Publicaties 2006

Publicaties van medewerkers Sint Antonius Ziekenhuis 2006

Dissertaties

Balemans, Walter A.F.
The role of childhood respiratory tract infections in the development of asthma and atopic disease - 2006 - [Ponsen en Looijen B.V. : Wageningen] Proefschrift Universiteit Utrecht
Bredenoord, Albert Jan
Gastro-oesophageal reflux and belching revistited - 2006 - [Enschede : Febo druk b.v.] Proefschrift Universiteit Utrecht
Herwaarden,Joost August van
Dynamics of endovascular aneurysm repair - 2006 - Enschede : Gildeprint b.v. Proefschrift Universiteit Utrecht
Janssen, Rob
Pneumoproteins in interstitial lung diseases - 2006 - [S.l. : s.n.] Proefschrift Universiteit Utrecht
Keller, Bastiaan Paul Johan Aart
Risks and risk-analysis for the development of pressure ulcers in surgical patients - 2006 - [Enschede : Febo druk b.v.] Proefschrift Universiteit Utrecht.
Kruit, Adrian
Gene polymorphisms in fibrotic sarcoidosi - 2006 - [Enschede : Febo druk b.v.] Proefschrift Universiteit Utrecht
Lee, Ivo van der
Nitric oxide and carbon monoxide diffusing capacity of the lung - 2006 - [S.l. : Drukkerij Gravé] Proefschrift Universiteit Utrecht.
Martens,Fabrice Marcel Anne Clément.
Vasoreactivity, Inflammation and vascular effects of Thiazolidinediones in Insulin resistance - 2006 - Utrecht: Universiteit Utrecht, Faculteit Geneeskunde
Meiland, Ruby
Pathogenesis, diagnosis, and consequences of bacteriuria in women with or without diabetes mellitus - 2006 - [S.l. : Febodruk B.V.] Proefschrift Universiteit Utrecht.
Post, Martijn Cornelis
Shunt closure and migraine relief - 2006 - [Enschede : Febo druk b.v.] Proefschrift Universiteit Utrecht.
Wal, Rudy Martinus Adrianus van de
Optimal blockade of the renin angiotensin system in cardiorenal dysfunction - 2006 - [Enschede : Gildeprint Drukkerijen] Proefschrift Rijksuniversiteit Groningen.

Artikelen / Abstracts / Hoofdstukken / Boeken / Dissertaties

Aantal referenties: 386

De commissie kwaliteitsindicatoren van de NVIC, van der Voort PHJ, de Vos MLG, Burger DHC, Corsten AA, van Dijk FE, de Jonge E, Kallewaard M, van Zanten ARH. Interne indicatoren voor Intensive Care afdelingen : een continue nationale registratie ten behoeve van kwaliteitsverbetering. Netherlands Journal of Critical Care 2006; 10(5):595-600.

Kwaliteitsinstituut voor de Gezondheidszorg CBO, de Krom MCTFM, Mink van der Molen AB. Richtlijn diagnostiek en behandeling van het carpale-tunnelsyndroom. 2006. Alphen aan den Rijn, Van Zuiden Communications.

Aanen MC, Bredenoord AJ, Samsom M, Smout AJ. The gastro-oesophageal common cavity revisited. Neurogastroenterology & Motility 2006; 18:1056-1061.

Aanen MC, Numans ME, Weusten BL, Smout AJ. Diagnostic value of the reflux disease questionnaire in general practice. Digestion 2006; 74(3-4):162-168.

Abstract: Objectives: This study determined the diagnostic and therapeutic response of the Reflux Disease Questionnaire (RDQ) using the symptom association probability (SAP) as reference. In addition, the RDQ's construct validity and its relationship to quality of life (QOL) were ascertained. Methods: Seventy-four patients with GORD symptoms (age 51 years (22-78); male symbol62%) derived from primary care completed the RDQ, GSRS and QOLRAD before and after a 2 weeks' course of esomeprazole 40 mg daily. The SAP was determined by a 24-hour pH recording before PPI treatment. The diagnostic abilities of the RDQ (total and 4 dimensions scores) were assessed with the area under the curve (AUC) of a receiver operating curve. RDQ scores before and after PPI treatment were compared with Wilcoxon tests. Multiple linear regressions assessed the RDQ's construct validity (GSRS) and relationship to QOL (QOLRAD). Results: The AUCs were low for all RDQ dimensions (AUC <0.6). In the SAP-positive patients all RDQ dimensions improved (p < 0.0001) while the scores of the SAP negatives did not (heartburn p < 0.01; GORD and total score p < 0.05; regurgitation and dyspepsia n.s.). The RDQ was related to the total and reflux GSRS dimensions while the food and drink QOL dimension was linearly associated with the RDQ. Conclusions: The RDQ is a valid and reliable questionnaire with excellent construct validity and a good relationship to QOL. The diagnostic value of the RDQ in primary care is limited, but combination with an additional PPI treatment course might improve the RDQ's ability to discriminate GORD patients according to their SAP outcome. Copyright (c) 2006 S. Karger AG, Basel

Aanen MC, Bredenoord AJ, Smout AJ. Effect of dietary sodium chloride on gastro-oesophageal reflux: A randomized controlled trial. Scandinavian Journal of Gastroenterology 2006; 41(10):1141-1146.

Abstract: Objective.It has been suggested that a high consumption of sodium chloride (NaCl) is associated with reflux symptoms. The objective of this study was to investigate the effect of increased dietary NaCl intake on gastro-oesophageal reflux and reflux mechanisms. Material and methods. In this double-blind, placebo-controlled, crossover study 10 healthy male subjects received 5 g NaCl or placebo in capsules per day for one week, after which concurrent manometric, pH and impedance monitoring was carried out for 4.5 h. Results. Oesophageal acid exposure time (pH < 4) was similar for placebo (median 11% (25th 3-75th 36)) and NaCl (9% (1-36)). No differences in the numbers of reflux episodes were found for NaCl (16 (13.5-22)) and placebo (23 (14.8-27)). Furthermore, similar numbers of liquid acid reflux episodes (placebo 12 (6.5-17.3); NaCl 10 (2.3-14.3)), liquid weakly acidic reflux episodes (placebo 5.5 (4-12.3); NaCl 6.5 (3-10.8)) and gaseous reflux episodes (placebo 1 (0-1.8); NaCl 2 (0-3)) were seen. In both conditions transient lower oesophageal sphincter relaxations (TLOSRs) were the most common reflux mechanism, followed by swallow-induced reflux. High salt intake lowered LOS pressure overall and in the first postprandial hour (p<0.01). Conclusions. High dietary sodium intake does not increase gastro-oesophageal reflux in healthy volunteers, despite a decrease in LOS pressure

Aanen MC, Weusten BL, Numans ME, de Wit NJ, Baron A, Smout AJ. Diagnostic value of the proton pump inhibitor test for gastro-oesophageal reflux disease in primary care. Alimentary Pharmacology & Therapeutics 2006; 24(9):1377-1384.

Abstract: Aim To assess the diagnostic accuracy of the proton pump inhibitor test in a primary care population as well as its additional value over reflux history, using the symptom association probability outcome during 24-h oesophageal pH recording as reference test for gastro-oesophageal reflux disease. Methods Subjects with symptoms suggestive of gastro-oesophageal reflux disease were recruited from primary care. After a 24-h pH recording with calculation of the symptom association probability, subjects started using 40 mg esomeprazole once daily for 13 days. The proton pump inhibitor test was considered positive when the subjects reported adequate symptom suppression. Data are presented as means with 95% confidence intervals. Results Successful 24-h pH recording was accomplished in 84 of the 90 subjects, while the symptom association probability was calculable in 74. The symptom association probability was positive in 70% of the subjects. The sensitivity of the proton pump inhibitor test was 0.91 (CI 0.78-0.96) and the specificity was 0.26 (CI 0.10-0.49). The mean likelihood ratio was 1.2 (CI 0.9-1.6) with little variation over the 13 consecutive proton pump inhibitor test days. The likelihood ratios of gastro-oesophageal reflux disease symptoms were comparable, ranging around 1. Conclusions In primary care patients with reflux symptoms gastro-oesophageal reflux disease is highly prevalent. Under these conditions the additional value of short-term treatment with a proton pump inhibitor for diagnosing gastro-oesophageal reflux disease is limited

Ackerstaff RGA. Cerebral Circulation Monitoring in Carotid Endarterectomy and Carotid Artery Stenting. In: Baumgartner RW, editor. Handbook on Neurovascular Ultrasound. Basel: Karger, 2006: 229-238.

Agterof MJ, Slee PHThJ. Abdominal pain in a diabetic patient. 18e Internistendagen : abstractboek : 27& 28 april 2006 MECC Maastricht 2006;105.

Al-Toma A, Goerres MS, Meijer JW, von Blomberg BM, Wahab PJ, Kerckhaert JA, Mulder CJ. Cladribine Therapy in Refractory Celiac Disease With Aberrant T Cells. Clinical Gastroenterology & Hepatology 2006; 4(11):1322-1327.

Abstract: Background & Aims: Refractory celiac disease (RCD) may be subdivided into RCD types I and II with phenotypically normal and aberrant intraepithelial T-cell populations, respectively. In RCD II, transition into enteropathy-associated T-cell lymphoma (EATL) is seen frequently. We have evaluated the effect of cladribine (2-CDA), a purine analogue inducing T-cell depletion, on clinical, histopathologic, and immunologic parameters, as well as the toxicity and side effects in a group of RCD II patients. Methods: Between 2000 and 2005, 17 patients were included (8 men, 9 women). All patients had a clonal rearrangement of the T-cell receptor gamma gene and immunophenotyping showed an aberrant T-cell population lacking surface expression of CD3, CD8, and T-cell receptor alphabeta, in the presence of expression of surface CD103 and intracytoplasmic CD3. Treatment consisted of 2-CDA (0.1 mg/kg/day) intravenously for 5 days, given in 1-3 courses every 6 months depending on the response. Results: All patients tolerated 2-CDA without serious side effects. Six patients (35.8%) showed a clinical improvement (weight gain, improvement of diarrhea, and hypoalbuminemia). In 10 patients (58.8%) a significant histologic improvement and in 6 patients (35.2%) a significant decrease in aberrant T cells was seen. Seven patients (41.1%) developed EATL and died subsequently. One patient died of progressive refractory state with emaciation. Conclusions: Treatment with 2-CDA in RCD II is feasible, well tolerated, and can induce clinical and histologic improvement as well as a significant decrease of aberrant T cells in a subgroup of patients, albeit it does not prevent EATL development. However, the earlier reported potential risk of precipitating an overt lymphoma should be taken into consideration

Aziz ZA, Wells AU, Bateman ED, Copley SJ, Desai SR, Grutters JC, Milne DG, Phillips GD, Smallwood D, Wiggins J, Wilsher ML, Hansell DM. Interstitial Lung Disease: Effects of Thin-Section CT on Clinical Decision Making. Radiology 2006; 238(2):725-733.

Abstract: Purpose: To retrospectively quantify the change in the diagnosis and management of suspected interstitial lung disease when thin-section computed tomography (CT) is added to pretest probabilities. Materials and Methods: The institutional review board does not require approval or patient informed consent for retrospective study of case records and CT studies. Six pulmonologists reviewed data sheets containing clinical information and results of pulmonary function tests and chest radiographs of 168 consecutive patients (86 women and 82 men; mean age, 59.8 years; age range, 22-86 years) suspected of having interstitial lung disease. Differential diagnoses and responses to specific questions regarding patient care were recorded before and after assimilation of thin-section CT findings. Both unweighted and weighted kappa analyses were used to determine agreement between pulmonologists before and after CT. Results: First-choice diagnosis changed in 520 (51%) of 1008 cases, and agreement on first-choice diagnosis increased from 0.47 to 0.72 after thin-section CT. In addition, confidence in the first-choice diagnosis increased, and there was a reduction in the number of differential diagnoses offered by all pulmonologists (P < .005 and P < .001, respectively). Agreement on diagnostic probabilities for individual disorders increased substantially, particularly for diagnoses of idiopathic pulmonary fibrosis (weighted kappa = 0.58-0.89). With CT findings, pulmonologists changed their pre-CT responses regarding the use of bronchoalveolar lavage, transbronchial biopsy, and thoracoscopic biopsy in 242 (24.0%), 282 (28.0%), and 292 (29.0%) of 1008 cases, respectively. However, agreement for the use of these investigations was low both before and after CT. The request rate for thoracoscopic biopsy in patients in whom idiopathic fibrosis was diagnosed decreased from 48 of 179 (26.8%) to 26 of 233 (11.2%) after CT. Conclusion: Thin-section CT resulted in a change in first-choice diagnosis in half the cases. Diagnostic confidence improved, and CT findings increased agreement between pulmonologists on diagnostic probabilities across a range of interstitial lung diseases. (c) RSNA, 2005

Bakker FR, Reniers AAPW, van Dijk A, Hagen P, Verzijlbergen JF, Tiel-van Buul MMC. De waarde van de dual phase 18FDG-PET bij de differentiatie tussen benigne en magligne longafwijkingen. Tijdschrift voor Nucleaire Geneeskunde 2006; 28(3):97-100.

Balemans WA, van der Ent CK, Schilder AG, Sanders EA, Zielhuis GA, Rovers MM. Prediction of asthma in young adults using childhood characteristics: Development of a prediction rule. Journal of Clinical Epidemiology 2006; 59(11):1207-1212.

Abstract: OBJECTIVE: To develop an easily applicable prediction rule for asthma in young adulthood using childhood characteristics. METHODS: A total of 1,055 out of 1,328 members of a Dutch birth cohort were followed from 2 to 21 years of age. Univariate and multivariate logistic regression analyses were used to evaluate the predictive value of childhood characteristics on asthma at 21 years of age. A prognostic function was developed, and the area under the receiving operating characteristic (ROC) curve was used to estimate the predictive ability of the prognostic models. RESULTS: Of the 693 responding subjects, 86 (12%) were diagnosed with asthma. Independent prognostic factors at ages 2 and 4 years were female gender (odds ratios (OR) 1.9 and 2.1; 95% confidence intervals (CI) 1.2-3.2 and 1.3-2.5), smoking mother (OR 1.6 and 1.6; CI 1.0-2.7 and 1.0-2.6), lower respiratory tract illness (OR 1.9 and 2.4; CI 1.0-3.6 and 1.4-4.0), and atopic parents (OR 2.1 and 1.9; CI 1.3-3.4 and 1.2-3.1). The predictive power of both models was poor; area under ROC curve was 0.66 and 0.68, respectively. CONCLUSION: Asthma in young adulthood could not be predicted satisfactorily based on childhood characteristics. Nevertheless, we propose that this method is further tested as a tool to predict development of asthma

Balemans WA, Rovers MM, Schilder AG, Sanders EA, Kimpen JL, Zielhuis GA, Ent CK. Recurrent childhood upper respiratory tract infections do not reduce the risk of adult atopic disease. Clinical & Experimental Allergy 2006; 36(2):198-203.

Abstract: BACKGROUND: Children of large families and those attending day care are at increased risk of respiratory tract infections, which in turn may protect against the development of allergic disease. Longitudinal studies investigating these associations beyond childhood are, however, scarce. OBJECTIVE: To investigate the association between childhood recurrent upper respiratory tract infections (URTI) and asthma, allergic rhinitis (AR) and eczema in adulthood. METHODS: A birth cohort of 1055 members followed prospectively from the ages of 2 to 21 years. Detailed information on URTI between the ages of 2 and 4 years was collected at 3 monthly intervals in a standardized interview. At the age of 8 years, a parental questionnaire regarding URTI between the ages of 4 and 8 years was used. The incidence of asthma and atopic disease at the age of 21 years was determined using a standardized questionnaire. RESULTS: Of the original cohort, 693 (66%) members completed the questionnaire. Children who experienced recurrent URTI before the age of 2 years, between the ages of 2-4 years and between ages of 4 and 8 years were not less likely to have asthma at 21 years of age than children who did not experience recurrent URTI, relative risk (RR) 0.97 (95% confidence interval (CI) 0.65-1.46), RR 1.45 (CI 0.95-2.21) and RR 1.51 (CI 0.97-2.36), respectively. Neither were recurrent URTI associated with a decreased risk of AR, nor eczema at the age of 21 years. CONCLUSIONS: Recurrent URTI in childhood did not reduce the risk of atopic disease in young adulthood

Balemans WAF. The role of childhood respiratory tract infections in the development of asthma and atopic disease. Wageningen: Ponsen en Looijen B.V., 2006.

Ballaux PK, Geuzebroek GS, van Hemel NM, Kelder JC, Dossche KM, Ernst JM, Boersma LV, Wever EF, de la Riviere AB, Defauw JJ. Freedom from atrial arrhythmias after classic maze III surgery: A 10-year experience. Journal of Thoracic & Cardiovascular Surgery 2006; 132(6):1433-1440.

Abstract: OBJECTIVES: We studied the persistence of favorable outcome, the occurrence of new atrial arrhythmias, and sinus node dysfunction in patients who underwent the maze III procedure. METHODS: Preoperative, in-hospital, and follow-up data of 203 patients who underwent the maze III procedure between June 1993 and June 2003 were collected. A total of 139 patients underwent the maze procedure for lone atrial fibrillation, and 64 patients underwent the maze procedure and concomitant cardiac surgery. RESULTS: There was no 30-day postoperative mortality. During a mean follow-up of 4.0 +/- 2.6 years, 12 patients (6%) died (2 cardiac related). At the end of follow-up, freedom from supraventricular arrhythmias was 80% for the lone atrial fibrillation group and 64% for the concomitant atrial fibrillation group. Freedom from stroke during follow-up was 100% in the lone atrial fibrillation group and 97% in the concomitant group. Multivariate analysis revealed that rhythm at 1-year follow-up (P < .001; odds ratio 9.56, 95% confidence limits 3.92-23.31) and preoperative left atrium dimension (P = .028; odds ratio 1.06 for every millimeter, 95% confidence limits 1.01-1.12) were predictors of success at the end of follow-up. CONCLUSIONS: This study shows that the favorable results of the maze III procedure in terms of freedom from supraventricular arrhythmias persist in most patients for at least 4 years

Balt JC, Suttorp MJ. Wat is de beste strategie ter preventie van atriumfibrilleren na hartchirurgie? Cardiologen Vademecum 2006; 9(7).

Bauwens AM, van de Graaf EA, van Ginkel WG, van Kessel DA, Otten HG. Pre-transplant soluble CD30 is associated with bronchiolitis obliterans syndrome after lung transplantation. Journal of Heart & Lung Transplantation 2006; 25(4):416-419.

Abstract: BACKGROUND: The purpose of this study was to determine the clinical relevance of soluble CD30 (sCD30) concentrations in sera from lung transplantation (LTx) candidates. METHODS: Soluble CD30 concentrations were determined by enzyme-linked immunoassay in pre-transplantation sera of 38 LTx candidates and in serial samples taken after LTx from 10 patients. RESULTS: LTx candidates did not have increased serum sCD30 concentrations when compared with healthy controls (mean +/- SE: 22.3 +/- 2.7 vs 26.2 +/- 3.4 U/ml). No relation could be found between age and serum sCD30 concentrations, neither in the pre-transplant patients nor in the healthy controls. In addition, no differences in sCD30 values could be detected between patients sorted by their original type of lung disease. Measurement of sCD30 in pre-transplant sera of LTx patients showed that the median concentration was 20 U/ml and that LTx patients with low sCD30 (< or = 20 U/ml) had a statistically significant (p = 0.039) longer period of freedom from bronchiolitis obliterans syndrome (BOS) compared to those with a high sCD30 concentration (> 20 U/ml). Furthermore, sCD30 concentrations in sera taken at several timepoints after LTx remained stable, although a peak could be observed before the clinical manifestation of acute rejection (AR). CONCLUSIONS: Soluble CD30 before lung transplantation is significantly associated with an increased risk of BOS after transplantation

Beckers MM, Schutgens RE, Prins MH, Biesma DH. Who is at risk for occult cancer after venous thromboembolism? Journal of Thrombosis & Haemostasis 2006; 4(12):2731-2733.

Besselink MG, de Bruijn MT, Rutten JP, Boermeester MA, Hofker HS, Gooszen HG. Surgical intervention in patients with necrotizing pancreatitis. British Journal of Surgery 2006; 93(5):593-599.

Abstract: BACKGROUND:: This study evaluated the various surgical strategies for treatment of (suspected) infected necrotizing pancreatitis (INP) and patient referrals for this condition in the Netherlands. METHODS:: This retrospective study included all 106 consecutive patients who had surgical treatment for INP in the period 2000-2003 in one of eight Dutch university medical centres including three teaching hospitals. Surgical approaches included an open abdomen strategy, laparotomy with continuous postoperative lavage, minimally invasive procedures or laparotomy with primary abdominal closure. The National Hospital Registration System was searched to identify patients with acute pancreatitis who were admitted to the 90 Dutch hospitals that did not participate in the present study. RESULTS:: The overall mortality rate was 34.0 per cent, 70 per cent (16 of 23) for the open abdomen strategy, 25 per cent (13 of 53) for continuous peritoneal lavage, 11 per cent (two of 18) for minimally invasive procedures and 42 per cent (five of 12) for primary abdominal closure (P < 0.001). During the study interval, 44 (12.2 per cent) of 362 patients with acute pancreatitis who were likely to require surgical intervention had been referred to university medical centres. CONCLUSION:: Laparotomy with continuous postoperative lavage is the surgical strategy most often used in the Netherlands. The results of the open abdomen strategy are poor whereas a minimally invasive approach seems promising. Copyright (c) 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd

Besselink MG, van Santvoort HC, Nieuwenhuijs VB, Boermeester MA, Bollen TL, Buskens E, Dejong CH, van Eijck CH, van Goor H, Hofker SS, Lameris HS, van Leeuwen MS, Ploeg RJ, van Ramshorst B, Schaapherder AF, Cuesta MA, Consten EC, Gouma DJ, van der Harst E, Hesselink EJ, Houdijk LP, Karsten TM, van Laarhoven CJ, Pierie JP, Rosman C, Spillenaar Bilgen EJ, Timmer R, van der Tweel I, de Wit RJ, Witteman BJ, Gooszen HG, Dutch Acute Pancreatitis Study Group. Minimally invasive 'step-up approach' versus maximal necrosectomy in patients with acute necrotising pancreatitis (PANTER trial): design and rationale of a randomised controlled multicenter trial [ISRCTN38327949]. BMC Surgery 2006; 6(1):6.

Abstract: ABSTRACT: BACKGROUND: The initial treatment of acute necrotizing pancreatitis is conservative. Intervention is indicated in patients with (suspected) infected necrotizing pancreatitis. In the Netherlands, the standard intervention is necrosectomy by laparotomy followed by continuous postoperative lavage (CPL). In recent years several minimally invasive strategies have been introduced. So far, these strategies have never been compared in a randomised controlled trial. The PANTER study (PAncreatitis, Necrosectomy versus sTEp up appRoach) was conceived to yield the evidence needed for a considered policy decision. Methods/design: 88 patients with (suspected) infected necrotizing pancreatitis will be randomly allocated to either group A) minimally invasive 'step-up approach' starting with drainage followed, if necessary, by videoscopic-assisted-retroperitoneal-debridement (VARD) or group B) maximal necrosectomy by laparotomy. Both procedures are followed by CPL. Patients will be recruited from 20 hospitals, including all Dutch university medical centres, over a 3-year period. The primary endpoint is the proportion of patients suffering from postoperative major morbidity and mortality. Secondary endpoints are minor complications, new onset sepsis, length of hospital and intensive care stay, quality of life and total (direct and indirect) costs. To demonstrate that the 'step-up approach' can reduce the major morbidity and mortality rate from 45 to 16%, with alpha 0.05 and a power of 80%, a total sample size of 88 patients was calculated. CONCLUSION: The PANTER-study is a randomised controlled trial that will provide the badly needed evidence on the merits of a minimally invasive 'step-up approach' in patients with (suspected) infected necrotizing pancreatitis

Besselink MG, van Santvoort HC, Bollen TL, van Leeuwen MS, Lameris JS, van der Jagt EJ, Strijk SP, Buskens E, Freeny PC, Gooszen HG, Dutch Acute Pancreatitis Study Group. Describing computed tomography findings in acute necrotizing pancreatitis with the atlanta classification: an interobserver agreement study. Pancreas 2006; 33(4):331-335.

Abstract: OBJECTIVES: The 1992 Atlanta classification is a clinically based classification system that defines the severity and complications of acute pancreatitis. A study was undertaken to assess the interobserver agreement of categorizing peripancreatic collections on computed tomography (CT) using the Atlanta classification. METHODS: Preoperative contrast-enhanced CTs from 70 consecutive patients (49 men; median age, 59 years; range, 29-79 years) operated for acute necrotizing pancreatitis (2000-2003) in 11 hospitals were reviewed. Five abdominal radiologists independently categorized the peripancreatic collections according to the Atlanta classification. Radiologists were aware of the timing of the CT and the clinical condition of the patient. Interobserver agreement was determined. RESULTS: Interobserver agreement among the radiologists was poor (kappa, 0.144; SD, 0.095). In 3 (4%) of 70 cases, the same Atlanta definition was chosen. In 13 (19%) of 70 cases, 4 radiologists agreed, and in 42 (60%) of 70 cases, 3 radiologists agreed on the definition. In 21 cases (30%), 1 or more of the radiologists classified a collection as "pancreatic abscess," whereas 1 or more radiologist used another Atlanta definition. CONCLUSION: The interobserver agreement of the Atlanta classification for categorizing peripancreatic collections in acute pancreatitis on CT is poor. The Atlanta classification should not be used to describe complications of acute pancreatitis on CT

Besselink MG, van Santvoort HC, Buskens E, Gooszen HG. Evidence-based treatment of acute pancreatitis: antibiotic prophylaxis in necrotizing pancreatitis. Annals of Surgery 2006; 244(4):637-638.

Besselink MGH, Schoenmaeckers EJP, Buskens E, Ridwan BU, Visser MR, Nieuwenhuijs VB, Gooszen HC. Timing of surgical intervention in necrotizing pancreatitis. Pancreas 2006; 33(4):447.

Besselink MGH, Schoenmaeckers EJP, Buskens E, Ridwan BU, Visser MR, Nieuwenhuijs VB, Gooszen HG. Timing of surgical intervention in necrotizing pancreatitis : a 10 year consecutive case series and systematic review. Pancreatology 2006; 6:323-405.

Besselink MGH, van Santvoort HC, Bollen TL, van Leeuwen MS, Gooszen HC. Describing CT findings in acute necrotizing pancreatitis with the atlanta classification: an interobserver agreement study. Pancreas 2006; 33(4):447.

Besselink MGH, de Vries AC, van de Kraats CIB, Buskens E, van Erpecum KJ. Antibiotic prophylaxis in necrotising pancreatitis: relation of methodological quality of randomised controlled trials to outcome. Pancreas 2006; 33(4):446.

Besselink MGH, van Santvoort HC, Bollen TL, Schaapherder AFM, van Ramshorst B, van Goor H, Gooszen HC. Feasibility of minimally invasive approach in patients with infected necrotizing pancreatitis. Pancreas 2006; 33(4):446.

Biemond-Moeniralam HS, Bras LJ. Compliance with the surviving sepsis bundles and outcome. Surviving Sepsis Campaign, Ede, December 2006.

Boerma D, Schwartz MP. Gallstone disease. Management of common bile-duct stones and associated gallbladder stones: Surgical aspects. Best Practice & Research in Clinical Gastroenterology 2006; 20(6):1103-1116.

Abstract: For many years, open exploration of the common bile duct has been the treatment of choice for patients with common bile-duct stones. During recent decades endoscopic sphincterotomy has gained wide acceptance as an effective and less invasive alternative. After sphincterotomy, subsequent (laparoscopic) cholecystectomy is warranted in patients with gallbladder stones. This chapter will discuss whether sphincterotomy should be performed prior to, during or after cholecystectomy, and will also address the question of whether single-stage treatment by laparoscopic cholecystectomy and laparoscopic bile-duct exploration is in fact preferable. The rate of recurrent choledocholithiasis after endoscopic biliary sphincterotomy can reach more than 20%. This review focuses on the risk factors--delayed bile-duct clearance and bactobilia--that may lead to recurrent primary bile-duct stone formation. Underlying altered bile composition (relative phospholipid deficiency) should be recognised in a subgroup of patients. Identification of these risk factors may significantly affect treatment policy

Boerma D, Schwartz MP. Management of common bile-duct stones and associated gallbladder stones: surgical aspects. Best Practice & Research in Clinical Gastroenterology 2006; 20(6):1103-1116.

Abstract: For many years, open exploration of the common bile duct has been the treatment of choice for patients with common bile-duct stones. During recent decades endoscopic sphincterotomy has gained wide acceptance as an effective and less invasive alternative. After sphincterotomy, subsequent (laparoscopic) cholecystectomy is warranted in patients with gallbladder stones. This chapter will discuss whether sphincterotomy should be performed prior to, during or after cholecystectomy, and will also address the question of whether single-stage treatment by laparoscopic cholecystectomy and laparoscopic bile-duct exploration is in fact preferable. The rate of recurrent choledocholithiasis after endoscopic biliary sphincterotomy can reach more than 20%. This review focuses on the risk factors - delayed bile-duct clearance and bactobilia - that may lead to recurrent primary bile-duct stone formation. Underlying altered bile composition (relative phospholipid deficiency) should be recognised in a subgroup of patients. Identification of these risk factors may significantly affect treatment policy

Boersma LV, Wittkampf FH, Khan M, Wever EF. Electrophysiological properties of the pulmonary veins in patients with an accessory pathway without atrial fibrillation. Heart Rhythm 2006; 3(5 (Suppl)):S319.

Bollen SM, van der Hoeven H. Broken Delta interference screw after ACL reconstruction: a report of two cases. Knee Surgery, Sports Traumatology, Arthroscopy 2006; 14(9):903-906.

Abstract: We report two cases of an intra-articular dislocation of the proximal part of a broken biodegradable interference screw (Delta screw) used for tibial fixation of a semitendinosis gracilis graft in an unstable knee

Bollen TL, Besselink MGH, van Santvoort HC, Gooszen HG, van Leeuwen MS. Towards an update of the Atlanta classification on acute pancreatitis: review of new and abandoned terms. Pancreas 2006; 33(4):448.

Bollen TL, van Santvoort HC, Besselink MGH, van Leeuwen MS, Horvath KD, Freeny PC, Gooszen HG. The Atlanta classification on acute pancreatitis revisited: review of the literature. Pancreas 2006; 33(4):448-449.

Bonatti J, van Boven WJ, Nagele G, Shahin G, Schachner T, Laufer G, Bergman P, van der Linden J, the AORTIC Study Group (Assessment Of the Risk of Emboli Transmission In Coronary Surgery). Do particulate emboli from the ascending aorta in coronary bypass grafting correlate with aortic wall thickness? Interactive Cardiovascular and Thoracic Surgery 2006; 5(6):716-720.

Abstract: This study investigated the previously uncertain relationship of embolic load captured during coronary artery bypass grafting and the extent of ascending aortic atherosclerosis as measured by wall thickness. Patients (n=113) underwent isolated arrested heart coronary artery bypass grafting. Ascending aortic wall thickness measures were obtained by epiaortic ultrasound. Aortic segmental values (distal, mid, proximal) were determined by the summation of measures (anterior lateral, posterior, medial) at each segment. An intraaortic filter (EMBOL-X(R) System, Edwards Lifesciences, Irvine, CA) was placed into the arterial cannula, distal to the aortic measurements, just before releasing the aortic cross-clamp. Particulate debris was found in 96% (109/113) of filters. Mean number of particles was 6.8{+/-}4.8 (range 0-23) and mean particle surface area was 5.5{+/-}7.0 mm2 (range 0-51 mm2). Total aortic wall thickness, distal third, mid third, and proximal third thicknesses were 27.4{+/-}4.4 mm, 9.5{+/-}2.0 mm, 9.0{+/-}1.9 mm, and 8.8{+/-}1.4 mm, respectively. There was no significant correlation between the number of particles or surface area and any of the aortic wall thickness measures. These results suggest that during on-pump, arrested heart coronary artery bypass grafting, embolic load from the ascending aorta is independent of the extent of ascending aortic atherosclerosis in patients with low or moderate risk aortic pathology

Borieffs CJW, Cramer M-JM, Wever EFD, Mosterd A. Clinical implementation of guidelines for cardioverterdefibrillator implantation: lost in transplantation? Netherlands Heart Journal 2006; 14(5):3.

Bos WJ, Vincent HH, Westerhof BE, Verrij E, van Montfrans GA. The mean brachial artery pressure is not calculated adequately by adding 1/3 of the pulse pressure to the diastolic pressure. European Society of Hypertension 16th European Meeting on Hypertension, Madrid, Juni 12 - 15 2006.

Bossema ER, Brand N, Moll FL, Ackerstaff RG, de Haan EH, van Doornen LJ. Cognitive functions in carotid artery disease before endarterectomy. Journal of Clinical & Experimental Neuropsychology 2006; 28(3):357-369.

Abstract: Restorative effects of carotid endarterectomy (CEA) on cognitive functioning in patients with severe atherosclerotic disease presuppose the existence of cognitive deficits prior to the intervention. Thorough examination of this premise received only minor attention. The present study assessed symptomatic and asymptomatic patients with severe unilateral or bilateral stenosis of the carotid arteries one day before CEA. Healthy volunteers with similar demographic characteristics served as control subjects. Patients overall showed decreased functioning on tests of attention, verbal and visual memory, verbal fluency, and psychomotor speed and executive functioning, even after correction for the effects of mood. Simple motor skills and visuospatial functioning were not affected. Patients grouped according to presence and type of previous clinical symptoms and severity of contralateral stenosis only slightly differed from each other. The findings leave open the potential of improving cognitive function after CEA

Braam RL, van Uum SH, Russel FG, Swinkels DW, Thien T. Bromide as a marker to measure adherence to drug therapy. European Journal of Clinical Pharmacology 2006; 62(4):285-290.

Abstract: OBJECTIVE: Several methods have been described to measure adherence to prescribed drug therapy. However, most of these have been shown to be inaccurate. Bromide is an anion that is readily absorbed in the gut and has an elimination half-life of about 12 days. In the present study, we investigated the pharmacokinetic properties of bromide with the objective to use it as a measure of drug adherence. METHODS: Three groups of each 8 healthy volunteers took 15, 24 or 30 mg potassium bromide, respectively, daily for 20 weeks. Serum concentrations of bromide were measured every two weeks. RESULTS: There was a linear relationship between the daily dosage taken and the mean increase of bromide concentration. In every group considerable inter-individual variability was seen. Correction for body weight resulted in an improved correlation between daily bromide dose and increase in concentration (r=0.78, p<0.01). CONCLUSIONS: Unfortunately, the inter-individual variability in clearance of bromide was considerable. This limits the use of bromide to primarily measuring adherence in individual patients during long term follow-up. Bromide appears to be a potentially useful marker to be added to drugs for assessment of individual adherence to long term drug therapy. This needs to be investigated in various patients, particularly for patients with relatively asymptomatic diseases (e.g. hypertension)

Bredenoord AJ, Smout AJ. Acid perfusion test: a useful test for evaluating esophageal acid sensitivity? Digestive Diseases & Sciences 2006; 51(5):873.

Bredenoord AJ, Weusten BL, Curvers WL, Timmer R, Smout AJ. Determinants of perception of heartburn and regurgitation. Gut 2006; 55(3):313-318.

Abstract: BACKGROUND AND AIMS: It is not known why some reflux episodes evoke symptoms and others do not. We investigated the determinants of perception of gastro-oesophageal reflux. METHODS: In 32 patients with symptoms suggestive of gastro-oesophageal reflux, 24 hour ambulatory pH and impedance monitoring was performed after cessation of acid suppressive therapy. In the 20 patients who had at least one symptomatic reflux episode, characteristics of symptomatic and asymptomatic reflux episodes were compared. RESULTS: A total of 1807 reflux episodes were detected, 203 of which were symptomatic. Compared with asymptomatic episodes, symptomatic episodes were associated with a larger pH drop (p<0.001), lower nadir pH (p<0.05), and higher proximal extent (p<0.005). Symptomatic reflux episodes had a longer volume and acid clearance time (p<0.05 and p<0.002). Symptomatic episodes were preceded by a higher oesophageal cumulative acid exposure time (p<0.05). The proximal extent of episodes preceding regurgitation was larger than those preceding heartburn; 14.8% of the symptomatic reflux episodes were weakly acidic. In total, 426 pure gas reflux episodes occurred, of which 12 were symptomatic. Symptomatic pure gas reflux was more frequently accompanied by a pH drop than asymptomatic gas reflux (p<0.05). CONCLUSIONS: Heartburn and regurgitation are more likely to be evoked when the pH drop is large, proximal extent of the refluxate is high, and volume and acid clearance is delayed. Sensitisation of the oesophagus occurs by preceding acid exposure. Weakly acidic reflux is responsible for only a minority of symptoms in patients off therapy. Pure gas reflux associated with a pH drop ("acid vapour") can be perceived as heartburn and regurgitation

Bredenoord AJ, Baron A, Smout AJ. Symptomatic gastro-oesophageal reflux in a patient with achlorhydria. Gut 2006; 55(7):1054-1055.

Bredenoord AJ, Weusten BL, Timmer R, Smout AJ. Characteristics of Gastroesophageal Reflux in Symptomatic Patients With and Without Excessive Esophageal Acid Exposure. American Journal of Gastroenterology 2006; 101(11):2470-2475.

Bredenoord AJ, Weusten BL, Timmer R, Smout AJ. Psychological Factors Affect the Frequency of Belching in Patients with Aerophagia. American Journal of Gastroenterology 2006; 101(12):2777-2781.

Abstract: BACKGROUND: In patients with aerophagia and excessive belching an organic cause is seldom found and a psychogenic cause is often suspected. AIM: To investigate the effects of attention and distraction on the frequency of belching in patients with aerophagia. METHODS: In 10 patients with aerophagia, combined esophageal manometry and impedance monitoring was performed for 2 h, consisting of four 30-minute recording periods. Period I: patient unaware that recording had commenced. Period II: patient informed of recording in progress. Period III: distraction by filling in questionnaires. Period IV: no distraction. RESULTS: A total of 1,258 belches was measured, 51 of which were the result of air that escaped from the stomach (gastric belches). A total of 1,207 belches (96%) were events during which air was expelled in the oral direction almost immediately after entering the esophagus from there (supragastric belches). Gastric belches were distributed equally over the first (1.5 [0.5-2.0]), second (1.5 [0.5-2.0]), third (1.0 [0-2.0]), and fourth (1.0 [0-2.0]) recording periods. In contrast, the incidence of supragastric belches increased significantly from 0 (0-32) in period I to 30 (18-60) in period II, after patients were told that recording was started. During period III (questionnaires) the incidence of supragastric belches decreased to 14 (4-30). In period IV the incidence of supragastric belches increased to 21 (10-49). CONCLUSIONS: When patients with excessive belching are unaware that they are being studied or when they are distracted, the incidence of belching is significantly reduced. These findings underline the importance of psychological factors and provide rationale for behavioral therapy

Bredenoord AJ, Weusten BL, Timmer R, Smout AJ. Air swallowing, belching, and reflux in patients with gastroesophageal reflux disease. American Journal of Gastroenterology 2006; 101(8):1721-1726.

