A mycotic aneurysm of the abdominal aorta in a child

A 6-year-old boy with a previous history of intracardiac correction of a partial atrioventricular canal defect presented with infective endocarditis. Despite antibiotic therapy and reoperation, he developed a mycotic abdominal aneurysm. In situ aortoiliac reconstruction with a prosthesis and an omental flap was performed. At follow-up after 2 {Mathematical expression} years there were no signs of prosthetic infection or problems with the anastomoses

Fauna en terreinkenmerken van bos; een studie naar de relatie tussen terreinkenmerken en de geschiktheid van bos als habitat voor een aantal diersoorten

In dit rapport wordt een methode beschreven waarmee de geschiktheid van het bos als habitat voor verschillende diersoorten kan worden bepaald op basis van de terreinkenmerken van het bos. De methode is gebaseerd op HSI-modellen. Er zijn 10 terreinkenmerken gebruikt om de habitatgeschiktheid te bepalen. Naast het onderdeel dat de habitatgeschiktheid van bos aangeeft, is er een onderdeel toegevoegd dat de bosbeheerder informatie geeft over de soorten die in het bos voor kunnen voorkomen op basis van de ligging en grootte van het bos. Voor zes diergroepen is de relatie tussen de terreinkenmerken en de habitatgeschiktheid weergegeven

AChR deficiency due to ε-subunit mutations: Two common mutations in the Netherlands

Congenital myasthenic syndromes are a clinically and genetically heterogeneous group of hereditary disorders affecting neuromuscular transmission. We have identified mutations within the acetylcholine receptor (AChR) ε-subunit gene underlying congenital myasthenic syndromes in nine patients (seven kinships) of Dutch origin. Previously reported mutations ε1369delG and εR311Q were found to be common; ε1369delG was present on at least one allele in seven of the nine patients, and εR311Q in six. Phenotypes ranged from relatively mild ptosis and external ophthalmoplegia to generalized myasthenia. The common occurrence of εR311Q and ε1369delG suggests a possible founder for each of these mutations originating in North Western Europe, possibly in Holland. Knowledge of the ethnic or geographic origin within Europe of AChR deficiency patients can help in targeting genetic screening and it may be possible to provide a rapid genetic diagnosis for patients of Dutch origin by screening first for εR311Q and ε1369delG

Stop or go? Preventive cognitive therapy with guided tapering of antidepressants during pregnancy: Study protocol of a pragmatic multicentre non-inferiority randomized controlled trial

Background: Approximately 6.2% of women in the USA and 3.7% of women in the UK, use Selective Serotonin Reuptake Inhibitors (SSRIs) during their pregnancies because of depression and/or anxiety. In the Netherlands, this prevalence is around 2%. Nonetheless, SSRI use during pregnancy is still controversial. On the one hand SSRIs may be toxic to the intrauterine developing child, while on the other hand relapse or recurrence of depression during pregnancy poses risks for both mother and child. Among patients and professionals there is an urgent need for evidence from randomized studies to make rational decisions regarding continuation or tapering of SSRIs during pregnancy. At present, no such studies exist. Methods/Design: 'Stop or Go' is a pragmatic multicentre randomized non-inferiority trial among 200 pregnant women with a gestational age of less than 16weeks who use SSRIs without clinically relevant depressive symptoms. Women allocated to the intervention group will receive preventive cognitive therapy with gradual, guided discontinuation of SSRIs under medical management (STOP). Women in the control group will continue the use of SSRIs (GO). Primary outcome will be the (cumulative) incidence of relapse or recurrence of maternal depressive disorder (as assessed by the Structured Clinical Inter

Non-adherence to disease-modifying antirheumatic drugs is associated with higher disease activity in early arthritis patients in the first year of the disease

Introduction: Non-adherence to disease-modifying antirheumatic drugs (DMARDs) hampers the targets of rheumatoid arthritis (RA) treatment, obtaining low disease activity and decreasing radiological progression. This study investigates if, and to what extent, non-adherence to treatment would lead to a higher 28-