Br J Clin Pharmacol. 2015 Sep;80(3):329-30. doi: 10.1111/bcp.12700. Epub 2015 Jul 22. No abstract available.
PMID: 26096416
Dautzenberg L, Jessurum N, Dautzenberg PL, Keijsers CJ. Reversible Methotrexate-Induced Dementia: A Case Report. J Am Geriatr Soc. 2015 Jun;63(6):1273-4. doi: 10.1111/jgs.13517. No abstract available.
PMID: 26104005
Claassen B, Barneveld PC, Jager G, Rutten MJ. Abdominal splenosis. Ned Tijdschr Geneeskd.
2015;159:A8880.
Splenosis is a common benign finding that occurs after splenic trauma or after splenectomy. It is auto-transplantation of splenic tissue and can be seen intra-abdominally, intra-thoracically and even subcutaneously. Splenosis is usually found incidentally at laparoscopy, laparotomy or on radiological examination and is mostly asymptomatic. Treatment is only required if a patient complains of abdominal pain, obstruction or bleeding. On radiological examination splenosis can mimic a metastatic malignant disease. For this reason it is important to recognise splenosis and know the patient’s medical history concerning splenic trauma or splenectomy, thus avoiding diagnostic laparoscopy or ultrasound guided biopsy. This paper presents two patients with splenosis. Additionally, we describe how to diagnose this entity by scintigraphy with (99m) Technetium-labelled heat-denatured erythrocytes.
PMID: 26105574
Kip MM, Kusters R, Ijzerman MJ, Steuten LM. A PCT algorithm for discontinuation of antibiotic therapy is a safe and cost-effective intervention to reduce antibiotic exposure in adult intensive care patients with sepsis. J Med Econ. 2015 Nov;18(11):944-53. doi: 10.3111/13696998.2015.1064934. Epub 2015 Jul 20.
OBJECTIVE: Procalcitonin (PCT) is a specific marker for differentiating bacterial from non-infective causes of inflammation. It can be used to guide initiation and duration of antibiotic therapy in intensive care unit (ICU) patients with suspected sepsis, and might reduce the duration of hospital stay. Limiting antibiotic treatment duration is highly important because antibiotic over-use may cause patient harm, prolonged hospital stay, and resistance development. Several systematic reviews show that a PCT algorithm for antibiotic discontinuation is safe, but upfront investment required for PCT remains an important barrier against implementation. The current study investigates to what extent this PCT algorithm is a cost-effective use of scarce healthcare resources in ICU patients with sepsis compared to current practice. METHODS: A decision tree was developed to estimate the health economic consequences of the PCT algorithm for antibiotic discontinuation from a Dutch hospital perspective. Input data were obtained from a systematic literature review. When necessary, additional information was gathered from open interviews with clinical chemists and intensivists. The primary effectiveness measure is defined as the number of antibiotic days, and cost-effectiveness is expressed as incremental costs per antibiotic day avoided. RESULTS:
The PCT algorithm for antibiotic discontinuation is expected to reduce hospital spending by circa κ 3503 per patient, indi-cating savings of 9.2%. Savings are mainly due to reductions in length of hospital stay, number of blood cultures performed, and, importantly, days on antibiotic therapy. Probabilistic and one-way sensitivity analyses showed the model outcome to be robust against changes in model inputs. CONCLUSION: Proven safe, a PCT algorithm for antibiotic discontinuation is a cost-effective means of reducing antibiotic exposure in adult ICU patients with sepsis, compared to current practice. Additional resources required for PCT are more than offset by downstream cost savings. This finding is highly important given the aim of preventing widespread antibiotic resistance.
PMID: 26123742
Visser NC, Bulten J, van der Wurff AA, Boss EA, Bronkhorst CM, Feijen HW, Haartsen JE, van Herk HA, de Kievit IM, Klinkhamer PJ, Pijlman BM, Snijders MP, Vandenput I, Vos MC, de Wit PE, van de Poll-Franse LV, Massuger LF, Pijnenborg JM. PIpelle Prospective ENDOmetrial carcinoma (PIPENDO) study, pre-operative recognition of high risk endometrial carcinoma: a multicentre prospective cohort study. BMC Cancer. 2015 Jun 30;15:487
BACKGROUND: Endometrial carcinoma is the most common gynaecologic malignancy in industrialised countries and the incidence is still rising. Primary treatment is based on preoperative risk classification and consists in most cases of hyste-rectomy with bilateral salpingo-oophohyste-rectomy. In patients with serous and clear cell histology a complete surgical staging is mandatory. However, in routine clinical practice final histology regularly does not correspond with the preoperative histolo-gical diagnosis. This results in both over and under treatment. METHODS/DESIGN: The aim of this multicentre, prospective cohort study is to select a panel of prognostic biomarkers to improve preoperative diagnosis of endometrial carcinoma in order to identify those patients that need extended surgery and/or additional treatment. Additionally, we will determine whether incorporation of cervical cytology and comorbidity could improve this preoperative risk classification. All patients treated for endometrial carcinoma in the participating hospitals from September 2011 till December 2013 are included.
