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1. Nationwide Outcomes of Octogenarians Following Open or Endovascular Management After Ruptured Abdominal Aortic Aneurysms

Author

Anna J. Alberga, Jorg L. de Bruin, Frederico Bastos Gonçalves, Eleonora G. Karthaus, Janneke A. Wilschut, Joost A. van Herwaarden, Jan J. Wever, Hence J. M. Verhagen, Van den Akker PJ, Akkersdijk GJ, Akkersdijk GP, Akkersdijk WL, van Andringa de Kempenaer MG, Arts CH, Avontuur JA, Bakker OJ, Balm R, Barendregt WB, Bekken JA, Bender MH, Bendermacher BL, van den Berg M, Berger P, Beuk RJ, Blankensteijn JD, Bleker RJ, Blok JJ, Bode AS, Bodegom ME, van der Bogt KE, Boll AP, Booster MH, Borger van der Burg BL, de Borst GJ, Bos-van Rossum WT, Bosma J, Botman JM, Bouwman LH, Brehm V, de Bruijn MT, de Bruin JL, Brummel P, van Brussel JP, Buijk SE, Buijs MA, Buimer MG, Burger DH, Buscher HC, Cancrinus E, Castenmiller PH, Cazander G, Coester AM, Cuypers PH, Daemen JH, Dawson I, Dierikx JE, Dijkstra ML, Diks J, Dinkelman MK, Dirven M, Dolmans DE, van Doorn RC, van Dortmont LM, Drouven JW, van der Eb MM, Eefting D, van Eijck GJ, Elshof JW, Elsman BH, van der Elst A, van Engeland MI, van Eps RG, Faber MJ, de Fijter WM, Fioole B, Fokkema TM, Frans FA, Fritschy WM, Fung Kon Jin PH, Geelkerken RH, van Gent WB, Glade GJ, Govaert B, Groenendijk RP, de Groot HG, van den Haak RF, de Haan EF, Hajer GF, Hamming JF, van Hattum ES, Hazenberg CE, Hedeman Joosten PP, Helleman JN, van der Hem LG, Hendriks JM, van Herwaarden JA, Heyligers JM, Hinnen JW, Hissink RJ, Ho GH, den Hoed PT, Hoedt MT, van Hoek F, Hoencamp R, Hoffmann WH, Hogendoorn W, Hoksbergen AW, Hollander EJ, Hommes M, Hopmans CJ, Huisman LC, Hulsebos RG, Huntjens KM, Idu MM, Jacobs MJ, van der Jagt MF, Jansbeken JR, Janssen RJ, Jiang HH, de Jong SC, Jongbloed-Winkel TA, Jongkind V, Kapma MR, Keller BP, Khodadade Jahrome A, Kievit JK, Klemm PL, Klinkert P, Koedam NA, Koelemaij MJ, Kolkert JL, Koning GG, Koning OH, Konings R, Krasznai AG, Krol RM, Kropman RH, Kruse RR, van der Laan L, van der Laa n MJ, van Laanen JH, van Lammeren GW, Lamprou DA, Lardenoye JH, Lauret GJ, Leenders BJ, Legemate DA, Leijdekkers VJ, Lemson MS, Lensvelt MM, Lijkwan MA, Lind RC, van der Linden FT, Liqui Lung PF, Loos MJ, Loubert MC, van de Luijtgaarden KM, Mahmoud DE, Manshanden CG, Mattens EC, Meerwaldt R, Mees BM, von Meijenfeldt GC, Menting TP, Metz R, Minnee RC, de Mol van Otterloo JC, Molegraaf MJ, Montauban van Swijndregt YC, Morak MJ, van de Mortel RH, Mulder W, Nagesser SK, Naves CC, Nederhoed JH, Nevenzel-Putters AM, de Nie AJ, Nieuwenhuis DH, Nieuwenhuizen J, van Nieuwenhuizen RC, Nio D, Noyez VJ, Oomen AP, Oranen BI, Oskam J, Palamba HW, Peppelenbosch AG, van Petersen AS, Petri BJ, Pierie ME, Ploeg AJ, Pol RA, Ponfoort ED, Post IC, Poyck PP, Prent A, ten Raa S, Raymakers JT, Reichart M, Reichmann BL, Reijnen MM, de Ridder JA, Rijbroek A, van Rijn MJ, de Roo RA, Rouwet EV, Saleem BR, Salemans PB, van Sambeek MR, Samyn MG, van ‘t Sant HP, van Schaik J, van Schaik PM, Scharn DM, Scheltinga MR, Schepers A, Schlejen PM, Schlosser FJ, Schol FP, Scholtes VP, Schouten O, Schreve MA, Schurink GW, Sikkink CJ, te Slaa A, Smeets HJ, Smeets L, Smeets RR, de Smet AA, Smit PC, Smits TM, Snoeijs MG, Sondakh AO, Speijers MJ, van der Steenhoven TJ, van Sterkenburg SM, Stigter DA, Stokmans RA, Strating RP, Stultiëns GN, Sybrandy JE, Teijink JA, Telgenkamp BJ, Teraa M, Testroote MJ, Tha-In T, The RM, Thijsse WJ, Thomassen I, Tielliu IF, van Tongeren RB, Toorop RJ, Tournoij E, Truijers M, Türkcan K, Tutein Nolthenius RP, Ünlü Ç, Vaes RH, Vafi AA, Vahl AC, Veen EJ, Veger HT, Veldman MG, Velthuis S, Verhagen HJ, Verhoeven BA, Vermeulen CF, Vermeulen EG, Vierhout BP, van der Vijver-Coppen RJ, Visser MJ, van der Vliet JA, Vlijmen—van Keulen CJ, Voorhoeve R, van der Vorst JR, Vos AW, de Vos B, Vos CG, Vos GA, Voute MT, Vriens BH, Vriens PW, de Vries AC, de Vries DK, de Vries JP, de Vries M, van der Waal C, Waasdorp EJ, Wallis de Vries BM, van Walraven LA, van Wanroij JL, Warlé MC, van de Water W, van Weel V, van Well AM, Welten GM, Welten RJ, Wever JJ, Wiersema AM, Wikkeling OR, Willaert WI, Wille J, Willems MC, Willigendael EM, Wilschut ED, Wisselink W, Witte ME, Wittens CH, Wong CY, Wouda R, Yazar O, Yeung KK, Zeebregts CJ, van Zeeland ML, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), and Surgery

