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Gotthardt M.,Universitair Medisch Centrum St Radboud
Nuklearmedizin. Nuclear medicine | Year: 2010

Patient-individual dosimetric analyses are a useful tool in external beam radiotherapy (EBR) to protect patients from side effects such as radiogenic nephropathy. At this point in time, individual dosimetry is not used as a standard in patient treated with radiolabelled antibody fragments or polypeptides. The reasons are a number of problems, which make patient dosimetry more challenging than in EBR. While in EBR, the dose is distributed evenly in the organ and the organ volume can exactly be determined, in internal radiotherapy the tracer is not evenly distributed within the organ leading to a non-uniform dose distribution. In addition, the dose rate of the most commonly used radionuclides is lower than in EBR and the range of their radiation differ, so that the radiobiological effects are differing considerably in comparison to EBR. Conclusion: More complex models have to be used for clinical kidney dosimetry in internal radiotherapy. In this paper, we give a concise overview of the reasons for accumulation of radiotracers in the kidney, the most recent developments in kidney dosimetry, and approaches to reduce the kidney uptake of radiotracers in order to avoid radiogenic nephropathy.

Verheugt F.,Universitair Medisch Centrum St Radboud
Nederlands tijdschrift voor geneeskunde | Year: 2011

Cerebral infarction is the most serious complication of atrial fibrillation. Coumarin derivatives (vitamin K antagonists) counteract systemic thromboembolism and reduce the risk of stroke by more than 60%, but carry a risk of serious bleeding. Antiplatelet therapy and subcutaneous low-molecular-weight heparin are as yet not sufficiently effective and are associated with a bleeding risk similar to vitamin K antagonists. Vitamin K antagonists require intensive INR monitoring to ensure efficacy and safety. In the past decade, oral agents have been developed that directly inhibit the activity of thrombin (factor IIa) and of activated factor X (Xa), which is the first compound in the final common pathway of the coagulation cascade. These do require INR monitoring and have rapid onset and offset of action. The first results with thrombin blockers, such as dabigatran, look promising in efficacy and safety and Xa inhibitors are currently under investigation in atrial fibrillation in 3 large clinical trials. Long-term safety of the new agents in patients with atrial fibrillation has not yet been determined.

Meijerink H.,Universitair Medisch Centrum St Radboud
Nederlands tijdschrift voor geneeskunde | Year: 2013

Intravenous drug use is a major international health problem. The transmission of HIV through sharing syringes or needles during drug use is an important part of this problem. Injection drug users (IDUs) also engage in high-risk sexual behaviour which facilitates the transmission between different groups. In this article, we present a global perspective of injection drug use in relation to HIV. There are 16 million IDUs worldwide, of whom an estimated 3 million are infected with HIV. The prevalence of HIV among IDUs varies greatly between countries as well as within them. There are intervention programmes to prevent HIV transmission via drug use such as needle and syringe exchange programmes (NSPs) and opioid substitution therapy (OST). These programmes are effective for preventing HIV transmission, provided that their implementation is adequate. 80% of the countries provide NSPs, 65% also provide OST. The coverage of these services is nevertheless insufficient to have an impact on the transmission of HIV.

Aerts M.B.,Universitair Medisch Centrum St Radboud
Nederlands tijdschrift voor geneeskunde | Year: 2011

Medication compliance is generally suboptimal, particularly in patients with complex polypharmacy. This generic treatment problem is described here for Parkinson's disease (PD). We would expect patients with PD to have good medication compliance, since missed doses immediately result in worsening of symptoms. However, recent research has revealed that PD patients demonstrate poor medication compliance. Poor medication compliance is particularly undesirable for patients with PD because regular intake of medication is required for optimal treatment effect. Possible ways of improving medication compliance are pharmacotherapeutic measures and behavioural interventions. Modern methods of communication (text message reminders) and 'smart' pill dispensers may be beneficial, but the advantages of such interventions have not yet been scientifically studied.

Verbeek A.L.,Universitair Medisch Centrum St Radboud
Nederlands tijdschrift voor geneeskunde | Year: 2011

In the Netherlands, national screening programs for breast and cervical cancer are operating, whilst that for colorectal cancer is in preparation. In the meantime, experimental studies have been conducted into the effectiveness of prostate and lung cancer screening. Death from these five types of cancer is reduced by these screening investigations. However, these screening programmes also have disadvantages, such as unnecessary referral for definitive diagnosis in the hospital. The average hospital would receive on a yearly basis via screening 156 referrals of women with breast cancer, 79 for cervical cancer and nearly 1100 persons for colorectal cancer. n average general practice encounters annually 3 positive screening results for breast cancer, almost 1 referral for cervical carcinoma or an early stage thereof, and every two years a patient with CIN III. For colorectal cancer around 22 referrals can be expected yearly, of which 8 will have adenoma or cancer.

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