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Amersfoort, Netherlands

van de Wall B.J.M.,Meander Medical Center | Draaisma W.A.,Meander Medical Center | Schouten E.S.,Meander Medical Center | Broeders I.A.M.J.,Meander Medical Center | And 2 more authors.
Journal of Gastrointestinal Surgery | Year: 2010

Purpose: The aim of this study was to provide a systematic overview on both laparoscopic and conventional Hartmann reversal. Furthermore, the Hartmann procedure is reevaluated in the light of new emerging alternatives. Methods: Medline, Ovid, EMBASE, and Cochrane database were searched for studies reporting on outcomes after Hartmann reversal. Results: Thirty-five studies were included in this review of which 30 were retrospective. A total of 6,249 patients with a mean age of 60 years underwent Hartmann reversal. Two thirds of patients were classified as American Society of Anesthesiologists (ASA) I-II. The mean reversal rate after a Hartmann procedure was 44%, and mean time interval between Hartmann procedure and Hartmann reversal was 7. 5 months. The most frequent reported reasons for renouncing Hartmann reversal were high ASA classification and patients' refusal. The overall morbidity rate ranged from 3% to 50% (mean 16. 3%) and mortality rate from 0% to 7. 1% (mean 1%). Patients treated laparoscopically had a shorter hospital stay (6. 9 vs. 10. 7 days) and appeared to have lower mean morbidity rates compared to conventional surgery (12. 2% vs. 20. 3%). Conclusion: Hartmann reversal carries a high risk on perioperative morbidity and mortality. The mean reversal rate is considerably low (44%). Laparoscopic reversal compares favorably to conventional; however, high level evidence is needed to determine whether it is superior. © 2009 The Author(s).

De Witte C.J.,Universal Medical Center Utrecht | Van De Sande A.J.M.,Netherlands Cancer Institute | Van Beekhuizen H.J.,Netherlands Cancer Institute | Koeneman M.M.,Maastricht University | And 2 more authors.
Gynecologic Oncology | Year: 2015

Human papillomavirus (HPV) infection is in the vast majority of patients accountable for the development of vulvar, cervical and vaginal intraepithelial neoplasia (VIN, CIN, VAIN); precursors of vulvar, cervical and vaginal cancers. The currently preferred treatment modality for high grade VIN, CIN and VAIN is surgical excision. Nevertheless surgical treatment is associated with adverse pregnancy outcomes and recurrence is not uncommon. The aim of this review is to present evidence on the efficacy, safety and tolerability of imiquimod (an immune response modifier) in HPV-related VIN, CIN and VAIN. A search for papers on the use of imiquimod in VIN, CIN and VAIN was performed in the MEDLINE, EMBASE and Cochrane library databases. Data was extracted and reviewed. Twenty-one articles met the inclusion criteria and were analyzed; 16 on VIN, 3 on CIN and 2 on VAIN. Complete response rates in VIN ranged from 5 to 88%. Although minor adverse effects were frequently reported, treatment with imiquimod was well tolerated in most patients. Studies on imiquimod treatment of CIN and VAIN are limited and lack uniformly defined endpoints. The available evidence however, shows encouraging effect. Complete response rates for CIN 2-3 and VAIN 1-3 ranged from 67 to 75% and 57 to 86% respectively. More randomized controlled trials on the use of imiquimod in CIN, VAIN and VIN with extended follow-up are necessary to determine the attributive therapeutic value in these patients. © 2015 Elsevier Inc.

Zwiers I.,Maastricht University | Hoogland C.M.T.,Vascular Center | Mackaay A.J.C.,Meander Medical Center Amersfoort
European Journal of Vascular and Endovascular Surgery | Year: 2016

