Vrouenraets B.C.,Sint Lucas Andreas Hospital
International Journal of Colorectal Disease | Year: 2012
Purpose The exact pathogenesis of diverticular disease of the sigmoid colon is not well established. However, the hypothesis that a low-fibre diet may result in diverticulosis and a high-fibre diet will prevent symptoms or complications of diverticular disease is widely accepted. The aim of this review is to assess whether a high-fibre diet can improve symptoms and/or prevent complications of diverticular disease of the sigmoid colon and/or prevent recurrent diverticulitis after a primary episode. Methods Clinical studies were eligible for inclusion if they assessed the treatment of diverticular disease or the prevention of recurrent diverticulitis with a high-fibre diet. The following exclusion criteria were used for study selection: studies without comparison of the patient group with a control group. Results No studies concerning prevention of recurrent diver-ticulitis with a high-fibre diet met our inclusion criteria. Three randomised controlled trials (RCT) and one case-control study were included in this systematic review. One RCT of moderate quality showed no difference in the primary endpoints. A second RCT of moderate quality and the case- control study found a significant difference in favour of a high-fibre diet in the treatment of symptomatic diverticular disease. The third RCTof moderate quality found a significant difference in favour of methylcellulose (fibre supplement). This study also showed a placebo effect. Conclusion High-quality evidence for a high-fibre diet in the treatment of diverticular disease is lacking, and most recommendations are based on inconsistent level 2 and mostly level 3 evidence. Nevertheless, high-fibre diet is still recommended in several guidelines. © 2011 CARS.
Braamskamp M.J.A.M.,Sint Lucas Andreas Hospital |
Dolman K.M.,Sint Lucas Andreas Hospital
European Journal of Pediatrics | Year: 2010
Protein-losing enteropathy (PLE) is a rare complication of a variety of intestinal disorders characterized by an excessive loss of proteins into the gastrointestinal tract due to impaired integrity of the mucosa. The clinical presentation of patients with PLE is highly variable, depending upon the underlying cause, but mainly consists of edema due to hypoproteinemia. While considering PLE, other causes of hypoproteinemia such as malnutrition, impaired synthesis, or protein loss through other organs like the kidney, liver, or skin, have to be excluded. The disorders causing PLE can be divided into those due to protein loss from intestinal lymphatics, like primary intestinal lymphangiectasia or congenital heart disease and those with protein loss due to an inflamed or abnormal mucosal surface. The diagnosis is confirmed by increased fecal concentrations of alpha-1-antitrypsin. After PLE is diagnosed, the underlying cause should be identified by stool cultures, serologic evaluation, cardiac screening, or radiographic imaging. Treatment of PLE consists of nutrition state maintenance by using a high protein diet with supplement of fat-soluble vitamins. In patients with lymphangiectasia, a low fat with medium chain triglycerides (MCT) diet should be prescribed. Besides dietary adjustments, appropriate treatment for the underlying etiology is necessary and supportive care to avoid complications of edema. PLE is a rare complication of various diseases, mostly gastrointestinal or cardiac conditions that result into loss of proteins in the gastrointestinal tract. Prognosis depends upon the severity and treatment options of the underlying disease. © 2010 The Author(s).
