Hengelo, Netherlands
Hengelo, Netherlands

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Elferink M.A.G.,Netherlands Comprehensive Cancer Organisation | de Jong K.P.,University of Groningen | Klaase J.M.,Spectrum | Siemerink E.J.,Ziekenhuis Groep Twente | de Wilt J.H.W.,Radboud University Nijmegen
International Journal of Colorectal Disease | Year: 2014

Purpose: The main cause of death of colorectal cancer patients is metastatic disease. Approximately 20–25 % of the patients present with metastases at time of diagnosis. The clinical course of patients who develop metachronous metastases, however, is less clear. The aims of this study were to describe the incidence, treatment and survival of patients with metachronous metastases from colorectal cancer and to determine risk factors for developing metachronous metastases.Methods: From the Netherlands Cancer Registry, patients diagnosed with colorectal carcinoma in the period 2002–2003 in North-East Netherlands were selected. Patients were followed for 5 years after diagnosis of the primary tumour. Kaplan-Meier method and Cox regression analyses were used to determine predictors for developing metastases and to analyse overall survival.Results: In total, 333 of 1743 (19 %) patients developed metachronous metastases. The majority (83 %) of these metastases were diagnosed within 3 years, and the most frequent site was the liver. Patients with advanced stage and patients with tumours in the descending colon or in the rectum were more likely to develop metastases. Approximately 10 % of all patients underwent intentionally curative treatment for their metastases, with a 5-year survival rate of 60 %. Treatment of metastases and pathologic N (pN) status were independent prognostic factors for overall survival.Conclusions: Site and stage of the primary tumour were predictors for developing metachronous metastases. A limited number of patients with metastatic disease were treated with a curative intent. These patients had a good prognosis. Therefore, focus should be on identifying more patients who could benefit from curative treatment. © 2014, Springer-Verlag Berlin Heidelberg.


Jobsen J.,Spectrum | Van Der Palen J.,Spectrum | Van Der Palen J.,University of Twente | Riemersma S.,Laboratory for Pathology Oost Nederland | And 4 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2014

Purpose To analyze the incidence and prognostic factors of ipsilateral breast tumor recurrence (IBTR) after breast-conserving therapy (BCT) in a large, population-based, single-center study with long-term follow-up. Methods and Materials We analyzed 3595 cases in which BCT was performed in 3824 women with stage I or II breast cancer. The incidence of IBTR was analyzed over time and was based on IBTR as first event. Results The 15-year local relapse-free survival was 90.9%. The hazard estimates for IBTR showed a time course with 2 peaks, the first at approximately 5 years and the second, twice as high, at 12 years. Stratifying subjects by age and margin status showed that, for women ≤40 years old with negative margins, adjuvant systemic therapy led to a 5-fold reduced risk of recurrence compared to none, and the presence of lymph vascular space invasion (LVSI) had a 3-fold increased risk compared to its absence. For women >40 years old, the presence of LVSI (hazard ratio [HR] 2.5) and the presence of lobular carcinoma in situ in the lumpectomy specimen (HR 2.3) were the only 2 risk factors. Conclusions We demonstrated a pattern in risk of IBTR over time, with 2 peaks, first at approximately 5 years and a second, much higher peak at approximately 12 years, especially for women ≤40 years old. For women ≤40 years old with tumor-free resection margins, we noted that the absence of adjuvant systemic therapy and the presence of LVSI were independent prognostic factors of IBTR. For women >40 years old, the presence of LVSI and the presence of lobular carcinoma in situ were independent risk factors. © 2014 Elsevier Inc. All rights reserved.