Background In this study the intra- and inter-observer variability of ultrasound measurements of the diameter of the popliteal artery were tested in a group of patients under surveillance for a small (diameter 10-20 mm), asymptomatic popliteal artery aneurysm (PAA). Methods From a group of patients under ultrasound surveillance for bilateral, asymptomatic PAAs, 13 consecutive patients agreed to participate in the study and provided informed consent. The maximum diameter of the popliteal arteries was assessed by a vascular technologist. The same assessment was repeated by a second vascular technologist, unaware of the results of the first measurement. After a week, this protocol was repeated. The intra- and inter-observer reliability of this measurement was calculated using intra-class correlation coefficients (ICCs) and Bland and Altman plots. Results Of the 10 patients with bilateral and three patients with unilateral PAA, 12 completed the 2 week protocol. A total of 86 measurements were analyzed. The mean diameter of the popliteal arteries was 13.5 ± 3.4 mm. The ICC for the intra-observer reliability of observer 1 was 0.96 (95% CI 0.92-0.99), p <.001 and of observer 2 was 0.98 (95% CI 0.95-0.99), p <.001. The ICC for the inter-observer reliability for the first measurements was 0.96 (95% CI 0.90-0.98), p <.001 and for the second measurements 0.97 (95% CI 0.94-0.99), p <.001. The Bland-Altman plots showed random error, while 95% of the variation was between 0.016 and 0.16, p >.47. The absolute magnitude of the systematic error of both observers was less than 0.135 mm (median 0.00). Conclusion Ultrasound measurement of the maximum diameter of the popliteal artery is reproducible; hence, it is suitable for making a clinical treatment decision. Its use for surveillance of small, asymptomatic PAAs is justified. © 2015 European Society for Vascular Surgery.

van Olden G.D.J.,Meander Medical Center Amersfoort
Musculoskeletal Surgery | Year: 2014

Introduction: The aim of this investigation was to evaluate the introduction of the VA-LCP anterior clavicle plate in the treatment of clavicle fractures.Material and methods: From March 2011 to March 2013, 42 clavicle fractures were treated; 40 were middle-third and 2 lateral-third, and 13/42 (31 %) patients were treated due to painful nonunion. Patient age ranged from 16 to 81 years.Results: Complications were screw placement through the AC-joint, one superficial wound infection and one neuropraxia of the nervus radialis with dropping hand. We had some difficulties prebending both lateral to low and lateral to high but without clinical consequences. In all cases, the fracture healed with full functionality. After 1 year, 4 patients underwent a removal of the hardware.Conclusion: The VA-LCP anterior plate showed good reliability and sufficient stability with both middle-third, lateral and nonunion fractures of the clavicle. © 2013, Istituto Ortopedico Rizzoli.

Van Doormaal P.J.,University of Groningen | Van Doormaal P.J.,Meander Medical Center Amersfoort | Meiners L.C.,University of Groningen | Ter Horst H.J.,University of Groningen | And 2 more authors.
European Radiology | Year: 2012

Objective Magnetic resonance spectroscopy can identify brain metabolic changes in perinatal asphyxia by providing ratios of metabolites, such as choline (Cho), creatine (Cr), N-acetyl aspartate (NAA) and lactate (Lact) [Cho/Cr, Lact/ NAA, etc.]. The purpose of this study was to quantify the separate white and grey matter metabolites in a slab cranial to the ventricles and relate these to the outcome. Methods A standard 2D-chemical shift imaging protocol was used for measuring a transverse volume of interest located cranial to the ventricles allowing for direct comparison of the metabolites in white and grey matter brain tissue in 24 term asphyxiated newborns aged 3 to 16 days. Results Cho, NAA and Lact showed significant differences between four subgroups of asphyxiated infants with more and less favourable outcomes. High levels of Cho and Lact in the grey matter differentiated non-survivors from survivors (P=0.003 and P=0.017, respectively). Conclusion In perinatal asphyxia the levels of Cho, NAA and Lact in both white and grey matter brain tissue are affected. The levels of Cho and Lact measured in the grey matter are the most indicative of survival. It is therefore advised to include grey matter brain tissue in the region of interest examined by multivoxel MR spectroscopy. Key Points . Magnetic resonance spectroscopy can identify brain metabolic changes in perinatal asphyxia. . Choline and lactate levels in grey matter seem the best indicators of survival. . Both grey and white matter should be examined during spectroscopy for perinatal asphyxia. © European Society of Radiology 2011.

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