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Hilversum, Netherlands

Bakker M.F.,University Utrecht | Jacobs J.W.G.,University Utrecht | Welsing P.M.J.,University Utrecht | Verstappen S.M.M.,Arthritis Research UK Epidemiology Unit | And 10 more authors.
Annals of Internal Medicine | Year: 2012

Background: Treatment strategies for tight control of early rheumatoid arthritis (RA) are highly effective but can be improved. Objective: To investigate whether adding prednisone, 10 mg/d, at the start of a methotrexate (MTX)-based treatment strategy for tight control in early RA increases its effectiveness. Design: A 2-year, prospective, randomized, placebo-controlled, double-blind, multicenter trial (CAMERA-II [Computer Assisted Management in Early Rheumatoid Arthritis trial-II]). (International Standard Randomised Controlled Trial Number: ISRCTN 70365169) Setting: 7 hospitals in the Netherlands. Patients: 236 patients with early RA (duration <1 year). Intervention: Patients were randomly assigned to an MTX-based, tight control strategy starting with either MTX and prednisone or MTX and placebo. Methotrexate treatment was tailored to the individual patient at monthly visits on the basis of predefined response criteria aiming for remission. Measurements: The primary outcome was radiographic erosive joint damage after 2 years. Secondary outcomes included response criteria, remission, and the need to add cyclosporine or a biologic agent to the treatment. Results: Erosive joint damage after 2 years was limited and less in the group receiving MTX and prednisone (n = 117) than in the group receiving MTX and placebo (n = 119). The MTX and prednisone strategy was also more effective in reducing disease activity and physical disability, achieving sustained remission, and avoiding the addition of cyclosporine or biologic treatment. Adverse events were similar in both groups, but some occurred less in the MTX and prednisone group. Limitation: A tight control strategy for RA implies monthly visits to an outpatient clinic, which is not always feasible. Conclusion: Inclusion of low-dose prednisone in an MTX-based treatment strategy for tight control in early RA improves patient outcomes. © 2012 American College of Physicians. Source

In order to obviate double arterial access for bi-coronary visualization during transradial intervention of chronic total coronary occlusions, a novel technique was used. A 3-in-6 mother-and-child technique was applied in which a 3 Fr intracoronary catheter was advanced via a 6 Fr guide into the artery supplying collaterals to the distal occluded segment of the right coronary artery (RCA). The same guide was used, with the 3 Fr catheter in situ, to visualize the occluded target vessel. With double contrast injections, the guidewire could be guided through the RCA occlusion while the intraluminal position could be visualized and confirmed. This was followed by successful drug-eluting stent implantation. This method to visualize both coronary arteries simultaneously is named the «Chameleon's technique.». Source

Dharma S.,University of Indonesia | Kedev S.,University of Macedonia | Patel T.,Apex Heart Institute | Kiemeneij F.,Tergooi Hospital | Gilchrist I.C.,Pennsylvania State University
Catheterization and Cardiovascular Interventions | Year: 2015

Objective To evaluate whether administration of nitroglycerin through the sheath at the end of a transradial procedure might preserve the patency of the radial artery. Background: Despite the increasing acceptance of transradial approach, radial artery occlusion (RAO) continues to be a vexing problem of transradial access and limits utility of the radial artery as an access site in the future. Methods We conducted a multicenter, prospective, randomized, placebo-controlled, operator-blinded trial and enrolled 1,706 patients who underwent transradial catheterization in three experienced radial centers. Patients were randomized to receive either 500 μg nitroglycerin (n = 853) or placebo (n = 853), given intra-arterially through the sheath at the end of the radial procedure. The primary outcome was the incidence of RAO as confirmed by absence of antegrade flow at one day after the transradial procedure evaluated by duplex ultrasound of the radial artery. Results The use of nitroglycerin, as compared with placebo, reduced the risk of the primary outcome [8.3% vs. 11.7%; odds ratio, 0.62; 95% confidence interval (CI), 0.44-0.87; P = 0.006]. From a multivariable analysis, duration of hemostasis was a predictor of RAO (odds ratio, (odds ratio, 3.11; 95% CI, 1.66 to 5.82; P < 0.001). There were no significant differences between the groups with respect to the sheath size (P = 0.311), number of puncture attempts (P = 0.941), duration of hemostasis (P = 0.379) and procedural time (P = 0.095). Conclusion The administration of nitroglycerin at the end of a transradial catheterization, reduced the incidence of RAO, examined 1 day after the radial procedure by ultrasound. Postprocedural/prehemostasis pharmacologic regimens may represent a novel target for further investigation to reduce RAO. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc. Source