Abstract: OBJECTIVES: Belching and gastroesophageal reflux share a common physiological mechanism. The aim of this study was to investigate whether air swallowing leads to both belching and reflux. METHODS: Esophageal impedance, pH, and pressure were measured during two 20-min recording periods in 12 controls and 12 patients with gastroesophageal reflux disease (GERD), before and after intragastric inflation of 600 mL of air. This was repeated after a meal. Subsequently, ambulatory 24-h impedance-pH measurement was performed. RESULTS: During the 24-h study, patients showed a higher incidence of air swallows (287 +/- 45 vs 176 +/- 24, p < 0.05), belches (52.4 +/- 6.6 vs 32.7, p < 0.01), and acid reflux (42.3 +/- 7.6 vs 19.1 +/- 2.8, p < 0.01) than controls. After air infusion the incidence of gas reflux episodes was increased, both in patients (0.58 +/- 0.36 vs 3.50 +/- 0.61, p < 0.01) and in controls (0.75 +/- 0.67 vs 4.08 +/- 0.59, p < 0.01). In contrast, the incidence of acid and weakly acidic reflux episodes was not increased after air infusion, neither in patients (acid: 1.25 +/- 0.37 vs 1.20 +/- 0.33, weakly acidic: 1.08 +/- 0.40 vs 0.80 +/- 0.23) nor in controls (acid: 0.72 +/- 0.34 vs 0.50 +/- 0.23, weakly acidic: 0.80 +/- 0.35 vs 0.33 +/- 0.19). Air infusion increased transient lower esophageal sphincter relaxations (TLESR) frequency in patients and controls, but this was entirely because of an increase in gas reflux-associated TLESRs. CONCLUSIONS: Patients with GERD swallow air more frequently and belch more frequently than healthy subjects. However, air swallowing is not the cause of their increase in reflux

Bredenoord AJ, Weusten BL, Timmer R, Vandevoorde RR, Smout AJ. Boeren (ructus). Nederlands Tijdschrift voor Geneeskunde 2006; 150(25):1385-1389.

Abstract: Accumulation of air in the stomach increases the gastric volume, which activates receptors in the gastric wall. This results in a reflex that relaxes the lower oesophageal sphincter, whereby the intragastric air can escape through the oesophagus. Ventilation of the stomach via the oesophagus is known as belching (ructus). Belching often occurs in combination with reflux symptoms and dyspepsia. In these cases, other symptoms are often more predominant, and it is advisable to treat these first. In patients with aerophagia, belching is the most common reason for medical consultation. These patients belch frequently, up to 20 times per minute, and often during consultation. Aerophagia results from air being sucked into the oesophagus or injected by pharyngeal contraction, after which it is expelled immediately. In contrast to the described gastric belching, aerophagia is therefore a form of supragastric belching. Aerophagia is a behavioural disorder, and behavioural therapy or logopedics appears to be most common therapeutic approach

Bredenoord AJ, Weusten BL, Timmer R, Conchillo JM, Smout AJ. Addition of Esophageal Impedance Monitoring to pH Monitoring Increases the Yield of Symptom Association Analysis in Patients off PPI Therapy. American Journal of Gastroenterology 2006; 101(3):453-459.

Abstract: BACKGROUND: The additional yield of esophageal impedance monitoring in identification of reflux as the cause of reflux symptoms is unknown. OBJECTIVES: To compare the yield of symptom-reflux association analysis of combined esophageal pH-impedance data with the yield of analysis of pH data alone. METHODS: In 60 patients with symptoms of heartburn and regurgitation combined, 24-h pH-impedance monitoring was performed. Acid-suppressive medication was stopped 1 wk in advance. Patients (48) with at least one symptom during the measurement period were selected for further analysis. Patients were instructed to note the time and nature of their symptoms. Eleven types of reflux episodes were defined, based on combinations of magnitude of the pH drop, nadir pH, and nature of the refluxate (gas and liquid) on impedance tracings. Symptom association analysis-symptom index, the symptom sensitivity index, and the symptom association probability (SAP)-was performed for each definition of reflux. RESULTS: The proportion of patients with a positive SAP (>/=95.0%) varied between 62.5% and 77.1%, depending on the definition of reflux episodes. When both pH and impedance parameters were used to identify reflux, a higher proportion of patients had a positive SAP than with pH alone (77.1%vs 66.7%, p < 0.05). Symptom association analysis for acidic and weakly acidic reflux separately did not result in a higher yield than analysis with all reflux episodes pooled, regardless of pH. CONCLUSION: In patients off proton pump inhibitor, the addition of impedance monitoring to esophageal pH monitoring leads to an increase in the proportion of patients in whom an association between reflux episodes and symptoms can be identified

Bredenoord AJ, Weusten BL, Timmer R, Smout AJ. Gastro-oesophageal reflux of liquids and gas during transient lower oesophageal sphincter relaxations. Neurogastroenterology & Motility 2006; 18(10):888-893.

Abstract: Some transient lower oesophageal sphincter relaxations (TLOSRs) are accompanied by gastro-oesophageal reflux and others are not. We aimed to investigate what factors determine the occurrence and type of reflux during TLOSRs. In 12 healthy subjects prolonged high-resolution manometry was performed. Reflux was detected using pH-impedance monitoring. A total of 219 TLOSRs were detected; no differences were observed between the duration of TLOSRs with liquid-containing reflux (20.2 +/- 1.0 s), gas reflux (17.0 +/- 1.0 s) and no reflux (19.0 +/- 1.0 s). Trans-sphincteric pressure gradient was similar in TLOSRs with liquid reflux (1.6 +/- 0.1 kPa), gas reflux (1.5 +/- 0.1 kPa) and no reflux (1.7 +/- 0.3 kPa). Prevalence, duration and amplitude of oesophageal pre-contractions and sphincteric after-contractions were not different for TLOSRs with and without reflux. The total number of TLOSRs decreased significantly from 8.2 +/- 0.8 in the first to 5.7 +/- 0.5 in the second and 4.4 +/- 0.6 in the third 70-min recording period. The number of TLOSRs accompanied by liquid-containing reflux decreased from 4.7 +/- 0.9 to 3.0 +/- 0.4 to 1.6 +/- 0.4, while the numbers of TLOSRs with gas reflux remained unchanged (2.1 +/- 0.6-2.1 +/- 0.7-2.2 +/- 0.6). Besides, time after the meal, no differences were observed in the characteristics of TLOSRs with and without gastro-oesophageal reflux. We conclude that factors, other than TLOSR characteristics, are important of whether or not a TLOSR is reflux-related

Bredenoord AJ, Weusten BL, Timmer R, Smout AJ. Intermittent spatial separation of diaphragm and lower esophageal sphincter favors acidic and weakly acidic reflux. Gastroenterology 2006; 130(2):334-340.

Abstract: Background & Aims: In small hiatal hernias, the size of the hernia is variable. Intermittent complete reduction can be observed with high-resolution manometry as a transition from a double-peak (hernia) to a single-peak (reduced) high-pressure zone. The aim of this study was to investigate whether intermittent separation of the diaphragm and lower esophageal sphincter (LES) favors the occurrence of gastroesophageal reflux. Methods: In 16 patients with a small hiatal hernia (3 cm), prolonged high-resolution manometry was performed. Acid and weakly acidic reflux episodes were detected with pH-impedance monitoring. Results: The single pressure peak profile (reduced hernia) was present for 814 minutes (56.5% of total time), and the double peak profile (unreduced hernia) was present for 626 minutes (43.5% of total time). In all patients, both pressure profiles were observed. The transition rate between the 2 profiles was 7.5 +/- 0.9 per hour. More reflux occurred when the LES and diaphragm were separated versus the reduced hernia state (23.1 +/- 5.1 vs 12.2 +/- 2.4 episodes per hour, respectively; P < .05). The proportions of acidic reflux episodes during the single and double pressure peaks were similar (70% and 67%, respectively). In the two-pressure-zone state, there was an increase in all reflux mechanisms except transient LES relaxation. Conclusions: In patients with a small hiatal hernia, intermittent reduction of the hernia occurs frequently. Spatial separation of the diaphragm and LES in the nonreduced state results in a 2-fold increase in acidic and weakly acidic reflux due to mechanisms other than transient LES relaxation

Bredenoord AJ. Gastro-oesophageal reflux and belching revisited. [Enschede: Febo druk b.v.], 2006.

Brouwer IA, Zock PL, Camm AJ, Bocker D, Hauer RN, Wever EF, Dullemeijer C, Ronden JE, Katan MB, Lubinski A, Buschler H, Schouten EG, SOFA Study Group. Effect of fish oil on ventricular tachyarrhythmia and death in patients with implantable cardioverter defibrillators: the Study on Omega-3 Fatty Acids and Ventricular Arrhythmia (SOFA) randomized trial. JAMA 2006; 295(22):2613-2619.

Abstract: CONTEXT: Very-long-chain n-3 polyunsaturated fatty acids (omega-3 PUFAs) from fish are thought to reduce risk of sudden death, possibly by reducing susceptibility to cardiac arrhythmia. OBJECTIVE: To study the effect of supplemental fish oil vs placebo on ventricular tachyarrhythmia or death. DESIGN, SETTING, AND PATIENTS: The Study on Omega-3 Fatty acids and ventricular Arrhythmia (SOFA) was a randomized, parallel, placebo-controlled, double-blind trial conducted at 26 cardiology clinics across Europe. A total of 546 patients with implantable cardioverter-defibrillators (ICDs) and prior documented malignant ventricular tachycardia (VT) or ventricular fibrillation (VF) were enrolled between October 2001 and August 2004. Patients were randomly assigned to receive 2 g/d of fish oil (n = 273) or placebo (n = 273) for a median period of 356 days (range, 14-379 days). MAIN OUTCOME MEASURE: Appropriate ICD intervention for VT or VF, or all-cause death. RESULTS: The primary end point occurred in 81 (30%) patients taking fish oil vs 90 (33%) patients taking placebo (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.64-1.16; P = .33). In prespecified subgroup analyses, the HR was 0.91 (95% CI, 0.66-1.26) for fish oil vs placebo in the 411 patients who had experienced VT in the year before the study, and 0.76 (95% CI, 0.52-1.11) for 332 patients with prior myocardial infarctions. CONCLUSION: Our findings do not indicate evidence of a strong protective effect of intake of omega-3 PUFAs from fish oil against ventricular arrhythmia in patients with ICDs. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00110838

Chitkara DK, Bredenoord AJ, Talley NJ, Whitehead WE. Aerophagia and rumination: recognition and therapy. Current treatment options in gastroenterology 2006; 9(4):305-313.

Abstract: Aerophagia and rumination syndrome are functional upper gastrointestinal disorders that are becoming increasingly recognized in otherwise-healthy children and adults. Aerophagia is primarily characterized by troublesome repetitive belching and abdominal symptoms that result from air sucking and swallowing. Rumination syndrome is primarily characterized by regurgitation occurring shortly after meal intake. Physiologic studies suggest that both disorders are a result of habitual behavior with associated esophageal and gastric physiologic deviations. However, the underlying etiology of these disorders remains unclear. Studies examining optimal treatments are lacking. However, therapeutic approaches utilizing biofeedback may be helpful in alleviating symptoms for patients with these conditions

Conchillo JM, Selimah M, Bredenoord AJ, Samsom M, Smout AJPM. Assessment of oesophageal emptying in achalasia patients by intraluminal impedance monitoring. Neurogastroenterology & Motility 2006; 18(11):971-977.

Dawkins KD, Chevalier B, Suttorp MJ, Thuesen L, Benit E, Bethencourt A, Morjaria U, Veldhof S, Dorange C, van Weert A. Effectiveness of "Direct" Stenting Without Balloon Predilatation (from the Multilink Tetra Randomised European Direct Stent Study [TRENDS]). American Journal of Cardiology 2006; 97(3):316-321.

Abstract: The purpose of the TRENDS trial was to assess the safety, efficacy, and cost effectiveness of a no-predilatation ("direct") stenting strategy in the treatment of de novo native coronary artery lesions using the Multilink Tetra stent system. In this multicenter, prospective clinical trial, 1,000 patients were randomized (1:1) to receive a Multilink Tetra stent with or without balloon predilatation. The primary outcome measurement was major adverse cardiac events (MACEs) at 30 days; secondary end points included resource utilization (including procedural duration, equipment use, and length of hospital stay), MACEs, and angiographic binary restenosis at 180 days. In the predilatation group, 587 stents were implanted in 499 patients; in the direct group, 579 stents were implanted in 501 patients. In the direct group, stents in 31 lesions (5.7%) required predilatation and multivariate analysis identified calcification (odds ratio 5.81), angulation (odds ratio 5.34), and preprocedural minimal lumen diameter (odds ratio 0.09) as direct stenting failure. MACEs at 30 days were similar in the 2 groups, with 19 (3.8%) in the predilatation group and 13 (2.6%) in the direct group (p = NS). Resource utilization favored the direct strategy, with decreases in balloon use, contrast media, and procedure time, but a larger number of guiding catheters was used. The 180-day MACE rate of 9.8% in the direct group was not significantly less than the rate of 10.8% in the predilatation group (p = NS). Quantitative angiographic follow-up at 6 months demonstrated in-stent binary restenotic rates of 11.4% in the predilatation group (late loss 0.88 +/- 0.53 mm) and 12.3% in the direct group (late loss 0.82 +/- 0.51 mm, p = NS) and in-segment restenosis rates of 12.2% and 13.4%, respectively (p = NS). In conclusion, a direct stenting strategy with the Multilink Tetra stent was feasible and safe in 94% of lesions and associated with lower resource utilization compared with a predilatation approach. Direct stenting was not associated with significantly lower MACE and target lesion revascularization rates and had no effect on late angiographic follow-up, with similar late loss reflecting an identical biologic response to bare metal stent placement

de Beij JS, van Loopik SJ, van Leeuwen MA, Stapper G, Lock MTWT. Benigne intratesticulaire afwijkingen. Nederlands Tijdschrift voor Urologie 2006;(4).

de Borst GJ, Hellings WE, Ackerstaff RG, Moll FL. Intrapatient comparison of restenosis between carotid artery angioplasty with stenting and carotid endarterectomy. Journal of Cardiovascular Surgery 2006; 47(1):49-54.

Abstract: AIM: Comparison of restenosis in patients who underwent both carotid artery angioplasty with stenting (CAS) and contralateral carotid endarterectomy (CEA). METHODS: From our CAS data registry (1998-present) all patients with a history of contralateral CEA at any other time were selected (n = 63). Mean age was 70.6, SD=6.8 for CAS and 68.2, SD=6.1 for CEA and symptomatic carotid artery stenosis was present in 24% of patients pre-CAS and 40% pre-CEA. All CEAs were primary interventions, 19% of CAS were secondary to restenosis after previous ipsilateral CEA. All patients were followed up prospectively with duplex at 1 year (CAS: n=58, CEA: n=59), 2 years (CAS: n=44, CEA: n=53), 3 years (CAS: n=27, CEA: n=41), and every year thereafter. Within each patient we compared restenosis (>50%) between CAS and CEA procedures. RESULTS: After a follow-up of 28.7 months for CAS (SD=16.9) and 54.4 months for CEA (SD=39.5) the rate of =/> 50% restenosis for CAS vs CEA at 1, 2, and 3 years was 23% vs 10%; 31% vs 19%; and 34 vs 24%, respectively (log rank P=NS). CONCLUSIONS: Our intrapatient comparison of patients who underwent both CAS and contralateral CEA did not reveal significant difference in restenosis between both procedures

de Graaff JC, Bras LJ, Vos JA. Early transection of a central venous catheter in a sedated ICU patient. British Journal of Anaesthesia 2006; 97(6):832-834.

Abstract: We report transection and embolization to the heart of a subclavian venous catheter in an immobilized and mechanical ventilated patient. The catheter tip was retrieved using a percutaneous method via the left femoral vein. Mechanical compression of the subclavian venous catheter at the costoclavicular area is termed pinch-off syndrome. It can be recognized by intermittent difficulties with drug injection, and chest wall swelling at the insertion site. The diagnosis can be confirmed by chest radiography with or without contrast administration. A more lateral approach of the subclavian vein is advocated to prevent compression

de Haan JE, Geers AB, Berghout A. Pregnancy in Gitelman's syndrome: a challenging delivery. 18e Internistendagen : abstractboek : 27& 28 april 2006 MECC Maastricht 2006;111.

de Haan L, Booij J, Lavalaye J, van Amelsvoort T, Linszen D. Occupancy of dopamine D2 receptors by antipsychotic drugs is related to nicotine addiction in young patients with schizophrenia. Psychopharmacology (Berl) 2006; 183(4):500-505.

Abstract: RATIONALE: Occupancy of dopamine D2 receptors by antipsychotic drugs depends on the individual availability of D2 receptors and on the dose and type of antipsychotic medication. It has been suggested that a low availability of these receptors may increase the risk for addictive behavior. OBJECTIVE: This study aims to show that patients with relatively high occupancy of D2 receptors by antipsychotic drugs are more prone to nicotine consumption. METHODS: Striatal D2 receptor occupancy by equivalent doses of olanzapine or risperidone was assessed with [123I]iodobenzamide single-photon emission computed tomography (SPECT) in 36 patients with schizophrenia. Smoking status at the time of SPECT imaging was assessed. The number of cigarettes used in the following three consecutive years was estimated with the Life Chart Schedule (LCS). RESULTS: There was a positive and significant relation between D2 receptor occupancy following treatment with olanzapine (n=19) or risperidone (n=12) and the number of cigarettes smoked in three consecutive years (r=0.60, p<0.001) in patients who smoked. There was a significant difference in the percentage of D2 occupancy for smokers (mean 74.3%, SD 12.8, n=31) and nonsmokers (mean 49.8%, SD 9.1, n=5). CONCLUSION: Frequency of cigarette smoking in schizophrenic patients treated with antipsychotic medication is significantly and negatively related to the availability of striatal D2 receptors

de Jager W, Rijkers GT. Solid-phase and bead-based cytokine immunoassay: A comparison. Methods 2006; 38(4):294-303.

Abstract: Cytokines and chemoattractive cytokines (chemokines) are present in a wide variety of body fluids such as plasma, cerebrospinal fluid, bronchoaveolar fluid, amniotic fluid, synovial fluid, middle ear effusion fluid, and urine. Cytokines can be detected using classical solid-phase sandwich immunoassays such as enzyme-linked immunosorbent assay (ELISA) or with a bead based multiplex immunoassay (MIA). The physical chemical properties of the different body fluids (such as pH and total protein content) differ, which may have an impact on the outcome of the cytokine assay. Both ELISA as well as MIA cytokine detection systems are constructed by sandwiching the protein of interest between a capture and reporter antibody. When the biological sample contains heterophilic antibodies (such as in patients with auto-immune diseases), these non-specific antibodies can cause false positive results. During pathological conditions, cytokines may be found over a wide concentration range; likewise have to cover this dynamic range in a similar fashion. The correct (statistical) analysis of standard curves and (multiplexed) data are critical for proper interpretation. Classical ELISA based cytokine assays are robust, easy to use and very well suited for measurement of single cytokines. Due to an increased interest in the integral approach to understand biological processes (the omics era), multiplex immunoassays for detection of cytokines and the interpretation of these assays are gaining popularity

de Jong JR, van Ramshorst B, Timmer R, Gooszen HG, Smout AJ. Effect of laparoscopic gastric banding on esophageal motility. Obesity Surgery 2006; 16(1):52-58.

Abstract: BACKGROUND: Alterations in esophageal motility may occur after placement of an adjustable gastric band as treatment for morbid obesity, near the gastro-esophageal junction. It causes an outlet obstruction, especially during follow-up after the band is filled.METHODS: 29 morbidly obese patients underwent conventional manometry preoperatively, 6 weeks postoperatively before and after filling the band and at 6 months postoperatively. A questionnaire was used to assess upper gastrointestinal symptoms during follow-up.RESULTS: After band placement, there was a significant increase in lower esophageal sphincter (LES) end-expiratory pressure at 6 weeks with an empty band: 1.3 (0.9-1.9) kPa (median (interquartile range) (P=0.003), 6 weeks with a filled band: 2.1 (1.5-2.8) kPa (P=0.0001), and at 6 months: 1.5 (1.3-1.9) kPa (P=0.001), compared to the preoperative pressure: 0.8 (0.6-1.3) kPa. Also after band placement, the high pressure zone length increased (preop 5.0 (4.3-6.0) cm vs 6 weeks 6.0 (5.0-6.5) cm (P=0.003). The propagation of peristaltic contractions was not significantly altered after band placement. Heartburn decreased 6 weeks postoperatively (P=0.04) but increased at 6 months. Heartburn at 6 months was correlated with pouch formation (0.667; P<0.01).CONCLUSION: Adjustable gastric band placement causes an increase in LES pressure and length of the high pressure zone. It decreases reflux symptoms in the short-term, but this effect appears not to be related to an effect on LES pressure or length. Pouch formation increases reflux symptoms without having any relationship to LES pressure and length. Band placement in the short-term does not disturb propagation of esophageal contractions

de Jongh BM, Kaan JA, Meinders AJ, Mager JJ, van Hannen EJ . Outbreak of three related cases of psittacosis detected by real-time PCR. Clinical Microbiology & Infection 2006; 12(Suppl 4):P1044.

den Hertog MP, van Hees BC. Behandelen we de patiënt of het zakje? Rondom Stomazorg 2006;(40):12-15.

den Ouden H, Slee PHThJ, Tersmette M, Meinders AJ, Biesma DH. Denk aan Dengue. Tijdschrift voor Infectieziekten 2006; 1(5):199-205.

den Ouden H, Slee PHThJ, Tersmette M, Meinders AJ, Biesma DH. Think of dengue. 18e Internistendagen : abstractboek : 27& 28 april 2006 MECC Maastricht 2006;14.

den Ouden H, Janssen E, de Vries JPPM, Geers AB. Gas gangrene spreading to the bone marrow. 18e Internistendagen : abstractboek : 27& 28 april 2006 MECC Maastricht 2006;97-98.

Deneer VHM. Helder en overzichtelijk : commentaar op de NHG-standaard cardiovasculair risicomanagement. Pharmaceutisch Weekblad 2006; 141(26):882-884.

Diepstraten J, van de Garde EMW, Wiltink EHH. Lage doseringen zijn effectief. Eptacog alfa in de cardiochirurgie. Pharmaceutisch Weekblad 2006; 141(20):681-684.

Dirksen MT, van Heerebeek L, Slagboom T, Suttorp MJ, van der Wieken LR, Kiemeneij F, Laarman GJ. Randomized comparison of paclitaxel eluting stent versus conventional stent in st-segment elevation myocardial infarction: results of the passion trial. Netherlands Heart Journal 2006; 14(suppl 1):9.

Draaisma WA, Ruurda JP, Scheffer RC, Simmermacher RK, Gooszen HG, Rijnhart-de Jong HG, Buskens E, Broeders IA. Randomized clinical trial of standard laparoscopic versus robot-assisted laparoscopic Nissen fundoplication for gastro-oesophageal reflux disease. British Journal of Surgery 2006; 93(11):1351-1359.

Eefting FD, Cramer MJ, Stella PRS, Rensing BJ, Doevendans PA. Rationale of the Reparator Study. Netherlands Heart Journal 2006; 14(3):95-99.

Efficace F, Bottomley A, Smit EF, Lianes P, Legrand C, Debruyne C, Schramel F, Smit HJ, Gaafar R, Biesma B, Manegold C, Coens C, Giaccone G, van Meerbeeck J. Is a patient's self-reported health-related quality of life a prognostic factor for survival in non-small-cell lung cancer patients? A multivariate analysis of prognostic factors of EORTC study 08975. Annals of Oncology 2006; 17(11):1698-1704.

Abstract: BACKGROUND: The aim of this prognostic factor analysis was to investigate if a patient's self-reported health-related quality of life (HRQOL) provided independent prognostic information for survival in non-small cell lung cancer (NSCLC) patients. PATIENTS AND METHODS: Pretreatment HRQOL was measured in 391 advanced NSCLC patients using the EORTC QLQ-C30 and the EORTC Lung Cancer module (QLQ-LC13). The Cox proportional hazards regression model was used for both univariate and multivariate analyses of survival. In addition, a bootstrap validation technique was used to assess the stability of the outcomes. RESULTS: The final multivariate Cox regression model retained four parameters as independent prognostic factors for survival: male gender with a hazard ratio (HR) = 1.32 (95% CI 1.03-1.69; P = 0.03); performance status (0 to 1 versus 2) with HR = 1.63 (95% CI 1.04-2.54; P = 0.032); patient's self-reported score of pain with HR= 1.11 (95% CI 1.07-1.16; P < 0.001) and dysphagia with HR = 1.12 (95% CI 1.04-1.21; P = 0.003). A 10-point shift worse in the scale measuring pain and dysphagia translated into an 11% and 12% increased in the likelihood of death respectively. A risk group categorization was also developed. CONCLUSION: The results suggest that patients' self-reported HRQOL provide independent prognostic information for survival. This finding supports the collection of such data in routine clinical practice

Eidhof HHM, Gratama JW, van Velzen-Blad H, van Beers WAM. Conducting a broncho alveolar lavage quality survey : what did we learn in the first five years? 6e Euroconference on Clinical Cell Analysis in Stresa, Italië, 14 - 16 september 2006.

El-Sharouni SY, Kal HB, Battermann JJ, Schramel FM. Sequential versus concurrent chemo-radiotherapy in inoperable stage III non-small cell lung cancer. Anticancer Research 2006; 26(1B):495-505.

Abstract: AIM: To define the best sequence of radiotherapy and chemotherapy for inoperable stage III non-small cell lung (NSCL) tumours. MATERIALS AND METHODS: A systematic review was performed on the clinical results of radiotherapy, combined or not with chemotherapy, for inoperable NSCL cancer stage III. The mean median survival time (MST) and mean overall survival (OS) percentages were derived for radiotherapy only, for sequential and for concurrent chemo-radiotherapy. RESULTS: The mean median survival duration +/- standard deviation for radiotherapy only was 10.4 +/- 1.8 months. For sequential chemo- and radiotherapy it was increased to 13.0 +/- 1.2 months. When radiotherapy in the sequential regimen was accompanied by chemotherapy, the mean median duration was 15.8 +/- 2.6 months. For concurrent radio-chemotherapy it was further increased to 16.4 +/- 2.7 months. The mean 2- and 3-year overall survivals for radiotherapy alone, sequential and concurrent radio-chemotherapy were 17.1 +/- 4.6 and 10, 23.8 +/- 6.3 and 18.5 +/- 7.0, and 32.5 +/- 8.7 and 25.7 +/- 6.3%, respectively. CONCLUSION: Concurrent chemo-radiotherapy demonstrated increased efficacy over sequential chemotherapy and radiotherapy and should be the treatment of choice. Further improvements may be obtained by optimising the conditions for concurrent chemo-radiotherapy

Elbers PW, de Haan P, Vanicky I, Legemate D, Dzoljic M. Effect of temporary visceral ischemia on spinal cord ischemic damage in the rabbit. Annals of Thoracic Surgery 2006; 81(3):910-917.

Abstract: BACKGROUND: Spinal cord ischemia and visceral ischemia may occur simultaneously during thoracoabdominal aortic aneurysm repair. The present rabbit study investigated the effect of a temporary interruption of the visceral perfusion on the development of ischemia-reperfusion injury of the spinal cord. METHODS: Spinal cord ischemia was induced by occlusion of the infrarenal aorta for variable durations (6 to 20 minutes) in 32 rabbits. In the visceral ischemia group, 20-minute concurrent clamping of the celiac trunk and mesenteric arteries was performed. At 24, 48, and 72 hours after ischemia, neurologic outcome was assessed in the control and visceral ischemia group. The PD(50) (the duration of ischemia that produces lower limb neurologic deficits in 50% of the animals) was determined by quantal bioassay analysis. At 72 hours, histologic evaluation of spinal cord infarct size was performed. RESULTS: Compared with control animals, PD(50) was significantly longer in the visceral ischemia group at 48 hours and 72 hours after ischemia. Neurologic and histologic outcomes correlated well (r = -0.90). CONCLUSIONS: The results of the present rabbit study suggest that concurrent temporary visceral ischemia does not aggravate spinal cord ischemic injury in the rabbit. Moreover, the results suggest that concurrent visceral ischemia may increase the tolerance of the spinal cord to ischemic damage

Elbers PW, Ince C. Bench-to-bedside review: mechanisms of critical illness - classifying microcirculatory flow abnormalities in distributive shock. Critical Care (London) 2006; 10(4):221.

Abstract: Over 30 years ago Weil and Shubin proposed a re-classification of shock states and identified hypovolemic, cardiogenic, obstructive and distributive shock. The first three categories have in common that they are associated with a fall in cardiac output. Distributive shock, such as occurs during sepsis and septic shock, however, is associated with an abnormal distribution of microvascular blood flow and metabolic distress in the presence of normal or even supranormal levels of cardiac output. This Bench-to-bedside review looks at the recent insights that have been gained into the nature of distributive shock. Its pathophysiology can best be described as a microcirculatory and mitochondrial distress syndrome, where time and therapy form an integral part of the definition. The clinical introduction of new microcirculatory imaging techniques, such as orthogonal polarization spectral and side-stream dark-field imaging, have allowed direct observation of the microcirculation at the bedside. Images of the sublingual microcirculation during septic shock and resuscitation have revealed that the distributive defect of blood flow occurs at the capillary level. In this paper, we classify the different types of heterogeneous flow patterns of microcirculatory abnormalities found during different types of distributive shock. Analysis of these patterns gave a five class classification system to define the types of microcirculatory abnormalities found in different types of distributive shock and indicated that distributive shock occurs in many other clinical conditions than just sepsis and septic shock. It is likely that different mechanisms defined by pathology and treatment underlie these abnormalities observed in the different classes. Functionally, however, they all cause a distributive defect resulting in microcirculatory shunting and regional dysoxia. It is hoped that this classification system will help in the identification of mechanisms underlying these abnormalities and indicate optimal therapies for resuscitating septic and other types of distributive shock

Endeman H, de Weerdt O, Biesma DH. Two mechanisms of carbamazepine induced pancy-topenia within one patient. 18e Internistendagen : abstractboek : 27& 28 april 2006 MECC Maastricht 2006;67.

Fattori R, Nienaber CA, Rousseau H, Beregi JP, Heijmen R, Grabenwoger M, Piquet P, Lovato L, Dabbech C, Kische S, Gaxotte V, Schepens M, Ehrlich M, Bartoli JM. Results of endovascular repair of the thoracic aorta with the Talent Thoracic stent graft: the Talent Thoracic Retrospective Registry. Journal of Thoracic & Cardiovascular Surgery 2006; 132(2):332-339.

Abstract: BACKGROUND: Endovascular treatment of thoracic aortic diseases demonstrated low perioperative morbidity and mortality when compared with conventional open repair. Long-term effectiveness of this minimally invasive technique remains to be proven. The Talent Thoracic Retrospective Registry was designed to evaluate the impact of this therapy on patients treated in 7 major European referral centers over an 8-year period. METHODS: Data from 457 consecutive patients (113 emergency and 344 elective cases) who underwent endovascular thoracic aortic repair with the Medtronic Talent Thoracic stent graft (Medtronic/AVE, Santa Rosa, Calif) were collected. Follow-up analysis (24 +/- 19.4 months, range 1-85.1 months) was based on clinical and imaging findings, including all adverse events. To ensure consistency of data interpretation and event reporting, one physician reviewed all adverse events and deaths for the whole cohort of patients. In the case of discrepancies, the treating physicians were queried. FINDINGS: Among 422 patients who survived the interventional procedure (in-hospital mortality 5%, 23 patients), mortality during follow-up was 8.5% (36 patients), and in 11 of them the death was related to the aortic disease. Persistent endoleak was reported at imaging follow-up in 64 cases: 44 were primary (9.6%) and 21 occurred during follow-up (4.9%). Seven patients with persistent endoleak had aortic rupture during follow-up, at a variable time from 40 days to 35 months, and all subsequently died. A minor incidence of migration of the stent graft (7 cases), graft fabric alteration (2 cases), and modular disconnection (3 cases) was observed at imaging. Kaplan-Meier overall survival estimate at 1 year was 90.97%, at 3 years was 85.36%, and at 5 years was 77.49%. At the same intervals, freedom from a second procedure (either open conversion or endovascular) was 92.45%, 81.3%, and 70.0%, respectively. CONCLUSION: Endovascular treatment for thoracic aortic disease with the Talent stent graft is associated with low early morbidity and mortality rates also for patients who are at high risk and treated on an emergency basis. Follow-up data indicate a substantial durability of the procedure with a high freedom from related death and secondary interventions

Fernandez-Martin JL, Ferreira A, Rutkowski B, Floege J, Benedik M, Pavlovic D, Wüthrich RP, Verbeelen D, Nagy J, Bos WJ, Memmos D, Cannata-Andia JB. Association between Cardiovascular Disease (CVD) and Achievement of K/DOQI Targets in European Hemodialysis (HD) Patients (Pts) from the COSMOS Study. American Society Nephrology 2006.

Fernandez-Martin JL, Rutkowski B, Kramar R, Covic A, Hollowell J, Wüthrich RP, Teplan V, Bos WJ, Chaussy J, Memmos D, Cannata-Andia JB, the COSMOS Group. Differences in baseline patient characteristics according to length of time on dialysis in cosmos, a prospective, pan-European, observational study. Nephrology Dialysis Transplantation 2006; 21(Suppl 4):iv420.

Fortunati E, van Aalst CW, Prinsen BH, Lammers J-WJ, Grutters JC, van den Bosch JMM. Protein profiles of alveolar macrophages from bronchoalveolar lavage of Löfgren's syndrome and non-sarcoid controls. European Respiratory Journal - Supplement 2006; 28(Suppl 50):746s.

Frenken JWFH, Bravenboer N, Zijderveld SA, Schulten EAJM, ten Bruggenkate CM. Straumann Bone Ceramic as a bone substitute in maxillary sinus floor augmentation. Starget 2006; 3.

Frericks DH, Weerman CA, Biesma DH. Discharge of haematological patients in the neutropenic phase. EBMT 2006 congress, Hamburg, Germany, March 19 - 22 2006.

Gallione CJ, Richards JA, Letteboer TG, Rushlow D, Prigoda NL, Leedom TP, Ganguly A, Castells A, Ploos van Amstel JK, Westermann CJ, Pyeritz RE, Marchuk DA. SMAD4 mutations found in unselected HHT patients. Journal of medical genetics 2006; 43(10):793-797.

Abstract: BACKGROUND: Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant disease exhibiting multifocal vascular telangiectases and arteriovenous malformations. The majority of cases are caused by mutations in either the endoglin (ENG) or activin receptor-like kinase 1 (ALK1, ACVRL1) genes; both members of the transforming growth factor (TGF)-beta pathway. Mutations in SMAD4, another TGF-beta pathway member, are seen in patients with the combined syndrome of juvenile polyposis (JP) and HHT (JP-HHT). METHODS: We sought to determine if HHT patients without any apparent history of JP, who were undergoing routine diagnostic testing, would have mutations in SMAD4. We tested 30 unrelated HHT patients, all of whom had been referred for DNA based testing for HHT and were found to be negative for mutations in ENG and ALK1. RESULTS: Three of these people harboured mutations in SMAD4, a rate of 10% (3/30). The SMAD4 mutations were similar to those found in other patients with the JP-HHT syndrome. CONCLUSIONS: The identification of SMAD4 mutations in HHT patients without prior diagnosis of JP has significant and immediate clinical implications, as these people are likely to be at risk of having JP-HHT with the associated increased risk of gastrointestinal cancer. We propose that routine DNA based testing for HHT should include SMAD4 for samples in which mutations in neither ENG nor ALK1 are identified. HHT patients with SMAD4 mutations should be screened for colonic and gastric polyps associated with JP

Geelhoed D, Agadzi F, Visser L, Ablordeppey E, Asare K, O'Rourke P, Schagen van Leeuwen JH, van Roosmalen J. Severe anemia in pregnancy in rural Ghana: a case-control study of causes and management. Acta Obstetricia et Gynecologica Scandinavica 2006; 85(10):1165-1171.

Abstract: BACKGROUND: Various factors contribute to severe anemia in pregnancy in low-income countries. This study assesses which of these are of importance in rural Ghana, and evaluates management. METHODS: Prospective case-control study in two (sub)district hospitals in rural Ghana among 175 severely anemic pregnant women (Hb < 8.0 g/dl), receiving a comprehensive treatment package; and 152 non-anemic pregnant women (Hb > or = 10.9 g/dl), giving birth at the study hospitals, matched for age and parity. Evaluated characteristics were need for treatment for urinary tract infection and schistosomiasis; sickle cell and HIV status; antenatal care characteristics; and Hb increase after treatment. Statistical analysis included Chi square test and general linear modeling. RESULTS: Associated with severe anemia were multiple pregnancy (OR 8.9; 95%CI 1.1-71.0), urinary tract infection (OR 6.2; 95%CI 3.5-11.0), residence outside study (sub)district (OR 2.7; 95%CI 1.7-4.3), body mass index < 20.0 (OR 2.0; 95%CI 1.2-3.4), and less than 4 antenatal clinic visits (OR 1.9; 95%CI 1.2-3.0). No association was found with sickle cell or HIV status, schistosomiasis treatment, blood loss in pregnancy, or gestational age at antenatal care registration. After treatment, mean Hb in the severe anemia group increased by 3.2 g/dl, significantly more than in the control group (0.2 g/dl; p<0.001). Modeling showed that the number of antenatal visits and the lowest Hb together explained approximately 25% of the variability in Hb prior to childbirth among women with severe anemia. CONCLUSIONS: Treatable causes contribute considerably to severe anemia in pregnancy in low-income countries. Even with limited resources, a substantial increase of Hb can be achieved

Geelhoed DW, Agadzi F, Visser LE, Ablordeppey E, Asare K, O'Rourke P, Schagen van Leeuwen JH, van Roosmalen J. Maternal and fetal outcome after severe anemia in pregnancy in rural Ghana. Acta Obstetricia et Gynecologica Scandinavica 2006; 85(1):49-55.

Geluk CA, Halkes CJM, de Jaegere PPTh, Plokker HWM, Castro Cabezas M. Coronary risk factors and metabolic disorders in first-degree relatives of normocholesterolaemic patients with premature atherosclerosis. Netherlands Heart Journal 2006; 14(4):125-131.

Gerritsen WB, van Boven WJ, Wesselink RM, Smelt M, Morshuis WJ, van Dongen HP, Haas FJ, Aarts LP. Significant reduction in blood loss in patients undergoing minimal extracorporeal circulation. Transfusion Medicine 2006; 16(5):329-334.

Abstract: Several recent studies have shown differences in blood loss and allogeneic transfusion requirements between on-pump and off-pump coronary artery bypass grafting (CABG). Recently a new concept, the mini-extracorporeal circulation, was introduced to minimize the side effects of extracorporeal circulation. Therefore, there are no data comparing the three techniques with special emphasis to blood loss and transfusion requirements. Two hundred and eighty-five patients undergoing first-time coronary artery bypass grafting were retrospectively matched for number of grafts, age and sex. Ninety-five patients underwent surgery with the off-pump CABG (OPCAB) technique, 97 patients using conventional CABG with cold cardioplegia (CCABG) and 93 patients with the mini-extracorporeal circuit with warm blood cardioplegia (MCABG). Blood loss for the CCABG group with a mean loss of 819 +/- 557 mL and the OPCAB group with a mean loss of 870 +/- 768 mL was significant different compared to the MCABG group with a mean loss of 679 +/- 290 mL. The use of units red blood cell units was significantly higher for CCABG group and OPCAB group compared to the MCABG group. On the day of operation the use of platelet concentrate was significantly higher for the CCABG group compared to MCABG group. As a consequence of improvements of several components of the mini heart lung machine, significantly less blood products are needed in MCABG patients. The expected reduced need for transfusion when the pump was completely avoided could not be confirmed in this single retrospective cohort study

Gerritsen WB, van Boven WJ, Boss DS, Haas FJ, van Dongen EP, Aarts LP. Malondialdehyde in plasma, a biomarker of global oxidative stress during mini-CABG compared to on- and off-pump CABG surgery: a pilot study. Interactive Cardiovascular and Thoracic Surgery 2006; 5(1):27-31.