Subjects
Radiology, Nuclear Medicine and imaging, Surgery, Cardiology and Cardiovascular Medicine
Abstract

Purpose: Octogenarians are known to have less-favorable outcomes following ruptured abdominal aortic aneurysm (rAAA) repair compared with their younger counterparts. Accurate information regarding perioperative outcomes following rAAA-repair is important to evaluate current treatment practice. The aim of this study was to evaluate perioperative outcomes of octogenarians and to identify factors associated with mortality and major complications after open surgical repair (OSR) or endovascular aneurysm repair (EVAR) of a rAAA using nationwide, real-world, contemporary data. Methods: All patients that underwent EVAR or OSR of an infrarenal or juxtarenal rAAA between January 1, 2013, and December 31, 2018, were prospectively registered in the Dutch Surgical Aneurysm Audit (DSAA) and included in this study. The primary outcome was the comparison of perioperative outcomes of octogenarians versus non-octogenarians, including adjustment for confounders. Secondary outcomes were the identification of factors associated with mortality and major complications in octogenarians. Results: The study included 2879 patients, of which 1146 were treated by EVAR (382 octogenarians, 33%) and 1733 were treated by OSR (410 octogenarians, 24%). Perioperative mortality of octogenarians following EVAR was 37.2% versus 14.8% in non-octogenarians (adjusted OR=2.9, 95% CI=2.8–3.0) and 50.0% versus 29.4% following OSR (adjusted OR=2.2, 95% CI=2.2–2.3). Major complication rates of octogenarians were 55.4% versus 31.8% in non-octogenarians following EVAR (OR=2.7, 95% CI=2.1–3.4), and 68% versus 49% following OSR (OR=2.2, 95% CI=1.8–2.8). Following EVAR, 30.6% of the octogenarians had an uncomplicated perioperative course (UPC) versus 49.5% in non-octogenarians (OR=0.5, 95% CI=0.4–0.6), while following OSR, UPC rates were 20.7% in octogenarians versus 32.6% in non-octogenarians (OR=0.5, 95% CI=0.4–0.7). Cardiac or pulmonary comorbidity and loss of consciousness were associated with mortality and major complications in octogenarians. Interestingly, female octogenarians had lower mortality rates following EVAR than male octogenarians (adjusted OR=0.7, 95% CI=0.6–0.8). Conclusion: Based on this nationwide study with real-world registry data, mortality rates of octogenarians following ruptured AAA-repair were high, especially after OSR. However, a substantial proportion of these octogenarians following OSR and EVAR had an uneventful recovery. Known preoperative factors do influence perioperative outcomes and reflect current treatment practice.

