Hofstra J.M.,Radboud University Nijmegen |
Branten A.J.W.,Radboud University Nijmegen |
Wirtz J.J.J.M.,Laurentius Hospital |
Noordzij T.C.,Franciscus Hospital |
And 2 more authors.
Nephrology Dialysis Transplantation | Year: 2010
Background. Immunosuppressive therapy in idiopathic membranous nephropathy (iMN) is debated. Accurate identification of patients at high risk for end-stage renal disease (ESRD) allows early start of therapy in these patients. It is unknown if early start of therapy is more effective andor less toxic than late start (i.e. when GFR deteriorates).Methods. We conducted a randomized open-label study in patients with iMN, a normal renal function and a high risk for ESRD (urinary β2m >0.5 μgmin, UIgG >125 mg day). Patients started with immunosuppressive therapy (cyclophosphamide for 12 months, and steroids) either immediately after randomization or when renal function deteriorated (ΔsCr ≥+25 and sCr >135 μmoll or ΔsCr ≥+50). End points were remission rates, duration of the nephrotic syndrome (NS), renal function and complications.Results. The study included 26 patients (24 M2 F), age 48 ± 12 years; sCr 96 μmoll (range 68-126) and median proteinuria 10.0 g10 mmol Cr. Early treatment resulted in a more rapid onset of remission (P = 0.003) and a shorter duration of the NS (P = 0.009). However, at the end of the follow-up (72 ± 22 m), there were no differences in overall remission rate, sCr (93 versus 105 μmoll), proteinuria, relapse rate and adverse events.Conclusions. In high-risk patients with iMN, immunosuppressive treatment is effective in inducing a remission. Early treatment shortens the duration of the nephrotic phase, but does not result in better preservation of renal function. Our study indicates that treatment decisions must be based on risk and benefit assessment in the individual patient.
Vermeulen J.,Maasstad Hospital |
Leijtens J.W.A.,Laurentius Hospital |
Mannaerts G.H.H.,Sint Franciscus Hospital
Digestive Surgery | Year: 2010
Aims: Reversal of Hartmann's procedure (HP) is a complex operation and only performed in 50-60% of the patients. Stomal incision reversal (SIR), a new minimally invasive procedure for HP reversal, was assessed and compared to the standard surgical approach. Methods: 16 patients who had undergone HP for perforated diverticulitis underwent HP reversal by SIR. The only incision in SIR is the one to release the end colostomy. Intra-abdominal adhesiolysis is done manually. A stapled end-to-end colorectal anastomosis is created. The 16 patients who underwent SIR were compared with 32 control patients who were matched according to gender, age, American Society of Anesthesiologists (ASA) classification and Hinchey stage. Results: The operation time was shorter after SIR than after reversal by laparotomy [75 min (58-208) vs. 141 min (85-276); p < 0.001]. Patients after SIR had a shorter hospital stay than patients after laparotomy [4 days (2-22) vs. 9 days (4-64); p < 0.001]. The numbers of total postoperative surgical complications (early and late) were not different (p = 0.13). The anastomotic leakage rate was similar in both groups (6%). The conversion rate in the SIR group was 19% (n = 3). Conclusion: SIR compared favorably with HP reversal by laparotomy in terms of operation time and hospital stay, without increasing the number of postoperative complications. Copyright © 2010 S. Karger AG, Basel.
Dingemans A.-M.C.,Maastricht University |
Bootsma G.,Atrium Medical |
Pitz C.,Laurentius Hospital |
Geraedts W.,Orbis Medical Center |
De Ruysscher D.,University Hospital Leuven
Radiotherapy and Oncology | Year: 2014
Background Non-small cell lung cancer (NSCLC) stage T4N0-1 or single nodal station IIIA-N2 are two stage III sub-groups for which the outcome of non-surgical therapy is not well known. We investigated the results of individualised isotoxic accelerated radiotherapy (INDAR) and chemotherapy in this setting. Methods Analysis of NSCLC patients included in 2 prospective trials (NCT00573040 and NCT00572325) stage T4N0-1 or IIIA-N2 with 1 pathologic nodal station, treated with chemo-radiotherapy (CRT) using INDAR with concurrent or sequential platinum-based chemotherapy. Overall survival (OS) was updated and calculated from date of diagnosis (Kaplan-Meier). Toxicity was scored following CTCAEv3.0. To allow comparison with other articles the subgroups were also analysed separately for toxicity, progression free and overall survival. Results 83 patients (42 T4N0-1 and 41 IIIA-N2) were identified: the median radiotherapy dose was 65 Gy. Thirty-seven percent of patients received sequential CRT and 63% received concurrent CRT. At a median follow-up of 48 months the median OS for T4N0-1 patients was 34 months with 55% 2-year survival and 25% 5-year survival. For stage IIIA-N2 at a median follow-up of 50 months the median OS was 26 months with 2- and 5-year survival rates of 53% and 24%, respectively. Conclusion Chemo-radiation using INDAR yields promising survival results in patients with single-station stage IIIA-N2 or T4N0-1 NSCLC. © 2013 Elsevier Ireland Ltd. All rights reserved.
