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Leusden, Netherlands

van Eekeren I.C.M.,University of Amsterdam | van Bergen C.J.A.,University of Amsterdam | Sierevelt I.N.,Slotervaart Ziekenhuis | Reilingh M.L.,University of Amsterdam | van Dijk C.N.,University of Amsterdam
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2016

Purpose: Osteochondral defects (OCD) often have a severe impact on the quality of life due to deep ankle pain during and after weight bearing, which prevents young patients from leading an active life. Arthroscopic debridement and bone marrow stimulation are currently the gold standard treatment. The purpose of this study was to evaluate the number of patients that resume and maintain sports to their pre-injury activity level after arthroscopic debridement and bone marrow stimulation. Methods: This retrospective study evaluated patients treated with arthroscopic debridement and bone marrow stimulation between 1989 and 2008. All patients who were participating in sports before injury were included. The Ankle Activity Scale (AAS) was used to determine activity levels during specific time points (before injury, before operation, after operation and at the time of final follow-up). Results: Ninety-three patients were included. Fifty-seven (76 %) patients continued participating in sports at final follow-up. The median AAS before injury of 8 (range 3–10) significantly decreased to 4 (range 2–10) at final follow-up. Conclusion: It is shown that 76 % of the patients were able to return to sports at long-term follow-up after arthroscopic debridement and bone marrow stimulation of talar OCDs. The activity level decreased at long-term follow-up and never reached the level of that before injury. The data of our study can be of importance to inform future patients on expectations after debridement and bone marrow stimulation of a talar OCD. Level of evidence: Retrospective case series, Level IV. © 2016, The Author(s).

Straatman J.,Medical Center | Cuesta M.A.,Medical Center | Schreurs W.H.H.,Medisch Centrum Alkmaar | Dwars B.J.,Slotervaart Ziekenhuis | And 6 more authors.
Trials | Year: 2015

Background: After major abdominal surgery (MAS), 20% of patients endure major complications, which require invasive treatment and are associated with increased morbidity and mortality. A quality control algorithm after major abdominal surgery aimed at early identification of patients at risk of developing major complications can decrease associated morbidity and mortality. Literature studies show promising results for C-reactive protein (CRP) as an early marker for postoperative complications, however clinical significance has yet to be determined. Methods: A multicenter, stepped wedge, prospective clinical trial including all adult patients planned to undergo elective MAS. The first period consists of standard postoperative monitoring, which entails on demand additional examinations. This is followed by a period with implementation of postoperative control according to the PRECious protocol, which implicates standardized measurement of CRP levels. If CRP levels exceed 140mg/L on postoperative day 3,4 or 5, an enhanced CT-scan is performed. Primary outcome in this study is a combined primary outcome, entailing all morbidity and mortality due to postoperative complications. Complications are graded according to the Clavien-Dindo classification. Secondary outcomes are hospital length of stay, patients reported outcome measures (PROMs) and cost-effectiveness. Data will be collected during admission, three months and one year postoperatively. Approval by the medical ethics committee of the VU University Medical Center was obtained (ID 2015.114). Discussion: the PRECious trial is a stepped-wedge, multicenter, open label, prospective clinical trial to determine the effect of a standardized postoperative quality control algorithm on postoperative morbidity and mortality, and cost-effectiveness. Trial registration: www.ClinicalTrials.gov, NCT02102217 . Registered 5 February 2015. © 2015 Straatman et al.

Doornberg J.N.,Slotervaart Ziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2013

We present a 28-year-old plasterer with symptomatic pes planus due to bilateral calcaneonavicular coalition. Computed tomography revealed an osseous calcaneonavicular bar of the right foot and a fibrous calcaneonavicular coalition of the left foot. Treatment options include conservative measures and surgical treatment consisting of a calcaneonavicular bar resection.

Swartjes M.,Leiden University | Mooren R.A.G.,Leiden University | Waxman A.R.,Queens College, City University of New York | Waxman A.R.,CUNY - College of Staten Island | And 8 more authors.
Molecular Medicine | Year: 2012

Opioid-induced hyperalgesia (OIH) is a paradoxical increase in pain perception that may manifest during opioid treatment. For morphine, the metabolite morphine-3-glucuronide (M3G) is commonly believed to underlie this phenomenon. Here, in three separate studies, we empirically assess the role of M3G in morphine-induced hyperalgesia. In the first study, CD-1 mice injected with morphine (15 mg/kg subcutaneously) after pretreatment with the opioid receptor antagonist naltrexone (NTX) (15 mg/kg) showed tail withdrawal latency reductions indicative of hyperalgesia (2.5 ± 0.1 s at t = 30 min, P < 0.001 versus baseline). In these mice, the morphine/M3G concentration ratios versus effect showed a negative correlation (rp = -0.65, P < 0.001), indicating that higher morphine relative to M3G concentrations are associated with increased OIH. In the second study, similar hyperalgesic responses were observed in mice lacking the multidrug resistance protein 3 (MRP3) transporter protein (Mrp3 -/- mice) in the liver and their wild-type controls (FVB mice; latency reductions: 3.1 ± 0.2 s at t = 30 min, P < 0.001 versus within-strain baseline). In the final study, the pharmacokinetics of morphine and M3G were measured in Mrp3 -/- and FVB mice. Mrp3 -/- mice displayed a significantly reduced capacity to export M3G into the systemic circulation, with plasma M3G concentrations just 7% of those observed in FVB controls. The data confirm previous literature that morphine causes hyperalgesia in the absence of opioid receptor activation but also indicate that this hyperalgesia may occur without a significant contribution of hepatic M3G. The relevance of these data to humans has yet to be demonstrated.

Kuijpers S.C.C.,Leiden University | De Jong E.,Slotervaart Ziekenhuis | Hamdy N.A.T.,Leiden University | Richard Van Merkesteyn J.P.,Leiden University
Journal of Cranio-Maxillofacial Surgery | Year: 2011

Objective: Diffuse sclerosing osteomyelitis (DSO) of the mandible is characterised by recurrent pain, swelling of the cheek and trismus. Treatment is difficult and symptoms often recur. Recently case reports and small series have reported good results after treatment with bisphosphonates. Study design: Seven patients suffering from treatment resistant DSO were treated with intravenous bisphosphonates. Diagnosis was based on clinical, radiological and histopathological examination. Symptoms had been present for between 20 and 167 months (mean 78). Patients were admitted, laboratory tests and Technetium-scans were performed. Pamidronate was administered intravenously up to four times a year. Follow-up varied from 18 to 46 months (mean 30). Results: In all patients, symptoms and the need for analgesic drugs diminished considerably. One patient remained free of symptoms after one treatment. In two patients a switch in bisphosphonate was made based on a decreased response. All patients showed a decrease in uptake in the DSO-area on the Tc-scans when comparing pre- and post-treatment. One patient was lost to follow-up. Conclusion: In therapy-resistant DSO bisphosphonate treatment may be a good option. © 2010 European Association for Cranio-Maxillo-Facial Surgery.

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