Prins H.A.,Robert Bosch GmbH |
Crolla R.M.P.H.,Amphia Hospital |
Den Outer A.J.,Rijnland Hospital |
Van Andel G.,Onze Lieve Vrouwe Gasthuis |
Van Helden S.H.,Maastricht University
New England Journal of Medicine | Year: 2010
BACKGROUND: Adverse events in patients who have undergone surgery constitute a large proportion of iatrogenic illnesses. Most surgical safety interventions have focused on the operating room. Since more than half of all surgical errors occur outside the operating room, it is likely that a more substantial improvement in outcomes can be achieved by targeting the entire surgical pathway. METHODS: We examined the effects on patient outcomes of a comprehensive, multidisciplinary surgical safety checklist, including items such as medication, marking of the operative side, and use of postoperative instructions. The checklist was implemented in six hospitals with high standards of care. All complications occurring during admission were documented prospectively. We compared the rate of complications during a baseline period of 3 months with the rate during a 3-month period after implementation of the checklist, while accounting for potential confounders. Similar data were collected from a control group of five hospitals. RESULTS: In a comparison of 3760 patients observed before implementation of the checklist with 3820 patients observed after implementation, the total number of complications per 100 patients decreased from 27.3 (95% confidence interval [CI], 25.9 to 28.7) to 16.7 (95% CI, 15.6 to 17.9), for an absolute risk reduction of 10.6 (95% CI, 8.7 to 12.4). The proportion of patients with one or more complications decreased from 15.4% to 10.6% (P<0.001). In-hospital mortality decreased from 1.5% (95% CI, 1.2 to 2.0) to 0.8% (95% CI, 0.6 to 1.1), for an absolute risk reduction of 0.7 percentage points (95% CI, 0.2 to 1.2). Outcomes did not change in the control hospitals. CONCLUSIONS: Implementation of this comprehensive checklist was associated with a reduction in surgical complications and mortality in hospitals with a high standard of care. (Netherlands Trial Register number, NTR1943.). Copyright © 2010 Massachusetts Medical Society.
Bosman W.M.P.F.,Rijnland Hospital |
Borger Van Der Burg B.L.S.,Rijnland Hospital |
Schuttevaer H.M.,Rijnland Hospital Leiderdorp |
Thoma S.,Rijnland Hospital Leiderdorp |
Hedeman Joosten P.P.,Rijnland Hospital
European Journal of Vascular and Endovascular Surgery | Year: 2014
Objective The objective of the paper is to present a case of an infected bare metal stent in the left common iliac artery that was removed by an urgent operation, and to review the literature on diagnosis and outcome of infected coronary and non-coronary metal stents. Methods A systematic search of the Medline database was performed with the purpose of identifying risk factors, signs and symptoms, imaging strategies, and treatment modalities of bare metal stent infections, both coronary and peripheral. Results In total, 76 additional studies/case reports (48 non-coronary; 29 coronary) were included and analyzed. Intravascular bare metal stent infections are a rare but serious complication, often leading to emergency surgery (overall: 75.3%; non-coronary cases: 83.3%; coronary cases: 62.1%). In 25.0% of the non-coronary cases, infection led to amputation of an extremity or removal of viscera. Reported mortality was up to 32.5% of the cases (non-coronary: 22.9%; coronary 48.3%). Physicians should always be suspicious of a stent infection when patients present with aspecific symptoms such as fever and chills after stent placement. Additional imaging can be used to detect the presence of a pseudoaneurysm. A PET-CT is an ideal medium for identification of a stent infection. Conclusions Intravascular stent infection is associated with a high risk of morbidity and mortality. Surgery is the preferred treatment option, but not always possible, especially in patients with a coronary stent. In selected cases, bare metal stent infections may be prevented by the use of prophylactic antibiotics at stent placement. © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
Reurink G.,Erasmus Medical Center |
Jansen S.P.L.,Rijnland Hospital |
Bisselink J.M.,Rijnland Hospital |
Vincken P.W.J.,Rijnland Hospital |
And 2 more authors.
