Medisch Centrum Alkmaar

Alkmaar, Netherlands

Medisch Centrum Alkmaar

Alkmaar, Netherlands

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Engelsma Y.,Medisch Centrum Alkmaar | Willems W.J.,Onze Lieve Vrouwe Gasthuis
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2010

Posterior shoulder instability is a rare and challenging condition with a complex patho-anatomy. The role of arthroscopic repair in the treatment remains poorly defined. The purpose of this study is to evaluate the result of arthroscopic stabilization procedures in patients with posterior shoulder instability. In this case series, we treated eighteen patients (19 shoulders) with posterior shoulder instability with either arthroscopic thermal capsular shrinkage (9 patients), capsulorrhaphy (3) or labral refixation (7). There were eight male and ten female patients with a mean age of 26 years. The study group included unidirectional (6 patients; PI), bi-directional (8; PII) and multidirectional posterior instability (5; MDI). The Rowe-score and DASH-score as well as subjective and objective evaluations of the patients function, range of motion, pain and instability were used as clinical outcome measurements. At a mean follow-up of 50 months, the Rowe-score improved significantly from 46 to 74 (P = 0.005). Four patients (21%) had recurrent instability after arthroscopic treatment (2 with generalized ligamentous laxity; 3 after thermal shrinkage). Analysis of postoperative DASH-scores showed a tendency toward inferior outcomes after thermal shrinkage and in patients with an a-traumatic origin of shoulder instability. We conclude that arthroscopic shoulder stabilization by either labral refixation or capsulorrhaphy is a safe and effective treatment for posterior shoulder instability. Thermal capsular shrinkage however showed poor results and should be abandoned for this indication. © 2010 Springer-Verlag.


Postma D.F.,University Utrecht | Van Werkhoven C.H.,University Utrecht | Van Elden L.J.R.,Diakonessenhuis Utrecht | Thijsen S.F.T.,Diakonessenhuis Utrecht | And 8 more authors.
New England Journal of Medicine | Year: 2015

Background: The choice of empirical antibiotic treatment for patients with clinically suspected community-acquired pneumonia (CAP) who are admitted to non-intensive care unit (ICU) hospital wards is complicated by the limited availability of evidence. We compared strategies of empirical treatment (allowing deviations for medical reasons) with beta-lactam monotherapy, beta-lactam-macrolide combination therapy, or fluoroquinolone monotherapy. Methods: In a cluster-randomized, crossover trial with strategies rotated in 4-month periods, we tested the noninferiority of the beta-lactam strategy to the beta-lactam-macrolide and fluoroquinolone strategies with respect to 90-day mortality, in an intention- to-treat analysis, using a noninferiority margin of 3 percentage points and a two-sided 90% confidence interval. Results: A total of 656 patients were included during the beta-lactam strategy periods, 739 during the beta-lactam-macrolide strategy periods, and 888 during the fluoroquinolone strategy periods, with rates of adherence to the strategy of 93.0%, 88.0%, and 92.7%, respectively. The median age of the patients was 70 years. The crude 90-day mortality was 9.0% (59 patients), 11.1% (82 patients), and 8.8% (78 patients), respectively, during these strategy periods. In the intention-to-treat analysis, the risk of death was higher by 1.9 percentage points (90% confidence interval [CI], -0.6 to 4.4) with the betalactam- macrolide strategy than with the beta-lactam strategy and lower by 0.6 percentage points (90% CI, -2.8 to 1.9) with the fluoroquinolone strategy than with the beta-lactam strategy. These results indicated noninferiority of the beta-lactam strategy. The median length of hospital stay was 6 days for all strategies, and the median time to starting oral treatment was 3 days (interquartile range, 0 to 4) with the fluoroquinolone strategy and 4 days (interquartile range, 3 to 5) with the other strategies. Conclusions: Among patients with clinically suspected CAP admitted to non-ICU wards, a strategy of preferred empirical treatment with beta-lactam monotherapy was noninferior to strategies with a beta-lactam-macrolide combination or fluoroquinolone monotherapy with regard to 90-day mortality. Copyright © 2015 Massachusetts Medical Society. All rights reserved.