Patient characteristics, as well as comorbidity are registered. Patients without preoperative histology, history of hysterectomy and/or endometrial carcinoma or no surgical treatment including hysterectomy are excluded. The preoperative histology and final pathology will be reviewed and compared by expert pathologists. Additional immunohistochemical analysis of IMP3, p53, ER, PR, MLH1, PTEN, beta-catenin, p16, Ki-67, stathmin, ARID1A and L1CAM will be performed. Preoperative histology will be compared with the final pathology results. Follow-up will be at least 24 months to determine risk factors for
159 BIJLAGE WETENSCHAPPELIJKE PUBLICATIES 2013-2014 OPGENOMEN IN PUBMED
recurrence and outcome. DISCUSSION: This study is designed to improve surgical treatment of endometrial carcinoma pa-tients. A total of 432 endometrial carcinoma patients were enrolled between 2011 and 2013. Follow-up will be completed in 2015. Preoperative histology will be evaluated systematically and background endometrium will be classified. This is the first study incorporating immunohistochemistry, cervical cytology and comorbidity to define the optimal panel of prognostic biomarkers that contribute in clinical decision making in the management of endometrial carcinoma. TRIAL REGISTRATION:
Netherlands Trial Register number NTR3503.
PMID: 26132155
Morroy G, van der Hoek W, Albers J, Coutinho RA, Bleeker-Rovers CP, Schneeberger PM. Population Screening for Chronic Q-Fever Seven Years after a Major Outbreak. PLoS One. 2015 Jul 1;10(7):e0131777. doi: 10.1371/
journal.pone.0131777. eCollection 2015.
INTRODUCTION: From 2007 through 2010, the Netherlands experienced a large Q-fever epidemic, with 4,107 notifications.
The most serious complication of Q-fever is chronic Q-fever. METHOD: In 2014, we contacted all 2,161 adult inhabitants of the first village in the Netherlands affected by the Q-fever epidemic and offered to test for antibodies against Coxiella burnetii using immunofluorescence assay (IFA) to screen for chronic infections and assess whether large-scale popula-tion screening elsewhere is warranted. RESULTS: Of the 1,517 participants, 33.8% were IFA-positive. Six IFA-positive participants had an IgG phase I titer ≥1:512. Two of these six participants were previously diagnosed with chronic Q-fever.
Chronic infection was diagnosed in one of the other four participants after clinical examination. CONCLUSIONS: Seven years after the initial outbreak, seroprevalence remains high, but the yield of screening the general population for chronic Q-fever is low. A policy of screening known high-risk groups for chronic Q-fever in outbreak areas directly following an outbreak might be more efficient than population screening. A cost-effectiveness analysis should also be performed before initiating a population screening program for chronic Q-fever.
PMID: 26149449
Eppenga WL, Wester WN, Derijks HJ, Hoedemakers RM, Wensing M, De Smet PA, Van Marum RJ. Fluctuation of the renal function after discharge from hospital and its effects on drug dosing in elderly patients--study protocol. BMC Nephrol. 2015 Jul 7;16:95. doi: 10.1186/s12882-015-0095-4.
BACKGROUND: Chronic kidney disease (CKD) is associated with an increased mortality rate, risk of cardiovascular events and morbidity. Impaired renal function is common in elderly patients, and their glomerular filtration rate (GFR) should be taken into account when prescribing renally excreted drugs. In a hospital care setting the GFR may fluctuate substantially, so that the renal function group and therefore the recommended dose, can change within a few days. The magnitude and prevalence of the fluctuation of renal function in daily clinical practice and its potential effects on appropriateness of drug prescriptions after discharge from the hospital is unknown. METHODS/DESIGN: This is a prospective observational study.
