Medische en Verpleegkundige Bibliotheek

Medische en Verpleegkundige Bibliotheek

Publicaties van medewerkers Sint Antonius Ziekenhuis 2009

Deze lijst is gepubliceerd op 17 maart 2009

Aantal publicaties : 67

Waarvan dissertaties:

Hartman,JM. Ultrasonography of the LIMA graft. s.l. : s.n., 2009
Thesis Erasmus University Rotterdam.

van Werkum, JW.Platelets and stent thrombosis. s.l.: s.n., 2009
Proefschrift Radboud Universiteit Nijmegen

Publicatielijst

Atar D, Petzelbauer P, Schwitter J, Huber K, Rensing B, Kasprzak JD, Butter C, Grip L, Hansen PR, Suselbeck T, Clemmensen PM, Marin-Galiano M, Geudelin B, Buser PT, for the FIRE, I. Effect of Intravenous FX06 as an Adjunct to Primary Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction: Results of the F.I.R.E. (Efficacy of FX06 in the Prevention of Myocardial Reperfusion Injury) Trial. Journal of the American College of Cardiology 2009; 53(8):720-729.

Abstract: ObjectivesThe purpose of this study was to investigate whether FX06 would limit infarct size when given as an adjunct to percutaneous coronary intervention. BackgroundFX06, a naturally occurring peptide derived from human fibrin, has been shown to reduce myocardial infarct size in animal models by mitigating reperfusion injury. MethodsIn all, 234 patients presenting with acute ST-segment elevation myocardial infarction were randomized in 26 centers. FX06 or matching placebo was given as intravenous bolus at reperfusion. Infarct size was assessed 5 days after myocardial infarction by late gadolinium enhanced cardiac magnetic resonance imaging. Secondary outcomes included size of necrotic core zone and microvascular obstruction at 5 days, infarct size at 4 months, left ventricular function, troponin I levels, and safety. ResultsThere were no baseline differences between groups. On day 5, there was no significant difference in total late gadolinium enhanced zone in the FX06 group compared with placebo (reduction by 21%; p = 0.207). The necrotic core zone, however, was significantly reduced by 58% (median 1.77 g [interquartile range 0.0, 9.09 g] vs. 4.20 g [interquartile range 0.3, 9.93 g]; p < 0.025). There were no significant differences in troponin I levels (at 48 h, -17% in the FX06 group). After 4 months, there were no longer significant differences in scar size. There were numerically fewer serious cardiac events in the FX06-treated group, and no differences in adverse events. ConclusionsIn this proof-of-concept trial, FX06 reduced the necrotic core zone as one measure of infarct size on magnetic resonance imaging, while total late enhancement was not significantly different between groups. The drug appears safe and well tolerated. (Efficacy of FX06 in the Prevention of Myocardial Reperfusion Injury [F.I.R.E.]; NCT00326976)

Baart JA, van der Waal I. Mondziekten, kaak- en aangezicht chirurgie. Houten: Bohn Stafleu van Loghum, 2009.

Backus BE, Verburg FA, Romijn RL, Konijnenberg MW, Beekman FJ, Verzijlbergen JF. Intra-patient reproducibility of myocardial SPECT imaging with (201)Tl. Journal of Nuclear Cardiology 2009; 16(1):97-104.

Abstract: BACKGROUND: To define the physical and clinical reproducibility of (201)Tl myocardial perfusion SPECT (MPS), this study assesses the variation between two repeated rest (201)Tl MPS with repositioning only, with a two-hour time interval and with phantom measurements as a reference. METHODS: Three anthropomorphic thorax phantoms were filled with (201)Tl. For each phantom five repeated (201)Tl MPS were obtained. In addition, in 20 patients repeated (201)Tl rest-MPS and in 26 patients early and delayed (201)Tl rest-MPS were performed. Quantitative analysis was done using MunichHeart. Statistical methods were used to calculate variability. Visual analysis was performed by 2 independent observers. RESULTS: The average variation between repeated phantom MPS was 0.5% (95% confidence interval (CI): -0.4% to 1.4%). For patient scans this was -5.0% (95% CI: -2.5% to -7.5%) and between early and delayed (201)Tl MPS -15.5% (95% CI: -11.7% to -19.3%). Visual assessment revealed no clinical significant differences between rest (201)Tl and repeated or delayed (201)Tl MPS. CONCLUSIONS: Repositioning in phantom (201)Tl MPS does not cause significant variation. Repeated (201)Tl MPS in patients shows 5.0% decrease of (201)Tl in 30 minutes, which increases to 15% during a two-hour time interval without quantitative or visual regional differences. This decrease indicates a time-related washout of (201)Tl, but does not change clinical diagnosis

Backus BE, Verzijlbergen JF, Six AJ, Plokker HW. Endothelial dysfunction: the reversible coronary disease. Journal of Nuclear Cardiology 2009; 16(1):154-157.

Bakker OJ, van Santvoort HC, Besselink MG, van der Harst E, Hofker HS, Gooszen HG. Prevention, detection, and management of infected necrosis in severe acute pancreatitis. Current Gastroenterology Reports 2009; 11(2):104-110.

Abstract: 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.

Bartelink IH, Bredius RG, Belitser SV, Suttorp MM, Bierings M, Knibbe, CA, Egeler M, Lankester AC, Egberts AC, Zwaveling J, Boelens JJ. Association between Busulfan Exposure and Outcome in Children Receiving Intravenous Busulfan before Hematologic Stem Cell Transplantation. Biology of Blood & Marrow Transplantation 2009; 15(2):231-241.

Abstract: Busulfan, combined with therapeutic drug monitoring-guided dosing, is associated with higher event-free survival (EFS) rates due to fewer graft failures/relapses and lower toxicity. The optimal target area under the curve (AUC) and dosing schedule of intravenous busulfan in children undergoing hematopoietic stem cell transplantation (HSCT) remain unclear, however. We conducted a retrospective analysis of the association between busulfan exposure and clinical outcome in 102 children age 0.2 to 21 years who received busulfan 1 or 4 times daily before undergoing HSCT (46 malignant and 56 nonmalignant indications). EFS and overall survival after a median of 2 years of follow-up were 68% and 72%, respectively. EFS was optimal when the exposure of busulfan (AUC) was 78 mg *h/L (95% confidence interval = 74 to 82 mg *h/L). Acute graft-versus-host disease (aGVHD) grade II-IV occurred more frequently with greater busulfan exposure. The addition of melphalan was an independent risk factor; melphalan use combined with high busulfan exposure (AUC > 74 mg *h/L) was associated with high incidences of aGVHD (58%), veno-occlusive disease (66%), and mucositis grade III-IV (26%). Dosing frequency (1 or 4 times daily) was not related to any outcome. In conclusion, dose targeting of busulfan to a narrow therapeutic range was found to increase EFS in children. Adding melphalan to optimal busulfan exposure is associated with a high incidence of toxicity. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&MODE=ovid&PAGE=fulltext&NEWS=n&D=prem&AUTOALERT=28841664%7c2

Besselink MG, van Santvoort HC, Boermeester MA, Nieuwenhuijs VB, van Goor H, Dejong CH, Schaapherder AF, Gooszen HG. Timing and impact of infections in acute pancreatitis. British Journal of Surgery 2009; 96(3):267-273.

Abstract: BACKGROUND:: Although infected necrosis is an established cause of death in acute pancreatitis, the impact of bacteraemia and pneumonia is less certain. METHODS:: This was a cohort study of 731 patients with a primary episode of acute pancreatitis in 2004-2007, including 296 patients involved in a randomized controlled trial to investigate the value of probiotic treatment in severe pancreatitis. Time of onset of bacteraemia, pneumonia, infected pancreatic necrosis, persistent organ failure and death were recorded. RESULTS:: The initial infection in 173 patients was diagnosed a median of 8 (interquartile range 3-20) days after admission (infected necrosis, median day 26; bacteraemia/pneumonia, median day 7). Eighty per cent of 61 patients who died had an infection. In 154 patients with pancreatic parenchymal necrosis, bacteraemia was associated with increased risk of infected necrosis (65 versus 37.9 per cent; P = 0.002). In 98 patients with infected necrosis, bacteraemia was associated with higher mortality (40 versus 16 per cent; P = 0.014). In multivariable analysis, persistent organ failure (odds ratio (OR) 18.0), bacteraemia (OR 3.4) and age (OR 1.1) were associated with death. CONCLUSION:: Infections occur early in acute pancreatitis, and have a significant impact on mortality, especially bacteraemia. Prophylactic strategies should focus on early intervention. Copyright (c) 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd

Besselink MG, van Santvoort HC, Boermeester MA, Buskens E, Akkermans LM, Gooszen HG. Probiotic prophylaxis in acute pancreatitis: prudence required. Nature Clinical Practice Gastroenterology & Hepatology 2009; 6(3):E3-E6.

Besselink MG, Venneman NG, Go PM, Broeders IA, Siersema PD, Gooszen HG, van Erpecum KJ. Is Complicated Gallstone Disease Preceded by Biliary Colic? Journal of Gastrointestinal Surgery 2009; 13(2):312-317.

Abstract: INTRODUCTION: Cholecystectomy in cases of "warning" episodes of biliary colic may prevent biliary pancreatitis. We aimed to determine which proportion of patients with biliary pancreatitis, compared to other complicated and uncomplicated symptomatic gallstone disease, experienced "warning" episodes of colic and why these episodes did not lead to early cholecystectomy. PATIENTS AND METHODS: One hundred seventy-five patients with complicated gallstone disease [pancreatitis (n = 53), symptomatic common bile duct (CBD) stones (n = 64), and acute cholecystitis (n = 58)] and 175 patients with symptomatic uncomplicated gallstones were interviewed at admission. RESULTS: Fifty-seven percent (100 of 175) of patients with complicated disease (95% confidence interval = 50-65%) experienced "warning" episodes of biliary colic (pancreatitis 58%, CBD stones 67%, cholecystitis 45%) vs 96% (164 of 175) in uncomplicated disease. Eighty-seven percent of patients with "warning" episodes and complicated disease experienced patient's and general practitioner's delays. General practitioner's delay was more frequent if pain was located in the epigastric region compared to the right upper quadrant (51% vs 38%, P = 0.03). CONCLUSIONS: Half of patients with biliary pancreatitis experience "warning" episodes of biliary colic, similar to other gallstone complications. In symptomatic patients, complications are often not prevented because of significant delays in diagnosis and treatment

Besselink MG, van Santvoort HC, van der Heijden GJ, Buskens E, Gooszen HG. New randomized trial of probiotics in pancreatitis needed? Caution advised. Langenbeck's archives of surgery 2009; 394(1):191-192.

