Onze Lieve Vrouwe Gasthuis OLVG

Amsterdam, Netherlands

Onze Lieve Vrouwe Gasthuis OLVG

Amsterdam, Netherlands
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Dewilde W.J.M.,Twee Steden Hospital | Oirbans T.,St Antonius Hospital | Verheugt F.W.A.,Onze Lieve Vrouwe Gasthuis OLVG | Kelder J.C.,St Antonius Hospital | And 9 more authors.
The Lancet | Year: 2013

Background If percutaneous coronary intervention (PCI) is required in patients taking oral anticoagulants, antiplatelet therapy with aspirin and clopidogrel is indicated, but such triple therapy increases the risk of serious bleeding. We investigated the safety and efficacy of clopidogrel alone compared with clopidogrel plus aspirin. Methods We did an open-label, multicentre, randomised, controlled trial in 15 centres in Belgium and the Netherlands. From November, 2008, to November, 2011, adults receiving oral anticoagulants and undergoing PCI were assigned clopidogrel alone (double therapy) or clopidogrel plus aspirin (triple therapy). The primary outcome was any bleeding episode within 1 year of PCI, assessed by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00769938. Findings 573 patients were enrolled and 1-year data were available for 279 (98·2%) patients assigned double therapy and 284 (98·3%) assigned triple therapy. Mean ages were 70·3 (SD 7·0) years and 69·5 (8·0) years, respectively. Bleeding episodes were seen in 54 (19·4%) patients receiving double therapy and in 126 (44·4%) receiving triple therapy (hazard ratio [HR] 0·36, 95% CI 0·26-0·50, p<0·0001). In the double-therapy group, six (2·2%) patients had multiple bleeding events, compared with 34 (12·0%) in the triple-therapy group. 11 (3·9%) patients receiving double therapy required at least one blood transfusion, compared with 27 (9·5%) patients in the triple-therapy group (odds ratio from Kaplan-Meier curve 0·39, 95% CI 0·17-0·84, p=0·011). Interpretation Use of clopiogrel without aspirin was associated with a significant reduction in bleeding complications and no increase in the rate of thrombotic events. Funding Antonius Ziekenhuis Foundation, Strect Foundation. © 2013 Elsevier Ltd.

Kraan W.,University of Amsterdam | Horlings H.M.,University of Amsterdam | Van Keimpema M.,University of Amsterdam | Schilder-Tol E.J.M.,University of Amsterdam | And 6 more authors.
Blood Cancer Journal | Year: 2013

Activating mutations in CD79 and MYD88 have recently been found in a subset of diffuse large B-cell lymphoma (DLBCL), identifying B-cell receptor and MYD88 signalling as potential therapeutic targets for personalized treatment. Here, we report the prevalence of CD79B and MYD88 mutations and their relation to established clinical, phenotypic and molecular parameters in a large panel of DLBCLs. We show that these mutations often coexist and demonstrate that their presence is almost mutually exclusive with translocations of BCL2, BCL6 and cMYC, or Epstein-Bar virus infection. Intriguingly, MYD88 mutations were by far most prevalent in immune-privileged site-associated DLBCL (IP-DLBCL), presenting in central nervous system (75%) or testis (71%) and relatively uncommon in nodal (17%) and gastrointestinal tract lymphomas (11%). Our results suggest that MYD88 and CD79B mutations are important drivers of IP-DLBCLs and endow lymphoma-initiating cells with tissue-specific homing properties or a growth advantage in these barrier-protected tissues. © 2013 Macmillan Publishers Limited.

Millett P.J.,Steadman Philippon Research Institute | Schoenahl J.-Y.,Steadman Philippon Research Institute | Register B.,Athens Orthopedic Clinic | Gaskill T.R.,Bone and Joints Sports Medicine Institute | And 3 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2013

Posterior shoulder instability with glenoid deficiency is a rare entity and its surgical treatment is challenging. Reconstructive techniques have focused on extra-articular structural bone transfer that obstructs humeral translation and thereby prevents glenohumeral dislocation. However, long-term results are not as promising. In this report, the authors describe a technique for anatomic posterior glenoid reconstruction using an osteoarticular distal tibia allograft in two patients including their outcomes after 2 years. Level of evidence IV. © 2012 Springer-Verlag Berlin Heidelberg.