Journal of Bone and Joint Surgery - Series A | Year: 2012
Background: Arthroscopic surgery of the hip is being increasingly used to diagnose and treat various abnormalities, including acetabular labral tears. Magnetic resonance arthrography has been suggested as the imaging test of choice for the evaluation of the acetabular labrum. There is substantial variability in the previously reported accuracy of magnetic resonance arthrography for diagnosing labral lesions. Interobserver reliability has not been established previously. The purpose of this study was to establish the interobserver reliability and the validity of magnetic resonance arthrography for detecting lesions of the acetabular labrum in a retrospective case series. Methods: Two radiologists independently assessed the acetabular labrum on magnetic resonance arthrograms of ninety-five hips in ninety-three patients who underwent hip arthroscopy for a suspected acetabular labral lesion. Magnetic resonance arthrography findings were compared with the gold standard, which was defined as the assessment of the labrum during the hip arthroscopy. Results: At arthroscopy, ninety-one labral lesions were identified in the ninety-five hips. The interobserver reliability of detecting labral lesions with magnetic resonance arthrography was fair (kappa = 0.268). Magnetic resonance arthrography, as interpreted by observers A and B, showed a sensitivity of 86% and 86%, specificity of 75% and 50%, negative predictive value of 19% and 13%, and positive predictive value of 99% and 98%, respectively. Conclusions: Because of its limited reliability and the high prevalence of labral lesions, magnetic resonance arthrography provides a limited complementary benefit in the detection of labral lesions in patients with a high clinical suspicion of labral pathology. When there is a high clinical suspicion of a labral lesion, magnetic resonance arthrography has a poor negative predictive value and cannot be used to rule out a labral lesion. Physicians should critically consider whether the findings on a magnetic resonance arthrogram will alter the treatment strategy for an individual patient with a clinical suspicion of labral pathology. Copyright © 2012 by The Journal of Bone and Joint Surgery, Incorporated.
Tan M.,Leiden University |
Mol G.C.,Diakonessenhuis |
Van Rooden C.J.,Haga Teaching Hospital |
Klok F.A.,Leiden University |
And 5 more authors.
Blood | Year: 2014
Accurate diagnostic assessment of suspected ipsilateral recurrent deep vein thrombosis (DVT) is a major clinical challenge because differentiating between acute recurrent thrombosis and residual thrombosis is difficultwith compression ultrasonography (CUS). We evaluated noninvasive magnetic resonance direct thrombus imaging (MRDTI) in a prospective study of 39 patients with symptomatic recurrent ipsilateral DVT (incompressibility of a different proximal venous segment than at the prior DVT) and 42 asymptomatic patients with at least 6-month-old chronic residual thrombi and normal D-dimer levels. All patients were subjected to MRDTI. MRDTI images were judged by 2 independent radiologists blinded for the presence of acute DVT and a third in case of disagreement. The sensitivity, specificity, and interobserver reliability of MRDTI were determined. MRDTI demonstrated acute recurrent ipsilateral DVT in 37 of 39 patients and was normal in all 42 patients without symptomatic recurrent disease for a sensitivity of 95% (95% CI, 83% to 99%) and a specificity of 100% (95% CI, 92% to 100%). Interobserver agreement was excellent (κ 5 0.98). MRDTI images were adequate for interpretation in 95% of the cases. MRDTI is a sensitive and reproducible method for distinguishing acute ipsilateral recurrent DVT from 6-month-old chronic residual thrombi in the leg veins. © 2014 by The American Society of Hematology.
De Witte P.B.,Leiden University |
Selten J.W.,Leiden University |
Navas A.,Leiden University |
Nagels J.,Leiden University |
And 3 more authors.
