Tilburg, Netherlands
Tilburg, Netherlands

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Grundeken M.J.,University of Amsterdam | Magro M.,TweeSteden Ziekenhuis | Gil R.,Central Clinical Hospital of the Ministry of Internal Affairs | Gil R.,Polish Academy of Sciences | And 4 more authors.
EuroIntervention | Year: 2015

Left main (LM) coronary bifurcation lesions have different anatomic features from non-LM bifurcation lesions. Dedicated bifurcation devices might facilitate percutaneous coronary intervention (PCI) of LM bifurcations and improve procedural and clinical outcomes. In this review we will discuss the available clinical data on dedicated bifurcation devices for the treatment of LM bifurcation lesions. Furthermore, we will try to discuss all the theoretical advantages and potential drawbacks of these devices in terms of their use in the LM. © 2015 Europa Digital & Publishing. All rights reserved.


Pijlman A.H.,University Utrecht | Verhagen S.N.,University Utrecht | Imholz B.P.M.,TweeSteden Ziekenhuis | Liem A.H.,Oosterscheldeziekenhuis | And 3 more authors.
Atherosclerosis | Year: 2010

Background: Heterozygous familial hypercholesterolemia (heFH) is a common autosomal dominant hereditary disorder caused by mutations in the LDL-receptor gene that lead to elevated plasma levels of low-density lipoprotein-cholesterol (LDL-c). Robust lowering of LDL-c levels is essential for risk reduction of premature cardiovascular diseases and early death. European and Dutch guidelines recommend to treat LDL-c to plasma levels <2.5 mmol/l. In the present study we evaluated the treatment of heFH patients in The Netherlands. Methods: A cross-sectional study was conducted in outpatient lipid clinics of three Academic Centers and two regional hospitals. Patient records of known heFH patients were retrieved and data were reviewed on the use of lipid-lowering medication, plasma lipids and lipoproteins, safety laboratory results and reasons for not achieving treatment goals. Results: The data of 1249 patients with heFH were available. Nearly all patients (96%) were on statin treatment. The treatment goal for LDL-c <2.5 mmol/l was achieved in 261 (21%) patients. Among those who did not reach LDL-c goals, 261 (27%) were on combination therapy of maximum statin dose and ezetimibe. Main reason (32%) why patients did not use maximum therapy despite an LDL-c ≥2.5 mmol/l, was acceptance of a higher target LDL-c level by the treating physician. An alternative treatment goal of >50% LDL-c reduction, as recommended in the NICE guidelines, was achieved in 47% of patients with an LDL-c ≥2.5 mmol/l and not using maximum therapy. Conclusion: Only a small proportion of patients with heFH reaches the LDL-c treatment target of <2.5 mmol/l. These results emphasize the need for better monitoring, better utilization of available medication and for new treatment options in heFH to further decrease LDL-c levels. © 2009 Elsevier Ireland Ltd. All rights reserved.


Vermeer M.,University of Twente | Kuper H.H.,Spectrum | Hoekstra M.,Isala Klinieken | Haagsma C.J.,Ziekenhuisgroep Twente | And 4 more authors.
Arthritis and Rheumatism | Year: 2011

Objective Clinical remission is the ultimate therapeutic goal in rheumatoid arthritis (RA). Although clinical trials have proven this to be a realistic goal, the concept of targeting at remission has not yet been implemented. The objective of this study was to develop, implement, and evaluate a treat-to-target strategy aimed at achieving remission in very early RA in daily clinical practice. Methods Five hundred thirty-four patients with a clinical diagnosis of very early RA were included in the Dutch Rheumatoid Arthritis Monitoring remission induction cohort study. Treatment adjustments were based on the Disease Activity Score in 28 joints (DAS28), aiming at a DAS28 of <2.6 (methotrexate, followed by the addition of sulfasalazine, and exchange of sulfasalazine with biologic agents in case of persistent disease activity). The primary outcome was disease activity after 6 months and 12 months of followup, according to the DAS28, the European League Against Rheumatism (EULAR) response criteria, and the modified American College of Rheumatology (ACR) remission criteria. Secondary outcomes were time to first DAS28 remission and outcome of radiography. Results Six-month and 12-month followup data were available for 491 and 389 patients, respectively. At 6 months, 47.0% of patients achieved DAS28 remission, 57.6% had a good EULAR response, and 32.0% satisfied the ACR remission criteria. At 12 months, 58.1% of patients achieved DAS28 remission, 67.9% had a good EULAR response, and 46.4% achieved ACR remission. The median time to first remission was 25.3 weeks (interquartile range 13.0-52.0). The majority of patients did not have clinically relevant radiographic progression after 1 year. Conclusion The successful implementation of this treat-to-target strategy aiming at remission demonstrated that achieving remission in daily clinical practice is a realistic goal. Copyright © 2011 by the American College of Rheumatology.