Verheugt F.W.A.,Onze Lieve Vrouwe Gasthuis OLVG | Bolte A.C.,VU University Amsterdam
International Journal of Women's Health | Year: 2011

Background: The aim of this review is to discuss the role of aspirin for various conditions in women. Methods: A nonsystematic review of articles published on PubMed® that examines the role of aspirin in women. Results: Aspirin is associated with a significant reduction of stroke risk in women, which may be linked to age. However, despite this evidence, underutilization of aspirin in eligible women is reported. In women of reproductive age, it may also have a role to play in reducing early-onset preeclampsia and intrauterine growth restriction, and in the prevention of recurrent miscarriage in women with antiphospholipid antibodies; it may also reduce cardiovascular risk in associated systemic conditions such as lupus. Aspirin may reduce colorectal cancer risk in women, but its role in breast cancer warrants further data from controlled trials. Conclusions: The risk-benefit threshold for aspirin use in women has been established for several conditions. Reasons why women are less likely to be prescribed aspirin have not been established, but the overall underuse of aspirin in women needs to be addressed. © 2011 Schindler, publisher and licensee Dove Medical Press Ltd.

Verheugt F.W.A.,Onze Lieve Vrouwe Gasthuis OLVG
Fundamental and Clinical Pharmacology | Year: 2012

Vitamin K antagonists have been used as oral anticoagulants (OACs) for over five decades, yet their use in real-world practice is problematic primarily because of their narrow therapeutic window, exacerbated by extensive food and drug interactions, necessitating regular coagulation monitoring and dose adjustment. Around half of patients receiving warfarin are within the therapeutic range, exposing them to the dangers of under-anticoagulation (i.e. thrombosis formation) or over-anticoagulation (i.e. bleeding). A new generation of OACs with improved pharmacology promises to revolutionize antithrombotic management. Rivaroxaban, apixaban (both oral direct Factor Xa inhibitors) and dabigatran (a direct thrombin inhibitor) all exhibit predictable anticoagulant responses and few drug-drug interactions and do not require routine coagulation monitoring. © 2011 The Author Fundamental and Clinical Pharmacology © 2011 Société Française de Pharmacologie et de Thérapeutique.

Patients with atrial fibrillation (AF) have an increased stroke risk compared with those in sinus rhythm, although the absolute risk for individual patients is modulated by the presence of various additional risk factors. Patient selection for oral anticoagulation for stroke prevention is based on risks of stroke and bleeding. Although CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack) is the most widely used scheme for evaluating stroke risk in patients with AF, several other stroke risk factors are not included; therefore, many patients' stroke risk may be underestimated, contributing to the underuse of anticoagulants. Furthermore, a substantial proportion of patients are categorized as being at moderate risk (CHADS2 = 1), and there has been some ambiguity regarding optimum thromboprophylaxis in this group. The refinement of CHADS2, CHA2DS2-VASc (Congestive heart failure, Hypertension, Age 75 years [2 points], Diabetes mellitus, Stroke or transient ischemic attack [2 points], Vascular disease, Age 65 to 74 years, Sex category [female]), considers additional risk factors. Its main advantage is its ability to identify patients truly at low risk of thromboembolism (CHA 2DS2-VASc = 0), who are unlikely to benefit from antithrombotic therapy. For all others, an oral anticoagulant may be the preferred approach, simplifying clinical decision making. Implementation of CHA2DS2-VASc may also result in an increased proportion of patients receiving anticoagulation. The emergence of newer oral anticoagulants that can be given without routine coagulation monitoring, with improved benefit-risk profiles vs vitamin K antagonists, promises to simplify therapy for patients with AF at risk of stroke. This, coupled with advances in stroke risk stratification, is expected to improve patient outcomes and reduce the burden of AF-related stroke. © 2013 Wiley Periodicals, Inc.