Abstract: In contrast to conventional on-pump coronary artery bypass grafting only mild increase of parameters of oxidative stress is reported during and after off-pump coronary artery bypass grafting. In an attempt to reduce the side effects of extra corporeal circulation the mini- extra corporeal circulation concept was introduced. In this study peroperative oxidative stress biomarkers were compared using three different techniques for CABG (conventional, mini and off-pump). It concerns a prospective randomized pilot study of 60 aged patients (70+ years) divided over 3 study groups. During the peroperative time points there was a significant increase in the mean concentration of uric acid for the CCABG group. On arrival at the intensive care unit the mean concentrations decreased significantly. During the per-operative period all groups showed significant increase in the concentration of malondialdehyde, however, this increase was the steepest for the CCABG group. On arrival at the intensive care unit the mean concentration decreased significantly for all groups. We found only mild organ ischemia/reperfusion injury and oxidative stress in the OPCAB group and the MCABG group with respect to the CCABG group

Geuzebroek GSC, Ballaux PhKEW, Kelder JC, Brutel de la Rivière A, Defauw JJAMT, van Hemel NM. Gunstige langetermijnresultaten van de originele 'maze'-operatie voor patiënten met medicamenteus moeilijk of niet te behandelen boezemfibrilleren; ervaringen van 1993/04. Nederlands Tijdschrift voor Geneeskunde 2006; 150(42):2314-2319.

Geuzebroek GSC, Ballaux PhKEW, van Hemel NM, Kelder JC, Defauw JJAM. Modified maze procedures; are we forgetting the right side? Netherlands Heart Journal 2006; 14(suppl 3):17.

Go PM. What is Next in Inguinal Hernia Surgery? Surgical technology international 2006; 15:116-119.

Abstract: Traditionally, the inguinal hernia repair is performed through an incision in the groin. Different kinds of operations are suggested as best repairs by using the patient's own tissue, or use of prosthetic mesh to reinforce the abdominal wall. The advent of the laparoscopic repair that also uses prosthetic mesh, made it even more complex to determine the best repair. Using the Evidence Based Medicine (EBM) principles, endpoints of the treatment are not only based on recurrence rates, but also on complications, patient satisfaction, convalescence, and costs. Several meta-analyses concluded that use of mesh is superior to the non-mesh operations. More difficult to determine is which mesh repair, open or laparoscopically, is the best. The laparoscopic repair is difficult and less suitable for general practice, but the open-mesh repair results in a higher percentage of chronic postoperative pain. Further research should be focused on making the laparoscopic repair less complicated, and development of new meshes for open surgery that reduce the amount of persistent postoperative pain

Goedhart DM, Zanen P, Lammers JW. Relevant and redundant lung function parameters in discriminating asthma from COPD. COPD 2006; 3(1):33-39.

Abstract: A relevant set of lung function parameters, derived from spirometry, flow-volume curves, diffusion capacity and bodyplethysmography, to discriminate asthma from COPD was established via logistic regression analysis. All new patients, referred to the outpatient clinic and later defined as asthma or COPD, underwent extensive lung function testing with reversibility testing. Logistic regression was used to calculate the probability to be a COPD or asthma patient. Selection of relevant parameters was done via 1] forward-, 2] backward-, 3] stepwise selection and 4] the best score method. All four methods were supplemented by bootstrapping to obtain a validated selection and estimation of the logistic regression parameters. The area under the ROC curve (mean+/-sd) for respectively the forward, backward, stepwise and best score selection method is 0.9348+/-0.0115, 0.9346+/-0.0115, 0.9348+/-0.0115 and 0.9296+/-0.0121. The TLCO, VA and the postdilator MEF50, VC and PEF were selected as the most relevant parameters in discriminating asthma from COPD: they appeared most often as relevant discriminators in 500 bootstrapped samples: TLco was present in all bootstrapped samples and VA, postdilator MEF50, VC and PEF in resp. 70.8%, 46.2%, 42.8% and 36.8%. Bodyplethysmography derived parameters turned out to be of limited value. Diffusion capacity testing and spirometry/flow-volume curve after administration of bronchodilators are the methods of choicewhen having to chose between asthma or COPD

Gonzalez MT, Hutchison AJ, Girndt M, Stahl-Nilsson A, Zani V, Carter D, Molemans B, Bos WJW. Secondary hyperparathyroidism (hpt) in patients receiving peritoneal dialysis (pd) can be effectively managed with Cinacalcet (Mimpara®/Sensipar®). Nephrology Dialysis Transplantation 2006; 21(Suppl 4):iv134.

Graven A, Hoekstra T. Variantieanalyse klinische paden - een eerste verkenning. Cordiaal 2006; 27(5):154-157.

Graziosi GC, Bruinse HW, Reuwer PJ, Mol BW. Women's preferences for misoprostol in case of early pregnancy failure. European Journal of Obstetrics, Gynecology, & Reproductive Biology 2006; 124(2):184-186.

Abstract: OBJECTIVE: The aim of this study was to assess the preference of women with early pregnancy failure for treatment with misoprostol as compared to curettage. STUDY DESIGN: Women with early pregnancy failure were interviewed and asked whether they were motivated to trade a non-invasive but potentially less effective treatment with misoprostol at the virtually 100% guarantee of complete evacuation after curettage. All women had a structured interview, in which they were informed about both treatment options. The women were asked for a treatment preference in case the complete evacuation rate after misoprostol was set at 100%. In case the women preferred misoprostol, the complete evacuation rate was subsequently decreased to 10% using steps of 5%. RESULTS: The study group consisted of 64 women with early pregnancy failure. Seven women (11%) did not opt for misoprostol at all, because of fear of pain or bleeding using misoprostol. Fifty percent of the women would prefer misoprostol if its complete evacuation rate exceeds 65%. CONCLUSION: A majority of women would prefer misoprostol over curettage if its complete evacuation rate exceeds 65%

Grimbergen MCM, van Swol CFP, van Moorselaar RJA, Mahadevan-Jansen A. Does bladder cancer detection benefit from depth resolved confocal Raman spectroscopy? SPIE Photonics West 2006; 6093:26.

Grimbergen MCM, van Swol CFP, van Moorselaar RJA, Stone N. Feasibility of Raman spectroscopy in vitro after 5-ALA based fluorescence diagnosis in the bladder. SPIE Photonics West 2006; 6078B:51.

Grootenboers MJ, Heeren J, van Putte BP, Hendriks JM, van Boven WJ, van Schil PE, Schramel FM. Isolated lung perfusion for pulmonary metastases, a review and work in progress. Perfusion 2006; 21(5):267-276.

Abstract: Pulmonary metastasectomy is a widely accepted treatment for many patients with pulmonary metastases from various solid tumors. Nevertheless, 5-year survival is disappointing, with rates of 25-40%, and many patients develop recurrences. Isolated lung perfusion (ILuP) is a promising new technique to deliver high-dose chemotherapy to the lungs, while minimising systemic toxicities. This procedure is technically safe and feasible; however, clinical value and efficacy remain unclear. The aim of this paper is to give a review of literature on ILuP in humans, and to describe the development of the perfusion procedure in our institute

Grootenboers MJJH, Hendriks JM, van Boven WJ, Knibbe CAJ, van Schil PE, Schramel FM. Toxicity in isolated lung perfusion with melphalan for resectable lung metastases. European Respiratory Journal - Supplement 2006; 28(Suppl 50):[4387].

Grutters JC. Interstitial pulmonary diseases: clinical and molecular background. Molecular imaging and biology 2006; 8(2):52.

Grutters JC, van den Bosch JM. Corticosteroid treatment in sarcoidosis. European Respiratory Journal 2006; 28(3):627-636.

Abstract: At present there is no curative treatment for sarcoidosis. Immunosuppressive and/or immunomodulatory drugs can, however, be used for controlling the disease. Corticosteroids remain the mainstay of therapy. They function by suppressing the pro-inflammatory cytokines and chemokines that are involved in cell-mediated immune responses and granuloma formation. Only in a select group of patients is it justifiable to use these drugs, after careful evaluation of the pros and cons. Importantly, disease severity, e.g. threatened organ functions, and not disease activity itself should be the deciding factor in this process. In the case of parenchymal involvement, there is substantial evidence that corticosteroids can improve respiratory symptoms and chest radiography and lung function parameters over 6-24 months. Other generally acknowledged (empirical) criteria for systemic treatment include neurological, cardiac and sight-threatening ocular involvement and hypercalcaemia. Remarkably, despite >50 yrs of use, there is no proof of long-term (survival) benefit from corticosteroid treatment. In addition, there are still no data regarding the optimal dose and duration of corticosteroid or other immunosuppressive therapy. One of the weightiest questions remaining is whether or not these drugs can prevent scarring in patients with a fibrogenic phenotype. As new agents, including infliximab and thalidomide, enter the stage and new diagnostic tools are now available, there is clearly a momentum to design multicentric randomised controlled trials with long enough follow-up (>5 yrs) to answer this pivotal question

Gu YJ, de Kroon TL, Elstrodt JM, Rakhorst G. Gastrointestinal motility during cardiopulmonary bypass: a sonomicrometric study. Artificial Organs 2006; 30(7):548-553.

Abstract: Cardiopulmonary bypass (CPB) is known to impair the integrity of the gastrointestinal tract. However, little is known about the movement behavior of the gastrointestinal tract during CPB. This study was aimed to assess the gastrointestinal motility with sonomicrometry, a distance measurement using ultrasound, in a porcine model of CPB. Twelve pigs weighing 70-112 kg were having a standard hypothermic CPB for 120 min either with the nonpulsatile flow (n = 6) or the pulsatile flow (n = 6). Before CPB, piezoelectric echo crystals were placed either along the longitudinal or the circular axis of the pylorus. Patterns of gut movement and the total sonomicrometric activity (TSA) were recorded at several time intervals during experiments as qualitative and quantitative parameters of gut motility. Results showed that the intact regular rhythmic pattern of gut movement was detected before CPB. This pattern changed little when CPB started, but it disappeared at 60 min when the body temperature lowered down to 32 degrees Celsius. During the same period, the TSA reduced significantly along the longitudinal as well as the circular directions of the pylorus. There was no significant difference between the nonpulsatile and pulsatile groups. Gut blood flow reduced significantly in both groups, but it was not associated with the reduced sonomicrometric activity. In conclusion, gastrointestinal motility during CPB can be measured qualitatively and quantitatively by sonomicrometry in a large animal model. Suppression of gut motility during CPB does not seem to be associated with the mode of perfusion but with the reduced body temperature during the hypothermic phase of CPB

Hacking HG, Post MW, Schepers VP, Visser-Meily JM, Lindemans E. A Comparison of 3 Generic Health Status Questionnaires Among Stroke Patients. Journal of Stroke & Cerebrovascular Diseases 2006; 15(6):235-240.

Harmsze AM. Groeiende inzetbaarheid verwacht. Biowaivers maken bio-equivalentieonderzoek in vitro mogelijk. Pharmaceutisch Weekblad 2006;(16):547-548, 563.

Heddema ER, van Hannen EJ, Duim B, Pannekoek Y. Genotypes of Chlamydophila psittaci causing zoonotic infection. Clinical Microbiology & Infection 2006; 12(Suppl 4):P535.

Heddema ER, van Hannen EJ, Duim B, de Jongh BM, Kaan JA, van Kessel R, Lumeij JT, Visser CE, Vandenbroucke-Grauls CM. An outbreak of psittacosis due to Chlamydophila psittaci genotype A in a veterinary teaching hospital. Journal of Medical Microbiology 2006; 55(11):1571-1575.

Abstract: An outbreak of psittacosis in a veterinary teaching hospital was recognized in December 2004. Outbreak management was instituted to evaluate the extent of the outbreak and to determine the avian source. Real-time PCR, serologic testing and sequencing of the ompA gene of Chlamydophila psittaci were performed. Sputum samples from patients, throat-swab samples from exposed students and staff, and faecal specimens from parrots and pigeons were tested. In this outbreak, 34 % (10/29) of the tested individuals were infected. The clinical features of the infection ranged from none to sepsis with multi-organ failure requiring intensive-care-unit admission. C. psittaci genotype A was identified as the outbreak strain. Parrots, recently exposed to a group of cockatiels coming from outside the teaching facility, which were used in a practical class, appeared to be the source of the outbreak. One of the tested pigeons harboured an unrelated C. psittaci genotype B strain. The microbiological diagnosis by real-time PCR on clinical specimens allowed for rapid outbreak management; subsequent genotyping of the isolates identified the avian source. Recommendations are made to reduce the incidence and extent of future outbreaks

Heemstra HE, Wiltink EH, de Weerdt O. Defibrotide belooft het meest. Medicamenteuze behandeling van veno-occlusive disease van de lever. Pharmaceutisch Weekblad 2006; 141(3):103-105.

Heestermans AACM, van Werkum JW, Schömig E, ten Berg JM, Taubert D. Clopidogrel resistance caused by a failure to metabolize clopidogrel into its metabolites. Journal of Thrombosis & Haemostasis 2006; 4(5):1143-1145.

Hellings WE, Ackerstaff RG, Pasterkamp G, de Vries JP, Moll FL. The carotid atherosclerotic plaque and microembolisation during carotid stenting. Journal of Cardiovascular Surgery 2006; 47(2):115-126.

Abstract: Microembolisation is an important issue in carotid artery stenting. During different phases in the stenting process, numerous emboli are dislodged from the atherosclerotic plaque. Embolisation can be measured as microembolic signals detected by transcranial Doppler (TCD) monitoring during the procedure or as new ischemic areas determined by magnetic resonance imaging. This article gives an overview of the principles of emboli detection methods, their clinical relevance, and risk factors associated with microembolisation. In addition, protection devices are discussed in relation to embolisation. Although they potentially protect the brain, particularly filter devices increase the amount of TCD-detected cerebral microemboli. Special attention is paid to the carotid artery plaque, which is subject to ongoing research that may yield important implications for clinical practice in the near future. Evidence is accumulating that unstable, vulnerable plaques are associated with increased microembolisation during carotid interventions. This knowledge of the vulnerable plaque can be translated to the clinical setting by plaque imaging. A first approach has been made by duplex imaging of carotid plaque morphology. More advanced methods such as molecular magnetic resonance imaging and optical coherence tomography could aid in optimal treatment selection based on plaque characteristics thus reducing microembolisation and associated cerebral adverse events

Hendriks JM, van Putte BP, Grootenboers M, van Boven WJ, Schramel F, van Schil PE. Isolated lung perfusion for pulmonary metastases. Thoracic Surgery Clinics 2006; 16(2):185-198.

Abstract: Isolated lung perfusion is an experimental surgical technique evaluated for the delivery of high-dose chemotherapy to improve 5-year survival after pulmonary metastasectomy. Extensive experimental work in animal models has demonstrated superior pharmacokinetics and efficacy compared with systemic therapy. Phase I clinical trials of isolated lung perfusion found a maximum tolerated dose**** of TNF-alpha, doxorubicin, cisplatin, and melphalan, whereas the combination of isolated lung perfusion with a complete metastasectomy was feasible. The combination of isolated lung perfusion and regional lung perfusion techniques needs further investigation

Heron M, Grutters JC, Claessen AME, van Velzen-Blad H, van den Bosch JMM. Peripheral blood monocytes of patients with pulmonary sarcoidosis show strong expression of proinflammatory molecules CD16, CD69 and VLA-4. European Respiratory Journal - Supplement 2006; 28(Suppl 50):288s.

Herpers BL, Immink MM, de Jong BA, van Velzen-Blad H, de Jongh BM, van Hannen EJ. Coding and non-coding polymorphisms in the lectin pathway activator L-ficolin gene in 188 Dutch blood bank donors. Molecular Immunology 2006; 43(7):851-855.

Abstract: Human L-ficolin (FCN) is a serum lectin characterized by a collagen-like and a fibrinogen-like domain that can activate the lectin pathway of complement. Structural and functional similarities to mannose-binding lectin (MBL) suggest a role for L-ficolin in innate immunity. Structural polymorphisms in the MBL2 gene lead to functional deficiency of MBL. Polymorphisms in the FCN2 gene have not been studied previously. We developed 10 denaturing gradient gel electrophoresis (DGGE) assays to screen a total of 188 Dutch Caucasians for polymorphisms in FCN2. Total gene screening in this large cohort revealed 10 single nucleotide polymorphisms (SNPs). Interestingly, two conserved coding SNPs were found in exon 8, leading to amino acid substitutions within the fibrinogen-like domain. Fibrinogen-like domains are highly conserved among several proteins in many species. As this domain is responsible for binding of L-ficolin, these newly found coding polymorphisms could alter the affinity of the protein for its substrates and possibly alter the ability of L-ficolin to recognize invading microorganisms

Hietbrink F, Koenderman L, Rijkers G, Leenen L. Trauma: the role of the innate immune system. World journal of emergency surgery : WJES 2006; 1:15.

Abstract: ABSTRACT : Immune dysfunction can provoke (multiple) organ failure in severely injured patients. This dysfunction manifests in two forms, which follow a biphasic pattern. During the first phase, in addition to the injury by trauma, organ damage is caused by the immune system during a systemic inflammatory response. During the second phase the patient is more susceptible for sepsis due to host defence failure (immune paralysis). The pathophysiological model outlined in this review encompasses etiological factors and the contribution of the innate immune system in the end organ damage. The etiological factors can be divided into intrinsic (genetic predisposition and physiological status) and extrinsic components (type of injury or "traumaload" and surgery or "intervention load"). Of all the factors, the intervention load is the only one which, can be altered by the attending emergency physician. Adjustment of the therapeutic approach and choice of the most appropriate treatment strategy can minimize the damage caused by the immune response and prevent the development of immunological paralysis. This review provides a pathophysiological basis for the damage control concept, in which a staged approach of surgery and post-traumatic immunomonitoring have become important aspects of the treatment protocol. The innate immune system is the main objective of immunomonitoring as it has the most prominent role in organ failure after trauma. Polymorphonuclear phagocytes and monocytes are the main effector-cells of the innate immune system in the processes that lead to organ failure. These cells are controlled by cytokines, chemokines, complement factors and specific tissue signals. The contribution of tissue barrier integrity and its interaction with the innate immune system is further evaluated

Hindori VG, Schepens MA. Tracheacompressie door divertikel van Kommerell bij een rechtszijdige aorta. Nederlands Tijdschrift voor Geneeskunde 2006; 150(10):554-558.

Abstract: A 64-year-old man who was evaluated for a long history of a discontinuous barking cough with difficulty in coughing up sputum was found to have 90% stenosis of the trachea. Further imaging studies revealed a right-sided descending aorta with an aberrant left subclavian artery arising from a Kommerell diverticulum. This caused the compression of the trachea. The compression was relieved by transposition of the aberrant left subclavian artery to the ascending aorta and replacement of the aneurysmatic part of the aorta by an endoprosthesis

Hissink RJ, Smeets L, de Vries JPPM, Moll FL. Bypass failure is worse than debulk failure performed for limb salvage. In: Greenhalg RM, editor. More Vascular and Endovasular Controversies. BIBA Publishing, 2006: 281-285.

Hoeksma HL, van den Ende CH, Breedveld FC, Ronday HK, Dekker J. A comparison of the OARSI response criteria with patient's global assessment in patients with osteoarthritis of the hip treated with a non-pharmacological intervention. Osteoarthritis and cartilage 2006; 14:77-81.

Abstract: OBJECTIVE: To compare the Osteoarthritis Research Society International (OARSI) response criteria for clinical trials with patient's global assessment in patients with osteoarthritis (OA) of the hip receiving a non-pharmacological intervention, i.e., manual therapy or exercise therapy. METHODS: Data of a randomized clinical trial on manual therapy and exercise therapy in patients with OA of the hip (n=109) were used. Change scores of measures of hip function, range of joint motion and pain were compared between patients who were differently classified by the OARSI response criteria and the patient's global assessment (using a t test, 95% CI). Furthermore, risk ratios (with 95% CI) were calculated for the contrast between treatment outcome, using the OARSI criteria or patient's global assessment. RESULTS: Few patients were classified as improved (i.e., responders) with the OARSI response criteria as compared to patient's global assessment. Significantly worse outcome for hip function and pain was observed in patients who were classified as non-responders (OARSI criteria), but who considered themselves as improved (patient's global assessment). Risk ratios for the contrast between the two treatment programs (manual therapy vs exercise therapy) were similar, when using the OARSI criteria or patient's global assessment. CONCLUSION: The validity of the OARSI response criteria has been previously demonstrated in OA patients treated with pharmacological interventions. The present study demonstrates the validity of the OARSI response criteria in OA patients treated with a non-pharmacological intervention, i.e., manual therapy and exercise therapy

Hoekstra TS, de Boer J, van den Elst A, Holierhoek M, Sprong E, van Vliet M, Weijers P, de Wit K. "Walk through" cardiologie & Cardio-thoracale chirurgie. Cordiaal 2006; 27(1):10-13.

Hospers GA, Schaapveld M, Nortier JW, Wils J, van Bochove A, de Jong RS, Creemers GJ, Erjavec Z, de Gooyer DJ, Slee PH, Gerrits CJ, Smit JM, Mulder NH. Randomised Phase III study of biweekly 24-h infusion of high-dose 5FU with folinic acid and oxaliplatin versus monthly plus 5-FU/folinic acid in first-line treatment of advanced colorectal cancer. Annals of Oncology 2006; 17(3):443-449.

Abstract: BACKGROUND: A phase III study was started to compare oxaliplatin/5FU/LV in the first-line with bolus FU/LV in metastatic colorectal cancer. PATIENTS AND METHODS: 302 patients were randomised and received bolus 5-FU 425 mg/m(2) day 1-5, FA 20 mg/m(2) day 1-5, q 4 wk or oxaliplatin 85 mg/m(2), 2 h-infusion, FA 200 mg/m(2), 1-h infusion. 5-FU 2600 mg/m(2), 24-h infusion day 1, q 2 wk. The primary endpoint was response rate (RR). RESULTS: The median follow-up is 31.8 months, 90.4% of the patients have died. Confirmed RR, progression free survival (PFS; months) and median overall survival (OS; months) in 5FU/LV versus 5FU/LV/oxaliplatin were respectively 18.5% versus (vs) 33.8% (P = 0.004), 5.6 vs 6.7 (P = 0.016) and 13.3 vs 13.8 (P = 0.619). In the 5FU/LV/oxaliplatin arm less grade (3/4) toxicity was measured for diarrhoea, stomatitis, an increase in idiosyncratic side effects and neurosensory events compared with 5FU/LV. The quality of life (QOL) was equal in both arms. Second line treatment was given in 62% of the patients, crossover of 5FU/LV to 5FU/LV/oxaliplatin occurred in 14%. CONCLUSIONS: Oxaliplatin in the first-line resulted in an increased RR and PFS with less grade 3/4 mucositis/diarrhoea compared with 5FU/LV alone. Idiosyncratic side effects deserve attention with oxaliplatin. Despite a low treatment cross over rate, OS in both groups was comparable

Hulsen HT, Nijdam ME, Bos WJ, Uiterwaal CS, Oren A, Grobbee DE, Bots M. Spurious systolic hypertension in young adults; prevalence of high brachial systolic blood pressure and low central pressure and its determinants. Journal of Hypertension 2006; 24(6):1027-1032.

Abstract: OBJECTIVE: To investigate the prevalence and determinants of spurious systolic hypertension (SSH) in a population-based sample of young adults and estimate their 20-year risk of coronary heart disease. POPULATION AND METHODS: Seven hundred and fifty young adults (352 men and 398 women), aged 26-31 years, from the Atherosclerosis Risk in Young Adults study were studied. Blood pressure levels were measured twice and central (aortic) pressures were derived by applanation tonometry on the radial artery using a generalized transfer function. SSH was defined as brachial systolic blood pressure (SBP) > or = 140 mmHg, brachial diastolic blood pressure (DBP) < 90 mmHg, and central SBP < 124 mmHg for men and < 120 mmHg for women. The Framingham risk score was calculated. Analysis of variance models were used to compare SSH individuals with normotensive and hypertensive males for cardiovascular risk factors. RESULTS: SSH was diagnosed in 57 men (16.1%; 95% confidence interval, 12.3-20.0) versus only three women (8%; 95% confidence interval, 0-1.6). The female population was excluded from further analysis. Compared with normotensive males, SSH individuals were heavier (88.7 versus 81.8 kg, P < 0.05) had a higher body mass index (25.8 versus 24.2 kg/m, P < 0.01) and significantly higher brachial and central SBP, DBP, pulse pressure, and mean arterial pressure. They had significantly higher pulse pressure amplification. Twenty-year Framingham risk scores based on DBP did not differ significantly between SSH subjects and normotensive individuals (2.72 versus 2.10%, respectively). CONCLUSION: SSH is predominantly found among young adult men. Apart from weight and body mass index, no other cardiovascular risk factors differed significantly between subjects with SSH and normotension or hypertension. When calculating the 20-year risk of coronary heart disease based on brachial DBP, SSH individuals were at intermediate risk between normotensive and hypertensive participants, but differences were not statistically significant

Janssen E, den Ouden H, van Herwaarden J, Bollen T, Geers T, Wille J, de Vries JP. Gas gangrene spreading to the bone marrow. Netherlands Journal of Medicine 2006; 64(7):256-257.

Janssen R, Kruit A, Grutters JC, Ruven HJ, Gerritsen WB, van den Bosch JM. The Mucin-1 568 Adenosine to Guanine Polymorphism Influences Serum Krebs von den Lungen-6 levels. American Journal of Respiratory Cell & Molecular Biology 2006; 34(4):496-499.

Abstract: Krebs von den Lungen (KL)-6 offers a new perspective as a disease marker in pulmonary diseases. The aim of this study was to analyze whether serum KL-6 levels are dependent on the functional adenosine to guanine mucin-1 (MUC1) gene polymorphism at nucleotide position 568 in a well-characterized white population. Polymorphisms were determined in 327 healthy, white individuals and 74 patients with sarcoidosis, using a PCR-sequence-specific primer assay. The serum KL-6 levels were measured by ELISA. Significant differences between serum KL-6 levels of healthy subjects who were grouped according to MUC1 568 genotype were observed (P < 0.0001) (mean +/- SEM): AA (195.2 +/- 9.9 U/ml; 95% confidence interval [CI], 175.7-214.8), AG (246.0 +/- 8.6 U/ml; 95% CI, 229.0-263.1), and GG (302.6 +/- 11.8 U/ml; 95%CI, 279.3-326.0). In the patients with sarcoidosis, the results were (mean +/- SD): AA (550.1 +/- 411.7; 95% CI, 380.2-720.1), AG (716.3 +/- 452.4; 95% CI, 547.4-885.2), GG (1,151.0 +/- 1122; 95% CI, 610.1-1692.0); P = 0.02. Comparison of the KL-6 levels in which the 568 genotype was ignored rendered 6 out of 74 (7.5%) misclassifications of "elevated" versus "normal" KL-6 levels or vice versa. In conclusion, the MUC1 568 A to G polymorphism may be of interest for diagnostic purposes because our study delivered in vivo evidence that it contributes to interindividual variations in KL-6 levels

Janssen R, Kruit A, Grutters JC, van den Bosch JM. Interleukin-18-607 promoter polymorphism in sarcoidosis: ignoring "negative" results. American Journal of Respiratory & Critical Care Medicine 2006; 173(7):814.

Janssen R. Pneumoproteins in interstitial lung diseases. 2006.

Jonker G, Meinders AJ. Hogere sterfte onder vrouwen na CABG lijkt grotendeels door infecties verklaard te kunnen worden. Nederlands Tijdschrift voor Geneeskunde 2006; 150:2115.

Kastrati A, Mehilli J, Neumann FJ, Dotzer F, ten Berg JM, Bollwein H, Graf I, Ibrahim M, Pache J, Seyfarth M, Schuhlen H, Dirschinger J, Berger PB, Schomig A. Abciximab in patients with acute coronary syndromes undergoing percutaneous coronary intervention after clopidogrel pretreatment: the ISAR-REACT 2 randomized trial. JAMA 2006; 295(13):1531-1538.

Abstract: CONTEXT: No specifically designed studies have addressed the role of the glycoprotein IIb/IIIa inhibitor abciximab in patients with non-ST-segment elevation acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) after pretreatment with 600 mg of clopidogrel. OBJECTIVE: To assess whether abciximab is associated with clinical benefit in high-risk patients with ACS undergoing PCI after pretreatment with 600 mg of clopidogrel. DESIGN, SETTING, AND PATIENTS: International, multicenter, randomized, double-blind, placebo-controlled study conducted from March 2003 through December 2005, enrolling 2022 patients (mean age, 66 years) with non-ST-segment elevation ACS undergoing PCI. INTERVENTIONS: Patients were assigned to receive either abciximab (0.25 mg/kg of body weight bolus, followed by a 0.125-microg/kg per minute [maximum, 10 microg/min] infusion for 12 hours, plus heparin, 70 U/kg of body weight) or placebo (placebo bolus and infusion of 12 hours, plus heparin bolus, 140 U/kg). All patients received clopidogrel, 600 mg, at least 2 hours prior to the procedure, as well as 500 mg of oral or intravenous aspirin. MAIN OUTCOME MEASURES: The primary end point was a composite of death, myocardial infarction, or urgent target vessel revascularization occurring within 30 days after randomization; secondary end points were rates of in-hospital major and minor bleeding. RESULTS: Of 2022 patients enrolled, 1012 were assigned to abciximab and 1010 to placebo. The primary end point was reached in 90 patients (8.9%) assigned to abciximab vs 120 patients (11.9%) assigned to placebo, a 25% reduction in risk with abciximab (relative risk [RR], 0.75; 95% CI, 0.58-0.97; P = .03). Among patients without an elevated troponin level, there was no difference in the incidence of primary end point events between the abciximab group (23/499 patients [4.6%]) and the placebo group (22/474 patients [4.6%]) (RR, 0.99; 95% CI, 0.56-1.76; P = .98), whereas among patients with an elevated troponin level, the incidence of events was significantly lower in the abciximab group (67/513 patients [13.1%]) compared with the placebo group (98/536 patients [18.3%]), which corresponds to an RR of 0.71 (95% CI, 0.54-0.95; P = .02) (P = .07 for interaction). There were no significant differences between the 2 groups regarding the risk of major and minor bleeding as well as need for transfusion. CONCLUSIONS: Abciximab reduces the risk of adverse events in patients with non-ST-segment elevation ACS undergoing PCI after pretreatment with 600 mg of clopidogrel. The benefits provided by abciximab appear to be confined to patients presenting with an elevated troponin level. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00133003

Kaya A, Heijmen RH, Overtoom TT, Vos JA, Morshuis WJ, Schepens MA. Thoracic stent grafting for acute aortic pathology. Annals of Thoracic Surgery 2006; 82(2):560-565.

Abstract: BACKGROUND: Elective endovascular repair of the thoracic aorta has shown reduced morbidity and mortality when compared with open surgery. The number of studies describing the use of thoracic endovascular stent grafts for acute pathology is limited, however. The purpose of this study was to describe our increasing experience with stent grafting for acute thoracic aortic pathology. METHODS: Since January 2002, 28 patients underwent endovascular stent graft treatment for various types of acute thoracic aorta diseases, including complicated Stanford type B dissection (n = 12), ruptured descending aorta aneurysms (n = 7), intramural hematoma (n = 4), traumatic rupture of the thoracic aorta (n = 2), aortopulmonary fistula (n = 2), and penetrating aortic ulcer (n = 1). These acute thoracic aortic syndromes were predominantly localized in the proximal descending thoracic aorta (75%). Talent stent grafts were used in 26 patients and Excluder stent grafts in 2 patients. RESULTS: Stent graft deployment at the intended position was successful in all patients. There was 1 intraoperative death (3.6%), due to acute myocardial infarction, after successful exclusion of the lesion with a stent graft. Hospital mortality was 21.4% (n = 6). Four of 6 hospital deaths, however, were directly related to the severely compromised clinical status preoperatively, including extensive bowel ischemia and irreversible cerebral damage after resuscitation. New neurologic symptoms were seen in 4 patients. The majority of the neurologic symptoms improved and faded away during hospital stay. Mean follow-up was 11 months (range, 1 to 31), and all the hospital survivors (n = 22) were alive. There was 1 nonrelated stroke 4 months postoperatively. During follow-up, 2 patients required transposition of the left subclavian artery for malperfusion, and 2 patients required a second stent graft procedure for endoleak. Additionally, 2 patients with early type II endoleaks were treated conservatively, and 1 of them sealed spontaneously at 6 months. CONCLUSIONS: Thoracic stent grafting for acute aortic pathology is feasible in critically ill patients. Postoperative morbidity and mortality is predominantly related to the compromised preoperative clinical status, illustrating its use as salvage strategy

Keller BP, Lubbert PH, Keller E, Leenen LP. Reply to: "Letter to the Editor: Tissue-interface pressure on three different support-surfaces for trauma patients". Injury 2006; 37(7):674-675.

Keller BP, Schuurman JP, van der Werken C. Can near infrared spectroscopy measure the effect of pressure on oxygenation of sacral soft tissue? Journal of Wound Care 2006; 15(5):213-217.

Abstract: OBJECTIVE: To test whether near infrared spectroscopy (NIRS) is applicable for the examination of the influence of external pressure on oxygenation of the soft tissues in the sacral area. METHOD: Tissue oxygenation was measured in 33 healthy volunteers in the prone position. A NIRS probe was positioned over the sacrum and external pressure was applied in 10 mmHg increments, from 20 mmHg to 200 mmHg and then decreased. At each level, tissue oxygen saturation (StO(2)) was measured. To test reproducibility, the protocol was repeated in six volunteers, in whom the thickness of the soft-tissue envelope at different levels of external pressure was assessed using ultrasound. RESULTS: There was wide variability in StO(2) courses between the 33 subjects, with a non-linear relationship between pressure and StO(2). The only consistent finding was that the StO(2) was significantly higher after decreasing pressure than at the initial pressure of 20 mmHg, which is indicative of reactive hyperaemia. Despite the application of high external pressures, reasonable tissue oxygenation was maintained in 19 of 33 subjects. Reproducibility of the measurements was poor. Comparison of soft-tissue thickness with corresponding StO(2) values showed that, with increasing pressure, the percentage decrease in tissue thickness was higher than the decrease in tissue oxygenation. CONCLUSION: This study confirms that NIRS is not useful for assessing tissue oxygenation in pressure ulcer research due to unacceptable inter-individual variability and poor reproducibility of measurements

Keller BPJA, van Overbeeke J, van der Werken C. Interface pressure measurement during surgery : a comparison of four operation table surfaces. Journal of Wound Care 2006; 15(1):5-9.

Keller BPJA. Risks and risk-analysis for the development of pressure ulcers in surgical patients. [Enschede: Febo druk b.v.], 2006.

Khan M, Wittkampf FHM, Wever EFD, Boersma LVA. Atrial fibrillation recurrence after classic maze III surgery is related to incomplete pulmonary vein isolation amenable to ablation treatment. Netherlands Heart Journal 2006; 14(suppl 3):-13.

Kiewiet RM, Durian MF, van Leersum M, Hesp FL, van Vliet AC. Gallstone formation after weight loss following gastric banding in morbidly obese Dutch patients. Obesity Surgery 2006; 16(5):592-596.

Abstract: BACKGROUND: Obesity is a risk factor for the development of gallstones. Rapid weight loss may be an even stronger risk factor. We retrospectively assessed the prevalence and risk factors of gallstone formation after adjustable gastric banding (AGB) in a Dutch population. METHODS: All patients who underwent AGB between Jan 1992 and Dec 2000 for morbid obesity were invited to take part in this study. Transabdominal ultrasonography of the gallbladder was performed in those patients without a prior history of cholecystectomy (Group A). Additionally, 45 morbidly obese patients underwent ultrasonography of the gallbladder before weight reduction surgery (Group B). RESULTS: 120 patients were enrolled in the study (Group A). Prior history of cholecystectomy was present in 21 patients: 16 before and 5 after AGB. Ultrasonography was performed in 98 patients: gallstones were present in 26 (26.5%). On multivariate analysis, neither preoperative weight, nor maximum weight loss, nor the interval between operation and the postoperative ultrasonography were determinants of the risk for developing gallstone disease. Prevalence of gallstones was significantly lower in the morbidly obese patients who had not yet undergone weight reduction surgery (Group B). CONCLUSIONS: Rapid weight loss induced by AGB, is an important risk factor for the development of gallstones. No additional determinants were found. Every morbidly obese patient undergoing bariatric surgery must be considered at risk for developing gallstone disease

Klein WM, van der Graaf Y, Seegers J, Spithoven JH, Buskens E, van Baal JG, Buth J, Moll FL, Overtoom TT, van Sambeek MR, Mali WP. Dutch iliac stent trial: long-term results in patients randomized for primary or selective stent placement. Radiology 2006; 238(2):734-744.

Abstract: PURPOSE: To determine long-term results of the prospective Dutch Iliac Stent Trial. MATERIALS AND METHODS: The study protocol was approved by local institutional review boards. All patients gave written informed consent. Two hundred seventy-nine patients (201 men, 78 women; mean age, 58 years) with iliac artery disease were randomly assigned to undergo primary stent placement (143 patients) or percutaneous transluminal angioplasty (PTA) with selective stent placement in cases in which the residual mean pressure gradient was greater than 10 mm Hg across the treated site (136 patients). Before and at 3, 12, and 24 months and 5-8 years after treatment, all patients underwent assessment, which included duplex ultrasonography (US), ankle-brachial index (ABI) measurement, Fontaine classification of symptoms, and completion of the Rand 36-Item Health survey for quality-of-life assessment. Treatment was considered successful for symptoms if symptoms increased at least one Fontaine grade, for ABI if ABI increased more than 0.10, for patency if peak systolic velocity ratio at duplex US was less than 2.5, and for quality of life if the RAND 36-Item Health Survey score increased more than 15 points. Effects of both treatments on symptoms, quality of life, patency, and ABI were compared by using survival analyses. RESULTS: Patients who underwent PTA and selective stent placement had better improvement of symptoms (hazard ratio [HR], 0.8; 95% confidence limits [CLs]: 0.6, 1.0) than did patients treated with primary stent placement, whereas ABI (HR, 0.9; 95% CLs: 0.7, 1.3), iliac patency (HR, 1.3; 95% CLs: 0.8, 2.1), and score for quality of life for nine survey dimensions did not support a difference between treatment groups. CONCLUSION: Patients treated with PTA and selective stent placement in the iliac artery had a better outcome for symptomatic success compared with patients treated with primary stent placement, whereas data about iliac patency, ABI, and quality of life did not support a difference between groups. (c) RSNA, 2005

Klerkx WM, van der Voet LF, Schagen van Leeuwen JH, Slee PHThJ, Ribbert LSM. Een vrouw met anemie en een afwijkende navel. Nederlands Tijdschrift voor Obstetrie & Gynaecologie 2006; 119(7):3-5.

