Meander Medical Center Amersfoort

Amersfoort, Netherlands

Meander Medical Center Amersfoort

Amersfoort, Netherlands
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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.


van de Wall B.J.M.,Meander Medical Center Amersfoort | Draaisma W.A.,Meander Medical Center Amersfoort | Consten E.C.J.,Meander Medical Center Amersfoort | van der Kaaij R.T.,Meander Medical Center Amersfoort | And 2 more authors.
Journal of Gastrointestinal Surgery | Year: 2013

Background: Information on long-term outcome of patients treated conservatively for diverticular abscess is scarce. This study aims to compare diverticulitis patients with abscess to patients without abscess with regard to readmission, complications, and surgical treatment during a follow-up period of at least 12 months. Methods: A chart review of all patients admitted for a primary manifestation of diverticulitis between January 2005 and January 2011 was performed. Results: Fifty-nine patients with abscess and 663 without abscess were identified. Median follow-up was 28 months (range 12-103). Initial conservative management was achieved in 54 (91. 5 %) patients with diverticular abscess and 635 (96. 8 %) without abscess. Readmission occurred more frequently among patients with abscess (hazard ratio (HR) 2. 6; confidence interval (CI) 1. 51-4. 33) with a first-year risk of 27. 3 versus 10. 7 % and second-year risk of 8. 2 versus 4. 6 %. Surgery was more frequently performed in patients with diverticular abscess (HR 2. 3; CI 1. 42-3. 66). The first-year risk was 35. 1 versus 16. 6 % and second-year risk was 12. 9 versus 2. 4 %. The most frequent indication for surgery was persisting or recurrent disease. Conclusion: Patients with diverticular abscess have a higher risk of being readmitted and/or requiring surgical treatment. The pattern suggests that readmission and need for surgery are the results of an ongoing inflammation of the initial episode. © 2012 The Society for Surgery of the Alimentary Tract.


van de Wall B.J.M.,Meander Medical Center Amersfoort | Draaisma W.A.,Meander Medical Center Amersfoort | van der Kaaij R.T.,Meander Medical Center Amersfoort | Consten E.C.J.,Meander Medical Center Amersfoort | And 2 more authors.
Colorectal Disease | Year: 2013

Aim: To determine the diagnostic value of serological infection markers and body temperature in discriminating complicated from uncomplicated diverticulitis. Methods: Patients in whom diverticulitis was pathologically or radiologically proven at presentation were included. Patients were classified as either complicated (Hinchey Ib, II, III and IV) or uncomplicated (Hinchey Ia) diverticulitis. The discriminative value of C-reactive protein (CRP), white blood cell (WBC) count and body temperature at presentation was tested. Results: A total of 426 patients were included in this study of which 364 (85%) presented with uncomplicated and 62 (15%) with complicated diverticulitis. Only CRP was of sufficient diagnostic value (area under the curve 0.715). The median CRP in patients with complicated diverticulitis was significantly higher than in patients with uncomplicated disease (224mg/l, range 99-284 vs 87mg/l, range 48-151). Patients with a CRP of 25mg/l had a 15% chance of having complicated diverticulitis. This increased from 23% at a CRP value of 100mg/l to 47% for 250mg/l or higher. The optimal threshold was reached at 175mg/l with a positive predictive value of 36%, negative predictive value of 92%, sensitivity of 61% and a specificity of 82%. Conclusion: WBC count and body temperature are of no value in discriminating complicated from uncomplicated diverticulitis. Only CRP can be used as an indicator for the presence of complications, but a low CRP does not mean that complicated disease can safely be excluded. Therefore, radiological examination remains central in the diagnostic work-up of patients presenting with diverticulitis. © 2012 The Authors Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.


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.,Flevo Hospital | 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 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).


Hilvering B.,Meander Medical Center Amersfoort | Draaisma W.A.,Meander Medical Center Amersfoort | Van Der Bilt J.D.W.,Meander Medical Center Amersfoort | Valk R.M.,Meander Medical Center Amersfoort | And 2 more authors.
British Journal of Surgery | Year: 2011

