Arnhem, Netherlands
Arnhem, Netherlands

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Groenen M.J.M.,Rijnstate Hospital Arnhem
Digestive Surgery | Year: 2012

Background and Aims: It is generally advised to perform colonoscopy after conservatively treated diverticulitis because colon cancer may present itself with similar symptoms, laboratory and radiological results. With this study we investigated in what percentage of patients a malignancy was found by performing routine colonoscopy or radiologic imaging after a conservatively treated episode of diverticulitis, and whether this follow-up programme could be reserved for a selected group of patients. Methods: In our hospital, routine colonoscopy or, as a second choice, radiologic imaging has been standard practice over the last decade. We collected all colonoscopy and radiologic imaging results that were conducted of all 516 patients who were diagnosed with diverticulitis in this period. Results: Of those 516 patients, 378 had undergone colonoscopy, 45 radiologic imaging and 93 did not undergo any additional investigation. Eight cases of malignant neoplasia were found in those patients (2.1%), and an additional number of 40 adenomatous polyps (9.5%). Six out of 8 patients with colon cancer reported rectal blood loss, significant weight loss or persisting abdominal pain after being treated for diverticulitis. Conclusions: In patients who were conservatively treated with routine colonoscopy or radiologic imaging for apparent diverticulitis, a malignant tumour was found in the colon in 2.1% of them. If only performed in patients reporting alarm symptoms, a case of colon cancer would be missed in only 0.5% of patients conservatively treated for diverticulitis. Therefore, screening for colon cancer after conservative treatment of diverticulitis is only indicated in symptomatic patients. © 2012 S. Karger AG, Basel.


Van Hagen P.,Erasmus Medical Center | Hulshof M.C.C.M.,Academic Medical Center Amsterdam | Van Lanschot J.J.B.,Erasmus Medical Center | Van Lanschot J.J.B.,Academic Medical Center Amsterdam | And 29 more authors.
New England Journal of Medicine | Year: 2012

BACKGROUND: The role of neoadjuvant chemoradiotherapy in the treatment of patients with esophageal or esophagogastric-junction cancer is not well established. We compared chemoradiotherapy followed by surgery with surgery alone in this patient population. METHODS: We randomly assigned patients with resectable tumors to receive surgery alone or weekly administration of carboplatin (doses titrated to achieve an area under the curve of 2 mg per milliliter per minute) and paclitaxel (50 mg per square meter of body-surface area) for 5 weeks and concurrent radiotherapy (41.4 Gy in 23 fractions, 5 days per week), followed by surgery. RESULTS: From March 2004 through December 2008, we enrolled 368 patients, 366 of whom were included in the analysis: 275 (75%) had adenocarcinoma, 84 (23%) had squamous- cell carcinoma, and 7 (2%) had large-cell undifferentiated carcinoma. Of the 366 patients, 178 were randomly assigned to chemoradiotherapy followed by surgery, and 188 to surgery alone. The most common major hematologic toxic effects in the chemoradiotherapy-surgery group were leukopenia (6%) and neutropenia (2%); the most common major nonhematologic toxic effects were anorexia (5%) and fatigue (3%). Complete resection with no tumor within 1 mm of the resection margins (R0) was achieved in 92% of patients in the chemoradiotherapy-surgery group versus 69% in the surgery group (P<0.001). A pathological complete response was achieved in 47 of 161 patients (29%) who underwent resection after chemoradiotherapy. Postoperative complications were similar in the two treatment groups, and in-hospital mortality was 4% in both. Median overall survival was 49.4 months in the chemoradiotherapy-surgery group versus 24.0 months in the surgery group. Overall survival was significantly better in the chemoradiotherapy-surgery group (hazard ratio, 0.657; 95% confidence interval, 0.495 to 0.871; P = 0.003). CONCLUSIONS: Preoperative chemoradiotherapy improved survival among patients with potentially curable esophageal or esophagogastric-junction cancer. The regimen was associated with acceptable adverse-event rates. (Funded by the Dutch Cancer Foundation [KWF Kankerbestrijding]; Netherlands Trial Register number, NTR487.) Copyright © 2012 Massachusetts Medical Society.