Geenen R.W.F.,Medisch Centrum Alkmaar | Kingma H.J.,Stichting Apotheek der Haarlemse Ziekenhuizen | van der Molen A.J.,Leiden University
Insights into Imaging | Year: 2013

Modern iodinated contrast media (CM) consist of one or two tri-iodobenzene rings. They differ from each other in the composition of the side chains, creating different molecules and thus different brand substances. After intravascular administration, all CM are distributed rapidly into intravascular and extracellular fluids. They are eliminated solely by glomerular filtration. In patients with normal renal function, CMs are eliminated within 24 h. The pathophysiology of contrast-induced nephropathy (CIN) is based on three distinct but interacting mechanisms: medullary ischaemia, formation of reactive oxygen species and direct tubular cell toxicity. The contribution of each of these mechanisms to the development of CIN in the individual patient remains unclear. CIN prevention is extensively described in guidelines, such as the recently updated guideline from the Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR). The recent update is briefly discussed. Furthermore, it remains unclear if volume expansion with either NaCl 0.9 % or NaHCO3 1.4 % is superior. Teaching points • After intravascular injection, CM are distributed over intravascular and extracellular fluids. • CM are eliminated by glomerular filtration in patients with normal kidney function. • CIN pathophysiology is based on medullary ischaemia, formation of reactive oxygen species (ROS) and tubular cell toxicity. • It remains unclear if volume expansion with either NaCl 0.9 % or NaHCO 3 1.4 % is superior. © 2013 The Author(s).


Kanhai R.C.J.,Medisch Centrum Alkmaar
Aesthetic Plastic Surgery | Year: 2016

Background: The cosmetic and functional results of vaginoplasty by inversion of penile and scrotal skin in male-to-female transsexuals are, in general, satisfactory. The sexual arousal function of the neo-female genitalia depends mainly on the clitoris. Due to the lack of a sexual arousal organ within the neo-vagina, patients are denied sexual arousal during penetration of the neo-vagina. This necessitated improvement of sexual innervation within the neo-vagina. Methods: A new technique to create a sexual arousal organ in the anterior wall of the neo-vagina by creation of a sensate pedicled-spot, in combination with the neo-clitoroplasty. Results: In this paper, this new technique and part of the long-term results in the first 50 patients with a sensate pedicled-spot plasty are presented and discussed. Conclusions: Sensate pedicled-spot plasty has proven to be a safe innovative technique which lead to adequate sexual functionality in all patients. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. © 2016, Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery.


Komen M.M.,Medisch Centrum Alkmaar
Nederlands tijdschrift voor geneeskunde | Year: 2011

Alopecia is a very common side effect of cytostatic therapy and is considered one of the most emotionally distressing effects. To prevent alopecia scalp cooling is currently used in some indications in medical oncology in 59 hospitals in the Netherlands. The success of scalp cooling depends on various factors such as type of chemotherapy, dose, infusion time, number of treatment cycles and combinations of drugs. In general, scalp cooling is well tolerated. The reported side-effects are headache, coldness, dizziness and sometimes claustrophobia. An increase in the risk of scalp metastases has not been demonstrated. Proceeding from the South Netherlands Comprehensive Cancer Centre a national working group is put together in order to draw up a national guideline for chemotherapy-induced alopecia.


van Rossum I.A.,Medisch Centrum Alkmaar
Nederlands tijdschrift voor geneeskunde | Year: 2010

An 11-year-old girl and a 25-year-old woman were both initially referred to a neurologist with 'common' neurological problems: The girl suffered from tics, and later epilepsy, and her serum lactate concentration was elevated. She had unilateral hyperintensity of the left cerebral cortex and later developed diabetes mellitus. The woman had muscle weakness, diabetes mellitus and ptosis. In both patients, the problems turned out to be an expression of MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes). The first patient died at 18 years of age during an epileptic seizure with severe metabolic disturbances. The second patient developed bilateral perceptive hearing loss, epilepsy and cardiomyopathy and she was repeatedly admitted to hospital with stroke-like episodes. She died at 46 years of age. Both patients had the MELAS A3243G point mutation. MELAS is a maternally inherited mitochondrial disorder. The age of onset and symptoms are highly variable, even within one family. To date there are no curative treatment options for the disease. Diagnosing MELAS is important though, for optimising the treatment of the individual symptoms and genetic counselling.


