JerOen bOsch Ziekenhuis 2009-2010

Transcription

publicaties
Jeroen Bosch Ziekenhuis 2009-2010
Publicaties
Jeroen Bosch
Ziekenhuis
2009-2010
’s-Hertogenbosch 2011
Onder redactie van:
Wetenschapscommissie
Wetenschapsbureau
Wetenschap:
de brug tussen
onderzoek en praktijk
Publicaties Jeroen Bosch Ziekenhuis 2010
Voorwoord
Voor u ligt het publicatieboek 2010 van het Jeroen Bosch Ziekenhuis (JBZ). Hier staan alle wetenschappelijke
publicaties van dat jaar in. Het overzicht laat zien dat wij behoren tot één van de topklinische ziekenhuizen van
Nederland. Niet zonder reden, want we doen veel op dat gebied.
Daarnaast leest u in deze uitgave diverse artikelen over managers, onderzoekscoördinatoren, artsen,
verpleegkundigen en artsen in opleiding. Ja, we nemen u letterlijk mee naar de alledaagse praktijk van het
onderzoeksveld. Het zijn persoonlijke verhalen waarin iedereen het belang van onderzoek vanuit een eigen
invalshoek benadrukt. Zo komt u meer te weten over de vier verschillende onderzoekslijnen die binnen het JBZ
bestaan:
• Kanker, afweer en infectie;
• Innovatie in techniek;
• Hart en Vaten;
• Leven in balans.
U krijgt uitleg over wat deze onderzoekslijnen inhouden en wat de speerpunten en richtlijnen zijn. Daarnaast geven
we u hopelijk een beter beeld van enkele onderzoeken die binnen het JBZ lopen. Ook ziet u in de artikelen terug hoe
onderzoekers tegen wetenschap aankijken: wat vindt iemand nuttig? Waar haalt hij of zij voldoening uit? Maar ook:
waar loopt diegene eventueel tegen aan?
Laat deze boeiende verhalen voor u een stimulans zijn om in de toekomst onderzoek te blijven doen. Want
wetenschap is enorm belangrijk om onze kwaliteit van zorg te verbeteren: het slaat de brug tussen onderzoek en de
dagelijkse praktijk.
Namens de wetenschapscommissie en het Wetenschapsbureau,
Judie van den Elshout
Staffunctionaris Wetenschapsbureau/ Cluster Leerhuis
voorwoord
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Inhoudsopgave
Voorwoord
Interview:
Willy Spaan en Marjolein Schouten
Rob van Marum
Esther de Vries
Koop Bosscha
Ellen Hoogeveen
Linda Kampschreur
Maaike Kusters Mirrian Hilbink
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6
8
10
12
14
57
64
132
1.ANESTHESIOLOGIE
17
2.CARDIOLOGIE
19
3.CHIRURGIE
21
4.DERMATOLOGIE
31
5.GERIATRIE
33
6.GYNAECOLOGIE
37
7.INTENSIVE CARE GENEESKUNDE
43
8.INTERNE GENEESKUNDE
47
9.KINDERGENEESKUNDE
59
10.KLINISCHE CHEMIE & HEMATOLOGIE
67
11.KLINISCHE FYSICA
73
12.KNO-HEELKUNDE
75
13.LONGZIEKTEN
77
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Publicaties 2009-2010 jeroen bosch ziekenhuis
14.MEDISCHE MICROBIOLOGIE
81
15.MOLECULAIRE DIAGNOSTIEK
89
16.NEUROLOGIE
95
17.NUCLEAIRE GENEESKUNDE
99
18.
OOGHEELKUNDE
101
19.
ORTHOPEDIE
103
20.
PATHOLOGIE
105
21.
PLASTISCHE CHIRURGIE
107
22.RADIOLOGIE
109
23.REUMATOLOGIE
115
24.REVALIDATIEGENEESKUNDE
117
25.SPOEDEISENDE GENEESKUNDE
119
26UROLOGIE
121
27.
ZIEKENHUISFARMACIE
125
28
OVERIGE STAFDIENSTEN
127
29.DIVERSEN
129
Wetenschapsmiddag 2009
Wetenschapsmiddag 2010
130
131
1. De rol van mri onderzoek in het diagnostisch traject van de oudere
alzheimer patiënt 1. 2. Nordic walking in parkinson’s disease: improves walking speed but
leaves stride length unchanged
3. Evaluation of a diagnostic algorithm for acute q-fever in an
outbreak setting
4.
Vkorc1 - resistent voor de trombosedienst
5. Effecten van fast-track protocol na een cystectomie met urinedeviatie
6. Medicatiebewaking ‘next generation’
7. Accuratesse van transrectale echografie in de preoperatieve stadiering
van rectum lesies mogelijk geschikt voor transanale endoscopische
microchirurgie (tem)
8. Acute q-fever-related mortality in the Netherlands(tem)
9. The value of an artificial neural network in the decision-making
for prostate biopsies
Bijlage I
Wetenschappelijke publicaties 2009-2010 opgenomen in PubMed
inhoudsopgave
134
135
136
137
138
139
141
142
143
144
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Samen zetten we net
dat stapje éxtra
Binnen het Jeroen Bosch Ziekenhuis staan onderzoek en opleiding hoog in het vaandel. Daarom
stimuleert het management artsen, verpleegkundigen en andere paramedici om hier tijd en energie
in te steken. Willy Spaan en Marjolein Schouten vertellen over deze ambities.
Prof. dr. Willy Spaan is voorzitter van de Raad van Bestuur van het Jeroen Bosch Ziekenhuis en hoogleraar in
Leiden. Toen ik hier kwam werken, heb ik mij voorgenomen om wetenschap en met name het toegepast
onderzoek prominent op de agenda te zetten. Want mijns inziens is onderzoek essentieel om de kwaliteit van
zorg en de kwaliteit van het onderwijs te verbeteren.” Ook Marjolein Schouten, manager van de Jeroen Bosch
Academie, zet zich in om onderzoek beter op de kaart te zetten. “Verpleegkundigen kijken niet altijd kritisch
genoeg naar zorgverlening: waarom doen wij de dingen die wij doen? En waar kunnen we verbeteren? Dat
vind ik jammer, want een kritische en nieuwsgierige houding is nodig om het JBZ het meest patiëntgerichte en
-veilige ziekenhuis te laten zijn.”
In de genen
“Gelukkig is er inmiddels veel meer aandacht voor het doen van onderzoek”, aldus Spaan. “Ik merk dat
medewerkers steeds ambitieuzer en kritischer worden. Ze hebben letterlijk de drive beter te willen zijn dan
anderen. Ik vind het belangrijk dat deze onderzoekscultuur bij iedereen in de genen gaat zitten.” Schouten vult
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aan: “Ook binnen de vereniging van samenwerkende topklinische opleidingsziekenhuizen (stz) neemt de
belangstelling voor onderzoek toe. Zo leren wij veel van de onderzoeksmethoden van het St. Antonius
Ziekenhuis in Nieuwegein en het Catharina-ziekenhuis in Eindhoven.”
Focussen
Spaan vindt een aantal dingen belangrijk: “We moeten meer met academische ziekenhuizen samenwerken.
Want we versterken elkaar op veel fronten, zoals het nadenken over de onderzoeksvraag, het bedenken van
hele onderzoeksprogramma’s en het gebruik maken van elkaars onderzoeksfaciliteiten. Door deze
samenwerking ontstaat er een vorm van wederkerigheid. Daarbij moet iemand een duidelijke koers varen.
Want je kunt niet alles onderzoeken. Het gaat om focussen en de juiste richting bepalen.” Schouten
benadrukt nog een belangrijk punt: “Het doen van onderzoek kost geld. Daarom zijn subsidies essentieel.
Niet alleen voor wetenschappelijke analyses, maar juist ook voor toegepast of praktijkgebonden onderzoek.
Onze onderzoekspopulaties zijn hier uitermate geschikt voor.”
Elkaar inspireren
Beiden hebben vertrouwen in de toekomst. Spaan: “De komende jaren gaan we het doen van onderzoek
verder professionaliseren. Onderzoekstrajecten moeten meer structuur en vorm krijgen. Daarbij is het
belangrijk fondsen te blijven werven om de nodige ondersteuning beter in te richten.” Schouten knikt
instemmend en voegt daarbij: “We trainen medewerkers tot hooggekwalificeerde zorgprofessionals. Daarbij
geven we iemand die competenties mee die nodig zijn voor het doen van onderzoek. Dit geldt voor artsen,
verpleegkundigen of andere paramedici. Hierin werken we bijvoorbeeld samen met een academische
werkplaats. Dit is een (kennis)infrastructuur waarin praktijk, onderzoek, beleid en opleiding met elkaar
samenwerken.” Spaan concludeert stellig: “Al met al werken we aan een betere onderzoekscultuur. Een
natuurlijke werkomgeving waar we elkaar inspireren en verder helpen. Samen zetten we net dat stapje éxtra!”
interview Willy Spaan en Marjolein Schouten
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Wie zaait, zal oogsten
Het Jeroen Bosch Ziekenhuis vindt opleiding en onderzoek belangrijk. Dat blijkt uit het feit dat niet
alleen artsen, maar ook verpleegkundigen en assistenten hun vak steeds vaker vanuit wetenschap
benaderen. Ook Rob van Marum ziet de toegevoegde waarde hiervan. Hij werkt er sinds ’n jaar als
klinisch geriater en klinisch farmacoloog. Hij vertelt graag over zijn ervaringen.
“Ik behandel oudere patiënten, die vaak meerdere aandoeningen tegelijkertijd hebben”, vertelt Van Marum.
“Denk hierbij aan mobiliteit- en continentieproblemen, somberheid en tekortkomingen in het geheugen.”
Opleidingsklimaat
“Bovendien ben ik naast het werk als clinicus en opleider aangesteld als onderzoekscoördinator”, vervolgt Van
Marum zijn verhaal. “Samen met nog drie anderen kregen we de opdracht op het wetenschappelijk onderzoek
binnen het JBZ te verbeteren. Want het ziekenhuis wil tot de top van opleidingsziekenhuizen horen. Dat
betekent concreet dat we samen met het wetenschapsbureau, -commissie en de Jeroen Bosch Academie een
goed opleidingsklimaat willen neerzetten. Denk aan het beter faciliteren van onderzoek met het opstellen van
procedures, statistische ondersteuning met dataverwerking en analyse. Dit om uiteindelijk tot meer
wetenschappelijke publicaties te kunnen komen. Dat geeft ons een gezicht naar buiten.”
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Leven in Balans
Elke onderzoekscoördinator heeft een eigen aandachtsgebied. Van Marum: “Ikzelf ben verantwoordelijk voor
de onderzoekslijn Leven in Balans. Deze onderzoekslijn sluit goed aan bij de kernwaarden kwaliteit, innovatie
en persoonlijke aandacht in het medische beleidsplan. Binnen het ziekenhuis verlenen we op alle terreinen
patiëntenzorg met een chronisch of preventief karakter. De overkoepelende structuur van een onderzoekslijn
zorgt ervoor dat de samenhang toeneemt. Voor deze lijn richt ik mij vooral op de domeinen preventie van
kwetsbaarheid, waaronder (medicatie)veiligheid, bewegen en gezondheid en cognitie. Kortom, dit biedt de
kans wetenschappelijk onderzoek op zowel somatisch als ondersteunend gebied in het Jeroen Bosch
Ziekenhuis verder te ontwikkelen. Dat vind ik belangrijk!”
Olievlek
Van Marum ziet het als zijn taak het wetenschappelijk onderzoek als een olievlek binnen JBZ te verspreiden.
“Ik probeer zoveel mogelijk arts-assistenten of verpleegkundigen enthousiast te maken voor het doen van
onderzoek. Want ik vind dat we de aanwezige talenten binnen onze organisatie zoveel mogelijk moeten
benutten. Om dit te bereiken, benader ik de connecties binnen mijn netwerk van academische ziekenhuizen en
universiteiten. Ook zoek ik daarbij de samenwerking op met apothekers, psychiaters of fysiotherapeuten. Door
deze verschillende partijen bij elkaar te brengen, bereiken we nog veel meer.”
Op de goede weg
Ondanks het feit dat Van Marum veel vertrouwen heeft in de toekomst, ziet hij toch ook een aandachtspunt.
“Samen met de andere onderzoekscoördinatoren hebben we de ambitie het JBZ te positioneren als
onderzoeksziekenhuis. We zijn al op de goede weg, maar hier en daar kan het nog beter. Want soms ontbreekt
het aan besef dat er letterlijk tijd moet worden vrijgemaakt voor onderzoek. Dat is nog wel eens lastig. Want
onze cultuur is er primair op gericht om patiëntenzorg te bieden. Hierdoor krijgt het doen van onderzoek geen
prioriteit. Dat is funest als je wil dat iets vorm krijgt. Ik weet zeker dat als we hier vanaf nu bewust meer
aandacht geven, zal dat ons vooruit helpen in de toekomst. Immers, wie zaait zal oogsten!”
interview Rob van marum
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Over muren heen kijken
Kinderarts dr. Esther de Vries werkt sinds 1997 in het Jeroen Bosch Ziekenhuis. Haar subspecialisme
richt zich op infectieziekten en afwijkingen aan het afweersysteem. Dagelijks krijgt ze ouders en
kinderen van verschillende leeftijden met diverse ziektebeelden in haar spreekkamer. Het doen en
begeleiden van onderzoek boeit haar enorm.
“Ik kwam hier werken om de kinderimmunologie en –infectiologie op te zetten”, steekt De Vries van wal. “Dit is
een topklinisch ziekenhuis dat zich veel bezighoudt met onderzoek en opleiding. Hier kon ik onderzoek
combineren met brede patiëntenzorg op hoog niveau. Het is de kunst uit een grote groep patiënten met vaak
voorkomende infecties juist díe mensen te filteren waarbij sprake is van een relatief zeldzame onderliggende
aandoening.”
Maatschappelijk belang
De Vries is ook voorzitter van de wetenschapscommissie en coördinator van de ziekenhuisbrede onderzoekslijn
Kanker, afweer en infecties: “Deze onderzoekslijn raakt alle medische specialismen en heeft ook een duidelijk
maatschappelijk belang. Elk jaar behandelen we hier ongeveer 2000 nieuwe patiënten met tumoren. Door de
vergrijzing groeit het aantal ouderen enorm. Dat gaat gepaard met verminderde weerstand tegen infecties en
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toenemen van oncologische aandoeningen. Ook maakt de maatschappij zich steeds meer zorgen over grote
uitbraken van infectieziekten. Op al deze gebieden lopen onderzoekstrajecten.”
Grote impact
Ze heeft een duidelijke missie. De Vries: “We proberen subsidies te krijgen voor het uitvoeren van goede
onderzoeken. Want deze leiden vaak tot publicaties waar anderen weer van kunnen leren. In universitaire
centra doet men vaak onderzoek naar zeldzame ziektes waar slechts weinig mensen aan lijden. Hier kunnen
we met onze eigen brede patiëntenpopulatie onderzoek doen naar veelvoorkomende ziekten, die samen grote
maatschappelijke impact hebben. Juist dat vind ik ontzettend waardevol.”
Kennis delen
“Er zijn in de loop der jaren meer onderzoeksfaciliteiten gekomen”, vervolgt De Vries. “Zoals goede interne
begeleiding en software om gegevens te verwerken. Ook zijn er nu een Wetenschapsbureau en de Jeroen
Bosch Academy die initiatieven voor onderzoek ondersteunen. Hierbij stimuleren we afdelingen om beter met
elkaar samen te werken. Door kennis te delen, wordt onze patiëntenzorg alleen maar beter.”
Over muren heen kijken
Niet alleen intern, maar ook extern zoekt het ziekenhuis de samenwerking steeds meer op.
“Zo is Fhealinc een uniek samenwerkingsverband tussen dit ziekenhuis, HAS Den Bosch, Avans Hogeschool, De
ZLTO en de Gemeente ’s-Hertogenbosch”, vertelt De Vries. “We willen ondernemingen en kennisinstellingen
ondersteunen bij het bedenken en uitwerken van innovatieve diensten op het snijvlak van voeding en
gezondheid. Deze partners werken bijvoorbeeld samen in het project Expertisecentrum voor Voeding, Afweer
en Allergie (EVAA). Dit project legt zich toe op het ontwikkelen van producten en diensten op het gebied van
voeding, afweer en allergie, op het fundament van de Zorgpaden Immunologie en Allergologie. Door deze
samenwerkingsverbanden neemt onze kennis toe. Maar ook het bedrijfsleven plukt daar de vruchten van.
Mijns inziens kunnen we nog veel meer over onze eigen muren heen kijken!”
Meer informatie
Heeft u vragen over dit onderwerp? Neem dan contact op met dr. Esther de Vries
via tel. (073) 6992965 of e-mail e.d.vries@jbz.nl
interview esther de vries
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‘Successen moet je
vieren’
Chirurg Koop Bosscha vindt dat het doen van onderzoek bijdraagt aan de kwaliteit van de
patiëntenzorg. Het biedt immers de mogelijkheid om datgene wat je doet te evalueren, te checken en
al dan niet bij te sturen. Daarom zet hij zich binnen het Jeroen Bosch Ziekenhuis al jaren in om dit te
stimuleren. En met succes.
Binnen het ziekenhuis is hij verantwoordelijk voor de onderzoekslijn Innovatie en Techniek. Bosscha licht toe:
“Deze onderzoekslijn sluit goed aan bij de speerpunten oncologie en minimale invasieve chirurgie. We richten
ons vooral op nieuwe onderzoeks- en behandelingsmethodieken van kanker. Verschillende vakgroepen zijn erg
actief op dit gebied. Dit leidde al regelmatig tot media-aandacht. Ook vanuit maatschappelijk oogpunt is er veel
belangstelling voor.” En niet zonder reden, aldus Bosscha: “Het levert een grotere patiëntgerichtheid op en
mogelijkheden tot kostenbesparing. De resultaten van de onderzoeken, die binnen deze onderzoekslijn
plaatsvinden, zijn goed. Dat helpt ons de topzorg te bieden, waar het Jeroen Bosch Ziekenhuis voor staat.”
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Onderzoek en opleiding
Bosscha vertelt meer over de achtergronden. “Ik heb me de afgelopen jaren ingezet om onderzoek te
stimuleren. Arts-assistenten willen daarom graag in ’s-Hertogenbosch werken omdat ze hopen op die manier
een opleidingsplaats te krijgen.
Op de goede weg
“Dus we zijn al op de goede weg”, zegt Bosscha. “Zo houd ik me bijvoorbeeld bezig met een studie die
analyseert waarom bij 20-30% van de patiënten dikke darmkanker – na een succesvolle operatie – tóch weer
terugkomt. Daar wilden we een verklaring voor vinden. Dat is gelukt, want met nieuwe onderzoekstechnieken
zien we uitzaaiingen beter, waardoor patiënten mogelijk beter te behandelen zijn.
Randvoorwaarden
Toch zijn er volgens Bosscha ook enkele aandachtspunten in het Bossche onderzoeksklimaat: “Om gedegen
onderzoek te doen, zijn goede randvoorwaarden nodig, zoals: voldoende tijd en geld. Dat is helaas niet altijd
beschikbaar. Daarom moeten we proberen mensen te faciliteren. Laten we hen structureel meer tijd geven om
onderzoek te doen. Ook is het nuttig beter naar beschikbare subsidies te kijken. Dat maakt het gemakkelijker
om een bepaald onderzoek op te starten. We moeten niet vergeten dat wij een van de grootste ziekenhuizen
zijn van Nederland. Daar hoort een bepaalde deskundigheid, expertise en uitstraling bij.”
Win-win situatie
De toegevoegde waarde van het doen van onderzoek staat Bosscha duidelijk voor ogen: “Mijns inziens zou elke
arts onderzoek moeten doen. Want het verrijkt je als mens en helpt het medische beroep en het Jeroen Bosch
Ziekenhuis nog beter neer te zetten. Als we zo’n onderzoek vervolgens ook nog publiceren in een
vooraanstaand wetenschappelijk vakblad, heeft de buitenwereld er ook nog profijt van. We hebben de
patiënten en goede doktors in huis. Dat moeten we laten zien. Want daarmee zetten we dit ziekenhuis op de
kaart. En zeg nou zelf: successen moet je vieren!”
interview koop bosscha
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“Onderzoek geeft ons
richting voor de
toekomst”
Dr. Ellen Hoogeveen is internist-nefroloog en epidemioloog binnen het Jeroen Bosch Ziekenhuis.
Ze behandelt patiënten met een verminderde nierfunctie wat varieert van een licht verminderde
nierfunctie tot nierfalen. Als wetenschappelijk onderzoekscoördinator is ze verantwoordelijk
voor de onderzoekslijn Hart- en Vaatziekten. Wat haar visie is op deze onderzoekslijn?
Dat licht ze graag even toe.
“Deze onderzoekslijn sluit goed aan bij een van de speerpunten van dit ziekenhuis: cardiovasculaire
geneeskunde”, trapt Hoogeveen af. “Een aanzienlijk deel van onze patiëntenpopulatie lijdt aan hart- en
vaatziekten. Dit is een van de belangrijkste doodsoorzaken onder de algemene bevolking in Nederland. Ook
neemt dit probleem verder toe door de vergrijzing. Ik waardeer dat dit topklinische ziekenhuis ook oog heeft
voor dit onderwerp.”
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Uitdaging
“Ik vind het leuk en inspirerend om onderzoekstrajecten op te zetten en jonge onderzoekers te stimuleren”,
vervolgt Hoogeveen enthousiast. “Het is een uitdaging om analyses zo te presenteren dat wij de vertaalslag
kunnen maken naar de praktijk. Zelf ben ik specifiek geïnteresseerd in het effect van overgewicht op de
nierfunctie.” Obesitas neemt zowel wereldwijd als in Nederland epidemische vormen aan. Uit haar eigen
onderzoek bij 1800 patiënten blijkt dat patiënten met ernstig overgewicht na niertransplantatie eerder hun
niertransplantaat verliezen. Ook hebben zij een lagere levensverwachting dan patiënten met een normaal
gewicht.”
Subsidie
Hoogeveen haalde nog meer resultaten uit haar onderzoek onder 2000 dialyse patiënten. “Iemand die
obesitas heeft en jonger is dan 65 jaar heeft 70% meer kans om binnen zeven jaar te sterven dan patiënten
met een normaal gewicht. Op dit moment onderzoeken we bij 500 pre-dialyse patiënten wat het effect is van
obesitas op de nierfunctie en sterfte”. Onlangs heeft de Nierstichting subsidie aan Hoogeveen toegekend om
het effect van visolie te onderzoeken op preventie van nierfunctieachteruitgang bij ruim 3000 patiënten na
een recent hartinfarct. Dit onderzoek vindt plaats in nauwe samenwerking met prof. Dr. Ron Kusters, klinische
chemicus. Door deze studie wordt een nieuwe chemische bepaling in ons ziekenhuis geïntroduceerd om de
nierfunctie te meten: Cystatine-C.”
Q-koorts en hart- en vaatziekten
De recente Q-koorts epidemie in Noord-Brabant was aanleiding voor diverse onderzoeken naar de effecten en
behandeling van chronische Q-koorts bij patiënten met hartklepafwijkingen en vaataandoeningen. Het
onderzoek wordt gesubsidieerd door ZonMW, een organisatie voor gezondheidsonderzoek en zorginnovatie.
Hierbij werkt men goed samen met diverse afdelingen van het JBZ: medisch microbiologie, chirurgie,
cardiologie en interne geneeskunde. Op dit moment zijn twee promovendi bij dit onderzoek betrokken.”
Kruisbestuiving
Tot slot heeft Hoogeveen nog ideeën om het Bossche onderzoeksklimaat te verbeteren: “Om gedegen
onderzoek te doen, zijn goede faciliteiten en randvoorwaarden voor succes nodig.” Ook is Hoogeveen
voorstander van het delen van kennis. “Onderzoekers weten nog te weinig van elkaar waar ze mee bezig zijn.
Het zou kunnen helpen om een overzicht op intranet te plaatsen waar alle wetenschappelijke onderzoeken van
het JBZ opstaan met daarbij de contactpersoon. Door kennis te delen, ontstaat vaak kruisbestuiving en zetten
we sneller een stap vooruit. Dat geeft ons richting voor de toekomst.”
interview ellen hoogeveen
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ANESTHESIOLOGIE
Abstracts, voordrachten en posters
Lechner TJ.
Het epidurale blok: niet voelen, maar horen.
DARA congres, Heeze, 2009.
Lechner TJ.
H2B. APAD
JBZ, juni 2010.
Lechner TJ.
The Acoustic puncture assist Device.
ESRA wintersymposium, Grindelwald Zwitserland, 2010.
Lechner TJ.
Workshop APAD.
OK dagen, jaarbeurs Utrecht, 2010.
Lechner TJ.
Een nieuw geluid op de operatiekamer.
Refereeravond UMC Gent, Belgie, 2009.
Van Niekerk J.
Voordracht: corpus alienum in de trachea bij
kinderen, een tricky gebeuren.
Nederlandse OK dagen, Oktober 2009.
Lechner TJ, van Wijk MG.
De akoestisch geleide ruggenprik.
IGZ Utrecht, 2009.
Publicaties (niet pubmed)
Iff I, Mosing M, Lechner T, Moens Y.
The use of an acoustic device to identify the extradural
space in standing horses.
Vet Anaesth Analg. 2010 Jan;37(1):57-62.
(Onderzoek verricht in Wenen.)
Anesthesiologie
Van Niekerk J, Cornelissen P.
Aspiratie van een corpus alienum bij kinderen?
Starre bronchoscopie bij spontane ademhaling.
Nederlands Tijdschrift voor Anesthesiologie.
2010 Nov;5.
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CARDIOLOGIE
Wetenschappelijke publicaties
Esselink AC, de Ruijter AM, Daniëls MC.
Application of NHG guidelines in patients referred
for stable chest pain syndromes.
Neth Heart J. 2010 Apr;18(4):178-82.
PMID: 20428415
Trefwoorden: richtlijnen, angina pectoris
Wever PC, Arts CH, Groot CA, Lestrade PJ,
Koning OH, Renders NH.
Screening for chronic Q fever in symptomatic patients
with an aortic aneurysm or prosthesis.
Ned Tijdschr Geneeskd. 2010;154(28):A2122.
PMID: 20699030
Hassink RJ, Haerkens-Arends HE, Daniels MC.
Extensive right coronary artery thrombosis.
Neth Heart J. 2009 Mar;17(3):115-6.
PMID: 19325905
Trefwoorden: hartinfarkt, coronairangiografie
Daniëls MC.
Voordracht: coronaire syndromen in de praktijk,
Venticare 2010, Utrecht, 2010.
Daniëls MC.
Voordracht: Hartfalen,
Nationale Patiëntendagen 2010, RAI A’dam,
8-10-2010.
Daniëls MC.
Voordracht: Hartritmestoornissen,
HAIO’s Universiteit Maastricht, 2010.
Daniëls MC.
Voordracht: Stabiele en Acute Coronaire
Cardiologie
Syndromen,
De Ruijter AM., Esselink AC., Daniëls MC.
Referral for stable angina: how do primary care
physicians adhere to guidelines?
Posterpresentatie NVVC, Neth. Heart J.2009:
17, Suppl.1: 14
Liem SS., Renders NH., Bouter KP., Daniëls MC.
Follow-up after diagnosis of Q-fever: the
’s-Hertogenbosch experience.
Posterpresentatie NVVC, Neth. Heart J. 2010:
18, Suppl. 1:21
Trefwoorden: Q-koorts
19
Daniëls MC.
Organisatie WDH/JBZ symposium Hartfalen,
Vught, 2009.
Daniëls MC.
Voordracht: ‘diagnostiek hartfalen’,
huisartsen nascholing regio ’s-Hertogenbosch, 2009.
Daniëls MC.
Voordracht: Stabiele en Acute Coronaire Syndromen,
Daniëls MC.
Voordracht: Hartritmestoornissen,
Daniëls MC.
Voordracht: acute coronaire syndromen,
NvHVV, 2009.
Meijs MF, Meijburg HW, Elsman P, Daniëls MC.
ST-segment elevation and ventricular tachycardia due
to multivessel coronary artery
spasm without significant coronary artery stenosis.
Neth.J.Crit.Care 2009; 13:318-320.
Trefwoorden: hartinfarkt, hartritmestoornis
20
3
CHIRURGIE
Dassen AE, Lemmens VE, van de Poll-Franse LV,
Creemers GJ, Brenninkmeijer SJ, Lips DJ, Vd Wurff AA,
Bosscha K, Coebergh JW.
Trends in incidence, treatment and survival of gastric
adenocarcinoma between 1990 and 2007: a
population-based study in the Netherlands.
Eur J Cancer. 2010 Apr;46(6):1101-10.
PMID: 20219351
Lips DJ, Koning OH.
Coral reef syndrome: a thoracic aorta stenosis as
explanation for a collection of symptoms.
Ned Tijdschr Geneeskd. 2009
Jan 17;153(3):91-4.
PMID: 19235346
Dassen AE, Lips DJ, Hoekstra CJ, Pruijt JF,
Bosscha K.
FDG-PET has no definite role in preoperative
imaging in gastric cancer.
Eur J Surg Oncol. 2009 May;35(5):449-55.
PMID: 19147324
Lips DJ, Barker N, Clevers H, Hennipman A.
The role of APC and beta-catenin in the aetiology
of aggressive fibromatosis (desmoid tumors).
Eur J Surg Oncol. 2009 Jan;35(1):3-10.
PMID: 18722078
Chirurgie
Koebrugge B, van Wensen RJ, Bosscha K,
Dautzenberg PL, Koning OH.
Delirium after Emergency/Elective Open and
Endovascular Aortoiliac Surgery at a Surgical Ward
with a High-standard Delirium Care Protocol.
Vascular. 2010 Sep-Oct;18(5):279-87.
PMID: 20822723
Koebrugge B, Bosscha K, Jager G, Ernst M.
Accuracy of transrectal ultrasonography in staging
rectal tumors that are clinically eligible for transanal
endoscopic microsurgery.
J Clin Ultrasound. 2010 Jun;38(5):250-3.
PMID: 20186761
Koebrugge B, Bosscha K, Ernst MF.
Transanal endoscopic microsurgery for local excision of
rectal lesions: is there a learning curve?
Dig Surg. 2009;26(5):372-7.
PMID: 19923824
Koebrugge B, Koek HL, van Wensen RJ,
Dautzenberg PL, Bosscha K.
Delirium after abdominal surgery at a surgical
ward with a high standard of delirium care:
incidence, risk factors and outcomes.
Dig Surg. 2009;26(1):63-8.
PMID: 19169032
21
Koebrugge B, Hermens RA.
A women with a lumpy calf.
Ned Tijdschr Geneeskd. 2010;154:A440.
PMID: 20298633
Koebrugge B, van Leuken M, Ernst MF,
van Munster I, Bosscha K.
Percutaneous Cholecystostomy in Critically Ill Patients
with a Cholecystitis: A Safe Option.
Dig Surg. 2010 Oct 15;27(5):417-421.
PMID: 20948216
in ’s-Hertogenbosch.
Acta Chir Belg. 2009 Jan-Feb;109(1):42-6.
PMID: 19341194
Van Vugt R, Bosscha K, van Munster IP, de Jager CP,
Rutten MJ.
Embolization as treatment of choice for bleeding peptic
ulcers in high-risk patients.
Dig Surg. 2009;26(1):37-42.
PMID: 19155626
Screening for chronic Q fever in symptomatic
patients with an aortic aneurysm or prosthesis.
PMID: 20699030
Van Luin M, Van der Ende ME, Richter C, Visser M,
Faraj D, Van der Ven A, Gelinck L, Kroon F, Wit FW, Van
Schaik RH, Kuks PF, Burger DM.
Lower atovaquone/proguanil concentrations in patients
taking efavirenz, lopinavir/ritonavir or atazanavir/
ritonavir.
AIDS. 2010 May 15;24(8):1223-6.
PMID: 20299957
Koning OH, Kaptein BL, van der Vijver R, Dias NV,
Malina M, Schalij MJ, Valstar ER, van Bockel JH.
Fluoroscopic Roentgen stereophotogrammetric
analysis (FRSA) to study three-dimensional stent graft
dynamics.
J Vasc Surg. 2009 Aug;50(2):407-12.
PMID: 19631876
Faraj D, Ruurda JP, Olsman JG, van Geffen HJ.
Five-year results of inguinal hernia treatment with the
Prolene Hernia System in a regional training hospital.
Hernia. 2010 Apr;14(2):155-8.
PMID: 19898738
Van Vugt R, Kruse RR, Sterkenburg SM,
Fritschy WM, Moll FL.
(Semi-)Closed Endarterectomy in Occlusive
Aortoiliac Disease.
Ann Vasc Surg. 2010 May 13.
PMID: 20471793
Van Vugt R, Kruse RR, Fritschy WM, Moll FL.
Treatment of dilated venous bypass grafts with an
expanded polytetrafluoroethylene-covered nitinol
endoprosthesis.
Vasc Endovascular Surg. 2009 Apr-May;43(2):190-2.
PMID: 19074204
Van Vugt R, Bosscha K, Olsman J, Jager GJ,
de Jager CP.
Management of hepatic trauma: a 9-year experience
22
Van der Sangen MJ, van de Wiel FM, Poortmans PM,
Tjan-Heijnen VC, Nieuwenhuijzen GA,
Roumen RM, Ernst MF, Tutein Nolthenius-Puylaert
MC, Voogd AC.
Are breast conservation and mastectomy equally
effective in the treatment of young women
with early breast cancer? Long-term results of
a population-based cohort of 1,451 patients aged
</=40 years.
Breast Cancer Res Treat. 2010 Aug 12.
PMID: 20703938
Hermans E, van Schaik PM, Prins HA,
Ernst MF, Dautzenberg PJ, Bosscha K.
Outcome of colonic surgery in elderly patients with
colon cancer.
J Oncol. 2010;2010:865908.
PMID: 20628482
Ruiterkamp J, Voogd AC, Bosscha K,
Tjan-Heijnen VC, Ernst MF.
Impact of breast surgery on survival in patients with
distant metastases at initial presentation: a systematic
review of the literature.
Breast Cancer Res Treat. 2010 Feb;120(1):9-16.
PMID: 20012891
Lammers EJ, Huibers P, van der Sangen MJ,
van de Poll-Franse LV, Poortmans PM, Ernst MF,
Lemaire BM, Meijs CM, Nuytinck HK, Voogd AC.
Factors contributing to improved local control after
mastectomy in patients with breast cancer aged 40
years or younger.
Breast. 2010 Feb;19(1):44-9. Epub 2009 Nov 12.
PMID: 19913419
Ruiterkamp J, Ernst MF, van de Poll-Franse LV,
Bosscha K, Tjan-Heijnen VC, Voogd AC.
Surgical resection of the primary tumour is
associated with improved survival in patients with
distant metastatic breast cancer at diagnosis.
Eur J Surg Oncol. 2009 Nov;35(11):1146-51.
PMID: 19398188
Van den Broek FJ, de Graaf EJ, Dijkgraaf MG,
Reitsma JB, Haringsma J, Timmer R, Weusten BL,
Gerhards MF, Consten EC, Schwartz MP, Boom MJ,
Derksen EJ, Bijnen AB, Davids PH, Hoff C, van
Dullemen HM, Heine GD, van der Linde K, Jansen JM,
Mallant-Hent RC, Breumelhof R, Geldof H, Hardwick
JC, Doornebosch PG, Depla AC, Ernst MF, van Munster
IP, de Hingh IH, Schoon EJ, Bemelman WA, Fockens P,
Dekker E.
Transanal endoscopic microsurgery versus endoscopic
mucosal resection for large rectal adenomas (TRENDstudy).
BMC Surg. 2009 Mar 13;9:4.
PMID: 19284647
Van la Parra RF, Ernst MF, Bevilacqua JL,
Mol SJ, Van Zee KJ, Broekman JM, Bosscha K.
Validation of a nomogram to predict the risk of
nonsentinel lymph node metastases in breast cancer
Chirurgie
patients with a positive sentinel node biopsy:
validation of the MSKCC breast nomogram.
Ann Surg Oncol. 2009 May;16(5):1128-35.
PMID: 19252954
Van Schaik PM, Hermans E, van der Linden JC,
Pruijt JR, Ernst MF, Bosscha K.
Micro-metastases in stages I and II colon cancer are
a predictor of the development of distant metastases
and worse disease-free survival.
PMID: 18775627
Ritchie ED, Jager GJ, van der Linden JC, Bosscha K.
Three adults with intra-abdominal lymphangioma.
Ned Tijdschr Geneeskd. 2009 Mar 7;153(10):456-9.
PMID: 19374097
Van Wensen RJA, Bosscha K, Jager GJ,
van der Linden JC, Fijnheer R.
An invasive process in the pancreas: sometimes
lymphoma. [Een ruimteinnemend proces in het
pancreas. Niet altijd een carcinoom.]
Ned Tijdschr Geneeskd. 2009;153:B164.
PMID: 19818177
Van Nes JG, Seynaeve C, Maartense E, Roumen RM, de
Jong RS, Beex LV, Meershoek-Klein Kranenbarg WM,
Putter H, Nortier JW, Van de Velde CJ; Cooperating
investigators of the Dutch TEAM trial (including
Bosscha K).
Patterns of care in Dutch postmenopausal patients
with hormone-sensitive early breast cancer
participating in the Tamoxifen Exemestane Adjuvant
Multinational (TEAM) trial.
Ann Oncol. 2010 May;21(5):974-82.
PMID: 19875752
Brokelman WJ, Holmdahl L, Janssen IM, Falk P,
Bergström M, Klinkenbijl JH, Reijnen MM.
Decreased peritoneal tissue plasminogen activator
during prolonged laparoscopic surgery.
J Surg Res. 2009 Jan;151(1):89-93.
PMID: 18541262
23
Lensvelt MM, Brokelman WJ, Ivarsson ML,
Falk P, Reijnen MM.
Peritoneal transforming growth factor beta-1
expression during prolonged laparoscopic procedures.
J Laparoendosc Adv Surg Tech A. 2010 JulAug;20(6):545-50.
PMID: 20578923
Bakker OJ, van Santvoort HC, Besselink MG,
van der Harst E, Hofker HS, Gooszen HG;
Dutch Pancreatitis Study Group.
Prevention, detection, and management of infected
necrosis in severe acute pancreatitis.
Curr Gastroenterol Rep. 2009 Apr;11(2):104-10.
PMID: 19281697
Van Santvoort HC, Besselink MG, Bakker OJ, Vleggaar
FP, Timmer R, Weusten BL, Gooszen HG; Dutch
Pancreatitis Study Group.
Endoscopic necrosectomy in necrotising pancreatitis:
indication is the key.
Gut. 2010 Nov;59(11):1587.
PMID: 20732915
Cobben LP, Bakker OJ, Puylaert JB, Kingma LM,
Blickman JG.
Imaging of patients with clinically suspected
appendicitis in the Netherlands: conclusions of a
survey.
Br J Radiol. 2009 Jun;82(978):482-5.
PMID: 19098079
Bakker OJ, Go PM, Puylaert JB, Kazemier G, Heij HA;
Werkgroep en klankbordgroep
Guideline on diagnosis and treatment of acute
appendicitis: imaging prior to appendectomy is
recommended.
PMID: 20482926
de Vries EN, Prins HA, Crolla RM, den Outer AJ,
van Andel G, van Helden SH, Schlack WS, van Putten
MA, Gouma DJ, Dijkgraaf MG, Smorenburg SM,
Boermeester MA; SURPASS Collaborative Group.
Effect of a comprehensive surgical safety system on
patient outcomes.
N Engl J Med. 2010 Nov 11;363(20):1928-37.
PMID: 21067384
Leeuwenburgh MM, Bakker OJ, Gorzeman MP,
Bollen TL, Seldenrijk CA, Go PM.
Fewer unnecessary appendectomies following
ultrasonography and CT.
PMID: 20456809
Van Santvoort HC, Besselink MG, Bakker OJ, Hofker
HS, Boermeester MA, Dejong CH, van Goor H,
Schaapherder AF, van Eijck CH, Bollen TL, van
Ramshorst B, Nieuwenhuijs VB, Timmer R, Laméris JS,
Kruyt PM, Manusama ER, van der Harst E, van der
Schelling GP, Karsten T, Hesselink EJ, van Laarhoven
CJ, Rosman C, Bosscha K, de Wit RJ, Houdijk AP, van
Leeuwen MS, Buskens E, Gooszen HG; Dutch
A step-up approach or open necrosectomy for
necrotizing pancreatitis.
N Engl J Med. 2010 Apr 22;362(16):1491-502.
PMID: 20410514
24
Swank HA, Vermeulen J, Lange JF, Mulder IM, van der
Hoeven JA, Stassen LP, Crolla RM, Sosef MN, Nienhuijs
SW, Bosker RJ, Boom MJ, Kruyt PM, Swank DJ, Steup
WH, de Graaf EJ, Weidema WF, Pierik RE, Prins HA,
Stockmann HB, Tollenaar RA, van Wagensveld BA,
Coene PP, Slooter GD, Consten EC, van Duijn EB,
Gerhards MF, Hoofwijk AG, Karsten TM, Neijenhuis PA,
Blanken-Peeters CF, Cense HA, Mannaerts GH, Bruin
SC, Eijsbouts QA, Wiezer MJ, Hazebroek EJ, van
Geloven AA, Maring JK, D’Hoore AJ, Kartheuser A,
Remue C, van Grevenstein HM, Konsten JL, van der
Peet DL, Govaert MJ, Engel AF, Reitsma JB, Bemelman
WA; Dutch Diverticular Disease (3D) Collaborative
Study Group.
The ladies trial: laparoscopic peritoneal lavage or
resection for purulent peritonitisA and Hartmann’s
procedure or resection with primary anastomosis for
purulent or faecal peritonitisB in perforated
diverticulitis (NTR2037).
BMC Surg. 2010 Oct 18;10:29.
PMID: 20955571
van de Wall BJ, Draaisma WA, Consten EC, van der
Graaf Y, Otten MH, de Wit GA, van Stel HF, Gerhards
MF, Wiezer MJ, Cense HA, Stockmann HB, Leijtens JW,
Zimmerman DD, Belgers E, van Wagensveld BA,
Sonneveld ED, Prins HA, Coene PP, Karsten TM,
Klaase JM, Statius Muller MG, Crolla RM, Broeders IA;
Dutch Diverticular Disease (3D) Collaborative Study
Group.
DIRECT trial. Diverticulitis recurrences or continuing
symptoms: Operative versus conservative treatment. A
multicenter randomised clinical trial.
BMC Surg. 2010 Aug 6;10:25.
PMID: 20691040
Hermans E, van Schaik PM, Prins HA, Ernst MF,
Dautzenberg PJ, Bosscha K.
colon cancer.
J Oncol. 2010;2010:865908.
PMID: 20628482
Color II Study Group, Buunen M, Bonjer HJ, Hop WC,
Haglind E, Kurlberg G, Rosenberg J, Lacy AM, Cuesta
MA, D’Hoore A, Fürst A, Lange JF, Jess P, Bulut O,
Poornoroozy P, Jensen KJ, Christensen MM, Lundhus
E, Ovesen H, Birch D, Iesalnieks I, Jäger C, Kreis M, van
riet Y, van der Harst E, Gerhards MF, Bemelman WA,
Hansson BM, Neijenhuis PA, Prins HA, Balague C,
Targarona E, Luján Mompeán JA, Franco Osorio JD,
Garcia Molina FJ, Skullman S, Läckberg Z, Kressner U,
Matthiessen P, Kim SH, Poza AA.
COLOR II. A randomized clinical trial comparing
laparoscopic and open surgery for rectal cancer.
Dan Med Bull. 2009 May;56(2):89-91.
PMID: 19486621
Richir MC, van Lambalgen AA, Teerlink T, Wisselink W,
Bloemena E, Prins HA, de Vries TP, van Leeuwen PA.
Low arginine/asymmetric dimethylarginine ratio
deteriorates systemic hemodynamics and organ blood
flow in a rat model.
Crit Care Med. 2009 Jun;37(6):2010-7.
PMID: 19384222
de Vries EN, Prins HA, Crolla RM, den Outer AJ, van
Andel G, van Helden SH, Schlack WS, van Putten MA,
Gouma DJ, Dijkgraaf MG, Smorenburg SM,
Boermeester MA; SURPASS Collaborative Group.
Effect of a comprehensive surgical safety system on
patient outcomes.
N Engl J Med. 2010 Nov 11;363(20):1928-37.
PMID: 21067384
Boeken
Van Doesburg IAJ, Besselink MGH, Bakker OJ, Van
Santvoort HC, Gooszen HG, on behalf of the Dutch
Antibiotics, Probiotics and Enteral Nutrition: Means to
Prevent Infected Necrosis in AP.
In: Tilg H, Mayerle J (eds): Clinical Update on
Inflammatory Disorders of the Gastrointestinal Tract.
Front Gastrointest Res. Basel, Karger, 2010, vol 26, pp
156–164
Chirurgie
25
Koebrugge B, Lips DJ, Pruijt JH, Van der Linden JC,
Ernst MF, Bosscha K.
Can we identify high-risk stage II colonic cancer
patients?
Najaarsvergadering NVGE/NVGIC, Veldhoven,
7 en 8 oktober 2010.
Koebrugge B, Lips DJ, Putter H, Pruijt JH,
Van der Linden CJ, Ernst MF, Bosscha K.
The influence of micrometastases on prognosis and
survival in stage I-II colon cancer patients - the
EnRoute+study.
ESSO 2010, Bordeaux, Frankrijk,
15-17 september 2010.
Koebrugge B, Lips DJ, Pruijt JH, Van der Linden CJ,
Adherence to national guidelines in stage II colinic
cancer patients in the Netherlands.
Koebrugge B, Lips DJ, Pruijt JH, Van der Linden JC,
Can we identify high-risk stage II colonic cancer
patients?
Lips DJ, Koebrugge B, Liefers GJ, Putter H, Smit V,
Van der Linden CJ, Pruijt JH, Van de Velde CJ,
Bosscha K.
The number of high risk factors in stage II (N0)
colonic cancer patients is related to outcome.
ESSO 2010, Bordeaux, Frankrijk, 15-17 september
2010.
Ruiterkamp J, Ernst MF, De Munck L, Van der
Heijden-Van der Loo M, Van de Poll-Franse LV,
Bosscha K, Tjan-Heijnen VC, Voogd AC.
Improved survival of patients with primary
metastatic breast cancer in the period 1995-2007.
26
Van la Parra RF, Peer PGM, Ernst MF, Bosscha K.
Meta-analysis of predictive factors for non-sentinel
lymph node metastases in breast cancer patients with
a positive SLN.
15-17september 2010.
Ruiterkamp J, Voogd AC, Bosscha K,
Tjan-Heijnen VC, Ernst MF.
A systematic review of the impact of breast
surgery on survival in patients with breast cancer
and distant metastases at initial presentation.
Van la Parra RF, Mulder D, Ernst MF,
de Roos W, Bosscha K.
Identification of lymphovascular invasion in breast
biopsy specimens.
Van la Parra RF, Francissen C, Peer PG,
Ernst MF, Mulder D, de Roos W, Bosscha K.
Validation of the MSKCC nomogram to predict sentinel
lymph node metastases in a Dutch breast cancer
population.
Geertsema D, Dassen AE, Lips DJ, Hoekstra CJ,
Nieuwenhuijzen GA, Bosscha K.
Value of PET-CT in patients with gastric cancer.
Koebrugge B, Bosscha K, Jager GJ, Ernst MF.
Transanal endoscopic microsurgery for local excision of
rectal lesions; is there a learning curve?
12th World Congress on Gastrointestinal Cancer,
Barcelona, Spain, June 2010.
Accuracy of transrectal ultrasonography (trus) in
staging clinically suspected t1-lesions prior to
transanal endoscopic microsurgery.
Chirurgendagen 2010, Veldhoven, 21 mei 2010.
Accuracy of Transrectal Ultrasonography in the
preoperative staging of T1 rectal lesions suitable for
Transanal Endoscopic Microsurgery.
Chirurgendagen 2010, Veldhoven, 21 mei 2010
Koebrugge B.
Transanal endoscopic microsurgery: staging and
results.
Voordracht regionale refereeravond regio Utrecht.’s
Hertogenbosch, 1 juni 2010.
DCCG-dag, Amersfoort, 3 december 2010.
Bosscha K, Lips DJ, Koebrugge B, Van der Linden JH,
Nooijen P, Pruijt JH, Van de Velde CJ.
Schildwachtklieronderzoek bij het coloncarcinoom,
praktische implicaties voor chirurg en patholoog.
DCCG-dag, Amersfoort, 3 december 2010.
Van la Parra RF, Peer PGM, De Roos WK, Ernst MF,
Bosscha K.
Een eenvoudige risicoscore om de kans op nietschildwachtklier metastasen te schatten als de
schildwachtklier positief is.
Najaarsvergadering NVvH, Ede, 26 november 2010.
Lemmens VEPP, Bosscha K, Van der Schelling G,
Brenninkmeier S, Coebergh JWW, De Hingh IHJT.
Significante verbetering van korte en lange
termijnsresultaten na centralisatie van
pancreaschirurgie in de IKZ-regio.
Van la Parra RF, Francissen C, Peer PG,
Ernst MF, Mulder D, de Roos W, Bosscha K.
Validatie van het MSKCC nomogram om de kans op
positieve schildwachtklieren te voorspellen.
Chirurgendagen, Veldhoven, Mei 2010.
Van la Parra RF, Mulder D, Ernst MF, de Roos W,
Bosscha K.
Identification of lymphovascular invasion in breast
biopsy specimens.
EBCC, Barcelona, maart 2010.
Voogd AC, Ruiterkamp J, De Munck L, Van der
Heijden-Van der Loo M, Van de Poll-Franse LV,
Bosscha K, Tjan-Heijnen VC, Ernst MF.
Ontwikkelingen in de overleving van patiënten met
primair gemetastaseerd mammacarcinoom in de
periode van 1995 – 2007 en het effect van chirurgie.
Chirurgendagen 2010, Veldhoven 21 mei 2010.
Van la Parra RF, Francissen C, Peer PG, Ernst MF,
Mulder D, de Roos W, Bosscha K.
Validation of the MSKCC nomogram to predict sentinel
lymph node metastases in a Dutch breast cancer
population.
Bosscha K, Lips DJ, Koebrugge B, Van der Linden JH,
Nooijen P, Pruijt JH, Van de Velde CJ.
De En Route-studie.
Van la Parra RF, Barneveld PC, Ernst MF,
Bosscha K.
Disconcordance between number of scintigraphic and
Chirurgie
27
peroperatively identified sentinel lymph nodes and
axillary tumour recurrence.
Van la Parra RF, Peer PG, Ernst MF,
Bosscha K.
Meta-analysis of predictive factors for non sentinel
lymph node metastases in breast cancer patients with
a positive sentinel lymph node.
Ruiterkamp J, Voogd AC, Tjan-Heijnen VC, Bosscha K,
Ernst MF.
A systematic review of the impact of breast surgery on
survival of patients with distant metastases at initial
presentation.
Van la Parra RF, Peer PG, Ernst MF,
Bosscha K.
Meta-analysis of predictive factors for non-sentinel
lymph node metastases after a positive sentinel lymph
node in breast cancer.
SSO, St Louis, maart 2010.
Koebrugge B, Koek HL, Van Wensen R,
Delirium na abdominale chirurgie op een chirurgische
afdeling met geprotocolleerde aandacht voor het
delirium.
Najaarsvergadering NVvH Ede, 27 november 2009.
Koebrugge B, Van Leuken M, Ernst MF,
Van Munster I, Bosscha K.
Percutane galblaasdrainage bij patiënten met een
acute cholecystitis in slechte klinische toestand: een
goede optie ?!
Accuratesse van Transrectale Echografie in de
preoperatieve stadiering van rectum lesies geschikt
voor transanale endoscopische microchirurgie.
28
Ruiterkamp J, Voogd AC, Tjan-Heijnen VC, Bosscha K,
Ernst MF.
Improved survival in patients with primary metastatic
breast cancer treated with resection of the breast
tumor.
34th ECCO/ESMO Multidisciplinary Congress, Berlin,
Germany, 20-24 september 2009 (persconferentie
ECCO/ESMO betreffende bovenstaande presentatie zie:
http://www.ecancermedicalscience.com/tv/?play=240)
Transanal Endoscopic Microssurgery (TEM) in
Tubulovillous Adenoma and T1 rectal lesions.
Germany, 20-24 september 2009.
Accuracy of Transrectal Ultrasonography in the
preoperative staging of rectal lesions suitable for
Transanal Endoscopic Microsurgery.
Dassen AE, Lips DJ, Hoekstra CJ, Ernst MF,
Bosscha K.
Value of 18F-FDG PET-CT in staging gastric cancer.
Van la Parra RF, Ernst MF, Bosscha K.
Schildwachtklierbiopsie na eerdere ipsilaterale mamma
chirurgie.
Bossche Mamma Congres, ’s Hertogenbosch, juni
2009.
Looij BG, Kreb DL, van der Linden JC, Ernst MF, Pruijt
JF, Bosscha K, Jager GJ, Rutten MJ.
In vivo radio frequency ablation (RFA) in small breast
cancer: preliminairy results.
ECR 2009, Wenen, 6 maart 2009.
Transanal Endoscopic Microsurgery for local resection
of rectal lesions: initial results in a university affiliated
teaching hospital.
SSO, Phoenix, USA, 5-8 maart 2009.
Accuracy of TransRectal UltraSonography (TRUS) in
preoperative staging of rectal lesions suitable for
Transanal Endoscopic Microsurgery. SSO, Phoenix,
USA, 5-8 maart 2009.
Ruiterkamp J, Voogd AC, Smilde T, Bosscha K,
Ernst MF.
Surgical resection of the primary tumor is associated
with improved survival in patients with metastatic
breast cancer at diagnosis.
Ruiterkamp J, Voogd AC, Smilde T, Bosscha K,
Ernst MF.
The prognostic significance of tumor surgery in
patients with primary metastatic breast cancer.
Van la Parra RF, Ernst MF, Bosscha K.
Sentinel lymph node biopsy after previous breast
surgery.
Van Baal MC, Besselink MG, OJ Bakker, van Santvoort
HC, Schaapherder AF, Nieuwenhuijs VB, Gooszen HG,
van Ramshorst B, Boerma D, for the Dutch Pancreatitis
Study Group.
Systematic review on timing of cholecystectomy after
mild biliary pancreatitis.
European Pancreatic Club 2010,June 2010,
Stockholm, Sweden.
BU Wu, OJ Bakker, GI Papachristou, K Repas, MG
Besselink, HC van Santvoort, V Muddana, VK Singh, DC
Whitcomb, HG Gooszen, PA Banks.
Prognostic Value of Blood Urea Nitrogen (BUN) in the
early assessment of Acute Pancreatitis: An
International Study.
Digestive Diseases Week, May 2010, New Orleans.
Distinguished session.
Chirurgie
Voermans RP, Bakker OJ, van Brunschot S,
van Santvoort HC, Boermeester MA, Timmer R,
Nieuwenhuijs VB, Bruno MJ, Gooszen HG and Fockens
P for the Dutch Pancreatitis Study Group.
Prospective evaluation of endoscopic and conservative
treatment of persistent symptomatic sterile pancreatic
necrosis.
Nederlandse Vereniging voor Gastro-Enterologie,
March 2010, Veldhoven, Nederland.
HC van Santvoort, MG Besselink, OJ Bakker,
HS Hofker, MA Boermeester, CH Dejong, H van Goor,
AF Schaapherder, CH van Eijck, TL Bollen, B van
Ramshorst, VB Nieuwenhuijs, R Timmer, JS Laméris,
PM Kruyt, ER Manusama, E van der Harst, GP van der
Schelling, T Karsten, EJ Hesselink, CJ van Laarhoven, C
Rosman, K Bosscha, RJ de Wit, AP Houdijk, MS van
Leeuwen, E Buskens, HG Gooszen, for the Dutch
Minimally invasive step-up approach versus open
necrosectomy in necrotizing pancreatitis: randomized
controlled multicenter trial (PANTER).
International Association of Pancreatology/ American
Pancreatic Association/ Japanese Pancreatic Society,
November 2009, Honolulu, Hawaii.
Van Baal MC, van Santvoort HC, Bollen TL,
OJ Bakker, Besselink MG, Gooszen HG, for the Dutch
Systematic review of percutaneous catheter drainage
as primary treatment for necrotizing pancreatitis.
International Association of Pancreatology/ American
Pancreatic Association/ Japanese Pancreatic Society,
November 2009, Honolulu, Hawaii.
HC van Santvoort, OJ Bakker, MG Besselink, TL
Bollen, K Fischer, H Gooszen, J van Erpecum.
Predictors of common bile duct stones during early
endoscopic retrograde cholangiopancreaticography in
acute biliary pancreatitis.
European Pancreatic Club, July 2009, Szeged,
Hungary.
29
OJ Bakker, HC van Santvoort, JC Hagenaars, TL
Bollen, MG Besselink, HG Gooszen, AFM Schaapherder.
Timing of Cholecystectomy in 418 patients with mild
and severe biliary pancreatitis: Dutch multicenter
experience.
European Pancreatic Club, July 2009, Szeged,
Hungary.
Bakker OJ, van Santvoort HC, Hagenaars JC, Bollen
TL, Besselink MG, Gooszen HG, Schaapherder AF.
Timing of cholecystectomy in 418 patients with mild
and severe biliary pancreatitis: Dutch multicenter
experience.
European Pancreatic Club (EPC), July 2009, Szeged,
Hongary.
Bakker OJ, van Santvoort HC, Besselink MG, Fischer K,
Bollen TL, Boermeester MA, Gooszen HG.
Timing of enteral nutrition in patients with predicted
severe acute pancreatitis: an early start is associated
with a reduction in bacteremia.
Digestive Disease Week (DDW), May 2009, Chicago,
USA.
Nijmeijer RM, Zhernakova A, Bakker OJ, van Santvoort
HC, Boermeester MA, Gooszen HG, Akkermans LM,
Wijmenga C , van Erpecum KJ.
Genetic Variants of Farnesoid X Receptor (FXR)
Predispose to Mortality and Infectious Complications in
Acute Pancreatitis.
Digestive Disease Week (DDW), May 2009, Chicago,
USA.
Lips DJ, Liefers GJ, Smit VTHBM, van der Linden JC,
Pruijt HF, van de Velde CJH,
Bosscha K.
Behandeling van stadium I-II coloncarcinoom moet en
kan beter.
Medisch Contact 2010. Online 10 March 2010.
Lips DJ, Koning OHJ.
Een thoracale aortastenose als oorzaak voor een
verzameling aan symptomen.
Gamma Professional;oktober 2009.
30
4
DERMATOLOGIE
Erceg A, Greebe RJ, Bovenschen HJ, Seyger MM.
A Comparative Study of Pulsed 532-nm Potassium
Titanyl Phosphate Laser and Electrocoagulation in the
Treatment of Spider Nevi.
Dermatologic surgery 2010;36:630-635.
PMID: 20384753
Trefwoorden: KTP laser, spider naevi.
Kleinpenning MM, Langewouters AMG,
Kerkhof PCM van de, Greebe RJ.
Severe pyoderma gangraenosum unresponsive to
etanercept and adalimumab.
J Dermatolog Treat. 2010 Aug 1.
PMID: 20673157
Trefwoorden: Pyoderma gangraenosum, biologicals.
van der Meijden E, Janssens RW, Lauber C,
Bouwes Bavinck JN, Gorbalenya AE,
Feltkamp MC.
Discovery of a New Human Polyomavirus Associated
with Trichodysplasia Spinulosa in an
Immunocompromized Patient.
PLoS Pathog. 2010 Jul 29; 6(7): e1001024.
PMID: 20686659
Greebe RJ.
Voordracht: Praktische aspecten van
chemische peelings.
Nederlands Genootschap van Cosmetische Artsen,
Nieuwegein, 9 juni 2009.
Janssens RW.
Voordracht Huid en diabetes.
Diabetes vereninging Den Bosch,
2 december 2009.
dermatologie
31
Hoogeveen E, Broekman J, Janssens RW.
Induction of eruptive benign melanocytic nevi after
kidney transplantation.
Dermatologia Kliniczna 2009;11:29-30
de Bruin IJ, Janssens RW, Seyger MM.
Mijn kind heeft bulten onder de voeten!
Ned Tijdschr Dermatol Venereol 2009;19:23.
Van der Meijden E, Janssens RW, Lauber C, Bouwes
Bavinck JN, Gorbalenya AE,
et al. (2010)
Discovery of a New Human Polyomavirus Associated
with Trichodysplasia Spinulosa in an
PLoS Pathog 6(7): e1001024. doi:10.1371/journal.
ppat.1001024.
32
5
GERIATRIE
Knol W, Keijsers CJPW, Jansen PAF, van Marum RJ.
Systematic evaluation of rating scales for drug induced
parkinsonism.
J Clin Psychopharmacol. 2010; 30(1): 57-61
PMID: 20075649
Meulendijks D, Manesse CK, Jansen PAF,
van Marum RJ, Egberts ACG.
Antipsychotic-induced hyponatriemia: a systematic
review of published evidence.
Drug Safety. 2010; 33(2): 101-14.
PMID: 20082537
Mannesse CK, van Puijenbroek EP, Jansen PA,
van Marum RJ, Souverein PC, Egberts TC.
Hyponatremia as an adverse drug reaction of
antipsychotic drugs: a case-control study in VigiBase.
Drug Safety. 2010; 33(7): 569-78.
PMID: 20553058
van der Linden CMJ, Jansen PAF, van Marum RJ,
Grouls RJE, Egberts ACG, Korsten HHM.
Reasons for discontinuation of medication during
hospitalization and documentation thereof: a
descriptive study of 400 geriatric and internal
medicine patients.
Arch Int Med. 2010 Jun 28;170(12):1085-7.
PMID: 20585080
geriatrie
van der Linden CM, Jansen PA, van Marum RJ,
Grouls RJ, Korsten EH, Egberts AC.
Recurrence of adverse drug reactions following
inappropriate re-prescription: better documentation,
availability of information and monitoring are needed.
Drug Saf. 2010 Jul 1;33(7):535-8.
PMID: 20553055
Kröger E, van Marum RJ, Souverein P, Egberts TC.
Discontinuation of cholinesterase inhibitor treatment
and determinants thereof in the Netherlands: A
retrospective cohort study.
Drugs Aging. 2010 Aug 1;27(8):663-75.
PMID: 20658794
Kleijer BC, Heerdink R, Egberts ACG, Jansen PAF,
van Marum RJ.
Antipsychotic drug use and the risk of venous
thromboembolism in elderly patients.
J Clin Psychopharmacol. 2010; Oct;30(5):526-30.
PMID: 20814323
Spee J, van Marum RJ, Egberts ACG, Drenth van
Maanen AC, Jansen PAF.
The process of bringing medication in line: the
additional benefits of a Structured Medication History.
[Het Medicatie Afstemmingsproces op een afdeling
geriatrie: de aanvullende waarde van een
33
Gestructureerde Medicatie Anamnese.]
Ned Tijdschr v Geneesk. 2010; 154: A904
PMID: 20356426
Koebrugge B, van Wensen RJ, Bosscha K,
Dautzenberg PL, Koning OH.
Delirium after Emergency/Elective Open and
Endovascular Aortoiliac Surgery at a Surgical Ward
with a High-standard Delirium Care Protocol.
Vascular. 2010 Sep-Oct;18(5):279-87.
PMID: 20822723
Wouters CJ, Dautzenberg L, Thissen A,
Dautzenberg PL.
Oral galantamine versus rivastigmine transdermal
patch: a descriptive study at a memory clinic in The
Netherlands.
Tijdschr Gerontol Geriatr. 2010 Jun;41(3):146-50.
PMID: 20593742
Sleegers MJ, Beutler JJ, Hardon WJ, Berden JH,
Verhave JC, Conemans JM, Hollander DA,
Dautzenberg PL, Hoogeveen EK.
Reversible rapidly progressive dementia with
parkinsonism induced by valproate in a patient with
systemic lupus erythematosus.
J Am Geriatr Soc. 2010 Apr;58(4):799-801.
PMID: 20398172
Feitsma MT, van Laar T, Dautzenberg PL.
The possible value of diagnosing MCI-DLB and
treatment options.
Tijdschr Gerontol Geriatr. 2009 Sep;40(4):168-72.
PMID: 20088343
Dautzenberg PL, van der Zande JA, Conemans JM,
Rikkert MG.
Off-label drug use on a Dutch geriatric ward.
Int J Geriatr Psychiatry. 2009 Oct;24(10):1173-4.
PMID: 19771542
Nijboer H, Dautzenberg PL.
Progressive supranucleair palsy: acetylcholineeseraseinhibitor a possible therapy?
34
PMID: 19731749
Robben SH, Sleegers MJ, Dautzenberg PL,
van Bergen FS, ter Bruggen JP, Rikkert MG.
Pilot study of a three-step diagnostic pathway for
young and old patients with Parkinson’s disease
dementia: screen, test and then diagnose.
Int J Geriatr Psychiatry. 2010 Mar;25(3):258-65.
PMID: 19582760
Bergen FS van, Terbruggen JP, Rikkert MG.
Int J Geriatr Psychiatry. 2010 Mar;25(3):258-65
PMID: 19582760
Dautzenberg PL, Nijboer H, Wouters CJ.
A triage system for non-urgent ambulant frail elderly.
Tijdschr Gerontol Geriatr. 2009 Feb;40(1):24-8.
PMID: 19326699
Koebrugge B, Koek HL, van Wensen RJ,
Delirium after abdominal surgery at a surgical ward
with a high standard of delirium care: incidence, risk
factors and outcomes.
Dig Surg. 2009;26(1):63-8.
PMID: 19169032
Hermans E, van Schaik PM, Prins HA, Ernst MF,
Dautzenberg PJ, Bosscha K.
colon cancer.
J Oncol. 2010; 2010:865908.
PMID: 20628482
Keijsers CJ, Custers EJ, ten Cate OT.
A new, problem oriented medicine curriculum in
Utrecht: less basic science knowledge.
PMID: 19785897
van Marum RJ
Lezing: “Farmacokinetiek en –dynamiek bij ouderen”
Cursus farmacologie voor verpleeghuisartsen.
Nascholingsinstituut Gerion, VUMC, 9 april 2010.
van Marum RJ
Lezing “Farmacokinetiek en polyfarmacie bij ouderen”
Cursusdag landelijke ziekenhuisapothekers in opleiding.
Utrecht. 17 nov 2010.
van Marum RJ
Lezing: De oudere patient met onrust.
Boerhave nascholing: Diagnostische strategieën.
LUMC Leiden. 22 april 2010.
Kröger E, van Marum RJ, Souverein P, Carmichael PH,
Egberts T.
Treatment with Cholinesterase Inhibitors May Increase
the Risk of Urinary Incontinence.
26th International Conference on
Pharmacoepidemiology & Therapeutic Risk
Management. Hilton Brighton Metropole Brighton,
United Kingdom. August 19-22, 2010
van Marum RJ
Lezing Drug management & polyfarmacy. Uitwisseling
ouderengeneeskundigen UK en NL. Univ Maastricht.
19 mei 2010.
van Marum RJ
Lezing “CVA, medicatie en valkuilen” Symposium Got to
Move; bewegen en multimorbiditeit na een beroerte”.
Revalidatiecentrum trappenburg Huizen.
4 juni 2010.
van Marum RJ
Lezing “Samenwerking Health & Pharma”.
Congres Dynamisch Noordoost. Den Bosch.
6 okt. 2010.
van Marum RJ
Lezing “Polypharmacie; bezwaren en bijwerkingen van
medicatie bij kwetsbare ouderen” Congres Palliatieve
zorg aan de dementerende patiënt. Amersfoort.
8 okt 2010.
van Marum RJ
Lezing “Medicamenteuze behandelingen voor
dementie in de (nabije) toekomst: Hoop of wanhoop.”
Landelijke 9e geheugenpolidag. Ede.
14 okt 2010.
van Marum RJ
Workshop “Psychofarmaca bij dementie”
Landelijke 9e geheugenpolidag. Ede.
14 okt 2010.
geriatrie
Mannesse CK, Jansen PA, van Marum RJ, Sival RC,
Kok, Haffmans PM, Egberts TC. Hyponatremia in
elderly patients treated with antidepressant drugs: a
cross-sectional study on prevalence and clinical
characteristics.
Poster EUGMS Dublin 2010.
Van der Linden C, Jansen P, van Marum RJ, Grouls R,
Egberts T, Korsten E.
Improvement Of Pharmacovigilance At The Individual
Patient Level; An Electronic System To Document
Reasons For Medication Discontinuation And To Alert In
Case Of Unwanted Represcription.
Poster EUGMS Dublin 2010.
Van den Heuvel PM, Los M, van Marum RJ, Jansen PA.
Reasons of underprescribing in the elderly using
polypharmacy: balanced prescribing by general
practitioners.
Poster Geriatriedagen 2010; 11-12 feb
Drenth-van Maanen AC, van Marum RJ, Egberts AC,
Spee J, Jansen PA.
Het medicatie afstemmingsproces op een afdeling
geriatrie: de aanvullende waarde van een
gestructureerde medicatie anamnese.
Poster Geriatriedagen 2010; 11-12 feb
35
Dautzenberg PL.
Dementie ontmaskert.
De POH 2009;2 (vol 5):8-10.
Dautzenberg PL.
Antidementiemiddelen: hun huidige en toekomstige
therapeutische waarde.
In Bijblijven Tijdschrift Praktische
Huisartsengeneeskunde 2009-8:blz 40-9.
Thissen AJ, Bergen van F, Jonghe de JF, Kessels RP,
Dautzenberg PL.
Bruikbaarheid en validiteit van de Nederlandse versie
van de Montreal Cognitive Assesment (MoCA-D) bij het
diagnosticeren van Mild Cognitive Impairment.
TGG 2010;41:231-40.
Van Marum RJ
Antipsychotic drug use and the risk of developing
pneumonia.
Aging Health 2010; 6(5): 529-532.
Kleijer BC, van Marum RJ, Egberts ACG, Jansen PAF,
Knol W, Heerdink ER.
Risico op CVA bij ouderen die antipsychotica gebruiken.
Psyfar. 2010; 4: 20-24.
Kleijer BC, van Marum RJ, Egberts ACG, Jansen PAF,
Frijters DHM, Heerdink ER,
Ribbe MW.
Het beloop van gedragsproblemen bij oudere
verpleeghuispatiënten met dementie die worden
behandeld met antipsychotica.
Tijdschrift voor Ouderengeneeskunde
2010; 35 (2): 70-79.
Van Marum RJ.
Huidige en toekomstige therapieen voor de ziekte van
Alzheimer.
Tijdschrift voor Ouderengeneeskunde
2010; 35 (5): 172-9.
36
6
GYNAECOLOGIE
Consten D, de Bruin JP, Bots RS,
Hamilton CJ, Peeters MF.
In vitro maturation of human egg cells. Introduction of
a new artificial reproduction technique in the
Netherlands.
Ned Tijdschr Geneeskd. 2009 Jan 17;153(3):82-6.
PMID: 19235344
Brandes M, van der Steen JO, Bokdam SB,
Hamilton CJ, de Bruin JP, Nelen WL,
Kremer JA.
When and why do subfertile couples discontinue their
fertility care? A longitudinal cohort study in a
secondary care subfertility population.
Hum Reprod. 2009 Dec;24(12):3127-35. Epub 2009
Sep 26.
PMID: 19783833
Brandes M, Hamilton CJ, de Bruin JP, Nelen WL,
Kremer JA.
The relative contribution of IVF to the total ongoing
pregnancy rate in a subfertile cohort.
Hum Reprod. 2010 Jan;25(1):118-26.
Epub 2009 Oct 24.
PMID: 19855108
Brandes M, Hamilton CJ, Bergevoet KA,
de Bruin JP, Nelen WL, Kremer JA.
gynaecologie
Origin of multiple pregnancies in a subfertile
population.
Acta Obstet Gynecol Scand. 2010 Sep;89(9):1149-54.
PMID: 20804340
Penninx J, Brandes M, de Bruin JP,
Schneeberger PM, Hamilton CJ.
Prediction of pelvic pathology in subfertile women with
combined Chlamydia antibody and CA-125 tests.
Eur J Obstet Gynecol Reprod Biol. 2009
Dec;147(2):178-82. Epub 2009 Sep 5.
PMID: 19733956
Bensdorp AJ, Slappendel E, Koks C, Oosterhuis J, Hoek
A, Hompes P, Broekmans F, Verhoeve H, de Bruin JP,
van Weert JM, Traas M, Maas J, Beckers N, Repping S,
Mol BW, van der Veen F, van Wely M.
The INeS study: prevention of multiple pregnancies: a
randomised controlled trial comparing IUI COH versus
IVF e SET versus MNC IVF in couples with unexplained
or mild male subfertility.
BMC Womens Health. 2009 Dec 18;9:35.
PMID: 20021654
De Reu PA, van Diem MT, Eskes M, Oosterbaan HP,
Smits LJ, Merkus JM, Nijhuis JG.
The Dutch Perinatal Audit Project: a feasibility study for
nationwide perinatal audit in the Netherlands.
37
Acta Obstet Gynec Scand. 2009;88(11):1201-8.
PMID: 19900138
De Reu PA, Oosterbaan HP, Smits LJ, Nijhuis JG.
Avoidable mortality in small-for-gestational-age
children in the Netherlands. An analysis of 59
successive cases of perinatal death in singletons with
birth weights below the 10th centile. J Perinat Med.
2010 May;38(3):311-8.
PMID: 20121528
Westerhuis ME, Visser GH, Moons KG, van Beek E,
Benders MJ, Bijvoet SM, van Dessel HJ, Drogtrop AP, van
Geijn HP, Graziosi GC, Groenendaal F, van Lith JM, Nijhuis
JG, Oei SG, Oosterbaan HP, Porath MM, Rijnders RJ,
Schuitemaker NW, Sopacua LM, van der Tweel I,
Wijnberger LD, Willekes C, Zuithoff NP, Mol BW, Kwee A.
Cardiotocography plus ST-analysis of the fetal
electrocardiogram versus cardiotocography only for
intrapartum monitoring: a randomised controlled trial.
Obstet Gynecol. 2010 Jun;115(6):1173-80.
PMID: 20502287
Trefwoorden: perinatale sterfte, groeivertraging
Trefwoorden: foetale bewaking
Trefwoorden: perinatal audit, perinatale sterfte
Proefschriften
Oosterbaan HP: copromotor voor:
Promotie Dr. P.A.O.M. de Reu.
Perinatal Mortality in the Netherlands: Perinatal
audit and fetal biometry.
Universiteit Maastricht, 29 april 2010.
Hamilton CJ, de Bruin JP, Nelen WL, Kremer JA.
Voordracht: Wanneer en waarom stoppen patiënten
hun vruchtbaarheidsbehandeling.
Symposium Psychosociale begeleiding tijdens
vruchtbeerheidsbehandelingen. Organize Meeting
Schering Plough,
Zeist 27-3-2009.
Hamilton CJ.
GnRH antagonisten: “the JBZ experience”.
Workshop GnRH agonisten versus GnRH antagonsiten.
Houten 7-4-2009.
Schenk A. Hamilton CJ.
Impementatie GnRH antagonisten protocol in the kliniek.
Workshop GnRH agonisten versus GnRH antagonsiten.
Houten 7-4-2009.
38
Kremer JA.
Heeft IVF de belofte waargemaakt.
Ledenvergadering IVF-NVOG werkgroep. Utrecht,
17-4-2009.
Hamilton CJ, de Bruin JP, Nelen WL, Kremer JA.
