59 results on '"Nieveen van Dijkum EJ"'
Search Results
2. Surveillance of high-risk early postsurgical patients for real-time detection of complications using wireless monitoring (SHEPHERD study): results of a randomized multicenter stepped wedge cluster trial.
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Posthuma LM, Breteler MJM, Lirk PB, Nieveen van Dijkum EJ, Visscher MJ, Breel JS, Wensing CAGL, Schenk J, Vlaskamp LB, van Rossum MC, Ruurda JP, Dijkgraaf MGW, Hollmann MW, Kalkman CJ, and Preckel B
- Abstract
Background: Vital signs measurements on the ward are performed intermittently. This could lead to failure to rapidly detect patients with deteriorating vital signs and worsens long-term outcome. The aim of this study was to test the hypothesis that continuous wireless monitoring of vital signs on the postsurgical ward improves patient outcome., Methods: In this prospective, multicenter, stepped-wedge cluster randomized study, patients in the control group received standard monitoring. The intervention group received continuous wireless monitoring of heart rate, respiratory rate and temperature on top of standard care. Automated alerts indicating vital signs deviation from baseline were sent to ward nurses, triggering the calculation of a full early warning score followed. The primary outcome was the occurrence of new disability three months after surgery., Results: The study was terminated early (at 57% inclusion) due to COVID-19 restrictions. Therefore, only descriptive statistics are presented. A total of 747 patients were enrolled in this study and eligible for statistical analyses, 517 patients in the control group and 230 patients in the intervention group, the latter only from one hospital. New disability at three months after surgery occurred in 43.7% in the control group and in 39.1% in the intervention group (absolute difference 4.6%)., Conclusion: This is the largest randomized controlled trial investigating continuous wireless monitoring in postoperative patients. While patients in the intervention group seemed to experience less (new) disability than patients in the control group, results remain inconclusive with regard to postoperative patient outcome due to premature study termination., Clinical Trial Registration: ClinicalTrials.gov, ID: NCT02957825., Competing Interests: MB was part time employee of Luscii Healthech BV (Amsterdam, Netherlands) at the time of the study period. MH executive section editor for Pharmacology with Anesthesia & Analgesia and a section editor for Anesthesiologie with the Journal of Clinical Medicine. He has received honoraria for lectures and research support from Eurocept BV, BBraun, Edwards and Behring, and is an advisory board member for Eurocept BV. CK received funding from the European Commission for Precommercial Procurement project Nightingale (#727534, 2016-2021; development of wearable wireless monitoring). BP previously member of the Advisory Board of Sensium Healthcare, United Kingdom. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Posthuma, Breteler, Lirk, Nieveen van Dijkum, Visscher, Breel, Wensing, Schenk, Vlaskamp, van Rossum, Ruurda, Dijkgraaf, Hollmann, Kalkman and Preckel.)
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- 2024
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3. Expression of integrin α v β 3 in medullary thyroid carcinoma.
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de Vries LH, Lodewijk L, Pijnappel EW, van Diest PJ, Schepers A, Bonenkamp HJ, van Engen-van Grunsven IA, Kruijff S, van Hemel BM, Links TP, Nieveen van Dijkum EJ, van Eeden S, van Leeuwaarde RS, Valk GD, de Keizer B, Borel Rinkes IH, and Vriens MR
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- Humans, Male, Female, Middle Aged, Adult, Aged, Lymphatic Metastasis, Young Adult, Prognosis, Aged, 80 and over, Tissue Array Analysis, Immunohistochemistry, Adolescent, Thyroid Neoplasms pathology, Thyroid Neoplasms metabolism, Thyroid Neoplasms genetics, Thyroid Neoplasms surgery, Carcinoma, Neuroendocrine pathology, Carcinoma, Neuroendocrine genetics, Carcinoma, Neuroendocrine metabolism, Integrin alphaVbeta3 metabolism, Biomarkers, Tumor metabolism
- Abstract
Aim: Tumor markers often remain elevated after intended curative resection of medullary thyroid carcinoma (MTC). The aim of this study was to determine the expression of α
v β3 , a promising theranostics target, in MTC and its metastases. Materials & methods: Av β3 expression was analyzed in 104 patients using a tissue microarray and correlated with clinicopathological variables and survival. Results: Cytoplasmic αv β3 positivity was seen in 70 patients and was associated with lymph node metastases at time of initial surgery. Membranous positivity was considered positive in 30 patients and was associated with sporadic MTC. Conclusion: Av β3 was expressed in the cytoplasm of 67% of MTC patients. Membranous expression, which is presumably most relevant for the theranostic use of αv β3 , was seen in 29%.- Published
- 2024
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4. Evidence-Based Medicine Course in Combination With Journal Clubs to Promote Evidence-Based Surgery.
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Ubbink DT, Augustinus S, Feenstra TM, De Graaf N, Van der Burgt SM, Koelemaij MJ, and Nieveen van Dijkum EJ
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Introduction To provide high-quality surgical care, surgeons must critically appraise medical literature to adapt their clinical practice whenever convincing evidence emerges. This will promote evidence-based surgery (EBS). Over the last decade, we have organized monthly journal clubs (JCs) and more extensive quarterly EBS courses for surgical residents and PhD students, supervised by surgical staff. We evaluated the participation, satisfaction, and knowledge gained by this EBS program, to make the program future-proof and aid other educators. Materials and methods An anonymous digital survey was distributed via email among residents, PhD students, and surgeons of the Amsterdam University Medical Centers' (UMC) surgical department in April 2022. The survey included general questions on EBS education, specific course-oriented questions for the residents and PhD students, and questions about supervision for surgeons. Results The survey was completed by 47 respondents from the surgery department of the Amsterdam UMC University Hospital, of whom 63.8% (n=30) were residents or PhD students and 36.2% (n=17) were surgeons. During one year of the combined EBS course and JCs, the EBS course was attended by 40.0% (n=12) of PhD students and was rated with a mean score of 7.6/10. JCs were attended by 86.6% (n=26) of residents or PhD students and received a mean score of 7.4/10. Reported strengths of the JCs were their easy accessibility and the acquisition of critical appraisal skills and scientific knowledge. A reported point of improvement was to focus more deeply on specific epidemiological topics per meeting. Of the surgeons, 64.7% (n=11) had supervised at least one JC and gave a mean score of 8.5/10. The main reasons to supervise JCs were the distribution of knowledge (45.5%), scientific discussion (36.3%), and contact with PhD students (18.1%). Conclusion Our EBS educational program, including JCs and EBS courses, was well appreciated by residents, PhD students, and staff. This format is advocated for other centers aiming to better implement EBS in surgical practice., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ubbink et al.)
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- 2023
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5. Author response to: Watchful waiting for small non-functional pancreatic neuroendocrine tumours: Nationwide prospective cohort study (PANDORA).
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Heidsma CM and Nieveen van Dijkum EJ
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- Humans, Prospective Studies, Watchful Waiting, Neuroendocrine Tumors surgery, Pancreatic Neoplasms surgery
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- 2022
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6. ENETS standardized (synoptic) reporting for neuroendocrine tumour pathology.
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van Velthuysen MF, Couvelard A, Rindi G, Fazio N, Hörsch D, Nieveen van Dijkum EJ, Klöppel G, and Perren A
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- Humans, Neurosecretory Systems, Neuroendocrine Tumors pathology
- Abstract
In recent years the WHO classification of neuroendocrine neoplasms (NEN) has evolved. Nomenclature as well as thresholds for grading have changed leading to potential confusion and lack of comparability of tumour reports. Therefore, the European Neuroendocrine Tumour Society (ENETS) has set-up an interdisciplinary working group to develop templates for a pathology data set for standardised reporting of NEN. Experts of various disciplines, members of the ENETS Advisory Board, formed a taskforce that discussed and decided on the structure, content and the number of templates needed for reporting the most common NEN. The selection of the required items was based on the WHO classification of digestive system tumours, the WHO classification of tumours of the lung and mediastinum and on "ENETS standard of care" reports. The final proposal of the working group was approved by the ENETS Advisory Board. Templates for synoptic reporting were created for the seven most common NEN primary sites, that is, stomach, duodenum, jejunum-ileum, appendix, colon-rectum, pancreas, lung and mediastinum. In addition, a general template for reporting biopsies was designed. The templates allow the recording of the essential items on differentiation, proliferation (Ki-67 and mitosis), neuroendocrine features (positivity for chromogranin A and synaptophysin) and stage as well as several optional markers especially helpful for the distinction of neuroendocrine tumours (NET) from neuroendocrine carcinomas (NEC). In summary, this paper presents the content and development of synoptic reports for most sites of NEN by a multidisciplinary team of international experts in the field, which could help to improve unambiguous reporting of NEN., (© 2022 The Authors. Journal of Neuroendocrinology published by John Wiley & Sons Ltd on behalf of British Society for Neuroendocrinology.)
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- 2022
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7. Watchful waiting for small non-functional pancreatic neuroendocrine tumours: nationwide prospective cohort study (PANDORA).
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Heidsma CM, Engelsman AF, van Dieren S, Stommel MWJ, de Hingh I, Vriens M, Hol L, Festen S, Mekenkamp L, Hoogwater FJH, Daams F, Klümpen HJ, Besselink MG, van Eijck CH, and Nieveen van Dijkum EJ
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- Follow-Up Studies, Humans, Incidence, Netherlands epidemiology, Pancreatic Neoplasms diagnosis, Pancreatic Neoplasms therapy, Prognosis, Prospective Studies, Time Factors, Neoplasm Staging methods, Pancreatectomy methods, Pancreatic Neoplasms epidemiology, Watchful Waiting statistics & numerical data
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- 2021
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8. Complications After Major Surgery for Duodenopancreatic Neuroendocrine Tumors in Patients with MEN1: Results from a Nationwide Cohort.
