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).


Schuttelaar M.L.A.,Universitair Medisch Centrum Groningen
Nederlands Tijdschrift voor Dermatologie en Venereologie | Year: 2017

Some experimental studies indicate that inhalant allergens may be relevant trigger factors in atopic dermatitis patients. Worsening of skin symptoms after inhalation or skin contact have been described in sensitized patients. However, there is insufficient evidence that reducing of exposure leads to improvement of eczema. Routine testing of specific IgE to inhalant allergens does not seem meaningful. Moreover, it is difficult to determine the clinical relevance. Patch testing in atopic dermatitis can be necessary in order to exclude a contributing allergic contact dermatitis. Indications for patch testing include worsening of eczema, insufficient response to topical therapy, an atypical distribution, and the occurrence of eczema in adolescence or adulthood. A pitfall in patch testing atopic dermatitis patients is the increased risk of irritant reactions. © 2017 De Nederlandse Vereniging voor Dermatologie en Venereologie.


Schuttelaar M.L.A.,Universitair Medisch Centrum Groningen
Nederlands Tijdschrift voor Dermatologie en Venereologie | Year: 2017

p-Phenylenediame (PPD) and toluene-2,5-diamine (TDA) are the most common precursors in oxidative hair dyes and they are strong sensitizing chemicals. Recently 2-methoxymethyl-p-phenylenediamine (ME-PPD) was developed, a precursor with similar color performance with reduced skin sensitization potential. ME-PPD has been developed for the prevention of sensitization, not for those who have been sensitized to other hair dye precursors, such as PPD and TDA. Clinical studies showed that PPD allergic individuals can cross-react with ME-PPD, but that ME-PPD also appears to be tolerated in some PPD allergic individuals.


Bolling M.C.,Universitair Medisch Centrum Groningen
Nederlands Tijdschrift voor Dermatologie en Venereologie | Year: 2017

In the past 10 years novel DNA and RNA analysis techniques in the diagnostics for genetic diseases have developed rapidly. These techniques provide quick results, and make it possible to look at several genes, and even the whole exome and/or genome instead of one gene at a time. DNA diagnostics has also been developed for patients with genodermatoses.For patients in whom no mutation was found in the past,these mutations can now be exposed with these new techniques. The development of diagnostics for genodermatoses will be discussed in this article.


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.


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.


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.

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