van den Ham L.H.,Rijnstate Hospital | Zeebregts C.J.,University of Groningen | de Vries J.-P.P.M.,St Antonius Hospital | Reijnen M.M.,Rijnstate Hospital Arnhem
Surgical technology international | Year: 2015

Since the dawn of endovascular aortic aneurysm repair (EVAR), starting from its initial report in 1991, there has been a significant evolution in stent graft design and delivery systems. Complications, mostly endoleaks, and re-intervention rates after EVAR remain amongst the most challenging aspects in comparison with traditional open repair. The use of a sac-anchoring endograft changes the approach of aneurysm exclusion. The Nellix™ EndoVascular Aneurysm Sealing system (Endologix Inc., Irvine, CA) consists of balloon expandable stents surrounded by endobags that are filled with a polymer thereby sealing the aneurysm. By sealing the aneurysm sac instead of exclusion with only proximal and distal fixation, the risk of stent migration and endoleaks is theoretically diminished. Current investigational use is aimed to confirm clinical success, decreased complication, and secondary intervention rates compared to conventional endovascular repair.


Hannemann P.F.W.,Maastricht University | Gottgens K.W.A.,Maastricht University | Van Wely B.J.,Canisius Wilhelmina Hospital | Kolkman K.A.,Rijnstate Hospital Arnhem | And 3 more authors.
Journal of Bone and Joint Surgery - Series B | Year: 2012

The use of pulsed electromagnetic fields (PEMF) to stimulate bone growth has been recommended as an alternative to the surgical treatment of ununited scaphoid fractures, but has never been examined in acute fractures. We hypothesised that the use of PEMF in acute scaphoid fractures would accelerate the time to union by 30% in a randomised, double-blind, placebo-controlled, multicentre trial. A total of 53 patients in three different medical centres with a unilateral undisplaced acute scaphoid fracture were randomly assigned to receive either treatment with PEMF (n = 24) or a placebo (n = 29). The clinical and radiological outcomes were assessed at four, six, nine, 12, 24 and 52 weeks. A log-rank analysis showed that neither time to clinical and radiological union nor the functional outcome differed significantly between the groups. The clinical assessment of union indicated that at six weeks tenderness in the anatomic snuffbox (p = 0.03) as well as tenderness on longitudinal compression of the scaphoid (p = 0.008) differed significantly in favour of the placebo group. We conclude that stimulation of bone growth by PEMF has no additional value in the conservative treatment of acute scaphoid fractures. ©2012 British Editorial Society of Bone and Joint Surgery.


Dogan K.,Rijnstate Hospital Arnhem | Kraaij L.,Rijnstate Hospital Arnhem | Aarts E.O.,Rijnstate Hospital Arnhem | Koehestanie P.,Rijnstate Hospital Arnhem | And 5 more authors.
Obesity Surgery | Year: 2015

Background: Due to the increased incidence of morbid obesity, the demand for bariatric surgery is increasing. Therefore, the methods for optimising perioperative care for the improvement of surgical outcome and to increase efficacy are necessary. The aim of this prospective matched cohort study is to objectify the effect of the fast-track surgery (FTS) programme in patients undergoing primary Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) surgery compared to conventional perioperative care (CPC). Methods: This study compared the perioperative outcome data of two groups of 75 consecutive morbid obese patients who underwent a primary LRYGB according to international guidelines in the periods January 2011–April 2011 (CPC group) and April 2012–June 2012 (FTS group). The two groups were matched for age and sex. Primary endpoints were surgery and hospitalisation time, while secondary endpoints were intraoperative medication use and complication rates. Results: Baseline patient characteristics for age, sex, weight and ASA classification were similar (p > 0.05) for CPC and FTS patients. BMI and waist circumference were significantly lower (p < 0.05) in the FTS compared to CPC. The total time from arrival at the operating room to the arrival at the recovery was reduced from 119 to 82 min (p < 0.001). Surgery time was reduced from 80 to 56 min (p < 0.001); mean hospital stay was reduced from 65 to 43 h (p < 0.001). Major complications occurred in 3 versus 4 % in the FTS and CPC, respectively. Conclusions: The introduction of a fast-track programme after primary LRYGB improves short-term recovery and may reduces direct hospital-related resources. © 2014, Springer Science+Business Media New York.