Wanneer en waarom stoppen patiënten hun
vruchtbaarheidsbehandeling.
Symposium IVF Paramedical Nederland (IPN),
’s-Hertogenbosch, 21-4-2009.
Kremer JA.
Heeft IVF de belofte waargemaakt.
Symposium IVF Paramedical Nederland (IPN),
Brandes M, Hamilton CJ, de Bruin JP,
Nelen WL, Kremer JA.
The relative contribution of in vitro fertilisation to the
cumulative ongoing pregnancy rate in subfertile couples.
ESHRE, Amsterdam, oral presentation. 30-6-2009.
Human Reprod, volume 24 suppl 1, i71, 2009.
Hamilton CJ, Brandes M, Verzijden JC, de Weys NP,
Is the fertility treatment itself a risk factor for early
pregnancy loss?
Proceeding 26th annual meeting ESHRE, Rome,
27-30 juni 2010 P-138, p165.
Brandes M, Hamilton CJ, van der Steen JO,
de Bruin JP, Bots, RS, Nelen WL, Kremer JA.
Evaluatie van behandeltrajecten bij mannelijke
subfertiliteit in de dagelijkse praktijk
Vereniging voor fertiliteitsstudie, Tilburg, 20-11-2009.
Thys SD, Coolen AL, Martens IR, Oosterbaan HP,
Roovers JP, Mol BW, Bongers MY.
Long term recurrence rates following Manchester
Fothergill compared to vaginal hysterectomy for pelvic
organ prolapse.
IUAG, Como (It), 16-20 juni 2009.
Hamilton CJ
Wat weten we tot nu toe over Q koorts en
zwangerschap.
Refereeravond kinderartsen Catharina ziekenhuis,
Eindhoven, 18-5-2010.
Hamilton CJ
De Wording van een fertiliteitskliniek.
Ter gelegenheid van de uitreiking van het ISO
certificaat aan het centrum voor
voorplantigsgeneeskunde, JBZ ’s-Hertogenbosch,
21-6-2010.
Hamilton CJ.
25 jaar IVF Maastricht: de beginjaren.
UMC Maastricht, 24-9-2010.
Brandes M, Hamilton CJ, Verzijden JC, de Weys NP,
Miskramen en vruchtbaarheidsbehandelingen.
Symposium Jonge zwangerschap, Amsterdam
7-10-2010.
Brandes M, Hamilton CJ, van der Steen JO,
Bokdam SB, de Bruin JP, Nelen WL, Kremer JA.
Poster: When and why do subfertile couples drop out
from fertility care.
ESHRE Amsterdam, 2009.
Hum Reprod volume 24 suppl 1, i125, 2009
gynaecologie
Westerhuis MH, Kwee A, Zuithoff NP, van den Akker ES,
van Beek E, van Dessel HJ, Drogtrop AP, van Geijn HP,
Graziosi GC, van Lith JM, Nijhuis JG, Oei SG, Oosterbaan
HP, Porath MM, Rijnders RJ, Schuitemaker NW,
Wijnberger LD, Willekes C, Wouters MG,
Visser GH, Mol BW, Moons KG.
Poster: Prediction of neonatal metabolic acidosis in
women with a cephalic positioned singleton term fetus.
30th annual meeting - the pregnancy meeting - SMFM,
Chicago Illinois, USA, February 5th, 2010
Vijgen S, Westerhuis ME, van den Akker SA, van Beek E,
Bolte AC, van Dessel HJ, Drogtrop AP, van Geijn HP,
Graziosi GC, van Lith JM, Nijhuis JG, Oei SG, Oosterbaan
HP, Opmeer BC, Porath MM, Rijnders RJ, Schuitemaker
NW, Willekes C, Visser GH, Mol BW, Moons KG.
Poster: Cost-effectiveness of cardiotocography plus
ST-analysis of the fetal electrocardiogram compared to
cardiotocography only in the prevention of cerebral palsy:
preliminary results.
30th annual meeting - the pregnancy meeting - SMFM,
Chicago Illinois, USA, February 5th, 2010.
Gaugler-Senden IP, Duivenvoorden HJ, Filius A,
de Groot CJ, Steegers EA, Passchier J.
Poster: Long term maternal psychosocial effects
after severe, early onset preeclampsia
56th annual scientific meeting of the Society of
Gynecologic Investigation, Glasgow UK,
18-21 maart 2009.
39
Oosterbaan HP.
Gynaecologie. Bijeenkomst voor eerstelijns
zorgverleners ter gelegenheid opening polikliniek
Nieuwkuijk, Nieuwkuijk. 19 maart 2009.
Oosterbaan HP.
Zorgpad verloskundige zorg en geboorteplan.
VSV, Den Bosch, 25 mei 2010.
Oosterbaan HP.
Hormoon Substitutie Therapie.
FTO Vught, 6 april 2009.
Oosterbaan HP.
Massive Obstetric Haemorrhage.
Managing Obstetric Emergencies & Trauma Course
(MOET), Riel, 11 juni 2010.
Oosterbaan HP.
Resuscitation and peri-mortem caesarean section.
MOET course, Riel, 17 september 2009.
Oosterbaan HP.
Herpes genitalis en zwangerschap.
VSV, Den Bosch, 28 september 2010.
Oosterbaan HP.
Massive Obstetric Haemorrhage.
MOET course, Riel, 18 september 2009,
Kerkhof MH
Blijft de generalist bestaan?
Voordracht Domus Medica opleiders gynaecologie, mei
2009
Oosterbaan HP.
Zin en onzin over de pil – een update.
Masterclass Gynaecologie, Soestduinen,
Kerkhof MH
Vulva pathologie
Voordracht kaderopleiding huisartsen, september 2009
Brandes M, Hamilton CJ, Bergevoet KA,
Prevalentie van meerlingen ten gevolge van
vruchtbaarheidsbehandelingen.
Ned Tijdschr Obstet Gynaecol. 122:239-243, 2009
FJ, Kwee A, Schuitemaker NW, Mol BW, van Rhenen DJ,
Duvekot JJ.
Well being of Obstetric patients on Minimal Blood
transfusions (WOMB trial).
BMC Pregnancy Childbirth. 2010 Dec 16;10(1):83.
Ennink TA, Hamilton CJ, Kemperman FA.
Heeft behandeling van subklinische hypothyroidie bij
zwangere vrouwen een positief effect op de
neurologische ontwikkeling van het kind.
Ned Tijdschr Obstet Gynaecol 2010, 123:47-48
Westerhuis ME, Visser GH, Moons KG, van Beek E,
Benders MJ, Bijvoet SM, van Dessel HJ, Drogtrop AP,
van Geijn HP, Graziosi GC, Groenendaal F, van Lith JM,
Nijhuis JG, Oei SG, Oosterbaan HP, Porath MM,
Rijnders RJ, Schuitemaker NW, Sopacua LM, van der
Tweel I, Wijnberger LD, Willekes C, Zuithoff NP, Mol BW,
Kwee A.
Cardiotocography plus ST analysis of fetal
electrocardiogram compared with cardiotocography
only for intrapartum monitoring: a randomized
controlled trial.
Prick BW, Steegers EA, Jansen AJ, Hop WC, Essink-Bot
ML, Peters NC, Uyl-de Groot CA, Papatsonis DN,
Akerboom BM, Metz GC, Bremer HA, van Loon AJ,
Stigter RH, van der Post JA, van Alphen M, Porath M,
Rijnders RJ, Spaanderman ME, Schippers DH,
Bloemenkamp KW, Boers KE, Scheepers HC, Roumen
40
Kaandorp JJ, Benders MJ, Rademaker CM, Torrance
HL, Oudijk MA, de Haan TR, Bloemenkamp KW, Rijken
M, van Pampus MG, Bos AF, Porath MM, Oetomo SB,
Willekes C, Gavilanes AW, Wouters MG, van Elburg RM,
Huisjes AJ, Bakker SC, van Meir CA, von Lindern J,
Boon J, de Boer IP, Rijnders RJ, Jacobs CJ, Uiterwaal
CS, Mol BW, Visser GH, van Bel F, Derks JB.
Antenatal allopurinol for reduction of birth asphyxia
induced brain damage (ALLO-Trial); a randomized
double blind placebo controlled multicenter study.
BMC Pregnancy Childbirth. 2010 Feb 18;10:8.
Kooper AJ, Faas BH, Feuth T, Creemers JW, Zondervan
HH, Boekkooi PF, Quartero RW, Rijnders RJ,
van der Burgt I, van Kessel AG, Smits AP.
Detection of chromosome aneuploidies in chorionic
villus samples by multiplex ligation-dependent probe
amplification.
J Mol Diagn. 2009 Jan;11(1):17-24.
Kerkhof MH
2 ingezonden brieven: “een beetje tijd” en “solliciteren”.
Medisch Contact 24-9-2010
Kerkhof MH
1 praktijkperikel: “zwanger bij IQ < 50.
Medisch Contact 24-9-2010
gynaecologie
41
42
7
INTENSIVE CARE
GENEESKUNDE
Van Kuilenburg JT, van Niekerk J, Sinnige H,
de Jager CP.
A woman with a swollen neck.
Neth J Med. 2009 Oct;67(9):308-9.
PMID: 19841489
de Jager CP, Rutten MJ.
Embolization as treatment of choice for bleeding
peptic ulcers in high-risk patients.
Dig Surg. 2009;26(1):37-42.
PMID: 19155626
De Wit NC, de Jager CP, Meekelenkamp JC, Schoorl M,
van Gageldonk-Lafeber AB, Leenders AC, Kusters R,
Wever PC.
Markers of infection in inpatients and outpatients with
acute Q-fever.
Clin Chem Lab Med. 2009;47(11):1407-9.
PMID: 19778289
Van de Veerdonk FL, de Jager CP, Schellekens JJ,
Huijsmans CJ, Beaumont F, Hermans MH, Wever PC.
Legionella pneumophila DNA in serum samples during
Legionnaires’ disease in relation to C-reactive protein
levels.
Eur J Clin Microbiol Infect Dis. 2009 Apr;28(4):371-6.
PMID: 18855027
De Jager CP, de Wit NC, Weers-Pothoff G,
van der Poll T, Wever PC.
Procalcitonin kinetics in Legionella pneumophila
pneumonia.
Clin Microbiol Infect. 2009 Nov;15(11):1020-5.
PMID: 19438643
Rozendaal FW, Spronk PE, Snellen FF, Schoen A,
van Zanten AR, Foudraine NA, Mulder PG, Bakker J;
UltiSAFE investigators.
Remifentanil-propofol analgo-sedation shortens
duration of ventilation and length of ICU stay
compared to a conventional regimen: a centre
randomised, cross-over, open-label study in the
Netherlands.
Intensive Care Med. 2009 Feb;35(2):291-8.
PMID: 18949456
Van Vugt R, Bosscha K, Olsman J, and Jager GJ,
de Jager CP.
PMID: 19341194
Van Vugt R, Bosscha K, van Munster IP,
intensive care geneeskunde
de Jager CP, van Wijk PT, Mathoera RB,
de Jongh-Leuvenink J, van der Poll T, Wever PC.
Lymphocytopenia and neutrophil-lymphocyte count
ratio predict bacteremia better than conventional
43
infection markers in an emergency care unit.
Crit Care. 2010;14(5):R192.
PMID: 21034463
Simons KS, Pickkers PP, Oyen WJG van der Hoeven JG.
F-18-fluorodeoxyglucose positron emission
tomography combined with CT in critically ill patients
with suspected of infection.
Intensive Care Med. 2010 Mar;36(3):504-11.
PMID: 19847397
Bisschops LL, Hoedemaekers CW, Simons KS,
van der Hoeven JG.
Preserved metabolic coupling and cerebrovascular
reactivity during mild hypothermia after cardiac arrest.
Crit Care Med. 2010 Jul;38(7):1542-7.
PMID: 20453643
Poster: Procalciton Kinetics in Legionella
pneumophila pneumonia.
Intensivisten dagen 2009.
Laheij R, de Jager CP, Markese M, van der Spoel JL,
van Oijen M.
Poster: The consequences of large gastric volumes
after start of enteral feeding in critically ill patients.
GASTRO Londen, 2009.
De Jager CP.
Voordracht: Predictive value of procalcitonin in
legionella infections.
Procalcitonin in the ICU- to do or not to do?
Symposium Brahm, Utrecht, 2009.
Bisschops L, Hoedemaekers CW, Simons K,
van der Hoeven JG.
Abstract: Cerebrovascular reactivity during
hypothermia after cardiac arrest.
Annual congress of Dutch Intensive Care Society, Ede
2009.
De Jager CP.
Thema conferentie VMS: vroege herkenning en
behandeling van de vitaal bedreigde patiënt,
Domus Medica, Dagvoorzitter 2009.
De Jager CP.
Poster: Increased unplanned extubations after
implmentation of analgosedation.
European Society of Intensive Care Medicine,
Barcelona, oktober 2010.
44
Bisschops L, Hoedemaekers CW, Simons K, van der
Hoeven JG.
Abstract: Cerebral blood flow in hypothermic and
normothermic patients after cardiac arrest.
Annual congress of Dutch Intensive Care Society, Ede,
2009.
De Jager CP.
Voordracht: Dynamisch licht op de Intensive Care.
Health to Business club JBZ Philips Eindhoven,
november 2010.
Veeken S, de Jager CP.
Een nieuw volkslied; ritmestoornissen en
pericardvocht als eerste uitingen van een primair
cardiaal non-hodgkin lymfoom.
Lunchbespreking Intensive Care, maart 2009.
Baten A, Rozendaal FW, de Jager CP.
The X-factor; pulmonale actinomycose bij een
immuungecompromiteerde patiënte.
Lunchbespreking Intensive Care, februari 2009.
Van Gulik J, van Dorsten F, de Jager CP.
Yellow Submarine; over fulminant leverfalen.
Lunchbespreking Intensive Care, mei 2009.
Evers J, Rozendaal FW, de Jager CP.
Centrale pontine myelinolyse door een te snelle
natriumcorrectie.
Lunchbespreking Intensive Care, januari 2009.
De Jager CP.
Invasieve Aspergillose.
Lunchbespreking intensive care, 2009.
De Jager CP.
Thuis opgelopen longontsteking.
De Jager CP.
De gevolgen van maagretentie voor de IC-patient.
De Jager CP.
Het voorschrijven en stoppen van antibiotica op geleide
van het procalcitonine.
Paling AJ
Voordracht: Ervaring met GHB-onttrekking op IC.
Opening GHB-monitor NISPA, Nijmegen, november
2010.
Salet GA, Lammers JL, Korst MB, Beaumont F,
Rozendaal FW, de Jager CP. Percutaneous mechanical
thrombectomy in recurrent massive pulmonary embolism.
Netherlands Journal of Critical Care, volume 14, no 6,
december 2010.
De Groot AC, van Meurs T, de Jager CP, Bosma J,
Wever PC, Stoof TJ. Necrotiserende fasciitis: kliniek,
diagnostiek en behandeling.
Nederlands tijdschrift voor dermatologie en venerologie,
volume 19, nummer 3, maart 2009.
De Groot AC, van Meurs T, de Jager CP,
Bosma J, Wever PC.
Necrotiserende fasciitis: casuïstiek.
Nederlands Tijdschrift voor dermatologie
en venerologie, 2009.
intensive care geneeskunde
Lips DJ, van Leuken M, de Jager CP.
“Goedaardig” vena cava superior syndroom, bijzondere
ziektebeelden op de intensive care. Cura, april 2009.
De Jager CP, van Leuken M, Wever PC.
Phelephlebitis; septische tromboflebitis van de poortader
en mesenteriaal vaten, bijzondere ziektebeelden op de
intensive care.
Cura, juli 2009.
Van Kuilenburg JT, Wever PC, de Jager CP.
Morbus strangularis, bijzondere ziektebeelden op de
intensive care. Cura, december 2009.
45
46
8
INTERNE GENEESKUNDE
Herbers AH, Verbruggen B, Van de Veerdonk F,
Van Kraaij M, Blijlevens NM, Novakova IR.
Misleading one-stage coagulation factor assay during
rFVIIa treatment in lupus patient. Haemophilia. 2009
Sep;15(5):1164-6.
PMID: 19601985
Van der Velden WJ, Herbers AH, Blijlevens NM.
Palifermin in allogeneic HSCT: many questions remain.
Bone Marrow Transplant. 2009 Jan;43(1):85-6.
PMID: 18762763
van Poppel PC, Stehouwer CD, Beutler JJ, Korst MB,
Beerlage HP, Hoogeveen EK. Hyperchloremic
metabolic acidosis in a patient with an
ureteroileostomy according to Bricker.
Ned Tijdschr Geneeskd. 2009 May 23;153(21):1024-8.
PMID: 19757757
van Poppel PC, Stehouwer CD, Beutler JJ, Korst MB,
Ned Tijdschr Geneeskd. 2009;153:B317. Dutch.
PMID: 19785899
Anderwald C, Ankersmit HJ, Badaoui A, Beneduce L,
Buko VU, Calo LA, Carrero JJ, Chang C-Y, Chang K-C,
interne geneeskunde
Chen Y-J, Cnotliwy M, Costelli P, Crujeiras AB, Cuocolo
A, Davis PA, de Boer OJ, Ebenbichler CF, Erridge C,
Fassina G, Felix SB, García-Gomez MC, GuerreroRomero F, Haider DG, HeinemannA, Herda LR,
Hoogeveen EK, Hörl WH, Iglseder B, Huang K-C,
Kaser S, Kastrati A, Kuzniatsova N, Latella G,
Lichtenauer M, Lin Y-K, Lip GYH, Lu N-H, Lukivskaya
O, Luschnig P, Maniscalco M, Martinez JA, MüllerKrebs S, Ndrepepa G, Nicolaou G, Peck-Radosavljevic
M, Penna F, Pinto X, Reiberger T, Rodriguez-Moran M,
Schmidt A, Schwenger V, Spinelli L, Starkel P,
Stehouwer CDA, Stenvinkel P, Strasser P, Suzuki H,
Tschoner A, van der Wal AC, Vesely DL, Wen C-J,
Wiernicki I, Zanninelli G and Zhu Y.
Research update for articles published in EJCI in 2008.
Eur J Clin Invest. 2010; 40: 770-790.
PMID: 20698878
Hoogeveen EK, Stehouwer CD.
Exclusion of a case-control study from meta-analysis.
Mayo Clin Proc. 2009; 84: 561.
PMID: 19483176
Sleegers MJ, Beutler JJ, Hardon W, Berden JH,
Hollander DA, Dautzenberg PL, Hoogeveen EK.
Reversible rapidly progressive dementia induced by
valproate in a patient with systemic lupus
erythematosus.
47
J Am Geriatr Soc. 2010; 58: 799-801.
PMID: 20398172
van der Horn G, Ranschaert ER, Dubelaar IJ,
van Munster IP.
An adult with vague abdominal complaints and atypical
colonoscopic findings.
Neth J Med. 2010 Aug;68(1):324-7.
No abstract available.
PMID: 20739731
Van Rossum LG, van Rijn AF, van Munster
IP, Jansen JB, Fockens P, Laheij RJ,
Dekker E.
Earlier stages of colorectal cancer detected with
immunochemical faecal occult blood tests.
Neth J Med. 2009 May;67(5):182-6.
PMID: 19581668
Van den Broek FJ, de Graaf EJ, Dijkgraaf MG,
Reitsma JB, Haringsma J, Timmer R,
Weusten BL, Gerhards MF, Consten EC, Schwartz MP,
Boom MJ, Derksen EJ, Bijnen AB, Davids PH, Hoff C,
van Dullemen HM, Heine GD, van der Linde K,
Jansen JM, Mallant-Hent RC, Breumelhof R, Geldof H,
Hardwick JC, Doornebosch PG, Depla AC,
Ernst MF, van Munster IP, de Hingh IH, Schoon EJ,
Bemelman WA, Fockens P, Dekker E.
Transanal endoscopic microsurgery versus endoscopic
mucosal resection for large rectal adenomas (TRENDstudy).
BMC Surg. 2009 Mar 13;9:4.
PMID: 19284647
Kuiper EM, Hansen BE, de Vries RA,
den Ouden-Muller JW, van Ditzhuijsen TJ,
Haagsma EB, Houben MH, Witteman BJ,
van Erpecum KJ, van Buuren HR;
Dutch PBC Study Group.
Improved prognosis of patients with primary biliary
cirrhosis that have a biochemical response to
ursodeoxycholic acid.
Gastroenterology. 2009 Apr;136(4):1281-7.
PMID: 19208346
48
van Vugt R, Bosscha K, van Munster IP, de Jager CP,
Rutten MJ.
Embolization as treatment of choice for bleeding peptic
ulcers in high-risk patients.
Dig Surg. 2009;26(1):37-42.
PMID: 19155626
Penne EL, van der Weerd NC, van den Dorpel MA,
Grooteman MP, Lévesque R, Nubé MJ, Bots ML,
Blankestijn PJ, ter Wee PM; CONTRAST Investigators
(Hoogeveen EK).
Short-term effects of online hemodiafiltration on
phosphate control: a result from the randomized
controlled Convective Transport Study (CONTRAST).
Am J Kidney Dis. 2010 Jan;55(1):77-87.
PMID: 19962805
Penne EL, van der Weerd NC, Blankestijn PJ, van den
Dorpel MA, Grooteman MP, Nubé MJ, Ter Wee PM,
Lévesque R, Bots ML; CONTRAST investigators.
(Hoogeveen EK).
Role of residual kidney function and convective volume
on change in beta2-microglobulin levels in
hemodiafiltration patients.
Clin J Am Soc Nephrol. 2010;5:80-86.
PMID: 19965537
van Kuilenburg JT, van Niekerk J, Sinnige H, de Jager CP.
Neth J Med. 2009 Oct;67(9):308-9.
PMID: 19841489
Bax L, Mali WP, Beutler JJ.
Stenting in patients with atherosclerotic renal artery
stenosis
PMID: 20619027
Bax L, Woittiez AJ, Kouwenberg HJ, Mali WP, Buskens E,
Beek FJ, Braam B, Huysmans FT, Schultze Kool LJ,
Rutten MJ, Doorenbos CJ, Aarts JC, Rabelink TJ, Plouin
PF, Raynaud A, van Montfrans GA, Reekers JA, van den
Meiracker AH, Pattynama PM, van de Ven PJ,
Vroegindeweij D, Kroon AA, de Haan MW, Postma CT,
Beutler JJ.
Stent placement in patients with atherosclerotic renal
artery stenosis and impaired renal function: a
randomized trial.
Ann Intern Med. 2009 Jun
16;150(12):840-8, W150-1.
PMID: 19414832
Boquoi A, Jover R, Chen T, Pennings M,
Enders GH.
Transgenic expression of VEGF in intestinal epithelium
drives mesenchymal cell interactions and epithelial
neoplasia.
Gastroenterology 2009; 136:596-606.
PMID: 19056388
De Mast Q, Beutler JJ.
The prevalence of atherosclerotic renal artery stenosis
in risk groups: a systematic literature review.
J Hypertens. 2009 Jul;27(7):1333-40.
PMID: 19365285
van Schaik PM, Hermans E, van der Linden JC,
Pruijt JF, Ernst MF, Bosscha K.
Micrometastases in stages I and II colon cancer are a
predictor of the development of distant
metastases and worse disease-free survival.
Eur J Surg Oncol 2009; May;35(5):492-6.
PMID: 18775627
Fellström BC, Jardine AG, Schmieder RE, Holdaas H,
Bannister K, Beutler J, Chae DW, Chevaile A, Cobbe
SM, Grönhagen-Riska C, De Lima JJ, Lins R, Mayer G,
McMahon AW, Parving HH, Remuzzi G, Samuelsson O,
Sonkodi S, Sci D, Süleymanlar G, Tsakiris D, Tesar V,
Todorov V, Wiecek A, Wüthrich RP, Gottlow M, Johnsson
E, Zannad F; AURORA Study Group.
Rosuvastatin and cardiovascular events in patients
undergoing hemodialysis.
N Engl J Med. 2009 Apr 2;360(14):1395-407.
PMID: 19332456
Van Dijk S, Scharloo M, Kaptein AA, Thong MS,
Boeschoten EW, Grootendorst DC, Krediet RT, Dekker
FW; NECOSAD Study Group, Apperloo AJ, Bijlsma JA,
Boekhout M, Boer WH, van der Boog PJ, Büller HR, van
Buren M, de Charro FT, Doorenbos CJ, van den Dorpel
MA, van Es A, Fagel WJ, Feith GW, de Fijter CW, Frenken
LA, van Geelen JA, Gerlag PG, Grave W, Gorgels JP,
Huisman RM, Jager KJ, Jie K, Koning-Mulder WA,
Koolen MI, Hovinga TK, Lavrijssen AT, Luik AJ, van der
Meulen J, Parlevliet KJ, Raasveld MH, van der Sande
FM, Schonck MJ, Schuurmans MM, Siegert CE,
Stegeman CA, Stevens P, Thijssen JG, Valentijn RM,
Vastenburg GH, Verburgh CA, Vincent HH, Vos PF.
Patients’ representations of their end-stage renal
disease: relation with mortality.
Nephrol Dial Transplant 2009 Oct;24(10):3183-5.
PMID: 19383834
interne geneeskunde
Dassen AE, Lips DJ, Hoekstra CJ, Pruijt JF, Bosscha K.
FDG-PET has no definite role in pre-operative imaging
in gastric cancer.
Eur J Surg Oncol 2009;May;35(5):449-55.
PMID: 19147324
van Steenbergen LN, Rutten HJ, Creemers GJ,
Pruijt JF, Coebergh JW, Lemmens VE.
Large age and hospital-dependent variation in
administration of adjuvant chemotherapy for stage III
colon cancer in southern Netherlands.
Ann Oncol. 2010 Jun;21(6):1273-8.
PMID: 19880434
van Herk-Sukel MP, van de Pll-Franse LV, Lemmens VE,
Vreugdenhil G, Pruijt JF, Coebergh JW, Herings RM.
New opportunities for drug outcomes research in
cancer patients: The linkage of the Eindhoven Cancer
Registry and the PHARMO Record Linkage System.
Eur J Cancer 2010;46:395-404.
PMID: 19811904
Berger LP, Scheffer RC, Weusten BL, Seldenrijk CA,
de Bruin PC, Timmer R, Stolk MF.
The additional value of EUS-guided Tru-cut biopsy to
EUS-guided FNA in patients with mediastinal lesions.
Gastrointest Endosc. 2009 May;69(6):1045-51.
PMID: 19249038
49
Frankhuisen R, Van Herwaarden MA, Scheffer RC,
Hebbard GS, Gooszen HG, Samsom M.
Increased intragastric pressure gradients are involved
in the occurrence of acid reflux in gastroesophageal
reflux disease.
Scand J Gastroenterol. 2009;44(5):545-50.
PMID:19191069
Krediet RT, Smit W, Coester AM, Struijk DG.
Dry body weight and ultrafiltration targets in
peritoneal dialysis.
Contrib Nephrol. 2009;163:90-5.
PMID: 19494600
Krediet RT, Sampimon DE, Vlijm A, Coester AM,
Struijk DG, Smit W.
Biological markers in the peritoneal dialysate effluent:
are they useful.
PMID: 19494595
Coester AM, Smit W, Struijk DG, Krediet RT.
Fluid transport with time on peritoneal dialysis: the
contribution of free water transport and solute coupled
water transport.
PMID: 19494591
Peritoneal function in clinical practice: the
importance of follow-up and its measurement in
patients. Recommendations for patient
information and measurement of peritoneal
function.
NDT Plus. 2009 Apr;2(2):104-110.
PMID: 19461865
Dorresteijn MJ, Visser T, Cox LA, Bouw MP, Pillay J,
Koenderman AH, Strengers PF, Leenen LP, van der
Hoeven JG, Koenderman L, Pickkers P.
C1-esterase inhibitor attenuates the inflammatory
response during human endotoxemia.
Crit Care Med. 2010 Nov;38(11):2139-45.
PMID: 20693886
50
Draisma A, Dorresteijn MJ, Bouw MP,
van der Hoeven JG, Pickkers P.
The role of cytokines and inducible nitric oxide
synthase in endotoxemia-induced endothelial
dysfunction.
J Cardiovasc Pharmacol. 2010
Jun;55(6):595-600.
PMID: 20224425
Dorresteijn MJ, Draisma A, van der Hoeven JG,
Pickkers P.
Lipopolysaccharide-stimulated whole blood cytokine
production does not predict the inflammatory response
in human endotoxemia.
Innate Immun. 2010 Aug;16(4):248-53.
PMID: 19710091
Boerjan M, Bluyssen SJ, Bleichrodt RP,
van Weel-Baumgarten EM, van Goor H.
Work-related health complaints in surgical residents
and the influence of social support and job-related
autonomy.
Med Educ. 2010 Aug;44(8):835-44.
PMID: 20633223
Trefwoorden: Opleidingsklimaat, arts-assistent.
Clement DS, Postma G, Rothova A, Grutters JC,
Prokop M, de Jong PA.
Intraocular sarcoidosis: association of clinical
characteristics of uveitis with positive chest highresolution computed tomography findings.
British journal of Ophthalmology 2010
Feb;94(2):219-22
PMID 19713200
Esselink AC, de Ruijter AM, Daniels MC.
Application of NHG guidelines in patients referred for
stable chest pain syndromes.
Neth Heart J 2010; 18:178-82
PMID 20428415
Scheffer RC, Bredenoord AJ, Hebbard GS, Smout AJ,
Samsom M.
Effect of proximal gastric volume on hiatal hernia.
Neurogastroenterol Motil. 2010
May;22(5):552-6, e120.
PMID: 20105278
Wijermans P, Schaafsma M, Termorshuizen F,
Ammerlaan R, Wittebol S, Sinnige H, Zweegman S,
van Marwijk Kooy M, van der Griend R, Lokhorst H,
Sonneveld P; Dutch-Belgium Cooperative Group
HOVON.
Phase III study of the value of thalidomide added to
melphalan plus prednisone in elderly patients with newly
diagnosed multiple myeloma: the HOVON 49 Study.
J Clin Oncol. 2010 ; 28 (19) :3160-6.
PMID: 20516439
Labar B, Suciu S, Willemze R, Muus P, Marie JP, Fillet
G, Berneman Z, Jaksic B, Feremans W, Bron D,
Sinnige H, Mistrik M, Vreugdenhil G, de Bock R, Nemet
D, Gilotay C, Amadori S, De Witte T; on behalf of the
EORTC Leukemia Group.
Dexamethasone versus prednisolone for adult acute
lymphoblastic leukemia (ALL) and lymphoblastic
lymphoma LBL) patients - final results of the ALL-4
randomized, Phase III trial of the EORTC Leukemia Group.
Haematologica 2010; 95(9):1489-95.
PMID: 20378563
Lokhorst HM, van der Holt B, Zweegman S, Vellenga E,
Croockewit S, van Oers MH, von dem Borne P,
Wijermans P, Schaafsma R, de Weerdt O, Wittebol S,
Delforge M, Berenschot H, Bos GM, Jie KS, Sinnige H,
van Marwijk-Kooy M, Joosten P, Minnema MC, van
Ammerlaan R, Sonneveld P; Dutch-Belgian HematoOncology Group (HOVON).
A randomized phase 3 study on the effect of
thalidomide combined with adriamycin,
dexamethasone, and high-dose melphalan, followed by
thalidomide maintenance in patients with multiple
myeloma.
Blood. 2010 Feb 11;115(6):1113-20.
PMID: 19880501
Tielemans MM, Eikendal T, Jansen JB,
van Oijen MG.
interne geneeskunde
Identification of NSAID users at risk for
gastrointestinal complications: a systematic
review of current guidelines and consensus
agreements.
Drug Saf. 2010 Jun 1;33(6):443-53.
PMID: 20486727
Kuiper EM, Hansen BE, De Vries RA, Den OudenMuller JW, Van Ditzhuijsen ThJ, Haagsma EB et al.
Improved diagnosis of patients with PBC that have a
biochemical response to ursodeoxycholic acid.
PMID 19208346
Ramakers BP, Pickkers P.
Adenosine-mediated attenuation of the innate
immune response for only those who need it?
The tailored potential of pentoxifylline.
Shock. 2010 Jul;34(1):105-6.
PMID: 20016402
Van den Boogaard M, Ramakers BP, van Alfen N, van
der Werf SP, Fick WF, Hoedemaekers CW, Verbeek MM,
Schoonhoven L, van der Hoeven JG, Pickkers P.
Endotoxemia-induced inflammation and the effect on
the human brain.
Crit Care. 2010;14(3):R81.
PMID: 20444270
Pillay J, Ramakers BP, Kamp VM, Loi AL, Lam SW,
Hietbrink F, Leenen LP, Tool AT, Pickkers P,
Koenderman L.
Functional heterogeneity and differential priming of
circulating neutrophils in human experimental
endotoxemia.
J Leukoc Biol. 2010 Jul;88(1):211-20.
PMID: 20400675
Herbers AHE, Feuth T, Donnelly JP, Blijlevens NM.
Citrulline-based assessment score: first choice for
measuring and monitoring intestinal failure after
high-dose chemotherapy.
Ann Oncol.2010 Aug;21(8):1706-11.
PMID: 20089560
51
Tieleman AA, Knoop H, van de Logt AE, Bleijenberg G,
van Engelen BG, Overeem S.
Poor sleep quality and fatigue but no excessive daytime
sleepiness in myotonic dystrophy type 2.
J Neurol Neurosurg Psychiatry. 2010 Sep;81(9):963-7.
PMID: 20798200
Tieleman AA, den Broeder AA, van de Logt AE,
van Engelen BG.
Strong association between myotonic dystrophy type 2
and autoimmune diseases.
J Neurol Neurosurg Psychiatry. 2009
Nov;80(11):1293-5.
PMID: 19864666
Boeken
Herbers AH, De Pauw P.
Managing infections in patients with acute leukemia and
febrile neutropenia. Managing Infections in Patients with
Hematological Malignancies. Edited by Michael
Kleinberg. New York, NY, United States: Humana Press
- Springer New York, 2010. ISBN: 978-1-58829-986-4.
Bons E, Herbers AH, van der Velden WJ.
Voordracht: Two cases of pneumocystis jirovecii
pneumonia during R-CHOP-14 for non-Hodgkin
lymphoma.
NIV dagen april 2009.
Herbers AH, Donnelly JP, Blijlevens NM.
Poster: Influence of rKGF on intestinal mucosal damage
measured by citrulline in autologous haematopoietic
stem cell transplant recipients treated after BEAM: a
safety and efficacy study.
EBMT maart 2010.
erythematosus.
Supplement Neth J Med. Abstractbook, 21e
internistendagen, 2009, A75. (NIV award: best
abstract/presentation)
Dieker H, Dorresteijn MJ, Hoogeveen EK,
Hollander AA.
The wolf and the white raven: diffuse alveolar
hemorrhage in SLE.
internistendagen, 2009, A46. (NIV award: best
abstract/presentation)
Kampschreur LM, Hoogeveen EK, Beutler JJ, Akker
Ocak G, Halbesma N, le Cessie S, Hoogeveen EK,
op den JW, Beems T, Seveaux de RG. A haemodialysis
patient with back pain.
internistendagen, 2009, A245.
van Dijk S, Kooman J, Dekker FW, Krediet RT,
Boeschoten EW, Verduijn M.
Hemodialysis catheters increase mortality as compared
to shunts especially in elderly patients. American
Society of Nephrology, Denver, USA, November 2010.
Sleegers MJ, Beutler JJ, Hardon W, Berden JH,
Dautzenberg PL, Hoogeveen EK.
Reversible cognitive and gait impairment induced by
valproate in a patient treated for systemic lupus
52
Hoogeveen EK, de Mutsert R, Halbesma N, Dekker FW,
Boeschoten EW for the Netherlands Cooperative Study
on the Adequacy of Dialysis-2 (NECOSAD) Study Group.
Obesity is a risk factor for mortality, especially among
younger dialysis patients.
American Society of Nephrology, Denver, USA, 18
november 2010.
Kemperman FA.
Androgeen deprivatie: effecten buiten de prostaat.
Regionale refereeravond urologie JBZ,
’s-Hertogenbosch, februari 2010.
van der Hilst JC, Kemperman FA.
Abstract: Myxoma cordis: a rare cause of fever of
unknown origin.
Abstractboek NIV 21e Internistendagen 2009; blz.
123: abstractnr. 232.
PICO Bello – Heeft behandeling van subklinische
hypothyreoïdie bij zwangere vrouwen een positief
effect op de neurologische ontwikkeling van het kind.
Ned Tijdschr Obstr Gyn 2010 Feb; 121(2):
blz 23-25.
Boerjan M, Liem S, Renders N, Lestrade P,
Bouter KP.
Q-fever endocarditis: a diagnosis easily missed with
serious consequences.
Abstractenboek NIV (internistendagen): Infectious
diseases Case reports.
Lips DL, Koebrugge B, Liefers GJ, Putter H, Smit V, van
der Linden JC, Pruijt HF, van de Velde CJH, Bosscha K.
The role of micro-metastases on prognosis and
survival in stage I-II colon cancer patients- the
EnRoute+ study.
Abstr. Nr. 324 ESSO 2010 Bordeaux
Jansen HJ, Pruijt JFM, de Jongh-Leuvenink J,
Bouter KP, Lestrade P.
Multiple hemoglobinopathies and glucose-6phosphate dehydrogenase deficiency in a patient with
diabetes mellitus de novo: usefulness of glycosylated
haemoglobin levels?
Internistendagen, Maastricht, april 2009.
Farré R, Blondeau K, Clement D, Vicario M, Cardozo L,
Vieth M, Mertens V, Pauwels A, Jimenez M, Tack J,
Sifrim D.
Poster: Evaluation of Esophageal Mucosa Integrity “In
Vivo”. Validation of Basal Intraluminal Impedance
Measurements to Assess Non- Erosive Changes
Induced by Esophageal Acid Exposure in Rabbit and
Healthy Human Subjects.
Digestive Disease Week, 4 Mei 2010.
Lestrade P. Botten en buffers.
Internisten, orthopeden, reumatologen en
arts-assistenten, Boxtel, 12 maart 2009.
Trefwoorden: Q-koorts, endocarditis.
Toonen FAJ, Bouter KP.
A 36-year-old patient with a congenital diabetes
mellitus may stop his use of insulin. Internistendagen,
Maastricht, april 2009.
van Warmerdam LJC, Schiphorst PP, Nieboer P,
Dercksen MW, Nijziel MR, Pruijt JFM, de Jongh FE,
Creemers GJM.
Cardiac safety of non-pegylated liposomal doxorubicine
in combination with docetaxel as 1st line treatment in
locally-advanced or metastatic HER-2 negative breast
cancer (MYOTAX study).
Abstr.nr. 5068. ESMO/ECCO 2009
interne geneeskunde
Lestrade P.
Prostaatca en botten.
Urologen, endocrinologen. Waalwijk,
29 september 2009.
Lestrade P. 3 x voordracht Q-koorts voor patiënten.
Februari/april 2010.
Pruijt J. Mutatieanalyse voor therapeutische
doeleinden binnen de oncologie.
Nederlandse Internistendagen Maastricht,
april 2009.
53
Pruijt J.
(Nieuwe) behandelmogelijkheden ITP.
Nederlandse avond ASCO 2009. Orlando USA,
01 Juni 09.
Pruijt J.
Epoëtine anno 2009 bij solide tumoren- is er nog
een indicatie?
Nederlandse Oncologiedagen. Papendal,
nov 2009.
Pruijt J.
“High Lights ASH 2009”.
ASH review. Utrecht, 16 december 2009
Pruijt J. Voordracht voor de patiëntenvereniging van
M. Waldenstrom.
’s-Hertogenbosch, 27 mei 2010
Pruijt J.
Voordracht: High-lights World Congres
Gastro-intestinal Cancer Barcelona 2010.
IKZ symposium gastro-enterologie.
05 juli 2010
Pruijt J.
Steeds meer farmaco-epidemiologie.
Symposium Leren door registreren.
Ter ere van 55 jaar IKZ kankerregistratie.
Eindhoven, 11 november 2010.
Smilde T.
Welkom in de wereld van de oncologie.
Voordracht voor huisartsen. Maart 2009.
Smilde T.
Het triple negatief mammacarcinoom.
Bossche mammadagen. Juni 2009.
Smilde T.
Behandeling van het testiscarcinoom.
Juni 2009.
54
Smilde T.
KPC necrologie.
September 2009.
Smilde T.
Behandeling van het blaascarcinoom met
chemotherapie.
December 2009.
Smilde T.
Als je lijf op de foto moet.
Nascholing radiologisch laboranten.
Februari 2010.
Smilde T.
Begeleidingsmodel, opleiden in de klinische praktijk.
Maart 2010.
Smilde T.
Het niet heldercellig niercelcarcinoom en bijzondere
blaastumoren.
Juni 2010.
Smilde T.
Het secundair gemetastaseerd mammacarcinoom,
hormonale therapie?
Juni 2010.
Beutler JJ.
Voordracht: ‘Vasculair risico begrijpen:
De wetenschap in praktijk’, Diagnostiek naar
nierarteriestenose: is opsporen en behandelen ook
genezen?’
Amsterdam, 31 januari 2009.
Beutler JJ.
Voordracht: STAR trial: Efficacy and Safety of Stenting
in Atherosclerotic Renovascular Disease.
World Congress Nephrology, Milaan,
24 mei 2009.
Tielemans MM, Van Oijen MG, Mulder CJ, Vos CJ,
Lems WF.
Poster: Similar effect of Esopramazole on upper
gastrointestinal symptoms in high upper GI risk versus
average risk NSAID users.
UEGW okt 2010.
Herbers AH.
Voordracht: Bloedaanmaak en aanverwante
bloedziekten.
Scholing Hematologie, oktober 2010.
Herbers AH.
Voordracht: Bloedziekten en gebruik hematopoetische
groeifactoren.
Voor oncologieverpleekundigen, Oud Empel, oktober
2010.
Ten Oever J, Herbers AH, Verhoef LH,
Van den Wall Bake AW.
Streptococcus equi subspecies zooepidemicus
bacteremia as First Manifestation of Hairy Cell
Leukemia. Infectious Diseases in Clinical Practice Nov
2009; 17: 407-408.
Herbers AH, Feuth T, Donnelly JP, Blijlevens NM.
Citrulline-based assessment score: first choice for
measuring and monitoring intestinal failure after
Annals of Oncology 2010. Vol 21, nr 8: 1706-1711.
Willemsen DJ, Bons E, Herbers AH, Mackenzie MA,
Van Spronsen DJ, Van der Velden WJ.
Pneumocystis jirovecii-pneumonia in non-hodgkin
lymphoma patients treated with R-CHOP.
Tijdschrift voor infectieziekten 2010. Vol 5,
nr 4, 152-156.
Hoogeveen EK, Broekman JM, Janssen RW.
Induction of eruptive benign melanocytic nevi after
kidney transplantation.
Clin Dermatol. 2009; 1: 29-30.
Kampschreur L, Hoogeveen EK, op den Akker JW,
Beutler JJ, Beems T, Dorresteijn LD, de Sévaux RG.
A haemodialysis patient with back pain: brown tumour
as a cause of spinal cord compression under cinacalcet
therapy.
Nephrol Dial Transplant Plus. 2010;
3: 291-295.
interne geneeskunde
Jansen JB, van Rossum LG, Laheij RJ.
Ter discussie. Bevolkingsonderzoek naar dikke
darmkanker. Bij voorkeur met een immunologische
test op fecaal occult bloed.
Ned Tijdschr Geneeskd. 2009; 11 juli; 153 (28).
Van Lieshout AW, Kampschreur LM, de Jong J,
Sinnige HA.
Anemie met een Chinees tintje.
Ned Tijdschr Hematol 2009; 6: 194-8.
Sonneveld P, Zweegman S, Vellenga E, Wittebol S,
Sinnige HA, Meijer E, Minnema MC, Lokhorst HM.
Richtlijn behandeling plasmacelaandoeningen anno 2010.
Ned tijdschrift Hematologie 2010; 7:41-52.
Van Rossum LG, van Rijn AF, van Munster IP,
Jansen JB, Fockens P, Laheij RJ, Dekker E.
Earlier stages of colorectal cancer detected with
immunochemical faecal occult blood tests. Neth J Med.
2009; 67 (5): 182-86.
Screening op chronische Q-koorts bij symptomatische
patiënt met aneurysma of prothese van de aorta.
Ned Tijdschr Geneeskd. 2010; 154:A2122.
Lips DJ, van der Linde JC, Pruijt JF, Bosscha K,
Liefers GJ, Smit VT, van de Velde CJ.
Betere stadiering darmkanker nodig.
Medisch Contact 2010;65:484-487.
55
Schipperus MR, Koene H, Zwaginga JJ,
te Boekhorst PA, Vreugdenhil G, Pruijt JF,
Novotny VM, van Pampus EC, Fijnheer R.
Nederlandse richtlijn voor de diagnose en
behandeling van immuun trombocytopenische
purpura bij volwassenen.
Ned Tijdschr Hematol. 2010;7:59-68
Tol J, Koopman M, Cats A, Rodenburg CJ,
Creemers GJ, Schrama JG, Erdkamp FL, Vos AH,
Van Groeningen CJ, Sinnige HA, et al.
Chemotherapy, Bevacizumab, and Cetuximab in
metastatic colorectal cancer.
N Engl J Med 2009; 360: 563-72.
van Bergen FS, ter Bruggen JP, Olde Rikkert MG.
Int J Geriatr Psychiatry 2009.
Cnossen TT, Smit W, Konings CJ, Kooman JP,
Leunissen KM, Krediet RT.
Quantification of free water transport during the
peritoneal equilibration test.
Perit Dial Int. 2009 Sep-Oct; 29(5):523-7.
Krediet RT, Coester AM, Kolesnyk I, de Graaff M,
Zweers MM, Smit W, Struijk DG.
Karl d. Nolph state of the art lecture: feasible and
future options for salvation of the peritoneal
membrane.
Perit Dial Int. 2009 Feb;29 Suppl 2:S195-7.
Cnossen T, Beerenhout C, Smit W, Konings C,
Kooman J, Leunissen K, Krediet RT.
Influence of the preceding dwell time on the peritoneal
equilibration test with 3.86% glucose solution in
automated peritoneal dialysis.
Perit Dial Int. 2010 Jan-Feb;30(1):95-8.
Toonen F, Smilde T.
A retroperitoneal mass with elevated alpha-I-
56
fetoprotein: not always a testicular carcinoma. The
Netherlands Journal of Medicine; 2010; 68: 33-34.
Case report.
Van Poppel PC, Stehouwer CD, Beutler JJ, Korst MB,
Beerlage HP, Hoogeveen EK.
Hyperchloremische metabole acidose bij een patiënt
met een brickerlis
Bax L, Woittiez AJ, Kouwenberg HJ, Mali WP, Buskens
E, Beek FJ, Braam B, Huysmans FT, Schultze Kool LJ,
Rutten MJ, Doorenbos CJ, Aarts JC, Rabelink TJ, Plouin
PF, Raynaud A, van Montfrans GA, Reekers JA, van den
Meiracker AH, Pattynama PM, van de Ven PJ,
Vroegindeweij D, Kroon AA, de Haan MW, Postma CT,
Beutler JJ.
randomized trial.
Ann Intern Med. 2009
Jun 16;150(12):840-8, W150-1.
Kampschreur LM, Wegdam-Blans MC, Thijsen SF,
Groot CA, Schneeberger PM, Hollander AA, Schijen JH,
Arents NL, Oosterheert JJ,
Wever PC.
Acute Q fever related in-hospital mortality in the
Netherlands.
Neth J Med. Dec 2010
Velden WJ, Herbers AH, Feuth T, Schaap NP, Donnelly
JP, Blijlevens NM.
Intestinal damage determines the inflammatory
response and early complications in patients receiving
conditioning for a stem cell transplantation.
PloS one 2010. Vol 5, 12: 1-8.
PICO Bello – Heeft behandeling van subklinische
hypothyreoïdie bij zwangere vrouwen een positief
effect op de neurologische ontwikkeling van het kind.
Ned Tijdschr Obstr Gyn 2010 Feb; 121(2):
blz 23-25
“Dit is een ervaring,
die ik niet had
willen missen”
Linda Kampschreur volgt de opleiding tot internist aan het Universitair Medisch Centrum in
Utrecht. Ze is bijzonder geïnteresseerd in de besmettelijke ziekte Q-koorts en verdiept zich
bij het Jeroen Bosch Ziekenhuis in de praktijk. Ze is jong, ambitieus en bevlogen in haar vak.
Wat drijft haar?
“De eerste drie jaar van mijn opleiding volgde ik in het Jeroen Bosch ziekenhuis. Vorig jaar sprak ik
een microbioloog van dit ziekenhuis, die mij vroeg of ik geïnteresseerd was in onderzoek naar
Q-koorts”, aldus Kampschreur. “Deze kans liet ik natuurlijk niet voorbij gaan. Ik mocht ook de
Q-koorts poli in het JBZ komen versterken: ik werk nu één dag per week op de poli en dat combineer
ik met mijn onderzoek.”
interview linda kampschreur
57
Ziektebeeld
Kampschreur: “Je hebt twee vormen: acute en chronische Q koorts. Ruim de helft van de mensen die
besmet zijn, wordt overigens helemaal niet ziek. Zij die wél ziek worden, krijgen er binnen een paar weken
na besmetting last van. Er is dan vaak sprake van koorts, koude rillingen, spier- en hoofdpijn. Dit gaat
meestal weer gewoon over. Bij een kleine groep patiënten ontstaat echter chronische Q koorts, zelfs tot
tien jaar na de eerste infectie. Vaak uit zich dit in ontsteking van de hartkleppen, grote vaten of hart- of
vaatprothesen. De kans om chronische Q-koorts te krijgen is groter voor zwangere vrouwen, patiënten
met hartklepafwijkingen, aneurysma’s of vaatprothesen. Zonder behandeling kan het tot ernstige
complicaties lijden. Mensen met een chronische besmetting krijgen vaak langdurig antibiotica toegediend
en dat valt hen zwaar. Dit zijn allemaal redenen om hier onderzoek naar te doen.”
Uniek
Binnen haar onderzoek heeft ze een aantal werkzaamheden. Kampschreur: “De diagnostiek was altijd
lastig en we maakten gebruik van onderzoeksresultaten uit het buitenland. Maar met de uitbraak in
Nederland hadden we ineens zelf een unieke onderzoekspopulatie. Daar wilden we gebruik van maken. Zo
stel ik een database op voor alle patiënten met chronische Q koorts in Nederland. Ik wil weten: wat zijn dat
voor mensen? Wat voor achtergrond en historie hebben zij? Dat geeft ons nog meer inzicht in de oorzaak
van de chronische infectie.”
Preventief
“Ook schreven we mensen aan die in het verleden een hartklepprothese of hartklepoperatie hadden. Want
zij hebben verhoogde kans om chronische Q-koorts op te lopen. Wij wilden hen preventief screenen om er
zeker van te zijn dat deze ziekte geen kans van slagen zou hebben. Want als de Q-koortsbacterie zich bij
die patiënten op de hartklep nestelt, is dat heel gevaarlijk.” Kampschreur zit in een landelijke werkgroep.
“Hier stellen internisten, microbiologen, cardiologen en vaatchirurgen richtlijnen op voor chronische
Q-koorts patiënten. Dit met als doel om onze eigen diagnoses en behandelingen scherper te maken.”
Onder de loep
Kampschreur: “Met onderzoek kunnen we de wetenschap kritisch onder de loep nemen. Ook bij het
analyseren van statistieken is het de kunst om juist op een andere manier naar gegevens te kijken. Want
soms zijn uitkomsten van een onderzoek niet zo hard als ze op papier lijken.” Lachend: “Ook op persoonlijk
vlak leer ik veel. Zo doe ik nu meer aan timemanagement en leer ik om goed te communiceren met
iedereen die bij het onderzoek betrokken is. Dit is een ervaring, die ik niet had willen missen.”
58
9
KINDERGENEESKUNDE
Schatorjé E, Hoekstra JH.
Transient hypertransaminasemia in paediatric patients
with crohn disease undergoing initial treatment with
enteral nutrition.
J Pediatr Gastroenterol Nutr. 2010 Sep;51(3):336-40.
PMID: 20601906
DA, Bocca G, Mieke Houdijk EC, Hokken-Koelega AC.
Bone mineral density and effects of growth hormone
treatment in prepubertal children with Prader-Willi
syndrome: a randomized controlled trial.
J Clin Endocrinol Metab. 2009 Oct;94(10):3763-71.
PMID: 19622627
Hoekstra JH, van der Weij AM, Groot-Loonen J,
Hoogerbrugge P, Kooy Y, Koning F. Succesful treatment
of celiac disease by allogeneic haematopoietic stem cell
transplantation.
J Pediatr Gastroenterol Nutr 2010;51:793-4
PMID: 20890214
Vink EE, van Coeverden SC, van Mil EG, Felius BA,
van Leerdam FJ, Delemarre-van de Waal HA.
Changes and tracking of fat mass in pubertal girls.
Obesity (Silver Spring). 2010 Jun;18(6):1247-51.
PMID: 19875991
de Lind van Wijngaarden RF, Siemensma EP, Festen
DA, Otten BJ, van Mil EG, Rotteveel J, Odink RJ,
Bindels-de Heus GC, van Leeuwen M, Haring DA,
Bocca G, Houdijk EC, Hoorweg-Nijman JJ, Vreuls RC,
Jira PE, van Trotsenburg AS, Bakker B, Schroor EJ,
Pilon JW, Wit JM, Drop SL, Hokken-Koelega AC.
Efficacy and safety of long-term continuous growth
hormone treatment in children with Prader-Willi
syndrome.
J Clin Endocrinol Metab. 2009 Nov;94(11):4205-15
PMID: 19837938
de Lind van Wijngaarden RF, Festen DA, Otten BJ, van
Mil EG, Rotteveel J, Odink RJ, van Leeuwen M, Haring
kindergeneeskunde
Kusters MA, Verstegen RH, Gemen EF, de Vries E.
Intrinsic defect of the immune system in children with
Down syndrome: a review.
Clin Exp Immunol. 2009 May;156(2):189-93. Epub
2009 Jan 22. Review.
PMID: 19250275.
Trefwoorden: Downsyndroom, immuundeficiëntie.
Verstegen RH, Kusters MA, Gemen EF,
de Vries E.
Down syndrome B-lymphocyte subpopulations,
intrinsic defect or decreased T-lymphocyte help.
Pediatr Res. 2010 May;67(5):563-9.
PMID: 20098344.
Trefwoorden: Downsyndroom, immuundeficiëntie.
59
Kusters MA, Gemen EF, Verstegen RH, Wever PC,
de Vries E.
Both normal memory counts and decreased naive cells
favor intrinsic defect over early senescence of Down
syndrome T lymphocytes.
Pediatr Res. 2010 May;67(5):557-62.
PMID: 20098345.
Trefwoorden: Downsyndroom, immuundeficiëntie
Van Beek E, Binkhorst M, de Hoog M, de Groot P,
van Dijk A, Schokking M,
Hopman M.
Exercise performance and activity level in children with
transposition of the great arteries treated by the
arterial switch operation.
Am J Cardiol 2010; 105: 398-403.
PMID: 20102956
Trefwoorden: inspanningstolerantie, congenitale hart
Hartley JL, Zachos NC, Dawood B, Donowitz M, Forman
J, Pollitt RJ, Morgan NV, Tee L, Gissen P, Kahr WHA,
Knisely AS, Watson S, Chitayat D, Booth IW, Protheroe
S, Murphy S, de Vries E, Kelly DA, Maher ER.
Mutations in TTC37 Cause Trichohepatoenteric
Syndrome (Phenotypic Diarrhoea of Infancy).
Gastroenterology. 2010 Jun;138(7):2388-98, 2398.e1-2.
PMID: 20176027.
De Groot PC, Thijssen D, Binkhorst M, Green DJ,
Schokking M, Hopman MT.
Vascular function in children with repaired tetralogy
of Fallot.
Am J Cardiol. 2010 Sep 15;106(6):851-5.
PMID: 20816127
Trefwoorden: Fenotypische diarree, immuundeficiëntie.
Trefwoorden: vaatfunctie, congenitale hartafwijkingen
Deniz G, Chapel H, Barlan I, de Vries E, Jaraquemada D.
Women advancing science.
Eur J Immunol. 2010 Mar;40(3):589-92.
PMID: 20201011.
Mattheij M, van der Weij AM.
A girl with recurrent swelling of the parotis region.
Ned Tijdschr Geneesk. 2009;153-A188.
PMID: 19930740
afwijkingen
Trefwoorden: Emancipatie, wetenschap.
Poodt AE, Driessen GJ, de Klein A, van Dongen J
J, van der Burg M, de Vries E.
TACI mutations and disease susceptibility in patients
with common variable immunodeficiency.
Clin Exp Immunol. 2009 Apr;156(1):35-9.
PMID: 19210517
Binkhorst M, de Leeuw N, Otten BJ.
A healthy, female chimera with 46,XX/46,XY karyotype.
J Pediatr Endocrinol Metab 2009; 22: 97-102.
PMID: 19344081
Munster JM, Leenders AC, van der Hoek W,
Schneeberger PM, Rietveld A, Riphagen-Dalhuisen J,
Stolk RP, Hamilton CJ, de Vries E, Meekelenkamp J,
Lo-Ten-Foe JR, Timmer A, De Jong-van den Berg LT,
Aarnoudse JG, Hak E.
Cost-effectiveness of a screening strategy for Q fever
among pregnant women in risk areas: a clustered
randomized controlled trial.
BMC Womens Health. 2010 Nov 1;10(1):32.
PMID: 21040534.
Trefwoorden: chimeer, intersexualiteit
Boeken
Binkhorst M, de Gier RP.
A large extra-abdominal prevesical pseudo-cyst in a
newborn with posterior urethral valves.
J Pediatr Urol 2010; 6: 91-93.
PMID: 19477688
van Mil EG.
Neonatale Hypoglycemiëen. C. Noordam. Uit:
Werkboek Kinderendocrinologie. Serie: Werkboeken
kindergeneeskunde. Eindredactie. C.M.F. Kneepkens.
VU Uitgeverij. 2010 Amsterdam.
Trefwoorden: urethrakleppen, blaasruptuur
60
Kuijpers TW, Prakken AB, de Vries E.
Het immuunsysteem, afweerstoornissen en allergie. In:
van den Brande JVL, Derksen-Lubsen G, Heymans HSA,
Kollée LAA (Eds.). Leerboek kindergeneeskunde. Een
interactieve benadering in woord en beeld. De
Tijdstroom Uitgeverij, Utrecht, 2010. Met dvd-rom.
ISBN 978-9-058-98079-3.
Hoekstra JH, van der Weij A, Groot-Loonen J,
Hoogerbrugge P, Kooy Y, Koning F.
Poster: Celiac disease cured by allogenic hematopoietic
stem cell transplantation.
Proceedings13th International Coeliac Disease
Symposium, Amsterdam, 2009
Schatorjé E, Hoekstra JH.
Poster: Transient hypertransaminasemia in pediatric
patients with Crohn’s disease undergoing initial
treatment with enteral feeding.
Proceedings PIBD, Paris, 2009, J of Crohn’s and Colitis
2009,3:S7
De Bie CI, Hummel TZ, Kinderman A, Kokke FT, Damen
GM, Kneepkens CMF, van Rheenen PF, Schweitzer JJ,
Hoekstra JH, Norbruis OF, Tjon A Ten WE, Vreugdenhil
AC, Deckers J, Gijsbers, de Ridder L. Escher JC.
Poster: Long-term efficacy of infliximab treatment in
pediatric Crohn’s disease in The Netherlands.
Proceedings AGA, New Orleans, 2010
Hoekstra JH.
Complicaties na rotavirusinfecties.
Periodieke conferentie, Nijmegen,
26 januari 2009.
Hoekstra JH.
Evidence Based behandeling van acute diarree.
EPGS, Amsterdam, 5 februari 2009.
Hoekstra JH.
ESPGHAN/ESPID EBM Guidelines for the treatment of
kindergeneeskunde
acute gastro-enteritis.
Karolinka seminars, Stockholm,
25 maart 2009.
Hoekstra JH.
Een nieuwe manier om te selecteren voor de opleiding
tot kinderarts.
PRG, Leuven, 26 september 2009.
Hoekstra JH.
Complementary feeding.
Eastern ESPGHAN Summer School, Budva,
9 september 2010.
Hoekstra JH.
Enteral feeding.
Eastern ESPGHAN Summer School, Budva,
10 september 2010.
Mattheij MA, van Mil EG.
Obesity in children: what Dutch pediatricians see and
do. Obesity Facts, 2 (suppl 1): 2009
van Mil EG.
Management of childhood obesity: lessons from a
business case.
Obesity Facts, 2 (suppl 1): 2009
Schatorjé E, Gemen EF, Driessen GA, Leuvenink J, van
der Burg M, de Vries E.
Poster: Age-matched reference values for lymphocyte
subpopulations show limitations of current EUROclass
CVID classification in children.
61
European Society for Immunodeficiencies, Istanbul,
2010.
Schatorjé E, de Vries E.
Voordracht: Normaalwaarden lymfocytensubsets in
relatie tot CVID classificatie bij kinderen.
Werkgroep Immuundeficiënties, Utrecht, 2010.
Walker JC, Smolders MA, Gemen EF, Antonius TA,
de Vries E.
Poster: Ontwikkeling van lymfocytensubpopulaties bij
prematuren.
Nederlandse Vereninging voor Kindergeneeskunde,
Veldhoven, 2009.
Kusters MA, Jol-van der Zijde CM, Van Tol MJ, Bolz
WE, Bok LA, Visser M, de Vries E. Poster: Serum
antibody response to tetanus toxoid in children with
Down syndrome. European Society for Paediatric
Infectious Diseases, Brussel, 2009.
Kusters MA, de Vries E.
Voordracht: Het afweersysteem bij kinderen met Down
syndroom.
Werkgroep Immuundeficienties, Utrecht, 2009.
Voordracht: Vaccinatieresponsen bij kinderen met
Down syndroom.
Werkgroep Immuundeficienties, Utrecht, 2010.
Driessen GJ, van Zelm MC, van Hagen PM, Hartwig NG,
Trip M, Warris A, de Vries E, Barendregt BH, Pico I,
van Dongen JJ, van der Burg M.
Poster: Patients with idiopathic
hypogammaglobulinemia can be divided in B-cell
phenotypes with different proliferation and somatic
hypermutation defects.
European Society for Immunodeficiencies, Istanbul,
2010.
Mattheij MA, de Vries E.
Voordracht: Een vermoeden van antibiotica-allergie bij
kinderen blijkt bij provocatie vaak onterecht.
Nederlandse Vereniging voor Kindergeneeskunde,
Veldhoven, 2009.
Van Beek E, Binkhorst M, de Hoog M, de Groot P,
van Dijk A, Schokking M, Hopman M.
Exercise performance and activity level in children with
transposition of the great arteries treated by the
Congres kindercardiologie, Weimar, Duitsland, oktober
2009.
Kusters MA, Jol-van der Zijde CM, van Tol MJ, Bolz
WE, Bok LA, Visser M, de Vries E. Poster: Children with
Down syndrome show decreased antibody response to
tetanus toxoid.
European Congress of Immunology, Berlijn, 2009.
Voordracht: T-lymfocyten bij kinderen met Down
syndroom (DS).
Jonge Onderzoekersdag Nederlandse Vereniging voor
Kindergeneeskunde, Veldhoven, 2009.
Verstegen RH, de Vries E.
Voordracht: B-lymfocyten bij het syndroom van Down:
intrinsiek defect of gestoorde hulp van T-lymfocyten?
Jonge Onderzoekersdag Nederlandse Vereniging voor
Kindergeneeskunde, Veldhoven, 2009.
62
Langens FN, van Binsbergen JJ, van Mil EG, Seidell JC.
Obesitas en een verhoogd cardiovasculair risico: de
aanpak begint al op jeugdige leeftijd!
Hartbulletin december 2009
van Mil EG.
Overgewicht bij een kind is eigenlijk niet meer dan een
signaal.
Health Management Forum. Maart 2009
van den Akker EL, van Mil EG.
Obesitas: Gen Diagnostiek en Geen Diagnostiek.
Praktische Pediatrie. April 2009
Vink EE, van Coeverden SC, van Mil EG, Felius BA,
van Leerdam FJ, Delemarre-van de Waal HA.
Obesity 2010 Jun;18(6):1247-51
Renders CM, Bulk-Bunschoten AM,
van Mil EG.
De richtlijn ‘Diagnostiek en behandeling van obesitas bij
kinderen’.
Praktische Pediatrie 2010 Juni. Jaargang 4, nr2: 94-100
van Mil EG, van den Akker EL.
Het metabool syndroom bij overgewicht en obesitas.
Praktische Pediatrie 2010 Juni. Jaargang 4, nr2:
102-106
van Heurn LW, Vreugdenhil A, van Mil EG.
Een extreem dik kind: is operatieve behandeling
wenselijk?
Praktische Pediatrie 2010 Juni. Jaargang 4, nr2:
107-110
van Mil EG.
Editorial: Samen sterk in de strijd tegen overgewicht.
Tijdschr Kindergeneeskund 2010; nr 3; 78: 98-99
Renders CM, Bulk-Bunschoten AM,
van Mil EG.
De CBO-richtlijn Diagnostiek en behandeling van obesitas
bij volwassenen en kinderen’ – wat betekent dit voor de
kindergeneeskunde?
van Heurn LW, van Mil EG, Greve JW, Delemarre-van de
Waal HA.
De chirurgische behandeling van morbide obesitas bij
kinderen.
de Vries E, Driessen GJ.
Primary immunodeficiencies in children: a diagnostic
challenge.
Eur J Pediatr, in press.
Trefwoorden: Diagnostiek, immuundeficiëntie.
kindergeneeskunde
63
Bruggen bouwen met
Bossche bollen
Het Jeroen Bosch Ziekenhuis (JBZ) doet al enige tijd wetenschappelijk onderzoek naar
afwijkingen in het afweersysteem bij Downsyndroom. Want bij deze patiënten komen vaker
infecties voor. Maaike Kusters doet er onderzoek naar en brengt verslag uit.
“Ik studeerde geneeskunde en kwam via een wetenschappelijke stage in het JBZ terecht. Doordat ik de
afgelopen jaren als ANIOS (arts-assistent niet in opleiding tot specialist) bij de kindergeneeskunde in
’s-Hertogenbosch werkte, kon ik naast mijn werkzaamheden als arts ook doorgaan met het onderzoek.
Inmiddels ben ik in opleiding tot kinderarts in het Academisch Ziekenhuis Maastricht. Ik verwacht in 2012
via de ‘Bossche’ constructie in Leiden te Promoveren.”
Last van infecties
Kusters vertelt over de achtergronden van haar specialisme. “Het afweersysteem van kinderen met
Downsyndroom werkt minder goed. Daardoor hebben ze vaker last van infecties. Ook lijkt het erop dat
kinderen met Downsyndroom minder goed reageren op sommige vaccinaties.” Daarom wil het JBZ er
64
graag onderzoek naar doen. “Afgelopen jaren deden we al veel onderzoek op dit gebied. Zo keken we
naar de verschillende afweercellen en afweerstoffen. Veel afweercellen komen minder voor, terwijl de
afweerstoffen soms juist verhoogd zijn in vergelijking met kinderen zonder Downsyndroom.”
Onderzoek
“Daarom zijn we verder gaan kijken hoe deze afweercellen en de afweerstoffen hun werk doen. De
reactie op vaccinatie en de productie van afweerstoffen hiertegen geeft een beter inzicht in hoe het
afweersysteem werkt”, vult Kusters verder aan. “We onderzoeken bijvoorbeeld wat de reactie is van
het afweersysteem van deze kinderen op een vaccinatie tegen pneumococcen. Dit is een bacterie die
vaak luchtweg-infecties zoals longontsteking en middenooronsteking veroorzaakt, iets wat bij
kinderen met Downsyndroom juist veel voorkomt. Maar ook kijken we naar vaccinaties tegen
Mexicaanse griep, tetanus en meningococcen.”
Onderzoek doen geen kinderspel
Een onderzoek is niet van vandaag op morgen afgerond. Kusters: “Het mag duidelijk zijn dat een
onderzoekstraject zorgvuldig en met veel voorbereiding gebeurt. Je mag bijvoorbeeld nooit zomaar
een medisch-wetenschappelijk onderzoek starten. Want eerst moet een erkende medisch-ethische
commissie beoordelen of het onderzoek wel verantwoord is en voldoet aan alle eisen. Immers, je
doet wel onderzoek met kinderen!”
Krachten bundelen
“Daarbij is een aantal dingen essentieel bij het doen van onderzoek”, aldus Kusters. “Het is belangrijk
dat je goede contacten legt met externe partners. Want zo kun je gebruik maken van elkaars
krachten.” Kusters licht dit toe aan de hand van een voorbeeld. “Het JBZ is een uitstekend perifeer
ziekenhuis, maar beschikt niet altijd over alle apparatuur die vaak wel in de academische centra
aanwezig is. Maar het JBZ heeft wel over een grote patiëntenpopulatie van kinderen met
Downsyndroom die regelmatig in het ziekenhuis komen voor policontroles en zo gemakkelijk mee
kunnen doen aan onderzoek. Daarom werken we samen met diverse centra om de krachten te
bundelen. Vaak gaat dit gepaard met het uitwisselen van expertise of het publiceren van een
gezamenlijk wetenschappelijk artikel.” Ze knipoogt: “Maar ook met het uitwisselen van Bossche
bollen. Want daarmee zijn al heel wat bruggen gebouwd!”
Wilt u meer weten over dit onderzoek? Neem gerust een kijkje op www.linkedin.com en type
“Maaike Kusters” in bij het zoekscherm.
interview Maaike kusters
65
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10
KLINISCHE CHEMIE &
HEMATOLOGIE
Verstegen RH, Kusters MA, Gemen EF, de Vries E.
Down syndrome B-lymphocyte subpopulations,
intrinsic defect or decreased T-lymphocyte help.
Pediatr. Res. 2010 May;67(5):563-9.
PMID: 20098344
Kusters MA, Gemen EF, Verstegen RH, Wever PC,
de Vries E
Both normal memory counts and decreased naive
cells favor intrinsic defect over early senescence of
Down syndrome T-lymphocytes.
Pediatr Res. 2010 May;67(5):557-62.
PMID: 20098345
Schmeits PC, Péquériaux NC, van Geest-Daalderop
JH, Ouwehand ME, Coremans AM, Hermans MH,
Conemans JM.
Investigating unexpected INRs: in search of the
culprit--adherence, interactions, genetics, and
superwarfarin.
Neth J Med. 2009 Feb;67(2):76-8.
PMID: 19299851
van Geest-Daalderop JH, Péquériaux NC,
van den Besselaar AM.
Variability of INR in patients on stable long-term
treatment with phenprocoumon and acenocoumarol
and implications for analytical quality requirements
klinische chemie & hematologie
Thromb Haemost. 2009 Sep;102(3):588-92.
PMID: 19718481
Trefwoorden: Vitamin K antagonist, international normalised
ratio, biological variation, analytical
performance goal
de Jager CP, de Wit NC, Weers-Pothoff G,
Procalcitonin kinetics in Legionella pneumophila
pneumonia.
PMID: 19438643
Wever PC.
acute Q-fever.
Clin Chem Lab Med. 2009;47(11):1407-9.
PMID: 19778289
Intrinsic defect of the immune system in children with
Down syndrome; a review.
Clin Exp Immunol. 2009 May;156(2):189-93.
PMID: 19250275
67
Meijer RP, Gemen EF, van Onna IE, vd Linden JC,
Beerlage HP, Kusters GC.
The value of an artificial neural network in the
decision-making for prostate biopsies.
World J Urol. 2009 Jun 28 Volume 27, Issue 5 (2009),
Page 593. PMID: 19562346
Hermans MH, Poodt J, van Geest-Daalderop JH,
Péquériaux NC, Conemans JM.
Resistance to coumarin derivatives due to mutated
vitamin-K enzyme.
Ned Tijdschr voor Geneeskd. 2009:153:A691
PMID: 19857286
De Waard H, van ’t Sant P.
Use of serum myoglobin assays for urine myoglobin
measurements can cause
false-negative results. Clin. Chem. 2009
Jun;55(6):1240-1.
PMID: 19342504
Schmeits PC, Hermans MH, van Geest-Daalderop
JH, Poodt J, de Sauvage Nolting PR, Conemans JM.
VKORC1 mutations in patients with partial resistance
to phenprocoumon.
Br J Haematol. 2010 Mar;148(6):955-7.
PMID: 19961479
Van Geest-Daalderop JH, Kraaijenhagen RJ,
Van Der Meer FJ, Van Den Besselaar AM.
Intraindividual variation of the International
Normalized Ratio in patients monitored with a
recombinant human thromboplastin.
J Thromb Haemost. 2010 Jul;8(7):1641-2.
PMID: 20403089
Van Geest-Daalderop JH, Hutten BA,
Péquériaux NC, Levi M, Sturk A.
Improvement in the regulation of the vitamin K
antagonist acenocoumarol after a standard initial dose
regimen: prospective validation of a prescription model.
J Thromb Thrombolysis. 2009 Feb;27(2):207-14.
PMID: 18270659
De Jager CP, van Wijk PT, Mathoera RB,
infection markers in an emergency care unit. Crit Care.
2010;14(5):R192.
PMID: 21034463
Boeken
de Wit NC
Klinische Chemie en Hematologie voor Analisten.
Deel 2, Hoofdstuk 17: “Bloedgassen”
Lesboek “Klinische Chemie en Hematologie voor
Analisten”.
Editors: E. ten Boekel en B.A. de Boer. Heron reeks
Februari 2010.
ISBN 9789077423738
68
Klinische Chemie deel 1. Hoofdstuk 3.
De chemie-analyser en inleiding tot de fotometrie.
Uitgever: Syntax media, Arnhem, 33-50. Heron reeks
Maart 2009.
ISBN 9789077423684
Gemen EF
Voordracht: The value of an artificial neural network in
the decision-making for prostate biopsies.
Wetenschapsdag Jeroen Bosch Ziekenhuis,’sHertogenbosch, 4 Februari 2010.
(3e prijs behaald).
Hoedemakers RM, Martens HA, Pruijt JF.
Poster: Efficiënt screening algoritme voor detectie van
monoklonale gammopathie.
NVKC congres, Veldhoven, 22 april 2010 t/m 23 april
2010.
Abstract: Efficiënt screening algoritme voor detectie
van monoklonale gammopathie.
Nederlands Tijdschrift Klinische Chemie en
Laboratoriumgeneeskunde 2010; 35:107-108.
de Waard H, Gemen EF, Leuvenink J, Péquériaux NC
Poster: Diagnostiek ijzergebrek, RET-He of toch maar
klassiek? Een systematische vergelijking met de
ijzervoorraad in beenmerg.
NVKC congres, Veldhoven,
22 april 2010 t/m 23 april 2010.
Leuvenink J, Gerven MP, Martens HA
Poster: IJzerdeficiëntie en Hb-pathie vaststellen op
basis van volbloedparameters.
22 april 2010 t/m 23 april 2010.
van Hulstein J, de Waard H, van Gool MJ,
Vanderloo RA, Kusters GC, van ‘t Sant P
Poster : Validatie Dimension Vista 1500 (Siemens
Healthcare Diagnostics).
22 april 2010 t/m 23 april 2010.
Schatorjé E, Gemen EF, Driessen GA, Leuvenink J,
van der Burg M, de Vries E
Poster: Age-matched reference values for lymphocyte
subpopulations show limitations of current EUROClass
CVID classification in children.