Pelle A.J.,University of Tilburg | Schiffer A.A.,TweeSteden Ziekenhuis | Smith O.R.,University of Tilburg | Widdershoven J.W.,TweeSteden Ziekenhuis | Denollet J.,University of Tilburg
International Journal of Cardiology | Year: 2010

Background: Psychological risk factors for impaired health outcomes have been acknowledged in chronic heart failure (CHF), with Type D personality being such a risk factor. Inadequate consultation behavior, a specific aspect of self-management, might be one mechanism in explaining the adverse effect of Type D on health outcomes. In this study we examined the relationship between Type D personality, impaired disease-specific health status, and inadequate consultation behavior. Methods and results: CHF outpatients (n = 313) completed the Type D Scale (DS14) at baseline, and the European Heart Failure Self-care Behaviour Scale (EHFScBS) and the Minnesota Living with Heart Failure Questionnaire (MLWHFQ) at 6-month follow-up. Type D personality independently predicted inadequate consultation behavior (OR = 1.80, 95%CI [1.03-3.16], p = .04) and impaired health status (OR = 3.61, 95%CI [1.93-6.74], p < .001) at 6-month follow-up, adjusting for demographic and clinical variables. Inadequate consultation behavior (OR = 1.80, 95%CI [1.11-2.94], p = .02) and NYHA-class (OR = 2.83, 95%CI [1.17-4.71], p < .001) were associated with impaired health status, after controlling for demographics, clinical variables, and Type D personality. Post-hoc multivariable analysis pointed out that Type D patients who displayed inadequate consultation behavior were at a 6-fold increased risk of reporting impaired health status, compared to the reference group of non-Type D patients who displayed adequate consultation behavior (OR = 6.06, 95%CI [2.53-14.52], p < .001). Conclusions: These findings provide evidence for inadequate behavior as a mechanism that may explain the link between Type D personality and impaired health status. Future studies are warranted to elaborate on these findings. © 2008 Elsevier Ireland Ltd. All rights reserved.


Wagemakers S.,TweeSteden Ziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2011

In 5% of endoscopically inserted biliary stents distal migration occurs. Mostly the endoprostheses pass the intestine spontaneously. In some patients the stent does not pass and causes complications such as perforation, fistulae and abscess formation. A 76-year-old woman with choledocholithiasis received endoscopic retrograde cholangiopancreatography (ERCP). A stone was crushed and a plastic endoprosthesis inserted. After six months the patient returned with relapsing urinary tract infections. A CT scan showed the stent perforating the sigmoid and stuck in the bladder. The patient underwent sigmoid resection, the stent was removed from the bladder and the roof of the bladder was sutured over. Bowel perforation and fistulae formation after migration of an endoscopically placed stent are rare but serious complications. Often symptoms of stent migration are not specific. When the diagnosis is made patients need to be carefully instructed and regularly inspected, especially patients with known risk factors such as adhesions, colonic diverticulae and abdominal hernias. If the stent does not pass spontaneously it has to be removed.


Klaassen K.M.G.,Radboud University Nijmegen | Van De Kerkhof P.C.M.,Radboud University Nijmegen | Bastiaens M.T.,TweeSteden Ziekenhuis | Plusje L.G.J.M.,Red Cross | And 2 more authors.
Journal of the American Academy of Dermatology | Year: 2014