Published
2022

2. Association of Hospital Volume with Perioperative Mortality of Endovascular Repair of Complex Aortic Aneurysms

Author

Alberga, Anna J., von Meijenfeldt, Gerdine C.I., Rastogi, Vinamr, de Bruin, Jorg L., Wever, Jan J., van Herwaarden, Joost A., Hamming, Jaap F., Hazenberg, Constantijn E.V.B., van Schaik, Jan, Mees, Barend M.E., van der Laan, Maarten J., Zeebregts, Clark J., Schurink, Geert W.H., Verhagen, Hence J.M., van den Akker, PJ., Akkersdijk, G.P., Akkersdijk, W.L., van Andringa de Kempenaer, M.G., Arts, C.H.P., Avontuur, A.M., Bakker, O.J., Balm, R., Barendregt, W.B., Bekken, J.A., Bender, M.H.M., Bendermacher, B.L.W., van den Berg, M., Beuk, R.J., Blankensteijn, ., Bodegom, M.E., Bogt, van der, Boll, A.P.M., Booster, M.H., Burg, Borger van der, de Borst, G.J., Rossum, Bos-van, Bosma, J., Botman, J.M.J., Bouwman, L.H., Brehm, V., de Bruijn, M.T., de Bruin, J.L., Brummel, P., Brussel, van, Buijk, S.E., Buimer, M.G., Buscher, Cancrinus, E., Castenmiller, P.H., Cazander, G., Cuypers, Ph.W.M., Daemen, J.H.C., Dawson, I., Dierikx, J.E., Dijkstra, M.L., Diks, J., Dinkelman, M.K., Dirven, M., Dolmans, D.E.J.G.J., van Dortmont, L.M.C., Drouven, J.W., van der Eb, M.M., Eefting, D., Eijck, van, Elshof, J.W.M., Elsman, A.H.P., van der Elst, A., van Engeland, M.I.A., van Eps, G.S., Faber, M.J., de Fijter, W.M., Fioole, B., Fritschy, W.M., Fung Kon Jin, P.H.P., Geelkerken, R.H., van Gent, W.B., Glade, G.J., Govaert, B., Groenendijk, R.P.R., de Groot, H.G.W., van den Haak, R.F.F., de Haan, E.F.A., Hajer, G.F., Hamming, J.F., van Hattum, E.S., Hazenberg, C.E.VB., Hedeman Joosten, P.Ph.A., Helleman, J.N., van der Hem, L.G., Hendriks, J.M., van Herwaarden, J.A., Heyligers, J.M.M., Hinnen, J.W., Hissink, R.J., Ho, G.H., den Hoed, P.T., Hoedt, M.T.C., van Hoek, F., Hoencamp, R., Hoffmann, W.H., Hoksbergen, A.W.J., Hollander, E.J.F., Huisman, L.C., Hulsebos, R.G., Huntjens, K.M.B., Idu, M.M., Jacobs, M.J.H.M., van der Jagt, M.F.P., Jansbeken, J.R.H., Janssen, R.J.L., Jiang, H.H.L., de Jong, S.C., Jongbloed-Winkel, T.A., Jongkind, V., Kapma, M.R., Keller, B.PJ.A., Jahrome, A. Khodadade, Kievit, J.K., Klemm, P.L., Klinkert, Koedam, N.A., Koelemaij, M.J.W., Kolkert, J.L.P., Koning, G.G., Koning, O.H.J., Konings, R., Krasznai, A.G., Kropman, R.H.J., Kruse, R.R., van der Laan, L., van der Laan, M.J., van Laanen, J.H.H., van Lammeren, G.W., Lamprou, D.A.A., Lardenoije, J.H.P., Lauret, G.J., Leenders, B.J.M., Legemate, Leij- dekkers, V.J., Lemson, M.S., Lensvelt, M.M.A., Lijkwan, M.A., van der Linden, F.Th.P.M., Lung, P.F. Liqui, Loos, M.J.A., Loubert, M.C., Luijtgaarden, van de, Mahmoud, D.E.A.K., Manshanden, C.G., Mat- tens, E.C.J.L., Meerwaldt, R., Mees, B.M.E., Menting, T.P., Metz, R., de Mol van Otterloo, J.C.A., Molegraaf, M.J., Montauban van Swijn- dregt, Y.C.A., Morak, M.J.M., van de Mortel, R.H.W., Mulder, W., Nagesser, S.K., Naves, C.C.L.M., Nederhoed, J.H., Nevenzel, A.M., de Nie, A.J., Nieuwenhuis, D.H., van Nieuwenhuizen, R.C., Nieuwenhui- zen, J., Nio, D., Oomen, A.P.A., Oranen, B.I., Oskam, J., Palamba, H.W., Peppelenbosch, A.G., van Petersen, A.S., Petri, ., Pierie, M.E.N., Ploeg, A.J., Pol, R.A., Ponfoort, E.D., Poyck, P.P.C., Prent, A., ten Raa, S., Raymakers, J.T.F.J., Reichmann, B.L., Reijnen, M.M.P.J., de Ridder, J.A.M., Rijbroek, A., van Rijn, M.J.E., de Roo, R.A., Rouwet, E.V., Saleem, B.R., van Sambeek, M.R.H.M., Samyn, M.G., van’t Sant, H.P., van Schaik, J., van Schaik, PM., Scharn, ., Scheltinga, M.R.M., Schepers, A., Schlejen, P.M., Schlösser, F.J. V., Schol, F.P.G., Scholtes, V.P.W, Schouten, O., Schreve, M.A., Schurink, G.W.H., Sikkink, C.J.J.M., te Slaa, A., Smeets, H.J., Smeets, L., Smeets, R.R., de Smet, A.A.E.A., Smit, PC., Smits, T.M., Snoeijs, M.G.J., Sondakh, A.O., Speijers, M.J., van der Steenhoven, T.J., van Sterkenburg, S.M.M., Stigter, D.A.A., Stokmans, R.A., Strating, R.P, Stultiëns, G.N.M., Sybrandy, J.E.M., Teijink, J.A.W., Telgenkamp, ., Testroote, M.J.G., Tha-In, T., The, R.M., Thijsse, W.J., Thomassen, I., Tielliu, I.F.J., van Tongeren, R.B.M., Toorop, R.J., Tournoij, E., Truijers, M., Türkcan, K., Nolthenius, R.P. Tutein, Ünlü, C., Vaes, R.H.D., Vahl, A.C., Veen, E.J., Veger, H.T.C., Veldman, M.G., Verhagen, H.J.M., Verhoeven, B.A.N., Vermeulen, C.F.W., Vermeulen, E.G.J., Vierhout, B.P., Coppen, van der Vijver-, Visser, M.J.T., van der Vliet, J.A., van Vlijmen-van Keulen, C.J., van der Vorst, J.R., Vos, A.W.F., Vos, C.G., Vos, G.A., de Vos, B., Voûte, M.T., Vriens, B.H.R., Vriens, P.W.H.E., de Vries, D.K., de Vries, J.P.P.M., de Vries, M., de Vries, A.C., van der Waal, C., Waasdorp, E.J., Wallis de Vries, ., van Walraven, L.A., van Wanroi, J.L., Warlé, M.C., van Weel, V, van Well, A.M.E., Welten, G.M.J.M., Wever, J.J., Wiersema, A.M., Wikkeling, O.R.M., Willaert, W.I.M., Wille, J., Willems, M.C.M., Willigendael, E.M., Wilschut, E.D., Wisselink, W., Witte, M.E., Wittens, C.H.A., Wong, C.Y., Yazar, O., Yeung, K.K., Zeebregts, C.J.A.M., and van Zeeland, M.L.P.

Published
2023
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3. A Parathyroid Adenoma Dorsal of the Esophagus, An Ectopic Localization

Author

Dulfer Rr, Smit Pc, and Hartholt Ka

Subjects
Hyperparathyroidism, Pathology, medicine.medical_specialty, Hypercalcaemia, endocrine system diseases, medicine.diagnostic_test, business.industry, Ultrasound, Physical examination, medicine.disease, medicine.anatomical_structure, medicine, Parathyroid gland, Esophagus, business, Primary hyperparathyroidism, Parathyroid adenoma
Abstract

A 65-year-old female was analyzed because of obstipation and hypercalcaemia, which was the result of primary hyperparathyroidism. The parathyroid adenoma was ectopically located. Initial physical examination was performed, followed by subsequent laboratory and ultrasound examination, tc-99m sestamibi scintigraphy and computed tomography. It revealed a parathyroid gland with an ectopic localization dorsally of the esophagus. The ectopic parathyroid adenoma was surgically removed, and her complaints disappeared.

Published
2017
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5. Intra-operative parathyroid hormone measurements - experience of a non-academic hospital

Author

Morks, AN, Van Ginhoven, TM, Pekelharing, JM, Duschek, EJJ, Smit, PC, and De Graaf, PW