ESID, Istanbul, Turkije,
6 oktober 2010 t/m 9 oktober 2010.
Kariman MA, Gemen EF, Péquériaux NC
Poster: Verlenging van het tijdsinterval tussen
bloedafname en plasmabereiding naar 6 uur is zonder
consequentie voor routine stollingsonderzoek.
22 april 2010 t/m 23 april 2010.
Gemen EF, Kusters MA.
Kunst poster: thema “ Immunologie/primaire
afweerziekten”, titel: Mijkes world
ESID, Istanbul, Turkije, 6 oktober 2010 t/m 9 oktober
2010.
(ESID Junior Best PID&ART Award 2010 behaald)
de Waard H, Gemen EF, Leuvenink J, Péquériaux NC
Poster: Iron deficiency, a systemic comparison of red
blood cell parameters, ferritin and iron-stores in the
bonemarrow.
First European Joint congress of EFCC and UEMS,
Lissabon, Portugal, 13 oktober 2010 t/m 16 oktober
2010. (1e prijs behaald)
van ’t Sant P, de Waard H.
Voordracht: Traject naar geautomatiseerd laboratorium
2011/2012.
Regio overleg klinisch chemici Oost Brabant,
2 april 2009.
Hoedemakers RM
Voordracht: Efficiente workflow M-proteinen onderzoek
Sebia gebruikersdag, Februari 2009.
Péquériaux NCV, van Litsenburg EHAA, Kooyman PJ,
Ligthart, M de Haas PC.
Poster: CASUS: Complexe antistoffen binnen het Kell
systeem bij noodzaak tot onderbeenamputatie.
NVB symposium, Ede, 13 mei 2009.
69
van Litsenburg EHAA, Péquériaux NCV.
Poster: Zeer ernstige auto-immuun hemolytische
anaemie; Transfusie met rug tegen de muur.
van Litsenburg EHAA, Péquériaux NCV.
Voordracht: Zeer ernstige auto-immuun hemolytische
anaemie; Transfusie met rug tegen de muur.
Walker JC, Smolders MAJC, Gemen EFA,
de Vries E.
Poster: Ontwikkeling van lymfocytensubpopulaties bij
prematuren.
NVK Veldhoven, 4 t/m 6 nov 2009.
Péquériaux NC.
Voordracht: DVT Diep veneuze trombose.
Huisartsen duodagen microbiologie en klinische
chemie. 27 mei en 2 juni 2009.
de Wit NC, Oosting JD, Hoffmann JJ, Krockenberger L,
van Dun M.
Poster: Novel method for measuring
reticulated platelets using the Abbott Cell
Dyn Sapphire.
ISLH Symposium, Las Vegas, USA, Mei 2009.
de Wit NC, Oosting JD, Hoffmann JJ, Krockenberger L,
van Dun M.
Poster: Comparative Evaluation of the Abbott
CELL-DYN Sapphire Reticulated Platelets fraction and
the Sysmex XE-2100 IPF.
de Wit NC.
Voordracht: Reticulated platelets.
Poodt J, Schmeits PC, Van Geest-Daalderop JH,
Conemans JM, Hermans MH.
Poster: Patients with partial resistance to
acenocoumarol and phenprocoumon; screening the
VKORC1 gene.
European Meeting on Molecular Diagnostics,
Scheveningen, 22/23-10-2009.
Vissers E, de Jager CP, Kusters R,
van Gageldonk-Lafeber AB, Wever PC.
Poster: Hypophosphatemia and prolonged length of
hospital stay in seronegative PCR positive patients with
early acute Q-fever.
Najaarsvergadering NVMM/VIZ/BVIKM, Amsterdam,
18-19 november 2010.
Efficiënt screeningalgoritme voor detectie van
monoklonale gammopathie.
Ned Tijdschr Klin Chem Labgeneesk 2010;
35: 182-183.
Gijsbrechts C
Nederland komt vitamine D3 tekort.
Folia Orthica, jaargang 2010, nr 1;
mei 2010 pag 26-27.
van ‘t Sant P, de Waard H
Reflecterend testen: een toegevoegde
70
waarde bij laboratoriumdiagnostiek, van reflexen
naar reflectie.
Labcontact 2010, nr 32.
Wetzer PM, Péquériaux NCV.
Plasmatransfusies, doen wij het goed?
Tijdschrift voor bloedtransfusie, VOL.2
NR.3 – 2009.
Trefwoorden: CBO-richtlijn Bloedtransfusie 2004, FFP.
van Lieshout AWT, Kampschreur LM,
de Jongh J, Sinnige HAM.
Anemie met een Chinees tintje.
NTVH, Vol. 6 Nr. 5; 2009.
Trefwoorden: anemie, chelatietherapie
Conemans J, Poodt J, Schmeits P,
Péquériaux N, van Geest A, Hermans M.
Een nieuwe VKORC1-mutatie in een patiënt met
fenprocoumonresistentie.
Cura: April 2009.
de Wit NC, Oosting JD.
Evaluatie van de aangepaste 4-5-6-flexinorm in
Ziekenhuis.
Bernhoven. Nederlands Tijdschrift voor
Bloedtransfusie 2009, 2,(1) 10-14.
de Wit NC, Baadenhuijsen H, Weykamp CW,
van ’t Sant P.
Geen goede commuteerbaarheid van monsters in de
SKML Combi Algemene Chemie enquete voor de
ASAT-bepaling.
Ned Tijdschr Klin Chem Labgeneesk 2009;
34: 162-164.
Gemen EF, de Wit NC, van Gerven MP,
de Jongh-Leuvenink J.
The Sysmex SP1000i for Automated Bone Marrow
Slide Smear Staining.
LABMEDICINE December 2009 vol 40 no 12 pp
719-723.
Conemans J, Péquériaux N, de Boer M, Eppenga W.
Wat moet de huisarts weten over orale anticoagulantia
en de trombosedienst?
Labcontact 2009, oktober, nr 30.
71
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11
KLINISCHE FYSICA
Renders AH, Claessens RA.
Voordracht: Bouw, kwaliteitscontrole en toepassing van
een generator voor Rb-82.
XXIVe NVKF-conferentie Woudschoten Nederland,
15 en 16 mei 2009.
Renders AH.
Quality assurance in nuclear medicine.
Gastcollege aan de Universiteit Twente in de cyclus
‘Medical Technology’
11 maart 2009 en 31 maart 2010.
klinische fysica
73
74
12
KNO-HEELKUNDE
Balter SG
Gastspreker op Tinnitus Informatie-avond
(georganiseerd door de NVVS)
JBZ lokatie Carolus ziekenhuis, 9 maart 2010
Op de Coul B,
Presentatie “Innovaties binnen KNO/ KNOstraten-boek”
Duodagen Huisartsen Vlissingen, 2-3 december 2010.
Op de Coul B,
Presentatie “Hooikoorts bestaat niet meer.”
Huisartsen en Apothekers Vught, 30 juni 2010.
De Visscher AV
Het KNO-stratenboek 1e editie
Voordracht Bossche samenscholingsdagen, Vlissingen,
25 en 26 november 2010.
Rutten GJ, Op de Coul B, Verschoor N.
Cervicale hyperostosis als behandelbare oorzaak voor
dysfagie.
Nederlands Tijdschrift voor Keel- Neus en
Oorheelkunde, 2009;15(1):29-31.
kno-heelkunde
75
76
13
LONGZIEKTEN
Herbst RS, Sun Y, Eberhardt WE, Germonpré P, Saijo N,
Zhou C, Wang J, Li L, Kabbinavar F, Ichinose Y, Qin S,
Zhang L, Biesma B, Heymach JV, Langmuir P, Kennedy
SJ, Tada H, Johnson BE.
Vandetanib plus docetaxel versus docetaxel as
second-line treatment for patients with advanced
non-small-cell lung cancer (ZODIAC): a double-blind,
randomised, phase 3 trial.
Lancet Oncol. 2010 Jul;11(7):619-26.
PMID: 20570559
Krzakowski M, Ramlau R, Jassem J, Szczesna A,
Zatloukal P, Von Pawel J, Sun X, Bennouna J,
Santoro A, Biesma B, Delgado FM, Salhi Y,
Vaissiere N, Hansen O, Tan EH, Quoix E, Garrido P,
Douillard JY.
Phase III trial comparing vinflunine with docetaxel in
second-line advanced non-small-cell lung cancer
previously treated with platinum-containing
chemotherapy.
J Clin Oncol. 2010 May 1;28(13):2167-73.
PMID: 20351334
Scagliotti GV, Germonpré P, Bosquée L, Vansteenkiste
J, Gervais R, Planchard D, Reck M, De Marinis F, Lee JS,
Park K, Biesma B, Gans S, Ramlau R, Szczesna A,
Makhson A, Manikhas G, Morgan B, Zhu Y, Chan KC,
von Pawel J.
longziekten
A randomized phase II study of bortezomib and
pemetrexed, in combination or alone, in patients with
previously treated advanced non-small-cell lung
cancer.
Lung Cancer. 2010 Jun;68(3):420-6.
PMID: 19692142
Veen EJ, Janssen-Heijnen ML, Ritchie ED, Biesma B,
van den Bogart MP, Bolhuis RJ.
Pneumonectomy for bronchogenic carcinoma: analysis
of factors predicting short- and long-term outcome.
Interact Cardiovasc Thorac Surg.
2009 Aug;9(2):260-4.
PMID: 19443491
Smit EF, Burgers SA, Biesma B, Smit HJ, Eppinga P,
Dingemans AM, Joerger M, Schellens JH, Vincent A,
van Zandwijk N, Groen HJ.
Randomized phase II and pharmacogenetic study of
pemetrexed compared with pemetrexed plus
carboplatin in pretreated patients with advanced
non-small-cell lung cancer.
J Clin Oncol. 2009 Apr 20;27(12):2038-45.
PMID: 19307503
Goss G, Ferry D, Wierzbicki R, Laurie SA, Thompson J,
Biesma B, Hirsch FR, Varella-Garcia M, Duffield E,
Ataman OU, Zarenda M, Armour AA.
77
Randomized phase II study of gefitinib compared with
placebo in chemotherapy-naive patients with advanced
non-small-cell lung cancer and poor performance
status.
J Clin Oncol. 2009 May 1;27(13):2253-60.
PMID: 19289623
Pompen M, Gok M, Novák A, van Wuijtswinkel R,
Biesma B, Schramel F, Stigt J, Smit H, Postmus P.
Direct costs associated with the disease management
of patients with unresectable advanced non-small-cell
lung cancer in The Netherlands.
Lung Cancer. 2009 Apr;64(1):110-6.
PMID: 18805601
Boeken
Schreurs AJ.
Corticosteroïden.
In: COPD, Dekhuijzen,P.N.R. (ed),van Zuiden Comm. B.V.,
2009.
Gatzemeier U, Eisen T, Santoro A, Paz-Ares L,
Bennouna J, Liao M, Strauss UP, Montegriffo E,
Ong TJ, Biesma B.
Voordracht: Sorafenib (S) + Gemcitabine/Cisplatin
(GC) vs GC alone in the First-line treatment of
advanced non-small cell lung cancer (NSCLC):
phase III NSCLC research experience utilizing
Sorafenib (NExUS) trial.
ESMO meeting, 8-12 October 2010, Milan.
Groen HJM, Hochstenbag MMH, van Putten JWG,
Vincent A, Dalesio O, Biesma B, Smit JM, Termeer A,
van den Borne BEEM, Schramel FMNH.
Abstract: A randomized placebo-controlled phase III
study of docetaxel/carboplatin with celecoxib in
patients (pts) with advanced non-small cell lung
cancer (NSCLC). The NVALT-4 study.
Proc Am Soc Clin Oncol, 2009, abstract ID 8005
Wymenga ANM, Biesma B, Vincent A, Dalesio O,
Groen HJM.
Is there a role for Complete Geriatric Assessment
(CGA) in the treatment of elderly non-small cell lung
cancer (NSCLC) patients (pts) receiving combination
chemotherapy? Final results from prospective
78
multicenter NVALT-3 study.
Proc Am Soc Clin Oncol, 2009.
Biesma B.
Interpretatie van studieresultaten.
Cursus ”Oncologie voor de longarts”. Terschelling
15-19 maart 2009.
Biesma B.
Chemotherapie voor de oudere patiënt.
Cursus ”Oncologie voor de longarts”, Prof. Dr. Jaap
Swierenga Stichting. Terschelling 15-19 maart 2009.
Biesma B.
(Neo-)adjuvante chemotherapie in NSCLC.
Curriculum Longoncologie voor longartsen in opleiding.
Utrecht 3 april 2009.
Biesma B, Jacobs M, Bots A.
De patiënt met acute dyspnoe.
Geaccrediteerde nascholingscursus voor huisartsen.
Vught, 12 mei 2009.
Biesma B.
Biologicals: een update.
Post WCLC meeting. Vught,
9 september 2009.
Biesma B, Lucas A.
CASPIR cursus 2009: Praktische spirometrie
voor de eerst lijn.
Vught, 16 september 2009.
Biesma B.
Nascholing voor longartsen: het belang
en de implicaties van EGFRmutatiebepaling bij het NSCLC. Tyrosine
Kinase Inhibitors.
’s-Hertogenbosch 5 november 2009.
Biesma B. Statistiek bij longkanker studies.
Avondsymposium Longoncologie.
Wageningen 14 januari 2010.
Biesma B.
Nascholing voor longartsen en aios: de rol van
TKI’s bij de behandeling van NSCLC.
’s-Hertogenbosch 11 maart 2010.
Biesma B.
Chemotherapie voor de oudere patiënt.
Cursus ”Oncologie voor de longarts”, Prof. Dr. Jaap
Swierenga Stichting. Terschelling 14-18 maart
2010.
Biesma B.
Bewijsvoering, richtlijnen en veiligheid bij het gebruik
van ESA’s.
Symposium Groeifactoren. ’s-Hertogenbosch
15 april 2010.
Macken T.
Voordracht: Rijvaardigheidskeuring bij OSAS.
Nederlandse Vereniging SlaapapneuPatienten.
’s-Hertogenbosch, 24 maart 2010.
Macken T.
Voordracht: COPD.
Nascholing huisartsen SCEM,
13 april 2010.
Macken T.
Caspir nascholing longfunctie.
Vught, 19 januari 2010 / 13 juli 2010.
Macken T.
COPD ketenzorg.
Bossche samenscholingsdagen,
26 november 2010.
Macken T.
Docentschap Ziekteleer Longziekten Master Medische
Psychologie,.
Universiteit van Tilburg (jaarlijks),
september 2010.
Biesma B.
Palliatieve chemotherapie voor de oudere patient.
Gamma Professional, 2: 28-32, 2009.
De Visser VL, Biesma B.
Wat is de beste eerstelijnsbehandeling voor
gemetastaseerd bronchoalveolaircel carcinoom.
Oncologie Vademecum, 6: 5, 2009.
longziekten
79
80
14
MEDISCHE MICROBIOLOGIE
Budding AE, Ingham CJ, Bitter W, VandenbrouckeGrauls CM, Schneeberger PM.
The Dienes phenomenon: competition
between unrelated strains of Proteus
mirabilis.
J Bacteriol 2009 Jun;191(12):3892-900.
PMID: 19251852
Karagiannis I, Schimmer B, van Lier A,
Timen A, Schneeberger PM, van Rotterdam B, de
Bruin A, Wijkmans C, Rietveld A, van Duynhoven Y.
Investigation of a Q fever outbreak in a rural area of
The Netherlands.
Epidemiol Infect 2009 Sep;137(9):1283-94.
PMID: 19161644
Schimmer B, Dijkstra F, Vellema P, Schneeberger PM,
Hackert V, ter Schegget R, Wijkmans C,
van Duynhoven Y, van der Hoek W.
Sustained intensive transmission of Q fever in the
south of the Netherlands, 2009.
Euro Surveill 2009;14:pii=19210.
PMID: 19442401
Penninx J, Brandes M, de Bruin JP, Schneeberger PM,
Hamilton CJ.
Prediction of pelvic pathology in subfertile women with
combined Chlamydia antibody and CA-125 tests.
medische microbiologie
Eur J Obstet Gynecol Reprod Biol 2009;147:178-82.
PMID: 19733956
de Jager CP, de Wit NC, Weers-Pothoff G,
Procalcitonin kinetics in Legionella
pneumophila pneumonia.
Clin Microbiol Infect 2009;15:1020-5.
PMID: 19438643
Daha TJ, Bilkert-Mooiman MA, Ballemans C,
Frijstein G, Keeman JN, de Man RA,
van Steenbergen JE, Weers-Pothoff G, Zaaijer HL.
Hepatitis B virus infected health care workers in The
Netherlands, 2000-2008.
Eur J Clin Microbiol Infect Dis 2009;28:1041-4.
PMID: 19350292
Wever PC.
acute Q-fever.
Clin Chem Lab Med 2009;47:1407-9.
PMID: 19778289
Van Asten L, van der Lubben M, van den Wijngaard C,
van Pelt W, Verheij R, Jacobi A, Overduin P, Meijer A,
81
Luijt D, Claas E, Hermans MH, Melchers W, Rossen J,
Schuurman R, Wolffs P, Boucher C, Schirm J, Kroes L,
Leenders AC, Galama J, Peeters M, van Loon A,
Stobberingh E, Schutten M, Koopmans M.
Strengthening the diagnostic capacity to detect Bio
Safety Level 3 organisms in unusual respiratory viral
outbreaks.
J Clin Virol 2009; 45:185-90.
PMID: 19515608
Chinnadurai SK, Troan BV, Wolf KN, DeVoe RS,
Huijsmans CJ, Hermans MH, Wever PC.
Septicemia, endocarditis, and cerebral infarction due to
Staphylococcus aureus in a harp seal (Phoca
groenlandica).
J Zoo Wildl Med 2009;40:393-7.
PMID: 19569495
levels.
PMID: 18855027
Schneeberger PM, Hermans MH, van Hannen EJ ,
Schellekens JJ, Leenders AC, Wever PC.
Real-time PCR with serum samples is indispensable
for early diagnosis of acute Q fever.
Clin Vaccine Immunol. 2010 Feb;17(2):286-90.
PMID:20032219
Van Wijk PT, Boland GJ, Voss A, Schneeberger PM.
Impact of new guidelines for blood exposure incidents
in The Netherlands.
Occup Med (Lond). 2010;60:270-6.
PMID: 20448058
Van Wijk P, Schneeberger PM, Heimeriks KT, Boland
GJ, Karagiannis I, Geraedts J, Ruijs WL.
Occupational blood exposure accidents in the
Netherlands
Eur J Public Health. 2010 Jun; 20(3): 281-7.
82
PMID: 19864365
Schimmer B, ter Schegget R,
Wegdam M, Züchner L, de Bruin A, Schneeberger PM,
Veenstra T, Vellema P,
van der Hoek W.
The use of a geographic information system to identify
a dairy goat farm as the most likely source of an urban
Q-fever outbreak.
BMC Infect Dis 2010 Mar 16; 10: 69.
PMID: 20230650
Van der Hoek W, Dijkstra F, Schimmer B,
Schneeberger PM, Vellema P, Wijkmans C,
ter Schegget R, Hackert V, van Duynhoven Y.
Q fever in the Netherlands: an update on the
epidemiology and control measures.
Euro Surveill 2010 Mar 25;15(12):pii=19520.
PMID: 20350500
Van der Hoek W, Dijkstra F, Rietveld A, Wijkmans CJ,
Steenbergen JE, Notermans DW, Schneeberger PM.
Three years of Q fever in the Netherlands: faster
diagnosis. [Drie Jaar Q-koorts in Nederland: snellere
diagnose.]
Ned Tijdschr Geneeskd 2010; 154:A1845
PMID: 20619049
Wegdam-Blans MC, Nabuurs-Franssen MH,
Horrevorts AM, Peeters MF, Schneeberger PM,
Bijlmer HA.
Laboratory diagnosis of acute Q fever.
[Laboratoriumdiagnostiek van acute Q-koorts.]
Ned Tijdschr Geneeskd 2010;154:A2388.
PMID: 20858325
Wever PC, Arts CH, Groot CA, Lestrade PJ, Koning OH,
Renders NM.
Screening for chronic Q fever in symptomatic patients
with an aortic aneurysm or prosthesis. [Screening op
chronische Q-koorts bij symptomatische patiënt met
aneurysma of prothese van de aorta.]
PMID: 20699030
Kusters MA, Gemen EF, Verstegen RH,
Wever PC, de Vries E.
Both normal memory counts and decreased naive cells
favor intrinsic defect over early senescence of Down
syndrome T lymphocytes.
Ped Res 2010 May;67(5):557-62.
PMID: 20098345
Jager MM, Murk JL, Pique R, Wulf MW, Leenders AC,
Buiting AG, Bogaards JA, Kluytmans JA,
Vandenbroucke-Grauls CM.
Prevalence of carriage of meticillin-susceptible and
meticillin-resistant Staphylococcus aureus in
employees of five microbiology laboratories in The
Netherlands.
J Hosp Infect 2010 Mar;74(3):292-4.
PMID: 20149482
Munster JM, Leenders AC, van der Hoek W,
Schneeberger PM, Rietveld A, Riphagen-Dalhuisen J,
Stolk RP, Hamilton CJ, de Vries E, Meekelenkamp J,
Lo-Ten-Foe JR, Timmer A, De Jong-van den Berg LT,
Aarnoudse JG, Hak E.
Cost-effectiveness of a screening strategy for Q fever
among pregnant woman in risk areas: a clustered
BMC Womens Health. 2010 Nov 1;10:32.
PMID: 21040534
Limonard GJ, Nabuurs-Franssen MH, Weers-Pothoff
G, Wijkmans C, Besselink R, Horrevorts AM,
Schneeberger PM, Groot CA.
One-year follow-up of patients of the ongoing Dutch Q
fever outbreak: clinical, serological and
echocardiographic findings.
Infection 2010 Dec;38(6):471-7.
PMID: 20857313
Limonard GJ, Peters JB, Nabuurs-Franssen MH,
Weers-Pothoff G, Besselink R, Groot CA, Dekhuijzen
PN, Vercoulen JH.
Detailed analysis of health status of Q fever patients 1
year after the first Dutch outbreak: a case-control
study.
QJM 2010 Dec;103(12):953-8.
PMID: 20802011
De Jager CP, van Wijk PT, Mathoera RB,
Crit Care 2010;14(5):R192.
PMID: 21034463
Groot CA, Schneeberger PM, Hollander AA, Schijen
JH, Arents NL, Oosterheert JJ, Wever PC.
Acute Q fever related in-hospital mortality in the
Netherlands.
Neth J Med 2010 Dec;68(12):408-413.
PMID: 21209466
Dijkstra F, Riphagen-Dalhuisen J, Wijers N, Hak E,
van der Sande MA, Morroy G, Schneeberger PM,
Schimmer B, Notermans DW, van der Hoek W.
Antibiotic therapy for acute Q fever in The Netherlands
in 2007 and 2008 and its relation to hospitalization.
Epidemiol Infect 2010 Nov 19:1-10.
PMID: 21087542
Proefschriften
Van Wijk P.
(copromotor Schneeberger PM)
Improving the Management of Blood Exposure
Accidents in The Netherlands, Radboud Universiteit
Nijmegen, 18 november 2009.
83
Poster: Procalcitonin kinetics in Legionella pneumophila
pneumonia.
Nederlandse Intensivisten Dagen 2009, Ede,
11-13 februari 2009.
Wever PC.
Voordracht: Q-koorts, geiten en bioterrorisme.
Venticare 2009, Utrecht, 14 mei 2009.
De Jager CP, Mathoera RB, de Jongh-Leuvenink J,
van Wijk PT, van der Poll T, Wever PC. Poster:
Lymphocytopenia and neutrophil/lymphocyte count
parameters in an emergency care unit.
ECCMID, Helsinki, Finland, 16-19 mei 2009.
Schneeberger PM, van Hannen EJ, Schellekens JJ,
Leenders AC, Hermans MH, Wever PC. Poster:
Real-time PCR is indispensable for early diagnosis of
acute Q-fever. ICAAC, San Francisco, USA,
Meiberg AE, van Wijk PT, Dam BA, Groenewold MH,
Bruers JJ, Schneeberger PM.
Poster: National program on blood-exposure incidents
in dental practices in The Netherlands. ICAAC, San
Francisco, USA, 12-15 september 2009.
Rentenaar RJ, de Jager CP, Schneeberger PM,
de Wit NC, Wever PC.
Poster: Cytomegalovirus latency does not influence
clinical presentation and outcome of infection with
Legionella pneumophila serogroup 1.
Legionella 2009, Parijs, Frankrijk, 13-17 oktober 2009.
Schellekens JJ, Wever PC, Schneeberger PM,
van Hannen EJ, Leenders AC, Hermans MH.
Voordracht en Poster: Real-time PCR is indispensable
for early diagnosis of acute Q-fever.
6th European Meeting on Molecular Diagnostics,
84
Scheveningen, 22-23 oktober 2009.
Jager MM, Weers-Pothoff G, Hermans MH,
Schellekens JJ, Meekelenkamp J, Schneeberger PM,
Wever PC.
Voordracht: Value of a diagnostic algorithm for the
diagnosis of acute Q-fever in an outbreak setting.
Symposium Q-koorts: een complexe ziekte,
’s-Hertogenbosch, 5 november 2009.
Dijkstra F, Riphagen-Dalhuisen J, Wijers N, Hak E,
van der Sande MA, Schneeberger PM, Morroy G,
Schimmer B, van der Hoek W.
Vooprdracht: Antibiotic therapy for Q fever in the
Netherlands in 2007 and 2008 and its relation to
clinical course: preliminary results.
Leenders AC.
Voordracht: De ene zwangerschap is de ander (niet)?
Renders NH.
Voordracht: Chronische Q-koorts.
Groot CA, Schneeberger PM, van Eede WL, Stals FS,
Hollander AA, Schijen JH, Arents NL, Wever PC.
Voordracht: Acute Q-fever-related mortality in the
Netherlands.
Najaarsvergadering NVMM, Zeist, 24 november 2009.
Schellekens JJ, Meekelenkamp JC, Schneeberger PM,
Wever PC.
Voordracht: Evaluation of a diagnostic algorithm for
acute Q-fever in an outbreak setting. ECCMID, Wenen,
Oostenrijk, 10-13 april 2010.
Schimmer B, Notermans DW, Harms MG, Reimerink
JH, Bakker J, Schneeberger PM, Mollema L, Teunis PF,
van Pelt W, van Duynhoven YT.
Poster: Seroprevalence of Q fever in The Netherlands
just preceding a series of large outbreaks.
ECCMID, Wenen, Oostenrijk, 10-13 april 2010.
Schneeberger PM, Schimmer B, Dijkstra F, Rietveld A,
Notermans D, Wegdam-Blans M, van Duynhoven Y,
van Rotterdam BJ, Vellema P, Roest HJ, Wijkmans C,
van der Hoek W.
Voordracht: Epidemiology and control of Q fever in the
Netherlands, 2007-2009.
Schimmer B, ter Schegget R, Wegdam M, Züchner L,
de Bruin A, Schneeberger PM, Veenstra T, Vellema P,
van der Hoek W.
Poster: The use of a geographic information system to
identify a dairy goat farm as the most likely source of
an urban Q-fever outbreak.
Schellekens JJ, Meekelenkamp JC, Schneeberger PM,
Wever PC.
Voordracht: Evaluation of a diagnostic algorithm for
acute Q-fever in an outbreak setting.
Voorjaarsvergadering NVMM, Papendal,
20-21 april 2010.
Renders NH, Stekelenburg CM, Lestrade PJ, Arts CH,
Wever PC.
Voordracht: In-hospital screening for Q-fever in
patients undergoing elective and emergency aneurysm
repair.
20-21 april 2010.
Schneeberger PM.
Voordracht: Diagnostic Dilemma’s for Q fever.
20-21 april 2010.
Wever PC, van Hannen EJ, Schellekens JJ,
van Lokven JW, Schneeberger PM, Zaaijer HL,
Hermans MH.
Voordracht: Detection of Coxiella burnetii DNA in
veterinary samples and supermarket dairy products
using routine hospital developed real-time PCR
techniques.
20-21 april 2010.
Kampschreur LM, Schneeberger PM, Jager MM,
Hoepelman AI, Leenders AC, Hermans MH,
Wever PC.
Poster: Early antibiotic treatment of acute Q-fever
does not preclude IgG antibody responses to Coxiella
burnetii.
20-21 april 2010.
Stekelenburg CM, Renders NH, Lestrade P,
Wever PC, Koning OH, Arts CH.
Voordracht: Q-koorts screening bij patiënten die een
electieve of acute aneurysma operatie ondergaan.
Chirurgendagen, Veldhoven, 20-21 mei 2010.
Wever PC.
Voordracht: Q-koorts, een complexe diagnostiek!
Infectieziektenserologie-SKML deelnemersmiddag, Het
Trippenhuis, Amsterdam, 27 mei 2010.
Wever PC.
Voordracht: Diagnostiek en behandeling bij Q-koorts.
Bijeenkomst Academische Werkplaats AMPHI,
Studiecentrum Soeterbeeck, Ravenstein, 1 juni 2010.
Wever PC.
Voordracht: Q-koorts.
Cursus Serologische Diagnostiek van Infectieziekten,
VU Medisch Centrum, Amsterdam, 15-17 juni 2010.
Leenders AC.
Voordracht: Q & A’s over Q koorts.
Schellekens symposium Infecties in de Obstetrie en
Gynaecologie, Den Haag, 18 juni 2010.
85
Meijer A, Jonges M, Abbink F, Ang W, Beersma T,
Bloembergen P, Boucher C, Claas E, Donker G,
Gooskens J, Isken L, de Jong A, Leenders AC,
van der Lubben M, Mascini E, Niesters B, Oosterheert
JJ, Osterhaus A, Riesmeijer R, Riezebos-Brilman A,
Schutten M, Sebens F, Stelma F, Swaan C, Timen A,
van ’t Veen A, van der Vries E, Wierik M, Koopmans M.
Voordracht en Poster: Oseltamivir resistant pandemic
A(H1N1) 2009 influenza viruses detected in the
Netherlands.
Options for the Control of Influenza VII, HongKong,
China, 3-7 september 2010.
Teunis P, Schimmer B, Leenders AC, Notermans D,
Herremans T, Wever PC, Schneeberger PM.
Poster: Modeling longitudinal serum antibody
responses against Coxiella burnetii phase I and II in
patients with acute Q fever.
ICAAC, Boston, Verenigde Staten,
Van der Hoek W, Versteeg B, Meekelenkamp JC,
Renders NH, Leenders AC, Weers-Pothoff G, Wever PC,
Schneeberger PM.
Poster: How to identify chronic Q fever with serologic
follow-up.
Van de Sande N, Leverstein M, Muilwijk J, Janssen M,
de Neeling H, Leenders A, Schneeberger PM.
Poster: Should Pig-MRSA Be Part Of The Dutch
‘Search And Destroy’ Policy For MRSA? ICAAC, Boston,
Verenigde Staten, 12-15 september 2010.
Van der Meeren BT, Chaganial KD, Pfeiffer A, Gomez E,
Ferro JJ, Macome C, Abdul R, van de Vondervoort FJ,
Steidel K, Wever PC.
Poster: Extremely high prevalence of multi-resistance
among uropathogens from hospitalized children in
Beira, Mozambique.
86
Leenders AC.
Voordracht: Q & A’s over Q koorts.
Stafbijeenkomst. Diaconessenziekenhuis,
Utrecht, 14 oktober 2010.
Munster JM, Leenders AC, Aarnoudse JG, Hak E,
for the Q fever during pregnancy study group,
The Netherlands.
Poster: A screening strategy for Q fever during
pregnancy.
ESCAIDE, Lissabon, Portugal, 11-13 november 2010.
Hautvast J, Schimmer B, Aangenend H, Lenferink A,
Schneeberger PM, Vellema P, van Duijnhoven Y.
Poster: Risk factors for Q fever infections in dairy goat
farmers’ households in the Netherlands.
Raven S, Hautvast JL, Herremans T, Leenders AC,
Schneeberger PM.
Poster: Predictive value of solitary IgM phase II positive
serology in acute Q fever; comparison of IFA and ELISA.
Whelan J, Schimmer B, Vromen H, Schneeberger PM,
Meekelenkamp J, van der Hoek W, du Ry van Beest
Holle MR.
Voordracht: Q fever in culling workers before and after
animal culling in the Netherlands, 2010.
Naesens R, Magerman K, Gyssens I, Leenders AC,
Coppens G, Oris E, Craeghs J, Thoelen I, Gabriëls P,
Vandevelde M, Forier A, Waumans L, Cartuyvels R.
Poster : Q-fever in Belgian Limburg: myth or reality?
Van den Brom R, Schimmer B, Schneeberger PM,
Swart W, van der Hoek W, Vellema P.
Poster: Seroepidemiological survey for Coxiella bunetii
antibodies and associated risk factors in Dutch livestock
veterinarians.
Herremans T, Hogema B, Galama J, Peeters M, Nijhuis
C, Notermans D, Nabuurs M, Schneeberger PM,
Wegdam M, Horrevorts A, van Loo I, Vlaminckx B,
Zaaijer H, Koopmans M, Berkhout H, Bijlmer H.
Voordracht: Comparison of the performance of CFA, IFA
and ELISA assays for the serodiagnosis of Q fever by
quality assessment.
Renders NH.
Voordracht: Chronic Q fever, a previously rare disease
in the Netherlands. Najaarsvergadering NVMM/VIZ/
BVIKM, Amsterdam,
Kampschreur LM, de Vries Feyens CA, Renders NH,
Hermans MH, Oosterheert JJ, Lestrade PJ, Elsman P,
Wever PC.
Voordracht: Chronic Q-fever related dual pathogen
endocarditis: case reports of three patients.
Vissers E, de Jager CP, Kusters R,
van Gageldonk-Lafeber AB, Wever PC.
Schneeberger PM.
Het mysterie van de Q-koorts.
Mednet 2009:5;20
Steggerda LM, van der Hoek W, Schimmer B,
Schneeberger PM, Opstelten W, Oldelohuis A, Hak E.
Q-koorts in de huisartsen praktijk: de stand van zaken.
Patient Care 2009; juni:7-11.
Meekelenkamp JC, Notermans DW, Rietveld A,
Marcelis JH, Schimmer B, Reimerink J, Vollebergh J,
Wijkmans CJ, Leenders AC.
Seroprevalentie van Coxiella burnetii bij zwangere
vrouwen in Noord-Brabant in 2007. Infectieziektenbull
2009;20:57-61.
Leenders AC.
Operatie in beeld.
Medisch Contact 2009;64:345.
Leenders AC, Pelk MP, Oosting JD, Brenninkmeijer BJ,
van ’t Hullenaar NG.
Handvat voor BOA-incidenten.
Medisch Contact 2009:64:1102.
De Groot AC, van Meurs T, de Jager CP, Bosma J,
Wever PC, Stoof TJ.
Necrotiserende fasciitis: kliniek, diagnostiek en
behandeling.
Ned Tijdschr Dermatol Venereol 2009;19:123-9.
Van Gageldonk-Lafeber R, van der Lubben M,
de Jager CP, Wever PC.
Tussenrapportage van de ‘VLO-CAP studie’.
Community-acquired pneumonia.
Cura 2009;6(1):9-10.
De Jager CP, Leuken M, Wever PC.
Pylephlebitis; septische tromboflebitis van de poortader
en mesenteriaal vaten.
Cura 2009;6(2):13.
87
Van Kuilenburg JT, Wever PC, de Jager CP.
Bijzondere ziektebeelden op de Intensive Care;
Morbus Strangularis.
Cura 2009;6(3):10.
Wever PC.
Is het zinvol om peracute cito-diagnostiek te verrichten
naar de immuunstatus voor parvovirus B19 bij een
zwangere met een parvoviruscontact binnen het gezin?
Labcontact 2009;10(28):1-2.
Wever PC, Hermans MH.
Wat zijn de nieuwe ontwikkelingen in de diagnostiek
van acute Q-koorts?
Labcontact 2009;10(29):3-4.
Wever PC.
Q-koorts versus de media.
Ned Tijdschr Med Microbiol 2010;18:26.
Schneeberger PM.
Wits and no genes.
Ned Tijdschr Med Microbiolog 2010;18:7-8.
Daha TJ, Bilkert-Mooiman MA, Ballemans C, Frijstein
G, Keeman JN, de Man RA, van Steenbergen JE,
Weers-Pothoff G, Zaaijer HL.
Gezondheidszorgmedewerkers met hepatitis B in
Nederland, 2000-2008.
Infect Bull 2010;21:online publicatie.
Wever PC.
Waarom lees je niet: ‘Pas op Q-koorts’?
De Volkskrant, 20 juni 2009.
Wever PC.
Zo vlot bij de griep, zo traag bij de Q-koorts.
NRC Handelsblad, 11 december 2009.
88
15
MOLECULAIRE
DIAGNOSTIEK
levels.
PMID: 18855027
trefwoorden: Legionella pneumophila, PCR
Lippert E, Girodon F, Hammond E, Jelinek J, Reading
NS, Fehse B, Hanlon K, Hermans M, Richard C,
Swierczek S, Ugo V, Carillo S, Harrivel V, Marzac C,
Pietra D, Sobas M, Mounier M, Migeon M, Ellard S,
Kröger N, Herrmann R, Prchal JT, Skoda RC,
Hermouet S. Concordance of assays designed
for the quantification of JAK2V617F: a multicenter
study. Haematologica.
2009 Jan;94(1):38-45.
PMID: 19001280
trefwoorden: JAK2V617F, MPD
Schmeits PC, Péquériaux NC, van Geest-Daalderop JH,
Ouwehand ME, Coremans AM, Hermans MH,
Conemans JM.
superwarfarin.
Neth J Med. 2009 Feb;67(2):76-8.
moleculaire diagnostiek
PMID: 19299851
trefwoorden: VKORC1, INR
Van Asten L, van der Lubben M, van den Wijngaard C,
van Pelt W, Verheij R, Jacobi A, Overduin P, Meijer A,
Luijt D, Claas E, Hermans M, Melchers W, Rossen J,
Schuurman R, Wolffs P, Boucher C, Schirm J, Kroes L,
Leenders S, Galama J, Peeters M, van Loon A,
Stobberingh E, Schutten M, Koopmans M.
Strengthening the diagnostic capacity to detect Bio
Safety Level 3 organisms in unusual respiratory viral
outbreaks.
J Clin Virol. 2009 Jul;45(3):185-90.
PMID: 19515608 Erratum in: J Clin Virol. 2010
Feb;47(2):204.
trefwoorden: diagnostiek, pandemie
Meijer A, Beerens A, Claas E, Hermans M, de Jong A,
Molenkamp R, Niesters H, Overduin P, Rossen J,
Schuurman R, Wolffs P, Fouchier R, Osterhaus A,
Schutten M, Koopmans M. Preparing the outbreak
assistance laboratory network in the Netherlands for
the detection of the influenza virus A(H1N1) variant.
J Clin Virol. 2009 Jul;45(3):179-84.
PMID: 19540155
trefwoorden: Influenza, pandemie
Chinnadurai SK, Troan BV, Wolf KN, DeVoe RS,
89
Huijsmans CJ, Hermans MH, Wever PC. Septicemia,
endocarditis, and cerebral infarction due to
Staphylococcus aureus in a harp seal (Phoca
groenlandica).
J Zoo Wildl Med. 2009. 40:393.
PMID: 19569495
Schellekens JJ, Leenders AC, Wever PC. Real-time
PCR with serum samples is indispensable for early
diagnosis of acute Q fever.
PMID: 20032219
trefwoorden: Q fever, diagnosis
trefwoorden: harp seal, Staphylococcus aureus
vitamin-K enzyme.
PMID: 19857286
trefwoorden: VKORC1, coumarines
Tilburg JJ, Melchers WJ, Pettersson AM, Rossen JW,
Hermans MH, van Hannen EJ, Nabuurs-Franssen MH,
de Vries MC, Horrevorts AM, Klaassen CH.
Interlaboratory evaluation of different extraction and
real-time PCR methods for the detection of Coxiella
burnetii DNA in serum.
J Clin Microbiol. 2010 Nov;48(11):3923-7.
PMID: 20826645
trefwoorden: Q fever, PCR
Schmeits PC, Hermans MH, van Geest-Daalderop JH,
Poodt J, de Sauvage Nolting PR, Conemans JM.
to phenprocoumon.
Br J Haematol. 2010 Mar;148(6):955-7.
PMID: 19961479
trefwoorden: VKORC1, mutatie
Schneeberger PM, Hermans MH, van Hannen EJ,
Huijsmans CJ, Damen J, van der Linden JC,
Savelkoul PH, Hermans MH.
Comparative analysis of four methods to extract DNA
from paraffin-embedded tissues: effect on downstream
molecular applications.
BMC Res Notes. 2010 Sep 14;3:239.
PMID: 20840759
trefwoorden: paraffine, DNA extractie
Trienekens TA, Broeren M, Linssen ET, Roorda L,
Hermans MH.
Poster: Evaluation of Becton Dickinson GeneOhm, Hain
GenoType MRSA Direct and two in house assays for
MRSA screening.
Antonie van Leeuwenhoek 95: 109: P076, Papendal,
2009.
Trienekens TA, van der Velden JJ, Heumassej AW,
Hermans MH.
Poster: Performance of Becton Dickinson GeneOhm
Methicillin-resistent Staphylococcus aureus PCR assay
in different spa- and PFGE-types of MRSA.
Antonie van Leeuwenhoek 95: 109: P077, Papendal,
2009.
90
Zee, A van der, Hermans MH, Kroonen R,
Breugelmans AJ, Mooy N, Westenend PJ.
Poster: Evaluation of an internally controlled semiquantitative real-time PCR for detection of
Pneumocystis jiroveci in paraffin-embedded clinical
samples.
Geraats CW, Catsburg A, Savelkoul P, Hermans MH.
Poster: Evaluation of a commercial real time PCR test
(Presto CT/NG Test) for simultaneous detection of CT
and NG. European Meeting on Molecular Diagnostics,
Scheveningen,
22/23-10-2009.
Poster: Patients with partial resistance to
VKORC1 gene. European Meeting on Molecular
Diagnostics, Scheveningen,
22/23-10-2009.
Poodt J, Hermans MH.
Poster: Ultra-sensitive and fast detection of the
JAK2V617F mutation in patients with a
myeloproliferative disease. European Meeting on
Molecular Diagnostics, Scheveningen, 22/23-102009.
Poodt J.
Voordracht:Patients with partial resistance to
VKORC1 gene.
Scheveningen, 22-10-2009.
Hermans M.
Voordracht: Real-time PCR is indispensable for early
diagnosis of acute Q-fever.
Zee A van der, Hermans M, Kroonen R,
Breugelmans A-J, Mooy N, Westenend PJ.
Poster: Evaluation of an internally controlled semiquantitative real-time PCR for detection of
Pneumocystis jiroveci in paraffin-embedded clinical
materials.
Schellekens J, Wever P, Schneeberger P,
van Hannen E, Leenders A, Hermans M.
Poster: Real-time PCR is indispensable for early
diagnosis of acute Q-fever.
Poster: Comparison of four methods to extract DNA
from paraffin embedded tissues for molecular
applications. European Meeting on Molecular
Diagnostics, Scheveningen, 2
3-10-2009 en Pathologendagen Zeist, 7/8-4-2010.
Huijsmans R.
Voordracht: Patientenverwisselingen binnen
de pathologie.
Congres Vereniging Analisten Pathologie (VAP),
Jaarbeurs Utrecht, 15-09-2009.
moleculaire diagnostiek
91
Onderzoekstalenten
aan boord halen
Hij praat enthousiast over DNA, celmembranen, vetten, eiwitten en suikers. Ook gaat zijn bloed
sneller stromen op het moment dat hij micro-organismen bestudeert. Al met al heeft hij een
passie voor moleculaire diagnostiek. Dat moet hij even uitleggen…
Ronald Huijsmans is promovendus bij het Jeroen Bosch Ziekenhuis en daarnaast unithoofd van de
afdeling Moleculaire Diagnostiek. Hij vertelt meer over zijn achtergrond: “Aan het einde van mijn studie
Hogere Laboratorium Opleiding kwam ik in aanraking met een moleculair bioloog van dit ziekenhuis. Ik
kreeg de mogelijkheid hier een afstudeerstage te volgen. Daarna behaalde ik een master en nu
promoveer ik bij de Vrije Universiteit in Amsterdam. Ik had het hier altijd naar mijn zin en ben er trots op
dat ik mijn promotieonderzoek in dit ziekenhuis kan afronden.”
92
Vingerafdruk
Het project van Huijsmans richt zich specifiek op het onderzoeken van de zogenaamde Single Nucleotide
Polymorphism (SNP). “De afkorting SNP wordt uitgesproken als snip. Het DNA bestaat simpel gezegd uit
vier bouwstenen: A, C, T en G. Een SNP is een variatie van zo’n bouwsteen. Persoon 1 heeft op een
bepaalde plaats in het DNA een A, persoon 2 heeft op die plek een C. Alle levensvormen hebben een groot
aantal van deze SNP’s. Door een slimme combinatie van SNP’s te gebruiken, kun je veel toepassingen
onderzoeken. Ik zie het als een vingerafdruk van ieder levend organisme.”
Snel, goedkoop en eenvoudig
Huijsmans: “Om DNA te onderzoeken moeten we het eerst zuiveren van allerlei celmateriaal, zoals
eiwitten, membranen en celorganellen. Dit noemen we DNA-isolatie. Vervolgens stelt de SNP-technologie
ons in staat snel, goedkoop en relatief eenvoudig genetische kenmerken uit het DNA in kaart te brengen.”
En dat is niet het enige: “Er is minder materiaal nodig om tot een genetische afdruk van een persoon,
tumor of micro-organisme te komen. De SNP-technologie is geschikt voor het werken met sterk
gedegradeerd DNA, vaak het geval bij weefsels van de pathologie”
Toepassingen
We gebruiken deze techniek voor een aantal toepassingen. Huijsmans: “Zo kijken we naar SNP’s wanneer
er mogelijk een monster verwisseld is. Een andere toepassing is het SNP-onderzoek waarbij we kijken
naar het verlies of juist de vermeerdering van bepaalde genen die kunnen leiden tot het ontstaan van
kanker. In Nederland was de afgelopen jaren de grootste Q-koorts uitbraak ter wereld. Dit is een zeer
besmettelijke infectieziekte die van dieren over kan gaan op mensen. Ook hier hebben we de SNPtechniek ingezet.”
Samenwerking
“De Q-koorts wordt veroorzaakt door de bacterie Coxiella burnetii”, vervolgt Huijsmans. “Met de
SNP-techniek ontdekten we maar liefst vijf verschillende typen bacteriën. Daarnaast toonden we met
deze test aan dat het DNA uit het Q-koorts vaccin in de melk van gevaccineerde geiten terechtkomt. Naar
aanleiding van deze bevinding is op landelijk niveau de tijd tussen vaccinatie en het nemen van een
diagnostisch tankmelk monster aangepast. Dat zou ons niet gelukt zijn zonder het doen van onderzoek.
Ook was er steeds goede samenwerking met artsen en andere paramedici. Dit topklinische ziekenhuis
heeft dan ook de ambitie onderzoekstalenten aan boord te halen!”
interview ronald huijsmans
93
94
16
NEUROLOGIE
Jongen PJ, Sindic C, Carton H, Zwanikken C, Lemmens
W, Borm G; Functional composite and quality of Life in
Avonex-treated Relapsing multiple sclerosis patients
study group.
Anten, Driessen, Baard, Frequin, Hintzen, Hupperts,
Jongen, Linssen, MispelblomBeyer, Moll, van Munster,
Pratzsky, Sanders, Smits, van Walbeek, Willems, Witjes,
van Zuilen, Bartholomé, Braeckveldt, Van der Motte,
Debruyne, Decoo, Dedeyn, Engelborghs, Dupuis,
Jacquerye, Van de Gaer, Guillaume, Reznik, Harmant,
D’Hooghe, Klippel, Willems, van Landegem, Strauven,
Maertens de Noordhout, Delavaux, Nagels,
Seeldrayers, Vervonck, Sindic, Goffette, El-Memar,
Hawkins, de Diego.
Improvement of health-related quality of life in
relapsing remitting multiple sclerosis patients after 2
years of treatment with intramuscular interferonbeta-1a.
J Neurol. 2010 Apr;257(4):584-9.
PMID: 19921303
Verhave JC, Conemans JM, Hollander DA,
Dautzenberg PL., Hoogeveen EK.
J Am Geriatr Soc. 2010. Apr; 58(4): 799-801.
PMID: 20398172
neurologie
Trefwoorden: Dementie en valproïnezuur
Walgaard C, Lingsma HF, Ruts L, Drenthen J, van
Koningsveld R, Garssen MP, van Doorn PA, Steyerberg
EW, Jacobs BC.
Prediction of respiratory insufficiency in Guillain-Barré
syndrome.
Ann Neurol. 2010 Jun;67(6):781-7.
PMID: 20517939
Van Nes SI, Vanhoutte EK, Faber CG, Garssen MP,
van Doorn PA, Merkies IS; PeriNomS Study Group.
Improving fatigue assessment in immune-mediated
neuropathies: the modified Rasch-built fatigue severity
scale.
J Peripher Nerv Syst. 2009 Dec;14(4):268-78.
PMID: 20021568
Bernsen RA, de Jager AE, Kuijer W, van der Meche FG,
Suurmeijer TP.
Psychosocial dysfunction in the first year after
Guillain-Barre syndrome.
Muscle Nerve 2010 Apr;41(4):533-9.
PMID: 19941334
Trefwoorden: Guillain-Barre syndrome, psychosocial.
Verra WC, Snijders TJ, Seute T, Han KS,
Nieuwenhuis HK, Rutten GJ.
Myeloid Sarcoma presenting as a recurrent, multifocal
95
nerve root entrapment syndrome.
J Neurooncol. 2009 Jan;91(1):59-62.
PMID: 18712278
Rutten GJ, Ramsey NF.
The role of functional magnetic resonance imaging in
brain surgery.
Neurosurg Focus 2010 Feb;28(2): E4.
PMID: 20121439
Munneke M, Nijkrake MJ, Keus SH, Kwakkel G,
Berendse HW, Roos RA, Borm GF, Adang EM,
Overeem S, Bloem BR; ParkinsonNet Trial Study
Group.(ter Bruggen JP)
Efficacy of community-based physiotherapy networks
for patients with Parkinson’s disease: a clusterrandomised trial.
Lancet Neurol. 2010 Jan;9(1):46-54.
PMID: 19959398
Keus SH, Nijkrake MJ, Borm GF, Kwakkel G, Roos RA,
Berendse HW, Adang EM, Overeem S, Bloem BR,
Munneke M; ParkinsonNet Trial Study Group. (ter
Bruggen JP)
The ParkinsonNet trial: design and baseline
characteristics.
Mov Disord. 2010 May 15;25(7):830-7.
PMID: 20461799
van Bergen FS, ter Bruggen JP, Rikkert MG.
Int J Geriatr Psychiatry. 2010 Mar;
25(3):258-65.
PMID: 19582760
Jongen PJ, van Munster ETh.
Poster: Retrospective study on predictors of a
favourable outcome of Mitoxantrone treatment in
patients with multiple sclerosis.
ECTRIMS Dusseldorf 2009.
Reijmers R, van Munster ETh. e.a.
Poster: Functional ambulation and handfunction
improves while using natalizumab in multiple sclerosis.
ECTRIMS Goteborg, 15 oktober 2010.
Vennegoor A, van Munster ETh. e.a
Poster: Indolent course of progressive multifocal
leukoencephalopathy during natalizumab treatment in
multiple sclerosis.
ECTRIMS Goteborg, 15 oktober 2010.
van Munster ETh.
Kwaliteitsdag zorgverzekeraars.
26 januari 2009.
van Munster ETh.
96
Minisymposium WDH; nieuwe ontwikkelingen.
15 april 2009.
van Munster ETh.
Voordracht: Mutiple Sclerose, wat hebben we te
bieden?
Symposium voor fysiotherapeuten, 12 mei 2009.
van Munster ETh.
Metaplansessie Parkinson.
16 september 2009.
van Munster ETh.
Verleden, heden en toekomst.
Landelijk symposium Multiple Sclerosis, 9 en 10
oktober 2009.
van Munster ETh.
Neuromyelitis optica, huidige inzichten en parktische
handvaten.
Landelijk symposium Multiple Sclerosis de komende 5
jaar, 5 en 6 november 2009.
van Munster ETh.
MS patiënten bijeenkomst DUET.
6 november 2009.
van Munster ETh.
Wereldwijd onerzoek bij MS.
Nationale MS-dag, 28 november 2009.
van Munster ETh.
Regionaal MS fysiotherapie netwerk.
15 januari 2010.
van Munster ETh.
Neurologie in ontwikkeling.
Rotary, 3 februari 2010.
van Munster ETh.
MS en multidisciplinair overleg.
MSVN, 16 juni 2010.
van Munster ETh.
Kwaliteitsdag zorgverzekeraars.
11 oktober 2010.
Van Nes SI, Vanhoutte EK, Faber CG, Garssen MP,
van Doorn PA, Merkies IS,
on behalf of the PeriNomS study group.
Improving Fatigue assessment in immune-mediated
neuropathies: The modified Rasch-built Fatigue
Severity Scale.
Peripheral Nerve Society 2009.
Garssen MP.
Voordracht: Het Guillain-Barré syndroom,
bespoedigen van het herstel.
Venticare, nationaal intensive care congres, 2010.
Rutten GJ.
A short history of functional neuroimaging.
Symposium Functional Neuro-Imaging: new clinical
applications. Hilvarenbeek, 26 juni 2009.
Rutten GJ.
Herstellen en voorspellen: neuropsychologisch
onderzoek bij patienten met een hersenaandoening.
Symposium “de geest uit de fles: medisch
psychologisch onderzoek in het St Elisabeth
Ziekenhuis”, CORPS, Tilburg, april 2010.
Jongen PJ, Lehnick D, Sanders E, S
eeldragers P, Frederikson S, Anderson M,
Speck J, Focus Study Group
(van Munster ETh, e.a.).
Health related quality of life in relapsing remitting
multiple sclerosis patients during treatment with
glatirameracetate: a prospective, observational,
international, multi-centre study.
Health and quality of life outcomes 2010,8:133-140.
Jeene PM, van Munster ETh, Louwerse ES.
Pergolidegebruik, benauwdheid en oedeem; altijd
klepfibrose?
Tijdschrift voor neurologie en neurochirurgie
2010;111:160-2 .
neurologie
van Munster ETh.
Copaxone: een remmende medicatie.
Uitgave van national ms fonds 2010.
White CM, van Doorn PA, Garssen MPJ, Stockley RC.
Interventions for fatigue in peripheral neuropathy.
Cochrane Database of Systematic Reviews 2009, Issue
4. Art. No.: CD008146. DOI:10.1002/14651858.
Rutten GJ, op de Coul B, Verschoor N.
Cervicale hyperostosis als behandelbare oorzaak voor
dysfagie.
Oorheelkunde, 2009;15(1):29-31.
97
Rutten GJ, Vincent AJ, Gosselaar PH,
de Witt Hamer PC.
Vroege resectie voor een vermoedelijk laaggradig
glioom.
Tijdschrift voor Neurologie en Neurochirurgie;
111:72-78, 2010
Jeene P, ter Bruggen JP.
Duodenal Duodopa in MSA-P.
Movement disorders. Supplement: 2010: 25: 2
Jeene PM, ter Bruggen JP.
Depressie bij de ziekte van Parkinson.
Neurologie Aktueel: 6: juli 2009
ter Bruggen JP.
Chronische vermoeidheid bij de ziekte van
Parkinson en MS.
Script neurologie: juli 2010
98
17
NUCLEAIRE
GENEESKUNDE
Hoetjes NJ, van Velden FH, Hoekstra OS, Hoekstra CJ,
Krak NC, Lammertsma AA, Boellaard R.
Partial volume correction strategies for quantitative
FDG PET in oncology.
Eur J Nucl Med Mol Imaging. 2010 Aug;37(9):1679-87.
PMID: 20422184
Boellaard R, O’Doherty MJ, Weber WA,
Mottaghy FM, Lonsdale MN, Stroobants SG, Oyen WJ,
Kotzerke J, Hoekstra OS, Pruim J, Marsden PK, Tatsch
K, Hoekstra CJ, Visser EP, Arends B, Verzijlbergen FJ,
Zijlstra JM,
Comans EF, Lammertsma AA, Paans AM, Willemsen AT,
Beyer T, Bockisch A, Schaefer-Prokop C, Delbeke D,
Baum RP, Chiti A,
Krause BJ.
FDG PET and PET/CT: EANM procedure guidelines for
tumour PET imaging: version 1.0.
Eur J Nucl Med Mol Imaging. 2010 Jan;37(1):181200.
PMID: 19915839
FDG-PET has no definite role in preoperative imaging
in gastric cancer.
PMID: 19147324
Hoekstra CJ
FDG PET respons monitoring bij het maligne lymfoom
HOVON Roadshow Dordrecht en Amersfoort, 2009.
nucleaire geneeskunde
99
100
18
OOGHEELKUNDE
Van Meel G.
Voordracht: “laserbehandeling van diabetische
retinopathie”.
De landelijke laserdag voor oogartsen in Nijmegen,
13 februari 2010.
oogheelkunde
101
102
19
ORTHOPEDIE
Rutten MJ, Spaargaren GJ, van Loon T,
de Waal Malefijt MC, Kiemeney LA,
Jager GJ.
Detection of rotator cuff tears: the value of MRI
following ultrasound.
Eur Radiol. 2010 Feb;20(2):450-7.
PMID: 19727754
A Prospective, Randomized, Controlled, Multicenter
Study of Osteogenic Protein-1 in Instrumented
Posterolateral Fusions. Report on Safety and Feasibility.
SPINE (Phila Pa 1976). 2010 May 20;35(12):1185-91.
PMID: 20445470
Trefwoorden:”OP1, posterolateral fusion
Delawi D, Dhert WJ, Rillardon L, Gay E, Prestamburgo
D, Garcia-Fernandez C, Guerado E, Specchia N, Van
Susante JL, Verschoor N, Quarles van Ufford HM,
Oner FC.
Rutten GJ, op de Coul B, Verschoor N.
Cervicale hyperostosis als behandelbare oorzaak
voor dysfagie.
Oorheelkunde, 2009;15(1):29-31.
Trefwoorden: DISH, dysfagie
orthopedie
103
104
20
PATHOLOGIE
Giard RW, Broekman JM.
Missed malignant melanoma: legal considerations
PMID: 20015414
van la Parra RF, Ernst MF, Bevilacque JL, Mol SJ,
van Zee KJ, Broekman JM, Bosscha K.
Validation of a nomogram to predict the risk of
nonsentinal lymph node metastases in
breast cancer patients with a positive sentinel
node biopsy: Validation of the MSKCC breast
nomogram.
Ann Surg. Oncol. 2009 May; 16(5)11285-35
PMID: 19252954
Van Wensen RJA, Bosscha K, Jager GJ,
Een ruimteinnemend proces in het pancreas.
Niet altijd een carcinoom. [An invasive process in the
pancreas: sometimes lymphoma.]
Ned Tijdschr Geneeskd. 2009;153:B164. Dutch.
PMID: 19818177
Van Schaik PM, Hermans E, van der Linden JC, Pruijt
JR, Ernst MF, Bosscha K.
pathologie
Micro-metastases in stages I and II colon cancer are a
predictor of the development of distant metastases
and worse disease-free survival.
PMID: 18775627
PMID: 19374097
Meijer RP, Gemen EF, van Onna IE, van der Linden JC,
The value of an artificial network in the decisionmaking for prostate biopsies.
World J Urol. 2009 Oct;27(5):593-8.
PMID 19562346
Comparative analysis of four methods to extract DNA
from paraffin-embedded tissues: effect on downstream
molecular applications.
PMID: 20840759
105
Meijer RP, Gemen EF, Onna IE, van der Linden JC,
Kusters GC.
Poster: The valus of an artificial network in the decision
making for prostate biopsies. Congres Nederlandse
Vereniging voor Klinische Chemie (NVKC) 24-25 april
2009.
Poster: Comparison of four methods to extract DNA
from paraffin embedded tissues for molecular
applications. European Meeting on Molecular
Diagnostics, Scheveningen, 23-10-2009 en
Pathologendagen Zeist, 7/8-4-2010.
106
21
PLASTISCHE CHIRURGIE
Kenis H, Zandbergen HR, Hofstra L, Petrov AD,
Dumont EA, Blankenberg FD, Haider N, Bitsch N,
Gijbels M, Verjans JW, Narula N, Narula J,
Reutelingsperger CP.
Annexin A5 Uptake in Ischemic Myocardium:
Demonstration of Reversible Phosphatidylserine
Externalization and Feasibility of Radionuclide Imaging.
Journal of Nuclear Medicine Vol. 51 No. 2 259-267,
2010.
Dumont EA, Lutgens SP, Reutelingsperger CP, Bos
GM, Hofstra L.
Minocycline Inhibits Apoptotic Cell Death in a Murine
Model of Partial Flap Loss.
J reconstr Microsurg 2010; 26(8): 523-528.
de With MC, de Vries AM, Kroese AB,
van der Heijden EP, Bleys RL, Segal SS, Kon M.
Vascular anatomy of the hamster retractor muscle
with regard to its microvascular transfer.
Eur Surg Res. 2009;42(2):97-105.
PMID: 19088476
de Wijn RS, van der Heijden EP, Kon M.
On lipoma of the buccal fat pad: report of two cases
and review of the literature.
J Plast Reconstr Aesthet Surg. 2009 Jan;62(1):28-35.
PMID: 18249050
Schouten HW, Knippels MC, Franken RJ.
Maggots in the wound, debridement, disinfection
and wound healing.
PMID: 19900320
de With MC, van der Heijden EP,
van Oosterhout MF, Kon M, Kroese AB.
Contractile and morphological properties of hamster
retractor muscle following 16 h of cold preservation.
Cryobiology. 2009 Dec;59(3):308-16.
PMID: 19733556
plastische chirurgie
107
Franken RJ
De Hand: Geneeskunde of geneeskunst?
Nederlandse OK dagen, RAI Amsterdam,
Van der Heijden EP
CMC1 arthrosis: diagnostiek en behandeling
Scholingsdag revalidatieartsen in opleiding,
’s-Hertogenbosch, februari 2009.
Van der Heijden EP
Diagnostiek en behandeling van dupuytren en mallet
vinger
Informatie avond fysiotherapeuten verzorgd door
handpolsexpertise centrum JBZ (HPEC),
’s-Hertogenbosch, augustus 2010.
Van der Heijden EP
Artrose van de handgewrichten en de operatieve
behandelopties
Bossche Samenscholingsdagen, Vlissingen,
november 2010.
Rutten MJ, Setz-Pels W, Hermens RA, Franken RJ.
Nieuwe CT-angiografie toepassing verkort
borstreconstructie.
Cura, jaargang 6, nr 3, dec 2009, blz 17.
Trefwoorden: borstreconstructie, CT-angiografie
Hermens RA, Franken RJ, Setz-Pels W, Rutten MJ.
Opereren aan de hand van een landkaart.
JBZ Palet, jaargang 5, nr 8, dec 2009.
Setz-Pels W, Rutten MJ, Franken RJ, Hermens RA.
Jeroen Bosch Ziekenhuis gebruikt nieuwe methode bij
borstreconstructie.
Medicalfacts: 20 jan 2010, Thuis in het nieuws: 23 jan
2010, Brug Berlicum eo: 28 jan 2010.
108
22
RADIOLOGIE
Rutten MJ, Collins JM, Maresch BJ, Smeets JH,
Janssen CM, Kiemeney LA, Jager GJ. Glenohumeral
joint injection: a comparative study of ultrasound and
fluoroscopically guided techniques before MRarthrography.
European Radiology, 2009; 19 (3):722-730.
PMID: 18958474
Trefwoorden: Echogeleide punctie, schouder
Vugt R, Bosscha K, van Munster IP, de Jager CP,
Rutten MJ.
Embolization as Treatment of Choice for Bleeding
Peptic Ulcers in High Risk Patrients. Digestive surgery
2009;26(1):37-42 (DOI: 10.1159/000193476).
PMID: 19155626.
Trefwoorden: Gastro-enterale bloeding, embolisatie
Ploegmakers MJ, Rutten MJ.
Fatal pericardial tamponade after superior vena cava
stenting.
CardioVascular Interventional Radiology 2009
May;32(3):585-9.
PMID: 18855048
Trefwoorden: Vena cava superior, stent
Bax L, Woittiez AJ, Kouwenberg HJ, Mali WP, Buskens
E, Beek EJ, Braam BB, Huysmans FT, Schultze Kool LJ,
Rutten MJ, Doorenbos CJ, Aarts HC, Rabelink TJ,
radiologie
Plouin PF, Raynaud A, van Montfrans GA, Reekers JA,
van den Meiracker AH, Pattynama PM, van de Ven PJ,
Vroegindeweij D, Kroon BA, de Haan MW, Postma CT,
Beutler JJ.
randomized trial.
Ann Intern Med 2009 Jun 16;150(12):840-8.
PMID: 19414832
Trefwoorden: a renalis stenose, stent
Rutten MJ, Spaargaren GJ, van loon T, de Waal Malefijt
MC, Kiemeney LA, Jager GJ. Detection of rotator cuff
tears: the value of MRI following ultrasound.
European Radiology, 2010; 20 (2):450–457. DOI
10.1007/s00330-009-1561-9
PMID: 19727754.
Trefwoorden: Schouderechografie,
rotator cuff rupturen
Rutten MJ, Collins JM, de Waal Malefijt MC,
Kiemeney LA, Jager GJ.
Unsuspected sonographic findings in patients with
post-traumatic shoulder complaints.
J Clin Ultrasound. 2010
Nov;38(9):457-65.
PMID: 20848574
Trefwoorden: Schouder trauma, echografie
109
Rutten MJ, de Jong MD, van Loon T, Jager GJ.
Intratendinous ganglion of the long head of the biceps
tendon: US and MRI features (2010: 9b).
Intratendinous ganglion.
Eur Radiol. 2010 Dec;20(12):2997-3001.
PMID: 21069528
van der Horn G, Ranschaert ER, Dubelaar IJ,
van Munster IP.
An adult with vague abdominal complaints and atypical
colonoscopic findings.
Neth J Med. 2010 Aug;68(1):324-7.
PMID: 20739731
Tiessen RG, Lagerwey HJ, Jager GJ, Sprenger HG.
Drug interaction caused by communication problems.
Rhabdomyolysis due to a combination of itraconazole
and simvastatin.
PMID: 20456775
van Wensen RJ, Bosscha K, Jager GJ,
An invasive process in the pancreas: sometimes
lymphoma.
PMID: 19818177
Hövels AM, Heesakkers RA, Adang EM, Barentsz JO,
Jager GJ, Severens JL.
Cost-effectiveness of MR lymphography for the
detection of lymph node metastases in patients with
prostate cancer.
Radiology. 2009 Sep;252(3):729-36.
PMID: 19717752
PMID: 19374097
van Vugt R, Bosscha K, Olsman J, Jager GJ,
de Jager CP.
PMID: 19341194
Brink M, Kool DR, Dekker HM, Deunk J, Jager GJ,
van Kuijk C, Edwards MJ, Blickman JG.
Predictors of abnormal chest CT after blunt trauma: a
critical appraisal of the literature.
Clin Radiol. 2009 Mar;64(3):272-83.
PMID: 19185657
Looij BG, Jager GJ, van Munster IP.
An adult with lower abdominal pain.
Neth J Med. 2008 Dec;66(11):495-6.
PMID: 19075319
Koebrugge B, van Leuken M, Ernst MF, van Munster I,
Bosscha K.
Percutaneous Cholecystostomy in Critically Ill Patients
with a Cholecystitis: A Safe Option.
Dig Surg. 2010 Oct 15;27(5):417-421.
PMID: 20948216
Heesakkers RA, Jager GJ, Hövels AM, de Hoop B,
van den Bosch HC, Raat F, Witjes JA, Mulders PF,
van der Kaa CH, Barentsz JO.
Prostate cancer: detection of lymph node metastases
outside the routine surgical area with ferumoxtran10-enhanced MR imaging.
Radiology. 2009 May;251(2):408-14.
PMID: 19401573
110
Proefschriften
Boeken
Rutten MJ.
Ultrasound of the shoulder. Efficacy studies.
St. Radboud Universiteit Nijmegen,
15 juni 2010, Nijmegen.
Rutten MJ.
15 juni 2010.
ISBN: 978-90-9025418-0
Trefwoorden: Echografie, Schouder
Looij BG, Kreb DL, van der Linden JC, Ernst MF,
Pruijt JFM, Bosscha K, Jager GJ, Rutten MJ.
In vivo radio frequency ablation (RFA) in small breast
cancer: Preliminairy results.
ECR 2009, Oral presentation, Wenen, 6 maart 2009.
Rutten MJ.
Radiofrequentie ablatie van longtumoren: techniek en
indicaties.
Thema-avond IKZ-werkgroep longtumoren: ‘Nieuwste
behandelingsmogelijkheden in de longoncologie’,
Eindhoven, 16 juni 2009.
Rutten MJ.
“Shoulder US: my number one”. MSK Refresher Course
Annual
Meeting Radiological Society. “How to try not to be torn
between ultrasound and
MRI of the shoulder”.
Radiologendagen 2009, Amsterdam, 18 september
2009.
Rutten MJ.
Shoulder Imaging.
Symposium Radiologie voor sport fysiotherapeut.
Nederland. Ede, 21 november 2009.
Martinoli C, Genova, ITALY; Bouffard JA, Detroit, MI;
Brandon CJ, Ann Arbor, MI; Cardinal E, Montreal, QC;
Ceulemans RY, Chicago, IL; Craig JG, Ann Arbor, MI;
Fessell DP, Ann Arbor, MI; Habra G, Troy, MI; Kislyakova
M, Moscow, RUSSIAN FEDERATION; Introcaso JH,
Northfield, IL; Jacobson JA, Ann Arbor, MI; Rutten MJ,
radiologie
’s-Hertogenbosch, NETHERLANDS; Van Holsbeeck
MT, Detroit, MI; Wortsman XL, Santiago, CHILE; Lee
KS, Marx MV.
RSNA 96th Scientific assembly and annual Meeting.
RSNA Refresher course: Musculoskeletal Ultrasound
with focus on peripheral nerves: The Brachial plexus.
Chicago, 1 december 2010.
Cardinal E, Montreal, QC; Van Holsbeeck MT, Detroit,
MI; Wortsman XL, Santiago, RM CHILE; Bouffard JA,
Detroit, MI; Bureau NJ, Montreal, QC; Craig JG, Ann
Arbor, MI; Ceulemans RY, Chicago, IL; Fessell DP, Ann
Arbor, MI; Habra G, Troy, MI; Introcaso JH, Northfield,
IL; Jacobson JA, Ann Arbor, MI; Martinoli C, Genova,
ITALY; Rutten MJ, ’s-Hertogenbosch,
NETHERLANDS; Khoury V, Montreal, QC; Lee KS, Marx
MV. RSNA 96th Scientific assembly and annual
Meeting. RSNA Refresher course: Dynamic
Musculoskeletal Ultrasound of the upper extremity
(Hands-on Workshop).
Chicago, 2 december 2010.
Martinoli C, Genova, ITALY; Bouffard JA, Detroit, MI;
Brandon CJ, Ann Arbor, MI; Cardinal E, Montreal, QC;
Ceulemans RY, Chicago, IL; Craig JG, Ann Arbor, MI;
Fessell DP, Ann Arbor, MI; Habra G, Troy, MI; Kislyakova
M, Moscow, RUSSIAN FEDERATION; Introcaso JH,
Northfield, IL; Jacobson JA, Ann Arbor, MI; Rutten MJ,
’s-Hertogenbosch, NETHERLANDS; Van Holsbeeck
MT, Detroit, MI; Wortsman XL, Santiago, CHILE; Lee
KS, Marx MV.
RSNA Refresher course: Musculoskeletal Ultrasound
111
with focus on peripheral nerves: The Brachial plexus.
Chicago, 2 december, Wen: 08:30 AM - 10:00 AM
2009.
Onderliggende techniek en scanmethode.
Regionale refereeravond OOR Oost Nederland. Vught,
23 september 2010.
Cardinal E, Montreal, QC; Van Holsbeeck MT, Detroit, MI;
Wortsman XL, Santiago, RM CHILE; Bouffard JA, Detroit,
MI; Bureau NJ, Montreal, QC; Craig JG, Ann Arbor, MI;
Ceulemans RY, Chicago, IL; Fessell DP, Ann Arbor, MI;
Habra G, Troy, MI; Introcaso JH, Northfield, IL; Jacobson
JA, Ann Arbor, MI; Martinoli C, Genova, ITALY; Rutten
MJ, ’s-Hertogenbosch, NETHERLANDS; Khoury V,
Montreal, QC; Lee KS, Marx MV.
RSNA Refresher course: Dynamic Musculoskeletal
Ultrasound of the upper extremity (Hands-on
Workshop).
Chicago, 3 december, Thu: 08:30 AM - 10:00 AM.
2009.
Fassaert T, de Jong M, Dubelaar I, Rutten MJ.
Automated 3D Breast Volume Scanning. Voor- en
nadelen.
23 september 2010.
Rutten MJ.
Instabiele schouder: CT-, directe en indirecte
MR-arthrografie SWC Skelet.
Bijscholingscursus Nederlandse Vereninging voor
Radiologie.
Ede, 2 en 5 februari 2010.
Rutten MJ.
Onderwijsdag OOR ZUID en Oost Nederland, Den
Bosch, 23 april 2010.
Rutten MJ.
Musculoskeletal lesions: Mistakes you shouldn’t make.
Interactive teaching session.
Onderwijsdag OOR ZUID en Oost Nederland, Den
Bosch, 23 april 2010.
Rutten MJ.
Verdediging dissertatie aan Radboud University
Nijmegen, 15 juni 2010.
Dubelaar I, Fassaert T, de Jong M, Rutten MJ.
Automated 3D Breast Volume Scanning.
112
Fassaert T, de Jong M, Dubelaar I, Rutten MJ.
Automated 3D Breast Volume Scanning. Echografische
kenmerken van solide tumoren en eerste klinische
ervaringen.
23 september 2010.
Rutten MJ.
Werkgroep Deskundigheidsbevordering
Sportgeneeskunde. UMCU: Opleidingen in de
Sportgeneeskunde: Cursus gewricht: De schouder.
Utrecht, 12 oktober 2010.
Rutten MJ.
Automated 3D Breast Volume Scanning.
Siemens Usersday 2010. Groningen, 4 november
2010.
Rutten MJ.
Siemens Usersday 2010. Groningen, 4 november
2010.
Ranschaert ER.
Online Radiology Resources: top 10 teaching websites
and how to find them.
ECR 2009, Vienna, Austria, 6-10 maart 2009.
Ranschaert ER.
Klinische ervaring met diffusie-MRI in het Jeroen
Bosch Ziekenhuis.
Symposium “Diffusie brengt MRI in beweging”,
’s-Hertogenbosch, 27 maart 2010.
Ranschaert ER.
How Radiologists can use the Web as a tool to Enhance
their Profession.
http://www.isrvirtual.org/program/congisr_prog_2009.htm
ISR 2nd Virtual Congress, 1-24 april 2009.
Ranschaert ER, Deckers F.
Diffusie-MRI van het abdomen,
Sectiedag Abdominale Radiologie NVvR,
Leiden, 8 mei 2010.
Ranschaert ER.
CT-colonografie,
Siemens CT-userdag,
Haarlem, 12 maart 2009.