Kluft C, Meijer P, de Maat PMP, Schutgens REG, Haas FJLM. Assay of fibrin/fibrinogen degradation products specific to the enzyme that is responsibl for the degradation, offers improved diagnostic possibilities. British Journal of Haematology 2006; 133(suppl 1):46.

Knibbe CAJ, DeJongh J, van Dijk M, Simons SHP, Bouwmeester NJ, Jacqz-Aigrain E, van den Anker JN, Tibboel D, Danhof M. New scaling factor for dosing in (preterm) newborns and infants based on morphine and its glucuronides as a model drug. Measurement and kinetics of in vivo drug effects. Advances in simultaneous pharmacokinetic/Pharmacodynamic Modeling. In: Danhof M, Stanski DR, Rolan P, editors. 5th International Symposium on Measurement and Kinetics of In Vivo Drug Effects. 26 - 29 April 2006, Noordwijkerhout, The Netherlands. Leiden: LADCR, 2006.

Koek MB, Buskens E, Steegmans PH, van Weelden BM, Bruijnzeel-Koomen CA, Sigurdsson V. UVB phototherapy in an outpatient setting or at home: a pragmatic randomised single-blind trial designed to settle the discussion. The PLUTO study. BMC Medical Research Methodology 2006; 6:39.

Abstract: ABSTRACT: BACKGROUND: Home ultraviolet B (UVB) treatment is a much-debated treatment, especially with regard to effectiveness, safety and side effects. However, it is increasingly being prescribed, especially in the Netherlands. Despite ongoing discussions, no randomised research has been performed, and only two studies actually compare two groups of patients. Thus, firm evidence to support or discourage the use of home UVB phototherapy has not yet been obtained. This is the goal of the present study, the PLUTO study (Dutch acronym for "national trial on home UVB phototherapy for psoriasis"). METHODS: We designed a pragmatic randomised single-blind multi-centre trial. This trial is designed to evaluate the impact of home UVB treatment versus UVB phototherapy in a hospital outpatient clinic as to effectiveness, quality of life and cost-effectiveness. In total 196 patients with psoriasis who were clinically eligible for UVB phototherapy were included. Normally 85% of the patients treated with UVB show a relevant clinical response. With a power of 80% and a 0.05 significance level it will be possible to detect a reduction in effectiveness of 15%. Effectiveness will be determined by calculating differences in the Psoriasis Area and Severity Index (PASI) and the Self Administered PASI (SAPASI) scores. Quality of life is measured using several validated generic questionnaires and a disease-specific questionnaire. Other outcome measures include costs, side effects, dosimetry, concomitant use of medication and patient satisfaction. Patients are followed throughout the therapy and for 12 months thereafter. The study is no longer recruiting patients, and is expected to report in 2006. DISCUSSION: In the field of home UVB phototherapy this trial is the first randomised parallel group study. As such, this trial addresses the weaknesses encountered in previous studies. The pragmatic design ensures that the results can be well generalised to the target population. Because, in addition to effectiveness, aspects such as quality of life and cost-effectiveness are also taken into consideration, this study will produce valuable evidence to either support or discourage prescription of home UVB phototherapy. TRIAL REGISTRATION: Current controlled trials/Nederlands Trial register: ISRCTN83025173. Clinicaltrials.gov: NCT00150930

Kramer GW, Legrand CL, van Schil P, Uitterhoeve L, Smit EF, Schramel F, Biesma B, Tjan-Heijnen V, van Zandwijk N, Splinter T, Giaccone G, van Meerbeeck JP. Quality assurance of thoracic radiotherapy in EORTC 08941: a randomised trial of surgery versus thoracic radiotherapy in patients with stage IIIA non-small-cell lung cancer (NSCLC) after response to induction chemotherapy. European Journal of Cancer 2006; 42(10):1391-1398.

Abstract: The aim of this study was to investigate the improvement of quality of radiotherapy and compliance to the protocol amendment of EORTC study 08941. The radiotherapy-specific data were analysed from 154 patients with stage IIIA-N2 Non-Small-Cell Lung Cancer who were actually irradiated after response to 3 cycles of platinum-based induction chemotherapy. The parameters of quality, assessed in 93 patients before and in 61 after protocol amendment, included: time interval between last chemotherapy course and start of thoracic radiotherapy, the use of a 3-D planning CT, dose and fractionation scheme to the primary tumour, the involved and uninvolved mediastinum, duration of radiotherapy and toxicity. A significant improvement of all quality parameters was noted, except for the overall treatment time, which decreased slightly. Protocol amendment resulted in an improvement of the quality and the compliance of most observed parameters, at the cost of some increase in overall treatment time. The latter reflects logistical problems rather than poor compliance

Kropman RH, Bemelman M, Vos JA, van den Berg JC, van de Pavoordt HD, van de Mortel RH, Moll FL, de Vries JP. Long-term Results of Percutaneous Transluminal Angioplasty for Symptomatic Iliac In-stent Stenosis. European Journal of Vascular & Endovascular Surgery 2006; 32(6):634-638.

Abstract: OBJECTIVE: This study describes the long-term results of endoluminal therapy for iliac in-stent obstructions. DESIGN: This is a retrospective study. MATERIALS AND METHODS: From 1992 to 2005, 68 patients (22 women), with a mean age of 61+/-13 years and 16 bi-iliacin-stent obstructions, underwent 84 endovascular interventions for focal iliac in-stent stenoses (n=61) or occlusions (n=23). Primarily, only uncovered stents were placed. All patients were symptomatic: 70% had disabling intermittent claudication, 23% had resting pain, and 7% had trophic changes. All had in-stent diameter reduction exceeding 50% that was confirmed by duplex scanning and angiography. Procedures were performed under local anesthesia via the femoral route. RESULTS: All interventions were initially technically successful, with a minor complication of pneumonia in one patient (2%). Initial clinical success was achieved in 86% of patients. PTA alone was used to treat 72 (86%) in-stent obstructions, the other 12 (14%) had PTA and renewed stent placement. The 30-day mortality rate was 0%. Mean follow-up was 35 months (range, 3 months to 10 years) and included duplex scanning. Primary clinical patency was 88% at 1 year, 62% at 3 years, and 38% at 5 years follow-up. During follow-up, 28 (33%) of 84 extremities required secondary reinterventions because of symptomatic renewed in-stent stenosis, and 11 were treated successfully with repeated endovascular interventions. Secondary patency at 1 year was 94%, 78% at 3 years, and 63% at 5 years. Surgical intervention was eventually needed in 17 (20%) of the 84 extremities. CONCLUSIONS: Endoluminal therapy for iliac focal in-stent obstructive disease seems to be a safe technique with acceptable long-term outcome and therefore a true alternative to primary surgical reconstruction

Kropman RHJ, Besselink MGH, Keller BPJA, Go PMNYH. Foto van de maand. Nederlands Tijdschrift voor Heelkunde 2006;(5).

Kruit A, Grutters JC, Ruven HJ, Sato H, Izumi T, Nagai S, Welsh KI, du Bois RM, van den Bosch JM. Chymase Gene (CMA1) Polymorphisms in Dutch and Japanese Sarcoidosis Patients. Respiration 2006; 73(5):623-633.

Abstract: Background: Chymase is released from mast cells following activation. Evidence suggests that chymase plays an important role in tissue injury and remodeling of the lungs, heart and skin. Objective: We postulated that chymase gene (CMA1) polymorphisms are associated with pulmonary fibrosis in Dutch and with cardiac and skin involvement in Japanese sarcoidosis patients. Patients and Methods: Dutch (n = 153) and Japanese (n = 122) sarcoidosis patients with controls (Dutch, n = 309; Japanese, n = 111) were studied. Pulmonary involvement in Dutch patients as well as clinical manifestations in Japanese patients was evaluated for association with five CMA1 polymorphisms. Results: The CMA1 polymorphisms were not associated with disease susceptibility in either population, or with radiographic evolution in the Dutch or with cardiac or skin involvement in the Japanese patients. The -526 T allele was associated with a lower iVC in Dutch patients. Conclusions: The CMA1 polymorphisms studied do not contribute to disease susceptibility in Japanese or Dutch sarcoidosis patients. CMA1 polymorphisms do not influence radiographic evolution in Dutch sarcoidosis patients, nor do they predispose to cardiac or skin involvement in Japanese patients. However, the association between CMA1 -526 C/T and iVC in the Dutch patients suggests that chymase may modify the functional outcome of pulmonary sarcoidosis. Copyright (c) 2006 S. Karger AG, Basel

Kruit A, Grutters JC, Ruven HJ, van Moorsel CH, Weiskirchen R, Mengsteab S, van den Bosch JM. Transforming Growth Factor-ß Gene Polymorphisms in Sarcoidosis Patients With and Without Fibrosis. Chest 2006; 129(6):1584-1591.

Abstract: STUDY OBJECTIVES: Pulmonary fibrosis develops in approximately 25% of patients with chronic sarcoidosis. Transforming growth factor (TGF)-beta1 plays a central role in fibrosis, and accruing reports address the implication of TGF-beta2 and TGF-beta3 in this process. We determined whether single-nucleotide polymorphisms (SNPs) in the TGF-beta1, TGF-beta2, and TGF-beta3 genes might contribute to pulmonary fibrosis in sarcoidosis patients. SETTING: A hospital in the Netherlands. DESIGN: Five SNPs per TGF-beta gene were investigated. Patients and control subjects: Patients with either acute/self-remitting sarcoidosis (n = 50) and Lofgren syndrome (n = 46) or chronic disease with fibrosis (n = 24) and without fibrosis (n = 34) were assessed over a 4-year follow-up period. The control subjects included 315 individuals. MEASUREMENTS AND RESULTS: Polymorphism frequencies were not discordant between the patients and control subjects. The TGF-beta3 4875 A allele was significantly higher in fibrotic patients (carrier frequency, 0.29) than in patients with acute/self-remitting (0.06) and chronic (0.03) sarcoidosis combined (corrected p = 0.01; odds ratio [OR], 7.9). The TGF-beta3 17369 C allele carrier frequency was significantly higher in fibrotic patients (0.29) compared to acute/self-remitting (0.08) and chronic (0.06) patients combined (corrected p = 0.05; OR, 5.1). Although not significant after correction, the TGF-beta3 15101 G allele carrier frequency was lower in fibrotic patients (0.79) compared to acute/self-remitting (0.94) and chronic (1.00) patients combined (p = 0.02; corrected p = 0.1; OR, 0.15). The TGF-beta2 59941 G allele was more abundant in fibrotic patients (carrier frequency, 0.62) compared to patients with acute/self-remitting (0.41) and chronic sarcoidosis combined (0.28) [p = 0.04; corrected p = 0.2; OR, 2.9]. TGF-beta1 gene polymorphisms were not associated with fibrosis. CONCLUSIONS: This study is the first to suggest the implication of genetic variation of TGF-beta3 in the predilection for pulmonary fibrosis developing in sarcoidosis patients

Kruit A. Gene polymorphisms in fibrotic sarcoidosis. 2006.

Kruyt ND, Wessels PH. Herseninfarct door polycytemie als eerste uiting van een niercelcarcinoom. Nederlands Tijdschrift voor Geneeskunde 2006; 150(17):969-972.

Abstract: A 65-year-old man with known diabetes mellitus and hypertension (cardiovascular risk factors) presented to the Emergency Clinic with a transient language disorder and motor- and cognitive-function disorders that had been present for the past half a year. Brain imaging revealed multiple white-matter lesions and a recent infarction. Routine blood tests revealed polycythaemia. Further tests revealed an elevated erythropoietin level and bilateral renal tumours. The cognitive functions improved after repeated phlebotomies and surgical resection of the renal-cell carcinomas. Before surgery, transcranial ultrasound had shown very low cerebral flow velocities, which became normal after correction of the haematocrit. This case emphasises the importance of routine blood tests in patients with suspected cerebral infarction. To our knowledge, this is the first case of cerebral infarction as the first manifestation ofa renal-cell carcinoma

Kuijk L, Mandey S, Frenkel J, Waterham H, Rijkers GT. Proteolytic activation and export of interleukin 1- and -18 rise in impaired isoprenoid biosynthesis. 1st Joint meeting of he european National Societies of Immunology 6-9 September, Paris, France 2006;PC-1654.

Kunst E, Rodel S, Moll F, van den Berg C, Teijink J, van Herwaarden J, van der Palen J, Geelkerken R. Towards a VR trainer for EVAR treatment. Studies in health technology and informatics 2006; 119:279-281.

Abstract: Endovascular repair of aortic abdominal aneurysms (AAA) is more and more becoming part of clinical practice. Up to approximately 30 clinical procedures however are necessary to obtain the surgical skills to make the procedure reliable and safe. The current study aims to generate a VR trainer to speed up the training process of experienced vascular surgeons to become experienced EVAR (endovascular AAA repair) surgeons by introducing a VR environment. This manuscript describes the contents and validation of the first step in the VR

Laarman GJ, Suttorp MJ, Dirksen MT, van Heerebeek L, Kiemeneij F, Slagboom T, van der Wieken LR, Tijssen JG, Rensing BJ, Patterson M. Paclitaxel-eluting versus uncoated stents in primary percutaneous coronary intervention. New England Journal of Medicine 2006; 355(11):1105-1113.

Abstract: BACKGROUND: Drug-eluting coronary-artery stents have been shown to decrease restenosis and therefore the likelihood that additional procedures will be required after percutaneous coronary intervention (PCI). We evaluated the use of a drug-eluting stent in patients undergoing PCI for acute myocardial infarction with ST-segment elevation. METHODS: We randomly assigned 619 patients presenting with an acute myocardial infarction with ST-segment elevation to receive either a paclitaxel-eluting stent or an uncoated stent. The primary end point was a composite of death from cardiac causes, recurrent myocardial infarction, or target-lesion revascularization at 1 year. RESULTS: Baseline clinical and angiographic characteristics in both groups were well matched. There was a trend toward a lower rate of serious adverse events in the paclitaxel-stent group than in the uncoated-stent group (8.8% vs. 12.8%; adjusted relative risk, 0.63; 95% confidence interval, 0.37 to 1.07; P=0.09). A nonsignificant trend was also detected in favor of the paclitaxel-stent group, as compared with the uncoated-stent group, in the rate of death from cardiac causes or recurrent myocardial infarction (5.5% vs. 7.2%, P=0.40) and in the rate of target-lesion revascularization (5.3% vs. 7.8%, P=0.23). The incidence of stent thrombosis during 1 year of follow-up was the same in both groups (1.0%). CONCLUSIONS: Although the use of paclitaxel-eluting stents in acute myocardial infarction with ST-segment elevation reduced the incidence of serious adverse cardiac events at 1 year by 4.0 percentage points, as compared with uncoated stents, the difference was not statistically significant. (Current Controlled Trials number, ISRCTN65027270 [controlled-trials.com].). Copyright 2006 Massachusetts Medical Society

Larsen JK, Geenen R, van Ramshorst B, Brand N, Hox JJ, Stroebe W, van Doornen LJ. Binge eating and exercise behavior after surgery for severe obesity: A structural equation model. International Journal of Eating Disorders 2006; 39(5):369-375.

Abstract: OBJECTIVE:: The current study sought to find indications for the appropriateness of a model in which eating patterns and exercise beliefs influence binge eating and physical exercise, respectively, that, in turn, influence outcome after gastric banding for severe obesity. METHOD:: Participants were 157 patients (144 females, 13 males) who completed questionnaires approximately 34 months (range = 8-68 months) after laparoscopic adjustable gastric banding (LAGB). RESULTS:: Our data showed a well-fitting model in which external and emotional eating were associated with outcome through binge eating. Several exercise beliefs were associated with physical exercise, but physical exercise was not associated with weight loss or physical health. CONCLUSION:: Binge eating was related more strongly to the outcome after gastric banding than physical exercise. Future research should examine whether a strong focus on the management of binge eating and external and emotional eating could improve the outcome of morbidly obese patients with unsuccessful weight outcome after obesity surgery. (c) 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006

Lases EC, Aarts LPHJ, Schepens MAAM, Haas FJLM, ter Beek HTM, van Dongen HPA, Siegers HP, van der Tweel I, Boezeman EHJF. Biochemical markers and motorevoked potentials for determining adverse neurological outcome after thoracic and thoracoabdominal aortic aneurysm surgery. Nederlands Tijdschrift voor Anesthesiologie 2006; 19(1):8.

Le Gal G, Righini M, Parent F, van Strijen M, Couturaud F. Diagnosis and management of subsegmental pulmonary embolism. Journal of Thrombosis & Haemostasis 2006; 4(4):724-731.

Abstract: INTRODUCTION: Although the advent of multi-detector row computed tomography (CT) has enabled better visualization of subsegmental pulmonary (SSP) arteries, SSP embolism is of uncertain clinical significance. We aimed at answering the following questions: Is spiral CT an accurate method to detect SSP embolism? How are subsegmental perfusion defects managed in outcome studies including spiral CT? What are the main characteristics and outcomes of patients in whom CT detects isolated subsegmental defects? METHODS: We performed a Medline search on July 1, 2004, using the keywords 'pulmonary embolism' and 'computed tomography'. We limited our search to English language prospective studies comparing CT to pulmonary angiography, and to prospective outcome studies including CT in a diagnostic strategy, with at least a 3-month follow-up. RESULTS: Fourteen studies comparing CT to pulmonary angiography, and five prospective management studies using CT were retrieved. The sensitivity of single-detector CT for detecting subsegmental defects compared with pulmonary angiography was low (25%). The proportion of isolated SSP images was significantly higher in management studies using multi-detector CT (17 of 770 scans, 2.2%) compared with those using single-detector CT (22 of 2232, 1.0%; P = 0.01). No straightforward attitude regarding anticoagulation therapy for isolated subsegmental defects emerged from the available literature. Finally, important clinical differences were found between patients having subsegmental and segmental or more proximal defects. CONCLUSIONS: These findings underline the uncertainty regarding the clinical significance of SSP embolism, and the management of patients with such findings

Letteboer TG, Mager JJ, Snijder RJ, Koeleman BP, Lindhout D, Ploos van Amstel JK, Westermann CJ. Genotype-phenotype relationship in hereditary haemorrhagic telangiectasia. Journal of medical genetics 2006; 43(4):371-377.

Abstract: Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant disorder characterised by vascular malformations in multiple organ systems, resulting in mucocutaneous telangiectases and arteriovenous malformations predominantly in the lungs (pulmonary arteriovenous malformation; PAVM), brain (cerebral arteriovenous malformation; CAVM), and liver (hepatic arteriovenous malformation; HAVM). Mutations in the ENG and ALK-1 genes lead to HHT1 and HHT2 respectively. In this study, a genotype-phenotype analysis was performed. A uniform and well classified large group of HHT patients and their family members were screened for HHT manifestations. Groups of patients with a clinically confirmed diagnosis and/or genetically established diagnosis (HHT1 or HHT2) were compared. The frequency of PAVM, CAVM, HAVM, and gastrointestinal telangiectases were determined to establish the genotype-phenotype relationship. The analysis revealed differences between HHT1 and HHT2 and within HHT1 and HHT2 between men and women. PAVMs and CAVMs occur more often in HHT1, whereas HAVMs are more frequent in HHT2. Furthermore, there is a higher prevalence of PAVM in women compared with men in HHT1. In HHT1 and HHT2, there is a higher frequency of HAVM in women. HHT1 has a distinct, more severe phenotype than HHT2. There is a difference in the presence of symptoms between men and women. With these data, genetic counselling can be given more accurately when the family mutation is known

Lichtveld RA, Gras T, Hammacher ER. "Een weg vol hobbels en kuilen". Vakblad voor Ambulancezorg 2006; 2:18-23.

Liem AL, Timmerman L. A new approach to neurostimulation for peripheral pain. Puesta al dia en anesthesia regional y tratamiento del dolor 2006; IX:235-237.

Lindeboom JA, Frenken JW, Dubois L, Frank M, Abbink I, Kroon FH. Immediate loading versus immediate provisionalization of maxillary single-tooth replacements: a prospective randomized study with BioComp implants. Journal of Oral & Maxillofacial Surgery 2006; 64(6):936-942.

Abstract: PURPOSE: The aim of this prospective randomized study was to evaluate the clinical outcome of immediately loaded solid plasma sprayed (TPS) BioComp (BioComp Industries BV, Vught, The Netherlands) implants versus immediate provisionalized but non-loaded BioComp implants in the anterior and premolar region of the maxilla. MATERIALS AND METHODS: Forty-eight patients (31 females and 17 males) with a mean age of 42.3+/-13.1 years (range 19 to 78 years) were included in the study. Fifty threaded TPS implants were placed and provisionalized within 24 hours after surgery. The patients were randomly assigned to 2 groups. In the immediate loaded (IL) group (n=24) the occlusion of the provisional was designed with normal contacts in centric relation and at lateral excursions, while in the non-immediate loaded (IP) group (n=24) the provisional restoration was adjusted to clear all occlusal contacts or contacts at lateral excursions. Patients were instructed to eat a soft diet and to avoid placing food in the area of the provisional crown during the first 6 weeks. Regular clinical and radiographic controls were performed and the survival rate and implant stability quotient (ISQ) values were evaluated at delivery of the definitive restoration at 6 months. At 1 year, radiographic coronal bone defects and gingival esthetics between the 2 groups were assessed. RESULTS: Of the IL group, 2 fixtures were lost, while 3 implants were lost in the IP group. The failing implants showed increasing mobility at 2 to 3 weeks after insertion, and were removed. The remaining 45 implants were stable at every subsequent follow-up examination, and 6 months after implant placement, ISQ values were measured. The mean ISQ value in the IL group was 63.7+/-5.8 versus 63.2+/-4.3 for the IP group (P=.78). The mean mesial marginal bone loss after 12 months in the IL group was 0.27+/-0.2 mm versus 0.28+/-0.22 mm in the IP group (P=.9). The mean distal marginal bone loss after 12 months in the IL group was 0.19+/-0.15 mm versus 0.2+/-0.11 mm in the IP group (P=.87). All implants of the IL group had an ideal gingival buccal margin, versus 91% of the IP group. Full regeneration of the mesial interdental papilla was observed in 70% of the IL group versus 91% of the IP group, while full regeneration of the distal papilla was observed in 91% of both the IL and IP implants. CONCLUSION: No significant differences in ISQ mean values in radiographic bone loss and gingival esthetics were found between immediate non-loaded provisionalization and immediately loaded BioComp implants in the maxilla

Lindeboom JA, Frenken JW, Tuk JG, Kroon FH. A randomized prospective controlled trial of antibiotic prophylaxis in intraoral bone-grafting procedures: preoperative single-dose penicillin versus preoperative single-dose clindamycin. International Journal of Oral & Maxillofacial Surgery 2006; 35(5):433-436.

Abstract: In this comparative study, 150 consecutive patients undergoing local intraoral bone grafting randomly received either an oral single dose of 600mg clindamycin or 2g of the penicillin phenethicillin 1h before incision. Primary endpoint was wound infection at the receptor site within 8 weeks of surgery. Secondary outcome measurements included postoperative infections at the donor site and adverse events as a result of antibiotic administration. Mean age of the patients was 36.8+/-12.7 years (range 18-67 years), and 98 patients were females (65.3%) and 52 males (34.7%). Infections at the receptor site were seen in 4 patients (5.3%; 95% CI 0.23-10.4%) of the phenethicillin group and in 2 patients (2.7%; 95% CI 0-6.36%) of the clindamycin group. In both groups, 3 patients had an infection at the donor site. Postoperative infections were predominantly caused by alpha-haemolytic Streptococci sensitive to penicillin. No significant difference was found between prophylactic single doses of phenethicillin and clindamycin with regard to postoperative infection in patients undergoing local bone augmentation procedures

Lotan C, Almagor Y, Kuiper K, Suttorp MJ, Wijns W. Sirolimus-Eluting Stent in Chronic Total Occlusion: The SICTO Study. Journal of Interventional Cardiology 2006; 19(4):307-312.

Abstract: Coronary stenting can significantly reduce the restenosis and reocclusion rates after successful balloon angioplasty for chronic total occlusions (CTO). Nevertheless, recanalization of CTO remains among the worst predictors for in-stent restenosis and reocclusion. This multicenter, nonrandomized study assessed the safety and effectiveness of the CYPHER((R)) sirolimus-eluting stent in reducing angiographic in-stent late loss in totally occluded native coronary arteries. A total of 25 eligible patients were treated with the CYPHER((R)) sirolimus-eluting stent. Baseline clinical and angiographic data were collected and 6-month follow-up angiography and intravascular ultrasound (IVUS) were performed. Clinical follow-up was required at 30 days, 6, 12, 18, and 24 months. Study stent implantation was successful in all patients, with a mean stent length of 28.4 +/- 11 mm. Six-month angiographic outcomes showed that mean lumen diameter stenosis did not change (2.22 +/- 0.56 mm postprocedure; 2.26 +/- 0.60 mm at 6 months follow-up; P = NS). Similarly, mean percent diameter stenosis did not change significantly (15.7 +/- 8.6% postprocedure, 19.3 +/- 11% at follow-up; P = NS). The absolute late lumen loss was -0.03 +/- 0.28 mm with a 6-month in-stent restenosis rate of 0%. IVUS follow-up revealed in-stent obstruction volume of only 4.9 +/- 6.8%. Long-term clinical follow-up showed target lesion revascularization at 12 months was only 4%, with target vessel revascularization of only 12%. The CYPHER((R)) sirolimus-eluting stent was safe and effective in the treatment of CTO compared to historical data with bare metal stents

Luermans J, Post M, Suttorp MJ, Bos WJ. Non-invasive measurement of haemodynamic changes during percutaneous shunt closure in adults: the difference between PFO and ASD. Nederlandse Vereniging voor Cardiologie Najaarscongres 2006.

Luermans JGLM, van de Brand MWM, Slee PHThJ, de Jong PC, Vijverberg PLM. Data on treatment and outcome in patients with germ-cell malignancies in a large general hospital. 18e Internistendagen : abstractboek : 27& 28 april 2006 MECC Maastricht 2006;71.

Luermans JGLM, Slee PHThJ. Non-endocrine illness. 18e Internistendagen : abstractboek : 27& 28 april 2006 MECC Maastricht 2006;50.

Luermans JGLM, Post MC, Temmerman F, Thijs V, Schonewille WJ, Plokker HWM, Suttorp MJ, Budts W. Is the presence of an atrial septal defect also related to an increased prevalence of migraine? A prostective multi-centre follow up study. Netherlands Heart Journal 2006; 14(5):7.

Lukkassen IM, Hassing MB, Markhorst DG. Dexamethasone reduces reintubation rate due to postextubation stridor in a high-risk paediatric population. Acta Paediatrica 2006; 95(1):74-76.

Abstract: Objective: To study the effect of dexamethasone on postextubation stridor (PS) incidence and reintubation rate due to PS in a high-risk paediatric intensive care population. Patients and methods: All children aged between 4 wk and 6 y, who were intubated for at least 24 h and extubated between August 1999 and May 2002, were retrospectively included (n=60). Medical records of the included patients were studied; records of patients treated with dexamethasone prior to and following extubation (n=23) were compared with control patients who had not received prophylactic medication (n=37). Results: Nine patients in the control group developed significant postextubation stridor, necessitating nebulized epinephrine or glucocorticosteroids. In six of these children, reintubation as a result of postextubation stridor was indicated. None of the patients treated with dexamethasone developed severe postextubation stridor or required reintubation.Conclusions: The risk of postextubation stridor is relatively high in the group of children aged between 4 wk and 6 y with intubation exceeding 24 h. We found dexamethasone to be effective in preventing reintubation due to postextubation stridor in this paediatric high-risk group

Lukkassen MA, Markhorst DG. Does dexamethasone reduce the risk of extubation failure in ventilated children? Archives of disease in childhood 2006; 91(9):791-793.

Lutgendorff F, Sandström PA, Trulsson LM, van Minnen LP, Rijkers GT, Timmerman HM, Gooszen HG, Akkermans LMA, Söderholm JD. Prophylactic probiotics reduce intestinal permeability in early phase experimental pancreatitis. 11th Kirurgveckan, Örebro, Sweden, 10 November 2006 2006.

Macaré van Maurik JFM, van Swieten HA, Duurkens VAM, Laban E, Kon M. Use of tissue expanders in postpneumonectomy syndrome. ERS Congres september Munchen 2006;597s.

Macaré van Maurik JFM, van Swieten HA, Duurkens VAM, Laban E, Kon M. Use of tissue expanders in postpneumonectomy syndrome. European Respiratory Journal - Supplement 2006; 28(Suppl 50):[3520].

Macaya C, García-García HM, Colombo A, Morice M-C, Legrand V, Kuck K-H, Sheiban I, Suttorp MJ, Carrie D, Vrolix M, Wittebols K, Stoll H-P, Donohoe D, Bressers M, Serruys PW. One-year results of coronary revascularization in diabetic patients with multivessel coronary artery disease. Sirolimus stent vs. coronary artery bypass surgery and bare metal stent : insights from ARTS-II and ARTS-I. EuroIntervention 2006; 2:69-76.

Martens FMAC. Vasoreactivity, Inflammation and vascular effects of Thiazolidinediones in Insulin resistance. Utrecht: Universiteit Utrecht, Faculteit Geneeskunde, 2006.

Mattace-Raso FUS, Bos WJ, van den Meiracker AH, van der Cammen TJM, Westerhof BE, Hofman A, Witteman JCM. Arterial stiffness is independently associated with impaired cardiovagal baroreflex sensitivity. The Rotterdam study. European Society of Hypertension 16th European Meeting on Hypertension, Madrid, Juni 12 - 15 2006.

Meiland R. Pathogenese, diagnostiek en gevolgen van bacteriurie bij vrouwen met en zonder diabetes mellitus. Tijdschrift voor Infectieziekten 2006; 1(4):169-171.

Meiland R. Pathogenesis, diagnosis, and consequences of bacteriuria in women with or without diabetes mellitus. [S.L.: Febodruk B.V.], 2006.

Meinders A-J. Er is verhoogde cardiale mortaliteit na een koolmonoxidevergiftiging. Nederlands Tijdschrift voor Geneeskunde 2006; 150:1537.

Meinders AJ, van der Ploeg H, Biemond-Moeniralam HS, Willems DL, Schultz MJ. Beslissingen rond het levenseinde bij ernstig zieke patiënten: de plaats van intensivecareverpleegkundigen. Nederlands Tijdschrift voor Geneeskunde 2006; 150(39):2133-2136.

Milhous JG, van der Heyden J, ten Berg JM. Images in cardiology. Spontaneous healing of a severe coronary artery dissection. Heart 2006; 92(5):692.

Milhous JG, Heijmen RH, Ball ET, Plokker HW. Myocardial infarction with ventricular septal rupture complicating elective aortic valve replacement. Journal of Heart Valve Disease 2006; 15(4):509-511.

Abstract: Herein is described the case of a 79-year-old woman who underwent elective aortic valve replacement. The procedure was complicated by a particulate embolism into the left anterior descending artery leading to a myocardial infarction, complicated by ventricular septal rupture. Subsequently, the patient was reoperated on and the septal defect closed successfully, with an uneventful recovery

Monteiro LM, Bollen CW, van Huffelen AC, Ackerstaff RG, Jansen NJ, van Vught AJ. Transcranial Doppler ultrasonography to confirm brain death: a meta-analysis. Intensive Care Medicine 2006; 32(12):1937-1944.

Abstract: OBJECTIVE: Barbiturate therapy or hypothermia precludes proper diagnosis of brain death either clinically or by EEG. Specific intracranial flow patterns indicating cerebral circulatory arrest (CCA) can be visualized by transcranial Doppler ultrasonography (TCD). The aim of this study was to assess the validity of TCD in confirming brain death. DESIGN: Meta-analysis of studies assessing the validity of TCD in confirming brain death. METHODS: A systematic review of articles in English on the diagnosis brain death by TCD, published between 1980 and 2004, was performed. An oscillating or reverberating flow and systolic spikes were considered to be compatible with CCA. The quality of each study was assessed using standardized methodological criteria. The literature was searched for any article reporting a false-positive result. RESULTS: Two high-quality and eight low-quality studies were included. Meta-analysis of the two high-quality studies showed a sensitivity of 95% (95% CI 92-97%) and a specificity of 99% (95% CI 97-100%) to detect brain death. Meta-analysis of all ten studies showed a sensitivity of 89% and a specificity of 99%. In the literature we found two false-positive results; however, in both patients brain-stem function did show brain death shortly thereafter. CONCLUSIONS: CCA by TCD in the anterior and posterior circulation predicted fatal brain damage in all patients; therefore, TCD can be used to determine the appropriate moment for angiography. Further research is needed to demonstrate that CCA by TCD on repeated examination can also predict brain death in all patients

Munnik P, Zanen P, Lammers JW. A comparison of lung function equipment with emphasis on interchangeability and methods. Physiological measurement 2006; 27(6):445-455.

Abstract: The replacement of lung function equipment may not result in changing values: transitions should be seamless. We compared the equipment of two manufacturers (ZAN and Jaeger) to estimate the differences in spirometry, bodyplethysmography and diffusion capacity derived parameters elicited by equipment differences, and also compared calibration systems. From Jaeger (1) a Masterlab bodyplethysmograph, (2) a Pneumoscreen pneumotachograph, (3) a Masterscreen CS-FRC and (4) a Masterlab CompactTransfer (the latter two measure the diffusion capacity) were compared, and from ZAN a bodyplethysmograph system encompassing spirometry, flow-volume curve and diffusion capacity measurements. In vitro (a 2 litre calibration syringe at three flows, a fixed flow generator (0.5 l s(-1), 1.67 l s(-1) and 5 l s(-1)) and a wave form generator) studies and an in vivo cross-over study (N = 59) were used to compare the pneumotachographs. Other parameters were compared only via the in vivo study. The calibration syringe study showed no differences between the pneumotachographs: all volumes in all systems were within 3% of the reference. The fixed flow generator showed no flow differences either: again within 3% of the reference. The wave form generator showed PEF, MEF(75/50/25) differences up to 10-15% from the reference, but none in FEV(1) and FVC. The in vivo study found similar system differences in PEF, MEF(75/50/25): up to 29%. FEV(1), VC and FVC differed by small amounts (in all cases <3% between systems). R(0.5), TLC, V(A) and RV differed by small amounts between the systems (in all cases <3%), but T(L,CO) up to 9%. This study showed that between and within manufacturers, significant differences can exist between pneumotachographs and that using calibration syringes or fixed flow generators these frequently go unnoticed. These approaches insufficiently test the dynamic features of pneumotachographs. For other parameters, in vivo calibration is the only option and accuracy is only achieved with rather large samples, so more research is needed into suitable in vitro systems

Ndrepepa G, Kastrati A, Mehilli J, Neumann FJ, ten Berg JM, Bruskina O, Dotzer F, Seyfarth M, Pache J, Dirschinger J, Ulm K, Berger PB, Schomig A. Age-dependent effect of abciximab in patients with acute coronary syndromes treated with percutaneous coronary interventions. Circulation 2006; 114(19):2040-2046.

Abstract: BACKGROUND: No studies have specifically performed an age-based analysis of the efficacy of abciximab in patients with non-ST-segment elevation acute coronary syndromes undergoing percutaneous coronary intervention (PCI). The aim of the study was to assess whether there are age-dependent differences in the clinical benefit of abciximab in patients with acute coronary syndrome treated with PCI. METHODS AND RESULTS: We performed this retrospective analysis of 2022 patients with acute coronary syndrome enrolled in the Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment (ISAR-REACT 2) study and randomized to receive abciximab or placebo during a PCI procedure. The incidence of major adverse cardiac events (MACE) during the 30 days after PCI was the primary end point of the study. On the basis of the cutoff age value provided by logistic regression in connection with bootstrap resampling, patients were divided into those younger (n=1220) and older (n=802) than 70 years. Among younger patients, the incidence of MACE was 7.7% in the abciximab group versus 13.3% in the placebo group (relative risk 0.57, 95% confidence interval 0.40 to 0.80, P=0.001). In contrast, no difference was observed among older patients: The incidence of MACE was 10.9% in the abciximab group versus 9.9% in the placebo group (relative risk 1.10, 95% confidence interval 0.72 to 1.69, P=0.65). After adjustment for other variables, including cardiac troponin, there was a significant interaction between age and abciximab (P=0.04) with respect to MACE reduction, with abciximab being more effective in younger patients. CONCLUSIONS: In patients with non-ST-elevation acute coronary syndromes undergoing PCI, the efficacy of abciximab appears to be age-dependent, with greater benefit among younger patients

Nieberg A. Non-Invasive Positive Pressure Ventilation : Een goed alternatief voor invasieve beademingsmethoden. Critical care : multidisciplinair vakblad 2006; 3:14-16.

Niers LEM, Rijkers GT, Splinter J, Nijhof SL, Kimpen JLL, Hoekstra MO. Perinatal administration of probiotic bacteria prevents the development of eczema in high risk children already at the age of 3 months. 6th Congress of the European Association of Allergy and Clinical Immunology, Vienna, Austria 2006.

Nijdam ME, Hulsen H, Bos WJ, Uiterwaal CS, Grobbee DE, Bots ML. Spurious systolic hypertension in young adults; prevalence and risk factors. European Society of Hypertension 16th European Meeting on Hypertension, Madrid, Juni 12 - 15 2006.

Nijhuis HJA. Neurophysiologic monitoring of pain : the laser evoked potential. Nederlands Tijdschrift voor Anesthesiologie 2006; 19(1):28.

Noordzij M, Korevaar JC, Boeschoten EW, Dekker FW, Bos WJ, Krediet RT. Hyperphosphataemia and related mortality. Nephrology Dialysis Transplantation 2006; 21(9):2676-2677.

Noordzij M, Korevaar JC, Bos WJ, Boeschoten EW, Dekker FW, Bossuyt PM, Krediet RT. Disordered mineral metabolism increases the risk of cardiovascular morbidity in dialysis patients. IEA-EEF European Congress of Epidemiology, Utrecht, June 2006.

Noordzij M, Korevaar JC, Bos WJ, Boeschoten EW, Dekker FW, Bossuyt PM, Krediet RT. Application of American guideline can reduce cardiovascular mortality risk in dialysis patients. IEA-EEF European Congress of Epidemiology, Utrecht, June 2006.

Noordzij M, Boeschoten EW, Dekker FW, Bos WJ, Krediet RT, Korevaar JC. Disordered mineral metabolism is associated with more physical symptoms in dialysis patients. ISN Nexus The Bone and the Kidney, October 12 - 15, Copenhagen, Denmark 2006.

Noordzij M, Korevaar JC, Boeschoten EW, Dekker FW, Bos WJ, Bossuyt PM, Krediet RT. Plasma phosphorus levels and health related quality of life in dialysis patients. Nephrology Dialysis Transplantation 2006; 21(Suppl 4):iv143.

Noordzij M, Korevaar JC, Bos WJ, Boeschoten EW, Dekker FW, Bossuyt PM, Krediet RT. Mineral metabolism and cardiovascular morbidity and mortality risk: peritoneal dialysis patients compared with haemodialysis patients. Nephrology Dialysis Transplantation 2006; 21(9):2513-2520.