De Vos M.J.,Tergooi Hospital | Wagener M.L.,Rijnstate Hospital | Verdonschot N.,Radboud University Nijmegen | Eygendaal D.,Upper Limb Unit
Journal of Shoulder and Elbow Surgery | Year: 2014

Background: This study describes a posterior approach to the elbow for placement of a total elbow prosthesis. Methods: Release of the medial collateral ligament is achieved by performing an osteotomy of the medial epicondyle. This allows anatomic refixation of the origin of the medial collateral ligament. A description of the posterior approach is given. Standard radiographs were used to analyze the bone-to-bone refixation of the osteotomy of the medial epicondyle in 13 elbows. Results: Radiographs showed proper bone healing in all elbows, with restoration of the anatomic origin of the medial collateral ligament. Discussion: The described approach provides a good exposure of the elbow necessary for the placement of modern total elbow prostheses, without compromising the stability of the elbow. Refixation of stabilizing structures is relatively easy and results in an anatomic position of the ligaments. © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Source

Badrising S.,Tergooi Hospital | Van Der Noort V.,Netherlands Cancer Institute | Van Oort I.M.,Radboud University Nijmegen | Van Den Berg H.P.,Tergooi Hospital | And 8 more authors.
Cancer | Year: 2014

BACKGROUND Enzalutamide (Enz) and abiraterone acetate (AA) are hormone treatments that have a proven survival advantage in patients with metastatic, castration-resistant prostate cancer who previously received docetaxel (Doc). Recently, limited activity of AA after Enz and of Enz after AA was demonstrated in small cohort studies. Here, the authors present the activity and tolerability of Enz in patients who previously received AA and Doc in the largest cohort to date. METHODS The efficacy and tolerability of Enz were investigated in men with progressive, metastatic, castrate-resistant prostate cancer who previously received Doc and AA. Toxicity, progression-free survival, time to prostate-specific antigen (PSA) progression, and overall survival were retrospectively evaluated. RESULTS Sixty-one patients were included in the analysis. The median age was 69 years (interquartile range [IQR], 64-74 years), 57 patients (93%) had an Eastern Cooperative Oncology Group performance status from 0 to 2, 48 patients (79%) had bone metastases, 33 patients (54%) had lymph node metastases, and 13 patients (21%) had visceral metastases. The median duration of Enz treatment was 14.9 weeks (IQR, 11.1-20.0 weeks), and 13 patients (21%) had a maximum PSA decline ≥50%. The median progression-free survival was 12.0 weeks (95% confidence interval [CI], 11.1-16.0 weeks), the median time to PSA progression was 17.4 weeks (95% CI, >16.0 weeks), and the median overall survival was 31.6 weeks (95% CI, >28.7 weeks). Enz was well tolerated, and fatigue and musculoskeletal pain were the most frequent grade ≥2 adverse events. The PSA response to Doc and AA did not predict the PSA response to Enz. CONCLUSIONS Enz has modest clinical activity in patients with metastatic, castrate-resistant prostate cancer who previously received Doc and AA. PSA response to Doc and AA does not predict for PSA response to ENz. © 2013 American Cancer Society. Source

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