Abstract

Background. Surgery is the treatment of choice for symptomatic primary hyperparathyroidism. The majority of research concerning intra-operative parathyroid hormone (ioPTH) measurements is conducted in university hospitals. Whether ioPTH measurements are feasible and useful in predicting the presence of remaining hyperfunctioning parathyroid tissue in a non-academic hospital remains uncertain. Methods. Data were collected on all patients with biochemically proven and surgically treated primary hyperparathyroidism< treated at the Reinier de Graaf Hospital from August 2002 to December 2007. Results. Sixty-five patients were included. The mean pre-operative serum calcium level was 2.78 mmol/l (range 2.28 - 3.80 mmol/l, normal range 2.20 - 2.65 mmol/l) and the mean serum parathyroid hormone level 17.0 pmol/l (range 4.0 - 90.3 pmol/l, normal range 1.0 - 5.5 pmol/l). All patients were operated on for primary hyperparathyroidism, using ioPTH measurements during their first operation. Sensitivity and specificity rates of ioPTH measurements were 98% and 89%, respectively. The ioPTH test accurately indicated incomplete removal of all hyperfunctioning parathyroid tissue in 8 patients (12%). Five patients (8%) were reexplored immediately, of whom 4 were successfully treated in this single operative session. One patient was operated on successfully the next day. Two patients were operated on with a successful result during a second admission. In all the ioPTH measurements there was 1 false-positive result (1.5%) and 1 false-negative result (1.5%). The mean postoperative calcium value for the successfully treated patients was 2.34 mmol/l (range 2.14 - 2.71 mmol/l, normal range 2.20 - 2.65 mmol/l). The mean postoperative PTH level for the successfully treated patients was 3.76 pmol/l (range 0.40 - 7.1 pmol/l). Conclusion. Our data suggest that ioPTH measurements are feasible and useful in a non-academic hospital.

Published
2011

6. Surgeon-Performed Ultrasound as Preoperative Localization Study in Patients with Primary Hyperparathyroidism

Author

van Ginhoven, Tessa, Morks, AN, Schepers, Tim, de Graaf, PW, Smit, PC, van Ginhoven, Tessa, Morks, AN, Schepers, Tim, de Graaf, PW, and Smit, PC

Abstract

Background: Minimally invasive parathyroidectomy is the treatment of choice for single-gland primary hyperparathyroidism. However, the exact location of the abnormal gland has to be established. Sestamibi scintigraphy, computed tomography and ultrasound (US) are commonly used modalities. We describe our experience in a non-academic center with surgeon-performed US (S-US) of the neck as preoperative localization study in patients with primary hyperparathyroidism (PHPT). Methods: Patients with a biochemically proven diagnosis of PHPT and preoperative S-US were included. Data were recorded prospectively. Perioperative gland location was compared to the preoperative S-US to determine sensitivity, specificity and accuracy rates. Results: Two of the 50 patients who underwent S-US were not subjected to surgery. In 85% of the patients analyzed by S-US, the appropriate abnormal gland(s) were identified. In 11%, no gland was identified, but abnormal glands were found during surgery. Sensitivity of S-US in our hospital is 85%, with a positive predictive value of 97%. Conclusions: We achieved a satisfactory sensitivity rate. S-US provides anatomic information to the surgeon which enables a more detailed operation planning, and it is a valuable diagnostic modality for patients with PHPT in our opinion. We hope that our data encourage other centers to implement this technique as well. Copyright (C) 2011 S. Karger AG, Basel

Published
2011

7. Editor's Choice - Nationwide Analysis of Patients Undergoing Iliac Artery Aneurysm Repair in the Netherlands.

Author

Jalalzadeh H, Indrakusuma R, Koelemay MJW, Balm R, Van den Akker LH, Van den Akker PJ, Akkersdijk GJ, Akkersdijk GP, Akkersdijk WL, van Andringa de Kempenaer MG, Arts CH, Avontuur JA, Baal JG, Bakker OJ, Balm R, Barendregt WB, Bender MH, Bendermacher BL, van den Berg M, Berger P, Beuk RJ, Blankensteijn JD, Bleker RJ, Bockel JH, Bodegom ME, Bogt KE, Boll AP, Booster MH, Borger van der Burg BL, de Borst GJ, Bos-van Rossum WT, Bosma J, Botman JM, Bouwman LH, Breek JC, Brehm V, Brinckman MJ, van den Broek TH, Brom HL, de Bruijn MT, de Bruin JL, Brummel P, van Brussel JP, Buijk SE, Buimer MG, Burger DH, Buscher HC, den Butter G, Cancrinus E, Castenmiller PH, Cazander G, Coveliers HM, Cuypers PH, Daemen JH, Dawson I, Derom AF, Dijkema AR, Diks J, Dinkelman MK, Dirven M, Dolmans DE, van Doorn RC, van Dortmont LM, van der Eb MM, Eefting D, van Eijck GJ, Elshof JW, Elsman BH, van der Elst A, van Engeland MI, van Eps RG, Faber MJ, de Fijter WM, Fioole B, Fritschy WM, Geelkerken RH, van Gent WB, Glade GJ, Govaert B, Groenendijk RP, de Groot HG, van den Haak RF, de Haan EF, Hajer GF, Hamming JF, van Hattum ES, Hazenberg CE, Hedeman Joosten PP, Helleman JN, van der Hem LG, Hendriks JM, van Herwaarden JA, Heyligers JM, Hinnen JW, Hissink RJ, Ho GH, den Hoed PT, Hoedt MT, van Hoek F, Hoencamp R, Hoffmann WH, Hoksbergen AW, Hollander EJ, Huisman LC, Hulsebos RG, Huntjens KM, Idu MM, Jacobs MJ, van der Jagt MF, Jansbeken JR, Janssen RJ, Jiang HH, de Jong SC, Jongkind V, Kapma MR, Keller BP, Khodadade Jahrome A, Kievit JK, Klemm PL, Klinkert P, Knippenberg B, Koedam NA, Koelemay MJ, Kolkert JL, Koning GG, Koning OH, Krasznai AG, Krol RM, Kropman RH, Kruse RR, van der Laan L, van der Laan MJ, van Laanen JH, Lardenoye JH, Lawson JA, Legemate DA, Leijdekkers VJ, Lemson MS, Lensvelt MM, Lijkwan MA, Lind RC, van der Linden FT, Liqui Lung PF, Loos MJ, Loubert MC, Mahmoud DE, Manshanden CG, Mattens EC, Meerwaldt R, Mees BM, Metz R, Minnee RC, de Mol van Otterloo JC, Moll FL, Montauban van Swijndregt YC, Morak MJ, van de Mortel RH, Mulder W, Nagesser SK, Naves CC, Nederhoed JH, Nevenzel-Putters AM, de Nie AJ, Nieuwenhuis DH, Nieuwenhuizen J, van Nieuwenhuizen RC, Nio D, Oomen AP, Oranen BI, Oskam J, Palamba HW, Peppelenbosch AG, van Petersen AS, Peterson TF, Petri BJ, Pierie ME, Ploeg AJ, Pol RA, Ponfoort ED, Poyck PP, Prent A, Ten Raa S, Raymakers JT, Reichart M, Reichmann BL, Reijnen MM, Rijbroek A, van Rijn MJ, de Roo RA, Rouwet EV, Rupert CG, Saleem BR, van Sambeek MR, Samyn MG, van 't Sant HP, van Schaik J, van Schaik PM, Scharn DM, Scheltinga MR, Schepers A, Schlejen PM, Schlosser FJ, Schol FP, Schouten O, Schreinemacher MH, Schreve MA, Schurink GW, Sikkink CJ, Siroen MP, Te Slaa A, Smeets HJ, Smeets L, de Smet AA, de Smit P, Smit PC, Smits TM, Snoeijs MG, Sondakh AO, van der Steenhoven TJ, van Sterkenburg SM, Stigter DA, Stigter H, Strating RP, Stultiëns GN, Sybrandy JE, Teijink JA, Telgenkamp BJ, Testroote MJ, The RM, Thijsse WJ, Tielliu IF, van Tongeren RB, Toorop RJ, Tordoir JH, Tournoij E, Truijers M, Türkcan K, Tutein Nolthenius RP, Ünlü Ç, Vafi AA, Vahl AC, Veen EJ, Veger HT, Veldman MG, Verhagen HJ, Verhoeven BA, Vermeulen CF, Vermeulen EG, Vierhout BP, Visser MJ, van der Vliet JA, Vlijmen-van Keulen CJ, Voesten HG, Voorhoeve R, Vos AW, de Vos B, Vos GA, Vriens BH, Vriens PW, de Vries AC, de Vries JP, de Vries M, van der Waal C, Waasdorp EJ, Wallis de Vries BM, van Walraven LA, van Wanroij JL, Warlé MC, van Weel V, van Well AM, Welten GM, Welten RJ, Wever JJ, Wiersema AM, Wikkeling OR, Willaert WI, Wille J, Willems MC, Willigendael EM, Wisselink W, Witte ME, Wittens CH, Wolf-de Jonge IC, Yazar O, Zeebregts CJ, and van Zeeland ML