Patients ≥ 70 years with renal impairment (eGFR < 60 ml/min/1.73 m(2)) admitted to a geriatric ward are eligible to partici-pate. Participants undergo blood sample collection to measure serum creatinine level at three time points: at discharge from hospital, 14 days, and 2 months after discharge. At these time points the actual medication of the participants is assessed and the number of incorrect prescriptions according to the Dutch guidelines in relation to their estimated renal function is measured. In addition, for a hypothetical selection of drugs, the need for drug dose adaptation in relation to renal function is measured. The outcome of interest is the percentage of patients that changes from renal function group after discharge from hospital compared to the renal function at discharge. In addition, the percentages of patients whose actual medicati-ons are incorrectly prescribed and for the hypothetical selection of drugs that would have required dose adaptation will be determined at discharge, 14 days and 2 months after discharge. For each outcome, risk factors which may lead to increased
risk for fluctuation of renal function and/or incorrect drug prescribing will also be identified and analysed.DISCUSSION: This study will provide data on changes in renal function in elderly patients after discharge from the hospital with a focus on the medications used. The benefits for healthcare professionals comprise of the creation, adjustment or confirmation of recom-mendations for the monitoring of the renal function after discharge from hospital of elderly patients.
PMID 26153882
Jie KE, van Dam LF, Hammacher ER. Isolated fat pad sign in acute elbow injury: is it clinically relevant?
Eur J Emerg Med. 2016 Jun;23(3):228-31.
An isolated fat pad sign (i.e. joint effusion without a visible fracture), commonly seen in acute elbow injury, is associated with occult fracture and treated as such. However, the clinical relevance of an isolated fat pad is unclear, thereby questioning the need for specialized follow-up. In this study, 111 patients (median age 15 years, interquartile range 9-27 years) with an isolated fat pad sign after acute elbow injury were included. The clinical relevance of an isolated fat pad sign was derived from descriptives on pain, elbow function, treatment change, number of revisits and recovery time after 1 week follow-up and long-term follow-up. Treatment alterations were rarely made and none of the patients needed an operative interven-tion; also, none of the patients had persistent symptoms. The median recovery time was 3 weeks (interquartile range 2-12 weeks). This study shows that, unless symptoms persist or worsen, regular follow-up at a specialized outpatient clinic is not needed.
PMID: 26156651
Soria JC, Felip E, Cobo M, Lu S, Syrigos K, Lee KH, Göker E, Georgoulias V, Li W, Isla D, Guclu SZ, Morabito A, Min YJ, Ardizzoni A, Gadgeel SM, Wang B, Chand VK, Goss GD; LUX-Lung 8 Investigators (Biesma B.). Afatinib versus erlotinib as second-line treatment of patients with advanced squamous cell carcinoma of the lung (LUX-Lung 8):
an open-label randomised controlled phase 3 trial. Lancet Oncol. 16(8):897-907, 2015. doi: 10.1016/
S1470-2045(15)00006-6.
BACKGROUND: There is a major unmet need for effective treatments in patients with squamous cell carcinoma of the lung. LUX-Lung 8 compared afatinib (an irreversible ErbB family blocker) with erlotinib (a reversible EGFR tyrosine kinase inhibitor), as second-line treatment for patients with advanced squamous cell carcinoma of the lung. METHODS: We did this open-label, phase 3 randomised controlled trial at 183 cancer centres in 23 countries worldwide. We enrolled adults with stage IIIB or IV squamous cell carcinoma of the lung who had progressed after at least four cycles of platinum-based-chemotherapy. Participants were randomly assigned (1:1) to receive afatinib (40 mg per day) or erlotinib (150 mg per day) until disease progression. The randomisation was done centrally with an interactive voice or web-based response system and stratified by ethnic origin (eastern Asian vs non-eastern Asian). Clinicians and patients were not masked to treatment allocation. The primary endpoint was progression-free survival assessed by independent central review (intention-to-treat population). The key secondary endpoint was overall survival. This trial is registered with ClinicalTrials.gov, NCT01523587.