Jansen P.M.,Erasmus University Rotterdam | De Bruijne E.L.E.,Red Cross | Deinum J.,University Medical Center St Nijmegen | Kerstens M.N.,University of Groningen | And 6 more authors.
Journal of Hypertension | Year: 2013

Background: Add-on therapy with aldosterone receptor antagonists has been reported to lower blood pressure (BP) in patients with uncontrolled hypertension. We assessed potential predictors of this response. Methods: In essential hypertensive patients with uncontrolled BP, despite the use of at least two antihypertensives, plasma renin and aldosterone concentrations and the transtubular potassium gradient (TTKG) were measured. Patients were treated with eplerenone 50 mg daily on top of their own medication. The office and ambulatory BP response and biochemical changes were evaluated after 1 week and 3 months of treatment and 6 weeks after discontinuation. Potential predictors for the change in 24-h ambulatory BP were tested in a multivariate regression model. Results: One hundred and seventeen patients with a mean age of 50.5 ± 6.6 years were included. Office BP decreased from 149/91 to 142/87 mmHg (P < 0.001) and ambulatory BP from 141/87 to 132/83 mmHg after 3 months of treatment (P < 0.001). Six weeks after discontinuation of eplerenone, office and ambulatory BP measurements returned to baseline values. Treatment resulted in a small rise in serum potassium and creatinine, and a small decrease in the TTKG. In a multivariate model, neither renin, aldosterone, or their ratio, nor the TTKG predicted the BP response. Only baseline ambulatory SBP predicted the BP response, whereas the presence of left ventricular hypertrophy was associated with a smaller BP reduction. Conclusion: Add-on therapy with eplerenone effectively lowers BP in patients with difficult-to-treat primary hypertension. This effect is unrelated to circulating renin-angiotensin-aldosterone system activity and renal mineralocorticoid receptor activity as assessed by the TTKG. © 2013 Wolters Kluwer Health | Lippincott Williams Wilkins.


Bul M.,Rotterdam University | Zhu X.,Rotterdam University | Valdagni R.,Fondazione IRCSS Instituto Nazionale Dei Tumori | Pickles T.,British Columbia Cancer Agency | And 15 more authors.
European Urology | Year: 2013

Background: Overdiagnosis and subsequent overtreatment are important side effects of screening for, and early detection of, prostate cancer (PCa). Active surveillance (AS) is of growing interest as an alternative to radical treatment of low-risk PCa. Objective: To update our experience in the largest worldwide prospective AS cohort. Design, setting, and participants: Eligible patients had clinical stage T1/T2 PCa, prostate-specific antigen (PSA) ≤10 ng/ml, PSA density <0.2 ng/ml per milliliter, one or two positive biopsy cores, and Gleason score ≤6. PSA was measured every 3-6 mo, and volume-based repeat biopsies were scheduled after 1, 4, and 7 yr. Reclassification was defined as more than two positive cores or Gleason >6 at repeat biopsy. Recommendation for treatment was triggered in case of PSA doubling time <3 yr or reclassification. Outcome measurements and statistical analysis: Multivariate regression analysis was used to evaluate predictors for reclassification at repeat biopsy. Active therapy-free survival (ATFS) was assessed with a Kaplan-Meier analysis, and Cox regression was used to evaluate the association of clinical characteristics with active therapy over time. Results and limitations: In total, 2494 patients were included and followed for a median of 1.6 yr. One or more repeat biopsies were performed in 1480 men, of whom 415 men (28%) showed reclassification. Compliance with the first repeat biopsy was estimated to be 81%. During follow-up, 527 patients (21.1%) underwent active therapy. ATFS at 2 yr was 77.3%. The strongest predictors for reclassification and switching to deferred treatment were the number of positive cores (two cores compared with one core) and PSA density. The disease-specific survival rate was 100%. Follow-up was too short to draw definitive conclusions about the safety of AS. Conclusions: Our short-term data support AS as a feasible strategy to reduce overtreatment. Clinical characteristics and PSA kinetics during follow-up can be used for risk stratification. Strict monitoring is even more essential in men with high-risk features to enable timely recognition of potentially aggressive disease and offer curative intervention. Limitations of using surrogate end points and markers in AS should be recognized. Trial registration: The current program is registered at the Dutch Trial Register with ID NTR1718 (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1718). © 2012 European Association of Urology.