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van Beek DJ, Nell S, Vorselaars WMCM, Bonsing BA, van Eijck CHJ, van Goor H, Nieveen van Dijkum EJ, Dejong CHC, Valk GD, Borel Rinkes IHM, and Vriens MR
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- Adult, Humans, Pancreatectomy, Pancreaticoduodenectomy adverse effects, Multiple Endocrine Neoplasia Type 1 surgery, Neuroendocrine Tumors surgery, Pancreatic Neoplasms surgery
- Abstract
Background: Little is known about complications after major duodenopancreatic surgery for duodenopancreatic neuroendocrine tumors (dpNETs) in multiple endocrine neoplasia type 1 (MEN1). Therefore, the incidence and severity of complications after major surgery for MEN1-related dpNETs were assessed., Methods: Patients were selected from the population-based Dutch MEN1 database if they had undergone a Whipple procedure or total pancreatectomy from 2003 to 2017. Complications were graded according to the Clavien-Dindo classification (grade III or higher complications were considered a severe complication) and definitions from the International Study Group of Pancreatic Surgery. The Cumulative Complication Index (CCI
® ) was calculated as the sum of all complications weighted for their severity. Univariable logistic regression was performed to assess potential associations between predictor candidates and a severe complication., Results: Twenty-seven patients (median age 43 years) underwent a major duodenopancreatic resection, including 14 Whipple procedures and 13 total pancreatectomies. Morbidity and mortality were 100% (27/27) and 4% (1/27), respectively. A severe complication occurred in 17/27 (63%) patients. The median CCI® was 47.8 [range 8.7-100]. Grade B/C pancreatic fistulas, delayed gastric emptying, bile leakage, hemorrhage, and chyle leakage occurred in 7/14 (50%), 10/27 (37%), 1/27 (4%), 7/27 (26%), 3/27 (11%) patients, respectively. Patients with a severe complication had longer operative time and higher blood loss. After Whipple, new-onset endocrine and exocrine insufficiency occurred in 1/13 and 9/14 patients, respectively., Conclusions: Major duodenopancreatic surgery in MEN1 is associated with a very high risk of severe complications and cumulative burden of complications and should therefore be reserved for a select subgroup of patients with MEN1-related dpNETs.- Published
- 2021
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9. hypercalcaemia due to a calcitriol-producing neuroendocrine tumour.
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van Lierop AH, Bisschop PH, Boelen A, van Eeden S, Engelman AF, Nieveen van Dijkum EJ, and Klümpen HJ
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In this case report, we describe a 40-year-old patient with a large grade 2 pancreatic neuroendocrine tumour (pNET) with spleen metastasis. Albeit radical resection, he developed liver metastasis after 2 years, for which he underwent radio frequency ablation and embolization, and was treated successfully with different subsequent lines of systemic therapy. Eight years after the initial diagnosis, he was admitted for symptomatic and refractory hypercalcaemia, due to calcitriol synthesis by the liver metastasis. After tumour load reduction by hemihepatectomy, there was an initial normalization of hypercalcaemia, until it recurred after 18 months. In this period, the liver metastasis had progressed despite chemo- and immunotherapy. Patient underwent an additional extend hemihepatectomy, from which he recovered well with normalization of calcium levels. This case illustrates the hormonal plasticity of pNETs and shows how prolonged survival can be achieved for metastatic pNET by multimodality approach., (Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author(s) 2019.)
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- 2019
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10. Early and Late Complications After Surgery for MEN1-related Nonfunctioning Pancreatic Neuroendocrine Tumors.
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Nell S, Borel Rinkes IHM, Verkooijen HM, Bonsing BA, van Eijck CH, van Goor H, de Kleine RHJ, Kazemier G, Nieveen van Dijkum EJ, Dejong CHC, Valk GD, and Vriens MR
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- Adult, Aged, Databases, Factual, Female, Follow-Up Studies, Humans, Logistic Models, Male, Middle Aged, Retrospective Studies, Multiple Endocrine Neoplasia Type 1 surgery, Pancreatectomy, Pancreatic Neoplasms surgery, Pancreaticoduodenectomy, Postoperative Complications epidemiology
- Abstract
Objective: To estimate short and long-term morbidity after pancreatic surgery for multiple endocrine neoplasia type 1 (MEN1)-related nonfunctioning pancreatic neuroendocrine tumors (NF-pNETs)., Background: Fifty percent of the MEN1 patients harbor multiple NF-pNETs. The decision to proceed to NF-pNET surgery is a balance between the risk of disease progression versus the risk of surgery-related morbidity. Currently, there are insufficient data on the surgical complications after MEN1 NF-pNET surgery., Methods: MEN1 patients diagnosed with a NF-pNET who underwent surgery were selected from the DutchMEN1 study group database, including >90% of the Dutch MEN1 population. Early postoperative complications, new-onset diabetes mellitus, and exocrine pancreatic insufficiency were captured., Results: Sixty-one patients underwent NF-pNET surgery at 1 of the 8 Dutch academic centers. Patients were young (median age 41 years) with low American Society of Anesthesiologists scores. Median NF-pNET size on imaging was 22 mm (3-157). Thirty-three percent (19/58) of the patients developed major early-Clavien-Dindo grade III to IV-complications mainly consisting International Study Group of Pancreatic Surgery grade B/C pancreatic fistulas. Twenty-three percent of the patients (14/61) developed endocrine or exocrine pancreas insufficiency. The development of major early postoperative complications was independent of the NF-pNET tumor size. Twenty-one percent of the patients (12/58) developed multiple major early complications., Conclusions: MEN1 NF-pNET surgery is associated with high rates of major short and long-term complications. Current findings should be taken into account in the shared decision-making process when MEN1 NF-pNET surgery is considered.
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- 2018
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11. Very Long-Chain Acyl-Coenzyme A Dehydrogenase Deficiency and Perioperative Management in Adult Patients.
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Welsink-Karssies MM, Polderman JAW, Nieveen van Dijkum EJ, Preckel B, Schlack WS, Visser G, Hollak CE, and Hermanides J
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Surgery and anesthesia pose a threat to patients with very long-chain acyl-CoA dehydrogenase deficiency (VLCADD), because prolonged fasting, stress, and pain are known risk factors for the induction of metabolic derangement. The optimal perioperative management in these patients is unknown and the use of volatile agents and agents dissolved in fatty acids has been related to postoperative metabolic complications. However, the occurrence of metabolic derangement is multifactorial and depends, amongst others, on the severity of the mutation and residual enzyme activity. Current guidelines suggest avoiding both volatile anesthetics as well as propofol, which seriously limits the options for providing safe anesthesia. Therefore, we reviewed the available literature on the perioperative management of patients with VLCADD. We concluded that the use of some medications, such as volatile anesthetics, in patients with VLCADD might be wrongfully avoided and could in fact prevent metabolic derangement by the adequate suppression of pain and stress during surgery. We will illustrate this with a case report of an adult VLCADD patient undergoing minor surgery. Besides the use of remifentanil, anesthesia was uneventfully maintained with the use of sevoflurane, a volatile agent, and continuous glucose infusion. The patient was monitored with a continuous glucose meter and creatinine kinase measurements.
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- 2017
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12. Robot-assisted spleen preserving pancreatic surgery in MEN1 patients.
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Nell S, Brunaud L, Ayav A, Bonsing BA, Groot Koerkamp B, Nieveen van Dijkum EJ, Kazemier G, de Kleine RH, Hagendoorn J, Molenaar IQ, Valk GD, Borel Rinkes IH, and Vriens MR
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- Adult, Female, Humans, Laparoscopy, Male, Minimally Invasive Surgical Procedures, Multiple Endocrine Neoplasia Type 1 surgery, Pancreatectomy methods, Pancreatic Neoplasms surgery, Robotic Surgical Procedures methods, Spleen surgery
- Abstract
Background: Multiple Endocrine Neoplasia type 1 (MEN1) patients often undergo multiple pancreatic operations at a young age., Objective: To describe robot-assisted and laparoscopic spleen-preserving pancreatic surgery in MEN1 patients, and to compare both techniques., Methods: Robot-assisted pancreatectomies of the DutchMEN1 study group and the Université de Lorraine, Nancy, France were compared to a historical cohort of laparoscopic treated MEN1 patients. Perioperative outcomes were compared., Results: A total of 21 MEN1 patients underwent minimally invasive pancreatic surgery for pancreatic neuroendocrine tumors, seven patients were subjected to robot-assisted surgery, and 14 patients underwent laparoscopic surgery. Demographics and clinical characteristics did not differ between the cohorts and no significant differences in operative outcomes were found. A high number of ISGPS grade B/C pancreatic fistulas were observed in both cohorts (38%), and no conversions were seen in the robot-assisted cohort (respectively 0% vs. 43%, P = 0.06). In one laparoscopic and one robot-assisted case the primary tumor was not resected., Conclusions: Minimally invasive spleen-preserving surgery in MEN1 patients is safe and feasible. Patients who underwent robot-assisted surgery did not require conversion to open surgery. J. Surg. Oncol. 2016;114:456-461. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)
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- 2016
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13. Impact of parathyroidectomy for primary hyperparathyroidism on quality of life: A case-control study using Short Form Health Survey 36.
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Dulfer R, Geilvoet W, Morks A, van Lieshout EM, Smit CP, Nieveen van Dijkum EJ, In't Hof K, van Dam F, van Eijck CH, de Graaf PW, and van Ginhoven TM
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- Adult, Aged, Case-Control Studies, Female, Humans, Hyperparathyroidism, Primary physiopathology, Male, Middle Aged, Parathyroidectomy psychology, Patient Satisfaction, Postoperative Period, Preoperative Period, Prognosis, Reference Values, Severity of Illness Index, Sickness Impact Profile, Treatment Outcome, Hyperparathyroidism, Primary psychology, Hyperparathyroidism, Primary surgery, Parathyroidectomy methods, Quality of Life, Surveys and Questionnaires
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Background: Physical and mental complaints are common in patients with primary hyperparathyroidism (PHPT) and negatively impact quality of life (QOL). Subjective symptoms in current guidelines are not considered an indication for surgery. The purpose of this study was to assess the effect of parathyroidectomy on QOL in patients with PHPT., Methods: This multicenter case-control study investigated preoperative and postoperative QOL scores in patients operated for PHPT, measured with the Short Form Health Survey-36 (SF-36) questionnaire. Results were compared with patients undergoing a hemithyroidectomy, the control group., Results: Fifty-two patients and 49 controls were included. Patients with PHPT had significantly lower QOL scores preoperatively and improved significantly after successful surgical treatment. Postoperatively, no differences were observed between the 2 groups., Conclusion: QOL was significantly lower in patients with untreated PHPT. Surgical treatment was associated with a significant increase in QOL. Decreased QOL should also be considered as an indicator for surgical treatment in patients with PHPT. © 2016 Wiley Periodicals, Inc. Head Neck 38:1213-1220, 2016., (© 2016 Wiley Periodicals, Inc.)
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- 2016
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14. The influence of somatostatin receptor scintigraphy during preoperative staging of non-functioning pancreatic neuroendocrine tumours.