American Journal of Sports Medicine | Year: 2013
Background: Calcific tendinitis of the rotator cuff (RCCT) is frequently diagnosed in patients with shoulder pain, but there is no consensus on its treatment. Purpose: To compare 2 regularly applied RCCT treatments: ultrasound (US)-guided needling and lavage (barbotage) combined with a US-guided corticosteroid injection in the subacromial bursa (subacromial bursa injection [SAI]) (group 1) versus an isolated SAI (group 2). Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients were randomly assigned to the 2 groups. Shoulder function was assessed before treatment and at regular follow-up intervals (6 weeks and 3, 6, and 12 months) using the Constant shoulder score (CS, primary outcome), the Western Ontario Rotator Cuff Index (WORC), and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Additionally, calcification location, size, and Gärtner classification were assessed on radiographs. Results were analyzed using the t test, linear regression, and a mixed model for repeated measures. Results: This study included 48 patients (25 female, 52.1%; mean age, 52.0 ± 7.3 years; 23 patients in group 1) with a mean baseline CS of 68.7 ± 11.9. No patients were lost to follow-up. Four patients in group 1 and 11 in group 2 (P = .06) had an additional barbotage procedure or surgery during the follow-up period because of persisting symptoms and no resorption. At 1-year follow-up, the mean CS in group 1 was 86.0 (95% CI, 80.3-91.6) versus 73.9 (95% CI, 67.7-80.1) in group 2 (P = .005). The mean calcification size decreased by 11.6 ± 6.4 mm in group 1 and 5.1 ± 5.7 mm in group 2 (P = .001). There was total resorption in 13 patients in group 1 and ± patients in group 2 (P = .07). With regression analyses, correcting for baseline CS and Gärtner type, the mean treatment effect was 20.5 points (P = .05) in favor of barbotage. Follow-up scores were significantly influenced by baseline scores. Results for the DASH and WORC were similar. Conclusion: On average, there was improvement at 1-year follow-up in both treatment groups, but clinical and radiographic results were significantly better in the barbotage group. © 2013 The Author(s).
Nelissen E.M.,Leiden University |
Van Langelaan E.J.,Rijnland Hospital |
Nelissen R.G.H.H.,Leiden University
International Orthopaedics | Year: 2010
Medial opening wedge high tibial osteotmy (HTO) is often used to treat varus gonarthrosis in young, active, highly demanding patients, although it has many pitfalls, which were evaluated in a consecutive cohort of patients. A retrospective analysis of a consecutive series of 45 patients with 49 medial opening HTO for varus gonarthrosis using a spacer plate (Puddu I, Arthrex, USA) were included. A Chi square test was used to study the effect between the wedge size and complications. Complications occurred in 22 knees (45%). There was no significant difference between groups for individual complications; however, when combined, there were significantly more complications in the >10 mm wedge group (Chi square p∈=∈0.05). The overall complication rate in this series was 45%. The majority were related to intrinsic instability at the osteotomy site (24%) and surgical technique (20%). The evaluated spacer provided inadequate stability. © 2009 Springer-Verlag.
Van Gerwen M.,Rijnland Hospital |
Shaerf D.A.,Royal Free Hospital |
Veen R.M.,Sint Antonius Hospital
Acta Orthopaedica | Year: 2010
Background and purpose Hip resurfacing arthroplasty is claimed to allow higher activity levels and to give better quality of life than total hip arthroplasty. In this literature review, we assessed the therapeutic value of hip resurfacing arthroplasty as measured by functional outcome. Methods An extensive literature search was performed using the PubMed, Embase, and Cochrane databases. Results 9 patient series, 1 case-control study, and 1 randomized controlled trial (RCT) were included. Clinically and statistically significant improvement in sporting activity and hip scores were found in 10 studies. Interpretation Studies with low levels of evidence have shown improvement in various different hip scores and one RCT showed better outcomes with hip resurfacing arthroplasty. There is no high-level evidence to prove that there is improved clinical outcome using hip resurfacing arthroplasty. More randomized research needs to be done. © Nordic Orthopaedic Federation.