Subjects
Aged, Aged, 80 and over, Endovascular Procedures methods, Endovascular Procedures mortality, Endovascular Procedures statistics & numerical data, Female, Guideline Adherence statistics & numerical data, Humans, Iliac Aneurysm epidemiology, Iliac Aneurysm mortality, Iliac Aneurysm pathology, Iliac Artery pathology, Iliac Artery surgery, Male, Netherlands epidemiology, Registries, Retrospective Studies, Sex Factors, Treatment Outcome, Iliac Aneurysm surgery
Abstract

Objective: The new 2019 guideline of the European Society for Vascular Surgery (ESVS) recommends consideration for elective iliac artery aneurysm (eIAA) repair when the iliac diameter exceeds 3.5 cm, as opposed to 3.0 cm previously. The current study assessed diameters at time of eIAA repair and ruptured IAA (rIAA) repair and compared clinical outcomes after open surgical repair (OSR) and endovascular aneurysm repair (EVAR)., Methods: This retrospective observational study used the nationwide Dutch Surgical Aneurysm Audit (DSAA) registry that includes all patients who undergo aorto-iliac aneurysm repair in the Netherlands. All patients who underwent primary IAA repair between 1 January 2014 and 1 January 2018 were included. Diameters at time of eIAA and rIAA repair were compared in a descriptive fashion. The anatomical location of the IAA was not registered in the registry. Patient characteristics and outcomes of OSR and EVAR were compared with appropriate statistical tests., Results: The DSAA registry comprised 974 patients who underwent IAA repair. A total of 851 patients were included after exclusion of patients undergoing revision surgery and patients with missing essential variables. eIAA repair was carried out in 713 patients, rIAA repair in 102, and symptomatic IAA repair in 36. OSR was performed in 205, EVAR in 618, and hybrid repairs and conversions in 28. The median maximum IAA diameter at the time of eIAA and rIAA repair was 43 (IQR 38-50) mm and 68 (IQR 58-85) mm, respectively. Mortality was 1.3% (95% CI 0.7-2.4) after eIAA repair and 25.5% (95% CI 18.0-34.7) after rIAA repair. Mortality was not significantly different between the OSR and EVAR subgroups. Elective OSR was associated with significantly more complications than EVAR (intra-operative: 9.8% vs. 3.6%, post-operative: 34.0% vs. 13.8%, respectively)., Conclusion: In the Netherlands, most eIAA repairs are performed at diameters larger than recommended by the ESVS guideline. These findings appear to support the recent increase in the threshold diameter for eIAA repair., (Copyright © 2020 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Published
2020
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8. The impact of the implementation of physician assistants in inpatient care: A multicenter matched-controlled study.

Author

Timmermans MJC, van Vught AJAH, Peters YAS, Meermans G, Peute JGM, Postma CT, Smit PC, Verdaasdonk E, de Vries Reilingh TS, Wensing M, and Laurant MGH

Subjects
Hospitalization, Humans, Inpatients, Netherlands, Surveys and Questionnaires, Length of Stay statistics & numerical data, Outcome Assessment, Health Care statistics & numerical data, Physician Assistants, Physicians, Quality of Health Care statistics & numerical data
Abstract

Background: Medical care for admitted patients in hospitals is increasingly reallocated to physician assistants (PAs). There is limited evidence about the consequences for the quality and safety of care. This study aimed to determine the effects of substitution of inpatient care from medical doctors (MDs) to PAs on patients' length of stay (LOS), quality and safety of care, and patient experiences with the provided care., Methods: In a multicenter matched-controlled study, the traditional model in which only MDs are employed for inpatient care (MD model) was compared with a mixed model in which besides MDs also PAs are employed (PA/MD model). Thirty-four wards were recruited across the Netherlands. Patients were followed from admission till one month after discharge. Primary outcome measure was patients' LOS. Secondary outcomes concerned eleven indicators for quality and safety of inpatient care and patients' experiences with the provided care., Results: Data on 2,307 patients from 34 hospital wards was available. The involvement of PAs was not significantly associated with LOS (β 1.20, 95%CI 0.99-1.40, p = .062). None of the indicators for quality and safety of care were different between study arms. However, the involvement of PAs was associated with better experiences of patients (β 0.49, 95% CI 0.22-0.76, p = .001)., Conclusions: This study did not find differences regarding LOS and quality of care between wards on which PAs, in collaboration with MDs, provided medical care for the admitted patients, and wards on which only MDs provided medical care. Employing PAs seems to be safe and seems to lead to better patient experiences., Trial Registration: ClinicalTrials.gov Identifier: NCT01835444.

