Medisch Centrum Haaglanden

Leidschendam, Netherlands

Medisch Centrum Haaglanden

Leidschendam, Netherlands
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Van Hooff C.C.D.,Bronovo Hospital | Verhage S.M.,Medisch Centrum Haaglanden | Hoogendoorn J.M.,Medisch Centrum Haaglanden
Foot and Ankle International | Year: 2015

Background: One of the factors contributing to long-term outcome of posterior malleolar fractures is the development of osteoarthritis. Based on biomechanical, cadaveric, and small population studies, fixation of posterior malleolar fracture fragments (PMFFs) is usually performed when fragment size exceeds 25-33%. However, the influence of fragment size on long-term clinical and radiological outcome size remains unclear. Methods: A retrospective cohort study of 131 patients treated for an isolated ankle fracture with involvement of the posterior malleolus was performed. Mean follow-up was 6.9 (range, 2.5-15.9) years. Patients were divided into groups depending on size of the fragment, small (<5%, n = 20), medium (5-25%, n = 86), or large (>25%, n = 25), and presence of step-off after operative treatment. We have compared functional outcome measures (AOFAS, AAOS), pain (VAS), and dorsiflexion restriction compared to the contralateral ankle and the incidence of osteoarthritis on X-ray. Results: There were no nonunions, 56% of patients had no radiographic osteoarthritis, VAS was 10 of 100, and median clinical score was 90 of 100. More osteoarthritis occurred in ankle fractures with medium and large PMFFs compared to small fragments (small 16%, medium 48%, large 54%; P = .006). Also when comparing small with medium-sized fragments (P = .02), larger fragment size did not lead to a significantly decreased function (median AOFAS 95 vs 88, P = .16). If the PMFF size was >5%, osteoarthritis occurred more frequently when there was a postoperative step-off ≥1 mm in the tibiotalar joint surface (41% vs 61%, P = .02) (whether the posterior fragment had been fixed or not). In this group, fixing the PMFF did not influence development of osteoarthritis. However, in 42% of the cases with fixation of the fragment a postoperative step-off remained (vs 45% in the group without fixation). Conclusion: Osteoarthritis is 1 component of long-term outcome of malleolar fractures, and the results of this study demonstrate that there was more radiographic osteoarthritis in patients with medium and large posterior fragments than in those with small fragments. Radiographic osteoarthritis also occurred more frequently when postoperative step-off was 1 mm or more, whether the posterior fragment was fixed or not. However, clinical scores were not different for these groups. © The Author(s) 2015.


Keller J.J.,Medisch Centrum Haaglanden | Kuijper E.J.,Leiden University
Annual Review of Medicine | Year: 2015

Clostridium difficile infection (CDI) is a serious complication of hospitalization and antibiotic use with a high mortality and very high costs. Despite appropriate treatment, a subset of patients develop chronic recurrent CDI. Some other patients develop severe and life-threatening colitis. The risk factors, pathogenesis, and treatment of recurrent CDI and severe CDI are discussed in this review. In particular, fecal microbiota transplantation (FMT) as a treatment strategy is outlined and a treatment algorithm incorporating FMT is described. © 2015 by Annual Reviews.


Mahajan M.,Medisch Centrum Haaglanden | Rhemrev S.J.,Medisch Centrum Haaglanden
International Journal of Emergency Medicine | Year: 2013

Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. This article provides a review of the relevant anatomy, the correct method of physical examination and the options for additional imaging and treatment with attention to possible pitfalls. © 2013 Mahajan and Rhemrev; licensee Springer.


Nelissen E.,Medisch Centrum Haaglanden
The journal of knee surgery | Year: 2010

We describe a case of a 47-year-old man with radiating pain and a palpable subcutaneous nodule on the medial side of the upper leg 10 years after hamstring anterior cruciate ligament reconstruction. Clinical and radiological investigations were highly suggestive for a neuroma of the infrapatellar branch of the saphenous nerve. After surgical excision, the diagnosis of traumatic neuroma was confirmed by pathology evaluation. To our knowledge, no similar case has previously been reported.