Ranschaert ER.
Diffusie-MRI van het abdomen.
Radiologendagen,
Amsterdam, 17-18 september 2009.
Ranschaert ER
CT-colonografie.
Regionale nascholing MDL-artsen, Ravenstein,
27 januari 2009.
Ranschaert ER.
Is er nog een rol voor X-colon?
Regionale nascholing MDL-artsen OOR-ON,
’s-Hertogenbosch, 8 Mei 2009.
Ranschaert ER.
CT colonografie: waar gaan we en waar staan we?
11e Bossche Gastro-enterologie Symposium,
Vught, 5 februari 2009.
Koebrugge B, Van Leuken M, Ernst MF, Van Munster I,
Bosscha K.
Percutane galblaasdrainage bij patiënten met een
acute cholecystitis in slechte klinische toestand: een
goede optie ?!
Rutten MJ, Setz-Pels W, Hermens H, Franken R.
Nieuwe CT-angiografie toepassing verkort
borstreconstructie.
Cura, jaargang 6, nr 3, dec 2009, blz 17.
Intratendinous ganglion of the long head of
the biceps tendon: US and MRI features. European
Radiology (2010). DOI 10.1007/s00330-010-1818-3.
Trefwoorden: Schouder, echografie
Hermens H, Franken R, Setz-Pels W,
Rutten MJ.
Opereren aan de hand van een landkaart.
JBZ Palet, jaargang 5, nr 8, dec 2009.
Spaargaren GJ, Rutten MJ.
Bone infarct.
Radiological Documents 2009; 27 (1): 1-3. JBR-BTR.
Setz-Pels W, Rutten MJ, Franken R, Hermens H.
Jeroen Bosch Ziekenhuis gebruikt nieuwe methode bij
borstreconstructie.
Medicalfacts: 20 jan 2010, Thuis in het nieuws: 23 jan
2010, Brug Berlicum eo: 28 jan 2010.
Trefwoorden: Bot infarct, radiologische beeldvorming
Rutten MJ, Jager GJ, Kiemeney LA.
Ultrasound detection of rotator cuff tears: observer
agreement related to increasing experience.
AJR 2010; 195:W440-W446
Trefwoorden: Schouderechografie, onderzoekers
afhankelijkheid
radiologie
113
Rutten MJ.
De schouders eronder.
De Gelderlander, 8 juni 2010.
mammadiagnostiek en screening
Medical 2010; 50:16-17
Trefwoorden: borstkanker, 3D-echografie
van den Horn G, Rutten MJ.
Pilomactricoma or epithelioma of Malherbe.
Radiological Documents 2009; 27 (2), case 10.
JBR-BTR.
Rutten MJ, Mus RD.
Automated Breast Volume Scanning. 3D echografie van
de mammae.
Siemens Whitepaper, september 2010
Trefwoorden: weke delen tumor, echografie
Crommentuyn R, Rutten MJ.
Nieuwe opleiden biedt houvast.
Medisch Contact 2010; 65 (27):1318-1321.
Trefwoorden: Medische opleiding, vernieuwing
Boon P, Rutten MJ.
Nieuwe echografie scanner ontdekt eerder
borsttumoren
Telegraaf. 28 aug 2010
Rutten MJ, Mus RD.
Automated Breast Volume Scanning. 3D Ultrasound of
the Breast.
Siemens Whitepaper, oktober 2010
Rutten MJ.
3D-echografie van de borsten.
Financieel Dagblad, November 2010.
Rutten MJ.
Veelbelovende toekomst voor driedimensionale
echografie.
Brabants Dagblad, 18 september 2010, Heusdense
Courant, 22 september 2010
Mus RD, Rutten MJ.
Radboudziekenhuis: 3D-echo zoekt naar borsttumor
De Gelderlander, dinsdag 05 oktober 2010.
Mus RD, Rutten MJ.
UMC St Radboud en Jeroen Bosch Ziekenhuis testen
nieuw 3D-echoapparaat.
Borstkankeronderzoek in drie dimensies. Nieuwsbank,
04-10-2010.
Rutten MJ, de Jong MD, van Loon T, Jager GJ. A rare
Cause of a soft tissue mass at the shoulder (2010:9A).
European Radiology (2010) 20 (9): 2305. DOI
M. Scholman, Rutten MJ
Primeur: radiologie heeft nieuwe 3D echografie
scanner.
Intranet JBZ. 27 aug 2010.
Ranschaert ER.
Tele-educatie voor CT-colonoscopie.
MemoRad 2009; 14(1): 26-28
Ranschaert ER, Jager G,
CT-colonografie.
Labcontact 2009.
Rutten MJ, Mus RD.
3D-echografie opent deuren voor efficiëntere
114
De Jong MD, Fassaert TA, Ranschaert ER.
Arrested pneumatization of the skulle base.
Radiological documents. 2010 Sep 8.
23
REUMATOLOGIE
Hartkamp A, Geenen R, Godaert GL, Bijl M, Bijlsma
JW, Derksen RH.
Effects of dehydroepiandrosterone on fatigue and
well-being in women with quiescent systemic lupus
erythematosus: a randomised controlled trial.
Ann Rheum Dis. 2010 Jun;69(6):1144-7.
PMID: 19854713
Van Hulst LT, Creemers MC, Fransen J, Li LC,
Grol R, Hulscher ME, van Riel PL.
How to improve DAS28 use in daily clinical practice?
A pilot study of a nurse-led intervention.
Rheumatology (Oxford). 2010 Apr;49(4):741-8.
PMID: 20083537
Trefwoorden: reumatoide arthritis, monitoring
ziekte-activiteit
Van Koulil S, van Lankveld W, Kraaimaat FW,
van Helmond T, Vedder A, van Hoorn H, Donders R,
de Jong AJ, Haverman JF, Korff KJ, van Riel PL,
Cats HA, Evers AW.
Tailored cognitive-behavioral therapy and exercise
training for high-risk patients with fibromyalgia.
Arthritis Care Res (Hoboken). 2010 Oct;62(10):1377-85.
PMID: 20521308
De Brouwer SJ, Kraaimaat FW, Sweep FC,
Creemers MC, Radstake TR, van Laarhoven AI,
van Riel PL, Evers AW.
Experimental stress in inflammatory rheumatic
diseases: a review of psychophysiological stress
responses. Arthritis Res Ther 2010;12(3):R89
PMID: 20478029
Trefwoorden: psychofysiologische stressrespons,
Kroft EB, Creemers MC, van den Hoogen FH
Boezeman JB, de Jong EM.
Effectiveness, side-effects and period of remission
after treatment with methotrexate in localized
scleroderma and related sclerotic skin diseases: an
inception cohort study.
Br J Dermatol. 2009;160:1075-82
PMID: 19210503
reumatologische ziekten
Trefwoorden: methotrexaat, sclerodermiforme
huidbeelden
reumatologie
115
Proefschriften
Boeken
Creemers MC.
Co-promotor M. Flendrie.
Titel dissertatie: Effectiveness and safety of TNFalpha-blocking therapy in patients with rheumatoid
artrhitis. 2009.
Creemers MC.
Hoofdstuk 4. Anti-TNF.
In: Reumatologie protocollen handboek. Ed. M.
Janssen, C.G.M. Kallenberg, PLCM van Riel. Academic
Pharmaceutical Productions bv. 2009
Trefwoorden: biologicals, anti-TNF
Creemers MC.
Klinische manifestaties van systemische vasculitis.
PAOG Heijendaal, Nijmegen, april 2009.
Creemers MC.
Dermatologie binnen de reumatologie.
Landelijke nascholing Nurse Practioners. Utrecht,
oktober 2009.
Creemers MC.
International course for rheumatologists and
dermatologists ‘psoriasis and psoriatic arthritis’.
Chairmen organising committee, speaker and trainer
workshop. Nijmegen, september 2009
Creemers MC.
Biologicals; pros and cons.
(N)ERASS; out of the box thinking, Leiden, maart 2010
Creemers MC.
Peers-to-peers bijeenkomst arthritis psoriatica.
Eindhoven, februari 2010.
de Smit OJ, van Vugt RM.
Gestruikeld over een paaltje?
Nederlands tijdschrift voor Reumatologie,
september 2009
Trefwoorden: Reactieve artritis na HIV infectie.
Van Koulil S, van Lankveld W, Kraaimaat FW, van
Helmond T, Vedder A, van Hoorn H, Donders R,
de Jong AJ, Haverman J, Korff KJ, van Riel PL,
Cats HA, Evers AW.
Tailored Cognitive–Behavioral Therapy and Exercise
Training for High-Risk Patients With Fibromyalgia.
Arthritis Care & Research.Vol. 62, No. 10,
October 2010, pp 1377–1385.
Creemers MC.
Reumatoide Artritis: Inzichten, Strategien en
vErwachtingen – de RAISE survey. Immunology Results
Today Sept. 2009
Trefwoorden: reumatoide artritis,
patientenverwachtingen
Evers AW, van Burik A, van de Goor SS, Hoeve D,
Kraaimaat FW, de Jong EM, Creemers MC, van de
Kerkhof PC, van Riel PL.
E-health behandelingen bij chronische lichamelijke
aandoeningen: Het patiëntenperspectief. N T v Reum
2010
Trefwoorden : E-health, chronische ziekten
Trefwoorden: fibromyalgie, cognitieve gedragstherapie
116
24
REVALIDATIE
GENEESKUNDE
Meijer JW, Voerman GE, Santegoets KM,
Geurts AC.
Short-term effects and long-term use of a hybrid
orthosis for neuromuscular electrical stimulation of the
upper extremity in patients after chronic stroke.
J Rehabil Med. 2009 Feb;41(3):157-61.
PMID: 19229448
van Nes IJ, van der Linden S, Hendricks HT,
van Kuijk AA, Rulkens M, Verhagen WI,
Geurts AC.
Is visuospatial hemineglect really a determinant of
postural control following stroke?
An acute-phase study.
Neurorehabil Neural Repair.
2009 Jul-Aug;23(6):609-14.
PMID: 19118129
revalidatiegeneeskunde
117
118
25
SPOEDEISENDE
GENEESKUNDE
Jaspers JW, Kuppens SM, van Zundert AA, de Wildt MJ.
Vaginal stones in a 5 year old girl: a novel approach of
removal.
J. Pediatrics and Adolescent Gynaecology 2010 feb:
23(1):e23-5
PMID 19643641.
Trefwoorden: vaginal stones.
Boeken
Alkemada AJ, Caminda K, Slenter M. Coauteur:
Vernooij CM.
Zakboek Spoedeisende geneeskunde voor artsen op de
SEH. Eerste editie.
Uitgave van Bohn Stafleu van Loghum, Nederland,
2010.
ISBN: 978 90 313 4260 0
Gafni A.
Poster: Diagnostic value of the ECG in extreme
hyperkalemia. A case report.
3rd Dutch Emergency Medicine Conference, Egmond
aan zee, June 2009.
spoedeisende geneeskunde
Vreeburg ME, Vernooij CM, Segers MJ, Hammacher ER.
Poster: Treatment of impacted greenstick forearm
fractures in children using bandage therapy; a
validation study.
EUSEM congress, Stockholm, Sweden,
October 2010.
119
Vissers E, de Jager CP, Kusters R, van GageldonkLafeber AB,Wever PC.
November 2010.
Vissers E, van Bebber IP, de Jager CP.
Poster: ‘Giant Kidney Stone’ as Surprising Cause of
Acute Abdominal Pain.
4th Dutch Emergency Medicine Conference, Egmond
aan zee, June 2010.
Gresnigt FM, de Jager CP.
Poster: When bacterial infection is suspected; Don’t
forget procalcitonin!
aan zee, June 2010.
Gresnigt FM, Louwerse E, de Jager CP.
Voordracht: Does reversal of oral anticoagulant therapy
in patients with intracerebral hemorrhage improve
clinical outcome?
Mediterranean Emergency Medicine Conference,
Valencia, Spain, September 2009.
Jaspers JW, van Leuken MH, Duppen JH, de Jager CP.
Poster: Acute painfull paraplegia: beware of aortic
dissection.
Fifth Mediterranean Emergency Medicine Congress,
Valencia, Spain, sept 2009.
Menapal K, Macken T, Korst M, Laheij R, de Jager CP.
Poster: The relation between D-dimer level and
radiographically proven pulmonary embolism.
aan zee, June 2010.
Gresnigt FM, Paling A.
Voordracht: Procedural sedation and analgesia,
Propofol-ketamine or propofol-fentanyl?
aan zee, June 2010.
Gresnigt FM, Louwerse E, de Jager CP.
Voordracht: Does reversal of oral anticoagulant therapy
in patients with intracerebral hemorrhage improve
clinical outcome?
3rd Dutch Emergency Medicine Conference, Egmond
aan zee, June 2009.
120
26
UROLOGIE
Persoon MC, Scherpbier AJ, Oei SG, Meijerink WJ,
Schijven MP, Schout B, Beerlage HP, Hendrikx AJ.
Learning laparoscopy without patients
PMID: 19235339
Van Poppel PC, Stehouwer CD, Beutler JJ, Korst MB,
PMID: 19757757
Meijer RP, Gemen EF, van Onna IE, van der Linden JC,
The value of an artificial neural network in the
decision-making for prostate biopsies.
World J Urol. 2009 Oct;27(5):593-8.
PMID: 19562346
Bolla M, de Reijke TM, Van Tienhoven G, Van den Bergh
AC, Oddens J, Poortmans PM, Gez E, Kil P, Akdas A,
Soete G, Kariakine O, van der Steen-Banasik EM,
Musat E, Piérart M, Mauer ME, Collette L; EORTC
Radiation Oncology Group and Genito-Urinary Tract
Cancer Group.
Duration of androgen suppression in the treatment of
prostate cancer.
N Engl J Med. 2009 Jun 11;360(24):2516-27.
PMID: 19516032
Van Onna IE, Oddens JR, Kok ET, van Moorselaar RJ,
Bosch JL, Battermann JJ.
External beam radiation therapy followed by interstitial
radiotherapy with iridium-192 for solitary bladder
tumours: results of 111 treated patients.
Eur Urol. 2009 Jul;56(1):113-21.
PMID: 18722048
De Vries RR, Nieuwenhuijzen JA, van Tinteren H,
Oddens JR, Visser O, van der Poel HG, Bex A,
Meinhardt W, Horenblas S; Urological Working Group of
the Amsterdam Comprehensive Cancer Center.
Prostate-sparing cystectomy: long-term oncological
results.
BJU Int. 2009 Nov;104(9):1239-43.
PMID: 19549261
urologie
121
Boeken
Beerlage HP.
Hoofdstuk : “Laparoscopische radicale prostatectomie”
in Handboek prostaataandoeningen.
onder redactie van prof. dr. T.A. Boon;
prof. dr. J.L.H.R. Bosch
De Tijdstroom, maart 2009.
Beerlage HP.
Aanbevelingen laparoscopie in de urologie.
Onder redactie van dr. J.P. van Basten en dr. H.P.
Beerlage
Najaar 2010
Schipper RA.
Erectiele Disfunctie: Oorzaak & Behandeling.
NVFB Voorjaarscongres Zadelpijn en ander
mannenleed.
Zwolle, 26-3-2010.
Schipper RA.
De geschiedenis van pompen, prikken,
pillen en prothesen.
Symposium Urologie Seks in de
Oude Kijk in ’t Jat. Groningen, 11-9-2010.
Schipper RA.
Opleiding stomaverpleegkundigen.
JBZ, 24-3-2009.
Schipper RA.
Huisartsen Nascholing Erectiele Disfunctie (BMC).
Vught, 21-4-2009.
Schipper RA.
BPH voor huisartsen, bijscholing.
Schipper RA.
Opleiding artsenbezoekers Lilly:
“Wat doet een uroloog”.
St. Michielsgestel, 7-1-2010.
Schipper RA.
Onderwijs arts-assistenten Geriatrie.
CLZ, 4-3-2010.
122
Jansonius, De Vylder A.
Voordracht: Buccal Mucosa Urethraplastiek,
onze ervaringen. Jeroen Bosch Ziekenhuis,
’s Hertogenbosch.
NVU najaarsvergadering,Groningen,
13 november 2009.
Schrier BPh.
Laparoscopische Sacrocolpopexie.
NVEC, april 2009 & 2010
Schrier BPh.
Resultaten Argus male sling.
AUA, april 2009 & 2010
Schrier BPh.
Workshop Argus male sling
JBZ, november 2009 & 2010
Beerlage HP.
Complicatie registratie en zo…..
NVEC congres, Amsterdam, 2 april 2009.
Beerlage HP.
Behandeling van UPJ-stenose.
Verplichte AIOS cursus laparoscopie, RITME instituut
Rotterdam, 3 juni 2009.
Beerlage HP.
Waarom maken mensen fouten
Praktisch Workshop Laparoscopie,
’s-Hertogenbosch, 26 juni 2009.
Beerlage HP.
Radicale prostatectomie; snijvlakken en leercurve.
Update in Urology, Lunteren, 5 september 2009.
Beerlage HP.
Toekomstige ontwikkelingen in de laparoscopie.
Cursus laparoscopie, Elancourt Parijs,
28 Oktober 2009.
Beerlage HP.
Assistentie, van laparoscopie naar
robotchirurgie.
Congres OK-assistenten, AVL, Amsterdam,
28 november 2009.
Beerlage HP.
Transurethrale resectie blaastumor (TURT).
Upfront cursus, Catharina ZKHS, Eindhoven,
18 december 2009.
Beerlage HP.
Transurethrale Resectie Prostaat (TURP).
Upfront cursus, Catharina ZKHS,
Eindhoven,
18 december 2009.
Beerlage HP.
Radicale prostatectomie; snijvlakken en
leercurve.
Update in Urology revisited, Oosterbeek,
6 februari 2010.
Beerlage HP.
Robot geassisteerde prostatectomy; impact van
conversie.
NVEC congres, Amersfoort, 16 maart 2010.
Beerlage HP.
Leercurve bij radicale prostatectomie,
welke benadering is de beste?
NVEC congres, Amersfoort, 16 maart 2010.
Ontwikkelingen in de laparoscopie.
Verplichte AIOS cursus laparoscopie, Elancourt,
Frankrijk, 13 april 2010.
urologie
Beerlage HP.
Conversion.
Advanced course on laparoscopic nephrectomy,
European School of Urology, EAU congres, Barcelona,
19 april 2010.
Beerlage HP.
Critical view of safety in laparoscopic nephrectomy.
19 april 2010.
Beerlage HP.
Extraperitoneal access.
19 april 2010.
Beerlage HP.
Extraperitoneal safe control of renal pedicle.
19 april 2010.
Beerlage HP.
Haemostasis.
19 april 2010.
Beerlage HP.
(Robot) partial nephrectomy.
19 april 2010.
Beerlage HP.
Laparoscopisch knopen.
Praktisch Workshop Laparoscopie, ’s-Hertogenbosch,
11 juni 2010.
Oddens JR.
(Laparoscopische) lymfeklierdissectie bij
prostaatcarcinoom: Vinden we wel wat we zoeken?
123
State of the art urology, Wolfheze,
6 februari 2009.
Oddens JR.
Quality control in Transurthral resection of bladder
tumours (TURBT).
EAU congress, Stockholm, 17 maart 2009.
Oddens JR.
Nut van een eenmalige instillatie bij het nietspierinvasief blaascarcinoom.
Refereeravond urologie, UMCN Nijmegen,
9 april 2009.
Oddens JR.
Kwaliteit van TURT in relatie tot oncologische uitkomst.
Decembersymposium Het blaascarcinoom van A tot Z,
JBZ, ’s-Hertogenbosch,
4 december 2009.
Bochove-Overgaauw DM, Gelders W,
De Vylder AM.
Routine biopsies in pediatric circumcision:
(non) sense?
Journal of Pediatric Urology,
Volume 5,Issue 3,1 june 2009,
Pages 178-180.
124
De Vylder AM, Van der Horst HJ.
Is de optimale leeftijd voor behandeling van een
primaire niet ingedaalde testis nog altijd tussen het
eerste en tweede levensjaar?
Urologen Vademecum,jaargang 4
nr.5/oktober 2009.
27
ZIEKENHUISFARMACIE
Verhave JC, Conemans JM, Hollander DA, Dautzenberg
PL, Hoogeveen EK.
PMID: 20398172
Schmeits PC, Péquériaux NC, van Geest-Daalderop JH,
Ouwehand ME, Coremans AM, Hermans MH,
Conemans JM.
superwarfarin.
Neth J Med. 2009 Feb;67(2):76-8.
PMID: 19299851
Schmeits PC, Hermans MH, van Geest-Daalderop JH,
Poodt J, de Sauvage Nolting PR, Conemans JM.
to phenprocoumon.
Br J Haematol. 2010 Mar;148(6):955-7.
PMID: 19961479
Van Puijenbroek EP, Conemans JM, Van Grootheest AC.
Spontaneous ADR Reports as a Trigger for
Pharmacogenetic Research: Experiences in the
Netherlands.
Drug Saf 2009;32(3):255-64.
PMID: 19338383
vitamin-K enzyme.
PMID: 19857286
Van Puijenbroek E, Conemans JM, Van Grootheest K.
Spontaneous reports and pharmacogenetics. The role
of the pharmacovigilance centre.
Drug Saf 2009;32:357-8.
PMID: 19388726
Dautzenberg PL, van der Zande JA, Conemans JM,
Rikkert MG.
PMID: 19771542
ziekenhuisfarmacie
Derijks HJ, Janknegt R, Heerdink ER, De Koning GH,
Krekels M, Looij, B-J, Egberts AC. Influence of
antidepressants on glycaemic control in patients with
diabetes mellitus: an open label comparative study.
J Clin Psychopharmacol. 2009; 29(4): 405-8.
PMID: 19593191
125
Proefschriften
Derijks HJ.
Influence of antidepressants on glucose homeostasis.
11 november 2009.
ISBN/EAN: 978-90-8559-564-9
Proefschrift digitaal te raadplegen op: http://igitur-archive.
library.uu.nl/dissertations/2009-1019-200116/UUindex.html
Patients with partial resistance to acenocoumarol and
phenprocoumon; screening the VKORC1 gene.
Meeting on Molecular Diagnostics. Scheveningen, 2009.
Conemans JM.
Bewaking op bijwerkingen in de (ziekenhuis)apotheek.
Lareb Bijwerkingendag. Utrecht, 2009.
Derijks HJ.
Influence of antidepressant use on glycemic control in
patients with diabetes mellitus: an open-label
comparative study. 9th Congress of the European
Association for Clinical Pharmacology and
Therapeutics, Edinburgh, 12-15 July 2009.
Derijks HJ.
Invloed van antidepressiva op de glucosehuishouding
Highlights Pharmacotherapy 2010, Utrecht,
16 December 2010.
Derijks HJ.
Farmacologische profielen van antidepressiva
Kerstbijeenkomst Lareb 2010, Beesd, 21 December 2010
Deinum JT.
Medicatieoverdracht: een regionale verantwoordelijkheid.
Prisma symposium, Amersfoort, 26 januari 2010.
Conemans JM, Eppenga W.
De koppeling van de gegevens van klinisch-chemische
laboratoria, apotheken en huisartsen. Wat kan de
voorschrijver op dit gebied verwachten? Een nieuwe
generatie medicatiebewaking.
Labcontact 2009;10(28):3-4.
Conemans JM, Péqueriaux N, de Boer M, Eppenga W.
Wat moet de huisarts weten over orale anticoagulantia
en de trombosedienst?
Labcontact 2009;30:1-2.
Derijks HJ, Heerdink ER, Janknegt R, De Koning GH,
126
Olivier B, Loonen AJ, Egberts AC. Farmacologische
profielen van antidepressiva.
Pharm Weekbl 2010; 4(5): 79-85.
Derijks HJ, Meyboom RH, Heerdink ER, De Koning,
Janknegt R, Lindquist M, Egberts AC. Associatie tussen
antidepressivagebruik en glucosedisregulatie bewijs op
basis van bijwerkingenmelding.
Pharm Weekbl 2009; 3(2): 22-27.
Derijks HJ.
Invloed van antidepressiva op de glucosehuishouding.
Psyfar 2010; 5(3): 28-33
28
OVERIGE STAFDIENSTEN
Verpleegkunde / kwaliteit van zorg
Schuurman JP, Schoonhoven L, Defloor T,
van Engelshoven I, van Ramshorst B, Buskens E.
Economic evaluation of pressure ulcer care: a cost
minimization analysis of preventive strategies.
Nurs Econ. 2009 Nov-Dec;27(6):390-400, 415.
PMID: 20050490
overige stafdiensten
127
128
29
DIVERSEN
Proefschriften
Van Wijk P.
(Co-promotor Schneeberger PM)
Improving the Management of Blood Exposure
Accidents in The Netherlands, Radboud Universiteit
Nijmegen, 18 november 2009.
Rutten MJ.
St. Radboud Universiteit Nijmegen, 15 juni 2010,
Nijmegen.
Creemers MC.
Titel dissertatie: Effectiveness and safety of TNFalpha-blocking therapy in patients with rheumatoid
artrhitis. 2009.
Derijks HJ.
Influence of antidepressants on glucose homeostasis.
11 november 2009.
ISBN/EAN: 978-90-8559-564-9
Proefschrift digitaal te raadplegen op: http://igiturarchive.library.uu.nl/dissertations/2009-1019-200116/
UUindex.html
diversen
129
WETENSCHAPSMIDDAG 2009
Programma 5de Wetenschapsmiddag JBZ –
12 maart 2009 – aula GZG
15:00
Opening
15:05
eter de Jager, internist-intensivist
P
PROCALCITONIN KINETICS IN LEGIONELLA PNEUMOPHILA PNEUMONIA
15:20Boukje Koebrugge, arts-assistent chirurgie
DELIRIUM NA ABDOMINALE CHIRURGIE OP EEN CHIRURGISCHE AFDELING MET STANDAARD
AANDACHT VOOR HET DELIRIUM: INCIDENTIE, RISICOFACTOREN EN UITKOMSTEN
15:35Marjolein Mattheij, arts-assistent kindergeneeskunde
OVERWEIGHT IN CHILDREN: WHAT DO DUTCH PEDIATRICIANS SEE AND DO?
15:50Deirdre Bochove-Overgaauw, arts-assistent urologie
ARGUS “ADJUSTABLE MALE SLING” VOOR STRESSINCONTINENTIE BIJ MANNEN
16:05Ellen Schatorjé, arts-assistent kindergeneeskunde
HYPERTRANSAMINASEMIE BIJ PEDIATRISCHE CROHN PATIËNTEN TIJDENS INITIËLE
BEHANDELING MET ENTERALE VOEDING
16:20
Pauze
16:35Janneke Bressers, arts-assistent geriatrie
BESPREKEN VAN HET REANIMATIEBELEID OP EEN AFDELING GERIATRIE: DE ERVARING VAN
PATIËNT EN FAMILIE
16:50Maaike Kusters, arts-assistent kindergeneeskunde
ANTISTOFRESPONS NA TETANUSVACCINATIE BIJ KINDEREN MET DOWNSYNDROOM
17:05Dashti Faraj, arts-assistent chirurgie
FIVE YEARS RESULTS OF INGUINAL HERNIA TREATMENT WITH THE PROLENE HERNIA
SYSTEM: A RETROSPECTIVE ANALYSIS
17:20Robert Laheij, arts-assistent interne geneeskunde
THE ANTIBACTERIAL ACTIVITY OF HONEY AGAINST A HYPERVIRULENT CLOSTRIDIUM
DIFFICILE STRAIN
17:35
130
Borrel en prijsuitreiking
WETENSCHAPSMIDDAG 2010
Programma 6de Wetenschapsmiddag JBZ –
4 februari 2010 – aula GZG
15:00
Openingswoord Willy Spaan, Voorzitter Raad van Bestuur, Jeroen Bosch Ziekenhuis
15:15Wietske Wester, arts-assistent geriatrie
DE ROL VAN MRI ONDERZOEK IN HET DIAGNOSTISCH TRAJECT VAN DE OUDERE ALZHEIMER
PATIËNT
15:30Frank van Eijkeren, klinisch fysiotherapeut
NORDIC WALKING IN PARKINSON’S DISEASE: IMPROVES WALKING SPEED BUT LEAVES
STRIDE LENGTH UNCHANGED
15:45Mischa Jager, arts-assistent medische microbiologie
EVALUATION OF A DIAGNOSTIC ALGORITHM FOR ACUTE Q-FEVER IN AN OUTBREAK SETTING
16:00
eter Schmeits, biomedisch wetenschapper
P
VKORC1 - RESISTENT VOOR DE TROMBOSEDIENST
16:15Maurits Barendrecht, arts-assistent urologie
EFFECTEN VAN FAST-TRACK PROTOCOL NA EEN CYSTECTOMIE MET URINEDEVIATIE
16:30
Pauze
16:45Willemijn Eppinga, ziekenhuisapotheker in opleiding
MEDICATIEBEWAKING “NEXT GENERATION”
17:00Boukje Koebrugge, arts-assistent chirurgie
ACCURATESSE VAN TRANSRECTALE ECHOGRAFIE IN DE PREOPERATIEVE STADIERING VAN T1
RECTUM LESIES MOGELIJK GESCHIKT VOOR TRANSANALE ENDOSCOPISCHE
MICROCHIRURGIE (TEM)
17:15Linda Kampschreur, arts-assistent interne geneeskunde
ACUTE Q-FEVER-RELATED MORTALITY IN THE NETHERLANDS
17:30Eugenie Gemen, research analist
THE VALUE OF AN ARTIFICIAL NEURAL NETWORK IN THE DECISION-MAKING FOR PROSTATE
BIOPSIES
17:45
Borrel en prijsuitreiking
131
Wetenschappelijk
onderzoek:
hoe en waarom?
Dr. Mirrian Hilbink werkt als klinisch epidemioloog bij het wetenschapsbureau van het Jeroen Bosch
Ziekenhuis. Zij helpt medisch specialisten, paramedici, analisten, arts-assistenten en verpleegkundigen
bij het opzetten van onderzoek en bij het verzamelen, verwerken en analyseren van
onderzoeksgegevens. Ze vertelt enthousiast over het belang hiervan.
“Het wetenschapsbureau heeft als belangrijkste taak wetenschappelijk onderzoek binnen het Jeroen Bosch
Ziekenhuis (JBZ) zoveel mogelijk te ondersteunen”, vertelt Hilbink. “Ik ben uitermate geïnteresseerd in onderzoek
binnen een ziekenhuis. Zo denk ik vaak mee over bijvoorbeeld de onderzoeksvragen, uitvoeringsmethoden en
analyses. De onderzoeken zijn boeiend, praktisch en zeer divers van aard. Ook begeleid ik vaker het opzetten van
postermateriaal voor congressen of het schrijven van wetenschappelijke publicaties. Ik werk twee dagen per week
in dit ziekenhuis. De overige tijd doe ik onderzoek in het Universitair Medisch Centrum St Radboud in Nijmegen.”
132
Werkwijze
Hilbink licht kort toe hoe ze te werk gaat: “Vaak krijg ik eerst een mailtje van een collega met een vraag over het
doen van patiëntonderzoek. Dan ga ik met diegene in gesprek om na te denken over de onderzoeksvraag, het
bepalen van de juiste onderzoeksopzet of geschikte analysetechniek. Ik heb graag dat mensen mij vroegtijdig bij
hun onderzoek betrekken zodat we samen na kunnen denken over een opzet die valide en betrouwbare
onderzoeksresultaten oplevert. Daarnaast is onderzoek vaak aan regels gebonden. Dit vanwege de
patiëntveiligheid. Het is uitermate belangrijk dat de patiënten die meedoen geen schade oplopen door het
onderzoek.”
Advies op maat
“Na het verzamelen van de onderzoeksgegevens begint het echte werk”, lacht Hilbink. “Namelijk het analyseren
van de data en het beschrijven van de onderzoeksresultaten. Dat is mijns inziens het leukste onderdeel van het
doen van onderzoek. De resultaten moeten altijd zorgvuldig en begrijpelijk opgeschreven worden: geven de
figuren en tabellen het juiste beeld? Klopt de structuur? En zijn de conclusies juist en helder verwoord? Ik lever
als het ware advies op maat. Dit is afhankelijk van de wensen en behoeften van de betreffende collega.”
Visie
Hilbink heeft een duidelijke visie voor ogen: “Binnen het JBZ is het aantal initiatieven voor het doen van
onderzoek groot. Alleen publiceren we er nog te weinig over. Dat is jammer! Ook loopt een onderzoek nog wel
eens vast in een vroeg stadium. Ik kan helpen om dat te voorkomen.” Tot slot benadrukt Hilbink nog een
belangrijk punt: “Niet alleen in academische, maar ook in perifere ziekenhuizen, zoals het JBZ, is het doen van
onderzoek belangrijk. De patiëntenpopulatie van perifere ziekenhuizen leent zich hier uitstekend voor. Mijns
inziens is het essentieel om bij te dragen aan het verbeteren van de patiëntenzorg. Ik wil mensen hier graag bij
helpen. Niet alleen individuele verzoeken, maar ik ga ook binnenkort intern scholingsbijeenkomsten geven.”
Meer informatie
Wilt u meer weten over dit onderwerp? Of heeft u vragen over het opzetten of uitvoeren van wetenschappelijk
patiëntenonderzoek? Neem dan contact op met epidemioloog dr. Mirrian Hilbink via tel.: (073) 699 2970 of
e-mail m.hilbink@jbz.nl. Zij werkt op woensdag en vrijdag bij het wetenschapsbureau van het Jeroen Bosch
Ziekenhuis.
interview mirrian hilbink
133
1. De rol van mri onderzoek in het diagnostisch
traject van de oudere alzheimer patiënt 1.
W.N. Wester1, M.D. Beutick1, P. Scheltens2, R.J. van Marum1, P.L.J. Dautzenberg1
Klinische geriatrie, Jeroen Bosch Ziekenhuis, ’s-Hertogenbosch, 2Afdeling neurologie, VU, Amsterdam
1
Achtergrond
Vanuit de huidige Richtlijn diagnostiek en medicamenteuze behandeling van dementie (2005) wordt beeldvormend onderzoek
van de hersenen aanbevolen bij patiënten jonger dan 65 jaar, bij iedere patiënt met klinische verdenking op een neurochirurgisch
behandelbare aandoening en indien er meer zekerheid verlangd wordt omtrent de oorzaak van de cognitieve stoornis. Hieruit
volgt dat op de afdeling geriatrie en op het geheugencentrum Jeroen Bosch Ziekenhuis niet bij iedereen met verdenking dementie
beeldvormend onderzoek plaats heeft en er protocollair gestart wordt met een cholinesterase remmer bij de ziekte van Alzheimer
en Lewy Body dementie en gestart wordt met preventieve maatregelen bij de klinische verdenking op Vasculaire dementie. In
andere centra, zoals het academisch ziekenhuis de VU, vindt wel bij iedereen met cognitieve klachten beeldvormend onderzoek
van de hersenen plaats. In de VU zullen door deze wijze ook weinig specifieke zeldzame aandoeningen minder worden gemist. De
vraag is of de werkwijze van de afdeling geriatrie van het Jeroen Bosch Ziekenhuis, voortkomend uit de huidige Richtlijn patiënten
tekort doet. De onderzoeksvraag is als volgt geformuleerd: leidt aanvullend MRI-cerebrum onderzoek bij patiënten >75jaar, tot
verandering van reeds gestelde diagnose en/of reeds voorgenomen beleid als daar klinisch geen argumenten voor zijn?
Methode
Het betreft een prospectief, gerandomiseerd onderzoek. Van december 2008 tot november 2009 werden patiënten gerekruteerd
van de poliklinieken en afdeling klinische geriatrie van het JBZ. Inclusiecriteria waren leeftijd >75 en, op grond van anamnese,
lichamelijk onderzoek en beperkt NPO, multidisciplinair vast gesteld geen noodzaak tot aanvullend MRI cerebrum onderzoek. De
interventiegroep onderging alsnog een MRI cerebrum. De controle groep is prospectief vervolgd om veranderingen in behandeling zonder MRI cerebrum te kunnen vervolgen. Patiënten die 2 jaar voorafgaand aan dit onderzoek MRI-c hadden ondergaan
zijn geëxcludeerd. De MRI’s werden verslagen en beoordeeld door prof. dr. Ph, Scheltens, hoogleraar cognitieve neurologie aan
het VU medisch centrum. Naar aanleiding van criteria volgens consensus in huidige literatuur werd de eerder gestelde diagnose
heroverwogen en eventueel bijgesteld.
Voorlopige resultaten
Er werden in totaal 48 patiënten bereid gevonden te participeren in de controle en de interventiegroep. Gemiddelde leeftijd in de
interventie groep was 82,8 jaar, variërend van 77-95 jaar. Ten tijde van deze wetenschapsmiddag zijn 16 van de 24 MRI’s officieel
verslagen, waarbij vooralsnog geen diagnose wijzigingen zijn opgetreden.
Voorlopige conclusie
Voor alsnog is er geen diagnose of behandeling gewijzigd. Echter, vanwege de incomplete data op dit moment, is het nog te vroeg om
onze onderzoeksvraag gefundeerd te beantwoorden. Wel bleek het erg lastig om voldoende patiënten te includeren in de interventiegroep. Blijkbaar worden aanvullende onderzoeken als overmatig belastend bevonden, hetgeen als secundaire overweging zeker
meegenomen dient te worden in de beslissing omtrent aanvullend onderzoek in een kwetsbare oudere populatie.
134
2. Nordic walking in parkinson’s disease: improves
walking speed but leaves stride length unchanged
Frank J.M. van Eijkeren1 Ruud S.J. Reijmers1 Mirjam J. Kleinveld1 Angret Minten1 Jan Pieter ter Bruggen1,
Bastiaan R. Bloem2
1
Department of Neurology, Jeroen Bosch Hospital, ’s-Hertogenbosch, The Netherlands, 2Parkinson Center Nijmegen
(ParC), Department of Neurology, Donders Center for Neuroscience, Radboud University Nijmegen Medical Center,
The Netherlands
Objective
Does a Nordic Walking-training program improve motor skills and walking condition in patients with Parkinson’s
disease (PD)? What is the effect of this training on stride length?
Methods
We included 23 patients with PD. (16 men; mean age 64 years; range 48-78; disease severity Hoehn Yahr mean stage
2, range 1-3). Patients were trained for 6 weeks, with a frequency of twice a week. Patients were tested at baseline
and immediately after the complete training program. Outcome measures included: the Timed 10-meter maximum
walking speed (10 M Walk), the Timed Get Up and Go Test (TUG), the 6 minutes walking test (6 Min Walk), the number
of steps as measured with the Runner FM05B step indicator (STEPS), stride length in meters (Stride Length) and the
Parkinson Disease Quality of life questionnaire (PDQ-39).
Results
After training, the 10 M Walk, TUG, 6 Min Walk and the STEPS had improved significantly compared to baseline. Stride
length and the PDQ-39 had not changed significantly.
Conclusion
After a six-week Nordic Walking training program, mildly affected IPD patients were able to improve their walking
speed. The improved walking speed could not be attributed to an increased stride length, but rather to an increased
movement frequency of the legs. Controlled studies are now justified to identify the intrinsic treatment effects, why
especially bradykinesia has been changed and to determine how clinically meaningful these improvements are.
135
3. Evaluation of a diagnostic algorithm for acute
q-fever in an outbreak setting
Mischa M. Jager1, Ineke Weers-Pothoff1, Mirjam H.A. Hermans2, Jeroen J.A. Schellekens2, Jamie C.E. Meekelenkamp1,
Peter M. Schneeberger1, Peter C. Wever1
1
Department of Medical Microbiology and Infection Control, 2Molecular Diagnostics, Jeroen Bosch Ziekenhuis,
’s-Hertogenbosch
Objectives
An outbreak of Q-fever with over 3300 notified cases is ongoing in the Netherlands. Since 2007, immunofluorescence
assay (IFA) has been the cornerstone of Q-fever serology in our hospital. IFA, however, is time-consuming and subject
to inter-observer variability. Furthermore, the lag phase in antibody response to Coxiella burnetii renders serology less
suitable for diagnosing early disease. Alternative diagnostic approaches include an ELISA for IgM phase II antibodies
as screening assay (M II screen). In addition, IS1111 PCR on serum samples is capable of diagnosing acute Q-fever
before antibodies appear. In 2009, we introduced a diagnostic algorithm (figure) for acute Q-fever with the M II screen
as initial step. Subsequently, IFA and/or PCR were performed depending on outcome of M II screen, date of onset of
disease and inpatient or outpatient setting. When diagnostics were inconclusive a 14-day follow-up serum sample was
requested. Here, we evaluated the value of the algorithm in an outbreak setting.
Methods
We retrospectively evaluated outcome of Q-fever diagnostics according to the new algorithm in all patients referred
between May 15th and 31st, 2009, with date of onset of disease unknown or < 3 months.
Results
In the 17-day period, 825 patients were tested. The diagnosis acute Q-fever was made in 256 patients (31%) - in 197
patients on the first serum sample, in 59 patients on the 14-day follow-up serum sample. A negative M II screen was
obtained in 669/825 first serum samples resulting in reduction of IFAs performed by more than 80%. Ninety-two M II
screen negative patients were diagnosed with acute Q-fever by positive PCR. Cross-reactivity was documented in 4% of
patients with a positive M II screen. Almost 50% of physicians did not list date of onset of disease. Requested follow-up
serum samples were not received from 306 patients leading to inconclusive outcomes.
Conclusion
Introduction of the M II screen significantly reduced the number of IFAs performed, while introduction of PCR allowed
for diagnosis of acute Q-fever in a substantial number of seronegative patients. Pitfalls to the presented algorithm are
the poor communication by many physicians of the first day of disease, which is a critical component in the algorithm,
and the suboptimal response to requests for follow-up serum samples implying that cases of acute Q-fever might have
been missed.
136
ELISA M2 screen
positive /
negative
doubtful
positive:
first day of
acute
symptoms:
Q-fever
≤ 14 days
or applicant
is specialist
and unknown
day of first
symptoms
IFA G
PCR
and M
negative:
request for
at least M2
follow-up
and G2
acute
Q-fever
positive
first day of
symptoms
no Q-fever
> 14 days
past or
only G
chronic
positive
infection
positive:
acute
Q-fever
applicant
general
practitioner
request for
and unknown
follow-up
first day of
symptoms
other
PCR
negative:
request for
follow-up
137
4. Vkorc1 - resistent voor de trombosedienst
Peter C. Schmeits1, Jeroen Poodt2, Mirjam H.A. Hermans2, Nathalie C. Péquériaux3, Jean M. Conemans1
1
Ziekenhuisapotheek Noordoost-Brabant’, ’s-Hertogenbosch, 2Moleculaire Diagnostiek, 3Laboratorium voor Klinische Chemie
en Hematologie, Jeroen Bosch Ziekenhuis,’s-Hertogenbosch
In 2006 stond er een casus in het Nederlands Tijdschrift voor de Geneeskunde van een 78-jarige man die niet ingesteld
kon worden op zijn antistollingsmedicatie. Eerst was hem acenocoumarol voorgeschreven; wegens onvoldoende effect werd
overgeschakeld op fenprocoumon. De maat van antistolling wordt weergegeven in een INR waarde. Een normale antistolling
heeft een INR (International Normalised Ratio) van 1. Patiënten die ontstold moeten worden, hebben een streefgebied waar
de INR tussen moet liggen. Dit streefgebied is meestal tussen de 2,5 en de 4,0. Bij de beschreven patiënt kon nauwelijks een
INR-verhoging worden bereikt. De auteurs suggereerden dat de oorzaak een genetische resistentie kon zijn in het VKORC1
(Vitamine K-epoxidereductasecomplex subunit 1) gen. Dit gen codeert voor het eiwit VKOR, het sleutelenzym in de vitamineK-pomp. Coumarines interacteren met dit eiwit. Afwijkingen in het VKORC1 gen kunnen de oorzaak zijn van therapiefalen.
Wij zochten contact met de auteurs en vroegen een buis bloed op van de patiënt. Deze patiënt bleek een afwijking te hebben
die zorgde voor een aminozuurverandering met als code Trp59Arg. De Tryptofaan op de 59e plaats van het eiwit was vervangen door een Arginine. Deze variant werd niet eerder beschreven in de literatuur. Bij het aanbieden van de bevindingen
aan een internationaal tijdschrift kwamen de reviewers met twee belangrijke vragen. 1) Komt deze variant nog meer voor bij
mensen met therapiefalen? 2) Komt deze variant niet voor bij patiënten die normaal reageren op hun medicatie?
Om dit uit te zoeken hebben we in het hele land bloedmonsters opgevraagd van patiënten die niet op coumarines reageerden. Dit leverde 10 monsters op waarvan er 2 een genetische afwijking toonden in het VKORC1 gen. Bij 1 patiënt werd de
Trp59Arg mutatie gevonden, bij een andere patiënt werd een andere nieuwe mutatie gevonden: Ser52Leu, de inbouw van
een Leucine in plaats van een Serine op aminozuur 52 van het eiwit. Bij de overige 8 patiënten had de lastige instelbaarheid
een andere oorzaak (non-adherence, interacties). Daarnaast werden 100 anonieme controles verkregen van de trombosedienst. Geen van deze 100 monsters bezat één van de bovengenoemde genetische afwijkingen in het VKORC1 gen. Tijdens
het schrijven van een artikel om de resultaten te publiceren ontvingen we een aanvraag van nog een patiënt. Ook deze
patiënt bezat de Trp59Arg mutatie.
Bij patiënten die niet in te stellen zijn op antistollingsmedicatie wordt eerst een aantal zaken nagekeken, waaronder geneesmiddeleninteracties en therapietrouw. Wanneer alle mogelijkheden zijn uitgesloten wordt de serumconcentratie van het
coumarine bepaald. Bij een hoge concentratie met tegelijk een erg lage INR wordt al veel duidelijk. Ter confirmatie wordt de
genetica nagekeken. Wanneer een genetische variant wordt gevonden betekent dit veel voor de patiënt en zijn behandelaar.
Het belangrijkste is duidelijkheid. Er hangt altijd een geur van therapieontrouw over een patiënt wanneer deze niet is in te
stellen. Wanneer wordt aangetoond dat de oorzaak in zijn/haar genen zit, zorgt dat voor veel opluchting. De therapie wordt
vervolgd door de antistollingsmedicatie verder op te hogen tot een dosis die levensgevaarlijk zou zijn bij patiënten zonder
genetische resistentie. Inmiddels hebben wij 5 patiënten geïdentificeerd met een dergelijke genetische “warfarine-resistentie.” Wij vonden bij hen dus 2 genetische varianten die beide niet eerder in de literatuur werden beschreven. Tenslotte
formuleerden wij een algoritme voor het Netherlands Journal of Medicine voor de onbegrepen INR, waar de besproken
coumarine-resistentie een -bescheiden- plaats in kreeg.
138
5. Effecten van fast-track protocol na een
cystectomie met urinedeviatie
Maurits Barendrecht, Jorg R. Oddens
Afdeling Urologie, Jeroen Bosch Ziekenhuis, ’s-Hertogenbosch
Introductie
In de postoperatieve fase na een cystectomie met aanleg van een urine deviatie (ileo-uretero-cutaneostomie volgens
Bricker of dundarm-neoblaas) wordt regelmatig een postoperatieve ileus (tot dag 4 post-operatief ontbreken van darm
peristaltiek) als complicatie gezien. Het Fast-Track protocol volgens ERAS (Enhanced Recovery After Surgery) heeft het
aantal complicaties, waaronder de postoperatieve ileus, bij verschillende vormen van colon-chirurgie verminderd. Echter,
deze vorm van peri-operatieve zorg is bij een cystectomie relatief onbekend. In deze studie is gekeken naar de effecten van
het invoeren van het Fast-Track protocol na een cystectomie met urinedeviatie.
Methode
Een retrospectieve analyse is verricht van de cystectomiën over de periode 2006 t/m 2009 bij patiënten van de afdeling
urologie in het Jeroen Bosch Ziekenhuis . Traditionele peri-operatieve zorg in het jaar 2006 en 2007 is vergeleken met de
jaren 2008 en 2009 waarin het Fast-Track protocol is toegepast. De uitkomstmaten voor deze vergelijking zijn het optreden
van een postoperatieve ileus en de gemiddelde opnameduur. Daarnaast zijn patiëntkarakteristieken, indicatie, per-operatieve gegevens, pathologische verslagen en follow-up geanalyseerd.
Resultaten
In 2006-2007 en 2008-2009 werden door 3 operateurs respectievelijk 27 en 30 (n totaal = 57) cystectomiën uitgevoerd.
Gemiddelde leeftijd, geslachtsverhouding, en per-operatieve parameters verschilden niet tussen de groepen. De gemiddelde
opnameduur in de traditionele behandelingsgroep en Fast-Track groep was 20,4 ± s.d. 7,8 en 17,0 ± s.d. 6,9 dagen respectievelijk (p = 0.08). De postoperatieve complicatie ileus kwam in de Fast-Track groep minder voor dan in de traditionele
groep (13% vs 19%) echter statistisch niet significant.
Conclusie
Het Fast-Track protocol volgens ERAS bij de cystectomie met aanleg urinedeviatie in deze retrospectieve studie lijkt tot een
daling van het aantal patiënten met een postoperatieve ileus te leiden. Gekoppeld aan deze bevinding is een dalende trend
waarneembaar in de gemiddelde opnameduur.
139
6. Medicatiebewaking ‘next generation’
Willemijn L. Eppenga, Jean M.H. Conemans
Ziekenhuisapotheek Noordoost-Brabant’, ’s-Hertogenbosch,
Inleiding
Het HARM-wrestling rapport heeft veel stof doen opwaaien. Maar liefst 19.000 medicatiegerelateerde ziekenhuisopnames per
jaar zijn onnodig. Het HARM-wrestlingrapport geeft gedetailleerde aanbevelingen om bijwerking-gerelateerde ziekenhuisopnames te reduceren. De suggesties zijn zowel inhoudelijk als organisatorisch. Eén van de aanbevelingen (aanbeveling 1e) betreft
ondersteuning door ICT.
Aanbeveling 1(e):
Het benutten van nieuwe ICT mogelijkheden, zoals het raadplegen en toepassen van elektronische patiëntgegevens via koppelingen tussen de computersystemen van zorgprofessionals en zorginstellingen in de eerste en tweede lijn.
Het aanbod aan software die medicatiegegevens kan combineren met laboratoriumuitslagen is beperkt. Ziekenhuisapotheek
Noordoost-Brabant heeft daarom in samenwerking met de bedrijven Inforay en Emotional Brain Pharmaps® Medicatiebewaking PLUS ontwikkeld. Dit is een intelligent medicatiebewakingssysteem dat webbased fungeert, onafhankelijk van andere
software. Met intelligent wordt bedoeld dat met redeneerregels alleen de echt relevante signalen met betrekking tot geneesmiddelen zichtbaar gemaakt worden.
Om te laten zien dat het nieuwe systeem Pharmaps daadwerkelijk beter is dan het huidige systeem Centrasys is als eerste onderzoeksvraag het volgende geformuleerd: “Hoe verhouden de sensitiviteit, specificiteit en positief voorspellende waarde van verschillende versies van Pharmaps® zich tot die van verschillende versies van Centrasys (“nieuwe” versus “oude” medicatiebewaking)?
Een voorbeeld van medicatiebewaking nieuwe stijl is de geautomatiseerde bewaking van de dosering door toetsing aan de
kreatinineklaring bij renaal geklaarde geneesmiddelen.
Onderzoeksopzet
Er wordt op dit moment een vergelijkend observationeel onderzoek uitgevoerd, waarbij de performance van 6 verschillende
versies van 2 medicatiebewakingssystemen met elkaar vergeleken worden. Hiervoor worden ongeveer 2000 medicatieopdrachten gebruikt. Om een goed beeld te krijgen moeten minimaal 400 medicatiebewakingsignalen beoordeeld worden. De
studie vindt plaats in het Jeroen Bosch Ziekenhuis.
Deze studie wordt uitgevoerd op 3 afdelingen van het Jeroen Bosch ziekenhuis, te weten cardiologie, orthopedie en geriatrie.
Door te kiezen voor drie verschillende afdelingen wordt gedacht een brede variëteit aan medicatiebewakingsignalen te observeren. Zo wordt de performance van de systemen op verschillende vlakken bekeken.
Het JBZ gebruikt Centrasys. Het EVS van iSoft is sinds 2007 operationeel in het Jeroen Bosch ziekenhuis. Voorschrijvers krijgen
een beperkt aantal medicatiebewakingsignalen te zienen de ziekenhuisapotheker controleert aan het eind van de dag nog de
overige medicatiebewakingsignalen..
Discussie
Het onderzoek is momenteel in volle gang. De resultaten zullen voor de zomer bekend zijn.
Pharmaps® Medicatiebewaking Plus is nog volop in ontwikkeling. Na uitvoering van deze studie en een validatietraject met de
gewenste uitkomst zal Pharmaps® Medicatiebewaking Plus geïmplementeerd worden in de ziekenhuisapotheek. Tevens zijn er
gesprekken met Alert® om Pharmaps® Medicatiebewaking Plus te integreren.
Het is evident dat door het combineren van individuele laboratoriumgegevens van een patiënt met zijn/haar medicatiegegevens
leidt tot medicatiebewakingsignalen toegespitst op de specifieke patiënt. Naast de individuele farmacotherapie is er nu ook een
weg ingeslagen om de medicatiebewaking van deze farmacotherapie te individualiseren en optimaliseren.
Het gaat om een systeem dat nu transmuraal functioneert. De medicatiebewakingsignalen komen nu nog in de ziekenhuisapotheek of stadsapotheek terecht. In de toekomst lijkt het zinvol om de signalen te presenteren op moment van voorschrijven
(clinical decision support). Voor het formuleren van farmacotherapeutisch beleid en van medicatieprotocollen zal een beroep
gedaan worden op ervaren clinici.
140
7. Accuratesse van transrectale echografie in de
preoperatieve stadiering van rectum lesies
mogelijk geschikt voor transanale endoscopische
microchirurgie (tem)
Boukje Koebrugge1, Koop Bosscha1, Gerrit Jager2, Miranda Ernst1
1
Afdeling Chirurgie, 2 Afd. Radiologie, Jeroen Bosch Ziekenhuis, ’s-Hertogenbosch
Achtergrond
De Transanale Endoscopische Microchirurgie (TEM) is een minimaal invasieve techniek voor de locale resectie van benigne
adenomen en stadium T1 rectum carcinomen in geselecteerde patiënten, gepaard gaande met lagere morbiditeit en mortaliteit dan conventionele open chirurgie. Transrectale Echografie is een belangrijk diagnosticum ter preoperatieve stadiëring
van deze rectumlaesies. Het doel van de studie was het bepalen van de accuratesse van preoperatieve transrectale echografie bij rectumlaesies, mogelijk geschikt voor TEM.
Methode
Sinds 2006 ondergaan alle patiënten mogelijk geschikt voor TEM transrectale echografie als onderdeel van de preoperatieve
T-stadiering. De belangrijkste vraag was of de muscularis propria was onderbroken (scheidingsvlak T1-T2 laesies).
Naar aanleiding van de stadiëring middels transrectale echografie werd respectievelijk een TEM uitgevoerd of aanvullende
diagnostiek vervaardigd (MRI rectum). Preoperatieve echografische bevindingen werden vergeleken met de postoperatieve
pathologische stadiering.
Resultaten
36 patiënten met rectale laesies met een gemiddelde leeftijd van 66 jaar werden geïncludeerd. Bij 30 patiënten was de
transrectale echografie conclusief en toonde 28 T0/T1 laesies waarbij een TEM werd vervaardigd, 1 T2 carcinoom (bevestigd
middels een MRI rectum) waarbij een Low Anterior Resectie werd vervaardigd en 1 T3 carcinoom (mogelijk artefact bevinding na eerdere biopsie). Na MRI werd bij deze patiënt alsnog een TEM uitgevoerd. Postoperatieve stadiëring bevestigde
de preoperatieve echografische bevindingen bij 29/30 patiënten. De T3 laesie bleek inderdaad een eerder gebiopteerde T0
laesie te zijn. Er vond geen onderstadiëring plaats. De accuratesse in deze groep was 97%.
Bij 6 patiënten was de transrectale echografie niet conclusief; bij 4 patiënten werd aanvullende diagnostiek verricht middels een MRI, waarbij in geen van de 4 patiënten tumorinvasie werd gezien. Bij 5 van de 6 patiënten werd alsnog een TEM
uitgevoerd. Bij 2 patiënten werd deze geconverteerd naar een Low Anterior Resectie in verband met localisatie/grootte van
de tumor. Postoperatieve stadiëring toonde 5 adenomen.
Bij 1 patiënt werd geen chirurgische ingreep uitgevoerd, omdat er geen tumor zichtbaar was op MRI. Stadiering van de
rectale laesie middels Transrectale echografie was mogelijk bij 30/36 patiënten (83%). Overall accuratesse van transrectale
echografie in de preoperatieve stadiëring van rectumlaesies mogelijk geschikt voor TEM was 80%. Accuratesse in de conclusieve groep was echter 97%.
Conclusie
Transrectale echografie is een goed diagnostisch middel om preoperatief T0/T1 laesies geschikt voor TEM te onderscheiden
van rectum laesies met invasie van de muscularis propria; een indicatie voor radicale chirurgie. Als Transrectale echografie
niet conclusief is of een hoog stadium rectum laesie (>T2) toont, dan is aanvullende diagnostiek (MRI rectum) geïndiceerd.
141
8. Acute q-fever-related mortality in the
Netherlands(tem)
L.M. Kampschreur1, M.C.A. Wegdam-Blans2, S.F.T. Thijsen3, C.A.R. Groot4, P.M. Schneeberger5, W.L. van Eede6, F.S. Stals7,
A.A.M.J. Hollander1, J.H.E.M. Schijen8, N.L.A. Arents2, P.C. Wever5
Dept. of Internal Medicine, Jeroen Bosch Ziekenhuis, ’s-Hertogenbosch, 2Regional Laboratory for Medical Microbiology, St.
1
PAMM, Veldhoven, 3Dept. of Microbiology, Diakonessenhuis Utrecht, Utrecht, 4Dept. of Pulmonology, Bernhoven Hospital, Oss,
Department of Medical Microbiology and Infection Control, Jeroen Bosch Ziekenhuis, ’s-Hertogenbosch, 6Dept. of Intensive Care
5
Medicine, Diakonessenhuis Utrecht, Utrecht, 7Atrium Medisch Centrum Parkstad, Heerlen, 8St. Elisabeth Hospital, Tilburg, The
Netherlands
A large outbreak of Q-fever with over 3300 cases since 2007 has been reported in the Netherlands. Available date indicate that
approximately 700 patients have been hospitalized with acute Q-fever. Reported mortality rates in hospitalized patients with acute
Q-fever range from 0.9 to 2.4%. Here, we analyzed mortality among hospitalized patients with acute Q-fever. Death resulting
from chronic Q-fever was not evaluated. Clinicians and microbiologists from hospitals in the afflicted region were asked to provide
details about patients who had died after diagnosis of acute Q-fever. Eight patients (7 males, 1 female) from 6 hospitals were
identified who died in approximately one month following hospitalization with acute Q-fever. Diagnosis was made by PCR only (4x),
serology only (2x) or both (2x). Six patients presented with infiltrative changes on the X-thorax and a median CURB-65 score of 3
(range 1-3). Median age at time of death was 76 years (range 55-86). Median time of hospitalization was 13 days (range 1-33).
All patients had serious, often coinciding, underlying conditions including chronic cardiovascular disease (6x), chronic lung disease
(5x), diabetes mellitus (3x) or malignancy (2x). Thus, we found a mortality rate around 1% among patients hospitalized with acute
Q-fever in the Netherlands. All patients had serious underlying conditions. It cannot be excluded that death to acute Q-fever is
underreported for instance because in many hospitals PCR for Q-fever was not introduced until 2009. This is illustrated by the fact
that in one case PCR analysis allowed for diagnosis four months postmortem.
142
9. The value of an artificial neural network in
the decision-making for prostate biopsies
RP Meijer1, EFA Gemen2, IEW van Onna4, JC vd Linden3, HP Beerlage1, GCM Kusters2
Department of Urology, 2Laboratory of Clinical Chemistry and Haematology, 3Laboratory of Pathology, Jeroen
Bosch Ziekenhuis, ’s-Hertogenbosch, The Netherlands, 4Department of Urology, Amphia Ziekenhuis, Breda
Purpose
In the majority of patients that are subjected to prostate biopsies, no prostate carcinoma (PCA) is found. It is
important to prevent unnecessary biopsies since serious complications may occur. An artificial neural network
(ANN) may be able to predict the risk of the presence of prostate cancer (PCa).
Methods
Included were all patients, who underwent transrectal ultrasound-guided prostate biopsies between June
2006 and June 2007 with a total PSA (tPSA) level between 2−20 μg/L. The patients were divided in two
groups according to their tPSA level (2−10 μg/L and 10−20 μg/L). The ANN ProstataClass of the
Universitätsklinikum Charité in Berlin version 9/29/2003 and the new ANN ProstataClass HCS 2008/4.2 was
used. The predictions of the ANN were compared to the pathology results of the biopsies.
Results
Overall 165 patients were included. PCa was diagnosed in 53 patients, whereas the ANN predicted ‘no risk’ in
19 of these patients (36%). The new version of the ANN uses a lower cut off value, thereby predicting minimal
risk in 7 of these patients (13%).
Conclusions
The ANN resulted in a false negative rate of 36%, missing PCa in 19 patients. As expected, by lowering the cut
off, the application of the new ANN results in a false negative rate of 7% and will advice to take more biopsies in
52 patients with no proven PCa.
We conclude that both the ANN and the new ANN are insufficient to predict the risk of presence of PCa reliably,
for use in an outpatient-clinical setting.
1
143
BIJLAGE I
Wetenschappelijke publicaties 2009-2010
opgenomen in PubMed
Volgorde op PubMed ID nummer.
Waar mogelijk is een samenvatting van de publicatie opgenomen. De artikelen worden in het overzicht
opgenomen op basis van het jaar van publicatie (dus niet het jaar van Epub).
PMID: 18249050
De Wijn RS, van der Heijden EP, Kon M.
On lipoma of the buccal fat pad: report of two cases and review of the literature.
J Plast Reconstr Aesthet Surg. 2009 Jan;62(1):28-35.
The buccal fat pad (BFP) has been the subject of numerous publications regarding its anatomy and clinical implications,
however our interest in the pathology was aroused by two cases of lipoma originating from the BFP that were particularly
interesting as one lipoma was congenital and the other recurred. A search of the international literature revealed a further
27 cases of BFP lipoma dating from 1848 to 2002. This suggests it is a rare entity but the authors suspect it to be under
reported because of unfamiliarity with the possibility and the various atypical characteristics that were observed. Firstly, BFP
lipomas appear to be congenital relatively often. Also, many are histological variants such as the spindle-cell lipoma, which
could be associated with a more diffuse growth in the various extensions. As the deep extensions are not routinely removed
due to the difficulty of the procedure, this could result in incomplete resection and recurrence. A possible explanation is the
hypothesis that the BFP has a different embryological origin than subcutaneous fat. More importantly, well-differentiated
liposarcoma of the BFP has also been described, which may be clinically and histologically indistinguishable from spindlecell lipoma. Therefore, the authors recommend a careful workup of every mass of the buccal space with consideration of
the BFP as a possible origin. Detailed knowledge of the anatomy and extensive MR-imaging are paramount in guiding the
surgical approach by visualising the extent of growth in the various extensions, and determining if the radiological picture is
suggestive of liposarcoma.
PMID: 18270659
Van Geest-Daalderop JH, Hutten BA, Péquériaux NC, Levi M, Sturk A.
Improvement in the regulation of the vitamin K antagonist acenocoumarol after a standard initial dose
regimen: prospective validation of a prescription model.
J Thromb Thrombolysis. 2009 Feb;27(2):207-14.
BACKGROUND: In a retrospective study we have developed a model which determines the dose of acenocoumarol based on
the age of the patient and on the first INR obtained after a standard initial loading dose. The group of patients of this study
144
was used as the control group of the present study.
AIM: The aim of this study was to prospectively validate the model and to assess whether the use of this model improves the
quality of the treatment in the 0-2 months study period.
PATIENTS AND METHODS: In 197 patients the model was evaluated by (1) in the initial phase: comparison of INRs with
the control group, after assessing the dose according to the model, and (2) in the 0-2 months period: calculation of the
percentage of time spent in the therapeutic target range compared to the control group. Furthermore, the eventual dose
was compared to the dose of the model when the INRs were within the therapeutic target range for the first time and on two
successive occasions.
RESULTS: (1) When dosed according to the model, 50% of INRs in the total group were within the therapeutic target range
compared to 45% in the control group, and (2) the percentage time spent within this range was 68 in the total group compared to 63 in the control group (P = 0.0013). When the INRs were within the range for the first time and successively twice,
the eventual doses were similar to the model in 59 and 50%, respectively. About 20% of the patients did not achieve two
successive INRs within the range.
CONCLUSIONS: Using the model the quality of treatment improved. We advice to use a standardized individualized dose
regimen at the initiation of vitamin K antagonist treatment.
PMID: 18541262
Brokelman WJ, Holmdahl L, Janssen IM, Falk P, Bergström M, Klinkenbijl JH, Reijnen MM.
Decreased peritoneal tissue plasminogen activator during prolonged laparoscopic surgery.
J Surg Res. 2009 Jan;151(1):89-93.
BACKGROUND: Peritoneal fibrinolysis is crucial in the peritoneal healing processes and subsequent adhesion formation.
During conventional surgery, the peritoneal fibrinolytic system is rapidly disturbed. Short-term laparoscopy does not seem
to affect peritoneal fibrinolysis. The aim of the present study was to assess the effect of prolonged laparoscopic surgery on
peritoneal fibrinolysis. METHODS: Twelve consecutive patients undergoing laparoscopic gastric bypass surgery for morbid
obesity were included in the study. During the procedure, biopsies of the parietal peritoneum were taken at the start of
the procedure and each 45 min afterward. Tissue samples were homogenized and tissue-type plasminogen activator (tPA)
antigen, tPA activity, urokinase-type PA antigen, and plasminogen activating inhibitors type 1 antigen were measured using
commercial assay techniques. RESULTS: Both tPA antigen and its activity progressively decreased during the procedure,
reaching significant levels after 90 min of surgery. The levels of uPA antigen and plasminogen activating inhibitors antigen
did not significantly change throughout the procedure. CONCLUSIONS: As for conventional surgery, prolonged laparoscopic
surgery causes a decreased fibrinolytic activity in the peritoneum due to decreased tPA levels.
PMID: 18712278
Verra WC, Snijders TJ, Seute T, Han KS, Nieuwenhuis HK, Rutten GJ.
Myeloid Sarcoma presenting as a recurrent, multifocal nerve root entrapment syndrome.
J Neurooncol. 2009 Jan;91(1):59-62.
BACKGROUND: Myeloid sarcoma is an extramedullary manifestation of haematologic malignancy, most commonly acute
myeloid leukemia (AML), which can cause neurological symptoms.
CASE DESCRIPTION: A 45-year-old male with a history of AML presented with a lumbosacral nerve root entrapment syndrome followed by cauda equina compression, but without systemic signs of AML recurrence. MRI showed a mass compressing the spinal cord at level L5-S2. After surgically removing the tumour pathologic examination yielded a myeloid sarcoma.
Combined chemotherapy and radiation therapy followed. Five months later the patient developed a thoracal (Th10-Th11)
bijlage wetenschappelijke publicaties 2009-2010 opgenomen in pubmed
145
radiculopathy due to a relapse of the myeloid sarcoma, followed by C8-Th1-radiculopathy caused by leptomeningeal spread.
CONCLUSION: This case forms the first description of recurrent, multifocal and progressive radiculopathy due to myeloid
sarcoma. This diagnosis should be considered in patients with radiculopathy with previous haematological malignancy and/
or signs or symptoms of such disease; the absence of systemic disease activity does not rule out myeloid sarcoma.
PMID: 18722048
Van Onna IE, Oddens JR, Kok ET, van Moorselaar RJ, Bosch JL, Battermann JJ.
External beam radiation therapy followed by interstitial radiotherapy with iridium-192 for solitary
bladder tumours: results of 111 treated patients.
Eur Urol. 2009 Jul;56(1):113-21.
BACKGROUND: Evaluation of bladder-preserving treatment protocol.
OBJECTIVE: To evaluate the long-term results of iridium-192 brachytherapy-based bladder-sparing treatment strategy in
patients with solitary invasive bladder tumours.
DESIGN, SETTING, AND PARTICIPANTS: We performed a retrospective analysis of 111 patients with solitary T1G3-T2Gall bladder
tumours (< or = 5 cm), who were treated with iridium-afterloading brachytherapy between February 1988 and May 2007.
INTERVENTION: After transurethral tumour resection, external beam radiotherapy (28 Gy; 12 fractions) was given, followed
by brachytherapy (Iridium-192; 40 Gy). Partial cystectomy was part of the treatment strategy in nine patients. In five of those
patients a T3 tumour was found, and they were included in the analysis.
MEASUREMENTS: The 5-, 10- and 15-yr overall survival rate (OS); disease-specific survival rate (DSS); and disease-free survival
rate (DFS) estimates were determined using the Kaplan-Meier method.
RESULTS AND LIMITATIONS: Mean follow-up period was 6.2 yr (range: 0.2-16.3 yr). At the last follow-up 75 patients were alive
without evidence of disease, whereas 17 patients had died without evidence of disease. Nineteen patients died of bladder cancer
after a mean follow-up period of 2.9 yr (range: 0.5-9.0). OS rates at 5 yr, 10 yr, and 15 yr were 70%, 55%, and 51%, respectively.
DSS rates at 5 yr, 10 yr, and 15 yr were 82%, 73% and 73%, respectively. DFS rates at 5 yr, 10 yr, and 15 yr were 60%, 47%, and
23%, respectively. Higher tumour stage (T3 vs T1) was negatively associated with DSS (hazard ratio [HR]:19.8; p=0.01) and DFS
(HR: 4.67; p=0.02). No prognostic factor was found for OS. Local recurrence occurred in 27% of patients and salvage cystectomy
was performed in 9% of patients. Bladder function was able to be preserved in 99 of 111 patients (89%).
CONCLUSIONS: In patients with solitary stage T1-T2 bladder cancer (< or = 5 cm) who refuse radical cystectomy or who are poor
candidates for major surgical procedures, this modality is a valuable treatment alternative.
PMID: 18722078
Lips DJ, Barker N, Clevers H, Hennipman A.
The role of APC and beta-catenin in the aetiology of aggressive fibromatosis (desmoid tumors).
Eur J Surg Oncol. 2009 Jan;35(1):3-10.
BACKGROUND: Aggressive fibromatosis (syn. desmoid tumor) is a sporadically occurring neoplastic proliferation of fibroblasts
originating from musculoaponeurotic planes, forming invasively growing masses without the capability to metastasize. The
choice of treatment remains surgical resection with or without radiotherapy, and is characterized by high recurrence rates.
Better understanding of the aetiology of aggressive fibromatosis is needed to be able to develop new treatment strategies to
cope with the high recurrence rates.
METHODS: Relevant studies were identified through a search of the electronic databases PubMed/ Medline. The following
search terms were used: ‘aggressive fibromatosis’, ‘desmoid tumor’, ‘adenomatous polyposis coli’, ‘APC’, ‘beta-catenin’, ‘Wnt’,
‘Wingless’ and ‘Wnt/Wingless’. Studies were selected for review on the basis of abstract reading. A hand search was perfor-
146
med by checking reference lists in selected articles.
RESULTS: The neoplastic nature of aggressive fibromatosis and the role of the adenomatous polyposis coli (APC) and betacatenin signaling cascade in driving the onset and progression of this disease are discussed.
CONCLUSION: Mutations in either the APC or beta-catenin genes are likely to be a major driving force in the formation of
these desmoid tumors. More research is needed to develop new treatment strategies.
PMID: 18762763
Van der Velden WJ, Herbers AH, Blijlevens NM.
Palifermin in allogeneic HSCT: many questions remain.
Bone Marrow Transplant. 2009 Jan;43(1):85-6.
PMID: 18775627
Van Schaik PM, Hermans E, van der Linden JC, Pruijt JR, Ernst MF, Bosscha K.
Micro-metastases in stages I and II colon cancer are a predictor of the development of distant metastases and
worse disease-free survival.
Approximately 30% of the patients with Dukes A/B colon carcinoma will develop loco-regional recurrence or distant metastases. The aim of this study was to evaluate if patients with micro-metastases are at higher risk for developing distant
metastases and therefore a worse disease-free survival and overall survival. In the period January 2000-January 2002,
137 patients underwent curative surgery for colon cancer. When patients had a Dukes A/B colon carcinoma, additional
staining and sectioning on the harvested lymph nodes were performed retrospectively. Lymph nodes were examined using 4
multilevel sections at 250-mum intervals and stained with Pan-Cytokeratin. There were 11 patients with a Dukes A and 61
patients with a Dukes B colon carcinoma. Twenty-two patients developed metastases in time (group I) whereas 50 patients
did not (group II). After additional staining and sectioning 41% of the patients of group I and 16% of the patients of group II
showed micro-metastases (p<0.05). The 5-year overall survival rate in the group with micro-metastases was 62% against
79% in the group without micro-metastases. The disease-free survival (DFS) was 51% and 72% (p<0.05), respectively.
Patients with micro-metastases develop significant more distant metastases in time and have a significant worse DFS.
PMID: 18805601
Pompen M, Gok M, Novák A, van Wuijtswinkel R, Biesma B, Schramel F, Stigt J, Smit H, Postmus P.
Direct costs associated with the disease management of patients with unresectable advanced non-small-cell
lung cancer in The Netherlands.
Lung Cancer. 2009 Apr;64(1):110-6.
INTRODUCTION: Disease management and costs of treatment of patients with unresectable advanced non-small-cell lung
cancer (NSCLC) in The Netherlands are not well known.
METHODS: A retrospective medical chart review was performed by collecting data from the time of diagnosis until the
time of death or the end of the evaluation period. In addition to the demographic data, information was collected on the
overall management of the patient. Hospital resource utilisation data collected included number of outpatient specialist
visits, number and length of hospitalisation, type and number of diagnostic and laboratory procedures, type and number of
radiotherapy cycles and detailed information on chemotherapy. To evaluate the economic impact of second-line treatment, a
distinction was made between patients who received only best supportive care (BSC, group A) and those who received chemotherapy as a second-line treatment in addition to BSC (group B). The study was performed from the hospital perspective
147
and reports on 2005 costs.
RESULTS: Of 102 patients, 74 belonged to group A and 28 to group B. Patient management included a multidisciplinary
approach, the extent of which depended on symptoms of the disease and presence of metastases. The average total
treatment cost per patient per year of unresectable advanced NSCLC in The Netherlands was euro32,840 in group A and
euro31,187 in group B. In both groups, hospitalisation was the major cost driver. In group B second-line chemotherapy
was the second largest contributor of the costs. In spite of the difference in numbers of treatment lines provided to patients
in groups A and B the total average costs per patient per year were comparable. Overall, the management of unresectable
advanced NSCLC appeared to conform with current guidelines in The Netherlands.
CONCLUSION: These patients show high medical resource consumption, with hospitalisation being the main cost driver in both
groups. As economic arguments are becoming increasingly important in medical decision making on both national and local
levels, this information is relevant for both policy makers and specialists. These data can also be used in future research to
evaluate the economic impact of new therapies in NSCLC, especially of those that aim to treat patients in an outpatient setting.
PMID: 18855027
Van de Veerdonk FL, de Jager CP, Schellekens JJ, Huijsmans CJ, Beaumont F,
Hermans MH, Wever PC.
