.0001), were more often small-cell carcinomas (seven [20%] vs eight [4%]; p=0.003) and less often adenocarcinomas (nine [26%] vs 102 [52%]; p=0.005). Interpretation: Lung cancer screening in the NELSON trial yielded high specificity and sensitivity, with only a small number of interval cancers. The results of this study could be used to improve screening algorithms, and reduce the number of missed cancers. Funding: Zorgonderzoek Nederland Medische Wetenschappen and Koningin Wilhelmina Fonds. © 2014 Elsevier Ltd.


De Jong M.F.C.,Kennemer Gasthuis | Soetekouw R.,Kennemer Gasthuis | Ten Kate R.W.,Kennemer Gasthuis | Veenendaal D.,Streeklaboratorium Voor Of Volksgezondheid
Journal of Clinical Microbiology | Year: 2010

Aerococcus urinae is a pathogen that rarely causes severe or fatal infections. We describe four cases of severe A. urinae bloodstream infections. All patients had underlying urologic conditions. Urine cultures, however, were negative. Copyright © 2010, American Society for Microbiology. All Rights Reserved.


The transanal total mesorectal excision (TME) for colorectal tumours is a new endoscopic approach in which the rectum is mobilized transanally from down-to-up using a flexible transanal single-access port. The advantage of this technique is that it could result in fewer conversions from laparoscopic to open procedures and consequently fewer complications and more radical resections. Standard endoscopic armamentarium is used for the transanal technique so that costs remain low. The length of the learning curve is expected to be comparable to other laparoscopic techniques, and is even shorter for an experienced laparoscopic surgeon. Additional research is needed to compare long-term oncological and clinical results of transanal TME to laparoscopic and open TME.


Bultink I.E.M.,VU University Amsterdam | Baden M.,Kennemer Gasthuis | Lems W.F.,VU University Amsterdam
Expert Opinion on Pharmacotherapy | Year: 2013

Introduction: Glucocorticoid-induced osteoporosis (GIOP) is one of the most devastating side-effects of glucocorticoid (GC) use, as it is associated with an increased fracture risk. The importance of GIOP as a health problem is underlined by the frequent use of GC treatment in patients with various chronic diseases and by the high rates of osteoporosis found in these patient groups. Areas covered: Recent studies on bone metabolism and the influence of GCs have contributed to a better understanding of the pathogenesis of GIOP. Furthermore, new intervention trials have reported beneficial effects of antiresorptive and anabolic agents on GIOP. This article reviews the epidemiology and pathophysiology of osteoporosis and fractures in GC-treated patients and discusses current pharmacotherapy and possible future treatment options. Expert opinion: Several guidelines for the management of GIOP have been published, using different criteria for bone mineral density (BMD) thresholds and for GC dosages above which anti-osteoporotic therapy should be started. Although alendronate and risedronate are currently first choice, the anabolic agent teriparatide seems to be superior and might be considered as a potential first-line therapy for patients with low BMD on long-term GC treatment. Adherence to anti-osteoporotic drugs is limited, particularly in GIOP patients, due to several factors. © 2013 Informa UK, Ltd.


Buijsman R.,Kennemer Gasthuis
Nederlands tijdschrift voor geneeskunde | Year: 2013

A 78-year-old woman presented with a 9-month history of an ulcerative umbilical swelling, which had recently started to produce feces. An abdominal CT-scan showed a tumour in the transverse colon, infiltrating the abdominal wall and skin, but without signs of distant metastases. Histopathological examination of a biopsy specimen revealed a slime-producing adenocarcinoma. Due to a myocardial infarction, the patient died two days prior to surgery. No permission to conduct an autopsy was granted.


de Ronde W.,Kennemer Gasthuis | de Jong F.H.,Erasmus Medical Center
Reproductive Biology and Endocrinology | Year: 2011

Aromatase inhibitors effectively delay epiphysial maturation in boys and improve testosterone levels in adult men Therefore, aromatase inhibitors may be used to increase adult height in boys with gonadotropin-independent precocious puberty, idiopathic short stature and constitutional delay of puberty. Long-term efficacy and safety of the use of aromatase inhibitors has not yet been established in males, however, and their routine use is therefore not yet recommended. © 2011 de Ronde and de Jong; licensee BioMed Central Ltd.


Haas R.L.M.,Netherlands Cancer Institute | de Klerk G.,Kennemer Gasthuis
Netherlands Journal of Medicine | Year: 2011

Radiation recall dermatitis (RRD) is a rare cutaneous reaction occurring within a previously irradiated field, precipitated by certain drugs. A case of RRD most likely induced by doxorubicin is presented and illustrated together with a review of the literature. © Van Zuiden Communications B.V.


Kwa B.H.B.,Kennemer Gasthuis | De Ronde W.,Kennemer Gasthuis
Current Opinion in Pulmonary Medicine | Year: 2012

PURPOSE OF REVIEW: Chronic obstructive pulmonary disease (COPD) is a widespread disease with high morbidity rates. Advanced stages can be complicated by unintentional weight loss and muscle wasting, which may contribute to increased morbidity and mortality. Reversal of weight loss increases muscle strength and exercise capacity and improves survival. This can partly be achieved by nutritional support, preferably combined with increase in exercise. Androgenic anabolic steroids (AASs), of which testosterone is the parent hormone, increase muscle size and strength. Due to these anabolic effects, AASs may emerge as a treatment option in COPD patients suffering from muscle wasting. RECENT FINDINGS: Seven trials investigated the effects of AAS in patients with COPD. Some studies also included nutritional therapy and/or a pulmonary rehabilitation program. Compared with placebo, AASs increase lean body mass (LBM) and muscle size. However, no consistent effects on muscle strength, exercise capacity, or pulmonary function are seen. SUMMARY: AASs increase LBM in patients with advanced stages of COPD. No consistent beneficial effect on other endpoints was demonstrated in the reviewed trials. However, probably higher doses of AASs are needed to exert a clinically meaningful effect on muscle strength or exercise capacity. Currently, no evidence is available to recommend AASs to all patients with COPD. In individual cases, treatment with AASs can be considered, particularly in men with advanced COPD, moderate-to-severe functional impairment, muscle wasting and on chronic corticosteroid therapy. Treatment with AASs should preferably be combined with a rehabilitation program and nutritional support. AASs should not be used in women or in men with symptomatic heart disease. When treatment with AASs is considered, intramuscular nandrolone-decanoate is preferred in a dose of 50-200mg per week for a period of 12 weeks. However, the efficacy of AAS treatment in COPD patients needs further clarification in well designed, adequately powered clinical studies. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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