Abstract: BACKGROUND: The K/DOQI guideline for bone metabolism and disease in chronic kidney disease is predominantly based on studies in haemodialysis (HD) patients. However, in clinical practice, this guideline is also applied to peritoneal dialysis (PD) patients. To validate the implementation of this guideline in PD patients, we evaluated the associations between plasma concentrations outside the K/DOQI-targets and the risk of cardiovascular morbidity and mortality in incident PD patients compared with HD patients. METHODS: In a large prospective multicentre study in the Netherlands (The Netherlands Cooperative Study on the Adequacy of Dialysis, NECOSAD), we included patients starting PD or HD between 1997 and 2004. Relative risk of cardiovascular morbidity and mortality were estimated using time-dependent Cox regression modelling. RESULTS: We included 586 PD patients with mean age 52 +/- 15 years (66% males) and 1043 HD patients with mean age 63 +/- 14 years (58% males). Cardiovascular disease (CVD) was the reason for hospitalization in 102 PD and 271 HD patients. In HD patients, the relative risk of CVD-related hospitalization increased with elevated plasma calcium concentrations (hazard ratio: 1.4; 95% CI: 1.1-1.9). Cardiovascular mortality was significantly higher for phosphorus concentrations above the K/DOQI-threshold in PD (2.4; 95% CI: 1.3-4.2) and HD patients (1.5; 95% CI: 1.1-2.1), and for elevated Ca x P in PD (2.2; 95% CI: 1.3-3.8) and HD patients (1.5; 95% CI: 1.1-2.1). CONCLUSIONS: Plasma calcium concentrations above the K/DOQI-threshold increase the relative risk of CVD-related hospitalization in HD patients. Associations with cardiovascular mortality were more pronounced. Both in PD and HD patients with elevated plasma phosphorus and Ca x P concentrations, the cardiovascular mortality risk is increased. Therefore, it seems appropriate to adopt the current guideline in PD patients

Noordzij M, Boeschoten EW, Dekker FW, Bos WJ, Krediet RT, Korevaar JC. Disordered Mineral Metabolism Is Associated with More Symptoms in Dialysis Patients. American Society Nephrology 2006.

Okletey PV, van de Garde EM, Verzijlbergen JF. Microbiological monitoring during the preparation of radiopharmaceuticals in hospitals. European Journal of Nuclear Medicine & Molecular Imaging 2006; 33(S15):S310-S311.

Oosterheert JJ, Bonten MJ, Schneider MM, Buskens E, Lammers JW, Hustinx WM, Kramer MH, Prins JM, Slee PH, Kaasjager K, Hoepelman AI. Effectiveness of early switch from intravenous to oral antibiotics in severe community acquired pneumonia: multicentre randomised trial. British Medical Journal 2006; 333(7580):1193.

Abstract: OBJECTIVES: To compare the effectiveness of an early switch to oral antibiotics with the standard 7 day course of intravenous antibiotics in severe community acquired pneumonia. DESIGN: Multicentre randomised controlled trial. SETTING: Five teaching hospitals and 2 university medical centres in the Netherlands. PARTICIPANTS: 302 patients in non-intensive care wards with severe community acquired pneumonia. 265 patients fulfilled the study requirements. INTERVENTION: Three days of treatment with intravenous antibiotics followed, when clinically stable, by oral antibiotics or by 7 days of intravenous antibiotics. MAIN OUTCOME MEASURES: Clinical cure and length of hospital stay. RESULTS: 302 patients were randomised (mean age 69.5 (standard deviation 14.0), mean pneumonia severity score 112.7 (26.0)). 37 patients were excluded from analysis because of early dropout before day 3, leaving 265 patients for intention to treat analysis. Mortality at day 28 was 4% in the intervention group and 6% in the control group (mean difference 2%, 95% confidence interval -3% to 8%). Clinical cure was 83% in the intervention group and 85% in the control group (2%, -7% to 10%). Duration of intravenous treatment and length of hospital stay were reduced in the intervention group, with mean differences of 3.4 days (3.6 (1.5) v 7.0 (2.0) days; 2.8 to 3.9) and 1.9 days (9.6 (5.0) v 11.5 (4.9) days; 0.6 to 3.2), respectively. CONCLUSIONS: Early switch from intravenous to oral antibiotics in patients with severe community acquired pneumonia is safe and decreases length of hospital stay by 2 days.Trial registration Clinical Trials NCT00273676

Oreel MA, Tiel-van Buul MMC, Lavalaye J, Verzijlbergen JF. F-18 DG PET total body in suspected lung cancer : with or without brainscanning? Tijdschrift voor Nucleaire Geneeskunde 2006; 28(3):108.

Oreel MA, Tiel-van Buul MM, de Bruin PC, Koelemij R, Verzijlbergen JF. Hurthle cell carcinoma with a giant cystic liver metastasis imaged with 18F-labeled fluorodeoxyglucose-positron emission tomography. Thyroid 2006; 16(2):195-196.

Otten HG, van den Bosch JM, van Ginkel WG, van Loon M, van de Graaf EA. Identification of Non-HLA Target Antigens Recognized After Lung Transplantation. Journal of Heart & Lung Transplantation 2006; 25(12):1425-1430.

Abstract: BACKGROUND: It has become evident that, besides cellular allogeneic immune responses against airway epithelial cells (AEC), humoral responses also contribute significantly to the pathogenesis of bronchiolitis obliterans syndrome (BOS) after lung transplantation (LTx). Antibody responses against transplanted lungs are directed against HLA and non-HLA antigens, but the identity of the latter antigens is presently unknown. METHODS: The main purpose of this study is to identify non-HLA target antigens on donor lungs recognized by patients' antibodies after LTx. Serum samples were taken before and 6 months after lung transplantation from 11 patients (4 men and 6 women, median age 44 years, range 18 to 63 years). Protein expression libraries were made from the luminal side containing AEC of discarded the donor bronchus, which was snap frozen in liquid N(2) during the organ harvesting procedure. Subsequently, all sera were analyzed for reactivity against library-encoded antigens by serologic analysis of recombinant cDNA expression libraries (SEREX). Recognized gene products were sequenced and analyzed by the NCBI/BLAST server. RESULTS: From a total of +/-3 x 10(4) gene products analyzed, six different non-HLA antigens were recognized by individual patient sera. Gene analysis indicated that they consisted of both polymorphic (PSMC4, F3, LOC284058, PLUNC, ZNF33A) and non-polymorphic (XP_931864) antigens. Cross-sectional analysis indicated that some antigens were recognized by 4 of 10 patient sera tested. CONCLUSIONS: Antibodies directed against non-HLA antigens are present after LTx, and can be identified using the SEREX technique. Identification of target antigens recognized after LTx will improve our understanding of the pathogenesis of BOS. Monitoring of the antibody response may be used to predict BOS

Peeters MY, Prins SA, Knibbe CA, DeJongh J, Mathot RA, Warris C, van Schaik RH, Tibboel D, Danhof M. Pharmacokinetics and pharmacodynamics of midazolam and metabolites in nonventilated infants after craniofacial surgery. Anesthesiology 2006; 105(6):1135-1146.

Abstract: BACKGROUND: Because information on the optimal dose of midazolam for sedation of nonventilated infants after major surgery is scant, a population pharmacokinetic and pharmacodynamic model is developed for this specific group. METHODS: Twenty-four of the 53 evaluated infants (aged 3-24 months) admitted to the Pediatric Surgery Intensive Care Unit, who required sedation judged necessary on the basis of the COMFORT-Behavior score and were randomly assigned to receive midazolam, were included in the analysis. Bispectral Index values were recorded concordantly. Population pharmacokinetic and pharmacodynamic modeling was performed using NONMEM V (GloboMax LLC, Hanover, MD). RESULTS: For midazolam, total clearance was 0.157 l/min, central volume was 3.8 l, peripheral volume was 30.2 l, and intercompartmental clearance was 0.30 l/min. Assuming 60% conversion of midazolam to 1-OH-midazolam, the volume of distribution for 1-OH-midazolam and 1-OH-midazolamglucuronide was 6.7 and 1.7 l, and clearance was 0.21 and 0.047 l/min, respectively. Depth of sedation using COMFORT-Behavior could adequately be described by a baseline, postanesthesia effect (Emax model) and midazolam effect (Emax model).The midazolam concentration at half maximum effect was 0.58 mum with a high interindividual variability of 89%. Using the Bispectral Index, in 57% of the infants the effect of midazolam could not be characterized. CONCLUSION: In nonventilated infants after major surgery, midazolam clearance is two to five times higher than in ventilated children. From the model presented, the recommended initial dosage is a loading dose of 1 mg followed by a continuous infusion of 0.5 mg/h during the night for a COMFORT-Behavior of 12-14 in infants aged 1 yr. Large interindividual variability warrants individual titration of midazolam in these children

Peeters MY, Prins SA, Knibbe CA, DeJongh J, van Schaik RH, van Dijk M, van der Heiden IP, Tibboel D, Danhof M. Propofol pharmacokinetics and pharmacodynamics for depth of sedation in nonventilated infants after major craniofacial surgery. Anesthesiology 2006; 104(3):466-474.

Abstract: BACKGROUND: To support safe and effective use of propofol in nonventilated children after major surgery, a model for propofol pharmacokinetics and pharmacodynamics is described. METHODS: After craniofacial surgery, 22 of the 44 evaluated infants (aged 3-17 months) in the pediatric intensive care unit received propofol (2-4 mg . kg-1 . h-1) during a median of 12.5 h, based on the COMFORT-Behavior score. COMFORT-Behavior scores and Bispectral Index values were recorded simultaneously. Population pharmacokinetic and pharmacodynamic modeling was performed using NONMEM V (GloboMax LLC, Hanover, MD). RESULTS: In the two-compartment model, body weight (median, 8.9 kg) was a significant covariate. Typical values were Cl = 0.70 . (BW/8.9)0.61 l/min, Vc = 18.8 l, Q = 0.35 l/min, and Vss = 146 l. In infants who received no sedative, depth of sedation was a function of baseline, postanesthesia effect (Emax model), and circadian night rhythm. In agitated infants, depth of sedation was best described by baseline, postanesthesia effect, and propofol effect (Emax model). The propofol concentration at half maximum effect was 1.76 mg/l (coefficient of variation = 47%) for the COMFORT-Behavior scale and 3.71 mg/l (coefficient of variation = 145%) for the Bispectral Index. CONCLUSIONS: Propofol clearance is two times higher in nonventilated healthy children than reported in the literature for ventilated children and adults. Based on the model, the authors advise a propofol dose of 30 mg/h in a 10-kg infant to achieve values of 12-14 on the COMFORT-Behavior scale and 70-75 on the Bispectral Index during the night. Wide pharmacodynamic variability emphasizes the importance of dose titration

Peeters RYM, Prins SA, Knibbe CAJ, DeJongh J, Mathôt RAA, van Schaik RHN, Tibboel D, Danhof M. Vergelijking met midazolam. Populatiefarmacokinetiek, populatiefarmacodynamiek en veiligheid van propofol bij niet-beademde kinderen op de IC na craniofaciale chirurgie. Pharmaceutisch Weekblad 2006; 141(3):91-94.

Phernambucq EC, Biesma B, Smit EF, Paul MA, Tol AV, Schramel FM, Bolhuis RJ, Postmus PE. Multicenter phase II trial of accelerated cisplatin and high-dose epirubicin followed by surgery or radiotherapy in patients with stage IIIa non-small-cell lung cancer with mediastinal lymph node involvement (N2-disease). British Journal of Cancer 2006; 95(4):470-474.

Abstract: To assess the therapeutic activity of accelerated cisplatin and high-dose epirubicin with erythropoietin and G-CSF support as induction therapy for patients with stage IIIa-N2 non-small-cell lung cancer (NSCLC). Patients with stage IIIa-N2 NSCLC were enrolled in a phase II trial. They received cisplatin 60 mg m(-2) and epirubicin 135 mg m(-2) every 2 weeks for three courses combined with erythropoietin and G-CSF. Depending on results of clinical response to induction therapy and restaging, patients were treated with surgery or radiotherapy. In total, 61 patients entered from March 2001 to April 2004. During 169 courses of induction chemotherapy, National Cancer Institute of Canada (NCI-C) grade III/IV leucocytopenia was reported in 35 courses (20.7%), NCI-C grade III/IV thrombocytopenia in 26 courses (15.4%) and NCI-C grade III/IV anaemia in six courses (3.6%). Main cause of cisplatin dose reduction was nephrotoxicity (12 courses). Most patients received three courses. There were no chemotherapy-related deaths. Three patients were not evaluable for clinical response. Twenty-eight patients had a partial response (48.3%, 95% CI: 36-61.1%), 24 stable disease and six progressive disease. After induction therapy, 30 patients underwent surgery; complete resection was achieved in 19 procedures (31.1%). Radical radiotherapy was delivered to 25 patients (41%). Six patients were considered unfit for further treatment. Median survival for all patients was 18 months. Response rate of accelerated cisplatin and high-dose epirubicin as induction chemotherapy for stage IIIa-N2 NSCLC patients is not different from more commonly used cisplatin-based regimen.British Journal of Cancer (2006) 95, 470-474. doi:10.1038/sj.bjc.6603289 www.bjcancer.com Published online 8 August 2006

Plantenga NJ, de Vries JPPM. Diagnose in beeld (267). Een man met een pijnlijk ulcus op de vinger. Nederlands Tijdschrift voor Geneeskunde 2006; 150(12):670.

Ponfoort ED, van de Pavoordt HD, Overtoom TT, The RM, de Vries JP. Vier patienten met een aneurysma van de A. hepatica. Nederlands Tijdschrift voor Geneeskunde 2006; 150(25):1402-1406.

Abstract: Two men aged 73 and 71 years and 2 women aged 76 and 80 years were referred for a false aneurysm (the 3rd patient) or true aneurysm (the other 3 patients) of an extrahepatic portion of the hepatic artery. The first patient was asymptomatic, the third patient had a rupture in the biliary duct and the remaining 2 patients had upper abdominal pain. In the first 2 patients, the aneurysm was removed surgically and replaced with a venous interposition graft. The 3rd patient received a coated stent. In the 4th patient, the artery was occluded, after which hepatic circulation recovered spontaneously. Treatment was successful in all 4 patients. Aneurysm of the hepatic artery is identified increasingly more often due to the current capabilities of diagnostic imaging. Elective treatment is indicated if the diameter is > 2 cm due to the increased risk of rupture, which has been associated with mortality rates of up to 40%. Primarily, endovascular treatment should be considered by means of a coated stent or aneurysm coiling. For patients with compromised intestinal circulation, surgical elimination with venous reconstruction is the treatment of choice

Post MC, Luermans JGLM, Temmerman F, Thijs V, Schonewille WJ, Plokker HWM, Suttorp MJ, Budts W. Closure of a patient foramen ovale is associated with a decrease in prevalence of migraine: a prospective observational study. Netherlands Heart Journal 2006; 14(suppl 1):13.

Post MC, Thijs V, Schonewille WJ, Budts W, Snijder RJ, Plokker HW, Westermann CJ. Embolization of pulmonary arteriovenous malformations and decrease in prevalence of migraine. Neurology 2006; 66(2):202-205.

Abstract: OBJECTIVE: To determine if embolization of pulmonary arteriovenous malformations (PAVMs) decreases the occurrence of migraine. METHODS: All 105 patients with hereditary hemorrhagic telangiectasia (HHT), minimum age 16 years, who underwent an embolization of PAVM in our hospital between June 1995 and April 2004, were included in this study. A structured headache questionnaire was sent to all patients and focused on two periods: 1 year before and at least 6 months after embolization. Two independent neurologists diagnosed migraine according to the International Headache Society criteria. RESULTS: Eighty-four patients (80%) sent back the questionnaire (mean age 47.8 +/- 15.1 years, 51 female). Median follow-up time was 48 months (first quartile: 23 months; third quartile: 66 months). The overall prevalence of migraine decreased from 45.2% before to 34.5% after embolization (p = 0.01). The prevalence of migraine with aura decreased from 33.3% before to 19.0% after embolization (p = 0.002). The severity of headache attacks decreased in patients who still had migraine (p = 0.15) or migraine with aura after embolization (p = 0.11). CONCLUSION: Embolization of pulmonary arteriovenous malformations in patients with hereditary hemorrhagic telangiectasia seems to be related to a decrease in prevalence of migraine, suggesting that the presence of a right-to-left shunt rather than the localization of this shunt plays a causative role in the pathogenesis of migraine

Post MC, Biesma DH. Etoposide-induced alveolar damage in chronic myelomonocytic leukaemia. 18e Internistendagen : abstractboek : 27& 28 april 2006 MECC Maastricht 2006;(130).

Post MC, Suttorp MJ, Jaarsma W, Plokker HW. Comparison of outcome and complications using different types of devices for percutaneous closure of a secundum atrial septal defect in adults: A single-center experience. Catheterization & Cardiovascular Interventions 2006; 67(3):438-443.

Abstract: The objective of this study was to find differences in outcome and complications using three different types of devices for percutaneous atrial septal defect (ASD) closure in adults. Percutaneous closure of a secundum-type ASD is increasingly performed in adult patients. All adult patients who underwent a percutaneous closure of a secundum-type ASD in our center between November 1996 and November 2004 were included. Failure was defined as dislocation or embolization of the device, which required surgical intervention. Periprocedural and mid-term complications were registered. Sixty-five patients, mean age 45.7 +/- 18.1 years (18 men, 47 women), underwent a percutaneous closure of an ASD with an ASDOS in 3, an Amplatzer in 36, and a Cardioseal/Starflex closure device in 26 patients. During an overall median follow-up of 1.2 years (range, 0.1-6.7 years), the failure occurred in four patients, all Cardioseal/Starflex (P = 0.04). Within the Cardioseal/Starflex subgroup, the ASD and device diameters were significantly higher in those patients in whom the primary endpoint occurred compared to the others, 18.8 +/- 3.8 vs. 13.0 +/- 3.8 mm for ASD diameter (P = 0.01) and 40 (range, 40-43) vs. 33 mm (range, 20-40) for device diameter (P = 0.008). Overall complications were transient arrhythmias in 15.4%, pericardial effusion in 1.5%, and transient ischemic attack in 1.5%. Complete closure 6 months after the procedure occurred in 79.6%, without difference between the devices. Percutaneous ASD closure seems to be a relatively safe and effective procedure. However, using the larger Cardioseal/Starflex devices for closure seems to be related to a higher rate of device dislocation and embolization. (c) 2006 Wiley-Liss, Inc

Post MC, Budts W. The Relationship Between Migraine and Right-to-Left Shunt: Fact or Fiction? Chest 2006; 130(3):896-901.

Abstract: The prevalence of a right-to-left shunt, both cardiac and pulmonary, is high in patients with migraines, especially migraine with aura. Percutaneous closure of a right-to-left shunt seems to be associated with a pronounced decrease in the number of migraine attacks or its prevalence. In this review, the relationship between migraine and right-to-left shunting is described by highlighting the different pathophysiologic hypotheses

Post MC. Shunt closure and migraine relief. Enschede: FEBO druk B.V., 2006.

Post S, Smits A, Sluijter J, Hoefer I, Snijder R, Mager J, Westermann C, Pasterkamp G, Doevendans PA, Goumans M-J. A disturbed mononuclear CXCR4/CD26 balance results in impaired homing in vivo. NIH meeting on HHT, Bethesda, Maryland, USA; June 8-9 2006.

Ramnarain D, Beerepoot L, Schutgens REG, Biesma DH. Bleeding and thrombosis : two sides of a medallion during asparaginase treatment for acute lymphoblastic leukemia. 18e Internistendagen : abstractboek : 27& 28 april 2006 MECC Maastricht 2006;69-70.

Rigter S, van Dongen HPA. Does etiology matter in prevention of catheter-related blood stream infection? Nederlands Tijdschrift voor Anesthesiologie 2006; 19(1):30.

Rijkers GT, Prakken BJ. Verstoorde immuunregulatie bij auto-immuniteit. Nederlands Tijdschrift voor Klinische Chemie en Laboratoriumgeneeskunde 2006; 2006(4):248-256.

Rijkers GT, Batstra MR, Allebes W, Janssens PMW. Auto-immuunziekten. Nederlands Tijdschrift voor Klinische Chemie en Laboratoriumgeneeskunde 2006; 31(4):246-248.

Rodel SG, Geelkerken RH, van Herwaarden JA, Kunst EE, van den Berg JC, van der Palen J, Teijink JA, Moll FL. Consistency in endovascular aneurysm repair suitability assessment requires group decision audit. Journal of Vascular Surgery 2006; 43(4):671-676.

Abstract: INTRODUCTION: Proper selection of patient and stent-graft combinations in endovascular aneurysm repair (EVAR) depends on knowledge and experience with the different types of stents that have to be adapted to the patient's unique abdominal aortoiliac anatomy. The aim of this study was to analyze the consistency and variance in EVAR suitability assessment between clinicians. METHODS: Worksheets that contained anatomic data derived from computed tomography scans and angiography were compiled for 202 patients. Five clinicians, all experienced in EVAR surgery, assessed the anatomic data on the worksheets for suitability for three types of stent-grafts. The obtained 3030 assessments represented a quantification of the likelihood of success the clinician expected for effective and durable sealing and fixation of the stent-graft in EVAR. The Delphi method was used to determine consensus in the thinking process among clinicians, and kappa analysis was used to determine the proportion of variances in the assessment result between clinicians. RESULTS: With the Delphi method, Cronbach alpha values of 0.87, 0.87, and 0.90 were reached for the three types of stent-grafts in the second assessment round. The individual clinician-group correlation in round two was between 0.69 and 0.86 for clinicians 1, 2, 3, and 4. Between clinician 5 and the others, correlation varied between 0.43 and 0.64. The kappa values ranged between 0.32 and 0.51 among clinicians 1, 2, and 3. Between clinician 5 and the others, kappa values between 0.08 and 0.29 were reached. CONCLUSION: EVAR suitability estimation in a cohort of patients is highly consistent in a group of experienced clinicians. The EVAR suitability estimation at the individual patient level varies substantially between clinicians, however. Aggregating expert opinions in abdominal aortic aneurysm anatomic suitability assessment for EVAR had the opportunity to replace individual clinician decision diversification in a more solid and consistent group decision process

Roovers JP, van der Bom A, Schagen van Leeuwen JH, Scholten P, Heintz P, van der Vaart H. Effects of genital prolapse surgery on sexuality. Journal of Psychosomatic Obstetrics & Gynecology 2006; 27(1):43-48.

Abstract: OBJECTIVE: A prospective study was performed to evaluate the effects of genital prolapse surgery on sexuality. Additionally we investigated which variables are risk factors for persistence or development of sexual problems after surgery. METHODS: All 82 patients participating in a randomized trial comparing vaginal and abdominal surgical correction of descensus uteri, were asked to complete the Questionnaire for screening Sexual Dysfunctions (QSD) before and at six months and one year after surgery. RESULTS: Sixty-two patients completed the questionnaire. General satisfaction about sexuality was significantly improved after surgery. Of 41 patients who were sexually active both before surgery and at one year after surgery, 28 (68.3%) patients reported sexual problems before surgery. In 13 (46.4%) of these patients, all sexual problems disappeared. Of the 13 patients without sexual problems before surgery, two patients reported de novo sexual problems. The relative risk on disappearance of sexual problems in patients with large cystocele was 1.5 (95% confidence interval 1.1-2.1) times higher than the risk in patients without large cystocele. CONCLUSION: Satisfaction about sexuality increases and the prevalence of sexual problems decreases in patients undergoing surgical correction of descensus uteri

Rosenthal D, Martin JD, Smeets L, Devries JP, Gisbertz S, Wellons ED, Moll F. Remote superficial femoral artery endarterectomy and distal aSpire stenting: results of a multinational study at three-year follow-up. Journal of Cardiovascular Surgery 2006; 47(4):385-391.

Abstract: AIM: The aim of this study was to examine the results of remote superficial femoral artery endarterectomy (RSFAE) in conjunction with distal aSpire stenting in a multinational study. METHODS: RSFAE is a minimally invasive procedure performed through a limited groin incision. A total of 210 patients were included in this study. The indications for the procedure were claudication in 158 (75%) patients and limb salvage in 52 (25%). After RSFAE the outflow tract atheromatous plaque was ''tacked'' with the aSpire stent, which is an expanded polytetrafluoroethylene (ePTFE) covered nitinol stent with high radial strength, yet it is flexible enough to withstand the compressive forces at the knee joint. Prior to stent deployment, if the stent position is not in optimal position, it can be ''wrapped down'', repositioned and re-expanded. Therefore, not only is the plaque end point tacked, but the collaterals are preserved as well. All patients underwent follow-up examination with serial color-flow duplex ultrasound scanning. RESULTS: The mean length of endarterectomized superficial femoral arteries (SFAs) was 28.2+/-6.2 cm (range 15-43 cm). The primary cumulative patency rate by means of life-table analysis was 60.6+/-4.8% (SE) at 33 months, (mean 17.1 months; range 1-33 months). During follow-up percutaneous transluminal balloon and/or stent angioplasty was necessary in 50 patients for a primary assisted patency of 70.2+/-4.8% at 33 months. The locations of the restenosis after RSFAE were evenly distributed along the endarterectomized artery. There were 2 deaths (myocardial infarctions), 12 (5.7%) wound complications (7 hematomas, 5 skin edge sloughs) and the mean hospital length of stay was only 1.3+/-0.5 days. CONCLUSION: RSFAE with distal aSpire stenting is a minimally invasive, safe durable procedure for the treatment of long-segment SFA occlusive disease

Rovers MM, Balemans WA, Sanders EA, van der Ent CK, Zielhuis GA, Schilder AG. Persistence of upper respiratory tract infections in a cohort followed from childhood to adulthood. Family practice 2006; 23(3):286-290.

Abstract: OBJECTIVE: To assess (1) prevalences of recurrent URTIs (rURTIs) and relapsing/persistent rURTIs and associated medical consumption between 0 and 21 years of age and (2) whether rURTIs experienced in early life predispose to upper airway disease later in life. METHODS: A cohort of all children born in Nijmegen, The Netherlands, between September 1982 and September 1983, was assessed repeatedly from 2 to 21 years of age with questionnaires regarding infections of the upper respiratory tract (URTIs), use of antibiotics, ENT operations and known risk factors for URTIs. RESULTS: One hundred and sixty-one of the 693 cohort member (23%) suffered from relapsing rURTIs between 0 and 21 years of age, whereas only 7 (1%) suffered from persistent rURTIs throughout this period. Two hundred and six (30%) had used antibiotics more than once; and 220 (32%) had undergone at least one ENT operation. Of the 166 participants with rURTI between 8 and 21 years, 140 (84%) had had rURTI before. CONCLUSIONS: rURTIs are highly prevalent throughout early life and associated medical consumption is substantial. The challenge therefore is to develop therapeutic/preventive strategies that will prevent rURTIs in the first years of life

Roza T, Kooistra A, Dom P, Onaca MG. Scrotale tuberculose. Nederlands Tijdschrift voor Urologie 2006;(februari).

Saltzherr TP, Borghans HJ, Bakker RH, Go PM. Proximale femurfracturen bij ouderen in Nederland in de periode 1991-2004: incidentie, sterfte, opnameduur en schatting van de in de toekomst benodigde zorgcapaciteit. Nederlands Tijdschrift voor Geneeskunde 2006; 150(47):2599-2604.

Abstract: OBJECTIVE: To assess the incidence of operations for neck and pertrochanteric femur fractures during the last 15 years and to estimate the future demand for such operations in The Netherlands. DESIGN: Retrospective. METHOD: For the years 1991, 1995, 2000 and 2004, the following anonymised data were collected in the National Medical Registry of Prismant for all patients admitted to Dutch hospitals for a hip fracture: age-group, gender, length of pre- and postoperative hospital stay, destination after discharge and hospital mortality. These data were related to demographic data for the Dutch population from Statistics Netherlands (CBCS) and to estimates for the Dutch population in the future from Primos Prognostic Data. RESULTS: The average absolute increase in the period 1991-2004 was linear, with 230 fractures per year. Women were operated for a hip fracture 1.5-2 times as often as men in the same age range. The age-specific incidence remained constant over the years but the absolute number of elderly persons per age group increased. The average length of pre- and postoperative hospital stay was reduced by half during the period under investigation. The postoperative hospital mortality decreased from 8.1% in 1991 to 5.6% in 2004, and was 1.5 times as high for men aged 70 years or over as for women of the same age group. In 2004 as compared to 1991, 2.5 times as many patients were discharged to a nursing home. In view of the increasing age of the population, the total number of operated hip fractures can be expected to be 20,200 in the year 2010 and 23,900 in the year 2020. CONCLUSION: In the period 1991-2004 there was an annual increase of 230 operations for proximal femur fractures that was closely related to the ageing of the Dutch population. During the years under investigation, the incidence in the same age range was higher in women, but men had a higher hospital mortality. It is estimated that the decreasing hospital mortality and the decrease in the length of hospital stay will increase the need for nursing-home care for this category of patients

Sandberg Y, Dezentje VO, Szuhai K, van Houte AJ, Tielemans D, Wolvers-Tettero IL, van Dongen JJ, van der Griend R, Langerak AW. Clonal T- and natural killer-cell large granular lymphocyte proliferations in a single patient established by array-based comparative genomic hybridization analysis. Leukemia 2006; 20(12):2212-2214.

Schagen van Leeuwen JH, van Lith JJM, Heringa MP. Indicatoren en kwaliteit ; kwali-rijk, kwali-kwansel of kwali-kwijt? Nederlands Tijdschrift voor Obstetrie & Gynaecologie 2006; 119(4):26-28.

Schagen van Leeuwen JH, Castro R, Busse M, Bemelmans BL. The placebo effect in the pharmacologic treatment of patients with lower urinary tract symptoms. European Urology 2006; 50(3):440-453.

Abstract: OBJECTIVES: We reviewed placebo responses in randomised controlled trials (RCTs) for pharmacologic treatment of lower urinary tract symptoms (LUTS), including urinary incontinence (UI), overactive bladder, and benign prostatic hyperplasia. Review papers on placebo effects in non-urologic disorders were assessed to compare the magnitude of placebo responses in drugs for LUTS with those reported for other diseases. METHODS: Data were retrieved from registration trials for LUTS drugs on the Web sites of the Food and Drugs Administration and the European Medicines Agency. Reviews were retrieved from Medline using the MeSH term "placebo effect" (English language; published between 1990 and 2005). RESULTS: Placebo treatment of LUTS yields reductions in incontinence episodes (IEs) ranging from 32% to 65%, whereas prostate or UI symptom scores are reduced by 9-34%. Genuine drugs decrease IEs by 45-77% and symptom scores by 22-45%. Placebo responses are much lower when objective changes in voided volume or peak flow rate are assessed. CONCLUSIONS: The placebo effect in LUTS has a strong behavioural component as patients become aware of their voiding habits and potential risk factors. Symptom severity, treatment naivety, study duration, and interaction with health care providers may also influence it. Proper patient selection, study duration, and objective and subjective outcome measures may better separate genuine treatment effects from artefacts. Observational studies with patients representative for real-life situations and covering a sufficient period of time could allow for better understanding of RCT results and their applicability in clinical practice

Scheffer RC, Samsom M, Hebbard GS, Gooszen HG. Effects of partial (Belsey Mark IV) and complete (Nissen) fundoplication on proximal gastric function and esophagogastric junction dynamics. American Journal of Gastroenterology 2006; 101(3):479-487.

Abstract: OBJECTIVES: This study aimed to assess the effects of Belsey Mark IV 270 degrees (partial) and Nissen 360 degrees (complete) fundoplication on proximal stomach function, transient lower esophageal sphincter relaxation (TLESR) elicitation and the esophagogastric junction (EGJ) pressure profile during TLESR to further elucidate the mechanism of action of fundoplication. METHODS: Ten patients after partial and 10 patients after complete fundoplication were studied. High-resolution EGJ manometry and pH recording were performed for 1 h at baseline and 2 h following meal ingestion (500 mL/300 kcal). Three dimensional (3D) ultrasonographic images of the stomach were acquired every 15 min after meal ingestion. From the 3D ultrasonographic images, proximal gastric volumes were computed. RESULTS: Postprandial proximal to complete gastric volume distribution ratios were larger among patients after partial (0.42 +/- 0.028) compared with patients after complete fundoplication (0.37 +/- 0.035; p < 0.05). Partial fundoplication patients had a markedly greater postprandial rate of TLESR (1.7 +/- 0.3/h) than patients after complete fundoplication (0.8 +/- 0.2/h; p < 0.05). The axial EGJ pressure profile was minimally affected by partial fundoplication but instead markedly changed after complete fundoplication. CONCLUSIONS: Patients after partial fundoplication exhibit a larger meal-induced increase in proximal stomach volume, a higher TLESR rate, and a minimally affected axial EGJ pressure profile compared to patients after complete fundoplication

Schepens M. Aortic Surgery in Marfan patients. In: Chiesa R, Melissano G, Alfieri O, editors. Aortic Surgery "How to do it" II. [S.l.]: Arte Grafiche Colombo s.r.l., 2006: 44-45.

Schepens M, Dossche K. Surgical treatment of acute type B dissection. In: Rousseau H, Verhoye JP, Heautot JF, editors. Thoracic Aortic Diseases. Berlin Heidelberg: Springer-Verlag, 2006: 175-180.

Schepens M. Een aortadissectie: een levensbedreigende en verscheurende situatie. In: Bakker J, van den Boogaard MHWA, de Lange B, editors. Intensive care capita selecta 2006. Utrecht: Venticare, 2006: 107-111.

Schiphorst AH, Besselink MG, Venneman NG, Go PM. Symptomatisch galsteenlijden: een operatie-indicatie. Nederlands Tijdschrift voor Geneeskunde 2006; 150(44):2405-2409.

Abstract: Three patients, men in the ages of 58, 66 and 56 years, respectively, had experienced 'warning colics' a considerable time before gallstone complications or severe recurrent colic. Ultrasonographically proven gallstones had not led to cholecystectomy. The 58-year-old man died of sepsis due to infected pancreatic necrosis; the other men underwent laparoscopic cholecystectomy, after which they recovered fully. Approximately 10-5% of the adult Dutch population have gallstones, but only 10% will develop symptoms. The annual risk for developing complicated gallstone disease is 1-2% in asymptomatic gallstone carriers. Of patients admitted with complicated gallstone disease, 58% have had prior 'warning colics'. Complicated gallstone disease can be prevented by timely treatment after recognition of warning colics. Cholecystectomy is indicated in patients with intermittent upper-abdominal pain and proven gallstones or sludge

Schiphorst AHW, Besselink MGH, Boerma D, Timmer R, Wiezer MJ, van Erpecum KJ, van Ramshorst B. Timing van cholecystectomie na ERCP met sfincterotomie voor galstenen. Nederlandse Vereniging voor Heelkunde Abstracts najaarsvergadering 2006 2006.

Schoenmakers MCJ, Bal ET, van Swieten HA. Cardiac surgery and operative mortality in 1992 and 2002 : the St Antonius experience. Netherlands Heart Journal 2006; 14(4):132-138.

Scholten E, Bras LJ, van Rooijen P, Aarts LPHJ, de Boer A, Schepens MAAM, van Dongen HPA. Postoperative ICU stay after TAA(A) surgery complicated by postoperative infections. Nederlands Tijdschrift voor Anesthesiologie 2006; 19(1):20.

Schotman M, Giesbers AAGM, Vijverberg PLM. Heeft de perineale prostatectomie nog toekomst? Nederlands Tijdschrift voor Urologie 2006;(6):73.

Schultz MJ, Royakkers AA, Levi M, Moeniralam HS, Spronk PE . Intensive Insulin Therapy in Intensive Care: An Example of the Struggle to Implement Evidence-Based Medicine. PLoS Medicine 2006; 3(12):e456.

Schultz MJ, Spronk PE, Moeniralam HS. Tight glycaemic control: a survey of intensive care practice in the Netherlands. Intensive Care Med 2006; 32(4):618-619.

Schuurman T, Roovers A, van der Zwaluw WK, van Zwet AA, Sabbe LJM, Brok M, Heilmann F, Buiting A, Ligtvoet E, Kooistra-Smid AMD, van Duynhoven YTHP. Development and validation of real-time pcr assays for, and preliminary results of a multi-center study to assess the prevalence and epidemiology of Shiga-toxin producing Escherichia coli in the Netherlands. Nederlands Tijdschrift voor Medische Microbiologie 2006; 14(Supplement):S86-S87.

Segarceanu EM, de Bruin PC, Veth G, Biesma DH. Primary T-cell lymphoma of the bone : a case report and review of literature. 18e Internistendagen : abstractboek : 27& 28 april 2006 MECC Maastricht 2006;66.

Shahin GM, van der Heijden GJ, Kelder JC, Boulaksil M, Knaepen PJ, Six AJ. Long-term follow-up of mitral valve repair: A single-center experience. Medical Science Monitor 2006; 12(7):CR308-CR314.

Abstract: Background: Our aim was to conduct a long-term follow-up of patients after mitral valve repair for incompetence. We identified determinants for mortality and compared mortality with standardized mortality rates of the Dutch population. Material/Methods: We included in this single-center retrospective study 119 patients operated from March 1976 to February 1981. Patients with previous mitral valve surgery, isolated mitral stenosis, and congenital heart disease were excluded. Routine echocardiography was performed every 6 to 12 months. The cumulative probability of survival was calculated (Kaplan-Meier). The variables that statistically significantly associated with mortality were selected for multivariate analysis. Maximum follow-up was 27 years and complete in 98%. Mean age was 49.4 years, and 55% were preoperatively in New York Heart Association (NYHA) class III. Concomitant cardiac procedures were performed in 49%. Results: The 30-day postoperative mortality was 6.7% and the 20-year overall mortality was 63%. The standardized mortality rate was 30%, which was based on survival rates of the general Dutch population. In 27 cases (22.7%), re-operation was performed. Independent predictors for mortality were, after univariate and multivariate analysis, concomitant coronary artery bypass grafting (p=0.002), renal impairment (p=0.027), age above 60 years (p<?i>=0.05), and ejection fraction </=40% (p=0.05). Conclusions: The observed mortality exceeded the expected mortality. Concomitant coronary artery bypass grafting, renal impairment, age above 60 years, and reduced left ventricular function were independent predictors of mortality in patients with surgical repair for mitral valve regurgitation

Siebenga J, Segers MJ, Elzinga MJ, Bakker FC, Haarman HJ, Patka P. Spine fractures caused by horse riding. European Spine Journal 2006; 15(4):465-471.

Abstract: Study Design: Retrospective study and review of literature. Objectives: Study of demographic data concerning spinal fractures caused by horse riding, classification of fractures according to the AO and Load Sharing classifications, evaluation of mid-term radiological results and long-term functional results. Methods: A review of medical reports and radiological examinations of patients presented to our hospital with horse riding-related spine fractures over a 13-year period; long-term functional follow-up is performed using the Roland Morris Disability Questionnaire (RMDQ-24). Results: Thirty-six spine fractures were found in 32 patients. Male to female ratio is 1:7. Average age is 33.7 years (8-58 years). The majority of the fractures (78%) are seen at the thoracolumbar junction Th11-L2. All but two patients have AO type A fractures. The average Load Sharing Classification score is 4.9 (range 3-9). Neurological examinations show ASIA/Frankel E status for all patients. Surgical treatment is performed on ten patients. Mean follow-up for radiological data is 15 months (range 3-63). Functional follow-up times range from 1 to 13 years with an average follow-up of 7.3 years. Mean RMDQ-24 score for all patients is 5.5 (range: 0-19), with significantly different scores for the non-operative and surgical group: 4.6 vs 8.1. Twenty-two percent of the patients have permanent occupational disabilities and there is a significant correlation between occupational disability and RMDQ-24 scores. Conclusions: Not only are short-term effects of spine fractures caused by horse riding substantial but these injuries can also lead to long-term disabilities

Siebenga J, Leferink VJ, Segers MJ, Elzinga MJ, Bakker FC, Haarman HJ, Rommens PM, ten Duis HJ, Patka P. Treatment of traumatic thoracolumbar spine fractures: a multicenter prospective randomized study of operative versus nonsurgical treatment. Spine 2006; 31(25):2881-2890.