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Jilesen AP, Hoefnagel SJ, Busch OR, Bennink RJ, Gouma DJ, and Nieveen van Dijkum EJ
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- Female, Humans, Male, Middle Aged, Neoplasm Staging, Neuroendocrine Tumors secondary, Preoperative Care methods, Radiopharmaceuticals pharmacokinetics, Reproducibility of Results, Sensitivity and Specificity, Somatostatin analogs & derivatives, Somatostatin pharmacokinetics, Tomography, Emission-Computed, Single-Photon methods, Tomography, X-Ray Computed methods, Neuroendocrine Tumors diagnostic imaging, Neuroendocrine Tumors metabolism, Pancreatic Neoplasms diagnostic imaging, Pancreatic Neoplasms metabolism, Pancreatic Neoplasms secondary, Receptors, Somatostatin metabolism
- Abstract
Aim: To determine whether somatostatin receptor scintigraphy (SRS) influences the preoperative staging and clinical management of non-functioning pancreatic neuroendocrine tumours (NF-pNETs)., Materials and Methods: All SRS examinations performed between 2002-2013 were selected. Patients with NF-pNET were included if both computed tomography (CT) and SRS was performed during preoperative staging. The diagnostic accuracy of CT and SRS for detecting NF-pNET metastases was analysed. Altered TNM classification and changed clinical management were calculated. Changed management was defined as a change from surgical resection into systemic treatment or vice versa. NF-pNETs were defined as tumours without clinical symptoms of hormonal hypersecretion., Results: Overall, 62 patients with NF-pNET were included with a mean age of 57 years (SD: 12.4)(2). In 28 patients (45%), CT and SRS were correct and in agreement in the detection of primary tumour/metastases. In 34 patients (55%), one of the techniques was incorrect and therefore, there was no agreement. SRS altered the TNM classification in 14 patients (23%) and clinical management in nine patients (15%). In patients without metastases on CT, SRS detected lymph node metastases in one patient. The sensitivity to detect the primary tumour with CT was 95% and with SRS was 73%. In detecting metastases, the sensitivity and specificity were both 85% for CT versus 80% and 90% for SRS., Conclusion: Overall, CT and SRS were in agreement in the detection of NF-pNET. In NF-pNET without suspicious metastatic lesions on CT, SRS has limited value. SRS may be indicated to confirm lesions suspicious for neuroendocrine tumours metastases., (Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)
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- 2016
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15. Characteristics of contralateral carcinomas in patients with differentiated thyroid cancer larger than 1 cm.
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Lodewijk L, Kluijfhout WP, Kist JW, Stegeman I, Plukker JT, Nieveen van Dijkum EJ, Bonjer HJ, Bouvy ND, Schepers A, de Wilt JH, Netea-Maier RT, van der Hage JA, Burger JW, Ho G, Lee WS, Shen WT, Aronova A, Zarnegar R, Benay C, Mitmaker EJ, Sywak MS, Aniss AM, Kruijff S, James B, Grogan RH, Brunaud L, Hoch G, Pandolfi C, Ruan DT, Jones MD, Guerrero MA, Valk GD, Borel Rinkes IH, and Vriens MR
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- Adult, Aged, Carcinoma surgery, Cross-Sectional Studies, Female, Humans, Incidence, Male, Middle Aged, Neoplasm Invasiveness, Neoplasms, Multiple Primary surgery, Retrospective Studies, Thyroid Neoplasms surgery, Thyroidectomy, Tumor Burden, Carcinoma epidemiology, Carcinoma pathology, Neoplasms, Multiple Primary epidemiology, Neoplasms, Multiple Primary pathology, Thyroid Neoplasms epidemiology, Thyroid Neoplasms pathology
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Purpose: Traditionally, total thyroidectomy has been advocated for patients with tumors larger than 1 cm. However, according to the ATA and NCCN guidelines (2015, USA), patients with tumors up to 4 cm are now eligible for lobectomy. A rationale for adhering to total thyroidectomy might be the presence of contralateral carcinomas. The purpose of this study was to describe the characteristics of contralateral carcinomas in patients with differentiated thyroid cancer (DTC) larger than 1 cm., Methods: A retrospective study was performed including patients from 17 centers in 5 countries. Adults diagnosed with DTC stage T1b-T3 N0-1a M0 who all underwent a total thyroidectomy were included. The primary endpoint was the presence of a contralateral carcinoma., Results: A total of 1313 patients were included, of whom 426 (32 %) had a contralateral carcinoma. The contralateral carcinomas consisted of 288 (67 %) papillary thyroid carcinomas (PTC), 124 (30 %) follicular variant of a papillary thyroid carcinoma (FvPTC), 5 (1 %) follicular thyroid carcinomas (FTC), and 3 (1 %) Hürthle cell carcinomas (HTC). Ipsilateral multifocality was strongly associated with the presence of contralateral carcinomas (OR 2.62). Of all contralateral carcinomas, 82 % were ≤10 mm and of those 99 % were PTC or FvPTC. Even if the primary tumor was a FTC or HTC, the contralateral carcinoma was (Fv)PTC in 92 % of cases., Conclusions: This international multicenter study performed on patients with DTC larger than 1 cm shows that contralateral carcinomas occur in one third of patients and, independently of primary tumor subtype, predominantly consist of microPTC.
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- 2016
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16. Electromagnetic-Guided Versus Endoscopic Placement of Nasojejunal Feeding Tubes After Pancreatoduodenectomy: A Prospective Pilot Study.
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Gerritsen A, Duflou A, Ramali M, Busch OR, Gouma DJ, van Gulik TM, Nieveen van Dijkum EJ, Mathus-Vliegen EM, and Besselink MG
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- Aged, Enteral Nutrition instrumentation, Feasibility Studies, Female, Humans, Intubation, Gastrointestinal instrumentation, Male, Middle Aged, Outcome Assessment, Health Care methods, Pilot Projects, Prospective Studies, Reproducibility of Results, Endoscopes, Gastrointestinal, Enteral Nutrition methods, Intubation, Gastrointestinal methods, Magnetic Phenomena, Pancreaticoduodenectomy methods
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Objective: An altered anatomy such as after pancreatoduodenectomy is currently seen as relative contraindication for bedside electromagnetic (EM)-guided nasojejunal feeding tube placement. The aim of this study was to determine the feasibility and safety of bedside EM-guided placement of nasojejunal feeding tubes as compared with endoscopy in patients after pancreatoduodenectomy., Methods: We performed a prospective monocenter pilot study in patients requiring enteral feeding after pancreatoduodenectomy (July 2012-March 2014). Primary end point was the success rate of primary tube placement confirmed on plain abdominal x-ray followed by successful enteral feeding., Results: Overall, 53 (42%) of 126 patients who underwent pancreatoduodenectomy required a nasojejunal feeding tube, of which 36 were placed under EM guidance and, in 17, it was placed by endoscopy. Initial tube placement was successful in 21 (58%) of 36 patients with EM guidance and 9 (53%) of 17 patients with endoscopy (P = 0.71). No complications occurred during the placement procedures. Dislodgement and/or blockage of the tube occurred in 14 (39%) of 36 patients in the EM-guided group and 8 (47%) of 17 patients in the endoscopic group (P = 0.57)., Conclusions: Bedside EM-guided placement of nasojejunal feeding tubes by nurses was equally successful as endoscopic placement in patients after pancreatoduodenectomy.
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- 2016
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17. Intermediate and long-term adverse effects of radioiodine therapy for differentiated thyroid carcinoma--a systematic review.
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Clement SC, Peeters RP, Ronckers CM, Links TP, van den Heuvel-Eibrink MM, Nieveen van Dijkum EJ, van Rijn RR, van der Pal HJ, Neggers SJ, Kremer LC, van Eck-Smit BL, and van Santen HM
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- Female, Gonadal Disorders etiology, Humans, Lacrimal Apparatus, Male, Neoplasms, Radiation-Induced, Neoplasms, Second Primary, Carcinoma radiotherapy, Eye Diseases etiology, Infertility, Female etiology, Iodine Radioisotopes adverse effects, Oligospermia etiology, Salivary Gland Diseases etiology, Thyroid Neoplasms radiotherapy
- Abstract
Background: Treatment of differentiated thyroid carcinoma (DTC) often involves administration of radioactive iodine (I-131) for remnant ablation or adjuvant therapy. As DTC has favorable outcome and the incidence is increasing, concerns have been raised about the possible adverse effects of I-131 therapy. We systematically reviewed the literature to examine the risk of intermediate and long-term adverse effects of I-131 therapy in DTC patients., Methods: Multiple electronic databases were searched up to November 2014 for English-language, controlled studies that reported on the risk of salivary gland dysfunction, lacrimal gland dysfunction, gonadal dysfunction, female reproductive outcomes or second primary malignancies (SPM) after I-131 exposure. The certainty of the evidence found was assessed using GRADE., Results: In total, 37 articles met all inclusion criteria, no studies reporting on adverse effects after I-131 treatment focused solely on children. After exposure to I-131 for DTC, patients experienced significantly more frequently salivary gland dysfunction (prevalence range: 16-54%, moderate-level evidence), lacrimal gland dysfunction (prevalence: 11%, low-level evidence), transient male gonadal dysfunction (prevalence: 35-100%, high-level evidence), transient female gonadal dysfunction (prevalence: 28%, low-level evidence) and SPM (prevalence: 2.7-8.7%, moderate-level evidence) compared to unexposed patients. I-131 therapy seems to have no deleterious effects on female reproductive outcomes (very-low level evidence). The prevalence and severity of adverse effects were correlated to increasing cumulative I-131 activity., Conclusion: Treatment with I-131 for DTC may have significant adverse effects, which seem to be dose dependent. These adverse effects of treatment must be balanced when choosing for I-131 therapy in patients with DTC., (Copyright © 2015 Elsevier Ltd. All rights reserved.)
- Published
- 2015
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18. Neoadjuvant Treatment of Nonfunctioning Pancreatic Neuroendocrine Tumors with [177Lu-DOTA0,Tyr3]Octreotate.
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van Vliet EI, van Eijck CH, de Krijger RR, Nieveen van Dijkum EJ, Teunissen JJ, Kam BL, de Herder WW, Feelders RA, Bonsing BA, Brabander T, Krenning EP, and Kwekkeboom DJ
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- Adult, Aged, Aged, 80 and over, Disease-Free Survival, Female, Humans, Kaplan-Meier Estimate, Liver Neoplasms secondary, Male, Middle Aged, Neoplasm Grading, Neoplasm Metastasis, Octreotide therapeutic use, Pancreatectomy, Pancreatic Neoplasms surgery, Pancreaticoduodenectomy, Splenectomy, Survival Analysis, Young Adult, Neoadjuvant Therapy methods, Octreotide analogs & derivatives, Pancreatic Neoplasms therapy, Radiopharmaceuticals therapeutic use
- Abstract
Unlabelled: Pancreatic neuroendocrine tumors (NETs) are rare neoplasms for which surgery has almost the only potential for cure. When surgery is not possible because of tumor size and vascular involvement, neoadjuvant treatment with [(177)Lu-DOTA(0),Tyr(3)]octreotate ((177)Lu-octreotate) may be an option., Methods: We studied 29 Dutch patients with a pathology-proven nonfunctioning pancreatic NET treated with (177)Lu-octreotate. All patients had a borderline or unresectable pancreatic tumor (group 1) or oligometastatic disease (defined as ≤3 liver metastases) (group 2). Progression-free survival (PFS) was analyzed using the Kaplan-Meier method and Cox proportional hazards modeling., Results: After the treatment with (177)Lu-octreotate, successful surgery was performed in 9 of 29 patients (31%). Six patients had a Whipple procedure, 2 patients had a pylorus-preserving pancreaticoduodenectomy, and 1 patient had a distal pancreatectomy and splenectomy. The median PFS was 69 mo for patients with successful surgery and 49 mo for the other patients. For comparison, the median PFS in 90 other patients with a nonfunctioning pancreatic NET with more than 3 liver metastases or other metastases was 25 mo., Conclusion: Neoadjuvant treatment with (177)Lu-octreotate is a valuable option for patients with initially unresectable pancreatic NETs., (© 2015 by the Society of Nuclear Medicine and Molecular Imaging, Inc.)
