Diagnostic outcome management study in patients with clinically suspected recurrent acute pulmonary embolism with a structured algorithm.

Introduction: The value of diagnostic strategies in patients with clinically suspected recurrent pulmonary embolism (PE) has not been established. The aim was to determine the safety of a simple diagnostic strategy using the Wells clinical decision rule (CDR), quantitative D-dimer testing and computed tomography pulmonary angiography (CTPA) in patients with clinically suspected acute recurrent PE.

Materials And Methods: Multicenter clinical outcome study in 516 consecutive patients with clinically suspected acute recurrent PE without using anticoagulants.

Decision-making considerations in application of biodegradable fixation systems in maxillofacial surgery--a retrospective cohort study.

In a recent RCT comparing biodegradable (Inion CPS) with titanium (KLS Martin) plates and screws for fixation of osteotomies or fractures, we found that in 21% of the cases the surgeon decided intra-operatively to switch from biodegradable to titanium. The aim of the current retrospective cohort study was to analyse the reasons for these switches in order to find predictor variables that may be helpful in the decision to use biodegradable devices or not. The surgeons' opinion about the biodegradable system, and if there was a learning curve in the application of the biodegradable system were also investigated.

Value of urodynamics before stress urinary incontinence surgery: a randomized controlled trial.

Objective: To estimate whether a strategy of immediate surgery was noninferior to a strategy based on discordant urodynamic findings followed by individually tailored therapy in women with stress urinary incontinence (SUI).

Methods: A multicenter diagnostic cohort study with an embedded noninferiority randomized controlled trial was conducted in six academic and 24 nonacademic Dutch hospitals. Women with predominant SUI eligible for surgical treatment based on clinical assessment were included between January 2009 and November 2010.

Routine screening for colon cancer after conservative treatment of diverticulitis.

Background And Aims: It is generally advised to perform colonoscopy after conservatively treated diverticulitis because colon cancer may present itself with similar symptoms, laboratory and radiological results. With this study we investigated in what percentage of patients a malignancy was found by performing routine colonoscopy or radiologic imaging after a conservatively treated episode of diverticulitis, and whether this follow-up programme could be reserved for a selected group of patients.

Methods: In our hospital, routine colonoscopy or, as a second choice, radiologic imaging has been standard practice over the last decade.

Rapid enterovirus molecular testing in cerebrospinal fluid reduces length of hospitalization and duration of antibiotic therapy in children with aseptic meningitis.

We studied the potential benefits of introducing a rapid enterovirus molecular test in children with enterovirus meningitis. The 2 groups of pediatric patients were comparable with respect to clinical and laboratory data, but differed in availability of enterovirus test results. In the control group, the results were available within 3 to 7 days, whereas in the study group, rapid enterovirus molecular test results were available within 3 to 24 hours.

Cholecalciferol loading dose guideline for vitamin D-deficient adults.

Introduction: Severe vitamin D deficiency is very common. Evidence-based guidelines for rapid correction with high-dose oral cholecalciferol are not yet available.

Objective: To develop a practical cholecalciferol loading dose regimen.

Acute chest pain in a patient treated with capecitabine.

A 61-year-old male with a history of metastatic colorectal cancer was referred to our hospital for primary coronary intervention because of acute ST-elevation myocardial infarction. Coronary angiography, however, revealed no significant stenoses. When asked, the patient revealed that capecitabine (Xeloda(R)) was started by his oncologist one day before admission.

Endovascular aneurysm repair: state-of-art imaging techniques for preoperative planning and surveillance.

Endovascular aneurysm repair (EVAR) represents one of the greatest advances in vascular surgery over the past 50 years. In contrast to conventional aneurysm repair, EVAR requires accurate preoperative imaging and stringent postoperative surveillance. Duplex ultrasound (DUS), transesophageal echocardiography, intravascular ultrasound, computed tomography (CT) and magnetic resonance (MR), each provide useful information for patient selection, choice of endograft type and surveillance.

Respiratory muscle strength and muscle endurance are not affected by acute metabolic acidemia.

Respiratory muscle fatigue in asthma and chronic obstructive lung disease (COPD) contributes to respiratory failure with hypercapnia, and subsequent respiratory acidosis. Therapeutic induction of acute metabolic acidosis further increases the respiratory drive and, therefore, may diminish ventilatory failure and hypercapnia. On the other hand, it is known that acute metabolic acidosis can also negatively affect (respiratory) muscle function and, therefore, could lead to a deterioration of respiratory failure.

A within-subjects comparison of learning and memory performance before and after cardiac catheterization.

Objective: To investigate the influence of stress on the recall of neutral information in a clinical setting, a prospective study was performed on patients who were admitted to the hospital for cardiac catheterization.

Methods: During their hospital stay, 39 cardiac patients were tested for verbal recall and face recognition before cardiac catheterization (day 1) and 24 h after (day 2). Plasma cortisol levels were also determined.

Trochlear osteotomy for patellar instability: satisfactory minimum 2-year results in patients with dysplasia of the trochlea.

Trochlear dysplasia is a predisposing factor for recurrent patellar instability. We evaluated the results of an anterior lateral femoral condyle open wedge osteotomy for treating patellar instability. A total of 16 consecutive patients (19 knees) with symptoms of recurrent patellar instability and trochlear dysplasia identified using a true lateral radiograph of the knee underwent an anterior lateral femoral osteotomy.

Normalization of serum calcium by cinacalcet in a patient with hypercalcaemia due to a de novo inactivating mutation of the calcium-sensing receptor.

