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Broyl A.,Erasmus Medical Center | Hose D.,University of Heidelberg | Lokhorst H.,University Utrecht | De Knegt Y.,Erasmus Medical Center | And 14 more authors.
Blood | Year: 2010

To identify molecularly defined subgroups in multiple myeloma, gene expression profiling was performed on purified CD138+ plasma cells of 320 newly diagnosed myeloma patients included in the Dutch-Belgian/German HOVON-65/GMMG-HD4 trial. Hierarchical clustering identified 10 subgroups; 6 corresponded to clusters described in the University of Arkansas for Medical Science (UAMS) classification, CD-1 (n = 13, 4.1%), CD-2 (n = 34, 1.6%), MF (n = 32, 1.0%), MS (n = 33, 1.3%), proliferation-associated genes (n = 15, 4.7%), and hyperdiploid (n = 77, 24.1%). Moreover, the UAMSlow percentage of bone disease cluster was identified as a subcluster of the MF cluster (n = 15, 4.7%). One subgroup (n = 39, 12.2%) showed a myeloid signature. Three novel subgroups were defined, including a subgroup of 37 patients (11.6%) characterized by high expression of genes involved in the nuclear factor kappa light-chain-enhancer of activated B cells pathway, which include TNFAIP3 and CD40. Another subgroup of 22 patients (6.9%) was characterized by distinct overexpression of cancer testis antigens without overexpression of proliferation genes. The third novel cluster of 9 patients (2.8%) showed upregulation of protein tyrosine phosphatases PRL-3 and PTPRZ1 as well as SOCS3. To conclude, in addition to 7 clusters described in the UAMS classification, we identified 3 novel subsets of multiple myeloma that may represent unique diagnostic entities. © 2010 by The American Society of Hematology.


Van't westeinde S.C.,Erasmus University Rotterdam | Horeweg N.,Erasmus University Rotterdam | De leyn P.,UZ Gasthuisberg | Groen H.J.M.,UMC Groningen | And 4 more authors.
European Journal of Cardio-thoracic Surgery | Year: 2012

OBJECTIVES: To assess the complication rate in participants of the screen arm of the NELSON lung cancer screening trial who underwent surgical resection and to investigate, based on a literature review, whether the complication rate, length of hospital stay, re-thoracotomy and mortality rates after a surgical procedure were different from those of the non-screening series, taking co-morbidity into account. METHODS: Between April 2004 and December 2008, 198 subjects underwent thoracic surgery. Co-morbid conditions were retrieved from the medical records. Postoperative complications were classified as minor and major. RESULTS: In total, 182 thoracotomies, 5 thoracotomies after video-assisted thoracoscopic surgery (VATS) and 11 VATS procedures were performed. In these patients, 36% had chronic obstructive lung disease, 16% coronary artery disease, 14% diabetes mellitus and 11% peripheral vascular disease. Following thoracotomy, 47% (88/187) had ≥1 minor (7-57% in literature) and 10% (18/187) ≥1 major complication (2-26% in literature); following VATS, 38% (6/16) had ≥1 minor complication, but no major complications. Seventeen per cent (3/18) of major complications and 21% (20/96) of minor complications were seen in subjects operated for benign disease. The re-thoracotomy rate was 3% and there was no 30-day mortality after thoracotomy or VATS (0-8.3% in literature). The mortality rate of 0% after surgical procedures is low when compared with the non-screening series (0-8.3%); the rate of complications (53%) is within range when compared with the non-screening series (8.5-58%). CONCLUSIONS: In conclusion, mortality rates after surgical procedures are lower in the NELSON lung cancer screening trial than those in the non-screening series. The rate of complications is within the same range as in the non-screening series. © Author 2012. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.


Kats S.,Catharina Hospital Eindhoven | Schonberger J.P.A.M.,Catharina Hospital Eindhoven | Brands R.,University Utrecht | Seinen W.,University Utrecht | van Oeveren W.,UMC Groningen
European Journal of Cardio-thoracic Surgery | Year: 2011

Cardiac surgery with cardiopulmonary bypass provokes a systemic inflammatory response syndrome caused by the surgical trauma itself, blood contact with the non-physiological surfaces of the extracorporeal circuit, endotoxemia, and ischemia. The role of endotoxin in the inflammatory response syndrome has been well investigated. In this report, we reviewed recent advances in the understanding of the pathophysiology of the endotoxin release during cardiopulmonary bypass and the possible therapeutic strategies aimed to reduce the endotoxin release or to counteract the inflammatory effects of endotoxin. Although many different strategies to detoxify endotoxins were evaluated, none of them were able to show statistically significant differences in clinical outcome. © 2010 European Association for Cardio-Thoracic Surgery.


Vitamin D deficiency is very common in the elderly, and the geriatric patient is probably at even greater risk. Vitamin D plays an important role in calcium homeostasis; recent studies point to a possible causal link between vitamin D deficiency and the development and severity of depression. In this article we focus on an 80-year-old patient with depression and severe vitamin D deficiency andgive advice on the diagnosis and treatment of vitamin D deficiency. To supplement the current multidisciplinary guidelines on depression, we recommend routine testing of serum vitamin D level prior to confirming the diagnosis of depression in the elderly.