Legionella pneumophila DNA in serum samples during Legionnaires’ disease in relation to
C-reactive protein levels.
Legionella pneumophila DNA can be detected in serum from patients with Legionnaires’ disease (LD). We explored this
observation studying the kinetics of L. pneumophila DNA in serum samples in relation to C-reactive protein (CRP). Eleven
hospitalized patients with LD were studied. Diagnosis was made by Legionella urinary antigen test in 8 patients and seroconversion in 3 patients. A macrophage infectivity potentiator (MIP) real-time PCR was performed on 31 serum samples,
including 20 follow-up serum samples. Serum samples obtained on the day of admission were MIP PCR-positive in 7 (64%)
and MIP PCR-negative in 4 (36%) patients. Three (75%) of the 4 patients with a MIP PCR-negative serum sample on the day
of admission became positive during follow-up. Overall, L. pneumophila DNA was detected in serum samples from 10 of
the 11 patients (91%). CRP levels in the 7 patients with a positive MIP PCR serum sample on day of admission (499 +/- 144
mg/l; median +/- SD) were significantly higher than those in the 4 patients with a negative MIP PCR serum sample on the
day of admission (244 +/- 97 mg/l). No difference in the severity of the disease on the day of admission was found between
these patients. The presence of L. pneumophila DNA in serum is a common phenomenon in hospitalized patients with LD,
although in some cases it is not yet present on the day of admission. L. pneumophila DNA in serum on the day of admission
correlates with high CRP levels, but not with the severity of the disease.
PMID: 18855048
Ploegmakers MJ, Rutten MJ.
Fatal pericardial tamponade after superior vena cava stenting.
CardioVascular Interventional Radiology 2009 May;32(3):585-9.
We discuss a fatal complication of percutaneous superior vena cava (SVC) self-expandable stent placement in a patient with
superior vena cava syndrome (SVCS). The SVCS was caused by a malignant mediastinal mass with total occlusion of the
SVC. Twenty-four hours after the procedure, the patient died of a hemopericardial tamponade. In the literature, only seven
cases have been described with this life-threatening complication. Patients with a necrotic tumor mass are more likely to
develop this complication. Knowledge of this complication may increase patient survival.
148
PMID: 18949456
Rozendaal FW, Spronk PE, Snellen FF, Schoen A, van Zanten AR, Foudraine NA, Mulder PG, Bakker J; UltiSAFE
investigators.
Remifentanil-propofol analgo-sedation shortens duration of ventilation and length of ICU stay compared to a
conventional regimen: a centre randomised, cross-over, open-label study in the Netherlands.
Intensive Care Med. 2009 Feb;35(2):291-8.
OBJECTIVE: Compare duration of mechanical ventilation (MV), weaning time, ICU-LOS (ICU-LOS), efficacy and safety of
remifentanil-based regimen with conventional sedation and analgesia.
DESIGN: Centre randomised, open-label, crossover, ‘real-life’ study.
SETTING: 15 Dutch hospitals.
PATIENTS: Adult medical and post-surgical ICU patients with anticipated short-term (2-3 days) MV.
INTERVENTIONS: Patient cohorts were randomised to remifentanil-based regimen (n = 96) with propofol as required, for a
maximum of 10 days, or to conventional regimens (n = 109) of propofol, midazolam or lorazepam combined with fentanyl
or morphine.
MEASUREMENTS AND MAIN RESULTS: Outcomes were weaning time, duration of MV, ICU-LOS, sedation- and analgesia
levels, intensivist/ICU nurse satisfaction, adverse events, mean arterial pressure, heart rate. Median duration of ventilation
(MV) was 5.1 days with conventional treatment versus 3.9 days with remifentanil (NS). The remifentanil-based regimen
reduced median weaning time by 18.9 h (P = 0.0001). Median ICU-LOS was 7.9 days versus 5.9 days, respectively (NS).
However, the treatment effects on duration of MV and ICU stay were time-dependent: patients were almost twice as likely
to be extubated (P = 0.018) and discharged from the ICU (P = 0.05) on day 1-3. Propofol doses were reduced by 20% (P =
0.05). Remifentanil also improved sedation-agitation scores (P < 0.0001) and intensivist/ICU nurse satisfaction (P < 0.0001).
All other outcomes were comparable.
CONCLUSIONS: In patients with an expected short-term duration of MV, remifentanil significantly improves sedation and
agitation levels and reduces weaning time. This contributes to a shorter duration of MV and ICU-LOS.
PMID: 18958474
Rutten MJ, Collins JM, Maresch BJ, Smeets JH, Janssen CM, Kiemeney LA, Jager GJ. Glenohumeral joint
injection: a comparative study of ultrasound and fluoroscopically guided techniques before MR-arthrography.
European Radiology, 2009; 19 (3):722-730.
To assess the variability in accuracy of contrast media introduction, leakage, required time and patient discomfort in four
different centres, each using a different image-guided glenohumeral injection technique. Each centre included 25 consecutive patients. The ultrasound-guided anterior (USa) and posterior approach (USp), fluoroscopic-guided anterior (FLa)
and posterior (FLp) approach were used. Number of injection attempts, effect of contrast leakage on diagnostic quality, and
total room, radiologist and procedure times were measured. Pain was documented with a visual analogue scale (VAS) pain
score. Access to the joint was achieved in all patients. A successful first attempt significantly occurred more often with US
(94%) than with fluoroscopic guidance (72%). Leakage of contrast medium did not cause interpretative difficulties. With US
guidance mean room, procedure and radiologist times were significantly shorter (p < 0.001). The USa approach was rated
with the lowest pre- and post-injection VAS scores. The four image-guided injection techniques are successful in injection of
contrast material into the glenohumeral joint. US-guided injections and especially the anterior approach are significantly less
time consuming, more successful on the first attempt, cause less patient discomfort and obviate the need for radiation and
iodine contrast.
149
PMID: 19001280
Lippert E, Girodon F, Hammond E, Jelinek J, Reading NS, Fehse B, Hanlon K, Hermans M, Richard C,
Swierczek S, Ugo V, Carillo S, Harrivel V, Marzac C, Pietra D, Sobas M, Mounier M, Migeon M, Ellard S, Kröger
N, Herrmann R, Prchal JT, Skoda RC, Hermouet S. Concordance of assays designed for the quantification of
JAK2V617F: a multicenter study. Haematologica. 2009 Jan;94(1):38-45.
BACKGROUND: Many different techniques have been designed for the quantification of JAK2V617F allelic burden, sometimes producing discrepant results.
DESIGN AND METHODS: JAK2V617F quantification techniques were compared among 16 centers using 11 assays based on
quantitative polymerase chain reaction (with mutation-specific primers or probes, or fluorescent resonance energy transfer/
melting curve analysis), allele-specific polymerase chain reaction, conventional sequencing or pyrosequencing.
RESULTS: A first series of blinded samples (granulocyte DNA, n=29) was analyzed. Seven assays (12 centers) reported
values inside the mean +/- 2SD; the mean coefficient of variation was 31%. Sequencing techniques lacked sensitivity, and
strong discrepancies were observed with four techniques, which could be attributed to inadequate standards or to different
modes of expression of results. Indeed, quantification of JAK2V617F in relation to another control gene produced higher
than expected values, suggesting the possibility of more than two JAK2 copies/cell. After calibration of assays with common
1% to 100% JAK2V617F standards (dilutions of UKE-1 cells in normal leukocytes), 14 centers tested ten new samples.
JAK2V617F allelic burdens greater or equal than 1% were then reliably quantified by five techniques -- one allele specificpolymerase chain reaction and four TaqMan allele-specific quantitative polymerase chain reaction assays, including one
previously giving results outside the mean +/- 2SD -- with a lower mean coefficient of variation (21%). Of these, only the
two TaqMan allele-specific quantitative polymerase chain reaction assays with primer-based specificity could detect 0.2%
JAK2V617F.
CONCLUSIONS: Techniques expressing the allelic burden as JAK2V617F/total JAK2 and using a common set of standards
produced similar quantification results but with variable sensitivity. Calibration to a reference standard improved
reproducibility.
PMID: 19056388
Boquoi A, Jover R, Chen T, Pennings M, Enders GH.
Transgenic expression of VEGF in intestinal epithelium drives mesenchymal cell interactions
and epithelial neoplasia.
BACKGROUND & AIMS: Vascular endothelial growth factor (VEGF) is expressed robustly in human colon neoplasia and is a
major new “rational” target of therapy for cancers of the colon and other organs. Nonetheless, the mechanism(s) of action of
VEGF-targeted therapies and the biologic roles of VEGF in tumorigenesis have not been well defined. We used a transgenic
approach to directly test the hypothesis that augmented VEGF expression can drive progression of intestinal neoplasia.
METHODS: Transgenic mouse lines were generated with moderate (vilVEGF1) and high (vilVEGF2) VEGF expression from
the intestinal epithelium. vilVEGF1 mice were bred to Min mice (adenomatous polyposis coli [APC] +/-). Colon epithelial cells
from an APC patient were cocultured with endothelial cells and fibroblasts.
RESULTS: vilVEGF mice were generally healthy but displayed red small intestines. Vessels were larger and more numerous
in the submucosa but not the mucosa. The mucosa showed striking stromal and epithelial hypercellularity, with increased
epithelial proliferation. Many crypts formed cysts composed of relatively undifferentiated epithelial cells surrounded by
cells with endothelial and myofibroblast markers. Compared with Min controls, vilVEGF1-Min mice developed 6-fold more
intestinal adenomas of all sizes, with more advanced histologic features. Polycystic masses were also observed. Coculture of
150
human colonocytes with endothelial cells and fibroblasts directly stimulated colonocyte proliferation.
CONCLUSIONS: Augmented VEGF expression from intestinal epithelium potently stimulated cross talk with mesenchymal
cells and proliferation of normal and neoplastic epithelium. These effects of VEGF, largely occurring prior to the canonical
angiogenic switch in tumors, may be in part independent of angiogenesis.
PMID: 19074204
Van Vugt R, Kruse RR, Fritschy WM, Moll FL.
Treatment of dilated venous bypass grafts with an expanded polytetrafluoroethylene-covered nitinol
endoprosthesis.
Vasc Endovascular Surg. 2009 Apr-May;43(2):190-2.
An above-knee femoropopliteal bypass graft constructed of great saphenous vein became dilated in 2 patients 12 and 25
years after surgery. Both patients had several concomitant disorders. The dilations were treated by insertion of an expanded
polytetrafluoroethylene-covered nitinol endoprosthesis. There were no major procedural complications. One minor endoleak that developed immediately after endograft placement resolved within 6 weeks. The leg swelling subsided, and the
endoprostheses have remained patent for 18 and 24 months, respectively. To our knowledge, these were the first cases in
which an endoprosthesis was used to treat dilation of a venous bypass graft.
PMID: 19088476
De With MC, de Vries AM, Kroese AB, van der Heijden EP, Bleys RL, Segal SS, Kon M.
Vascular anatomy of the hamster retractor muscle with regard to its microvascular transfer.
Eur Surg Res. 2009;42(2):97-105.
BACKGROUND: The hamster retractor muscle (RET) is used as an in vivo model in studies of skeletal muscle ischemiareperfusion injury. The RET is unique in that the muscle can be isolated while preserving the primary vascular supply so that
its contractile function can be measured simultaneously with local microvascular responses to experimental interventions.
The goal of this study was to understand the anatomical origin of the vascular supply to the RET and determine whether the
RET can be used as a free flap after surgical isolation of the thoracodorsal vessels.
METHODS: Microdissection was performed to determine the anatomy of the vasculature that supplies and drains the RET.
RESULTS: Distinct numbers and patterns of feed arteries (2-4) and collecting veins (1-3) were identified
(n = 26 animals). Dye injection (n = 8) of the thoracodorsal artery demonstrated that the RET remains perfused following its
isolation on the thoracodorsal pedicle. Heterotopic allograft transplantation of the RET (n = 2) was performed by anastomosing the thoracodorsal vessels to the femoral vessels using the end-to-side technique.
CONCLUSIONS: The anatomical relationships indicate that the RET can be used as a free flap model for evaluating the effect
of preservation strategies and transplantation on skeletal muscle microcirculation and contractile function.
PMID: 19098079
Cobben LP, Bakker OJ, Puylaert JB, Kingma LM, Blickman JG.
Imaging of patients with clinically suspected appendicitis in the Netherlands: conclusions
of a survey.
Br J Radiol. 2009 Jun;82(978):482-5.
The aim of this study was to summarize the extent of variation in imaging strategies in patients clinically suspected of having
appendicitis. By means of a written survey, the policies for the imaging management of patients clinically suspected of ha-
151
ving appendicitis in the Netherlands were inventoried. A questionnaire was sent to the departments of surgery and radiology
of all 105 Dutch hospitals, including the 8 academic medical centres, in March 2006. Questionnaires were returned from 98
hospitals. It was found that, in the work-up of patients suspected of having appendicitis, ultrasound or CT was performed in
a minority of hospitals for 50% or more of these patients. In the majority of hospitals, it was carried out for less than 50% of
these patients. There is a widespread variability in pre-operative imaging regardless of hospital type. This survey shows that,
despite the ubiquitous presence of ultrasound and CT in Dutch hospitals, the pre-operative imaging work-up in patients clinically suspected of having acute appendicitis does not reflect this, being performed in only a minority of patients suspected
of having acute appendicitis. Radiologists and surgeons alike should be aware of the positive impact of adjunctive imaging in
this group of patients - most importantly lowering the negative appendicectomy rate and also lowering total hospital costs.
PMID: 19118129
Van Nes IJ, van der Linden S, Hendricks HT, van Kuijk AA, Rulkens M, Verhagen WI, Geurts AC.
Is visuospatial hemineglect really a determinant of postural control following stroke? An acute-phase study.
Neurorehabil Neural Repair. 2009 Jul-Aug;23(6):609-14.
OBJECTIVE: The purpose of this study was to determine the independent contribution of visuospatial hemineglect to impaired
postural control in the acute phase (<2 weeks) of stroke compared with other possible clinical and biological determinants.
METHODS: This study was conducted in 4 hospitals in the mid-east region of the Netherlands. A total of 78 consecutive patients with a first-ever acute supratentorial stroke was included. Functional balance was measured with the Trunk
Impairment Scale, the Trunk Control Test, the Berg Balance Scale, and the Functional Ambulation Categories. Visuospatial
hemineglect was assessed by means of an asymmetry index obtained from the Behavioral Inattention Test. The Motricity
Index, vibration threshold, sustained attention, and the presence of hemianopia were registered as other possible clinical
determinants. Stepwise backward multiple linear regression analysis was performed introducing all selected clinical determinants as well as age and poststroke time as possible biological determinants.
RESULTS: Hemineglect was present in 17 patients (21.8%). The groups with and without hemineglect were different for
gender and the proportion of right hemisphere strokes, but not for age, type of stroke, or poststroke time. Neglect patients
had on average lower scores on all functional balance tests as well as on the clinical assessments. Multivariate linear
regression showed that, besides hemineglect, only muscle strength and age independently contributed to impaired balance
explaining 65% to 72% of variance of the selected outcomes.
CONCLUSION: This study showed that hemineglect independently contributes to impaired postural control in the acute
phase of stroke.
PMID: 19147324
FDG-PET has no definite role in preoperative imaging in gastric cancer.
BACKGROUND: Gastric cancer is fourth on the incidence list of cancers worldwide with a high disease-related mortality
rate. Curation can only be achieved by a radical resection including an adequate lymphadenectomy. However, prognosis
remains poor and cancer recurrence rates are high, also due to lymph node metastases. To improve outcome, (neo)adjuvant
treatment strategies with chemo- and/or radiotherapy regimes are employed.
AIMS: Accurate staging of gastric cancer at primary diagnosis is essential for adequate treatment. In this non-systematic
review the role 18-F-Fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) in preoperative staging is
investigated. Furthermore, the results of neoadjuvant chemotherapy-induced tumour response monitoring by
152
FDG-PET are discussed.
RESULTS AND CONCLUSION: It is concluded that currently FDG-PET has no role in the primary detection of gastric cancer
due to its low sensitivity. FDG-PET shows, however, slightly better results in the evaluation of lymph node metastases in
gastric cancer compared to CT and could have therefore a role in the preoperative staging. Improvement in accuracy could
be achieved by using PET/CT or other PET tracers than FDG, but these modalities need further investigation. FDG-PET,
however, adequately detects therapy responders at an early stage following neoadjuvant chemotherapy.
PMID: 19155626
Van Vugt R, Bosscha K, van Munster IP, de Jager CP, Rutten MJ.
Embolization as treatment of choice for bleeding peptic ulcers in high-risk patients.
Dig Surg. 2009;26(1):37-42.
BACKGROUND/AIM: Peptic ulcers are the most common cause of acute upper gastrointestinal bleedings in the digestive
tract. Most patients are poor surgical candidates. The aim was to describe the efficacy of embolization as the treatment of
choice for bleeding peptic ulcers in high-risk patients when endoscopic treatment failed.
METHODS: All patients who underwent a selective embolization of branches of the superior mesenteric artery and/or
branches of the gastroduodenal artery for a bleeding peptic ulcer in the period January 2004 until December 2007 were
included in this retrospective descriptive study. We examined the known risk factors for surgery and mortality in upper gastrointestinal bleeding due to peptic ulcers and describe the clinical course and outcome. Primary endpoints were the primary
technical success and the clinical success rates. The secondary endpoint was the 30-day mortality.
RESULTS: 16 patients were included. All patients had at least two risk factors for surgery and mortality. The clinical success
rate was 81% (13/16). The first embolization failed in 3 patients, 1 was successful re-embolized and 2 were operated upon
without re-embolization. The primary technical success rate, i.e. bleedings controlled by radiologic intervention, was 88%
(14/16). 6 patients died due to non-embolization-related problems; 5 of them developed upper gastrointestinal bleeding
during a stay in the hospital.
CONCLUSION: Embolization was a successful, minimal invasive alternative for surgical intervention in high-risk patients with
upper gastrointestinal bleeding after failure of endoscopic treatment.
PMID: 19161644
Karagiannis I, Schimmer B, van Lier A, Timen A, Schneeberger PM, van Rotterdam B, de Bruin A, Wijkmans C,
Rietveld A, van Duynhoven Y.
Investigation of a Q fever outbreak in a rural area of The Netherlands.
Epidemiol Infect 2009 Sep;137(9):1283-94.
A Q fever outbreak occurred in the southeast of The Netherlands in spring and summer 2007. Risk factors for the acquisition
of a recent Coxiella burnetii infection were studied. In total, 696 inhabitants in the cluster area were invited to complete a
questionnaire and provide a blood sample for serological testing of IgG and IgM phases I and II antibodies against C. burnetii,
in order to recruit seronegative controls for a case-control study. Questionnaires were also sent to 35 previously identified
clinical cases. Limited environmental sampling focused on two goat farms in the area. Living in the east of the cluster area,
in which a positive goat farm, cattle and small ruminants were situated, smoking and contact with agricultural products were
associated with a recent infection. Information leaflets were distributed on a large scale to ruminant farms, including hygiene
measures to reduce the risk of spread between animals and to humans.
153
PMID: 19169032
Koebrugge B, Koek HL, van Wensen RJ, Dautzenberg PL, Bosscha K.
Delirium after abdominal surgery at a surgical ward with a high standard of delirium care: incidence, risk
factors and outcomes.
Dig Surg. 2009;26(1):63-8.
BACKGROUND: Although delirium is a common problem in elderly patients undergoing surgery, standard delirium care is
not available in all wards. The object of this study was to determine the incidence, risk factors and outcomes of postoperative
delirium among patients aged 65 and above undergoing elective abdominal surgery at a surgical ward with a high standard
delirium care.
METHODS: Prospective descriptive survey in 71 patients. The Delirium Observation Scale was used to screen for delirium.
Patients were classified as having a delirium if they met the DSM IV-criteria. Delirious and nondelirious patients were
compared and associated risk factors were calculated using logistic regression analyses.
RESULTS: Incidence of postoperative delirium was 24%. Univariate analysis showed that age above 74 years, CST score,
ASA score, length of ICU stay, length of hospital stay and number of complications were significant risk factors for delirium.
Older age, however, was the only significant risk factor in multivariate analysis (OR 1.16; 95% CI 1.00-1.35; p = 0.05). Lastly,
mortality was significantly higher in the delirium group (29.4 vs. 3.7%; p = 0.001).
CONCLUSION: At a surgical ward with high standard delirium care, the incidence of delirium was 24% and mortality was
higher in delirious patients undergoing elective abdominal surgery.
PMID: 19185657
Brink M, Kool DR, Dekker HM, Deunk J, Jager GJ, van Kuijk C, Edwards MJ, Blickman JG.
Predictors of abnormal chest CT after blunt trauma: a critical appraisal of the literature.
Clin Radiol. 2009 Mar;64(3):272-83.
AIM: To identify and to evaluate predictors that determine whether chest computed tomography (CT) is likely to reveal relevant injuries in adult blunt trauma patients.
METHODS: After a comprehensive literature search for original studies on blunt chest injury diagnosis, two independent
observers included studies on the accuracy of parameters derived from history, physical examination, or diagnostic imaging
that might predict injuries at (multidetector row) CT in adults and that allowed construction of 2x2 contingency tables. For
each article, methodological quality was scored and relevant predictors for injuries at CT were extracted. For each predictor,
sensitivity, specificity, positive and negative likelihood ratio and diagnostic odds ratio (DOR) including 95% confidence intervals were calculated.
RESULTS: Of 147 articles initially identified, the observers included 10 original studies in consensus. Abnormalities at physical examination (abnormal respiratory effort, need for assisted ventilation, reduced airentry, coma, chest wall tenderness)
and pelvic fractures were significant predictors (DOR: 2.1-6.7). The presence of any injuries at conventional radiography of
the chest (eight articles) was a more powerful significant predictor (DOR: 2.2-37). Abnormal chest ultrasonography (four
articles) was the most accurate predictor for chest injury at CT (DOR: 491-infinite).
CONCLUSION: The current literature indicates that in blunt trauma patients with abnormal physical examination, abnormal
conventional radiography, or abnormal ultrasonography of the chest, CT was likely to reveal relevant chest injuries. However,
there was no strong evidence to suggest that CT could be omitted in patients without these criteria, or whether these
findings are beneficial for patients.
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PMID:19191069
Frankhuisen R, Van Herwaarden MA, Scheffer RC, Hebbard GS, Gooszen HG, Samsom M.
Increased intragastric pressure gradients are involved in the occurrence of acid reflux in
gastroesophageal reflux disease.
Scand J Gastroenterol. 2009;44(5):545-50.
OBJECTIVE: Increased pressure gradients across the esophagogastric junction (DeltaEGJp) play a role in gastroesophageal
flow during TLESR. The aim of this study was to further explore DeltaEGJp in patients with gastroesophageal reflux disease
(GERD) and controls.
MATERIAL AND METHODS: Twenty GERD patients were studied along with 20 control subjects. High resolution manometry
and pH recording were performed 1 h before and 2 h after a liquid meal (500 ml/300 kcal). DeltaEGJp was calculated at the
start of a TLESR and at 180, 60, and 10 s before TLESR.
RESULTS: DeltaEGJp at the start of a TLESR and at 180, 60, and 10 s before TLESR was markedly increased in GERD
patients compared with that in control subjects (9.9 mmHg and 7.5 mmHg, respectively; p<0.05). Whilst intragastric pressure gradients in GERD patients were increased compared with those in controls (4.6 mmHg and 2.5 mmHg, respectively;
p<0.01), intraesophageal pressure gradients were similar in both groups. Furthermore, in controls, first- and second-hour
postprandial intragastric pressures were decreased compared with in fasting periods (1.9 +/- 0.4 mmHg and 2.1 +/- 0.4
mmHg versus 3.5 +/- 0.4 mmHg; p<0.05), while this was not observed in GERD patients.
CONCLUSIONS: In GERD patients, DeltaEGJp is greater than that in controls both before and during TLESR. This phenomenon is caused by increased intragastric pressure and might contribute to increased rates of acid reflux during TLESR in
GERD patients.
PMID: 19208346
Kuiper EM, Hansen BE, de Vries RA, den Ouden-Muller JW, van Ditzhuijsen ThJ, Haagsma EB, Houben MH,
Witteman BJ, van Erpecum KJ, van Buuren HR; Dutch PBC Study Group.
Improved prognosis of patients with primary biliary cirrhosis that have a biochemical response to
ursodeoxycholic acid.
Gastroenterology. 2009 Apr;136(4):1281-7.
BACKGROUND & AIMS: Ursodeoxycholic acid (UDCA) improves laboratory liver test results in patients with primary biliary
cirrhosis (PBC). Few studies have assessed the prognostic significance of biochemical data collected following UDCA treatment.
We performed a prospective multicenter study of patients with PBC treated with UDCA to compare prognosis with biochemical
response.
METHODS: PBC was classified as early (pretreatment bilirubin and albumin levels normal), moderately advanced (one level
abnormal), or advanced (both levels abnormal). Biochemical response was defined as proposed by Pares (decrease in alkaline
phosphatase [ALP] level>40% of baseline level or normal level), Corpechot (ALP level<3-fold the upper limit of normal [ULN],
aspartate aminotransferase level<2-fold the ULN, bilirubin level<1-fold the ULN), and our group (Rotterdam; normalization of
abnormal bilirubin and/or albumin levels).
RESULTS: The study included 375 patients, and median follow-up time was 9.7 (range, 1.0-17.3) years. The prognosis for
early PBC was comparable with that of the Dutch population and better than predicted by the Mayo risk score. Survival of
responders was better than that of nonresponders, according to Corpechot and Rotterdam criteria (P<.001). Prognosis of
early PBC was comparable for responders and nonresponders; prognosis of responders was significantly better in those with
(moderately) advanced disease.
CONCLUSIONS: Prognosis for UDCA-treated patients with early PBC is comparable to that of the general population. Survival
155
of those with advanced PBC with biochemical response to UDCA is significantly better than for nonresponders. Thus, UDCA may
be of benefit irrespective of the stage of disease. Prognostic information, based on bilirubin and albumin levels, is superior to that
provided by ALP levels.
PMID: 19210503
Kroft EB, Creemers MC, van den Hoogen FH Boezeman JB, de Jong EM.
Effectiveness, side-effects and period of remission after treatment with methotrexate in localized scleroderma
and related sclerotic skin diseases: an inception cohort study.
Br J Dermatol. 2009;160:1075-82.
BACKGROUND: Detailed information is lacking on effectiveness of methotrexate (MTX) in sclerotic skin diseases, side-effects,
and duration of remission after discontinuation.
OBJECTIVES: To determine effectiveness, side-effects and period of remission gained by use of MTX in sclerotic skin diseases.
METHODS: All patients with a sclerotic skin disease who were treated with MTX (group A) or MTX with corticosteroids (CS)
(group B) between 1995 and 2007 were evaluated. Detailed information was collected on dosage and duration of MTX treatment, concomitant immunosuppressive medication and CS treatment, effectiveness, side-effects, duration of the remission
period, and time until restart.
RESULTS: Fifty-eight patients (A, n = 47; B, n = 11) were evaluated. Clinical assessment revealed that 38 patients (81%)
treated with MTX and 11 patients (100%) treated with MTX + CS showed improvement of sclerotic skin. After one treatment
course 51% of the patients treated with MTX and 73% treated with MTX + CS reached remission status with a median followup time of 55 and 58 months. Patients showing relapse still responded to a second and even to a third course of MTX. Patients
who showed a relapse had received a lower cumulative dose, due to a shorter period of treatment with MTX in the first course.
Serious side-effects were seen in six patients (10%).
CONCLUSIONS: MTX was an effective treatment for various sclerotic skin diseases with a long period of remission and relatively low toxicity. Patients showing relapse still responded to a second and third course of MTX.
PMID: 19210517
Poodt AE, Driessen GJ, de Klein A, van Dongen JJ, van der Burg M, de Vries E.
TACI mutations and disease susceptibility in patients with common variable immunodeficiency.
Clin Exp Immunol. 2009 Apr;156(1):35-9.
The most prevalent primary immunodeficiency is common variable immunodeficiency (CVID). Mutations have been described
in four genes, ICOS, CD19, BAFF-R and TNFRSF13B (encoding TACI), together associated with 10-15% of CVID cases. We investigated a family with CVID and identified the heterozygous C104R TNFRSF13B mutation in two of the three index-children
with CVID, a mother with selective immunoglobulin A deficiency, a mother with recurrent infections and a healthy grandfather.
Remarkably, we did not find the TNFRSF13B mutation in the third index-child with CVID, despite his hypogammaglobulinaemia and decreased response to unconjugated pneumococcal vaccine. This family illustrates that TNFRSF13B mutations induce
disease susceptibility rather than cause disease directly. Apparently, other genetic or environmental factors, still to be identified,
contributed to the development of CVID in this family. Consequently, TNFRSF13B mutations must be interpreted with caution
in the clinical setting.
PMID: 19229448
Meijer JW, Voerman GE, Santegoets KM, Geurts AC.
Short-term effects and long-term use of a hybrid orthosis for neuromuscular electrical stimulation of the upper
156
extremity in patients after chronic stroke.
J Rehabil Med. 2009 Feb;41(3):157-61.
OBJECTIVE: To associate the short-term effects of the Handmaster orthosis on disabling symptoms of the affected upper
extremity with long-term Handmaster orthosis use after stroke.
DESIGN: Historic cohort study.
PATIENTS: Patients with chronic stroke.
METHODS: The Modified Ashworth Scale (0-5) for wrist (primary outcome) and elbow flexor hypertonia, visual analogue scale
(0-10) for pain, oedema score (0-3), and passive range of wrist flexion and extension (pROM, degrees) were assessed prior to
Handmaster orthosis prescription (T0), after 6 weeks try-out (T1) and a subsequent 4 weeks withhold period (T2). Long-term
use was evaluated using a questionnaire. Non-parametric analyses and predictive values were used for statistical analyses.
RESULTS: Of the 110 included patients 78.2% were long-term Handmaster orthosis users. Long-term users showed significant
short-term (T0-T1) improvements on all impairment scores and a significant relapse of wrist and elbow Modified Ashworth
Scale (T1-T2). Non-users showed significant short-term effects on elbow Modified Ashworth Scale and visual analogue scale
only. Positive predictive values of short-term effects for long-term use varied between 75% and 100%, with 85% (95% confidence interval (CI) 0.72-0.93) for wrist Modified Ashworth Scale. Negative predictive values were low (11-27%).
CONCLUSION: Short-term Handmaster orthosis effects were generally beneficial for hypertonia, pain, oedema, and pROM,
especially in long-term users. Short-term beneficial effects were highly predictive for long-term use, but not for non-use.
PMID: 19235339
Persoon MC, Scherpbier AJ, Oei SG, Meijerink WJ, Schijven MP, Schout B, Beerlage HP, Hendrikx AJ.
Learning laparoscopy without patients
PMID: 19235344
Consten D, de Bruin JP, Bots RS, Hamilton CJ, Peeters MF.
In vitro maturation of human egg cells. Introduction of a new artificial reproduction technique in the Netherlands.
PMID: 19235346
Lips DJ, Koning OH.
Coral reef syndrome: a thoracic aorta stenosis as explanation for a collection of symptoms.
PMID: 19249038
Berger LP, Scheffer RC, Weusten BL, Seldenrijk CA, de Bruin PC, Timmer R, Stolk MF.
The additional value of EUS-guided Tru-cut biopsy to EUS-guided FNA in patients with mediastinal lesions.
Gastrointest Endosc. 2009 May;69(6):1045-51.
BACKGROUND AND OBJECTIVE: EUS-guided FNA is a sensitive method to obtain cytologic specimens from solid lesions in
close proximity to the GI tract. Although FNA provides cells for analysis, large-caliber Tru-cut biopsy (EUS-TCB) needles obtain
samples that can be used for additional histopathologic analysis. We assessed the additional diagnostic yield of EUS-TCB in
patients with solid mediastinal lesions in whom EUS-FNA was performed.
PATIENTS AND DESIGN: In the period from July 2003 to July 2007, all patients with mediastinal lesions accessible to EUS-FNA
157
and EUS-TCB were evaluated. In all patients, a mean of 3 passes of EUS-FNA was followed by EUS-TCB. Cytologic and histologic specimens were evaluated by 2 pathologists blinded for patient condition. A final diagnosis was obtained by combining all
information present (EUS-FNA and EUS-TCB results, mediastinoscopy, bronchoscopy [if performed], and other investigations).
RESULTS: The diagnostic accuracy of EUS-FNA, EUS-TCB, and the combination of both techniques was 93%, 90%, and 98%,
respectively (not significant). In EUS-FNA-negative patients, EUS-TCB provided a final diagnosis in an additional 3 patients
(5%). Malignant disease found by EUS-FNA could be specified by EUS-TCB in 15 patients (25% of patients). The granulomatous
disease established by cytologic samples of clinically suspected tuberculosis could be specified by EUS-TCB in 2 patients (3%). In
1 patient (2%), both FNA and TCB were inconclusive.
LIMITATIONS: Retrospective study.
CONCLUSIONS: The diagnostic yield of EUS-FNA and EUS-TCB is comparable. We recommend limiting the use of EUS-TCB to
specific cases in which EUS-FNA is not conclusive.
PMID: 19250275
Intrinsic defect of the immune system in children with Down syndrome: a review.
Clin Exp Immunol. 2009 May;156(2):189-93.
Down syndrome (DS) is the most frequent cause of mental retardation in man. Immunological changes in DS have been
observed since the 1970s. The neurological system appears to be ageing precociously, with early occurrence of Alzheimer
disease; until now, the observed immunological differences have been interpreted in the same context. Looking back at past
and present results of immunological studies in DS children in relation to the clinical consequences they suffer, we conclude
that it is more likely that the DS immune system is intrinsically deficient from the very beginning.
PMID: 19251852
Budding AE, Ingham CJ, Bitter W, Vandenbroucke-Grauls CM, Schneeberger PM.
The Dienes phenomenon: competition and territoriality in Swarming Proteus mirabilis.
J Bacteriol. 2009 Jun;191(12):3892-900.
When two different strains of swarming Proteus mirabilis encounter one another on an agar plate, swarming ceases and a
visible line of demarcation forms. This boundary region is known as the Dienes line and is associated with the formation of
rounded cells. While the Dienes line appears to be the product of distinction between self and nonself, many aspects of its
formation and function are unclear. In this work, we studied Dienes line formation using clinical isolates labeled with fluorescent proteins. We show that round cells in the Dienes line originate exclusively from one of the swarms involved and that
these round cells have decreased viability. In this sense one of the swarms involved is dominant over the other. Close cell
proximity is required for Dienes line formation, and when strains initiate swarming in close proximity, the dominant Dienes
type has a significant competitive advantage. When one strain is killed by UV irradiation, a Dienes line does not form. Killing
of the dominant strain limits the induction of round cells. We suggest that both strains are actively involved in boundary
formation and that round cell formation is the result of a short-range killing mechanism that mediates a competitive
advantage, an advantage highly specific to the swarming state. Dienes line formation has implications for the physiology of
swarming and social recognition in bacteria.
PMID: 19252954
Van la Parra RF, Ernst MF, Bevilacqua JL, Mol SJ, Van Zee KJ, Broekman JM, Bosscha K.
Validation of a nomogram to predict the risk of nonsentinel lymph node metastases in breast cancer patients
158
with a positive sentinel node biopsy: validation of the MSKCC breast nomogram.
Ann Surg Oncol. 2009 May;16(5):1128-35.
BACKGROUND: Completion axillary lymph node dissection (ALND) remains the standard of care for patients with diseasepositive sentinel lymph nodes (SLN). However, approximately two-thirds will have no additional disease-positive nodes. To
identify the patient’s individual risk for non-SLN metastases, the Memorial Sloan-Kettering Cancer Center (MSKCC) developed a nomogram.
METHODS: The records of 182 breast cancer patients who underwent SLN and ALND were selected. Serial hematoxylin and
eosin (HE) analysis and immunohistochemistry were routinely performed on each sentinel node. For application of the nomogram, the detection method was assigned in two ways: for all metastases visible by serial HE, the method of detection was
scored as “serial HE” (method 1), independent of the tumor size, and by a combination of size and staining method (method
2); so macrometastasis were scored as detected by routine HE, micrometastasis by serial HE, and isolated tumor cells by immunohistochemistry. A receiver operating characteristic curve (ROC) was drawn, and the area under the curve was calculated
to assess the discriminative power of the nomogram.
RESULTS: The area under the ROC was .71 (range, .64-.79) according to method 1 and .75 (range, .67-.88) according to
method 2.
CONCLUSIONS: Because the variable “method of detection” in the MSKCC nomogram is a surrogate for SLN metastasis size,
the size category of the SLN metastasis can be used in applying the nomogram to patients in whom the SLN histologic analysis is performed by a much different procedure than that used to develop the MSKCC nomogram. This results in an improved
predictive accuracy.
PMID: 19281697
Bakker OJ, van Santvoort HC, Besselink MG, van der Harst E, Hofker HS, Gooszen HG; Dutch Pancreatitis Study
Group.
Prevention, detection, and management of infected necrosis in severe acute pancreatitis.
Curr Gastroenterol Rep. 2009 Apr;11(2):104-10.
The management of infected peripancreatic or pancreatic necrosis in patients with severe pancreatitis has changed considerably in recent years. This review discusses the recent literature on prevention, detection, and management of infected
necrosis. Though antibiotics, probiotics, and enteral nutrition have been tried to prevent infected necrosis, only enteral
nutrition has consistently proven to be effective. Antibiotics and probiotics have not shown a consistent beneficial effect on
outcome. Enteral nutrition reduced infectious complications and mortality in severe pancreatitis, compared with parenteral
nutrition. The detection of infection of pancreatic necrosis is important for clinical decision making. Fine-needle aspiration
may be used to confirm suspected infection, but if its results will not change clinical decisions, it should be omitted, as it may
even introduce infection. Minimally invasive surgical, radiologic, or endoscopic intervention is increasingly being applied. In
the absence of level 1 evidence, local expertise dictates which type of intervention is applied.
PMID: 19284647
Van den Broek FJ, de Graaf EJ, Dijkgraaf MG, Reitsma JB, Haringsma J, Timmer R, Weusten BL, Gerhards MF,
Consten EC, Schwartz MP, Boom MJ, Derksen EJ, Bijnen AB, Davids PH, Hoff C, van Dullemen HM, Heine GD,
van der Linde K, Jansen JM, Mallant-Hent RC, Breumelhof R, Geldof H, Hardwick JC, Doornebosch PG, Depla
AC, Ernst MF, van Munster IP, de Hingh IH, Schoon EJ, Bemelman WA, Fockens P, Dekker E.
Transanal endoscopic microsurgery versus endoscopic mucosal resection for large rectal adenomas (TREND-study).
BMC Surg. 2009 Mar 13;9:4.
159
BACKGROUND: Recent non-randomized studies suggest that extended endoscopic mucosal resection (EMR) is equally
effective in removing large rectal adenomas as transanal endoscopic microsurgery (TEM). If equally effective, EMR might
be a more cost-effective approach as this strategy does not require expensive equipment, general anesthesia and hospital
admission. Furthermore, EMR appears to be associated with fewer complications.The aim of this study is to compare the
cost-effectiveness and cost-utility of TEM and EMR for the resection of large rectal adenomas.
METHODS/DESIGN: Multicenter randomized trial among 15 hospitals in the Netherlands. Patients with a rectal adenoma >
or = 3 cm, located between 1-15 cm ab ano, will be randomized to a TEM- or EMR-treatment strategy. For TEM, patients
will be treated under general anesthesia, adenomas will be dissected en-bloc by a full-thickness excision, and patients will
be admitted to the hospital. For EMR, no or conscious sedation is used, lesions will be resected through the submucosal
plane in a piecemeal fashion, and patients will be discharged from the hospital. Residual adenoma that is visible during the
first surveillance endoscopy at 3 months will be removed endoscopically in both treatment strategies and is considered as
part of the primary treatment. Primary outcome measure is the proportion of patients with recurrence after 3 months.
Secondary outcome measures are: 2) number of days not spent in hospital from initial treatment until 2 years afterwards;
3) major and minor morbidity; 4) disease specific and general quality of life; 5) anorectal function; 6) health care utilization
and costs. A cost-effectiveness and cost-utility analysis of EMR against TEM for large rectal adenomas will be performed
from a societal perspective with respectively the costs per recurrence free patient and the cost per quality adjusted life year
as outcome measures. Based on comparable recurrence rates for TEM and EMR of 3.3% and considering an upper-limit of
10% for EMR to be non-inferior (beta-error 0.2 and one-sided alpha-error 0.05), 89 patients are needed per group.
DISCUSSION: The TREND study is the first randomized trial evaluating whether TEM or EMR is more cost-effective for the
treatment of large rectal adenomas.
PMID: 19289623
Goss G, Ferry D, Wierzbicki R, Laurie SA, Thompson J, Biesma B, Hirsch FR, Varella-Garcia M, Duffield E,
Ataman OU, Zarenda M, Armour AA.
Randomized phase II study of gefitinib compared with placebo in chemotherapy-naive patients with advanced
non-small-cell lung cancer and poor performance status.
J Clin Oncol. 2009 May 1;27(13):2253-60.
PURPOSE: To compare gefitinib with placebo in chemotherapy naïve patients with advanced non-small-cell lung cancer
(NSCLC) and poor performance status.
PATIENTS AND METHODS: NSCLC patients (chemotherapy naïve, WHO performance status 2 or 3; unfit for chemotherapy;
stage IIIB/IV) were randomly assigned to gefitinib (250 mg/d) plus best supportive care (BSC; n = 100) or placebo plus
BSC (n = 101). The primary end point was progression-free survival (PFS). Secondary end points included overall survival
(OS), objective response rate (ORR), quality of life (QOL), pulmonary symptom improvement (PSI), and safety. Correlation of
gefitinib efficacy with EGFR gene copy number (fluorescent in situ hybridization [FISH]) was explored.
RESULTS: Hazard ratios (HRs; gefitinib:placebo) were 0.82 (95% CI, 0.60 to 1.12; P = .217) for PFS and 0.84 (95% CI, 0.62
to 1.15; P = .272) for OS. As expected for this patient population, OS for both arms was poor, at about 3 months. ORRs
were 6.0% (gefitinib) and 1.0% (placebo). QOL and PSI rates were 21.1% and 28.3% (gefitinib) and 20.0% and 28.3% (placebo),
respectively. In EGFR FISH-positive patients (n = 32), HRs were 0.29 (95% CI, 0.11 to 0.73) for PFS and 0.44 (95% CI, 0.17
to 1.12) for OS. No unexpected adverse events occurred.
CONCLUSION: There was no statistically significant difference in PFS, OS, and ORRs after treatment with gefitinib or placebo,
in the overall population; improvements in QOL and symptoms were similar in both groups. Tolerability profile of gefitinib
was consistent with previous studies. PFS was statistically significantly improved for gefitinib-treated patients with EGFR
FISH-positive tumors.
160
PMID: 19299851
Schmeits PC, Péquériaux NC, van Geest-Daalderop JH, Ouwehand ME, Coremans AM, Hermans MH,
Conemans JM.
Investigating unexpected INRs: in search of the culprit--adherence, interactions, genetics, and superwarfarin.
Neth J Med. 2009 Feb;67(2):76-8.
Treatment with coumarin derivatives is highly individualised due to high intra- and inter-individual variation in dose response
and risks of severe bleeding or thromboembolic complications. Treatment focuses on reaching and maintaining a stable target
international normalised ratio (INR). However, unexpected INRs that are not explained by noncompliance or vitamin K intake
may occur. Here we describe seven cases of unexpected INRs, and provide clues that clarify the underlying mechanism.
PMID: 19307503
Smit EF, Burgers SA, Biesma B, Smit HJ, Eppinga P, Dingemans AM, Joerger M, Schellens JH, Vincent A, van
Zandwijk N, Groen HJ.
Randomized phase II and pharmacogenetic study of pemetrexed compared with pemetrexed plus carboplatin
in pretreated patients with advanced non-small-cell lung cancer.
J Clin Oncol. 2009 Apr 20;27(12):2038-45.
PURPOSE: We performed a randomized phase II trial comparing pemetrexed with pemetrexed plus carboplatin (PC) in
patients experiencing relapse after platinum-based chemotherapy.
PATIENTS AND METHODS: Main eligibility criteria were histologic or cytologic proof of advanced non-small-cell lung cancer
(NSCLC), relapse more than 3 months after platinum-based chemotherapy, normal organ function, and Eastern Cooperative Oncology Group performance status 0 to 2. Patients were randomly assigned to pemetrexed 500 mg/m(2) (arm A) or
carboplatin area under the curve 5 and pemetrexed 500 mg/m(2) (arm B), both administered intravenously every 3 weeks.
Response assessment was performed every 6 weeks; toxicity assessment was performed every 3 weeks. Primary end point
was time to progression (TTP); secondary end points were objective response rate (ORR), overall survival (OS), and toxicity.
The study was designed to detect a 33% decrease in the hazard of disease progression in the combination arm (alpha =
0.05, two-sided log-rank test). Polymorphisms of thymidylate synthase, the reduced folate carrier, gamma-glutamyl hydrolase, and methylenetetrahydrofolate reductase (MTHF) were investigated in peripheral WBCs of consenting patients.
RESULTS: Two hundred forty patients were enrolled. Median TTP was 2.8 months for arm A versus 4.2 months for arm B
(hazard ratio, 0.67; 95% CI, 0.51 to 0.89; P = .005). Median OS was 7.6 months and 8.0 months and ORR was 4% and 9% for
arms A and B, respectively. Subgroup analyses found adenocarcinoma to be associated with favorable outcome. Toxicities in
both arms was negligible, with one potential toxic death in arm A. Patients with MTHFR C677T homozygous mutation had
increased progression-free survival compared with patients with wild-type or heterozygous mutations (P = .03).
CONCLUSION: PC as second-line treatment for relapsed NSCLC resulted in a significant 33% reduction of the hazard of
disease progression as compared with pemetrexed alone.
PMID: 19325905
Hassink RJ, Haerkens-Arends HE, Daniels MC.
Extensive right coronary artery thrombosis.
Neth Heart J. 2009 Mar;17(3):115-6.
161
PMID: 19326699
Dautzenberg PL, Nijboer H, Wouters CJ.
A triage system for non-urgent ambulant frail elderly.
Tijdschr Gerontol Geriatr. 2009 Feb;40(1):24-8.
PURPOSE: This study aimed to examine a triage system for non-urgent ambulant frail elderly.
METHODS: Three months prospective evaluation of patients, admitted for an out-hospital evaluation on a geriatric ward of
an non-academic teaching hospital and not suitable for a memory clinic or falls clinic. A maximum of four patients entered
the triage system at the same moment and a nurse and a physiotherapist investigated these patients separately during
30 minutes in total. After these investigations, triage consensus was reached and immediately thereafter, 2 patients were
admitted to a fall clinic, 1 patient was admitted to a consultant and 1 patient was admitted to a resident. For each admission,
there were positive and negative reasons defined.
RESULTS: During 22 moments of triage, 68 patients were admitted to the different out-hospital evaluations. In 90% positive
reasons for triage were used.
CONCLUSIONS: A triage system for non-urgent ambulant frail elderly seems to be effective. However, more research is
needed.
PMID: 19332456
Fellström BC, Jardine AG, Schmieder RE, Holdaas H, Bannister K, Beutler J, Chae DW, Chevaile A, Cobbe SM,
Grönhagen-Riska C, De Lima JJ, Lins R, Mayer G, McMahon AW, Parving HH, Remuzzi G, Samuelsson O,
Sonkodi S, Sci D, Süleymanlar G, Tsakiris D, Tesar V, Todorov V, Wiecek A, Wüthrich RP, Gottlow M, Johnsson E,
Zannad F; AURORA Study Group.
Rosuvastatin and cardiovascular events in patients undergoing hemodialysis.
N Engl J Med. 2009 Apr 2;360(14):1395-407.
BACKGROUND: Statins reduce the incidence of cardiovascular events in patients at high cardiovascular risk. However, a benefit
of statins in such patients who are undergoing hemodialysis has not been proved.
METHODS: We conducted an international, multicenter, randomized, double-blind, prospective trial involving 2776 patients, 50
to 80 years of age, who were undergoing maintenance hemodialysis. We randomly assigned patients to receive rosuvastatin,
10 mg daily, or placebo. The combined primary end point was death from cardiovascular causes, nonfatal myocardial infarction,
or nonfatal stroke. Secondary end points included death from all causes and individual cardiac and vascular events.
RESULTS: After 3 months, the mean reduction in low-density lipoprotein (LDL) cholesterol levels was 43% in patients receiving
rosuvastatin, from a mean baseline level of 100 mg per deciliter (2.6 mmol per liter). During a median follow-up period of 3.8
years, 396 patients in the rosuvastatin group and 408 patients in the placebo group reached the primary end point (9.2 and
9.5 events per 100 patient-years, respectively; hazard ratio for the combined end point in the rosuvastatin group vs. the placebo group, 0.96; 95% confidence interval [CI], 0.84 to 1.11; P=0.59). Rosuvastatin had no effect on individual components of
the primary end point. There was also no significant effect on all-cause mortality (13.5 vs. 14.0 events per 100 patient-years;
hazard ratio, 0.96; 95% CI, 0.86 to 1.07; P=0.51).
CONCLUSIONS: In patients undergoing hemodialysis, the initiation of treatment with rosuvastatin lowered the LDL cholesterol
level but had no significant effect on the composite primary end point of death from cardiovascular causes, nonfatal myocardial
infarction, or nonfatal stroke.
PMID: 19338383
Van Puijenbroek EP, Conemans JM, Van Grootheest AC.
162
Spontaneous ADR Reports as a Trigger for Pharmacogenetic Research: Experiences in the Netherlands.
Drug Saf 2009;32(3):255-64.
BACKGROUND: Information on genetic polymorphisms in drug-metabolizing enzymes is valuable when analysing the causal
relationship between drug intake and an adverse drug reaction (ADR). Patients who have experienced an ADR should be informed about the possible existence of genetic polymorphisms that may contribute to the occurrence of ADRs, since this will
allow adequate dosing of future medication.In collaboration with the regional hospital pharmacy Ziekenhuisapotheek NoordOost-Brabant (ZANOB), the Netherlands Pharmacovigilance Centre Lareb developed a method for informing physicians or
pharmacists and their patients about a possible pharmacogenetic involvement in the pathogenesis of the reported ADR and
for offering easy access to genotyping if requested by the treating physician. An anonymized copy of the test results could be
used for the interpretation of possible signals at the pharmacovigilance centre.
OBJECTIVES: The aim of this study was to gain insight into the feasibility of informing the reporting physician or pharmacist about possible involvement of a genetic polymorphism and subsequent genotyping of patients based on ADR reports
received by the Netherlands Pharmacovigilance Centre.
RESULTS: A total of 38 reports were selected in which genotyping was considered useful. In 15 of 38 cases (39.5%), the
reporting health professionals actually initiated genotyping. The majority of the drugs implicated in causing ADRs were
selective serotonin reuptake inhibitors, followed by other antidepressants and antipsychotic drugs. No logistical problems
were encountered during this study.
CONCLUSION: The level of participating health professionals in genotyping their patients was relatively high. Apparently, reporting health professionals share the vision that information on pharmacogenetic characteristics of their individual patients
is important. The use of an existing infrastructure for DNA sampling that is familiar to the patients and health professionals
may have contributed to the high response rate.Pharmacovigilance centres may suggest pharmacogenetic investigation and
subsequent individualized pharmacogenetic counselling after a reported ADR. These centres can also be a valuable starting
point for pharmacogenetic studies, since data from different sources can be combined in the assessment of the causal relationship between drug intake and an ADR. This study shows that genotyping initiated by pharmacovigilance centres is indeed
feasible, when using the standard laboratory testing infrastructure.
PMID: 19341194
Van Vugt R, Bosscha K, Olsman J, Jager GJ, de Jager CP.
Management of hepatic trauma: a 9-year experience in ’s-Hertogenbosch.
BACKGROUND: In patients who sustain abdominal trauma the liver is the most frequently injured organ. Although treatment
for haemodynamically unstable patients remains urgent surgery, there has been a shift of management in haemodynamacally
stable patients towards non-operative management. We performed an outcome assessment of traumatic hepatic injury.
METHODS: A retrospective study was performed to assess incidence, mechanisms, management and outcome of traumatic
liver injury in the region of ’s-Hertogenbosch, The Netherlands, in the period 1999-2007.
RESULTS: A total of 47 patients were identified. Thirty-six patients had blunt hepatic trauma, eleven sustained penetrating
hepatic injury. In 67% (n = 24) of the blunt hepatic trauma patients the initial intention was to treat non-operatively. Yet, two
patients underwent explorative laparotomy after one and two days. In the penetrating liver trauma patients, 91% (n = 10)
underwent urgent surgery. In total, 31 of 47 patients were treated conservatively.
CONCLUSION: Blunt hepatic trauma is the most common cause of hepatic trauma. Most patients sustaining hepatic trauma
can be managed conservatively at a dedicated ICU and/or surgical trauma ward.
163
PMID: 19342504
Use of serum myoglobin assays for urine myoglobin measurements can cause false-negative results. Clin.
Chem. 2009 Jun;55(6):1240-1.
PMID: 19344081
Binkhorst M, de Leeuw N, Otten BJ.
A healthy, female chimera with 46,XX/46,XY karyotype.
J Pediatr Endocrinol Metab 2009; 22: 97-102.
We report a healthy and unambiguously female newborn, whose phenotypic sex contradicted the expected male sex based
on previously performed prenatal cytogenetic analysis. Both 46,XX and 46,XY cells were detected in a villus sample, the former having been attributed to maternal cell contamination. Postnatal karyotyping in peripheral lymphocytes confirmed the
presence of two cell lines, one 46,XX (70%) and one 46,XY (30%). After exclusion of alternative explanations for the observed
genotype, a diagnosis of chimerism was made. Chimeras containing cell lines of opposite sex usually feature ovotesticular
development with associated genital ambiguity. To account for the normal female appearance of our patient, we postulate
the exclusive involvement of 46,XX cells in gonad formation.
PMID: 19350292
Daha TJ, Bilkert-Mooiman MA, Ballemans C, Frijstein G, Keeman JN, de Man RA, van Steenbergen JE,
Weers-Pothoff G, Zaaijer HL.
Hepatitis B virus infected health care workers in The Netherlands, 2000-2008.
In response to the confirmed transmission of hepatitis B virus (HBV) from a surgeon to several patients in the Netherlands,
a ‘Committee for Prevention of Iatrogenic Hepatitis B’ was established in 2000. During the years 2000-2008, the committee reviewed 99 cases of HBV-infected health care workers. Fifty of them were found to perform exposure prone procedures
(EPPs). Because of high levels of HBV DNA (>100,000 copies/ml), a ban on performing EPPs was applied in 11/50 cases;
25/50 low-viremic health care workers were allowed to continue EPPs while their HBV load was being monitored; and
14/50 cases had stopped working or changed profession. In five restricted workers who started oral antiviral treatment, HBV
replication was persistently suppressed, enabling the ban on EPPs to be lifted. Throughout the European Union different
levels of HBV viremia have been chosen, above which health care workers are not allowed to perform EPPs. It remains
unknown how this affects the safety of patients. Application in the Netherlands of a European or a British guideline would
have, respectively, doubled or tripled the number of restricted health care workers.
PMID: 19365285
De Mast Q, Beutler JJ.
The prevalence of atherosclerotic renal artery stenosis in risk groups: a systematic
literature review.
J Hypertens. 2009 Jul;27(7):1333-40.
OBJECTIVE: We performed a literature review and analysis to improve the insight in the prevalence of renal artery stenosis
(RAS) in risk groups.
METHODS: Relevant studies were identified by a MEDLINE and EMBASE database search (1966 to December 2007),
164
complemented by hand searching of reference lists. Review was restricted to English language studies, using any form of
angiography as diagnostic method. Studies were grouped in risk group categories sharing similar clinical characteristics, and
pooled prevalence rates were calculated for each category.
RESULTS: Forty studies, involving a total number of 15 879 patients, were identified. The following pooled prevalence rates
(95% confidence interval; sample size risk group) of RAS were found: suspected renovascular hypertension, 14.1% (12.715.8%; n = 1931); hypertension and diabetes mellitus, 20% (14.9-25.1%; n = 240); coronary angiography (CAG) in consecutive patients, 10.5% (9.8-11.2%; n = 8011); CAG in hypertensive patients, 17.8% (15.4-20.6%; n = 836); CAG and suspected
renovascular disease, 16.6% (14.8-18.5%; n = 1576); congestive heart failure, 54.1% (45.7-62.3%; n = 135); peripheral
vascular disease, 25.3% (23.6-27.0%; n = 2632); abdominal aortic aneurysm, 33.1% (27.4-39.2%; n = 239) and end-stage
renal failure, 40.8% (27-55.8%; n = 49.) In patients with an incidentally discovered RAS, hypertension and renal failure were
present in 65.5 and 27.5%, respectively.
CONCLUSION: RAS has a high prevalence in risk groups, especially in those with extrarenal atherosclerosis, end-stage renal
failure and heart failure. These findings are important when screening for RAS or prescription of an angiotensin converting
enzyme inhibitor or angiotensin-II receptor blocker is considered.
PMID: 19374097
PMID: 19383834
Van Dijk S, Scharloo M, Kaptein AA, Thong MS, Boeschoten EW, Grootendorst DC, Krediet RT, Dekker FW;
NECOSAD Study Group, Apperloo AJ, Bijlsma JA, Boekhout M, Boer WH, van der Boog PJ, Büller HR, van
Buren M, de Charro FT, Doorenbos CJ, van den Dorpel MA, van Es A, Fagel WJ, Feith GW, de Fijter CW, Frenken
LA, van Geelen JA, Gerlag PG, Grave W, Gorgels JP, Huisman RM, Jager KJ, Jie K, Koning-Mulder WA, Koolen
MI, Hovinga TK, Lavrijssen AT, Luik AJ, van der Meulen J, Parlevliet KJ, Raasveld MH, van der Sande FM,
Schonck MJ, Schuurmans MM, Siegert CE, Stegeman CA, Stevens P, Thijssen JG, Valentijn RM, Vastenburg GH,
Verburgh CA, Vincent HH, Vos PF.
Patients’ representations of their end-stage renal disease: relation with mortality.
Nephrol Dial Transplant 2009 Oct;24(10):3183-5.
BACKGROUND: Self-regulation theory explains how patients’ illness perceptions influence self-management behaviour (e.g.
via adherence to treatment). Following these assumptions, we explored whether illness perceptions of ESRD-patients are
related to mortality rates.
METHODS: Illness perceptions of 182 patients participating in the NECOSAD-2 study in the period between December
2004 and June 2005 were assessed. Cox proportional hazard models were used to estimate whether subsequent all-cause
mortality could be attributed to illness perception dimensions.
RESULTS: One-third of the participants had died at the end of the follow-up. Mortality rates were higher among patients
who believed that their treatment was less effective in controlling their disease (perceived treatment control; RR = 0.71, P =
0.028). This effect remained stable after adjusting for sociodemographic and clinical variables (RR = 0.65, P = 0.015).
CONCLUSIONS: If we consider risk factors for mortality, we tend to rely on clinical parameters rather than on patients’
representations of their illness. Nevertheless, results from the current exploration may suggest that addressing patients’
personal beliefs regarding the effectiveness of treatment can provide a powerful tool for predicting and perhaps even
enhancing survival.
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PMID: 19384222
Richir MC, van Lambalgen AA, Teerlink T, Wisselink W, Bloemena E, Prins HA, de Vries TP, van Leeuwen PA.
Low arginine/asymmetric dimethylarginine ratio deteriorates systemic hemodynamics and organ blood flow in
a rat model.
Crit Care Med. 2009 Jun;37(6):2010-7.
OBJECTIVE: Both arginine and asymmetric dimethylarginine (ADMA) play a crucial role in the arginine-nitric oxide pathway.
Low arginine and high ADMA levels can be found in critically ill patients after major surgery. The aim of this study was to evaluate the effects of low arginine plasma concentrations in combination with high ADMA plasma concentrations on hemodynamics
and organ blood flow.
DESIGN: Randomized, placebo-controlled animal laboratory investigation.
SUBJECTS: Male Wistar rats (n = 21), anesthetized.
INTERVENTIONS: Rats were randomly assigned to three groups: a control group, an ADMA group, or an arginase (ASE)/ADMA
group. In the control group, rats received (at t = 0) an intravenous (IV) infusion of 1.5 mL 0.9% NaCl during a 20-minute period.
After 60 minutes (t = 60), rats received an IV bolus of 1.0 mL 0.9% NaCl. In the ADMA group, rats received an IV infusion of 1.5
mL 0.9% NaCl during a 20-minute period and at t = 60 an IV bolus of 1.0 mL ADMA (20 mg/kg). In the ASE/ADMA group, rats
received an IV infusion of 1.5 mL ASE (3200 IU) solution during a 20-minute period and at t = 60 an IV bolus of 1.0 mL ADMA
(20 mg/kg).
MEASUREMENTS AND MAIN RESULTS: Infusion of ADMA (20 mg/kg) and ASE (3200 IU) resulted in increased plasma ADMA
levels and decreased arginine levels. During the whole experiment, systemic hemodynamics (heart rate, mean arterial pressure
[MAP], and cardiac output) were measured. In addition, organ blood flow was measured at t = 90 and t = 180 minutes, using
fluorescent microspheres. Compared with the control group, MAP and systemic vascular resistance were increased after infusion of ADMA. Infusion of ASE in combination with ADMA significantly deteriorated systemic hemodynamics (MAP, cardiac output, stroke volume, and systemic vascular resistance) and organ blood flow through the kidney and spleen. In addition, an initial
decrease in arterial flow, followed by a later major increase, and panlobular apoptosis and necrosis of the liver was observed.
CONCLUSIONS: The current study shows that low arginine plasma levels in combination with high ADMA plasma levels deteriorates systemic hemodynamics and reduces blood flow through the kidney and spleen and liver. These data suggest that a
diminished nitric oxide production may be involved in the onset of organ failure.
PMID: 19388726
Van Puijenbroek E, Conemans JM, Van Grootheest K.
Spontaneous reports and pharmacogenetics. The role of the pharmacovigilance centre.
Drug Saf 2009;32:357-8.
PMID: 19398188
Ruiterkamp J, Ernst MF, van de Poll-Franse LV, Bosscha K, Tjan-Heijnen VC, Voogd AC.
Surgical resection of the primary tumour is associated with improved survival in patients with distant
metastatic breast cancer at diagnosis.
Eur J Surg Oncol. 2009 Nov;35(11):1146-51.
OBJECTIVE: Recent studies indicate that removal of the primary tumour may have a beneficial effect on mortality risk of patients
with primary distant metastatic breast cancer (stage IV), although most of them did not rule out confounding by the presence of
co-morbidity. In this retrospective study the impact of surgical resection of the primary tumour on the survival of patients with primary distant metastatic disease is investigated, taking into account the presence of co-morbidity and other potential confounders.
166
METHODS: Between 1993 and 2004, 15 769 patients with breast cancer were diagnosed in the south of the Netherlands. This
study included the 728 patients with distant metastatic disease at initial presentation, which was 5% of all patients. Of them, 40%
had surgery of the primary tumour. Follow-up was carried out until 1 July 2006.
RESULTS: Median survival of the patients who had surgery of their primary tumour was significantly longer than for the patients
who did not have surgery (31 vs. 14 months). The 5-year survival rates were 24.5% and 13.1%, respectively (p < 0.0001). In
a multivariable Cox regression analysis, adjusting for age, period of diagnosis, T-classification, number of metastatic sites, comorbidity, use of loco-regional radiotherapy and use of systemic therapy, surgery appeared to be an independent prognostic factor
for overall survival (HR = 0.62; 95% CI 0.51-0.76).
CONCLUSION: Removal of the primary tumour in patients with primary distant metastatic disease was associated with a reduction
of the mortality risk of around 40%. The association was independent of age, presence of co-morbidity and other potential confounders, but a randomized controlled trial will be needed to rule out residual confounding.
PMID: 19401573
Heesakkers RA, Jager GJ, Hövels AM, de Hoop B, van den Bosch HC, Raat F, Witjes JA, Mulders PF, van der
Kaa CH, Barentsz JO.
Prostate cancer: detection of lymph node metastases outside the routine surgical area with ferumoxtran-10enhanced MR imaging.
Radiology. 2009 May;251(2):408-14.
PURPOSE: To prospectively evaluate the feasibility of magnetic resonance (MR) imaging with ferumoxtran-10 in patients
with prostate cancer to depict lymph node metastases outside the routine pelvic lymph node dissection (PLND) area.
MATERIALS AND METHODS: The study was approved by the institutional review boards at all four hospitals; patients
provided written informed consent. Two hundred ninety-six consecutive men (mean age, 67 years; range, 47-83 years) with
prostate cancer and an intermediate-to-high risk for nodal metastases (prostate-specific antigen level >10 ng/mL, Gleason
score >6, or stage T3 disease) were enrolled. MR lymphography of the pelvis was performed 24 hours after intravenous drip
infusion of ferumoxtran-10. Positive nodes at MR lymphography were indicated to be inside or outside the routine dissection
area (RDA). On the basis of MR lymphography computed tomographic (CT)-guided biopsy, routine PLND, or MR imagingguided minimal extended PLND was performed.
RESULTS: MR lymphography findings were positive in 58 patients. Of these, 44 had histopathologic confirmation of lymph
node metastases. In 18 of 44 patients (41%), MR lymphography findings showed nodes exclusively outside the RDA, which
were confirmed with MR lymphography-guided extended PLND (n = 13) and CT-guided biopsy (n = 5). In another 18 patients (41%), positive nodes were located both inside and outside the RDA at MR lymphography. In these 18 patients, routine
PLND was used to confirm the nodes inside the RDA (n = 11); CT-guided biopsy was used to confirm nodes outside the RDA
(n = 7). In the remaining eight patients, MR lymphography findings showed only nodes inside the RDA, which was confirmed
with PLND (n = 5) and CT-guided biopsy (n = 3). In 14 of the 58 patients (24%), there was no histologic confirmation.
CONCLUSION: In 41% of patients with prostate cancer, nodal metastases outside the area of routine PLND were detected by
using MR imaging with ferumoxtran-10.
PMID: 19414832
Bax L, Woittiez AJ, Kouwenberg HJ, Mali WP, Buskens E, Beek FJ, Braam B, Huysmans FT, Schultze Kool LJ,
Rutten MJ, Doorenbos CJ, Aarts JC, Rabelink TJ, Plouin PF, Raynaud A, van Montfrans GA, Reekers JA, van den
Meiracker AH, Pattynama PM, van de Ven PJ, Vroegindeweij D, Kroon AA, de Haan MW, Postma CT, Beutler JJ.
Stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function: a randomized trial.
Ann Intern Med. 2009 Jun 16;150(12):840-8, W150-1.
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BACKGROUND: Little is known about the efficacy and safety of renal artery stenting in patients with atherosclerotic renal
artery stenosis (ARAS) and impaired renal function.
OBJECTIVE: To determine the efficacy and safety of stent placement in patients with ARAS and impaired renal function.
DESIGN: Randomized clinical trial. Randomization was centralized and computer generated, and allocation was assigned
by e-mail. Patients, providers, and persons who assessed outcomes were not blinded to treatment assignment.
SETTING: 10 European medical centers.
PARTICIPANTS: 140 patients with creatinine clearance less than 80 mL/min per 1.73 m(2) and ARAS of 50% or greater.
INTERVENTION: Stent placement and medical treatment (64 patients) or medical treatment only (76 patients). Medical
treatment consisted of antihypertensive treatment, a statin, and aspirin.
MEASUREMENTS: The primary end point was a 20% or greater decrease in creatinine clearance. Secondary end points
included safety and cardiovascular morbidity and mortality.
RESULTS: Forty-six of 64 patients assigned to stent placement had the procedure. Ten of the 64 patients (16%) in the
stent placement group and 16 patients (22%) in the medication group reached the primary end point (hazard ratio, 0.73
[95% CI, 0.33 to 1.61]). Serious complications occurred in the stent group, including 2 procedure-related deaths (3%), 1
late death secondary to an infected hematoma, and 1 patient who required dialysis secondary to cholesterol embolism.
The groups did not differ for other secondary end points.
LIMITATION: Many patients were falsely identified as having renal artery stenosis greater than 50% by noninvasive imaging and did not ultimately require stenting.
CONCLUSION: Stent placement with medical treatment had no clear effect on progression of impaired renal function but
led to a small number of significant procedure-related complications. The study findings favor a conservative approach to
patients with ARAS, focused on cardiovascular risk factor management and avoiding stenting.
PMID: 19438643
De Jager CP, de Wit NC, Weers-Pothoff G, van der Poll T, Wever PC.
Procalcitonin kinetics in Legionella pneumophila pneumonia.
Little is known about procalcitonin (PCT) levels in patients with community-acquired pneumonia (CAP) caused by
Legionella pneumophila. The aim of the present study was to investigate this infection marker in patients admitted with
L. pneumophila pneumonia in relation to conventional inflammatory parameters, severity of pneumonia upon admission
and clinical outcome. Eighteen patients admitted with CAP caused by L. pneumophila serogroup 1 were retrospectively
examined. PCT measurements were carried out during the first week of admission in addition to measurements of Creactive protein (CRP), white blood cell (WBC) count and registration of severity of pneumonia upon admission (CURB-65
score). The mean PCT level upon admission in patients with L. pneumophila pneumonia was 13.5 ng/mL (range 0.3-55.7
ng/mL). Mean CRP level was 397 mg/L (range 167-595 mg/L) and mean WBC count 11.7 x 10(9)/L (range 4.5-20.4
x 10(9)/L). Initial high PCT levels were indicative of more severe disease as reflected by prolonged intensive care unit
(ICU) stay and/or in-hospital death. Patients admitted to the ICU showed significantly higher PCT levels compared with
the remaining patients [26.7 ng/mL (range 4.6-55.7 ng/mL) vs. 6.9 ng/mL (range 0.3-29.3 ng/mL); p 0.019]. There
was a significant correlation between Acute Physiology and Chronic Health Evaluation-II scores upon ICU admission and
initial PCT levels upon hospital admission (r = 0.86; p 0.027). Persistently increased PCT levels during treatment were
indicative of unfavourable clinical outcome. Conventional inflammatory parameters (CRP and WBC) and the CURB-65
score lacked this discriminatory capacity in our study population. PCT may therefore be a valuable tool in the initial clinical
assessment and follow-up of patients with L. pneumophila pneumonia.
168
PMID: 19442401
Schimmer B, Dijkstra F, Vellema P, Schneeberger PM, Hackert V, ter Schegget R, Wijkmans C, van
Duynhoven Y, van der Hoek W.
Sustained intensive transmission of Q fever in the south of the Netherlands, 2009.
Euro Surveill 2009;14:pii=19210.
The Netherlands is again facing a sharp increase in Q fever notifications, after the unprecedented outbreaks of 2007 and
2008. The most affected province of Noord Brabant has a high density of large dairy goat farms, and farms with abortion
waves have been incriminated. Mandatory vaccination of small ruminants has started and should have an effect in 2010.
A large multidisciplinary research portfolio is expected to generate better knowledge about transmission and additional
control measures.
PMID: 19443491
Veen EJ, Janssen-Heijnen ML, Ritchie ED, Biesma B, van den Bogart MP, Bolhuis RJ.
Pneumonectomy for bronchogenic carcinoma: analysis of factors predicting short- and long-term outcome.
Interact Cardiovasc Thorac Surg. 2009 Aug;9(2):260-4.
The objective of this study was to analyse predictive factors for postoperative and long-term outcome after pneumonectomy.
From 1 January 2000 to 1 January 2005 a total of 91 (31%) pneumonectomies were performed. Multivariable analysis for
postoperative morbidity, mortality, and long-term survival was performed. Patients over 70 years had 1.5 times higher risk
of dying (HR=1.5, 95% CI=1.1-2.0) within five years compared to younger patients, those with co-morbidity had 1.8 times
higher risk compared to no co-morbidity (HR=1.8, 95% CI=1.3-2.7) and those with stage IIIA had 2.3 times higher risk of
dying compared to stage I (HR=2.3, 95% CI=1.5-3.6). Overall postoperative mortality within 30 days in patients undergoing
pneumonectomy was 10% (n=9). Most patients who died postoperatively were 70 years or older, had cardiovascular comorbidity and underwent right-sided pneumonectomy (n=6). Patients over 70 years had three times higher risk of complications compared to younger patients (OR=3.1, 95% CI=1.1-8.2), and patients undergoing right-sided pneumonectomy had 2.4
times higher risk compared to left-sided pneumonectomy (OR=2.4, 95% CI=0.9-6.4). Pneumonectomy is accompanied by
high postoperative mortality and morbidity rates, the highest risk in patients over 70 years and right-sided pneumonectomy,
and consequently should lead to meticulous patient selection and perioperative care.
PMID: 19461865
Peritoneal function in clinical practice: the importance of follow-up and its measurement in patients.
Recommendations for patient information and measurement of peritoneal function. NDT Plus. 2009
Apr;2(2):104-110.
A review is given on peritoneal function, especially ultrafiltration and ultrafiltration failure followed by recommendations
on how to translate pathophysiology into clinical practice. The subsequent consequences for management of peritoneal
membrane function and for patient information are also included.
PMID: 19477688
Binkhorst M, de Gier RP.
A large extra-abdominal prevesical pseudo-cyst in a newborn with posterior urethral valves.
J Pediatr Urol 2010; 6: 91-93.
169
A male newborn is described, in whom a large extra-abdominal prevesical pseudo-cyst as well as prune-belly features
were present, both of which were supposedly secondary to posterior urethral valves. It is postulated that the subvesical
obstruction caused pressure build-up in the urinary tract, followed by fetal bladder rupture. The resultant urinoma migrated extra-abdominally. Distension of the urinary tract, bilateral cryptorchidism and abdominal wall laxity contributed
to a prune-belly phenotype.
PMID: 19483176
Hoogeveen EK, Stehouwer CD.
Exclusion of a case-control study from meta-analysis.
Mayo Clin Proc. 2009; 84: 561.
PMID: 19486621
Color II Study Group, Buunen M, Bonjer HJ, Hop WC, Haglind E, Kurlberg G, Rosenberg J, Lacy AM, Cuesta
MA, D’Hoore A, Fürst A, Lange JF, Jess P, Bulut O, Poornoroozy P, Jensen KJ, Christensen MM, Lundhus E,
Ovesen H, Birch D, Iesalnieks I, Jäger C, Kreis M, van riet Y, van der Harst E, Gerhards MF, Bemelman WA,
Hansson BM, Neijenhuis PA, Prins HA, Balague C, Targarona E, Luján Mompeán JA, Franco Osorio JD,
Garcia Molina FJ, Skullman S, Läckberg Z, Kressner U, Matthiessen P, Kim SH, Poza AA.
COLOR II. A randomized clinical trial comparing laparoscopic and open surgery for rectal cancer.
Dan Med Bull. 2009 May;56(2):89-91.
INTRODUCTION: Laparoscopic resection of rectal cancer has been proven efficacious but morbidity and oncological outcome need to be investigated in a randomized clinical trial. Trial design: Non-inferiority randomized clinical trial.
METHODS: The COLOR II trial is an ongoing international randomized clinical trial. Currently 27 hospitals from Europe,
South Korea and Canada are including patients. The primary endpoint is loco-regional recurrence rate three years postoperatively. Secondary endpoints cover quality of life, overall and disease free survival, post-operative morbidity and
health economy analysis.