Abstract: STUDY DESIGN: Multicenter prospective randomized trial. OBJECTIVE: To test the hypotheses that thoracolumbar AO Type A spine fractures without neurologic deficit, managed with short-segment posterior stabilization will show an improved radiographic outcome and at least the same functional outcome as compared with nonsurgically treated thoracolumbar fractures. SUMMARY OF BACKGROUND DATA: There are various opinions regarding the ideal management of thoracolumbar Type A spine fractures without neurologic deficit. Both operative and nonsurgical approaches are advocated. METHODS: Patients were randomized for operative or nonsurgical treatment. Data sampling involved demographics, fracture classifications, radiographic evaluation, and functional outcome. RESULTS: Sixteen patients received nonsurgical therapy, and 18 received surgical treatment. Follow-up was completed for 32 (94%) of the patients after a mean of 4.3 years. At the end of follow-up, both local and regional kyphotic deformity was significantly less in the operatively treated group. All functional outcome scores (VAS Pain, VAS Spine Score, and RMDQ-24) showed significantly better results in the operative group. The percentage of patients returning to their original jobs was found to be significantly higher in the operative treated group. CONCLUSIONS: Patients with a Type A3 thoracolumbar spine fracture without neurologic deficit should be treated by short-segment posterior stabilization

Simmers T, Boersma L. Implantable device recalls: are we throwing away the baby with the bath water? Netherlands Heart Journal 2006; 14(12):422-424.

Slee PH, Verzijlbergen JF, Schagen van Leeuwen JH, van der Waal RI. CASE 2. Acquired Hypertrichosis: A Rare Paraneoplastic Syndrome in Various Cancers. Journal of Clinical Oncology 2006; 24(3):523-524.

Sluijter JP, Pulskens WP, Schoneveld AH, Velema E, Strijder CF, Moll F, de Vries JP, Verheijen J, Hanemaaijer R, de Kleijn DP, Pasterkamp G. Matrix metalloproteinase 2 is associated with stable and matrix metalloproteinases 8 and 9 with vulnerable carotid atherosclerotic lesions: a study in human endarterectomy specimen pointing to a role for different extracellular matrix metalloproteinase inducer glycosylation forms. Stroke 2006; 37(1):235-239.

Abstract: BACKGROUND AND PURPOSE: We studied matrix metalloproteinases (MMP) 2, 8, and 9 and extracellular matrix metalloproteinase inducer (EMMPRIN) levels in relation to carotid atherosclerotic plaque characteristics. METHODS: Carotid atherosclerotic plaques (n=150) were stained and analyzed for the presence of collagen, smooth muscle cell (SMC), and macrophages. Adjacent segments were used to isolate total protein to assess MMP-2 and MMP-9 activities and gelatin breakdown, MMP-8 activity, and EMMPRIN levels. RESULTS: Macrophage-rich lesions revealed higher MMP-8 and MMP-9 activities, whereas SMC-rich lesions showed higher MMP-2 activity. The levels of less glycosylated EMMPRIN-45kD were higher in SMC-rich lesions and lower in macrophage-rich plaques. EMMPRIN-45kD was associated with MMP-2 levels, whereas EMMPRIN-58kD was related to MMP-9 levels. CONCLUSIONS: MMP-2, MMP-8, and MMP-9 activities differed among carotid plaque phenotypes. Different EMMPRIN glycosylation forms are associated with either MMP-2 or MMP-9 activity, which suggests that EMMPRIN glycosylation may play a role in MMP regulation and plaque destabilization

Sluman MA, Verhaar MC, van der Wall EE, Westerveld HE. Vrouwen en hart- en vaatziekten. Nederlands Tijdschrift voor Geneeskunde 2006; 150(37):2018-2022.

Snijder RJ. Porto-pulmonary hypertension. In: Benecke NI, editor. Yearbook Pulmonary hypertension 2006. Amsterdam: 2006: 51-61.

Sonneveld P, van Putten W, Biesma D, Holt H, van Marwijk-Kooij M, Kramer M, Weijermans P, Steijaert M, van Imhoff G, Lugtenburg P, Huijgens PJ, Erikson M, Dutch HOVON group, Nordic lymphoma group. Phase III trial of 2-weekly CHOP with Rituximab for aggressive B-cell non-Hodgkin's lymphoma in elderly patients. 48th ASH annual meeting Orlando 2006;A210.

Spijker A, Struijk-Wielenga T. Eten met plezier : dieetinformatie en recepten voor nierpatiënten. 6e ed. Wormer: Inmerc, 2006.

Staartjes WR, Oosterheert JJ, Hustinx WMN, Kaasjager K, Prins J, Slee PHThJ, Bonten MJM, Hoepelman IM. Evaluation of the Binax NOW® Streptococcus pneumoniae urinary antigen test for the diagnosis of pneumococcal pneumonia in adults. 18e Internistendagen : abstractboek : 27& 28 april 2006 MECC Maastricht 2006;91.

Stolk MF, Becx MC, Kuypers KC, Seldenrijk CA. Severe hepatic side effects of ezetimibe. Clinical Gastroenterology & Hepatology 2006; 4(7):908-911.

Abstract: Background & Aims: Ezetimibe was introduced recently as a new class of cholesterol-lowering drugs. Until now only limited increases of transaminase levels were reported. Methods: We studied 2 patients with severe hepatic side effects of ezetimibe in a general community hospital. Results: Ezetimibe may lead to 2 distinct types of severe hepatic side effects. Conclusions: Ezetimibe may rarely cause hepatotoxicity, severe cholestatic hepatitis, or acute autoimmune hepatitis

Sugita J, Cremonesi A, van Elst F, Stockx L, Mathias K, Schofer J, Suttorp MJ, Reul J, Lowens S, Sievert H. European carotid PROCAR Trial: prospective multicenter trial to evaluate the safety and performance of the ev3 Protege stent in the treatment of carotid artery stenosis--1- and 6-month follow-up. Journal of Interventional Cardiology 2006; 19(3):215-221.

Abstract: BACKGROUND: The purpose of the European PROCAR Trial was to evaluate the safety and performance of the Protege stent in the treatment of common and/or internal carotid artery stenoses with adjunctive use of a filter embolic protection device. METHOD: The Protege GPS stent is a self-expanding Nitinol stent system mounted on a 6 Fr 0.018'' (6-9 mm stent) or 7 Fr 0.035'' (10 mm stent) over-the-wire delivery system. Study patient assessments were conducted at baseline, periprocedure, discharge, and 1 and 6 months postprocedure. A total of 77 patients have been enrolled in the trial. RESULTS: In the 77 lesions treated (31 symptomatic, 46 asymptomatic), the procedure was technically successful in 76 (99%), with an average residual stenosis of less than 30%. One procedure failed because the embolic protection device could not be retrieved and the patient was sent to surgery. Within 30 days, there were four (5.2%) major adverse neurological events (MANEs). Three of the MANEs were major strokes (3.9%), one a minor stroke. The fifth MANE occurred prior to the 6-month follow-up visit; this patient had a major stroke 75 days after the procedure and died 36 days later. One additional death occurred because of urosepsis. CONCLUSIONS: The PROCAR trial shows that the Protege stent with adjuvant use of a filter embolic protection device satisfies safety and performance criteria for the treatment of carotid artery stenosis. The incidence of MANEs for the Protege stent is comparable to the incidence of these events in other recent carotid stent studies and standard carotid endarterectomy (CEA)

Suttorp MJ, Laarman GJ, Rahel BM, Kelder JC, Bosschaert MA, Kiemeneij F, ten Berg JM, Bal ET, Rensing BJ, Eefting FD, Mast EG. Primary Stenting of Totally Occluded Native Coronary Arteries II (PRISON II): a randomized comparison of bare metal stent implantation with sirolimus-eluting stent implantation for the treatment of total coronary occlusions. Circulation 2006; 114(9):921-928.

Abstract: BACKGROUND: Sirolimus-eluting stents markedly reduce the risk of restenosis compared with bare metal stents. However, it is not known whether there are differences in effectiveness between bare metal and sirolimus-eluting stents in patients with total coronary occlusions. METHODS AND RESULTS: In a prospective, randomized, single-blind, 2-center trial, we enrolled 200 patients with total coronary occlusions: Half (n = 100) were randomly assigned to receive bare metal BxVelocity stents and half (n = 100) to receive sirolimus-eluting Cypher stents. The primary end point was angiographic binary in-segment restenosis rate at 6-month follow-up. Secondary end points were a composite of major adverse cardiac events, target vessel failure, binary in-stent restenosis rate, in-stent and in-segment minimal lumen diameter, percent diameter stenosis, and late luminal loss at 6-month follow-up. The sirolimus stent group showed a significantly lower in-stent binary restenosis rate of 7% compared with 36% in the bare metal stent group (P < 0.001). The in-segment binary restenosis rate was 11% in the group receiving a sirolimus stent versus 41% in the bare metal stent group (P < 0.0001), resulting in a target lesion revascularization rate of 4% in the sirolimus group versus 19% in the bare metal group (P < 0.001). Patients who received the drug-eluting stent also had significantly lower rates of target vessel revascularization, target vessel failure, and all major adverse cardiac events. CONCLUSIONS: In patients with total coronary occlusions, use of the sirolimus-eluting stents are superior to the bare metal stents with significant reduction in angiographic binary restenosis, resulting in significantly less need for target lesion and target vessel revascularization

Swart EL, van der Waal RIF, Kirtschig G. Systemische medicatie in de dermatologie : Praktische handleiding ten behoeve van een verantwoorde toepassing van anti-inflammatoire middelen. Maarn: Prelum, 2006.

Swinkels BM, Suttorp MJ. Percutane aortaklepvervanging is een goede optie bij niet-operabele symptomatische aortaklepstenose. Nederlands Tijdschrift voor Geneeskunde 2006; 150:1856-1857.

Tan ME, van Boven WJ, van Swieten EA. Combined off-pump coronary surgery and left lung resection through midline sternotomy with a Medtronic Starfish(R) 2 Heart Positioner. Minerva Chirurgica 2006; 61(2):159-161.

Abstract: Concomitant lung malignancy and coronary artery disease is uncommon. When the left lung is involved, the approach is considered to be staged or through left thoracotomy. We present a patient who was operated on for left pneumonectomy and off-pump coronary surgery through a midline sternotomy with the use of a Medtronic Starfish 2 Heart Positioner

te Riele WW, Overtoom TT, van den Berg JC, van de Pavoordt ED, de Vries JP. Endovascular recanalization of chronic long-segment occlusions of the inferior vena cava: midterm results. Journal of Endovascular Therapy 2006; 13(2):249-253.

Abstract: Purpose: To report the midterm results of endovascular recanalization of chronic long-segment (>5 cm) occlusions of the inferior vena cava (IVC) with stent placement. Methods: Nine patients (5 men; median age 30 years, range 14-58) with disabling complaints for more than 6 months caused by IVC occlusions were treated by endovascular recanalization. Mean occlusion length was 11 cm (range 6-22); some occlusions extended to the iliac (n=3) or common femoral (n=2) veins. All procedures were performed under local anesthesia via a bilateral femoral (n=7) or popliteal (n=2) approach. In 3 patients, combined access to the brachial or internal jugular vein was necessary. Patients with acute-on-chronic thrombosis were pretreated with urokinase. After guidewire recanalization, the chronic occlusions were predilated and self-expanding Wallstents were implanted. Results: The initial technical and clinical success was 100%. The venous clinical severity score (pain, venous edema, inflammation, and active ulceration) decreased from a mean 8+/-2 to 5+/-1 after the procedure. Over a median follow-up of 9 months (mean 21, range 4- 110), 3 patients died. One rethrombosis occurred, and an asymptomatic restenosis was discovered on routine imaging. The primary patency rate was 78%, and the 9-month occlusion-free survival rate was 56%. Conclusion: Endovascular recanalization of chronic long-segment occlusions of the IVC is a safe and worthwhile technique to offer patients with debilitating symptoms

ten Berg JM, van Werkum JW, Heestermans AACM, Jaarsma W, Hautvast RMA, den Heijer P, de Boer MJ. Antiplatelet therapy in patients undergoing coronary stenting : the risk of late stent thrombosis. Netherlands Heart Journal 2006; 14(9):297-300.

ten Broeke R, de Crom R, van Haperen R, Verweij V, Leusink-Muis T, van Ark I, de Clerck F, Nijkamp FP, Folkerts G. Overexpression of endothelial nitric oxide synthase suppresses features of allergic asthma in mice. Respiratory research 2006; 7:58.

Abstract: BACKGROUND: Asthma is associated with airway hyperresponsiveness and enhanced T-cell number/activity on one hand and increased levels of exhaled nitric oxide (NO) with expression of inducible NO synthase (iNOS) on the other hand. These findings are in paradox, as NO also relaxes airway smooth muscle and has immunosuppressive properties. The exact role of the endothelial NOS (eNOS) isoform in asthma is still unknown. We hypothezised that a delicate regulation in the production of NO and its bioactive forms by eNOS might be the key to the pathogenesis of asthma. METHODS: The contribution of eNOS on the development of asthmatic features was examined. We used transgenic mice that overexpress eNOS and measured characteristic features of allergic asthma after sensitisation and challenge of these mice with the allergen ovalbumin. RESULTS: eNOS overexpression resulted in both increased eNOS activity and NO production in the lungs. Isolated thoracic lymph nodes cells from eNOS overexpressing mice that have been sensitized and challenged with ovalbumin produced significantly less of the cytokines IFN-gamma, IL-5 and IL-10. No difference in serum IgE levels could be found. Further, there was a 50% reduction in the number of lymphocytes and eosinophils in the lung lavage fluid of these animals. Finally, airway hyperresponsiveness to methacholine was abolished in eNOS overexpressing mice. CONCLUSION: These findings demonstrate that eNOS overexpression attenuates both airway inflammation and airway hyperresponsiveness in a model of allergic asthma. We suggest that a delicate balance in the production of bioactive forms of NO derived from eNOS might be essential in the pathophysiology of asthma

ten Cate TJF, Scheffer MG, Verzijlbergen JF, van Hemel NM. Effect of right ventricular apical and outflow pacing on timing of myocardial activation and wall motion in patients with normal ventricles. Netherlands Heart Journal 2006; 14(suppl 1):14.

ter Borg EJ, Haanen HC, Seldenrijk CA. Relationship between histological subtypes and clinical characteristics at presentation and outcome in biopsy-proven temporal arteritis : Identification of a relatively benign subgroup. Clinical Rheumatology 2006; 26(4):529-532.

Abstract: Temporal arteritis (TA) may offer major complications, whilst high dosage of prednisone may result in serious side effects. We tried to identify a subgroup of TA, which can be treated with a lower dosage of prednisone. Retrospectively, clinical and laboratory data were studied at presentation, as well as the outcome in 44 consecutive patients with biopsy-proven temporal arteritis. These data were related to three particular histological subgroups, (a) classical giant cell arteritis, (b) atypical arteritis, and (c) 'healed arteritis', defined according to Allsop and Gallagher (The American Journal of Surgical Pathology 5:317-332, 1981). At presentation in subgroup c, erythrocyte sedimentation rate was lower and the level of haemoglobin was higher than in the other two subgroups. During follow-up in the healed arteritis group, reactivation, recurrence, or early death were not observed, whilst prednisone dosage after 2 and 3 years was lower compared to subgroup b. Major complications (permanent blindness and cerebrovascular accident) were only observed in subgroups a and b. We believe that the healed arteritis subgroup represents a relatively benign subgroup with a mild clinical presentation and a good prognosis. Therefore, a much lower initial prednisone dosage (15 mg/day) is suggested for patients in subgroup c than in the other two subgroups (40-60 mg/day)

Terng SC, Kuypers KC, Koch AR. Inter-carpal soft tissue entrapment. A possible explanation for chronic dorsal wrist pain. Journal of Hand Surgery - British Volume 2006; 31(1):41-46.

Abstract: This retrospective study evaluates the surgical treatment of a group of patients with unknown chronic dorsal wrist pain. The cause of their symptoms was interpreted as a painful entrapment of fibrous tissue in the radio-carpal and inter-carpal joints during specific movements. Between 1997 and 2001, 30 patients were treated by surgical excision of this tissue and 26 patients were traced for follow-up. Twenty-three patients were symptom free, or experienced major benefit from surgery. Wrist function measurements using the VAS scale showed improvement in 24 patients. Microscopic examination of the removed specimen shows fibrous tissue with non-specific changes. Inter-carpal soft tissue entrapment can explain the typical clinical findings in some patients with unknown chronic dorsal wrist pain. After careful selection, surgical excision of all entrapped tissue in the radio-carpal and mid-carpal joint may give relief of pain and improvement of wrist function

Tersmette M, van Dongen-Schmets MM, Bijl M, van Bemmelen FM, Jonkman A. Samen de markt op : specialisten en raad van bestuur bepalen gezamenlijk het ziekenhuisprofiel. Medisch Contact 2006; 61(31/32):1260-1263.

Teutelink A, Rutten A, Muhs BE, Olree M, van Herwaarden JA, de Vos AM, Prokop M, Moll FL, Verhagen HJ. Pilot study of dynamic cine CT angiography for the evaluation of abdominal aortic aneurysms: implications for endograft treatment. Journal of Endovascular Therapy 2006; 13(2):139-144.

Abstract: PURPOSE: To utilize 40-slice electrocardiographically (ECG)-gated cine computed tomographic angiography (CTA) to characterize normal aortic motion during the cardiac cycle at relevant anatomical landmarks in preoperative abdominal aortic aneurysm (AAA) patients. METHODS: In 10 consecutive preoperative AAA patients (10 men; mean age 78.8 years, range 69-86), an ECG-gated CTA dataset was acquired on a 40-slice CT scanner using a standard radiation dose. CTA quality was graded and scan time was measured. Pulsatility measurements at multiple relevant anatomical levels were performed in the axial plane. Changes in aortic circumference were determined for both the aortic wall and the luminal diameter. RESULTS: All 10 CT scans were of good quality. All patients could be scanned in 14 to 33 seconds (mean 21). At each anatomical level measured, there was a 2.2- to 3.4-mm increase in the aortic wall circumference per cardiac cycle. A similar increase was observed in luminal circumference, with a 2.4- to 3.6-mm increase per cycle. CONCLUSION: This study introduces the concept of dynamic cine CTA imaging of aortic motion, providing insight into the pathophysiology of abdominal aortic and iliac pulsations. Patients with AAAs selected for EVAR demonstrate changes in aortic circumference with each cardiac cycle that may have consequences for endograft sizing and future design. The potential for graft migration, intermittent type I endoleak, and poor patient outcome following EVAR can be anticipated. Complex aortic dynamics deserve increased scrutiny in an effort to prevent potential complications

Thomeer MG, Pattynama PM, Hartmann IJ, Kieft GJ, van Strijen MJ. High incidence of isolated subsegmental pulmonary emboli on multi-slice spiral CT: a comparative clinical study. Thrombosis & Haemostasis 2006; 95(5):914-915.

Tupker RA, Dubois AEJ, de Groot H, Knulst AC, Lucker GPH. Leidraad immunotherapie voor insecten. Nederlands Tijdschrift voor Dermatologie en Venereologie 2006; 16(7):293-297.

Tupker RA, Harmsze AM, Deneer VH. Oxybutynin therapy for generalized hyperhidrosis. Archives of Dermatology 2006; 142(8):1065-1066.

Tupker RA, Pinnagoda J. Measurement of transepidermal water loss by semiopen systems. In: Serup J, editor. Handbook of non-invasive methods and the skin. Boca Raton: Informa Healthcare, 2006: 383-393.

Tupker RA. Sodium lauryl sulfate (SLS) testing: ESCD application and reading standards. In: Serup J, editor. Handbook of non-invasive methods and the skin. Boca Raton: Informa Healthcare, 2006: 943-955.

Tupker RA. Wat is een kokkogeen eczeem en hoe is dit te behandelen? Vademecum permanente nascholing huisartsen 2006; 24(27).

van Beek FT, Maas KW, Timmer R, Seldenrijk CA, de Bruin PC, Schramel FM. Slokdarmendo-echografie met dunnenaaldaspiratie ter stadiering bij niet-kleincellig longcarcinoom; resultaten bij 43 patienten. Nederlands Tijdschrift voor Geneeskunde 2006; 150(3):144-150.

Abstract: OBJECTIVE: To calculate the number of cervical mediastinoscopies that need not be carried out ifoesophageal endoscopic ultrasound and fine-needle aspiration biopsy (EUS-FNA) are included in the staging of patients with non-small-cell lung carcinoma (NSCLC). DESIGN: Retrospective, descriptive. METHOD: Patients referred to the St. Antonius Hospital in Nieuwegein, the Netherlands, with NSCLC from January to December 2003 routinely underwent EUS-FNA during the staging process. If mediastinal or distant metastases were found to be present then cervical mediastinoscopy was not carried out as the patient was not eligible for operation. If no metastases were demonstrated then cervical mediastinoscopy was carried out. The value of EUS-FNA was calculated. RESULTS: A total of 43 patients underwent EUS-FNA: 32 men and 11 women with an average age of 64 (range: 45-77). In 22 (51%) of them, cervical mediastinoscopy was not performed as EUS-FNA demonstrated malignant cells in the lymph nodes of the mediastinum or abdomen, in the left adrenal gland or in the primary tumour which had grown into the mediastinum. In 2 of the 21 other patients malignant cells were found on mediastinoscopy showing the EUS-FNA results in 2 of 43 patients (5%) to be false-negative. No complications occurred. CONCLUSION: Based on the findings from EUS-FNA, cervical mediastinoscopy was not performed in 51% of the patient group

van Belle A, Buller HR, Huisman MV, Huisman PM, Kaasjager K, Kamphuisen PW, Kramer MH, Kruip MJ, Kwakkel-van Erp JM, Leebeek FW, Nijkeuter M, Prins MH, Sohne M, Tick LW, Christopher Study Investigators, Janssen R, (among others). Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA 2006; 295(2):172-179.

Abstract: CONTEXT: Previous studies have evaluated the safety of relatively complex combinations of clinical decision rules and diagnostic tests in patients with suspected pulmonary embolism. OBJECTIVE: To assess the clinical effectiveness of a simplified algorithm using a dichotomized clinical decision rule, D-dimer testing, and computed tomography (CT) in patients with suspected pulmonary embolism. DESIGN, SETTING, AND PATIENTS: Prospective cohort study of consecutive patients with clinically suspected acute pulmonary embolism, conducted in 12 centers in the Netherlands from November 2002 through December 2004. The study population of 3306 patients included 82% outpatients and 57% women. INTERVENTIONS: Patients were categorized as "pulmonary embolism unlikely" or "pulmonary embolism likely" using a dichotomized version of the Wells clinical decision rule. Patients classified as unlikely had D-dimer testing, and pulmonary embolism was considered excluded if the D-dimer test result was normal. All other patients underwent CT, and pulmonary embolism was considered present or excluded based on the results. Anticoagulants were withheld from patients classified as excluded, and all patients were followed up for 3 months. MAIN OUTCOME MEASURE: Symptomatic or fatal venous thromboembolism (VTE) during 3-month follow-up. RESULTS: Pulmonary embolism was classified as unlikely in 2206 patients (66.7%). The combination of pulmonary embolism unlikely and a normal D-dimer test result occurred in 1057 patients (32.0%), of whom 1028 were not treated with anticoagulants; subsequent nonfatal VTE occurred in 5 patients (0.5% [95% confidence interval {CI}, 0.2%-1.1%]). Computed tomography showed pulmonary embolism in 674 patients (20.4%). Computed tomography excluded pulmonary embolism in 1505 patients, of whom 1436 patients were not treated with anticoagulants; in these patients the 3-month incidence of VTE was 1.3% (95% CI, 0.7%-2.0%). Pulmonary embolism was considered a possible cause of death in 7 patients after a negative CT scan (0.5% [95% CI, 0.2%-1.0%]). The algorithm was completed and allowed a management decision in 97.9% of patients. CONCLUSIONS: A diagnostic management strategy using a simple clinical decision rule, D-dimer testing, and CT is effective in the evaluation and management of patients with clinically suspected pulmonary embolism. Its use is associated with low risk for subsequent fatal and nonfatal VTE

van de Garde EM, Souverein PC, van den Bosch JM, Deneer VH, Leufkens HG. Angiotensin-converting enzyme inhibitor use and pneumonia risk in a general population. European Respiratory Journal 2006; 27(6):1217-1222.

Abstract: The aim of the present study was to assess whether the use of angiotensin-converting enzyme (ACE) inhibitors is associated with a decreased risk of hospitalisation for community-acquired pneumonia (CAP) in a general, essentially white population. Data were obtained from the Dutch PHARMO Record Linkage System. Cases were defined as patients with a first hospital admission for CAP. For each case, up to four population controls were matched by age and sex. The study population comprised 1,108 patients with a first hospital admission for CAP and 3,817 matched controls. After adjusting for several confounders, ACE inhibitor use was not associated with a decreased incidence of pneumonia (adjusted odds ratio (OR) 1.12; 95% confidence interval (CI) 0.88-1.43). Additionally, no significant association was observed in patients with diabetes, respiratory diseases, heart failure, or patients with both of the last two conditions. Furthermore, adjustment of treatment effects on pneumonia risk using stratification on balancing score also showed no significant association between ACE inhibitor use and pneumonia risk within the different strata (overall adjusted OR 1.09; 95% CI 0.87-1.36). In contrast with previous findings in Asian populations, the current authors were not able to confirm the beneficial effect of angiotensin-converting enzyme inhibitors on pneumonia risk in a general, essentially white population

van de Garde EM, Bras LJ, Heijmen RH, Knibbe CA, van Dongen EP, Wiltink EH, Biesma DH. Low-Dose Recombinant Factor VIIa in the Management of Uncontrolled Postoperative Hemorrhage in Cardiac Surgery Patients. Journal of Cardiothoracic & Vascular Anesthesia 2006; 20(4):573-575.

van de Garde EM, Souverein PC, van den Bosch JM, Deneer VH, Goettsch WG, Leufkens HG. Prior outpatient antibacterial therapy as prognostic factor for mortality in hospitalized pneumonia patients. Respiratory Medicine 2006; 100(8):1342-1348.

Abstract: STUDY OBJECTIVES: To assess whether prior outpatient treatment is associated with outcome in patients hospitalized for community-acquired pneumonia (CAP). PATIENTS AND METHODS: All patients with a first hospital admission for CAP between 1995 and 2000 were selected. Patients were divided into two groups, one of patients with use of antibacterial agents prior to hospitalization and one of patients treated as inpatient directly. The main outcome measures were duration of hospital stay and in-hospital mortality. RESULTS: The two patient groups comprised 296 and 794 patients, respectively. The median duration of hospital stay was 10 days and was similar for both groups. In patients with respiratory diseases or heart failure, the median duration of hospital stay was 12 and 14 days, respectively. The overall in-hospital mortality was 7.2% and did not largely differ between both groups. In patients with congestive heart failure, the mortality was 9.8% for controls and 23.3% for patients hospitalized after initial outpatient treatment (adjusted OR 2.78, 95% CI 1.01-7.81). CONCLUSIONS: Prior outpatient antibacterial therapy is not associated with outcome in hospitalized pneumonia patients. In patients with underlying chronic heart failure, prior outpatient antibiotic is associated with a significant increased mortality

van de Garde EM, Hak E, Souverein PC, Hoes AW, van den Bosch JM, Leufkens HG. Statin therapy and reduced risk of pneumonia in patients with diabetes. Thorax 2006; 61(11):957-961.

Abstract: Background: Recent prognostic studies showed that prior statin therapy is associated with better outcome in patients hospitalized for pneumonia. Because of an increased risk of pneumonia in patients with diabetes we aimed to assess the effects of statin use on the occurrence of pneumonia in adult diabetic patients. Methods: We included all patients with a diagnosis of diabetes (both type 1 and type 2) enlisted in the U.K. General Practice Research Database between 1/6/1987 and 21/1/2001. A case-control study was performed with cases defined as patients with a first recorded diagnosis of pneumonia. For each case, up to 4 controls were matched by age, gender, practice, and index date. Patients were classified as current user when the index date was between start and end date of statin therapy. Conditional multiple logistic regression analysis was used to estimate the strength of the association between statin therapy and pneumonia occurrence. Results: Statins were used in 1.1% of 4,719 cases and in 2.1% of 15,322 matched controls (crude OR: 0.51, 95% CI 0.37-0.68). After adjusting for potential confounders, statin therapy was associated with a significant reduction in pneumonia risk (adjusted OR: 0.49, 95% CI 0.35-0.69). The association was consistent among relevant subgroups (cardiovascular diseases, pulmonary diseases) and independent of use of other prescription drugs. Discussion: Use of statins was associated with a considerable reduction in pneumonia risk in diabetic patients and may apart from cardiovascular risk lowering properties be useful in prevention of respiratory infections

van de Garde EM, Hak E, Souverein PC, Hoes AW, van den Bosch JM, Leufkens HG. Statin therapy and reduced risk of pneumonia in elderly patients with diabetes. European Respiratory Journal 2006; 28(S50):S531.

van de Garde EMW, Hak E, Souverein PC, Hoes AW, van den Bosch JMM, Leufkens HGM. Statin therapy and reduced risk of pneumonia in elderly patients with diabetes. Pharmacoepidemiology and Drug Safety 2006; 15(S1):S47-S48.

van de Garde EMW, Souverein PC, Hak E, Deneer VHM, van den Bosch JMM, Leufkens HGM. ACE-inhibitor use and decreased pneumonia risk in elderly patients with diabetes. European Journal of Epidemiology 2006; 21:S30.

van de Wal RM, Plokker HW, Lok DJ, Boomsma F, van der Horst FA, van Veldhuisen DJ, van Gilst WH, Voors AA. Determinants of increased angiotensin II levels in severe chronic heart failure patients despite ACE inhibition. International Journal of Cardiology 2006; 106(3):367-372.

Abstract: INTRODUCTION: The beneficial effects of ACE inhibitors are generally ascribed to blockade of neurohormonal activation. However, especially in chronic heart failure (CHF) patients plasma angiotensin II and aldosterone levels can be elevated despite ACE inhibition, the so-called ACE escape. In the present study, we aimed to identify the frequency and determinants of ACE escape in CHF patients. METHODS: We studied 99 stable chronic heart failure patients (NYHA class III and IV, 66% ischemic etiology) receiving long-term therapy with ACE inhibitors. In all patients, cardiac, renal, and neurohormonal parameters were measured. ACE escape was defined as plasma angiotensin level > or = 16 pmol/L. RESULTS: Mean (+/- SD) left ventricular ejection fraction of our 99 patients (79 men and 20 women, age 69 +/- 12 years) was 28 +/- 10%. In addition to an ACE inhibitor, 93% of patients received diuretics, 71% a beta-blocker, and 49% spironolactone. None of the patients used an angiotensin receptor blocker. In our population, 45% of the patients had an angiotensin II plasma concentration higher than 16 pmol/L (median concentration was 14.1 pmol/L). Spironolactone use was an independent predictor of elevated plasma angiotensin II levels. Furthermore, spironolactone users had significantly higher plasma active renin protein and aldosterone levels. Plasma angiotensin II concentration was positively correlated to active renin, plasma angiotensin I and plasma aldosterone. No correlation was found between plasma angiotensin II levels and serum ACE activity, dose of ACE inhibitor, or duration of use. CONCLUSION: In a group of severe chronic heart failure patients, 45% had elevated plasma angiotensin II levels independent of serum ACE activity despite long-term ACE inhibitor use. Although a causal link could not be proven, an association was found between spironolactone use and active renin protein, angiotensin II and aldosterone levels, suggesting that escape from ACE is mainly caused by a feedback mechanism

van de Wal RM, Gansevoort RT, van der Harst P, Boomsma F, Plokker HW, van Veldhuisen DJ, de Jong PE, van Gilst WH, Voors AA. Predictors of Angiotensin-converting enzyme inhibitor-induced reduction of urinary albumin excretion in nondiabetic patients. Hypertension 2006; 48(5):870-876.

Abstract: Urinary albumin excretion is a predictor for cardiovascular mortality and morbidity. We investigated which parameters determine baseline urinary albumin excretion in nondiabetic subjects, without renal disease. In addition, we evaluated the parameters that predict the albuminuria-lowering efficacy of an angiotensin-converting enzyme inhibitor. In this substudy of the Prevention of Renal and Vascular Endstage Disease Intervention Trial, 384 microalbuminuric patients were included. Patient and biochemical characteristics were obtained at baseline and after 3 months of double-blinded, randomized treatment (fosinopril 20 mg or placebo). Mean age was 51.1+/-11.5 years, and 65.6% were male. Median urinary albumin excretion was 22.2 mg per 24 hours. At baseline, mean arterial pressure (beta(standardized)=0.161; P=0.006), urinary sodium excretion (beta(standardized)=0.154; P=0.011), and estimated renal function were independently associated with albumin excretion. In these predominantly normotensive to prehypertensive subjects, fosinopril reduced albumin excretion by 18.5% versus a 6.1% increase on placebo after 3 months (P<0.001). Fosinopril use and blood pressure reduction independently predicted the change in urinary albumin excretion. Baseline urinary albumin excretion independently predicted the antialbuminuric effect of fosinopril (beta(standardized)=-0.303; P<0.001). In conclusion, at baseline, sodium intake and blood pressure were positively associated with urinary albumin excretion. Fosinopril reduced albuminuria more than might be expected from its blood pressure-lowering effect alone, and this effect was more outspoken in subjects with higher baseline albumin excretion. Based on our data, we hypothesize that angiotensin-converting enzyme inhibition may result in superior cardiovascular protection when compared with other blood pressure-lowering agents in subjects with higher baseline levels of albuminuria

van de Wal RMA. Optimal blockade of the renin angiotensin system in cardiorenal dysfunction. [s.l.: s.n.], 2006.

van den Besselaar AM, Haas FJ, Kuypers AW. Harmonisation of factor VIII:C assay results: study within the framework of the Dutch project 'Calibration 2000'. British Journal of Haematology 2006; 132(1):75-79.

Abstract: Summary In a Dutch project for harmonisation of factor VIII coagulant activity (FVIII:C) assays, the commutability of potential calibrators for FVIII:C was assessed by means of a 'twin-study design', which is in essence a multi-centre, split-patient sample, between-field-methods protocol. Commutability was defined as the degree to which a material yielded the same numerical relationships between results of measurements by a given set of measurement procedures as those between the expectations of the relationships for the same procedures applied to those types of material for which the procedures were intended. The study consisted of the simultaneous analysis of fresh frozen patient plasmas and three potential calibrators for FVIII:C by 16 Dutch laboratories forming eight couples. The state-of-the-art intra-laboratory standard deviation was used to assess the commutability of the potential calibrators. One potential calibrator was used to harmonise FVIII:C assay results in a Dutch field study. The inter-laboratory coefficient of variation of two test samples could be reduced significantly, but no significant effect was observed with three other test samples. We recommend that at least three different sample dilutions be used in each FVIII:C assay, in agreement with previous recommendations

van den Bosch JM. Longtransplantatie met behulp van levende donoren. Nederlands Tijdschrift voor Geneeskunde 2006; 150(4):184-188.

Abstract: In certain centres, following the practice in liver and kidney transplantation, lung transplantation programmes have been set up in which two healthy living donors undergo removal of the right lower lobe and the left lower lobe, respectively, which are then implanted bilaterally in the recipient in place of the usual whole right and left post-mortem lungs: 'living donor lobar lung transplantation'. The relatively high morbidity in the donors and the complicated procedure constitute obstacles to worldwide application. Besides medical problems, the procedure also raises ethical questions. Whether living donor lobar lung transplantation should also be applied in the Netherlands can only be answered following a broad public, ethical and medical discussion. In the meantime, the lung transplant centres may analyse the prerequisites and make the necessary preparations

van der Bruggen T, Kaan JA, Meinders AJ, Mager J, Heddema ER, van Hannen E, de Jongh BM. Outbreak of three related cases of psittacosis detected by real-time PCR. Nederlands Tijdschrift voor Medische Microbiologie 2006; 14(Supplement):S81-S82.

van der Heiden PL, Prins MH, de Monye W, van Strijen ML, Banga JD, Postmus PE, ten Wolde M, Buller HR, Brandjes DP, Huisman MV, ANTELOPE study group. Pulmonary embolism as a first clinical sign of occult malignancy: a prospective follow-up study. Thrombosis & Haemostasis 2006; 95(3):584-585.

van der Hoeven H, Kibler WB, Willems WJ. Shoulder injuries in tennis players. British Journal of Sports Medicine 2006; 40(5):435-440.

Abstract: The mechanism of the overhead action in throwing sports has been studied extensively. This motion is unnatural and highly dynamic, often exceeding the physiological limits of the joint. Owing to overload of various anatomical structures, the shoulder is susceptible to injury. Optimal shoulder function requires good kinetic chain function, optimal stability, and coordination of the scapula in the overhead action. A well balanced action of the rotator cuff muscles and capsular structures is necessary to obtain a stable centre of rotation during the overhead action. This review concerns shoulder injuries, related to the overhead motion in tennis players, which can be explained by the same mechanism as thrower's shoulder

van der Horst FA, Wolthuis A, de Vries JW, Wetzels A, Arts EG, Beijer C, Curfs M, Njo T, Weber R. Herziene richtlijn 'Vasectomie' van de Nederlandse Vereniging voor Urologie. Nederlands Tijdschrift voor Geneeskunde 2006; 150(14):819-820.

van der Kooi EL, de Leeuw GE, Vlak MH, Hendriks JC, Padberg GW, Vogels OJ. An unbiased and efficient computerised tomography method to quantify muscle and adipose tissue volume in neuromuscular patients. Neurological Sciences 2006; 26(6):423-429.

Abstract: The objective was to evaluate the applicability and reliability of an unbiased stereological computerised tomography (CT) method for estimating total human body (HB), skeletal muscle (SM) and adipose tissue (AT) volumes in groups of neuromuscular patients. In 10 neuromuscular patients HB, SM and AT volumes were estimated using systematic sampling on equidistant CT sections throughout the total body axis using a counting grid with systematically ordered intersection points. Each intersection point hitting HB, SM or AT represented a known volume dependent on intersection point distance and sum of section thickness and gap. Random and systematic intra- and interobserver errors for volume estimates were below 0.035. These errors were negligible to the coefficient of variation of the group mean, being 0.190 for HB, 0.323 for SM and 0.471 for AT. Even in the presence of intrafascicular and intramuscular fat in neuromuscular patients, unbiased and reliable quantification of HB, SM and AT is possible

van der Lee I, Zanen P, Grutters JC, Snijder RJ, van den Bosch JM. Diffusing capacity for nitric oxide and carbon monoxide in patients with diffuse parenchymal lung disease and pulmonary arterial hypertension. Chest 2006; 129(2):378-383.