Bot PTG, Hoefer IE, Sluijter JPG, van Vliet P, Smits AM, Lebrin F, Moll F, de Vries JP, Doevendans P, Piek JJ, Pasterkamp G, Goumans MJ. Increased Expression of the Transforming Growth Factor-b Signaling Pathway, Endoglin, and Early Growth Response-1 in Stable Plaques. Stroke 2009; 40(2):439-447.

Abstract: Background and Purpose--Unstable atherosclerotic plaques are characterized by increased macrophages and reduced smooth muscle cells (SMCs) and collagen content. Endoglin, an accessory transforming growth factor-{beta} (TGF{beta}) receptor, is a modulator of TGF{beta} signaling recently found to be expressed on SMCs in atherosclerotic plaques. Its function in plaque SMCs and plaque development is unknown. Early growth response-1 (EGR-1), a transcription factor downstream of TGF{beta}, stimulates SMC proliferation and collagen synthesis. In atherosclerotic lesions, it is mainly expressed by SMCs. Therefore, we studied the TGF{beta}, endoglin, and EGR-1 pathway in advanced atherosclerotic plaques in relation to plaque phenotype.Methods--Human carotid atherosclerotic plaques (n=103) were collected from patients undergoing carotid endarterectomy. Histologically, plaques were analyzed for plaque characteristics, ie, collagen, macrophage and SMC content, and intraplaque thrombus. Intraplaque endoglin, pSmad (indicative for TGF{beta} signaling), EGR-1, and TGF{beta} levels were analyzed using Western blots and enzyme-linked immunosorbent assays, respectively.Results--Higher endoglin and EGR-1 protein levels correlated positively with increased plaque collagen levels, increased smooth muscle cell content, and decreased intraplaque thrombi as well as TGF{beta} signaling (pSmad). Although EGR-1 overexpression in vitro stimulated collagen synthesis, inhibiting endoglin resulted in lower EGR-1 levels, decreased SMC proliferation, and decreased collagen content.Conclusions--TGF{beta} in human atherosclerotic plaques is active and signals through the TGF{beta}/Smad pathway. For the first time, we show a strong association between endoglin and EGR-1, increased collagen and SMCs expression, decreased levels of intraplaque thrombosis, and a stable plaque phenotype

Botta L, Bechan R, Yilmaz A, Di Bartolomeo R. Prosthetic valve endocarditis due to Brucella: successful outcome with a combined strategy. Journal of Cardiovascular Medicine 2009; 10(3):257-258.

Abstract: Infective endocarditis is a serious heart disease that can affect native and prosthetic valves. Staphylococci and Streptococci are the etiological agents in almost 80% of cases. Human brucellosis is a multiple organ disease often transmitted via contaminated, unpasteurized goat milk and cheese. Brucella endocarditis is a rare complication associated with elevated morbidity and mortality rates; it can affect native or, even more rarely, prosthetic valves. In this report, we present the successful management of an infected aortic biological prosthesis in a man of 68 years.

Braak SJ, van Strijen MJ, van Leersum M, van Es HW, van Heesewijk JPM. Live 3D-fluoroscopy guidance during needle intervention: Clinical Implications & Benefits. European Congress of Radiology 2009 March 6-10 2009 Vienna Austria 2009.

Cornelissen JJ, van der Holt B, Verhoef GE, van't Veer MB, van Oers MH, Schouten HC, Ossenkoppele G, Sonneveld P, Maertens J, van Marwijk KM, Schaafsma MR, Wijermans PW, Biesma DH, Wittebol S, Voogt PJ, Baars JW, Zachee P, Verdonck LF, Lowenberg B, Dekker AW. Myeloablative allogeneic versus autologous stem cell transplantation in adult patients with acute lymphoblastic leukemia in first remission: a prospective sibling donor versus no-donor comparison. Blood 2009; 113(6):1375-1382.

Abstract: While commonly accepted in poor-risk acute lymphoblastic leukemia (ALL), the role of allogeneic hematopoietic stem cell transplantation (allo-SCT) is still disputed in adult patients with standard-risk ALL. We evaluated outcome of patients with ALL in first complete remission (CR1), according to a sibling donor versus no-donor comparison. Eligible patients (433) were entered in 2 consecutive, prospective studies, of whom 288 (67%) were younger than 55 years, in CR1, and eligible to receive consolidation by either an autologous SCT or an allo-SCT. Allo-SCT was performed in 91 of 96 patients with a compatible sibling donor. Cumulative incidences of relapse at 5 years were, respectively, 24 and 55% for patients with a donor versus those without a donor (hazard ratio [HR], 0.37; 0.23-0.60; P < .001). Nonrelapse mortality estimated 16% (+/- 4) at 5 years after allo-SCT. As a result, disease-free survival (DFS) at 5 years was significantly better in the donor group: 60 versus 42% in the no-donor group (HR: 0.60; 0.41-0.89; P = .01). After risk-group analysis, improved outcome was more pronounced in standard-risk patients with a donor, who experienced an overall survival of 69% at 5 years (P = .05). In conclusion, standard-risk ALL patients with a sibling donor may show favorable survival following SCT, due to both a strong reduction of relapse and a modest nonrelapse mortality. This trial is registered with http://www.trialregister.nl under trial ID NTR228

de Hoop B, Gietema H, van Ginneken B, Zanen P, Groenewegen G, Prokop, M. A comparison of six software packages for evaluation of solid lung nodules using semi-automated volumetry: what is the minimum increase in size to detect growth in repeated CT examinations. European Radiology 2009; 19(4):800-808.

Abstract: We compared interexamination variability of CT lung nodule volumetry with six currently available semi-automated software packages to determine the minimum change needed to detect the growth of solid lung nodules. We had ethics committee approval. To simulate a follow-up examination with zero growth, we performed two low-dose unenhanced CT scans in 20 patients referred for pulmonary metastases. Between examinations, patients got off and on the table. Volumes of all pulmonary nodules were determined on both examinations using six nodule evaluation software packages. Variability (upper limit of the 95% confidence interval of the Bland-Altman plot) was calculated for nodules for which segmentation was visually rated as adequate. We evaluated 214 nodules (mean diameter 10.9 mm, range 3.3 mm-30.0 mm). Software packages provided adequate segmentation in 71% to 86% of nodules (p < 0.001). In case of adequate segmentation, variability in volumetry between scans ranged from 16.4% to 22.3% for the various software packages. Variability with five to six software packages was significantly less for nodules >or=8 mm in diameter (range 12.9%-17.1%) than for nodules <8 mm (range 18.5%-25.6%). Segmented volumes of each package were compared to each of the other packages. Systematic volume differences were detected in 11/15 comparisons. This hampers comparison of nodule volumes between software packages.

de Jong JR, van Ramshorst B, Gooszen HG, Smout AJ, Tiel-van Buul MM. Weight Loss After Laparoscopic Adjustable Gastric Banding is not Caused by Altered Gastric Emptying. Obesity Surgery 2009; 19(3):287-292.

Abstract: BACKGROUND: In order to know the role of gastric emptying in the mechanism of weight loss and early satiety after a restrictive surgical procedure for treatment of morbid obesity, a consecutive series of patients were scintigraphically investigated before and after laparoscopic adjustable gastric banding. METHODS: Sixteen patients undergoing laparoscopic adjustable gastric banding underwent preoperatively, and at 6 months postoperatively, a gastric emptying study (solid meal and single isotope). Esophageal retention time, lag phase, peak activity time, gastric emptying rate, fundus emptying rate, and weight loss were recorded. Upper GI symptom assessment was carried out by using a standardized questionnaire. Gastric emptying parameters were correlated with the upper GI symptoms. RESULTS: Gastric band placement showed no significant influence on postoperative gastric emptying rate [median % (interquartile range): 42 (23.3-59) preoperatively vs 38 (31-71) postoperatively and fundus emptying rate: 59(37-91) preoperatively vs 70 (53-89) postoperatively]; however, an increase in early satiety was found. Neither gastric emptying rate nor fundus emptying rate showed a relation with early satiety or weight loss. Furthermore, no correlation was found between early satiety and lag phase, esophageal retention time, start of activity, and peak activity time in proximal stomach. CONCLUSION: Laparoscopic adjustable gastric banding seems not to affect gastric emptying. Neither a relation between postoperative gastric emptying rate and weight loss nor between early satiety and weight loss was found. Therefore, it is unlikely that gastric emptying plays a role in the mechanism of weight loss following laparoscopic adjustable gastric banding

de Smet AM, Kluytmans JA, Cooper BS, Mascini EM, Benus RF, van der Werf TS, van der Hoeven JG, Pickkers P, Bogaers-Hofman D, van der Meer NJ, Bernards AT, Kuijper EJ, Joore JC, Leverstein-van Hall MA, Bindels AJ, Jansz AR, Wesselink RM, de Jongh BM, Dennesen PJ, van Asselt GJ, te Velde LF, Frenay IH, Kaasjager K, Bosch FH, van Iterson M, Thijsen SF, Kluge GH, Pauw W, de Vries JW, Kaan JA, Arends JP, Aarts LP, Sturm PD, Harinck HI, Voss A, Uijtendaal EV, Blok HE, Thieme Groen ES, Pouw ME, Kalkman CJ, Bonten MJ. Decontamination of the digestive tract and oropharynx in ICU patients. New England Journal of Medicine 2009; 360(1):20-31.