Bosman G.J.C.G.M.,Radboud University Nijmegen | Lasonder E.,Radboud University Nijmegen | Groenen-Dopp Y.A.M.,Rijnstate Hospital Arnhem | Willekens F.L.A.,Rijnstate Hospital Arnhem | And 2 more authors.
Journal of Proteomics | Year: 2010

During aging in vivo and in vitro, erythrocytes display removal signals. Phagocytosis is triggered by binding of autologous IgG to a senescent cell antigen originating on band 3. Erythrocytes generate vesicles as an integral part of the aging process in vivo and in vitro, i.e. during storage. These vesicles display senescent cell antigens as well as phosphatidylserine, that is recognized by scavenger receptors. Recent comparative proteomic analyses of erythrocytes and their vesicles support the hypothesis that aging is accompanied by increased binding of modified hemoglobins to band 3, disruption of the band 3-mediated anchorage of the cytoskeleton to the lipid bilayer, vesicle formation, and antigenic changes in band 3 conformation. Proteomic data also suggest an, until then unknown, involvement of chaperones, stress proteins, and proteasomes. Thus, the presently available comparative proteomic analyses not only confirm previous immunochemical and functional data, but also (1) provide new clues to the mechanisms that maintain erythrocyte homeostasis; (2) open new roads to elucidate the processes that regulate physiological erythrocyte aging and removal, and thereby; (3) provide the foundation for rational interventions to prevent untimely erythrocyte removal, and unwanted interactions between the erythrocyte and the immune system, especially after transfusion. © 2009.


Van Groningen L.,Rijnstate Hospital Arnhem | Opdenoordt S.,Rijnstate Hospital Arnhem | Van Sorge A.,Rijnstate Hospital Arnhem | Telting D.,Rijnstate Hospital Arnhem | And 2 more authors.
European Journal of Endocrinology | Year: 2010

Introduction: Severe vitamin D deficiency is very common. Evidence-based guidelines for rapid correction with high-dose oral cholecalciferol are not yet available. Objective: To develop a practical cholecalciferol loading dose regimen. Materials and methods: A total of 208 vitamin D-deficient subjects (serum 25-hydroxyvitamin D3 (25-OHD3) level <50 nmol/l), aged 18-88 years, were treated with solubilized cholecalciferol, 50 000 IU/ml. They received either 25 000 IU every fortnight for 8 weeks (total dose 100 000 IU), 25 000 IU every week for 6 weeks (total dose 150 000 IU), or 25 000 IU every week for 8 weeks (total dose 200 000 IU). Blood samples were collected at baseline and 10 days after the final dose of cholecalciferol. Results: Most patients were severely vitamin D deficient: 76% had a serum 25-OHD3 level <30 nmol/l at baseline. Cholecalciferol in a cumulative dose of 100 000, 150 000, and 200 000 IU increased mean serum 25-OHD3 level by 29 nmol/l (95% confidence interval (CI): 23-35 nmol/l), 43 nmol/l (95% CI: 36-50 nmol/l), and 69 nmol/l (95% CI: 64-75 nmol/l) respectively. The change in 25-OHD3 (Δ25-OHD3) was related to the dose per kilogram body weight (R2=0.38, P<0.0001), and is described by the equation: Δ25-OHD3=0.025x(dose per kg body weight). Conclusion: The cholecalciferol loading dose required to reach the serum 25-OHD3 target level of 75 nmol/l can be calculated as follows: dose (IU)=40x(75 - serum 25-OHD3)xbody weight. © 2010 European Society of Endocrinology.


Huizing K.M.N.,Rijnstate Hospital Arnhem | Swanink C.M.A.,Rijnstate Hospital Arnhem | Landstra A.M.,Rijnstate Hospital Arnhem | Van Zwet A.A.,Rijnstate Hospital Arnhem | Van Setten P.A.,Rijnstate Hospital Arnhem
Pediatric Infectious Disease Journal | Year: 2011

We studied the potential benefits of introducing a rapid enterovirus molecular test in children with enterovirus meningitis. The 2 groups of pediatric patients were comparable with respect to clinical and laboratory data, but differed in availability of enterovirus test results. In the control group, the results were available within 3 to 7 days, whereas in the study group, rapid enterovirus molecular test results were available within 3 to 24 hours. The median duration of hospitalization and the duration of antibiotics were significantly reduced to, respectively, 2 days and 1 day in the study group when compared with the control group (P < 0.001). Mean costs per patient calculation showed an average reduction of more than US $1450 (P < 0.001). © 2011 by Lippincott Williams & Wilkins.