Background: Postoperative pain is one of the main reasons for a prolonged hospital stay after laparoscopic cholecystectomy (LC). Reduced postoperative pain might result in faster recovery and establish LC as a day-care surgical procedure. Peroperative local anaesthesia has been suggested to reduce postoperative pain. The aim of this study was to determine the effect of combined subcutaneous infiltration and intraperitoneal instillation of levobupivacaine before the start of LC on postoperative abdominal pain up to 24 h after surgery. Methods: Patients eligible for elective LC were randomized to receive preincisional infiltration and preoperative intraperitoneal instillation of 80 ml of either 0.125 per cent levobupivacaine (experimental group) or normal saline (placebo group). The primary outcome measure was abdominal pain estimated by means of a visual analogue scale at 0.5, 2, 4, 8 and 24 h after surgery. Results: Eighty of the 101 patients assessed for eligibility were randomized. There was no significant reduction in postoperative abdominal pain with levobupivacaine compared with placebo during the 24-h follow-up; the overall difference in pain score was 2.2 (95 per cent confidence interval - 4.9 to 9.3; P = 0.540). The duration of operation, use of anaesthesia, use of rescue analgesia, shoulder pain, duration of hospital stay and time to resumption of normal daily activities did not differ between the two groups. Conclusion: Combined subcutaneous and intraperitoneal administration of levobupivacaine did not influence postoperative abdominal pain after LC. © 2011 British Journal of Surgery Society Ltd.


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.


Timmers T.K.,Meander Medical Center Amersfoort | van der Ven D.J.C.,University Utrecht | de Vries L.S.,Meander Medical Center Amersfoort | van Olden G.D.J.,Meander Medical Center Amersfoort
Knee | Year: 2014

Background: Tibial plateau fractures often require surgical treatment. Functional outcome depends mainly on the range of knee motion, joint stability, and pain. Only a few studies evaluate the functional outcome of a tibial plateau fracture after operation. The primary aim of this study was to evaluate the results and functional outcome of surgically treated (ORIF) tibial plateau fractures. Methods: Between January 2000 and December 2010 all consecutive patients undergoing osteosynthesis of a tibial plateau fracture were included if they were discharged alive and completed the questionnaire. The primary outcome measures were functional outcome ("Knee injury and Osteoarthritis Score" (KOOS) questionnaire) and Health-related quality of life (HrQoL) using the EuroQol-6D (EQ-6D) questionnaire at the end of the study follow-up period (May 2013). Results: Eighty-two patients were included in the functional outcome and HrQoL analysis. The functional outcome results were concluded as "Fair" for the overall cohort within the sections Symptoms/Pain/Self-care. A significant difference was seen in the Sport/Recreation section (functional outcome: "Poor"). Dividing our cohort in a low-energy and a high-energy-trauma group, significant lower functional outcome score was seen in the KOOS section Pain for the high-energy-trauma patients. The HrQoL of the total study-population was worse in comparison to an age-matched general Dutch population on the EQ-us (difference of 0.15). This decrease in HrQoL was seen in all dimensions of the EuroQol questionnaire. Conclusions: Six years after discharge from hospital, patients still alive had a "Fair" functional knee outcome. However, HrQoL was lower in comparison to the general Dutch population. © 2014 Elsevier B.V.


Van De Wall B.J.M.,Meander Medical Center Amersfoort | Draaisma W.A.,Meander Medical Center Amersfoort | Van Iersel J.J.,Meander Medical Center Amersfoort | Consten E.C.J.,Meander Medical Center Amersfoort | And 2 more authors.
Digestive Surgery | Year: 2013

Background: Although the risks of elective resection for diverticular disease are well studied, studies on subjective improvement are scarce. This study aims to investigate subjective improvement. Methods: All patients who underwent elective resection for recurring or persisting complaints after an episode of diverticulitis were identified from an in-hospital database. Patients with at least 1 year of follow-up were sent visual analogue scales (VAS) to grade their quality of life (QoL) and the degree of discomfort caused by abdominal pain, abnormal defecation and fatigue before and after resection. Results: One hundred and five patients responded to the questionnaire (response rate 76.6%). The median follow-up was 33 (15-53) months. Elective resection improved general QoL (median VAS improvement 40) and reduced discomfort caused by abdominal pain (median VAS improvement 60) in up to 89.3 and 87.5% of patients, respectively. The effects of elective resection are less profound for discomfort caused by abnormal defecation (77.1%, median VAS improvement 33) and fatigue (75.2%, median VAS improvement 30). Conclusion: Elective resection of the sigmoid for persisting or recurring symptoms after an episode of diverticulitis improves general QoL and discomfort caused by abdominal pain, abnormal defecation and fatigue in the vast majority of patients. Copyright © 2013 S. Karger AG, Basel.

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