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Delft, Netherlands

van der Horst M.P.,Reinier de Graaf Groep
Nederlands tijdschrift voor geneeskunde | Year: 2010

A 54-year-old man presented with intermittent pain in the left testis caused by a fibrothecoma of the testis.

To compare the prevalence of sensitization and allergy to natural rubber latex amongst Erasmus Medical Centre (MC) operating theatre employees before and 10 years after the introduction of powder-free latex gloves. Descriptive study. Employees working permanently in the operating theatre were evaluated in 1998 (n = 163) and in 2009 (n = 178) for sensitization and allergies to natural latex by means of questionnaires, serological analyses and skin testing. The prevalence of sensitization and allergies within these 2 groups was then established and compared. RESULTS : The two groups were comparable in terms of gender, smoking habits, job classification, work-related symptoms and the number of individuals who had atopy. In 2009, the prevalence of sensitization to latex was statistically significantly lower than in 1998 (4.5 vs. 14.1%). Allergy to latex was also established a statistically significantly fewer number of times in 2009 than in 1998 (2.8 vs. 9.8%). This same trend could be observed in the subgroup that participated both years (n = 49). Individuals with an atopic constitution had a statistically significant higher risk of developing hypersensitivity to natural latex; the risk of developing an allergy to latex was also higher, but not significantly. After the study in 1998, the introduction of sterile, powder-free latex gloves very likely led to a decline in the prevalence of sensitization and allergy to natural latex in 2009.

Kamphuis D.J.,Reinier de Graaf Groep
Parkinsonism and Related Disorders | Year: 2012

Rationale: Cervical dystonia, also called spasmodic torticollis, is the most common form of (primary) dystonia. Intramuscular injections with botulinum toxin are the first line of treatment for cervical dystonia. To optimise the treatment response to botulinum toxin correct muscles should be selected. Clinical evaluation is important for muscle selection but the value of additional tests to identify dystonic muscles remains unclear. Objective: To evaluate all relevant literature regarding the best approach to select dystonic muscles for treatment with botulinum toxin. Methods: We conducted a systematic review of studies that had investigated methods of selecting muscles for treatment with botulinum toxin. In addition, we compared all prospective botulinum toxin trials using either clinical evaluation or polymyographic electromyography for muscle selection. Results: Forty relevant studies were included and polymyographic electromyography recordings were most often employed. In several studies, polymyographic electromyography revealed a different pattern of muscle involvement compared to that found during clinical evaluation. In one randomized controlled trial polymyographic electromyography significantly improved the outcome of botulinum toxin treatment. A limited number of studies used positron emission tomography - computed tomography imaging or frequency analysis of the electromyography signal to identify dystonic muscles but their effect on the outcome of treatment has never been studied. Conclusion: Polymyographic electromyography may improve the outcome of botulinum toxin treatment in cervical dystonia, but evidence is limited and larger studies are needed. © 2012 Elsevier Ltd.

Srebniak M.I.,Erasmus Medical Center | Diderich K.E.M.,Erasmus Medical Center | Noomen P.,Erasmus Medical Center | Dijkman A.,Reinier de Graaf Groep | And 2 more authors.
Ultrasound in Obstetrics and Gynecology | Year: 2014

We present a unique case in which non-invasive and invasive prenatal diagnoses showed abnormal, but discordant, results. A patient with abnormal non-invasive prenatal test (NIPT) results, indicating a 99% risk for monosomy X, was referred to our center for genetic counseling and confirmatory studies. Cytogenetic analysis of uncultured mesenchymal core of chorionic villi (CV) revealed a mosaic male karyotype consisting of two abnormal cell lines: one with monosomy X and the other with an isodicentric chromosome Y. Array analysis of the trophoblast confirmed the NIPT results. Based on the CV results, the patient opted for termination of pregnancy. After extensive counseling by a clinical geneticist about the possible outcomes and by a gynecologist about the risk of a second-trimester abortion procedure, the patient agreed to undergo early amniocentesis. Amniocentesis confirmed that the fetus had a male karyotype with an isodicentric chromosome Y, and the single nucleotide polymorphism (SNP) array profile suggested absence of the monosomy X cell line. The male infant was expected to be infertile. The patient finally decided to continue the pregnancy. Our case confirms that NIPT results are comparable with those of short-term cultured CV investigating the cytotrophoblast. Our patient was not aware that the NIPT results reveal the placental karyotype, which sometimes may be different from the fetal karyotype. Pretest counseling and providing the risk figures for false-positive and false-negative NIPT results are of great importance in order to discourage women from terminating pregnancies based on NIPT results alone. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

Hospitalized patients are at risk for adverse events such as unexpected cardiac arrest or admission to an Intensive Care Unit (ICU). Prior to these adverse events these patients often have derangements in vital signs that are not recognized and treated adequately. To identify and treat those patients at risk, our hospital implemented a rapid response system in 2004. The purpose of this paper is to describe implementation and results of our rapid response system. Prospective cohort study. The implementation of the rapid response system started by training all doctors and nurses to score vital signs using a dedicated score card. If a patient scores 3 or more points, the patients' treating physician has to see the patient and - if necessary - call the medical emergency team (MET), consisting of an ICU physician and an ICU nurse. We analyzed all consecutive MET calls in the period January 2005-December 2009. A total of 1058 MET calls for 981 patients were analyzed. In 606 patients (57.3%) it was decided to transfer the patient to a higher dependency unit, in most cases the ICU. In 353 patients (33.4%) treatment could be continued on the ward. In 88 patients (8.4%) it was decided that ICU treatment would not be beneficial and limits on treatment were put in place. Of the 981 patients, 255 (26.0%) died in hospital. In our hospital the rapid response system has developed into an important tool for the early identification and treatment of patients at risk. However, our data cannot prove the efficacy of the rapid response system in terms of reducing hospital mortality.

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