Smit E.J.,University Utrecht | Vonken E.-J.,University Utrecht | Van Der Schaaf I.C.,University Utrecht | Mendrik A.M.,University Utrecht | And 6 more authors.
Radiology | Year: 2012

Purpose: To suggest a simple and robust technique used to reconstruct high-quality computed tomographic (CT) angiographic images from CT perfusion data and to compare it with currently used CT angiography techniques. Materials and Methods: Institutional review board approval was waived for this retrospective study, which included 25 consecutive patients who had had a stroke. Temporal maximum intensity projection (tMIP) CT angiographic images were created by using prior temporal filtering as a timing-insensitive technique to produce CT angiographic images from CT perfusion data. The temporal filter strength was optimized to gain maximal contrast-to-noise ratios (CNRs) in the circle of Willis. The resulting timing-invariant (TI) CT angiography was compared with standard helical CT angiography, the arterial phase of dynamic CT angiography, and nonfiltered tMIP CT angiography. Vascular contrast, image noise, and CNR were measured. Four experienced observers scored all images for vascular noise, vascular contour, detail of small and medium arteries, venous superimposition, and overall image quality in a blinded side-by-side comparison. Measurements were compared with a paired t test; P ≤ .05 indicated a significant difference. Results: On average, optimized temporal filtering in TI CT angiography increased CNR by 18% and decreased image noise by 18% at the expense of a decrease in vascular contrast of 3% when compared with nonfiltered tMIP CT angiography. CNR, image noise, vascular noise, vascular contour, detail visibility of small and medium arteries, and overall image quality of TI CT angiograms were superior to those of standard CT angiography, tMIP CT angiography, and the arterial phase of dynamic CT angiography at a vascular contrast that was similar to that of standard CT angiography. Venous superimposition was similar for all techniques. Image quality of the arterial phase of dynamic CT angiography was rated inferior to that of standard CT angiography. Conclusion: TI CT angiographic images constructed by using temporally filtered tMIP CT angiographic data have excellent image quality that is superior to that achieved with currently used techniques, but they suffer from modest venous superimposition. © RSNA, 2012.


Bech A.,Rijnstate Hospital Arnhem | Van Bentum P.,Rijnstate Hospital Arnhem | Nabbe K.,Rijnstate Hospital | Gisolf J.,Rijnstate Hospital Arnhem | And 2 more authors.
HIV Medicine | Year: 2012

Objectives: Hypophosphataemia is common in HIV-positive patients, in particular in those using tenofovir disoproxil fumarate (TDF). Its pathogenesis is not well understood. The importance of fibroblast growth factor 23 (FGF-23), the most potent phosphaturic hormone known today, has not been studied in these patients. The aim of the study was to investigate whether FGF-23 might be involved in the aetiology of hypophosphataemia in HIV-positive patients on tenofovir. Methods: Calcium and phosphate metabolism was studied in 36 HIV-positive patients on TDF. Hypophosphataemia was defined as a serum phosphate level<0.75mmol/L. Results: Fifteen patients (42%) had hypophosphataemia (group 1), and 21 had a normal serum phosphate level (group 2). The renal phosphate reabsorption threshold [tubular maximum phosphate reabsorption per glomerular filtration rate (TmP/gfr)] was significantly lower in group 1 than in group 2 (0.58±0.04 vs. 0.91±0.03mmol/L, respectively; P<0.0001). The serum phosphate concentration was strongly correlated with TmP/gfr (R=0.71; P<0.0001). Both groups had normal serum FGF-23 levels, and serum phosphate and TmP/gfr were not related to serum parathyroid hormone (PTH) or FGF-23 levels. Conclusion: FGF-23 is not involved in the pathogenesis of hypophosphataemia in HIV-positive patients on TDF. The data suggest that a PTH-like factor may be involved. © 2012 British HIV Association.

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