Hoogwerf D.,Reinier de Graaf Gasthuis |
van Doorn J.,University Utrecht |
Maartense E.,Reinier de Graaf Gasthuis
Annals of Clinical Biochemistry | Year: 2013
Lactic acidosis is a rare complication of haematological malignancies with a poor prognostic outcome and unclear aetiology. Possible mechanisms include high rate of glycolysis by cancer cells, in part due to over-expression of hexokinase II. The insulin-like growth factor (IGF)-system has an important role in normal as well as tumour cell growth. We present a case of a 79-year-old man with a diffuse large B-cell lymphoma and lactic acidosis. Initially, the patient was successfully treated according to the R-CHOP scheme. After recurrence of disease, the patient was treated according to a protocol of the Dutch-Belgian Haemato-Oncology Group (HOVON-85 study). Eleven months after completion of the last therapy, the patient still appeared to be in complete remission. Serum levels of IGFs, pro-IGF-IIE[68-88], IGF binding proteins (IGFBPs)-1 to -4, acid labile subunit (ALS), as well as ternary IGF-I-IGFBP-3-ALS complex formation, were determined in samples taken before, during and after treatment, respectively. Before treatment patient's serum concentration of the growth hormone-dependent parameters of the IGF-system and IGF-II were clearly reduced when compared with patient's values during remission of disease. On the other hand, during acidosis a relatively higher proportion of IGFs is present in binary complexes, instead of 150 kDa complexes, that may allow an increased access of IGFs to target cells including the malignant ones. Pretreatment serum levels of IGFBP-1 and -2 were elevated, decreased during therapy and normalized at remission. Especially IGFBP-2 seems a suitable marker for disease activity.
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.
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.
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.
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.
Management of chronic heart failure guided by individual N-terminal ProB-type natriuretic peptide targets: Results of the PRIMA (Can PRo-brain-natriuretic peptide guided therapy of chronic heart failure IMprove heart fAilure morbidity and mortality?) Study
Eurlings L.W.M.,Maastricht University |
Van Pol P.E.J.,Reinier de Graaf Gasthuis |
Van Wijk S.,Maastricht University |
Lodewijks-Van Der Bolt C.,Atrium Medical |
And 7 more authors.
Journal of the American College of Cardiology | Year: 2010
Objectives The purpose of this study was to assess whether management of heart failure (HF) guided by an individualized N-terminal proB-type natriuretic peptide (NT-proBNP) target would lead to improved outcome compared with HF management guided by clinical assessment alone. Background Natriuretic peptides may be attractive biomarkers to guide management of heart failure (HF) and help select patients in need of more aggressive therapy. The PRIMA (Can PRo-brain-natriuretic peptide guided therapy of chronic heart failure IMprove heart fAilure morbidity and mortality?) study is, to our knowledge, the first large, prospective randomized study to address whether management of HF guided by an individualized target NT-proBNP level improves outcome. Methods A total of 345 patients hospitalized for decompensated, symptomatic HF with elevated NT-proBNP levels at admission were included. After discharge, patients were randomized to either clinically-guided outpatient management (n = 171), or management guided by an individually set NT-proBNP (n = 174) defined by the lowest level at discharge or 2 weeks thereafter. The primary end point was defined as number of days alive outside the hospital after index admission. Results HF management guided by this individualized NT-proBNP target increased the use of HF medication (p = 0.006), and 64% of HF-related events were preceded by an increase in NT-proBNP. Nevertheless, HF management guided by this individualized NT-proBNP target did not significantly improve the primary end point (685 vs. 664 days, p = 0.49), nor did it significantly improve any of the secondary end points. In the NT-proBNPguided group mortality was lower, as 46 patients died (26.5%) versus 57 (33.3%) in the clinically-guided group, but this was not statistically significant (p = 0.206). Conclusions Serial NT-proBNP measurement and targeting to an individual NT-proBNP value did result in advanced detection of HF-related events and importantly influenced HF-therapy, but failed to provide significant clinical improvement in terms of mortality and morbidity. (Effect of NT-proBNP Guided Treatment of Chronic Heart Failure [PRIMA]; NCT00149422) © 2010 American College of Cardiology Foundation.
