Universitair Medisch Centrum Groningen

Groningen, Netherlands

Universitair Medisch Centrum Groningen

Groningen, Netherlands
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Mutsaerts M.A.Q.,Universitair Medisch Centrum Groningen
Nederlands Tijdschrift voor Geneeskunde | Year: 2017

Small intervention studies suggest that modest weight loss increases the chance of conception and may improve perinatal outcome, but large randomized controlled trials (RCT) are lacking. Our objective was to investigate the effects of a lifestyle intervention in obese infertile women in a multicenter RCT. Design We randomly assigned infertile women with body mass index ≥ 29 k/m to a six-month lifestyle intervention preceding infertility treatment or to prompt infertility treatment. The primary outcome was the vaginal birth of a healthy singleton at term within 2 years of randomization. Results Between June 2009-June 2102 we randomly allocated 577 women to one of two treatment strategies: 290 to lifestyle intervention preceding infertility treatment (intervention group) and 287 to prompt infertility treatment (control group). Three women withdrew informed consent, leaving 289 and 285 women for analysis. Discontinuation rate during the lifestyle intervention was 22%. Mean weight loss in the intervention group was 4.4 kg and in the control group 1.1 kg ( p < 0.001); the primary outcome occurred in 76 women (27%) in the intervention group versus 100 (35%) in the control group (RR: 0.77, 95% CI 0.60 to 0.99). The number of natural conceptions leading to ongoing pregnancies was 73 (26%) versus 46 (16%) (RR: 1.6, 95% CI 1.2 to 2.2). Maternal pregnancy-related and labor-related complications and neonatal complications were comparable. Conclusion In obese infertile women lifestyle intervention preceding infertility treatment did not result in better rates of vaginal birth of healthy singletons at term as compared to prompt infertility Conflict of interest and financial support: ICMJE forms provided by the authors are available online along with the full text of this article. Dutch Trial Register NTR1530. The trial was funded by ZonMW (project number 50-50110-96-518).

A 58-year-old man, who spoke very little Dutch, had various symptoms and used several drugs including simvastatin. He was prescribed itraconazole for onychomycosis. Simvastatin was concurrently replaced with pravastatin to prevent drug interactions. However, the interaction still occurred when the pravastatin ran out, and the patient resumed taking simvastatin on his own initiative. Myalgia and muscle weakness developed after one week. The general practitioner found a strongly elevated creatine kinase level in the blood. The patient required hospitalisation for severe rhabdomyolysis. He was treated with an infusion of an ample quantity of physiological saline solution and made a full recovery. Due to the elevated risk of toxic interactions, doctors should beware of communication problems in complex patients and avoid new prescriptions not strictly required.

Douwes J.M.,Universitair Medisch Centrum Groningen
Nederlands tijdschrift voor geneeskunde | Year: 2011

Progressive pulmonary arterial hypertension (PAH) is a rare condition with high morbidity and mortality. Paediatric PAH distinguishes itself from PAH in adults, but is still poorly characterized. Paediatric PAH presents itself with non-specific symptoms which often results in later diagnosis. Determination of the correct underlying diagnosis in paediatric PAH is complex, and must therefore take place at specialized centres. Paediatric progressive PAH is usually either idiopathic or associated with congenital heart disease. Pediatric PAH frequently co-occurs with dysmorphic abnormalities, which may point towards aetiological mechanisms. Recent reports suggest an improved survival and exercise tolerance due to treatment with new second-generation drugs for paediatric PAH. In the Netherlands, the care for children with PAH is centralised to guarantee the optimization of diagnosis and treatment in accordance with the most recent scientific insights.

Gemella haemolysans, Streptococcus equinus and Tropheryma whipplei are rare Gram-positive bacteria which may cause endocarditis and are associated with gastrointestinal disorders. We report on three patients with infective endocarditis caused by these microorganisms. G. haemolysans and S. equinus (Streptococcus bovis group) were isolated from blood cultures, and T. whipplei was diagnosed by molecular typing of an excised heart valve. The association between endocarditis caused by these microorganisms and gastrointestinal disorders warranted further examination. Endoscopic examination revealed a colonic carcinoma in the patient with G. haemolysans endocarditis and diverticulosis in the patient with S. equinus endocarditis. No gastrointestinal tract disorders were found in the patient with T. whipplei endocarditis, but this does not exclude Whipple's disease. Examination of the gastrointestinal tract for a focus of infection should be considered in patients with endocarditis caused by G. haemolysans, S. equinus and T. whipplei if no other source of bacteraemia is apparent.

Schuling J.,Universitair Medisch Centrum Groningen
Nederlands tijdschrift voor geneeskunde | Year: 2013

Elderly patients with multimorbidity treated in accordance with disease-specific guidelines use a large number of drugs. As this approach may harm the patient's wellbeing, our care should evolve from disease-oriented to patient-oriented. A simple tool has been introduced to facilitate this type of consultation. On a visual analogue scale (VAS; 0-100) four generic treatment goals are presented to the patient: extending life, maintaining independence, pain relief and relief of other symptoms. The patient is invited to weigh the importance of these outcomes using the 'trade-off' principle, and asked to rank these goals in such a way that the score reflects the patient's preference profile. With the help of this decision aid, the medication of two female patients aged 85 and 94 was reviewed. Embedding this tool in the first step of the medication review process may help to shift the focus from the disease to the patient.