Bachmann A.,University of Basel | Tubaro A.,University of Rome La Sapienza | Barber N.,Frimley Park Hospital | D'Ancona F.,Radboud University Nijmegen | And 25 more authors.
European Urology | Year: 2014

Background The comparative outcome with GreenLight (GL) photoselective vaporisation of the prostate and transurethral resection of the prostate (TURP) in men with lower urinary tract symptoms due to benign prostatic obstruction (BPO) has been questioned. Objective The primary objective of the GOLIATH study was to evaluate the noninferiority of 180-W GL XPS (XPS) to TURP for International Prostate Symptom Score (IPSS) and maximum flow rate (Q max) at 6 mo and the proportion of patients who were complication free. Design, setting, and participants Prospective randomised controlled trial at 29 centres in 9 European countries involving 281 patients with BPO. Intervention 180-W GL XPS system or TURP. Outcome measurements and statistical analysis Measurements used were IPSS, Qmax, prostate volume (PV), postvoid residual (PVR) and complications, perioperative parameters, and reintervention rates. Noninferiority was evaluated using one-sided tests at the 2.5% level of significance. The statistical significance of other comparisons was assessed at the (two-sided) 5% level. Results and limitations The study demonstrated the noninferiority of XPS to TURP for IPSS, Qmax, and complication-free proportion. PV and PVR were comparable between groups. Time until stable health status, length of catheterisation, and length of hospital stay were superior with XPS (p < 0.001). Early reintervention rate within 30 d was three times higher after TURP (p = 0.025); however, the overall postoperative reintervention rates were not significantly different between treatment arms. A limitation was the short follow-up. Conclusions XPS was shown to be noninferior (comparable) to TURP in terms of IPSS, Qmax, and proportion of patients free of complications. XPS results in a lower rate of early reinterventions but has a similar rate after 6 mo. Trial registration ClinicalTrials.gov, identifier NCT01218672. © 2013 European Association of Urology.


Sumpio B.E.,Yale University | Forsythe R.O.,St Georges Vascular Institute | Ziegler K.R.,Yale University | Van Baal J.G.,Ziekenhuis Groep Twente | And 2 more authors.
Journal of Vascular Surgery | Year: 2013

Vascular surgery has seen a revolutionary transformation in its approach to peripheral vascular disease over the last 2 decades, fueled by technological innovation and a willingness by the field to adopt these changes. However, the underlying pathology behind critical limb ischemia and the significant rate of unhealed wounds and secondary amputations despite apparently successful revascularization needs to be addressed. In seeking to improve outcomes, it may be beneficial to examine our approach to vascular disease at the fundamental level of anatomy, the angiosome, to better dictate reperfusion strategies beyond a simple determination of open vs endovascular procedure. We performed a systematic review of the current literature concerning the significance of the angiosome concept in the realm of vascular surgery. The dearth of convincing evidence in the form of prospective trials and large patient populations, and the lack of a consistent, comparable vocabulary to contrast study findings, prevent recommendation of the conceptual model at a wider level for guidance of revascularization attempts. Further well-structured, prospective studies are required as well as emerging imaging strategies, such as indocyanine green dye-based fluorescent angiography or hyperspectral imaging, to allow wider adoption of the angiosome model in vascular operations. Copyright © 2013 by the Society for Vascular Surgery.


Bergenhenegouwen L.A.,Ziekenhuis Groep Twente | Meertens L.J.E.,Maastricht University | Schaaf J.,Amsterdam Medical Center | Nijhuis J.G.,Maastricht University | And 3 more authors.
European Journal of Obstetrics Gynecology and Reproductive Biology | Year: 2014

There is controversy on the preferred mode of delivery (vaginal delivery (VD) versus caesarean section (CS)) in preterm breech delivery in relation to neonatal outcome. While CS is supposed to be safer for the fetus, arguments against CS can be the increased risk of maternal morbidity, risks for future pregnancies, and costs. Moreover, neonatal respiratory distress syndrome occurs more frequently after CS compared to VD. In the past, several RCTs have been started on this subject, but they were all preliminary and stopped due to recruitment difficulties. As the Cochrane review of these RCT's reported on 116 women only, knowledge on the effectiveness of CS and VD can at present only be obtained from non-randomized studies. We performed a systematic review and meta-analysis of non-randomized studies that assessed the association between mode of delivery and neonatal mortality in women with preterm breech presentation. We searched Pubmed, Embase and the Cochrane library for articles comparing neonatal mortality after VD versus CS in preterm breech presentation (gestational age 25+0 till 36+6 weeks). Seven studies, involving a total of 3557 women, met the eligibility criteria and were included in this systematic review. The weighted risk of neonatal mortality was 3.8% in the CS group and 11.5% in the VD group (pooled RR 0.63 (95% CI 0.48-0.81)). We conclude that cohort studies indicate that CS reduces neonatal mortality as compared to VD. © 2013 Elsevier Ireland Ltd.


