Susceptibility weighted imaging in intracranial hemorrhage:not all bleeds are black

To correctly recognize intracranial hemorrhage (ICH) and differentiate it from other lesions, knowledge of the imaging characteristics of an ICH on Susceptibility Weighted Imaging (SWI) is essential. It is a common misconception that blood is always black on SWI, and it is important to realize that hemorrhage has a variable appearance in different stages on SWI. Furthermore, the presence of a low signal on SWI does not equal the presence of blood products. In this review the appearance of ICH on SWI during all its stages and common other causes of a low signal on SWI are further discussed and illustrated.</p

Outcomes of submucosal (T1b) esophageal adenocarcinomas removed by endoscopic mucosal resection

AIM: To investigate the outcomes and recurrences of pT1b esophageal adenocarcinoma (EAC) following endoscopic mucosal resection (EMR) and associated treatments. METHODS: Patients undergoing EMR with pathologically confirmed T1b EAC at two academic referral centers were retrospectively identified. Patients were divided into 4 groups based on treatment following EMR: Endoscopic therapy alone (group A), endoscopic therapy with either chemotherapy, radiation or both (group B), surgical resection (group C) or no further treatment/lost to follow-up (< 12 mo) (group D). Pathology specimens were reviewed by a central pathologist. Follow-up data was obtained from the academic centers, primary care physicians and/or referring physicians. Univariate analysis was performed to identify factors predicting recurrence of EAC. RESULTS: Fifty-three patients with T1b EAC underwent EMR, of which 32 (60%) had adequate follow-up ≥ 12 mo (median 34 mo, range 12-103). There were 16 patients in group A, 9 in group B, 7 in group C and 21 in group D. Median follow-up in groups A to C was 34 mo (range 12-103). Recurrent EAC developed overall in 9 patients (28%) including 6 (38%) in group A (median: 21 mo, range: 6-73), 1 (11%) in group B (median: 30 mo, range: 30-30) and 2 (29%) in group C (median 21 mo, range: 7-35. Six of 9 recurrences were local; of the 6 recurrences, 5 were treated with endoscopy alone. No predictors of recurrence of EAC were identified. CONCLUSION: Endoscopic therapy of T1b EAC may be a reasonable strategy for a subset of patients including those either refusing or medically unfit for esophagectomy

Vergroten zelfvoorzienendheid watervoorziening glastuinbouw : watervraag glastuinbouw Haaglanden : deelrapport A

De watervoorziening van de glastuinbouw in Haaglanden staat onder druk door toekomstige ontwikkelingen zoals klimaatverandering (langere perioden van droogte en toename verzilting), veranderingen in het beheer van het hoofdwatersysteem en verschuivingen in de zoet-zout grens (uitvoering kierbesluit en planvorming voor een zout water Volkerak-Zoommeer) en de discussie rondom het infiltreren van brijn in de ondergrond. Dit heeft zowel betrekking op de beschikbaarheid van regenwater als ook van voldoende en geschikt oppervlaktewater

Eindrapport 20 juni 2014 : deelrapport B: wateraanbod glastuinbouw Haaglanden

In de regio Haaglanden is veel glastuinbouw. Op dit moment wordt hemelwater als primaire gietwaterbron gebruikt voor de substraatteelt, wat 88% van het glastuinbouw areaal in deze regio beslaat. Bedrijven zijn verplicht een hemel-waterberging te hebben van minimaal 500 m3/ha. Dit is echter niet genoeg voor de meeste bedrijven. Doordat water tijdens piekbuien onvoldoende kan worden opgevangen, en het meeste water nodig is in een periode met weinig regenval, ontstaat een watertekort. Om het huidige tekort op te lossen wordt een alternatieve bron ingezet als aanvullend gietwater. Een veelbelovende alternatieve gietwaterbron lijkt water van de afvalwaterzui-vering Harnaschpolder. Behalve het inzetten van een alternatieve waterbron, of het vergroten van de bergingscapaciteit, kan ook gezocht worden naar manieren om de watervraag te verminderen

Disease Manifestations and Complications in Dutch X-Linked Hypophosphatemia Patients

X-linked hypophosphatemia (XLH) is the most common monogenetic cause of chronic hypophosphatemia, characterized by rickets and osteomalacia. Disease manifestations and treatment of XLH patients in the Netherlands are currently unknown. Characteristics of XLH patients participating in the Dutch observational registry for genetic hypophosphatemia and acquired renal phosphate wasting were analyzed. Eighty XLH patients, including 29 children, were included. Genetic testing, performed in 78.8% of patients, showed a PHEX mutation in 96.8%. Median (range) Z-score for height was − 2.5 (− 5.5; 1.0) in adults and − 1.4 (− 3.7; 1.0) in children. Many patients were overweight or obese: 64.3% of adults and 37.0% of children. All children received XLH-related medication e.g., active vitamin D, phosphate supplementation or burosumab, while 8 adults used no medication. Lower age at start of XLH-related treatment was associated with higher height at inclusion. Hearing loss was reported in 6.9% of children and 31.4% of adults. Knee deformities were observed in 75.0% of all patients and osteoarthritis in 51.0% of adult patients. Nephrocalcinosis was observed in 62.1% of children and 33.3% of adults. Earlier start of XLH-related treatment was associated with higher risk of nephrocalcinosis and detection at younger age. Hyperparathyroidism longer than six months was reported in 37.9% of children and 35.3% of adults. This nationwide study confirms the high prevalence of adiposity, hearing loss, bone deformities, osteoarthritis, nephrocalcinosis and hyperparathyroidism in Dutch XLH patients. Early start of XLH-related treatment appears to be beneficial for longitudinal growth but may increase development of nephrocalcinosis.</p