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Arnhem, Netherlands

Van Nieuwenhove Y.,Ghent University | Dambrauskas Z.,Kaunas University of Medicine Hospital | Campillo-Soto A.,Hospital General Universitario rales Meseguer | Van Dielen F.,Maxima Medisch Centrum | And 4 more authors.
Archives of Surgery | Year: 2011

Hypothesis: A 14-day very low-calorie diet (VLCD) regimen before a laparoscopic gastric bypass procedure will improve perioperative and postoperative outcomes. Design: Multicenter, randomized, single-blind study. Setting: Five high-volume bariatric centers in Sweden, the Netherlands, Lithuania, Spain, and Belgium. Patients: Two hundred ninety-eight morbidly obese patients undergoing laparoscopic gastric bypass from March 1, 2009, through December 5, 2010. Intervention: Patients were randomly allocated to a 2-week preoperative VLCD regimen or no preoperative dietary restriction (control group). Main Outcome Measures: Operating time, surgeon's perceived difficulty of the operation, liver lacerations, intraoperative bleeding and complications, 30-day weight loss, and morbidity. Results: Mean (SD) preoperative weight change was -4.9 (3.6) kg in the VLCD group vs -0.4 (3.2) kg in the control group (P<.001). Although the surgeon's perceived difficulty of the procedure was lower in the VLCD group (median [interquartile range], 26 [15-42] vs 35 [18-50] mmon a visual analog scale; P=.04), no differences were found regarding mean (SD) operating time (81 [21] vs 80 [23] min; P=.53), estimated blood loss (P=.62), or intraoperative complications (P=.88). At the 30-day follow-up, the number of complications was greater in the control compared with the VLCD group (18 vs 8; P=.04). Conclusions: Although weight reduction with a 14-day VLCD regimen before laparoscopic gastric bypass performed in high-volume centers seems to reduce the perceived difficulty of the procedure, only minor effects on operating time, intraoperative complications, and short-term weight loss could be expected. However, the finding of reduced postoperative complication rates suggests that such a regimen should be recommended before bariatric surgery. ©2011 American Medical Association. All rights reserved.

Bech A.P.,Ziekenhuis Rijnstate
Nederlands tijdschrift voor geneeskunde | Year: 2011

A 76-year-old woman presented with dyspnea. She had received breast conserving therapy for cancer in her left breast 26 years earlier. During physical examination a redness of the skin on the left side of the torso and neck, as well as disappearance of the left breast and shift of the left nipple was noted. This proved to be a metastatic recurrence of the breast cancer. Despite over 20 years of follow-up consisting of mammography, the complete shrinkage of the breast as an expression of locally recurrent disease was missed because no physical examination was performed. This underlines the importance of physical examination in addition to mammography in the follow-up of breast cancer patients.

Holtzer-Goor K.M.,Erasmus University Rotterdam | Schaafsma M.R.,Spectrum | Joosten P.,Medisch Centrum Leeuwarden | Posthuma E.F.M.,Leiden University | And 10 more authors.
Quality of Life Research | Year: 2015

Purpose: To describe the health-related quality of life (HRQoL) of an unselected population of patients with chronic lymphocytic leukaemia (CLL) including untreated patients. Methods: HRQoL was measured by the EORTC QLQ-C30 including the CLL16 module, EQ-5D, and VAS in an observational study over multiple years. All HRQoL measurements per patient were connected and analysed using area under the curve analysis over the entire study duration. The total patient group was compared with the general population, and three groups of CLL patients were described separately, i.e. patients without any active treatment (“watch and wait”), chlorambucil treatment only, and patients with other treatment(s). Results: HRQoL in the total group of CLL patients was compromised when compared with age- and gender-matched norm scores of the general population. CLL patients scored statistically worse on the VAS and utility score of the EQ-5D, all functioning scales of the EORTC QLQ-C30, and the symptoms of fatigue, dyspnoea, sleeping disturbance, appetite loss, and financial difficulties. In untreated patients, the HRQoL was slightly reduced. In all treatment stages, HRQoL was compromised considerably. Patients treated with chlorambucil only scored worse on the EORTC QLQ-C30 than patients who were treated with other treatments with regard to emotional functioning, cognitive functioning, bruises, uncomfortable stomach, and apathy. Conclusions: CLL patients differ most from the general population on role functioning, fatigue, concerns about future health, and having not enough energy. Once treatment is indicated, HRQoL becomes considerably compromised. This applies to all treatments, including chlorambucil, which is considered to be a mild treatment. © 2015, The Author(s).