Abstract: BACKGROUND: The passage of carbon monoxide (CO) through the alveolocapillary membrane and into the plasma and intraerythrocytic compartments determines the diffusing capacity of the lung for CO (Dlco) as defined by the Roughton and Forster equation. On the other hand, the single-breath diffusing capacity of the lung for nitric oxide (Dlno) is thought to represent the true membrane diffusing capacity because of its very high affinity for hemoglobin (Hb) and its independence from pulmonary capillary blood volume. Therefore, the Dlno/Dlco ratio can be used to differentiate between thickened alveolocapillary membranes (both Dlno and Dlco are decreased, and the Dlno/Dlco ratio is normal) and decreased perfusion of ventilated alveoli (the Dlno less decreased than the Dlco; therefore, the Dlno/Dlco ratio is high) in patients with pulmonary disease.Study design: We measured the combined values of Dlco and Dlno in 41 patients with diffuse parenchymal lung disease (DPLD), 26 patients with pulmonary arterial hypertension (PAH), and 71 healthy subjects. RESULTS: The Dlco (corrected to the standard Hb value) was lowered in the DPLD group (64% of predicted) and in the PAH group (64% of predicted), and was normal in the control group (105% of predicted). The Dlno/Dlco ratio in patients with PAH (4.98) was significantly higher than that in patients with DPLD (4.56) and in healthy subjects (4.36). CONCLUSION: The Dlno/Dlco ratio is significantly higher in patients with PAH than in healthy subjects, although this ratio cannot be applied as a screening test to discriminate between patients with DPLD and PAH as the overlap between these groups is too large

van der Lee I, van Es HW, Noordmans HJ, van den Bosch JM, Zanen P. Alveolar volume determined by single-breath helium dilution correlates with the high-resolution computed tomography-derived nonemphysematous lung volume. Respiration 2006; 73(4):468-473.

Abstract: Background: The alveolar volume (V(A)), determined by single-breath helium dilution, is a measure for the total lung capacity (TLC) that is very sensitive to ventilatory disturbances. In chronic obstructive pulmonary disease (COPD), the emphysematous lung parts are less accessible to test gas; therefore, the V(A) is smaller than TLC measured by multiple-breath helium dilution (TLC(He)). Objectives: The aim of this study was to investigate whether the V(A) represents the nonemphysematous lung parts. Methods: We measured V(A) as part of the diffusing capacity for carbon monoxide (DL(CO)), TLC(He) and spirometry in 50 patients with COPD. High-resolution computed tomography (HRCT) scans of all subjects were analyzed with the density mask method, where parts with an attenuation of less than -950 Hounsfield units were considered as emphysematous. Results: A strong correlation was observed between the V(A) (mean 5.2 liters) and nonemphysematous HRCT lung volume (mean 5.2 liters, r(2) = 0.9) and between the TLC(He) (mean 6.6 liters) and total HRCT lung volume (mean 6.4 liters, r(2) = 0.9). Bland-Altman plots showed considerable disagreement between the V(A) and the nonemphysematous HRCT lung volume. A weak correlation between the forced expiratory volume in 1 s (mean 46% predicted) and DL(CO) (mean 46% predicted) versus the HRCT emphysema ratio (nonemphysematous/total HRCT lung volume) was observed (r(2) = 0.3 and 0.3, respectively). Conclusion: We concluded that the V(A) correlates with the nonemphysematous HRCT lung volume, although the two measurements are not equivalent, possibly due to technical factors. Copyright (c) 2006 S. Karger AG, Basel

van der Lee I, Zanen P, van den Bosch JM, Lammers JW. Pattern of diffusion disturbance related to clinical diagnosis: The K(CO) has no diagnostic value next to the DL(CO). Respiratory Medicine 2006; 100(1):101-109.

Abstract: AIM OF THE STUDY: The diffusion capacity of the lung for carbon monoxide (DL(CO)) is an important tool in the diagnosis and follow-up of patients with pulmonary diseases. In case of a decreased DL(CO) the K(CO), defined as DL(CO)/V(A) (V(A) is alveolar volume), can differentiate between normal alveolocapillary membrane (normal K(CO)) and abnormal alveolocapillary membrane (low K(CO)). The latter category consists of decreased surface of the membrane, increased thickness or decreased perfusion of ventilated alveoli. The V(A)/TLC (TLC is total lung capacity determined by whole body plethysmography) can partially differentiate between these categories. The aim of this study was to investigate the diagnostic value of the specific diffusion disturbances, which can be constructed by combining the DL(CO), K(CO) and V(A)/TLC. METHODS: In 460 patients the diagnosis made by clinicians were fitted into five diagnostic categories: asthma, chronic obstructive pulmonary disease (COPD), treatment effects of haematologic malignancies, heart failure and diffuse parenchymal lung diseases (DPLD). These categories were linked to the pattern of diffusion disturbance. RESULTS: Almost all patients with asthma have a normal DL(CO), most patients in the other groups do not have the expected pattern of diffusion disturbance, especially in the group with DPLD a bad match is observed. CONCLUSION: In this study the pattern of diffusion disturbance is of limited use in establishing a diagnosis. The use of the K(CO) next to the DL(CO) has no additional diagnostic value. Regional ventilation-perfusion inequality probably forms an important underlying mechanism of decreased DL(CO)

van der Lee I. Nitric oxide and carbon monoxide diffusing capacity of the lung. [S.l.]: Drukkerij Gravé, 2006.

van der Meer RW, Pattynama PM, van Strijen MJ, van den Berg-Huijsmans AA, Hartmann IJ, Putter H, de Roos A, Huisman MV. Rechterventrikeldisfunctie en index voor pulmonale vasculaire obstructie: voorspellende variabelen voor het klinische beloop gedurende 3 maanden bij patienten met acute longembolie. Nederlands Tijdschrift voor Geneeskunde 2006; 150(15):845-850.

Abstract: OBJECTIVE: To quantify right-ventricular dysfunction and the pulmonary artery obstruction index, in patients with acute pulmonary embolism, using helical CT, and to assess the prognostic value of these parameters. DESIGN: Prospective. METHOD: In 120 consecutive patients with proven acute pulmonary embolism, the extent of right-ventricular dysfunction was assessed by quantifying the ratios of the right to left-ventricular short-axis diameters (RV/LV ratio) and the extent ofobstruction ofthe pulmonary-artery circulation by using helical CT images. Regression analysis was used to correlate these parameters with patient outcome. RESULTS: Right-ventricular dysfunction (RV/LV ratio > 1.0) was seen in 69 patients (57.5%). Seven patients died as a direct result of pulmonary embolism. Both the RV/LV ratio and the obstruction index were significant risk factors for mortality within three months (p = 0.04 and 0.01 respectively). The positive predictive value for pulmonary embolism-related mortality of an RV/LV ratio > 1.0 was 10.1% (95% CI: 2.9-17.4). The negative predictive value for an uneventful outcome of an RV/LV ratio < or = 1.0 was 100% (95% CI: 94.3-100). There was a 11.2-fold risk of dying of pulmonary embolism in patients with an obstruction index > or = 40% (95% CI: 1.3-93.6). CONCLUSION: Markers of right-ventricular dysfunction and pulmonary vascular obstruction, assessed by helical CT-examination at baseline, help to predict mortality during follow-up of patients with acute pulmonary embolism

van der Spek E, Bloem A, van de Donk NJCM, van der Griend R, Wittebol S, de Weerdt O, Kramer MHH, Lokhorst HM. Phase I study of simvastatin combined with chemotherapy in patients with relapsed or refractory myeloma and lymphoma. 18e Internistendagen : abstractboek : 27& 28 april 2006 MECC Maastricht 2006;24-25.

van der Spek E, Bloem AC, van de Donk NW, Bogers LH, van der Griend R, Kramer MH, de Weerdt O, Wittebol S, Lokhorst HM. Dose-finding study of high-dose simvastatin combined with standard chemotherapy in patients with relapsed or refractory myeloma or lymphoma. Haematologica 2006; 91(4):542-545.

Abstract: In vitro statins induce apoptosis in myeloma and lymphoma cells in a dose-and time-dependent way. In combination with dexamethasone and doxorubicin, statins have a chemo-sensitizing effect. Twenty-eight patients with relapsed myeloma or lymphoma were treated with a dose-escalating regimen of simvastatin for 7 days followed by VAD in myeloma patients and CHOP in lymphoma patients. The maximum tolerated dose was 15 mg/kg/day simvastatin. The most frequently reported side-effects were fatigue, gastrointestinal CTC grade 1-2 and neutropenic fever. The dose-limiting toxicity was neutropenic sepsis and grade 3 gastrointestinal side effects. High-dose simvastatin given immediately prior to chemotherapy is safe and tolerable up to a dose of 15 mg/kg/day

van der Spoel TIG, Cramer MJM, Kelder JC, van de Graaf EA, van der Spoel OP, Bauwens AMM. Dyspnoepoli : Multidisciplinaire aanpak van onbegrepen chronische kortademigheid. Hart Bulletin 2006; 37(4):82-86.

van Dijk N, Vogels OJ. Het 'restless legs'-syndroom, te behandelen met dopamineagonisten. Nederlands Tijdschrift voor Geneeskunde 2006; 150(52):2895.

van Dockum WG, Kuijer JP, Gotte MJ, ten Cate FJ, ten Berg JM, Beek AM, Twisk JW, Marcus JT, Visser CA, van Rossum AC. Septal ablation in hypertrophic obstructive cardiomyopathy improves systolic myocardial function in the lateral (free) wall: a follow-up study using CMR tissue tagging and 3D strain analysis. European Heart Journal 2006; 27(23):2833-2839.

Abstract: AIMS: Alcoanalysis; Antoniuswerkhol septal ablation (ASA) has been successful in the treatment of symptomatic hypertrophic obstructive cardiomyopathy (HOCM). The aim of this study is to evaluate the effects of ethanol-induced myocardial infarcts on regional myocardial function using cardiac magnetic resonance (CMR) tissue tagging and 3-dimensional (3D) strain analysis. METHODS AND RESULTS: In nine patients (age 52+/-15 years) who underwent ASA, CMR was performed prior to and 6 months after the procedure. Regional myocardial mass was evaluated using cine imaging. Myocardial tagging was used to calculate systolic 3D myocardial strain values. These strain values were used to calculate the shortening index (SI), a robust parameter for myocardial contraction. Maximum end-systolic (ES) SI and systolic SI rate were quantified in three circumferential segments: septum, adjacent, and remote (lateral) myocardium. Compared with baseline, septal and non-septal mass decreased at follow-up (from 72+/-27 to 59+/-21 g; P=0.008 and from 131+/-34 to 109+/-30 g; P=0.008, respectively). In the septum, maximum ES SI and SI rate remained unchanged after ASA. In adjacent myocardium, ES SI remained unchanged, whereas SI rate improved (from -56.5+/-21.1 to -70.0+/-16.7%/s; P=0.02). Both ES SI and SI rate improved significantly in remote myocardium (from -16.9+/-2.8 to -18.8+/-3.2%; P=0.02 and from -70.3+/-9.2 to -86.1+/-15.0%/s; P=0.01, respectively). CONCLUSION: Reduction of left ventricular (LV) outflow tract obstruction in symptomatic HOCM is associated with a significant reduction in myocardial mass and improvement of intramural systolic function in the lateral (remote) wall, indicating reversed LV remodelling

van Es HW. Interstitiële pneumonie en fibrose: de "letter salad". Edurad 2006; 55:20-23.

van Es HW. Plexus Brachialis. Edurad 2006; 54:34-37.

van Everdingen JJE, Tiel-van Buul MMC, van der Waal RIF, [et al.]. Pinkhof geneeskundig woordenboek. 11e, herz. en uitgebr. dr. ed. Houten: Bohn Stafleu van Loghum, 2006.

van Gent MWF, Schölzel BE, Idzerda HHD, Kelder JC, Knaepen PJ, van Swieten HA, ten Berg JM. Hocm, a single centre comparison of surgical and non-surgical therapy. Netherlands Heart Journal 2006; 14(suppl 3):10.

van Gils EJM, Veenhoven RH, Hak E, IJzerman EPF, Rijkers GT, Sanders EAM. Effect of 2 versus 3 pneumococcal conjugate vaccinations Prevnar on nasopharyngeal carriage, transmission and herd immunity: a randomized, controlled study. 5th International Symposium on Pneumococci and Pneumococcal diseases 2-6 April 2006, Alice Springs, Australia 2006;185.

van Hannen EJ, Foppen P, de Jongh BM. Molecular analysis of broth enriched screening samples: a sensitive, high throughput method to exclude the presence of methicillin-resistant Staphylococcus aureus . Nederlands Tijdschrift voor Medische Microbiologie 2006; 14(Supplement):S94.

van Hannen EJ, Foppen P, de Jongh BM. Molecular MRSA screening: finding negatives a.s.a.p. Clinical Microbiology & Infection 2006; 12(Suppl 4):P1339.

van Hattum ES, Balemans WA, Rovers MM, Zielhuis GA, Schilder AG, van der Ent CK. Adenoidectomy and/or tonsillectomy in childhood is not associated with atopic disease later in life. Clinical & Experimental Allergy 2006; 36(1):40-43.

Abstract: OBJECTIVE: To investigate the association between adenoidectomy and/or tonsillectomy in childhood and asthma, allergic rhinitis (AR), and eczema in adolescence. METHODS: Longitudinal birth cohort study of 1328 members born in the city of Nijmegen. Information on ear-nose-throat surgery was documented at 2, 4, and 8 years of age. In 1055 cohort members the incidence of asthma, AR, and eczema at 21 years of age was determined using the International Study of Asthma and Allergic disease in Childhood Core Questionnaire. To analyse the association between adenoidectomy and/or tonsillectomy in childhood and asthma, AR, and eczema at age 21 years, relative risks (RR) were calculated. RESULTS: Six hundred and ninety-three (66%) members completed the questionnaire at age 21 years, of whom 104 (15%) had undergone adenoidectomy and/or tonsillectomy and 262 (38%) reported atopic disease. Children who underwent adenoidectomy and/or tonsillectomy before the age of 8 years were not more likely to develop asthma, AR, or eczema at the age of 21 years than children who did not; RR 0.93 (95% confidence limits (CL) 0.52-1.64), RR 0.94 (CL 0.68-1.30), and RR 1.00 (CL 0.59-1.68), respectively. CONCLUSIONS: Our data show no association between adenoidectomy and/or tonsillectomy in childhood and the incidence of atopic disease in young adults

van Hees BC, Veldman-Ariesen MJ, de Jongh BM, Tersmette M, van Pelt W. Regional, seasonal differences and secular trends in incidence and antibiotic resistance of Campylobacter in a nationwide surveillance study in The Netherlands: an
overview 2000-2004. Nederlands Tijdschrift voor Medische Microbiologie 2006; 14(Supplement):S66-S67.

van Hees BC, de Ruiter H, Wiltink EH, de Jongh BM, Tersmette M. Optimizing use of ciprofloxacin in a large teaching hospital: a prospective intervention study. Nederlands Tijdschrift voor Medische Microbiologie 2006; 14(Supplement):S66.

van Hees BC, Veldman-Ariesen MJ, de Jongh BM, Tersmette M, van Pelt W. National surveillance of Campylobacter infections and resistance in the Netherlands; an overview 2000–2004. Clinical Microbiology & Infection 2006; 12(Suppl 4):P1032.

van Hemel N. De smaakpapillen moeten weer naar school. Hart Bulletin 2006; 37(4):98-100.

van Herwaarden JA, Muhs BE, Vincken KL, van Prehn J, Teutelink A, Bartels LW, Moll FL, Verhagen HJ. Aortic compliance following EVAR and the influence of different endografts: determination using dynamic MRA. Journal of Endovascular Therapy 2006; 13(3):406-414.

Abstract: PURPOSE: To utilize dynamic magnetic resonance angiography (MRA) to characterize aortic stiffness (beta) and elastic modulus (Ep) as indexes of wall compliance during the cardiac cycle and determine any influence of different endograft designs or the presence of endoleaks on these indexes. METHODS: Eleven consecutive patients (11 men; median age 74 years, range 63-78) with abdominal aortic aneurysm (AAA) selected for endovascular repair were scanned pre- and postoperatively. Aortic area and diameter changes during the cardiac cycle were determined using dynamic MRA at 4 levels: 3 cm above the renal arteries, between the renal arteries, 1 cm below the renal arteries, and at the level of maximum aneurysm sac diameter. Ep and beta were calculated. Data are presented as median (range); p<0.05 was considered significant. RESULTS: Preoperatively, Ep and beta were significantly higher at the level of the aneurysm sac compared to all other levels (p<0.05). Following EVAR, stiffness increased at this level (p<0.05). After implantation, patients with an Excluder endograft demonstrated Ep and beta measurements at the aneurysm neck that were 94% and 60% higher, respectively, compared to those with a Talent (p<0.05) endograft. The presence of an endoleak had no effect on Ep or beta. CONCLUSION: This study introduces the feasibility of dynamic MRA imaging-based calculations of aortic elastic modulus and stiffness. AAA patients demonstrate increased Ep and beta at the level of the aneurysm sac. EVAR results in increased aneurysm sac Ep and beta. Stent-graft design seems to alter Ep and beta within the aneurysm neck, which may have consequences for endograft durability. The presence of an endoleak does not seem to have an effect on Ep or beta

van Herwaarden JA, de Vries JPPM, Moll FL. Endovascular repair of infrarenal abdominal aortic aneurysms. [Roentgenoendovascular surgery of the cardiovascular patholoy. Volume 1 : Roentgenoendovascular surgery of the vascular patholoy] [Book in Russian]. 2006.

van Herwaarden JA, Bartels LW, Muhs BE, Vincken KL, Lindeboom MY, Teutelink A, Moll FL, Verhagen HJ. Dynamic magnetic resonance angiography of the aneurysm neck: conformational changes during the cardiac cycle with possible consequences for endograft sizing and future design. Journal of Vascular Surgery 2006; 44(1):22-28.

Abstract: OBJECTIVE: Proper proximal fixation and stent-graft sealing within the aneurysm neck are critical for endovascular aneurysm repair (EVAR) durability. Computed tomography angiography (CTA) is the gold standard for preoperative sizing of endograft diameters, but the accuracy of these measurements is uncertain because they rely on static images of a dynamic process. The aortic configuration and diameter may change during the cardiac cycle. We studied these phenomena using dynamic electrocardiograph-triggered magnetic resonance angiography (MRA). METHODS: Eleven consecutive EVAR patients were included. Dynamic MRA was used to perform preoperative and postoperative measurements. Changes were measured in transverse aortic sections 10 mm below the lowest renal artery (level A), at the level of the renal arteries (level B), and 3 cm above the lowest renal artery (level C). Data were analyzed using image segmentation software. Aortic area and diameter changes along 256 axes were determined. RESULTS: Dynamic MRA demonstrated significant aortic area changes during the cardiac cycle before and after EVAR at all three measured levels. Pre-EVAR aortic area significantly increased per cardiac cycle: 8.4% at level A; 9.3% at level B; and 13.3% at level C (P < .001 for all levels). Post-EVAR aortic area increased 9.7% at level A, 9.6% at level B, and 15.8% at level C per cardiac cycle (P < .001 for all levels). Significant diameter changes during cardiac cycles were also observed at all three levels. Pre-EVAR mean diameter changed up to 8.9% (P < .001) compared with post-EVAR aortic changes of up to 11.5% (P < .001). EVAR had no effect on change in aortic area and diameter. Dynamic MRA also demonstrated that pulsatile aortic distension was not equal in all axes, but rather occurred as an asymmetrical expansion and contraction. CONCLUSION: In patients with (atherosclerotic) aneurysm disease, the aortic dimensions at the level of and proximal to the aneurysm neck change during the cardiac cycle. This phenomenon is preserved after EVAR. Therefore, maximum diameter using dynamic MRA may not be similar to the maximum diameter with static CTA in all patients, and a standard regimen of 10% to 15% oversizing of an endograft based on static CTA images may be inadequate for some patients. Further studies using dynamic MRA to evaluate effects of different endografts are anticipated, with possible consequences for endograft designs

van Herwaarden JA. Dynamics of endovascular aneurysm repair. Enschede: Gildeprint b.v., 2006.

van Laake LW, van den Driesche S, Post S, Feijen A, Jansen MA, Driessens MH, Mager JJ, Snijder RJ, Westermann CJ, Doevendans PA, van Echteld CJ, ten Dijke P, Arthur HM, Goumans MJ, Lebrin F, Mummery CL. Endoglin has a crucial role in blood cell-mediated vascular repair. Circulation 2006; 114(21):2288-2297.

Abstract: BACKGROUND: Endoglin, an accessory receptor for transforming growth factor-beta in vascular endothelial cells, is essential for angiogenesis during mouse development. Mutations in the human gene cause hereditary hemorrhagic telangiectasia type 1 (HHT1), a disease characterized by vascular malformations that increase with age. Although haploinsufficiency is the underlying cause of the disease, HHT1 individuals show great heterogeneity in age of onset, clinical manifestations, and severity. METHODS AND RESULTS: In situ hybridization and immunohistochemical analysis of mouse and human hearts revealed that endoglin is upregulated in neoangiogenic vessels formed after myocardial infarction. Microvascularity within the infarct zone was strikingly lower in mice with reduced levels of endoglin (Eng+/-) compared with wild-type mice, which resulted in a greater deterioration in cardiac function as measured by magnetic resonance imaging. This did not appear to be because of defects in host inflammatory cell numbers in the infarct zone, which accumulated to a similar extent in wild-type and heterozygous mice. However, defects in vessel formation and heart function in Eng+/- mice were rescued by injection of mononuclear cells from healthy human donors but not by mononuclear cells from HHT1 patients. CONCLUSIONS: These results establish defective vascular repair as a significant component of the origin of HHT1. Because vascular damage or inflammation occurs randomly, it may also explain disease heterogeneity. More generally, the efficiency of vascular repair may vary between individuals because of intrinsic differences in their mononuclear cells

van Lankveld MA, Koot NC, Peeters PH, Schagen van Leeuwen JH, Jurgenliemk-Schulz IM, van Eijkeren MA. Compliance to surgical and radiation treatment guidelines in relation to patient outcome in early stage endometrial cancer. Journal of Evaluation in Clinical Practice 2006; 12(2):196-201.

Abstract: RATIONALE, AIMS AND OBJECTIVES: We evaluated the adherence to treatment guidelines in early stage endometrial cancer and the influence of adherence to guidelines on overall survival. METHOD: Patients were identified in the central region in the Netherlands from 1990 till 1995. Patient and tumour characteristics, surgical findings, radiation and follow-up data were abstracted from medical records. Endpoint was overall survival. Kaplan-Meier method was used to perform time-to-event analysis. Hazard ratios for overall survival were estimated with a Cox Proportional Hazards model. RESULTS: 359 patients were eligible for analysis. 335 patients presented with a clinical stage I cancer. 333 patients underwent a Total Abdominal Hysterectomy with Bilateral Salpingo Oophorectomy (TAH/BSO), of which 301 were staged as International Federation of Gynaecology and Obstetrics (FIGO) stage I, whereas 34 (10.2%) as FIGO stage II. Of the 24 patients with a clinical stage II cancer, 12 underwent a Radical Hysterectomy with Pelvic Lymph Node Dissection (RH/PLND), of which seven were diagnosed with FIGO stage II. In 72.1% of the patients adjuvant radiation was given or not in adherence to the guidelines. Whether treatment was given according to the guidelines or not did not affect 5 years overall survival. CONCLUSION: This suggests that extensive surgical procedures are redundant in the treatment of occult stage II endometrial cancer

van Leeuwen MA, Nadorp S, Bosch JLHR, Lock MTWT. Incidence of germ cell tumors during follow-up of testicular microlithiasis. European Urology Suppl 2006; 5(2):87.

van Leeuwen MA, Nadorp S, Bosch JLHR, Lock MTWT. Incidence of germ cell tumors during follow-up of testicular microlithiasis. Journal of Andrology Suppl 2006;(March/April):56.

van Leeuwen MA, de Jong TPVM, Dik P, Klijn AJ, de Kort LMO . Primary repair of bladder exstrophy followed by clean intermittent catheterization : outcome of 15 consecutive cases. Journal of Pediatric Urology 2006; 2(2):109.

van Leeuwen MA, Dik P, Klijn AJ, de Kort LM, de Jong TP. Primary repair of bladder exstrophy followed by clean intermittent catheterization: outcome of 15 years' experience. Urology 2006; 67(2):394-398.

Abstract: OBJECTIVES: To determine the continence and spontaneous voiding rate after neonatal reconstruction of bladder exstrophy without formal bladder neck reconstruction in patients undergoing primary reconstruction and treated with clean intermittent catheterization (CIC) after closure. METHODS: From 1987 to 2003, 15 consecutive patients (8 boys and 7 girls) with bladder exstrophy underwent neonatal reconstruction. Reconstruction focused on bringing the bladder neck and proximal urethra intra-abdominally and meticulously closing the pelvic floor muscles around the urethra. Three weeks postoperatively, CIC was started until toilet-training age. Bladder capacity, continence status, renal anatomy and function, and additional urologic surgical procedures during follow-up were analyzed. RESULTS: Nine patients (60%) became socially continent after primary closure without any additional bladder neck surgery. Twelve patients (80%) were continent when those who underwent endoscopic bulking injection were included. One patient became socially continent after bladder neck reconstruction, and one was dry and used CIC after bladder neck reconstruction and ileocystoplasty. One patient remained incontinent because of the parents' refusal of surgery. Ultimately, of 15 patients, 14 were dry (93%) of whom 10 were completely continent, 3 were partially continent (dry intervals of 1 to 3 hours), and 1 was dry by catheterizable stoma. The bladder capacity was adequate for age in 80% of patients. Febrile urinary tract infection occurred in 33% of patients, and 67% needed endoscopy for urethral stenosis. Upper tract dilation and loss of renal function was not seen. CONCLUSIONS: The results of our study have shown that primary repair of bladder exstrophy followed by CIC has encouraging continence and bladder capacity rates, with preservation of the upper urinary tract and limited need for additional bladder neck surgery

van Leeuwen MA, Dik P, Klijn A, de Kort L, de Jong T. Continence rate and spontaneous voiding after neonatal reconstruction of bladder exstrophy. European Surgery Suppl 2006; 38(208):23-24.

van Lelyveld N, Scheffer R, Mundt M, Samsom M. Partial Gastric Volumes and Upper Abdominal Sensations in Functional Dyspeptic and GERD Patients: A 3D Ultrasonographic Study. American Journal of Gastroenterology 2006; 101(8):1845-1852.

Abstract: OBJECTIVES: The aim of the study was to evaluate the change in proximal and distal gastric volumes after ingestion of a nutrient drink and its relationship to upper abdominal sensations using three-dimensional ultrasonography. METHODS: Fifty FD patients, 20 GERD patients patients and 35 healthy controls participated. Partial gastric volumes and sensations were assessed while fasting and after ingestion of a nutrient drink (500 mL, 300 kcal). Division of partial gastric volumes by total gastric volume was used to calculate proximal and distal gastric volume ratios. RESULTS: The proximal gastric volume ratio was smaller in FD patients and larger in GERD patients compared to controls (p < 0.001 and p= 0.008, respectively). FD patients with impaired proximal relaxation (46%) had a larger increase in distal gastric volume (p= 0.008) and higher fullness sensations (p= 0.027) compared to FD patients with normal proximal relaxation. Fullness was related to distal gastric volume in both GERD patients and healthy controls (r= 0.761, p < 0.001 and r= 0.674, p= 0.001, respectively). In FD patients this relationship was not observed. CONCLUSIONS: Impaired proximal gastric volume change after ingestion of a nutrient drink is associated with a larger distal gastric volume and increased fullness. In health and in GERD patients, the distal stomach is important in the regulation of fullness. However, in FD patients with normal or altered gastric volume distribution, this relationship is disturbed, implying that other causes are involved in the excessive generation of fullness

van Loveren M, Onaca MG. Hematospermie bij cysten van de vesicula seminalis en tevens lever- en niercysten : een toevallige comorbiditeit? Nederlands Tijdschrift voor Urologie 2006;(7).

van Minnen LP, Verheem A, Lutgendorff F, Timmerman HM, Rijkers GT, Rychter J, Gooszen HG, Akkermans LMA, Kroese ABA. Multispecies probiotics abolish acute pancreatitis-associated mucosal barrier failure in murine ileum. Pancreas 2006; 33(4):505.

van Minnen LP, Timmerman HM, Lutgendorff F, Verheem A, Harmsen W, Konstantinov SR, Smidt H, Visser MR, Rijkers GT, Gooszen HG, Akkermans LMA. Prophylactic probiotics reduce bacterial translocation and improve outcome in experimental pancreatitis. Pancreas 2006; 33(4):504.

van Moorsel CHM, Grutters JC, Heins MJ, Ruven HJT, van den Bosch JMM. Genetic studies on sarcoidosis: launch of a website. European Respiratory Journal - Supplement 2006; 28(Suppl 50):521s.

van Oostrom AJ, Plokker HW, van Asbeck BS, Rabelink TJ, van Kessel KP, Jansen EH, Stehouwer CD, Cabezas MC. Effects of rosuvastatin on postprandial leukocytes in mildly hyperlipidemic patients with premature coronary sclerosis. Atherosclerosis 2006; 185(2):331-339.

Abstract: We investigated whether pro-inflammatory aspects of the postprandial phase can be modulated by rosuvastatin in premature coronary artery disease (CAD) patients. Herefore standardized 8h oral fat loading tests were performed off-treatment and after rosuvastatin 40mg/d in 20 male CAD patients (50+/-4 years). The expression of leukocyte activation markers CD11a, CD11b, CD62L and CD66b was studied using flowcytometry. Migration of isolated neutrophils towards chemoattractants was determined in a fluorescence-based assay. Rosuvastatin did not affect baseline leukocyte counts nor the postprandial neutrophil increment (maximum mean increase +10% pre- and +14% post-treatment, P<0.01 for each). Rosuvastatin reduced baseline platelets (from 266+/-78 to 225+/-74x10(9)cells/L, P<0.001) and blunted the postprandial platelet count change (maximum mean increase +6%, P=0.01, and 0%, respectively). The baseline expression of CD11a, CD11b and CD62L increased on most types of leukocytes by rosuvastatin, whereas the postprandial responses were unaffected. Pretreatment, postprandial neutrophil migration increased dose-dependently, but there were no postprandial changes after rosuvastatin. The latter effect was unrelated to changes in lipoprotein concentrations. In conclusion, in CAD patients postprandial pro-inflammatory and pro-coagulant changes can be modified by rosuvastatin. These apparently lipid-lowering independent effects may render protection against atherosclerosis

van Putte BP, Hendriks JM, Romijn S, de Greef K, van Schil PE. Toxicity and efficacy of isolated lung perfusion with gemcitabine in a rat model of pulmonary metastases. Thoracic & Cardiovascular Surgeon 2006; 54(2):129-133.

Abstract: BACKGROUND: Long-term toxicity and efficacy of isolated left lung perfusion (ILuP) with gemcitabine (GCB) were studied in a rat model of metastatic pulmonary adenocarcinoma. MATERIALS: Toxicity: Forty rats were randomized into six groups and administered 160 or 320 mg/kg GCB or buffered starch, received either via intravenous injection (i.v.) or via ILuP. Efficacy experiment: Rats with unilateral metastases had ILuP with 320 mg/kg GCB (maximally tolerated dose administered by ILuP), while rats with bilateral metastases had an i.v. injection of 160 mg/kg GCB (maximally tolerated dose given by i.v.). RESULTS: Toxicity experiment: After i.v. treatments, all rats receiving 320 mg/kg GCB died within one week, while rats who had received 160 mg/kg GCB had a survival rate of 60%. After ILuP with 160 mg/kg GCB and 320 mg/kg GCB, survival rates were 83% in both groups. A significant increase in collagen deposits was observed for ILuP with 320 mg/kg GCB compared to rats treated i.v. with 160 mg/kg GCB. Efficacy experiment: Median survival of ILuP rats treated with 320 mg/kg (38 +/- 4 days) was significantly longer compared to i.v. rats treated with 160 mg/kg (27 +/- 2 days; p = 0.02). CONCLUSIONS: ILuP with GCB prolongs survival in experimental metastatic adenocarcinoma while no major acute or long term toxicity is observed

van Putte BP, Hendriks JM, Guetens G, de Boeck G, de Bruijn EA, van Schil PE, Folkerts G. Modified approach of administering cytostatics to the lung: more efficient isolated lung perfusion. Annals of Thoracic Surgery 2006; 82(3):1033-1037.

Abstract: BACKGROUND: Isolated lung perfusion (ILuP) is an experimental technique for the treatment of pulmonary metastases. We hypothesized that part of the drug taken up by the lung during ILuP is washed out during the flush procedure. Therefore, we investigated gemcitabine uptake at different inflow concentrations, and the effect of delayed clamp release after ILuP on lung levels was studied. METHODS: Thirty rats had ILuP during 30 minutes using gemcitabine perfusate levels of 1.3, 2.7, 4.0, 5.3, and 6.7 mg/mL. Another 37 rats underwent ILuP with gemcitabine perfusate levels of 6.7 mg/mL during 6 minutes followed by a 5-minute flush and 30 or 60 minutes of reperfusion, while two other groups had ILuP and delayed clamp release for 30 or 60 minutes followed by a 5-minute flush. All effluent and lung samples were stored for later analysis. Results were evaluated using Friedmann two-way analysis and two-way analysis of variance. RESULTS: At 6 minutes, steady-state of gemcitabine uptake was achieved for all inflow concentrations and a linear relation (r = 0.933, p < 0.0001) between effluent and lung levels was observed. Delayed clamp release resulted in significantly higher lung levels compared with immediate restoration of blood circulation after ILuP (456% at 30 minutes and 828% at 60 minutes). CONCLUSIONS: Effective gemcitabine lung levels are already achieved after 6 minutes of ILuP with 6.7 mg/mL followed by delayed clamp release during 30 minutes instead of the clinically applied 30 minutes ILuP

van Santvoort HC, Besselink MG, van Minnen LP, Timmerman HM, Akkermans LM, Gooszen HG. Potentiele rol voor probiotica bij de preventie van infectieuze complicaties tijdens acute pancreatitis. Nederlands Tijdschrift voor Geneeskunde 2006; 150(10):535-540.

Abstract: Acute pancreatitis has a high mortality in case of secondary infection of (peri-)pancreatic necrosis. Bacterial translocation is held responsible for the majority of these infectious complications of severe acute pancreatitis. Prophylactic strategies should therefore be directed at the three most important pathophysiological mechanisms of bacterial translocation: disturbed small-bowel motility and bacterial overgrowth, failure of the mucosal barrier function and a disturbed response of the immune system. In-vitro studies and research in experimental animals have shown that specially selected probiotics exert an effect on these mechanisms and can prevent bacterial translocation. Recently, several randomised, double-blind, placebo-controlled trials evaluating prophylactic treatment with enteral probiotics have shown good results. A Dutch multicentre trial, 'Probiotics in pancreatitis trial' (PROPATRIA), is currently underway

van Santvoort HC, Besselink MGH, Bollen TL, van Leeuwen MS, van Ramshorst B, Gooszen HG. Videoscopic assisted retroperitoneal debridement in infected necrotizing pancreatitis: initial results and the start of a nationwide randomized controlled trial. Pancreas 2006; 33(4):505.

van Santvoort HC, Besselink MG, Cirkel GA, Gooszen HG. Landelijk onderzoek naar optimale behandeling van patienten met geinfecteerde necrotiserende pancreatitis: PANTER-trial. Nederlands Tijdschrift voor Geneeskunde 2006; 150(33):1844-1846.

van Santvoort HC, Besselink MGH, Bollen TL, van Leeuwen MS, van Ramshorst B, Gooszen HG. Videoscopic assisted retroperitoneal debridement in infected necrotising pancreatitis as a pilot study to introduce a randomised controlled trial. Pancreatology 2006; 6:323-405.

van Santvoort HC, de Vries JP, van de Mortel R, Wille J, van de Pavoordt ED. Rupture of a popliteal artery aneurysm 10 years after surgical repair. Vascular 2006; 14(4):227-230.

Abstract: The usual method for popliteal artery aneurysm exclusion is distal and proximal ligation followed by bypass grafting via a medial approach. This technique preserves collaterals to the aneurysm, which might cause back-bleeding and symptomatic enlargement. We report the eighth case in the literature of a ruptured popliteal artery aneurysm after previous ligation and bypass grafting. The ruptured aneurysm was successfully excluded via a posterior approach. The advantage of this approach over the medial approach is the possibility of opening the aneurysm sac to oversew patent side branches, thereby excluding back-bleeding. We review the advantages and disadvantages of both the medial and the dorsal technique to treat popliteal aneurysms

van Strijen M, Le Gal G, Righini M, Parent F, Couturaud F. Diagnosis and management of subsegmental pulmonary embolism. Radiologendagen 2006.

van Tooren R, Stofmeel M, Kelder J, de Cock C, de Voogt W, van Erven L, Sedney M, van Hemel N, on behalf of the PROUST investigators, Nieuwegein. The short-term functional and echocardiographic effects of right ventricular outflow, apical and combined pacing are comparable: results of the proust study. Netherlands Heart Journal 2006; 14(5):4.

van Trijp MJ, Uiterwaal CS, Bos WJ, Oren A, Grobbee DE, Bots ML. Noninvasive arterial measurements of vascular damage in healthy young adults: relation to coronary heart disease risk. Annals of Epidemiology 2006; 16(2):71-77.

Abstract: PURPOSE: There is an increasing interest in noninvasive measurements of early structural or functional changes in large arteries such as pulse wave velocity (PWV), carotid intima-media thickness (CIMT), and augmentation index (AIx). These measurements may be applied in etiologic or prognostic research. The role of the AIx as a marker of cardiovascular risk has not fully been established. Our aim was to study whether AIx is related to coronary heart disease (CHD) risk and to compare the strength of the relations of AIx, PWV, and CIMT with cardiovascular risk in healthy young adults. METHODS: Our study included 224 men and 273 women (mean age 28 years, range 27-30 years) from the Atherosclerosis Risk in Young Adults (ARYA) study. Cardiovascular risk profile was determined and CHD risk was estimated using the Framingham risk score. AIx, PWV and CIMT were measured using standard methods. Data were analyzed in strata of gender using linear regression models. RESULTS: In men, PWV and CIMT were most strongly related to CHD risk. The increase in CHD risk per standard deviation increase in measurement was 0.24%/m/s, 95% CI (0.01;0.33) and 0.32%/mm, 95% CI (0.08;0.55), whereas the AIx was not significantly related to CHD risk (0.09 %/% 95% CI [-0.15;0.33]). In women, AIx, PWV, and CIMT were weakly but significantly related to CHD risk; there was no clear difference between the measurements. CONCLUSION: In young men, PWV and CIMT are better measures of CHD risk than AIx. In women, AIx, PWV and CIMT estimate CHD risk equally well

van Trijp MJ, Bos WJ, van der Schouw YT, Muller M, Grobbee DE, Bots ML. Non-invasively measured structural and functional arterial characteristics and coronary heart disease risk in middle aged and elderly men. Atherosclerosis 2006; 187(1):110-115.