Kramer A.B.,Universitair Medisch Centrum Groningen
Nederlands tijdschrift voor geneeskunde | Year: 2011

IgG4-related systemic disease is a new clinical entity with a large variety of clinical symptoms that can affect almost all organs. The best known manifestations are retroperitoneal fibrosis and autoimmune pancreatitis. We present 3 patients aged 71, 83 and 70 years, with malaise, fatigue and swellings suggestive of a malignancy. However, histopathology of these swellings showed infiltration with plasma cells. Increased serum IgG4-levels confirmed the diagnosis 'IgG4-related systemic disease'. All patients responded well to treatment with glucocorticoids. IgG4-related systemic disease is often mistaken for malignancy because of similar presenting symptoms. The diagnosis can easily be confirmed by high serum protein levels, high serum IgG4-levels and infiltrates of IgG4-positive plasma cells. Response to treatment with glucocorticoids is good, as is the prognosis. IgG4-related systemic disease should be part of the differential diagnosis when patients present with malaise, high protein-levels and multi-organ involvement. Rapid diagnosis can prevent unnecessary surgical procedures for malignancy.

Cohen D.,Universitair Medisch Centrum Groningen
Tijdschrift voor Psychiatrie | Year: 2010

Clozapine is an effective antipsychotic drug for the treatment of therapy-resistant schizophrenia. Mandatory saeening of white blood cells is a safety measure for the early detection of agranulocytosis caused by treatment with clozapine. However, so far, there is no standard screening for two other potentially lethal side-effects, namely diabetic ketoacidosis and gastro-intestinal hypomotility. The current situation is weighed up on the basis of a comparison of the chances that these side-effects can occur and cause death. The conclusion is that weekly or monthly saeening should be carried out for all these side-effects.

D'haeseleer M.,Vrije Universiteit Brussel | Cambron M.,Vrije Universiteit Brussel | Vanopdenbosch L.,AZ Sint Jan Bruges | De Keyser J.,Vrije Universiteit Brussel | De Keyser J.,Universitair Medisch Centrum Groningen
The Lancet Neurology | Year: 2011

Three types of vascular dysfunction have been described in multiple sclerosis (MS). First, findings from epidemiological studies suggest that patients with MS have a higher risk for ischaemic stroke than people who do not have MS. The underlying mechanism is unknown, but might involve endothelial dysfunction secondary to inflammatory disease activity and increased plasma homocysteine concentrations. Second, patients with MS have global cerebral hypoperfusion, which might predispose them to the development of ischaemic stroke. The widespread decrease in perfusion in normal-appearing white matter and grey matter in MS seems not to be secondary to axonal degeneration, but might be a result of reduced axonal activity, reduced astrocyte energy metabolism, and perhaps increased blood concentrations of endothelin-1. Data suggest that a subtype of focal MS lesions might have an ischaemic origin, and there seems to be a link between reduced white matter perfusion and cognitive dysfunction in MS. Third, the pathology of MS might be the consequence of a chronic state of impaired venous drainage from the CNS, for which the term chronic cerebrospinal venous insufficiency (CCSVI) has been coined. A number of recent vascular studies do not support the CCSVI theory, but some elements of CCSVI might be explained by slower cerebral venous blood flow secondary to the reduced cerebral perfusion in patients with MS compared with healthy individuals. © 2011 Elsevier Ltd.

Munster J.M.,Universitair Medisch Centrum Groningen
Nederlands tijdschrift voor geneeskunde | Year: 2011

A 42-year-old woman visited the pulmonologist for follow-up after a pneumonia. In retrospect the pneumonia appeared to be a manifestation of an acute Q fever infection. A few weeks later the patient was found to be unexpectedly pregnant. At the normal serological follow-up six months after the primary infection chronic Q fever infection was diagnosed. Doxycycline and hydroxychloroquine are contraindicated in pregnancy and the patient was found to be allergic to co-trimoxazole. Therefore treatment with erythromycin was chosen on empirical grounds. The patient had many symptoms during pregnancy. After 38 weeks and 2 days amenorrhea labour was induced on maternal indication. Finally a healthy boy of 3850 grams was born by caesarean section. In view of the increased risk of chronic Q fever infection during pregnancy we advise intensified serological monitoring of patients with acute Q fever who subsequently become pregnant.

Voors A.A.,Universitair Medisch Centrum Groningen
Nederlands tijdschrift voor geneeskunde | Year: 2011

In the multidisciplinary practice guideline 'Heart failure 2010', the diagnosis of heart failure relies on a combination of signs and symptoms and on supplementary investigation with natriuretic peptides and echocardiography. Once diagnosed, it is important to detect the potentially treatable cause of the heart failure. The non-medical treatment consists of lifestyle advice, of which regular body exercise is the most important component. The medical treatment of patients with systolic heart failure consists of a diuretic, ACE inhibitor, and beta-blocker, optionally extended by an aldosterone antagonist, an angiotensin receptor blocker and/or digoxin. A restricted group of patients may require an internal cardiac defibrillator (ICD) and/or cardiac resynchronisation therapy. There is limited scientific evidence concerning treatment of patients with diastolic heart failure. It is important to coordinate the care of the patient with heart failure within a multidisciplinary team to provide optimal treatment and information for the patient.

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