Lequin M.B.,Sint Lucas Andreas Hospital |
Verbaan D.,Sint Lucas Andreas Hospital |
Bouma G.J.,Sint Lucas Andreas Hospital
Journal of Neurosurgery: Spine | Year: 2014
Object. Patients with recurrent sciatica due to repeated reherniation of the intervertebral disc carry a poor prognosis for recovery and create a large burden on society. There is no consensus about the best treatment for this patient group. The goal of this study was to evaluate the 12-month results of the placement of stand-alone Trabecular Metal cages in these patients. Methods. The authors performed a retrospective analysis of 26 patients with recurrent disc herniations treated with stand-alone posterior lumbar interbody fusion (PLIF) with Trabecular Metal cages. At 1 year patients were evaluated using the Roland Morris Disability Questionnaire (RMDQ) and a visual analog scale (VAS) for back and leg pain. Furthermore, Likert scores of perceived recovery and satisfaction with the treatment were recorded. Lumbar spine radiographs after 1 year were compared with postoperative radiographs to measure subsidence. Stability of the operated segment was assessed using dynamic radiography. Results. The patient group consisted of 26 patients (62% male) with a mean age of 45.7 ± 11.4 years (± SD). Patients had a history of 1 (31%), 2 (42%), or more (27%) discectomies at the same level. The mean follow-up period was 15.3 ± 7.3 months. At follow-up the mean VAS score for pain in the affected leg was 36.7 ± 27.9. The mean VAS score for back pain was 42.5 ± 30.2. The mean RMDQ score at follow-up was 9.8 ± 6.2. Twelve (46%) of the 26 patients had a global perceived good recovery. With respect to treatment satisfaction, 18 patients (69%) were content or very content with the operation and would recommend it. Disc height was increased immediately postoperatively, and at the 1-year follow-up it was still significantly higher compared with the preoperative height (mean 41% ± 38.7%, range -25.7 to 126.8, paired t-test, both p< 0.001), although a mean of 7.52% ± 11.6% subsidence occurred (median 2.0% [interquartile range 0.0%-10.9%], p<0.003). No significant correlation between subsidence and postoperative back pain was found (Spearman's rho -0.2, p=0.459). Flexion-extension radiographs showed instability in 1 patient. Conclusions. Although only 46% of patients reported a good recovery with significant reductions in back and leg pain, 85% of patients reported at least some benefit from the operation, and a marked improvement in working status at follow-up was noted. In view of previously published poor results of instrumented lumbar fusion for patients with failed back surgery syndrome, the present data indicate that Trabecular Metal interbody fusion cages can be used in a stand-alone fashion and should not always need supplemental posterior fixation in patients with recurrent disc herniation without spinal instability, although a long-term follow-up study is warranted. ©AANS, 2014.
Prins M.C.,Sint Lucas Andreas Hospital |
van Meijel J.J.,Sint Lucas Andreas Hospital
Netherlands Journal of Medicine | Year: 2011
A patient with valproic acid induced hyperammonaemic encephalopathy is presented. During chronic treatment with valproic acid this patient developed a potentially life-threatening encephalopathy without signs of liver failure. After discontinuing the valproic acid the patient recovered completely. In the case of a patient presenting with hyperammonaemic encephalopathy, the possibility of the use of valproic acid should not be overlooked. © Van Zuiden Communications B.V.
Karres J.,Sint Lucas Andreas Hospital |
Heesakkers N.A.,Sint Lucas Andreas Hospital |
Ultee J.M.,Sint Lucas Andreas Hospital |
Vrouenraets B.C.,Sint Lucas Andreas Hospital
Injury | Year: 2015
While predictors for mortality after hip fracture surgery have been widely studied, research regarding risk prediction models is limited. Risk models can predict mortality for individual patients, provide insight in prognosis, and be valuable in surgical audits. Existing models have not been validated independently. The purpose of this study is to evaluate the performance of existing risk models for predicting 30-day mortality following hip fracture surgery. Patients and methods: In this retrospective study, all consecutive hip fracture patients admitted between 2004 and 2010 were included. Predicted mortality was calculated for individual patients and compared to the observed outcome. The discriminative performance of the models was assessed using the area under the receiver operating characteristic curve (AUC). Calibration was analysed with the Hosmer-Lemeshow goodness-of-fit test. Results: A literature search yielded six risk prediction models: the Charlson Comorbidity Index (CCI), Orthopaedic Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (O-POSSUM), Estimation of Physiologic Ability and Surgical Stress (E-PASS), a risk model by Jiang et al., the Nottingham Hip Fracture Score (NHFS), and a model by Holt et al. The latter three models were specifically designed for the hip fracture population. All models except the O-POSSUM achieved an AUC greater than 0.70, demonstrating acceptable discriminative power. The score by Jiang et al. performed best with an AUC of 0.78, this was however not significantly different from the NHFS (0.77) or the model by Holt et al. (0.76). When applying the Hosmer-Lemeshow goodness-of-fit test, the model by Holt et al., the NHFS and the model by Jiang et al. showed a significant lack of fit (p < 0.05). The CCI, O-POSSUM and E-PASS did not demonstrate lack of calibration. Discussion: None of the existing models yielded excellent discrimination (AUC > 0.80). The best discrimination was demonstrated by the models designed for the hip fracture population, however, they had a lack of fit. The NHFS shows most promising results, with reasonable discrimination and extensive validation in earlier studies. Additional research is needed to examine recalibration and to determine the best risk model for predicting early mortality following hip fracture surgery. © 2014 Elsevier Ltd. All rights reserved.