Abstract: BACKGROUND: Selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) are infection-prevention measures used in the treatment of some patients in intensive care, but reported effects on patient outcome are conflicting. METHODS: We evaluated the effectiveness of SDD and SOD in a crossover study using cluster randomization in 13 intensive care units (ICUs), all in The Netherlands. Patients with an expected duration of intubation of more than 48 hours or an expected ICU stay of more than 72 hours were eligible. In each ICU, three regimens (SDD, SOD, and standard care) were applied in random order over the course of 6 months. Mortality at day 28 was the primary end point. SDD consisted of 4 days of intravenous cefotaxime and topical application of tobramycin, colistin, and amphotericin B in the oropharynx and stomach. SOD consisted of oropharyngeal application only of the same antibiotics. Monthly point-prevalence studies were performed to analyze antibiotic resistance. RESULTS: A total of 5939 patients were enrolled in the study, with 1990 assigned to standard care, 1904 to SOD, and 2045 to SDD; crude mortality in the groups at day 28 was 27.5%, 26.6%, and 26.9%, respectively. In a random-effects logistic-regression model with age, sex, Acute Physiology and Chronic Health Evaluation (APACHE II) score, intubation status, and medical specialty used as covariates, odds ratios for death at day 28 in the SOD and SDD groups, as compared with the standard-care group, were 0.86 (95% confidence interval [CI], 0.74 to 0.99) and 0.83 (95% CI, 0.72 to 0.97), respectively. CONCLUSIONS: In an ICU population in which the mortality rate associated with standard care was 27.5% at day 28, the rate was reduced by an estimated 3.5 percentage points with SDD and by 2.9 percentage points with SOD. (Controlled Clinical Trials number, ISRCTN35176830.)

de Weerd S. De toetsingscomissie. METCforum 2009; 13(1):2-3.

Derksen WJ, Verhoeven BA, van de Mortel RH, Moll FL, de Vries JP. Risk Factors for Surgical-Site Infection Following Common Femoral Artery Endarterectomy. Vascular & Endovascular Surgery 2009; 43(1):69-75.

Abstract: Surgical-site infection is a major complication following endarterectomy of the common femoral artery. The aim of this single-center study was to determine risk factors for surgical-site infection after endarterectomy of the common femoral artery and especially the possible association between patch type (venous, bovine, or prosthetic) and the occurrence of groin infection. Retrospectively 140 patients who underwent an endarterectomy of the common femoral artery between 2003 and 2006 were reviewed. About 20 patients (14%) suffered from a surgical-site infection (12 superficial and 8 deep, of which 2 with involvement of the patch). All infections occurred within 30 days postoperatively. There was no statistically significant difference between type of patch and surgical-site infection. However, using multivariate analysis, previous arterial surgery in the groin (P = .013) and a wound drain left postoperatively (P = .016) were independent variables for the development of a surgical-site infection after endarterectomy of the common femoral artery

Disselhoff BC, Buskens E, Kelder JC, der Kinderen DJ, Moll FL. Randomised comparison of costs and cost-effectiveness of cryostripping and endovenous laser ablation for varicose veins: 2-year results. European Journal of Vascular & Endovascular Surgery 2009; 37(3):357-363.

Abstract: BACKGROUND: Although endovenous laser ablation for varicose veins is replacing surgical stripping, proper economic evaluation with adequate follow-up in a randomised clinical trial is important for considered policy decisions regarding the implementation of new techniques. METHODS: Data from a randomised controlled trial comparing cryostripping and endovenous laser ablation in 120 patients were combined to study Short Form (SF) 6D outcome, costs and cost-effectiveness 2 years after treatment. Incremental cost per quality-adjusted life year (QALY) gained 2 years after treatment was calculated using different strategies, and uncertainty was assessed with bootstrapping. RESULTS: Over the total study period, mean SF-6D scores improved slightly from 0.78 at baseline to 0.80 at 2 years for patients who underwent cryostripping and from 0.77 to 0.79 for patients who underwent endovenous laser. QALY (SF-6D) was 1.59 in patients who underwent cryostripping and 1.60 in patients who underwent endovenous laser 2 years after treatment. The costs of cryostripping and endovenous laser per patient were euro2651 and euro2783, respectively. Bootstrapping indicated that cryostripping was associated with an incremental cost-effectiveness ratio of euro32 per QALY gained. With regard to different strategies, outpatient cryostripping was less costly and more effective 2 years after treatment. CONCLUSION: In this study, in terms of costs per QALY gained, outpatient cryostripping appeared to be the dominant strategy, but endovenous laser yielded comparable outcomes for a relatively little additional cost

Elbers PWG, Ozdemir A, van Iterson M, van Dongen EPA, Ince C. Microcirculatory Imaging in Cardiac Anesthesia: Ketanserin Reduces Blood Pressure But Not Perfused Capillary Density. Journal of Cardiothoracic and Vascular Anesthesia 2009; 23(1):95-101.

Abstract: Objectives It has become possible to image the human microcirculation at the bedside using sidestream dark field (SDF) imaging. This may help the clinician when correlation between global and microvascular hemodynamics may not be straightforward. Ketanserin, a serotonin and [alpha]-1 adrenoceptor antagonist, is used in some countries to treat elevated blood pressure after extracorporeal circulation. This might hamper microcirculatory perfusion. Conversely, it is also conceivable that microcirculatory flow is maintained or improved as a result of flow redistribution. In order to introduce SDF imaging in cardiac anesthesia, the authors set out to directly observe the sublingual microcirculation in this setting.Design An observational study.Setting A large teaching hospital.Participants Mechanically ventilated patients with elevated arterial blood pressure immediately after extracorporeal circulation (ECC).Intervention An intravenous bolus of ketanserin, 0.15 mg/kg.Measurements and Main Results Five minutes before and 10 minutes after ketanserin administration, global hemodynamic variables were recorded. In addition, the authors used SDF imaging to record video clips of the microcirculation. Analysis of these allowed for quantification of microvascular hemodynamics including determination of perfused vessel density (PVD) and microcirculatory flow index (MFI). After ketanserin administration, there was a significant reduction in systolic arterial blood pressure (129 ¦ 9 to 100 ¦ 15 mmHg, p = 0.0001). At the level of the microcirculation, the mean MFI did not change significantly for small (diameter <20 [mu]m, 2.79 [interquartile range, 1.38-3] to 2.38 [1.88-2.75], p = 0.62) or large (diameter >20 [mu]m, 2.83 [1.4-3] to 2.67 [0.35-2.84] p = 1.0) vessels. There was a significant increase in mean PVD for large vessels (1.23 ¦ 0.63 to 1.70 ¦ 79 mm-1, p = 0.017) but not for small vessels (5.59 ¦ 2.60 to 5.87 ¦ 1.22 mm-1, p = 0.72) where red blood cell flow was maintained.Conclusions SDF imaging clearly showed a discrepancy between global and microvascular hemodynamics after the administration of ketanserin for elevated blood pressure after ECC. Ketanserin effectively lowers arterial blood pressure. However, capillary perfusion is maintained at a steady value. Both effects may be explained by an increase in shunting in the larger vessels of the microcirculation

Fortunati E, Kazemier KM, Grutters JC, Koenderman L, van den Bosch JMM. Human neutrophils switch to an activated phenotype after homing to the lung irrespective of inflammatory disease. Clinical & Experimental Immunology 2009; 155(3):559-566.

Abstract: Summary Systemic inflammation can be investigated by changes in expression profiles of neutrophil receptors. Application of this technology for analysis of neutrophil phenotypes in diseased tissues is hampered by the absence of information regarding the modulation of neutrophil phenotypes after extravasation to tissues under non-inflammatory conditions. To fill this gap we measured the expression of neutrophil receptors in bronchoalveolar lavage fluid (BALF) and in the peripheral blood of healthy volunteers, which included both smokers and non-smokers. Blood and BALF neutrophils were identified by CD16(bright)/CD45(dim) cells, and triple-stained with antibodies directed against integrins, chemokine- and Fcgamma-receptors. BALF neutrophils of healthy volunteers showed an activated phenotype characterized by Mac-1 (CD11b)(bright), L-selectin (CD62L)(dim), intrecellular adhesion molecule 1 (ICAM-1) (CD54)(bright), FcgammaRII (CD32)(bright), C5a receptor (CD88)(bright) and CD66b(bright). A similar phenotype was observed for BALF neutrophils of patients affected by sarcoidosis. Furthermore, our results demonstrate a modulated expression of C5a receptor (CD88) and ICAM-1 (CD54) in neutrophils of sarcoidosis patients. In conclusion, our data indicate that neutrophils found in the lung exhibit an activated phenotype under both homeostatic and inflammatory conditions

Gisbertz SS, Ramzan M, Tutein Nolthenius RP, van der Laan L, Overtoom, TT, Moll FL, de Vries JP. Short-Term Results of A Randomized Trial Comparing Remote Endarterectomy and Supragenicular Bypass Surgery for Long Occlusions of the Superficial Femoral Artery [The REVAS Trial]. European Journal of Vascular & Endovascular Surgery 2009; 37(1):68-76.