Published
2017
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10. Introduction of day care thyroid surgery in a Dutch non-academic hospital.

Author

Dulfer RR, de Valk KS, Gilissen F, van Ginhoven TM, and Smit PC

Subjects
Adult, Aged, Cohort Studies, Feasibility Studies, Female, Hoarseness epidemiology, Humans, Male, Middle Aged, Netherlands, Postoperative Complications epidemiology, Prospective Studies, Retrospective Studies, Ambulatory Surgical Procedures methods, Thyroid Diseases surgery, Thyroidectomy methods
Abstract

Objective: Hemithyroidectomy is the most common endocrine surgical procedure and is performed with low complication rates. Multiple international reports indicate that thyroid surgery in the day care setting is feasible and safe. Despite these results, day care thyroid surgery has not yet been implemented in the Netherlands. The objective of this study is to assess the safety of thyroid surgery in our institution and, when deemed safe, implement day care thyroid surgery., Methods: All patients who underwent hemithyroidectomy in our institution between January 2010 and December 2014 were included in the retrospective analysis. Hypothetical candidates for day care surgery were identified. All patients undergoing thyroid surgery in 2015 were included in a prospective cohort. Data regarding baseline characteristics, surgical procedures, complications and adherence to the day care schedule are presented., Results: A total of 210 patients were included in the retrospective cohort; 149 patients complied with the day care criteria. No complications occurred that would prevent day care surgery, or make it unsafe. Day care thyroid surgery was implemented from January 2015. In one year 43 patients underwent hemithyroidectomy. Thirty-one patients were eligible for day care surgery of which 18 patients were treated in day care. Failure of the day care regimen was due to the patient's own choice (n = 5), large retrosternal goitre (n = 2) or failure of logistics (n = 6). Besides transient hoarseness, no complications occurred in this group., Conclusion: Based on a retrospective safety analysis we successfully introduced day care thyroid surgery in our clinic. Hemithyroidectomy can safely be conducted in day care setting. However, patient selection is of vital importance to minimise the risk of complications.

Published
2016

11. Hygroma in a 23-year-old man.

Author

Bussink BE, van Ginhoven TM, and Smit PC

Subjects
Head and Neck Neoplasms surgery, Humans, Lymphangioma, Cystic surgery, Male, Neck diagnostic imaging, Neck surgery, Tomography, X-Ray Computed, Ultrasonography, Young Adult, Head and Neck Neoplasms diagnosis, Lymphangioma, Cystic diagnosis, Neck pathology
Abstract

We describe a 23-year-old man with a cystic hygroma on the right side of his lower neck. Cystic hygromas are uncommon congenital lesions of the lymphatic system and are often diagnosed before the age of 2. The finding of a cystic hygroma is rare in adults. We report the results regarding a cystic hygroma in a 23-year-old man. An initial physical examination was performed, followed by an ultrasound examination and CT. Surgical excision was the treatment of choice. Adequate imaging and physical examination of lateral neck masses in adults are needed to confirm the diagnosis.

Published
2013
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12. Intra-operative parathyroid hormone measurements - experience of a non-academic hospital.

Author

Morks AN, Van Ginhoven TM, Pekelharing JM, Duschek EJ, Smit PC, and De Graaf PW

Subjects
Adult, Aged, Aged, 80 and over, Cohort Studies, Feasibility Studies, Female, Humans, Hyperparathyroidism pathology, Male, Middle Aged, Monitoring, Intraoperative, Predictive Value of Tests, Treatment Outcome, Hyperparathyroidism blood, Hyperparathyroidism surgery, Parathyroid Hormone blood
Abstract

Background: Surgery is the treatment of choice for symptomatic primary hyperparathyroidism. The majority of research concerning intra-operative parathyroid hormone (ioPTH) measurements is conducted in university hospitals. Whether ioPTH measurements are feasible and useful in predicting the presence of remaining hyperfunctioning parathyroid tissue in a non-academic hospital remains uncertain., Methods: Data were collected on all patients with biochemically proven and surgically treated primary hyperparathyroidism treated at the Reinier de Graaf Hospital from August 2002 to December 2007., Results: Sixty-five patients were included. The mean pre-operative serum calcium level was 2.78 mmol/l (range 2.28 - 3.80 mmol/l, normal range 2.20 - 2.65 mmol/l) and the mean serum parathyroid hormone level 17.0 pmol/l (range 4.0 - 90.3 pmol/l, normal range 1.0 - 5.5 pmol/l). All patients were operated on for primary hyperparathyroidism, using ioPTH measurements during their first operation. Sensitivity and specificity rates of ioPTH measurements were 98% and 89%, respectively. The ioPTH test accurately indicated incomplete removal of all hyperfunctioning parathyroid tissue in 8 patients (12%). Five patients (8%) were re-explored immediately, of whom 4 were successfully treated in this single operative session. One patient was operated on successfully the next day. Two patients were operated on with a successful result during a second admission. In all the ioPTH measurements there was 1 false-positive result (1.5%) and 1 false-negative result (1.5%). The mean postoperative calcium value for the successfully treated patients was 2.34 mmol/l (range 2.14 - 2.71 mmol/l, normal range 2.20 - 2.65 mmol/l). The mean postoperative PTH level for the successfully treated patients was 3.76 pmol/l (range 0.40 - 7.1 pmol/l)., Conclusion: Our data suggest that ioPTH measurements are feasible and useful in a non-academic hospital.