RESULTS: By July 2008, 27 hospitals from the Netherlands, Belgium, Germany, Sweden, Spain, Denmark, South Korea
and Canada had included 739 patients. The intra-operative conversion rate in the laparoscopic group was 17%. Distribution of age, location of the tumor and radiotherapy were equal in both treatment groups. Most tumors are located in the
mid-rectum (41%).
CONCLUSION: Laparoscopic surgery in the treatment of rectal cancer is feasible. The results and safety of laparoscopic
surgery in the treatment of rectal cancer remain unknown, but are subject of interim analysis within the COLOR II trial.
PMID: 19494591
Fluid transport with time on peritoneal dialysis: the contribution of free water transport and solute coupled
water transport.
Ultrafiltration in peritoneal dialysis occurs through endothelial water channels (free water transport) and together with
solutes across small pores: solute coupled water transport. A review is given of cross-sectional studies and on the results
of longitudinal follow-up.
170
PMID: 19494595
Krediet RT, Sampimon DE, Vlijm A, Coester AM, Struijk DG, Smit W.
Biological markers in the peritoneal dialysate effluent: are they useful.
A review is given on biomarkers in peritoneal effluent. It comprises methods to distinguish between diffusion and local
production. This is followed by examples of various biomarkers. Their potential use is discussed in 4 situations: inherent
fast transporters, longitudinal follow-up of patients, biocompatibility testing of new dialysis solutions, and their potential
use in the detection of patients who are likely to develop encapsulating peritoneal sclerosis.
PMID: 19494600
Krediet RT, Smit W, Coester AM, Struijk DG.
Dry body weight and ultrafiltration targets in peritoneal dialysis.
A review is given on methods that can be used for the assessment of dry body weight in peritoneal dialysis patients.
Besides clinical examination, the use of natriuretic hormone concentrations in plasma, and the value of multifrequency
bio-impedance analysis is discussed. Ultrafiltration targets as formulated in various guidelines are reviewed. Finally, it is
concluded that the ultrafiltration target is the amount required to keep patients euvolemic with an exposure to glucose
that is as low as possible.
PMID: 19515608
Van Asten L, van der Lubben M, van den Wijngaard C, van Pelt W, Verheij R, Jacobi A, Overduin P, Meijer A,
Luijt D, Claas E, Hermans MH, Melchers W, Rossen J, Schuurman R, Wolffs P, Boucher C, Schirm J, Kroes L,
Leenders AC, Galama J, Peeters M, van Loon A, Stobberingh E, Schutten M, Koopmans M.
Strengthening the diagnostic capacity to detect Bio Safety Level 3 organisms in unusual respiratory viral
outbreaks.
J Clin Virol. 2009 Jul;45(3):185-90.
BACKGROUND: Experience with a highly pathogenic avian influenza outbreak in the Netherlands (2003) illustrated that
the diagnostic demand for respiratory viruses at different biosafety levels (including BSL3), can increase unexpectedly
and dramatically.
OBJECTIVES: We describe the measures taken since, aimed at strengthening national laboratory surge capacity and
improving preparedness for dealing with diagnostic demand during outbreaks of (emerging) respiratory virus infections,
including pandemic influenza virus.
STUDY DESIGN: Academic and peripheral medical-microbiological laboratories collaborated to determine minimal laboratory requirements for the identification of viruses in the early stages of a pandemic or a large outbreak of avian influenza
virus. Next, an enhanced collaborative national network of outbreak assistance laboratories (OAL) was set up. An inventory was made of the maximum diagnostic throughput that this network can deliver in a period of intensified demand.
For an estimate of the potential magnitude of this surge demand, historical counts were calculated from hospital- and
physician-based registries of patients presenting with respiratory symptoms.
RESULTS: Number of respiratory physician-visits ranged from 140,000 to 615,000 per month and hospitalizations
ranged from 3000 to 11,500 per month. The established OAL-network provides rapid diagnostic response with agreed
171
quality requirements and a maximum throughput capacity of 1275 samples/day (38,000 per month), assuming other
routine diagnostic work needs to be maintained.
CONCLUSIONS: Thus surge demand for diagnostics for hospitalized cases (if not distinguishable from other respiratory
illness) could be handled by the OAL network. Assessing etiology of community acquired acute respiratory infection however,
may rapidly exceed the capacity of the network. Therefore algorithms are needed for triaging for laboratory diagnostics; currently this is not addressed in pandemic preparedness plans.
PMID: 19516032
Bolla M, de Reijke TM, Van Tienhoven G, Van den Bergh AC, Oddens J, Poortmans PM, Gez E, Kil P, Akdas A,
Soete G, Kariakine O, van der Steen-Banasik EM, Musat E, Piérart M, Mauer ME, Collette L; EORTC Radiation
Oncology Group and Genito-Urinary Tract Cancer Group.
Duration of androgen suppression in the treatment of prostate cancer.
N Engl J Med. 2009 Jun 11;360(24):2516-27.
BACKGROUND: The combination of radiotherapy plus long-term medical suppression of androgens (> or = 2 years) improves
overall survival in patients with locally advanced prostate cancer. We compared the use of radiotherapy plus short-term androgen suppression with the use of radiotherapy plus long-term androgen suppression in the treatment of locally advanced
prostate cancer.
METHODS: We randomly assigned patients with locally advanced prostate cancer who had received external-beam
radiotherapy plus 6 months of androgen suppression to two groups, one to receive no further treatment (short-term suppression) and the other to receive 2.5 years of further treatment with a luteinizing hormone-releasing hormone agonist
(long-term suppression). An outcome of noninferiority of short-term androgen suppression as compared with long-term
suppression required a hazard ratio of more than 1.35 for overall survival, with a one-sided alpha level of 0.05. An interim
analysis showed futility, and the results are presented with an adjusted one-sided alpha level of 0.0429.
RESULTS: A total of 1113 men were registered, of whom 970 were randomly assigned, 483 to short-term suppression
and 487 to long-term suppression. After a median follow-up of 6.4 years, 132 patients in the short-term group and 98 in
the long-term group had died; the number of deaths due to prostate cancer was 47 in the short-term group and 29 in the
long-term group. The 5-year overall mortality for short-term and long-term suppression was 19.0% and 15.2%, respectively; the observed hazard ratio was 1.42 (upper 95.71% confidence limit, 1.79; P=0.65 for noninferiority). Adverse events in
both groups included fatigue, diminished sexual function, and hot flushes.
CONCLUSIONS: The combination of radiotherapy plus 6 months of androgen suppression provides inferior survival as compared with radiotherapy plus 3 years of androgen suppression in the treatment of locally advanced prostate cancer.
PMID: 19540155
Meijer A, Beerens A, Claas E, Hermans M, de Jong A, Molenkamp R, Niesters H, Overduin P, Rossen J,
Schuurman R, Wolffs P, Fouchier R, Osterhaus A, Schutten M, Koopmans M. Preparing the outbreak assistance
laboratory network in the Netherlands for the detection of the influenza virus A(H1N1) variant.
J Clin Virol. 2009 Jul;45(3):179-84.
BACKGROUND: Late April 2009, human infection with variant influenza virus A(H1N1)v emerged in the Northern Americas posing
a threat that this virus may become the next pandemic influenza virus.
OBJECTIVES: To prepare laboratories for surge capacity for molecular diagnosis of patients suspected for A(H1N1)v infection in the
Netherlands.
STUDY DESIGN: A panel of 10 blinded specimens containing seasonal A(H1N1) or A(H3N2), or A/Netherlands/602/2009(H1N1)
172
v influenza virus, or negative control was distributed to the outbreak assistance laboratories (OAL) together with influenza virus A
(M-gene), swine influenza virus A (NP-gene) and influenza virus A(H1N1)v (H1v-gene) specific primers and probes and protocol
(CDC Atlanta, USA). Laboratories were asked to implement and test this protocol.
RESULTS: All OAL were able to detect A(H1N1)v using the CDC M-gene reagents, the majority with similar sensitivity as the inhouse M-gene based assays. RT-PCRs used in routine diagnostic setting in the OAL specifically designed to detect H1, H3, or NS1
from seasonal influenza A viruses, did not or at very low level cross-react with A(H1N1)v. The CDC swine NP-gene and H1v-gene
RT-PCRs showed somewhat reduced sensitivity compared to the CDC and in-house M-gene RT-PCRs. In contrast, in-house
developed A(H1N1)v specific H1v-gene and N1v-gene RT-PCRs showed equal sensitivity to CDC and in-house M-gene RT-PCRs.
CONCLUSIONS: The Dutch OAL are prepared for detection and specific identification of A(H1N1)v, although some level of crossreactivity was observed with seasonal influenza viruses. Additionally, M-gene based generic influenza A virus detection is recommended to be able to detect emerging influenza A viruses in routine settings.
PMID: 19549261
De Vries RR, Nieuwenhuijzen JA, van Tinteren H, Oddens JR, Visser O, van der Poel HG, Bex A, Meinhardt W,
Horenblas S; Urological Working Group of the Amsterdam Comprehensive
Cancer Center.
Prostate-sparing cystectomy: long-term oncological results.
BJU Int. 2009 Nov;104(9):1239-43.
OBJECTIVE: To analyse the oncological outcome of prostate-sparing cystectomy (PSC).
PATIENTS AND METHODS: Between 1994 and 2006, 63 men were treated with PSC after meeting the inclusion criteria (no
tumour at the bladder neck, no prostate cancer). The results were compared with patients who had a standard cystoprostatectomy (SC) during the same study period, after matching for clinical and pathological characteristics.
RESULTS: The 3- and 5-year disease-specific survival rates were 77% and 66% in the PSC group, and 68% and 64% in the
SC group (log-rank, P = 0.6). The local recurrence rate was 7.9% and 16% for the PSC and the SC groups, respectively, and
the respective distant recurrence rate was 29% and 33%. Subsequent prostate cancer was detected in 3% in the PSC group.
None of these patients died from prostate cancer. In the SC group the final pathology showed that 18% had prostate cancer.
CONCLUSION: Local recurrences were not diagnosed more often in the PSC than the SC group. The outcomes of both
procedures are comparable with contemporary cystoprostatectomy series. We consider this procedure oncologically safe and
offer this to selected patients. However, selection is the key to success, and our results should further be corroborated by the
experience of others.
PMID: 19562346
Meijer RP, Gemen EF, van Onna IE, van der Linden JC, Beerlage HP, Kusters GC.
The value of an artificial neural network in the decision-making for prostate biopsies.
World J Urol. 2009 Oct;27(5):593-8.
PURPOSE: In majority of patients who are subjected to prostate biopsies, no prostate cancer (PCa) is found. It is important
to prevent unnecessary biopsies since serious complications may occur. An artificial neural network (ANN) may be able to
predict the risk of the presence of PCa.
METHODS: Included were all patients, who underwent transrectal ultrasound-guided prostate biopsies between June 2006
and June 2007 with a total PSA (tPSA) level between 2 and 20 microg/l. The patients were divided into two groups according to their tPSA level (2-10 microg/l and 10-20 microg/l). The ANN Prostataclass of the Universitätsklinikum Charité in
Berlin was used. The predictions of the ANN were compared to the pathology results of the biopsies.
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RESULTS: Overall 165 patients were included. PCa was diagnosed in 53 patients, whereas the ANN predicted “no risk” in 19
of these patients (36%). The ANN output receiver operator characteristic (ROC) plots for the range of tPSA 2-10 microg/l and
tPSA 10-20 microg/l showed an area under the curve (AUC) of 63 and 88% for the initial biopsy group, versus 69 and 57%,
respectively, for the repeat biopsy group.
CONCLUSIONS: The ANN resulted in a false negative rate of 36%, missing PCa in 19 patients. For use in an outpatientclinical setting, this ANN is insufficient to predict the risk of presence of PCa reliably.
PMID: 19569495
Chinnadurai SK, Troan BV, Wolf KN, DeVoe RS, Huijsmans CJ, Hermans MH, Wever PC. Septicemia,
endocarditis, and cerebral infarction due to Staphylococcus aureus in a harp seal (Phoca groenlandica).
J Zoo Wildl Med. 2009. 40:393.
An adult, wild-collected, male harp seal (Phoca groenlandica) was transferred from a rehabilitation center to a display facility
because of unilateral phthisis bulbi and decreased use of the right forelimb, which precluded its release. In quarantine, the
animal demonstrated limited use of the right forelimb, which acutely progressed to complete disuse of the limb accompanied
by intermittent lethargy. One month after transfer, the animal was found dead on exhibit. Necropsy showed septic arthritis
of the right scapulohumeral joint, valvular endocarditis with systemic bacterial thromboembolism, and infarction of the cerebrum and myocardium. Culture of the blood and affected joint space revealed Staphylococcus aureus. Bacterial polymerase
chain reaction of formalin-fixed tissues from the heart and brain were also positive for S. aureus. Staphylococcus aureus
infection should be considered as an additional cause of endocarditis and embolic encephalitis in seals.
PMID: 19581668
Van Rossum LG, van Rijn AF, van Munster IP, Jansen JB, Fockens P, Laheij RJ, Dekker E.
Earlier stages of colorectal cancer detected with immunochemical faecal occult blood tests.
Neth J Med. 2009 May;67(5):182-6.
BACKGROUND: The aim of colorectal cancer screening is to improve prognosis by the detection of early cancer and precursor
stages. We compared the stage distribution of asymptomatic colorectal cancer patients detected by a positive immunochemical or guaiac-based faecal occult blood test (FOBT) with symptomatic colorectal cancer patients.
METHODS: In a longitudinal cohort study tumour stages were assessed in 144 symptomatic (mean age 69.3 years, 56%
male) and 41 asymptomatic colorectal cancer patients (mean age 64.9 years, 56% male) of which 11 were detected with
guaiac FOBT s (G-FOBT, Hemoccult-II) and 30 with immunochemical FOBTs (I-FOBT, OCSensor). Stage distributions were
used to calculate average stage specific predicted five-year survival rates and to analyse group differences with Wilcoxon
log-rank test.
RESULTS: Colorectal cancer was detected in significantly earlier stages in symptomatic compared with asymptomatic
patients patients (p<0.0001). Average stage specific predicted five-year survival was 59.1% in symptomatic and 76.6% in
asymptomatic patients. Compared with the symptomatic patients the stage distribution for colorectal cancer patients detected with Hemoccult-II was not significantly different(p=0.29), whereas colorectal cancer was detected at significantly earlier
stages with the OCSensor (p<0.0001).Treatment could be confined to colonoscopy in 27% of the asymptomatic patients
compared with 3% of the symptomatic patients (p<0.0001). Cancer distribution over the colon was comparable between
symptomatic and asymptomatic patients (p=0.3).
CONCLUSIONS: Compared with symptomatic patients,patients detected by FOBT and especially immunochemical FOBT ,
presented significantly more often at earlier stages suggesting increased survival. Additionally treatment could more often
be confined to colonoscopy.
174
PMID: 19582760
Robben SH, Sleegers MJ, Dautzenberg PL, van Bergen FS, ter Bruggen JP, Rikkert MG.
Pilot study of a three-step diagnostic pathway for young and old patients with Parkinson’s disease dementia:
screen, test and then diagnose.
Int J Geriatr Psychiatry. 2010 Mar;25(3):258-65.
OBJECTIVE: To pilot a three-step diagnostic model for young and old patients with Parkinson’s disease dementia (PDD).
METHODS: Prospective investigator-blinded study. We developed a screening questionnaire for patients with Parkinson’s
disease (PD) and their caregivers. Further, patients were subjected to three screening instruments (Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), Addenbrooke’s Cognitive Examination-revised (ACE-R) and a detailed
neuropsychological examination (NPE). Based on the NPE, patients were divided in a PD (without dementia) and a PDD-group.
RESULTS: Forty-one PD patients, aged 37-94 years, participated in this study. Patients were divided in a young group, <
or = 65 (n = 22) and an old group >65 years (n = 19). In the young group (PDD, n = 5) the patient-screening questionnaire
predicted PDD with a sensitivity/specificity of 100.0%/94.1%; in the old group (PDD, n = 10) the proxy-screening questionnaire
predicted PDD with a sensitivity/specificity of 88.9%/66.7%. In the young group, ACE-R had the largest Area Under the Curve
(AUC) 0.88 (0.70-1.00), in the old group MoCA (AUC 1.00). However, the three instruments did not differ significantly.
CONCLUSIONS: It seems feasible and efficient to use three consecutive diagnostic steps for PDD: (1) a screening questionnaire,
(2) if positive: MoCA, FAB or ACE-R as screening instrument and (3) if positive: a detailed NPE for diagnosing PDD.
PMID: 19593191
Derijks HJ, Janknegt R, Heerdink ER, De Koning GH, Krekels M, Looij, B-J, Egberts AC. Influence of
antidepressants on glycaemic control in patients with diabetes mellitus: an open label comparative study.
PMID: 19601985
Herbers AH, Verbruggen B, Van de Veerdonk F, Van Kraaij M, Blijlevens NM, Novakova IR.
Misleading one-stage coagulation factor assay during rFVIIa treatment in lupus patient. Haemophilia. 2009
Sep;15(5):1164-6.
PMID: 19622627
de Lind van Wijngaarden RF, Festen DA, Otten BJ, van Mil EG, Rotteveel J, Odink RJ, van Leeuwen M, Haring
DA, Bocca G, Mieke Houdijk EC, Hokken-Koelega AC.
Bone mineral density and effects of growth hormone treatment in prepubertal children with Prader-Willi
syndrome: a randomized controlled trial.
J Clin Endocrinol Metab. 2009 Oct;94(10):3763-71.
BACKGROUND: Bone mineral density (BMD) is unknown in children with Prader-Willi syndrome (PWS),
but is decreased in adults with PWS. In patients with GH deficiency, BMD increases during GH treatment.
OBJECTIVES: The aim of the study was to evaluate BMD in children with PWS and to study the effects
of GH treatment.
DESIGN: We conducted a randomized controlled GH trial. Forty-six prepubertal children were randomized into either a GHtreated group (1.0 mg/m(2) . d) or a control group for 2 yr. At start, 6, 12, and 24 months of study, total body and lumbar
spine BMD were measured by dual-energy x-ray absorptiometry, and lumbar spine bone mineral apparent density (BMAD)
was calculated.
175
RESULTS: Baseline total body and lumbar spine BMD sd score (SDS) were normal [mean (sd), -0.2 SDS (1.1) and -0.4
SDS (1.2), respectively]. BMADSDS, which corrects for short stature, was also normal [mean (sd), 0.40 SDS (1.1)]. Total
body BMDSDS decreased during the first 6 months of GH (P < 0.0001), but increased during the second year of treatment.
After 24 months of study, total body and lumbar spine BMDSDS, and the BMADSDS did not significantly differ between
GH-treated children and randomized controls (P = 0.30, P = 0.44, and P = 0.47, respectively). Results were similar when
corrected for body mass index SDS. Repeated measurements analysis showed a significant positive association between
IGF-I SDS and total body and lumbar spine BMDSDS, but not with BMADSDS.
CONCLUSIONS: Our results show that prepubertal children with PWS have a normal BMD. GH treatment had no effect on
BMD, except for a temporary decrease of total body BMDSDS in the first 6 months.
PMID: 19631876
Koning OH, Kaptein BL, van der Vijver R, Dias NV, Malina M, Schalij MJ, Valstar ER, van Bockel JH.
Fluoroscopic Roentgen stereophotogrammetric analysis (FRSA) to study three-dimensional stent graft dynamics.
J Vasc Surg. 2009 Aug;50(2):407-12.
We report the clinical feasibility of fluoroscopic Roentgen stereophotogrammetric analysis (FRSA), a validated method to
quantify real time three-dimensional (3D) dynamic motion of stent grafts and the first clinical results after abdominal and
thoracic endovascular repair (EVAR). Stent graft motion was measured at 30 (stereo) frames per second, during the cardiac
cycle and in the patient after abdominal EVAR, due to respiratory action. Translational motions of the center of mass, diameter change, and rotational and axial motion could be measured. Quantification of 3D motion was not available until now.
FRSA can provide crucial information on the forces exerted on stent grafts and will, therefore, provide essential information
for improvements in stent graft design.
PMID 19643641
Jaspers JW, Kuppens SM, van Zundert AA, de Wildt MJ.
Vaginal stones in a 5 year old girl: a novel approach of removal.
J. Pediatrics and Adolescent Gynaecology 2010 feb: 23(1):e23-5
BACKGROUND: Primary vaginal stones in children are extremely rare and removal can be difficult. We describe a procedure
for safe extraction of vaginal stones.
CASE: A 5-year-old, wheelchair-bound girl was referred to the urologic department with recurrent febrile urinary tract infection. Diagnostics of the kidneys showed no abnormalities. The bladder appeared to contain two stones. On urethro-cystoscopy no stones were seen. Vaginoscopy identified vaginal stones. After 4 weeks of estrogen treatment, a second procedure
via vaginal introduction of a nephroscope in combination with an ultrasonic device, effectively disintegrated the stones.
SUMMARY AND CONCLUSION: We recommend the use of a nephroscope in visualizing the vagina and cervix and facilitating
instrumentation in prepubertal girls.
PMID: 19692142
Scagliotti GV, Germonpré P, Bosquée L, Vansteenkiste J, Gervais R, Planchard D, Reck M, De Marinis F, Lee JS, Park
K, Biesma B, Gans S, Ramlau R, Szczesna A, Makhson A, Manikhas G, Morgan B, Zhu Y, Chan KC, von Pawel J.
A randomized phase II study of bortezomib and pemetrexed, in combination or alone, in patients with previously
treated advanced non-small-cell lung cancer.
Lung Cancer. 2010 Jun;68(3):420-6.
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BACKGROUND: This is a phase II randomized study to evaluate the efficacy and safety of bortezomib and pemetrexed alone
or in combination, in patients with previously treated advanced non-small-cell lung cancer (NSCLC). The primary end point
was assessment of response rate.
METHODS: A total of 155 patients were randomized (1:1:1) to pemetrexed (500mg/m(2)) on day 1 plus bortezomib
(1.6mg/m(2)) on days 1 and 8 (Arm A) or pemetrexed (500mg/m(2)) on day 1 (Arm B) or bortezomib (1.6mg/m(2)) on days
1 and 8 (Arm C) of a 21 day cycle. Response rate was assessed by investigators using Response Evaluation Criteria In Solid
Tumors (RECIST) criteria and toxicity assessed by the National Cancer Institute-Common Terminology Criteria for Adverse
Events (NCI-CTCAE) grading system.
RESULTS: Response rate was 7% in Arm A, 4% in Arm B, and 0% in Arm C; disease control rates were 73%, 62%, and 43%,
respectively. Median overall survival was 8.6 months in Arm A, 12.7 months in Arm B, and 7.8 months in Arm C; time to
progression was 4.0 months, 2.9 months, and 1.4 months, respectively. Most common reported adverse events >/=grade
3 were neutropenia (19%), thrombocytopenia (15%), and dyspnea (13%) in Arm A, neutropenia (10%) in Arm B, and dyspnea
(13%) and fatigue (10%) in Arm C.
CONCLUSION: In previously treated NSCLC the addition of bortezomib to pemetrexed was well tolerated but offered no
statistically significant response or survival advantage versus pemetrexed alone, while bortezomib alone showed no clinically
significant activity.
PMID: 19710091
Dorresteijn MJ, Draisma A, van der Hoeven JG, Pickkers P.
Lipopolysaccharide-stimulated whole blood cytokine production does not predict the inflammatory response in
human endotoxemia.
Innate Immun. 2010 Aug;16(4):248-53.
A widely applied method to study the activation of the innate immune system is in vitro stimulation of whole blood using
lipopolysaccharide (LPS). However, it is unclear if in vitro cytokine production relates to in vivo cytokine levels elicited during
experimental endotoxemia or sepsis. To determine the correlation between in vitro cytokine production and the in vivo
inflammatory response, blood was obtained from 15 healthy volunteers for in vitro incubation with Escherichia coli LPS,
immediately followed by experimental E. coli endotoxemia. Correlations of in vitro and peak in vivo cytokine concentrations were determined using Pearson correlation coefficient. In stimulated whole blood, tumor necrosis factor (TNF)-alpha,
Interleukin (IL)-1beta, IL-6, IL-10 and interferon (IFN)-gamma were induced to 279 +/- 53, 392 +/- 64, 5312 +/- 624, 83
+/- 20 and 343 +/- 85 pg/ml, respectively, whereas in vivo cytokine induction led to cytokine levels of 603 +/- 123, 11 +/1, 4999 +/- 1228, 167 +/- 25 and 194 +/- 40 pg/ml, respectively. Correlation coefficients between the in vitro and in vivo
cytokine concentrations were for TNF-alpha, IL-1beta, IL-6, IL-10 and IFN-gamma -0.10 (P = 0.7), 0.09 (P = 0.8), 0.36 (P
= 0.2), 0.19 (P = 0.5) and 0.40 (P = 0.1), respectively. Comparison between in vitro and in vivo stimulation with LPS shows
no correlation between the amount of cytokines produced. In vitro cytokine production, therefore, does not predict the in
vivo inflammatory response.
PMID 19713200
Clement DS, Postma G, Rothova A, Grutters JC, Prokop M, de Jong PA.
Intraocular sarcoidosis: association of clinical characteristics of uveitis with positive chest high-resolution
computed tomography findings.
British journal of Ophthalmology 2010 Feb;94(2):219-22.
177
AIM: To assess specific clinical criteria in patients with uveitis that are related to signs of sarcoidosis on high-resolution computed tomography (HRCT) of the chest.
METHODS: Retrospective study of 50 consecutive patients with uveitis who were referred for chest HRCT because of suspicion
of sarcoidosis. Clinical characteristics, laboratory findings, chest radiographs and chest HRCT scans were retrieved. HRCT scans
were reassessed for signs of sarcoidosis. Mann-Whitney and Fisher exact test were used for data analysis.
RESULTS: Ten of 50 (20%) uveitis patients referred for HRCT demonstrated signs of sarcoidosis on HRCT. The median age of
these patients was significantly higher than those patients with a negative HRCT (71.1 vs 44.7 years, p=0.002). The presence
of peripheral chorioretinal punched out lesions and posterior synechiae were significantly related to an abnormal HRCT scan.
CONCLUSION: Increasing age, presence of peripheral multifocal chorioretinitis and posterior synechiae were associated with an
abnormal HRCT scan.
PMID: 19717752
Hövels AM, Heesakkers RA, Adang EM, Barentsz JO, Jager GJ, Severens JL.
Cost-effectiveness of MR lymphography for the detection of lymph node metastases in patients with prostate
cancer.
Radiology. 2009 Sep;252(3):729-36.
PURPOSE: To apply a decision analytic model to determine whether the addition of magnetic resonance (MR) lymphography
to the diagnostic workup of patients with intermediate or high probability of lymph node metastases is cost effective from a
health care perspective.
MATERIALS AND METHODS: The data that were used for the decision analytic model were obtained from an empiric
study population of 375 patients. As the input of the decision analytic model was made given prospective patient data
from several hospitals, the ethics review board of each hospital approved the study. Written consent was obtained from all
patients. To investigate possible differences between strategies that utilize MR lymphography and those that do not (pelvic
lymph node dissection [PLND]), two outcome measures were examined and combined in an incremental cost-effectiveness
ratio (ICER) of health care resources consumed and quality-adjusted life-years (QALYs). Probabilistic and one-way sensitivity
analyses were performed.
RESULTS: The PLND strategy is dominated by the MR lymphography strategy. Probabilistic sensitivity analysis showed that
in 63% of simulations, MR lymphography was cost saving and resulted in better patient outcome for patients with prostate
cancer and intermediate or high probability of lymph node metastases. The probability of MR lymphography being inferior
(more expensive and worse patient outcome) is less than 3%.
CONCLUSION: MR lymphography is an efficient strategy in the detection of lymph node metastases of prostate cancer when
compared with the PLND strategy.
PMID: 19718481
van Geest-Daalderop JH, Péquériaux NC, van den Besselaar AM.
Variability of INR in patients on stable long-term treatment with phenprocoumon and acenocoumarol and
implications for analytical quality requirements.
Thromb Haemost. 2009 Sep;102(3):588-92.
Within each patient treated with vitamin K antagonist (VKA), variation of the international normalised ratio (INR) occurs
over the treatment period. The purpose of the present study was to assess INR variation in selected patients on long-term
treatment in whom the dose of VKA was not changed. This type of variation is considered as “biological variation” which is
caused by many factors but not VKA dose changes or other medication. Four groups of long-term patients were examined:
178
each group with a different VKA (acenocoumarol or phenprocoumon) or a different target intensity (INR 2.0-3.5 or 2.5-4.0).
All patients were monitored with the same PT system (Hepato Quick, STA-R Evolution coagulation instrument) by one laboratory. The variation of the INR within each patient was expressed as coefficient of variation (CV, in %). The CV was corrected
for the average imprecision of the INR measurement (CV, 2.4%). The mean corrected CV values for the four groups were:
10.9% (acenocoumarol, target INR 2.0-3.5); 10.5% (acenocoumarol, target INR 2.5-4.0); 10.4% (phenprocoumon, target INR
2.0-3.5); 9.1% (phenprocoumon, target INR 2.5-4.0). The analytical performance goal for the INR measurement (imprecision) can be derived from the within-subject biological variation. Desirable INR imprecision goals are <4.9% and <5.3% CV for
monitoring of phenprocoumon and acenocoumarol, respectively. These goals were achieved using the aforesaid PT system.
PMID: 19727754
Rutten MJ, Spaargaren GJ, van Loon T, de Waal Malefijt MC, Kiemeney LA, Jager GJ.
Detection of rotator cuff tears: the value of MRI following ultrasound.
Eur Radiol. 2010 Feb;20(2):450-7.
OBJECTIVE: To evaluate the need for additional magnetic resonance imaging (MRI) following ultrasound (US) in patients with
shoulder pain and/or disability and to compare the accuracy of both techniques for the detection of partial-thickness and fullthickness rotator cuff tears (RCT).
METHODS: In 4 years, 5,216 patients underwent US by experienced musculoskeletal radiologists. Retrospectively, patient
records were evaluated if MRI and surgery were performed within 5 months of US. US and MRI findings were classified into
intact cuff, partial-thickness and full-thickness RCT, and were correlated with surgical findings.
RESULTS: Additional MR imaging was performed in 275 (5.2%) patients. Sixty-eight patients underwent surgery within 5
months. US and MRI correctly depicted 21 (95%) and 22 (100%) of the 22 full-thickness tears, and 8 (89%) and 6 (67%) of the 9
partial-thickness tears, respectively. The differences in performance of US and MRI were not statistically significant (p = 0.15).
CONCLUSIONS: MRI following routine shoulder US was requested in only 5.2% of the patients. The additional value of MRI was
in detecting intra-articular lesions. In patients who underwent surgery, US and MRI yielded comparably high sensitivity for detecting full-thickness RCT. US performed better in detecting partial-thickness tears, although the difference was not significant.
PMID: 19731749
Nijboer H, Dautzenberg PL.
Progressive supranucleair palsy: acetylcholineeserase-inhibitor a possible therapy?
Progressive supranucleair palsy (PSP) is a serious neurologic disease which is seldom diagnosed due to its complexity. In
1996 international diagnostic criteria were developed by a group of experts, the diagnosis remains complicated. We describe
three cases, which were followed in the period 2001-2008. In these case reports we elaborate on the therapeutic use of
rivastigmine. During off-label rivastigmine use, patients showed minimal further cognitive decline, specifically with respect
to frontal defects. However, larger studies and trials are necessary to explore the effects of rivastigmine in patients with PSP.
PMID: 19733556
de With MC, van der Heijden EP, van Oosterhout MF, Kon M, Kroese AB.
Contractile and morphological properties of hamster retractor muscle following 16 h of cold preservation.
Cryobiology. 2009 Dec;59(3):308-16.
INTRODUCTION: Cold hypoxia is a common factor in cold tissue preservation and mammalian hibernation. The purpose of
179
this study was to determine the effects of cold preservation on the function of the retractor (RET) muscle of the hamster
in the non-hibernating state and compare these with previously published data (van der Heijden et al., 2000) on the rat
cutaneus trunci (CT) muscle.
MATERIALS AND METHODS: After cold storage (16 h at 4 degrees C), muscles were stimulated electrically to measure
maximum tetanus tension (P(0)) and histologically analyzed. The protective effects of addition of the antioxidants trolox and
deferiprone and the calcium release inhibitor BDM to the storage fluid were determined.
RESULTS: After storage, the twitch threshold current was increased (from 60 to 500 microA) and P(0) was decreased to 27%
of control. RET morphology remained unaffected. RET muscle function was protected by trolox and deferiprone (P(0), resp.,
43% and 59% of control). Addition of BDM had no effect on the RET.
CONCLUSIONS: The observed effects of cold preservation and of trolox and deferiprone on the RET were comparable to
those on CT muscle function, as reported in a previously published study (van der Heijden et al., 2000). Both hamster RET
and rat CT muscles show considerable functional damage due to actions of reactive oxygen species. In contrast to the CT, in
the RET cold preservation-induced functional injury could not be prevented by BDM and was not accompanied by morphological damage such as necrosis and edema. This suggests that the RET myocytes possess a specific adaptation to withstand
the Ca(2+) overload induced by cold ischemia.
PMID: 19733956
Penninx J, Brandes M, de Bruin JP, Schneeberger PM, Hamilton CJ.
Prediction of pelvic pathology in subfertile women with combined Chlamydia antibody and CA-125 tests.
Eur J Obstet Gynecol Reprod Biol. 2009 Dec;147(2):178-82.
OBJECTIVES: Chlamydia antibody test (CAT) has been proposed to predict tubal disease. A correlation between CA-125 and
the extent of endometriosis has been found by others. In this study we explored whether a combination of the two tests
adds to the predictive value of the individual tests for predicting tubal disease or endometriosis. We also used the combination of tests as a new index test to screen for severe pelvic pathology.
STUDY DESIGN: This retrospective study compares the findings of 240 laparoscopies with the serological test results. Findings were classified according to the existing ASRM scoring systems for adnexal adhesions, distal tubal occlusion and endometriosis. Severe pelvic pathology was defined as the presence of ASRM classes III and IV tubal disease or ASRM classes III
and IV endometriosis. The predictive value was calculated for both tests separately and for the combined test. The combined
test was positive if at least one test result was abnormal (CAT positive and/or CA-125 > or =35 IU/ml).
RESULTS: 67/240 women had tubal disease, 81/240 had some degree of endometriosis. The odds ratios (ORs) of the CAT
and the combined test to diagnose severe tubal disease were 6.6 (2.6-17.0) and 7.3 (2.9-19.3), respectively. The ORs of
the CA-125 and the combined test to diagnose severe endometriosis were 15.6 (6.2-40.2) and 3.0 (1.2-8.0), respectively.
Severe pelvic pathology was present in 65/240 women (27%). The ORs for severe pelvic pathology of the CAT, CA-125 and
the combined test were 2.5 (1.4-5.3), 4.9 (1.9-9.6) and 6.6 (3.3-13.4), respectively. If the combined test was normal 15 out
131 women (11%) were shown to have severe pelvic pathology.
CONCLUSIONS: The combined test adds hardly anything to the predictive value of CAT alone to diagnose severe tubal
disease. The combined test is better than the CAT to predict severe pelvic pathology, but is not significantly better than the
CA-125. If both the CAT and CA-125 are normal one could consider not performing a laparoscopy.
PMID: 19757757
van Poppel PC, Stehouwer CD, Beutler JJ, Korst MB, Beerlage HP, Hoogeveen EK. Hyperchloremic
metabolic acidosis in a patient with an ureteroileostomy according to Bricker.
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PMID: 19771542
Dautzenberg PL, van der Zande JA, Conemans JM, Rikkert MG.
PMID: 19778289
De Wit NC, de Jager CP, Meekelenkamp JC, Schoorl M, van Gageldonk-Lafeber AB,
Leenders AC, Kusters R, Wever PC.
Markers of infection in inpatients and outpatients with acute Q-fever.
Clin Chem Lab Med. 2009;47(11):1407-9.
BACKGROUND: Query-fever (Q-fever) is a zoonotic infection caused by the intracellular Gram-negative coccobacillus Coxiella
burnetii. A large ongoing outbreak of Q-fever has been reported in the Netherlands. We studied various markers of infection
in inpatients (hospitalised) and outpatients (treated by a general physician) with acute Q-fever in relation to disease severity.
METHODS: Leukocyte counts, C-reactive protein (CRP) and procalcitonin (PCT) concentrations were measured in 25
inpatients and 40 outpatients upon presentation with acute Q-fever. Chest X-rays, if available, were analysed and confusion,
urea, respiratory rate, blood pressure-age 65 (CURB-65) scores, indicating severity of pneumonia, were calculated.
RESULTS: CRP was the only marker that significantly differentiated between inpatients and outpatients. It was increased in
all patients from both groups. Leukocyte counts and PCT concentrations did not differ between inpatients and outpatients.
Overall, only 13/65 patients had an increased leukocyte count and only 11/65 patients presented with PCT concentrations
indicative of possible bacterial respiratory tract infection. Infiltrative changes on the chest X-ray were observed in the majority of patients. CURB-65 score was 0+/-1 (mean+/-SD).
CONCLUSIONS: Acute Q-fever, a relatively mild pneumonia with low CURB-65 scores, specifically induces a response in CRP,
while PCT concentrations and leukocytes are within the normal range or increased only marginally.
PMID: 19783833
Brandes M, van der Steen JO, Bokdam SB, Hamilton CJ, de Bruin JP, Nelen WL, Kremer JA.
When and why do subfertile couples discontinue their fertility care? A longitudinal cohort study in a secondary
care subfertility population.
Hum Reprod. 2009 Dec;24(12):3127-35.
BACKGROUND: A substantial number of subfertile couples discontinues fertility care before achieving pregnancy. Most
studies on dropouts are related to IVF. The aim here is to examine dropout rates at all stages of fertility care.
METHODS: We analysed a consecutive cohort of 1391 couples, referred to our secondary care hospital between January
2002 and December 2006. Discontinuation rates were studied at six stages. Stage I: immediately after first visit, Stage II:
during diagnostic workup, Stage III: after finishing diagnostic workup but before treatment, Stage IV: during or after non-IVF
treatment, Stage V: during IVF, Stage VI: after at least 3 cycles of IVF. Reasons to discontinue and spontaneous pregnancy
rates after discontinuation were secondary outcomes.
RESULTS: In our cohort 319 couples dropped out of fertility care, 76.8%, [95% confidence interval (CI): 72.2-81.4] on their
own initiative and 23.2% (95% CI: 18.6-27.8) on doctor’s advice. Percentage (95% CI) of couples discontinuing per stage
were: Stage I 6.0% (3.4-8.6), Stage II 3.4% (1.5-5.5), Stage III 35.7% (30.5-41.0), Stage IV 23.5% (18.9-28.2), Stage V 17.9%
(13.7-22.1) and Stage VI 13.5% (9.7-17.2). Main reasons for dropout (%, 95% CI) were ‘emotional distress’ (22.3%, 17.726.8), ‘poor prognosis’ (18.8%, 14.5-23.1) and ‘reject treatment’ (17.2%, 13.1-21.4). The spontaneous ongoing pregnancy
181
rate after discontinuation was 10% (6.7-13.3).
CONCLUSION: About half of the couples stopped before any fertility treatment was started and one-third stopped after at
least one IVF cycle. The main reasons for withdrawal were emotional distress and poor prognosis. This insight may help to
improve quality of patient care by making care more responsive to the needs and expectations of subfertile couples.
PMID: 19785897
Keijsers CJ, Custers EJ, ten Cate OT.
A new, problem oriented medicine curriculum in Utrecht: less basic science knowledge.
OBJECTIVE: To investigate whether the transition from a conventional, discipline-based curriculum to a problem-orientated,
integrated curriculum at the University Medical Center Utrecht, the Netherlands, has resulted in students having less knowledge of the basic medical sciences.
DESIGN: Comparative.
METHOD: The difference in the amount of basic science between the curricula was quantitatively assessed. 37 final-year
students in each curriculum volunteered to complete a test specifically designed to measure knowledge of the basic sciences,
a few weeks before their graduation.
RESULTS: The transition from the old to the new curriculum resulted in a decline of almost half in the amount of time dedicated to the basic sciences, from 84 to 48 ‘fulltime week equivalents’. Students in the old curriculum performed significantly
better on the test than students in the new curriculum, with 43.2% (SD: 9.56) correct answers versus 35.8% (SD: 8.19)
correct answers respectively, which amounted to an effect size of 0.828 (Cohen-d). Yet, on the pathophysiology/pathology
subscale, students in each curriculum showed similar performance: 36.1% (SD: 11.55) correct answers for students in the
old curriculum, versus 37.2% (SD: 11.66) correct answers for students in the new curriculum.
CONCLUSION: Students in the old curriculum had overall significantly more knowledge of the basic sciences than students in
the new curriculum, except for pathophysiology/pathology, though the time devoted to this discipline in the new curriculum
had also decreased considerably.
PMID: 19785899
van Poppel PC, Stehouwer CD, Beutler JJ, Korst MB, Beerlage HP, Hoogeveen EK. Hyperchloremic metabolic
acidosis in a patient with an ureteroileostomy according to Bricker.
A 79-year-old male with a Bricker loop and chronic renal failure was admitted to hospital because progressive dyspnoea.
This was due to severe hyperchloraemic metabolic acidosis. Hyperchloraemic acidosis can occur if urinary diversions are
constructed from the colon or ileum. Contact between intestinal mucosa and urine may cause reabsorption of ammonium
and chloride, and secretion of bicarbonate. Hyperchloraemic acidosis is rarely seen with an incontinent ileal loop due to its
small absorbing surface area and the rapid drainage of urine from the loop. Hyperchloraemic acidosis in a patient with a
Bricker loop may point to prolonged contact between the ileum and urine. A loopogram is necessary to investigate the cause.
In our patient the loopogram showed that the incorporated bowel segment was too long. After shortening of the Bricker
loop, the patient recovered from the hyperchloraemic metabolic acidosis.
PMID: 19811904
van Herk-Sukel MP, van de Pll-Franse LV, Lemmens VE, Vreugdenhil G, Pruijt JF, Coebergh JW, Herings RM.
New opportunities for drug outcomes research in cancer patients: The linkage of the Eindhoven Cancer Registry
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and the PHARMO Record Linkage System.
Eur J Cancer 2010;46:395-404.
BACKGROUND: Insight into co-morbidity and treatment effects is pivotal to improve quality of care for
cancer patients.
OBJECTIVES: To determine whether linkage of the Eindhoven Cancer Registry (ECR) and the PHARMO
Record Linkage System (RLS) was technically feasible and to assess which patient-centric data would result from this linkage.
METHODS: The ECR records data on tumour stage and primary treatment of all newly diagnosed cancer patients in the southeastern Netherlands including co-morbidity at diagnosis, whereas the PHARMO RLS includes data from multiple linked observational databases such as data on drug utilisation (for both in- and out-patients, including chemotherapy), hospitalisations
and clinical laboratory measurements. All patients who lived or had been living in the overlapping area served by the ECR and
the PHARMO RLS during 1998-2006 were selected for linkage which was performed with probabilistic medical record linkage.
RESULTS: The linkage resulted in an ECR-PHARMO cohort of 40,004 cancer patients with a total of 42,767 primary tumours.
The cancer patients in the linked ECR-PHARMO cohort were representatives for the cancer patients included in the total ECR
during 1998-2006. Cancer patients included in the cohorts had a mean history of 5 years and a mean follow-up ranging from
2 to more than 4 years (dependent on the survival rate of the specific cancer type).
CONCLUSIONS: Linkage of ECR and the PHARMO RLS creates the possibility to study patient-centric drug utilisation, health
resources utilisation and their costs, in addition to the effectiveness and safety of pharmaceuticals in routine daily practice in
cancer patients.
PMID: 19818177
Van Wensen RJA, Bosscha K, Jager GJ, van der Linden JC, Fijnheer R.
An invasive process in the pancreas: sometimes lymphoma. (Een ruimteinnemend proces in het pancreas. Niet
altijd een carcinoom.)
An invasive process in the pancreas was found in a 60-year-old woman and a 50-year-old man with abdominal symptoms.
Generally, such findings turn out to be adenocarcinoma. However, these patients had lymphoma. Primary pancreatic
lymphoma or localization of lymphoma in the pancreas are rare and chemotherapy may be curative. Therefore, obtaining
tissue for histopathological confirmation of the diagnosis is very important. Both patients underwent chemotherapy. The first
patient was in complete remission one month after the last chemotherapy cycle. In the second, the disease went into remission, but he suddenly died of sepsis after the fourth chemotherapy cycle.
PMID: 19837938
de Lind van Wijngaarden RF, Siemensma EP, Festen DA, Otten BJ, van Mil EG, Rotteveel J, Odink RJ, Bindels-de
Heus GC, van Leeuwen M, Haring DA, Bocca G, Houdijk EC, Hoorweg-Nijman JJ, Vreuls RC, Jira PE, van
Trotsenburg AS, Bakker B, Schroor EJ, Pilon JW, Wit JM, Drop SL, Hokken-Koelega AC.
Efficacy and safety of long-term continuous growth hormone treatment in children with Prader-Willi syndrome.
J Clin Endocrinol Metab. 2009 Nov;94(11):4205-15.
BACKGROUND: Children with Prader-Willi syndrome (PWS) have abnormal body composition and impaired growth. Shortterm GH treatment has beneficial effects.
OBJECTIVES: The aim of the study was to investigate effects of long-term continuous GH treatment on body composition,
growth, bone maturation, and safety parameters.
183
SETTING: We conducted a multicenter prospective trial.
DESIGN: Fifty-five children with a mean +/- sd age of 5.9 +/- 3.2 yr were followed during 4 yr of continuous GH treatment
(1 mg/m(2) . d). Data were annually obtained in one center: fat percentage (fat%) and lean body mass (LBM) by dual-energy
x-ray absorptiometry, height, weight, head circumference, bone age, blood pressure, and fasting IGF-I, IGF binding protein-3, glucose, insulin, glycosylated hemoglobin, total cholesterol, high-density lipoprotein, and low-density lipoprotein. sd
scores (SDS) were calculated according to Dutch and PWS reference values (SDS and SDS(PWS)).
RESULTS: Fat%SDS was significantly lower after 4 yr of GH treatment (P < 0.0001). LBMSDS significantly increased during
the first year (P = 0.02) but returned to baseline values the second year and remained unchanged thereafter. Mean +/- sd
height normalized from -2.27 +/- 1.2 SDS to -0.24 +/- 1.2 SDS (P < 0.0001). Head circumference SDS increased from
-0.79 +/- 1.0 at start to 0.07 +/- 1.1 SDS after 4 yr. BMISDS(PWS) significantly decreased. Mean +/- sd IGF-I and the IGFI/IGF binding protein-3 ratio significantly increased to 2.08 +/- 1.1 and 2.32 +/- 0.9 SDS, respectively. GH treatment had no
adverse effects on bone maturation, blood pressure, glucose homeostasis, and serum lipids.
CONCLUSIONS: Our study in children with PWS shows that 4 yr of continuous GH treatment (1 mg/m(2) . d) improves
body composition by decreasing fat%SDS and stabilizing LBMSDS and head circumference SDS and normalizes heightSDS
without adverse effects. Thus, long-term continuous GH treatment is an effective and safe therapy for children with PWS.
PMID: 19841489
Van Kuilenburg JT, van Niekerk J, Sinnige H, de Jager CP.
Neth J Med. 2009 Oct;67(9):308-9.
PMID: 19847397
Simons KS, Pickkers PP, Oyen WJG van der Hoeven JG.
F-18-fluorodeoxyglucose positron emission tomography combined with CT in critically ill patients with
suspected of infection.
Intensive Care Med. 2010 Mar;36(3):504-11.
PURPOSE: To assess the value of F-18-fluorodeoxyglucose positron emission tomography (FDG-PET)
combined with CT in critically ill patients suspected of having an infection.
METHODS: FDG-PET CT scans requested for evaluation of a suspected infection or inflammatory process in critically ill,
mechanically ventilated patients were analyzed (blinded for the final clinical diagnosis) and compared with clinical follow-up.
RESULTS: Thirty-five FDG-PET/CT scans performed in 33 ICU patients (28 adults and 5 children), median age 58 years
(range 1 month-72 years), were analyzed. Twenty-one FDG-PET/CT scans were true positive. Three FDG-PET/CT scans
were considered false positive, in one case leading to additional diagnostic procedures (specificity 79%). Additionally, 11 true
negatives were found (sensitivity 100%), leading to an overall accuracy of 91%.
CONCLUSIONS: FDG-PET/CT scanning is of additional value in the evaluation of suspected infection in critically ill patients
in whom conventional diagnostics did not lead to a diagnosis. Apart from the high accuracy, in this study it appeared that, in
addition to conventional diagnostic techniques that were routinely performed, a normal FDG-PET/CT ruled out important
infections requiring prolonged antibiotic therapy or drainage. Since sensitivity is lower in highly metabolic active tissues (e.g.,
endocarditis, meningitis), the FDG-PET/CT scan is not suited to detect infections in these tissues.
PMID: 19854713
Hartkamp A, Geenen R, Godaert GL, Bijl M, Bijlsma JW, Derksen RH.
Effects of dehydroepiandrosterone on fatigue and well-being in women with quiescent
184
systemic lupus erythematosus: a randomised controlled trial.
Ann Rheum Dis. 2010 Jun;69(6):1144-7.
OBJECTIVE: Dehydroepiandrosterone (DHEA) has been reported to improve fatigue and reduced well-being. Both are major
problems in patients with systemic lupus erythematosus (SLE), even with quiescent disease. Low serum DHEA levels are
common in SLE. The present work investigates the effects of DHEA administration on fatigue, well-being and functioning in
women with inactive SLE.
METHODS: In a double-blind, randomised, placebo-controlled study, 60 female patients with inactive SLE received 200 mg
oral DHEA or placebo. Primary outcome measures were general fatigue, depressive mood, mental well-being and physical
functioning. Assessments were made before treatment, after 3, 6 and 12 months on medication, and 6 months after cessation of treatment.
RESULTS: Patients from the DHEA and placebo group improved on general fatigue (p<0.001) and mental well-being
(p=0.04). There was no differential effect of DHEA. The belief that DHEA had been used was a stronger predictor for improvement of general fatigue than the actual use of DHEA (p=0.04).
CONCLUSIONS: The trial does not indicate an effect of daily 200 mg oral DHEA on fatigue and well-being, and therefore
DHEA treatment is not recommended in unselected female patients with quiescent SLE.
PMID: 19855108
Brandes M, Hamilton CJ, de Bruin JP, Nelen WL, Kremer JA.
The relative contribution of IVF to the total ongoing pregnancy rate in a subfertile cohort.
Hum Reprod. 2010 Jan;25(1):118-26.
BACKGROUND: Although in vitro fertilization (IVF) was introduced more than 30 years ago, its exact role in the spectrum of
fertility treatments has never been studied in an unselected population. The aim of this study was to visualize the contribution of IVF to the ongoing pregnancy rates in a cohort of newly referred subfertile couples.
MATERIALS: All new subfertile couples (n = 1391) that were referred to our fertility clinic by their general practitioner
between January 2002 and December 2006 were included. Fertility care was provided according to the national Dutch
fertility guidelines. Data on diagnosis, treatment, mode of conception and pregnancy outcome were documented. If followup data were missing, couples were contacted. Cumulative pregnancy curves were constructed for the whole cohort and per
diagnostic group.
RESULTS: As per December 2008 the overall ongoing pregnancy rate was 72.0% (n = 1001). Almost half of the pregnancies
were conceived spontaneously (45.6%), 19.2% after ovulation induction (OI), 14.0% after intrauterine insemination (IUI) and
21.2% after IVF. A quarter (n = 349) of couples received IVF treatment, which was successful in 60% of cases. IVF had the
largest contribution to ongoing pregnancies in patients with ‘tubal factor’, ‘endometriosis’ and ‘male factor’ (45, 45 and 37%,
respectively) while in couples with ‘unexplained subfertility’ and ‘ovulation disorders’ the contribution to ongoing pregnancies
of IVF was limited (13 and 4.5%, respectively).
CONCLUSIONS: In a cohort of subfertile couples, most pregnancies were conceived spontaneously. The contribution of IVF to
ongoing pregnancy rates was comparable to those of OI and IUI. Compared with the pre-IVF era, couples with ‘endometriosis’, ‘tubal factor’ and ‘male subfertility’ have benefited most from its introduction.
PMID: 19857286
Hermans MH, Poodt J, van Geest-Daalderop JH, Péquériaux NC, Conemans JM.
Resistance to coumarin derivatives due to mutated vitamin-K enzyme.
185
In 2006 a case report was published in this journal describing partial acenocoumarol- and phenprocoumon resistance in a
78-year-old man. A mutation in the VKORC1 gene was suggested to be the cause of the observed resistance. We examined
the patient and found a new and hitherto unknown mutation in the VKORC1 gene which may well explain the observed resistance. The mutation concerns a polymorphism in exon 2 that predicts the substitution of tryptophan at position 59 of the
VKOR protein by arginine, the p.Trp59Arg mutation. Meanwhile, we have detected the same p.Trp59Arg mutation in another
patient with coumarin derivative resistance. The fact that this mutation did not occur in 100 individuals who responded well
to coumarin derivatives, together with the knowledge that amino acid 59 is conserved among species, renders it likely that
p.Trp59Arg was the cause of the partial acenocoumarol- and phenprocoumon resistance observed in these two patients.
PMID: 19864365
Van Wijk PT, Schneeberger PM, Heimeriks K, Boland GJ, Karagiannis I, Geraedts J, Ruijs WL.
Occupational blood exposure accidents in the Netherlands.
Eur J Public Health. 2010 Jun;20(3):281-7.
BACKGROUND: To make proper evaluation of prevention policies possible, data on the incidence and associated medical
costs of occupational blood exposure accidents in the Netherlands are needed.
METHODS: Descriptive analysis of blood exposure accidents and risk estimates for occupational groups. Costs of handling
accidents were calculated.
RESULTS: Each year, an estimated 13,000-15,000 blood exposure accidents are reported in the Netherlands, 95% in occupational settings. Hepatitis B (HBV) vaccination is offered free of charge only to people in risk groups, the seroprevalence
of HBV, hepatitis C (HCV) and human immunodeficiency virus (HIV) is low and few infections are related to blood exposure
accidents. High-risk accidents occur mainly in hospitals. In nursing homes and home care settings, the majority of the
accidents are low-risk. Limited data are available about occurrence of accidents in other occupational groups. Associated
medical costs from occupational blood exposure accidents are mainly determined by the initial risk management.
CONCLUSIONS: Accidents must be managed effectively to prevent infection and reduce anxiety in injured employees. While
strategies to reduce HCV and HIV infection should be primarily aimed at reducing the occurrence of high-risk accidents,
vaccination can prevent HBV infection and cut the costs of handling low-risk accidents. The implementation of vaccination
strategies, safe working policies and the proper use of safe equipment should be monitored better.
PMID: 19864666
Tieleman AA, den Broeder AA, van de Logt AE, van Engelen BG.
Strong association between myotonic dystrophy type 2 and autoimmune diseases.
J Neurol Neurosurg Psychiatry. 2009 Nov;80(11):1293-5.
BACKGROUND: Myotonic dystrophy type 2 (DM2) is a dominantly inherited multisystem disorder, characterised by progressive proximal weakness, myotonia, cataracts and cardiac conduction abnormalities. Our clinical impression of an association
between DM2 and autoimmune diseases or autoantibody formation has not been published previously.
OBJECTIVE: The aim of the present study was to investigate the frequency of autoimmune diseases and serum autoantibodies in patients with DM2 compared with patients with adult onset myotonic dystrophy type 1 (DM1).
METHODS: 28 genetically proven Dutch DM2 patients participated in the study and were compared with 51 age and sex
matched adult onset DM1 patients. As the primary outcome measure, the presence of an autoantibody or autoreactive T cell
associated autoimmune disorder was assessed. As a secondary outcome measure, the presence of autoantibodies in serum
(nuclear and non-nuclear antibodies) was assessed in all patients.
RESULTS: The frequency of autoimmune diseases (21% vs 2%) and the frequency of autoantibodies (25% vs 2%) were both
186
significantly (p<0.01) higher in DM2 patients compared with DM1 patients. Data on DM1 patients were comparable with the
general population. Results were not confounded by smoking, medication use, familial clustering, age or sex.
CONCLUSION: The results provide new insight into the clinical picture of DM2. In addition, possible explanations for the association between DM2 and autoimmune diseases are proposed.
PMID: 19875752
Van Nes JG, Seynaeve C, Maartense E, Roumen RM, de Jong RS, Beex LV, Meershoek-Klein Kranenbarg WM,
Putter H, Nortier JW, Van de Velde CJ; Cooperating investigators of the Dutch TEAM trial (Bosscha K).
Patterns of care in Dutch postmenopausal patients with hormone-sensitive early breast cancer participating in
the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial.
Ann Oncol. 2010 May;21(5):974-82.
BACKGROUND: The Tamoxifen and Exemestane Adjuvant Multinational (TEAM) trial investigates the efficacy and safety
of adjuvant exemestane alone and in sequence after tamoxifen in postmenopausal women with hormone-sensitive early
breast cancer. As there was a nationwide participation in The Netherlands, we studied the variations in patterns of care in
the Comprehensive Cancer Centre Regions (CCCRs) and compliance with national guidelines.
METHODS: Clinicopathological characteristics, carried out local treatment strategies and adjuvant chemotherapy data were
collected.
RESULTS: From 2001 to January 2006, 2754 Dutch patients were randomised to the study. Mean age of patients was 65
years (standard deviation 9). Tumours were < or =2 cm in 46% (within CCCRs 39%-50%), node-negative disease varied from
25% to 45%, and PgR status was determined in 75%-100% of patients. Mastectomy was carried out in 55% (45%-70%),
sentinel lymph node procedure in 68% (42%-79%) and axillary lymph node dissections in 77% (67%-83%) of patients, all
different between CCCRs (P < 0.0001). Adjuvant chemotherapy was given in 15%-70% of eligible patients (P < 0.001).
DISCUSSION: In spite of national guidelines, breast cancer treatment on specific issues widely varied between the various
Dutch regions. These data provide valuable information for breast cancer organisations indicating (lack of) guideline
adherence and areas for breast cancer care improvement.
PMID: 19875991
Vink EE, van Coeverden SC, van Mil EG, Felius BA, van Leerdam FJ, Delemarre-van de Waal HA.
Obesity (Silver Spring). 2010 Jun;18(6):1247-51.
Puberty is a critical period in body composition development. The influence of puberty on the development of fat mass
asks for further investigation. We investigated the development of fat mass during puberty in a longitudinal prospective
study in 152 healthy nonobese white girls, initial ages between 9 to 12 years. The influence of menarcheal age and the
existing of tracking of fat mass have been analyzed. In 10 years time, participants were measured on eight time points.
Various anthropometric data were collected, breast development was staged according to Tanner and body composition
was determined with the dual-energy X-ray absorptiometry (DXA) scan. Calculations were made with the use of a linear
mixed model. Fat mass increases from 7.9 kg (23.6%) at B1 to 18.5 kg (29.3%) at B5. Fat mass is higher in girls with an early
menarche than in girls with a late menarche from B2. Girls in the quartile with initially the lowest fat mass have a chance
of being in the same quartile after 10 years of 77% (P < 0.001). Girls in the quartile with initially the highest fat mass, have
a risk of staying in the highest quartile of 55% (P < 0.001). Menarcheal age is of great influence on the development of fat
mass. Girls with an early menarche, will have a bigger fat mass, especially at the end of puberty. Tracking of fat mass exists:
a high amount of fat mass in early puberty will continue to exist at young adulthood.
187
PMID: 19880434
van Steenbergen LN, Rutten HJ, Creemers GJ, Pruijt JF, Coebergh JW, Lemmens VE.
Large age and hospital-dependent variation in administration of adjuvant chemotherapy for stage III colon
cancer in southern Netherlands.
Ann Oncol. 2010 Jun;21(6):1273-8.
BACKGROUND: The purpose was to assess factors associated with the administration of chemotherapy and their relation to
survival at a population-based level.
METHODS: All patients diagnosed with primary colon cancer stage III from 2001 to 2007 in the area of the Eindhoven
Cancer Registry were included (N = 1637). We examined determinants of the administration of adjuvant chemotherapy and
their relation to survival.
RESULTS: The proportion of patients receiving adjuvant chemotherapy decreased with increasing age from 85% for patients
<65 years to 68% for those 65-74 years and 17% for patients > or =75 years, with large interhospital variation. Elderly
patients {odds ratio (OR) 0.1 [95% confidence interval (CI) 0.1-0.1]} and those with comorbidity [OR 0.6 (95% CI 0.5-0.8)]
received adjuvant chemotherapy less often. Patients with an intermediate [OR 1.4 (95% CI 1.1-1.9)] or high socioeconomic
status [OR 1.5 (95% CI 1.1-2.0)] or stage IIIC [OR 1.5 (95% CI 1.1-2.0)] received adjuvant chemotherapy more often.
Adjuvant chemotherapy was the most important predictor of survival. In a multivariable analysis, older age was no longer a
significant negative predictor of survival, in contrast to comorbidity, higher tumor stage, poor tumor grade, and male gender.
The improvement in survival from 2001 to 2006 did not reach statistical significance.
CONCLUSION: Adherence to guidelines for adjuvant chemotherapy was still suboptimal in 2007, especially for elderly
patients, and differed widely between hospitals.
PMID: 19880501
Lokhorst HM, van der Holt B, Zweegman S, Vellenga E, Croockewit S, van Oers MH, von dem Borne P,
Wijermans P, Schaafsma R, de Weerdt O, Wittebol S, Delforge M, Berenschot H, Bos GM, Jie KS, Sinnige H,
van Marwijk-Kooy M, Joosten P, Minnema MC, van Ammerlaan R, Sonneveld P; Dutch-Belgian HematoOncology Group (HOVON).
A randomized phase 3 study on the effect of thalidomide combined with adriamycin, dexamethasone, and
high-dose melphalan, followed by thalidomide maintenance in patients with multiple myeloma.
Blood. 2010 Feb 11;115(6):1113-20.
The phase 3 trial HOVON-50 was designed to evaluate the effect of thalidomide during induction treatment and as
maintenance in patients with multiple myeloma who were transplant candidates. A total of 556 patients was randomly
assigned to arm A: 3 cycles of vincristine, adriamycin, and dexamethasone, or to arm B: thalidomide 200 mg orally, days 1
to 28 plus adriamycin and dexamethasone. After induction therapy and stem cell mobilization, patients were to receive highdose melphalan, 200 mg/m(2), followed by maintenance with alpha-interferon (arm A) or thalidomide 50 mg daily (arm
B). Thalidomide significantly improved overall response rate as well as quality of the response before and after high dose
melphalan. Best overall response rate on protocol was 88% and 79% (P = .005), at least very good partial remission 66% and
54% (P = .005), and complete remission 31% and 23% (P = .04), respectively, in favor of the thalidomide arm. Thalidomide
also significantly improved event-free survival from median 22 months to 34 months (P < .001), and prolonged progression
free from median 25 months to 34 months (P < .001). Median survival was longer in the thalidomide arm, 73 versus 60
months; however, this difference was not significant (P = .77). Patients randomized to thalidomide had strongly reduced
survival after relapse.
188
PMID: 19898738
Faraj D, Ruurda JP, Olsman JG, van Geffen HJ.
Five-year results of inguinal hernia treatment with the Prolene Hernia System in a regional training hospital.
Hernia. 2010 Apr;14(2):155-8.
PURPOSE: Long-term results of inguinal hernia repair with the Prolene Hernia System (PHS) in our regional training
hospital were retrospectively analysed. Research was conducted in an identical cohort of patients previously investigated
for short-term results.
METHODS: One-hundred and fifty-eight patients (217 inguinal hernias) treated with the PHS were traced and included.
Patients were invited to visit the outpatient clinic for a brief history, physical examination and ultrasound. A quality of life
questionnaire was completed by all patients. The primary endpoint was recurrence rate. Testis atrophy, chronic pain and
hypaesthesia were secondary endpoints.
RESULTS: The mean age of the population (n = 187) was 62.2 years (range 28-92), with a male:female ratio of
15:1 (175:12). The median follow-up was 5.5 years (range 3.9-6.8). One-hundred and forty-five patients visited the
outpatient clinic, while 13 patients were included by telephone interview. Twenty-one patients died during follow-up
and eight others were lost to follow-up. The resulting follow-up rate was 85% (158/187). In our initial study, we found
four recurrences (1.8%) and seven patients with persisting pain (3.2%) after 32 months. During current follow-up, five
patients were diagnosed with recurrent herniation (2.3%, 5/217) and only four patients (1.8%) suffered from persisting
pain. Three patients (1.4%) were diagnosed with testicular atrophy, while ten patients (4.4%) experienced hypaesthesia.
CONCLUSION: In a regional training hospital, the recurrence rate and long-term complications of patients treated
for inguinal hernia with the PHS are acceptable after a follow-up of 5.5 years. The number of patients experiencing
persistent pain seems to decrease over time.
PMID: 19900138
De Reu PA, van Diem MT, Eskes M, Oosterbaan HP, Smits LJ, Merkus JM, Nijhuis JG.
The Dutch Perinatal Audit Project: a feasibility study for nationwide perinatal audit in the Netherlands.
Acta Obstet Gynec Scand. 2009;88(11):1201-8.
OBJECTIVE: To investigate the feasibility of nationwide perinatal mortality audits in the Netherlands.
STUDY DESIGN: Over a one-year period, data for all cases of perinatal mortality were collected. Six perinatal audit
panels of professionals within perinatal care investigated and classified causes of death and identified the presence of
substandard care factors (SSF).
RESULTS: Out of 22,189 newborns, 228 cases of perinatal mortality were audited. Placental pathology, congenital
anomalies and preterm birth were the main causes of perinatal death. SSF by caregivers were identified in 72 cases (32
%). Almost 20% of the cases were not reported.
CONCLUSIONS: In the Netherlands, perinatal audit is well supported by all groups of caregivers. It reveals usable facts
and findings for the quality assessment of perinatal care. This audit showed that in 9% of the cases perinatal death was
related to SSF and potentially avoidable. However, immediate reporting of cases of perinatal death apart from regular
registration in the perinatal database proved to be inaccurate. Once a nationwide audit program is realized, in which
data from the different caregivers will be collected in a single database instead of collection by linkage afterwards,
this problem should be solved. Local audits will start from 2009. These audits will assess mortality cases within their
respective areas and may initiate adjustments for perinatal care and optimize the quality of care and inter-professional
collaboration. Yearly nationwide audits will focus on specific items (e.g. term or post-term deliveries) and may well offer
an opportunity for the development or adjustment of national guidelines.
189
PMID: 19900320
Schouten HW, Knippels MC, Franken RJ.
Maggots in the wound, debridement, disinfection and wound healing.
An 87-year-old man had a longstanding untreated large basosquamous carcinoma on his right ear. He was admitted
to the emergency department at our hospital. A large portion of the auricle had perished, together with part of the
tumour. Surgery was planned but two days before, the patient complained of an irritating loud noise in his ear. We
discovered this was caused by maggots in his external acoustic meatus: myiasis. Dozens of maggots were removed.
A striking finding was that the smell of the wound had disappeared and that the wound was much cleaner, with a
reddish aspect and less necrosis. The surgical procedure was uneventful. Larval therapy has been known for centuries.
In recent years it has gained renewed interest as it may enhance wound debridement, wound disinfection, and may
promote wound healing.
PMID: 19913419
Lammers EJ, Huibers P, van der Sangen MJ, van de Poll-Franse LV, Poortmans PM,
Ernst MF, Lemaire BM, Meijs CM, Nuytinck HK, Voogd AC.
Factors contributing to improved local control after mastectomy in patients with breast cancer aged 40
years or younger.
Breast. 2010 Feb;19(1):44-9.
Long-term local control rates were studied in a series of 659 patients with invasive breast cancer aged 40 years or
younger, who underwent mastectomy in general hospitals in the southern part of the Netherlands between 1988 and
2005. During a median follow-up time of 6.0 years, 34 patients developed a local recurrence in the chest wall without
previous or simultaneous evidence of distant disease. The 5- and 10-year actuarial local recurrence rates for the total
group were 5.6% (95% confidence interval [95% CI], 3.5-7.7%) and 7.3% (95% CI, 4.7-9.9%), respectively. A multivariate
analysis showed that patients receiving radiotherapy (hazards ratio [HR], 0.29; 95% CI, 0.10-0.96) or adjuvant systemic
treatment (HR 0.23; 95% CI, 0.08-0.65) had a significantly lower risk of local recurrence. It is concluded that excellent
local control rates can be obtained with mastectomy in young women with breast cancer, especially in those who
receive adjuvant systemic treatment and/or radiotherapy.
PMID: 19915839
Boellaard R, O’Doherty MJ, Weber WA, Mottaghy FM, Lonsdale MN, Stroobants SG, Oyen WJ, Kotzerke J,
Hoekstra OS, Pruim J, Marsden PK, Tatsch K, Hoekstra CJ, Visser EP, Arends B, Verzijlbergen FJ, Zijlstra
JM, Comans EF, Lammertsma AA, Paans AM, Willemsen AT, Beyer T, Bockisch A, Schaefer-Prokop C,
Delbeke D, Baum RP, Chiti A, Krause BJ.
FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0.
Eur J Nucl Med Mol Imaging. 2010 Jan;37(1):181-200.
The aim of this guideline is to provide a minimum standard for the acquisition and interpretation of PET and PET/
CT scans with [18F]-fluorodeoxyglucose (FDG). This guideline will therefore address general information about[18F]fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) and is provided to help the
physician and physicist to assist to carrying out,interpret, and document quantitative FDG PET/CT examinations,but will
concentrate on the optimisation of diagnostic quality and quantitative information.
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PMID: 19921303
Jongen PJ, Sindic C, Carton H, Zwanikken C, Lemmens W, Borm G;
Functional composite and quality of Life in Avonex-treated Relapsing multiple sclerosis patients study
group. Anten, Driessen, Baard, Frequin, Hintzen, Hupperts, Jongen, Linssen, MispelblomBeyer, Moll, van
Munster, Pratzsky, Sanders, Smits, van Walbeek, Willems, Witjes, van Zuilen, Bartholomé, Braeckveldt,
Van der Motte, Debruyne, Decoo, Dedeyn, Engelborghs, Dupuis, Jacquerye, Van de Gaer, Guillaume,
Reznik, Harmant, D’Hooghe, Klippel, Willems, van Landegem, Strauven, Maertens de Noordhout,
Delavaux, Nagels, Seeldrayers, Vervonck, Sindic, Goffette, El-Memar, Hawkins, de Diego.
Improvement of health-related quality of life in relapsing remitting multiple sclerosis patients after 2
years of treatment with intramuscular interferon-beta-1a.
J Neurol. 2010 Apr;257(4):584-9.
In patients with relapsing remitting multiple sclerosis (RRMS), the effect of interferon-beta (INFb) on health-related
quality of life (HR-QoL) is not firmly documented. The objective of this study is to assess HR-QoL during 2 years of
treatment with intramuscular INFb and its correlation with disability. In 36 neurological practices in the Netherlands
(17), Belgium (16), United Kingdom (2) and Luxemburg (1), 284 RRMS patients were treated with intramuscular INFb1a. Physical and mental domains of HR-QoL were measured by the MS54 Quality of Life (MS54QoL) questionnaire,
and disability was assessed by the Multiple Sclerosis Functional Composite (MSFC) (Timed 25-Foot Walk Test [Timed
25-FWT], 9 Hole Peg Test [9-HPT], Paced Auditory Serial Addition Test [PASAT]) at baseline and at months 3, 6, 12, 18
and 24. Expanded Disability Status Scale (EDSS) score was assessed at baseline and month 24. Pearson’s correlation
coefficients were determined and predefined factors were analyzed for relation to HR-QoL after baseline by stepwise
regression analyses on physical and mental scores. 204 patients (71.8%) completed 2 years of treatment. Mean values
for MS54QoL increased from 56.6 to 61.0 for physical (p < 0.05) and from 57.2 to 61.1 for mental domain (p = 0.07).
Correlations between physical domain and MSFC was -0.40 (p < 0.05), and between mental domain and MSFC -0.24
(p < 0.05). MSFC and EDSS did not change. Increase of physical MS54QoL was associated with lower age, lower EDSS,
less time for Timed 25-FWT, and higher PASAT score at baseline. Increase of mental MS54QoL was associated with
higher PASAT and lower EDSS. Patients who discontinued INFb had lower physical or mental HR-QoL at baseline. In
RRMS patients, 2 years of treatment with intramuscular INFb-1a is associated with an increase in HR-QoL, especially
in younger patients with low disability.
PMID: 19923824
Transanal endoscopic microsurgery for local excision of rectal lesions: is there a learning curve?
Dig Surg. 2009;26(5):372-7.
BACKGROUND: Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for the local resection of
benign and stage T1 rectal lesions in selected patients, associated with lower morbidity and mortality rates than open
surgery. We present our initial results and assess whether experience influences outcome after TEM.
METHODS: This was a prospective descriptive survey. All patients undergoing TEM for tubulovillous adenoma or
carcinoma between 2002 and 2007 were included.
RESULTS: A total of 105 patients were included. Median age was 68 years. Median distance of the lesion from the anal
verge was 7.0 cm; median operating time was 90 min. In 10 patients, the peritoneum was opened. Six procedures
were converted to (low) anterior resections. Postoperative staging revealed 77 tubulovillous adenomas, 22 stage T1,
5 stage T2 and 1 stage T3 carcinomas; tumor resection was radical in 86%. The postoperative complication rate was
191
7.6%. Length of hospital stay, operating time and complications significantly diminished over time. After a median
follow-up of 27 months, 8 recurrences occurred (7.6%).
CONCLUSION: TEM is a safe technique with low morbidity and recurrence rates. Over time, experience leads to a
reduction in operation time, length of patients’ hospital stay and complication rate. TEM remains the treatment of
choice for benign lesions and stage T1 rectal carcinomas in selected patients.
PMID: 19930740
Mattheij M, van der Weij AM.
A girl with recurrent swelling of the parotis region.
Ned Tijdschr Geneesk. 2009;153-A188.
PMID: 19941334
Bernsen RA, de Jager AE, Kuijer W, van der Meche FG, Suurmeijer TP.
Psychosocial dysfunction in the first year after Guillain-Barre syndrome.
Muscle Nerve 2010 Apr;41(4):533-9.
In this investigation we study the impact of Guillain-Barré syndrome (GBS) on psychological distress, depressive
symptoms, and health status of patients during the first year after GBS. At 3, 6, and 12 months, patients were given
the General Health Questionnaire, the Sickness Impact Profile, and the Center for Epidemiologic Studies Depression
Scale. Eighty-five patients participated. Psychological distress and depressive symptoms were present but improved
between 3 and 6 months. At 12 months the psychosocial health status was still impaired. Patients who perceived their
physical residua to be moderately to seriously disruptive and patients with muscle ache and cramps had worse scores
on all scales. It can be concluded that most of the improvement occurred in the first 6 months. Psychosocial health
status, however, was still impaired at 1 year, but depressive symptoms played no role. Treatment of muscle ache and
cramps, and the disruptive effect of physical residua should be seriously considered.
PMID: 19959398
Munneke M, Nijkrake MJ, Keus SH, Kwakkel G, Berendse HW, Roos RA, Borm GF, Adang EM, Overeem S,
Bloem BR; ParkinsonNet Trial Study Group.(ter Bruggen JP)
Efficacy of community-based physiotherapy networks for patients with Parkinson’s disease: a clusterrandomised trial.
Lancet Neurol. 2010 Jan;9(1):46-54.