Kreis B.E.,Medisch Centrum Haaglanden | de Mol van Otterloo J.C.A.,Medisch Centrum Haaglanden | Kreis R.W.,Rode Kruis Ziekenhuis
Medical Science Monitor | Year: 2013

In this review we look into the historical development of open abdomen management. Its indication has spread in 70 years from intra-abdominal sepsis to damage control surgery and abdominal compartment syndrome. Different temporary abdominal closure techniques are essential to benefit the potential advantages of open abdomen management. Here, we discuss the different techniques and provide a new treatment strategy, based on available evidence, to facilitate more consistent decision making and further research on this complicated surgical topic. © Med Sci Monit, 2013.


van Baardewijk L.J.,Medisch Centrum Haaglanden
Nederlands tijdschrift voor geneeskunde | Year: 2010

A 74-year-old woman underwent a laparotomy for a rectal carcinoma. Multiple lesions of the liver were discovered as incidental findings. Histopathology revealed that these were Von Meyenburg complexes (VMCs). VMCs, also called biliary hamartomas, are rare and benign malformations of the bile ducts. The lesions present as diffuse greyish-white to greyish-yellow or black nodules of the liver, which on gross inspection and in radiological examinations strongly resemble liver metastases. VMCs are mostly asymptomatic and therefore often an incidental finding at laparotomy or post-mortem examination. The prevalence of VMC is age dependent and is 5.6% in adult patients at post-mortem examination. VMCs are sometimes associated with cholangiocarcinoma. Diagnostic imaging of VMC is difficult and of little specificity. Intraoperative frozen section analysis to differentiate between malignant and benign lesions has a sensitivity of 97% and a specificity of 99%. The benign nature of VMCs means that they do not require treatment. The patient underwent total mesorectal excision and follow-up after 3, 7 and 9 months did not reveal any indications of recurrent colorectal cancer or metastases.


van der Zwaal P.,Medisch Centrum Haaglanden
Nederlands tijdschrift voor geneeskunde | Year: 2011

A rotator cuff tear is a highly prevalent disorder, occurring in 25% of people over 60 years of age. In two thirds of patients the tear is small and asymptomatic. Acute, symptomatic cuff tears may occur in active sportsmen and women aged 30-50. There is often a considerable delay in diagnosis in this group, due to a lack of recognition by either the patient or the doctor. Recently identified risk factors for the development of cuff tear are nicotine abuse, hypercholesterolaemia, contralateral cuff tear and genetic predisposition. Conservative treatment can be very successful and consists of physical therapy and effective analgesics. Repeated steroid injections are harmful to the tendinous tissue and should be avoided. The aim of surgery is anatomical reinsertion of the ruptured tendon using an open or arthroscopic procedure. The arthroscopic procedure enables the surgeon to perform a more extensive evaluation and treatment of the joint. The arthroscopic procedure is technically more demanding than the open procedure, but seems to have a shorter rehabilitation period.


Van Drooge A.M.,University of Amsterdam | Vrijman C.,University of Amsterdam | Van Der Veen W.,Medisch Centrum Haaglanden | Wolkerstorfer A.,University of Amsterdam
Dermatologic Surgery | Year: 2015

BACKGROUND: Although ablative fractional laser is the gold standard for acne scars, evidence is still lacking for other types of scars. OBJECTIVE: To evaluate the efficacy and safety of the ablative fractional 10,600-nm CO2 laser in the treatment of various scar types. MATERIALS AND METHODS: The authors performed an intraindividual single-blinded randomized controlled split-lesion trial. Adult patients received 3 laser treatments at 8-week intervals for scars existing at least 1 year. Primary end points were the Physician Global Assessment (PhGA) and the assessment of adverse effects. RESULTS: Twenty-five consecutive patients with atrophic (52%) or hypertrophic (48%) scars located mainly on the body (84%) were included in the study. At 6-month follow-up of 21 patients, the PhGA showed no statistically significant difference between the treated and untreated side of the scar (p = .70). Persistent erythema, postinflammatory pigmentary changes, and scarring after ulceration (n = 3) were observed as side effects. CONCLUSION: In this trial involving various types of scars, the efficacy of ablative fractional CO2 laser could not be confirmed. The authors presume that different types of scars have a different response to treatment. Future studies should aim to identify the type of scars that may benefit from ablative fractional laser therapy. © 2015 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.