Verheugt F.W.A.,Onze Lieve Vrouwe Gasthuis OLVG
Netherlands Heart Journal | Year: 2013

In patients with nonvalvular atrial fibrillation, oral anticoagulation with the vitamin K antagonists acenocoumarol, phenprocoumon and warfarin reduces the risk of stroke by more than 60%, whereas single or double antiplatelet therapy is much less effective and sometimes associated with a similar bleeding risk as vitamin K antagonists. Besides bleeding, and intracranial haemorrhage in particular, INR monitoring remains the largest drawback of vitamin K antagonists. In the last decade oral agents have been developed that directly block the activity of thrombin (factor IIa), as well as drugs that directly inhibit activated factor X (Xa), which is the first compound in the final common pathway to the activation of thrombin. These agents have been approved for stroke prevention in atrial fibrillation and are now reimbursed under a national guideline for their safe use. They have advantages in that they do not need monitoring and have a fast onset and offset of action, but lack an established specific antidote. This survey addresses the role of modern anticoagulation for stroke prevention in atrial fibrillation. © The Author(s) 2013.

Walstra F.E.,Onze Lieve Vrouwe Gasthuis OLVG | Alta T.D.,Onze Lieve Vrouwe Gasthuis OLVG | van der Eijken J.-W.,Onze Lieve Vrouwe Gasthuis OLVG | Willems W.J.,Onze Lieve Vrouwe Gasthuis OLVG | Ham S.J.,Onze Lieve Vrouwe Gasthuis OLVG
Journal of Shoulder and Elbow Surgery | Year: 2013

Background: Sprengel's deformity is a congenital anomaly of the shoulder with superior displacement and rotation of the hypoplastic scapula. The functional impairment and misshapen appearance of the shoulder can be minimized with different surgical techniques. The aim of this study was to evaluate the long-term results after correction of Sprengel's deformity using the Woodward procedure. Methods: In this retrospective study, 8 shoulders were examined at 3 different periods in time. The average follow-up was 14.7 years (range, 8-26). Range of motion, Constant score, DASH (Disabilities of the Arm, Shoulder and Hand) score, and simple shoulder test (SST) were obtained to evaluate shoulder function. Scapula placement and degenerative disease were assessed by radiographic examination and the Rigault's classification. Cavendish grading was used to evaluate cosmetic appearance. Results: Mean age at the time of surgery had been 8 years and 9 months. Mean follow-up was 13.5 years. Abduction improved by 41° in the first year after surgery, with final improvement of 56° at long-term follow-up. At the latest follow-up evaluation, the mean Constant score was 85 points, the DASH score 14.59 points, and the SST 9.5 points. Radiographs showed superior displacement of the involved scapula in all cases, with no signs of degenerative disease of the shoulder. Cavendish grade improved from grade 3 preoperatively to grade 1 or 2 at the latest follow-up examination. No long-term complications had occurred. Conclusion: The Woodward procedure shows to be an effective surgical procedure to improve shoulder function as well as cosmetic appearance in patients with Sprengel's deformity. © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees.

Verheugt F.W.A.,Onze Lieve Vrouwe Gasthuis OLVG
Netherlands Heart Journal | Year: 2012

Patients with congestive heart failure have a significant risk of stroke due to thromboembolism from the dilated left ventricle. Two relatively small trials suggest that oral anticoagulation with vitamin-K antagonists may reduce this risk when compared with placebo, aspirin or clopidogrel. However, more studies are eagerly awaited. So far, physicians seeing patients with heart failure should decide who needs antithrombotic prophylaxis on a case-by-case basis, especially since most heart failure patients have significant comorbidity precluding the use of oral anticoagulant. © Springer Media/Bohn Stafleu van Loghum 2012.

Donkervoort S.C.,Onze Lieve Vrouwe Gasthuis OLVG | Boerma D.,Onze Lieve Vrouwe Gasthuis OLVG
Journal of the Society of Laparoendoscopic Surgeons | Year: 2011

The presentation of acute appendicitis during pregnancy may cause diagnostic and therapeutic difficulty. Delay in diagnosis may lead to increased maternal and fetal risk. Therefore, an aggressive surgical approach is mandatory, even though this may result in an increased number of appendectomies for normal appendices. Diagnostic laparoscopy, followed by laparoscopic appendectomy in case of inflammation, seems a logical strategy. We present the case of a 36-week pregnant woman who presented with suspicion of acute appendicitis. The pro and cons of a laparoscopic approach in the third trimester of pregnancy are discussed as is its safety by reviewing the literature. © 2011 by JSLS, Journal of the Society of Laparoendoscopic Surgeons.

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