Van Boeckel P.G.A.,University Utrecht | Steyerberg E.W.,Rotterdam University | Vleggaar F.P.,University Utrecht | Groenen M.J.M.,Ziekenhuis Rijnstate | And 7 more authors.
Journal of Gastroenterology | Year: 2011

Background Self-expanding metal stents (SEMS) are known to have a significantly higher patency rate than plastic stents. We aimed to identify prognostic factors, besides stent type, for stent patency and to develop a score model that could further aid in guiding stent choice for the palliation of a malignant biliary stricture. Methods A retrospective multicenter study was conducted. Data on consecutive patients who had a stent placed between January 2002 and July 2009 were collected. Cumulative stent occlusion rates were analyzed by Kaplan-Meier curves and log rank testing, and prognostic factors were assessed by Cox regression analysis. Results A total of 690 stents (512 plastic stents, 174 SEMS) were endoscopically placed in 390 patients. At 8 weeks, stent occlusion had occurred in 32% of the plastic stents and 11% of the SEMS. Multivariate analysis indicated that plastic stents (hazard ratio [HR] 2.5, 95% confidence interval [CI] 1.9-3.5), a tight stricture requiring preceding dilation (HR 1.8, 95% CI 1.3-2.5), and a high initial bilirubin level (<50 μmol/L (HR 1.3, 95% CI 1.0-1.7) were independently associated with an increased risk of stent occlusion. A score model based on these 3 factors was able to distinguish between stent procedures with a relatively high and low risk of stent occlusion (median 14 vs. 26 weeks, respectively). Conclusion Besides plastic stents, stricture severity requiring preceding dilation, and initial higher bilirubin level were associated with a shorter period of stent patency. A simple score model based on these factors was able to predict stent occlusion and may aid in choosing the most appropriate stent type in individual patients. © Springer 2011.

Gras L.,Stichting HIV Monitoring | Geskus R.B.,University of Amsterdam | Jurriaans S.,University of Amsterdam | Bakker M.,University of Amsterdam | And 83 more authors.
PLoS ONE | Year: 2013

Introduction:Studies suggest that the HIV-1 epidemic in the Netherlands may have become more virulent, leading to faster disease progression if untreated. Analysis of CD4 cell count decline before antiretroviral therapy (ART) initiation, a surrogate marker for disease progression, may be hampered by informative censoring as ART initiation is more likely with a steeper CD4 cell count decline.Methods:Development of CD4 cell count from 9 to 48 months after seroconversion was analyzed using a mixed-effects model and 2 models that jointly modeled CD4 cell counts and time to censoring event (start ART, <100 CD4 cells/mm3, or AIDS) among therapy-naïve MSM HIV-1 seroconverters in the Netherlands. These models make different assumptions about the censoring process.Results:All 3 models estimated lower median CD4 cell counts 9 months after seroconversion in later calendar years (623, 582, and 541 cells/mm3 for 1984-1995 [n = 111], 1996-2002 [n = 139], and 2003-2007 seroconverters [n = 356], respectively, shared-parameter model). Only the 2 joint-models found a trend for a steeper decline of CD4 cell counts with seroconversion in later calendar years (overall p-values 0.002 and 0.06 for the pattern-mixture and the shared-parameter model, respectively). In the shared-parameter model the median decline from 9 to 48 months was 276 cellsmm3 for 1984-1995 seroconverters and 308 cells/mm3 for 2003-2007 seroconverters (difference in slope, p = 0.045).Conclusion:Mixed-effects models underestimate the CD4 cell decline prior to starting ART. Joint-models suggest that CD4 cell count declines more rapidly in patients infected between 2003 and 2007 compared to patients infected before 1996. © 2013 Gras et al.

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