Familial benign hypocalciuric hypercalcaemia (FHH) results from a heterozygous inactivating mutation of the calcium-sensing receptor (CaR) and is characterized by hypercalcaemia, hypocalciuria and inappropriately normal plasma levels of parathyroid hormone. In a minority of patients, a loss of function mutation of the CaR results in severe hypercalcaemia associated with complications for which no effective surgical or medical treatment is available. We investigated the effects of the calcimimetic agent cinacalcet, an allosteric modulator of the CaR, in a 26-year-old man presenting with hypercalcaemia due to a de novo inactivating mutation of the CaR.

Oral decontamination with chlorhexidine reduces the incidence of ventilator-associated pneumonia.

Rationale: Ventilator-associated pneumonia (VAP) is the most frequently occurring nosocomial infection associated with increased morbidity and mortality. Although oral decontamination with antibiotics reduces incidences of VAP, it is not recommended because of potential selection of antibiotic-resistant pathogens. We hypothesized that oral decontamination with either chlorhexidine (CHX, 2%) or CHX/colistin (CHX/COL, 2%/2%) would reduce and postpone development of VAP, and oral and endotracheal colonization.

Deficient UDP-glucuronosyltransferase detoxification enzyme activity in the small intestinal mucosa of patients with coeliac disease.

Background: Small intestinal malignancies in humans are rare; however, patients with coeliac disease have a relatively high risk for such tumours. Intestinal UDP-glucuronosyltransferases are phase II drug metabolism enzymes also involved in the detoxification of ingested toxins and carcinogens. As many toxins and carcinogens are ingested via food, the human gastrointestinal tract not only has an important role in the uptake of essential nutrients, but also acts as a first barrier against such harmful constituents of the food.

Familial Aggregation of Non-Hodgkin's Lymphoma (NHL). A Case Report.

A family is reported in which three male siblings of Asian descent developed non-Hodgkin's lymphoma (NHL). Case 1 was diagnosed with indolent follicular lymphoma stage IIIA at age 45. Case 2 presented with large B-cell lymphoma stage IIB at age 56.

Survival of chronic hypercapnic COPD patients is predicted by smoking habits, comorbidity, and hypoxemia.

Study Objectives: Chronic hypercapnia in patients with COPD has been associated with a poor prognosis. We hypothesized that, within this group of chronic hypercapnic COPD patients, factors that could mediate this hypercapnia, such as decreased maximum inspiratory mouth pressure (P(I(max))), decreased maximum expiratory mouth pressure (P(E(max))), and low hypercapnic ventilatory response (HCVR), could be related to survival. Other parameters, such as arterial blood gas values, airway obstruction (FEV1), body mass index (BMI), current smoking status, and the presence of comorbidity were studied as well.

Tremor side effects of salbutamol, quantified by a laser pointer technique.

Objective: To study tremor side effects of salbutamol an easily applicable, quick and low-priced method is needed. A new method using a commercially available, pen-shaped laser pointer was developed. Aim of the study was to determine sensitivity, reproducibility, reference values and the agreement with a questionnaire.

Residual disease after excision of non-palpable breast tumours: analysis of tumour characteristics.

Introduction: A tumour-positive resection margin is a well-known prognostic factor for local recurrence. The aim of this study was to evaluate tumour characteristics that might be predictive for the presence of residual disease after excisional surgery.

Patients And Methods: Data of 295 patients, subjected to a wire-guided excisional breast biopsy were studied.

Safety of thiopurines in the treatment of inflammatory bowel disease.

Background: Thiopurines have proven efficacy in inflammatory bowel disease. However, concerns regarding toxicity have limited the use of these agents as first line of medical therapy.

Methods: Review of the literature regarding metabolism, efficacy and side effects.

Cerebrovascular response to acute metabolic acidosis in humans.

Objectives: Evaluation of the cerebrovascular response (delta CBV/delta PaCO2) during baseline metabolic conditions and acute metabolic acidosis.

Methods: 15 healthy subjects, 5 m, 10 f, 56 +/- 10 yrs were investigated. For acidification, NH4Cl was given orally.

Randomized clinical trial of ultrasonic versus electrocautery dissection of the gallbladder in laparoscopic cholecystectomy.

Background: Laparoscopic cholecystectomy is frequently complicated by gallbladder perforation and loss of bile or stones into the peritoneal cavity. The aim of this study was to compare the use of ultrasonic dissection and electrocautery with respect to the incidence of gallbladder perforation and intraoperative consequences.

Methods: Between January 1998 and January 2000, 200 patients undergoing elective laparoscopic cholecystectomy were randomized to electrocautery or ultrasonic dissection of the gallbladder.

Small intestinal biopsies in celiac disease: duodenal or jejunal?

Background: For diagnosis and follow-up of celiac disease, pediatric societies advise that intestinal mucosal specimens should be obtained using suction capsule from the jejunum. This procedure is strenuous for patients, time-consuming, expensive and requires radiographic guidance. Mucosal biopsies from the distal duodenum can be obtained more easily under endoscopic vision using forceps.

Histologic follow-up of people with celiac disease on a gluten-free diet: slow and incomplete recovery.

To assess histologic recovery in response to gluten withdrawal in celiac disease, 158 patients seen in our hospital during a 15-year period underwent follow-up small intestine biopsies (SIBs) within 2 years after starting a gluten-free diet; further SIBs were done if villous atrophy was present. A modified Marsh classification was used (IIIA, partial villous atrophy; IIIB, subtotal villous atrophy; IIIC, total villous atrophy). Of patients with Marsh IIIA, IIIB, or IIIC lesions, histologic remission was seen in 65.