FINDINGS: 795 eligible patients were randomly assigned (398 to afatinib, 397 to erlotinib). Median follow-up at the time of the primary analysis of progression-free survival was 6•7 months (IQR 3•1-10•2), at which point enrolment was not complete. Progression free-survival at the primary analysis was significantly longer with afatinib than with erlotinib (median 2•4 months [95% CI 1•9-2•9] vs 1•9 months [1•9-2•2]; hazard ratio [HR] 0•82 [95% CI 0•68-1•00], p=0•0427). At the time of the primary analysis of overall survival (median follow-up 18•4 months [IQR 13•8-22•4]), overall survival was significantly greater in the afatinib group than in the erloinib group (median 7•9 months [95% CI 7•2-8•7] vs 6•8 months [5•9-7•8]; HR 0•81 [95% CI 0•69-0•95], p=0•0077), as were progression-free survival (median 2•6 months [95% CI
2•0-161 BIJLAGE WETENSCHAPPELIJKE PUBLICATIES 2013-2014 OPGENOMEN IN PUBMED
2•9] vs 1•9 months [1•9-2•1]; HR 0•81 [95% CI 0•69-0•96], p=0•0103) and disease control (201 [51%] of 398 patients vs 157 [40%] of 397; p=0•0020). The proportion of patients with an objective response did not differ significantly between groups (22 [6%] vs 11 [3%]; p=0•0551). Tumour shrinkage occurred in 103 (26%) of 398 patients versus 90 (23%) of 397 patients. Adverse event profiles were similar in each group: 224 (57%) of 392 patients in the afatinib group versus 227 (57%) of 395 in the erlotinib group had grade 3 or higher adverse events. We recorded higher incidences of treatment-related grade 3 diarrhoea with afatinib (39 [10%] vs nine [2%]), of grade 3 stomatitis with afatinib (16 [4%] vs none), and of grade 3 rash or acne with erlotinib (23 [6%] vs 41 [10%]). INTERPRETATION: The significant improvements in progression-free sur-vival and overall sursur-vival with afatinib compared with erlotinib, along with a manageable safety profile and the convenience of oral administration suggest that afatinib could be an additional option for the treatment of patients with squamous cell carcinoma of the lung. FUNDING: Boehringer Ingelheim.
PMID: 26158249
Hinnen JW, Konickx MA, Meerwaldt R, Kolkert JL, van der Palen J, Huisman AB, Geelkerken RH. Long Term Results of Kissing Stents in the Aortic Bifurcation. Acta Chir Belg. 2015 May-Jun;115(3):191-7.
BACKGROUND: To evaluate the long-term outcome after aortoiliac kissing stent placement and to analyze variables, which potentially influence the outcome of endovascular reconstruction of the aortic bifurcation. METHODS: All patients treated with aortoiliac kissing stents at our institution between April 1995 and August 2011 were retrospectively identified from a prospective single-center database. Data regarding patient characteristics (age, gender, smoking, cardio- and cerebrovas-cular risk factors, hyperlipidaemia, diabetes mellitus and use of antihypertensive medication), symptoms, pre-interventional examination and imaging, procedural details and follow-up were retrieved. Patency rates were calculated with Kaplan-Meier analysis. Factors affecting the patency were determined with Cox uni- and multivariate analysis. RESULTS: A total of 215 patients (63% men, mean age 61 ± 10 years) were included. The median follow-up period was 31 (IQR 47.1) months.
Primary, primary assisted, and secondary patency rates were 97%, 97%, and 99%, respectively, at one month; 92%, 95% and 94% at four months; 75%, 86%, and 91% at two years; 70%, 81%, and 91% at 5 years; and 67%, 81%, and 91% at ten years.
Younger age and previous aortoiliac treatment were predictors for reduced primary and primary assisted patency. Smoking, previous aortoiliac intervention, TASC C and D lesions were predictors for reduced secondary patency. CONCLUSIONS: Re-construction of the aortoiliac bifurcation with kissing stents is feasible, safe and effective in all types of lesions with satisfying long term patencies. TASC C and D lesions are associated with a higher occlusion rate. Younger age and previous aortoiliac interventions are predictors for reduced primary and primary assisted patency.
PMID: 26156860
Van Strien AM, Keijsers CJ, Derijks HJ, van Marum RJ. Rating scales to measure side effects of antipsychotic medication: A systematic review. J Psychopharmacol. 2015 Aug;29(8):857-66. doi:
10.1177/0269881115593893. Epub 2015 Jul 8. Review.
INTRODUCTION: Many patients experience side effects during treatment with antipsychotics. This article reviews the clinical use and psychometric characteristics of rating scales used to assess side effects in patients treated with antipsychotics.
METHODS: A systematic literature search was performed using the electronic databases PubMed and Embase, with prede-fined search terms. RESULTS: In total, 52 different scales were used in the 440 articles retrieved. For multiple side effects measured with one scale, the Udvalg for Kliniske Undersøgelser Side Effects Rating Scale for Clinicians was used the most, whereas the Liverpool University Neuroleptic Side Effect Rating Scale had the best psychometric characteristics (Cronbach’s κ 0.81 and test-retest reliability 0.89). The Simpson Angus Scale was used the most to rate extrapyramidal side effects, although the Maryland Psychiatric Research Center scale had the best characteristics (Cronbach’s κ 0.80, test-retest reli-ability 0.92 and inter-rater relireli-ability 0.81-0.90). The Arizona Sexual Experience Scale was used the most to assess sexual
dysfunction, but the Antipsychotics and Sexual Functioning Questionnaire and the Nagoya Sexual Functioning Questionnaire had the best characteristics. CONCLUSION: This review will help researchers and clinicians make a purpose-oriented choice of which scale to use. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42014013010.