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- 2015
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19. Screw needle cytology of thyroid nodules is associated with a lower non-diagnostic rate compared to fine needle aspiration.
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Klooker TK, Huibers A, In 't Hof K, Nieveen van Dijkum EJ, Phoa SS, van Eeden S, and Bisschop PH
- Subjects
- Adult, Aged, Biopsy, Fine-Needle standards, Biopsy, Fine-Needle statistics & numerical data, Biopsy, Needle statistics & numerical data, Endoscopic Ultrasound-Guided Fine Needle Aspiration standards, Endoscopic Ultrasound-Guided Fine Needle Aspiration statistics & numerical data, Female, Humans, Image-Guided Biopsy statistics & numerical data, Male, Middle Aged, Thyroid Nodule diagnostic imaging, Biopsy, Needle standards, Image-Guided Biopsy standards, Thyroid Nodule pathology
- Abstract
Background: Fine needle aspiration (FNA) cytology is the method of choice to exclude malignancy in thyroid nodules. A major limitation of thyroid FNA is the relatively high rate (13-17%) of non-diagnostic samples. The aim of this study is to determine the diagnostic yield of a screw needle compared to the conventional FNA., Methods: We retrospectively analysed thyroid nodule cytology of all patients that underwent thyroid nodule fine needle or screw needle aspiration between July 2007 and July 2012 in a single academic medical centre. Cytology results were categorized according to the Bethesda classification system., Results: In total, 644 punctures of thyroid nodules from 459 patients were available for analysis. The screw needle was used 531 times, and the conventional fine needle 113 times. The percentage of non-diagnostic cytology was significantly lower in the screw needle samples than in the fine needle samples (3% vs 17%, P<0.001)., Conclusion: This study shows a significantly better diagnostic performance of the screw needle compared to the conventional fine needle in cytology of thyroid nodules., (© 2015 European Society of Endocrinology.)
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- 2015
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20. Quality of life and clinical outcome after thyroid surgery in children: A 13 years single center experience.
- Author
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Stokhuijzen E, van der Steeg AF, Nieveen van Dijkum EJ, van Santen HM, and van Trotsenburg AS
- Subjects
- Adolescent, Child, Child, Preschool, Female, Follow-Up Studies, Humans, Infant, Male, Retrospective Studies, Surveys and Questionnaires, Treatment Outcome, Quality of Life, Thyroid Diseases surgery, Thyroidectomy
- Abstract
Background: Given the low mortality of pediatric patients diagnosed with thyroid disease, quality of life (QoL) after thyroid surgery is very important. To organize the best possible patient care we analyzed our experience with respect to QoL and clinical outcome., Methods: This is a single center, retrospective cohort study. Data of patients who underwent thyroid surgery < 19 years between January 2000 and December 2012 were collected. QoL was measured using the child health questionnaire child form (CHQ-CF87, < 18 years) and the World Health Organization quality of life assessment (WHOQOL-100, ≥ 18 years)., Results: Forty patients were included (mean age 13.7 years; 29 females (72.5%)). Twenty-six patients underwent total thyroidectomy (including 7 repeat surgeries), 14 underwent hemithyroidectomy. QoL assessment in 26 patients revealed lower physical QoL in patients with a current age < 18 years (n = 11) (p < .001), but higher overall and physical QoL in patients ≥ 18 years (n = 15) compared with controls (p = .01 and p = .036 respectively). Patients ≥ 18 years, who underwent total thyroidectomy experienced lower overall and physical QoL compared with those who underwent hemithyroidectomy (p = .035 and p = .005 respectively)., Conclusions: Surgery for thyroid disease during childhood significantly affects QoL. However, QoL seems to improve with increasing age, and hemi-thyroidectomy has less negative effects on QoL than total thyroidectomy., (Copyright © 2015 Elsevier Inc. All rights reserved.)
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- 2015
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21. Factors determining the patients' care intensity for surgeons and surgical nurses: a conjoint analysis.
- Author
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van Oostveen CJ, Vermeulen H, Nieveen van Dijkum EJ, Gouma DJ, and Ubbink DT
- Subjects
- Adult, Aged, Electronic Mail, Female, Health Resources, Hospitalization, Humans, Male, Middle Aged, Netherlands, Patient Discharge, Self Care, Surveys and Questionnaires, Workload, Nursing Staff, Hospital psychology, Quality of Health Care, Surgeons psychology
- Abstract
Background: Surgeons and nurses sometimes perceive a high workload on the surgical wards, which may influence admission decisions and staffing policy. This study aimed to explore the relative contribution of various patient and care characteristics to the perceived patients' care intensity and whether differences exist in the perception of surgeons and nurses., Methods: We invited surgeons and surgical nurses in the Netherlands for a conjoint analysis study through internet and e-mail invitations. They rated 20 virtual clinical scenarios regarding patient care intensity on a 10-point Likert scale. The scenarios described patients with 5 different surgical conditions: cholelithiasis, a colon tumor, a pancreas tumor, critical leg ischemia, and an unstable vertebral fracture. Each scenario presented a mix of 13 different attributes, referring to the patients' condition, physical symptoms, and admission and discharge circumstances., Results: A total of 82 surgeons and 146 surgical nurses completed the questionnaire, resulting in 4560 rated scenarios, 912 per condition. For surgeons, 6 out of the 13 attributes contributed significantly to care intensity: age, polypharmacy, medical diagnosis, complication level, ICU-stay and ASA-classification, but not multidisciplinary care. For nurses, the same six attributes contributed significantly, but also BMI, nutrition status, admission type, patient dependency, anxiety or delirium during hospitalization, and discharge type. Both professionals ranked 'complication level' as having the highest impact., Discussion: The differences between surgeons and nurses on attributes contributing to care intensity may be explained by differences in professional roles and daily work activities. Surgeons have a medical background, including technical aspects of their work and primary focus on patient curation. However, nurses are focused on direct patient care, i.e., checking vital functions, stimulating self-care and providing woundcare., Conclusions: Surgeons and nurses differ in their perception of patients' care intensity. Appreciation of each other's differing interpretations might improve collaboration between doctors and nurses and may help managers to match hospital resources and personnel.
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- 2015
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22. Quality indicators for safe medication preparation and administration: a systematic review.
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Smeulers M, Verweij L, Maaskant JM, de Boer M, Krediet CT, Nieveen van Dijkum EJ, and Vermeulen H
- Subjects
- Databases, Factual, Drug Prescriptions, Evidence-Based Medicine, Humans, Medication Errors, Pharmaceutical Preparations administration & dosage, Quality Indicators, Health Care
- Abstract
Background: One-third of all medication errors causing harm to hospitalized patients occur in the medication preparation and administration phase, which is predominantly a nursing activity. To monitor, evaluate and improve the quality and safety of this process, evidence-based quality indicators can be used., Objectives: The aim of study was to identify evidence-based quality indicators (structure, process and outcome) for safe in-hospital medication preparation and administration., Methods: MEDLINE, EMBASE and CINAHL were searched for relevant studies published up to January 2015. Additionally, nine databases were searched to identify relevant grey literature. Two reviewers independently selected studies if (1) the method for quality indicator development combined a literature search with expert panel opinion, (2) the study contained quality indicators on medication safety, and (3) any of the quality indicators were applicable to hospital medication preparation and administration. A multidisciplinary team appraised the studies independently using the AIRE instrument, which contains four domains and 20 items. Quality indicators applicable to in-hospital medication preparation and administration were extracted using a structured form., Results: The search identified 1683 studies, of which 64 were reviewed in detail and five met the inclusion criteria. Overall, according to the AIRE domains, all studies were clear on purpose; most of them applied stakeholder involvement and used evidence reasonably; usage of the indicator in practice was scarcely described. A total of 21 quality indicators were identified: 5 structure indicators (e.g. safety management and high alert medication), 11 process indicators (e.g. verification and protocols) and 5 outcome indicators (e.g. harm and death). These quality indicators partially cover the 7 rights., Conclusion: Despite the relatively small number of included studies, the identified quality indicators can serve as an excellent starting point for further development of nursing specific quality indicators for medication safety. Especially on the right patient, right route, right time and right documentation there is room future development of quality indicators.
- Published
- 2015
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23. A nationwide comparison of laparoscopic and open distal pancreatectomy for benign and malignant disease.
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de Rooij T, Jilesen AP, Boerma D, Bonsing BA, Bosscha K, van Dam RM, van Dieren S, Dijkgraaf MG, van Eijck CH, Gerhards MF, van Goor H, van der Harst E, de Hingh IH, Kazemier G, Klaase JM, Molenaar IQ, Nieveen van Dijkum EJ, Patijn GA, van Santvoort HC, Scheepers JJ, van der Schelling GP, Sieders E, Vogel JA, Busch OR, and Besselink MG
- Subjects
- Adult, Aged, Female, Health Care Surveys, Humans, Intention to Treat Analysis, Length of Stay statistics & numerical data, Male, Middle Aged, Netherlands, Postoperative Complications epidemiology, Propensity Score, Treatment Outcome, Attitude of Health Personnel, Laparoscopy statistics & numerical data, Pancreatectomy methods, Pancreatic Diseases surgery, Postoperative Complications etiology, Surgeons
- Abstract
Background: Cohort studies from expert centers suggest that laparoscopic distal pancreatectomy (LDP) is superior to open distal pancreatectomy (ODP) regarding postoperative morbidity and length of hospital stay. But the generalizability of these findings is unknown because nationwide data on LDP are lacking., Study Design: Adults who had undergone distal pancreatectomy in 17 centers between 2005 and 2013 were analyzed retrospectively. First, all LDPs were compared with all ODPs. Second, groups were matched using a propensity score. Third, the attitudes of pancreatic surgeons toward LDP were surveyed. The primary outcome was major complications (Clavien-Dindo grade ≥III)., Results: Among 633 included patients, 64 patients (10%) had undergone LDP and 569 patients (90%) had undergone ODP. Baseline characteristics were comparable, except for previous abdominal surgery and mean tumor size. In the full cohort, LDP was associated with fewer major complications (16% vs 29%; p = 0.02) and a shorter median [interquartile range, IQR] hospital stay (8 days [7-12 days] vs 10 days [8-14 days]; p = 0.03). Of all LDPs, 33% were converted to ODP. Matching succeeded for 63 LDP patients. After matching, the differences in major complications (9 patients [14%] vs 19 patients [30%]; p = 0.06) and median [IQR] length of hospital stay (8 days [7-12 days] vs 10 days [8-14 days]; p = 0.48) were not statistically significant. The survey demonstrated that 85% of surgeons welcomed LDP training., Conclusions: Despite nationwide underuse and an impact of selection bias, outcomes of LDP seemed to be at least noninferior to ODP. Specific training is welcomed and could improve both the use and outcomes of LDP., (Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2015
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24. An adrenal mass and increased catecholamines: monoamine oxidase or pheochromocytoma effect?