Abstract: OBJECTIVE: Techniques for surgical repair of Trans-Atlantic Inter-Society Consensus (TASC) C and D lesions of the superficial femoral artery (SFA) are supragenicular bypass grafting or the less invasive remote endarterectomy (RSFAE). This trial compares the patency rates of both techniques. DESIGN: Randomized, multicenter trial. MATERIALS AND METHODS: 116 patients were randomized to RSFAE (n=61) and supragenicular bypass surgery (n=55). Indications for surgery were claudication (n=77), rest pain (n=21), or tissue loss (n=18). RESULTS: Median hospital stay was 4 days in the RSFAE group compared with 6 days in the bypass group (p=0.004). Primary patency after 1-year follow-up was 61% for RSFAE and 73% for bypass (p=0.094). Secondary patency was 79% for both groups. Subdividing between venous (n=25) and prosthetic grafts (n=30) shows a primary patency of 89% and 63% respectively at 1-year follow-up (p=0.086). CONCLUSION: RSFAE is a minimally invasive adjunct in the treatment of TASC C and D lesions of the SFA, with shorter admittance and a comparable secondary patency rate to bypass. The venous bypass is superior to both RSFAE and PTFE bypass surgery, but only 45% of patients had a sufficient saphenous vein available. This study is registered with ClinicalTrials.gov, number NCT00566436

Grootenboers MJ, Schramel FM, van Boven WJ, Hendriks JM, van Schil PE, de Wit PE, Pasterkamp G, Folkerts G, van Putte BP. Selective pulmonary artery perfusion followed by blood flow occlusion: New challenge for the treatment of pulmonary malignancies. Lung Cancer 2009; 63(3):400-404.

Abstract: INTRODUCTION: Selective pulmonary artery perfusion (SPAP) is an experimental endovascular technique for the treatment of pulmonary malignancies. This study evaluated blood flow occlusion (BFO) after SPAP and dose-escalation in order to delay washout of gemcitabine from the lung tissue, to augment pulmonary drug exposure and to maintain plasma concentrations equivalent to intravenous administration. MATERIAL AND METHODS: Six groups of pigs underwent left-sided SPAP using gemcitabine in a clinically applied dose of 1-1.5g/m(2) after balloon catheterisation. BFO experiment: four groups (n=4, each) were treated with SPAP with 1g/m(2) of gemcitabine during 2min followed by BFO for 0, 10, 20 and 30min, respectively. Dose-escalation experiment: two more groups (n=3, each) received SPAP with 1.25 and 1.5g/m(2) of gemcitabine during 2min followed by 30min BFO. All pigs underwent left thoracotomy with sampling of lung, liver and blood. The animals were sacrificed after 1h. The lung and plasma areas under the curve (AUC) were calculated for each group and ANOVA and t-test was used for comparison. RESULTS: Thirty minutes BFO resulted in the highest lung AUC compared to 0, 10 and 20min BFO (p&lt;0.001), while no significant differences in plasma AUC and liver levels were observed. Gemcitabine dose-escalation up to 1.25g/m(2) resulted in significantly higher lung AUC (p=0.02) compared to 1g/m(2), while plasma AUC was equivalent with intravenous treatment. Further dose-escalation to 1.5g/m(2) did not result in significantly higher lung levels compared to 1.25g/m(2). CONCLUSION: BFO after SPAP delays the washout of gemcitabine from lung tissue. Dose-escalation resulted in higher lung concentrations, while plasma levels were equivalent with intravenous administration. We advocate 2min of SPAP with 1.25g/m(2) of gemcitabine followed by 30min of BFO to be investigated as a new treatment modality for pulmonary malignancies

Hammacher ER, Backx FJG, Voorn TB, Baarveld F. Romp. In: Baarveld F, Backx FJG, Voorn FJG, editors. Sportgeneeskunde. Bohn Stafleu van Loghum, 2009: 271-278.

Hartman JM. Ultrasonography of the LIMA graft. s.l.: s.n., 2009.
Ref ID: 9615

Hemmink GJ, Weusten BL, Bredenoord AJ, Timmer R, Smout AJ. Increased swallowing frequency in GORD is likely to be caused by perception of reflux episodes. Neurogastroenterology & Motility 2009; 21(2):143-148.

Abstract: Abstract Patients with gastro-oesophageal reflux disease (GORD) swallow air more frequently and have more gas-containing reflux episodes than healthy controls. One explanation for this phenomenon may be that GORD patients primarily swallow more frequently and, as a consequence, have more swallow- or transient lower oesophageal sphincter relaxation-associated reflux episodes. Another explanation may be that GORD patients swallow more often in response to perception of reflux episodes. The aim of this study was to differentiate between these two possible mechanisms. In 34 patients with typical reflux symptoms oesophageal 24-h pH-impedance monitoring was performed twice, once off and once on proton pump inhibitor (PPI) therapy. The number of reflux episodes and number of swallows and air swallows was evaluated. The symptom association probability (SAP) was used to distinguish patients with a good relationship between symptoms and reflux episodes (SAP+) from those who had not (SAP-). In both the SAP+ (n = 21) as SAP- patients (n = 13), the acid exposure time decreased during PPI therapy. In the SAP+ patients, the number of swallows decreased on PPI (829 +/- 85 off vs 701 +/- 79 on PPI, P < 0.05), whereas in the SAP- patients, the incidence of swallows (802 +/- 93 off vs 814 +/- 69 on PPI, P = NS) was not influenced by the PPI therapy. PPI therapy reduces the number of swallows in patients with a positive SAP, but not in those with a negative SAP. This finding supports the hypothesis that the increased incidence of swallows in GORD is brought about by responses to perceived reflux events

Herpers BL, de Jong BA, Dekker B, Aerts PC, van DH, Rijkers GT, van Velzen-Blad H. Hemolytic assay for the measurement of functional human mannose-binding lectin: A modification to avoid interference from classical pathway activation. Journal of Immunological Methods 2009; 343(1):61-63.

Abstract: Diagnostic assays for measurement of functional mannose-binding lectin (MBL) in serum are widely performed as part of immune status assessment. Classical pathway mediated complement activity can interfere in these functional MBL assays. Here we describe classical pathway interference incidentally occurring in a previously described hemolytic MBL assay and the modification of this assay to prevent this artifact by addition of anti-C1q antibodies. Classical pathway interference in functional MBL assays can and should be inhibited to prevent that MBL deficiency is overlooked and patients are misdiagnosed

Herpers BL, Yzerman EP, Jong BA, Bruin JP, Lettinga KD, Kuipers S, Boer JW, Hannen EJ, Rijkers GT, van Velzen-Blad H, de Jongh BM. Deficient mannose-binding lectin-mediated complement activation despite mannose-binding lectin-sufficient genotypes in an outbreak of Legionella pneumophila pneumonia. Human immunology 2009; 70(2):125-129.

Abstract: Polymorphisms leading to deficiency of mannose-binding lectin (MBL) are associated with predisposition to infection. However, MBL deficiency can be protective against intracellular pathogens that use MBL to enter host cells. The role of MBL genotype and activity in infection with the intracellular pathogen Legionella pneumophila was studied in a large outbreak of legionellosis at a Dutch flower show. A total of 141 patients, 65 exposed asymptomatic exhibition staff members and 670 unexposed blood bank donors were included for the study of MBL2 genotypes and MBL-mediated complement activation. Genotypic MBL deficiency was equally prevalent in patients and controls. Deficient MBL-mediated complement activation was more prevalent in patients. Even in patients with genotypes that confer MBL sufficiency, 20.6% lacked MBL-mediated complement activation. In most patients with MBL-sufficient genotypes who lacked MBL-mediated activation at the acute phase of disease, lectin pathway functionality was restored at convalescence. In conclusion, genotypic MBL deficiency was not a risk factor for legionellosis. However, patients with legionellosis displayed deficient MBL-mediated complement activation even with MBL-sufficient genotypes. Together, these genotypical and functional data suggest that the observed deficiency of lectin pathway activation is an effect of legionellosis rather than a risk factor for acquiring it

Ince I, de Wildt SN, Tibboel D, Danhof M, Knibbe CA. Tailor-made drug treatment for children Creation of an infrastructure for data-sharing and population PK-PD modeling. Drug discovery today 2009; 14(5-6):316-320.

Abstract: Rational dosing guidelines for drugs in pediatrics are urgently needed. To develop these guidelines, we use population pharmacokinetic-pharmacodynamic (PK-PD) modeling and simulation by: (i) optimization of clinical trial designs based on preliminary data; (ii) development and internal validation of population PK-PD models using sparse data; (iii) external validation using independent data; and (iv) prospective clinical evaluation. Optimized dosing regimens for specific drugs may then serve as a basis to develop dosing guidelines for existing or newly developed drugs with similar disposition and/or effect. In addition to modeling of drug disposition (PK) pathways, we emphasize the need for modeling of effect (PD) pathways and the use of a multidisciplinary infrastructure for data-sharing

Jottard K, Hoff C, Maessen J, van Ramshorst B, van Berlo CLH, Logeman F, Dejong CHC. Life and death of the nasogastric tube in elective colonic surgery in the Netherlands. Clinical Nutrition 2009; 28(1):26-28.

Abstract: SummaryBackground & aims There is abundant evidence that the routine use of nasogastric decompression following elective abdominal surgery is ineffective in achieving any goals it is intended for. Nevertheless its use is still standard of care. The aim of the present study was to investigate whether it is possible to ban nasogastric decompression after elective colonic surgery.Methods At first baseline measurements concerning elements of perioperative care, including nasogastric tubes, were recorded retrospectively over the year 2004. In 2006-2007 the implementation of a fast-track colonic surgery project was guided by the Dutch Institute for Quality of Healthcare CBO, using Berwick's Breakthrough approach.Results A total of 2007 patients were enrolled. The baseline measurement showed that the use of nasogastric drainage is still common practice in the Netherlands. 953 patients (88.3%) had a nasogastric tube postoperatively. That tube was removed after a median of 2.5 days (range 1-3 days). After the implementation of the Perioperative Care Breakthrough project the percentage of patients having a nasogastric tube postoperatively dropped to 9.6% (pá<á0.0001).Conclusions Our results show using the Breakthrough Methodology it is possible to eradicate the inappropriate routine use of NG tubes

Kaya A, Heijmen RH, Rousseau H, Nienaber CA, Ehrlich M, Amabile P, Beregi JP, Fattori R. Emergency treatment of the thoracic aorta: results in 113 consecutive acute patients (the Talent Thoracic Retrospective Registry). European Journal of Cardio-Thoracic Surgery 2009; 35(2):276-281.