Purpose: To compare higher-order aberrations (HOAs) after foldable phakic intraocular lens (pIOL) implantation and wavefront-guided photorefractive keratectomy (PRK) for the correction of myopia. Setting: Department of Ophthalmology, Medisch Centrum Haaglanden, Den Haag, The Netherlands. Design: Comparative case series. Methods: This retrospective comparative case series comprised eyes that had implantation of an Artiflex foldable pIOL or wavefront-guided PRK. Preoperative and postoperative refractive data, pupil diameter, endothelial cell density, and higher-order aberrations (HOAs) were measured and compared. Results: The median follow-up was 13 months in the pIOL group and 10 months in the PRK group. The mean spherical equivalent (SE) in the pIOL group was -5.50 diopters (D) ± 1.05 (SD) (range -3.25 to -7.13 D) preoperatively and -0.26 ± 0.28 D (range -0.88 to 0.38 D) postoperatively and the mean in the PRK group, -5.72 ± 0.88 D (range -4.25 to -7.50 D) and -0.03 ± 0.42 D (range -0.75 to 1.00 D), respectively. The postoperative SE was within ±0.50 D in 86.4% of eyes and 85.2% of eyes, respectively. Postoperatively, the significant changes in the pIOL group and the PRK group, respectively, were as follows: total HOAs, 0.03 μm and 0.26 μm (P=.001); trefoil-y, 0.09 μm and -0.04 μm (P=.004); spherical aberration, -0.05 μm and 0.21 μm (P=.002). Conclusions: Foldable pIOL implantation increased total HOAs and spherical aberration less than wavefront-guided PRK to correct low to moderate myopia, suggesting foldable pIOL implantation maintains the cornea's prolate shape better. Financial Disclosure: The author has no financial or proprietary interest in any material or method mentioned. © 2011 ASCRS and ESCRS.


Wlodzimirow K.A.,University of Amsterdam | Abu-Hanna A.,University of Amsterdam | Slabbekoorn M.,Medisch Centrum Haaglanden | Chamuleau R.A.F.M.,Tytgat Institute for Liver and Intestinal Research | And 2 more authors.
Critical Care | Year: 2012

Introduction: The Risk, Injury, Failure, Loss, and End-Stage Renal Disease (RIFLE) is a consensus-based classification system for diagnosing acute kidney insufficiency (AKI), based on serum creatinine (SCr) and urine output criteria (RIFLESCr+UO). The urine output criteria, however, are frequently discarded and many studies in the literature applied only the SCr criteria (RIFLESCr). We diagnosed AKI using both RIFLE methods and compared the effects on time to AKI diagnosis, AKI incidence and AKI severity.Methods: This was a prospective observational cohort study during four months in adult critically ill patients admitted to the ICU for at least 48 hours. During the first week patients were scored daily for AKI according to RIFLESCr+UOand RIFLESCr.We assessed urine output hourly and fluid balance daily. The baseline SCr was estimated if a recent pre-ICU admission SCr was unknown. Based on the two RIFLE methods for each patient we determined time to AKI diagnosis (AKI-0) and maximum RIFLE grade.Results: We studied 260 patients. A pre-ICU admission SCr was available in 101 (39%) patients. The two RIFLE methods resulted in statistically significantly different outcomes for incidence of AKI, diagnosis of AKI for individual patients, distribution of AKI-0 and distribution of the maximum RIFLE grade. Discarding the RIFLE urine criteria for AKI diagnosis significantly underestimated the presence and grade of AKI on admission and during the first ICU week (P < 0,001) and significantly delayed the diagnosis of AKI (P < 0.001). Based on RIFLESCr45 patients had no AKI on admission but subsequently developed AKI. In 24 of these patients (53%) AKI would have been diagnosed at least one day earlier if the RIFLE urine criteria had been applied. Mortality rate in the AKI population was 38% based on RIFLESCrand 24% based on RIFLESCr+UO(P = 0.02).Conclusions: The use of RIFLE without the urine criteria significantly underscores the incidence and grade of AKI, significantly delays the diagnosis of AKI and is associated with higher mortality. © 2012 Wlodzimirow et al.; licensee BioMed Central Ltd.

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