Van Dillen J.,Reinier de Graaf Gasthuis |
Zwart J.,Leiden University |
Schutte J.,Isala Klinieken |
Van Roosmalen J.,Leiden University |
Van Roosmalen J.,VU University Amsterdam
Current Opinion in Infectious Diseases | Year: 2010
PURPOSE OF REVIEW: Sepsis is a major cause of maternal death worldwide. Little is known on the incidence of severe maternal morbidity related to sepsis. In this review, we focus on new findings concerning epidemiology, etiology and outcome of maternal sepsis in low-income as well as high-income countries. RECENT FINDINGS: It is estimated that puerperal sepsis causes at least 75 000 maternal deaths every year, mostly in low-income countries. Studies from high-income countries report incidence of maternal morbidity due to sepsis of 0.1-0.6 per 1000 deliveries. The causative microorganisms are generally polymicrobial with β-haemolytic streptococci group A (GAS) often being the cause of severe cases of puerperal fever. The single most important risk factor for postpartum infection seems to be caesarean section, and prophylactic antibiotics during the procedure substantially reduce the infection risk. Improvements in service provision as promoted through the Surviving Sepsis Campaign can reduce the overall risk of mortality and morbidity from maternal sepsis in high-income as well as in low-income countries. SUMMARY: Maternal sepsis is an infrequent, but important complication of pregnancy, childbirth and puerperium, resulting in significant maternal morbidity and mortality worldwide. Improved outcome is possible through improved service provision. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.
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.
Coebergh van den Braak R.R.,Reinier de Graaf Gasthuis
Nederlands tijdschrift voor geneeskunde | Year: 2013
In blunt abdominal traumata the spleen is the most frequently and often the only injured organ. Splenic rupture can result in severe abdominal pain and haemodynamic instability, but may only have mild symptoms. A normal physical exam following abdominal trauma does not exclude splenic rupture. A general practitioner referred a 34-year-old patient with a clean medical history to our hospital for an abdominal ultrasound for progressive abdominal pain and blood cells in the urine after blunt abdominal trauma sustained in a bicycle accident two days previously. Because of intra-abdominal free fluid seen on ultrasound we performed a CT scan which showed a grade 3 splenic rupture. The patient was treated conservatively and discharged after two days of clinical observation. Intra-abdominal injuries after blunt abdominal trauma can present late and with only mild symptoms. New or progressive symptoms indicate the need for further imaging investigations. Non-operative treatment is indicated for most haemodynamically stable patients with splenic rupture; exercise restrictions and outpatient check-ups are necessary.
Lisowski L.A.,Academic Medical Center Amsterdam |
van den Bekerom M.P.J.,Academic Medical Center Amsterdam |
Pilot P.,Reinier de Graaf Gasthuis |
van Dijk C.N.,Academic Medical Center Amsterdam |
Lisowski A.E.,Atrium Medical
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2011
Purpose: In the last decade, a major increase in the use of and interest in unicompartmental knee arthroplasty (UKA) has developed. The Oxford Phase 3 UKA is implanted with a minimally invasive technique using newly developed instruments. The objective of this prospective study was to evaluate the outcome of UKA in patients with medial osteoarthritis of the knee in a high-volume unit. Methods: Two-hundred and forty-four UKAs were performed with a minimally invasive approach. The median age was 72 (43-91) years. The median follow-up was 4. 2 years (range 1-10. 4 years). Fourteen patients died, and nine were considered to be lost to follow-up, but all had a well-functioning prosthesis in situ until their last follow-up. Pain, function and health-related quality of life were evaluated pre- and postoperatively using patient- and assessor-based outcome scores, as well as radiographic evidence. Results: The mean Knee Society knee and function scores, WOMAC-scores, Oxford-score and VAS pain and satisfaction all improved. Nine knees required revision. Eleven patients required an additional arthroscopic procedure due to persisting pain secondary to intra-articular pathology, and four patients required manipulation under anaesthesia because of limited range of motion. The 7-year cumulative survival rate of the arthroplasty was 94. 4%. A low incidence (21%) of a radiolucent line beneath the tibial component was observed at 5 years of follow-up. Conclusion: This study showed a high survival rate of the Oxford Phase 3 UKA. Patient satisfaction and functional performance were also very high. Major complication rate was low; in addition, the incidence of radiolucency under the tibial component, when compared to present literature, was low. When strict indication criteria are followed, excellent, durable, and in our opinion reliable, results can be expected for this procedure. © 2010 The Author(s).