PMID: 26161658
Wielders CC, van Loenhout JA, Morroy G, Rietveld A, Notermans DW, Wever PC, Renders NH, Leenders AC, van der Hoek W, Schneeberger PM. Long-Term Serological Follow-Up of Acute Q-Fever Patients after a Large Epidemic. PLoS One. 2015 Jul 10;10(7):e0131848. doi: 10.1371/journal.pone.0131848. eCollection 2015.
BACKGROUND: Serological follow-up of acute Q-fever patients is important for detection of chronic infection but there is no consensus on its frequency and duration. The 2007-2009 Q-fever epidemic in the Netherlands allowed for long-term follow-up of a large cohort of acute Q-fever patients. The aim of this study was to validate the current follow-up strategy targeted to identify patients with chronic Q-fever. METHODS: A cohort of adult acute Q-fever patients, diagnosed between 2007 and 2009, for whom a twelve-month follow-up sample was available, was invited to complete a questionnaire and provide a blood sample, four years after the acute episode. Antibody profiles, determined by immunofluorescence assay in serum, were investigated with a special focus on high titres of IgG antibodies against phase I of Coxiella burnetii, as these are considered indicative for possible chronic Q-fever. RESULTS: Of the invited 1,907 patients fulfilling inclusion criteria, 1,289 (67.6%) were included in the analysis. At any time during the four-year follow-up period, 58 (4.5%) patients were classified as possible, probable, or proven chronic Q-fever according to the Dutch Q-fever Consensus Group criteria (which uses IgG phase I ≥1:1,024 to as serologic criterion for chronic Q-fever). Fifty-two (89.7%) of these were identified within the first year after the acute episode. Of the six patients that were detected for the first time at four-year follow-up, five had an IgG phase I titre of 1:512 at twelve months. CONCLUSIONS: A twelve-month follow-up check after acute Q-fever is recommended as it adequately detects chronic Q-fever in patients without known risk factors. Additional serological and clinical follow-up is recommended for patients with IgG phase I ≥1:512, as they showed the highest risk to progress to chronic Q-fever.
PMID: 26170033
Reintjes W, Romijn MD, Hollander D, Ter Bruggen JP, van Marum RJ. Reversible Dementia: Two Nursing Home Patients With Voltage-Gated Potassium Channel Antibody-Associated Limbic Encephalitis. J Am Med Dir Assoc. 2015 Sep 1;16(9):790-4. doi: 10.1016/j.jamda.2015.06.008. Epub 2015 Jul 10.
Voltage-gated potassium channel antibody-associated limbic encephalitis (VGKC-LE) is a rare disease that is a diagnostic and therapeutic challenge for medical practitioners. Two patients with VGKC-LE, both developing dementia are presented.
Following treatment, both patients showed remarkable cognitive and functional improvement enabling them to leave the psychogeriatric nursing homes they both were admitted to. Patients with VGKC-LE can have a major cognitive and functional improvement even after a diagnostic delay of more than 1 year. Medical practitioners who treat patients with unexplained cognitive decline, epileptic seizures, or psychiatric symptoms should be aware of LE as an underlying rare cause.
PMID: 26177672
Ebisch R, Rovers MM, Bosgraaf RP, van der Pluijm-Schouten HW, Melchers W, van den Akker P, Massuger L, Bekkers R. Evidence supporting see-and-treat management of cervical intraepithelial neoplasia: a systematic review and meta-analysis. BJOG. 2016 Jan;123(1):59-66. doi: 10.1111/1471-0528.13530. Epub 2015 Jul 14.
BACKGROUND: Studies of see-and-treat management of cervical intraepithelial neoplasia (CIN) vary in their inclusion criteria, resulting in a broad range of overtreatment rates. OBJECTIVES: To determine overtreatment rates in see-and-treat management of women referred for colposcopy because of suspected CIN, in order to define circumstances supporting
see-163 BIJLAGE WETENSCHAPPELIJKE PUBLICATIES 2013-2014 OPGENOMEN IN PUBMED