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Bosscher MR, Wentholt IM, Ackermans MT, and Nieveen van Dijkum EJ
- Abstract
Hormonal evaluation in patients with an adrenal incidentaloma can be difficult in patients with comorbidities or in patients using interfering drugs. We present a case of a 54-year-old man who was evaluated for an adrenal mass. The medical history reported treatment with a monoamine oxidase (MAO) inhibitor for recurrent psychoses. Hormonal screening showed elevated levels of normetanephrine and metanephrine in plasma and urine, suggesting a diagnosis of pheochromocytoma (PHEO), and an adrenalectomy was performed. Histologic examination showed that the tumor had an origin of the adrenal cortex. MAO inhibitors are also known to cause elevated levels of catecholamines. In this case, a PHEO seemed more likely the cause due to repeatedly elevated levels of metanephrines and normal levels of catecholamines. Since the tumor had an origin of the adrenal cortex, the use of MAO inhibitors was the most likely explanation for the elevated levels of metanephrines. This case illustrated the difficulties in diagnosing PHEO, especially in patients with comorbidities and interfering drugs.
- Published
- 2015
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25. Pancreatic fistulae after pancreatic resections for neuroendocrine tumours compared with resections for other lesions.
- Author
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Atema JJ, Jilesen AP, Busch OR, van Gulik TM, Gouma DJ, and Nieveen van Dijkum EJ
- Subjects
- Adult, Aged, Chi-Square Distribution, Female, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Neuroendocrine Tumors pathology, Odds Ratio, Pancreatic Fistula diagnosis, Pancreatic Neoplasms pathology, Retrospective Studies, Risk Factors, Treatment Outcome, Neuroendocrine Tumors surgery, Pancreatectomy adverse effects, Pancreatic Fistula etiology, Pancreatic Neoplasms surgery
- Abstract
Background: Resection for pancreatic neuroendocrine tumours (PNET) is suggested to be associated with an increased risk of a post-operative pancreatic fistula (POPF). The aim of this study was to describe morbidity after resections for PNET, focusing on POPF. Outcomes were compared with resections for other lesions., Methods: Patients undergoing an elective pancreatic resection during a 12-year period were retrospectively analysed. Morbidity was defined according to the International Study Group of Pancreatic Surgery (ISGPS) definitions., Results: Eighty-eight out of 832 patients (10.6%) underwent a resection for PNET. Atypical pancreatic resections (enucleation and central pancreatectomy) and distal pancreatectomies were more frequently performed for PNET. The POPF rate was 22.7% in patients operated for PNET compared with 17.2% in other patients (P = 0.200). In univariate analysis, body mass index (BMI), pancreatic duct diameter, somatostatin analogue administration, type of resection and type of pathology were associated with a POPF. In multivariate analysis, BMI, a pancreatic duct diameter <3 mm and central pancreatectomy remained independent risk factors [odds ratio (OR) 1.93, 95% confidence interval (CI) 1.22-3.07 and OR 3.04, 95% CI 1.05-8.82, respectively]., Conclusions: High rates of POPF were found in patients operated for PNET. However, this was mainly owing to the fact that atypical resections, known to be associated with a higher fistula rate, were performed more frequently in these patients., (© 2014 International Hepato-Pancreato-Biliary Association.)
- Published
- 2015
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26. Emergency management in patients with late hemorrhage after pancreatoduodenectomy for a periampullary tumor.
- Author
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Jilesen AP, Tol JA, Busch OR, van Delden OM, van Gulik TM, Nieveen van Dijkum EJ, and Gouma DJ
- Subjects
- Aged, Ampulla of Vater, Emergencies, Female, Humans, Male, Middle Aged, Postoperative Hemorrhage etiology, Postoperative Hemorrhage mortality, Radiology, Interventional, Retrospective Studies, Stents, Adenocarcinoma surgery, Digestive System Neoplasms surgery, Embolization, Therapeutic, Pancreatic Fistula etiology, Pancreaticoduodenectomy adverse effects, Postoperative Hemorrhage therapy
- Abstract
Background: The mortality rate due to late hemorrhage after surgery for periampullary tumors is high, especially in patients with anastomotic leakage. Patients usually require emergency intervention for late hemorrhage. In this study patients with late hemorrhage and their outcomes were analyzed. Furthermore, independent predictors for late hemorrhage, the need for emergency intervention, and type of intervention are reported., Methods: From a prospective database that includes 1,035 patients who underwent pancreatoduodenectomy for periampullary tumors between 1992 and 2012, patients with late hemorrhage (>24 h after index operation) were identified. Patient, disease-specific, and operation characteristics, type of intervention, and outcomes were analyzed. Emergency intervention was defined as surgical or radiological intervention in hemodynamically unstable patients., Results: Of the 47 patients (4.5 %) with late hemorrhage, pancreatic fistula was an independent predictor for developing late hemorrhage (OR 10.2). The mortality rate in patients with late hemorrhage was 13 % compared with 1.5 % in all patients without late hemorrhage. Twenty patients required emergency intervention; 80 % underwent primary radiological intervention and 20 % primary surgical intervention. Extraluminal location of the bleeding (OR 5.6) and occurrence of a sentinel bleed (OR 6.6) are indications for emergency intervention., Conclusion: The type of emergency intervention needed for late hemorrhage is unpredictable. Radiological intervention is preferred, but if it fails, immediate change to surgical treatment is mandatory. This can be difficult to manage but possible when both radiological and surgical interventions are in close proximity such as in a hybrid operating room and should be considered in the emergency management of patients with late hemorrhage.
- Published
- 2014
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27. Standard pre- and postoperative determination of chromogranin a in resectable non-functioning pancreatic neuroendocrine tumors--diagnostic accuracy: NF-pNET and low tumor burden.
- Author
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Jilesen AP, Busch OR, van Gulik TM, Gouma DJ, and Nieveen van Dijkum EJ
- Subjects
- Adult, Aged, False Positive Reactions, Female, Humans, Male, Middle Aged, Neoplasm Recurrence, Local blood, Neuroendocrine Tumors blood, Neuroendocrine Tumors secondary, Neuroendocrine Tumors surgery, Pancreatic Neoplasms blood, Pancreatic Neoplasms pathology, Pancreatic Neoplasms surgery, Postoperative Period, Predictive Value of Tests, Preoperative Period, Retrospective Studies, Tumor Burden, Biomarkers, Tumor blood, Chromogranin A blood, Neoplasm Recurrence, Local diagnosis, Neuroendocrine Tumors diagnosis, Pancreatic Neoplasms diagnosis
- Abstract
Background: Chromogranin A (CgA) is often used in metastatic patients with nonfunctioning pancreatic neuroendocrine tumors (NF-pNET). The aim of this study is to assess the diagnostic accuracy of CgA in patients with low tumor burden., Methods: Resectable patients with NF-pNET without metastases at time of diagnosis were included between 2002 and 2013 in the Academic Medical Center of Amsterdam. CgA was determined at time of diagnosis and during follow-up according to a standardized method. The upper reference range was 94 µg/l., Results: Overall, 47 patients were included in this study. CgA was elevated preoperatively in only 10 patients (27%). In the detection of metastases during follow-up, the positive predictive value for CgA was 50% and negative predictive value was 81%. In 50% of the patients with an elevated CgA during follow-up, this test result was false-positive., Conclusions: The diagnostic accuracy of CgA was low preoperatively in patients with resectable NF-pNET and low tumor burden. In the detection of recurrent disease after curative resection of NF-pNET, the diagnostic accuracy of CgA was moderate (50%). We conclude that the routine measurement of CgA at time of diagnosis or during follow-up after curative resection had limited value in patients with resectable NF-pNET., (© 2015 S. Karger AG, Basel.)
- Published
- 2014
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28. [Multinodular goitre: not always harmless].
- Author
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Dam L, in 't Hof KH, Smit N, and Nieveen van Dijkum EJ
- Subjects
- Aged, Female, Humans, Male, Practice Guidelines as Topic, Time Factors, Goiter, Nodular diagnosis, Goiter, Nodular therapy, Iodine Radioisotopes therapeutic use, Thyroidectomy
- Abstract
Multinodular goitre has a slow and progressive growth. The clinical presentation of patients with multinodular goitre is variable and dependent on size, location and the functional state of the thyroid tissue. The most frequent clinical symptoms are caused by compression and deviation of the trachea and range from dyspnoea to acute asphyxia. Imaging is important to confirm the size of the multinodular goitre. Timing of the treatment can be critical. However, a good treatment guideline is lacking. There are two treatment options: radioactive iodine and surgical resection. The best treatment option and timing of treatment for patients with multinodular goitre should be assessed and decided on an individual basis. In this clinical report we present two patients who had a multinodular goitre with progressive symptoms for years. Patient A, 66 years of age, was successfully treated with radioactive iodine. Patient B, 77 years of age, underwent a total thyroidectomy.
- Published
- 2014
29. Selective Arterial Embolization of Liver Metastases from Gastrinomas: A Single-Centre Experience.
- Author
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Jilesen AP, Klümpen HJ, Busch OR, van Gulik TM, van Lienden KP, Gouma DJ, and Nieveen van Dijkum EJ
- Abstract
Background. Gastrinomas are rare functional neuroendocrine tumors causing the Zollinger-Ellison syndrome (ZES). At presentation, up to 25% of gastrinomas are metastasized, predominantly to the liver. Embolization of liver metastases might reduce symptoms of ZES although a postembolization syndrome can occur. In this study, the results of embolization are presented, and the literature results are described. Methods. From a prospective database of pancreatic neuroendocrine tumors, all patients with liver metastatic gastrinomas were selected if treated with arterial embolization. Primary outcome parameters were symptom reduction, complications, and response rate. The literature search was performed with these items. Results. Three patients were identified; two presented with synchronous liver metastases. All the three patients had symptoms of ZES before embolization. Postembolization syndrome occurred in two patients. Six months after embolization, all the 3 patients had a clinical and complete radiological response; a biochemical response was seen in 2/3 patients. From the literature, only a small number of gastrinoma patients treated with liver embolization for liver metastases were found, and similar results were described. Conclusion. Selective liver embolization is an effective and safe therapy for the treatment of liver metastatic gastrinomas in the reduction of ZES. Individual treatment strategies must be made for the optimal success rate.
