Nijmegen, Netherlands
Nijmegen, Netherlands

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PubMed | Slotervaart Ziekenhuis, Universitair Medisch Centrum Utrecht, Jan van Goyen Kliniek, Elisabeth Ziekenhuis and 14 more.
Type: Journal Article | Journal: Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases | Year: 2016

Within the Dutch Acute HCV in HIV Study, a surveillance system was initiated to estimate the incidence of hepatitis C virus (HCV) infections in 2014. Following the Dutch HIV treatment guidelines, HIV-positive men having sex with men (MSM) in 19 participating centers were screened. Ninety-nine acute HCV infections were reported, which resulted in a mean incidence of 11 per 1000 patient-years of follow-up. Unfortunately, the HCV epidemic among Dutch HIV-positive MSM is not coming to a halt.


PubMed | Slotervaart Ziekenhuis, Public Health Service of Amsterdam, University of Groningen, Medisch Centrum Haaglanden and 8 more.
Type: Journal Article | Journal: Journal of hepatology | Year: 2016

Acute hepatitis C virus infections (AHCV) are prevalent among HIV positive men having sex with men and generally treated with pegylated interferon-alpha (PegIFN) and ribavirin (RBV) during 24weeks. The addition of a protease inhibitor could shorten therapy without loss of efficacy.We performed an open-label, single arm study to investigate the efficacy and safety of a 12-week course of boceprevir, PegIFN and RBV for AHCV genotype 1 infections in 10 Dutch HIV treatment centers. The primary endpoint of the study was achievement of sustained virological response rate at week 12 (SVR12) in patients reaching a rapid viral response at week 4 (RVR4) and SVR12 in the intent to treat (ITT) entire study population was the most relevant secondary endpoint.One hundred twenty-seven AHCV patients were screened in 16 months, of which 65 AHCV genotype 1 patients were included. After spontaneous clearance in six patients and withdrawal before treatment initiation in two, 57 started therapy within 26 weeks after infection. RVR4 rate was 72%. SVR12 rate was 100% in the RVR4 group. SVR12 rate in the ITT group was 86% and comparable to the SVR12 rate of 84% in 73 historical controls treated for 24 weeks with PegIFN and RBV in the same study centers.With the addition of boceprevir to PegIFN and RBV, treatment duration of AHCV genotype 1 can be reduced to 12 weeks without loss of efficacy. Given the high drug costs and limited availability of interferon-free regimens, boceprevir PegIFN and RBV can be a considered a valid treatment option for AHCV. ClinicalTrials.gov, number NCT01912495.


Pasch M.C.,Radboud Universitair Medisch Centrum
Nederlands Tijdschrift voor Dermatologie en Venereologie | Year: 2014

Most ungual melanomas start with brown to black nail pigmentation. However, a number of different pathologic processes may cause discoloration of the nail and must therefore be excluded. Discoloration may be exogenous, for example by a yeast infection with candida, or by a bacterial infection with pseudomonas aeruginosa. Discoloration, however, can also be endogenous, for example, the result of a traumatic hemorrhage, the use of certain medication, localized dermatological diseases, or by systemic diseases. Clinical clues and an ABCDEF rule were developed to distinguish harmless darkening of the nail from subungual melanoma. However, the gold standard remains histological examination. Due to the high prevalence of linear melanonychia in people with skin type V or VI, the early diagnosis of subungual melanoma in this group is even more challenging than in people with fair skin.


Lubeek S.F.K.,Radboud universitair medisch centrum | Pasch M.C.,Radboud universitair medisch centrum
Nederlands Tijdschrift voor Dermatologie en Venereologie | Year: 2014

A 62-year old female developed a linear melanonychia with periungual hyperpigmentation of her right thumb.These findings were initially interpreted as a junctional melanocytic nevus, based on the clinical and histopathological examination of several biopsies. The periungual hyperpigmentation was interpreted as a pseudo-Hutchinson sign. However, after frequent follow-up a subungual melanoma was diagnosed. The sensitivity and specificity of a (pseudo-)Hutchinson sign as an expression of a subungual melanoma is far from ideal. There are various other causes of this sign. Strict follow-up and repeated histopathological examination is indicated in a case of a suspected pseudo-Hutchinson sign.


