De effectiviteit van echografische screening op dysplastische heupontwikkeling bij zuigelingen

Het belang van vroegtijdige opsporing en behandeling van dysplastische heupontwikkeling (DHO) wordt algemeen onderkend. Eerder onderzoek heeft aangetoond dat de sensitiviteit en positief voorspellende waarde van de in Nederland uitgevoerde screening op het consultatiebureau (CB-screening) beperkt is. Aangezien in een aantal landen screening op DHO uitgevoerd wordt met behulp van echografie, is een onderzoek opgezet naar de waarde van echografische screening op DHO in Nederland. In 1998/1999 werden ouders van 6259 pasgeborenen benaderd voor deelname aan het onderzoek. De kinderen werden echografisch gescreend op de leeftijd van 1, 2 en 3 maanden. De controlegroep bestaat uit een geboortecohort pasgeborenen (n=2105) uit 1992/1993 bij wie de gebruikelijke CB-screening heeft plaatsgevonden. Voor beide cohorten geldt dat na de leeftijd van 5 maanden een echo van de heupen werd gemaakt om eventueel in de screening gemiste cases op te sporen. Aan de echografische screening namen 5170 kinderen deel; 392 (8%) kinderen werden verwezen voor nader diagnostisch onderzoek. Van de 270 behandelde kinderen was 90% (243/270) positief bij de echografische screening. Aan de CB-screening namen 2066 kinderen deel; op basis van deze screening werd 19% (n=397) verwezen. Van de 72 behandelde kinderen was 86% (62/72) positief bij de CB-screening. Ingrijpende behandelingen kwamen bij de echografische screening en CB-screening respectievelijk bij 0,8 en 3,4 kinderen per 1000 gescreende kinderen voor. Bij de echografisch screening wordt een aanzienlijk lager percentage kinderen verwezen voor diagnostisch onderzoek zonder dat dit ten koste gaat van de sensitiviteit. Dat het percentage kinderen dat voor DHO wordt behandeld hoger is bij de echografische screening (5,2% versus 3,5%), suggereert dat er sprake is van overbehandeling

Rising incidence of celiac disease in the Netherlands; an analysis of temporal trends from 1995 to 2010

Item does not contain fulltextOBJECTIVE: According to screening studies, celiac disease (CD) is prevalent in Western Europe. Actual prevalence tends to be much lower. The width of this actual gap is determined by the balance between disease symptoms and the "case-finding" capabilities of the healthcare system. Therefore, we conducted a nationwide study to determine the temporal trends in the incidence in the Netherlands including a focus on demographic aspects. MATERIALS AND METHODS: We performed a nationwide search in the Dutch Pathology Registry (PALGA) to identify all biopsy-proven cases of CD in five different years between 1995 and 2010. Furthermore, demographic profiles and socioeconomic status (SES) of patients were studied. RESULTS: The overall incidence of CD increased from 2.72 (confidence interval [CI] 2.46-2.99) in 1995 to 6.65 (CI 6.27-7.06) per 100,000 inhabitants in 2010. No significant regional differences were noticed. In men, rates increased from 2.28 (CI 1.95-2.65) to 4.71 (CI 4.25-5.20) per 100,000 in 2010. In women, the increase was from 3.27 (CI 2.88-3.70) to 8.66 (CI 8.04-9.31) per 100,000 in 2010. A trend toward leveling of incidence was observed from 2008 to 2010. Patients diagnosed during childhood live in areas with a higher SES compared with patients diagnosed at adult age. CONCLUSION: The incidence of biopsy-proven CD in the Netherlands increased almost threefold between 1995 and 2010. In areas with a higher SES, relatively more children were diagnosed

Robot-Assisted Total Laparoscopic Hysterectomy in Different Classes of Obesity: A Cohort Study

BACKGROUND AND OBJECTIVES: Robot-assisted laparoscopic hysterectomy is a safe and feasible approach in patients with higher body mass index (BMI). Slightly longer operating time in patients with high BMI did not result in higher complication or conversion rates. The purpose of this study was to evaluate whether robot-assisted total laparoscopic hysterectomy is a feasible and safe surgical approach in different classes of obesity. METHODS: A single center retrospective cohort study was performed in a large secondary teaching hospital in the Netherlands. All patients who underwent robot-assisted total laparoscopic hysterectomy between January 1, 2011 and January 31, 2019 were included. RESULTS: Data regarding patient characteristics, complication rate, conversion rate, skin-to-skin time, robot console time, and operating room time were collected. Surgery specific data were compared in patients with several classes of obesity. In total 356 cases were included. Median BMI was 29 kg/m(2) (range 18 - 59). Complication rate and conversion to laparotomy did not differ significantly in different classes of obesity. Robot console time and skin-to-skin time was significantly longer in women with a BMI ≥ 40 kg/m(2) (n = 34) compared to patients with normal BMI. CONCLUSION: Robot-assisted laparoscopic hysterectomy is a safe and feasible approach in women in different classes of obesity. The significantly prolonged operating time does not result in higher complication or conversion rates