Abstract: Background: Elective thoracic endovascular aortic repair in selected patients with suitable aortic anatomy is associated with low morbidity and mortality, and is gaining widespread acceptance. Its benefit in acute thoracic aorta diseases, however, has not yet been demonstrated in high-numbered studies. This report presents data of the Talent Thoracic Retrospective Registry (TTR) of all patients who underwent endovascular stent grafting for acute thoracic aorta pathology. Methods: Between December 1996 and July 2004 data were collected regarding 113 consecutive patients who underwent emergent endovascular stent grafting of the thoracic aorta using the Talent thoracic stent graft (Medtronic, Inc., Santa Rosa, California) in 7 European referral centers. Acute thoracic aorta pathology consisted of 41 (36.3 %) traumatic aortic injuries, 37 (32.7 %) Stanford type B dissections, 5 (4.4 %) intramural hematomas, 18 (15.9 %) thoracic aorta aneurysms, 4 (3.5 %) pseudoaneurysms and 8 (7.1 %) penetrating ulcers. Results: In all patients the stent graft system could be introduced via the common femoral artery. Conversion to open surgical repair was necessary in 2 patients, one in the early phase due to persistent bleeding via backflow in the false lumen from a distal entry tear, and another patient in a late phase due to retrograde dissection. Intraoperative mortality was 1.8%, one patient suffered a massive myocardial infarction, and another died of tamponade secondary to retrograde dissection. Overall hospital mortality was 8.0% (9 patients). In only 2 of them, it was considered a stent graft procedure related death. New neurological symptoms were seen in 6.2% (7 patients), with complete recovery in 5 patients. Mean follow-up was 15 months (range 1-69 months). Late mortality was 8.7% (9 patients). Only one late death was considered aorta related. Overall re-intervention rate was 8.9% (n=10) and was mainly for type I endoleak or persistent false lumen perfusion. Conclusion: Sub-analysis of the Talent Thoracic Retrospective Registry for endovascular stent grafting of acute thoracic aorta pathology in over 100 consecutive patients demonstrated its feasibility, with low morbidity and acceptable low mortality rates.

Kelder JC, Rutten FH, Hoes AW. Clinically relevant diagnostic research in primary care: the example of B-type natriuretic peptides in the detection of heart failure. Family practice 2009; 26(1):69-74.

Abstract: With the emergence of novel diagnostic tests, e.g. point-of-care tests, clinically relevant empirical evidence is needed to assess whether such a test should be used in daily practice. With the example of the value of B-type natriuretic peptides (BNP) in the diagnostic assessment of suspected heart failure, we will discuss the major methodological issues crucial in diagnostic research; most notably the choice of the study population and the data analysis with a multivariable approach. BNP have been studied extensively in the emergency care setting, and also several studies in the primary care are available. The usefulness of this test when applied in combination with other readily available tests is still not adequately addressed in the relevant patient domain, i.e. those who are clinically suspected of heart failure by their GP. Future diagnostic research in primary care should be targeted much more at answering the clinically relevant question 'Is it useful to add this (new) test to the other tests I usually perform, including history taking and physical examination, in patients I suspect of having a certain disease'

Kloppenburg GTL, Grauls G, Bruggeman C, Stassen F. Adenoviral activin A expression prevents vein graft intimal hyperplasia in a rat model. Interactive Cardiovascular and Thoracic Surgery 2009; 8(1):31-34.

Abstract: Autologus vein grafts are used for coronary artery and infra-inguinal bypass procedures. Although initially successful long-term patency rates are limited by lumen occlusion due to neointima formation by smooth muscle cell hyperplasia. Gene therapy to prevent this smooth muscle cell proliferation has been studied extensively with limited success. Activin A, a member of the transforming growth factor-{beta} super family, promotes the contractile phenotype of smooth muscle cells. Maintaining the contractile phenotype could be a novel strategy to prevent intimal hyperplasia. In an epigastric vein-to-common femoral artery interposition grafts rat model activin A over-expression resulted in a significant decrease in intimal cross-sectional area and percentage stenosis as compared to the control group. BrdU staining identified lower proliferation rates of the smooth muscle cells in the group treated with activin A. We rapport for the first time evidence that activin A can diminish vein graft failure in a rat model supporting a novel strategy to prevent intimal hyperplasia. Keywords: Activin; Hyperplasia; Vein graft; Rat

Lavalaye J, Grutters JC, van de Garde EM, van Buul MM, van den Bosch JM, Windhorst AD, Verzijlbergen FJ. Imaging of Fibrogenesis in Patients with Idiopathic Pulmonary Fibrosis with cis-4-[(18)F]-Fluoro-L: -Proline PET. Molecular imaging and biology 2009; 11(2):123-127.

Abstract: PURPOSE: Idiopathic pulmonary fibrosis (IPF) is a lethal lung disease for which no single diagnostic modality is able to evaluate the activity of the disease process. Cis-4-(18)F-fluoro-L: -proline ((18)F-proline) was shown in animal studies to be a reliable marker for fibrosis formation. We tested this candidate radioligand for imaging of fibrogenesis in patients with IPF. METHODS: Five patients with IPF proven by lung biopsy and computed tomography were included. Furthermore, we also included one patient with non-specific interstitial pneumonia (NSIP) and scleroderma and one with NSIP and organising pneumonia. Positron emission tomography (PET) acquisition was performed 1, 2 and 3h after injection of 400MBq (18)F-proline. We scored (18)F-proline activity visually and quantitatively by calculating the activity in the regions of interest over lung, liver and mediastinum. RESULTS: We found low uptake of (18)F-proline in the lungs of all patients with IPF. The highest uptake was seen at 2h post-injection, with a decline at 3h past injection. The differences in lung uptake between patients were small, except for one patient with NSIP and organising pneumonia who had a slightly higher (18)F-proline uptake. No significant correlations between (18)F-proline uptake and clinical parameters were found. CONCLUSIONS: Due to the low pulmonary uptake of (18)F-proline in patients with IPF, (18)F-proline does not seem to be a suitable radioligand to evaluate the activity of fibrosis formation in patients with IPF. The low uptake in the lungs of patients with interstitial fibrosis may be explained by the slow nature of fibrogenesis or to the relatively low dose of proline that can be used

Liedorp M, van der Flier WM, Hoogervorst EL, Scheltens P, Stam CJ. Associations between patterns of EEG abnormalities and diagnosis in a large memory clinic cohort. Dementia & Geriatric Cognitive Disorders 2009; 27(1):18-23.

Abstract: AIM: To describe associations of abnormalities in the electroencephalogram (EEG) with the most prevalent diagnoses in a memory clinic cohort. METHODS: Associations between visual EEG findings and diagnoses in 1,116 consecutive patients [382 Alzheimer's disease (AD), 274 subjective complaints, 190 mild cognitive impairment (MCI), 118 psychiatric disorder, 61 frontotemporal lobar degeneration, 53 vascular dementia (VaD), 38 dementia with Lewy bodies (DLB)] were determined by prevalence ratio (PR). RESULTS: Diagnoses of subjective complaints [PR = 1.6; 95% confidence interval (CI) = 1.4-1.9] and psychiatric disorder (1.4; 95% CI = 1.1-1.9) were associated with a normal EEG, while subjects with both focal and diffuse EEG disturbances were more likely to have DLB (3.5; 95% CI = 2.1-5.6), VaD (2.3; 95% CI = 1.4-3.6) or AD (1.5; 95% CI = 1.3-1.8). Subjects with only diffuse EEG abnormalities were more likely to have AD (PR = 1.5; 95% CI = 1.3-1.9). The prevalence of MCI was higher among those with only focal EEG abnormalities (PR = 1.3; 95% CI = 1.0-1.7). CONCLUSIONS: A normal EEG argues for subjective complaints or psychiatric diagnosis. An EEG with only focal abnormalities supports MCI. An EEG with only diffuse abnormalities argues for AD. An EEG with both focal and diffuse abnormalities argues for DLB, VaD or AD.

Limandjaja GC, Breugem CC, Mink van der Molen AB, Kon M. Complications of otoplasty: a literature review. Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS 2009; 62(1):19-27.

Abstract: Over 200 otoplasty techniques have been described in the current literature. However, relatively few articles focus on the associated complication rates. The goal of this review is to examine the incidence of complication rates associated with otoplasty procedures. An electronic search of the Pubmed database yielded 205 articles with significant overlap in search results. Twenty articles published between 2000 and 2007 adhered to our inclusion criteria. Early complications included in this review were haematoma, bleeding, infection, skin necrosis and wound dehiscence; late complications included suture extrusion, scarring, hypersensitivity, asymmetry and inaesthetic results. The cumulative incidence of early complications was low and varied from 0% to 8.4%, with the exception of two outliers. Although cumulative late complication incidences varied greatly from 0% to 47.3%, complication rates on the higher end of the spectrum were not accompanied with revision rates of the same magnitude. Comparison of the different articles was made difficult by the lack of a uniform calculation method for complication incidence, variable follow-up length and data collection, inconsistent use of operation technique and publication bias. Recommendations for future studies include: consistent use of operative technique or at least differentiate between the used surgical techniques when presenting complication rates, inclusion of only patients with bilateral primary procedures, considering each operated ear as an independent variable when calculating complication incidence and a minimum follow-up period of 2 years, with both objective and subjective data collection

Los M, van der Waal RIF. Huidlaesies door capecitabine: ongewenste geneesmiddelreactie? Nederlands Tijdschrift voor Dermatologie en Venereologie 2009; 19:31.

Meinders AJ, Elbers P. Images in clinical medicine. Leukocytosis and sublingual microvascular blood flow. New England Journal of Medicine 2009; 360(7):e9.

Mourad SM, Hermens RPMG, Cox-Witbraad T, Grol RPTM, Nelen WLDM, Kremer JAM. Information provision in fertility care: a call for improvement. Human Reproduction 2009; [Epub ahead of print].