- Published
- 2013
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30. Response to teszler.
- Author
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van Santen HM, Tytgat GA, van de Wetering MD, van Eck-Smit BL, Hopman SM, van der Steeg AF, Nieveen van Dijkum EJ, and van Trotsenburg AS
- Subjects
- Female, Humans, Male, Ultrasonography, 3-Iodobenzylguanidine adverse effects, 3-Iodobenzylguanidine therapeutic use, Adrenal Gland Neoplasms radiotherapy, Neuroblastoma radiotherapy, Thoracic Neoplasms radiotherapy, Thyroid Neoplasms diagnostic imaging, Thyroid Neoplasms etiology
- Published
- 2013
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31. Surgical treatment of gastrinomas: a single-centre experience.
- Author
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Atema JJ, Amri R, Busch OR, Rauws EA, Gouma DJ, and Nieveen van Dijkum EJ
- Subjects
- Adult, Aged, Disease-Free Survival, Duodenal Neoplasms mortality, Duodenal Neoplasms pathology, Duodenal Neoplasms surgery, Female, Gastrinoma mortality, Gastrinoma secondary, Humans, Lymph Nodes pathology, Lymph Nodes surgery, Male, Middle Aged, Multimodal Imaging, Netherlands, Pancreatic Neoplasms mortality, Pancreatic Neoplasms pathology, Positron-Emission Tomography, Retrospective Studies, Survival Analysis, Tertiary Care Centers, Time Factors, Tomography, X-Ray Computed, Treatment Outcome, Gastrinoma surgery, Pancreatectomy adverse effects, Pancreatectomy mortality, Pancreatic Neoplasms surgery, Pancreaticoduodenectomy adverse effects, Pancreaticoduodenectomy mortality
- Abstract
Background: Gastrinomas are rare neuroendocrine tumours, and responsible for Zollinger-Ellison syndrome (ZES). Surgery is the only treatment that can cure gastrinomas. The success of surgical treatment of gastrinomas in a single centre was evaluated., Methods: A retrospective review of all patients who underwent resection for a gastrinoma between 1992 and 2011 at a single institution was performed. Presentation, diagnostics, operative management and outcome were analysed., Results: Eleven patients with a median age of 46 years were included. All patients had fasting hypergastrinaemia and a primary tumour was localized using imaging studies in all patients. A pylorus-preserving pancreaticoduodenectomy was performed in three patients: two patients underwent duodenectomy and one patient central pancreatectomy. The remaining five patients underwent enucleation. A primary tumour was removed in nine patients: five tumours were situated in the pancreas, three in the duodenum and one patient was considered to have a primary lymph node gastrinoma. The median follow-up was 3 years (range 1-15) after which 7 patients were disease-free and 3 patients had (suspected) metastatic disease. One patient died 13 years after initial surgery., Conclusion: The success of surgical treatment of a gastrinoma in this series was 7/11 with a median follow-up of 3 years; comparable to recent published studies., (© 2012 International Hepato-Pancreato-Biliary Association.)
- Published
- 2012
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32. An adrenal incidentaloma: how often is it detected and what are the consequences?
- Author
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Minnaar EM, Human KE, Henneman D, Nio CY, Bisschop PH, and Nieveen van Dijkum EJ
- Abstract
Objectives. The aim of this study was to investigate the detection rate of adrenal incidentalomas and subsequent workup. Design. Retrospective cohort study. Methods. Two investigators evaluated the adrenals on abdominal CT scans. Abnormalities were compared to the original radiology reports and an experienced abdominal radiologist reviewed the CT scans. All additional imaging and laboratory tests were assessed. Results. The investigators detected 44/356 adrenal incidentalomas (12%). In 25 patients an adrenal incidentaloma had been noted in the radiology report. The expert radiologist agreed on 19 incidentalomas in 17 patients, two with bilateral incidentalomas. Of the 25 incidentaloma patients, 4 (16%) patients were screened for hormonal overproduction and 2 (8%) patients had follow-up imaging studies. Conclusions. 12% of the patients had an adrenal incidentaloma (42 of 356). 17 (40%) had initially not been reported by the radiologist. When diagnosed with an adrenal incidentaloma, only a small percentage of patients (16%) is screened or undergoes repeated imaging (8%) as proposed in the National Institutes of Health (NIH) guidelines on adrenal incidentalomas.
- Published
- 2012
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33. Vitamin D, or wait and see?
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Wentholt IM, Bras J, Kroon FH, Nieveen van Dijkum EJ, and Fliers E
- Subjects
- Humans, Vitamin D
- Published
- 2012
34. Surgery in adrenocortical carcinoma: Importance of national cooperation and centralized surgery.
- Author
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Hermsen IG, Kerkhofs TM, den Butter G, Kievit J, van Eijck CH, Nieveen van Dijkum EJ, and Haak HR
- Subjects
- Adolescent, Adrenal Cortex Neoplasms epidemiology, Adrenal Cortex Neoplasms mortality, Adrenocortical Carcinoma epidemiology, Adrenocortical Carcinoma mortality, Adult, Aged, Female, Humans, Incidence, Male, Middle Aged, Multivariate Analysis, Neoplasm Recurrence, Local epidemiology, Netherlands, Registries, Retrospective Studies, Survival Rate, Treatment Outcome, Young Adult, Adrenal Cortex Neoplasms surgery, Adrenocortical Carcinoma surgery, Centralized Hospital Services, National Health Programs
- Abstract
Background: The low incidence rate of adrenocortical carcinoma (ACC) requires a multidisciplinary approach in which surgery plays an essential role because complete resection of the primary tumor is the only chance of cure. To improve patient care, insight into operative results within the ACC population is essential. In 2007, a Dutch Adrenal Network Registry was created covering care and outcome of patients treated for ACC in the Netherlands since 1965. Using this database, we performed a study (1) to gain insight into surgical performance in the Netherlands and (2) to compare operative data with international literature., Methods: Data on patients treated from 1965 until January 2008 were studied. The following data were collected: age, gender, functionality of the tumor, stage at diagnosis, operative procedure, completeness of surgery, disease recurrence, adjuvant mitotane therapy, and recurrence-free and overall survival (OS)., Results: A total of 175 patients were studied, of whom 149 underwent surgery. Patients with complete resection had significantly longer OS times than patients with incomplete resection (P = .010). Patients operated on in a Dutch Adrenal Network center had significantly longer duration of OS in both univariate (P = .011) and multivariate analysis (P = .014). A significantly greater OS was observed for operated stage IV patients compared with nonoperated patients (P = .002)., Conclusion: Our data suggest the relevance of national cooperation and centralized surgery in ACC. For selected patients with stage IV disease, surgery can be beneficial in extending survival. On the basis of the retrospective analysis, operative ACC in the Netherlands can and will be improved., (Copyright © 2012. Published by Mosby, Inc.)
- Published
- 2012
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35. Differentiated thyroid carcinoma after 131I-MIBG treatment for neuroblastoma during childhood: description of the first two cases.
- Author
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van Santen HM, Tytgat GA, van de Wetering MD, van Eck-Smit BL, Hopman SM, van der Steeg AF, Nieveen van Dijkum EJ, and van Trotsenburg AS
- Subjects
- Adolescent, Carcinoma, Carcinoma, Papillary, Child, Female, Humans, Iodine Radioisotopes adverse effects, Iodine Radioisotopes therapeutic use, Male, Thyroid Cancer, Papillary, Thyroid Neoplasms surgery, Thyroidectomy, Treatment Outcome, Ultrasonography, 3-Iodobenzylguanidine adverse effects, 3-Iodobenzylguanidine therapeutic use, Adrenal Gland Neoplasms radiotherapy, Neuroblastoma radiotherapy, Thoracic Neoplasms radiotherapy, Thyroid Neoplasms diagnostic imaging, Thyroid Neoplasms etiology
- Abstract
Background: It is well known that the thyroid gland is sensitive to the damaging effects of irradiation (X-radiation or (131)I¯). For this reason, during exposure to (131)I- metaiodobenzylguanidine (MIBG) in children with neuroblastoma (NBL), the thyroid gland is protected against radiation damage by the administration of either potassium iodide (KI) or a combination of KI, thyroxine, and methimazole. Although hypothyroidism and benign thyroid nodules are frequently encountered during follow-up of these children, differentiated thyroid carcinoma (DTC) has never been reported after treatment with (131)I-MIBG in children who have not been given external beam irradiation. Here, we describe the first two cases of DTC after (131)I-MIBG-therapy., Patient Findings: A 6-year-old boy, treated with (131)I-MIBG for NBL at the age of 4 months, and a 13-year-old girl, treated at the age of 9 months, were both diagnosed with DTC at 5 and 12 years after (131)I-MIBG treatment, respectively. Both children received thyroid protection during exposure to (131)I-MIBG. In each child DTC was discovered in nonpalpable nodules by thyroid ultrasound., Summary: The first two pediatric patients with DTC after treatment with (131)I-MIBG are reported., Conclusions: Both these cases of DTC after (131)I-MIBG for childhood NBL underline the importance of adequate thyroid protection against radiation exposure during treatment for NBL. Children who have been treated with (131)I-MIBG should be given life-long follow-up, not only with regard to thyroid function, but also with surveillance for the development of thyroid nodules and thyroid cancer.
- Published
- 2012
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36. Thyroid function after subtotal thyroidectomy in patients with Graves' hyperthyroidism.