Weir A.,Hague Medical Center |
De Vos R.J.,Hague Medical Center |
Moen M.,Rijnland Hospital |
Holmich P.,Copenhagen University |
Tol J.L.,Hague Medical Center
British Journal of Sports Medicine | Year: 2011
Objective: A decreased range of motion (ROM) of the hip joint is known to predispose to athletic groin injury. Femoroacetabular impingement (FAI) of the hip leads to a reduced ROM. This study examined the prevalence of radiological signs of FAI in patients presenting with longstanding adductor-related groin pain (LSARGP). Design: Prospective case series. Setting: Outpatient Sports Medicine Department. Patients: 34 athletes with LSARGP defined as pain on palpation of the proximal insertion of adductor muscle and a painful, resisted adduction test. Assessment: A clinician blinded to the results of the radiological assessment performed a physical examination: iliopsoas length, hip ROM and anterior hip impingement test. Anteroposterior pelvic radiographs were examined by a second blinded clinician for the presence of: pistol grip deformity, centrum-collumdiaphyseal angle, femoral head neck ratio, coxa profunda, protrusio acetabuli, lateral centre edge angle, acetabular index and cross-over sign. Results: The prevalence of radiological signs of FAI was 94% (64/68). The mean number of radiological signs in hips with LSARGP was 1.84 (range 0-4, SD 1.05) and 1.96 (range 0-5, SD 1.12) in asymptomatic groins (p=0.95). The anterior hip impingement test was positive in nine cases. There was no relationship with the number of radiological signs (p=0.95). There was no correlation between hip ROM and the number of radiological signs (p=0.37). Conclusion Radiological signs of FAI are frequently observed in patients presenting with LSARGP. Clinicians should be aware of this fact and the possible lack of correlation when assessing athletes with groin pain.
Rutten J.W.,Leiden University |
Haan J.,Rijnland Hospital |
Haan J.,Leiden University |
Terwindt G.M.,Leiden University |
And 3 more authors.
Expert Review of Molecular Diagnostics | Year: 2014
CADASIL is an autosomal dominant inherited disease, characterized by mid-adult onset of cerebrovascular disease and dementia. CADASIL is caused by mutations in the NOTCH3 gene, which encodes the NOTCH3 protein. Pathogenic mutations in CADASIL are highly distinctive in the sense that they lead to the loss or gain of a cysteine residue in 1 of the 34 EGFr domains of the NOTCH3 protein. The majority are missense mutations, but small deletions, insertions and splice-site mutations have been reported, which typically also lead to a numerical cysteine alteration. Whether numerical cysteine-altering mutations are a rule in CADASIL remains subject of debate, as there are reports suggesting pathogenicity of other types of mutations. However, for most of these the association with CADASIL was later revoked or is questionable. Here, we discuss and provide recommendations for the interpretation of NOTCH3 mutations in the diagnosis of CADASIL. © 2014 Informa UK, Ltd.
van Langevelde K.,Leiden University |
Sramek A.,Leiden University |
Vincken P.W.J.,Rijnland Hospital |
van Rooden J.-K.,Haga Teaching Hospital |
And 2 more authors.
Haematologica | Year: 2013
Pulmonary embolism is considered to originate from embolization of a deep-vein thrombosis, resulting in two manifestations of one disease: venous thrombosis. However, in up to 50% of patients with pulmonary embolism no deep-vein thrombosis is found with ultrasonography. An explanation for this low proportion is currently lacking. Other imaging modalities may increase the yield of detection of deep-vein thrombosis in the calf or in the abdominal region. Alternatively, not all pulmonary emboli may originate from deep-vein thromboses in the extremities. We searched for the origin of pulmonary emboli, by performing total-body magnetic resonance imaging-scans to visualize thrombi. Ninety-nine patients with a first pulmonary embolism confirmed by computed tomography underwent a magnetic resonance direct thrombus imaging-scan, a validated technique using endogenous contrast. Additionally, acquired and genetic risk factors were assessed. No thrombus was found in 55 patients, whereas a thrombus was identified in 44 patients. The commonest thrombus location was the lower leg; 12 patients had isolated calf vein thrombosis and five had isolated superficial vein thrombosis. A peripheral thrombus was found by magnetic resonance imaging in less than half of patients with pulmonary embolism. We propose several hypotheses to explain the absence of thrombi, such as a cardiac thrombus origin or embolization of the whole deep-vein thrombus. The possibility that pulmonary embolism arises de novo in the lungs, due to local inflammation-driven coagulation, needs to be considered.