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Tilburg, Netherlands

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.

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.

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.

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.

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.

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