Abstract: BACKGROUND: In cardiovascular (CV) epidemiology, interest increases in studying etiologic and prognostic implications of early structural or functional changes of the large arteries. Examples of such measurements are pulse wave velocity (PWV), carotid intima-media thickness (CIMT) and augmentation index (AIx). PWV and CIMT are established markers of CV risk whereas the role of AIx as indicator of risk has not fully been established. Therefore, our aim was to relate AIx to CV risk and to compare the magnitude of relations of PWV, CIMT and AIx to CV risk. METHODS: Two hundred and ninty-nine men free from cardiovascular disease (mean age 59.2 years), participated in this cross-sectional study. Cardiovascular risk profile was determined and 10-year coronary heart disease risk was estimated using the Framingham risk score (FRS). PWV, CIMT and AIx were measured and data were analyzed using linear regression models. RESULTS: PWV and CIMT were strongest related to FRS whereas AIx showed the weakest relation. Ten-year coronary heart disease risk increased 6.24%, 95% confidence interval (CI) [5.11;7.37] per standard deviation (S.D.) increase in PWV, 6.39% [5.24;7.54] per S.D. increase in CIMT and 2.50% [1.19;3.80] per S.D. increase in AIx. CONCLUSION: In middle aged and elderly men AIx is related to CV risk. However, compared with AIx, PWV and CIMT seem better markers of cardiovascular risk

van Tuyl SA, van Noorden JT, Kuipers EJ, Stolk MF. Results of videocapsule endoscopy in 250 patients with suspected small bowel pathology. Digestive Diseases & Sciences 2006; 51(5):900-905.

Abstract: We aimed to assess technical feasibility, clinical applicability, and diagnostic yield of videocapsule endoscopy (VCE) in a large group of unselected patients. VCE was performed with the Given Imaging swallowable capsule. Findings were considered diagnostic if the observed finding could explain the symptomatology of the patient. Findings were considered suspicious if an observed finding failed to completely explain the patient's symptoms. We studied 250 patients. A definite diagnosis was made in 95 patients (38%). Suspicious findings were noted in 80 patients (32%). No diagnosis was obtained in 74 patients (30%). The yield of VCE was higher in patients with suspected Crohn's disease. Mean viewing time decreased significantly from 51 +/- 14 to 30 +/- 7 minutes after reviewing 50 procedures. VCE is an important diagnostic tool, but a definite diagnosis is established in only 38% of the patients. The highest diagnostic yield is obtained in patients with suspected Crohn's disease

van Tuyl SA, van Noorden JT, Timmer R, Stolk MF, Kuipers EJ, Taal BG. Detection of small-bowel neuroendocrine tumors by video capsule endoscopy. Gastrointestinal Endoscopy 2006; 64(1):66-72.

Abstract: OBJECTIVES: Carcinoid tumors are the most common GI neuroendocrine tumors (NET). They often originate in the small intestine. The primary tumor is often difficult to locate, and resection in an early phase is recommended to prevent complications. This study evaluated the value of videocapsule endoscopy (VCE) in the detection of small-intestinal primary carcinoid tumor. DESIGN: Prospective descriptive study. SETTING: Tertiary referral center. PATIENTS: Twenty consecutive patients (13 men, 7 women; 60.5 +/- 9.3 years) with metastatic NET of unknown primary tumor. INTERVENTIONS: All patients underwent CT, enteroclysis, nuclear imaging, and VCE of the small bowel. RESULTS: CTs and enteroclysis did not detect a primary small-intestinal carcinoid tumor. Nuclear imaging demonstrated abnormalities in the abdominal area in 13 patients but was unable to relate this to an intestinal localization in any patient. VCE revealed a small-intestinal tumor in 9 patients. Three other patients showed external compression and erosions. At surgery, 5 patients had a small-intestinal carcinoid tumor, and, in 2 patients, a small-intestinal ischemic segment was present. LIMITATIONS: The number of false-positive VCE findings was not clear, because not all patients underwent surgery. The absence of abnormalities at VCE in patients with abnormalities at nuclear imaging might be related to the presence of carcinoid tumor restricted to the mesenterium or to a false-negative VCE. CONCLUSIONS: VCE had a high diagnostic yield of 45% for identification of primary small-intestinal carcinoid tumors. Although nuclear imaging had a comparable diagnostic yield, it could not differentiate between intestinal and mesenterial localization of the carcinoid

van Veen M, Balemans WA, Schipper JA, Arets HG. Hoesten en piepen bij jonge zuigelingen door een congenitale luchtwegafwijking. Nederlands Tijdschrift voor Geneeskunde 2006; 150(37):2009-2012.

van Venrooij FV, Slee PHThJ. Diagnose in beeld (303). Een sterk gebruinde vrouw. Nederlands Tijdschrift voor Geneeskunde 2006; 150(49):2702.

van Wageningen B, Berends FJ, van Ramshorst B, Janssen IF. Revision of Failed Laparoscopic Adjustable Gastric Banding to Roux-en-Y Gastric Bypass. Obesity Surgery 2006; 16(2):137-141.

Abstract: BACKGROUND: The most common bariatric surgical operation in Europe, laparoscopic adjustable gastric banding (LAGB), is reported to have a high incidence of long-term complications. Also, insufficient weight loss is reported. We investigated whether revision to Roux-en-Y gastric bypass (RYGBP) is a safe and effective therapy for failed LAGB and for further weight loss.METHODS: From Jan 1999 to May 2004, 613 patients underwent LAGB. Of these, 47 underwent later revisional Roux-en-Y gastric bypass (RYGBP). Using a prospectively collected database, we analyzed these revisions. All procedures were done by two surgeons with extensive experience in bariatric surgery.RESULTS: All patients were treated with laparoscopic (n=26) or open (n=21) RYGBP after failed LAGB. Total follow-up after LAGB was 5.5+/-2.0 years. For the RYGBP, mean operating time was 161+/-53 minutes, estimated blood loss was 219+/-329 ml, and hospital stay was 6.7+/-4.5 days. There has been no mortality. Early complications occurred in 17%. There was only one late complication (2%) - a ventral hernia. The mean BMI prior to any form of bariatric surgery was 49.2+/-9.3 kg/m(2), and decreased to 45.8+/-8.9 kg/m(2) after LAGB and was again reduced to 37.7+/-8.7 kg/m(2) after RYGBP within our follow-up period.CONCLUSION: Conversion of LAGB to RYGBP is effective to treat complications of LAGB and to further reduce the weight to healthier levels in morbidly obese patients

van Werkum JW, ten Berg J, Kelder J, Suttorp M, Rensing B, Tersmette M. Staphylococcus aureus infections complicating percutaneous coronary interverntion. American Journal of Cardiology 2006; 97(8B):79D.

van Werkum JW, Heestermans AA, ten Berg JM. Point-of-care devices for monitoring anti-platelet therapy. Thrombosis Research 2006; 118(6):769-770.

van Werkum JW, Heestermans AA, Jaarsma W, Hautvast RW, de Boer MJ, ten Berg JM. Trombose van een coronaire stent na het staken van behandeling met clopidogrel. Nederlands Tijdschrift voor Geneeskunde 2006; 150(15):863-868.

Abstract: A drug-eluting stent was implanted in four patients, a man aged 67 and a woman aged 42 with acute myocardial infarction, a woman aged 41 with unstable angina pectoris and a man aged 41 with stable angina pectoris. All suffered stent thrombosis after discontinuation (in three cases prematurely) of clopidogrel therapy. Reasons for discontinuation included allergic reaction, a dental procedure and refusal of reimbursement by the insurer. In order to restore stent patency they were treated by percutaneous coronary intervention and all patients suffered irreversible myocardial damage. Combination therapy using acetylsalicylic acid and clopidogrel during and after angioplasty for the prevention of long- and short-term complications is necessary. Stent thrombosis after drug-eluting stent implantation usually occurs within 1-4 weeks following discontinuation ofantiplatelet medication. These cases stress the importance of antiplatelet therapy after stent implantation. Physicians, dentists and patients must be aware of the risk of the early discontinuation ofantiplatelet therapy

van Werkum JW, Heestermans AACM, Deneer VHM, Hackeng CM, ten Berg JM. Clopidogrel resistance: fact and fiction. Future Cardiology 2006; 2(2):215-228.

van Werkum JW, Heestermans A, Suttorp MJ, Rensing B, Kelder J, ten Berg JM. Femoral Vascular Access Site Complications with the Use of Angioseal in Patients Undergoing Percutaneous Coronary Intervention Treated with Double and Triple Antiplatelet Regimens in the Real World. American Journal of Cardiology 2006; 97(8B):79D.

van Werkum JW, van der Stelt CA, Seesing TH, Hackeng CM, ten Berg JM. A head-to-head comparison between the VerifyNowP2Y12-assay and light transmittance aggregometry for monitoring the individual platelet response to clopidogrel in patients undergoing elective PCI. Journal of Thrombosis & Haemostasis 2006; 4(11):2516-2518.

Veltkamp M, Grutters JC, van Moorsel CHM, Ruven HJT, van den Bosch JMM. Toll-like receptor (TLR) 2 promotor polymorphism is associated with the disease course in sarcoidosis patients. European Respiratory Journal - Supplement 2006; 28(Suppl 50):148s.

Veltkamp M, Grutters JC, van Moorsel CHM, Ruven HJT, van den Bosch JMM. Toll-like receptor (TLR) 9 genetics in sarcoidosis patients. European Respiratory Journal - Supplement 2006; 28(Suppl 50):520s.

Veltkamp M, Grutters JC, van Moorsel CH, Ruven HJ, van den Bosch JM. Toll-like receptor (TLR) 4 polymorphism Asp299Gly is not associated with disease course in Dutch sarcoidosis patients. Clinical & Experimental Immunology 2006; 145(2):215-218.

Abstract: The aetiology of sarcoidosis, a systemic disorder characterized by the formation of non-caseating granulomas in variable organs, remains enigmatic. Clarification is hampered by heterogeneity in disease phenotypes and course, due partly to the influence of a variety of genetic and environmental factors. Multiple studies have pointed towards bacteria as possible causative agents. Toll-like receptors (TLR) are innate immunity receptors important in the immune response against pathogens. TLR-4, together with CD14 and MD-2, is an essential receptor for the recognition of lipopolysaccharide (LPS), unique to the cell wall of Gram-negative bacteria. Recently, an association between TLR-4 polymorphism Asp299Gly, leading to a change in the extracellular domain of the receptor and possible hyporesponsiveness to LPS, and a chronic course of sarcoidosis was found in German patients. In the present study this polymorphism was genotyped in 156 Dutch sarcoidosis patients and 200 healthy Dutch controls using dual-labelled fluorescent oligonucleotides. No differences were found in allelic distributions between patients and controls (P = 0.79) or within the different clinical entities of the sarcoidosis group (P = 0.44). Importantly, there were no differences between the Dutch and German sarcoidosis patients (P = 0.62). However, the allelic distribution of the Asp299Gly polymorphism differed significantly between both control groups (P = 0.04). This study highlights the importance of testing a reported gene association in a distinct population when performing genetic association studies

Venneman NG, van Erpecum KJ. Gallstone disease: primary and secondary prevention. Best Practice & Research in Clinical Gastroenterology 2006; 20(6):1063-1073.

Abstract: Several risk factors for cholesterol gallstone formation in the general population have been identified. There is a strongly increased risk of gallstone disease during prolonged fasting, rapid weight loss, total parenteral nutrition, and somatostatin(-analogue) treatment. The annual risk of biliary colic and gallstone complications in asymptomatic gallstone carriers has been investigated sparsely. In asymptomatic and symptomatic gallstone carriers, treatment with the hydrophilic bile salt ursodeoxycholic acid (UDCA) has been claimed to reduce the risk of biliary colic and gallstone complications such as acute cholecystitis and acute pancreatitis. Also, prophylactic cholecystectomy could be beneficial in certain subgroups of asymptomatic gallstone carriers. However, randomized, double-blind, placebo-controlled trials are lacking. In this review, strategies for the prevention of gallstone formation in the general population and in high-risk conditions are dealt with. Also, strategies for the prevention of biliary colic and gallstone complications in asymptomatic and symptomatic gallstone carriers are discussed

Venneman NG, Besselink MG, Keulemans YC, Vanberge-Henegouwen GP, Boermeester MA, Broeders IA, Go PM, van Erpecum KJ. Ursodeoxycholic acid exerts no beneficial effect in patients with symptomatic gallstones awaiting cholecystectomy. Hepatology 2006; 43(6):1276-1283.

Abstract: Ursodeoxycholic acid (UDCA) and impaired gallbladder motility purportedly reduce biliary pain and acute cholecystitis in patients with gallstones. However, the effect of UDCA in this setting has not been studied prospectively. This issue is important, as in several countries (including the Netherlands) scheduling problems result in long waiting periods for elective cholecystectomy. We conducted a randomized, double-blind, placebo-controlled trial on effects of UDCA in 177 highly symptomatic patients with gallstones scheduled for cholecystectomy. Patients were stratified for colic number in the preceding year (<3: 32 patients; >/=3: 145 patients). Baseline postprandial gallbladder motility was measured by ultrasound in 126 consenting patients. Twenty-three patients (26%) receiving UDCA and 29 (33%) receiving placebo remained colic-free during the waiting period (89 +/- 4; median [range]: 75[4-365] days) before cholecystectomy (P = .3). Number of colics, non-severe biliary pain, and analgesics intake were comparable. A low number of prior colics was associated with a higher likelihood of remaining colic-free (59% vs. 23%, P < .001), without effects on the risk of complications. In patients evaluated for gallbladder motility, 57% were weak and 43% were strong contractors (minimal gallbladder volume > respectively </= 6 mL). Likelihood to remain colic-free was comparable in strong and weak contractors (31% vs. 33%). In weak contractors, UDCA decreased likelihood to remain colic-free (21% vs. 47%, P = .02). In the placebo group, 3 preoperative and 2 post-cholecystectomy complications occurred. In contrast, all 4 complications in the UDCA group occurred after cholecystectomy. In conclusion, UDCA does not reduce biliary symptoms in highly symptomatic patients. Early cholecystectomy is warranted in patients with symptomatic gallstones. (HEPATOLOGY 2006;43:1276-1283.)

Verdaasdonk RM, van Swol CF, Grimbergen MC, Rem AI. Imaging techniques for research and education of thermal and mechanical interactions of lasers with biological and model tissues. Journal of Biomedical Optics 2006; 11(4):041110.

Abstract: A setup based on color Schlieren techniques has been developed to study the interaction of energy sources, such as lasers, with biological tissues. This imaging technique enables real-time visualization of dynamic temperature gradients with high spatial and temporal resolution within a transparent tissue model. High-speed imaging techniques were combined in the setup to capture mechanical phenomena such as explosive vapor, cavitation bubbles, and shock waves. The imaging technique is especially used for qualitative studies because it is complex to obtain quantitative data by relating the colors in the images to temperatures. By positioning thermocouples in the field of view, temperature figures can be added in the image for correlation to colored areas induced by the temperature gradients. The color Schlieren setup was successfully used for various studies to obtain a better understanding of interaction of various laser, rf, and ultrasound devices used in medicine. The results contributed to the safety and the optimal settings of various medical treatments. Although the interaction of energy sources is simulated in model tissue, the video clips have proven to be of great value for educating researchers, surgeons, nurses, and students to obtain a better understanding of the mechanism of action during patient treatment

Verhagen MF, Lukkassen IM, Hammacher ER. Detection of child abuse in the emergency department. European Journal of Emergency Medicine 2006; 13(5):A10-A11.

Verhoeven BA, Moll FL, Koekkoek JA, van der Wal AC, de Kleijn DP, de Vries JP, Verheijen JH, Velema E, Busser E, Schoneveld A, Virmani R, Pasterkamp G. Statin treatment is not associated with consistent alterations in inflammatory status of carotid atherosclerotic plaques: a retrospective study in 378 patients undergoing carotid endarterectomy. Stroke 2006; 37(8):2054-2060.

Abstract: BACKGROUND AND PURPOSE: Anti-inflammatory qualities are held partially responsible for the reduction of cardiovascular events after statin treatment. We examined the phenotype of carotid atherosclerotic plaques harvested during carotid endarterectomy in relation to the previous use of different statins prescribed in clinical practice. METHODS: Three hundred and seventy-eight patients were included. Atherosclerotic plaques were harvested, immunohistochemically stained and semiquantitively examined for the presence of macrophages (CD68), smooth muscle cells, collagen and fat. Adjacent atherosclerotic plaques were used to study protease activity and interleukin levels. Patients' demographics were recorded and blood samples were stored. RESULTS: Serum cholesterol, low-density lipoprotein, apolipoprotein B, and C-reactive protein levels were lower in patients treated with statins compared with patients without statin treatment. Atheromatous plaques were less prevalent in patients receiving statins compared with patients without statin therapy (29% versus 42%, P=0.04). An increase of CD68 positive cells was observed in patients receiving statins compared with nonstatin treatment (P=0.05). This effect was specifically related to atorvastatin treatment. In patients treated with atorvastatin, the increased amount of CD68 positive cells were not associated with increased protease activity. In contrast, a dose-dependent decrease in protease activity was shown in the atorvastatin group. Interleukin 6 expression was lower in plaques obtained from patients treated with statins (P=0.04). CONCLUSIONS: Statin use may exert pleiotropic effects on plaque phenotype. However, not the presence of macrophages but activation with subsequent protease and cytokine release may be attenuated by statin use

Verhoeven BAN. Athero Express : ATHERO-sclerotic plaque EXPRESSion in relation to vascular events and patient characteristics. Enschede: Febodruk B.V., 2006.

Verrij E, van Montfrans GA, Bos WJ. Riva Rocci versus Korotkoff. European Society of Hypertension 16th European Meeting on Hypertension, Madrid, Juni 12 - 15 2006.

Verrij EA, van Montfrans GA, Bos WJ. Riva Rocci vs. Korotkoff. 18e Internistendagen : abstractboek : 27& 28 april 2006 MECC Maastricht 2006;81.

Verrij EA, Geers ABM. An interesting cause of hypocalcaemia. 18e Internistendagen : abstractboek : 27& 28 april 2006 MECC Maastricht 2006;54-55.

Verrij EA, de Weerdt O, Geers ABM, Wassink AMJ. Treatment of a metformin induced lactic acidosis. 18e Internistendagen : abstractboek : 27& 28 april 2006 MECC Maastricht 2006;60.

Verrij EA, Bos WJ, van Montfrans GA, Vincent HH, Westerhof BE. The mean brachial artery pressure in not calculated adequately by adding 1/3 of the pulse pressure to the diastolic pressure. 18e Internistendagen : abstractboek : 27& 28 april 2006 MECC Maastricht 2006;81-82.

Verstappen SM, Hoes JN, ter Borg EJ, Bijlsma JW, Blaauw AA, van Albada-Kuipers GA, van Booma-Frankfort C, Jacobs JW. Joint surgery in the Utrecht Rheumatoid Arthritis Cohort: the effect of treatment strategy. Annals of the Rheumatic Diseases 2006; 65(11):1506-1511.

Abstract: OBJECTIVE: To investigate the prevalence and prognostic factors of joint surgery in a large cohort of patients with rheumatoid arthritis, whose treatment, clinical and radiographic data have been assessed at predefined points in time since disease onset. METHODS: Data on surgical interventions were retrospectively obtained from 482 patients with rheumatoid arthritis whose follow-up data for at least 2 years were available, including treatment and response to treatment during the first 2 years. Survival time until the first surgical intervention and until the first major surgical intervention was determined for the total study population by Kaplan-Meier survival curves. Three separate Cox regression analyses were carried out to determine which variables measured at baseline, during the first year and during the first 2 years were predictors for joint surgery. RESULTS: 27% of the patients underwent surgical interventions. Mean survival time until the first surgical intervention was 10.4 years. The percentage of patients with a surgical intervention was 10% lower in the group with response to treatment when compared with the non-response group. Next to a delayed start with disease-modifying antirheumatic drugs, fast radiographic progression during the first year and first 2 years was a predictor of joint surgery in the multivariate regression analyses. CONCLUSION: Treatment with disease-modifying antirheumatic drugs immediately after diagnosis results in less joint surgery when compared with a delayed start. Furthermore, joint surgery is carried out more often in patients who do not respond to treatment

Vidakovic MV, van Beurden A. Quality of life after succesful resuscitation. 18e Internistendagen : abstractboek : 27& 28 april 2006 MECC Maastricht 2006;124-125.

Vijverberg PLM. Perineale prostatectomie, de beste anatomische benadering. State of the Art in Urology 2006, Garderen 2006.

Vilstrup H, Markiewicz M, Biesma D, Brozovic VV, Laminoga N, Malik M, Milanov S, Patch D, Platikanov V. Recombinant activated factor VII in an unselected series of cases with upper gastrointestinal bleeding. Thrombosis Research 2006; 118(5):595-601.

Abstract: INTRODUCTION: The mortality rate associated with UGI bleeding remains high at 7-14%. Pharmacologic and endoscopic interventions are the current standard treatment, but there are few alternative options should these fail. This study aimed to assess the efficacy and safety of recombinant activated factor VII (rFVIIa) in the rescue treatment of severe upper gastrointestinal (UGI) bleeding. METHOD: Eleven patients (age: 8-64 years) were treated with rFVIIa at 15.0-90 microg/kg to control UGI bleeds. All three pediatric/adolescent cases and four of the eight adults had UGI hemorrhage associated with liver disease; the origins of the bleeds for remaining adults were trauma (n=1), peptic duodenal ulcer (n=1), hemorrhagic gastritis with sepsis (n=1) and pancreatitis (n=1). RESULTS: Bleeding stopped in seven patients and was markedly reduced in two patients, while there was no change in two patients. Coagulation parameters displayed a tendency to improve, and transfusion requirements were reduced in most patients. In total, five patients died within 2 weeks of rFVIIa treatment. In each case, fatality was judged unrelated to rFVIIa treatment. No thromboembolic events occurred. CONCLUSIONS: These results suggest that, even if our data are optimistic, the use of rFVIIa in the treatment of severe UGI bleeding warrants further investigation in prospective, randomized trials

Vlieger AM, van de Putte EM, Hoeksma H. Het gebruik van complementaire en alternatieve geneeswijzen door kinderen op een polikliniek voor kindergeneeskunde en de redenen van ouders daarvoor. Nederlands Tijdschrift voor Geneeskunde 2006; 150(11):625-630.

Voorneveld H, Veldhuizen C, Ammerlaan J, van Mourik H. Sport: systematische professionele ontwikkeling reumazorg telt (systematic professional development rheumatology care counts). Annals of the Rheumatic Diseases 2006; 65(Suppl2):667-66.

Vos JA. Prestatie-indicatoren. Memorad 2006; 11(2):5.

Vriesendorp TM, Devries JH, van Santen S, Moeniralam HS, de Jonge E, Roos YB, Schultz MJ, Rosendaal FR, Hoekstra JB. Evaluation of short-term consequences of hypoglycemia in an intensive care unit. Critical Care Medicine 2006; 34(11):2714-2718.

Abstract: BACKGROUND:: Introduction of strict glycemic control has increased the risk for hypoglycemia in the intensive care unit. Little is known about the consequences of hypoglycemia in this setting. We examined short-term consequences (seizures, coma, and death) of hypoglycemia in the intensive care unit. PATIENTS AND METHODS:: All occurrences of hypoglycemia (glucose of <45 mg/dL) in our intensive care unit between September 1, 2002, and September 1, 2004, were identified. Patients with hypoglycemia (n = 156) were matched for time to hypoglycemia with control patients drawn from the at-risk population (nested case control method). Seizures observed within 8 hrs after hypoglycemia were scored. Discharge summaries for cases and controls were reviewed for occurrence of possible hypoglycemia-associated coma and death. A hazard ratio for in-hospital death was calculated with Cox regression analysis. RESULTS:: The hazard ratio for in-hospital death was 1.03 (95% confidence interval, 0.68-1.56; p = .88) in patients with a first occurrence of hypoglycemia relative to the controls without hypoglycemia, corrected for duration of intensive care unit admittance before hypoglycemia, age, sex, and Acute Physiology and Chronic Health Evaluation II score at admission. No cases of hypoglycemia-associated death were reported. Hypoglycemic coma was reported in two patients. Seizures after hypoglycemia were observed in one patient. CONCLUSIONS:: In this study, no association between incidental hypoglycemia and mortality was found. However, this data set is too small to definitely exclude the possibility that hypoglycemia is associated with intensive care unit mortality. In three patients with possible hypoglycemia-associated coma or seizures, a causal role for hypoglycemia seemed likely but could not fully be established

Waasdorp E. Single-centre experience with the talent stentgraft for endovascular aneurysm repair. Interactive Cardiovascular and Thoracic Surgery 2006; 5(Suppl 1):S63.

Wasfi YS, Rose CS, Murphy JR, Silveira LJ, Grutters JC, Inoue Y, Judson MA, Maier LA. A new tool to assess sarcoidosis severity. Chest 2006; 129(5):1234-1245.

Abstract: STUDY OBJECTIVES: Sarcoidosis is a granulomatous disorder primarily affecting the lung, but with frequent extrapulmonary organ involvement. There are no comprehensive scoring systems for sarcoidosis disease severity. Our goal was to develop and validate an objective and comprehensive sarcoidosis disease severity scoring system. DESIGN: Three sarcoidosis experts reviewed clinical data on 104 patients with biopsy-confirmed sarcoidosis. Each expert independently scored disease severity using a visual analog scale. Interrater agreement was assessed. Univariate analysis was performed, and those variables with p values </= 0.25 were used in backward regression multivariable analysis. A model was obtained including variables with a p value of </= 0.15 to predict severity scores. This model was subsequently validated using an independent panel of three additional international experts. SETTING: Granuloma clinic at National Jewish Medical and Research Center. PATIENTS: A total of 104 patients with biopsy-confirmed sarcoidosis. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Pairwise assessment of interrater agreement yielded high degrees of correlation with Spearman correlation coefficients of 0.86 to 0.89 and an intraclass correlation coefficient of 0.87. Univariate analysis showed that smoking status, immunosuppressive therapy, percent predicted for diffusing capacity of the lung for carbon monoxide (Dlco), FEV(1), FVC, and total lung capacity, FEV(1)/FVC ratio, disease duration, sites of organ involvement, and African-American race were associated with mean severity score. The multivariable model included cardiac and neurologic involvement, current therapy with noncorticosteroid immunosuppressive agents, Dlco percent predicted, FEV(1)/FVC ratio, African-American race, FVC percent predicted, and skin involvement. This model was validated using additional reviewer scores yielding Spearman correlation coefficients of 0.66 to 0.76 and an intraclass correlation coefficient of 0.74. CONCLUSIONS: We derived an objective disease severity scoring system that incorporates data on demographics, pulmonary function, and organ involvement to produce a whole-body sarcoidosis assessment. This preliminary tool has potential applicability in the assessment of disease severity in sarcoidosis research

Wasowicz-Kemps DK, Bliemer B, Boom FA, de Zwaan NM, van Ramshorst B. Laparoscopic gastric banding for morbid obesity: outpatient procedure versus overnight stay. Surgical Endoscopy 2006; 20(8):1233-1237.

Abstract: BACKGROUND: In western countries, laparoscopic gastric banding is increasingly used in the surgical treatment of morbid obesity. This study aimed to investigate the feasibility, safety, morbidity, and costs of an outpatient procedure (OP) compared with an overnight stay (OS). METHODS: In a 2-year period, 50 consecutive patients were randomized to an OP group or an OS group. RESULTS: In the OP group, 76% of the patients were successfully discharged the same day, without readmissions. Four procedures were converted, and one complication occurred. The patients in the OP group seemed to experience more pain (p = 0.009). Satisfaction scores were 8.1 (OP) and 8.8 (OS) (p = 0.06). Half of the OP patients and most of the OS patients preferred a clinical admission. The OP treatment cost 600 euros less than OS. CONCLUSION: With proper patient selection, laparoscopic gastric banding can be performed safely and at lower cost as an outpatient procedure

Wasowicz-Kemps DK, Biesma DH, Schagen van Leeuwen J, van Ramshorst B. Thromboseprofylaxe in de algemene chirurgische praktijk. Nederlands Tijdschrift voor Geneeskunde 2006; 150(4):220-221.

Wasowicz-Kemps DK, Biesma DH, Schagen van Leeuwen JH, van Ramshorst B. Prophylaxis of venous thromboembolism in general and gynecologic day surgery in the Netherlands. Journal of Thrombosis & Haemostasis 2006; 4(1):269-271.

Weerman C, Frericks D. Vervroegd met ontslag : ontslag van hematologische patiënten in de neutropene fase. Oncologica 2006; 23(1):23-24.

Wegdam JA, Hofker HS, Dijkstra G, Stolk MF, Jacobs MA, Suurmeijer AJ. Occult gastro-intestinaal bloedverlies door een laesie van Dieulafoy in het terminale ileum. Nederlands Tijdschrift voor Geneeskunde 2006; 150(32):1776-1779.

Abstract: A 50-year-old man awaiting liver transplantation for primary sclerosing cholangitis developed iron-deficiency anaemia. Repeated occult gastrointestinal bleeding led to an increasing need for blood transfusions. After multiple oesophagogastroduodenoscopies and colonoscopies, videocapsule endoscopy finally demonstrated a polyp-like lesion in the terminal ileum. The lesion had not been detected despite two attempts (oral and anal) at double-balloon enteroscopy and even a peroperative enteroscopy. Only during a second laparotomy, again involving peroperative enteroscopy, a small red lesion was detected and resected 80 cm proximal to the ileocecal valve (Bauhin's valve). Histology revealed a Dieulafoy lesion. Four months later, after normalisation and stabilisation of his haemoglobin level, the patient received a successful liver transplant. If the cause of occult gastrointestinal bleeding in a patient remains unclear despite regular endoscopic procedures, new techniques like videocapsule endoscopy and double-balloon enteroscopy may contribute to identifying the cause. This may lead to an exceptional finding such as a Dieulafoy lesion in the distal ileum

Wiertsema SP, Khoo SK, Baynam G, Veenhoven RH, Laing IA, Zielhuis GA, Rijkers GT, Goldblatt J, Lesouef PN, Sanders EAM. Association of the CD14 promotor polymorphism with otitis media and pneumococcal vaccine responses. 5th International Symposium on Pneumococci and Pneumococcal diseases 2-6 April 2006, Alice Springs, Australia 2006;110.

Wiertsema SP, Herpers BL, Walraven V, Veenhoven RH, Schilder AGM, Ruven HJT, Rijkers GT, Sanders EAM. Mannan-binding lectin levels and polymorphisms in children with recurrent acute otitis media. 5th International Symposium on Pneumococci and Pneumococcal diseases 2-6 April 2006, Alice Springs, Australia 2006;208.

Wiertsema SP, Vossers MJ, Krediet TG, Hoeks SB, Fleer A, Ruven HJT, Rijkers GT. Association of Toll-Like Receptor-2 Polymorphisms with Premature Birth Among Infants Admitted to a Neonatal Intensive Care Unit. Pediatric Academic Associations Annual Meeting San Fransisco USA, 29-30 april 2006 2006;2610.6.

Wiertsema SP, Veenhoven RH, Walraven V, Uiterwaal CS, Schilder AG, Rijkers GT, Sanders EA. Pneumococcal vaccine efficacy for mucosal pneumococcal infections depends on Fcgamma receptor IIa polymorphism. Vaccine 2006; 24(6):792-797.

Abstract: IgG2 antibodies are the main antibody subclass produced after pneumococcal polysaccharide vaccination. For these antibodies to be effective, interaction with FcgammaIIa receptors on phagocytic cells is necessary. FcgammaRIIa displays a functional polymorphism with either a histidine (H) or arginine (R) at position 131. Interaction of IgG2 antibodies depends on the H131 allele, whereas this interaction is low to absent with the R131 allele. We tested the clinical efficacy of combined pneumococcal conjugate and pneumococcal polysaccharide vaccination according to FcgammaIIa-H/R131 genotype in a randomized double blind placebo controlled vaccination trial in children with a history of acute otitis media. We found a decisive role for the FcgammaIIa-H/R131 polymorphism on the clinical vaccine efficacy of combined pneumococcal conjugate and polysaccharide vaccinations. RR homozygotes showed a significant increase in recurrence of acute otitis media after pneumococcal vaccinations. This cannot be explained by differences in the pneumococcal specific antibody response or differences in nasopharyngeal pneumococcal carriage, but may be explained by less efficient interaction of FcgammaRIIa with polysaccharide-induced IgG2 anti-pneumococcal antibodies in RR homozygotes. Our data show that the genetic make-up of individuals or populations under study should be considered while evaluating vaccine efficacy trials

Wiertsema SP, Herpers BL, Walraven V, Veenhoven RH, Schilder AGM, Ruven HJT, Rijkers GT, Sanders EAM. Mannan-Binding Lectin Levels and Polymorphisms in Children with Recurrent Acute Otitis Media. Pediatric Academic Associations Annual Meeting San Fransisco USA, 29-30 april 2006 2006;3530.201.

Wiertsema SP, Khoo SK, Baynam G, Veenhoven RH, Laing IA, Zielhuis GA, Rijkers GT, Goldblatt J, Lesouef PN, Sanders EA. Association of CD14 promoter polymorphism with otitis media and pneumococcal vaccine responses. Clinical and vaccine immunology : CVI 2006; 13(8):892-897.

Abstract: Innate immunity is of particular importance for protection against infection during early life, when adaptive immune responses are immature. CD14 plays key roles in innate immunity, including in defense against pathogens associated with otitis media, a major pediatric health care issue. The T allele of the CD14 C-159T polymorphism has been associated with increased serum CD14 levels. Our objective was to investigate the hypothesis that the CD14 C-159T allele is protective against recurrent acute otitis media in children. The association between the CD14 promoter genotype and the number of acute otitis media episodes was evaluated both retrospectively and prospectively in a cohort of 300 children. Serotype-specific immunoglobulin G (IgG) antibody responses after pneumococcal vaccinations were examined according to CD14 genotype to compare immune responsiveness across genotypes. An age-dependent association was found: compared with that for CC homozygotes aged between 12 to 24 months, TT homozygotes had fewer episodes of acute otitis media (79 versus 41%, respectively; P = 0.004); this relationship was absent in older children. Additionally, TT homozygotes showed higher serotype-specific anti-pneumococcal IgG antibody levels. Our data suggest that genetic variation in CD14, a molecule at the interface of innate and adaptive immune responses, plays a key role in the defense against middle ear disease in childhood and in pneumococcal vaccine responsiveness. These findings are likely to be important to these and other immune-mediated outcomes in early life

Wiertsema SP, Herpers BL, Veenhoven RH, Salimans MM, Ruven HJ, Sanders EA, Rijkers GT. Functional polymorphisms in the mannan-binding lectin 2 gene: Effect on MBL levels and otitis media. Journal of Allergy & Clinical Immunology 2006; 117(6):1344-1350.

Abstract: BACKGROUND: Mannan-binding lectin (MBL) can bind to microorganisms, initiating the lectin pathway of complement activation. Aberrant MBL serum levels, caused by MBL2 gene polymorphisms, are a possible risk factor for recurrent infections. Within the 7 common MBL haplotypes, still considerable variation in MBL serum levels exists. OBJECTIVE: To investigate functional MBL levels and MBL2 polymorphisms in a large cohort of children with recurrent acute otitis media. METHODS: Twelve genetic variants in the MBL2 gene and functional MBL serum levels were determined in a cohort of children with recurrent acute otitis media. Haplotypes were constructed and associated with functional MBL serum levels and the number of otitis episodes in the previous year. RESULTS: The 7 common MBL2 haplotypes mainly determine the level of functional MBL in serum. In addition, the 3130G>C single nucleotide polymorphism, located in exon 4, further significantly influenced functional MBL levels within the LXPA haplotype. LXPA carriers with 3130G showed a significantly lower geometric mean functional MBL serum level of 0.19 mug/mL compared with 0.70 mug/mL in 3130C carriers (P = .026). Nonwild-type MBL2 carriers between 12 and 24 months had a significantly increased number of otitis episodes (5.1/y) compared with wild-type MBL2 carriers (4.1/y; P = .027). In older children, this association was not found anymore. CONCLUSION: Additional single nucleotide polymorphisms within the 7 common haplotypes can further explain the observed variation in functional MBL serum levels. MBL seems to be of particular clinical importance during early childhood, when maternally derived antibodies have waned, and protective adaptive immunity is not well developed yet. CLINICAL IMPLICATIONS: Single nucleotide polymorphisms in the promoter region, in exon 1, and in exon 4 of MBL2 contribute to increased risk for otitis media in children younger than 2 years

Wilhelm M, van Staveren O. Institutional repository in a teaching hospital. 10th Conference of the European Association for Health Information and Libraries : Europe as an open book : 11-16 September 2006 Cluj-Napoca, Romania 2006;29-30.

Wille J, Vos JA, Overtoom TT, Suttorp MJ, van de Pavoordt ED, de Vries JP. Acute leg ischemia: the dark side of a percutaneous femoral artery closure device. Annals of Vascular Surgery 2006; 20(2):278-281.

Abstract: The use of femoral artery closure devices to obtain hemostasis after percutaneous catheterization has become widespread because of their proven feasibility in combination with patient-related advantages. Since 2002 more than 6,500 patients have undergone either diagnostic angiography or therapeutic intervention via the femoral route with an Angioseal closure device in our hospital. We were faced with six cases of limb-threatening complications, which are described here. Most (5/6) complications were of obstructive origin due to traumatic dissection or occlusion of the artery mainly caused by malpositioning of the device. Recommendations are made in order to prevent or successfully overcome this certainly increasing problem in the vascular field

Wille J, de Vries JP, Hammacher ER, van de Pavoordt HD, Moll FL. Claudicatio intermittens bij een 26-jarige wielrenner. Nederlands Tijdschrift voor Geneeskunde 2006; 150(38):2116.

Wirds JW, van Teeffelen ASP, Smal JC, Blümer N, Blomjous FJEM, van Diemen-Steenvoorde JAAM, Schagen van Leeuwen JH, Haas FJLM, Gerritsen WBM, de Boer A, Leusink JA. On the origin of S100B protein in umbilical cord blood in healthy newborns. Nederlands Tijdschrift voor Anesthesiologie 2006; 19:18.

Zhu Y, van der Bruggen T, de Jongh BM, Meinders AJ, Slee PHThJ. Diarree na een bezoek aan India. Tijdschrift voor Infectieziekten 2006; 1(6):248-251.

Zijlstra H, Larsen JK, van Ramshorst B, Geenen R. The association between weight loss and self-regulation cognitions before and after laparoscopic adjustable gastric banding for obesity: A longitudinal study. Surgery 2006; 139(3):334-339.

Abstract: BACKGROUND: The outcome of restrictive types of bariatric operation might be affected by cognitions (beliefs) about one's capability to regulate eating behavior. Our aim was to examine the association between weight loss and self-regulation cognitions before and after laparoscopic adjustable gastric banding for morbid obesity or severe obesity with serious comorbidity. METHODS: Six months before and 1 year after the operation, the Obesity Cognition Questionnaire and an eating behavior self-efficacy scale were completed by 77 patients: 68 women, 9 men, mean age 43 years (range, 27-62 y), mean preoperative body mass index 47 kg/m(2) (range, 36-63 kg/m(2)). Pearson correlations were calculated and t tests and effect size calculations were used to examine preoperative to postoperative changes of self-regulation cognitions. RESULTS: The mean body mass index 1 year after the operation was 38 kg/m(2) (range, 25-55 kg/m(2)). Self-regulation cognitions did not predict weight outcome, but the self-regulation cognitions time-line (ie, the attitude about the prognosis of one's overweight, P < .001), psychologic consequences (P = .002), and self-efficacy (P < .001) changed in a positive way 1 year after the operation. CONCLUSIONS: Intake screening of self-regulation cognitions is of little use for prediction of short-term weight outcome after bariatric operation. It is suggested that beliefs about one's capability to control eating behavior change after the operation