- Author
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Limonard EJ, Bisschop PH, Fliers E, and Nieveen van Dijkum EJ
- Subjects
- Adolescent, Adult, Child, Female, Graves Disease physiopathology, Humans, Male, Middle Aged, Retrospective Studies, Young Adult, Graves Disease surgery, Thyroid Function Tests, Thyroidectomy
- Abstract
Background: Subtotal thyroidectomy is a surgical procedure, in which the surgeon leaves a small thyroid remnant in situ to preserve thyroid function, thereby preventing lifelong thyroid hormone supplementation therapy., Aim: To evaluate thyroid function after subtotal thyroidectomy for Graves' hyperthyroidism., Subjects and Methods: We retrospectively reviewed the medical records of all patients (n = 62) who underwent subtotal thyroidectomy for recurrent Graves' hyperthyroidism between 1992 and 2008 in our hospital. Thyroid function was defined according to plasma TSH and free T4 values., Results: Median followup after operation was 54.6 months (range 2.1-204.2 months). Only 6% of patients were euthyroid after surgery. The majority of patients (84%) became hypothyroid, whereas 10% of patients had persistent or recurrent hyperthyroidism. Permanent recurrent laryngeal nerve palsy and permanent hypocalcaemia were noted in 1.6% and 3.2% of patients, respectively., Conclusion: In our series, subtotal thyroidectomy for Graves' hyperthyroidism was associated with a high risk of postoperative hypothyroidism and a smaller, but significant, risk of persistent hyperthyroidism. Our data suggest that subtotal thyroidectomy seems to provide very little advantage over total thyroidectomy in terms of postoperative thyroid function.
- Published
- 2012
- Full Text
- View/download PDF
37. [Intraoperative neuromonitoring during endocrine surgery].
- Author
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Ram K, Dam L, in 't Hof KH, and Nieveen van Dijkum EJ
- Subjects
- Humans, Recurrent Laryngeal Nerve Injuries etiology, Trauma, Nervous System etiology, Trauma, Nervous System prevention & control, Monitoring, Intraoperative methods, Recurrent Laryngeal Nerve Injuries prevention & control, Thyroid Neoplasms surgery, Thyroidectomy adverse effects
- Abstract
Recurrent laryngeal nerve (RLN) injury is a known complication of thyroid surgery. Patients undergoing reoperations or extensive resections of malignancies carry an increased risk of nerve damage. The gold standard for preventing RLN injury is identification of the RLN. The development of a new technique has enabled intraoperative testing of RLN function. Intraoperative neuromonitoring has an excellent specificity and negative predictive value in which an unchanged positive signal is highly predictive of intact nerve function. This technique facilitates RLN identification in altered anatomy as is found at reoperation and can prevent bilateral vocal cord palsy. Additionally the prognosis of patients with postoperative voice symptoms can be supported by the objective intraoperative measurements.
- Published
- 2012
38. Secondary hyperparathyroidism: Uncommon cause of a leg ulcer.
- Author
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van Rijssen LB, Brenninkmeijer EE, and Nieveen van Dijkum EJ
- Abstract
Introduction: Most leg ulcers are vascular based. Only if vascular therapy fails other causes are considered. We report the case of a female with incapacitating leg ulcers caused by a rare condition which was only diagnosed after failing treatment., Presentation of Case: The female had an extensive previous history including diabetes, renal insufficiency and cardiovascular disease and presented with three large and painful ulcers on her left lower leg. Standard treatment with antibiotics, wound excision and additional treatment with hyperbaric oxygen were ineffective. One month post hospital-admission calciphylaxis cutis caused by renal failure induced secondary hyperparathyroidism was diagnosed. Surgical treatment by a parathyroidectomy induced rapid regeneration of the ulcers., Discussion: Our patient's vast comorbidity and previous history had expanded differential considerations causing a delay in diagnosis. Our patient's previous history led us to believe her ulcers were vascular based, however her chronic renal failure appeared responsible for her condition., Conclusion: Although less probable than venous insufficiency and concomittant leg ulcers or other differential considerations, calciphylaxis cutis should be part of the differential diagnosis in any end stage renal disease-patient with unexplained ulcers as an effective therapy is readily available.
- Published
- 2012
- Full Text
- View/download PDF
39. An unusual groin swelling.
- Author
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Minnee RC, Nieveen-van Dijkum EJ, and Ruurda JP
- Subjects
- Aged, Appendicitis complications, Appendicitis diagnostic imaging, Hernia, Inguinal complications, Hernia, Inguinal surgery, Humans, Inflammation etiology, Male, Pain etiology, Ultrasonography, Appendicitis diagnosis, Groin pathology, Hernia, Inguinal diagnostic imaging
- Published
- 2010
40. [Pain in the throat due to acute suppurative thyroiditis caused by Salmonella].
- Author
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van Bon AC, Krudop W, van Eeden S, Schreuder MC, Nieveen van Dijkum EJ, Fliers E, and Wiersinga WM
- Subjects
- Female, Humans, Middle Aged, Salmonella Infections drug therapy, Salmonella Infections surgery, Thyroidectomy methods, Thyroiditis, Suppurative drug therapy, Thyroiditis, Suppurative microbiology, Thyroiditis, Suppurative surgery, Treatment Outcome, Anti-Bacterial Agents therapeutic use, Salmonella Infections diagnosis, Thyroiditis, Suppurative diagnosis
- Abstract
A 53-year-old woman presented with fever accompanied by chills and an extremely painful swelling of her right thyroid lobe. She was initially diagnosed as having subacute thyroiditis, but after 14 days her disease appeared to be caused by a destructive suppurative thyroiditis due to Salmonella group C. A pre-existing hyperplastic nodule in the right thyroid lobe was the predisposing factor. Antibiotics were given for several weeks and surgical drainage was performed. Finally a hemithyroidectomy was done to eliminate the predisposing factor.
- Published
- 2008
41. Quality of life after curative or palliative surgical treatment of pancreatic and periampullary carcinoma.
- Author
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Nieveen van Dijkum EJ, Kuhlmann KF, Terwee CB, Obertop H, de Haes JC, and Gouma DJ
- Subjects
- Female, Humans, Longitudinal Studies, Male, Middle Aged, Pancreaticoduodenectomy methods, Postoperative Period, Prospective Studies, Survival Analysis, Treatment Outcome, Common Bile Duct Neoplasms surgery, Palliative Care methods, Pancreatic Neoplasms surgery, Quality of Life
- Abstract
Background: Quality of life (QOL) is an important outcome measure after treatment of pancreatic and periampullary carcinoma. The aim of this prospective longitudinal study was to analyse QOL after surgery for resectable pancreatic or periampullary carcinoma., Methods: Patients with potentially resectable tumours underwent pancreaticoduodenectomy (n = 72) or a double-bypass procedure (n = 42). They were asked to complete a questionnaire before laparotomy and at 2 weeks, 6 weeks, and 3, 6, 9 and 12 months after surgery. Fifty-nine patients completed a shortened questionnaire on a weekly basis., Results: There was a temporary decrease in physical and gastrointestinal functioning after pancreaticoduodenectomy. A similar decrease in QOL was observed after double bypass, as well as decreases in mental functioning and overall QOL. Almost all QOL scores returned to preoperative values by about 3 months after surgery, although only briefly so in patients who had a double-bypass procedure. There were no differences between groups in the terminal stages of disease. A rapid decrease on all QOL scales was observed in the last 8 weeks before death., Conclusion: Surgery for pancreatic and periampullary carcinoma was not associated with irreversible impairment or protracted recovery of QOL. The relatively long plateau phase after recovery supports the argument for surgical treatment, including surgical palliation in selected patients.
- Published
- 2005
- Full Text
- View/download PDF
42. Laparoscopic staging and subsequent palliation in patients with peripancreatic carcinoma.
- Author
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Nieveen van Dijkum EJ, Romijn MG, Terwee CB, de Wit LT, van der Meulen JH, Lameris HS, Rauws EA, Obertop H, van Eyck CH, Bossuyt PM, and Gouma DJ
- Subjects
- Aged, Bile Duct Neoplasms mortality, Cholangiopancreatography, Endoscopic Retrograde methods, Female, Humans, Laparotomy methods, Male, Middle Aged, Minimally Invasive Surgical Procedures methods, Neoplasm Staging, Pancreatic Neoplasms mortality, Prospective Studies, Reference Values, Sensitivity and Specificity, Severity of Illness Index, Survival Analysis, Tomography, X-Ray Computed, Treatment Outcome, Ultrasonography, Interventional, Bile Duct Neoplasms pathology, Bile Duct Neoplasms surgery, Laparoscopy methods, Palliative Care methods, Pancreatic Neoplasms pathology, Pancreatic Neoplasms surgery
- Abstract
Objective: To test the hypothesis that laparoscopic staging improves outcome in patients with peripancreatic carcinoma compared to standard radiology staging., Summary Background Data: Diagnostic laparoscopy of peripancreatic malignancies has been reported to improve assessment of tumor stage and to prevent unnecessary exploratory laparotomies in 10% to 76% of patients., Methods: Laparoscopy and laparoscopic ultrasound were performed in 297 consecutive patients with peripancreatic carcinoma scheduled for surgery after radiologic staging. Patients with pathology-proven unresectable tumors were randomly allocated to either surgical or endoscopic palliation. All others underwent laparotomy., Results: Laparoscopic staging detected biopsy-proven unresectable disease in 39 patients (13%). At laparotomy, unresectable disease was found in another 72 patients, leading to a detection rate for laparoscopic staging of 35%. In total, 145 of the 197 patients classified as having "possibly resectable" disease after laparoscopic staging underwent resection (74%). Average survival in the group of 14 patients with biopsy-proven unresectable tumors randomly allocated to endoscopic palliation was 116 days, with a mean hospital-free survival of 94 days. The corresponding figures were 192 days and 164 days in the 13 patients allocated to surgical palliation., Conclusions: Because of the limited detection rate for unresectable metastatic disease and the likely absence of a large gain after switching from surgical to endoscopic palliation, laparoscopic staging should not be performed routinely in patients with peripancreatic carcinoma.