Kieviet N.,Sint Lucas Andreas Hospital |
Dolman K.M.,Sint Lucas Andreas Hospital |
Honig A.,Sint Lucas Andreas Hospital
Neuropsychiatric Disease and Treatment | Year: 2013
Infants are at risk of developing symptoms of Poor Neonatal Adaptation (PNA) after exposure to psychotropic drugs in utero. Such symptoms are largely similar after exposure to antidepressants, antipsychotics and benzodiazepines and consist of mostly mild neurologic, autonomic, respirator and gastro-intestinal abnormalities. Most symptoms develop within 48 hours after birth and last for 2-6 days. After exposure to Selective Serotonin Reuptake Inhibitors (SSRIs), mirtazapine or venlafaxine in utero, breastfeeding is presumably protective for development of PNA. The dosage of antidepressants does not seem to be related to the risk of PNA. In order to objectify possible symptoms of PNA, observation of mother and child at the maternity ward is advisable. If PNA symptoms do not occur, an observation period of 48-72 hours is sufficient. This applies to all types of psychotropic drugs. When PNA symptoms are present it is advisable to observe the infant until the symptoms are fully resolved. Observation can be performed by trained nurses using the Finnegan scoring list. This observation list should be administered every 8 hours. Interpretation of the scores should be carried out by a paediatrician. In most cases symptoms are non-specific. Therefore other diagnoses, such as infection or neurologic problems, have to be excluded. When there is any doubt on possible intoxications during pregnancy, toxicological urine screening is indicated. Most cases of PNA are mild, of short duration and self-limiting without need for treatment. Supporting measures such as frequent small feedings, swaddling and increase of skin to skin contact with the mother is usually sufficient. In case of severe PNA it is advised to admit the infant to the Neonatal Care Unit (NCU). Phenobarbital is a safe therapeutic option. There seem to be no major long term effects; however, additional studies are necessary in order to draw definite conclusions. © 2013 Kieviet et al.
Van Der Ende-Kastelijn K.,Sint Lucas Andreas Hospital |
Oerlemans W.,Meander Medical Center |
Goedegebuure S.,Sint Lucas Andreas Hospital
Headache | Year: 2012
Background.-Primary exertional headache (PEH) is a long-known phenomenon. Divergent prevalences of between 0.2 and 12.3% are reported among the general population. The aim of this study was to establish the prevalence among an athletic population. Method.-A link to an online questionnaire was sent to all participants of a tough cycling event held in The Netherlands. Results.-Four thousand participants filled out the questionnaire. One thousand eight hundred and ten (45%) stated that they had suffered, at least once in their lives, from exercise-related headaches (EHs). Thirty-seven percent (668) of them had those headaches at least once a month and 10% (174) experienced a weekly occurrence. The rate of female cyclists with a history of EHs was 54%. With an increasing age, a decline of EHs was found. Five hundred eighty-one (37%) of the participants used medication for EHs. Conclusions.-An estimation of the prevalence of PEHs among the studied population by comparison to the International Headache Society criteria resulted in a rate of 26%. The lower prevalence among older cyclists could be caused by avoidance of (high-intensity) exercise due to the burden that EH brings along. PEH appears to be quite common among an athletic population and merits further investigation. © 2012 American Headache Society.
Coblijn U.K.,Sint Lucas Andreas Hospital |
Verveld C.J.,Sint Lucas Andreas Hospital |
Van Wagensveld B.A.,Sint Lucas Andreas Hospital |
Lagarde S.M.,Sint Lucas Andreas Hospital
Obesity Surgery | Year: 2013
The adjustable gastric band (L)AGB gained popularity as a weight loss procedure. However, long-term results are disappointing; many patients need revision to laparoscopic Roux-en-Y gastric bypass (LRYGB) or sleeve gastrectomy (LSG). The purpose of this study was to assess morbidity, mortality, and results of these two revisional procedures. Fifteen LRYGB studies with a total of 588 patients and eight LSG studies with 286 patients were included. The reason for revision was insufficient weight loss or weight regain in 62.2 and 63.9 % in LRYGB and LSG patients. Short-term complications occurred in 8.5 and 15.7 % and long-term complications in 8.9 and 2.5 %. Reoperation was performed in 6.5 and 3.5 %. Revision to LRYGB or LSG after (L)AGB is feasible and relatively safe. Complication rate is higher than in primary procedures. © 2013 Springer Science+Business Media New York.