Meijer G.J.,Radboud universitair medisch centrum
Nederlands Tijdschrift voor Geneeskunde | Year: 2014

The importance of the introduction of dental implants can only be understood when the historical context is clarified. In the past, the main treatment carried out by dentists consisted of filling or, in unfortunate cases, removal of painful teeth. Only since the introduction of dental implants did it become feasible to restore dental arches in edentulous patients with complaints about their freestanding prostheses. Initially much scepticism prevailed about dental implants. When titanium with a roughened surface is used, implant success rises above 95%, provided that the implants are placed into sufficient bone volume.


It has been suggested that clinical oncologists do not discontinue active treatment in the palliative setting in a timely manner, and only care about the extension rather than the quality of life. Moreover, patients may be not very well informed about their prognosis and the intention behind their treatment. To improve decision-making in the palliative phase, understanding of recent advances in cancer care should be shared, as well as any potential adverse effects. Decision aids may be useful to improve the chance of satisfactory treatment decisions. The desire to obtain information is high in the majority of patients; however, oncologists do not always provide enough key information, particularly in terms of survival. During consultations, the time available to discuss these aspects is limited; it is believed that allocating more time for outpatient consultations could improve the quality and satisfaction regarding the decision to treat or not to treat. Ideally, general practitioners and palliative teams should be involved early in the decision-making process.


Dijkstra S.S.,Radboud Universitair Medisch Centrum
Nederlands tijdschrift voor geneeskunde | Year: 2012

In men aged 15-34 testicular cancer is the most commonly occurring malignancy. After treatment, the average 5-year survival rate is 85%. Recurring symptoms or raised tumour markers may indicate the presence of a second primary contralateral testicular tumour. A 34-year-old man presented with pain in his left testicle. Eight years previously he had been diagnosed with cancer of his right testicle which was treated successfully by orchidectomy and two cycles of chemotherapy. Further investigations revealed raised tumour markers. The patient proved to have a contralateral testis carcinoma with 2 lung metastases. 1-3% of patients with testicular cancer develop metachronous (i.e. not concurrent) contralateral testicular cancer. Follow-up and self-examination are very important for early diagnosis of a metachronous contralateral malignancy.


De Man R.,Radboud universitair medisch centrum | Pasch M.C.,Radboud universitair medisch centrum
Nederlands Tijdschrift voor Dermatologie en Venereologie | Year: 2014

Subungual melanoma is a rare tumour.Because of its atypical presentation there is often a delay in diagnosis and is therefore associated with a poor prognosis. We report two cases of subungual amelanotic melanoma that were initially misdiagnosed. Since amelanotic melanoma usually presents as a vascular or ulcerating lesion it should be considered in the differential diagnosis of such lesions.


Baars M.P.,Radboud universitair medisch centrum | Pasch M.C.,Radboud universitair medisch centrum
Nederlands Tijdschrift voor Dermatologie en Venereologie | Year: 2014

The yellow nail syndrome is a rare disorder and is associated with lymphedema and chronic respiratory conditions like chronic bronchitis, bronchiectasis, sinusitis and pleural effusions. Nails are yellow, thickened, the growth is retarded and they are transversely and longitudinally curved with disappearance of the cuticle. Onycholysis is frequently seen. In most cases all 20 nails are involved. The pathophysiology remains unclear. The diagnosis is based on clinical signs or by exclusion. Treatment is symptomatic.


PubMed | Radboud Universitair Medisch Centrum
Type: | Journal: Nederlands tijdschrift voor geneeskunde | Year: 2016

Positive muscle phenomena are due to muscle overactivity. Examples are cramp, myalgia, and stiffness. These manifestations have mostly acquired causes, e.g. side-effects of medication, metabolic disorders, vitamin deficiency, excessive caffeine intake or neurogenic disorders. We report on three patients with various positive muscle phenomena, to illustrate the clinical signs that indicate an underlying myopathy. Patient A, a 56-year-old man, was diagnosed with muscle cramp in the context of excessive coffee use and previous lumbosacral radiculopathy. Patient B, a 71-year-old man, was shown to have RYR1-related myopathy. Patient C, a 42-year-old man, suffered from Brody myopathy. We propose for clinicians to look out for a number of red flags that can point to an underlying myopathy, and call for referral to neurology if indicated. Red flags include second wind phenomenon, familial occurrence of similar complaints, marked muscle stiffness, myotonia, muscle weakness, muscle hypertrophy, and myoglobinuria. Establishing a correct diagnosis is important for proper treatment. Certain myopathies call for cardiac or respiratory screening.

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