Klaver-Krol E.G.,Ziekenhuis Groep Twente | Rasker J.J.,University of Twente | Henriquez N.R.,University Utrecht | Verheijen W.G.,Ziekenhuis Groep Twente | Zwarts M.J.,Radboud University Nijmegen
Muscle and Nerve | Year: 2012

Introduction: Fibromyalgia (FM) is a disorder of widespread muscular pain. We investigated possible differences in surface electromyography (sEMG) in clinically unaffected muscle between patients with FM and controls. Methods: sEMG was performed on the biceps brachii muscle of 13 women with FM and 14 matched healthy controls during prolonged dynamic exercises, unloaded, and loaded up to 20% of maximum voluntary contraction. The sEMG parameters were: muscle fiber conduction velocity (CV); skewness of motor unit potential (peak) velocities; peak frequency (PF) (number of peaks per second); and average rectified voltage (ARV). Results: There was significantly higher CV in the FM group. Although the FM group performed the tests equally well, their electromyographic fatigue was significantly less expressed compared with controls (in CV, PF, and ARV). Conclusion: In the patients with FM, we clearly showed functional abnormalities of the muscle membrane, which led to high conduction velocity and resistance to fatigue in electromyography. © 2012 Wiley Periodicals, Inc.


Baan H.,Ziekenhuis Groep Twente | Baan H.,University of Twente | Dubbeldam R.,Roessingh Research and Development | Nene A.V.,Roessingh Research and Development | van de Laar M.A.F.J.,University of Twente
Seminars in Arthritis and Rheumatism | Year: 2012

Introduction: In rheumatoid arthritis (RA), signs and symptoms of feet and ankle are common. To evaluate the dynamic function of feet and ankles, namely walking, a variety of gait studies have been published. In this systematic review, we provide a systematic overview of the available gait studies in RA, give a clinimetrical assignment, and review the general conclusions regarding gait in RA. Methods: A systematic literature search within the databases PubMed, CINAHL, sportdiscus, Embase, and Scopus was described and performed and delivered 78 original gait studies that were included for further data extraction. Results: The clinimetrical quality of the 78 included RA gait studies measured according a tailored QUADAS item list and proposed clinimetrical criteria by Terwee and coworkers are moderate. General conclusions regarding the walking abnormalities of RA patients point to a slower walk, longer double support time, and avoidance of extreme positions. Frequently found static features in RA are hallux valgus, pes planovalgus, and hind foot abnormalities. Conclusions: Gait studies in RA patients show moderate clinimetrical properties, but are a challenging way of expressing walking disability. Future gait research should focus on more uniformity in methodology. When this need is satisfied, more clinical applicable conclusions can be drawn. © 2012 Elsevier Inc.


Van Es P.,University of Twente | Biswas S.K.,University of Twente | Moens H.J.B.,Ziekenhuis Groep Twente | Steenbergen W.,University of Twente | Manohar S.,University of Twente
Journal of Biomedical Optics | Year: 2014

We present a photoacoustic computed tomography investigation on a healthy human finger, to image blood vessels with a focus on vascularity across the interphalangeal joints. The cross-sectional images were acquired using an imager specifically developed for this purpose. The images show rich detail of the digital blood vessels with diameters between 100 ?m and 1.5 mm in various orientations and at various depths. Different vascular layers in the skin including the subpapillary plexus could also be visualized. Acoustic reflections on the finger bone of photoacoustic signals from skin were visible in sequential slice images along the finger except at the location of the joint gaps. Not unexpectedly, the healthy synovial membrane at the joint gaps was not detected due to its small size and normal vascularization. Future research will concentrate on studying digits afflicted with rheumatoid arthritis to detect the inflamed synovium with its heightened vascularization, whose characteristics are potential markers for disease activity.© Society of Photo-Optical Instrumentation Engineers.

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