BACKGROUND: Many patients with Parkinson’s disease are treated with physiotherapy. We have developed a communitybased professional network (ParkinsonNet) that involves training of a selected number of expert physiotherapists to work
according to evidence-based recommendations, and structured referrals to these trained physiotherapists to increase the
numbers of patients they treat. We aimed to assess the efficacy of this approach for improving health-care outcomes.
METHODS: Between February, 2005, and August, 2007, we did a cluster-randomised trial with 16 clusters (defined
as community hospitals and their catchment area). Clusters were randomly allocated by use of a variance minimisation
algorithm to ParkinsonNet care (n=8) or usual care (n=8). Patients were assessed at baseline and at 8, 16, and 24 weeks
of follow-up. The primary outcome was a patient preference disability score, the patient-specific index score, at 16 weeks.
Health secondary outcomes were functional mobility, mobility-related quality of life, and total societal costs over 24
weeks. Analysis was by intention to treat. This trial is registered, number NCT00330694.
FINDINGS: We included 699 patients. Baseline characteristics of the patients were comparable between the ParkinsonNet
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clusters (n=358) and usual-care clusters (n=341). The primary endpoint was similar for patients within the ParkinsonNet
clusters (mean 47.7, SD 21.9) and control clusters (48.3, 22.4). Health secondary endpoints were also similar for patients
in both study groups. Total costs over 24 weeks were lower in ParkinsonNet clusters compared with usual-care clusters
(difference euro727; 95% CI 56-1399).
INTERPRETATION: Implementation of ParkinsonNet networks did not change health outcomes for patients living in ParkinsonNet clusters. However, health-care costs were reduced in ParkinsonNet clusters compared with usual-care clusters.
FUNDING: ZonMw; Netherlands Organisation for Scientific Research; Dutch Parkinson’s Disease Society; National
Parkinson Foundation; Stichting Robuust.
PMID: 19961479
Schmeits PC, Hermans MH, van Geest-Daalderop JH, Poodt J, de Sauvage Nolting PR, Conemans JM.
VKORC1 mutations in patients with partial resistance to phenprocoumon.
Br J Haematol. 2010 Mar;148(6):955-7.
PMID: 19962805
Penne EL, van der Weerd NC, van den Dorpel MA, Grooteman MP, Lévesque R, Nubé MJ, Bots ML,
Blankestijn PJ, ter Wee PM; CONTRAST Investigators.
Short-term effects of online hemodiafiltration on phosphate control: a result from the randomized
controlled Convective Transport Study (CONTRAST). (Hoogeveen EK).
Am J Kidney Dis. 2010 Jan;55(1):77-87.
BACKGROUND: Hyperphosphatemia is an independent risk factor for all-cause and cardiovascular mortality in hemodialysis (HD) patients. Phosphate control often is unsuccessful using conventional dialysis therapies.
STUDY DESIGN: Short-term analysis of a secondary outcome of an ongoing randomized controlled trial.
SETTING & PARTICIPANTS: 493 (84%) consecutive patients from 589 patients included in the Convective Transport
Study (CONTRAST) by January 2009 from 26 centers in 3 countries.
INTERVENTION: Online hemodiafiltration (HDF) versus continuation of low-flux HD.
OUTCOMES: Differences in change from baseline to 6 months in phosphate levels and proportion of patients reaching
phosphate treatment targets (phosphate < or = 5.5 mg/dL).
MEASUREMENTS: Phosphate, use of phosphate-binding agents, and proportion of patients achieving treatment
targets at baseline, 3 months, and 6 months.
RESULTS: Phosphate levels decreased from 5.18 +/- 0.10 (SE) mg/dL at baseline to 4.87 +/- 0.10 mg/dL at 6 months
in HDF patients (P < 0.001) and were stable in HD patients (5.10 +/- 0.10 mg/dL at baseline and 5.03 +/- 0.10 mg/
dL after 6 months; P = 0.5). The difference in change in phosphate levels between HD and HDF patients (B = -0.24;
95% CI, -0.52 to 0.03; P = 0.08) increased after adjustment for phosphate-binder use (B = -0.36; 95% CI, -0.65 to
-0.06; P = 0.02). The proportion of patients reaching phosphate treatment targets increased from 64% to 74% in HDF
patients and was stable in HD patients (66% and 66%); the difference between groups reached statistical significance (P
= 0.04). Nutritional parameters and residual renal function were similar in both treatment groups.
LIMITATIONS: Only predialysis serum phosphate levels were measured; phosphate clearance could therefore not be
calculated.
CONCLUSION: HDF may help improve phosphate control. Whether this contributes to improved clinical outcome
remains to be established.
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PMID: 19965537
Penne EL, van der Weerd NC, Blankestijn PJ, van den Dorpel MA, Grooteman MP, Nubé MJ, Ter Wee PM,
Lévesque R, Bots ML; CONTRAST investigators.(Hoogeveen EK).
Role of residual kidney function and convective volume on change in beta2-microglobulin levels in
hemodiafiltration patients.
Clin J Am Soc Nephrol. 2010;5:80-86.
BACKGROUND AND OBJECTIVES: Removal of beta2-microglobulin (beta2M) can be increased by adding convective
transport to hemodialysis (HD). The aim of this study was to investigate the change in beta2M levels after 6-mo
treatment with hemodiafiltration (HDF) and to evaluate the role of residual kidney function (RKF) and the amount of
convective volume with this change.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Predialysis serum beta2M levels were evaluated in 230
patients with and 176 patients without RKF from the CONvective TRAnsport STudy (CONTRAST) at baseline and 6 mo
after randomization for online HDF or low-flux HD. In HDF patients, potential determinants of change in beta2M were
analyzed using multivariable linear regression models.
RESULTS: Mean serum beta2M levels decreased from 29.5 +/- 0.8 (+/-SEM) at baseline to 24.3 +/- 0.6 mg/L after
6 mo in HDF patients and increased from 31.9 +/- 0.9 to 34.4 +/- 1.0 mg/L in HD patients, with the difference of
change between treatment groups being statistically significant (regression coefficient -7.7 mg/L, 95% confidence
interval -9.5 to -5.6, P < 0.001). This difference was more pronounced in patients without RKF as compared with
patients with RKF. In HDF patients, beta2M levels remained unchanged in patients with GFR >4.2 ml/min/1.73 m2.
The beta2M decrease was not related to convective volume.
CONCLUSIONS: This study demonstrated effective lowering of beta2M levels by HDF, especially in patients without
RKF. The role of the amount of convective volume on beta2M decrease appears limited, possibly because of resistance
to beta2M transfer between body compartments.
PMID: 20012891
Ruiterkamp J, Voogd AC, Bosscha K, Tjan-Heijnen VC, Ernst MF.
Impact of breast surgery on survival in patients with distant metastases at initial presentation: a
systematic review of the literature.
Breast Cancer Res Treat. 2010 Feb;120(1):9-16.
According to current treatment standards, patients with metastatic breast cancer at diagnosis receive palliative therapy.
Local treatment of the breast is only recommended if the primary tumor is symptomatic. Recent studies suggest that
surgical removal of the primary tumor has a favorable impact on the prognosis of patients with primary metastatic
breast cancer. We performed a systematic review of the literature to weigh the evidence for and against breast surgery
in this patient group. Ten retrospective studies were found in which the use of breast surgery in primary metastatic
breast cancer and its impact on survival was examined. The hazard ratios of the studies were pooled to provide an
estimate of the overall effect of surgery, and the results and conclusions of the studies were analyzed. A crude analysis,
without adjustment for potential confounders, showed that surgical removal of the breast lesion in stage-IV disease
was associated with a significantly higher overall survival rate in seven of the ten studies, and a trend toward a better
survival in the three remaining studies. Surgery of the primary tumor appeared to be an independent factor for an
improved survival in the multivariate analyses from the individual studies, with hazard ratios ranging from 0.47 to
0.71. The pooled hazard ratio for overall mortality was 0.65 (95% CI 0.59-0.72) in favor of the patients undergoing
surgery. This systematic review of the literature suggests that surgery of the primary breast tumor in patients with
194
stage-IV disease at initial presentation does have a positive impact on survival. In order to provide a definite answer
on whether local tumor control in patients with primary metastatic disease improves survival, a randomized controlled
trial comparing systemic therapy with and without breast surgery is needed.
PMID: 20015414
Giard RW, Broekman JM.
Missed malignant melanoma: legal considerations
Malignant melanoma may be missed both clinically and histopathologically. The appearance of metastases after
local excision of a skin lesion which was not recognized as melanoma indicates a diagnostic error. In a lawsuit three
things have to be proven: that the doctor has behaved negligently, that the patient has been damaged and that there
is a causal relation between the two. After local excision of a lesion that subsequently proves to be a metastasized
melanoma, no damage (‘loss of chance’) occurs because neither local surgery nor adjuvant therapy influences diseasefree survival. These particularities are of importance in legal judgments.
PMID: 20016402
Ramakers BP, Pickkers P.
Adenosine-mediated attenuation of the innate immune response for only those who need it? The tailored
potential of pentoxifylline.
Shock. 2010 Jul;34(1):105-6.
PMID: 20021568
Van Nes SI, Vanhoutte EK, Faber CG, Garssen MP, van Doorn PA, Merkies IS; PeriNomS Study Group.
Improving fatigue assessment in immune-mediated neuropathies: the modified
Rasch-built fatigue severity scale.
J Peripher Nerv Syst. 2009 Dec;14(4):268-78.
Fatigue is a major disabling complaint in patients with immune-mediated neuropathies (IN). The 9-item fatigue
severity scale (FSS) has been used to assess fatigue in these conditions, despite having limitations due to its classic
ordinal construct. The aim was to improve fatigue assessment in IN through evaluation of the FSS using a modern clinimetric approach [Rasch unidimensional measurement model (RUMM2020)]. Included were 192 stable patients with
Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) or polyneuropathy
associated with monoclonal gammopathy of undetermined significance (MGUSP). The obtained FSS data were exposed
to RUMM2020 model to investigate whether this scale would meet its expectations. Also, reliability and validity studies
were performed. The original FSS did not meet the Rasch model expectations, primarily based on two misfitting
items, one of these also showing bias towards the factor ‘walking independent.’ After removing these two items and
collapsing the original 7-point Likert options to 4-point response categories for the remaining items, we succeeded in
constructing a 7-item Rasch-built scale that fulfilled all requirements of unidimensionality, linearity, and rating scale
model. Good reliability and validity were also obtained for the modified FSS scale. In conclusion, a 7-item linearly
weighted Rasch-built modified FSS is presented for more proper assessment of fatigue in future studies in patients
with immune-mediated neuropathies.
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PMID: 20021654
Bensdorp AJ, Slappendel E, Koks C, Oosterhuis J, Hoek A, Hompes P, Broekmans F, Verhoeve H,
de Bruin JP, van Weert JM, Traas M, Maas J, Beckers N, Repping S, Mol BW, van der Veen F, van Wely M.
The INeS study: prevention of multiple pregnancies: a randomised controlled trial comparing IUI COH
versus IVF e SET versus MNC IVF in couples with unexplained or mild male subfertility.
BMC Womens Health. 2009 Dec 18;9:35.
BACKGROUND: Multiple pregnancies are high risk pregnancies with higher chances of maternal and neonatal mortality
and morbidity. In the past decades the number of multiple pregnancies has increased. This trend is partly due to the
fact that women start family planning at an increased age, but also due to the increased use of ART.Couples with unexplained or mild male subfertility generally receive intrauterine insemination IUI with controlled hormonal stimulation
(IUI COH). The cumulative pregnancy rate is 40%, with a 10% multiple pregnancy rate.This study aims to reveal whether
alternative treatments such as IVF elective Single Embryo Transfer (IVF e SET) or Modified Natural Cycle IVF (MNC IVF)
can reduce the number of multiple pregnancy rates, but uphold similar pregnancy rates as IUI COH in couples with
mild male or unexplained subfertility. Secondly, the aim is to perform a cost effective analyses and assess treatment
preference of these couples.
METHODS/DESIGN: We plan a multicentre randomised controlled clinical trial in the Netherlands comparing six cycles
of intra-uterine insemination with controlled ovarian hyperstimulation or six cycles of Modified Natural Cycle (MNC)
IVF or three cycles with IVF-elective Single Embryo Transfer (eSET) plus cryo-cycles within a time frame of 12 months.
Couples with unexplained subfertility or mild male subfertility and a poor prognosis for treatment independent pregnancy will be included. Women with anovulatory cycles, severe endometriosis, double sided tubal pathology or serious
endocrine illness will be excluded.Our primary outcome is the birth of a healthy singleton. Secondary outcomes are
multiple pregnancy, treatment costs, and patient experiences in each treatment arm. The analysis will be performed
according tot the intention to treat principle. We will test for non-inferiority of the three arms with respect to live birth.
As we accept a 12.5% loss in pregnancy rate in one of the two IVF arms to prevent multiple pregnancies, we need 200
couples per arm (600 couples in total).
DISCUSSION: Determining the safest and most cost-effective treatment will ensure optimal chances of pregnancy for
subfertile couples with substantially diminished perinatal and maternal complications. Should patients find the most
cost-effective treatment acceptable or even preferable, this could imply the need for a world wide shift in the primary
treatment.
PMID: 20032219
Schneeberger PM, Hermans MH, van Hannen EJ, Schellekens JJ, Leenders AC,
Wever PC.
Real-time PCR with serum samples is indispensable for early diagnosis of acute Q fever.
The world’s largest Q fever outbreak is ongoing in The Netherlands with around 3,000 confirmed cases since the first
half of 2007. Increased awareness has resulted in early referral of patients for diagnostics. An important drawback to
serological diagnosis of acute Q fever is the lag phase in antibody response. Therefore, we evaluated the performance
of a real-time PCR for detection of Coxiella burnetii DNA using serum samples from patients with acute Q fever. PCR,
targeting IS1111, was retrospectively performed on acute-phase and follow-up convalescent-phase serum samples
from 65 patients with acute Q fever as diagnosed by immunofluorescence assay. The results obtained by PCR were
196
related to disease stage as defined by subsequent appearance of phase II IgM, phase II IgG, phase I IgM, and phase I
IgG (IgM-II, IgG-II, IgM-I, and IgG-I, respectively) antibodies and time since onset of disease. In addition, we analyzed
seronegative acute-phase serum samples from patients with inconclusive Q fever serology, because no convalescentphase serum samples were available. PCR was scored positive in 49/50 (98%) seronegative sera, 9/10 (90%) sera
with isolated IgM-II antibodies, 3/13 (23%) sera with IgM-II/IgG-II antibodies, 2/41 (5%) sera with IgM-II/IgG-II/IgM-I
antibodies, 0/15 (0%) sera with IgM-II/IgG-II/IgM-I/IgG-I antibodies, and 0/1 (0%) serum sample with IgM-II/IgG-II/IgGI antibodies. The latest time point after onset of disease in which C. burnetii DNA could be detected was at day 17. In
patients with inconclusive Q fever serology, PCR was positive in 5/50 (10%) cases. We conclude that real-time PCR with
serum samples is indispensable for early diagnosis of acute Q fever. C. burnetii DNA becomes undetectable in serum as
the serological response develops.
PMID: 20050490
Schuurman JP, Schoonhoven L, Defloor T, van Engelshoven I, van Ramshorst B,
Buskens E.
Economic evaluation of pressure ulcer care: a cost minimization analysis of
preventive strategies.
Nurs Econ. 2009 Nov-Dec;27(6):390-400, 415.
The purpose of this study was to determine the cost for prevention and treatment of pressure ulcers from a hospital
perspective and to identify the least resource-intensive pressure ulcer prevention strategy. Cost analyses were examined from a hospital perspective using direct costs. The study was carried out alongside a prospective cohort study
on the incidence and risk factors for pressure ulcers. Two large teaching hospitals in the Netherlands with (partly)
opposing approaches in prevention, a technological versus a human approach, were analyzed. The main outcome measures were resource use, costs of preventive measures and treatment, and pressure ulcer incidence in both hospitals.
Pressure ulcer prevention through a predominantly technical approach resulted in a similar incidence rate as prevention through a predominantly human approach. However, the technical approach was considerably less expensive.
PMID: 20075649
Knol W, Keijsers CJPW, Jansen PAF, van Marum RJ.
Systematic evaluation of rating scales for drug induced parkinsonism.
OBJECTIVE: Drug-induced parkinsonism (DIP) is one of the most common adverse effects of antipsychotic agents. The
limited agreement about which rating scale should be used in clinical practice to assess DIP prompted us to review the
feasibility and the psychometric qualities of the available instruments.
METHODS: The PubMed and EMBASE databases were searched in November 2008 using the terms “parkinsonism,”
“scale,” and “drug induced” to identify instruments used to measure DIP. Then, the literature was searched for studies
investigating the use and psychometric properties of each identified instrument. Outcome measures included feasibility, validity (including appropriateness of used reference test), and reliability (internal consistency and interrater and
intrarater reliability).
RESULTS: Seventeen rating scales were identified, each with a different representation of the concept of parkinsonism. The Simpson Angus Scale (SAS) was used the most, followed by the Extrapyramidal Symptom Rating Scale.
There were limited psychometric data, especially regarding validity, available for any scale. The SAS, the Drug-Induced
Extrapyramidal Scale, and the parkinsonism subscale of the Schedule for the Assessment of Drug-Induced Movement
197
Disorders, which is identical to the St Hans Rating Scale for Extrapyramidal Syndromes, seemed to have moderate to
good reliability and acceptable validity. The time-consuming nature of the Schedule for the Assessment of Drug-Induced Movement Disorders would make it less useful in daily practice.
CONCLUSIONS: Although various scales are used to assess DIP, few have been evaluated for validity and reliability. The
SAS, St Hans Rating Scale for Extrapyramidal Syndromes, and Drug-Induced Extrapyramidal Scale seem to be the
most valid, reliable, and easy-to-use instruments to evaluate DIP in clinical practice.
PMID: 20082537
Meulendijks D, Manesse CK, Jansen PAF, van Marum RJ, Egberts ACG.
Antipsychotic-induced hyponatriemia: a systematic review of published evidence.
Drug Safety. 2010; 33(2): 101-14.
Hyponatraemia is known to occur as a rare but clinically important adverse reaction to treatment with different psychotropic drugs, including selective serotonin reuptake inhibitors and antiepileptic drugs. In past decades, reports have been
published that describe the development of hyponatraemia in association with antipsychotic drug treatment. Our objective was to systematically review the available evidence on antipsychotic-induced hyponatraemia, focussing on patient
characteristics, drug dosage, polydipsia and the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). A
search was carried out in the MEDLINE and EMBASE databases from January 1966 to 11 April 2009. Inclusion criteria
were (i) hyponatraemia (serum sodium level <136 mmol/L) occurring after the start of treatment with an antipsychotic
drug; and (ii) that the hyponatraemia potentially occurred as an adverse reaction to antipsychotic drug treatment in accordance with the WHO definition. Articles in languages other than English, Dutch, German, French and Spanish were excluded. Information on patient characteristics, medical and diagnostic data, pharmacological treatment, drug dechallenge
and drug rechallenge were extracted from the publications whenever available. A causality assessment was performed on
all case reports using Naranjo’s adverse drug reaction probability scale. Correlational analysis was performed to assess
correlations between antipsychotic drug dosage and both serum sodium level and time to onset of hyponatraemia. We
included four studies and 91 publications containing case reports and case series; no randomized controlled studies were
identified. Data from the identified case reports were further analysed. The mean age of the patients was 46 years; 57%
were male. The diagnosis was schizophrenia in 70% of the cases. A history of polydipsia was diagnosed as positive in 67%
of the cases and negative in 23% of the cases. Polydipsia occurred in the remaining 10% of cases, although it was reported
to be drug-induced (i.e. a severe increase in water intake was observed in relation to treatment with the suspected drug).
Analysis of the case reports using the adverse drug reaction probability scale indicated possible causality in most cases
(80%), probable causality in a significant amount of cases (19%) and unlikely causality in one case (1%). Overall correlational analysis yielded no significant correlations between defined daily dose-equivalent dosages and serum sodium or
time to onset of hyponatraemia. The incidence of hyponatraemia induced by antipsychotics may be much higher than is
currently thought. Both the newer atypical antipsychotics and the older drugs have been associated with the development
of hyponatraemia. Physicians, psychiatrists and other healthcare workers should be aware of the possibility of hyponatraemia associated with the use of antipsychotics. Further studies are required to establish the risks of and risk factors
associated with antipsychotic-induced hyponatraemia.
PMID: 20083537
Van Hulst LT, Creemers MC, Fransen J, Li LC, Grol R, Hulscher ME, van Riel PL.
How to improve DAS28 use in daily clinical practice? A pilot study of a nurse-led intervention.
Rheumatology (Oxford). 2010 Apr;49(4):741-8.
198
OBJECTIVES: To determine whether DAS28 measurements by a specialized nurse, before the rheumatologist visit, in
combination with the advice to rheumatologists to reach a DAS28 < or = 3.2, had beneficial effects on disease activity
and medication prescription in patients with RA and to explore possible predictors for variation in medication changes
and reasons for non-adherence to the advice to reach a DAS28 < or = 3.2.
METHODS: In this pilot study, rheumatologists were randomized to ‘usual care’ (n = 3) or DAS28 measurement by a
nurse prior the rheumatologist visit (n = 4). In the usual care group, the DAS28 was measured but not provided to
rheumatologists. Mixed model analyses were used for analysing between-group differences and for the prediction model. Rheumatologists in the intervention group were asked to provide reasons in cases of non-adherence to the advice.
RESULTS: After 18 months, DAS28 was reduced by - 0.69 and - 0.66 (P = 0.70) in, respectively, the intervention (144
patients) and the usual care (104 patients) groups. In the intervention group, medication was changed by rheumatologists in 35% of the visits with a DAS28 > 3.2; in the usual care group this was 33% (P = 0.99). Baseline DAS28 (OR
1.6; P< or =0.0001) and HAQ (OR 1.3; P = 0.03) were positively related to a medication change. The most frequently
mentioned reason not to change medication was patient refusal (26%).
CONCLUSIONS: DAS28 measurement by a nurse was as effective as usual care; however, this intervention without
protocolized treatment adjustments is not sufficient to lead to a considerable reduction in disease activity compared
with trials with protocolized treatment adjustments.
PMID: 20088343
Feitsma MT, van Laar T, Dautzenberg PL.
The possible value of diagnosing MCI-DLB and treatment options.
Tijdschr Gerontol Geriatr. 2009 Sep;40(4):168-72.
Dementia with Lewy Bodies (DLB) is a well-described clinical entity. DLB patients can be treated with acetylcholinesterase inhibitors (AChEI’s). However, should we also treat patients who have but part of the symptoms and who
are currently described as MCI-DLB? Will these MCI-DLB patients benefit from AChEI’s in terms of direct effect on
cognition and behaviour and final outcome? Two cases are presented to demonstrate the clinical features of MCI-DLB
and the effect of treatment with rivastigmine (AChEI). The discussion then focuses on the possible value of diagnosing
MCI-DLB and if this diagnosis should result in a different medication treatment than the diagnosis MCI-AD, for which
AChEI medication is not recommended.
PMID: 20089560
Herbers AHE, Feuth T, Donnelly JP, Blijlevens NM.
Citrulline-based assessment score: first choice for measuring and monitoring intestinal failure after
Ann Oncol.2010 Aug;21(8):1706-11.
BACKGROUND: Currently, objective tests are lacking that enable the extent and duration of intestinal mucosal damage
induced by myeloablative chemotherapy to be determined. To address this problem, we explored a citrulline-based
assessment score as this amino acid is a simple quantitative marker of intestinal failure.
PATIENTS AND METHODS: From March 2004 to June 2007, citrulline concentrations were determined at baseline
and at least once weekly after the start of myeloablative chemotherapy until 30 days thereafter among 94 allogeneic
or autologous haematopoietic stem-cell transplant recipients. The patients were divided into three groups according to
the regimen they received: (i) carmustine, etoposide, cytarabine and melphalan/high-dose melphalan, (ii) cyclophosphamide and total body irradiation +/- antithymocyte globulin and (iii) idarubicin-containing regimens. Intestinal
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mucosal damage was described either by level of citrulline on each day, on the basis of different thresholds of citrulline
indicating the severity of villous atrophy, or by area under the curve using reciprocal value of 10/citrulline.
RESULTS: Regimens that incorporated idarubicin induced the most severe intestinal toxicity. Scores based on the level
of citrulline, using severity thresholds, and on the area under the reciprocal curve are able to discriminate between the
damage induced by different high-dose chemotherapy regimens.
CONCLUSION: A citrulline-based assessment score appears objective, validated, reproducible, reliable, specific and
sensitive making it a suitable first choice for measuring and monitoring intestinal mucositis.
PMID: 20098344
Verstegen RH, Kusters MA, Gemen EF, de Vries E.
Down syndrome B-lymphocyte subpopulations, intrinsic defect or decreased T-lymphocyte help.
Pediatr Res. 2010 May;67(5):563-9.
Down syndrome (DS) is known for increased incidence of respiratory infections and autoimmune diseases, indicating
impaired immunity. Until now, attention has been mainly focused on T lymphocytes. Therefore, we determined Blymphocyte subpopulations in 95 children with DS compared with 33 age-matched control (AMC) children. DS serum
immunoglobulin levels were compared with 962 non-DS children with recurrent infections. The results were combined
with clinical data. Transitional and naive B lymphocytes are profoundly decreased in the children with DS. This could
be caused by an intrinsic B-lymphocyte defect resulting in (partial) failure of B-lymphocyte generation, decreased
antigen-induced proliferation and/or increased apoptosis, or by decreased proliferation due to deficient T-lymphocyte
help, or a combination of these. The decreased CD27, CD21, and CD23 cells are reminiscent of common variable
immunodeficiency and suggestive of disturbed peripheral B-lymphocyte maturation. Immunoglobulin levels in DS are
abnormal-as has been described before-and different from non-DS children with recurrent infections. We conclude
that the humoral immune system is abnormal in DS, but could not find a relation between B-lymphocyte subsets,
immunoglobulins and clinical features of the children with DS in our cohort, nor could we answer the question whether
DS lymphocytes are truly intrinsically deficient, or could all findings be explained by deficient T-lymphocyte help.
PMID: 20098345
Kusters MA, Gemen EF, Verstegen RH, Wever PC, de Vries E.
Both normal memory counts and decreased naive cells favor intrinsic defect over early senescence of
Down syndrome T lymphocytes.
Pediatr Res. 2010 May;67(5):557-62.
Because of their increased malignancies, autoimmune diseases, and infections, patients with Down syndrome (DS)
show features of immunodeficiency. The DS thymus and T lymphocyte subsets have indeed proven to be different, and
this has been interpreted as precocious aging. Our study on T lymphocyte subpopulations in DS shows that the normal
expansion of naive helper (CD4CD45RA) and cytotoxic (CD8CD45RACD27) T lymphocytes is lacking in the first years of
life; this is more logically explainable with an intrinsic T lymphocyte defect. Furthermore, memory cell numbers are not
different from age-matched controls (AMC), which does not support the hypothesis of precocious aging. Although the
absolute numbers of T lymphocyte subpopulations approach AMC levels toward adulthood, the persistent clinical problems suggest that these cells may not function optimally. However, the clinical picture does not fit severe T lymphocyte
deficiency. The latter concept is also supported by our finding that cytomegalovirus (CMV)-seropositive DS children
show similar numbers of terminally differentiated cytotoxic T lymphocytes when compared with healthy children, not
increased numbers as are seen in immunocompromised hosts.
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PMID: 20102956
Van Beek E, Binkhorst M, de Hoog M, de Groot P, van Dijk A, Schokking M,
Hopman M.
Exercise performance and activity level in children with transposition of the great arteries treated by the
Am J Cardiol 2010; 105: 398-403.
The exercise capacity of children after arterial switch for transposition of the great arteries (TGA) is known to be at the
lower limit of normal. We aimed to ascertain whether this results from compromised hemodynamics or deconditioning.
A total of 17 children with TGA (12 male and 5 female children; age 12.1 + or - 2.0 years) treated with the arterial
switch operation were compared with 20 age-matched controls (13 male and 7 female children; age 12.8 + or - 2.4
years) regarding their peak exercise capacity, peak workload, and peak heart rate, as assessed by cycle ergometry.
The children’s physical activity level was monitored for a 7-day period using a pedometer and diary, and a questionnaire was used to assess physical activity participation and overprotection. The results demonstrated that TGA children
showed a significantly reduced peak exercise capacity (47.4 + or - 6.4 vs 41.1 + or - 6.6 ml/kg/min; p <0.05), maximal
workload (3.7 + or - 0.5 vs 3.1 + or - 0.6 W/kg; p <0.01), and maximal heart rate (189 + or - 9 vs 180 + or - 14
beats/min; p <0.05) compared to the controls. No significant differences were found in the physical activity pattern or
overprotection. In conclusion, given the comparable physical activity level, but reduced exercise capacity in the TGA
children, these children most likely fall short in their exercise performance because of restrictive hemodynamics rather
than deconditioning from reduced daily life activity.
PMID: 20105278
Scheffer RC, Bredenoord AJ, Hebbard GS, Smout AJ, Samsom M.
Effect of proximal gastric volume on hiatal hernia.
Neurogastroenterol Motil. 2010 May;22(5):552-6, e120.
BACKGROUND: Spatial separation of the diaphragm and the lower esophageal sphincter (LES) occurs frequently and
intermittently in patients with a sliding hiatus hernia and favors gastro-esophageal reflux. This can be studied with
high-resolution manometry. Although fundic accommodation is associated with a lower basal LES pressure, its effect
on esophagogastric junction configuration and hiatal hernia is unknown. Therefore, the aim of this study was to investigate the relationship between proximal gastric volume, the presence of a hiatal hernia profile and acid reflux.
METHODS: Twenty gastro-esophageal reflux disease (GERD) patients were studied and compared to 20 healthy controls. High-resolution manometry and pH recording were performed for 1 h before and 2 h following meal ingestion
(500 mL per 300 kcal). Volume of the proximal stomach was assessed with three-dimensional ultrasonography before
and every 15 min after meal ingestion.
KEY RESULTS: During fasting, the hernia profile [2 separate high-pressure zones (HPZs) at manometry] was present
for 31.9 +/- 4.9 min h(-1) (53.2%) in GERD patients, and 8.7 +/- 3.3 min h(-1) (14.5%) in controls (P < 0.001). In
GERD patients, the presence of hernia profile decreased during the first postprandial hour to 15.9 +/- 4.2 min h(-1),
26.5%, P < 0.01 whilst this phenomenon was not observed in controls. The rate of transition between the two profiles
was 5.7 +/- 1.1 per hour in GERD patients and 2.5 +/- 1.0 per hour in controls (P < 0.001). The pre and postprandial
acid reflux rate in GERD patients during the hernia profile (6.4 +/- 1.1 per hour and 18.4 +/- 4.3 per hour respectively)
was significantly higher than during reduced hernia (2.1 +/- 0.6 per hour; P < 0.05 and 3.8 +/- 0.9 per hour; P < 0.05).
A similar difference was found in controls. Furthermore, an inverse correlation was found between fundic volume and
the time the hernia profile was present (r = -0.45; P < 0.05) in GERD patients, but not in controls.
201
CONCLUSIONS & INFERENCES: (i) In GERD patients a postprandial increase in proximal gastric volume is accompanied
by a decrease in hernia prevalence, which can be explained by a reduction of the intra-thoracic part of the stomach.
(ii) A temporal hernia profile also occurs in healthy subjects. (iii) During the hernia profile, acid reflux is more prevalent,
especially after meal ingestion.
PMID: 20121439
Rutten GJ, Ramsey NF.
The role of functional magnetic resonance imaging in brain surgery.
Neurosurg Focus 2010 Feb;28(2): E4.
New functional neuroimaging techniques are changing our understanding of the human brain, and there is now
convincing evidence to move away from the classic and clinical static concepts of functional topography. In a modern
neurocognitive view, functions are thought to be represented in dynamic large-scale networks. The authors review
the current (limited) role of functional MR imaging in brain surgery and the possibilities of new functional MR imaging
techniques for research and neurosurgical practice. A critique of current clinical gold standard techniques (electrocortical stimulation and the Wada test) is given.
PMID: 20121528
De Reu PA, Oosterbaan HP, Smits LJ, Nijhuis JG.
Avoidable mortality in small-for-gestational-age children in the Netherlands. An analysis of 59 successive
cases of perinatal death in singletons with birth weights below the 10th centile. J Perinat Med. 2010
May;38(3):311-8.
OBJECTIVE: To analyze avoidable perinatal mortality in small-for-gestational-age (SGA) children.
METHODS: All SGA-children (< or =10(th) percentile) among 22,189 newborns delivered after 24 weeks’ gestation (175
days), from three regions of the Netherlands during 2003-2004 were evaluated. Cases of perinatal mortality were identified and assessed in a consensus model by perinatal audit groups for cause of death and the presence of substandard
care factors (SSF). We analyzed all singleton SGA-cases with and without SSF for avoidable perinatal mortality.
RESULTS: Out of 20,927 singletons, 2396 newborns were SGA. Of those, 59 died perinatally (2.46%), and 55 of which
were assessed by perinatal audit groups. SSF by caregivers were found in 22 cases (40%). In 16 of these cases (29%) the
relation to the perinatal death was considered possible or (very) probable. Of the cases without SSF by caregivers, 15
cases (25%) could possibly have been avoided: in 13 cases an avoidable condition and in 2 cases avoidable death were
identified. Failure in the correct and timely diagnosis of fetal growth restriction appears to be an important issue in all
cases of perinatal mortality in SGA-children. Before referral growth restriction was suspected only in 22% of all SGA cases
during the third trimester of pregnancy.
CONCLUSIONS: More adequate action by caregivers could decrease perinatal mortality in nearly 1/3 among SGAchildren. Adjustments in pregnancy monitoring, especially in low-risk pregnancies, such as routine ultrasound biometry
examination, may improve the accuracy in detecting growth deviations and decreasing the number of possibly avoidable
cases of perinatal mortality in this category.
PMID: 20149482
Jager MM, Murk JL, Pique R, Wulf MW, Leenders AC, Buiting AG, Bogaards JA, Kluytmans JA,
Vandenbroucke-Grauls CM.
Prevalence of carriage of meticillin-susceptible and meticillin-resistant Staphylococcus aureus in
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employees of five microbiology laboratories in The Netherlands.
J Hosp Infect 2010 Mar;74(3):292-4.
PMID: 20176027
Hartley JL, Zachos NC, Dawood B, Donowitz M, Forman J, Pollitt RJ, Morgan NV, Tee L, Gissen P, Kahr
WHA, Knisely AS, Watson S, Chitayat D, Booth IW, Protheroe S, Murphy S, de Vries E, Kelly DA, Maher ER.
Mutations in TTC37 Cause Trichohepatoenteric Syndrome (Phenotypic Diarrhoea of Infancy).
Gastroenterology. 2010 Jun;138(7):2388-98, 2398.e1-2.
BACKGROUND & AIMS: Trichohepatoenteric syndrome (THES) is an autosomal-recessive disorder characterized
by life-threatening diarrhea in infancy, immunodeficiency, liver disease, trichorrhexis nodosa, facial dysmorphism,
hypopigmentation, and cardiac defects. We attempted to characterize the phenotype and elucidate the molecular basis
of THES.
METHODS: Twelve patients with classic THES from 11 families had detailed phenotyping. Autozygosity mapping was
undertaken in 8 patients from consanguineous families using 250,000 single nucleotide polymorphism arrays and
linked regions evaluated using microsatellite markers. Linkage was confirmed to one region from which candidate
genes were analyzed. The effect of mutations on protein production and/or localization in hepatocytes and intestinal
epithelial cells from affected patients was characterized by immunohistochemistry.
RESULTS: Previously unrecognized platelet abnormalities (reduced platelet alpha-granules, unusual stimulated alpha
granule content release, abnormal lipid inclusions, abnormal platelet canalicular system, and reduced number of
microtubules) were identified. The THES locus was mapped to 5q14.3-5q21.2. Sequencing of candidate genes showed
mutations in TTC37, which encodes the uncharacterized tetratricopeptide repeat protein, thespin. Bioinformatic
analysis suggested thespin to be involved in protein-protein interactions or chaperone. Preliminary studies of
enterocyte brush-border ion transporter proteins (sodium hydrogen exchanger 2, sodium hydrogen exchanger 3,
aquaporin 7, sodium iodide symporter, and hydrogen potassium adenosine triphosphatase [ATPase]) showed reduced
expression or mislocalization in all THES patients with different profiles for each. In contrast the basolateral localization
of Na/K ATPase was not altered.
CONCLUSIONS: THES is caused by mutations in TTC37. TTC37 mutations have a multisystem effect, which may be
owing to abnormal stability and/or intracellular localization of TTC37 target proteins.
PMID: 20186761
Koebrugge B, Bosscha K, Jager G, Ernst M.
Accuracy of transrectal ultrasonography in staging rectal tumors that are clinically eligible for transanal
endoscopic microsurgery.
J Clin Ultrasound. 2010 Jun;38(5):250-3.
PURPOSE: Transanal endoscopic microsurgery (TEM) is performed in patients with premalignant or selected stage T1
rectal lesions. Transrectal ultrasonography (TRUS) is an important tool in the preoperative staging of rectal lesions to
determine whether lesions are suitable for TEM or not. We analyze the accuracy of TRUS in distinguishing between
rectal lesions requiring TEM or more radical excision.
METHODS: From 2006 to 2008 thirty-five patients were included. All patients underwent TRUS. Following TRUS
and/or additional imaging, patients underwent surgery. Preoperative TRUS staging was correlated to postoperative
pathology findings.
RESULTS: In 30 patients TRUS was diagnostic. Postoperative pathologic findings confirmed the preoperative TRUS
findings in 29 patients; in 1 patient, a T3 staged tumor was an overstaged lesion biopsied as a tubulovillous adenoma.
203
The accuracy level in the diagnostic TRUS group was 97% (29/30). In 5 patients TRUS was nondiagnostic; in 4 of these
patients MRI was performed showing no tumor invasion in all 4 patients, confirmed by pathologic findings. Correct
TRUS interpretation was possible in 86% (30/35). Overall accuracy of TRUS was 83% (29/35).
CONCLUSION: TRUS is accurate in distinguishing rectal lesions suitable for TEM from the lesions needing more radical
surgery. If TRUS is nondiagnostic or the lesion is of high stage (>or=T2), MRI should be performed.
PMID: 20201011
Deniz G, Chapel H, Barlan I, de Vries E, Jaraquemada D.
Women advancing science.
Eur J Immunol. 2010 Mar;40(3):589-92.
PMID: 20219351
Dassen AE, Lemmens VE, van de Poll-Franse LV, Creemers GJ, Brenninkmeijer SJ,
Lips DJ, Vd Wurff AA, Bosscha K, Coebergh JW.
Trends in incidence, treatment and survival of gastric adenocarcinoma between 1990
and 2007: a population-based study in the Netherlands.
Eur J Cancer. 2010 Apr;46(6):1101-10.
BACKGROUND: Survival of gastric cancer in the Western world remains poor. We conducted a retrospective populationbased study to evaluate trends in incidence, treatment and outcome of gastric adenocarcinoma.
METHODS: All patients diagnosed with gastric adenocarcinoma during 1990-2007 in the Dutch Eindhoven Cancer Registry area were included (n=4,797). Trend analyses were conducted for incidence, mortality, tumour and patient characteristics, treatment and crude overall survival, according to tumour location (cardia versus non-cardia). Temporal changes
in the odds of undergoing surgery and the risk of death were analysed by means of multivariable regression methods.
RESULTS: Age-standardised incidence decreased among males (24-12 per 100,000 inhabitants) and females (10-6);
mortality rates decreased at a similar pace. The proportion of cardia tumours remained stable. Stage distribution worsened over time among patients with cardia (stages I and II: 32% in 1990-1993 and 22% in 2006-2007, p=0.005) and
non-cardia (stage IV: 33% in 1990-1993 and 40% in 2006-2007, p=0.0003) cancer. Chemotherapy rates increased in
all settings. Five-year survival worsened over time for patients with non-cardia tumours. Age and stage had significant
influence on survival after stratification for tumour localisation. After adjustments for relevant factors (i.e. stage), the risk
of death decreased since the late 90s for patients with a cardia tumour (hazard ratio 0.8, p=0.01).
CONCLUSION: The absence of improvement in survival rates indicates the need for earlier detection and prospective
studies to evaluate new therapy regimens with standardised surgery and pathology.
PMID: 20224425
Draisma A, Dorresteijn MJ, Bouw MP, van der Hoeven JG, Pickkers P.
The role of cytokines and inducible nitric oxide synthase in endotoxemia-induced endothelial dysfunction.
J Cardiovasc Pharmacol. 2010 Jun;55(6):595-600.
Sepsis is characterized by a blunted vascular responses due to impairment of endothelial function. The aim of
our study was to assess endothelial function and the role of cytokines and nitric oxide (NO). Endotoxin tolerance
was induced in 14 healthy volunteers by intravenous injection of 2 ng.kg.d lipopolysaccharide on 5 consecutive
days. Forearm blood flow (FBF) was measured by strain-gauge plethysmography during dose-response curves of
endothelium-dependent vasodilator acetylcholine and endothelium-independent vasodilator sodium nitroprusside
204
before and 4 hours after LPS administration on days 1 and 5. In another study, 7 healthy volunteers were given
selective inducible NO synthase inhibitor aminoguanidine intravenous continuously from 1 hour after a single LPS
administration until 5 hours. FBF showed an attenuation of ACh-induced vasodilatory response with 67% (45%-72%) 4
hours after the first LPS administration (P = 0.01) with an unchanged dose-response curve to sodium nitroprusside.
This attenuation to ACh infusion did not occur in the presence of aminoguanidine (P = 0.21) and also did not occur
when tolerance was present on day 5 (P = 0.45). Our data demonstrate that endothelial dysfunction caused by
endotoxemia does not occur when endotoxin tolerance develops, indicated by the absence of cytokine production and
during administration of selective inducible NO synthase inhibitor aminoguanidine in vivo.
PMID: 20230650
Schimmer B, ter Schegget R, Wegdam M, Züchner L, de Bruin A, Schneeberger PM, Veenstra T, Vellema
P, van der Hoek W.
The use of a geographic information system to identify a dairy goat farm as the most likely source of an
urban Q-fever outbreak.
BMC Infect Dis 2010 Mar 16; 10: 69.
BACKGROUND: A Q-fever outbreak occurred in an urban area in the south of the Netherlands in May 2008. The
distribution and timing of cases suggested a common source. We studied the spatial relationship between the
residence locations of human cases and nearby small ruminant farms, of which one dairy goat farm had experienced
abortions due to Q-fever since mid April 2008. A generic geographic information system (GIS) was used to develop a
method for source detection in the still evolving major epidemic of Q-fever in the Netherlands.
METHODS: All notified Q-fever cases in the area were interviewed. Postal codes of cases and of small ruminant farms
(size >40 animals) located within 5 kilometres of the cluster area were geo-referenced as point locations in a GISmodel. For each farm, attack rates and relative risks were calculated for 5 concentric zones adding 1 kilometre at a
time, using the 5-10 kilometres zone as reference. These data were linked to the results of veterinary investigations.
RESULTS: Persons living within 2 kilometres of an affected dairy goat farm (>400 animals) had a much higher risk for
Q-fever than those living more than 5 kilometres away (Relative risk 31.1 [95% CI 16.4-59.1]).
CONCLUSIONS: The study supported the hypothesis that a single dairy goat farm was the source of the human
outbreak. GIS-based attack rate analysis is a promising tool for source detection in outbreaks of human Q-fever.
PMID: 20298633
Koebrugge B, Hermens RA.
A women with a lumpy calf.
A 24-year-old woman had big neurofibromas on her left leg caused by type 1 neurofibromatosis. Four kilograms of
tissue were excised.
PMID: 20299957
Van Luin M, Van der Ende ME, Richter C, Visser M, Faraj D, Van der Ven A, Gelinck L,
Kroon F, Wit FW, Van Schaik RH, Kuks PF, Burger DM.
Lower atovaquone/proguanil concentrations in patients taking efavirenz, lopinavir/ritonavir or atazanavir/
ritonavir.
AIDS. 2010 May 15;24(8):1223-6.
205
HIV-infected travellers frequently use atovaquone/proguanil as malaria prophylaxis. We compared atovaquone/
proguanil pharmacokinetics between healthy volunteers and HIV-infected patients taking efavirenz, lopinavir/ritonavir
or atazanavir/ritonavir. The geometric mean ratio (95% confidence interval) area under the curve (AUC)0-->t for
atovaquone relative to the healthy volunteers was 0.25 (0.16-0.38), 0.26 (0.17-0.41) and 0.54 (0.35-0.83) for
patients on efavirenz, lopinavir/ritonavir and atazanavir/ritonavir, respectively. Proguanil plasma concentrations were
also significantly lower (38-43%). Physicians should be alert for atovaquone/proguanil prophylaxis failures in patients
taking efavirenz, lopinavir/ritonavir or atazanavir/ritonavir.
PMID: 20350500
Van der Hoek W, Dijkstra F, Schimmer B, Schneeberger PM, Vellema P, Wijkmans C, ter Schegget R,
Hackert V, van Duynhoven Y.
Q fever in the Netherlands: an update on the epidemiology and control measures.
Euro Surveill 2010 Mar 25;15(12):pii=19520.
Since the steady rise in human cases which started in 2007, Q fever has become a major public health problem in
the Netherlands with 2,357 human cases notified in the year 2009. Ongoing research confirms that abortion waves
on dairy goat farms are the primary source of infection for humans, primarily affecting people living close (under 5
km) to such a dairy goat farm. To reverse the trend of the last three years, drastic measures have been implemented,
including the large-scale culling of pregnant goats on infected farms.
PMID: 20351334
Krzakowski M, Ramlau R, Jassem J, Szczesna A, Zatloukal P, Von Pawel J, Sun X, Bennouna J, Santoro A,
Biesma B, Delgado FM, Salhi Y, Vaissiere N, Hansen O, Tan EH, Quoix E, Garrido P, Douillard JY.
Phase III trial comparing vinflunine with docetaxel in second-line advanced non-small-cell lung cancer
previously treated with platinum-containing chemotherapy.
J Clin Oncol. 2010 May 1;28(13):2167-73.
PURPOSE: To compare vinflunine (VFL) to docetaxel in patients with stage IIIB/IV non-small-cell lung cancer (NSCLC)
who have experienced treatment failure with first-line platinum-based chemotherapy.
PATIENTS AND METHODS: Randomized, multicenter, phase III study, 551 patients received either vinflunine 320
mg/m(2) or docetaxel 75 mg/m(2) every 21 days until disease progression or serious toxicity. The primary end point
was progression-free survival (PFS). The noninferiority analysis was based on a 10% difference (types I/II error rates:
5%/20%). Secondary end points included response rate (ORR), response duration, overall survival (OS), clinical benefit,
quality of life (QOL), and safety.
RESULTS: Median PFS was 2.3 months for each arm (HR, 1.004; 95% CI, 0.841 to 1.199). ORR, stable disease,
median OS, were 4.4% versus 5.5%, 36.0% versus 39.6%, 6.7 versus 7.2 months (HR, 0.973; 95% CI, 0.805 to 1.176),
respectively. No significant difference in patient benefit and QOL (Functional Assessment of Cancer Therapy-Lung).
No unexpected adverse events were observed. Grade higher than 0 (vinflunine v docetaxel) anemia (82.1% v 79.8%),
neutropenia (49.3 v 39.02%), thrombocytopenia (30.6% v 14.3%), febrile neutropenia (3.3% v 4.7%), constipation (39.2%
v 11.7%), fatigue (36.6% v 33.9%), injection site reaction (31.9% v 0.7%), nausea (26.7% v 23.7%), vomiting (23.8% v
14.2%), alopecia (19.8% v 35.4%), stomatis (19.4% v 12.4%), abdominal pain (20.1% v 3.6%), myalgia (14.7% v 6.6%),
peripheral neuropathy (10.7% v 15.0%), arthralgia (7.0% v 7.7%), diarrhea (6.2% v 12.4%), edema (1.5% v 5.4%), and nail
disorders (1.1% v 5;1%) were observed.
CONCLUSION: This noninferiority phase III study showed similar efficacy end points for vinflunine and docetaxel.
206
Despite higher rates of some adverse effects (anemia, abdominal pain, constipation, fatigue) the overall toxicity profile
of vinflunine was manageable. Therefore, VFL may be another option in the second-line treatment of patients with
advanced NSCLC.
PMID: 20356426
Spee J, van Marum RJ, Egberts ACG, Drenth van Maanen AC, Jansen PAF.
The process of bringing medication in line: the additional benefits of a Structured Medication History. [Het
Medicatie Afstemmingsproces op een afdeling geriatrie: de aanvullende waarde van een Gestructureerde
Medicatie Anamnese.]
Ned Tijdsch v Geneesk. 2010; 154: A904.
OBJECTIVE: To determine the additional benefits of a structured history-taking of medication use (SHIM) from patients
admitted to a geriatric ward for obtaining a complete and accurate list of medication used at home, in comparison to
an unstructured medication history-taking by the resident physician.
DESIGN: Prospective, observational.
METHOD: The SHIM, a standardized questionnaire, was used for history-taking from patients admitted to the geriatric
ward, and often from their caregivers, too. The number and type of discrepancies were noted between this medication
history and the medication history obtained by the resident physician at admission as noted on the medical chart.
Discrepancies were assessed for clinical relevance.
RESULTS: The SHIM was used for 47 patients with a mean age of 84.4 years. At least one discrepancy was found
in all patients. Comparison of the SHIM to the medication history obtained by the resident physician revealed 4.2
discrepancies per patient on average. Omission of medication in the history taken by the resident was the most
common discrepancy. 66% of all discrepancies were considered as potentially clinically relevant; in 19% of the patients
this actually resulted in a moderate degree of discomfort or clinical deterioration. The number of discrepancies was
statistically significantly associated with the use of a higher number of medications and with the use of ‘over the
counter’ (OTC) medications.
CONCLUSION: The SHIM provides a better insight into the actual use of medication by the patient than history taking
of medication use by the resident at admission.
PMID: 20378563
Labar B, Suciu S, Willemze R, Muus P, Marie JP, Fillet G, Berneman Z, Jaksic B, Feremans W, Bron D,
Sinnige H, Mistrik M, Vreugdenhil G, de Bock R, Nemet D, Gilotay C, Amadori S, De Witte T; on behalf of
the EORTC Leukemia Group.
Dexamethasone versus prednisolone for adult acute lymphoblastic leukemia (ALL) and lymphoblastic
lymphoma LBL) patients - final results of the ALL-4 randomized, Phase III trial of the EORTC Leukemia
Group.
Haematologica 2010; 95(9):1489-95.
BACKGROUND: Corticosteroids are a standard component of the treatment of acute lymphoblastic leukemia and
lymphoblastic lymphoma. Our aim was to determine whether dexamethasone results in a better outcome than
prednisolone.
DESIGN AND METHODS: Adult patients with acute lymphoblastic leukemia or lymphoblastic lymphoma were
randomized to receive, as part of their induction therapy on days 1-8 and 15-22, either dexamethasone 8 mg/m(2)
or prednisolone 60 mg/m(2). Those who reached complete remission were given two courses of consolidation therapy
207
with high-dose cytarabine and mitoxantrone and methotrexate and asparaginase. Subsequently patients younger than
50 years, with a suitable donor, were to undergo allogeneic stem cell transplantation, whereas the others were planned
to receive either an autologous stem cell transplant or high-dose maintenance chemotherapy with prophylactic central
nervous system irradiation. Randomization was done with a minimization technique. The primary endpoint was eventfree survival and the analyses was conducted on an intention-to-treat basis.
RESULTS: Between August 1995 and October 2003, 325 patients between 15 to 72 years of age were randomized
to receive either dexamethasone (163 patients) or prednisolone (162 patients). After induction and the course of
first consolidation therapy, 131 (80.4%) patients in the dexamethasone group and 124 (76.5%) in the prednisolone
group achieved complete remission. No significant difference was observed between the two treatment groups with
regards to 6-year event-free survival rates (+/-SE) which were 25.9% (3.6%) and 28.7% (3.5%) in the dexamethasone
and prednisolone groups, respectively (P=0.82, hazard ratio 0.97; 95% confidence interval, 0.75-1.25). Disease-free
survival after complete remission was also similar in the dexamethasone and prednisolone groups, the 6-year rates
being 32.3% and 37.5%, respectively (hazard ratio 1.03; 95% confidence interval 0.76-1.40). The 6-year cumulative
incidences of relapse were 49.8% and 53.5% (Gray’s test: P=0.30) while the 6-year cumulative incidences of death
were 18% and 9% (Gray’s test: P=0.07).
CONCLUSIONS: In the ALL-4 trial in adult patients with acute lymphoblastic leukemia or lymphoblastic lymphoma,
treatment with dexamethasone did not show any advantage over treatment with prednisolone.
PMID: 20384753
Erceg A, Greebe RJ, Bovenschen HJ, Seyger MM.
A Comparative Study of Pulsed 532-nm Potassium Titanyl Phosphate Laser and Electrocoagulation in the
Treatment of Spider Nevi.
Dermatologic surgery 2010;36:630-635.
OBJECTIVE: To assess the clinical efficacy and safety of potassium titanyl phosphate (KTP) laser treatment and
electrocoagulation (EC) for the treatment of spider nevi (SN).
METHOD: A randomized single-blind intrapatient comparison study was performed. A blinded observer and patients
reported the clinical treatment outcome and pain on a visual analogue scale (0-10). Side effects were noted if present.
RESULTS: Mean physician-rated clinical efficacy scores+/-standard error of the mean were 7.7+/-0.7 for KTP laser
and 6.2+/-0.9 for EC treatment (p=.05). Patient-rated mean clinical efficacy of KTP laser was 8.3+/-0.6 and of EC
was 7.3+/-0.7 (p=.09). Stratification for potential confounding bias, such as location of SN, central bulging vein, and
diameter (p=.25) of the treated SN did not reveal any statistically significant differences between the treatments.
Treatment with KTP or EC did not result in scarring or pigmentary changes. Pain was reported for KTP treatment
(3.1+/-0.4) and EC (6.4+/-0.7) (p<.05).
CONCLUSION: Clinical efficacy of KTP laser and EC for SN is comparable, although there is a tendency toward an
advantage in favor of the KTP laser. KTP laser treatment was less painful.
PMID: 20398172
Sleegers MJ, Beutler JJ, Hardon WJ, Berden JH, Verhave JC, Conemans JM,
Hollander DA, Dautzenberg PL, Hoogeveen EK.
Reversible rapidly progressive dementia with parkinsonism induced by valproate in a
patient with systemic lupus erythematosus.
208
PMID: 20400675
Pillay J, Ramakers BP, Kamp VM, Loi AL, Lam SW, Hietbrink F, Leenen LP, Tool AT,
Pickkers P, Koenderman L.
Functional heterogeneity and differential priming of circulating neutrophils in human experimental
endotoxemia.
J Leukoc Biol. 2010 Jul;88(1):211-20.
Neutrophils play an important role in host defense. However, deregulation of neutrophils contributes to tissue damage in
severe systemic inflammation. In contrast to complications mediated by an overactive neutrophil compartment, severe
systemic inflammation is a risk factor for development of immune suppression and as a result, infectious complications.
The role of neutrophils in this clinical paradox is poorly understood, and in this study, we tested whether this paradox could
be explained by distinct neutrophil subsets and their functionality. We studied the circulating neutrophil compartment
immediately after induction of systemic inflammation by administering 2 ng/kg Escherichia coli LPS i.v. to healthy volunteers.
Neutrophils were phenotyped by expression of membrane receptors visualized by flow cytometry, capacity to interact with
fluorescently labeled microbes, and activation of the NADPH-oxidase by oxidation of Amplex Red and dihydrorhodamine.
After induction of systemic inflammation, expression of membrane receptors on neutrophils, such as CXCR1 and -2 (IL8Rs), C5aR, FcgammaRII, and TLR4, was decreased. Neutrophils were also refractory to fMLF-induced up-regulation of
membrane receptors, and suppression of antimicrobial function was shown by decreased interaction with Staphylococcus
epidermis. Simultaneously, activation of circulating neutrophils was demonstrated by a threefold increase in release of ROS.
The paradoxical phenotype can be explained by the selective priming of the respiratory burst. In contrast, newly released,
CD16(dim) banded neutrophils display decreased antimicrobial function. We conclude that systemic inflammation leads to a
functionally heterogeneous neutrophil compartment, in which newly released refractory neutrophils can cause susceptibility
to infections, and activated, differentiated neutrophils can mediate tissue damage.
PMID: 20403089
Van Geest-Daalderop JH, Kraaijenhagen RJ, Van Der Meer FJ, Van Den Besselaar AM.
Intraindividual variation of the International Normalized Ratio in patients monitored with a recombinant
human thromboplastin.
J Thromb Haemost. 2010 Jul;8(7):1641-2.
PMID: 20410514
Van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, van Goor H,
Schaapherder AF, van Eijck CH, Bollen TL, van Ramshorst B, Nieuwenhuijs VB, Timmer R, Laméris JS,
Kruyt PM, Manusama ER, van der Harst E, van der Schelling GP, Karsten T, Hesselink EJ, van Laarhoven
CJ, Rosman C, Bosscha K, de Wit RJ, Houdijk AP, van Leeuwen MS, Buskens E, Gooszen HG; Dutch
A step-up approach or open necrosectomy for necrotizing pancreatitis.
N Engl J Med. 2010 Apr 22;362(16):1491-502.
BACKGROUND: Necrotizing pancreatitis with infected necrotic tissue is associated with a high rate of complications
and death. Standard treatment is open necrosectomy. The outcome may be improved by a minimally invasive step-up
approach.
METHODS: In this multicenter study, we randomly assigned 88 patients with necrotizing pancreatitis and suspected
or confirmed infected necrotic tissue to undergo primary open necrosectomy or a step-up approach to treatment. The
209
step-up approach consisted of percutaneous drainage followed, if necessary, by minimally invasive retroperitoneal
necrosectomy. The primary end point was a composite of major complications (new-onset multiple-organ failure or
multiple systemic complications, perforation of a visceral organ or enterocutaneous fistula, or bleeding) or death.
RESULTS: The primary end point occurred in 31 of 45 patients (69%) assigned to open necrosectomy and in 17 of 43
patients (40%) assigned to the step-up approach (risk ratio with the step-up approach, 0.57; 95% confidence interval,
0.38 to 0.87; P=0.006). Of the patients assigned to the step-up approach, 35% were treated with percutaneous
drainage only. New-onset multiple-organ failure occurred less often in patients assigned to the step-up approach than
in those assigned to open necrosectomy (12% vs. 40%, P=0.002). The rate of death did not differ significantly between
groups (19% vs. 16%, P=0.70). Patients assigned to the step-up approach had a lower rate of incisional hernias (7% vs.
24%, P=0.03) and new-onset diabetes (16% vs. 38%, P=0.02).
CONCLUSIONS: A minimally invasive step-up approach, as compared with open necrosectomy, reduced the rate of the
composite end point of major complications or death among patients with necrotizing pancreatitis and infected necrotic
tissue.
PMID: 20422184
Hoetjes NJ, van Velden FH, Hoekstra OS, Hoekstra CJ, Krak NC, Lammertsma AA, Boellaard R.
Partial volume correction strategies for quantitative FDG PET in oncology.
Eur J Nucl Med Mol Imaging. 2010 Aug;37(9):1679-87.
PURPOSE: Quantitative accuracy of positron emission tomography (PET) is affected by partial volume effects resulting
in increased underestimation of the standardized uptake value (SUV) with decreasing tumour volume. The purpose of
the present study was to assess accuracy and precision of different partial volume correction (PVC) methods.
METHODS: Three methods for PVC were evaluated: (1) inclusion of the point spread function (PSF) within the
reconstruction, (2) iterative deconvolution of PET images and (3) calculation of spill-in and spill-out factors based
on tumour masks. Simulations were based on a mathematical phantom with tumours of different sizes and shapes.
Phantom experiments were performed in 2-D mode using the National Electrical Manufacturers Association (NEMA)
NU2 image quality phantom containing six differently sized spheres. Clinical studies (2-D mode) included a testretest study consisting of 10 patients with stage IIIB and IV non-small cell lung cancer and a response monitoring
study consisting of 15 female breast cancer patients. In all studies tumour or sphere volumes of interest (VOI) were
generated using VOI based on adaptive relative thresholds.
RESULTS: Simulations and experiments provided similar results. All methods were able to accurately recover true SUV
within 10% for spheres equal to and larger than 1 ml. Reconstruction-based recovery, however, provided up to twofold better
precision than image-based methods. Clinical studies showed that PVC increased SUV by 5-80% depending on tumour size.
Test-retest variability slightly worsened from 9.8 +/- 6.5 without to 10.8 +/- 7.9% with PVC. Finally, PVC resulted in slightly
smaller SUV responses, i.e. from -30.5% without to -26.3% with PVC after the first cycle of treatment (p < 0.01).
CONCLUSION: PVC improves accuracy of SUV without decreasing (clinical) test-retest variability significantly and it has a
small, but significant effect on observed tumour responses. Reconstruction-based PVC outperforms image-based methods,
but requires dedicated reconstruction software. Image-based methods are good alternatives because of their ease of
implementation and their similar performance in clinical studies.
PMID: 20428415
Esselink AC, de Ruijter AM, Daniëls MC.
Application of NHG guidelines in patients referred for stable chest pain syndromes.
Neth Heart J. 2010 Apr;18(4):178-82.
210
Purpose. Guidelines of the Dutch Association of General Practitioners (NHG) dictate the evaluation, treatment, and
referral process of patients with stable chest pain syndromes (CPS). Adherence to this guideline was assessed in
a consecutive group of patients referred to our hospital. Methods. We retrospectively studied the records of 296
subjects referred to our outpatient department in 2007 for evaluation of stable CPS. Referral letters were checked for
completeness (past and present history, mentioning of risk factors for cardiovascular disease, physical examination,
listing of medication) and used to judge adherence to the guideline. In a subset of patients, additional information
regarding the referral process was gathered by telephone interview. Results. The referral letter was complete in only
67 patients (23%); items most often not reported were physical examination (63%) and cardiovascular risk factors
(62%). Judging from the referral letter, 23 patients (8%) were evaluated in accordance with the NHG guideline prior
to their referral. In patients in whom the final diagnosis of angina pectoris was made by the cardiologist, this was
20%. Seventy-nine patients were contacted by telephone after their work-up by the cardiologist; 36 of them (44%)
reported being referred at their first visit to their primary physician, while 14 (18%) were referred at their own request.
Conclusion: Prior to referral, only a minority of patients with stable CPS were evaluated and treated in accordance with
NHG guidelines. Furthermore, their referral letter was often incomplete.
PMID: 20444270
Van den Boogaard M, Ramakers BP, van Alfen N, van der Werf SP, Fick WF, Hoedemaekers CW, Verbeek
MM, Schoonhoven L, van der Hoeven JG, Pickkers P.
Endotoxemia-induced inflammation and the effect on the human brain.
Crit Care. 2010;14(3):R81.
INTRODUCTION: Effects of systemic inflammation on cerebral function are not clear, as both inflammation-induced
encephalopathy as well as stress-hormone mediated alertness have been described.
METHODS: Experimental endotoxemia (2 ng/kg Escherichia coli lipopolysaccharide [LPS]) was induced in 15 subjects,
whereas 10 served as controls. Cytokines (TNF-alpha, IL-6, IL1-RA and IL-10), cortisol, brain specific proteins (BSP),
electroencephalography (EEG) and cognitive function tests (CFTs) were determined.
RESULTS: Following LPS infusion, circulating pro- and anti-inflammatory cytokines, and cortisol increased (P <
0.0001). BSP changes stayed within the normal range, in which neuron specific enolase (NSE) and S100-beta
changed significantly. Except in one subject with a mild encephalopathic episode, without cognitive dysfunction,
endotoxemia induced no clinically relevant EEG changes. Quantitative EEG analysis showed a higher state of
alertness detected by changes in the central region, and peak frequency in the occipital region. Improved CFTs
during endotoxemia was found to be due to a practice effect as CFTs improved to the same extent in the reference
group. Cortisol significantly correlated with a higher state of alertness detected on the EEG. Increased IL-10 and the
decreased NSE both correlated with improvement of working memory and with psychomotor speed capacity. No other
significant correlations between cytokines, cortisol, EEG, CFT and BSP were found.
CONCLUSIONS: Short-term systemic inflammation does not provoke or explain the occurrence of septic
encephalopathy, but primarily results in an inflammation-mediated increase in cortisol and alertness.
PMID: 20445470
Delawi D, Dhert WJ, Rillardon L, Gay E, Prestamburgo D, Garcia-Fernandez C, Guerado E, Specchia N, Van
Susante JL, Verschoor N, Quarles van Ufford HM, Oner FC.
A Prospective, Randomized, Controlled, Multicenter Study of Osteogenic Protein-1 in Instrumented
Posterolateral Fusions. Report on Safety and Feasibility.
SPINE (Phila Pa 1976). 2010 May 20;35(12):1185-91.
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STUDY DESIGN: A prospective, randomized, controlled, multicenter clinical study.
OBJECTIVE: To evaluate the safety and feasibility of osteogenic protein (OP)-1 in 1-level lumbar spine instrumented
posterolateral fusions.
SUMMARY OF BACKGROUND DATA: Instrumented posterolateral fusion with the use of autograft is a commonly performed
procedure for a variety of spinal disorders. However, harvesting of bone from the iliac crest is associated with complications.
A promising alternative for autograft are bone morphogenetic proteins.
METHODS: As part of a larger prospective, randomized, multicenter study, 36 patients were included, who received a
1-level instrumented posterolateral fusion of the lumbar spine. All patients had a degenerative or isthmic spondylolisthesis
with symptoms of neurologic compression. There were 2 treatment arms: OP-1 combined with locally available bone from
laminectomy (OP-1 group) or iliac crest autograft (autograft group). The primary outcome was the fusion rate based on
a computed tomography scan after 1-year follow-up. The clinical outcome was measured using the Oswestry Disability
Index. Additionally, the safety of OP-1 was evaluated by comparing the number and severity of adverse events that occurred
between both groups.
RESULTS: Using strict criteria, fusion rates of 63% were found in the OP-1 group and 67% in the control group (P = 0.95).
There was a decrease in Oswestry scores at subsequent postoperative time points compared with preoperative values (P >
0.001). There were no significant differences in the mean Oswestry scores between the study group and control group at any
time point (P = 0.56). No product-related adverse events occurred.
CONCLUSION: The results demonstrate that OP-1 combined with locally obtained autograft is a safe and effective alternative
for iliac crest autograft in instrumented single-level posterolateral fusions of the lumbar spine. The main advantage of OP-1
is that it avoids morbidity associated with the harvesting of autogenous bone grafts from the iliac crest.
PMID: 20448058
Van Wijk PT, Boland GJ, Voss A, Schneeberger PM.
Impact of new guidelines for blood exposure incidents in The Netherlands.
Occup Med (Lond). 2010 Jun;60(4):270-6.
BACKGROUND: In 2007, a new set of guidelines for blood exposure incidents was introduced in The Netherlands to
standardize management and reduce use of hepatitis B immunoglobulin (HBIg). Accidents now have to be assigned
into risk categories with the corresponding medical intervention.
AIMS: To study the consequences of the guidelines on overall risk assessment and costs of hepatitis B virus (HBV)
prevention.
METHODS: Incidents (n = 461) from both hospital as well as non-hospital health care workers and others registered
by a call centre from the year 2005 were reassessed and reclassified as ‘no-risk’, ‘high-risk’ or ‘low-risk’ according to
the corresponding risk categories of the new guidelines. The differences in classification, use of HBV immunoglobulin,
source testing and the costs of the HBV prevention strategy were evaluated.
RESULTS: Of all incidents, 86% could be reassigned directly into the new risk categories. However, there was
a significant shift from ‘low-’ to ‘high-risk’ incidents. Overall, administration of HBV vaccination increased and
administration of HBIg decreased significantly, although within the group of high-risk incidents, administration of HBIg
increased. There was no effect on the frequency of reference serum taken after an incident. While fewer incidents
needed intervention, the total costs of HBV prevention still increased by 50%. Total costs increased by 13%, due to a
shift in classification.
CONCLUSIONS: The use of the new protocol facilitated standardized risk assessment for blood exposure accidents.
HBIg administration and source testing decreased. An increased proportion of high-risk classifications resulted in an
increase in the associated costs.
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PMID: 20453643
Bisschops LL, Hoedemaekers CW, Simons KS, van der Hoeven JG.
Preserved metabolic coupling and cerebrovascular reactivity during mild hypothermia
after cardiac arrest.
Crit Care Med. 2010 Jul;38(7):1542-7.
OBJECTIVE: Although mild hypothermia improves outcome in patients after out-of-hospital cardiac arrest, the
cardiodepressive effects of hypothermia may lead to secondary brain damage. This study was performed to assess the
cerebral blood flow, cerebral oxygen extraction, and cerebrovascular reactivity to changes in partial pressure of carbon
dioxide in the arterial blood in comatose patients after out-of-hospital cardiac arrest treated with mild hypothermia.
DESIGN: Observational study.
SETTING: Tertiary care university hospital.
PATIENTS: Ten comatose patients after out-of-hospital cardiac arrest.
INTERVENTIONS: All patients were cooled to 32-34 degrees C for 24 hrs. Cerebrovascular reactivity to changes in
carbon dioxide in the arterial blood was measured after increasing or decreasing the minute ventilation by 20%.
MEASUREMENTS AND MAIN RESULTS: Mean flow velocity in the middle cerebral artery and pulsatility index were
measured by transcranial Doppler at 0, 3, 6, 9, 12, 18, 24, and 48 hrs after admission. Jugular bulb oxygenation was
measured at the same intervals. Cerebrovascular reactivity to changes in carbon dioxide in the arterial blood was
studied on admission to the intensive care unit and at 6, 12, 18, and 24 hrs by measurement of mean flow velocity
in the middle cerebral artery and jugular bulb oxygenation. Mean flow velocity in the middle cerebral artery was low
(30.3+/-9.5 cm/sec) on admission and remained relatively stable for the first 24 hrs. After rewarming, it increased to
67.5+/-33.0 cm/sec at 48 hrs after admission from 30.3+/-9.5 at admission (p=.009). Jugular bulb oxygenation at
the start of the study was 66.2+/-8.5% and gradually increased to 82.9+/-4.9% at 48 hrs (p<.001). Regression analysis
showed a significant correlation between changes in carbon dioxide in the arterial blood, mean flow velocity in the
middle cerebral artery (p<.001) and jugular bulb oxygenation (p<.001). The mean percentage change in mean flow
velocity in the middle cerebral artery was 3.6+/-2.9% per 1-mm Hg change of carbon dioxide in the arterial blood.
CONCLUSIONS: The mean flow velocity in the middle cerebral artery, as a parameter of cerebral blood flow, was
low during mild hypothermia, whereas cerebral oxygen extraction remained normal, suggesting decreased cerebral
metabolic activity. We demonstrated that CO2 reactivity is preserved during hypothermia in these patients.
PMID: 20456775
Tiessen RG, Lagerwey HJ, Jager GJ, Sprenger HG.
Drug interaction caused by communication problems. Rhabdomyolysis due to a combination of
itraconazole and simvastatin.
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.
213
PMID: 20456809
Leeuwenburgh MM, Bakker OJ, Gorzeman MP, Bollen TL, Seldenrijk CA, Go PM.
Fewer unnecessary appendectomies following ultrasonography and CT.
OBJECTIVE: To evaluate the effect of the use of ultrasonography (US) and optional computed tomography (CT)
or diagnostic laparoscopy on the percentage of unnecessary appendectomies in patients with suspected acute
appendicitis.
DESIGN: Prospective and comparison with a historical control group.
METHOD: Following the introduction of ultrasound imaging as an initial step, the outcomes in all patients presenting
with suspected appendicitis in the emergency department were prospectively collected during a period of 18 months
(July 2006-December 2007). Results were compared to retrospectively collected data on all patients who had
undergone appendectomy for acute appendicitis in 2001, before the introduction of this imaging investigation.
RESULTS: Of the 312 consecutive patients in the emergency department with suspected acute appendicitis, the
condition was excluded in 51 patients following clinical and laboratory investigation. The diagnostic algorithm was
applied in 239 of the 261 patients (92%). All of them had initial US, followed by additional CT in 75 patients (31%)
and diagnostic laparoscopy in 12 patients (5%). Appendectomy was performed in 130 patients, and 8 (6%) of the
appendices were shown to be healthy following pathological investigation. Before the implementation of preoperative
imaging 36 of the 170 appendices (21%) were healthy. Following the introduction of imaging techniques in accordance
with the guideline there was a significant reduction in the percentage of unnecessary appendectomies (21% versus
6%; p < 0,001). The complete supplementary diagnostic algorithm had a positive and negative predictive value of
respectively 90% and 98% for acute appendicitis.
CONCLUSION: Structural implementation of US with optional CT and diagnostic laparoscopy in patients with suspected
acute appendicitis resulted in a lower percentage of unnecessary appendectomies.
PMID: 20461799
Keus SH, Nijkrake MJ, Borm GF, Kwakkel G, Roos RA, Berendse HW, Adang EM, Overeem S, Bloem BR,
Munneke M; ParkinsonNet Trial Study Group. (ter Bruggen JP)
The ParkinsonNet trial: design and baseline characteristics.
Mov Disord. 2010 May 15;25(7):830-7.
The companion paper describes how implementation of professional networks (ParkinsonNet) may improve the quality
and efficiency of allied health care in Parkinson’s disease (PD). We designed a cluster-randomized controlled trial to
evaluate this ParkinsonNet concept for one allied health discipline, namely physical therapy. Here we describe the
study design and baseline characteristics. The design fully complies with the CONSORT criteria. Sixteen regions in the
Netherlands were randomly divided into eight experimental regions where a ParkinsonNet was implemented, and eight
control regions where the organization of care was left unchanged (usual care). Participating patients were followed for
6 months to evaluate the implementation process, health benefits and costs of the intervention. In the ParkinsonNet
regions, 46 therapists were trained and 358 patients were included. In the usual care regions, 341 patients were
included. Baseline characteristics of participants in the ParkinsonNet and control clusters were comparable. With 699
participating patients, this is the largest allied health study in PD to date.
PMID: 20471793
Van Vugt R, Kruse RR, Sterkenburg SM, Fritschy WM, Moll FL.
214
(Semi-)Closed Endarterectomy in Occlusive Aortoiliac Disease.
Ann Vasc Surg. 2010 May 13.
BACKGROUND: Evaluation of the long-term results of a (semi-) closed endarterectomy of the aortoiliac segment with the
use of the arterial disobliteration device.
METHODS: From 1984 until 2005, a total of 157 patients (mean age, 53 years) with aortoiliac occlusive disease
underwent a (semi-)closed endarterectomy of the aortoiliac segment. The primary operation indication was disabling
claudication in 60.5% and advanced symptoms of ischemia or gangrene in 39.5%. The (semi-) closed endarterectomy was
performed in 75% through a standard left retroperitoneal approach.
RESULTS: Mean follow-up time was 18.2 years. Primary patency was 96% after 5 and 92% after 10 years. Fourteen
patients underwent a reintervention within 30 days. The operative 30-day mortality rate was 1.5%. A reintervention for
recurrence of occlusive disease during follow-up was necessary in 22 patients. At follow-up after an average of 18.2
years, 105 patients were alive, with 52 not related deaths.
CONCLUSION: Retroperitoneal (semi-) closed disobliteration, with the use of the arterial disobliteration device, of the
aortoiliac segment for stenotic and occlusive vascular disease is a safe and successful procedure the results of which are
comparable with the implantation of a vascular aortic prosthesis. We consider this technique a valuable tool in vascular
surgery.