Voshaar R.C.O.,UMC Groningen
Tijdschrift voor Gerontologie en Geriatrie | Year: 2012

Benzodiazepines are frequently prescribed for a longer period of time for anxiety disorders and insomnia in spite of the many guidelines to prescribe these drugs only short-term. These guidelines are based on the risk-benefit balance between long-term effectiveness and side effects like addiction, anterograde amnesia, and increased risk on falling (resulting in hip fractures), traffic accidents and even mortality. Also low-dose benzodiazepine use can lead to benzodiazepine dependence. Although initially most attention has been paid to the physical withdrawal syndrome, psychological aspects of benzodiazepine dependence have received more and more attention in the past decades. Recently, a relationship between the brain-reward system, involved in addiction, and benzodiazepine use, was demonstrated. When long-term benzodiazepine use is recognised as problematic by both physician and patient, different treatment modalities are available to support patients in achieving abstinence. One of every four patients is able to stop by themselves with the aid of a minimal intervention providing psychoeducation and encouragement. Two out of three long-term uses are able to stop their usage with the aid of systematic tapering protocols guided by a physician or psychologist. In case of an underlying insomnia or anxiety disorder, cognitive-behavioural therapy should be added to the tapering protocol. In contrast to the general opinion, advanced old age has no negative impact on the treatment response.


Aalfs A.S.,UMC Groningen
Nederlands tijdschrift voor geneeskunde | Year: 2013

Acute blistering and erosion in a newborn is one of the few emergency cases seen in dermatology. It is important to differentiate between infectious causes, congenital abnormalities, autoimmune bullous dermatitis, immunological skin diseases and skin burns within 24 hours. In this clinical lesson, we present a case of acute skin detachment in a newborn caused by staphylococcal scalded skin syndrome (SSSS). Our patient was a six-day-old boy who had developed flaccid blisters around the umbilicus, which ruptured on minimal friction. Generalised superficial erosions on the face, hands and feet arose within hours. Based on the clinical presentation combined with a subcorneal blister found on histopathological examination and a positive culture for Staphylococcus aureus on nasal and umbilical smears, the diagnosis of SSSS was made. Our patient was treated successfully with flucloxacillin and gentamicin; the skin lesions healed without scarring within six days.


Brugemann J.,UMC Groningen | Gerds-Ploeger H.Z.R.,UMC Groningen
Nederlands Tijdschrift voor Geneeskunde | Year: 2015

Only a minority of patients receive cardiac rehabilitation after acute coronary syndrome, coronary bypass grafting or heart valve operation. A recent study published in the European Heart Journal, presents the results from approximately 36,000 patients who participated in a rehabilitation program. It showed a 35% reduction in mortality during 4-year followup. Modern cardiac rehabilitation does not only focus on physical training but also includes interactive education, relaxation therapy, coping and self-management. Patients are also encouraged to participate in structural physical activity, which is incorporated into their daily life after the rehabilitation program. From other studies we know that not only is mortality reduced but also quality of life is improved as a result of cardiac rehabilitation. We both strongly recommend and encourage our colleagues to refer their caardiac patients to a multidisciplinary cardiac rehabilitation program.


Organ donation is at the centre of medical and societal attention. An important reason for this is the shortage of donors and thus organs. One of these shortages concerns cadaveric-donor livers. The alternative is living-donor liver transplantation. Until recently, the donors' healthcare costs and loss of income were impediments to living-donor liver transplantation. However, the Dutch government has now removed these obstacles, on the one hand by covering the medical costs associated with the donation, the travelling costs of the donor and a companion, and on the other hand by a subsidy to cover loss of income for the self-employed. This subsidy is limited to a maximum and does not include full compensation for salaried workers fully disabled for work as a result of medical complications of the donation. Complication insurance is needed similar to that developed for kidney donors.


Collard R.M.,UMC St. Radboud | Oude Voshaar R.C.,UMC Groningen
Tijdschrift voor Psychiatrie | Year: 2012

BACKGROUND: Frailty can be regarded as a condition in which the reserve capacity of various physical systems has sunk to a critical low, at which point minor disturbances can develop into serious health problems. AIM: To review the various operationalisations of the concept of frailty and describe the relationship between frailty and psychopathology. METHOD: We searched the literature up to October 2010 using PubMed, PsycINFO and CINAHL. RESULTS: We founds operationalisations of the concept of frailty; 4 single measurements as a proxy for frailty (e.g. muscle strength), 18 syndrome diagnoses which can be subdivided into single (n=5) and multiple syndrome diagnoses (n = 13) and 13 dimensional operationalisations for which measurement instruments were used. Only 6 studies reported the relationship between frailty and psychopathology. The studies revealed an association between depression and psychopathology. An important finding was the association between depression and frailty, but the direction of the association is unknown. CONCLUSION: No consensus has been reached regarding the operationalisation of the concept of frailty. For the purpose of gerontopsychiatric research we recommend the inclusion of a syndrome diagnosis based on physical criteria (physical frailty) because this should make it possible to unravel the relationship between psychopathology and underlying ageing mechanisms.


Gingival enlargement commonly occurs in patients treated with fixed orthodontic appliances. In a study, 25 patients were monitored during and after treatment with fixed orthodontic appliances. The extent of the enlargement of the gingiva was determined by means of intra-oral photographs made shortly before the placement of the appliances, immediately after their removal and at 3 and 6 months after the appliances had been removed. The enlargement of the gingival was determined using a Visual Analogue Scale. During orthodontic treatment the average degree of gingival enlargement increased significantly. After removal of the appliances a significant decrease in the degree of gingival enlargement occurred. Within 3 months after debonding the gingival enlargement was at the same level as before starting the orthodontic treatment. The conclusion was that the enlargement of the gingiva that takes place during treatment with fixed orthodontic appliances was reversible.

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