Abstract: BACKGROUNDAdequate information provision is a crucial dimension of high-quality fertility care. Clinical practice guidelines containing consensus-based recommendations may standardize practice between settings. This study was designed for three purposes: (i) to assess actual adherence to recommendations on information provision, (ii) to measure patient satisfaction with current practice and (iii) to analyse how variation in adherence relates to the characteristics of patients and clinics. METHODSAll recommendations concerning patient information were extracted from 10 national fertility guidelines and edited into a patient questionnaire. Additional questions concerning patient satisfaction and potential determinants of information provision at patient level were included. A total of 2698 couples from 16 clinics were invited to participate. A professional's questionnaire was sent to all gynaecologists to gather potential determinants at clinic level. Multilevel regression analysis was performed to identify the determinants of information provision. RESULTSA total of 1499 couples (56%) participated. The percentage of couples who reported to have received complete information varied between recommendations from 10 to 96% (mean 57%). Overall, 94% of couples were satisfied with fertility services. The use of checklists for information provision, the presence of obstetrics/gynaecology residents and specialized nursing personnel, and higher patient anxiety scores were significantly associated (P < 0.05) with higher levels of information received. CONCLUSIONSDespite the possibility of recall bias in questionnaire studies and observed high patient satisfaction with fertility services, we conclude that information provision for infertile couples is currently poor and in need of improvement. This could easily be procured by, for example, the use of information checklists

Peeters W, Hellings WE, de Kleijn DPV, de Vries JPPM, Moll FL, Vink A, Pasterkamp G. Carotid Atherosclerotic Plaques Stabilize After Stroke. Insights Into the Natural Process of Atherosclerotic Plaque Stabilization. Arteriosclerosis, Thrombosis & Vascular Biology 2009; 29(1):128-133.

Abstract: OBJECTIVE: Rupture of unstable atherosclerotic plaques is the pathological substrate for acute ischemic events. Underlying cellular and molecular characteristics of plaque rupture have been studied extensively. However, the natural course of symptomatic plaque remodeling after ischemic events is relatively unexplored. METHODS AND RESULTS: Atherosclerotic carotid plaques were obtained from 804 symptomatic (stroke=204 and TIA=426) and asymptomatic (n=174) patients undergoing carotid endarterectomy. The presence of macrophages, smooth muscle cells (SMC), collagen, calcification, and lipid-core size were assessed histologically. At protein level, inflammatory mediators (interleukin [IL]-2, IL-4, IL-5, IL-8, IL-10, IL-12p70, interferon-gamma [INF-gamma], tumor necrosis factor-alpha [TNF-alpha], matrix degrading proteinases (MMPs), and an apoptosis marker (caspase-3) were determined. We associated plaque characteristics with time elapsed between the latest event and surgery. Early after stroke and TIA, plaques revealed an unstable phenotype. After stroke, the content of macrophages decreased significantly with time (P=0.02), whereas SMC content tended to increase. At protein level, IL-6, IL-8 expression levels and caspase activity strongly decreased after stroke or TIA. CONCLUSIONS: Symptomatic carotid lesions remodel into more stable plaques over time after stroke. Changes in IL-6 and IL-8 and caspase preceded the decrease of macrophages. These temporal phenotypic plaque alterations should be taken into account for biomarker and therapeutic target validation studies using human atherosclerotic plaques

Pompen M, Gok M, Novak 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; 64(1):110-116.

Abstract: 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 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 [euro]32,840 in group A and [euro]31,187 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

Rahel BM, Laarman GJ, Kelder JC, ten Berg JM, Suttorp MJ. Three-year clinical outcome after primary stenting of totally occluded native coronary arteries: A randomized comparison of bare-metal stent implantation with sirolimus-eluting stent implantation for the treatment of total coronary occlusions (Primary Stenting of Totally Occluded Native Coronary Arteries [PRISON] II study). American Heart Journal 2009; 157(1):149-155.

Abstract: Background The purpose of this study was to examine the 3-year clinical outcome in patients enrolled in the Primary Stenting of Totally Occluded Native Coronary Arteries II study.Methods Patients with totally occluded coronary arteries randomized to either sirolimus-eluting Cypher stents (SESs) (Cordis, a Johnson & Joshson Company, Miami Lakes, FL) (100 patients) or bare-metal BxVelocity stents (BMSs) (Cordis) (100 patients) were followed clinically for 3 years.Results Between 1 and 3 years, there were infrequent additional clinical events that were equally distributed between the SES and the BMS group. After 3 years, target lesion revascularization was 7% in the SES group versus 27% in the BMS group (P < .001); and target vessel revascularization was seen in 11% in the SES group versus 30% in the BMS group (P = .002). Major adverse cardiac events were noted in 10% of the SES group versus 34% in the BMS group (P < .001). There were no statistically significant differences in death, myocardial infarction, and stent thrombosis according to the Academic Research Consortium criteria between the 2 groups.Conclusions Clinical outcome up to 3 years after implantation of SESs for total coronary occlusions continues to demonstrate a significant reduction in adverse clinical events compared with BMSs without the evidence for either disproportionate late restenosis or late stent thrombosis

Schuurman JP, Schoonhoven L, Keller BP, van Ramshorst B. Do pressure ulcers influence lenght of hospital stay in surgical cardiothoracic patients? A prospective evaluation. Journal of clinical nursing 2009; [Epub head of print].

Schuurman JP, de Vries JP, van den Heuvel DAF, Disch FJM, Wille J. Een man met ernstige pijn aan de rechterzijde van het gelaat. Nederlands tijdschrift voor keel-, neus- oorheelkunde 2009; 15:35.

Schuurman JP, de Vries JP, Vos JA, Wille J. Renal artery pseudoaneurysm caused by a complete stent fracture: a case report. Journal of Vascular Surgery 2009; 49(1):214-216.

Abstract: We report the case of a 71-year-old man with acute back and left flank pain caused by a large pseudoaneurysm of the left renal artery. The pseudoaneurysm resulted from a complete fracture of a stent that had been placed at the origin of this vessel 10 months earlier. Because the left kidney had no residual function, the patient was treated by percutaneous occlusion of the left renal artery with a vascular plug. The symptoms rapidly subsided, and he remained symptom free at the 6-month follow-up. Stent fractures, their complications, and management are discussed

Sonker U, Kloppenburg GT, Knoop EA, Seldenrijk CA, Morshuis WJ. Emergency Surgery for Acute Mitral Valve Obstruction Resulting From Hemorrhage Within a Left Atrial Myxoma. Annals of Thoracic Surgery 2009; 87(2):636-638.

Abstract: Left atrial myxomas are benign, slow-growing primary cardiac tumors. They present with gradual onset of one or more of a triad of obstructive, embolic, or constitutional symptoms. Transesophageal echocardiography aids in the detailed preoperative and intraoperative evaluation of the myxoma for surgical strategy planning. We describe a previously unreported case of interstitial hemorrhage in a left atrial myxoma leading to rapid expansion of the tumor with features of acute, mitral valve obstruction. Transesophageal echocardiography showed a cystic area in the left atrial tumor that corresponded to an area of recent hemorrhage confirmed on surgical removal

ten Cate TJ, Kelder JC, Bogaard MD, van Hemel NM, Fred VJ. The prognostic significance of typical perfusion defects on vasodilator stress myocardial perfusion SPECT in patients with left bundle branch block or right ventricular apical pacing. Nuclear Medicine Communications 2009; 30(3):232-239.

Abstract: PURPOSE: Left bundle branch block (LBBB) and ventricular pacing may induce typical artefacts that appear as perfusion defects in myocardial perfusion single photon emission computed tomography (MPS). We assessed the prognosis of patients with LBBB or right ventricular apical (RVA) pacing who had chest pain and an MPS with only abnormal activation-related defects (AARD). METHODS: All patients with LBBB or ventricular pacing referred for vasodilator stress MPS between April 2002 and January 2006 were analyzed. AARD were defined as small, nontransmural, fixed defects and small reversible defects in well-defined regions always accompanied with concomitant wall motion abnormalities. RESULTS: Ninety-seven patients were included, with a mean follow-up period of 3+/-1.3 years. MPS showed AARD in 57 and it was completely normal in 40 patients. No significant difference in cumulative cardiac event-free follow-up was observed between patients with AARD (93%) and normal MPS (85%). The average annual cardiac event rate was not significantly different between the groups (1.7 and 4.3% per year, respectively). No difference was found between patients with LBBB and RVA pacing. CONCLUSION: Patients with chest pain and LBBB or RVA pacing who show AARD on MPS have a comparable prognosis as patients with abnormal activation and a normal MPS. This justifies MPS for risk stratification of patients with chest pain and LBBB or RVA pacing

Tupker RA. Filaggrines bij atopisch eczeem. Nederlands Tijdschrift voor Allergie 2009; 9(1):35.

van Bindsbergen L, Fioole B, Hissink RJ, van Leersum M, de Vries JPPM. Kritieke ischemie van het been door twee bijzondere vormen van diepveneuze thrombose. Nederlands Tijdschrift voor Geneeskunde 2009; 153(6):228-231.

van der Heyden J, Suttorp MJ, Schepens MA. Revascularization strategy in patients with severe concurrent severe carotid and coronary artery disease: ''Failure to move forward is reason to regress''. Journal of Cardiovascular Surgery 2009; 50(1):55-62.