Background Scoring systems are indispensable in evaluating the severity of disease and monitoring treatment response. Objective We sought to evaluate the competence of various nail psoriasis severity scoring systems and to develop a new scoring system. Methods The authors conducted a prospective, observational, single-point study of 36 patients given the diagnosis of fingernail psoriasis. Seven scoring systems were evaluated: Nail Psoriasis Severity Index (NAPSI), modified NAPSI, target NAPSI, Psoriasis Nail Severity Score, Nail Area Severity, Baran, and Cannavò et al. All tools were correlated with the Physician Global Assessment. Obtained information was integrated into the Nijmegen-Nail psoriasis Activity Index tooL (N-NAIL), and interrater and intrarater reliability was assessed. Results Physician Global Assessment showed an acceptable correlation with the scoring system designed by Baran (r = 0.735, P <.01) and the Psoriasis Nail Severity Score (r = 0.734, P <.01). Target NAPSI showed low correlation (r = 0.203, P >.05). The correlation between Physician Global Assessment and the N-NAIL was 0.861 (P <.01). Excellent agreement was found for the intrarater and interrater reliability of the N-NAIL. Limitations Sample size was limited. Conclusion An adequate nail psoriasis scoring system is needed, as studies of treatments for nail psoriasis are on the horizon. Clinical severity of nail psoriasis was best reflected by the N-NAIL, followed by the Baran system and the Psoriasis Nail Severity Score. © 2014 by the American Academy of Dermatology, Inc.


Stoffelen S.,TweeSteden Ziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2013

A 16-year-old boy who had aspirated a straw came to the Emergency Ward. The only symptom was a soft whistling sound while breathing. The straw was found in the right middle lobar bronchus and was removed by flexible bronchoscope and forceps. Prompt removal of foreign bodies from the airways, preferably by flexible bronchoscopy, is necessary to avoid complications.


Rademakers L.M.,Catharina ziekenhuis | Laarman G.J.,TweeSteden Ziekenhuis
Netherlands Heart Journal | Year: 2012

We describe a case of critical hand ischaemia after transradial cardiac catheterisation. The patient presented with hand ischaemia 5 days after transradial coronary angiography. Urgent angiography demonstrated radial artery occlusion with embolisation to the palmar arch and digital arteries. The ischaemia was refractory to an extensive thrombolytic regimen, and subsequently, the patient was referred to the vascular surgeon for urgent thrombectomy and patch angioplasty. The patient recovered slowly and no amputation was necessary, but complaints of right hand numbness and paresthesia of all digits remained. © Springer Media / Bohn Stafleu van Loghum 2012.


Smit J.V.,Maastricht University | Wierema T.K.A.,TweeSteden Ziekenhuis | Kroon A.A.,Maastricht University | De Leeuw P.W.,Maastricht University
Journal of Hypertension | Year: 2013

Objective: To evaluate the long-term effects of percutaneous transluminal renal angioplasty (PTRA) on blood pressure and renal function in patients with fibromuscular dysplasia (FMD). Methods: Patients in whom FMD was diagnosed during renal angiography (n = 51) were compared with a matched group of hypertensive patients in whom angiography revealed normal renal arteries (n = 51). Blood pressure, intensity of antihypertensive medication and creatinine clearance were assessed at 0, 1, 6 and 12 months. In addition, we recorded the frequencies of cure, improvement and failure of treatment. Results: The two groups did not differ with regard to baseline characteristics. In the FMD group, average blood pressure fell from 172/97 to 155/90 mmHg (P < 0.001) at 12 months of follow-up, without significant changes in medication (P = 0.61). Blood pressure in the group without FMD decreased from 168/96 to 150/89 mmHg (P < 0.001), but with an increase in medication (P = 0.03). In the FMD group, 5% of the patients were cured and 43% improved at 12 months. In the other group, these figures were 2 and 24%, respectively. Creatinine clearance did not significantly change after 12 months. Complications of angiography were seen in nine patients of which seven were from the FMD group. Conclusion: PTRA resulted in better blood pressure control in patients with FMD as compared to a group without FMD under intensified treatment. Although there was little cure, FMD patients needed less antihypertensive medication. Renal function after PTRA remained stable. The benefits of PTRA should be weighed against a higher risk of complications. © 2013 Lippincott Williams & Wilkins.


Driessen C.M.,TweeSteden ziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2011

Disseminated gonococcal infection occurs in less than 5% of patients infected with Neisseria gonorrhoeae. The majority of these patients present with arthritis, tenosynovitis, polyarthralgia or dermatitis. In this article we present two patients with disseminated gonococcal infection, each with different symptoms. The first patient, a 23-year-old woman, was suffering from erythema nodosum, chronic polyarthralgia and weight loss. The second patient, a 32-year-old woman, was suffering from arthritis and tenosynovitis. Both patients were admitted for parenteral treatment with ceftriaxone. Disseminated gonococcal infection can be treated with a short course of broad spectrum parenteral antibiotics. Therapy can be switched to oral therapy in accordance with the susceptibility pattern of the N. gonorrhoea strain and when an improvement in the patient is noted.

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