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Nieuwegein, Netherlands

Liem L.,Sint. Antonius Hospital
Progress in Neurological Surgery | Year: 2015

Dorsal root ganglion (DRG) stimulation has recently emerged as a new neuromodulation modality that stays on the intersection of the peripheral and central nervous system. With DRG location within the spinal column and with electrodes for DRG stimulation placed through the intraspinal epidural space, it may make more sense to group DRG stimulation together with more commonly used spinal cord stimulation (SCS) rather than peripheral nerve stimulation (PNS), particularly if one agrees that the stimulation delivered to DRG partly works downstream at the spinal cord level. Based on current experience, it appears that DRG stimulation of the spinal cord is as effective as SCS in relieving various neuropathic pain syndromes including pain due to failed back surgery syndrome, complex regional pain syndromes, and chronic postsurgical pain. In addition to its efficacy, DRG stimulation of the spinal cord is associated with a lower rate of migrations and lack of positional side effects that may be seen with SCS and PNS. Here we summarize the knowledge base and clinical evidence for DRG stimulation of the spinal cord, and present hypotheses of its mechanism of action. © 2016 S. Karger AG, Basel. Source

Van Buyten J.-P.,Multidisciplinary Pain Center | Smet I.,Multidisciplinary Pain Center | Liem L.,Sint. Antonius Hospital | Russo M.,Hunter Pain Clinic | Huygen F.,Erasmus University Rotterdam
Pain Practice | Year: 2015

Background: Complex regional pain syndrome (CRPS) is a chronic and progressive pain condition usually involving the extremities and characterized by sensorimotor, vascular, and trophic changes. Spinal cord stimulation (SCS) is an effective intervention for this condition, but is hampered by the technical challenges associated with precisely directing stimulation to distal extremities. Dorsal root ganglia (DRG) may be more effective as a physiological target for electrical modulation due to recruitment of the primary sensory neurons that innervate the painful distal anatomical regions. Methods: Eleven subjects diagnosed with uni- or bilateral lower-extremity CRPS were recruited as part of a larger study involving chronic pain of heterogeneous etiologies. Quadripolar epidural leads of a newly developed neurostimulation system were placed near lumbar DRGs using conventional percutaneous techniques. The neurostimulators were trialed; 8 were successful and permanently implanted and programed to achieve optimal pain-paresthesia overlap. Results: All 8 subjects experienced some degree of pain relief and subjective improvement in function, as measured by multiple metrics. One month after implantation of the neurostimulator, there was significant reduction in average self-reported pain to 62% relative to baseline values. Pain relief persisted through 12 months in most subjects. In some subjects, edema and trophic skin changes associated with CRPS were also mitigated and function improved. Neuromodulation of the DRG was able to provide excellent pain-paresthesia concordance in locations that are typically hard to target with traditional SCS, and the stimulation reduced the area of pain distributions. Conclusions: Neuromodulation of the DRG appears to be a promising option for relieving chronic pain and other symptoms associated with CRPS. The capture of discrete painful areas such as the feet, combined with stable paresthesia intensities independent of body position, suggests this stimulation modality may allow more selective and consistent targeting of painful areas than traditional SCS. © 2014 World Institute of Pain. Source

Mijatovic V.,VU University Amsterdam | Veersema S.,Sint. Antonius Hospital | Emanuel M.H.,Spaarne Hospital | Schats R.,VU University Amsterdam | Hompes P.G.A.,VU University Amsterdam
Fertility and Sterility | Year: 2010

Objective: To investigate the success rate of proximal tubal occlusion with Essure devices in subfertile women with hydrosalpinges, and to observe the results of subsequent treatment with IVF. Design: Prospective, single-arm, clinical study. Setting: University hospital and teaching hospital. Patient(s): Ten women with uni- or bilateral hydrosalpinges prior to IVF. In all patients laparoscopy was felt to be contraindicated. Intervention(s): Hysteroscopic placement of Essure devices in an office setting. Main Outcome Measure(s): Placement rate, successful proximal tubal occlusion, and pregnancy rate after IVF. Result(s): All patients had successful placement of the Essure devices without any complications. Proximal tubal occlusion was confirmed by hysterosalpingography in 9 out of 10 patients. A 40% ongoing pregnancy rate was achieved with 20% life births after one IVF cycle and/or frozen embryo transfer. Conclusion(s): Proximal occlusion of hydrosalpinges with Essure devices before IVF is a successful treatment for patients with a contraindication for salpingectomy. © 2010 American Society for Reproductive Medicine. Source

Klaassen E.M.M.,Maastricht University | Van De Kant K.D.G.,Maastricht University | Jobsis Q.,Maastricht University | Van Schayck O.C.P.,Maastricht University | And 9 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2015

Rationale: A reliable asthma diagnosis is difficult in wheezing preschool children. Objectives: To assess whether exhaled biomarkers, expression of in flammation genes, and early lung function measurements can improve a reliable asthma prediction in preschool wheezing children. Methods: Two hundred two preschool recurrent wheezers (aged 2-4 yr) were prospectively followed up until 6 years of age. At 6 years of age, a diagnosis (asthma or transient wheeze) was based on symptoms, lung function, and asthma medication use. The added predictive value (area under the receiver operating characteristic curve [AUC]) of biomarkers to clinical information (assessed with the Asthma Predictive Index [API]) assessed at preschool age in diagnosing asthma at 6 years of age was determined with a validation set. Biomarkers in exhaled breath condensate, exhaled volatile organic compounds (VOCs), gene expression, and airway resistance were measured. Measurements and Main Results: At 6 years of age, 198 children were diagnosed (76 with asthma, 122 with transient wheeze). Information on exhaled VOCs significantly improved asthma prediction (AUC, 89% [increase of 28%]; positive predictive value [PPV]/negative predictive value [NPV], 82/83%), which persisted in the validation set. Information on gene expression of toll-like receptor 4, catalase, and tumor necrosis factor-α significantly improved asthma prediction (AUC, 75% [increase of 17%]; PPV/NPV, 76/73%). This could not be confirmed after validation. Biomarkers in exhaled breath condensate and airway resistance (pre- and post- bronchodilator) did not improve an asthma prediction. The combined model with VOCs, gene expression, and API had an AUC of 95% (PPV/NPV, 90/89%). Conclusions: Adding information on exhaled VOCs and possibly expression of inflammation genes to the API significantly improves an accurate asthma diagnosis in preschool children. Clinical trial registered with www.clinicaltrial.gov (NCT 00422747). Copyright © 2015 by the American Thoracic Society. Source

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. Source

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