- Published
- 2003
- Full Text
- View/download PDF
43. Staging laparoscopy for gastrointestinal malignancies: current indications.
- Author
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Bemelman WA, Nieveen van Dijkum EJ, de Wit LT, and Gouma DJ
- Subjects
- Endosonography, Humans, Lymphatic Metastasis, Neoplasm Staging, Predictive Value of Tests, Prognosis, Gastrointestinal Neoplasms pathology, Laparoscopy
- Published
- 2001
44. Laparoscopy and laparoscopic ultrasonography in staging carcinoma of the gastric cardia.
- Author
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Hulscher JB, Nieveen van Dijkum EJ, de Wit LT, van Delden OM, van Lanschot JJ, Obertop H, and Gouma DJ
- Subjects
- Adult, Aged, Aged, 80 and over, Digestive System Neoplasms diagnosis, Digestive System Neoplasms diagnostic imaging, Digestive System Neoplasms secondary, Esophageal Neoplasms surgery, Female, Gastrectomy, Humans, Male, Middle Aged, Retrospective Studies, Stomach Neoplasms surgery, Ultrasonography, Cardia diagnostic imaging, Esophageal Neoplasms diagnosis, Esophageal Neoplasms diagnostic imaging, Laparoscopy, Stomach Neoplasms diagnosis, Stomach Neoplasms diagnostic imaging
- Abstract
Objective: To investigate the role of diagnostic laparoscopy and laparoscopic ultrasonography in the staging of carcinoma of the gastric cardia that is involving the distal oesophagus., Design: Retrospective consecutive case series., Setting: Tertiary care centre, The Netherlands., Subjects: 48 patients (34 men and 14 women, median age 63 years, range 39-84) who presented with tumours of the gastric cardia that involved the distal oesophagus and in whom non-invasive staging had not shown unresectable locoregional disease or distant metastases., Interventions: In addition to laparoscopy and laparoscopic ultrasonography, biopsy of all suspected lesions outside the area of potential resection., Main Outcome Measures: Number of patients in whom the findings obviated the need for exploratory laparotomy., Results: There were no complications related to the laparoscopy. The investigation showed distant metastases (which were histologically verified) in 11 patients (23%, 95% confidence interval (CI) 16 to 30). These patients had non-operative palliation. Seven were identified by laparoscopy, and laparoscopic ultrasonography showed the other four. In three patients whose distant metastases had already been identified by laparoscopy, ultrasonography was omitted. Three additional patients had suspect lesions, but these were not confirmed histologically. However, these lesions were shown to be cancerous at laparotomy. One additional patient had an intra-abdominal metastasis which was missed by laparoscopy with ultrasonography., Conclusions: Laparoscopy with ultrasonography safely detected metastases that had not been shown by conventional staging investigations in 23% of 48 patients with carcinoma of the gastric cardia. The investigation should therefore be added to the standard staging procedures in patients with carcinoma of the gastric cardia that is involving the distal oesophagus.
- Published
- 2000
- Full Text
- View/download PDF
45. Pooling of prognostic studies in cancer of the pancreatic head and periampullary region: the Triple-P study. Triple-P study group.
- Author
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Terwee CB, Nieveen Van Dijkum EJ, Gouma DJ, Bakkevold KE, Klinkenbijl JH, Wade TP, van Wagensveld BA, Wong A, and van der Meulen JH
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Models, Statistical, Palliative Care, Pancreatic Neoplasms therapy, Prognosis, Proportional Hazards Models, Risk Factors, Survival Rate, Pancreatic Neoplasms mortality
- Abstract
Objective: Development of a prognostic tool for patients with unresectable pancreatic cancer to distinguish between with low or high probabilities of survival 3 to 9 months after diagnosis., Design: Data about individual patients from five studies were pooled. A multivariate proportional hazards model with time-dependent covariates was developed, including age, sex, and metastases. An extended model was developed on a subset of patients, including weight loss, pain, and jaundice at diagnosis., Setting: Multicentre study, The Netherlands, Norway, USA, UK, and Canada., Subjects: 1020 patients with unresectable pancreatic cancer., Main Outcome Measures: Prediction of prognosis., Results: Patients with metastases, pain, or weight loss at diagnosis had a significantly poorer prognosis than the others. Older men had a worse prognosis than younger men, while older women had a better prognosis than younger ones. Patients with jaundice had a relatively good prognosis. Differences in survival among the studies were incorporated in a prognostic score chart., Conclusion: The prognostic score chart can be used to select patients with relatively low expectation of survival for endoscopic palliation, and patients with relatively high expectation for surgical palliation.
- Published
- 2000
- Full Text
- View/download PDF
46. Validation of the gastrointestinal quality of life index for patients with potentially operable periampullary carcinoma.
- Author
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Nieveen Van Dijkum EJ, Terwee CB, Oosterveld P, Van Der Meulen JH, Gouma DJ, and De Haes JC
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Health Status Indicators, Humans, Male, Middle Aged, Reproducibility of Results, Surveys and Questionnaires, Ampulla of Vater, Common Bile Duct Neoplasms surgery, Quality of Life
- Abstract
Background: A disease-specific quality of life questionnaire is not available for patients with periampullary carcinoma, although cancer-specific questionnaires and the Gastrointestinal Quality of Life Index (GIQLI) have been used. The aim of this study was to validate the GIQLI for patients with periampullary tumours and to evaluate if subscales of the GIQLI could be identified to allow a more detailed assessment of the patients' quality of life., Methods: Patients with periampullary carcinoma, included in a study concerning diagnostic laparoscopy, were asked about symptoms and completed a questionnaire comprising the Medical Outcomes Study (MOS) 24 questionnaire, the GIQLI and one question of the Rotterdam Symptom Check List (RSCL). Clinical interpretation and statistical factor analysis were used to identify subscales of the GIQLI., Results: The GIQLI could be divided into four subscales, measuring physical well-being, mental well-being, digestion and defaecation. All four subscales had a good internal reliability and the construct validity was supported by the pattern of correlations with the MOS and RSCL as well as differences in subscale scores for patients with or without certain symptoms., Conclusion: In patients with periampullary tumours the GIQLI can be divided into four subscales, measuring different aspects of quality of life. These subscales provide insight into the different problems affecting the patient.
- Published
- 2000
- Full Text
- View/download PDF
47. Staging laparoscopy and laparoscopic ultrasonography in more than 400 patients with upper gastrointestinal carcinoma.
- Author
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Nieveen van Dijkum EJ, de Wit LT, van Delden OM, Kruyt PM, van Lanschot JJ, Rauws EA, Obertop H, and Gouma DJ
- Subjects
- Endosonography adverse effects, Follow-Up Studies, Gastrointestinal Neoplasms diagnostic imaging, Gastrointestinal Neoplasms surgery, Humans, Laparoscopy adverse effects, Neoplasm Metastasis, Palliative Care, Postoperative Complications, Predictive Value of Tests, Sensitivity and Specificity, Endosonography methods, Gastrointestinal Neoplasms pathology, Laparoscopy methods, Neoplasm Staging methods
- Abstract
Background: Resection offers the only chance of cure to patients with esophageal, gastroesophageal junction, and hepatopancreatobiliary tumors. Staging is essential to select patients who will benefit from operation because palliation can also be performed nonoperatively. Several studies, including limited numbers of patients, have shown that laparoscopic staging prevents unnecessary laparotomies, but it is doubtful whether general application of this staging method can be advised. The aim of this study was to assess the benefit of diagnostic laparoscopy for staging patients with esophageal, gastroesophageal junction, and hepatopancreatobiliary tumors., Study Design: Between June 1992 and December 1996, 420 patients with a resectable tumor after conventional staging underwent diagnostic laparoscopy combined with laparoscopic ultrasonography. Histologic proof of metastases or ingrowth was used to cancel laparotomy., Results: Laparoscopic staging avoided laparotomy in 20% of patients (sensitivity 0.70): 5% with an esophageal tumor, 20% with a gastroesophageal junction tumor, 15% with a periampullary tumor, 40% with a proximal bile duct tumor, 35% with a liver tumor, and 40% with a pancreatic body or tail tumor. Complications and port-site metastases were seen in 4% and 2% of patients, respectively., Conclusions: Laparoscopic staging is a safe procedure with low morbidity and without mortality in this series. It has shown no benefit in esophageal cancer, but seems beneficial for staging tumors located at the gastroesophageal junction, proximal bile duct tumors, liver tumors, and pancreatic body and tail tumors. The value of laparoscopic staging for patients with periampullary tumors is not as great as stated in previous studies and is still the subject of investigation.
- Published
- 1999
- Full Text
- View/download PDF
48. Are there indications for palliative resection in pancreatic cancer?
- Author
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Gouma DJ, Nieveen van Dijkum EJ, van Geenen RC, van Gulik TM, and Obertop H
- Subjects
- Gastric Outlet Obstruction etiology, Gastric Outlet Obstruction therapy, Humans, Intestinal Obstruction etiology, Intestinal Obstruction therapy, Jaundice etiology, Jaundice therapy, Pancreatic Neoplasms complications, Pancreatic Neoplasms mortality, Quality of Life, Survival Analysis, Palliative Care, Pancreatic Neoplasms surgery, Pancreaticoduodenectomy
- Abstract
Controversy exists about the indication for a palliative pancreatoduodenectomy. A palliative resection for patients with a pancreatic carcinoma can be performed safely nowadays with low mortality and acceptable morbidity in centers with experience. The early results in terms of mortality and morbidity are not different from resections with curative intent or even after bypass surgery. The procedure seems effective for controlling symptoms of the disease, and the quality of life after a palliative resection is acceptable and not worse than after bypass surgery. It is, however, still doubtful whether the incidence of symptom recurrence, such as jaundice, obstruction, and pain, is lower after resection than after bypass surgery. The longer survival after palliative resection could also be due to patient selection and postoperative treatment. There are no randomized trials to prove the superiority of palliative resection over bypass surgery. The safety of pancreatic resection for cancer has already changed the policy in centers with experience, and surgeons are more willing to perform a resection because the results are better or at least the same as after bypass surgery. There are, however, no results to confirm that a palliative resection should be performed routinely or to justify resection as a debulking procedure.
- Published
- 1999
- Full Text
- View/download PDF
49. The standard diagnostic work-up and surgical treatment of pancreatic head tumours.
- Author
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Gouma DJ, Nieveen van Dijkum EJ, and Obertop H
- Subjects
- Diagnosis, Differential, Humans, Laparoscopy, Neoplasm Metastasis, Neoplasm Staging, Palliative Care, Pancreatic Neoplasms complications, Pancreatic Neoplasms therapy, Quality of Life, Randomized Controlled Trials as Topic, Survival, Pancreatic Neoplasms diagnosis, Pancreatic Neoplasms surgery
- Published
- 1999
- Full Text
- View/download PDF
50. Laparoscopic staging of biliopancreatic malignancy.
- Author
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Gouma DJ, Nieveen van Dijkum EJ, de Wit LT, and Obertop H
- Subjects
- Bile Duct Neoplasms diagnostic imaging, Humans, Laparoscopy, Neoplasm Metastasis, Neoplasm Staging, Pancreatic Neoplasms diagnostic imaging, Ultrasonography, Bile Duct Neoplasms pathology, Pancreatic Neoplasms pathology
- Abstract
The main benefit of laparoscopic staging (LLU) of (distal) bilio-pancreatic malignancy is the detection of small superficial metastases at the liver surface and peritoneum and local tumor ingrowth. The different aspects of laparoscopic staging have been described extensively in the literature and the benefit is generally expressed in terms of prevention of laparotomy. The impact of this final staging procedure on outcome for the patient in terms of the efficacy of the subsequent non-surgical palliative treatment have been analysed scarsely. In this review the results of laparoscopic staging of bilio-pancreatic tumors concerning the detection of metastases and tumor ingrowth as well as the results of long term follow up after subsequent non-surgical treatment and the preferred palliative treatment after laparoscopic staging are discussed.
- Published
- 1999
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