Abstract: In the absence of randomized trials, the optimal management of patients with concomitant carotid and coronary artery disease remains disputable. The initial studies of combined or staged carotid endarterectomy in these patients were conceived in an attempt to reduce perioperative mortality. Although encouraging results have been reported with combined carotid endarterectomy and cardiac surgery, this combination requires long operative times and remains a surgical challenge. Recent studies have shown that carotid angioplasty and stenting prior to cardiac surgery is a feasible and effective minimal invasive technique. However, the effect of carotid stenting on the incidence of death and stroke after cardiac surgery is indistinct. Carotid stenting followed by cardiac surgery may provide a valuable treatment for patients with combined carotid and cardiac disease. The high rate of freedom from death and stroke during follow-up supports the long-term durability of this strategy. In the present review, we highlight the available data on carotid stenting and cardiac surgery.

van der Waal RIF, Slee PHTJ, Eland IA, Schagen van Leeuwen JH, Timmer R, Schramel FMNH, Goedkoop AY, Veersema S, Los M, de Jong PC. Hypertrichosis lanuginosa acquisita als paraneoplastische manifestatie: minder zeldzaam dan gedacht. Nederlands Tijdschrift voor Dermatologie en Venereologie 2009; 19(1):19-24.

van der Waal RIF, de Visscher JGAM. Huidafwijkingen van het aangezicht. In: Baart JA, van der Waal I, editors. Mondziekten, kaak- en aangezichtschirurgie. Houten: Bohn Stafleu van Loghum, 2009: 67-75.

van Deurzen CH, Bult P, de Boer M, Koelemij R, van Hillegersberg R, Tjan-Heijnen VC, Hobbelink MG, de Bruin PC, van Diest PJ. Morphometry of isolated tumor cells in breast cancer sentinel lymph nodes: metastases or displacement? American Journal of Surgical Pathology 2009; 33(1):106-110.

Abstract: Iatrogenic displacement and mechanical transport of epithelial cells to the sentinel node (SN) has been suggested to result in false-positive findings in breast cancer patients, but little biologic evidence has yet been presented for this hypothesis. As malignant nuclei are larger than benign ones, nuclear morphometry of SN isolated tumor cells (ITC) could provide relevant information with regard to the malignant origin-or-not of epithelial cells in the SN. In patients with primary invasive breast cancer and SN ITC with (N=16) or without (N=45) non-SN involvement, nuclear morphometry was performed on the primary tumor as well as on the ITC in the SN. Nuclear size in the primary tumor was compared with that in the corresponding ITC. Patients with SN micrometastases (N=30) and SN macrometastases (N=30) served as controls. Nuclear size of ITC was significantly smaller compared with nuclear size of the corresponding primary tumor (P<0.0001). In contrast, there were no differences in nuclear size between SN micrometastases and macrometastases on the one hand and their corresponding primary tumors on the other. In addition, a subgroup of cases (10/61, 16%) with benign morphometric features of SN ITC nuclei (small and isomorph) could be discerned that had no non-SN metastases. In conclusion, nuclei of SN ITC are significantly smaller compared with the corresponding primary tumor and are often not associated with non-SN involvement. This supports the hypothesis that some of these deposits could represent benign epithelium or degenerated malignant cells lacking outgrowth potential.

van Gent MW, Post MC, Luermans JG, Snijder RJ, Westermann CJ, Plokker HW, Overtoom TT, Mager JJ. Screening for pulmonary arteriovenous malformations using transthoracic contrast echocardiography: a prospective study. European Respiratory Journal 2009; 33(1):85-91.

Abstract: Pulmonary arteriovenous malformations (PAVMs) are associated with severe neurological complications in patients with hereditary hemorrhagic telangiectasias (HHT). The objective of our study was to prospectively establish the diagnostic value of TTCE as a screening technique for PAVM using chest HRCT as the gold standard for PAVMs.All consecutive adult persons referred for HHT screening underwent a chest HRCT (n=299), TTCE (n=281), arterial blood gas analysis (n=291), shunt fraction measurement (n=111) and chest radiography (n=296).TTCE was positive in 87 (58.8%), 12 (16.7%) and 4 (6.7%), and chest HRCT was positive in 54 (36.5%), 3(4.2%) and 0 patients with respectively a definite, possible and negative clinical diagnosis HHT. Two patients with a negative TTCE were diagnosed with PAVMs on CT; in both cases the PAVMs were too small for embolotherapy. Sensitivity of TTCE was 97% (95% CI 93.6-98.3) and NPV 99% (95% CI 96.9-99.8). The other diagnostic tests showed a considerable lower diagnostic value.This prospective study shows that TTCE has an excellent diagnostic value and can be used as an initial screening procedure for PAVM. The high falsely positive rate of TTCE possibly represents microscopic PAVMs

van Hemel NM, Scheffer M. Cardiac resynchronisation therapy in daily practice and loss of confidence in predictive techniques to response. Netherlands Heart Journal 2009; 17(1):4-5.

van Middendorp JJ, Slooff WB, Nellestein WR, Oner FC. Incidence of and risk factors for complications associated with halo-vest immobilization: a prospective, descriptive cohort study of 239 patients. Journal of Bone & Joint Surgery - American Volume 2009; 91(1):71-79.

Abstract: BACKGROUND: Since high rates of serious complications, such as death and pneumonia, during halo-vest immobilization have been reported, there has been a tendency of restraint with regard to the use of the halo vest. However, the rate of complications in a high-volume center with sufficient experience is unknown. Our objective was to determine the incidence of and risk factors associated with complications during halo-vest immobilization. METHODS: During a five-year period, a prospective cohort study was performed in a single, level-I trauma center that was also a tertiary referral center for spinal disorders. Data from all patients undergoing halo-vest immobilization were collected prospectively, and every complication was recorded. The primary outcome was the presence or absence of complications. Univariate regression analysis and regression modeling were used to analyze the results. RESULTS: In 239 patients treated with halo-vest immobilization, twenty-six major, seventy-two intermediate, and 121 minor complications were observed. Fourteen patients (6%) died during the treatment, although only one death was related directly to the immobilization and three were possibly related directly to the immobilization. Twelve patients (5%) acquired pneumonia during halo-vest immobilization. Patients older than sixty-five years did not have an increased risk of pneumonia (p = 0.543) or halo vest-related mortality (p = 0.467). Halo vest-related complications ranged from three patients (1%) with incorrect initial placement of the halo vest to twenty-nine patients (12%) with a pin-site infection. Pin-site infection was significantly related to pin penetration through the outer table of the skull (odds ratio, 4.34; 95% confidence interval, 1.22 to 15.51; p = 0.024). In 164 trauma patients treated only with halo-vest immobilization, cervical fractures with facet joint involvement or dislocations were significantly related to radiographic loss of alignment during follow-up (odds ratio, 2.81; 95% confidence interval, 1.06 to 7.44; p = 0.031). CONCLUSIONS: There are relatively low rates of mortality and pneumonia during halo-vest immobilization, and elderly patients do not have an increased risk of pneumonia or death related to halo-vest immobilization. Nevertheless, the total number of minor complications is substantial. This study confirms that awareness of and responsiveness to minor complications can prevent subsequent development of serious morbidities and perhaps reduce mortality.

van Oostrom AJ, Alipour A, Sijmonsma TP, Verseyden C, linga-Thie GM, Plokker HW, Castro Cabezas M. Comparison of different methods to investigate postprandial lipaemia. Netherlands Journal of Medicine 2009; 67(1):13-20.

Abstract: Postprandial hyperlipidaemia has been associated with coronary artery disease (CAD). We investigated which of the generally used methods to test postprandial lipaemia differentiated best between patients with premature CAD (50+/-4 years, n=20) and healthy controls. Furthermore, the effects of rosuvastatin 40 mg/day on postprandial parameters were assessed. Standardised oral fat-loading tests (OFLT) and ambulant self-measurements of daylong capillary triglycerides (TGc) were performed. Total responses of individual lipoproteins, plasma TG (TGp) and remnant-like particle cholesterol (RLP-C) were estimated as area under the curve (AUC). Most AUCs were highest in untreated patients and reached control levels after rosuvastatin. From all AUCs, RLP-C-AUC was best associated to TGp-AUC in untreated patients and controls (adjusted R2=0.84, &#946&semi;=0.92, p

van Werkum JW, Heestermans AA, de Korte FI, Kelder JC, Suttorp MJ, Rensing BJ, Zwart B, Brueren BR, Koolen JJ, Dambrink JH, Van't Hof AW, Verheugt FW, ten Berg JM. Long-Term Clinical Outcome After a First Angiographically Confirmed Coronary Stent Thrombosis: An Analysis of 431 Cases. Circulation 2009; 119(6):828-834.

Abstract: BACKGROUND: There are limited data on the long-term clinical outcome after an angiographically confirmed (definite) stent thrombosis (ST). METHODS AND RESULTS: Four hundred thirty-one consecutive patients with a definite ST were enrolled in this multicenter registry. The primary end point was the composite of cardiac death and definite recurrent ST. Secondary end points were all-cause death, cardiac death, definite recurrent ST, definite and probable recurrent ST, any myocardial infarction, and any target-vessel revascularization. The primary end point occurred in 111 patients after a median follow-up of 27.1 months. The estimated cumulative event rates at 30 days and 1, 2, and 3 years were 18.0%, 23.6%, 25.2%, and 27.9%, respectively. The cumulative incidence rates of definite recurrent ST, definite or probable recurrent ST, any myocardial infarction, and any target-vessel revascularization were 18.8%, 20.1%, 21.3%, and 32.0%, respectively, at the longest available follow-up. Independent predictors for the primary end point were diabetes mellitus, total stent length, severe calcification, American College of Cardiology/American Heart Association B2-C lesions, TIMI (Thrombolysis In Myocardial Infarction) flow grade <3 after percutaneous coronary intervention, and left ventricular ejection fraction <45%. The implantation of an additional coronary stent during the first ST was also associated with unfavorable outcome. Clinical outcome was not affected by the type of previously implanted stent (drug-eluting or bare-metal stent) or the category of ST (early versus late). CONCLUSIONS: The long-term clinical outcome after a first definite ST is unfavorable, with a high mortality and recurrence rate. Diabetes mellitus, left ventricular ejection fraction <45%, long total stent length, complex coronary lesions, TIMI flow grade <3 after percutaneous coronary intervention, and implantation of an additional coronary stent during the emergent percutaneous coronary intervention for the ST were associated with this unfavorable outcome

van Werkum JW. Platelets and stent thrombosis. s.l.: s.n., 2009.
Ref ID: 9558

Verra WC, Snijders TJ, Seute T, Han KS, Nieuwenhuis HK, Rutten GJ. Myeloid sarcoma presenting as a recurrent, multifocal nerve root entrapment syndrome. Journal of neuro-oncology 2009; 91(1):59-62.