Beerepoot M.A.J.,Sint Lucas Andreas Hospital |
Beerepoot M.A.J.,Center for Infection and Immunity Amsterdam |
Geerlings S.E.,Sint Lucas Andreas Hospital |
Van Haarst E.P.,Sint Lucas Andreas Hospital |
And 2 more authors.
Journal of Urology | Year: 2013
Purpose: Increasing antimicrobial resistance has stimulated interest in nonantibiotic prophylaxis of recurrent urinary tract infections. We assessed the effectiveness, tolerability and safety of nonantibiotic prophylaxis in adults with recurrent urinary tract infections. Materials and Methods: MEDLINE®, EMBASE™, the Cochrane Library and reference lists of relevant reviews were searched to April 2013 for relevant English language citations. Two reviewers selected randomized controlled trials that met the predefined criteria for population, interventions and outcomes. The difference in the proportions of patients with at least 1 urinary tract infection was calculated for individual studies, and pooled risk ratios were calculated using random and fixed effects models. Adverse event rates were also extracted. The Jadad score was used to assess risk of bias (0 to 2dhigh risk and 3 to 5dlow risk). Results: We identified 5,413 records and included 17 studies with data for 2,165 patients. The oral immunostimulant OM-89 decreased the rate of urinary tract infection recurrence (4 trials, sample size 891, median Jadad score 3, RR 0.61, 95% CI 0.48e0.78) and had a good safety profile. The vaginal vaccine Urovac® slightly reduced urinary tract infection recurrence (3 trials, sample size 220, Jadad score 3, RR 0.81, 95% CI 0.68e0.96) and primary immunization followed by booster immunization increased the time to reinfection. Vaginal estrogens showed a trend toward preventing urinary tract infection recurrence (2 trials, sample size 201, Jadad score 2.5, RR 0.42, 95% CI 0.16e1.10) but vaginal irritation occurred in 6% to 20% of women. Cranberries decreased urinary tract infection recurrence (2 trials, sample size 250, Jadad score 4, RR 0.53, 95% CI 0.33e0.83) as did acupuncture (2 open label trials, sample size 165, Jadad score 2, RR 0.48, 95% CI 0.29e0.79). Oral estrogens and lactobacilli prophylaxis did not decrease the rate of urinary tract infection recurrence. Conclusions: The evidence of the effectiveness of the oral immunostimulant OM-89 is promising. Although sometimes statistically significant, pooled findings for the other interventions should be considered tentative until corroborated by more research. Large head-to-head trials should be performed to optimally inform clinical decision making.
Coblijn U.K.,Sint Lucas Andreas Hospital |
Goucham A.B.,Sint Lucas Andreas Hospital |
Lagarde S.M.,Sint Lucas Andreas Hospital |
Kuiken S.D.,Sint Lucas Andreas Hospital |
Van Wagensveld B.A.,Sint Lucas Andreas Hospital
Obesity Surgery | Year: 2014
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the gold standard in bariatric surgery. A long-term complication can be marginal ulceration (MU) at the gastrojejunostomy. The mechanism of development is unclear and symptoms vary. Management and prevention is a continuous subject of debate. The aim was to assess the incidence, mechanism, symptoms, and management of MU after LRYGB by means of a systematic review. Forty-one studies with a total of 16,987 patients were included, 787 (4.6 %) developed MU. The incidence of MU varied between 0.6 and 25 %. The position and size of the pouch, smoking, and nonsteroidal inflammatory drugs usage are associated with the formation of MU. In most cases, MU is adequately treated with proton pump inhibitors, sometimes reoperation is required. Laparoscopic approach is safe and effective. © 2013 Springer Science+Business Media New York.