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Delft, Netherlands

Van Hoof J.J.,University of Twente | Van Der Lely N.,Reinier de Graaf Gasthuis | Bouthoorn S.H.,Reinier de Graaf Gasthuis | Van Dalen W.E.,Dutch Institute for Alcohol Policy | Pereira R.R.,Applied Scientific Research
Journal of Adolescent Health | Year: 2011

Purpose: To monitor the prevalence of, and the circumstances leading to, adolescent alcohol intoxication admissions in Dutch hospital departments of pediatrics. Methods: Data were collected in 2007 and 2008, using the Dutch Pediatric Surveillance System, in which pediatricians received questionnaires on varying issues, including adolescent alcohol intoxication admissions. Results: The adolescents treated in 2008, as in 2007, were average youth across proportion of gender, educational level, school performances, family structure, siblings, familiarity with medical or aid agencies, alcohol use, and other (illicit) drug use. In 2008, 13% more adolescents were treated. These adolescents showed a trend of having a younger average age, higher blood alcohol concentrations, and longer durations of mental impairment. About 45% of the adolescents who were treated for alcohol intoxication had purchased alcohol from a commercial place, despite that 51 times the specific adolescent had not reached the legal age of 16 years old. About one-third of the youngsters consumed alcohol at home or at a friend's home. Conclusions: The number of adolescents suffering from alcohol intoxication increased in 2008 compared with 2007. Parental (lack of) involvement and responsibilities of commercial sales personnel are discussed. © 2011 Society for Adolescent Health and Medicine. All rights reserved. Source

Van Genderen M.E.,Erasmus Medical Center | Klijn E.,Erasmus Medical Center | Lima A.,Erasmus Medical Center | De Jonge J.,Erasmus Medical Center | And 4 more authors.
Critical Care Medicine | Year: 2014

OBJECTIVES:: To study regional perfusion during experimental endotoxemic and obstructive shock and compare the effect of initial cardiac output-targeted fluid resuscitation with optimal cardiac output-targeted resuscitation on different peripheral tissues. DESIGN:: Controlled experimental study. SETTING:: University-affiliated research laboratory. SUBJECTS:: Fourteen fasted anesthetized mechanically ventilated domestic pigs. INTERVENTIONS:: Domestic pigs were randomly assigned to the endotoxemic (n = 7) or obstructive shock (n = 7) model. Central and regional perfusion parameters were obtained at baseline, during greater than or equal to 50% reduction of cardiac output (T1), after initial resuscitation to baseline (T2), and after optimization of cardiac output (T3). MEASUREMENTS AND MAIN RESULTS:: Regional perfusion was assessed in the sublingual, intestinal, and muscle vascular beds at the different time points and included visualization of the microcirculation, measurement of tissue oxygenation, and indirect assessments of peripheral skin perfusion. Hypodynamic shock (T1) simultaneously decreased all regional perfusion variables in both models. In the obstructive model, these variables returned to baseline levels at T2 and remained in this range after T3, similar to cardiac output. In the endotoxemic model, however, the different regional perfusion variables were only normalized at T3 associated with the hyperdynamic state at this point. The magnitude of changes over time between the different vascular beds was similar in both models, but the endotoxemic model displayed greater heterogeneity between tissues. CONCLUSIONS:: This study demonstrates that the relationship between the systemic and regional perfusion is dependent on the underlying cause of circulatory shock. Further research will have to demonstrate whether different microvascular perfusion variables can be used as additional resuscitation endpoints. © 2013 by the Society of Critical Care Medicine and Lippincott. Source

van der Weegen W.,St. Anna Hospital | Sijbesma T.,St. Anna Hospital | Hoekstra H.J.,St. Anna Hospital | Brakel K.,St. Anna Hospital | And 2 more authors.
Journal of Arthroplasty | Year: 2014

Peri-prosthetic pseudotumor formation can be a severe complication following Metal-on-Metal hip resurfacing arthroplasty (MoMHRA), with limited data on the optimal management of this complication. The aims of this study were (1) to evaluate the prevalence and severity of pseudotumors in a consecutive cohort of 248 MoMHRA (214 patients, mean follow-up 4.6. years, range: 1 - 8.2), and (2) to present a clinical guideline for their treatment based on severity grading with Metal Artefact Reduction Sequence Magnetic Resonance Imaging, metal ion levels and symptoms. Pseudotumor prevalence was 36.3%: 61 mild, 25 moderate and four were graded severe. Five revisions followed, all in symptomatic patients with elevated metal ion levels. Pseudotumor severity grading allowed us to be conservative with revision surgery for mild and moderate MoM disease. © 2014 Elsevier Inc. Source

Heimans L.,Leiden University | Wevers-de Boer K.V.C.,Leiden University | Visser K.,Leiden University | Goekoop R.J.,Haga Hospital | And 9 more authors.
Annals of the Rheumatic Diseases | Year: 2014

Objectives To assess which treatment strategy is most effective in inducing remission in early (rheumatoid) arthritis. Methods 610 patients with early rheumatoid arthritis (RA 2010 criteria) or undifferentiated arthritis (UA) started treatment with methotrexate (MTX) and a tapered high dose of prednisone. Patients in early remission (Disease Activity Score <1.6 after 4 months) tapered prednisone to zero and those with persistent remission after 8 months, tapered and stopped MTX. Patients not in early remission were randomised to receive either MTX plus hydroxychloroquine plus sulfasalazine plus low-dose prednisone (arm 1) or to MTX plus adalimumab (ADA) (arm 2). If remission was present after 8 months both arms tapered to MTX monotherapy; if not, arm 1 changed to MTX plus ADA and arm 2 increased the dose of ADA. Remission rates and functional and radiological outcomes were compared between arms and between patients with RA and those with UA. Results 375/610 (61%) patients achieved early remission. After 1 year 68% of those were in remission and 32% in drug-free remission. Of the randomised patients, 25% in arm 1 and 41% in arm 2 achieved remission at year 1 (p<0.01). Outcomes were comparable between patients with RA and those with UA. Conclusions Initial MTX and prednisone resulted in early remission in 61% of patients with early (rheumatoid) arthritis. Of those, 68% were in remission and 32% were in drug-free remission after 1 year. In patients not in early remission, earlier introduction of ADA resulted in more remission at year 1 than first treating with disease-modifying antirheumatic drug combination therapy plus prednisone. Source

de Groot P.C.,Reinier de Graaf Gasthuis
Nederlands tijdschrift voor geneeskunde | Year: 2010

A levonorgestrel-releasing intrauterine device (LNG-IUD) had been placed in 4 patients, aged 33, 27, 46 and 27 years. They subsequently experienced symptoms that were possibly related to the IUD, such as haemorrhagic discharge, pain and dyspareunia. Patients who have persistent symptoms after IUD placement need to be examined. If a malpositioned IUD is suspected, outpatient vaginoscopic hysteroscopy should be considered. Hysteroscopy can reveal the cause of the symptoms. Furthermore, an IUD that is incorrectly positioned can be repositioned during the same procedure. One advantage to this is that unnecessary removal of an IUD may be prevented. The first patient referred to in this article had lost confidence in the IUD and requested its removal. In the second patient, the IUD had perforated the anterior wall of the uterus and it was removed as well. In the third patient, the IUD had perforated the posterior wall of the uterus, but it was repositioned during the hysteroscopy. In the last patient, hysteroscopy showed the IUD to be in a transverse position, but this could be corrected immediately. Source

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