Teunissen J.,Viecuri Medical Center |
Hochs A.H.J.,Viecuri Medical Center |
Vaessen-Verberne A.,Amphia Hospital |
Boehmer A.L.M.,Maasstad Hospital |
And 12 more authors.
European Respiratory Journal | Year: 2014
Bronchiolitis is a common disorder in young children that often results in hospitalisation. Except for a possible effect of nebulised hypertonic saline (sodium chloride), no evidence-based therapy is available. This study investigated the efficacy of nebulised 3% and 6% hypertonic saline compared with 0.9% hypertonic saline in children hospitalised with viral bronchiolitis. In this multicentre, double-blind, randomised, controlled trial, children hospitalised with acute viral bronchiolitis were randomised to receive either nebulised 3%, 6% hypertonic saline or 0.9% normal saline during their entire hospital stay. Salbutamol was added to counteract possible bronchial constriction. The primary endpoint was the length of hospital stay. Secondary outcomes were need for supplemental oxygen and tube feeding. From the 292 children included in the study (median age 3.4 months), 247 completed the study. The median length of hospital stay did not differ between the groups: 69 h (interquartile range 57), 70 h (IQR 69) and 53 h (IQR 52), for 3% (n=84) and 6% (n=83) hypertonic saline and 0.9% (n=80) normal saline, respectively, (p=0.29). The need for supplemental oxygen or tube feeding did not differ significantly. Adverse effects were similar in the three groups. Nebulisation with hypertonic saline (3% or 6% sodium chloride) although safe, did not reduce the length of stay in hospital, duration of supplemental oxygen or tube feeding in children hospitalised with moderateto- severe viral bronchiolitis. Copyright © 2014 ERS.
Van Gijn W.,Netherlands Cancer Institute |
De Graaf E.,IJsselland Hospital |
Neijenhuis P.A.,Rijnland Hospital |
Stassen L.P.S.,Maastricht University |
And 3 more authors.
European Journal of Surgical Oncology | Year: 2013
Background Transanal endoscopic microsurgery (TEM) has gained wide-spread acceptance as a safe and useful technique for the resection of rectal adenomas and selected T1 malignant lesions. If the lesion appears >T1 rectal cancer after resection with TEM, a completion TME resection is recommended. The aim of this study was to investigate the results of TME surgery after TEM for rectal cancer. Methods In four tertiary referral hospitals for TEM, all patients with completion TME surgery after initial TEM were selected. All eligible patients who were treated with 5 × 5 Gy radiotherapy followed by TME surgery from the Dutch TME trial were selected as reference group. A multivariate logistic regression model was used to calculate odds ratio's (OR) for colostomies and for colo- and ileostomies combined. Local recurrence and survival rates were compared in hazard ratio's (HR) using the multivariate Cox proportional hazard model. Results Fifty-nine patients were included in the TEM-COMPLETION group and 881 patients from the TME trial. In the TEM-COMPLETION group, 50.8% of the patients had a colostomy compared to 45.9% in the TME trial, OR 2.51 (p < 0.006). There is no significant difference when ileo- and colostomies are analyzed together. In the TEM-COMPLETION group, 10.2% developed a local recurrence compared to 5.2% in the TME trial, HR 6.8 (p < 0.0001). Conclusions Completion TME surgery after TEM for unexpected rectal adenocarcinoma results in more colostomies and higher local recurrence rates compared to one stage TME surgery preceded with preoperative 5 × 5 Gy radiotherapy. Pre-operative investigations must be optimized to distinguish malignant and benign lesions and prevent avoidable local recurrence and colostomies. © 2013 Elsevier Ltd. All rights reserved.