Dose-Escalating (50-500 mg) Gluten Administration Leads to Detectable Gluten-Immunogenic-Peptides in Urine of Patients with Coeliac Disease Which Is Unrelated to Symptoms, a Placebo Controlled Trial

BACKGROUND: To determine the applicability and sensitivity of a urine self-test to detect gluten-immunogenic-peptides (GIP) in daily-life for patients with coeliac disease and correlate the test results with reported symptoms. METHODS: We performed a prospective double-blinded placebo-controlled study, including adults with coeliac disease adhering to a strictly gluten-free diet. Patients were administered gluten in test-cycles of ascending doses of 50, 100, 200, and 500 mg alternated with placebo. Urine portions from 2, 5-17 h after the ingestion were collected and analyzed for GIP using the iVYCHECK-GIP-Urine rapid lateral flow test. Patients completed a diary mapping symptoms (nausea, bloating, diarrhea, abdominal pain, and lower level of energy). RESULTS: We enrolled 15 patients and 7 received all 4 cycles with increasing gluten dosing. GIP was detected from urine in 47% of the patients receiving 50 mg gluten and in 86% with 500 mg gluten. We detected GIP in 20-50% of urine samples after placebo. There was no correlation between symptoms, gluten administration and/or GIP in urine. CONCLUSIONS: Gluten intake, even with a dose as low as 50 mg, leads to detectable urinary GIP concentrations. There is no correlation of coeliac disease ascribed symptoms with detection of urinary GIP

Ultrasonographic screening for developmental dysplasia of the hip in infants: reproducibility of assessments made by radiographers

We studied the reproducibility of ultrasonographic screening examination of the hip when read by diagnostic radiographers. In order to determine interobserver variability, 200 ultrasonograms were classified according to Graf’s method by five observers (four radiographers and one radiologist). The kappa values for interobserver variability indicated moderate agreement (kappa 0.47) for the exact Graf classification and substantial agreement (kappa 0.65) for the classification of normal (type I) versus abnormal (type IIa-IV). Agreement was significantly different for normal, immature and abnormal hips. Comparison of the findings in our interobserver study with existing information based on other examinations and treatment revealed that only a small number of infants with mildly dysplastic hips would have been typed as normal by some observers as a result of observer variability. In conclusion, the interobserver agreement on the ultrasound assessment of the hip was good enough for screening purposes. Observer variability did not result in any severe cases being misse

Voorkeurshouding bij zuigelingen: prevalentie, preventie en anpak.

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Use of diuretics and the risk of gouty arthritis: a systematic review

Item does not contain fulltextOBJECTIVE: To systematically review the literature investigating the relationship between use of diuretics and the risk of gouty arthritis. METHODS: PubMed (1950-October 2009), Embase (1974-October 2009), and the Cochrane Library (up to October 2009) were searched using keywords and MeSH terms diuretics, adverse effects, and gout. For this review, the technique of "best evidence synthesis" was used. Studies reporting frequency, absolute or relative risks, odds ratio, or rate ratio of gouty arthritis in diuretic users compared with nonusers were selected and evaluated. Studies had to be published in English. Checklists from the Dutch Cochrane Centre were used to assess the quality of randomized controlled trials (RCTs), cohort, and case-control studies. RESULTS: Two RCTs, 6 cohort studies, and 5 case-control studies met the inclusion criteria. The overall quality of the studies was moderate. In a RCT the rate ratio of gout for use of bendrofluazide vs placebo was 11.8 (95% CI 5.2-27.0). The other RCT found a rate ratio of 6.3 (95% CI 0.8-51) for use of hydrochlorothiazide plus triamterene vs placebo. Three cohort studies and 4 case-control studies found higher risks of gouty arthritis in users compared with nonusers of diuretics. CONCLUSIONS: There is a trend toward a higher risk for acute gouty arthritis attacks in patients on loop and thiazide diuretics, but the magnitude and independence is not consistent. Therefore, stopping these useful drugs in patients who develop gouty arthritis is not supported by the results of this review