Abstract: 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) 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

Versteeg D, Dol E, Hoefer IE, Flier S, Buhre WF, de Kleijn D, van Dongen EP, Pasterkamp G, de Vries JP. Toll-like receptor 2 and 4 response and expression on monocytes decrease rapidly in patients undergoing arterial surgery and are related to preoperative smoking. Shock 2009; 31(1):21-27.

Abstract: Previously, we have shown that small arterial trauma is accompanied by a decreased capability of both toll-like receptors (TLRs) 2 and 4 to respond to stimulation with their respective ligands Pam3Cys and LPS. In this study, we assessed whether surgical arterial trauma induces a decrease in the TLR response and investigated the time course of the altered responsiveness. In addition, TLR responsiveness was related to baseline patient characteristics. Patients undergoing arterial surgery were included in the study. Patients undergoing pacemaker replacement served as control. Blood samples were drawn before, during, and immediately after vascular surgery and 24 h postoperatively. In all samples, we measured TLR-2 and TLR-4 expression using flow cytometry. Whole-blood samples were incubated with 5, 50, and 500 ng/mL Pam3Cys and with 1, 10, and 100 ng/mL LPS. Toll-like receptor response was assessed by measuring TNF-alpha in the supernatant with an enzyme-linked immune fluorescent assay. We observed a dose-dependent response in TNF-alpha production after stimulation with both LPS and Pam3Cys (P < 0.001). The TLR response decreased significantly after arterial trauma (P = 0.022). This effect on TLR response persisted in the 24-h postoperative period, whereas no such effect was observed in the control group. Toll-like receptor 2 expression decreased significantly immediately after surgery (P = 0.005) but increased 24 h after surgery (P < 0.001). Furthermore, an inverse relation between the TLR response and smoking was observed (P = 0.026). Toll-like receptor 2 and 4 response declines rapidly after arterial trauma in patients undergoing vascular surgery. These results point to a significant role for TLRs in the induction of postoperative immune tolerance. Furthermore, smoking is negatively related to baseline TLR response

Vlek AL, van der Graaf Y, Sluman M, Moll FL, Visseren FL. Course and Consequences of the Metabolic Syndrome in Patients with Peripheral Arterial Disease from the SMART Study: A 5.5-Year Follow-up Study. Circulation 2009; 119(10):e300.

Vrieling A, Voskuil DW, Bosma A, Majoor DM, van Doorn J, Cats A, Depla ACTM, Timmer R, Witteman BJM, Wesseling J, Kampman E, van't Veer LJ . Expression of insulin-like growth factor system components in colorectal tissue and its relation with serum IGF levels. Growth Hormone & IGF Research 2009; 19(2):126-135.

Abstract: Context The insulin-like growth factor (IGF)-system has been implicated in colorectal tumor carcinogenesis. Although both tumor expression levels and serum concentrations of IGF-system components are related to colorectal cancer risk, it is unknown whether IGF levels in tissue and serum are correlated.Objective The objective of this study was to determine expression levels of various IGF-system components in different locations of the colorectum, and to investigate whether normal tissue IGF expression levels are correlated with serum IGF-I and IGF-II concentrations.Design Biopsies from macroscopically normal mucosa at four locations in the colorectum (ascending, transverse, sigmoid colon, and rectum) and a fasting serum sample were obtained from 48 asymptomatic patients at increased risk of colorectal cancer. Expression levels of IGF-I, IGF-II, IGF-IR, IGF-IIR, and IGFBP-3 messenger RNA (mRNA) in tissue were quantitatively evaluated using real-time RT-PCR. Expression of IGF-IR protein in the ascending colon and rectum tissue specimens was assessed semi-quantitatively by immunohistochemistry. Serum IGF-I and IGF-II concentrations were determined using immunometric assays.Results With the exception of IGF-IIR, mRNA levels of all the IGF-system components investigated, as well as IGF-IR protein expression, were significantly higher in the rectum compared with the ascending colon (pá[less-than-or-equals, slant]á0.001). Serum IGF-I and IGF-II concentrations did not correlate with any of the parameters studied in colorectal tissues.Conclusions Our results indicate that in humans IGF-system components are differentially expressed in the colorectum. Moreover, our findings suggest that local and circulating components of the IGF-system are differentially regulated. However, due to large intra-individual variation in mRNA expression, we cannot formally exclude undetected but existing routes of co-regulation

Walhout RJ, Suttorp MJ, Mackaij GJ, Ernst JM, Plokker HW. Long-term outcome after balloon angioplasty of coarctation of the aorta in adolescents and adults: Is aneurysm formation an issue? Catheterization & Cardiovascular Interventions 2009; 73(4):549-556.

Abstract: Objectives: The purpose was to evaluate long-term outcome following balloon angioplasty for coarctation in adults. Background: Long-term results of balloon angioplasty for native coarctation in adults remain incomplete, especially concerning the occurrence of aneurysm formation. Methods: Long-term follow-up data were collected in consecutive patients retrospectively. Results of balloon angioplasty (29 patients, age 15-71 years, during 1995-2005) for discrete, native coarctation were evaluated, including MRI or CT. Results: Mean follow-up ranged from 2.2 to 13 years (mean 8.5 +/- 3.2). Immediate success was obtained in all patients. Early mortality or complications were not encountered. Peak systolic pressure gradient decreased from 52 +/- 21 to 7.2 +/- 7.6 mm Hg (P < 0.001). Intima tear was detected in eight procedures angiographically, without signs of dissection. Three-month follow-up angiography in these patients showed unchanged (4/8 patients) or diminished abnormalities (4/8 patients). One asymptomatic patient, known with left ventricular dysfunction due to significant aortic valve insufficiency, died suddenly 5 years after balloon angioplasty. Recoarctation occurred in one patient (3%). Late aneurysm formation was excluded by MR in 24/29 and CT in remaining 5/29 patients during follow-up, including those patients in whom intima tear was encountered immediately postangioplasty. In three of seven patients an irregular aortic contour persisted, without indication of progression or aneurysm formation. Hypertension was completely relieved in 67% (14/21 patients) and improved in 33% (7/21 patients). Conclusions: Balloon angioplasty for native coarctation yields low reintervention probability in adult patients. Despite occurrence of angiographically established intimal tearing, aortic dissection and aneurysm formation were not encountered. (c) 2009 Wiley-Liss, Inc

Yilmaz A, Rehman A, Sonker U, Kloppenburg GT. Minimal access aortic valve replacement using a minimal extracorporeal circulatory system. Annals of Thoracic Surgery 2009; 87(3):720-725.

Abstract: BACKGROUND: Minimal access aortic valve replacement (mAVR) has been demonstrated to be beneficial over standard median sternotomy. Similarly, minimal extracorporeal circulation (MECC) has been shown to have less deleterious effects than conventional cardiopulmonary bypass. We report a previously undescribed technique for AVR in combination with MECC by minimal access. METHODS: We prospectively collected data including one-month postoperative follow-up of the first 50 patients who underwent mAVR utilizing MECC. A temporary Cordis Ventricor (Cordis Corp, Miami, FL) ventricular pacemaker and external defibrillation pads were placed at induction. A J-shaped partial upper sternotomy ending in the third intercostal space was performed. Cannulation was performed in the groin using the Seldinger technique. A vent was introduced directly in the pulmonary artery. Warm blood cardioplegia and carbon dioxide field flooding were used. RESULTS: Fifty consecutive patients (24 male) with a mean age of 68 (range, 34 to 89) were operated between May and December 2007. Operating time was 147 +/- 20 minutes, cross-clamp time was 64 +/- 10 minutes, and perfusion time was 84 +/- 17 minutes. There were no conversions to median sternotomy. Only one peroperative blood transfusion was required and postoperative blood loss was 372 +/- 170 cc. Intensive care unit stay was uneventful (average stay 2 days, range 1 to 8). One patient required a permanent pacemaker and other complications included pneumothorax, superficial wound infection, a late transient postoperative neurologic deficit, and excessive postoperative blood loss requiring mediastinal reexploration. Renal failure and major cerebral accidents did not occur. There was a 100% survival at one-month follow-up. CONCLUSION: We have shown that minimal access aortic valve replacement using minimal extracorporeal circulation is feasible and provides excellent clinical and cosmetic results.

Zijlstra H, Boeije HR, Larsen JK, van Ramshorst B, Geenen R. Patients' explanations for unsuccessful weight loss after laparoscopic adjustable gastric banding (LAGB). Patient education and counseling 2009; 75(1):108-113.

Abstract: OBJECTIVE: Not all morbidly obese patients attain sufficient weight loss after laparoscopic adjustable gastric banding (LAGB). We examined patients' explanations for unsuccessful weight loss and self-awareness regarding food intake. METHODS: Interviews with 11 patients (10 female/1 male; mean age 46 years) with unsuccessful weight loss were transcribed and analyzed with the MAXqda2 program. RESULTS: Interviewees were disappointed with the postoperative outcome. Some showed no awareness of their own role, while others were inefficacious to continue the actions needed to maintain weight loss, especially during times of stress. Typical statements that distinguished interviewees were: 'It didn't work out', 'I don't care anymore', 'I know I have to do it', 'I know I can do it'. CONCLUSION: Some patients with unsuccessful weight loss after LAGB are insufficiently aware that their own effort is needed to maintain weight loss. Others have self-awareness, but find it difficult to turn awareness into action. PRACTICE IMPLICATIONS: This group could perhaps be helped by tailoring postoperative guidance to the stage of change of an individual patient. Counseling could include increasing awareness of the need to self-control eating and offering assistance to turn intentions into action and to deal with stress, emotions and physical problems

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