Published
2011

13. Surgeon-performed ultrasound as preoperative localization study in patients with primary hyperparathyroidism.

Author

van Ginhoven TM, Morks AN, Schepers T, de Graaf PW, and Smit PC

Subjects
Adenoma diagnostic imaging, Adenoma surgery, Adult, Aged, Aged, 80 and over, Female, Hospitals, Humans, Male, Middle Aged, Minimally Invasive Surgical Procedures methods, Netherlands, Parathyroid Neoplasms diagnostic imaging, Parathyroid Neoplasms surgery, Parathyroidectomy methods, Predictive Value of Tests, Preoperative Period, Prospective Studies, Ultrasonography, Young Adult, Hyperparathyroidism, Primary diagnostic imaging, Hyperparathyroidism, Primary surgery
Abstract

Background: Minimally invasive parathyroidectomy is the treatment of choice for single-gland primary hyperparathyroidism. However, the exact location of the abnormal gland has to be established. Sestamibi scintigraphy, computed tomography and ultrasound (US) are commonly used modalities. We describe our experience in a non-academic center with surgeon-performed US (S-US) of the neck as preoperative localization study in patients with primary hyperparathyroidism (PHPT)., Methods: Patients with a biochemically proven diagnosis of PHPT and preoperative S-US were included. Data were recorded prospectively. Perioperative gland location was compared to the preoperative S-US to determine sensitivity, specificity and accuracy rates., Results: Two of the 50 patients who underwent S-US were not subjected to surgery. In 85% of the patients analyzed by S-US, the appropriate abnormal gland(s) were identified. In 11%, no gland was identified, but abnormal glands were found during surgery. Sensitivity of S-US in our hospital is 85%, with a positive predictive value of 97%., Conclusions: We achieved a satisfactory sensitivity rate. S-US provides anatomic information to the surgeon which enables a more detailed operation planning, and it is a valuable diagnostic modality for patients with PHPT in our opinion. We hope that our data encourage other centers to implement this technique as well., (Copyright © 2011 S. Karger AG, Basel.)

Published
2011
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14. Peroperative measurement of PTH in the management of primary hyperparathyroidism.

Author

Borel Rinkes IH, Smit PC, Thijssen JH, and van Vroonhoven TJ

Subjects
Adult, Aged, Aged, 80 and over, Calcium blood, Female, Humans, Luminescent Measurements, Male, Middle Aged, Minimally Invasive Surgical Procedures methods, Prospective Studies, Reproducibility of Results, Hyperparathyroidism diagnosis, Hyperparathyroidism surgery, Minimally Invasive Surgical Procedures standards, Parathyroid Hormone blood, Postoperative Care, Preoperative Care
Abstract

Unlabelled: This study was performed to prospectively evaluate the efficacy of a newly developed, non-expensive and non-commercial perioperative PTH-assay as indicator of successful surgery in minimally invasive adenomectomy (MIA) for primary hyperparathyroidism (pHPT)., Methods: A chemoluminescence-based PTH-assay was modified to significantly shorten the incubation time, producing results in a total of 45-60 minutes. Its reliability was tested in 19 patients undergoing MIA for pHPT. Patients were selected for MIA based on preoperative imaging including ultrasound and CT. After verification of its reliability, the PTH assay was incorporated into our treatment protocol and its results registered and correlated with serum calcium levels and surgical outcome., Results: The PTH assay was found to fully correlate with the current gold standard, i.e. serum calcium levels on the first postoperative day after MIA. It was subsequently used in 55 patients selected for MIA, as well as in 26 patients undergoing conventional neck exploration (CNE). In all cases it correctly indicated surgical failure/success. The conventional re-exploration that was required in 3 patients after unsuccessful MIA, was also correctly interpreted on the basis of the PTH-assay. In 2 cases an unexpected delay was encountered in the decline of PTH-levels following adenomectomy., Conclusion: The perioperative PTH-assay described is a reliable, inexpensive, and relatively fast predictor of surgical outcome, and should be considered essential for minimally invasive surgery in patients with pHPT.

Published
2001

15. Direct, minimally invasive adenomectomy for primary hyperparathyroidism: An alternative to conventional neck exploration?

Author

Smit PC, Borel Rinkes IH, van Dalen A, and van Vroonhoven TJ

Subjects
Adenoma complications, Adenoma surgery, Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Hyperparathyroidism etiology, Male, Middle Aged, Minimally Invasive Surgical Procedures, Parathyroid Neoplasms complications, Parathyroid Neoplasms surgery, Prospective Studies, Treatment Outcome, Hyperparathyroidism surgery, Parathyroidectomy methods
Abstract

Objective: To evaluate the feasibility and efficacy of a direct, minimally invasive adenomectomy (MIA) as an alternative to conventional neck exploration (CNE) in patients with primary hyperparathyroidism., Summary Background Data: Because primary hyperparathyroidism is caused by a solitary adenoma in 85% to 90% of patients, a direct adenomectomy through a mini-incision would theoretically suffice whenever an adenoma is correctly localized on preoperative imaging. If effective, a less invasive method could spare the patient an unnecessary bilateral neck exploration, thus saving time and rendering future surgical procedures in the neck less problematic., Methods: Between October 1994 and October 1998, 110 consecutive patients with biochemically proven primary hyperparathyroidism who were to undergo surgery were enrolled in this study. Ultrasound and spiral CT were routinely performed as standard preoperative imaging modalities in the first series of 65 patients. In the second series of 45 patients, ultrasound was performed as the sole initial modality; it was supplemented by CT only in case of inconclusive test results. If test results were unequivocal (one adenoma), the patient was offered MIA. CNE was performed if the results were equivocal or if multiglandular disease was suspected., Results: Overall, 84 patients were selected for MIA and 26 for CNE. In the first series, 2 MIA procedures (2/51) were converted to CNE because of negative perioperative findings. All 65 procedures resulted in normocalcemia. In the second series, all but five (4/33 MIAs, 1/12 CNEs) resulted in normocalcemia. A reexploration (CNE) was performed in three patients, resulting in normocalcemia after resection of a second or third adenoma. Two patients are still awaiting reexploration. In both series together, 78 of the 110 patients were successfully treated with MIA and spared CNE., Conclusion: MIA is a safe and effective alternative to CNE that may replace CNE in approximately two thirds of all patients.

Published
2000
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16. [Analysis and treatment of pancreatic cystic diseases].