Thrombocytopenia usually has a moderate course in full-term babies. Here, however, we describe two newborns with serious complications due to neonatal alloimmune thrombocytopenia. One patient was transferred to the paediatrician because of pallor, a swelling on the head and petechiae. He had a subgaleal hemorrhage. Following a platelet transfusion he made a complete recovery. The other presented with thrombocytopenia and petechiae and was treated with intravenous immunoglobulin. Several days later the patient started vomiting. Cranial ultrasound showed hydrocephalus most probably arising from an intraventricular haemorrhage following the thrombocytopenia, for which he received a ventriculoperitoneal drain. After this he made a successful recovery. Although neonatal alloimmune thrombocytopenia is a rare condition it can have serious consequences for the newborn and for subsequent pregnancies. It is important that treatment be started early and that cranial ultrasound always be performed.


van Rooijen C.R.,Medisch Centrum Alkmaar
Nederlands tijdschrift voor geneeskunde | Year: 2013

In a 79-year-old female, a markedly elevated alkaline phosphatase level was found by chance. She had noticed her hats had become too small. Clinical examination revealed a large skull with frontal bossing. Bone scintigraphy showed increased activity of bone metabolism in the skull. These three findings combined are considered a classic example of Paget's disease.


Zutt R.,Medisch Centrum Alkmaar
Nederlands tijdschrift voor geneeskunde | Year: 2010

Rhabdomyolysis is a rare potentially dangerous syndrome resulting from the dissolution of skeletal muscle fibres. An isolated attack of rhabdomyolysis can have various causes, such as trauma, hyperpyrexia, infections, electrolyte imbalances, seizures, severe exertion, and drugs or substance abuse or a combination of these. Recurrent episodes and/or a family history of rhabdomyolysis is more likely caused by an underlying genetic defect. Three patients with rhabdomyolysis are described. One patient had an isolated episode due to excessive exercise. The other patients had a medical history or accompanying symptoms that suggested an underlying genetic metabolic myopathy confirmed in both by DNA analysis. An algorithm on when and how to screen for underlying genetic diseases is presented. Diagnosis of these genetic diseases is important for adequate counselling and dietary measures to prevent future episodes.


Bernstein L.R.,Terrametrix | van der Hoeven J.J.M.,Medisch Centrum Alkmaar | Boer R.O.,Medisch Centrum Alkmaar
Anti-Cancer Agents in Medicinal Chemistry | Year: 2011

Gallium is antiproliferative to many types of cancer, due primarily to its ability to act as a non-functional mimic of ferric iron (Fe3+). Because Fe3+ is needed for ribonucleotide reductase activity-and thus DNA synthesis-gallium can inhibit DNA production and cell division. Diagnostic gallium scans have shown that hepatocellular carcinoma (HCC) is commonly avid for gallium. Furthermore, in vitro studies have found that gallium nitrate, and particularly gallium maltolate (GaM), have dose-dependent antiproliferative activity against HCC cell lines. Rationale thus exists to use GaM, an orally active compound that has been well tolerated in Phase I clinical trials, to treat patients whose HCC is gallium-avid in a gallium scan. Because gallium absorbed from orally administered GaM is bound predominately to serum transferrin, which travels to all tissues in the body, GaM has the potential to treat even distant metastases. A patient with advanced HCC (20 × 10 cm primary tumor, ascites around liver and spleen, resistant to sorafenib (Nexavar®), whose cancer was highly gallium-avid in a 67Ga-scan, was treated with oral gallium maltolate at 1500 mg/day q.d. After four weeks of treatment, the patient had a large reduction in pain, with greatly increased mobility and quality of life, and significantly lowered serum bilirubin and inflammation-related liver enzymes. At eight weeks, CT scans showed apparent necrosis of the tumor. © 2011 Bentham Science Publishers Ltd.

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