PMID: 20478029
De Brouwer SJ, Kraaimaat FW, Sweep FC, Creemers MC, Radstake TR, van Laarhoven AI, van Riel PL,
Evers AW.
Experimental stress in inflammatory rheumatic diseases: a review of psychophysiological stress responses.
Arthritis Res Ther 2010;12(3):R89.
INTRODUCTION: Stressful events are thought to contribute to the aetiology, maintenance and exacerbation of rheumatic
diseases. Given the growing interest in acute stress responses and disease, this review investigates the impact of real-life
experimental psychosocial, cognitive, exercise and sensory stressors on autonomic, neuroendocrine and immune function in
patients with inflammatory rheumatic diseases.
METHODS: Databases Medline, PsychINFO, Embase, Cinahl and Pubmed were screened for studies (1985 to 2009)
investigating physiological stress responses in inflammatory rheumatic diseases. Eighteen articles met the inclusion criteria.
RESULTS: Results suggest that immune function may be altered in response to a stressor; such alterations could contribute
to the maintenance or exacerbation of inflammatory rheumatic diseases during stressful events in daily life.
CONCLUSIONS: This review emphasizes the need for more experimental research in rheumatic populations with
controlled stress paradigms that include a follow-up with multiple evaluation points, simultaneous assessment of different
physiological stress systems, and studying factors contributing to specific physiological responses, such as stress appraisal.
PMID: 20482926
Bakker OJ, Go PM, Puylaert JB, Kazemier G, Heij HA; Werkgroup en klankbordgroup
Guideline on diagnosis and treatment of acute appendicitis: imaging prior to appendectomy is
recommended.
Every year, over 2500 unnecessary appendectomies are carried out in the Netherlands. At the initiative of the Dutch
College of Surgeons, the evidence-based guideline on the diagnosis and treatment of acute appendicitis was developed.
215
This guideline recommends that appendectomy should not be carried out without prior imaging. Ultrasonography
is the recommended imaging technique in patients with suspected appendicitis. After negative or inconclusive
ultrasonography, a CT scan can be carried out. Appendectomy is the standard treatment for acute appendicitis; this
can be done either by open or laparoscopic surgery. The first choice treatment of appendicular infiltrate is conservative
treatment.
PMID: 20486727
Tielemans MM, Eikendal T, Jansen JB, van Oijen MG.
Identification of NSAID users at risk for gastrointestinal complications: a systematic review of current
guidelines and consensus agreements.
Drug Saf. 2010 Jun 1;33(6):443-53.
NSAIDs are among the most often used drugs worldwide. Numerous NSAID users are at risk for developing
gastrointestinal complications. The purpose of this review was to identify and stratify risk factors for gastrointestinal
complications in NSAID users documented in guidelines and consensus agreements, and to collect recommendations
regarding over-the-counter (OTC) NSAID use. To facilitate this, a PubMed search from 1 January 1999 until 1 March
2009 was performed, resulting in the inclusion of nine English-language guidelines in our analysis. Risk factors were
defined as ‘definite’ if mentioned in all guidelines; otherwise they were defined as ‘controversial’ risk factors. ‘Definite’
risk factors were a history of (complicated) peptic ulcer disease, older age (cut-off range 60-75 years), concomitant
anticoagulant or corticosteroid use and multiple NSAID use, including low-dose aspirin (acetylsalicylic acid).
‘Controversial’ risk factors were high-dose NSAID use, concomitant clopidogrel or selective serotonin reuptake inhibitor
use, a history of gastrointestinal symptoms, rheumatoid arthritis disability and cardiovascular disease. Infection with
Helicobacter pylori was identified as an additive risk factor. Risk factors in OTC NSAID users were difficult to identify in
the current literature. Risk factors were not all uniformly present in analysed guidelines and consensus agreements.
We identified a history of (complicated) peptic ulcer disease, older age, concomitant anticoagulant or corticosteroid use
and multiple NSAID use, including low-dose aspirin, as definite gastrointestinal risk factors in NSAID users.
PMID: 20502287
Westerhuis ME, Visser GH, Moons KG, van Beek E, Benders MJ, Bijvoet SM, van Dessel HJ, Drogtrop AP, van
Geijn HP, Graziosi GC, Groenendaal F, van Lith JM, Nijhuis JG, Oei SG, Oosterbaan HP, Porath MM, Rijnders
RJ, Schuitemaker NW, Sopacua LM, van der Tweel I, Wijnberger LD, Willekes C, Zuithoff NP, Mol BW, Kwee A.
Cardiotocography plus ST-analysis of the fetal electrocardiogram versus cardiotocography only for
intrapartum monitoring: a randomised controlled trial.
OBJECTIVE: To estimate the effectiveness of intrapartum fetal monitoring by cardiotocography plus ST analysis using a
strict protocol for performance of fetal blood sampling.
METHODS: We performed a multicenter randomized trial among laboring women with a high-risk singleton pregnancy
in cephalic presentation beyond 36 weeks of gestation. Participants were assigned to monitoring by cardiotocography
with ST analysis (index) or cardiotocography only (control). Primary outcome was metabolic acidosis, defined as an
umbilical cord artery pH below 7.05 combined with a base deficit calculated in the extracellular fluid compartment
above 12 mmol/L. Secondary outcomes were metabolic acidosis in blood, operative deliveries, Apgar scores, neonatal
admissions, and hypoxic-ischemic encephalopathy.
RESULTS: We randomly assigned 5,681 women to the two groups (2,832 index, 2,849 control). The fetal blood
216
sampling rate was 10.6% in the index compared with 20.4% in the control group (relative risk 0.52; 95% [CI] 0.460.59). The primary outcome occurred 0.7% in the index compared with 1.1% in the control group (relative risk 0.70;
95% CI 0.38-1.28; number needed to treat 252). Using metabolic acidosis calculated in blood, these rates were
1.6% and 2.6%, respectively (relative risk 0.63; 95% CI 0.42-0.94; number needed to treat 100). The number of
operative deliveries, low Apgar scores, neonatal admissions, and newborns with hypoxic-ischemic encephalopathy was
comparable in both groups.
CONCLUSION: Intrapartum monitoring by cardiotocography combined with ST analysis does not significantly reduce
the incidence of metabolic acidosis calculated in the extracellular fluid compartment. It does reduce the incidence of
metabolic acidosis calculated in blood and the need for fetal blood sampling without affecting the Apgar score, neonatal
admissions, hypoxic-ischemic encephalopathy, or operative deliveries.
LEVEL OF EVIDENCE: I.
PMID: 20516439
Wijermans P, Schaafsma M, Termorshuizen F, Ammerlaan R, Wittebol S, Sinnige H, Zweegman S, van
Marwijk Kooy M, van der Griend R, Lokhorst H, Sonneveld P; Dutch-Belgium Cooperative Group HOVON.
Phase III study of the value of thalidomide added to melphalan plus prednisone in elderly patients with
newly diagnosed multiple myeloma: the HOVON 49 Study.
J Clin Oncol. 2010 ; 28 (19) :3160-6.
PURPOSE: For several decades, the treatment of elderly patients with multiple myeloma (MM) has consisted of
melphalan and prednisone (MP). The Dutch-Belgium Hemato-Oncology Cooperative Group (HOVON) investigated
the efficacy of thalidomide added to MP (MP-T) in a randomized phase III trial. The objective of this study was to
investigate the efficacy, toxicity, and effects on quality of life of MP-T.
PATIENTS AND METHODS: A randomized phase III trial compared standard MP with MP-T (thalidomide 200 mg/d)
in newly diagnosed patients with multiple myeloma older than age 65 years. Maintenance therapy with thalidomide
50 mg/d was administered to patients after MP-T until relapse. The primary end point was event-free survival (EFS);
response rate, overall survival (OS), and progression-free survival (PFS) were secondary end points.
RESULTS: An intent-to-treat analysis of 333 evaluable patients showed significantly higher response rates in MP-Ttreated patients compared with MP-treated patients a response (> or = partial response: 66% v 45%, respectively; P <
.001; and > or = very good partial response [VGPR]: 27% v 10%, respectively; P < .001). EFS was 13 months with MP-T
versus 9 months with MP (P < .001). OS was 40 months with MP-T versus 31 months with MP (P = .05).
CONCLUSION: This study demonstrates that thalidomide improves the response rate and VGPR in elderly patients with
newly diagnosed MM. MP-T also results in a better EFS, PFS, and OS.
PMID: 20517939
Walgaard C, Lingsma HF, Ruts L, Drenthen J, van Koningsveld R, Garssen MP, van Doorn PA,
Steyerberg EW, Jacobs BC.
Prediction of respiratory insufficiency in Guillain-Barré syndrome.
Ann Neurol. 2010 Jun;67(6):781-7.
OBJECTIVE: Respiratory insufficiency is a frequent and serious complication of the Guillain-Barré syndrome (GBS). We
aimed to develop a simple but accurate model to predict the chance of respiratory insufficiency in the acute stage of the
disease based on clinical characteristics available at hospital admission.
METHODS: Mechanical ventilation (MV) in the first week of admission was used as an indicator of acute stage respiratory
217
insufficiency. Prospectively collected data from a derivation cohort of 397 GBS patients were used to identify predictors of
MV. A multivariate logistic regression model was validated in a separate cohort of 191 GBS patients. Model performance
criteria comprised discrimination (area under receiver operating curve [AUC]) and calibration (graphically). A scoring
system for clinical practice was constructed from the regression coefficients of the model in the combined cohorts.
RESULTS: In the derivation cohort, 22% needed MV in the first week of admission. Days between onset of weakness and
admission, Medical Research Council sum score, and presence of facial and/or bulbar weakness were the main predictors
of MV. The prognostic model had a good discriminative ability (AUC, 0.84). In the validation cohort, 14% needed MV in the
first week of admission, and both calibration and discriminative ability of the model were good (AUC, 0.82). The scoring
system ranged from 0 to 7, with corresponding chances of respiratory insufficiency from 1 to 91%.
INTERPRETATION: This model accurately predicts development of respiratory insufficiency within 1 week in patients with
GBS, using clinical characteristics available at admission. After further validation, the model may assist in clinical decision
making, for example, on patient transfer to an intensive care unit.
PMID: 20521308
Van Koulil S, van Lankveld W, Kraaimaat FW, van Helmond T, Vedder A, van Hoorn H, Donders R, de Jong
AJ, Haverman JF, Korff KJ, van Riel PL, Cats HA, Evers AW.
Tailored cognitive-behavioral therapy and exercise training for high-risk patients with fibromyalgia.
Arthritis Care Res (Hoboken). 2010 Oct;62(10):1377-85.
OBJECTIVE: The treatment of patients with fibromyalgia (FM), a high-prevalence chronic pain condition with a high
impact on both patients and society, poses a great challenge to clinicians due to a lack of effective treatments. In view
of the large individual variability in outcome, selecting patients at risk of long-term dysfunction and offering tailored
treatment may be promising for beneficial treatment effects.
METHODS: High-risk patients were selected and classified into 2 groups (pain-persistence and pain-avoidance groups)
and subsequently randomized in groups to either a treatment condition (TC) or a waiting list control condition (WLC).
Treatment consisted of 16 sessions of cognitive-behavioral therapy (CBT) and exercise training in groups, tailored to
the patient’s specific cognitive-behavioral pattern, delivered within 10 weeks. Physical and psychological functioning
and impact of FM were assessed at baseline, posttreatment, and 6-month followup. Treatment effects were evaluated
using a linear mixed model.
RESULTS: The treatment effects were significant for all primary outcomes, showing significant differences in physical
(pain, fatigue, and functional disability) and psychological (negative mood and anxiety) functioning, and impact of FM
for the TC in comparison with the WLC. Effect sizes in the TC were overall large, and reliable change indices indicated a
clinically relevant improvement among the TC.
CONCLUSION: The presented results demonstrate for the first time that tailored CBT and exercise training for high-risk
patients with FM is effective in improving short- and long-term physical and psychological functioning, indicating that
tailoring treatment is likely to promote beneficial outcomes in FM and reduce the burden for patients and society.
PMID: 20553055
van der Linden CM, Jansen PA, van Marum RJ, Grouls RJ, Korsten EH, Egberts AC.
Recurrence of adverse drug reactions following inappropriate re-prescription: better documentation,
availability of information and monitoring are needed.
Adverse drug reactions (ADRs) are a common, and often preventable, cause of hospital admission, especially in the elderly,
and can occur during hospitalization. In this current opinion article, we present three cases of recurrence of a serious
218
ADR due to re-prescription of a withdrawn medication that highlight the need for a system to prevent the undesirable
re-prescription of medications withdrawn because of an ADR. In addition, we describe an electronic system that could help
prevent undesirable re-prescription following an ADR. Such a system should document ADRs systematically at the patient
level, make this information available to relevant healthcare providers and the patient, and flag re-prescription of the
offending drug. The effectiveness and cost effectiveness of such a system would need to be determined.
Drug Saf. 2010 Jul 1;33(7):535-8.
PMID: 20553058
Mannesse CK, van Puijenbroek EP, Jansen PA, van Marum RJ, Souverein PC, Egberts TC. Hyponatremia as
an adverse drug reaction of antipsychotic drugs: a case-control study in VigiBase.
Drug Safety. 2010; 33(7): 569-78.
BACKGROUND: Hyponatraemia due to antipsychotic use is a potentially serious problem; however, it is not known
whether it is an adverse drug reaction (ADR) to antipsychotic use or is due to the underlying psychiatric disease.
OBJECTIVE: To estimate the strength of the association between antipsychotics and hyponatraemia or syndrome of
inappropriate antidiuretic hormone secretion (SIADH), using information reported to the WHO Collaborating Centre for
International Drug Monitoring, the Uppsala Monitoring Centre (UMC).
SETTING: The WHO global individual case safety report database system (VigiBase) maintained by the UMC.
STUDY DESIGN: Case-control study, with cases being reports of hyponatraemia/SIADH, and controls being reports of
other ADRs. Each case was sampled with ten controls sequencing in time from the date the corresponding case was
entered into the database. The potential contribution of the chemical structures and receptor affinity (dopaminergic
and/or serotonergic) of the antipsychotics was studied, as was the influence of concomitant use of other medications
known to cause hyponatraemia.
MAIN OUTCOME MEASURES: The strength of the association between antipsychotic use and hyponatraemia in
comparison with other drugs was expressed as reporting odds ratio (ROR), a measure of disproportionality, with
corresponding 95% CIs, adjusted for age, sex and concomitant medication associated with hyponatraemia. In addition,
stratification by the presence or absence of concomitant medication was performed.
RESULTS: Up to August 2008, 3 881 518 suspected ADRs were reported and filed in VigiBase, with 912 reports on
hyponatraemia related to antipsychotics. The adjusted ROR for the association between antipsychotic use and hyponatraemia was 1.58 (95% CI 1.46, 1.70). The adjusted RORs did not vary for the different chemical structures or dopamine D(2) and serotonin 5-HT(2A) receptor affinity profiles. The ROR was 3.00 (95% CI 2.65, 3.39) for the association
between hyponatraemia and antipsychotic use in the absence of concomitant medication associated with hyponatraemia, and 1.16 (95% CI 1.06, 1.28) in the presence of concomitant medication associated with hyponatraemia.
CONCLUSIONS: Antipsychotic use may be associated with reporting of hyponatraemia. Moreover, the concomitant use
of medication associated with hyponatraemia potentially leads to under-reporting of antipsychotic-associated hyponatraemia. We advise testing patients whose psychiatric and/or physical condition deteriorates while on antipsychotics for
hyponatraemia.
PMID: 20570559
Herbst RS, Sun Y, Eberhardt WE, Germonpré P, Saijo N, Zhou C, Wang J, Li L, Kabbinavar F, Ichinose Y, Qin S,
Zhang L, Biesma B, Heymach JV, Langmuir P, Kennedy SJ, Tada H, Johnson BE.
Vandetanib plus docetaxel versus docetaxel as second-line treatment for patients with advanced non-smallcell lung cancer (ZODIAC): a double-blind, randomised, phase 3 trial.
Lancet Oncol. 2010 Jul;11(7):619-26.
219
BACKGROUND: Vandetanib is a once-daily oral inhibitor of vascular endothelial growth factor receptor (VEGFR),
epidermal growth factor receptor (EGFR), and rearranged during transfection (RET) tyrosine kinases. In a randomised
phase 2 study in patients with previously treated non-small-cell lung cancer (NSCLC), adding vandetanib 100 mg to
docetaxel significantly improved progression-free survival (PFS) compared with docetaxel alone, including a longer PFS
in women. These results supported investigation of the combination in this larger, definitive phase 3 trial (ZODIAC).
METHODS: Between May, 2006, and April, 2008, patients with locally advanced or metastatic (stage IIIB-IV) NSCLC
after progression following first-line chemotherapy were randomly assigned 1:1 through a third-party interactive
voice system to receive vandetanib (100 mg/day) plus docetaxel (75 mg/m(2) intravenously every 21 days; maximum
six cycles) or placebo plus docetaxel. The primary objective was comparison of PFS between the two groups in the
intention-to-treat population. Women were a coprimary analysis population. This study has been completed and is
registered with ClinicalTrials.gov, number NCT00312377.
FINDINGS: 1391 patients received vandetanib plus docetaxel (n=694 [197 women]) or placebo plus docetaxel (n=697
[224 women]). Vandetanib plus docetaxel led to a significant improvement in PFS versus placebo plus docetaxel
(hazard ratio [HR] 0.79, 97.58% CI 0.70-0.90; p<0.0001); median PFS was 4.0 months in the vandetanib group
versus 3.2 months in placebo group. A similar improvement in PFS with vandetanib plus docetaxel versus placebo plus
docetaxel was seen in women (HR 0.79, 0.62-1.00, p=0.024); median PFS was 4.6 months in the vandetanib group
versus 4.2 months in the placebo group. Among grade 3 or higher adverse events, rash (63/689 [9%] vs 7/690 [1%]),
neutropenia (199/689 [29%] vs 164/690 [24%]), leukopenia (99/689 [14%] vs 77/690 [11%]), and febrile neutropenia
(61/689 [9%] vs 48/690 [7%]) were more common with vandetanib plus docetaxel than with placebo plus docetaxel.
The most common serious adverse event was febrile neutropenia (46/689 [7%] in the vandetanib group vs 38/690 [6%]
in the placebo group).
INTERPRETATION: The addition of vandetanib to docetaxel provides a significant improvement in PFS in patients with
advanced NSCLC after progression following first-line therapy.
PMID: 20578923
Lensvelt MM, Brokelman WJ, Ivarsson ML, Falk P, Reijnen MM.
Peritoneal transforming growth factor beta-1 expression during prolonged laparoscopic procedures.
J Laparoendosc Adv Surg Tech A. 2010 Jul-Aug;20(6):545-50.
BACKGROUND: Laparoscopic surgery may affect peritoneal physiology. Short-term laparoscopic surgery does not affect
peritoneal transforming growth factor beta (TGF-b1) expression. The current study was conducted to evaluate the
hypothesis that prolonged laparoscopic surgery may affect peritoneal TGF-b1 expression.
STUDY DESIGN: In the first study, 24 patients scheduled for a right colonic resection were enrolled in the trial. Twelve
underwent conventional surgery (CCR) and 12 were operated on laparoscopically (LCR). In the second study, 12
patients undergoing laparoscopic gastric bypass (LGB) surgery for morbid obesity were included. Biopsies of the parietal
peritoneum were taken at standardized moments during the procedures. Tissue concentrations of active and total TGF-b1
were measured by using enzyme-linked immunosorbent assays.
RESULTS: During the LCR, there was a significant increase in peritoneal active TGF-b1 levels (P < 0.05). A similar, but not
significant, trend was observed during the CCR. A similar pattern was seen in the total TGF-b1 concentrations during both
procedures. The LGB procedure did not affect peritoneal active or total TGF-b1 concentrations. During the procedure,
both the active and total TGF-b1 levels were significantly higher in the LCR, when compared to the LGB, group (P < 0.05).
CONCLUSIONS: Prolonged laparoscopic surgery may affect peritoneal TGF-b1 expression, depending on the procedure
performed. Considering the role of TGF-b1 in various biologic processes, including adhesiogenesis and oncology, these
results may have clinical consequences.
220
PMID: 20585080
van der Linden CMJ, Jansen PAF, van Marum RJ, Grouls RJE, Egberts ACG, Korsten HHM.
Reasons for discontinuation of medication during hospitalization and documentation thereof: a descriptive
study of 400 geriatric and internal medicine patients.
Arch Int Med. 2010 Jun 28;170(12):1085-7.
PMID: 20593742
Wouters CJ, Dautzenberg L, Thissen A, Dautzenberg PL.
Oral galantamine versus rivastigmine transdermal patch: a descriptive study at a memory clinic in The
Netherlands.
OBJECTIVES: Since January 2008 in The Netherlands, two cholinesterase inhibitors, oral galantamine and rivastigmine
transdermal patch, are registered as a one-day symptomatic treatment for Alzheimer’s disease. As no head to head study
was performed yet, the objective of this study was to describe the daily practice of oral galantamine and rivastigmine
transdermal patch in a real life population of a memory clinic of a suburban teaching hospital in The Netherlands.
METHODS: A randomized open label study in 84 ambulant Alzheimer’s patients with at least 6 months follow-up and
treated either with oral galantamine (group G) or rivastigmine transdermal patch (group R). Data collection included
patients’ demographic and disease variables. Adverse events were collected and, in case of interruption of the primary
treatment, the alternative treatment was registered.
RESULTS: Serious adverse events did not occur. In group G respectively group R adverse events occurred in 20 patients
(50%) and 18 patients (41%). No difference occurred in the frequency of nausea or vomiting. In group R more patients
noted dermatological adverse events. In group G respectively group R medication was stopped in 12 patients (30%) and
14 patients (32%). However, compared to group G after stopping the treatment in group R more patients received a new
anti-dementia medication (respectively 11 patients (79%) and 4 patients (33%)) (chi2(1) = 5.418, p = .026).
CONCLUSION: Despite different forms, the use of oral galantamine and rivastigmine transdermal patch showed neither
difference in the frequency of adverse events neither in the frequency of stopping primary treatment. However, compared
to oral galantamine use, rivastigmine transdermal patch resulted in more dermatological adverse events and after
stopping rivastigmine transdermal patch, new anti-dementia medication or form was more often started. More research
is urgently needed.
PMID: 20601906
Schatorjé E, Hoekstra H.
Transient hypertransaminasemia in paediatric patients with crohn disease undergoing initial treatment with
enteral nutrition.
J Pediatr Gastroenterol Nutr. 2010 Sep;51(3):336-40.
OBJECTIVES: Total enteral nutrition (TEN) is frequently used as monotherapy in children with Crohn disease to prevent
steroid toxicity. Liver disease is a known complication in inflammatory bowel disease, and liver enzymes are regularly
obtained in these patients.
PATIENTS AND METHODS: Prospective follow-up of liver enzymes was performed in 11 new consecutive patients
ages 7.6 to 17.1 years who were primarily treated with TEN for 6 weeks. Liver enzymes were measured before
starting TEN and after 3, 6, and 12 weeks.
RESULTS: At the beginning of TEN, the mean aspartate aminotransferase (ASAT) was 18.4 U/L and the mean alanine
221
aminotransferase (ALAT) 17.1 U/L. The mean ASAT and ALAT were 202.0 U/L and 269.0 U/L after 3 weeks and
109.6 U/L and 180.9 U/L at 6 weeks. After 12 weeks values decreased to 22.8 U/L (ASAT) and 20.9 U/L (ALAT).
Overall, 9 of 11 patients had transient elevated ASAT and 10 patients showed elevated ALAT. Gamma-glutamyl
transpeptidase was slightly elevated in 3 patients during therapy, but alkaline phosphatase and bilirubin showed
no changes. None of the patients developed liver disease during follow-up, and prolonged clinical remission was
achieved in 9 patients.
CONCLUSIONS: This study shows that TEN can be associated with transient hypertransaminasemia without evidence
of liver disease. We hypothesise that insulin resistance in patients with Crohn disease in combination with standard
TEN formulae can result in transient hepatic steatosis causing the hypertransaminasemia. For the clinician it is
important to be aware of this benign TEN-associated condition to prevent unnecessary investigations.
PMID: 20619027
Bax L, Mail WP, Beutler JJ.
Stenting in patients with atherosclerotic renal artery stenosis.
PMID: 20619049
Van der Hoek W, Dijkstra F, Rietveld A, Wijkmans CJ, Steenbergen JE, Notermans DW, Schneeberger PM.
Three years of Q fever in the Netherlands: faster diagnosis. [Drie Jaar Q-koorts in Nederland: snellere
diagnose.]
Ned Tijdschr Geneeskd 2010; 154:A1845.
OBJECTIVE: To assess if more rapid diagnosis and treatment is possible and to assess if this could be improved, since
the first outbreak of Q fever in 2007.
DESIGN: Retrospective study of secondary data.
METHODS: Analysis of surveillance data regarding Q fever over the period 2007 to 2009 and additional information
on some patients from 2007 and 2008 obtained from general practitioners.
RESULTS: Diagnostic delay fell sharply between 2007 and 2009 and to a lesser extent, so did therapeutic delay from
2007 to 2008. In high incidence areas, diagnosis and treatment was faster with a lower proportion of patients admitted to hospital than in low incidence areas.
CONCLUSION: It appears that familiarity with the condition leads to faster diagnosis coupled with a lower
percentage of hospital admissions. In order to react quickly it is necessary that doctor and patient should be aware of
Q fever, especially in areas of low incidence. Polymerase chain reaction diagnostic techniques should also be available.
PMID: 20628482
Hermans E, van Schaik PM, Prins HA, Ernst MF, Dautzenberg PJ, Bosscha K.
Outcome of colonic surgery in elderly patients with colon cancer.
J Oncol. 2010;2010:865908.
Introduction. Colonic cancer is one of the most commonly diagnosed malignancies and most often occurs in patients
aged 65 years or older. Aim. To evaluate the outcome of colonic surgery in the elderly in our hospital and to compare
five-year survival rates between the younger and elderly patients. Methods. 207 consecutive patients underwent
surgery for colon cancer. Patients were separated in patients younger than 75 and older than 75 years. Results.
Elderly patients presented significantly more (P < .05) as a surgical emergency, had a longer duration of admission
222
and were more often admitted to the ICU (P < .01). Also, elderly patients had significant more co-morbidities, especially
cardiovascular pathology (P < .01). Post-operative complications were seen more often in the elderly, although no
significant difference was seen in anastomotic leakage. The five-year survival rate in the younger group was 62%
compared with 36% in the elderly (P < .05). DFS was 61% in the younger patients compared with 32% in the elderly (P
< .05). Conclusion. Curative resection of colonic carcinoma in the elderly is well tolerated and age alone should not be
an indication for less aggressive therapy. However, the type and number of co-morbidities influence post-operative
mortality and morbidity.
PMID: 20633223
Boerjan M, Bluyssen SJ, Bleichrodt RP, van Weel-Baumgarten EM, van Goor H.
Work-related health complaints in surgical residents and the influence of social support and job-related
autonomy.
Med Educ. 2010 Aug;44(8):835-44.
METHODS: All (n = 400) Dutch residents in training in general surgery were sent validated self-report questionnaires.
Odds ratios were calculated predicting health and exposure to long-term stress for gender, number of working hours,
type of hospital, level of social support, job-related autonomy and training phase. The interactions between job-related
autonomy and level of social support provided by consultants and colleagues, and all variables, were analysed.
RESULTS: A total of 254 of 400 (64%) residents returned questionnaires that were eligible for analysis. Residents
experienced more health complaints than the average member of the Dutch working population (4.0 versus 2.5; p =
0.000). Male and senior residents were significantly ‘healthier’ than female and junior residents, respectively. Social
support by consultants was a strong predictor of health and social support by colleagues showed a significant interaction with gender. Women and residents in university hospitals experienced less social support by consultants than men
and residents in general teaching hospitals. Residents working in university hospitals experienced lower levels of jobrelated autonomy and less support from colleagues in comparison with those working in general teaching hospitals. A
working week of > 60 hours adversely affected health and job-related autonomy.
CONCLUSIONS: Social support provided by consultants and colleagues, and job control, are important factors that
interact with the work-associated, stress-related health of residents in training in general surgery. Residents report a
greater number of health complaints than the average member of the working population, especially female and junior
residents. General teaching hospitals seem to provide better support at work than university hospitals.
PMID: 20658794
Kröger E, van Marum RJ, Souverein P, Egberts TC.
Discontinuation of cholinesterase inhibitor treatment and determinants thereof in the Netherlands: A
retrospective cohort study.
Drugs Aging. 2010 Aug 1;27(8):663-75.
BACKGROUND: The cholinesterase inhibitors (ChEIs) rivastigmine and galantamine have been approved for the treatment of mild to moderate Alzheimer’s disease in the Netherlands. Differences between ChEIs regarding persistence or
the use of effective doses in daily clinical practice have been observed. However, most studies assessing ChEI discontinuation and associated determinants have been conducted in North America and there is a lack of knowledge about
ChEI discontinuation and its determinants in daily clinical practice in Europe.
OBJECTIVES: To assess ChEI discontinuation in daily practice in the Netherlands and to seek its determinants, including
suboptimal utilization.
223
METHODS: A retrospective cohort study was performed using data from the Dutch PHARMO Record Linkage System.
Included patients were aged > or =50 years at first dispensing of a ChEI, had a first dispensing of a ChEI between 1998
and 2008, had a prior medication history of 12 months and had at least one subsequent dispensing of any kind of
medication. The proportion of patients who discontinued ChEIs over 3 years was determined. Cox regression was used
to assess determinants for early (< or =6 months) discontinuation and, separately, for late discontinuation during a
subsequent 30-month follow-up among those persisting with treatment for >6 months.
RESULTS: At 6 months, 30.8% of 3369 study patients had discontinued ChEIs, compared with 59.0% after 3 years.
Thirty-five percent of patients taking rivastigmine reached the WHO-defined daily dose compared with 80% taking
galantamine. At 6 months, compared with regular-dose rivastigmine, low-dose rivastigmine or low-dose galantamine
was associated with an increased risk of early discontinuation, whereas regular-dose galantamine was associated with
a decreased risk, as was concurrent use of cardiac medications, drugs for Parkinson’s disease, propulsives, selective
serotonin reuptake inhibitors and benzodiazepines. Associations of ChEI type/dose or co-medications with discontinuation among patients persisting for > 6 months differed somewhat from associations with discontinuation before 6
months.
CONCLUSIONS: Fewer patients taking rivastigmine than those taking galantamine reached recommended doses.
Furthermore, patients taking rivastigmine had an increased risk of early discontinuation compared with patients taking
galantamine. Adverse effects leading to treatment intolerance and suboptimal utilization may have been contributing
factors to these observed differences.
PMID: 20673157
Kleinpenning MM, Langewouters AMG, Kerkhof PCM van de, Greebe RJ.
Severe pyoderma gangraenosum unresponsive to etanercept and adalimumab.
J Dermatolog Treat. 2010 Aug 1.
Abstract Background: A 74-year-old female with severe and therapy-resistant pyoderma gangrenosum (PG) was
treated for more than 40 years with topical antibacterial ointments, topical and systemic corticosteroids, dapsone and
azathioprine. Generally, immunosuppression is the mainstay of treatment of PG, but in our patient cyclosporine had to
be discontinued because of significant serious side effects. An attempt was made to decrease the amount of steroids,
but tapering of the prednisone dose resulted in relapses of PG. Observation: Off-label use of etanercept resulted in
a temporary limited clinical improvement. After 6 months, initial clinical improvement reduced and adalimumab was
started. Unfortunately, after 6 months of adalimumab no clinical improvement was seen. Therefore, systemic corticosteroids had to be continued with very good clinical results. Conclusion: In concordance with previous results of several
other studies, reviews and case reports, we presume that possibly both etanercept and adalimumab could be excellent
therapeutic alternatives in the treatment of PG. Unfortunately, the effectiveness of both etanercept and adalimumab
were very limited in our case. Literature research revealed no other successful studies on the off-label use of other
immunomodulators as an alternative treatment option for PG. However, infliximab or ustekinumab could be alternative
treatment options.
PMID: 20686659
van der Meijden E, Janssens RW, Lauber C, Bouwes Bavinck JN, Gorbalenya AE, Feltkamp MC.
Discovery of a New Human Polyomavirus Associated with Trichodysplasia Spinulosa in an
PLoS Pathog. 2010 Jul 29; 6(7): e1001024.
224
The Polyomaviridae constitute a family of small DNA viruses infecting a variety of hosts. In humans, polyomaviruses can cause infections of the central nervous system, urinary tract, skin, and possibly the respiratory tract. Here
we report the identification of a new human polyomavirus in plucked facial spines of a heart transplant patient with
trichodysplasia spinulosa, a rare skin disease exclusively seen in immunocompromized patients. The trichodysplasia
spinulosa-associated polyomavirus (TSV) genome was amplified through rolling-circle amplification and consists of
a 5232-nucleotide circular DNA organized similarly to known polyomaviruses. Two putative “early” (small and large
T antigen) and three putative “late” (VP1, VP2, VP3) genes were identified. The TSV large T antigen contains several
domains (e.g. J-domain) and motifs (e.g. HPDKGG, pRb family-binding, zinc finger) described for other polyomaviruses
and potentially involved in cellular transformation. Phylogenetic analysis revealed a close relationship of TSV with
the Bornean orangutan polyomavirus and, more distantly, the Merkel cell polyomavirus that is found integrated in
Merkel cell carcinomas of the skin. The presence of TSV in the affected patient’s skin was confirmed by newly designed
quantitative TSV-specific PCR, indicative of a viral load of 10(5) copies per cell. After topical cidofovir treatment, the
lesions largely resolved coinciding with a reduction in TSV load. PCR screening demonstrated a 4% prevalence of TSV in
an unrelated group of immunosuppressed transplant recipients without apparent disease. In conclusion, a new human
polyomavirus was discovered and identified as the possible cause of trichodysplasia spinulosa in immunocompromized
patients. The presence of TSV also in clinically unaffected individuals suggests frequent virus transmission causing
subclinical, probably latent infections. Further studies have to reveal the impact of TSV infection in relation to other
populations and diseases.
PMID: 20691040
van de Wall BJ, Draaisma WA, Consten EC, van der Graaf Y, Otten MH, de Wit GA, van Stel HF, Gerhards MF,
Wiezer MJ, Cense HA, Stockmann HB, Leijtens JW, Zimmerman DD, Belgers E, van Wagensveld BA,
Sonneveld ED, Prins HA, Coene PP, Karsten TM, Klaase JM, Statius Muller MG, Crolla RM, Broeders IA;
Dutch Diverticular Disease (3D) Collaborative Study Group.
DIRECT trial. Diverticulitis recurrences or continuing symptoms: Operative versus conservative treatment. A
multicenter randomised clinical trial.
BMC Surg. 2010 Aug 6;10:25.
BACKGROUND: Persisting abdominal complaints are common after an episode of diverticulitis treated conservatively.
Furthermore, some patients develop frequent recurrences. These two groups of patients suffer greatly from their
disease, as shown by impaired health related quality of life and increased costs due to multiple specialist consultations,
pain medication and productivity losses.Both conservative and operative management of patients with persisting
abdominal complaints after an episode of diverticulitis and/or frequently recurring diverticulitis are applied. However,
direct comparison by a randomised controlled trial is necessary to determine which is superior in relieving symptoms,
optimising health related quality of life, minimising costs and preventing diverticulitis recurrences against acceptable
morbidity and mortality associated with surgery or the occurrence of a complicated recurrence after conservative
management.We, therefore, constructed a randomised clinical trial comparing these two treatment strategies.
METHODS/DESIGN: The DIRECT trial is a multicenter randomised clinical trial. Patients (18-75 years) presenting
themselves with persisting abdominal complaints after an episode of diverticulitis and/or three or more recurrences
within 2 years will be included and randomised. Patients randomised for conservative treatment are treated according
to the current daily practice (antibiotics, analgetics and/or expectant management). Patients randomised for elective
resection will undergo an elective resection of the affected colon segment. Preferably, a laparoscopic approach is used.
The primary outcome is health related quality of life measured by the Gastro-intestinal Quality of Life Index, ShortForm 36, EQ-5D and a visual analogue scale for pain quantification. Secondary endpoints are morbidity, mortality and
225
total costs. The total follow-up will be three years.
DISCUSSION: Considering the high incidence and the multicenter design of this study, it may be assumed that the
number of patients needed for this study (n = 214), may be gathered within one and a half year.Depending on the
expertise and available equipment, we prefer to perform a laparoscopic resection on patients randomised for elective
surgery. Should this be impossible, an open technique may be used as this also reflects the current situation.
PMID: 20699030
Wever PC, Arts CH, Groot CA, Lestrade PJ, Koning OH, Renders NH.
Screening for chronic Q fever in symptomatic patients with an aortic aneurysm or prosthesis.
A 76-year-old man was referred to the Emergency Department because of collapse, epigastric pain and nausea. The
patient had been diagnosed with an infrarenal aneurysm of the abdominal aorta nine years earlier. His symptoms
were attributed to an aortic-duodenal fistula originating from the aneurysm. The patient died despite placement of
an aortic prosthesis. A hospital screening programme for chronic Q fever in patients with aortic aneurysm revealed
chronic Q fever. Until recently, vascular infection with Coxiella burnetii was an unknown disease in the Netherlands. In
view of the nonspecific clinical presentation, severity and therapeutic consequences of the disease, we advise screening
for chronic Q fever in all symptomatic patients with an aortic aneurysm or prosthesis - whether or not with aspecific
symptoms - in regions where the disease is endemic.
PMID: 20693886
Dorresteijn MJ, Visser T, Cox LA, Bouw MP, Pillay J, Koenderman AH, Strengers PF, Leenen LP, van der
Hoeven JG, Koenderman L, Pickkers P.
C1-esterase inhibitor attenuates the inflammatory response during human endotoxemia.
Crit Care Med. 2010 Nov;38(11):2139-45.
OBJECTIVE: Besides its role in regulation of the complement and contact system, C1-esterase inhibitor has other
immunomodulating effects that could prove beneficial in patients with acute inflammation such as during sepsis or
after trauma. We examined the immunomodulating properties of C1-esterase inhibitor during human experimental
endotoxemia, in which the innate immune system is activated in the absence of activation of the classic complement
pathway.
DESIGN: Double-blind placebo-controlled study.
SETTING: Research intensive care unit of the Radboud University Nijmegen Medical Centre.
SUBJECTS: Twenty healthy volunteers.
INTERVENTIONS: Intravenous injection of 2 ng/kg Escherichia coli lipopolysaccharide. Thirty minutes thereafter (to
prevent binding of lipopolysaccharide), C1-esterase inhibitor concentrate (100 U/kg, n = 10) or placebo (n = 10) was
infused.
MEASUREMENTS AND MAIN RESULTS: Pro- and anti-inflammatory mediators, markers of endothelial and complement activation, hemodynamics, body temperature, and symptoms were measured. C1-esterase inhibitor reduced the
release of proinflammatory cytokines as well as C-reactive protein (peak levels of: interleukin-6 1521 ± 209 vs. 932
± 174 pg/mL [p = .04], tumor necrosis factor-± 1213 ± 187 vs. 827 ± 167 pg/mL [p = .10], monocyte chemotactic
protein-1 6161 ± 1302 vs. 3373 ± 228 pg/mL [p = .03], interleukin-1β 34 ± 5 vs. 23 ± 2 pg/mL [p < .01], Creactive protein 39 ± 4 vs. 29 ± 2 mg/L [p = .02]). In contrast, release of the anti-inflammatory cytokine interleukin-10 was increased by C1-esterase inhibitor (peak level 73 ± 11 vs. 121 ± 18 pg/mL, p = .02). The increase in
226
interleukin-1 receptor antagonist tended to be smaller in the C1-esterase inhibitor group, but this effect did not reach
statistical significance (p = .07). Markers for endothelial activation were increased after lipopolysaccharide infusion,
but no significant differences between groups were observed. The lipopolysaccharide-induced changes in heart rate,
blood pressure, body temperature, and symptoms (all p < .001 over time) were not influenced by C1-esterase inhibitor.
Complement fragment C4 was not increased after lipopolysaccharide challenge.
CONCLUSIONS: This study is the first to demonstrate that C1-esterase inhibitor exerts anti-inflammatory effects in the
absence of classic complement activation in humans.
PMID: 20698878
Anderwald C, Ankersmit HJ, Badaoui A, Beneduce L, Buko VU, Calo LA, Carrero JJ, Chang C-Y, Chang K-C,
Chen Y-J, Cnotliwy M, Costelli P, Crujeiras AB, Cuocolo A, Davis PA, de Boer OJ, Ebenbichler CF, Erridge C,
Fassina G, Felix SB, García-Gomez MC, Guerrero-Romero F, Haider DG, HeinemannA, Herda LR,
Hoogeveen EK, Hörl WH, Iglseder B, Huang K-C, Kaser S, Kastrati A, Kuzniatsova N, Latella G,
Lichtenauer M, Lin Y-K, Lip GYH, Lu N-H, Lukivskaya O, Luschnig P, Maniscalco M, Martinez JA, MüllerKrebs S, Ndrepepa G, Nicolaou G, Peck-Radosavljevic M, Penna F, Pinto X, Reiberger T, Rodriguez-Moran
M, Schmidt A, Schwenger V, Spinelli L, Starkel P, Stehouwer CDA, Stenvinkel P, Strasser P, Suzuki H,
Tschoner A, van der Wal AC, Vesely DL, Wen C-J, Wiernicki I, Zanninelli G and Zhu Y.
Research update for articles published in EJCI in 2008.
Eur J Clin Invest. 2010; 40: 770-790.
PMID: 20703938
Van der Sangen MJ, van de Wiel FM, Poortmans PM, Tjan-Heijnen VC, Nieuwenhuijzen GA, Roumen RM,
Ernst MF, Tutein Nolthenius-Puylaert MC, Voogd AC.
Are breast conservation and mastectomy equally effective in the treatment of young women with early
breast cancer? Long-term results of a population-based cohort of 1,451 patients aged </=40 years.
Breast Cancer Res Treat. 2010 Aug 12.
To compare the effectiveness of breast-conserving therapy (BCT) and mastectomy, all women aged </=40 years, treated for early-stage breast cancer in the southern part of the Netherlands between 1988 and 2005, were identified.
A total of 562 patients underwent mastectomy and 889 patients received BCT. During follow-up, 23 patients treated
with mastectomy and 135 patients treated with BCT developed a local relapse without previous or simultaneous
evidence of distant disease. The local relapse risk for patients treated with mastectomy was 4.4% (95% confidence interval (CI) 2.4-6.4) at 5 years and reached a plateau after 6 years at 6.0% (95% CI 3.5-8.5). After BCT, the 5-, 10- and
15-year risks were 8.3% (95% CI 6.3-10.5), 18.4% (95% CI 15.0-21.8) and 28.2% (95% CI 23.0-33.4), respectively (P
< 0.0001). Adjuvant systemic therapy following BCT reduced the 15-year local relapse risk from 32.9% (95% CI 26.739.1) to 16.1% (95% CI 9.1-23.1), (P = 0.0007). In conclusion, local tumor control in young patients with early-stage
breast cancer is worse after BCT than after mastectomy. Adjuvant systemic therapy significantly improves local control
following BCT and also for that reason it should be considered for most patients </=40 years. Long-term follow-up
is highly recommended for young patients after BCT, because even with systemic treatment an annual risk of local
relapse of 1% remains up to 15 years after treatment.
PMID: 20732915
Van Santvoort HC, Besselink MG, Bakker OJ, Vleggaar FP, Timmer R, Weusten BL, Gooszen HG; Dutch
227
Endoscopic necrosectomy in necrotising pancreatitis: indication is the key.
Gut. 2010 Nov;59(11):1587.
PMID: 20739731
van der Horn G, Ranschaert ER, Dubelaar IJ, van Munster IP.
An adult with vague abdominal complaints and atypical colonoscopic findings.
Neth J Med. 2010 Aug;68(1):324-7.
PMID: 20798200
Tieleman AA, Knoop H, van de Logt AE, Bleijenberg G, van Engelen BG, Overeem S.
Poor sleep quality and fatigue but no excessive daytime sleepiness in myotonic dystrophy type 2.
J Neurol Neurosurg Psychiatry. 2010 Sep;81(9):963-7.
BACKGROUND: In myotonic dystrophy type 1 (DM1), sleep disorders are common, with excessive daytime sleepiness
(EDS) as a predominant feature. In myotonic dystrophy type 2 (DM2), the presence of sleep disturbances is unknown.
OBJECTIVE: To investigate the frequency of EDS, poor sleep quality and fatigue in DM2.
METHODS: 29 genetically proven DM2 patients were surveyed using the Epworth Sleepiness Scale, Pittsburgh Sleep
Quality Index (PSQI) and Checklist Individual Strength. The results were compared with 29 adult onset DM1 patients
and 65 population controls, both matched for age and sex.
RESULTS: Only 6.9% of DM2 patients had EDS compared with 44.8% of DM1 patients and 6.2% of population controls
(DM2-DM1: p=0.001; DM2-controls: p=0.51). Sleep quality was poor (PSQI >5) in both DM2 and DM1 groups, and
differed significantly from population controls (DM2 6.5+/-3.0; DM1 6.2+/-3.7; controls 4.3+/-3.0; DM2-controls:
p=0.002). Poor sleep quality was not explained by depression or other comorbidity but was mainly due to sleep
disturbances as a result of nocturnal pain. Comparable with the DM1 group, DM2 patients experienced severe fatigue
(DM2 38.7+/-13.1; DM1 42.9+/-8.5; controls 21.1+/-11.1; DM2-controls: p<0.001). Results were not confounded by
abnormal thyroid function or medication use.
CONCLUSION: These results provide new insight into the phenotype of DM2 and have consequences for clinical treatment. In addition, the absence of EDS in DM2 is a new discriminative feature with adult onset DM1.
PMID: 20802011
Limonard GJ, Peters JB, Nabuurs-Franssen MH, Weers-Pothoff G, Besselink R, Groot CA, Dekhuijzen PN,
Vercoulen JH.
Detailed analysis of health status of Q fever patients 1 year after the first Dutch outbreak: a case-control
study.
QJM 2010 Dec;103(12):953-8.
BACKGROUND: Q fever is a zoonosis caused by the obligate intracellular bacterium Coxiella burnetii. The two longterm complications, after primary infection, are chronic Q fever in ∼1% of patients, and a chronic fatigue syndrome in
10-20%. However, the existence of a protracted decreased health status after Q fever remains controversial.
AIM: To determine the health status of the patients of the Q fever outbreak in The Netherlands in 2007, 1 year after
primary infection.
DESIGN: Cross-sectional case-control study.
METHODS: Health status of the patients from the 2007 Dutch Q fever outbreak was compared to age-, sex- and
geographically matched and Q fever seronegative controls. Health status of both patients and controls was assessed
228
with the Nijmegen Clinical Screening Instrument (NCSI).
RESULTS: Fifty-four Q fever patients provided 34 years of age- and sex-matched controls from the same neighbourhood. Eleven controls had positive Q fever serology and were excluded. Q fever patients had significantly more
problems on the subdomains of symptoms and functional impairment. Overall quality of life was decreased in both
patients and controls, 59% vs. 39%, respectively, ns). Severe fatigue levels were present in 52% of patients vs. 26% in
controls (P < 0.05).
CONCLUSION: These data support a sustained decrease in many aspects of health status in Q fever patients in The
Netherlands, 1 year after primary infection.
PMID: 20804340
Brandes M, Hamilton CJ, Bergevoet KA, de Bruin JP, Nelen WL, Kremer JA.
Origin of multiple pregnancies in a subfertile population.
Acta Obstet Gynecol Scand. 2010 Sep;89(9):1149-54.
OBJECTIVE: To evaluate the contribution of different subfertility treatments to the number of multiple pregnancies in a
subfertile population.
DESIGN: A prospective cohort study between January 2002 and December 2006.
SETTING: A subfertility clinic in a large regional training hospital in the Netherlands.
POPULATION: A total of 1,001 continuing pregnancies, of which 63 (6.3%) were multiple.
METHODS: Of all pregnancies, mode of conception, outcome and type of pregnancy (singleton or multiple) were
documented.
MAIN OUTCOME MEASURES: Proportions of continuing and multiple pregnancies caused by the different modes of
conception.
RESULTS: Of all subfertility related continuing pregnancies, 46% were conceived spontaneously, 16% were induced by
clomiphene citrate (CC), 2.4% by follicle stimulating hormone (FSH) and 14% by intra-uterine insemination combined
with controlled hyperstimulation (IUI/(COH)). In vitro fertilization (IVF) and its related techniques resulted in about a
fifth of all continuing pregnancies (n = 212), but were responsible for more than half (n = 36) of the multiple pregnancies. Furthermore, 18% of the multiple pregnancies were induced by IUI/(COH), 3% by FSH, 11% by CC, whereas about
11% were conceived spontaneously.
CONCLUSIONS: IVF and intra-cytoplasmic sperm injection (ICSI) were responsible for the majority of the multiple
pregnancies in a subfertile population. Therefore, twin prevention should be focused on further promoting elective
single embryo transfer (eSET). Fertility treatment and particular IVF should not be started as long as the spontaneous
pregnancy prognosis is good.
PMID: 20814323
Kleijer BC, Heerdink R, Egberts ACG, Jansen PAF, van Marum RJ.
Antipsychotic drug use and the risk of venous thromboembolism in elderly patients.
J Clin Psychopharmacol. 2010; Oct;30(5):526-30.
OBJECTIVE: Our aim was to investigate the relationship between exposure to antipsychotic drugs and the risk of
venous thromboembolism (VTE) in elderly patients.
METHODS: A time-matched case-control analysis nested within a cohort of 111,818 patients with at least 1 antipsychotic drug prescription during 1998 to 2008. Data were used from the PHARMO institute’s database, which
contains drug dispensing data from community pharmacies and hospital admission data. The index date was for the
229
cases defined as the date of hospital admission for VTE (deep venous thrombosis [DVT] or pulmonary embolism) or, for
outpatient cases, the start of therapeutic dose low-molecular weight heparin therapy. For each case, 4 controls matched
by age and sex were randomly sampled from the cohort.
MEASUREMENTS: Two measures were used to evaluate the temporal relationship between antipsychotic drug use and
the occurrence of VTE: being a current, recent, or past user and the duration of use up to the index date. The strength of
the association was expressed as odds ratios with 95% confidence intervals, taking into account potential confounders.
RESULTS: We identified 367 cases of hospital admission for DVT, 342 cases of hospital admission for PE, and 323 cases
of outpatient treatment of DVT. Current exposure to antipsychotic drugs was not associated with an increased risk of
VTE, compared with nonusers (odds ratio, 0.9; 95% confidence interval, 0.7-1.1). We found no association between
dosage, the duration of use, or the type of antipsychotic drug and the risk of VTE.
CONCLUSIONS: We found no evidence of an increased risk of VTE in elderly patients using antipsychotic drugs.
PMID: 20816127
De Groot PC, Thijssen D, Binkhorst M, Green DJ, Schokking M, Hopman MT.
Vascular function in children with repaired tetralogy of Fallot.
Am J Cardiol. 2010 Sep 15;106(6):851-5.
We compared the endothelial function and vascular wall characteristics of 11 children with tetralogy of Fallot (TOF) (age
13 +/- 3 years) with the characteristics of 17 age-matched peers (12 +/- 2 years). Echocardiographic Doppler measurements were performed under standardized conditions to assess (1) the carotid and femoral artery diameter and intimamedia thickness, (2) brachial artery endothelial function using flow-mediated dilation, and (3) central and peripheral
compliance using pulsewave velocity. In addition, the physical activity level was assessed using a validated questionnaire.
We found that the physical activity level of the children with TOF was lower than that of the controls, but the difference
did not reach statistical significance (4.5 vs 5.9 h/wk, p = 0.087). A significantly larger femoral artery intima-media thickness was observed in those with TOF, and the carotid and brachial artery diameter and intima-media thickness were
comparable between groups. The children with TOF demonstrated a significantly lower brachial artery flow-mediated dilation than that of the controls. The central and peripheral compliance did not differ between the 2 groups. In conclusion,
children with TOF demonstrated an impaired brachial artery endothelial function and increased intima-media thickness
of the femoral artery compared to their healthy peers. In conclusion, our findings have, therefore, indicated that children
with TOF, already at a young age, have changes in vascular function and structure.
PMID: 20822723
Koebrugge B, van Wensen RJ, Bosscha K, Dautzenberg PL, Koning OH.
Delirium after Emergency/Elective Open and Endovascular Aortoiliac Surgery at a Surgical Ward with a
High-standard Delirium Care Protocol.
Vascular. 2010 Sep-Oct;18(5):279-87.
Delirium is a common problem in elderly patients undergoing surgery. Standard delirium care is not available at all
surgical wards. We determined the incidence, risk factors, and outcomes of postoperative delirium among patients
undergoing elective/emergency aortoiliac surgery at a surgical ward with high-standard delirium care. A prospective
descriptive survey in 107 patients was conducted. High-standard delirium care was given to patients above age 65,
consisting of an extended focus on risk factors and intensive screening. The Delirium Observation Scale was used as a
screening instrument for delirium. Patients were classified as having delirium if they met the DSM-IV criteria. The overall
incidence of delirium was 23%. The incidence was 14% after elective surgery. Delirium occurred in 59% after emergency
230
surgery and more often after open than after endovascular aneurysm repair (p < .01). Delirium was associated with
age (p < .01) and emergency surgery (p = .01) and is an important and frequent complication after aortoiliac surgery.
PMID: 20826645
Tilburg JJ, Melchers WJ, Pettersson AM, Rossen JW, Hermans MH, van Hannen EJ, Nabuurs-Franssen
MH, de Vries MC, Horrevorts AM, Klaassen CH.
Interlaboratory evaluation of different extraction and real-time PCR methods for the detection of
Coxiella burnetii DNA in serum.
J Clin Microbiol. 2010 Nov;48(11):3923-7.
In the Netherlands, there is an ongoing and unparalleled outbreak of Q fever. Rapid and reliable methods to identify
patients infected with Coxiella burnetii, the causative agent of Q fever, are urgently needed. We evaluated the
performance of different DNA extraction methods and real-time PCR assays that are in use in seven diagnostic or
reference laboratories in the Netherlands. A low degree of variation in the sensitivities of most of the developed realtime PCR assays was observed. However, PCR assays amplifying short DNA fragments yielded better results than
those producing large DNA fragments. With regard to DNA extraction, the automated MagNA Pure Compact system
and the manual QIAamp DNA mini kit consistently yielded better results than either the MagNA Pure LC system and
NucliSens EasyMag (both automated) or the High Pure viral nucleic acid kit (manual). The present study shows that
multiple combinations of DNA extraction kits and real-time PCR assays offer equivalent solutions to detect C. burnetii
DNA in serum samples from patients suspected to have Q fever.
PMID: 20840759
Huijsmans CJ, Damen J, van der Linden JC, Savelkoul PH, Hermans MH.
Comparative analysis of four methods to extract DNA from paraffin-embedded tissues: effect on
downstream molecular applications.
BACKGROUND: A large portion of tissues stored worldwide for diagnostic purposes is formalin-fixed and paraffin-embedded (FFPE). These FFPE-archived tissues are an extremely valuable source for retrospective (genetic) studies. These
include mutation screening in cancer-critical genes as well as pathogen detection. In this study we evaluated the impact
of several widely used DNA extraction methods on the quality of molecular diagnostics on FFPE tissues.
FINDINGS: We compared 4 DNA extraction methods from 4 identically processed FFPE mammary-, prostate-, colonand lung tissues with regard to PCR inhibition, real time SNP detection and amplifiable fragment size. The extraction
methods, with and without proteinase K pre-treatment, tested were: 1) heat-treatment, 2) QIAamp DNA-bloodmini-kit, 3) EasyMAG NucliSens and 4) Gentra Capture-Column-kit.Amplifiable DNA fragment size was assessed by
multiplexed 200-400-600 bp PCR and appeared highly influenced by the extraction method used. Proteinase K pretreatment was a prerequisite for proper purification of DNA from FFPE. Extractions with QIAamp, EasyMAG and heattreatment were found suitable for amplification of fragments up to 400 bp from all tissues, 600 bp amplification was
marginally successful (best was QIAamp). QIAamp and EasyMAG extracts were found suitable for downstream real time
SNP detection. Gentra extraction was unsuitable. Hands-on time was lowest for heat-treatment, followed by EasyMAG.
CONCLUSIONS: We conclude that the extraction method plays an important role with regard to performance in downstream molecular applications.
231
PMID: 20848574
Rutten MJ, Collins JM, de Waal Malefijt MC, Kiemeney LA, Jager GJ.
Unsuspected sonographic findings in patients with post-traumatic shoulder complaints.
J Clin Ultrasound. 2010 Nov;38(9):457-65.
PURPOSE: To prospectively assess the frequency of abnormal sonographic findings in patients with posttraumatic shoulder pain and/or disability in whom ultrasound (US) was not considered and to assess the effect of sonographic findings on
working diagnosis and therapeutic strategy, to analyze the possible role of US in the diagnostic workup of these patients.
METHODS: A survey was performed under general practitioners and orthopedic surgeons. They were requested to refer
patients with persistent posttraumatic complaints for an US examination of the shoulder and to fill out a questionnaire
concerning working diagnosis and therapy. In 50 patients examinations were performed separately by two radiologists.
Findings were confirmed with additional radiographs and/or MRI and/or surgery. Four weeks after the US examination,
the survey was repeated to inquire about changes in diagnosis and/or treatment that resulted from US.
RESULTS: US showed relevant pathology in 45 (90%) of 50 patients, a proximal humerus fracture in 25 (50%) patients,
and a rotator cuff tear in 43 (86%) patients. Twenty-three (92%) fractures were accompanied by a rotator cuff tear, and 23
(54%) rotator cuff tears were accompanied by a fracture. Ten fractures were initially missed radiographically. US findings
changed the working diagnosis and therapeutic strategy in 37 (74%) and 26 (52%) patients, respectively.
CONCLUSION: In patients with posttraumatic shoulder complaints, US showed a high rate (90%) of relevant pathology.
This changed the initial working diagnosis in 74% of the patients and the therapeutic strategy in more than half of the
patients. Active referral for US examination may identify these abnormalities in an earlier phase and improve clinical
outcome.
PMID: 20857313
Limonard GJ, Nabuurs-Franssen MH, Weers-Pothoff G, Wijkmans C, Besselink R, Horrevorts AM,
Schneeberger PM, Groot CA.
One-year follow-up of patients of the ongoing Dutch Q fever outbreak: clinical, serological and
echocardiographic findings.
Infection 2010 Dec;38(6):471-7.
PURPOSE: In 2007, a large goat-farming-associated Q fever outbreak occurred in the Netherlands. Data on the clinical
outcome of Dutch Q fever patients are lacking. The current advocated follow-up strategy includes serological follow-up to
detect evolution to chronic disease and cardiac screening at baseline to identify and prophylactically treat Q fever patients
in case of valvulopathy. However, serological follow-up using commercially available tests is complicated by the lack of
validated cut-off values. Furthermore, cardiac screening in the setting of a large outbreak has not been implemented
previously. Therefore, we report here the clinical outcome, serological follow-up and cardiac screening data of the Q fever
patients of the current ongoing outbreak.
METHODS: The implementation of a protocol including clinical and serological follow-up at baseline and 3, 6 and 12
months after acute Q fever and screening echocardiography at baseline.
RESULTS: Eighty-five patients with acute Q fever were identified (male 62%, female 38%). An aspecific, flu-like illness was
the most common clinical presentation. Persistent symptoms after acute Q fever were reported by 59% of patients at 6
months and 30% at 12 months follow-up. We observed a typical serological response to Coxiella burnetii infection in both
anti-phase I and anti-phase II IgG antibodies, with an increase in antibody titres up to 3 months and a subsequent decrease in the following 9 months. Screening echocardiography was available for 66 (78%) out of 85 Q fever patients. Cardiac
valvulopathy was present in 39 (59%) patients. None of the 85 patients developed chronic Q fever.
232
CONCLUSIONS: Clinical, serological and echocardiographic data of the current ongoing Dutch Q fever outbreak cohort are
presented. Screening echocardiography is no longer part of the standard work-up of Q fever patients in the Netherlands.
PMID: 20858325
Wegdam-Blans MC, Nabuurs-Franssen MH, Horrevorts AM, Peeters MF, Schneeberger PM, Bijlmer HA.
Laboratory diagnosis of acute Q fever. [Laboratoriumdiagnostiek van acute Q-koorts.]
In the Netherlands an increasing number of laboratories are involved in diagnosing acute Q-fever. More uniformity in
diagnostics and interpretation is desirable. To enable this, a working group on diagnostics of acute Q-fever was created
on the initiative of the National Institute for Public Health and the Environment (RIVM) and the Dutch Association for
Medical Microbiology (NVMM). The diagnostics of acute Q-fever includes a diagnostic flow chart (algorithm) consisting
of tests for DNA and for antibodies against the antigens that appear in the successive stages of the disease. Reporting
of both confirmed and suspected cases of acute Q-fever is obligatory.
PMID: 20890214
Hoekstra JH, van der Weij AM, Groot-Loonen J, Hoogerbrugge P, Kooy Y, Koning F. Succesful treatment of
celiac disease by allogeneic haematopoietic stem cell transplantation.
J Pediatr Gastroenterol Nutr 2010;51:793-4.
PMID: 20948216
Koebrugge B, van Leuken M, Ernst MF, van Munster I, Bosscha K.
Percutaneous Cholecystostomy in Critically Ill Patients with a Cholecystitis: A Safe Option.
Dig Surg. 2010 Oct 15;27(5):417-421.
Background: Cholecystectomy is the standard procedure in patients with acute cholecystitis. However, some patients
might not be able to undergo immediate surgery because of severe sepsis or underlying comorbid conditions.
Percutaneous cholecystostomy is a minimally invasive radiological procedure under local anesthesia which seems to
be an effective alternative to conservative treatment or immediate laparoscopic/open cholecystectomy. Methods: We
retrospectively analyzed 35 patients who underwent percutaneous cholecystostomy between 2003 and 2009. Results:
Percutaneous cholecystostomy was technically successful in all patients. Symptoms resolved within 3 days in 33/35
patients. Two patients needed an emergency laparotomy. The catheter dislodged in 5 patients and was replaced in 2/5.
The 30-day mortality rate was 3/35 (8.7%) due to gallbladder necrosis, myocardial infarction and multiorgan failure.
Median length of hospital stay was 17 days and median drainage time was 28 days. 23 patients (66%) underwent open
or laparoscopic cholecystectomy after a median interval of 44 days. Conclusion: Percutaneous cholecystostomy is an
effective procedure and a good alternative for patients unfit to undergo immediate surgery because of severe sepsis or
underlying comorbid conditions, preferably followed by interval cholecystectomy to prevent recurrent cholecystitis.
PMID: 20955571
Swank HA, Vermeulen J, Lange JF, Mulder IM, van der Hoeven JA, Stassen LP, Crolla RM, Sosef MN,
Nienhuijs SW, Bosker RJ, Boom MJ, Kruyt PM, Swank DJ, Steup WH, de Graaf EJ, Weidema WF, Pierik RE,
Prins HA, Stockmann HB, Tollenaar RA, van Wagensveld BA, Coene PP, Slooter GD, Consten EC, van Duijn
EB, Gerhards MF, Hoofwijk AG, Karsten TM, Neijenhuis PA, Blanken-Peeters CF, Cense HA, Mannaerts GH,
Bruin SC, Eijsbouts QA, Wiezer MJ, Hazebroek EJ, van Geloven AA, Maring JK, D’Hoore AJ, Kartheuser A,
233
Remue C, van Grevenstein HM, Konsten JL, van der Peet DL, Govaert MJ, Engel AF, Reitsma JB, Bemelman
WA; Dutch Diverticular Disease (3D) Collaborative Study Group.
The ladies trial: laparoscopic peritoneal lavage or resection for purulent peritonitisA and Hartmann’s
procedure or resection with primary anastomosis for purulent or faecal peritonitisB in perforated
diverticulitis (NTR2037).
BMC Surg. 2010 Oct 18;10:29.
BACKGROUND: Recently, excellent results are reported on laparoscopic lavage in patients with purulent perforated
diverticulitis as an alternative for sigmoidectomy and ostomy.The objective of this study is to determine whether LaparOscopic LAvage and drainage is a safe and effective treatment for patients with purulent peritonitis (LOLA-arm) and
to determine the optimal resectional strategy in patients with a purulent or faecal peritonitis (DIVA-arm: perforated
DIVerticulitis: sigmoidresection with or without Anastomosis).
METHODS/DESIGN: In this multicentre randomised trial all patients with perforated diverticulitis are included. Upon
laparoscopy, patients with purulent peritonitis are treated with laparoscopic lavage and drainage, Hartmann’s procedure or sigmoidectomy with primary anastomosis in a ratio of 2:1:1 (LOLA-arm). Patients with faecal peritonitis will
be randomised 1:1 between Hartmann’s procedure and resection with primary anastomosis (DIVA-arm). The primary
combined endpoint of the LOLA-arm is major morbidity and mortality. A sample size of 132:66:66 patients will be able
to detect a difference in the primary endpoint from 25% in resectional groups compared to 10% in the laparoscopic lavage group (two sided alpha = 5%, power = 90%). Endpoint of the DIVA-arm is stoma free survival one year after initial
surgery. In this arm 212 patients are needed to significantly demonstrate a difference of 30% (log rank test two sided
alpha = 5% and power = 90%) in favour of the patients with resection with primary anastomosis. Secondary endpoints
for both arms are the number of days alive and outside the hospital, health related quality of life, health care utilisation
and associated costs.
DISCUSSION: The Ladies trial is a nationwide multicentre randomised trial on perforated diverticulitis that will provide
evidence on the merits of laparoscopic lavage and drainage for purulent generalised peritonitis and on the optimal
resectional strategy for both purulent and faecal generalised peritonitis.
PMID: 21034463
de Jager CP, van Wijk PT, Mathoera RB, de Jongh-Leuvenink J, van der Poll T, Wever PC.
Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional
Crit Care. 2010;14(5):R192.
INTRODUCTION: Absolute lymphocytopenia has been reported as a predictor of bacteremia in medical emergencies.
Likewise, the neutrophil-lymphocyte count ratio (NLCR) has been shown a simple promising method to evaluate systemic inflammation in critically ill patients.
METHODS: We retrospectively evaluated the ability of conventional infection markers, lymphocyte count and NLCR
to predict bacteremia in adult patients admitted to the Emergency Department with suspected community-acquired
bacteremia. The C-reactive protein (CRP) level, white blood cell (WBC) count, neutrophil count, lymphocyte count and
NLCR were compared between patients with positive blood cultures (n = 92) and age-matched and gender-matched
patients with negative blood cultures (n = 92) obtained upon Emergency Department admission.
RESULTS: Significant differences between patients with positive and negative blood cultures were detected with respect to the CRP level (mean ± standard deviation 176 ± 138 mg/l vs. 116 ± 103 mg/l; P = 0.042), lymphocyte count
(0.8 ± 0.5 × 109/l vs. 1.2 ± 0.7 × 109/l; P < 0.0001) and NLCR (20.9 ± 13.3 vs. 13.2 ± 14.1; P < 0.0001) but not
234
regarding WBC count and neutrophil count. Sensitivity, specificity, positive and negative predictive values were highest
for the NLCR (77.2%, 63.0%, 67.6% and 73.4%, respectively). The area under the receiver operating characteristic curve
was highest for the lymphocyte count (0.73; confidence interval: 0.66 to 0.80) and the NLCR (0.73; 0.66 to 0.81).
CONCLUSIONS: In an emergency care setting, both lymphocytopenia and NLCR are better predictors of bacteremia
than routine parameters like CRP level, WBC count and neutrophil count. Attention to these markers is easy to integrate in daily practice and without extra costs.
PMID: 21040534
Munster JM, Leenders AC, van der Hoek W, Schneeberger PM, Rietveld A, Riphagen-Dalhuisen J, Stolk RP,
Hamilton CJ, de Vries E, Meekelenkamp J, Lo-Ten-Foe JR, Timmer A, De Jong-van den Berg LT, Aarnoudse
JG, Hak E.
Cost-effectiveness of a screening strategy for Q fever among pregnant women in risk areas: a clustered
BMC Womens Health. 2010 Nov 1;10(1):32.
BACKGROUND: In The Netherlands the largest human Q fever outbreak ever reported in the literature is currently
ongoing with more than 2300 notified cases in 2009. Pregnant women are particularly at risk as Q fever during
pregnancy may cause maternal and obstetric complications. Since the majority of infected pregnant women are
asymptomatic, a screening strategy might be of great value to reduce Q fever related complications. We designed a trial
to assess the (cost-)effectiveness of a screening program for Q fever in pregnant women living in risks areas in The
Netherlands.
METHODS/DESIGN: We will conduct a clustered randomized controlled trial in which primary care midwife centres in
Q fever risk areas are randomized to recruit pregnant women for either the control group or the intervention group. In
both groups a blood sample is taken around 20 weeks postmenstrual age. In the intervention group, this sample is immediately analyzed by indirect immunofluorescence assay for detection of IgG and IgM antibodies using a sensitive cutoff level of 1:32. In case of an active Q fever infection, antibiotic treatment is recommended and serological follow up is
performed. In the control group, serum is frozen for analysis after delivery. The primary endpoint is a maternal (chronic
Q fever or reactivation) or obstetric complication (low birth weight, preterm delivery or fetal death) in Q fever positive
women. Secondary aims pertain to the course of infection in pregnant women, diagnostic accuracy of laboratory tests
used for screening, histo-pathological abnormalities of the placenta of Q fever positive women, side effects of therapy,
and costs. The analysis will be according to the intention-to-screen principle, and cost-effectiveness analysis will be
performed by comparing the direct and indirect costs between the intervention and control group.
DISCUSSION: With this study we aim to provide insight into the balance of risks of undetected and detected Q fever
during pregnancy.
PMID: 21067384
de Vries EN, Prins HA, Crolla RM, den Outer AJ, van Andel G, van Helden SH, Schlack WS, van Putten MA,
Gouma DJ, Dijkgraaf MG, Smorenburg SM, Boermeester MA; SURPASS Collaborative Group.
Effect of a comprehensive surgical safety system on patient outcomes.
N Engl J Med. 2010 Nov 11;363(20):1928-37.
BACKGROUND: Adverse events in patients who have undergone surgery constitute a large proportion of iatrogenic
illnesses. Most surgical safety interventions have focused on the operating room. Since more than half of all surgical
errors occur outside the operating room, it is likely that a more substantial improvement in outcomes can be achieved
235
by targeting the entire surgical pathway.
METHODS: We examined the effects on patient outcomes of a comprehensive, multidisciplinary surgical safety
checklist, including items such as medication, marking of the operative side, and use of postoperative instructions. The
checklist was implemented in six hospitals with high standards of care. All complications occurring during admission
were documented prospectively. We compared the rate of complications during a baseline period of 3 months with the
rate during a 3-month period after implementation of the checklist, while accounting for potential confounders. Similar
data were collected from a control group of five hospitals.
RESULTS: In a comparison of 3760 patients observed before implementation of the checklist with 3820 patients observed after implementation, the total number of complications per 100 patients decreased from 27.3 (95% confidence
interval [CI], 25.9 to 28.7) to 16.7 (95% CI, 15.6 to 17.9), for an absolute risk reduction of 10.6 (95% CI, 8.7 to 12.4).
The proportion of patients with one or more complications decreased from 15.4% to 10.6% (P<0.001). In-hospital
mortality decreased from 1.5% (95% CI, 1.2 to 2.0) to 0.8% (95% CI, 0.6 to 1.1), for an absolute risk reduction of 0.7
percentage points (95% CI, 0.2 to 1.2). Outcomes did not change in the control hospitals.
CONCLUSIONS: Implementation of this comprehensive checklist was associated with a reduction in surgical complications and mortality in hospitals with a high standard of care.
PMID: 21069528
Intratendinous ganglion of the long head of the biceps tendon: US and MRI features (2010: 9b).
Intratendinous ganglion.
Eur Radiol. 2010 Dec;20(12):2997-3001.
We present a case report and literature review of the ultrasound (US) and magentic resonance imaging (MRI) features
of an intratendinous ganglion originating from the long head of the biceps tendon. Intratendinous ganglia are very
rare entities and intratendinous ganglion of the long head of the biceps tendon has only been described once. To the
best of our knowledge, this is the first case report presenting the sonographic features of an intratendinous ganglion
originating from the long head of the biceps tendon.
PMID: 21087542
Dijkstra F, Riphagen-Dalhuisen J, Wijers N, Hak E, van der Sande MA, Morroy G, Schneeberger PM,
Schimmer B, Notermans DW, van der Hoek W.
Antibiotic therapy for acute Q fever in The Netherlands in 2007 and 2008 and its relation to hospitalization.
Epidemiol Infect 2010 Nov 19:1-10.
SUMMARYData about the effectiveness of different antibiotic regimens for the treatment of acute Q fever from clinical
studies is scarce. We analysed the antibiotic treatment regimens of acute Q fever patients in 2007 and 2008 in The
Netherlands and assessed whether hospitalization after a minimum of 2 days antibiotic therapy was related to the
initial antibiotic therapy. Clinical data on antibiotic treatment and risk factors of acute Q fever patients were obtained
from general practitioner medical records and self-reported by patients. For the 438 study patients, doxycycline was
the most commonly prescribed initial antibiotic in both study years. After adjustments for confounding factors, doxycycline (200 mg/day), moxifloxacin, as well as other possibly effective antibiotics [including other new fluoroquinolones
and doxycycline (100 mg/day)] showed significant lower risks for hospitalization compared to β-lactam antibiotics and
azithromycin (reference group), with the lowest risk for doxycycline (200 mg/day) (odds ratio 0·04, 95% confidence
236
interval 0·01-0·22). These data support current guidelines that recommend doxycycline as the first choice antibiotic for
treating acute Q fever.
PMID: 21209466
Kampschreur LM, Wegdam-Blans MC, Thijsen SF, Groot CA, Schneeberger PM, Hollander AA, Schijen JH,
Arents NL, Oosterheert JJ, Wever PC.
Acute Q fever related in-hospital mortality in the Netherlands.
Neth J Med 2010 Dec;68(12):408-413.
INTRODUCTION: A large outbreak of acute Q fever has been reported in the Netherlands with over 3500 cases from
2007 to 2009, during which 749 patients were hospitalised. In foreign cohorts, reported mortality rates in patients
hospitalised with acute Q fever, ranged from 0.9 to 2.4%. We analysed mortality among hospitalised patients with acute
Q fever in the Netherlands.
METHODS: Physicians from hospitals in the afflicted region were asked to provide details about patients who died with
a diagnosis of acute Q fever between 2007 and 2009.
RESULTS: Nine patients (seven males, median age 72 years) from six hospitals were reported, who died within approximately one month following hospitalisation for acute Q fever. Six definite acute Q fever cases and three probable
cases were identified. Six patients presented with infiltrates on the chest X-ray and a median CURB-65 score of 3. Median time of hospitalisation was 13 days (range 1-33). All patients had serious, often coinciding, underlying conditions
including chronic cardiovascular disease, chronic lung disease, diabetes mellitus and malignancy.
CONCLUSION: The mortality rate of patients hospitalised because of acute Q fever was estimated at approximately 1%.
Patients who died with acute Q fever were often male, of older age, and had chronic coinciding underlying conditions,
which gives an a priori higher risk of death.
237

JerOen bOsch Ziekenhuis 2009-2010

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