Author

Gooszen HG, Schmitz RF, Smit PC, Schipper ME, van Leeuwen MS, and van Laarhoven CJ

Subjects
Adenoma therapy, Cystadenocarcinoma, Mucinous diagnosis, Cystadenocarcinoma, Mucinous surgery, Cystadenocarcinoma, Serous diagnosis, Cystadenocarcinoma, Serous surgery, Diagnosis, Differential, Female, Gastrostomy, Humans, Male, Pancreas diagnostic imaging, Pancreas pathology, Pancreas surgery, Pancreatectomy, Pancreatic Pseudocyst diagnosis, Pancreatic Pseudocyst therapy, Pancreaticojejunostomy, Radiography, Adenoma diagnosis, Pancreatic Cyst diagnosis, Pancreatic Cyst therapy, Pancreatic Neoplasms diagnosis, Pancreatic Neoplasms surgery
Abstract

Owing to the spectacular progress in imaging techniques, cystic lesions of the pancreas are detected more often than previously, and this leads to therapeutic dilemmas. Of the cystic lesions of the pancreas, 80% are found to be pseudocysts and 10-15%, neoplastic cysts. The definition of a pseudocyst is: 'an accumulation of pancreatic juice surrounded by a wall of connective tissue or granulation tissue, developed as the result of acute pancreatitis, pancreatic injury or chronic pancreatitis'. In cases of asymptomatic pseudocyst, an expectative policy suffices; growth and symptomatic pseudocysts justify intervention. In addition to surgical internal drainage (cystojejunostomy) there are new therapeutic techniques: external drainage guided by ultrasonography or CT, and internal drainage guided by endoscopy. Endoscopic drainage is the treatment of choice, but it requires experienced hands. The cystic tumours are subdivided into two groups: serous and mucinous cystadenomas. The group of mucinous tumours is subdivided into mucinous cystadenomas and intraductal papillary mucinous tumours. The mucinous or macrocystic adenoma is potentially malignant and should be treated as a malignancy.

Published
1999

17. [Peroperative parathyroid hormone assay: assurance of successful surgical treatment of primary hyperparathyroidism].

Author

Smit PC, Thijssen JH, Borel Rinkes IH, and van Vroonhoven TJ

Subjects
Adult, Aged, Female, Humans, Male, Middle Aged, Parathyroid Hormone metabolism, Predictive Value of Tests, Prospective Studies, Reoperation, Reproducibility of Results, Hyperparathyroidism diagnosis, Hyperparathyroidism surgery, Intraoperative Care methods, Parathyroid Glands surgery, Parathyroid Hormone blood
Abstract

Objective: To study the reliability and applicability of a rapid parathormone (PTH) test as predictor of successful surgical treatment of primary hyperparathyroidism., Design: Prospective., Method: All 35 consecutive patients undergoing surgery for primary hyperparathyroidism in the University Hospital Utrecht, the Netherlands, in august 1997-august 1998, were tested just prior to surgery, and immediately following adenomectomy. The rapid PTH test consisted of a modification of the computerized immunometric detection by chemoluminescence. The decrease of serum PTH as estimated with the rapid test was correlated with surgical findings as well as postoperative serum calcium levels. In the first 25 patients (group A) the reliability of the test was investigated. In the next 10 patients (group B) the PTH test results were allowed to have implications for surgical management, i.e. an insufficient (< 50%) decrease of serum PTH following adenomectomy resulted in immediate re-exploration., Results: The 35 patients, 22 women and 13 men, had a median age of 58 years (range: 22-80). The results obtained with our rapid PTH test correlated fully with both conventional PTH measurement techniques and postoperative serum calcium levels. In group A 21/25 patients showed adequate (> 50%) decrease of their serum PTH levels; the 4 patients without such decrease were the ones displaying persistent postoperative hypercalcaemia. In group B 9/10 patients had adequate PTH decrease immediately following adenomectomy, while in one patient this was only attained after further exploration and excision of a second adenoma. No false-positive or false-negative measurements were encountered., Conclusion: The rapid PTH test used is a reliable predictor of successful adenomectomy for primary hyperparathyroidism, also in minimally invasive surgery.

Published
1999

19. Clinical trials, children and the law.

Author

Smit PC

Subjects
Adolescent, Adult, Child, Humans, Infant, Nontherapeutic Human Experimentation, Parental Consent, Parents, South Africa, Therapeutic Human Experimentation, Human Experimentation, Informed Consent, Legislation, Medical
Abstract

Clinical trials are necessary for the advancement of medical science. The law is reasonably tolerant as far as experiments on adults are concerned. The legal limits within which experiments on children, especially children of tender years, may take place are, however, far more strict. The medical researcher who goes beyond these limits is liable to be attacked for legal indecorum. This article deals with these legal limits and with guidelines for the researcher.

Published
1977

20. [A professional duty to heal!].

Author

Smit PC

Subjects
Child, Humans, Parents, South Africa, Delivery of Health Care legislation & jurisprudence, Legislation, Medical, Patient Participation, Physician-Patient Relations
Abstract

The rules of South African law are analysed, especially any possible rules which may impose a duty upon a medical practitioner to heal in cases where the patient refuses treatment. The conclusion is reached that a refusal of medical treatment expressed on behalf of a minor child or an unconscious patient might safely be ignored by a medical practitioner, but that an express refusal by a major patient of full legal capacity should be heeded. It is also concluded that, according to South African law, there rests no legal duty upon a medical practitioner to treat a patient where such treatment--even if necessary to save the patient's life--is refused by the patient himself. Therefore, where the conditions imposed by a Jehovah's Witness preclude a medical practitioner from practising good medicine, he should refuse the case.

Published
1983

22. Protection of computerized medical data--a problem?

Author

van der Poel KG and Smit PC

Subjects
Codes of Ethics, Computers, Forms and Records Control, Government Regulation, Internationality, South Africa, Confidentiality legislation & jurisprudence, Ethics, Medical, Information Systems legislation & jurisprudence, Medical Records standards
Abstract

The rules of South African and international law and practice in respect of the medical practitioner's duty to preserve confidential information are briefly analysed and the consequences of breaches of this duty discussed. The impact of computer technology on medical practice and the attendant risks of 'information leaks' from medical data banks are reviewed. A call is made for a multidisciplinary approach to the problem of computerization and confidentiality involving the medical, legal and data-processing professions.

Published
1985

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